Abstract
Background and Hypothesis
People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective ...pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI.
Study Design
We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted.
Study Results
Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk RR = 1.40 95% confidence interval = 1.21–1.62), 1-year (1.68 1.42–1.98), and 30-day (1.26 1.05–1.51) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 0.49–0.67), and cardioprotective medications (RR = 0.89 0.85–0.94), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization.
Conclusions
SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.
Wearable electronic knitwear has recently been gaining the attention of both researchers and industrial sectors. Combining knitting technology with electronics may become a dominant trend in the ...future. There is a need to develop an analytical equation to model the complex resistive network for a given set of conductive stitches in order to meet the high demand for rapid prototype designing of smart knitwear. Currently, a matrix equation with high dimensionality must be solved, which is impractical and requires high computational power, retarding the growing demand for smart knitwear design with resistive routing paths. The routing network embedded into smart knitwear with conductive knitting stitches is a critical element for connecting different electronic devices, such as textile electrodes, sensors, and heaters. The knitting stitch made with conductive yarn is one of the essential building blocks for textile-based circuitry and controls the power distribution in the wearable electronic knitwear. Knitwear exhibits high flexibility and comfort, making it a good candidate for applications in sports, medicine, and other areas that incorporate electronic devices. Textile-based electronic circuits have become a key element in recent developments in intelligent textiles. Different manufacturing processes for textile-based electronic circuits have been reported, such as embroidery, weaving, printing, and coating. However, few studies have given an analytical equation and a systematic approach to obtaining the equivalent resistance of the conductive knitting stitch network. This paper describes work done to derive analytical equations to model a given resistive network of conductive knitting stitches, built with conductive yarn, and based on the common intarsia knitting and jersey knitting techniques. The experimental results revealed that the derived equations could accurately model the equivalent electrical resistance of conductive stitches of knitwear and could greatly simplify existing models.
Introduction: The presence of multiple comorbidities increases the risk of all-cause mortality, but the effects of the comorbidity sequence before the baseline date on mortality remain unexplored. ...This study investigated the relationship between coronary heart disease (CHD), atrial fibrillation (AF) and heart failure (HF) through their sequence of development and the effect on all-cause mortality risk in type 2 diabetes mellitus. Methods: This study included patients with type 2 diabetes mellitus prescribed antidiabetic/cardiovascular medications in public hospitals of Hong Kong between 1 January 2009 and 31 December 2009, with follow-up until death or 31 December 2019. The Cox regression was used to identify comorbidity sequences predicting all-cause mortality in patients with different medication subgroups. Results: A total of 249,291 patients (age: 66.0 ± 12.4 years, 47.4% male) were included. At baseline, 7564, 10,900 and 25,589 patients had AF, HF and CHD, respectively. Over follow-up (3524 ± 1218 days), 85,870 patients died (mortality rate: 35.7 per 1000 person-years). Sulphonylurea users with CHD developing later and insulin users with CHD developing earlier in the disease course had lower mortality risks. Amongst insulin users with two of the three comorbidities, those with CHD with preceding AF (hazard ratio (HR): 3.06, 95% CI: 2.60−3.61, p < 0.001) or HF (HR: 3.84 3.47−4.24, p < 0.001) had a higher mortality. In users of lipid-lowering agents with all three comorbidities, those with preceding AF had a higher risk of mortality (AF-CHD-HF: HR: 3.22, 2.24−4.61, p < 0.001; AF-HF-CHD: HR: 3.71, 2.66−5.16, p < 0.001). Conclusions: The sequence of comorbidity development affects the risk of all-cause mortality to varying degrees in diabetic patients on different antidiabetic/cardiovascular medications.
This paper proposes a FPAA-FPGA/DSP-based mixed signal controller that achieves superior performance when compared with conventional digital controllers in power quality compensation. This includes ...adaptive signal conditioning and programmability on-the-fly, higher flexibility, parallel computation capability, and easy implementation. In practical applications, the power quality compensator may suffer from poor compensation performance, particularly during light loading. The adaptive signal gain and programmable on-the-fly functions of the mixed signal controller are intended to improve the system compensation performance, which cannot be achieved by using conventional digital controllers alone. In this study, an approximate total harmonic distortion (ATHD) is proposed to determine the total harmonic distortion value more quickly, reducing the evaluation time of the power quality compensation system performance. With hysteresis pulse width modulations, when the hysteresis error margin is designed, the ATHD can be determined instantaneously. Finally, representative simulation and experimental results of a three-phase four-wire center-split hybrid active power filter are presented. These verify the validity and effectiveness of the proposed mixed signal controller in improving current quality compensation performance during light load conditions, compared with a conventional digital controller.
The COVID-19 pandemic significantly increased depression prevalence in general population. However, the relationship between persistent dysfunctional thinking associated with COVID-19 ...(perseverative-cognition) and depression, and its potential moderators are understudied. We aimed to examine the association between COVID-19 perseverative-cognition and depression, and the moderating effect of potential risk and protective factors on this association in general public during the peak of fifth COVID-19 wave in Hong Kong.
This survey recruited 14,269 community-dwelling adults between March 15–April 3, 2022 to investigate association between COVID-19 perseverative-cognition and depression, and the moderating effect of resilience, loneliness and three coping strategies (including emotion-focused, problem-focused and avoidant coping) on this association, using hierarchical regression models and simple slope analyses. COVID-19 perseverative cognition was assessed by the Obsession with COVID-19 Scale (OCS) and depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9).
Perseverative-cognition was positively associated with depression severity. Resilience, loneliness and three coping strategies moderated the association between perseverative-cognition and depression. Specifically, greater resilience and emotion-focused coping ameliorated the association between perseverative-cognition and depression, while higher levels of loneliness, avoidant and problem-focused coping accentuated such association.
Cross-sectional design precluded establishing causality among variables.
This study affirms that COVID-19 perseverative-cognition is significantly related to depression. Our findings indicate the potential critical role of enhanced personal resilience and social support, and adoption of emotion-focused coping in mitigating negative effect of COVID-19 related maladaptive thinking on depression severity, thereby facilitating development of targeted strategies to reduce psychological distress amidst the prolonged pandemic.
•Moderators between depression and COVID-19 dysfunctional cognition are understudied.•COVID-19 dysfunctional cognition is positively associated with depression severity.•Resilience & emotion-focused coping reduce COVID cognition-depression association.•Loneliness, avoidant & problem-focused coping exacerbate such association.
Objective
To compare the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2Is) and dipeptidyl peptidase-4 inhibitors (DPP4Is) on adverse outcomes in diabetic patients in Hong Kong.
Methods
...This was a retrospective population-based cohort study of type 2 diabetes mellitus patients (
n
= 72
,
746) treated with SGLT2I or DPP4I between January 1, 2015, and December 31, 2020, in Hong Kong. Patients with exposure to both DPP4I and SGLT2I therapy, without complete demographics or mortality data, or who had prior atrial fibrillation (AF) were excluded. The study outcomes were new-onset AF, stroke/transient ischemic attack, cardiovascular mortality and all-cause mortality. Propensity score matching (1:1 ratio) between SGLT2I and DPP4I users was performed.
Results
The unmatched study cohort included 21,713 SGLT2I users and 39,510 DPP4I users (total:
n
= 61,233 patients; 55.37% males, median age: 62.7 years interquartile range (IQR): 54.6–71.9 years). Over a median follow-up of 2030 (IQR: 1912–2117) days, 2496 patients (incidence rate IR: 4.07%) developed new-onset AF, 2179 patients (IR: 3.55%) developed stroke/transient ischemic attack, 1963 (IR: 3.20%) died from cardiovascular causes and 6607 patients (IR: 10.79%) suffered from all-cause mortality. After propensity score matching (SGLT2I:
n
= 21,713; DPP4I:
n
= 21,713), SGLT2I users showed lower incidence of new-onset AF (1.96% vs. 2.78%, standardized mean difference SMD = 0.05), stroke (1.80% vs. 3.52%, SMD = 0.11), cardiovascular mortality (0.47% vs. 1.56%, SMD = 0.11) and all-cause mortality (2.59% vs. 7.47%, SMD = 0.22) compared to DPP4I users. Cox regression found that SGLT2I users showed lower risk of new-onset AF (hazard ratio HR: 0.68, 95% confidence interval CI: 0.56, 0.83,
P
= 0.0001), stroke (HR: 0.64, 95% CI: 0.53, 0.79,
P
< 0.0001), cardiovascular mortality (HR: 0.39, 95% CI: 0.27, 0.56,
P
< 0.0001) and all-cause mortality (HR: 0.44, 95% CI: 0.37, 0.51,
P
< 0.0001) after adjusting for significant demographics, past comorbidities, medications and laboratory tests.
Conclusions
Based on real-world data of type 2 diabetic patients in Hong Kong, SGLT2I use was associated with lower risk of incident AF, stroke/transient ischemic attack, and cardiovascular and all-cause mortality outcomes compared to DPP4I use.
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