In search of a few good apps Powell, Adam C; Landman, Adam B; Bates, David W
JAMA : the journal of the American Medical Association,
05/2014, Letnik:
311, Številka:
18
Journal Article
The origins of modern human behavior are marked by increased symbolic and technological complexity in the archaeological record. In western Eurasia this transition, the Upper Paleolithic, occurred ...about 45,000 years ago, but many of its features appear transiently in southern Africa about 45,000 years earlier. We show that demography is a major determinant in the maintenance of cultural complexity and that variation in regional subpopulation density and/or migratory activity results in spatial structuring of cultural skill accumulation. Genetic estimates of regional population size over time show that densities in early Upper Paleolithic Europe were similar to those in sub-Saharan Africa when modern behavior first appeared. Demographic factors can thus explain geographic variation in the timing of the first appearance of modern behavior without invoking increased cognitive capacity.
Understanding cumulative cultural evolution Henrich, Joseph; Boyd, Robert; Derex, Maxime ...
Proceedings of the National Academy of Sciences - PNAS,
11/2016, Letnik:
113, Številka:
44
Journal Article
To examine whether the demographics of providers' prior year patient cohorts, providers' historic degree of catheter-based fractional flow reserve (FFR) utilization, and other provider ...characteristics were associated with post-catheterization performance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
A retrospective, observational analysis of outpatient claims data was performed.
All 2018 outpatient catheterization claims from a national organization offering commercial and Medicare Advantage health plans were examined. Claims were excluded if the patient had a prior catheterization in 2018, had any indications of CABG or valvular heart disease in the prior year of claims, or if the provider had ≤10 catheterization claims in 2017. Downstream PCI and CABG were determined by examining claims 0-30 days post-catheterization. Using multivariate mixed effects logistic regression with provider identity random effects, the association between post-catheterization procedures and provider characteristics was assessed, controlling for patient characteristics.
The sample consisted of 31,920 catheterization claims pertaining to procedures performed by 964 providers. Among the catheterization claims, 8,554 (26.8%) were followed by PCI and 1,779 (5.6%) were followed by CABG. Catheterizations performed by providers with older prior year patient cohorts were associated with higher adjusted odds of PCI (1.78; CI: 1.26-2.53), even after controlling for patient age. Catheterizations performed by providers with greater historic use of FFR had significantly higher adjusted odds of being followed by PCI (1.73; CI: 1.26-2.37).
Provider characteristics may impact whether patients receive a procedure post-catheterization. Further research is needed to characterize this relationship.
While prior research shows that mental illness is associated with lower utilization of screening imaging, little is known about how mental illness impacts use of diagnostic imaging, other than for ...screening. This study explores the association between a history of anxiety or depression in the prior year and utilization of diagnostic imaging. Commercial and Medicare Advantage health plan claims from 2017 and 2018 from patients with plans from one national organization were extracted. Exclusions were made for patients without continuous plan enrollment. History of anxiety or depression was determined using 2017 claims, and downstream diagnostic imaging was determined using 2018 claims. Univariate associations were assessed with Chi-square tests. A matched sample was created using Coarsened Exact Matching, with history of mental illness serving as the treatment variable. Logistic regressions were used to calculate adjusted odds ratios, before and after matching, controlling for age, sex, urbanicity, local income, comorbidities, claims history, region, and health plan characteristics. Associations between mental illness and chest imaging, neuroimaging, and emergency department imaging were also evaluated. The sample included 2,381,851 patients before matching. Imaging was significantly more likely for patients with a history of anxiety (71.1% vs. 55.7%, P < .001) and depression (73.2% vs. 55.3%, P < .001). The adjusted odds of any imaging were 1.24 (95% confidence interval CI: 1.22-1.26) for patients with a history of anxiety, and 1.43 (CI: 1.41-1.45) for patients with a history of depression before matching, and 1.18 (CI: 1.16-1.20) for a history of anxiety and 1.33 (CI: 1.32-1.35) for a history of depression after matching. Adjusted analyses found significant, positive associations between mental illness and chest imaging, neuroimaging, and emergency department imaging both before and after matching. In contrast to prior findings on screening, anxiety and depression were associated with greater likelihood of diagnostic imaging within the population studied.
Patients with univentricular physiology palliated with the Fontan operation have multiple late cardiovascular and extracardiac complications, including autonomic dysfunction. Despite the observation, ...little is known about autonomic function driving exercise-related heart rate responses in Fontan patients and whether dominant ventricle subtype or underlying cardiac anatomy affects heart rate responses during exercise.
We performed a retrospective chart review of all single ventricle patients palliated with a Fontan operation who underwent a maximal effort cardiopulmonary exercise test at Cincinnati Children’s Hospital Medical Center from 2013 to 2018.
One hundred and three Fontan patients aged 16.7 ± 5.5 years were included in this study. Although both the systemic right (n = 38) and systemic left (n = 65) ventricle groups demonstrated chronotropic incompetence, there were no differences between the groups in maximal heart rate (167.5 ± 17.4 vs 169.6 ± 20.9 bpm, P = 0.59), heart rate reserve (87.3 ± 22.6 vs 96.8 ± 25.7, P = 0.06) nor chronotropic index (70 ± 13% vs 74 ± 20%, P = 0.19). In addition, there were no differences between the groups in heart rate recovery at 1, 3, 5, and 10 minutes. Interestingly, patients with hypoplastic left heart syndrome (n = 34) had lower heart rate reserve (84.76 ± 22.8 vs 96.38 ± 26.75, P = 0.04) and chronotropic index (70.5 ± 12.5% vs 76.3 ± 13.2%, P = 0.04) compared with patients with tricuspid atresia (n = 42).
Fontan patients commonly have chronotropic incompetence, diminished heart rate reserve but with preserved heart rate recovery. Although there is overall no difference in chronotropy in Fontan patients based on dominant systemic ventricle, there is a difference between patients with hypoplastic left heart syndrome and those with tricuspid atresia.
Les patients qui ont subi une intervention de Fontan pour pallier la physiologie univentriculaire ont de multiples complications cardiovasculaires et extracardiaques tardives, notamment une dysfonction autonome. En dépit de l’observation, on en connaît peu sur la fonction autonome qui dirige les réponses de la fréquence cardiaque à l’exercice des patients ayant subi une intervention de Fontan, et on ne sait pas très bien si le sous-type ventriculaire dominant ou si l’anatomie cardiaque sous-jacente affect les réponses de la fréquence cardiaque durant l’exercice.
Nous avons réalisé une revue rétrospective des dossiers de tous les patients ayant subi une intervention de Fontan pour pallier le ventricule unique qui ont subi une épreuve d’effort cardiopulmonaire maximal au Cincinnati Children’s Hospital Medical Center de 2013 à 2018.
Cent trois patients de 16,7 ± 5,5 ans qui avaient subi une intervention de Fontan ont participé à cette étude. Bien que les groupes à ventricule droit systémique (n = 38) et à ventricule gauche systémique (n = 65) aient démontré une incompétence chronotrope, il n’y avait aucune différence entre les groupes dans la fréquence cardiaque maximale (167,5 ± 17,4 vs 169,6 ± 20, 9 bpm, P = 0,59), la fréquence cardiaque de réserve (87,3 ± 22,6 vs 96,8 ± 25,7, P = 0,06) et l’indice chronotrope (70 ± 13 % vs 74 ± 20 %, P = 0,19). De plus, il n’y avait aucune différence entre les groupes dans le rétablissement de la fréquence cardiaque après 1, 3, 5 et 10 minutes. Il est intéressant de noter que les patients ayant un syndrome d’hypoplasie du cœur gauche (n = 34) avaient une fréquence cardiaque de réserve (84,76 ± 22,8 vs 96,38 ± 26,75, P = 0,04) et un indice chronotrope (70,5 ± 12,5 % vs 76,3 ± 13,2 %, P = 0,04) plus faibles que les patients ayant une atrésie tricuspidienne (n = 42).
Les patients ayant subi une intervention de Fontan ont souvent une incompétence chronotrope, une fréquence cardiaque de réserve réduite, mais un rétablissement de la fréquence cardiaque préservé. Bien qu’il n’existe dans l’ensemble aucune différence dans la chronotropie des patients ayant subi une intervention de Fontan selon le ventricule systémique dominant, il existe une différence entre les patients ayant un syndrome d’hypoplasie du cœur gauche et les patients ayant une atrésie tricuspidienne.
Efficient aerobic oxidative methyl esterification of primary alcohols has been achieved with a heterogeneous catalyst consisting of 1 mol % Pd/charcoal (5 wt %) in combination with bismuth(III) ...nitrate and tellurium metal. The Bi and Te additives significantly increase the reaction rate, selectivity, and overall product yields. This readily accessible catalyst system exhibits a broad substrate scope and is effective with both activated (benzylic) and unactivated (aliphatic) alcohols bearing diverse functional groups.
In 2017, the Supreme Court of India ruled that privacy is a fundamental right of every citizen. Although mobile phone apps have the potential to help people with noncommunicable diseases, such as ...diabetes and mental illness, they often contain complex privacy policies, which consumers may not understand. This complexity may impede the ability of consumers to make decisions regarding privacy, a critical issue due to the stigma of mental illness.
Our objective is to determine whether mental health apps have more complex privacy policies than diabetes apps.
The study used privacy policies extracted from apps. The apps pertained to diabetes or mental health, and were all of Indian origin. Privacy policy reading complexity was compared between the two types of apps using a series of 15 readability measures. The universe of applicable apps on the Google Play store, as viewed between May and June 2017, was considered. The measures of readability were compared using chi-square tests.
No significant difference was found between the privacy policy readability of the diabetes apps versus the mental health apps for each of the measures considered. The mean Flesch-Kincaid Grade Level was 13.9 for diabetes apps and 13.6 for mental health apps; therefore, the mean policy grade level for both types of apps was written at a college level. Privacy policies in the 25th percentile of complexity were also written at a college level for both types of apps.
Privacy policy complexity may be a barrier for informed decision making.
For mental health researchers and others committed to a bio-cultural understanding of religious experience, there is a need for empirical studies capable of shedding light on the interplay between ...beliefs, personalities, and the occurrence of anomalous sensory experiences. Absorption, a trait linked to one's tendency to become immersed in experience or thought, may be key for understanding that relationship. Spiritualist mediums (N = 65) completed an online questionnaire assessing the timing, nature, and frequency of their auditory (clairaudient) spiritual communications - including scales measuring paranormal beliefs, absorption, hallucination-proneness, and aspects of identity. These measures were compared to a general population group (N = 143), with results showing higher levels of auditory hallucination-proneness and absorption among the Spiritualists as well as correlations between spiritual beliefs and absorption, but not spiritual beliefs and hallucination-proneness, for the general population. Findings are discussed in relation to attribution models of religious experience and the complexity of "absorption" as a construct.
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