We implement and compute the density functional nonadditive three-body dispersion interaction using a combination of Tang-Karplus formalism and the exchange-dipole moment model of Becke and Johnson. ...The computation of the C9 dispersion coefficients is done in a non-empirical fashion. The obtained C9 values of a series of noble atom triplets agree well with highly accurate values in the literature. We also calculate the C9 values for a series of benzene trimers and find a good agreement with high-level ab initio values reported recently in the literature. For the question of damping of the three-body dispersion at short distances, we propose two damping schemes and optimize them based on the benzene trimers data, and the fitted analytic potentials of He3 and Ar3 trimers fitted to the results of high-level wavefunction theories available from the literature. Both damping schemes respond well to the optimization of two parameters.
Long QT-Syndrome (LQTS) patients are at risk of arrhythmias and seizures. We investigated whether autonomic and cardiac repolarization measures differed based on LQTS genotypes, and in LQTS patients ...with vs. without arrhythmias and seizures.
We used 24-h ECGs from LQTS1 (n = 87), LQTS2 (n = 50), and LQTS genotype negative patients (LQTS(−), n = 16). Patients were stratified by LQTS genotype, and arrhythmias/seizures. Heart rate variability (HRV) and QT variability index (QTVI) measures were compared between groups during specific physiological states (minimum, middle, & maximum sympathovagal balance, LF/HF). Results were further tested using logistic regression for each ECG measure, and all HRV measures in a single multivariate model.
Across multiple physiological states, total autonomic (SDNN) and vagal (RMSSD, pNN50) function were lower and repolarization dynamics (QTVI) were elevated in LQTS(+), LQTS1, and LQTS2, compared to LQTS(−). Many measures remained significant in the regression models. Multivariate modeling demonstrated that SDNN, RMSSD, and pNN50 were independent markers of LQTS(+) vs. LQTS(−), and SDNN and pNN50 were markers for LQTS1 vs. LQTS(−). During sympathovagal balance (middle LF/HF), RMSSD and pNN50 distinguished LQTS1 vs. LQTS2. LQTS1 patients with arrhythmias had lower total (SDNN) and vagal (RMSSD and pNN50) autonomic function, and SDNN remained significant in the models. In contrast, ECG measures did not differ in LQTS2 patients with vs. without arrhythmias, and LQTS1 and LQTS2 with vs. without seizures.
Autonomic (HRV) and cardiac repolarization (QTVI) ECG measures differ based on LQTS genotype and history of arrhythmias in LQTS1. SDNN, RMSSD, and pNN50 were each independent markers for LQTS genotype.
•HRV and QTVI are non-invasive measures of autonomic and cardiac electrical function.•These ECG measures differ in LQTS(−) vs LQTS(+), LQTS1, and LQTS2.•SDNN, RMSSD, and pNN50 are independent markers of LQTS-genotype.•HRV measures are depressed in LQTS1 patients with arrhythmias.•Basal autonomics are similar in LQTS1 and LQTS2 with vs. without seizures.
This study uses the hidden Markov model (HMM) to identify different market regimes in the US stock market and proposes an investment strategy that switches factor investment models depending on the ...current detected regime. We first backtested an array of different factor models over a roughly 10.5 year period from January 2007 to September 2017, then we trained the HMM on S&P 500 ETF historical data to identify market regimes of that period. By analyzing the relationship between factor model returns and different market regimes, we are able to establish the basis of our regime-switching investing model. We then back-tested our model on out-of-sample historical data from September 2017 to April 2020 and found that it both delivers higher absolute returns and performs better than each of the individual factor models according to traditional portfolio benchmarking metrics.
To evaluate complications following urinary diversion for non-malignant conditions.
We performed a retrospective review of patients undergoing urinary diversion for benign indications between 2000 ...and 2017. Data collected including patient demographic and clinical characteristics, surgical characteristics, and complications. Complications were graded using Clavien-Dindo classification and were categorized as early versus delayed (≤ versus > 90 day postoperatively). Logistic regression assessed for predictors of developing any postoperative complication.
A total of 68 patients were identified for study analysis with median follow up of 24 (7-72) months. Sixty-eight and 25% of patients underwent diversion for neurogenic bladder and complications related to pelvic radiation, respectively. A majority (90%) underwent ileal conduit with the remainder undergoing continent diversion. A total of 121 complications were identified, comprising 50 early and 72 delayed. Overall, 77% of patients had at least one complication during the follow up period. Fifty-one percent of patients experienced early complication, while 66% of patients experienced delayed complications. Complications of Clavien-Dindo Score ≥ IIIB were seen in 48% of patients. The most common early complication was wound infection (12%); delayed was urinary tract infection (39%). Multivariable logistic regression modeling found no independent predictors of complication, although the best-fit model included BMI, diabetes, presence of multiple comorbidities, and operative time (hr) as positive predictors of complication.
Our study demonstrates that urinary diversion for benign etiologies is associated with a significant rate of complication. A large percentage of these complications occur in the delayed period and are classified as severe complications.
Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload, which results in progressive LV remodeling negatively affecting outcomes. Whether cardiac magnetic resonance (CMR) ...volumetric quantification can provide incremental risk stratification over standard clinical and echocardiographic evaluation in patients with chronic moderate or severe AR is unknown.
To compare LV remodeling measurements by CMR and echocardiography between patients with and without heart failure symptoms and to verify the association of remodeling measurements of patients with chronic moderate or severe AR but no or minimal symptoms with clinical outcomes receiving medical management.
This multicenter retrospective cohort study included consecutive patients with at least moderate chronic native AR evaluated by 2-dimensional transthoracic echocardiography and CMR examination within 90 days from each other between January 2012 and February 2020 at Allina Health System. Data were analyzed from June 2021 to January 2022.
Clinical evaluation and risk stratification by CMR.
The end point was a composite of death, heart failure hospitalization, or progression of New York Heart Association functional class while receiving medical management, censoring patients at the time of aortic valve replacement (when performed) or at the end of follow-up.
Of the 178 included patients, 119 (66.9%) were male, 158 (88.8%) presented with no or minimal symptoms (New York Heart Association class I or II), and the median (IQR) age was 58 (44-69) years. Compared with patients with no or minimal symptoms, symptomatic patients had greater LV end-systolic volume index (LVESVi) by CMR (median IQR, 66 46-85 mL/m2 vs 42 30-58 mL/m2; P < .001), while there were no significant differences by echocardiography (LVESVi: median IQR, 38 30-58 mL/m2 vs 27 20-42 mL/m2; P = .07; LV end-systolic diameter index: median IQR, 21 17-25 mm/m2 vs 18 15-22 mm/m2; P = .17). During the median (IQR) follow-up of 3.3 (1.6-5.8) years, 50 patients with no or minimal symptoms receiving medical management developed the composite end point, which, in multivariate analysis adjusted for age and EuroSCORE II, was independently associated with LVESVi of 45 mL/m2 or greater and aortic regurgitant fraction of 32% or greater, the latter adding incremental prognostic value to CMR volumetric assessment.
In patients with chronic moderate or severe AR, patients presenting with heart failure symptoms have greater LVESVi by CMR than those with no or minimal symptoms. In patients with no or minimal symptoms, CMR quantification of LVESVi and AR severity may identify those at risk of death or incident heart failure and therefore should be considered in the clinical evaluation and decision-making of these patients.
Providing effective tobacco dependence treatments to hospitalized patients remains a challenge. Prior to 2021, the Rochester Model program used staff nurses for both bedside and post-discharge ...counseling necessary to maintain abstinence. When nurse shortages and elevated job stress occurred during the COVID Pandemic, we proposed that medical students learn to counsel patients at the bedside and after discharge.
Due to COVID restrictions, first- and second-year medical students trained using remote Zoom sessions. The total training time was 2.5 hr without role-play or additional evaluations. A survey measured the students' satisfaction, confidence, and counseling barriers. A smoking patient on a participating hospital unit can enroll in the program. Students delivered bedside counseling, then provided follow-up treatment and outcome calls along with New York State Quitline counselors.
The survey demonstrated that 89% of the students were satisfied with the training. The bedside counseling confidence was greater than the phone counseling confidence. All students felt the program experience has value to them as future physicians. 124 smoking patients enrolled, and outcomes followed out to 6 months. The 7-day point prevalence quit rates using the as-treated (patients contacted) analysis were 57% at 4 weeks, 48% at 3 months, and 43% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis were 31% at 4 weeks, 16% at 3 months and 14% at 6 months.
Medical students given minimal training are effective tobacco cessation counselors at no cost to the hospital system. The Rochester Model program using student counseling benefits patients, the students, and the health-care system.
Background
Alzheimer’s disease (AD) is the leading cause of disability and 5th cause of death in people over 65 years of age. Approximately 2/3 of AD patients are women, most of whom are ...postmenopausal. Menopause is linked with cognitive changes in women: younger age at menopause is associated with worse cognitive outcomes. Moreover, menopause accelerates mid‐life risk factors for dementia, by increasing risk for cardiovascular and cerebrovascular disease and metabolic disease which is by itself a risk factor for dementia. We have previously shown that female 3xTg‐AD mice are more greatly impacted cognitively and metabolically by a high fat diet when compared to males. We therefore hypothesized that menopause would exacerbate both metabolic and cognitive impairment and pathology in a mouse model of AD.
Method
Female App
NL‐F mice were placed on either low fat (LF; 10% fat) or high fat (HF; 60% fat; metabolic disease model) diet for 7 months. An accelerated ovarian failure model of menopause (4‐vinylcyclohexene diepoxide) was used at diet onset and female estrus cycles were monitored to determine menopause onset. Metabolic status was assessed by tracking weight gain and assessing glucose tolerance. Mice were then subjected to a battery of behavioral tests before being euthanized and brains and serum were collected.
Result
Menopausal mice tended to be more metabolically impaired (worse glucose tolerance) regardless of diet. Cognitive impairment differences between groups were investigated using several behavioral tests. Neither menopause nor HF diet affected anxiety‐like behavior (open field testing), however HF diet decreased general activity levels. Novel object recognition testing demonstrated that menopause, regardless of diet, impaired episodic‐like memory. Additionally, HF diet, regardless of menopause, impaired spatial learning (assessed via Barnes maze testing). We are currently evaluating the underlying pathology in the brain that could mediate these cognitive deficits (i.e. Amyloid pathology, white matter damage and neuroinflammation).
Conclusion
We hope that this work will highlight the need to model endocrine aging in animal models of dementia and will contribute to further understanding of the interaction between metabolic disease and menopause in the scope of AD.
Many studies have aimed to identify risk factors contributing to medication nonadherence with the goal of developing interventions to improve adherence rates. Several different intervention ...strategies have been studied. Psychoeducation, cognitive-behavioral therapy, and motivational interviewing have all positively influenced medication adherence and combinations of these approaches may bring about better results than one approach alone. In addition, pharmacists' intervention through answering patients' questions, performing follow up phone calls, offering additional education, and changing of medications or doses, may help the patient and ultimately lead to an increase in medication adherence and disease state improvement.
Current medical ultrasound datasets used in training simulators lack adequate coverage due to imaging hardware limitations. We present software solutions both for generating and for interacting with ...large-scale ultrasound datasets. The generation process combines a physical simulation with a ray tracing rendering technique to create synthetic ultrasound volumes for use as ground-truth test data. These datasets allow us both to train users and to evaluate an automatic registration solution used to align multiple real ultrasound volumes. We merge the aligned results with a multiresolution functional-based convex optimization technique to achieve seamless blends between adjacent volumes. A content-aware embedding algorithm places the merged data into a clean background template. We enable end-users to interact with the final results through a real-time mannequin-based translational tracking system.
PDF
