Summary
Background
There is an increasing amount of evidence suggesting multiple fatal complications in takotsubo syndrome; however, findings on the long-term outcome are scarce and show inconsistent ...evidence.
Methods
This is a single center study of long-term prognosis in takotsubo patients admitted to the Klinik Ottakring, Vienna, Austria, from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared.
Results
Overall, 147 patients were included in the study and 49 takotsubo patients (33.3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71.4% of all deaths), especially malignancies (26.5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Adjusted analysis showed no feature of an independent predictor of cardiovascular mortality for takotsubo patients. Female gender (HR = 0.32, CI: 0.16–0.64,
p
< 0.001), cancer (HR = 2.35, CI: 1.15–4.8,
p
= 0.019) and chronic kidney disease (HR = 2.61, CI: 1.11–6.14,
p
= 0.028) showed to be independent predictors of non-cardiovascular mortality.
Conclusion
Long-term prognosis of takotsubo patients is not favorable, mainly due to noncardiac comorbidities. Hence, consequent outpatient care in regular intervals after a takotsubo event based on risk factor control and early detection of malignancies seems justified.
We introduce sparse-ir, a collection of libraries to efficiently handle imaginary-time propagators, a central object in finite-temperature quantum many-body calculations. We leverage two concepts: ...firstly, the intermediate representation (IR), an optimal compression of the propagator with robust a priori error estimates, and secondly, sparse sampling, near-optimal grids in imaginary time and imaginary frequency from which the propagator can be reconstructed and on which diagrammatic equations can be solved. IR and sparse sampling are packaged into stand-alone, easy-to-use Python, Julia and Fortran libraries, which can readily be included into existing software. We also include an extensive set of sample codes showcasing the library for typical many-body and ab initio methods.
The origins of high-energy astrophysical neutrinos remain a mystery despite extensive searches for their sources. We present constraints from seven years of IceCube Neutrino Observatory muon data on ...the neutrino flux coming from the Galactic plane. This flux is expected from cosmic-ray interactions with the interstellar medium or near localized sources. Two methods were developed to test for a spatially extended flux from the entire plane, both of which are maximum likelihood fits but with different signal and background modeling techniques. We consider three templates for Galactic neutrino emission based primarily on gamma-ray observations and models that cover a wide range of possibilities. Based on these templates and in the benchmark case of an unbroken E − 2.5 power-law energy spectrum, we set 90% confidence level upper limits, constraining the possible Galactic contribution to the diffuse neutrino flux to be relatively small, less than 14% of the flux reported in Aartsen et al. above 1 TeV. A stacking method is also used to test catalogs of known high-energy Galactic gamma-ray sources.
We present an all-sky search for muon neutrinos produced during the prompt γ-ray emission of 1172 gamma-ray bursts (GRBs) with the IceCube Neutrino Observatory. The detection of these neutrinos would ...constitute evidence for ultra-high-energy cosmic-ray (UHECR) production in GRBs, as interactions between accelerated protons and the prompt γ-ray field would yield charged pions, which decay to neutrinos. A previously reported search for muon neutrino tracks from northern hemisphere GRBs has been extended to include three additional years of IceCube data. A search for such tracks from southern hemisphere GRBs in five years of IceCube data has been introduced to enhance our sensitivity to the highest energy neutrinos. No significant correlation between neutrino events and observed GRBs is seen in the new data. Combining this result with previous muon neutrino track searches and a search for cascade signature events from all neutrino flavors, we obtain new constraints for single-zone fireball models of GRB neutrino and UHECR production.
Lorentz symmetry is a fundamental spacetime symmetry underlying both the standard model of particle physics and general relativity. This symmetry guarantees that physical phenomena are observed to be ...the same by all inertial observers. However, unified theories, such as string theory, allow for violation of this symmetry by inducing new spacetime structure at the quantum gravity scale. Thus, the discovery of Lorentz symmetry violation could be the first hint of these theories in nature. Here we report the results of the most precise test of spacetime symmetry in the neutrino sector to date. We use high-energy atmospheric neutrinos observed at the IceCube Neutrino Observatory to search for anomalous neutrino oscillations as signals of Lorentz violation. We find no evidence for such phenomena. This allows us to constrain the size of the dimension-four operator in the standard-model extension for Lorentz violation to the \10^{-28}\ level and to set limits on higher-dimensional operators in this framework. These are among the most stringent limits on Lorentz violation set by any physical experiment.
•CHA₂DS₂-VASc scores significantly higher in this rural sample than in US averages.•mECG screening yielded a 3–4% rate of positive AFib, higher than similar studies.•Results suggest potential value ...in using mECG technology to screen in rural areas.
Atrial fibrillation (AFib) is a growing health concern, affecting more than 40 million patients worldwide and increasing stroke risk by five times. Community screening initiatives in rural healthcare establishments are becoming more feasible with the development of innovative, mobile-ECG (mECG) technology. The purpose of this research was to characterize increased rates of stroke risk factors and to determine AFib incidence in rural, pharmacy settings.
The researchers examined the prevalence of risk factors associated with AFib and calculated CHA₂DS₂-VASc stroke risk scores in a previously undiagnosed AFib community sample of 250 participants. Eligible participants at two rural pharmacies were administered a 1-lead mECG reading. Participants were then asked to complete questionnaires on demographic and medical history information. All participants were given educational materials on AFib and medical referrals when indicated.
Prevalence rates of six, known independent stroke risk factors (CHA₂DS₂-VASc scores: (2.68 ± 1.35)) were significantly higher in the study sample than reported national US averages. Screening via mECG indicated preliminary AFib rates of approximately 4%; however, upon independent adjudication of the readings from three electrophysiologists AFib prevalence ranged between 1% and 8%.
Collectively, an alarming rate of untreated stroke risk in a rural pharmacy sample was identified by the researchers utilizing mECG technology. These results suggest potential value to the use of mECG technology to screen for AFib in at-risk communities.
In laboratory dogs, aging leads to a decline in various cognitive domains such as learning, memory and behavioural flexibility. However, much less is known about aging in pet dogs, i.e. dogs that are ...exposed to different home environments by their caregivers. We used tasks on a touchscreen apparatus to detect differences in various cognitive functions across pet Border Collies aged from 5 months to 13 years. Ninety-five dogs were divided into five age groups and tested in four tasks: (1) underwater photo versus drawing discrimination, (2) clip art picture discrimination, (3) inferential reasoning by exclusion and (4) a memory test with a retention interval of 6 months. The tasks were designed to test three cognitive abilities: visual discrimination learning, logical reasoning and memory. The total number of sessions to reach criterion and the number of correction trials needed in the two discrimination tasks were compared across age groups. The results showed that both measures increased linearly with age, with dogs aged over 13 years displaying slower learning and reduced flexibility in comparison to younger dogs. Inferential reasoning ability increased with age, but less than 10 % of dogs showed patterns of choice consistent with inference by exclusion. No age effect was found in the long-term memory test. In conclusion, the discrimination learning tests used are suitable to detect cognitive aging in pet dogs, which can serve as a basis for comparison to help diagnose cognition-related problems and as a tool to assist with the development of treatments to delay cognitive decline.
Summary Background Insecticide-treated bednets (ITNs) are effective in preventing malaria where vectors primarily bite indoors and late at night, but their effectiveness is uncertain where vectors ...bite outdoors and earlier in the evening. We studied the effectiveness of ITNs following a mass distribution in Haiti from May to September, 2012, where the Anopheles albimanus vector bites primarily outdoors and often when people are awake. Methods In this case-control study, we enrolled febrile patients presenting to outpatient departments at 17 health facilities throughout Haiti from Sept 4, 2012, to Feb 27, 2014, who were tested with malaria rapid diagnostic tests (RDTs), and administered questionnaires on ITN use and other risk factors. Cases were defined by positive RDT and controls were febrile patients from the same clinic with a negative RDT. Our primary analysis retrospectively matched cases and controls by age, sex, location, and date, and used conditional logistic regression on the matched sample. A sensitivity analysis used propensity scores to match patients on ITN use propensity and analyse malaria among ITN users and non-users. Additional ITN bioefficacy and entomological data were collected. Findings We enrolled 9317 patients, including 378 (4%) RDT-positive cases. 1202 (13%) patients reported ITN use. Post-hoc matching of cases and controls yielded 362 cases and 1201 matched controls, 19% (333) of whom reported consistent campaign net use. After using propensity scores to match on consistent campaign ITN use, 2298 patients, including 138 (7%) RDT-positive cases, were included: 1149 consistent campaign ITN users and 1149 non-consistent campaign ITN users. Both analyses revealed that ITNs did not significantly protect against clinical malaria (odds ratio OR=0·95, 95% CI 0·68–1·32, p=0·745 for case-control analysis; OR=0·95, 95% CI 0·45–1·97, p=0·884 for propensity score analysis). ITN and entomological data indicated good ITN physical integrity and bioefficacy, and no permethrin resistance among local mosquitoes. Interpretation We found no evidence that mass ITN campaigns reduce clinical malaria in this observational study in Haiti; alternative malaria control strategies should be prioritised. Funding The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the US-based Centers for Disease Control and Prevention (CDC).
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