Using a smartphone app, the investigators recruited 419,297 participants to be monitored for irregular pulses. Patterns suggesting atrial fibrillation were detected in 2161 participants who then ...received ECG monitoring devices to be worn for 7 days to confirm the presence or absence of atrial fibrillation.
The central nervous system of humans and other animals modulates spinal cord activity to achieve several locomotion behaviors. Previous neuromechanical models investigated the modulation of human ...gait changing selected parameters belonging to CPGs (Central Pattern Generators) feedforward oscillatory structures or to feedback reflex circuits. CPG-based models could replicate slow and fast walking by changing only the oscillation's properties. On the other hand, reflex-based models could achieve different behaviors through optimizations of large dimensional parameter spaces. However, they could not effectively identify individual key reflex parameters responsible for gait characteristics' modulation. This study investigates which reflex parameters modulate the gait characteristics through neuromechanical simulations. A recently developed reflex-based model is used to perform optimizations with different target behaviors on speed, step length, and step duration to analyze the correlation between reflex parameters and their influence on these gait characteristics. We identified nine key parameters that may affect the target speed ranging from slow to fast walking (0.48 and 1.71 m/s) as well as a large range of step lengths (0.43 and 0.88 m) and step duration (0.51, 0.98 s). The findings show that specific reflexes during stance significantly affect step length regulation, mainly given by positive force feedback of the ankle plantarflexors' group. On the other hand, stretch reflexes active during swing of iliopsoas and gluteus maximus regulate all the gait characteristics under analysis. Additionally, the results show that the hamstrings' group's stretch reflex during the landing phase is responsible for modulating the step length and step duration. Additional validation studies in simulations demonstrated that the modulation of identified reflexes is sufficient to regulate the investigated gait characteristics. Thus, this study provides an overview of possible reflexes involved in modulating speed, step length, and step duration of human gaits.
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bstract
Holographic entanglement entropy was recently recast in terms of Riemannian flows or ‘bit threads’. We consider the Lorentzian analog to reformulate the ‘complexity=volume’ conjecture using ...Lorentzian flows — timelike vector fields whose minimum flux through a boundary subregion is equal to the volume of the homologous maximal bulk Cauchy slice. By the nesting of Lorentzian flows, holographic complexity is shown to obey a number of properties. Particularly, the rate of complexity is bounded below by
conditional complexity
, describing a multi-step optimization with intermediate and final target states. We provide multiple explicit geometric realizations of Lorentzian flows in AdS backgrounds, including their time-dependence and behavior near the singularity in a black hole interior. Conceptually, discretized flows are interpreted as Lorentzian threads or ‘gatelines’. Upon selecting a reference state, complexity thence counts the minimum number of gatelines needed to prepare a target state described by a tensor network discretizing the maximal volume slice, matching its quantum information theoretic definition. We point out that suboptimal tensor networks are important to fully characterize the state, leading us to propose a refined notion of complexity as an ensemble average. The bulk symplectic potential provides a specific ‘canonical’ thread configuration characterizing perturbations around arbitrary CFT states. Consistency of this solution requires the bulk satisfy the linearized Einstein’s equations, which are shown to be equivalent to the holographic first law of complexity, thereby advocating for a principle of ‘spacetime complexity’. Lastly, we argue Lorentzian threads provide a notion of emergent time. This article is an expanded and detailed version of 1, including several new results.
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Consistent coupling of quantum and classical degrees of freedom exists so long as there is both diffusion of the classical degrees of freedom and decoherence of the quantum system. In this ...paper, we derive the Newtonian limit of such classical-quantum (CQ) theories of gravity. Our results are obtained both via the gauge fixing of the recently proposed path integral theory of CQ general relativity and via the CQ master equation approach. In each case, we find the same weak field dynamics. We find that the New-tonian potential diffuses by an amount lower bounded by the decoherence rate into mass eigenstates. We also present our results as an unraveled system of stochastic differential equations for the trajectory of the hybrid classical-quantum state and provide a series of kernels for constructing figures of merit, which can be used to rule out part of the parameter space of classical-quantum theories of gravity by experimentally testing it via the decoherence-diffusion trade-off. We compare and contrast the weak field limit to previous models of classical Newtonian gravity coupled to quantum systems. Here, we find that the Newtonian potential and quantum state change in lock-step, with the flow of time being stochastic.
The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.
A ...comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.
Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
Summary Background & aims Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the relationship between sarcopenia and 2-year ...risk of falls in a population of persons aged 80 years or older. Methods Data are from the baseline and follow-up evaluations of the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study) ( n = 260). According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass (mid-arm muscle circumference) plus either low muscle strength (hand grip) or low physical performance (4-m walking speed). The primary outcome measure was the incident falls during the follow-up period of 2 years. The relationship between sarcopenia and incident falls was estimated by deriving hazard ratios (HRs) from multiple logistic regression models considering the dependent variable of interest at least one fall during the follow-up period. Results Sixty-six participants (25.4%) were identified as affected by sarcopenia. Eighteen out of 66 (27.3%) participants with sarcopenia and 19 out of 194 (9.8%) without sarcopenia reported incident falls during the two-year follow-up of the study ( p < 0.001). After adjusting for age, gender, cognitive impairment, ADL impairment, sensory impairments, BMI, depression, physical activity, cholesterol, stroke, diabetes, number of medications, and C-reactive protein, participants with sarcopenia had a higher risk of incident falls compared with non sarcopenic subjects (adjusted hazard ratio HR, 3.23; 95% confidence interval CI, 1.25–8.29). Conclusions The present study suggests that sarcopenia – assessed using the EWGSOP algorithm – is highly prevalent among elderly persons without gender differences (25%). Sarcopenic participants were over three times more likely to fall during a follow-up period of 2 years relative to non sarcopenic individuals, regardless of age, gender and other confounding factors.
Diabetic retinopathy (DR) is one of the leading causes of visual impairment in the working-age population. DR is a progressive eye disease caused by long-term accumulation of hyperglycaemia-mediated ...pathological alterations in the retina of diabetic patients. DR begins with asymptomatic retinal abnormalities and may progress to advanced-stage proliferative diabetic retinopathy (PDR), characterized by neovascularization or preretinal/vitreous haemorrhages. The vitreous, a transparent gel that fills the posterior cavity of the eye, plays a vital role in maintaining ocular function. Structural and molecular alterations of the vitreous, observed during DR progression, are consequences of metabolic and functional modifications of the retinal tissue. Thus, vitreal alterations reflect the pathological events occurring at the vitreoretinal interface. These events are caused by hypoxic, oxidative, inflammatory, neurodegenerative, and leukostatic conditions that occur during diabetes. Conversely, PDR vitreous can exert pathological effects on the diabetic retina, resulting in activation of a vicious cycle that contributes to disease progression. In this review, we recapitulate the major pathological features of DR/PDR, and focus on the structural and molecular changes that characterize the vitreal structure and composition during DR and progression to PDR. In PDR, vitreous represents a reservoir of pathological signalling molecules. Therefore, in this review we discuss how studying the biological activity of the vitreous in different in vitro, ex vivo, and in vivo experimental models can provide insights into the pathogenesis of PDR. In addition, the vitreous from PDR patients can represent a novel tool to obtain preclinical experimental evidences for the development and characterization of new therapeutic drug candidates for PDR therapy.
•PDR is the major cause of vision loss in the working age population.•Structural and molecular vitreal alterations play a key role in PDR progression.•PDR vitreous represents a “reservoir” of pathological signalling molecules.•The study of the biological activity of PDR vitreous offers new pathogenic insights.•PDR vitreous can be used as a tool for the identification of novel drug candidates.
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and ...professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a potential alternative to transvenous systems in hypertrophic cardiomyopathy (HCM) where lead complications are a significant ...issue.
To compare the S-ICD efficacy of defibrillation threshold (DFT) testing, arrhythmia therapy, and complications in HCM versus non-HCM patients.
Outcomes of patients with HCM implanted with S-ICD were compared to non-HCM S-ICD recipients using pooled data from a total of 872 subjects enrolled in the EFFORTLESS Registry and US IDE study.
The cohort included 99 HCM (75% male) and 773 non-HCM (72% male) patients with a median follow-up of 637 days. The HCM cohort was younger and more likely to receive a primary-prevention S-ICD (88.5% vs 67.5%, P < .0001). During implant testing, successful defibrillation at ≤80 J was achieved in 98.9% of HCM and 98.5% of non-HCM patients. One year postoperative complication-free rates were similar: 92.7% in HCM (with no lead complications) versus 89.5% in non-HCM. There were 3 appropriate shocks for ventricular tachycardia in 3 HCM patients that were all converted by the first shock. Overall final shock conversion efficacy was 100% in HCM versus 98% in non-HCM (P = ns). Inappropriate shocks occurred in 12.5% of HCM patients and 10.3% of non-HCM patients (P = ns), being reduced by 47% using dual-zone programming.
These initial data indicate the S-ICD is safe and effective in patients with HCM who are at high risk of ventricular arrhythmias and pass preimplantation electrocardiogram screening. Inappropriate shocks were mainly due to T-wave oversensing, but there were no lead complications requiring reintervention.
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