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AIMS AND OBJECTIVES: We aimed to investigate age and gender differences in arterial stiffness, and whether this cardiovascular risk factor was detectable in healthy Caucasians before established disease was manifest. BACKGROUND: A growing number of risk factors including diabetes, obesity, hypertension, hyperlipidaemia, smoking and age have been linked to the adverse cardiovascular end-points of myocardial infarction, stroke and heart failure. These risk factors lead to an increase in arterial stiffness. Measuring this stiffness at an early age may identify candidates for primary preventative intervention strategies by nurses. METHODS: Caucasian Canadians (n = 176) were recruited. Peripheral and central blood pressure, pulse pressure, augmentation pressure, arterial compliance (augmentation index and pulse wave velocity) and sub-endocardial viability ratio (SEVR), were assessed using applanation tonometry (SphygmoCor system). Blood was drawn for fasting lipid and glucose profiling. RESULTS: Women participants had significantly stiffer arteries than men (augmentation index: 28 SEM = 1% vs. 18 SEM = 2% respectively; p < 0.001). Pulse wave velocity, however, was not different (7.7 SEM = 0.2 m/s vs. 8.3 SEM = 0.1 m/s respectively; p < 0.001). Age was a strong predictor of arterial stiffening in both genders, but the effect was greater in women. CONCLUSIONS: Women having stiffer arteries than men, thus at greater cardiovascular risk, may require earlier screening. The effect might be postmenopausal, and mechanisms require further investigation. However, both middle-aged men and women considering themselves 'healthy' may benefit from more proactive primary prevention. RELEVANCE TO CLINICAL PRACTICE: Applanation tonometry, used extensively by nurses, provides early detection of central haemodynamic changes and vascular compliance at all ages. Knowledge of arterial stiffness could guide the management of primary prevention in the nursing cardiovascular risk reduction clinic. [ABSTRACT FROM AUTHOR]

Background and Objectives: We aimed to analyze the study designs, modeling approaches, and performance evaluation metrics in studies using machine learning techniques to develop clinical prediction models for children and adolescents with COVID-19., Methods: We searched four databases for articles published between 01/01/2020 and 10/25/2023, describing the development of multivariable prediction models using any machine learning technique for predicting several outcomes in children and adolescents who had COVID-19., Results: We included ten articles, six (60 % [95 % confidence interval (CI) 0.31 - 0.83]) were predictive diagnostic models and four (40% [95 % CI 0.170.69]) were prognostic models. All models were developed to predict a binary outcome (n= 10/10, 100 % [95 % CI 0.72-1]). The most frequently predicted outcome was disease detection (n=3/10, 30% [95 % CI 0.11-0.60]). The most commonly used machine learning models in the studies were tree-based (n=12/33, 36.3% [95 % CI 0.17-0.47]) and neural networks (n=9/27, 33.2% [95% CI 0.15-0.44])., Conclusion: Our review revealed that attention is required to address problems including small sample sizes, inconsistent reporting practices on data preparation, biases in data sources, lack of reporting metrics such as calibration and discrimination, hyperparameters and other aspects that allow reproducibility by other researchers and might improve the methodology., Competing Interests: Declaration of competing interest The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: A new strain of WNV lineage 1 (WNV - 1) emerged in the Veneto Region, northern Italy, in 2021, eight years after the last outbreak of WNV - 1 in Italy. The virus, which co-circulates with WNV-2, has become endemic in the Region, where, in 2022, most human cases of neuroinvasive disease (WNND) reported in Europe have occurred., Methods: Comparative analysis of the epidemiology and clinical presentation of WNV-1 and WNV-2 infection in humans, as well as the temporal and geographic distribution of WNV-1 and WNV-2 among wild birds and Culex pipiens mosquitoes in Veneto, from May 16th to August 21st, 2022, to determine if the high number of WNND cases was associated with WNV-1., Results: As of August 21st, 2022, 222 human cases of WNV infection were confirmed by molecular testing, including 103 with fever (WNF) and 119 with WNND. WNV lineage was determined in 201 (90.5%) cases, comprising 138 WNV-1 and 63 WNV-2 infections. During the same period, 35 blood donors tested positive, including 30 in whom WNV lineage was determined (13 WNV-1 and 17 WNV-2). Comparative analysis of the distribution of WNV-1 and WNV-2 infections among WNND cases, WNF cases and WNV-positive blood donors showed that patients with WNND were more likely to have WNV-1 infection than blood donors (odds ratio 3.44; 95% CI 95% 1.54 to 8.24; p = 0.0043). As observed in humans, in wild birds WNV-1 had higher infectious rate (IR) and showed a more rapid expansion than WNV-2. At variance, the distribution of the two lineages was more even in mosquitoes, but with a trend of rapid increase of WNV-1 IR over WNV-2., Conclusions: Comparative analysis of WNV-1 vs WNV-2 infection in humans, wild birds, and mosquitos showed a rapid expansion of WNV-1 and suggested that WNV-1 infected patients might have an increased risk to develop severe disease., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society of Travel Medicine.)

This paper presents a methodology and its application for the compilation of elemental carbon (EC) and organic carbon (OC) emission inventories. The methodology consists of the estimation of EC and OC emissions from available total suspended particulate matter (TSP) emission inventory data using EC and OC abundances in TSP derived from an extensive literature review, by taking into account the local technological context. In particular, the method is applied to the 2008 emissions of Lombardy region, Italy, considering 148 different activities and 30 types of fuels, typical of Western Europe. The abundances estimated in this study may provide a useful basis to assess the emissions also in other emission contexts with similar prevailing sources and technologies. The dominant sources of EC and OC in Lombardy are diesel vehicles for EC and the residential wood combustion (RWC) for OC which together account for about 83% of the total emissions of both pollutants. The EC and OC emissions from industrial processes and other fuel (e.g., gasoline, kerosene and LPG) combustion are significantly lower, while non-combustion sources give an almost negligible contribution. Total EC+OC contribution to regional greenhouse gas emissions is positive for every sector assuming whichever GWP100 value within the range proposed in literature. An uncertainty assessment is performed through a Monte Carlo simulation for RWC, showing a large uncertainty range (280% of the mean value for EC and 70% for OC), whereas for road transport a qualitative analysis identified a narrower range of uncertainty., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness.

The purpose of this study was to examine the relationship of health risk level to charged medical costs and determine the excess cost of higher risk individuals compared to low risk. Two years of medical claims from six corporations were used to determine costs of health risk assessment (HRA) participants and nonparticipants. A total of 165,770 employees, 21,124 of which took an HRA, were used for the study. Costs increased as risk level increased. There were no significant differences within a risk level between companies for the cost ratio. Percent of medical costs due to excess risk ranged from 15.0-30.8% for HRA participants and 23.8-38.3% for the study population. Cost patterns were consistent across companies. Excess cost as the result of increased risk level accounted for a substantial portion of the cost at each company. These results can be used to justify the need for a health-promotion program and to estimate potential savings as the result of excess risk. Even without the use of an HRA, health practitioners should feel confident stating that excess risk accounts for at least 25% to 30% of medical costs per year across a wide variety of companies, regardless of industry or demographics. The numbers can be used as a realistic estimate for any health promotion program financial proposal.

The authors describe a case similar to the complex syndrome described by Seckel (1960), "dwarf-headed dwarfism." This case differs from others previously reported because of slight hypophyseal hypoplasia with a slight reduction of human chorionic gonadotrophin (HCG) serum levels, and because of the parent's consanguinity (first cousins). A comparative critical examination was carried out on the 44 cases of Seckel's syndrome described in the literature. Only 19 of these cases appear to be comparable with Seckel's description, while the others are dubious, due to incomplete data. Some can be identified as ordinary cases of dwarfism with microcephaly or mental deficit. Until more precise and objective parameters are established, it would be advisable to refer to this particular form of dwarfism as "Virchow-Seckel type dwarf-headed dwarfism," in order to avoid using the more binding term "syndrome" and the misleading term "bird-headed."

A study was designed to compare three independent measures of cutaneous blood flow in normal healthy volunteers: xenon-133 washout, helium flux, and laser velocimetry. All measurements were confined to the volar aspect of the forearm. In a large group of subjects we found that helium flux through intact skin changes nonlinearly with the controlled local skin temperature whereas helium flux through stripped skin, which is directly proportional to skin blood flow, changes linearly with cutaneous temperature over the range 33 degrees to 42 degrees. In a second group of six volunteers we compared helium flux through stripped skin to xenon-133 washout (intact skin) at a skin temperature of 33 degrees, and we found an essentially linear relationship between helium flux and xenon measured blood flow. In a third group of subjects we compared helium flux blood flow (stripped skin) to laser doppler velocimetric (LDV) measurements (intact skin) at adjacent skin sites and found a nonlinear increase in the LDV skin blood flow compared to that determined by helium over the same temperature range. A possible explanation for the nonlinear increases of helium flux through intact skin and of LDV output with increasing local skin temperature is that they reflect more than a change in blood flow. They may also reflect physical changes in the stratum corneum, which alters its diffusional resistance to gas flux and its optical characteristics.