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Post-transplant diabetes mellitus (PTDM) is common following heart transplant, impacting greater than 20% of patients with most cases occurring in the first year after transplant. PTDM is associated with multiple negative sequelae including increased post-operative infections, a higher rate of renal failure, and increased mortality. Compared with pre-transplant diabetes mellitus, PTDM has several unique risk factors and immunosuppressive medications play an important role in disease pathophysiology. Newer treatments for hyperglycemia, including glucagon like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, may counter the mechanisms of immunosuppression-related hyperglycemia making them an appealing treatment option for patients with PTDM. Here, we review the definitions, incidence, risk factors, pathophysiology, clinical outcomes, treatment options, pharmacologic considerations, and future directions in PTDM.

A polygenic risk score (PGS) is associated with obstructive coronary artery disease (CAD) independent of traditional risk factors. Coronary computed tomography angiography (CTA) can characterize coronary plaques, including features of highrisk CAD. However, it is unknown if a PGS is associated with obstructive CAD and high-risk CAD phenotypes in patients with symptoms suggestive of CAD.

The ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial randomized participants with chronic coronary disease (CCD) to guideline-directed medical therapy with or without angiography and revascularization. The study examined the association of nonadherence with health status outcomes.The study sought to compare 12-month health status outcomes of adherent and nonadherent participants with CCD with an a priori hypothesis that nonadherent patients would have better health status if randomized to invasive management.Self-reported medication-taking behavior was assessed at randomization with a modified 4-item Morisky-Green-Levine Adherence Scale, and participants were classified as adherent or nonadherent. Twelve-month health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ-7) summary score (SS), which ranges from 0 to 100 (higher score = better). The association of adherence with outcomes was evaluated using Bayesian proportional odds models, including an interaction by study arm (conservative vs invasive).Among 4,480 randomized participants, 1,245 (27.8%) were nonadherent at baseline. Nonadherent participants had worse baseline SAQ-7 SS in both conservative (72.9 ± 19.3 vs 75.6 ± 18.4) and invasive (71.0 ± 19.8 vs 74.2 ± 18.7) arms. In adjusted analyses, adherence was associated with higher 12-month SAQ-7 SS in both treatment groups (mean difference in SAQ-7 SS with conservative treatment = 1.6 [95% credible interval: 0.3-2.9] vs with invasive management = 1.9 [95% credible interval: 0.8-3.1]), with no interaction by treatment.More than 1 in 4 participants reported medication nonadherence, which was associated with worse health status in both conservative and invasive treatment strategies at baseline and 12 months. Strategies to improve medication adherence are needed to improve health status outcomes in CCD, regardless of treatment strategy. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial demonstrated no overall difference in the composite primary endpoint and the secondary endpoints of cardiovascular (CV) death/myocardial infarction or all-cause mortality between an initial invasive or conservative strategy among participants with chronic coronary disease and moderate or severe myocardial ischemia. Detailed cause-specific death analyses have not been reported.We compared overall and cause-specific death rates by treatment group using Cox models with adjustment for pre-specified baseline covariates. Cause of death was adjudicated by an independent Clinical Events Committee as CV, non-CV, and undetermined. We evaluated the association of risk factors and treatment strategy with cause of death.Four-year cumulative incidence rates for CV death were similar between invasive and conservative strategies (2.6% vs 3.0%; hazard ratio [HR] 0.98; 95% CI [0.70-1.38]), but non-CV death rates were higher in the invasive strategy (3.3% vs 2.1%; HR 1.45 [1.00-2.09]). Overall, 13% of deaths were attributed to undetermined causes (38/289). Fewer undetermined deaths (0.6% vs 1.3%; HR 0.48 [0.24-0.95]) and more malignancy deaths (2.0% vs 0.8%; HR 2.11 [1.23-3.60]) occurred in the invasive strategy than in the conservative strategy.In International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, all-cause and CV death rates were similar between treatment strategies. The observation of fewer undetermined deaths and more malignancy deaths in the invasive strategy remains unexplained. These findings should be interpreted with caution in the context of prior studies and the overall trial results.

Fine particulate air pollution

PURPOSE: A key property to consider in all genetic tests is clinical utility, the ability of the test to influence patient management and health outcomes. Here we assess the current clinical utility of genetic testing in diverse pediatric inherited eye disorders (IEDs).METHODS: Two hundred one unrelated children (0-5 years old) with IEDs were ascertained through the database of the North West Genomic Laboratory Hub, Manchester, UK. The cohort was collected over a 7-year period (2011-2018) and included 74 children with bilateral cataracts, 8 with bilateral ectopia lentis, 28 with bilateral anterior segment dysgenesis, 32 with albinism, and 59 with inherited retinal disorders. All participants underwent panel-based genetic testing.RESULTS: The diagnostic yield of genetic testing for the cohort was 64% (ranging from 39% to 91% depending on the condition). The test result led to altered management (including preventing additional investigations or resulting in the introduction of personalized surveillance measures) in 33% of probands (75% for ectopia lentis, 50% for cataracts, 33% for inherited retinal disorders, 7% for anterior segment dysgenesis, 3% for albinism).CONCLUSION: Genetic testing helped identify an etiological diagnosis in the majority of preschool children with IEDs. This prevented additional unnecessary testing and provided the opportunity for anticipatory guidance in significant subsets of patients.

Given the intersection between diabetes mellitus and cardiovascular disease (CVD), pharmacologic agents used to treat type 2 diabetes mellitus must show cardiovascular safety. Comorbid conditions, including heart failure and chronic kidney disease, are increasingly prevalent in patients with diabetes; therefore, they also play a large role in drug safety. Although biguanides, sulfonylurea, glitazones, and dipeptidyl peptidase 4 inhibitors have variable effects on cardiovascular events, sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have consistently shown safety and reduction in cardiovascular events in patients with established CVD. These medications are becoming essential tools for cardioprotection for patients with diabetes and CVD. They may also have roles in primary prevention and renal protection. This paper will review the cardiovascular impact, adverse effects, and possible mechanisms of action of pharmacologic agents used to treat patients with type 2 diabetes.

A new cardiometabolic-based chronic disease (CMBCD) model is presented that provides a basis for early and sustainable, evidence-based therapeutic targeting to promote cardiometabolic health and mitigate the development and ravages of cardiovascular disease. In the first part of this JACC State-of-the-Art Review, a framework is presented for CMBCD, focusing on 3 primary drivers (genetics, environment, and behavior) and 2 metabolic drivers (adiposity and dysglycemia) with applications to 3 cardiovascular endpoints (coronary heart disease, heart failure, and atrial fibrillation). Specific mechanistic pathways are presented configuring early primary drivers with subsequent adiposity, insulin resistance, β-cell dysfunction, and metabolic syndrome, leading to cardiovascular disease. The context for building this CMBCD model is to expose actionable targets for prevention to achieve optimal cardiovascular outcomes. The tactical implementation of this CMBCD model is the subject of second part of this JACC State-of-the-Art Review.

INTRODUCTION: Perfluoroalkyl substances (PFAs) are ubiquitous, anthropogenic organic compounds that have been linked with cardiovascular disease and cardiovascular risk factors. Older, long-chain PFAs have been phased out due to adverse cardiometabolic health effect and replaced by newer short-chain PFAs. However, emerging research suggests that short-chain PFAs may also have adverse cardiovascular effects. Non-invasive measures of vascular function can detect preclinical cardiovascular disease and serve as a useful surrogate for early CVD risk. We hypothesized that serum concentrations of PFAs would be associated with noninvasive measures of vascular function, carotid-femoral pulse wave velocity (PWV) and brachial artery reactivity testing (BART), in adults with non-occupational exposure to PFAs. METHODS: We measured serum concentrations of 14 PFAs with hybrid solid-phase extraction and ultrahigh-performanee liquid chromatography–tandem mass spectrometry in 94 adult outpatients with no known cardiovascular disease. We collected clinical and demographic data; and measured vascular function, PWV and BART, using standard protocols. We assessed associations of individual PFAs with log-transformed BART and PWV using linear regression. We used weighted quantile sum regression to assess effects of correlated PFA mixtures on BART and PWV. RESULTS: Ten PFAs were measured above the limit of detection in >50% of participants. Each standard deviation increase in concentration of perfluoroheptanoic acid (PFHpA) was associated with 15% decrease in BART (95% CI: −28.5, −0.17). The weighted index of a mixture of PFAs with correlated concentrations was inversely associated with BART: each tertile increase in the weighted PFA mixture was associated with 25% lower BART, with 73% of the effect driven by PFHpA. In contrast, no PFAs or mixtures were associated with PWV. CONCLUSIONS: Serum concentration of PFHpA, a new, short-chain PFA, was associated with impaired vascular function among outpatients without CVD. Our findings support a potential adverse cardiovascular effect of newer, short-chain PFAs.

This ERP study of Chinese subject- and object-modifying relative clauses (RCs) aimed at investigating how sentence context (embeddedness) temporally interacted with relativization in terms of processing load. In stead of adotping a static view of processing costs of RCs, we focused on the dynamic modulation of processing load by sentence context at two critical words–the relative marker de and head noun. Using cluster-based permutation analyses of ERPs, our study found an early relativization effect (110–220 ms) followed by an embeddedness effect (411–441 ms) and a late interaction effect (540–620 ms) at the relative marker de. The main effect of relativization as an early left anterior negativity suggests a transitory processing advantage of subject-relativization independent of sentence context. The sentence context was processed just 410 ms after word onset as a late left-lateralized anterior negativity for the center-embedded RCs, indicating increased working memory load introduced by sentence context constraints. A late centro-posterior positivity registered for object-relativization RCs with preceding sentence context due to structural reanalysis. An early anterior negativity (73–123 ms) reflecting the embeddedness effect at the head noun suggests the complexity of information encoded in phrase markers when semantic contents of verb arguments are instantiated. Our results indicate that it is necessary to adjust the account of RC processing beyond a universal processing advantage for subject-relativization to integrate the effects of sentence context cross-linguistically.

fMRI has been used as an outcome measure in dementia treatment studies, with many previous studies comparing only single pre- and post-treatment fMRI scans to determine treatment-induced neural changes, while utilizing single subject experimental designs. The purpose of the current study was to evaluate fMRI test-retest reliability in dementia patients and typical older adults using noun and verb confrontation naming to evaluate the validity of using a single pre/post-treatment scan comparison. Seven individuals with dementia and 9 control participants were tested three times over two months using the same fMRI procedures. Differences in individual and group level activation patterns were observed that varied across time. Additionally, the extent of variability fluctuated across individuals, groups, and the grammatical category of target words. Our findings suggested that one time fMRI scanning may inadequately represent an individual's typical brain activation pattern, particularly an individual with dementia. Thus, multiple imaging baselines are recommended.

The CanMars Mars Sample Return (MSR) analogue mission was a high-fidelity rover campaign conducted over a total of five weeks in November 2015 and November 2016. The analogue mission team consisted of a Mission Control Team located at the University of Western Ontario (Western) in London, Ontario, Canada, and a Field Team including the Mars Exploration Science Rover (MESR) platform conducting in situ field operations in the desert north of Hanksville, Utah, USA. This location served as an analogue martian terrain for the duration of the CanMars mission campaign. The main science goal of the mission was to explore the field area using the MESR platform in order to locate and sample geologic materials best suited for identifying evidence for the existence of past or extant life. The CanMars analogue mission necessitated the organization and interpretation of several remote sensing datasets to provide regional morphological and compositional context for the lithological units observed by the rover in the operational field area. These tasks were given to the GIS (Geographic Information Systems) and Mapping team, a sub-team of the Mission Control Team located at Western. These remote sensing datasets were intended to be used as analogues for remote sensing data currently available for the Martian surface and included a HiRISE equivalent full colour Quickbird-2 satellite image (60 cm/pixel), a HiRISE/CTX approximating DEM (5 m/pixel horizontal resolution and a vertical accuracy on the order of 4 m or less), and CRISM and THEMIS equivalent visible to thermal infrared spectral images from Landsat-8 and ASTER (15–90 m/pixel). The GIS and Mapping Team used these datasets in concert with a range of additional derived data products (e.g., hillshade, slope, spectral and thermal inertia maps, etc.). This information was analyzed to create interpreted geomorphological maps of the operational field area. A major goal of the GIS and Mapping Team was to provide valuable contextual information to the Science and Planning Teams pertaining to the rover's position and the characteristics of the surrounding landscape and geology. The GIS and Mapping Team made use of geographic information systems including ArcMap and ArcScene to create a detailed database of geologic and geographic information as well as to derive additional geospatial data products. Additionally, the CanMars analogue missions provided an ideal setting to test the use of immersive virtual reality (VR) technology to aid scientists with both data and image interpretation as they conducted remote field operations. This included the development and implementation of immersive versions of the 360° panoramic images taken by the rover and an interactive immersive VR terrain model of the rover landing site and surrounding area. In the inherently time-sensitive role of interpreting data before sending the rover platform its next set of commands, the immersive technologies became important tools to facilitate a rapid understanding of the rover's location and orientation was well as the geologic and topographic setting of the surrounding region. These immersive products provided a first-person experience of the rover's surroundings that aided in the discussion and decision-making efforts of the CanMars team.

Subtle aspects of illumination sources and their characterization methods can introduce significant uncertainty into the data gathered from light-activated experiments, limiting their reproducibility and technology transition. Degradation kinetics of methyl orange (MO) and carbamazepine (CM) under illumination with TiO2 were used as a case study for investigating the role of incident photon flux on photocatalytic degradation rates. Valerophenone and ferrioxalate actinometry were paired with optical radiometry in three different illumination systems: xenon arc (XE), tungsten halogen (W-H), and UV fluorescent (UV-F). Degradation rate constants for MO and CM varied similarly among the three light systems as k W - H k U V - F k X E , implying the same relative photon flux emission by each light. However, the apparent relative photon flux emitted by the different lights varied depending on the light characterization method. This discrepancy is shown to be caused by the spectral distribution present in light emission profiles, as well as absorption behavior of chemical actinometers and optical sensors. Data and calculations for the determination of photon flux from chemical and calibrated optical light characterization is presented, allowing us to interpret photo-degradation rate constants as a function of incident photon flux. This approach enabled the derivation of a calibrated ‘rate-flux’ metric for evaluating and translating data from photocatalysis studies.

The return of samples from known locations on Mars is among the highest priority goals of the international planetary science community. A possible scenario for Mars Sample Return (MSR) is a series of 3 missions: sample cache, fetch, and retrieval. The NASA Mars 2020 mission represents the first cache mission and was the focus of the CanMars analogue mission described in this paper. The major objectives for CanMars included comparing the accuracy of selecting samples remotely using rover data versus a traditional human field party, testing the efficiency of remote science operations with periodic pre-planned strategic observations (Strategic Traverse Days), assessing the utility of realistic autonomous science capabilities to the remote science team, and investigating the factors that affect the quality of sample selection decision-making in light of returned sample analysis. CanMars was conducted over two weeks in November 2015 and continued over three weeks in October and November 2016 at an analogue site near Hanksville, Utah, USA, that was unknown to the Mission Control Team located at the University of Western Ontario (Western) in London, Ontario, Canada. This operations architecture for CanMars was based on the Phoenix and Mars Exploration Rover missions together with previous analogue missions led by Western with the Mission Control Team being divided into Planning and Science sub-teams. In advance of the 2015 operations, the Science Team used satellite data, chosen to mimic datasets available from Mars-orbiting instruments, to produce a predictive geological map for the landing ellipse and a set of hypotheses for the geology and astrobiological potential of the landing site. The site was proposed to consist of a series of weakly cemented multi-coloured sedimentary rocks comprising carbonates, sulfates, and clays, and sinuous ridges with a resistant capping unit, interpreted as inverted paleochannels. Both the 2015 CanMars mission, which achieved 11 sols of operations, and the first part of the 2016 mission (sols 12–21), were conducted with the Mars Exploration Science Rover (MESR) and a series of integrated and hand-held instruments designed to mimic the payload of the Mars 2020 rover. Part 2 of the 2016 campaign (sols 22–39) was implemented without the MESR rover and was conducted exclusively by the field team as a Fast Motion Field Test (FMFT) with hand-carried instruments and with the equivalent of three sols of operations being executed in a single actual day. A total of 8 samples were cached during the 39 sols from which the Science Team prioritized 3 for “return to Earth”. Various science autonomy capabilities, based on flight-proven or near-future techniques intended for actual rover missions, were tested throughout the 2016 CanMars activities, with autonomous geological classification and targeting and autonomous pointing refinement being used extensively during the FMFT. Blind targeting, contingency sequencing, and conditional sequencing were also employed. Validation of the CanMars cache mission was achieved through various methods and approaches. The use of dedicated documentarians in mission control provided a detailed record of how and why decisions were made. Multiple separate field validation exercises employing humans using traditional geological techniques were carried out. All 8 of the selected samples plus a range of samples from the landing site region, collected out-of-simulation, have been analysed using a range of laboratory analytical techniques. A variety of lessons learned for both future analogue missions and planetary exploration missions are provided, including: dynamic collaboration between the science and planning teams as being key for mission success; the more frequent use of spectrometers and micro-imagers having remote capabilities rather than contact instruments; the utility of strategic traverse days to provide additional time for scientific discussion and meaningful interpretation of the data; the benefit of walkabout traverse strategies along with multi-sol plans with complex decisions trees to acquire a large amount of contextual data; and the availability of autonomous geological targeting, which enabled complex multi-sol plans gathering large suites of geological and geochemical survey data. Finally, the CanMars MSR activity demonstrated the utility of analogue missions in providing opportunities to engage and educate children and the public, by providing tangible hands-on linkages between current robotic missions and future human space missions. Public education and outreach was a priority for CanMars and a dedicated lead coordinated a strong presence on social media (primarily Twitter and Facebook), articles in local, regional, and national news networks, and interaction with the local community in London, Ontario. A further core objective of CanMars was to provide valuable learning opportunities to students and post-doctoral fellows in preparation for future planetary exploration missions. A learning goals survey conducted at the end of the 2016 activities had 90% of participants “somewhat agreeing” or “strongly agreeing” that participation in the mission has helped them to increase their understanding of the four learning outcomes.

Background Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality. Aim This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants’ knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries. Methods An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria. Findings Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49–43/1000 births to 10.5–3.7/1000 births. Conclusion Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates.

Approaches to rover mission operations were investigated in the framework of the CanMars Mars Sample Return (MSR) analogue mission deployments. Improving the efficiency of operations is a necessity for future planetary missions, including Mars 2020, which seek to combine sample targeting with in situ investigations in the fixed amount of time available in primary science operations and with increasingly high public and science community expectations for results. Analogue missions provide an important opportunity to experiment with mission operation strategies and learn lessons that can be incorporated in future missions. Improving the efficiency of operations was a key objective of the 2015 and 2016 CanMars mission deployment. The mission overall operations organisation for CanMars is described with comparison to current implementation of Mars Exploration Rover and Mars Science Laboratory missions. Approaches being tested included 3-sol plan sequences with increased use of waypoints for teach and return as part of a global Walkabout approach, use of Strategic Observation days to focus the Science Team's efforts, and consideration to improvements in how information is exchanged tactically and strategically in operations.

Prediabetes affects at least 1 in 3 adults in the U.S. and 1 in 5 in Europe. Although guidelines advocate aggressive management of lipid parameters in diabetes, most guidelines do not address treatment of dyslipidemia in prediabetes despite the increased atherosclerotic cardiovascular disease (ASCVD) risk. Several criteria are used to diagnose prediabetes: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and HbA1c of 5.7-6.4%. Individuals with prediabetes have a greater risk of diabetes, a higher prevalence of dyslipidemia with a more atherogenic lipid profile and an increased risk of ASCVD. In addition to calculating ASCVD risk using traditional methods, an OGTT may further stratify risk. Those with 1-hour plasma glucose ≥8.6 mmol/L (155 mg/dL) and/or 2-hour ≥7.8 mmol/L (140 mg/dL) (IGT) have a greater risk of ASCVD. Diet and lifestyle modification are fundamental in prediabetes. Statins, ezetimibe and PCSK9 inhibitors are recommended in people requiring pharmacotherapy. Although high-intensity statins may increase risk of diabetes, this is acceptable because of the greater reduction of ASCVD. The LDL-C goal in prediabetes should be individualized. In those with IGT and/or elevated 1-hour plasma glucose, the same intensive approach to dyslipidemia as recommended for diabetes should be considered, particularly if other ASCVD risk factors are present.

Self-Admitted Technical Debt (SATD) is a metaphorical concept to describe the self-documented addition of technical debt to a software project in the form of source code comments. SATD can linger in projects and degrade source-code quality, but it can also be more visible than unintentionally added or undocumented technical debt. Understanding the implications of adding SATD to a software project is important because developers can benefit from a better understanding of the quality trade-offs they are making. However, empirical studies, analyzing the survivability and removal of SATD comments, are challenged by potential code changes or SATD comment updates that may interfere with properly tracking their appearance, existence, and removal. In this paper, we propose SATDBailiff, a tool that uses an existing state-of-the-art SATD detection tool, to identify SATD in method comments, then properly track their lifespan. SATDBailiff is given as input links to open source projects, and its output is a list of all identified SATDs, and for each detected SATD, SATDBailiff reports all its associated changes, including any updates to its text, all the way to reporting its removal. The goal of SATDBailiff is to aid researchers and practitioners in better tracking SATDs instances, and providing them with a reliable tool that can be easily extended. SATDBailiff was validated using a dataset of previously detected and manually validated SATD instances. SATDBailiff is publicly available as an open source, along with the manual analysis of SATD instances associated with its validation, on the project website. 1

Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Despite improved risk factor control, however, adults with T2D continue to experience substantial excess CVD risk. Until recently, however, improved glycemic control has not been associated with robust macrovascular benefit. The advent of 2 new classes of antihyperglycemic agents, the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, and their respective large cardiovascular outcome trials, has led to a paradigm shift in how cardiologists and heath care practitioners conceptualize T2D treatment. Herein, the authors review the recent trial evidence, the potential mechanisms of action of the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, safety concerns, and their use for the primary prevention of CVD as well as in diabetic patients with impaired renal function and heart failure.

Introduction A prominent effect of acute cannabis use is impaired motor coordination and driving performance. However, few studies have evaluated balance in chronic cannabis users, even though density of the CB1 receptor, which mediates the psychoactive effects of cannabis, is extremely high in brain regions critically involved in this fundamental behavior. The present study measured postural sway in regular cannabis users and used rambling and trembling analysis to quantify the integrity of central and peripheral nervous system contributions to the sway signal. Methods Postural sway was measured in 42 regular cannabis users (CB group) and 36 non-cannabis users (N-CB group) by asking participants to stand as still as possible on a force platform in the presence and absence of motor and sensory challenges. Center of pressure (COP) path length was measured, and the COP signal was decomposed into rambling and trembling components. Exploratory correlational analyses were conducted between sway variables, cannabis use history, and neurocognitive function. Results The CB group had significantly increased path length and increased trembling in the anterior-posterior (AP) direction. Exploratory correlational analyses suggested that AP rambling was significantly inversely associated with visuo-motor processing speed. Discussion Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system’s contribution to the sway signal.

Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation.A prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 month.The mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P.001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non-HDL-C100 mg/dL (initial exclusion criterion), Δ non-HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P = .04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P = .03).Although non-HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.

Background This study examined a racially diverse sample of nursing students' participation in simulation using racially diverse manikins. Method This mixed-methods pilot study utilized pre-post self-efficacy and post satisfaction measures of 16 black and 16 white students. Following completion of the simulation experience, the students participated in single-race focus groups. Results There was a statistically significant difference (p Conclusion Results provide baseline evidence that race of both students and manikins may be a demographic characteristic variable that influences outcomes in simulation. Further research is needed to determine if race is a variable that can be added to the NLN/Jeffries simulation theory.

Background Multiple studies demonstrate the benefit of a vegan diet on cardiovascular risk factors when compared to no intervention or usual dietary patterns. The aim of this study is to evaluate the effect of a vegan diet versus the American Heart Association (AHA)-recommended diet on inflammatory and glucometabolic profiles in patients with angiographically defined coronary artery disease (CAD). Study design This study is a randomized, open label, blinded end-point trial of 100 patients with CAD as defined by ≥ 50% diameter stenosis in a coronary artery ≥2 mm in diameter on invasive angiography. Participants are randomized to 8 weeks of either a vegan or AHA-recommended diet (March 2014 and February 2017). Participants are provided weekly groceries that adhere to the guidelines of their diet. The primary endpoint is high sensitivity C-reactive concentrations. Secondary endpoints include anthropometric data, other markers of inflammation, lipid parameters, glycemic markers, endothelial function, quality of life data, and assessment of physical activity. Endpoints are measured at each visit (baseline, 4 weeks, and 8 weeks). Dietary adherence is measured by two weekly 24-h dietary recalls, a 4-day food record during the week prior to each visit, and both plasma and urine levels of trimethylamine- N -oxide at each visit. Conclusion This study is the first to comprehensively assess multiple indices of inflammation and glucometabolic profile in a rigorously conducted randomized trial of patients with CAD on a vegan versus AHA-recommended diet.

Individuals with primary progressive aphasia (PPA) exhibit differential impairment patterns in noun and verb naming, but it remains unclear whether anomia treatment results in similar improvements in noun and verb naming. Therefore, we examined the immediate and long-term (3-months post-treatment) behavioral and neural effects of an anomia treatment on object and action naming skills in PPA. A case-series design was utilized involving two individuals with PPA. Object and action words were trained concurrently and probed regularly using word lists matched on a number of lexical characteristics. One participant showed improvements in all word categories with different effect sizes whereas the other participant demonstrated improved naming only on trained object words. Treatment-induced fMRI changes were found in both hemispheres, with distinct patterns observed across participants. Further research is needed to better understand the effects of residual language and cognitive skills on behavioral and neurophysiological outcomes following anomia treatment for PPA.

This review endeavours to explore the power of quantum chemistry, especially density functional theory (DFT) to unravel mechanisms underlying the fascinating field of FLP chemistry. Apart from the fundamental mechanism of hydrogen activation by FLPs, borylation, silylation, polymerization, formation of heterocycles, reaction with small gaseous molecules, alkenes, terminal alkynes have also been reviewed. The role of DFT in understanding regio-selectivity, steric effects, London dispersion and covalent Interactions in FLPs are also discussed.

Coastal tundra ecosystems are relatively flat, and yet display large spatial variability in ecosystem traits. The microtopographical differences in polygonal geomorphology produce heterogeneity in permafrost depth, soil temperature, soil moisture, soil geochemistry, and plant distribution. Few measurements have been made, however, of how water fluxes vary across polygonal tundra plant types, limiting our ability to understand and model these ecosystems. Our objective was to investigate how plant distribution and geomorphological location affect actual evapotranspiration (ET). These effects are especially critical in light of the rapid change polygonal tundra systems are experiencing with Arctic warming. At a field site near Barrow, Alaska, USA, we investigated the relationships between ET and plant cover in 2014 and 2015. ET was measured at a range of spatial and temporal scales using: (1) An eddy covariance flux tower for continuous landscape-scale monitoring; (2) An automated clear surface chamber over dry vegetation in a fixed location for continuous plot-scale monitoring; and (3) Manual measurements with a clear portable chamber in approximately 60 locations across the landscape. We found that variation in environmental conditions and plant community composition, driven by microtopographical features, has significant influence on ET. Among plant types, ET from moss-covered and inundated areas was more than twice that from other plant types. ET from troughs and low polygonal centers was significantly higher than from high polygonal centers. ET varied seasonally, with peak fluxes of 0.14 mm h−1 in July. Despite 24 hours of daylight in summer, diurnal fluctuations in incoming solar radiation and plant processes produced a diurnal cycle in ET. Combining the patterns we observed with projections for the impact of permafrost degradation on polygonal structure suggests that microtopographic changes associated with permafrost thaw have the potential to alter tundra ecosystem ET.

The sites of action regulating meal size (MS) and intermeal interval (IMI) length by glucagon like peptide-1 (7–36) (GLP-1 (7–36)) and cholecystokinin-8 (CCK-8) reside in the areas supplied by the two major branches of the abdominal aorta, celiac and cranial mesenteric arteries. We hypothesized that infusing GLP-1 near those sites reduces body weight (BW) and adding CCK-8 to this infusion enhances the reduction. Here, we measured BW in diet-induced obese (DIO) male rats maintained and tested on normal rat chow and infused with saline, GLP-1 (0.5 nmol/kg) and GLP-1 + CCK-8 (0.5 nmol/kg each) in the aorta once daily for 21 days. We found that GLP-1 and GLP-1 + CCK-8 decrease BW relative to saline vehicle and GLP-1 + CCK-8 reduced it more than GLP-1 alone. Reduction of BW by GLP-1 alone was accompanied by decreased 24-h food intake, first MS, duration of first meal and number of meals, and an increase in latency to first meal. Reduction of BW by the combination of the peptides was accompanied by decrease 24-h food intake, first MS, duration of first meal and number of meals, and increase in the IMI length, satiety ratio and latency to first meal. In conclusion, GLP-1 reduces BW and CCK-8 enhances this reduction if the peptides are given near their sites of action.

Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Yet

Objectives Building on mounting evidence distinguishing the neurological basis of different movement imagery abilities (visual versus kinesthetic), this study compared brain activity (i.e., blood flow changes) through functional magnetic resonance imaging elicited by movement imagery in participants self-reporting good and poor imagery abilities with the Movement Imagery Questionnaire-3. Participants also completed the Vividness of Movement Imagery Questionnaire-2. Method: Thirty-seven females (good imagery ability = 18; poor imagery ability = 19) were randomly presented with four experimental conditions (i.e., Kinesthetic, Internal Perspective, External Perspective and Rest) counterbalanced for condition, during three separate 11-min functional brain scans. Results: Kinesthetic and visual (internal/external) subscale mean differences of the Vividness of Movement Imagery Questionnaire-2 favored good imagers and high Movement Imagery Questionnaire-3 inter-scale correlations evidenced convergent validity. As in prior published work, kinesthetic, internal, and external visual imagery elicited distinct patterns of brain activation relative to rest. Overall, the patterns of brain activity in the good and poor imager groups were remarkably similar, indicating that they both generally relied on a similar brain network during movement imagery. Conclusions: Contrary to processing efficiency hypotheses (i.e., neural efficiency hypothesis) we report that during kinesthetic imagery and external visual imagery only, good imagers actually activated a greater number of spatially distinct cortical sites than did poor imagers. Furthermore, research is needed to fully characterize the neural signature of movement imagery in good and poor imagers. Such research is critical to the appropriate creation and proper application of neuroscience-inspired movement imagery-based learning interventions in healthy and clinical populations.