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The tip of the red giant branch (TRGB) is an apparent discontinuity of the luminosity function (LF) due to the end of the red giant evolutionary phase and is used to measure distances in the local universe. In practice, tip localization via edge detection response (EDR) relies on several methods applied on a case-by-case basis. It is hard to evaluate how individual choices affect a distance estimation using only a single host field while also avoiding confirmation bias. To devise a standardized approach, we compare unsupervised , algorithmic analyses of the TRGB in multiple halo fields per galaxy. We first optimize methods for the lowest field-to-field dispersion, including spatial filtering, smoothing, and weighting of LF, color band selection, and tip selection based on the number of likely RGB stars and the ratio of stars below versus above the tip ( R ). We find R , which we call the tip contrast , to be the most important indicator of the quality of EDR measurements; higher R selection can decrease field-to-field dispersion. Further, since R is found to correlate with the age or metallicity of the stellar population based on theoretical modeling, it might result in a displacement of the detected tip magnitude. We find a tip-contrast relation with a slope of −0.023 ± 0.0046 mag/ratio, an ∼5 σ result that can be used to correct these variations in the detections. When using TRGB to establish a distance ladder, consistent TRGB standardization using tip-contrast relation across rungs is vital to make robust cosmological measurements.

Observations with the Hubble Space Telescope unexpectedly revealed that the dwarf galaxy ESO 006–001 is a near neighbor to the Local Group at a distance of 2.70 ± 0.11 Mpc. The stellar population in the galaxy is well resolved into individual stars to a limit of M _I ∼ − 0.5 mag. The dominant population is older than 12 Gyr yet displays a significant range in metallicity of −2 < [Fe/H] < − 1, as evidenced by a red giant branch with substantial width. Superimposed on the dominant population are stars on the main sequence with ages less than 100 Myr and helium burning blue loop stars with ages of several hundred Myr. ESO 006–001 is an example of a transition dwarf; a galaxy dominated by old stars but one that has experienced limited recent star formation in a swath near the center. No H i gas is detected at the location of the optical galaxy in spite of the evidence for young stars. Intriguingly, an H i cloud with a similar redshift is detected 9 kpc away in projection. Otherwise, ESO 006–001 is a galaxy in isolation with its nearest known neighbor IC 3104, itself a dwarf, at a distance of ∼500 kpc.

With Cosmicflows- 4, distances are compiled for 55,877 galaxies gathered into 38,065 groups. Eight methodologies are employed, with the largest numbers coming from the correlations between the photometric and kinematic properties of spiral galaxies (TF) and elliptical galaxies (FP). Supernovae that arise from degenerate progenitors (type Ia SNe) are an important overlapping component. Smaller contributions come from distance estimates from the surface brightness fluctuations of elliptical galaxies and the luminosities and expansion rates of core-collapse supernovae (SNe II). Cepheid period–luminosity relation and tip of the red giant branch observations founded on local stellar parallax measurements along with the geometric maser distance to NGC 4258 provide the absolute scaling of distances. The assembly of galaxies into groups is an important feature of the study in facilitating overlaps between methodologies. Merging between multiple contributions within a methodology and between methodologies is carried out with Bayesian Markov chain Monte Carlo procedures. The final assembly of distances is compatible with a value of the Hubble constant of H _0 = 74.6 km s ^−1 Mpc ^−1 with the small statistical error of ±0.8 km s ^−1 Mpc ^−1 but a large potential systematic error of ∼3 km s ^−1 Mpc ^−1 . Peculiar velocities can be inferred from the measured distances. The interpretation of the field of peculiar velocities is complex because of large errors on individual components and invites analyses beyond the scope of this study.

Background Little is known about the impact of chronic obstructive pulmonary disease (COPD) in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results We examined outcomes in patients with heart failure with preserved ejection fraction, according to COPD status, in the PARAGON‐HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and cardiovascular death. Of 4791 patients, 670 (14%) had COPD. Patients with COPD were more likely to be men (58% versus 47%; P

Background: The effect of beta-blockade (BB) on response to vagus nerve stimulation (VNS) has not been reported in patients with heart failure and reduced ejection fraction (HFrEF). In the ANTHEM-HF Study, 60 patients received chronic cervical VNS. Background pharmacological therapy remained unchanged during the study, and VNS intensity was stable once up-titrated. Significant improvement from baseline occurred in resting 24-hour heart rate (HR), 24-hour HR variability (SDNN), left ventricular EF (LVEF), 6-minute walk distance (6MWD), and quality of life (MLWHFS) at 6 months post-titration. We evaluated whether response to VNS was related to percentage of target BB dose (PTBBD) at baseline. Methods: Patients were categorized by baseline PTBBD, then analyzed for changes from baseline in symptoms and function at 6 months after VNS titration. Results: All patients received BB, either PTBBD ≥ 50 % (16 patients, 27 %; group 1) or PTBBD

To date, research on social capital in Indigenous contexts has been scarce. In this quantitative study, our objectives were to (1): Describe bonding social capital within four distinct First Nations communities in Canada, and (2) Explore the associations between bonding social capital and self-rated health in these communities. With community permission, cross-sectional data were drawn from the Canadian Alliance for Healthy Hearts and Minds study. Four reserve-based First Nations communities were included in the analysis, totaling 591 participants. Descriptive statistics were computed to examine levels of social capital among communities and logistic regression analyses were performed to identify social capital predictors of good self-rated health. Age, sex, education level, and community were controlled for in all models. Across the four communities in this study, areas of common social capital included frequent socialization among friends and large and interconnected family networks. Positive self-rated health was associated with civic engagement at federal or provincial levels (OR=1.65, p

Background: Achieving diversity, inclusion, and gender equity remains an elusive challenge for many institutions worldwide and is understudied in Canadian academic health science centres. Methods: McMaster University’s Department of Medicine undertook surveys and analyses to determine whether there was inequity in leadership positions and salaries, or unprofessional behaviour within the department. Measures of academic productivity in relation to gender for both educators and researchers were analyzed. The department began shifting policies to foster greater gender diversity and inclusion. A revision of the leadership selection process, incorporating tenets of equity and a new game theory–based strategy called Diversitive Agreement Versus Nash Equilibrium (DAvNE) was evaluated. Results: The department’s survey revealed underrepresentation of women and people of colour in leadership positions, with perceived barriers to their promotion. Both women and people of colour reported experiencing unprofessional behaviour directed toward them. A gender gap in base salary was observed, with female full professors being paid less. No difference in academic productivity was seen between male and female educators or researchers. The leadership competitions conducted under new selection processes emphasizing diversity resulted in 66% of participating women securing a leadership position, in comparison to 25% of participating men. People of colour made up 27% of members participating in these leadership competitions, but none was successful in obtaining a position. Conclusions: Diversity and inclusion disparities in the Department of Medicine at McMaster University indicate a need for further efforts and innovation to bring about greater gender and racial equity. Résumé: Contexte: La mise en place des conditions nécessaires à la diversité, à l’inclusion et à l’équité des genres demeure un défi difficile à relever pour de nombreux établissements dans le monde entier. C’est une démarche peu étudiée dans les centres universitaires canadiens des sciences de la santé. Méthodologie: Le département de médecine de l’Université McMaster a mené des sondages et des analyses en vue de déterminer s’il existait en son sein même des iniquités en matière d’attribution des postes de direction et de fixation des salaires, ou des comportements non professionnels. Des mesures de la productivité universitaire des éducateurs et des chercheurs ont été analysées en fonction des genres. Le département a entrepris une réforme de ses politiques afin de favoriser une plus grande diversité et inclusion des genres. Une révision du processus de sélection des candidats aux postes de direction, intégrant les principes d’équité et une nouvelle stratégie fondée sur la théorie des jeux appelée Diversitive Agreement Versus Nash Equilibrium (DAvNE [accord de diversité vs équilibre de Nash]), a été évaluée. Résultats: Le sondage du département a révélé qu’il existait une sous-représentation des femmes et des personnes de couleur parmi les titulaires des postes de direction, ainsi que des obstacles perçus à leur promotion. Tant les femmes que les personnes de couleur ont fait état de comportements non professionnels à leur endroit. Un écart entre les genres a été observé au chapitre de la rémunération de base, les professeurs titulaires de sexe féminin étant moins rémunérées. Aucune différence n’a été observée sur le plan de la productivité universitaire entre les femmes et les hommes au sein de l’effectif des éducateurs et des chercheurs. Les concours pour les postes de direction ont été organisés en fonction de nouveaux processus de sélection mettant l’accent sur la diversité. Au final, 66 % des candidats qui ont vu leur candidature retenue étaient des femmes et 25 %, des hommes. Dans le cadre de ces concours, 27 % des candidats étaient des personnes de couleur, mais aucun n’a réussi à obtenir un poste. Conclusions: Les disparités notées en matière de diversité et d’inclusion au sein du département de médecine de l’Université McMaster montrent que l’atteinte d’une plus grande équité des genres et des races passe par des efforts et une innovation soutenus.

Abstract The metabolic syndrome is a cluster of conditions that increase an individual's risk of developing diseases. Being physically active throughout life is known to reduce the prevalence and onset of some aspects of the metabolic syndrome. Furthermore, previous studies have demonstrated that an individual's gut microbiome composition has a large influence on several aspects of the metabolic syndrome. However, the mechanism(s) by which physical activity may improve metabolic health are not well understood. We sought to determine if endurance exercise is sufficient to prevent or ameliorate the development of the metabolic syndrome and its associated diseases. We also analyzed the impact of physical activity under metabolic syndrome progression upon the gut microbiome composition. Utilizing whole‐body low‐density lipoprotein receptor (LDLR) knockout mice on a “Western Diet,” we show that long‐term exercise acts favorably upon glucose tolerance, adiposity, and liver lipids. Exercise increased mitochondrial abundance in skeletal muscle but did not reduce liver fibrosis, aortic lesion area, or plasma lipids. Lastly, we observed several changes in gut bacteria and their novel associations with metabolic parameters of clinical importance. Altogether, our results indicate that exercise can ameliorate some aspects of the metabolic syndrome progression and alter the gut microbiome composition.

The objective of this study was to examine if longitudinal trajectories of hair cortisol concentrations (HCC) measured at two or three yearly time points can identify 1-3 year old children at risk for altered hypothalamic-pituitary-adrenal (HPA)-axis function due to early life stress (ELS). HCC was measured (N = 575) in 265 children using a validated enzyme-linked immunosorbent assay. Hair was sampled in Clinic Visits (CV) centered at years 1, 2, and 3 (n = 45); 1 and 2 (n = 98); 1 and 3 (n = 27); 2 and 3 (n = 95). Log-transformed HCC values were partitioned using latent class mixed models (LCMM) to minimize the Bayesian Information Criterion. Multivariable linear mixed effects models for ln-HCC as a function of fixed effects for age in months and random effects for participants (to account for repeated measures) were generated to identify the factors associated with class membership. Children in Class 1 (n = 69; 9% Black) evidenced declining ln-HCC across early childhood, whereas Class 2 members (n = 196; 43% Black) showed mixed trajectories. LCMM with only Class 2 members revealed Class 2A (n = 17, 82% Black) with sustained high ln-HCC and Class 2B (n = 179, 40% Blacks) with mixed ln-HCC profiles. Another LCMM limited to only Class 2B members revealed Class 2B1 (n = 65, 57% Black) with declining ln-HCC values (at higher ranges than Class 1), and Class 2B2 (n = 113, 30% Black) with sustained high ln-HCC values. Class 1 may represent hair cortisol trajectories associated with adaptive HPA-axis profiles, whereas 2A, 2B1, and 2B2 may represent allostatic load with dysregulated profiles of HPA-axis function in response to varying exposures to ELS. Sequential longitudinal hair cortisol measurements revealed the allostatic load associated with ELS and the potential for developing maladaptive or dysregulated HPA-axis function in early childhood.

In recent years, there has been an increasing interest in space exploration, supported by the accelerated technological advancements in the field. This has led to a new potential environment that humans could be exposed to in the very near future, and therefore an increasing request to evaluate the impact this may have on our body, including health risks associated with this endeavor. A critical component in regulating the human pathophysiology is represented by the cardiovascular system, which may be heavily affected in these extreme environments of microgravity and radiation. This mini review aims to identify the impact of microgravity and radiation on the cardiovascular system. Being able to understand the effect that comes with deep space explorations, including that of microgravity and space radiation, may also allow us to get a deeper understanding of the heart and ultimately our own basic physiological processes. This information may unlock new factors to consider with space exploration whilst simultaneously increasing our knowledge of the cardiovascular system and potentially associated diseases.

Background Dyslipidemia is common in heart failure with preserved ejection fraction. Sacubitril/valsartan improves glycemic control and augments natriuretic peptide signaling, providing mechanisms by which sacubitril/valsartan may affect serum lipids. However, empiric data on these effects are lacking. Methods and Results We analyzed 4774 participants from PARAGON‐HF (Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor With Angiotensin‐Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) with available screening lipids. During follow‐up visits, we analyzed the treatment effect on lipid levels and assessed for interaction by baseline lipid levels. At the 16‐week visit, we adjusted these treatment effects for the change in several biomarkers (including hemoglobin A1c and urinary cyclic guanosine monophosphate/creatinine [a biomarker of natriuretic peptide activation]). The average age was 73±8 years, 52% were women, 43% had diabetes mellitus, and 64% were on statin therapy. Compared with valsartan, sacubitril/valsartan reduced triglycerides −5.0% (95% CI, −6.6% to −3.5%), increased high‐density lipoprotein cholesterol +2.6% (95% CI, +1.7% to +3.4%), and increased low‐density lipoprotein cholesterol +1.7% (95% CI, +0.4% to +3.0%). Sacubitril/valsartan reduced triglycerides most among those with elevated baseline levels (triglycerides≥200 mg/dL) (P‐interaction

BACKGROUND:. Immunotherapy treatment for coronavirus disease 2019 combined with antiviral therapy and supportive care remains under intense investigation. However, the capacity to distinguish patients who would benefit from immunosuppressive or immune stimulatory therapies remains insufficient. Here, we present a patient with severe coronavirus disease 2019 with a defective immune response, treated successfully with interleukin-7 on compassionate basis with resultant improved adaptive immune function. CASE SUMMARY:. A previously healthy 43-year-old male developed severe acute respiratory distress syndrome due to the severe acute respiratory syndrome coronavirus 2 virus with acute hypoxemic respiratory failure and persistent, profound lymphopenia. Functional analysis demonstrated depressed lymphocyte function and few antigen-specific T cells. Interleukin-7 administration resulted in reversal of lymphopenia and improved T-cell function. Respiratory function and clinical status rapidly improved, and he was discharged home. Whole exome sequencing identified a deleterious autosomal dominant mutation in TICAM1, associated with a dysfunctional type I interferon antiviral response with increased severity of coronavirus disease 2019 disease. CONCLUSIONS:. Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening severe coronavirus disease 2019 infections, particularly by applying a precision medicine approach in selecting patients expressing an immunosuppressive phenotype.

Given the significant health burden of childhood obesity, it is imperative that effective programs be better understood. When evaluating obesity prevention efforts, one must recognize the contextual factors which drive the disproportionate risk of obesity between populations. This systematic review sought to understand if programs aimed at obesity prevention and/or the promotion of healthy lifestyle behaviours for Indigenous children are effective.We conducted a search using Medline, EMBASE, PsychINFO, ERIC, CINAHL and iPORTAL databases from inception to August 13, 2019. We included experimental and quasi-experimental studies. The main outcomes of interest were change in anthropometrics, nutrition or physical activity. Our narrative synthesis included an assessment of study quality using the Effective Public Health Practice Project Quality assessment tool.A total of 34 studies met selection criteria. Most studies used a quasi-experimental design (n = 25) and were assessed as low to moderate quality (n = 32). Three studies showed a significant change in anthropometric measures, 14 studies demonstrated at least one significant nutrition-related behaviour or dietary-pattern change, and six studies demonstrated a significant impact on physical activity.This systematic review of programs to prevent obesity among Indigenous children finds a limited impact on anthropometric measurements. Future studies must prioritize Indigenous knowledge and ways of knowing to lead all phases of development, implementation, and evaluation of programs.

Abstract Cardiovascular diseases including coronary heart disease, stroke, and peripheral arterial disease were responsible for an estimated 18 million deaths in 2017. Despite advances in management over the past several decades, these patients continue to have substantial risk of subsequent cardiovascular events. We provide a narrative review of randomized clinical trials evaluating direct oral anticoagulants (DOACs) for the treatment of acute coronary syndromes, noncardioembolic ischemic stroke, embolic stroke of undetermined source, and peripheral arterial disease. In these conditions, considerations for use of single antiplatelet therapy, dual antiplatelet therapy, or low‐dose DOACs used together with antiplatelet therapy are presented.

Background: Guyana experiences health challenges related to both communicable and non-communicable diseases. Cardiovascular disease (CVD) is the most common non-communicable disease in Guyana. The main causes of the increased prevalence of non-communicable diseases are modifiable risk factors (e.g. obesity, hypertension, elevated cholesterol, unhealthy dietary patterns) and non-modifiable risk factors (e.g. age and genetics). Objective: The aim of this review is to understand CVD and risk factor data, in the context of ethnicity in Guyana. Methods: A review of the published literature as well as government and international health agency reports was conducted. All publications from 2002–2018 describing CVD and related risk factors in Guyana were screened and extracted. Findings: The population of Guyana is comprised of six ethnic groups, of which East Indian (39.8%) and African (29.3%) are the majority. CVD accounts for 526 deaths per 100,000 individuals per year. Among Indo-Guyanese and Afro-Guyanese, CVD is the primary cause of death affecting 32.6% and 22.7% of the populations, respectively. Within the Indo-Guyanese and Afro-Guyanese communities there is a high prevalence of hypertension and diabetes among individuals over the age of 50. There is a lack of available data describing ethnic disparities in CVD and related risk factors such as obesity, smoking, alcohol, physical activity and diet in Guyana. Conclusions: Important knowledge gaps remain in understanding the ethnic disparities of CVD and related risk factors in Guyana. Future research should focus on high risk populations and implement widespread screening and treatment strategies of common risk factors such as hypertension, diabetes, and elevated cholesterol to curb the epidemic of CVD in Guyana.

Background: Several elements that are either anesthesia-related (the type and span of sedation), medical procedure related (the sort of a medical procedure and the degree of the surgery), or patient-related (age, orientation, body weight, and their typical body core temperature) impact body core temperature. Strangely, not much information is available about patients' temperatures and their body mass index (BMI). The point of this study was to assess the effect of BMI on body core temperature in patients undergoing General versus Spinal anesthesia during the surgery. Duration of the surgery is also compared. Materials and Methods: An observational study was conducted in Chettinad hospital and research institute. Two sub-groups (General and spinal anesthesia), Body Mass Index and the duration of the surgery were evaluated. The actual hypothermia prevention guidelines were followed when treating patients. Temperature was measured in axilla after inducing the patient with anesthesia throughout the procedure. Each subgroup was divided into BMIs of less than and greater than 30 kg/m2 with mild and moderate hypothermia. Result: A sum of 100 patients were assessed. Fifty patients went through General anesthesia and fifty patients received spinal anesthesia for surgery. Temperature was decreased in all subgroups after the induction of anesthesia, but the decrease was more pronounced during spinal anesthesia, even in patients with BMI<30kg/m2 (less than 30). Regardless of the type of anesthesia, the type of surgery, or the BMI, throughout the course of the procedure, there was a noticeable drop of temperature. Conclusion: We conclude that, in General Aanesthesia, even the patients BMI >30 kg/m2 are less prone to hypothermia. In spinal anesthesia, even patients with BMI <30 kg/m2 are more prone to hypothermia. As the duration of surgery increases, irrespective to the type of anesthesia, surgery and BMI, the chances of hypothermia increases. [ABSTRACT FROM AUTHOR]

Abstract Aims Clinical trials of new heart failure (HF) therapies administer guideline‐directed medical therapy (GDMT) as background pharmacologic treatment (BPT). In the ANTHEM‐HF Pilot Study, addition of autonomic regulation therapy to GDMT significantly improved left ventricular function, New York Heart Association (NYHA) class, 6 min walk distance, and quality of life in patients with HF with reduced ejection fraction (HFrEF). A post hoc analysis was performed to compare BPT in ANTHEM‐HF with two other trials of novel HF therapies: the PARADIGM‐HF study of sacubitril–valsartan and the SHIFT study of ivadrabine. All three studies evaluated patients with HFrEF, and the recommendations for use of GDMT were similar. A left ventricular ejection fraction ≤40% was required for entry into ANTHEM‐HF and PARADIGM‐HF and ≤35% for SHIFT. NYHA 2 or 3 symptoms were required for entry into ANTHEM‐HF, and patients with predominantly NYHA 2 or 3 symptoms were enrolled in PARADIGM‐HF and SHIFT. Methods and results Data on BPT were obtained from peer‐reviewed publications and the public domain. Pearson's χ2 test was used to evaluate differences in proportions, and Student's unpaired t‐test was used to evaluate differences in mean values. The minimum period of stable GDMT required before randomization was longer in ANTHEM‐HF: 3 months vs. 1 month in PARADIGM‐HF and SHIFT, respectively. When compared with PARADIGM‐HF and SHIFT, more patients in ANTHEM‐HF received beta‐blockers (100% vs. 93% and 89%, P < 0.04 and P < 0.007) and mineralocorticoid receptor antagonists (75% vs. 55% and 61%, P < 0.002 and P < 0.03). More patients in PARADIGM‐HF received an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker than in ANTHEM‐HF or SHIFT (100% vs. 85%, P < 0.0001, and 100% vs. 91%, P < 0.001), which was related to PARADIGM's design. When beta‐blocker doses in ANTHEM‐HF and SHIFT were compared, significantly fewer patients in ANTHEM‐HF received doses ≥100% of target (10% vs. 23%, P < 0.02), and fewer patients tended to receive doses ≥50% of target (17% vs. 26%, P = 0.11). When ANTHEM‐HF and PARADIGM‐HF were compared, more patients in ANTHEM‐HF tended to receive doses ≥100% of target (10% vs. 7%, P = 0.36), and fewer patients tended to receive doses ≥50% of target (17% vs. 20%, P = 0.56). Conclusions Background treatment with GDMT in ANTHEM‐HF compared favourably with that in two other contemporary trials of new HF therapies. The minimum period of stable GDMT required before randomization was longer, and GDMT remained unchanged for the study's duration. These findings serve to further support the potential role of autonomic regulation therapy as an adjunct to GDMT for patients with HFrEF.

Background: Most of the data on neuroendocrine tumors (NETs) are from the Western literature. Indian studies regarding clinicopathological characteristics and treatment outcomes are lacking. Methods: This is a prospective observational study of all new patients with NETs (except small-cell lung cancer) registered at our tertiary care cancer institute from November 2014 to November 2016. A total of 97 new patients were registered, of which 20 were lost to follow-up before starting any planned treatment. Epidemiological and clinicopathological features of all these 97 patients were studied, and the remaining 77 patients were analyzed for treatment response and survival analysis. Results: The median age at diagnosis was 49 years (20–74 years) with male preponderance (M: F = 1.85:1). The most common primary site of origin was pancreas (34/97 = 35%), followed by unknown primary origin (19%), small intestine (9%), and pulmonary (6%). Of 97 patients, 91 (93.8%) presented with nonfunctional symptoms, 3 (3.1%) had purely functional symptoms, and 3 (3.1%) presented with both functional and nonfunctional symptoms. The most common presenting symptom was abdominal pain (59.7%), followed by jaundice (9.3%), whereas watery diarrhea (83.3%) and flushing (66.7%) were the most common functional symptoms. Sixty-six percent (64/97) of cases were metastatic at presentation. A strong correlation was noted between the primary site of origin and metastatic presentation (P = 0.016). Chemotherapy was the most common primary therapy (40.2%), followed by surgery (28.6%), watchful waiting (15.6%), and somatostatin analogs (11.7%). The median event-free survival was highest for patients undergoing surgery (10 months). Conclusions: The clinicopathological profile of NETs in the Indian population differs from Western countries. Majority of patients present with metastatic disease, thus representing a need for creating awareness among patients and medical fraternity and formulating Indian guidelines for optimized treatment.

BACKGROUND: Gait instability is one of the disabling clinical features of majority of patients suffering from Parkinson’s disease (PD). It is partially responsive to dopamine replacement therapy. Precise evaluation of distinct l-DOPA-sensitive and l-DOPA-resistant gait profiles might help in planning therapy of PD patients with gait disorder.METHOD: In this cross-sectional analytical study, we measured the gait parameters of 70 patients and 37 healthy participants using a 6.1-m long electronic walkway containing thousands of pressure sensors embedded in a carpet. The patients were evaluated in their OFF and ON phases of l-DOPA medication, and the data were compared with age- and gender-matched healthy controls.RESULTS: Except for the cadence, most gait parameters including velocity, stride length, and step length were deranged in PD patients. The mean velocity was significantly higher among healthy volunteers (99.19cm/s) compared to PD patients (73.90cm/s, P value 0.0001). However, the mean cadence was comparable between healthy and patient groups (103.29 vs. 103.39, P value 0.966). Certain temporal parameters (cadence, cycle time, and swing time) were nonresponsive to the dopaminergic therapy.CONCLUSION: On the basis of the findings, we propose that l-DOPA treatment improves most of the spatiotemporal gait parameters but cannot completely eliminate the risk of fall.

The extent to which variation in food-related metabolites are attributable to non-dietary factors remains unclear, which may explain inconsistent food-metabolite associations observed in population studies. This study examined the association between non-dietary factors and the serum concentrations of food-related biomarkers and quantified the amount of variability in metabolite concentrations explained by non-dietary factors. Pregnant women (n = 600) from two Canadian birth cohorts completed a validated semi-quantitative food frequency questionnaire, and serum metabolites were measured by multisegment injection-capillary electrophoresis-mass spectrometry. Hierarchical linear modelling and principal component partial R-square (PC-PR2) were used for data analysis. For proline betaine and DHA (mainly exogenous), citrus foods and fish/fish oil intake, respectively, explained the highest proportion of variability relative to non-dietary factors. The unique contribution of dietary factors was similar (15:0, 17:0, hippuric acid, TMAO) or lower (14:0, tryptophan betaine, 3-methylhistidine, carnitine) compared to non-dietary factors (i.e., ethnicity, maternal age, gestational age, pre-pregnancy BMI, physical activity, and smoking) for metabolites that can either be produced endogenously, biotransformed by gut microbiota, and/or derived from multiple food sources. The results emphasize the importance of adjusting for non-dietary factors in future analyses to improve the accuracy and precision of the measures of food intake and their associations with health and disease.