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PURPOSE Food insecurity is prevalent among low-income immigrant and minority patients with cancer. To our knowledge, this randomized controlled trial is the first to prospectively examine the impact on cancer outcomes of food insecurity interventions, with the goal of informing evidence-based interventions to address food insecurity in patients with cancer. METHODS A three-arm randomized controlled trial was conducted among food-insecure (18-item US Department of Agriculture Household Food Security Survey Module score ≥ 3) patients with cancer (N = 117) at four New York City safety net cancer clinics. Arms included a hospital cancer clinic–based food pantry (arm 1), food voucher plus pantry (arm 2), and home grocery delivery plus pantry (arm 3). Treatment completion (primary outcome) and full appointment attendance were assessed at 6 months. Food security status, depression symptoms (Patient Health Questionnaire-9), and quality-of-life scores (Functional Assessment of Cancer Therapy-General) were assessed at baseline and at 6 months. RESULTS Voucher plus pantry had the highest treatment completion rate (94.6%), followed by grocery delivery plus pantry (82.5%) and pantry (77.5%; P = .046). Food security scores improved significantly in all arms, and Patient Health Questionnaire-9 and Functional Assessment of Cancer Therapy-General scores improved significantly in the pantry and delivery plus pantry arms. CONCLUSION Our findings in this preliminary study suggest that voucher plus pantry was the most effective intervention at improving treatment completion, and it met our a priori criterion for a promising intervention (≥ 90%). All interventions demonstrated the potential to improve food security among medically underserved, food-insecure patients with cancer at risk of impaired nutrition status, reduced quality of life, and poorer survival. All patients with cancer should be screened for food insecurity, with evidence-based food insecurity interventions made available.

Background: T-wave (TW) morphology indices based on time-warping (dw) have shown significant cardiovascular risk stratification value. However, errors in the location of TW boundaries may impact their prognostic power. Our aim was to test the hypothesis that a weighted time-warping function (WF) would reduce the sensitivity of dw to these errors and improve their clinical significance. Methods: The WFs were proportional to (i) the reference TW (T), and (ii) the absolute value of its derivative (D). The index dw was recalculated using these WFs, and its performance was compared to the unweighted control case (C) in four different scenarios: 1) robustness against simulated TW boundaries location errors; 2) ability to retain physiological information in an electrophysiological cardiac model; 3) ability to monitor blood potassium concentration changes ([K+]) in 29 hemodialysis (HD) patients; 4) and the sudden cardiac death (SCD) risk stratification value of the TW morphology restitution (TMR) index, derived from dw, in 651 chronic heart failure (CHF) patients. Results and Discussion: The WFs led to a reduced sensitivity (R) of dw to TW boundary location errors as compared to C (median R=0.19 and 0.22 and 0.35 for T, D and C, respectively). They also preserved the physiological relationship between dw and repolarization dispersion changes at ventricular level. No improvements in [K+] tracking were observed for the HD patients (Pearsons median correlation [r] between [K+] and dw was 0.86r0.90 for T, D and C). In CHF patients, the SCD risk stratification value of TMR was improved by applying T (hazard ratio, HAR, of 2.80), followed by D (HAR=2.32) and C (HAR=2.23). Conclusions and Significance: The proposed WFs, with T showing the best performance, increased the robustness of time-warping based markers against TW location errors preserving their physiological information content and boosting their SCD risk stratification value. Results from this work support the use of T when deriving dw for future clinical applications. This work was funded by Products&TechnologyS.L. (Castellbisbal,Barcelona,Spain),and by AGAUR,Generalitat de Catalunya (Spain) grant DI001-2018 and CIBER-BBN ref:“DEKOALE”.The work was also supported by project PID2019-104881RB-I00, and PID2019-105674 RB-I00 funded bySpanish Ministry of Science and Innovation (MICINN) and FEDER, by Gobierno de Aragón (Reference Group Biomedical Signal Interpretation and Computational Simulation (BSICoS)) T39-20 Rand projects LMP94-21,LMP14121cofunded by FEDER 2014-2020 “Building Europe from Aragón”, J.R. acknowledge the “María Zambrano” fellowship support from the European Union-Next Generation EU and the support from the Marie Sklodowska-Curie grant No786833. The computation was performed at the High Performance computing platform of the NANBIOSISICTS.

Context Circulating microRNAs (miRNAs) are emerging biomarkers of thyroid cancer. Objective This study sought to identify the profile of circulating miRNAs and its response to human recombinant TSH (rhTSH) in thyroid cancer patients with recurrent/persistent disease. Methods We obtained serum samples from 30 patients with differentiated thyroid cancer, 14 with recurrent/persistent disease and 16 with complete remission. We used next-generation sequencing to define the miRnomes along with a comprehensive quantitative PCR (qPCR) validation using 2 different platforms. We made a transversal study by comparing serum miRNA profiles of patients with or without recurrent/persistent disease and a longitudinal study looking at differences before and after rhTSH stimulation. Selected miRNAs were then studied in human thyroid cancer cell lines TPC-1, FTC-133, and OCUT-2 in response to TSH stimulation. Results We could not demonstrate any consistent differences in serum profiles of known miRNAs between patients with and without recurrent/persistent disease or before and after rhTSH stimulation. However, our sequencing data revealed 2 putative novel miRNAs that rise with rhTSH stimulation in the serums of patients with recurrent/persistent disease. We further confirmed by qPCR the upregulation of these putative miRNAs both in serums and in TSH-stimulated cells. We also show miRNAs that are good candidates for housekeeping genes in the serum of patients independently of the levels of TSH. Conclusions The present study does not provide evidence that known miRNAs can be used as circulating markers for recurrence of thyroid cancer. However, we suggest that novel miRNA molecules may be related to thyroid cancer pathogenesis.

The resting QT interval, an electrocardiographic (ECG) measure of ventricular myocardial repolarization, is a heritable risk marker of cardiovascular mortality, but the mechanisms remain incompletely understood. Previously reported candidate genes have provided insights into the regulatory mechanisms of the QT interval. However, there are still important knowledge gaps. We aimed to gain new insights by (i) providing new candidate genes, (ii) identifying pleiotropic associations with other cardiovascular traits, and (iii) scanning for sexually dimorphic genetic effects. We conducted a genome-wide association analysis for resting QT interval with ~9.8 million variants in 52 107 individuals of European ancestry without known cardiovascular disease from the UK Biobank. We identified 40 loci, 13 of which were novel, including 2 potential sex-specific loci, explaining ~11% of the trait variance. Candidate genes at novel loci were involved in myocardial structure and arrhythmogenic cardiomyopathy. Investigation of pleiotropic effects of QT interval variants using phenome-wide association analyses in 302 000 unrelated individuals from the UK Biobank and pairwise genome-wide comparisons with other ECG and cardiac imaging traits revealed genetic overlap with atrial electrical pathology. These findings provide novel insights into how abnormal myocardial repolarization and increased cardiovascular mortality may be linked.

Hispanics are the largest U.S. immigrant group and Mexican Americans are the largest U.S. Hispanic population. Hispanics, particularly Mexican Americans, are among the highest risk groups for obesity, placing them at increased risk for cardiovascular disease and certain types of cancer. Obesity lifestyle interventions incorporating Motivational Interviewing techniques and specific adaptations for the population of interest can have a significant impact on reducing health risks. This paper presents a community-engaged, culturally-sensitive nutrition and dietary counseling intervention conducted between 2016 and 2018 at the Consulate General of Mexico in New York City and reports preliminary findings regarding participant satisfaction and self-reported changes in eating and exercise habits. In addition, it describes the community and academic partners' roles and processes in program development, discusses strengths and challenges posed by a multi-sector partnership and describes adaptations made using the Behavioral Model for Vulnerable Populations to increase the program's sustainability and potential for scalability.

While psychotic experiences are core symptoms of mental health disorders like schizophrenia, they are also reported by 5–10% of the population. Both smoking behaviour and genetic risk for psychiatric disorders have been associated with psychotic experiences, but the interplay between these factors remains poorly understood. We tested whether smoking status, maternal smoking around birth, and number of packs smoked/year were associated with lifetime occurrence of three psychotic experiences phenotypes: delusions (n = 2067), hallucinations (n = 6689), and any psychotic experience (delusions or hallucinations; n = 7803) in 157,366 UK Biobank participants. We next calculated polygenic risk scores for schizophrenia (PRSSCZ), bipolar disorder (PRSBP), major depression (PRSDEP) and attention deficit hyperactivity disorder (PRSADHD) in 144,818 UK Biobank participants of European ancestry to assess whether association between smoking and psychotic experiences was attenuated after adjustment of diagnosis of psychiatric disorders and the PRSs. Finally, we investigated whether smoking exacerbates the effects of genetic predisposition on the psychotic phenotypes in gene-environment interaction models. Smoking status, maternal smoking, and number of packs smoked/year were associated with psychotic experiences (p −5). Except for packs smoked/year, effects were attenuated but remained significant after adjustment for diagnosis of psychiatric disorders and PRSs (p −3). Gene-environment interaction models showed the effects of PRSDEP and PRSADHD (but not PRSSCZ or PRSBP) on delusions (but not hallucinations) were significantly greater in current smokers compared to never smokers (p

Taxi and for-hire vehicle (FHV) drivers are a predominantly immigrant population facing a range of occupational stressors, including lack of workplace benefits and increasing financial strain from tumultuous industry changes and now COVID-19’s devastating impact. Bilingual research staff surveyed 422 New York City taxi/FHV drivers using a stratified sampling approach in driver-frequented locations to examine drivers’ health and financial planning behaviors for the first time. Drivers lacked health insurance at double the NYC rate (20% vs. 10%). Life insurance and retirement savings rates were lower than U.S. averages (20% vs. 60%, 25% vs. 58%, respectively). Vehicle ownership was a significant predictor of health insurance, life insurance, and retirement savings. Compared to South Asian drivers, Sub-Saharan African drivers were significantly less likely to have health insurance and North African, and Middle Eastern drivers were significantly less likely to have retirement savings. Although most drivers indicated the importance of insurance and benefits

Background: The P-wave duration (PWD) is an electrocardiographic measurement that represents cardiac conduction in the atria. Shortened or prolonged PWD is associated with atrial fibrillation (AF). We used exome-chip data to examine the associations between common and rare variants with PWD. Methods: Fifteen studies comprising 64 440 individuals (56 943 European, 5681 African, 1186 Hispanic, 630 Asian) and ≈230 000 variants were used to examine associations with maximum PWD across the 12-lead ECG. Meta-analyses summarized association results for common variants; gene-based burden and sequence kernel association tests examined low-frequency variant-PWD associations. Additionally, we examined the associations between PWD loci and AF using previous AF genome-wide association studies. Results: We identified 21 common and low-frequency genetic loci (14 novel) associated with maximum PWD, including several AF loci ( TTN , CAND2 , SCN10A , PITX2 , CAV1 , SYNPO2L , SOX5 , TBX5, MYH6, RPL3L ). The top variants at known sarcomere genes ( TTN, MYH6 ) were associated with longer PWD and increased AF risk. However, top variants at other loci (eg, PITX2 and SCN10A ) were associated with longer PWD but lower AF risk. Conclusions: Our results highlight multiple novel genetic loci associated with PWD, and underscore the shared mechanisms of atrial conduction and AF. Prolonged PWD may be an endophenotype for several different genetic mechanisms of AF.

The QT interval is an electrocardiographic measure representing the sum of ventricular depolarization (QRS duration) and repolarization (JT interval). Abnormalities of the QT interval are associated with potentially fatal ventricular arrhythmia. We conducted genome-wide multi-ancestry analyses in >250,000 individuals and identified 177, 156 and 121 independent loci for QT, JT and QRS, respectively, including a male-specific X-chromosome locus. Using gene-based rare-variant methods, we identified associations with Mendelian disease genes. Enrichments were observed in established pathways for QT and JT, with new genes indicated in insulin-receptor signalling and cardiac energy metabolism. In contrast, connective tissue components and processes for cell growth and extracellular matrix interactions were significantly enriched for QRS. We demonstrate polygenic risk score associations with atrial fibrillation, conduction disease and sudden cardiac death. Prioritization of druggable genes highlighted potential therapeutic targets for arrhythmia. Together, these results substantially advance our understanding of the genetic architecture of ventricular depolarization and repolarization.

Five finalists were selected for the 2021 British Cardiovascular Society (BCS) Young Investigator Award (YIA) from a competitive pool of young researchers. At the virtual BCS meeting in June, each finalist gave a 10-minute oral presentation followed by questions from a panel of independent judges. The prize was established by the Society 20 years ago to “recognise excellence among young researchers intending to pursue a career in cardiovascular clinical medicine or research”.1 Dr Blanca Tardajos Ayllon is a postdoctoral researcher at the University of Sheffield in the Department of Infection, Immunity and Cardiovascular Disease, funded by the British Heart Foundation. She obtained a BSc in Biochemistry at Universidad Autonoma de Madrid (Spain) with a year abroad at the University of York. Later, she completed an MSc in Molecular Medicine at the University of Sheffield where her work focused on the identification of mechanoreceptors that regulate endothelial apoptosis using zebrafish models. Dr Tardajos Ayllon then did her PhD in Cardiovascular Science with Professor Paul Evans. Her PhD, funded by the MRC-DiMeN Doctoral Training Partnership, focused on the role of the NF-κB transcription factor c-Rel in endothelial mechanobiology and atherosclerosis (figure 1). Figure 1 Dr Blanca Tardajos Ayllon. Atherosclerosis is a major cause of death that can lead to heart attack or stroke. It develops in the arteries at …

T-wave (TW) morphology has been extensively investigated to develop specific risk prediction markers like dw quantifying the level of warping needed to temporally align a TW respect to a reference one. However, TW boundaries delineation errors may jeopardise dw diagnostic power. Hence, we proposed two TW-based weighting function (WFs) obtained from (i) the reference TW (T), and (ii) the absolute value of its first-derivative (D). We, first, simulated TW boundaries delineation errors by shortening and widening two TWs with morphological variability. We, then, used the variation ratio (R) to compare dw derived applying the two WFs with that obtained in the control case (no weighting, C). Next, we compared the ability of dw, with and without WFs, in monitoring blood potassium concentration changes (¿[K+]) by means of the Pear-son's correlation (r) in 29 48-hour Holter recordings from hemodyalisis (HD) patients. The simulations showed that R values for the two studied TWs, respectively, were 0.17 and 0.19 for C, 0.05 and 0.08 for T and 0.07 and 0.10 for D. However, similar r median [interquartile range] values were found for C (0.90 [0.27]), T (0.90 [0.25]) and D (0.90 [0.29]) in HD scenario. Thus, using WFs to compute dw reduces the effects of TW boundaries delineation errors, but no improvements in ¿[K+] monitoring in HD patients were observed. WFs impact on dw risk prediction power remains to be studied

The electrocardiogram (ECG) is a commonly used clinical tool that reflects cardiac excitability and disease. Many parameters are can be measured and with the improvement of methodology can now be quantified in an automated fashion, with accuracy and at scale. Furthermore, these measurements can be heritable and thus genome wide association studies inform the underpinning biological mechanisms. In this review we describe how we have used the resources in UK Biobank to undertake such work. In particular, we focus on a substudy uniquely describing the response to exercise performed at scale with accompanying genetic information.

Introduction Electrocardiographic (ECG) markers of ventricular depolarisation and repolarisation are associated with an increased risk of arrhythmia and sudden cardiac death. Our prior work indicated lower serum calcium concentrations are associated with longer QT and JT intervals in the general population. Here, we investigate whether serum calcium is a causal risk factor for changes in ECG measures using Mendelian Randomisation (MR). Methods We performed a new genome-wide association study (GWAS) for serum calcium in >300,000 European-ancestry participants from UK-Biobank. Independent lead variants were extracted to be used as instrumental variables (figure 1). Two-sample MR analyses were performed to approximate the causal effect of serum calcium on QT, JT and QRS intervals using an inverse-weighted method in 76,226 UK-Biobank participants with ECG data, not contributing to the serum calcium GWAS. A secondary analysis wase performed using lead variants from a calcium GWAS corrected for serum albumin. Sensitivity analyses were performed using contemporary methods to test for the presence of horizontal pleiotropy. Results 205 independent lead calcium-associated variants were used as instrumental variables for Mendelian Randomisation. A decrease of 0.1 mmol/L genetically-determined serum calcium, was associated with longer QT (3.01ms (95% CI 2.03, 3.99)) and JT (2.89ms (1.91, 3.87)) intervals. A weak association was observed for QRS duration in secondary analyses only (0.39ms (0.08, 0.69)). Results were concordant in all sensitivity analyses. Conclusion These analyses support a causal effect of serum calcium levels on ventricular repolarisation, in a middle-aged population of European-ancestry where serum calcium concentrations are likely stable and chronic. Modulation of calcium concentration may therefore directly influence cardiovascular disease risk. Further research into the effects of serum calcium concentration on arrhythmogenesis is warranted and calcium variants could be considered for inclusion in genetic risk score models for predictive testing. Conflict of Interest None

Introduction Premature ventricular complexes (PVCs) are frequently detected on routine electrocardiogram monitoring during exercise. The prognostic implications of frequent or repetitive PVCs during exercise are well recognised in individuals with known heart disease, but conflicting results have been reported in individuals without known structural or ischaemic substrates. The aim of this study was to evaluate the relationship between PVC frequency during exercise and the risk of major adverse cardiovascular events (MACE) in a large cohort of ~56,000 individuals without known cardiovascular disease with long-term follow-up. Methods Approximately 77,000 individuals from the UK Biobank study participated in an exercise test using a stationary bicycle in conjunction with a 4-lead electrocardiograph device. We excluded individuals with a known cardiovascular disease or a corrupt/incomplete ECG registration. The number of PVCs in the ECG registration were counted for the remaining individuals (N=56,176) using an in-house developed deep learning algorithm. All registrations with a PVC frequency of ≧5% were reviewed manually and corrected if needed. The study endpoint was MACE, defined as either hospitalization or death due to myocardial infarction, heart failure, or ventricular arrhythmia. The association with MACE was evaluated for a range of PVC counts (up to 30 PVCs during exercise) using uni- and multivariate Cox regression analysis. In the multivariate model we adjusted for established cardiovascular risk factors, including age, sex, body mass index, smoking, diabetes, and heart rate recovery. Results The mean age of all individuals was 56,7 (± 8.2) years and men and women were relatively even numbered (47% men). The median follow-up was 10 years during which N=1,871 (3.3%) individuals reached the study endpoint. The prevalence of PVCs observed during the stress test ranged from N=16,330 (29%) individuals having ≧1 PVC, to N=1758 (x%) and N=856 (1.5%) for >10% and ≧25% PVCs, respectively. Interestingly, having at least 1 PVC was already significantly associated with adverse outcome: hazard ratio (HR) [95% CI]: 1.6 [1.4 – 1.7], p Conclusion Historically, occasional occurrence of PVCs during exercise has been considered benign. However, the results of this study may suggest that also low PVC frequencies may carry relevant prognostic information for cardiovascular disease independent of other cardiovascular risk factors. The mechanisms remain to be investigated, but may include subclinical changes in myocardial functioning. Conflict of Interest None

OBJECTIVES: To examine nutrition benefit under-enrollment in Latinx American immigrant families. METHODS: We administered a survey to 100 adults attending a NY Latinx American community serving organization. We used a logistic regression approach to analyze misinformation impact on enrollment, and examined non-enrollment explanations, among participants in whose families a child or pregnant or breastfeeding woman appeared SNAP- or WIC-eligible. RESULTS: Among households (N=51) with ≥1 SNAP-eligible child, 49% had no child enrolled. Reasons included repercussion fears (e.g. payback obligation, military conscription, college aid ineligibility, child removal, non-citizen family member penalties), and logistical barriers. In multivariable regression models, having heard the rumor that SNAP/WIC participation makes unauthorized status family members vulnerable to being reported to the government was associated with an 85% lower enrollment rate (OR 0.15, CI 0.03, 0.94). CONCLUSIONS: Misinformation impedes nutrition benefit participation. A multi-level intervention is necessary to inform potential applicants and providers regarding eligibility criteria and erroneous rumors, along with an informed discussion of the risks versus benefits of using resources, especially as public charge criteria change.

Cognitive interviewing was used to refine nutrition and exercise health education materials for use in the New York City taxi driver community. Cognitive interviews were conducted with taxi drivers at garages and community centers across New York City. Interviews were conducted in five rounds with approximately 10 interviews conducted in each round. Modifications were made to the education materials between rounds based on driver feedback. Interviews were transcribed, coded to identify areas needing improvement, and then used to modify materials. Areas that needed adaptation included colloquialisms, literacy level, complex jargon/terminology, vague/confusing phrasing, driver-specific and ethnic-specific preferences, visual aids, and mathematical calculations. These were organized into four key themes: linguistic responsiveness, occupational and cultural adaptation, visuals, and calculations. Cognitive interviewing is a useful method for refining health education materials in the diverse driver population. Cognitive interviewing revealed a need to reduce literacy level, avoid complex terminology, make further occupational and cultural adaptations, use clear visual aids, and avoid the use of complex calculations. Cognitive interviewing is an effective method for refining health education materials for immigrant and low literacy populations.

Atrial fibrillation (AF) and ventricular arrhythmia (Arr) are among the most common and fatal cardiac arrhythmias in the world. Electrocardiogram (ECG) data, collected as part of the UK Biobank, represents an opportunity for analysis and classification of these two diseases in the UK. The main objective of our study is to investigate a two-stage model for the classification of individuals with AF and Arr in the UK Biobank dataset. The current literature addresses heart arrhythmia classification very extensively. However, the data used by most researchers lack enough instances of these common diseases. Moreover, by proposing the two-stage model and separation of normal and abnormal cases, we have improved the performance of the classifiers in detection of each specific disease. Our approach consists of two stages of classification. In the first stage, features of the ECG input are classified into two main classes: normal and abnormal. At the second stage, the features of the ECG are further categorised as abnormal and further classified into two diseases of AF and Arr. A diverse set of ECG features such as the QRS duration, PR interval and RR interval, as well as covariates such as sex, BMI, age and other factors, are used in the modelling process. For both stages, we use the XGBoost Classifier algorithm. The healthy population present in the data, has been undersampled to tackle the class imbalance present in the data. This technique has been applied and evaluated using an ECG dataset from the UKBioBank ECG taken at rest repository. The main results of our paper are as follows: The classification performance for the proposed approach has been measured using F1 score, Sensitivity (Recall) and Specificity (Precision). The results of the proposed system are 87.22%, 88.55% and 85.95%, for average F1 Score, average sensitivity and average specificity, respectively. Contribution and significance: The performance level indicates that automatic detection of AF and Arr in participants present in the UK Biobank is more precise and efficient if done in a two-stage manner. Automatic detection and classification of AF and Arr individuals this way would mean early diagnosis and prevention of more serious consequences later in their lives.

Fifty-six percent of high-needs NYC cancer patients are food insecure, at times choosing between medical treatment and food. We describe FOOD (Food to Overcome Outcome Disparities), an innovative intervention, which has established eleven medically tailored food pantries in NYC cancer centers and distributed the equivalent of 307,080 meals since 2011.

Purpose To assess the prevalence of socioeconomic needs and associations between housing characteristics and food insecurity among low-income cancer patients, among whom housing and food insecurity are particularly prevalent. Methods Low-income cancer patients in active treatment (N = 1618) were enrolled in a comprehensive patient navigation program. Food insecurity was assessed using the 18-item US Department of Agriculture US Household Food Security Survey Module. Participants self-reported their need for assistance with housing issues/type of assistance needed, perception of overcrowding, satisfaction with living situation, and household density via a cross-sectional survey. Descriptive analyses, cross-tabulations and tests of proportions, and binary logistic regression were used in data analyses. Results Seventy percent of patients were food insecure. Housing characteristics associated with food insecurity were homelessness or living in sheltered/supportive housing (83.3% food insecure), renting (71.9%), and homeownership (58.1%; p

BackgroundReduced heart rate (HR) increase (HRI), recovery (HRR), and higher resting HR are associated with cardiovascular (CV) disease, but causal inferences have not been deduced. We investigated causal effects of HRI, HRR, and resting HR on CV risk, all-cause mortality (ACM), atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke (IS) using Mendelian Randomization.Methods11 variants for HRI, 11 for HRR, and two sets of 46 and 414 variants for resting HR were obtained from four genome-wide association studies (GWASs) on UK Biobank. We performed a lookup on GWASs for CV risk and ACM in UK Biobank (N = 375,367, 5.4% cases and N = 393,165, 4.4% cases, respectively). For CAD, AF, and IS, we used publicly available summary statistics. We used a random-effects inverse-variance weighted (IVW) method and sensitivity analyses to estimate causality.ResultsIVW showed a nominally significant effect of HRI on CV events (odds ratio [OR] = 1.0012, P = 4.11 × 10–2) and on CAD and AF. Regarding HRR, IVW was not significant for any outcome. The IVW method indicated statistically significant associations of resting HR with AF (OR = 0.9825, P = 9.8 × 10–6), supported by all sensitivity analyses, and a nominally significant association with IS (OR = 0.9926, P = 9.82 × 10–3).ConclusionOur findings suggest no strong evidence of an association between HRI and HRR and any outcome and confirm prior work reporting a highly significant effect of resting HR on AF. Future research is required to explore HRI and HRR associations further using more powerful predictors, when available.

Using a testimonio methodology, this study provides insight on how language ideologies, family, and education in the Texas Borderlands impacted two Latina teachers’ view and understanding of their identity. Through our personal experiences as PK-16 students, classroom teachers, and doctoral students, we were able to understand the colonization of our language and the subsequent endangerment of our bilingualism, which upon reflecting, had an impact on how we see ourselves as individuals, bilinguals, teachers, and Latinas. Our experiences with our bilingualism affected the way in which we perceive ourselves and our community. The reflection and analysis of our experiences allowed us to adjust our mindset towards a culturally sustaining lens, to improve our instructional practices, and to accept ourselves for who we are and where we were raised. Findings reveal how others’ ideologies about language and education can have a lasting consequence on us as well as how we go about changing our mindset to one of acceptance and pride.

Objective The aim of this study is to compare the performance of two electrocardiogram (ECG) lead-space reduction (LSR) techniques in generating a transformed ECG lead from which T-wave morphology markers can be reliably derived to non-invasively monitor blood potassium concentration ( [ K + ] ) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). These LSR techniques are: (1) principal component analysis (PCA), learned on the T wave, and (2) periodic component analysis ( π CA), either learned on the whole QRST complex ( π C B ) or on the T wave ( π C T ). We hypothesized π CA is less sensitive to non-periodic disturbances, like noise and body position changes (BPC), than PCA, thus leading to more reliable T wave morphology markers. Methods We compared the ability of T wave morphology markers obtained from PCA, π C B and π C T in tracking [ K + ] in an ESRD-HD dataset, including 29 patients, during and after HD (evaluated by correlation and residual fitting error analysis). We also studied their robustness to BPC using an annotated database, including 20 healthy individuals, as well as to different levels of noise using a simulation set-up (assessed by means of Mann–Whitney U test and relative error, respectively). Results The performance of both π C B and π C T -based markers in following [ K + ] -variations during HD was comparable, and superior to that from PCA-based markers. Moreover, π C T -based markers showed superior robustness against BPC and noise. Conclusion Both π C B and π C T outperform PCA in terms of monitoring [ K + ] in ESRD-HD patients, as well as of robustness against BPC and low SNR, with π C T showing the highest stability for continuous post-HD monitoring. Significance The usage of π CA (i) increases the accuracy in monitoring dynamic [ K + ] variations in ESRD-HD patients and (ii) reduces the sensitivity to BPC and noise in deriving T wave morphology markers.

We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ($$d_{w}$$ d w ) and amplitude ($$d_a$$ d a ), as well as their non-linear components ($${d_w^{{\mathrm{NL}}}}$$ d w NL and $${d_a^{\mathrm{NL}}}$$ d a NL ), and the heart rate corrected counterpart ($$d_{w,c}$$ d w , c ), to monitor potassium concentration ($$[K^{+}]$$ [ K + ] ) changes ($$\Delta [K^+]$$ Δ [ K + ] ) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed $$[K^{+}]$$ [ K + ] markers, such as T-wave width ($$T_w$$ T w ) and T-wave slope-to-amplitude ratio ($$T_{S/A}$$ T S / A ), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of $$d_w$$ d w , $$d_a$$ d a , $${d_w^{\mathrm{NL}}}$$ d w NL , $${d_a^{\mathrm{NL}}}$$ d a NL and $$d_{w,c}$$ d w , c were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs $$T_w$$ T w and $$T_{S/A}$$ T S / A were also extracted. Similarly, $$\Delta [K^+]$$ Δ [ K + ] was calculated as the difference between the $$[K^{+}]$$ [ K + ] values at each hour and the $$[K^{+}]$$ [ K + ] reference level at the end of the HD session. We found that $$d_{w}$$ d w and $$d_{w,c}$$ d w , c showed higher correlation coefficients with $$\Delta [K^+]$$ Δ [ K + ] than $$T_{S/A}$$ T S / A —Spearman’s ($$\rho$$ ρ ) and Pearson’s (r)—and $$T_w$$ T w —Spearman’s ($$\rho$$ ρ )—in both SL and PCA approaches being the intra-patient median $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.87$$ r ≥ 0.87 in SL and $$\rho \ge 0.82$$ ρ ≥ 0.82 and $$r \ge 0.89$$ r ≥ 0.89 in PCA respectively. Our findings would point at $$d_{w}$$ d w and $$d_{w,c}$$ d w , c as the most suitable surrogate of $$\Delta [K^+]$$ Δ [ K + ] , suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote $$[K^{+}]$$ [ K + ] monitoring of ESRD-HD patients and flagging risk of $$[K^{+}]$$ [ K + ] -related cardiovascular events.

Supplemental Digital Content is available in the text., Background: ECG markers of ventricular depolarization and repolarization are associated with an increased risk of arrhythmia and sudden cardiac death. Our prior work indicated lower serum calcium concentrations are associated with longer QT and JT intervals in the general population. Here, we investigate whether serum calcium is a causal risk factor for changes in ECG measures using Mendelian randomization (MR). Methods: Independent lead variants from a newly performed genome-wide association study for serum calcium in >300 000 European-ancestry participants from UK Biobank were used as instrumental variables. Two-sample MR analyses were performed to approximate the causal effect of serum calcium on QT, JT, and QRS intervals using an inverse-weighted method in 76 226 participants not contributing to the serum calcium genome-wide association study. Sensitivity analyses including MR-Egger, weighted-median estimator, and MR pleiotropy residual sum and outlier were performed to test for the presence of horizontal pleiotropy. Results: Two hundred five independent lead calcium-associated variants were used as instrumental variables for MR. A decrease of 0.1 mmol/L serum calcium was associated with longer QT (3.01 ms [95% CI, 2.03 to 3.99]) and JT (2.89 ms [1.91 to 3.87]) intervals. A weak association was observed for QRS duration (secondary analyses only). Results were concordant in all sensitivity analyses. Conclusions: These analyses support a causal effect of serum calcium levels on ventricular repolarization, in a middle-aged population of European-ancestry where serum calcium concentrations are likely stable and chronic. Modulation of calcium concentration may, therefore, directly influence cardiovascular disease risk.

Objective: Chronic kidney disease affects more than 10% of the world population. Changes in serum ion concentrations increase the risk for ventricular arrhythmias and sudden cardiac death, particularly in end-stage renal disease (ESRD) patients. We characterized how T wave amplitude, duration and morphology descriptors change with variations in serum levels of potassium and calcium and in heart rate, both in ESRD patients and in simulated ventricular fibers. Methods: Electrocardiogram (ECG) recordings from twenty ESRD patients undergoing hemodialysis (HD) and pseudo-ECGs (pECGs) calculated from twenty-two simulated ventricular fibers at varying transmural heterogeneity levels were processed to quantify T wave width ( $T_{\mathrm{w}}$ ), T wave slope-to-amplitude ratio ( $T_{\text{S/A}}$ ) and four indices of T wave morphological variability based on time warping ( $d_{\mathrm{w}}$ , $d^{\text{NL}}_{\mathrm{w}}$ , $d_{\mathrm{a}}$ and $d^{\text{NL}}_{\mathrm{a}}$ ). Serum potassium and calcium levels and heart rate were measured along HD. Results: $d^{\text{NL}}_{\mathrm{a}}$ was the marker most strongly correlated with serum potassium, $d_{\mathrm{w}}$ with calcium and $d_{\mathrm{a}}$ with heart rate, after correction for covariates. Median values of partial correlation coefficients were 0.75, $-$ 0.74 and $-$ 0.90, respectively. For all analyzed T wave descriptors, high inter-patient variability was observed in the pattern of such relationships. This variability, accentuated during the first HD time points, was reproduced in the simulations and shown to be influenced by differences in transmural heterogeneity. Conclusion: Changes in serum potassium and calcium levels and in heart rate strongly affect T wave descriptors, particularly those quantifying morphological variability. Significance: ECG markers have the potential to be used for monitoring serum ion concentrations in ESRD patients.

Genome-wide association studies (GWAS) have discovered hundreds of genetic loci for resting heart rate (RHR). However, the impact of intra-individual variation in RHR on GWAS results is unclear. We evaluated this impact by analyzing two RHR recordings from N ~61,000 subjects from UK Biobank. In addition, we modelled variations in RHR as independent white zero-mean Gaussian noise with a standard deviation of 0.5x, 1x, and 2x the standard deviation of the difference between the original RHR values (4,8, and 16 bpm, respectively). The two original RHR recordings were highly correlated (ρ =0.77), but results from the genetic analyses were s lightly different: the number of genome-wide significant (p < 5x10−8) variants at the locus with the strongest reported association (MYH6): n=39 vs. n=34; the p-value of the corresponding lead-variant, 3.6x10−24 vs. 2.1x10−19; and the estimated heritability 20.0% vs. 16.7%. Simulated data showed an inverse relationship between RHR variation and genetic association strength and heritability. Results formally demonstrate the impact of intra-individual RHR variability on the discovery of genetic variants in single-measurement studies.

Coronary artery disease (CAD) is the main contributor to cardiovascular mortality in developed countries, making accurate diagnosis of utmost importance. We developed risk scores to assess CAD risk in a population without known cardiovascular disease by combining ECG and a genetic risk score (GRS) for CAD. We analysed data in 52,260 individuals in the UK Biobank study. ECG indices included heart rate, PR, QRS, QT and T-peak-to-T-end intervals, while we built the GRS from publicly available genome-wide association results for CAD that were derived in an independent population. In a training set (N = 39,195), the indices with the strongest CAD prognostic impact were the PR and QT intervals, and the GRS. When combined together into a Multivariate model, both the ECG markers and the GRS were independently associated with CAD. In an independent test set (N = 13,065), we then built three risk scores based on (1) ECG markers, (2) genetic data, and (3) a combination of ECG and genetic data, respectively. The hazard ratio (95% confidence interval) for CAD comparing high versus low-risk individuals was 6.5 (5.1 – 8.3),8.4 (6.4 – 10.8) and 8.4 (6.5 – 10.8) for the three risk scores, respectively. In conclusion, the inclusion of genetic markers into risk scores with ECG markers independently contributes to CAD risk prediction in a large population of individuals without known cardiovascular disease.