MO146RENAL FUNCTION MEDIATES THE EFFECT OF FLUID EXCESS ON LUNG CONGESTION IN PATIENTS WITH HFREF

Abstract Background and Aims Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Pulmonary congestion is considered the leading cause for hospital admissions and death among patients with HF. The aim of this study is to investigate if the effect of fluid status, as assessed by bioimpedance spectroscopy (BIS) on lung congestion is mediated by renal function, inflammation or cardiac function. Method This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction (LVEF) below 45% was required for inclusion (HFrEF). Mediation is the process through which an exposure causes disease. We hypothesized that some of the total effect of extracellular water (ECW) to intracellular water (ICW) (as assessed by bioimpedance) ratio on lung congestion (as assessed by lung ultrasonography) is mediated by C-reactive protein (CRP), left atrium volum index (LAVI) or estimated glomerular filtration rate (eGFR) – the mediators. Results Our study included 153 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 ml/min/1.73m2. The mean median value for CRP was 25.6 (IQR 9.0-56.4) mg/L. Figure 1 depicts the structural equation models with the calculated magnitude of the direct and indirect effects of ECW/ICW on the B-lines number in our population. In this model, the fluid status has both direct and indirect effects on lung congestion. Specifically, it has a direct effect on LAVI and eGFR, which in turn have a direct effect on the number of B-lines. Therefore, the indirect effect mediated by LAVI and eGFR accounts for a significant proportion of 27.6% of the total effect of ECW/ICW on lung congestion Although ECW/ICW has a direct effect on inflammation, this doesn’t have any effect on renal function or lung congestion. Conclusion We show that eGFR and LAVI partly mediate the effect of ECW/ICW on lung congestion in patients with HFrEF. While the deleterious effects of fluid overload on lung congestion have long been recognized, this study provides evidence for a relationship of significant magnitude linking fluid overload with decreased eGFR and increased LAVI, which in turn lead to elevations in the B-lines number. This work was supported by a grant of the Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by a grant of the “Grigore T. Popa” University of Medicine and Pharmacy, contract number 27505/2018.

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Direct and indirect effects of marijuana use on the risk of fatal 2-vehicle crash initiation

Injury Epidemiology ◽

10.1186/s40621-020-00276-9 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Stanford Chihuri ◽

Guohua Li

Keyword(s):

Direct Effect ◽

Interaction Effect ◽

Indirect Effect ◽

Indirect Effects ◽

Marijuana Use ◽

Total Effect ◽

Direct And Indirect Effects ◽

Positive Interaction ◽

Fatal Crash ◽

Vehicle Crash

Abstract Background Marijuana and alcohol each play a significant role in fatal crash initiation. We decomposed the total effect of marijuana use in the presence or absence of alcohol on fatal crash initiation into direct and indirect effects. Methods Pair-matched data on 5856 culpable drivers (initiators) and 5856 nonculpable drivers (noninitiators) involved in the same fatal 2-vehicle crashes recorded in the Fatality Analysis Reporting System between 2011 and 2016 were analyzed using the conditional logistic regression model and the unified mediation and interaction analysis framework. Results Crash initiators were more likely than noninitiators to test positive for marijuana (16.1% vs. 9.2%, P < 0.001), alcohol (28.6% vs. 9.7%, P < 0.001) and both substances (6.3% vs. 1.6%, P < .0001). Adjusted odds ratios of fatal 2-vehicle crash initiation revealed a positive interaction on the additive scale between marijuana and alcohol. Of the total effect of marijuana use on fatal 2-vehicle crash initiation, 68.8% was attributable to the direct effect (51.5% to controlled direct effect and 17.3% to reference interaction effect with alcohol) and 31.2% to the indirect effect (7.8% to mediated interaction effect and 23.4% to pure indirect effect through alcohol). Conclusion Our results indicate that the increased odds of fatal 2-vehicle crash initiation associated with marijuana use is due mainly to the direct effect.

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Using occupancy models to assess the direct and indirect impacts of agricultural expansion on species’ populations

Biodiversity and Conservation ◽

10.1007/s10531-020-02042-1 ◽

2020 ◽

Vol 29 (13) ◽

pp. 3669-3688

Author(s):

Asunción Semper-Pascual ◽

Julieta Decarre ◽

Matthias Baumann ◽

Micaela Camino ◽

Yamil Di Blanco ◽

...

Keyword(s):

Land Use ◽

Land Use Change ◽

Direct Effect ◽

Indirect Effects ◽

Agricultural Land ◽

Conservation Strategies ◽

Agricultural Expansion ◽

Direct And Indirect Effects ◽

Occupancy Models ◽

Occupancy Modelling

Abstract Land-use change is a global threat to biodiversity, but how land-use change affects species beyond the direct effect of habitat loss remains poorly understood. We developed an approach to isolate and map the direct and indirect effects of agricultural expansion on species of conservation concern, using the threatened giant anteater (Myrmecophaga tridactyla) in the Gran Chaco as an example. We reconstructed anteater occupancy change between 1985 and 2015 by fitting single-season occupancy models with contemporary camera-trap data and backcasting the models to 1985 and 2000 land-cover/use maps. Based on this, we compared the area of forest loss (direct effect of agricultural expansion) with the area where forests remained but occupancy still declined (indirect effect of agricultural expansion). Anteater occupancy decreased substantially since 1985, particularly after 2000 when agriculture expanded rapidly. Between 1985 and 2015, ~ 64,000 km2 of forest disappeared, yet occupancy declined across a larger area (~ 102,000 km2), extending far into seemingly untransformed habitat. This suggests that widespread sink habitat has emerged due to agricultural land-use change, and that species may lose their habitat through direct and indirect effects of agricultural expansion, highlighting the urgent need for broad-scale conservation planning in the Chaco. Appropriate management responses could proactively protect more habitat where populations are stable, and restore habitat or address causes of mortality in areas where declines occur. Our work also highlights how occupancy modelling combined with remote sensing can help to detect the direct and indirect effects of agricultural expansion, providing guidance for spatially targeting conservation strategies to halt extinctions.

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DIRECT AND INDIRECT EFFECTS OF SOCIAL SUPPORT ON PSYCHOLOGICAL WELL-BEING

Social Behavior and Personality An International Journal ◽

10.2224/sbp.2004.32.5.449 ◽

2004 ◽

Vol 32 (5) ◽

pp. 449-458 ◽

Cited By ~ 25

Author(s):

Tülin Gençöz ◽

Yeşim Özlale ◽

Randy Lennon

Keyword(s):

Social Support ◽

University Students ◽

Direct Effect ◽

Indirect Effects ◽

Well Being ◽

The Other ◽

Depression Symptoms ◽

Direct And Indirect Effects ◽

Psychological Well Being ◽

Undergraduate University Students

The aim of this study was to investigate the direct and indirect effects of social support on psychological well-being. Social support was evaluated under two different categories which were named as Aid-Related and Appreciation-Related Socia+l Support. The first category was more related to potential for receiving help from others when needed, and being cared for by others, while the latter category was more related to being recognized by others as an efficient source of help and reassurance of worth. Undergraduate university students (N =342) served as subjects, and results revealed that aid-related social support and psychological well-being (i.e., alleviated depression symptoms) association was partially mediated by experiencing fewer life stresses. On the other hand, appreciation-related social support had a direct effect on psychological well-being. Implications of these results are discussed.

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Factors influencing malaria infection in Rwanda 2010: a cross-sectional survey study using generalized structural equation modeling

10.21203/rs.2.18420/v1 ◽

2019 ◽

Author(s):

Muhammad Abu Bakar ◽

Rahma Fiaz ◽

Eustasius Musenge

Keyword(s):

Health Insurance ◽

Indirect Effects ◽

Malaria Infection ◽

Structural Equation ◽

Total Effect ◽

Survey Study ◽

Outcome Variable ◽

Direct And Indirect Effects ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract BackgroundMalaria is one of the primary public health concerns in the world and an important cause of morbidity and mortality in sub-Saharan Africa. Malaria morbidity is associated with poverty and vulnerability as it is not easy for the poor people to access preventive treatment and protective measures. In Rwanda, malaria prevention has become a major problem against the double-barreled burden of an overstretched health system and strained financial resources.MethodsThis work was a cross-sectional survey study design based on data from Rwanda collected in 2010 through the Malaria Indicator Survey as part of the Demographic and Health Survey. The primary outcome variable was an ordinal variable with three categories; no malaria, probable malaria, and confirmed malaria cases. The outcome variable was formulated by combining rapid malaria test and confirmatory blood smear laboratory test. Statistical analysis was done using survey ordinal logistic regression modelling adjusting for random effects for direct effects and generalised structural equation modelling (G-SEM) to obtain total (direct and indirect) effects of malaria morbidity. ResultsThe 11,865 participants had a mean age of 22 years, and two-thirds of the participants were females (67%). Household related variables (socio-economic status, health insurance, age in years) showed a significant total effect on malaria infection. Socioeconomic status had the greatest total effect which was a sum of the direct and indirect effects influenced indirectly by education, health insurance and the number of rooms for sleeping. Conclusion Poverty is still the core issue to the morbidity patterns driving the malaria epidemic in Rwanda. Access to health insurance has a high positive impact on decreasing disease as such a special focus on some regions can be an effective intervention strategy. A better understanding of the drivers of morbidity directly and/or indirectly can better target interventions to be more efficient in those affected areas.

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The Influence of Directive Strategies on Settlement Duration

International Negotiation ◽

10.1163/15718069-12341276 ◽

2014 ◽

Vol 19 (2) ◽

pp. 201-220 ◽

Cited By ~ 4

Author(s):

Scott Sigmund Gartner

Keyword(s):

Statistical Analysis ◽

Direct Effect ◽

Indirect Effect ◽

Indirect Effects ◽

Negative Selection ◽

Direct And Indirect Effects ◽

Influence Strategies ◽

Process Effects ◽

Durable Peace

Are Directive Strategies in international disputes the most effective mediation method for obtaining durable peace? A standard statistical analysis shows no effect of Directive Strategies on settlement durability. This result however, is misleading, failing to take selection and indirect effects into account. In this article, I identify when selection and process effects reinforce or oppose each other. Directive Strategies have opposing negative selection and positive process effects, which can distort inferences about their influence. Strategies’ direct and indirect effects are also examined. Directive Strategies are more likely to lead to Full Settlements – the most comprehensive form of agreement, which improve the settlement durability (an indirect effect). However, Directive Strategies are used in more intractable disputes that result in fragile settlements (a direct effect). A statistical analysis of international disputes that takes these conflicting dynamics into account demonstrates the efficacy of Directive Mediation Strategies in producing durable agreements.

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Studies on Direct and Indirect Effects of Different Plant Characters on Yield of Taro (Colocasia esculenta L. Schott) Var. Antiquorum

The Agriculturists ◽

10.3329/agric.v9i1-2.9483 ◽

1970 ◽

Vol 9 (1-2) ◽

pp. 89-98 ◽

Cited By ~ 2

Author(s):

KK Paul ◽

MA Bari

Keyword(s):

Plant Height ◽

Direct Effect ◽

Indirect Effects ◽

Residual Effect ◽

Colocasia Esculenta ◽

Leaf Length ◽

Direct And Indirect Effects ◽

Petiole Length ◽

Effect On Yield ◽

Peduncle Length

Thirty accessions of taro (Colocasia esculenta L) varieties were evaluated to estimate the direct and indirect effects of different plant characters, namely, plant height, petiole length, petiole breadth, leaf number, leaf length, leaf breadth, LAI, inflorescence length, peduncle length, corm length, corm breadth, cormel number, cormel length, cormel breadth, corm weight, cormel weight on yield per plant. Plant height, petiole length, corm breadth, cormel number, cormel length exhibited direct effect on yield per plant at the genotypic level. Cormel weight and cormel breadth had the highest direct effect on yield per plant at the phenotypic level. The residual effect was 0.3043 at the genotypic level and that at phenotypic level was 0.4874. Keywords: Colocasia esculenta; direct effect; indirect effect; yield of taro DOI: http://dx.doi.org/10.3329/agric.v9i1-2.9483 The Agriculturists 2011; 9(1&2): 89-98

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Insulin inhibits glucose production by a direct effect in diabetic depancreatized dogs during euglycemia

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00091.2002 ◽

2002 ◽

Vol 283 (5) ◽

pp. E1002-E1007 ◽

Cited By ~ 5

Author(s):

Neehar Gupta ◽

Harmanjit Sandhu ◽

Tracy Goh ◽

Keyur Shah ◽

Stephanie R. Wiesenthal ◽

...

Keyword(s):

Direct Effect ◽

Indirect Effects ◽

Insulin Infusion ◽

Glucose Production ◽

Direct And Indirect Effects ◽

Euglycemic Clamp ◽

Glycemic Level ◽

Hyperinsulinemic Euglycemic Clamp

In our previous studies in nondiabetic dogs and humans, insulin suppressed glucose production (GP) by both an indirect extrahepatic and a direct hepatic effect. However, insulin had no direct effect on GP in diabetic depancreatized dogs under conditions of moderate hyperglycemia. The present study was designed to investigate whether insulin can inhibit GP by a direct effect in this model under conditions of euglycemia. Depancreatized dogs were made euglycemic (∼6 mmol/l), rather than moderately hyperglycemic (∼10 mmol/l) as in our previous studies, by basal portal insulin infusion. After ∼100 min of euglycemia, a hyperinsulinemic euglycemic clamp was performed by giving an additional infusion of insulin either portally (POR) or peripherally at about one-half the rate (½ PER) to match the peripheral venous insulin concentrations. The greater hepatic insulin load in POR resulted in greater suppression of GP (from 16.5 ± 1.8 to 12.2 ± 1.6 μmol · kg−1 · min−1) than ½ PER (from 17.8 ± 1.9 to 15.6 ± 2.0 μmol · kg−1 · min−1, P < 0.001 vs. POR), consistent with insulin having a direct hepatic effect in suppressing GP. We conclude that the direct effect of insulin to inhibit GP is present in diabetic depancreatized dogs under conditions of acutely induced euglycemia. These results suggest that, in diabetes, the prevailing glycemic level is a determinant of the balance between insulin's direct and indirect effects on GP.

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Efeitos diretos e indiretos da migração de retorno no Brasil nos anos 2000 / Direct and indirect effects of the return migration in Brazil in the 2000’s

Caderno de Geografia ◽

10.5752/p.2318-2962.2016v26n47p672 ◽

2016 ◽

Vol 26 (47) ◽

pp. 672

Author(s):

Adriana De Miranda-Ribeiro ◽

Ricardo Alexandrino Garcia ◽

Carlos Lobo

Keyword(s):

Spatial Distribution ◽

Direct Effect ◽

Internal Migration ◽

Indirect Effect ◽

Indirect Effects ◽

Return Migration ◽

Direct And Indirect Effects ◽

Place Of Birth ◽

Brazilian Immigrants

No cenário das migrações no Brasil, o retorno ao local de nascimento tem crescido de importância nas últimas décadas. Este artigo tem como objetivo principal a mensuração dos efeitos direto e indireto da migração de retorno às unidades da Federação brasileira, no período 2000-2010. Foram utilizados os microdados do Censo Demográfico de 2010. A metodologia denomina de efeito direto os retornados ao local de nascimento. O efeito indireto é composto por parentes do retornado, desde que cumpram alguns requisitos. Os resultados apontam que a soma dos efeitos diretos e indiretos da migração de retorno correspondem a quase a metade dos imigrantes de última etapa do país.Abstract The return to the place of birth plays an important role in the Brazilian migration scenario. This paper measures the direct and indirect effects of return migration in Brazil between 2000 and 2010. Data come from the 2010 Brazilian Demographic Census. Those who return to the place of birth compose the direct effect. The indirect effect is composed by the returned migrant’s relatives, conditioned to some rules. Results show that the return migration effects in Brazil represent almost a half of the Brazilian immigrants in the period.Keywords: spatial distribution, internal migration, return migration.

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Grain Yield and Its Associations With Pre-harvest Sprouting in Wheat

Journal of Agricultural Science ◽

10.5539/jas.v11n4p142 ◽

2019 ◽

Vol 11 (4) ◽

pp. 142

Author(s):

Alexsander Rigatti ◽

Daniela Meira ◽

Tiago Olivoto ◽

Carine Meier ◽

Maicon Nardino ◽

...

Keyword(s):

Grain Yield ◽

Direct Effect ◽

Indirect Effects ◽

Agronomic Traits ◽

Block Design ◽

Direct And Indirect Effects ◽

Environmental Correlations ◽

Randomized Block Design ◽

Positive Direct ◽

Lower Tolerance

This study aimed to evaluate direct and indirect effects of agronomic traits importance on grain yield with focus in pre-harvest sprouting. Experiment was conducted in 2017 crop season, and conducted in a randomized block design, with three replications, with eight wheat cultivars (BRS Sábia, CD 105, CD 1104, CD 1440, Frontana, Jadeíte 11, Mirante and ORS Vintecinco). Grain yield and its components were evaluated, as well as other important traits such as pre-harvest sprouting. Data were submitted to variance analysis; and phenotypic, genotypic and environmental correlations were estimated to understand grain yield expression, direct and indirect effects of its components were evaluated through path analysis. Cultivar BRS Sabiá showed shorter cycle, cultivar CD 1104 was highlighted in number of spikes per area, hectoliter weight and grain yield. And cultivars Frontana, CD 1440 and ORS Vintecinco presented the best tolerances pre-harvest sprouting. Grain yield showed high and positive phenotypic and genotypic correlations with number of ears per square meter. Furthermore, high positive direct effect of pre-harvest sprouting on grain yield, revels lower tolerance for cultivars with high grain yield. Number of spikes per square meter showed intermediate and positive direct effect and pre-harvest sprouting had the greatest direct effect on grain yield.

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The Effect of Training and Work Engagement on the Performance of Educational Staff Mercu Buana University with Work Discipline as a Mediation Variable

European Journal of Business Management and Research ◽

10.24018/ejbmr.2021.6.3.842 ◽

2021 ◽

Vol 6 (3) ◽

pp. 55-60

Author(s):

Pratiwi Triasti ◽

Charles Bohlen Purba

Keyword(s):

Direct Effect ◽

Work Engagement ◽

Indirect Effects ◽

Quantitative Research ◽

Partial Least Square ◽

Least Square ◽

Direct Influence ◽

Direct And Indirect Effects ◽

Training Variable ◽

Educational Staff

This study aims to measure the effect of training and work engagement on the performance of Mercu Buana University educational staff with work discipline as a mediating variable. This research is a type of quantitative research. The analysis in this study used SEM where the data processing uses the Partial Least Square (PLS) version 3.2.7 program. The number of respondents who were sampled in this study were 80 educational staff at Mercu Buana University. The results of the analysis show that there are differences in results between direct and indirect effects, where the direct effect on the training variable shows a positive and significant effect on performance og educational staff, while the direct effect shows that training has no effect on performance if it is mediated by work discipline, besides the direct influence of the variable. work engagement on performance has no effect, while the indirect effect mediated by work discipline shows the results of work engagement have a positive and significant effect on the performance of Mercu Buana University educational staff.

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