The cardiovascular benefits of GLP1-RA are directly related to their positive effect on glycaemic control: A meta-regression analysis

Review question / Objective: P (patient population) = Type 2 diabetes patients with high CV risk or established atherosclerotic cardiovascular disease; I (intervention) = Received drugs: GLP1-RA; C (control group) = Compared to a control group that received a placebo; O (outcome) = Outcomes of interest included primary CV outcomes (MACE, CV death, MI, and Stroke). Condition being studied: To explore whether the heterogeneity associated with the primary outcomes benefits can be attributed to the metabolic improvements associated with GLP1-RA. The plan is to use HBA1c, weight, and SBP reduction as moderators attempting to explain any variance between the true and observed effect size.

90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up. Setting The study included national inpatient hospitalization and outpatient visits. Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). Interventions This study investigated transphenoidal or subfrontal approach for tumor resection. Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001). Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.

Demographic and Socioeconomic Factors Influencing Uptake of Striga Weed Control Technologies in Kenya

Over the years, new technologies have been tested and introduced to control Striga in maize producing areas but adoption has remained low. The study done in 2013, determined the demographic and socioeconomic factors that influenced the adoption of Striga control technologies in Kisumu West, Bumula and Teso South sub counties of Western Kenya. Through Multi stage sampling technique, 40 households were selected per sub county for questionnaire administration; to gather information on demographic profiles of the sample population, type of fertilizer and seed variety used, income of the household, source of credit facilities and challenges faced in weed control. Chi square test at P<0.05 and logistic regression analysis, using R software was used to determine the relationship between demographic and socioeconomic factors and uptake of Striga control technologies. Farmers cited high cost, poor availability of improved varieties and lack of adequate knowledge as reasons for non-adoption of the Striga control strategies. Farmer’s age, education, land size and hiring of labour were found to significantly influence the adoption of the Striga control technologies. The low levels of adoption of modern technology indicate that they were not meeting farmers’ expectations, thus, researchers should put into consideration farmers’ education, age, land size and ability to high labour in their planning for an informed technology adoption. In addition, alternative options should be extended to farmers who are not able to use expensive technologies.

Relationship Between Type 2 Diabetes Control and Cognition in Older Adults: Findings From NHANES

Cognitive health has emerged as an important public health concern for America’s aging population. Type 2 Diabetes (T2D) may be associated with an exacerbated decline in cognitive performance. This study aimed to examine the relationship between T2D control and cognitive performance in older adults (≥60 years) using the 2013-2014 National Health and Nutrition Examination Surveys. Participants who completed the following cognitive assessments were included: 1) Consortium to Establish a Registry for Alzheimer’s Disease Word List (CERAD-WL), 2) Animal Fluency (AF), 3) Digit Symbol Substitution Test (DSST) (higher scores associated with better cognition). Participants were stratified by four groups: no T2D (N=557), treated/controlled T2D (controlled; N=41), treated/uncontrolled T2D (uncontrolled; N=120), untreated T2D (N=86), based on self-reported T2D treatment, fasting plasma glucose, and hemoglobin A1c. Logistic regression was used to examine the relationship between T2D control and cognition. We observed that those with uncontrolled and untreated T2D each had ~15% lower DSST than those with no T2D (P&lt;0.01). CERAD-WL and AF were similar across all groups. Unadjusted analyses showed that individuals with 1) lower CERAD-WL were more likely to have controlled and untreated T2D, 2) lower AF were more likely to have controlled and uncontrolled T2D, and 3) lower DSST were more likely to have uncontrolled and untreated T2D (P’s&lt;0.05). After adjusting for significant demographics and cardiovascular risk factors, only having uncontrolled T2D was associated with lower DSST (β=-3.164, P=0.04). These data indicate the need for longitudinal studies to further explore dynamic relationship and causal pathway between T2D control and cognitive impairment.

Risk perception and communal coping in families affected by type 2 diabetes

Despite a recent decline, rates of type 2 diabetes remain high among older adults. Preventing and delaying the onset of the condition with lifestyle changes is key to reducing disease burden in the population. Type 2 diabetes is a complex disease, likely a result from the joint effect of genetic, socio-environmental and lifestyle risk factors that are clustered in families. As such, the prevention of type 2 diabetes is a communal coping process, where individuals communicate about risk and establish routines to facilitate one another’s health habits and compliance with therapeutics. This poster investigates how such a process is affected by one’s perception of risk based on his/her knowledge about family health history (FHH). We collected family network data from families of different racial backgrounds in the greater Cincinnati area (28 white and 17 black/ African American households; 127 participants). The analysis focuses on how the density of diabetes diagnosis in one’s FHH affects communication about shared risk for type 2 diabetes and encouragement to maintain or adopt a healthy lifestyle. Results suggest a higher concentration of diabetes diagnosis in one’s FHH is associated with a higher number of risk communication ties in all families. With regards to encouragement ties, high rates of diabetes diagnosis in FHH are associated with an increased number of encouragement ties only in families of black/African heritage. The findings highlight the need and promise of using FHH to motivate co-encouragement to maintain/adopt a healthier lifestyle in families of black/African heritage.

Juvenile Justice Realignment: A policy analysis of California Senate Bill 823

New legislation (Senate Bill 823) in the State of California, to realign the serious felony juvenile offender population from state facilities to county facilities, will go into effect July 1, 2021 (SB823, 2020). County probation departments will now be faced with determining how to provide adequate programming to a new population type of serious offender that includes adults in the age range of 18 to 25 years old. This places pressure on smaller county agencies to either find a cost-effective solution to modify their current facilities and programs or send this population to other county agencies. This research project analyzes the impact of SB823 on a sample of smaller counties.

Population dynamics and pathogens of the invasive yellow crazy ant (Anoplolepis gracilipes) in Arnhem Land, Australia

<p>Though many populations of introduced species have been observed to collapse, the reasons behind these declines are seldom investigated. Anoplolepis gracilipes is considered among one of the top six most economically and ecologically damaging invasive ant species in the world. However, introduced populations of A. gracilipes have been observed to decline. My overall aims in this thesis were to document A. gracilipes population declines, to investigate the possibility that pathogens were playing a role in the observed population declines, and to identify putative pathogens infecting A. gracilipes as potential candidates for biocontrol agents. I documented the observed A. gracilipes population declines that were the driving force for this project. I detailed large-scale reductions in the spatial extent of four populations with before and after survey data. I also presented data on three populations that were recorded as present, but disappeared before they could be spatially delimited. I speculated on the possible reasons for these declines and explained why I do not think other explanations are likely. I then investigated the hypothesis that a pathogen or parasite is affecting A. gracilipes queens in declining Arnhem Land populations. I did this in three ways: 1) based on preliminary findings, I looked at the effect of an artificial fungal infection on A. gracilipes reproduction. I compared reproductive output between control colonies and those treated with either a fungal entomopathogen (Metarhizium anisopliae) or fungicidal antibiotics. There was no correlation between either treatment and the number of eggs, larvae, pupae or males a colony produced after 70 days. I found queen number had no effect on colony reproductive output, suggesting that queens are able to adjust their egg-laying rate in the presence of other queens. I found no evidence that M. anisopliae affected reproductive output at the tested concentrations; 2) I explored the hypothesis that a pathogen that kills or affects the reproductive output of A. gracilipes queens is the mechanism or reason behind the population declines. I measured queen number per nest, egg-laying rate, fecundity and fat content and compared them between sites in different stages of decline or expansion (population types, consisting of low, medium and high-density populations). I discovered that 23% of queens had melanized nodules, a cellular immune response in insects, in their ovaries or fat bodies. The presence of nodules was correlated with a 22% decrease in the number of oocytes per ovary; however, nodule presence was not associated with population type, suggesting that though there are clearly pathogens or parasites capable of penetrating the cuticle of A. gracilipes, they are unlikely to be responsible for the observed population declines; 3) I compared microbial communities (bacteria and viruses) between queens from different population types. I found viral sequences that match to the Dicistroviridae family of viruses in low and medium-density populations. I found no differences in bacterial community structure between population types. The presence of sequences similar to the entomopathogens Rhabdochlamydia and Serratia marcescens, as well as the reproductive parasite Cardinium in A. gracilipes, deserves further investigation. Though introduced species’ populations have been observed to decline, this is one of the first studies to quantitatively examine, document, and investigate a mechanism behind such a decline. Understanding the mechanisms by which an invader declines may have important implications for invasive ant management worldwide.</p>

Population dynamics and pathogens of the invasive yellow crazy ant (Anoplolepis gracilipes) in Arnhem Land, Australia

<p>Though many populations of introduced species have been observed to collapse, the reasons behind these declines are seldom investigated. Anoplolepis gracilipes is considered among one of the top six most economically and ecologically damaging invasive ant species in the world. However, introduced populations of A. gracilipes have been observed to decline. My overall aims in this thesis were to document A. gracilipes population declines, to investigate the possibility that pathogens were playing a role in the observed population declines, and to identify putative pathogens infecting A. gracilipes as potential candidates for biocontrol agents. I documented the observed A. gracilipes population declines that were the driving force for this project. I detailed large-scale reductions in the spatial extent of four populations with before and after survey data. I also presented data on three populations that were recorded as present, but disappeared before they could be spatially delimited. I speculated on the possible reasons for these declines and explained why I do not think other explanations are likely. I then investigated the hypothesis that a pathogen or parasite is affecting A. gracilipes queens in declining Arnhem Land populations. I did this in three ways: 1) based on preliminary findings, I looked at the effect of an artificial fungal infection on A. gracilipes reproduction. I compared reproductive output between control colonies and those treated with either a fungal entomopathogen (Metarhizium anisopliae) or fungicidal antibiotics. There was no correlation between either treatment and the number of eggs, larvae, pupae or males a colony produced after 70 days. I found queen number had no effect on colony reproductive output, suggesting that queens are able to adjust their egg-laying rate in the presence of other queens. I found no evidence that M. anisopliae affected reproductive output at the tested concentrations; 2) I explored the hypothesis that a pathogen that kills or affects the reproductive output of A. gracilipes queens is the mechanism or reason behind the population declines. I measured queen number per nest, egg-laying rate, fecundity and fat content and compared them between sites in different stages of decline or expansion (population types, consisting of low, medium and high-density populations). I discovered that 23% of queens had melanized nodules, a cellular immune response in insects, in their ovaries or fat bodies. The presence of nodules was correlated with a 22% decrease in the number of oocytes per ovary; however, nodule presence was not associated with population type, suggesting that though there are clearly pathogens or parasites capable of penetrating the cuticle of A. gracilipes, they are unlikely to be responsible for the observed population declines; 3) I compared microbial communities (bacteria and viruses) between queens from different population types. I found viral sequences that match to the Dicistroviridae family of viruses in low and medium-density populations. I found no differences in bacterial community structure between population types. The presence of sequences similar to the entomopathogens Rhabdochlamydia and Serratia marcescens, as well as the reproductive parasite Cardinium in A. gracilipes, deserves further investigation. Though introduced species’ populations have been observed to decline, this is one of the first studies to quantitatively examine, document, and investigate a mechanism behind such a decline. Understanding the mechanisms by which an invader declines may have important implications for invasive ant management worldwide.</p>

Computed Tomographic Analysis of Aortic Arch Branching Patterns - Revisited

Background /ObjectivesBranching pattern of aortic arch (AA) has a direct impact on the outcome of thoracic surgical and angiographic procedures. Geographical variations in the branching pattern of AA has been described. Hence, this descriptive cross sectional study describes the AA variations in a Sri Lankan population compared to the available global statistics.MethodsContrast-enhanced computed tomographic studies (CTC) of thorax (n=219) performed in males (49.3%) and females (50.7%); aged 59±17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al.ResultsFour AA types were identified in the study population: Type 1 (90%; n=197), Type 2 (n=10, 4.6%), Type 3 (n=8, 3.7%) and Type 6 AA (n=4; 1.8%). The prevalence of AA variations was 10%. Type 1 was the most prevalent pattern in both genders: female-91%; males-88.9%. The most prevalent AA variant in females was Type 2 (n=6; 5.4%); males Type 3 (n=5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (Odds: 0.792; 95% CI: 0.327 - 1.917; p=0.605). ConclusionVariations in branching pattern of AA is as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications surgical approaches and the choice of angiographic catheters to be utilized, which in turn, would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

Mental Health in COVID-19 Pandemic: A Meta-Review of Prevalence Meta-Analyses

Background: Mental health burden has been massively reported during the COVID-19 pandemic period. Aiming to summarise these data, we present a meta-review of meta-analyses that evaluated the impact of COVID-19 pandemic on anxiety, depressive and stress symptoms, psychological distress, post-traumatic stress disorder/symptoms (PTSD), and sleep disturbance, reporting its prevalence on general public (GP) and health care workers (HCW).Methods: A search was performed in the PubMed, EMBASE, and the Web of Science. Sleep disturbances, psychological distress, stress, and burnout were grouped as “Psychophysiological stress,” and anxiety, depression, and PTSD were grouped as “Psychopathology.” A random-effects model, calculating the pooled prevalence together with 95% confidence interval was performed for each domain. Subgroup analyses were performed for each population type (GP and HCW) and for each mental health outcome. For anxiety and depression, subgroup analysis for population type was performed. Heterogeneity is reported as I2. Publication bias was assessed through visual inspection of the funnel plot, and further tested by Egger's test and trim and fill analyses.Results: A total of 18 meta-analyses were included. The prevalence of psychophysiological stress was 31.99% (CI: 26.88–37.58, I2 = 99.9%). HCW showed a higher prevalence (37.74%, CI: 33.26–42.45, I2 = 99.7%) than the GP (20.67%, 15.07–27.66, I2 = 99.9%). The overall prevalence of insomnia, psychological distress, and stress were, respectively, 32.34% (CI: 25.65–39.84), 28.25% (CI: 18.12–41.20), and 36% (CI: 29.31–43.54). Psychopathology was present at 26.45% (CI: 24.22–28.79, I2 = 99.9%) of the sample, with similar estimates for population (HCW 26.14%, CI: 23.37–29.12, I2 = 99.9%; GP: 26.99%, CI: 23.41–30.9, I2 = 99.9%). The prevalence of anxiety, depression, and PTSD was 27.77% (CI: 24.47–31.32), 26.93% (CI: 23.92–30.17), and 20% (CI: 15.54–24.37), respectively. Similar proportions between populations were found for anxiety (HCW = 27.5%, CI: 23.78–31.55; GP = 28.33%, CI: 22.1–35.5) and depression (HCW = 27.05%, CI: 23.14–31.36; GP = 26.7%, CI: 22.32–31.59). Asymmetry in the funnel plot was found, and a slight increase in the estimate of overall psychopathology (29.08%, CI: 26.42–31.89) was found after the trim and fill analysis.Conclusions: The prevalence of mental health problems ranged from 20 to 36%. HCW presented a higher prevalence of psychophysiological stress than the general population.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=252221, identifier: CRD42021252221.