Understanding the travel challenges and gaps for older adults during the COVID-19 outbreak: Insights from the New York City area

The COVID-19 pandemic has greatly impacted lifestyles and travel patterns, revealing existing societal and transportation gaps and introducing new challenges. In the context of an aging population, this study investigated how the travel behaviors of older adults (aged 60+) in New York City were affected by COVID-19, using an online survey and analyzing younger adult (aged 18-59) data for comparative analysis. The purpose of the study is to understand the pandemic's effects on older adults' travel purpose and frequency, challenges faced during essential trips, and to identify potential policies to enhance their mobility during future crises. Descriptive analysis and Wilcoxon signed-rank tests were used to summarize the changes in employment status, trip purposes, transportation mode usage, and attitude regarding transportation systems before and during the outbreak and after the travel restrictions were lifted. A Natural Language Processing model, Gibbs Sampling Dirichlet Multinomial Mixture, was adopted to open-ended questions due to its advantage in extracting information from short text. The findings show differences between older and younger adults in telework and increased essential-purpose trips (e.g., medical visits) for older adults. The pandemic increased older adults' concern about health, safety, comfort, prices when choosing travel mode, leading to reduced transit use and walking, increased driving, and limited bike use. To reduce travel burdens and maintain older adults' employment, targeted programs improving digital skills (telework, telehealth, telemedicine) are recommended. Additionally, safe, affordable, and accessible transportation alternatives are necessary to ensure mobility and essential trips for older adults, along with facilitation of walkable communities.

Impact of Social Media on Travel Behaviors during the COVID-19 Pandemic: Evidence from New York City

During the outbreak of COVID-19, people's reliance on social media for pandemic-related information exchange, daily communications, and online professional interactions increased because of self-isolation and lockdown implementation. Most of the published research addresses the performance of nonpharmaceutical interventions (NPIs) and measures on the issues impacted by COVID-19, such as health, education, and public safety; however, not much is known about the interplay between social media use and travel behaviors. This study aims to determine the effect of social media on human mobility before and after the COVID-19 outbreak, and its impact on personal vehicle and public transit use in New York City (NYC). Apple mobility trends and Twitter data are used as two data sources. The results indicate that Twitter volume and mobility trend correlations are negative for both driving and transit categories in general, especially at the beginning of the COVID-19 outbreak in NYC. A significant time lag (13 days) between the online communication rise and mobility drop can be observed, thereby providing evidence of social networks taking quicker reactions to the pandemic than the transportation system. In addition, social media and government policies had different impacts on vehicular traffic and public transit ridership during the pandemic with varied performance. This study provides insights on the complex influence of both anti-pandemic measures and user-generated content, namely social media, on people's travel decisions during pandemics. The empirical evidence can help decision-makers formulate timely emergency responses, prepare targeted traffic intervention policies, and conduct risk management in similar outbreaks in the future.

Calibrating stochastic traffic simulation models for safety and operational measures based on vehicle conflict distributions obtained from aerial and traffic camera videos

Proper calibration process is of considerable importance for traffic safety evaluations using simulation models. Allowing for a pure with and without comparison under identical circumstances that is not directly testable in the field, microsimulation-based approach has drawn considerable attention for the performance evaluation of emerging technologies, such as connected vehicle (CV) safety applications. Different from the traditional approaches to evaluate mobility impacts, safety evaluations of such applications demand the simulation models to be well calibrated to match real-world safety conditions. This paper proposes a novel calibration framework which combines traffic conflict techniques and multi-objective stochastic optimization so that the operational and safety measures can be calibrated simultaneously. The conflict distribution of different severity levels categorized by time-to-collision (TTC) is applied as the safety performance measure. Simultaneous perturbation stochastic approximation (SPSA) algorithm, which can efficiently approximate the gradient of the multi-objective stochastic loss function, is used for model parameters optimization that minimizes the total simulation error of both operational and safety performance measures. The proposed calibration methodology is implemented using an open-source software SUMO on a simulation network of the Flatbush Avenue corridor in Brooklyn, NY. 17 key parameters are calibrated using the SPSA algorithm and are compared with the real-world traffic conflicts extracted using vehicle trajectories from 14 h' high-resolution aerial and traffic surveillance videos. Representative days are identified to create variation envelopes for performance measures. Four acceptability criteria, including control for time-variant outliers and inliers, bounded dynamic absolute and system errors are adopted for results analysis. The results show that the calibrated parameters can significantly improve the performance of the simulation model to represent real-world safety conditions (i.e., traffic conflicts) as well as operational conditions. The case study also demonstrates the usefulness of aerial imagery and the applicability of the proposed model calibration framework, so the calibrated model can be used to evaluate the safety benefits of CV applications more accurately.

Relationships of adiponectin to regional adiposity, insulin sensitivity, serum lipids, and inflammatory markers in sedentary and endurance-trained Japanese young women

INTRODUCTION

This study aims to compare the differences in circulating adiponectin levels and their relationships to regional adiposity, insulin resistance, serum lipid, and inflammatory factors in young, healthy Japanese women with different physical activity statuses.

METHODS

Adipokines (adiponectin and leptin), full serum lipid, and inflammatory factors [white blood cell counts, C-reactive protein, tumor necrosis factor-α, tissue plasminogen activator inhibitor-1 (PAI-1)] were measured in 101 sedentary and 100 endurance-trained healthy Japanese women (aged 18-23 years). Insulin sensitivity was obtained through a quantitative insulin-sensitivity check index (QUICKI). Regional adiposity [trunk fat mass (TFM), lower-body fat mass (LFM), and arm fat mass (AFM)] was evaluated using the dual-energy X-ray absorptiometry method.

RESULTS

No significant difference was observed between the sedentary and trained women in terms of adiponectin levels. The LFM-to-TFM ratio and the high-density lipoprotein cholesterol (HDL-C) were the strong positive determinants for adiponectin in both groups. Triglyceride in the sedentary women was closely and negatively associated with adiponectin, as well as PAI-1 in the trained women. The QUICKI level was higher in the trained than sedentary women. However, no significant correlation between adiponectin and insulin sensitivity was detected in both groups. Furthermore, LFM was associated with a favorable lipid profile against cardiovascular diseases (CVDs) in the whole study cohort, but this association became insignificant when adiponectin was taken into account.

CONCLUSIONS

These findings suggest that adiponectin is primarily associated with regional adiposity and HDL-C regardless of insulin sensitivity and physical activity status in young, healthy women. The associations among adiponectin, lipid, and inflammatory factors are likely different in women with different physical activity statuses. The correlation of LFM and a favorable lipid profile against CVD and adiponectin is likely involved in this association.

Tumor Organoid Model and Its Pharmacological Applications in Tumorigenesis Prevention

Cancer is a leading cause of death and a severe threat to global public health. Organoid, as a novel 3D in vitro model, has been applied in various tumor related studies due to its apparent advantages. The organoid is mainly constructed by Matrigel-depended 3D culture system, Air-Liquid Interface (ALI) culture, and Microfluidic culture or Organ-on-chips platform. For the application in carcinogenesis studies, the organoid model may favor depicting initiative hallmarks and identifying potential intervening targets, investigating driver genes of carcinogenesis, and identifying known or unknown risk or protective factors. In this review, we discussed different organoid construction methods and their properties. We also noted that tumor organoids can portray initiative hallmarks and identify possible intervening targets, as well as explore carcinogenesis driver genes and uncover known or unknown risks or protective factors. Organoid systems have been used to identify tumor-preventive drugs such as oligomeric proanthocyanidins, Vitamin D, n-3 PUFAs, and pomegranate. The current evidence underscores the organoid model's potential importance in developing innovative tumorprevention techniques.

Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study

BACKGROUND

Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care.

METHODS

300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies.

RESULTS

Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists.

CONCLUSIONS

Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.

Exosomal MIF Derived From Nasopharyngeal Carcinoma Promotes Metastasis by Repressing Ferroptosis of Macrophages

Nasopharyngeal carcinoma (NPC) is the most common malignant tumor of the head and neck cancer (HNC). Metastasis is the main cause of treatment failure. However, the molecular mechanism for NPC metastasis is still unclear. As one of the most common host immune cells in the tumor microenvironment, macrophages have been proven to regulate metastasis. Besides, exosomes are the important bridge connecting various cells in TME. Currently, the role of NPC-exos on macrophages and their impact on metastasis remains to be unexplored. In this study, we found that MIF was highly expressed in NPC cells, and the exosomes secreted by NPC cells could be taken up by macrophages, thereby, inhibiting the ferroptosis of macrophages and then promoting the metastasis of NPC. Targeting MIF may be a potential treatment to reduce the rate of metastasis.

Exenatide improves hepatocyte insulin resistance induced by different regional adipose tissue

Obesity is resulted from energy surplus and is characterized by abnormal adipose tissue accumulation and/or distribution. Adipokines secreted by different regional adipose tissue can induce changes in key proteins of the insulin signaling pathway in hepatocytes and result in impaired hepatic glucose metabolism. This study aimed to investigate whether exenatide affects key proteins of IRS2/PI3K/Akt2 signaling pathway in hepatocytes altered by the different regional fat depots. Six non-obese patients without endocrine diseases were selected as the research subjects. Their subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT)were co-cultured with HepG2 cells in the transwell chamber. In the presence or absence of exenatide, adipokines content in the supernatant of each experimental group was detected by ELISA. In addition, HepG2 cells in each co-culture group with and without insulin were collected, and the expression of key proteins IRS2, p-IRS2(S731), PI3K-p85, Akt2, and p-Akt2(S473) was detected by western blotting (WB). The results showed that the adipokines IL-8, MCP-1, VEGF, and sTNFR2 in the supernatant of HepG2 cells induced by different regional adipose tissue were significantly higher than those in the HepG2 group, and VAT released more adipokines than SAT. Furthermore, these adipokines were significantly inhibited by exenatide. Importantly, the different regional fat depot affects the IRS2/PI3K/Akt2 insulin signaling pathway of hepatocytes. Exenatide can up-regulate the expression of hepatocyte proteins IRS2, PI3K-p85, p-Akt2(S731) inhibited by adipose tissue, and down-regulate the expression of hepatocyte proteins p-IRS2(S731) promoted by adipose tissue. The effect of VAT on the expression of these key proteins in hepatocytes is more significant than that of SAT. But there was no statistical difference in the expression of Akt2 protein among each experimental group, suggesting that exenatide has no influence on the expression of Akt2 protein in hepatocytes. In conclusion, exenatide may improve hepatic insulin resistance (IR) by inhibiting adipokines and regulating the expression of key proteins in the IRS2/PI3K/Akt2 pathway.

A functional approach for characterizing safety risk of signalized intersections at the movement level: An exploratory analysis

Safety evaluation of signalized intersections is often conducted by developing statistical and data-driven methods based on data aggregated at certain temporal and spatial levels (e.g., yearly, hourly, or per signal cycle; intersection or approach leg). However, such aggregations are subject to a major simplification that masks the underlying spatio-temporal safety risk patterns within the data aggregation levels. Consequently, high-resolution analysis such as safety risk within signal cycles and at traffic movement level cannot be performed. This study contributes to the literature by proposing a new functional data analysis (FDA) approach for a novel characterization of safety risk patterns of signalized intersections. Functional data smoothing methods that can mitigate overfitting and account for the nonnegative characteristics of safety risk are proposed to model the time series of safety risk within signal cycles at the traffic movement level. Functional analysis of variance method (FANOVA) that can compare the group level differences of functional curves is used to test differences of safety risk functions among different traffic movements. A typical signalized intersection with representative signal types and channelizations is selected as the study location and approximately 1-hour traffic video data recorded by an unmanned aerial vehicle are used to extract traffic conflicts. New movement-level safety risk patterns are characterized based on the safety risk functions that can reveal the temporal distribution of risk within signal cycles. Most of the tested traffic movements have significantly distinct functional risk patterns according to the FANOVA results while risk patterns for most of the traffic movements cannot be differentiated based on the data aggregated at the cycle and approach levels. The proposed functional approach has the potential to be used for facilitating proactive safety management, calibrating microsimulation models for safety evaluation, and optimizing signal timing while considering traffic safety at more disaggregated levels.

Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial

BACKGROUND

The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial.

METHODS

We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40-64 years residing in the neighbourhoods. Public health nurses trained as "prevention practitioners" held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline.

RESULTS

Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22-1.84]).

CONCLUSION

Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage.

TRIAL REGISTRATION

NCT03052959 , registered February 10, 2017.

Unusual Role of Point Defects in Perovskite Nickelate Electrocatalysts

Low-cost transition-metal oxide is regarded as a promising electrocatalyst family for an oxygen evolution reaction (OER). The classic design principle for an oxide electrocatalyst believes that point defect engineering, such as oxygen vacancies (V_O^..) or heteroatom doping, offers the opportunities to manipulate the electronic structure of material toward optimal OER activity. Oppositely, in this work, we discover a counterintuitive phenomenon that both V_O^.. and an aliovalent dopant (i.e., proton (H⁺)) in perovskite nickelate (i.e., NdNiO₃ (NNO)) have a considerably detrimental effect on intrinsic OER performance. Detailed characterizations unveil that the introduction of these point defects leads to a decrease in the oxidative state of Ni and weakens Ni-O orbital hybridization, which triggers the local electron-electron correlation and a more insulating state. Evidenced by first-principles calculation using the density functional theory (DFT) method, the OER on nickelate electrocatalysts follows the lattice oxygen mechanism (LOM). The incorporation of point defect increases the energy barrier of transformation from OO*(V_O) to OH*(V_O) intermediates, which is regarded as the rate-determining step (RDS). This work offers a new and significant perspective of the role that lattice defects play in the OER process.

Reference-free video-to-real distance approximation-based urban social distancing analytics amid COVID-19 pandemic

INTRODUCTION

The rapidly evolving COVID-19 pandemic has dramatically reshaped urban travel patterns. In this research, we explore the relationship between "social distancing," a concept that has gained worldwide familiarity, and urban mobility during the pandemic. Understanding social distancing behavior will allow urban planners and engineers to better understand the new norm of urban mobility amid the pandemic, and what patterns might hold for individual mobility post-pandemic or in the event of a future pandemic.

METHODS

There are still few efforts to obtain precise information on social distancing patterns of pedestrians in urban environments. This is largely attributed to numerous burdens in safely deploying any effective field data collection approaches during the crisis. This paper aims to fill that gap by developing a data-driven analytical framework that leverages existing public video data sources and advanced computer vision techniques to monitor the evolution of social distancing patterns in urban areas. Specifically, the proposed framework develops a deep-learning approach with a pre-trained convolutional neural network to mine the massive amount of public video data captured in urban areas. Real-time traffic camera data collected in New York City (NYC) was used as a case study to demonstrate the feasibility and validity of using the proposed approach to analyze pedestrian social distancing patterns.

RESULTS

The results show that microscopic pedestrian social distancing patterns can be quantified by using a generalized real-distance approximation method. The estimated distance between individuals can be compared to social distancing guidelines to evaluate policy compliance and effectiveness during a pandemic. Quantifying social distancing adherence will provide decision-makers with a better understanding of prevailing social contact challenges. It also provides insights into the development of response strategies and plans for phased reopening for similar future scenarios.

Time lag effects of COVID-19 policies on transportation systems: A comparative study of New York City and Seattle

The unprecedented challenges caused by the COVID-19 pandemic demand timely action. However, due to the complex nature of policy making, a lag may exist between the time a problem is recognized and the time a policy has its impact on a system. To understand this lag and to expedite decision making, this study proposes a change point detection framework using likelihood ratio, regression structure and a Bayesian change point detection method. The objective is to quantify the time lag effect reflected in transportation systems when authorities take action in response to the COVID-19 pandemic. Using travel patterns as an indicator of policy effectiveness, the length of policy lag and magnitude of policy impacts on the road system, mass transit, and micromobility are investigated through the case studies of New York City (NYC), and Seattle-two U.S. cities significantly affected by COVID-19. The quantitative findings show that the National declaration of emergency had no policy lag while stay-at-home and reopening policies had a lead effect on mobility. The magnitude of impact largely depended on the land use and sociodemographic characteristics of the area, as well as the type of transportation system.

A randomized surgical trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis – primary results of the CAMRA CardioLink-2 trial

Background

The gold standard treatment for mitral valve regurgitation due to prolapse involves surgery with annuloplasty and either leaflet resection or leaflet preservation, with placement of artificial neochordae. It has been suggested that leaflet resection may be prone to functional mitral stenosis, whereby a patient may have a higher mitral gradient at peak exercise compared to a leaflet preservation strategy. Although both techniques are widely used, there has been no prospective randomized study conducted to compare these two techniques, particularly in regard to functional mitral stenosis.

Methods

A total of 104 patients with posterior leaflet prolapse were randomized to undergo mitral repair with either leaflet resection (N=54) or leaflet preservation (N=50) at 7 specialized Canadian cardiac centers. Patient age, proportion of female patients, and mean Society of Thoracic Surgeons risk score was 63.9±10.4 years, 19%, and 1.4% for those who underwent leaflet resection, and 66.3±10.8 years, 16%, and 1.9% for those who underwent leaflet preservation, respectively. The primary endpoint was the mean trans-mitral repair gradient at peak exercise 12-months after repair.

Results

Baseline characteristics were similar between the groups. At 12-months, the mean trans-mitral repair gradient at peak exercise in patients who underwent leaflet resection and preservation was 9.1±5.2 and 8.3±3.3 mmHg (P=0.4), respectively. The two groups had similar mean mitral valve gradient at rest (3.2±1.9 mmHg following resection and 3.1±1.1 mmHg following leaflet preservation, P=0.7). There was no between-group difference for the 6-minute walk distance (451±147 m and 481±95 m for the resection and preservation groups, respectively, P=0.3).

Conclusion

We report the first prospective surgical randomized trial to evaluate commonly used mitral valve repair strategies for posterior leaflet prolapse. Leaflet resection and leaflet preservation both yield acceptable results with no difference in postoperative valve gradient and functional status 12-months after surgical mitral valve repair.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heart and Stroke Foundation of Canada

Effect of Insulin-Regulated FOXC2 Expression in Adipocyte Differentiation and Insulin Resistance

OBJECTIVE

1) To investigate the effect of FOXC2 on the differentiation of adipose-derived mesenchymal stem cells. 2) To analyze the mechanism between FOXC2 expression regulation in adipose differentiation and insulin resistance (IR).

METHODS

We first amplified the FOXC2 promoter region-512 and cloned it into the luciferase expression vector. The reporter gene system was transfected into the adipose tissue-derived mesenchymal stem cell to study insulin-mediated FOXC2 expression. We also manipulated FOXC2 protein expression by either siRNA or overexpression and studied the differentiation capability of adipose tissue-derived mesenchymal stem cell into adipocytes, as well as the influence on several IR-related genes: GLUT4, PPARγ, UCP1 and PAI-1.

RESULTS

1) Insulin effectively induced the expression of FOXC2 protein in adipose tissue-derived mesenchymal stem cells under differentiation (P<0.01). Insulin also induced FOXC2-pro-512T promoter activity significantly (P<0.01). 2) The stem cell adipose differentiation decreased in the FOXC2 overexpression group. 3) When FOXC2 was overexpressed, the expression of GLUT4, PAI-1 and UCP1 was higher than control groups (p<0.001). When FOXC2 was down-regulated by siRNA, both GLUT4 and PAI-1's protein expression were decreased (p<0.001), and the protein expression of PPARγ was increased (p<0.001). In the presence of insulin induction, overexpression of FOXC2 led to significantly higher UCP-1 expression (p<0.001) and lower PAI-1 expression (p<0.001). The protein expression of GLUT4, PAI-1 (p<0.001) and UCP-1 (p<0.05) was decreased in cells transfected with FOXC2 siRNA.

CONCLUSION

Insulin effectively induced the expression of FOXC2 protein in adipose tissue-derived mesenchymal stem cells under differentiation, possibly through the regulation of the FOXC2-pro-512T promoter activity. The different protein expression of FOXC2 has regulatory effects on several genes related to insulin resistance. FOXC2 is an important regulatory factor in adipocyte differentiation and insulin resistance.

P5602Comparison of innominate vs axillary artery cannulation for cerebral protection on neurocognitive outcomes in aortic surgery: a pre-specified analysis of the ACE CardioLink-3 randomised trial

Background

Success after aortic surgery depends on avoidance of neurocognitive dysfunction, thus novel adjuncts to proximal aortic surgery must be evaluated for efficacy of cerebral protection during circulatory arrest. We report the primary neurocognitive results from the ACE CardioLink-3 randomised controlled trial comparing innominate to axillary artery cannulation for cerebral protection (NCT02554032).

Methods

The primary safety endpoint was the proportion of patients with new radiologically severe ischaemic cerebral lesions found on post-operative versus pre-operative diffusion weighted magnetic resonance imaging (DW-MRI). Neurocognitive outcomes were assessed using the Mini-Mental State Exam (MMSE), and the Montreal Cognitive Assessment (MoCA). Continuous and binary outcomes were analysed using ANCOVA (controlling for baseline score) and chi-square/Fisher's exact tests.

Results

Of the 111 patients randomised, 102 patients were included in the primary safety per-protocol analysis. The primary safety outcome (significant new ischaemic lesions on DW-MRI) occurred in 34% in the innominate group and 38.8% in the axillary group (OR 0.81; 0.41 to 1.60; P=0.0009 for non-inferiority). Rates of post-operative stroke/transient ischaemic attack, seizure, delirium, and encephalopathy were similar between groups. The rate of patients with a post-operative MoCA score less than 26 was 44.9% and 39.1% in the innominate and axillary groups respectively (P=0.807). A post-operative MMSE score of less than 24 was observed in 2% vs. 6.5% of the patients in the innominate and axillary groups respectively (P=0.866). A >1-point decrease in the MoCA score from pre-operatively to post-operatively was seen in 32.7% and 34.8% in the innominate and axillary groups respectively (P=0.962). A >1-point decrease in the MMSE score from pre-to post-operative was observed in 20.4% in the innominate artery group compared with 30.4% in the axillary group (P=0.346).

Conclusion

Post-operative neurocognitive dysfunction and DW-MRI incidence of severe ischaemic lesions did not differ in patients randomised to innominate artery cannulation vs, conventional axillary artery cannulation, though the burden of new severe ischaemic lesions is high in both groups.

P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial

Introduction

The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure.

Purpose

To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD.

Methods

In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA.

Results

Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures.

Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602

Conclusions

Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone.

Acknowledgement/Funding

This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.

Comparison of mRNA expression from Y-chromosome X-degenerate region genes in taurine cattle, yaks and interspecific hybrid bulls

The yattle (dzo) is an interspecific hybrid of the taurine cattle (Bos taurus) and the domestic yak (Bos grunniens). F₁ hybrid yattle bulls are sterile due to spermatogenic arrest and have misregulation of spermatogenesis genes in the testes. However, the expression pattern of Y chromosome-linked genes in cattle, yaks and yattle testes is still unknown. In this study, we analyzed the mRNA expression pattern of 10 genes known to be present as single copies in the X-degenerate region of the bovine male-specific region of the Y chromosome. Using male-specific primers and reverse transcription quantitative PCR, the ubiquitously transcribed tetratricopeptide repeat gene, Y-linked (UTY), oral-facial-digital syndrome 1, Y-linked (OFD1Y) and ubiquitin specific peptidase 9, Y-linked (USP9Y) genes were ubiquitously expressed and significantly more highly expressed in yattle than in cattle and yaks testes (P < 0.001). RNA binding motif protein, Y-linked (RBMY) had testes-specific expression, and eukaryotic translation initiation factor 1A, Y-linked (EIF1AY) was expressed mainly in testis, whereas yattle and cattle did not show significant differences with respect to the expression of RBMY and EIF1AY. Thus, based on the model of yattle bull sterility, the high expression of UTY, OFD1Y and USP9Y may be associated with yattle infertility.

Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics

This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases.A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis.With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis.The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up.

[Effectiveness of bupropion and counseling for smoking cessation]

OBJECTIVE

To evaluate the effectiveness of bupropion for smoking cessation among Chinese smokers at a smoking cessation clinic.

METHODS

A prospective observational study was conducted in a hospital located in Beijing during 2008 and from 28 to 31 October 2014. A total of 287 smokers (265 men and 22 women) were assessed using data from structured questionnaires at baseline and were followed up at 1 and 6 months. Trained physician counselors provided free brief education and individual counseling sessions for all participants at the first visit. A total 131 participants were prescribed bupropion in addition to counseling. The counseling plus bupropion group was compared with the group who underwent counseling without bupropion. Outcomes were self-reported 7-day point prevalence abstinence rates at 1- and 6-month follow-up and continuous abstinence rates at 6-month follow-up. Smoking reduction rates at 1 and 6 months were also measured.

RESULTS

By intention-to-treat analysis, the 7-day point prevalence abstinence rate of the bupropion group at 1 and 6 months was higher than for the counseling-only group: at 1-month follow-up, 26.0% (34/131) vs. 15.4% (24/156), with OR (95% CI) 1.93(1.07-3.46); these rates at 6-month follow-up were 27.8% (35/131) vs. 15.4% (24/156), with OR (95% CI) 2.01(1.12-3.59). The 1-month continuous abstinence rate at 6 months was higher in the bupropion group: 26.0% (34/131) vs. 14.7% (23/156), with OR (95%CI) 2.03(1.12-3.66). Participants in the bupropion group also had a higher smoking reduction rate at 1 month than those in the counseling-only group: 55.0% (72/131) vs. 38.5% (60/156), with OR (95%CI) 1.95 (1.22-3.13).

CONCLUSION

Prescription of bupropion at this smoking cessation clinic was effective in doubling the quitting rates and smoking reduction rates among Chinese smokers.

A randomized trial testing the efficacy of modifications to the nutrition facts table on comprehension and use of nutrition information by adolescents and young adults in Canada

INTRODUCTION

Given the proposed changes to nutrition labelling in Canada and the dearth of research examining comprehension and use of nutrition facts tables (NFts) by adolescents and young adults, our objective was to experimentally test the efficacy of modifications to NFts on young Canadians' ability to interpret, compare and mathematically manipulate nutrition information in NFts on prepackaged food.

METHODS

An online survey was conducted among 2010 Canadians aged 16 to 24 years drawn from a consumer sample. Participants were randomized to view two NFts according to one of six experimental conditions, using a between-groups 2 x 3 factorial design: serving size (current NFt vs. standardized serving-sizes across similar products) x percent daily value (% DV) (current NFt vs. "low/med/high" descriptors vs. colour coding). The survey included seven performance tasks requiring participants to interpret, compare and mathematically manipulate nutrition information on NFts. Separate modified Poisson regression models were conducted for each of the three outcomes.

RESULTS

The ability to compare two similar products was significantly enhanced in NFt conditions that included standardized serving-sizes (p ≤ .001 for all). Adding descriptors or colour coding of % DV next to calories and nutrients on NFts significantly improved participants' ability to correctly interpret % DV information (p ≤ .001 for all). Providing both standardized serving-sizes and descriptors of % DV had a modest effect on participants' ability to mathematically manipulate nutrition information to calculate the nutrient content of multiple servings of a product (relative ratio = 1.19; 95% confidence limit: 1.04-1.37).

CONCLUSION

Standardizing serving-sizes and adding interpretive % DV information on NFts improved young Canadians' comprehension and use of nutrition information. Some caution should be exercised in generalizing these findings to all Canadian youth due to the sampling issues associated with the study population. Further research is needed to replicate this study in a more heterogeneous sample in Canada and across a range of food products and categories.

Self-doped Ti(3+)-TiO2 as a photocatalyst for the reduction of CO2 into a hydrocarbon fuel under visible light irradiation

Self-doped TiO2 shows visible light photocatalytic activity, while commercial TiO2 (P25) is only UV responsive. The incorporation of Ti(3+) into TiO2 structures narrows the band gap (2.90 eV), leading to significantly increased photocatalytic activity for the reduction of CO2 into a renewable hydrocarbon fuel (CH4) in the presence of water vapour under visible light irradiation.

Role of chloride in the morphological evolution of organo-lead halide perovskite thin films

A comprehensive morphological study was used to elucidate chloride's role in CH(3)NH(3)PbI(3-x)Cl(x) film evolution on a conducting polymer, PEDOT:PSS. Complex ion equilibria and aggregation in solution, as well as the role they play in nucleation, are found to ultimately be responsible for the unique morphological diversity observed in perovskite films grown in the presence of the chloride ion. An intermediate phase that is generated upon deposition and initial annealing templates continued self-assembly in the case of CH(3)NH(3)PbI(3-x)Cl(x). In the absence of chloride, the film growth of CH(3)NH(3)PbI(3) is directed by substrate interfacial energy. By employing the through-plane TEM analysis, we gain detailed insight into the unique crystallographic textures, grain structures, and elemental distributions across the breadth of films grown from precursor solutions with different chemistries. The lattice coherence seen in morphologies generated under the influence of chloride provides a physical rational for the enhancement in carrier diffusion length and lifetime.

Binary-metal perovskites toward high-performance planar-heterojunction hybrid solar cells

A simple, low temperature solution process for Pb/Sn binary-metal perovskite planar-heterojunction solar cells is demonstrated. Sn inclusion substantially influences the band-gap, crystallization kinetics, and thin-film formation leading to a broadened light absorption and enhanced film coverage on ITO/PEDOT:PSS. As a result, the optimized device shows a PCE exceeding 10%, which is the best result for binary-metal perovskite solar cells so far.

Branched WO3 nanosheet array with layered C3 N4 heterojunctions and CoOx nanoparticles as a flexible photoanode for efficient photoelectrochemical water oxidation

A hybrid WO3 /C3 N4 /CoOx system exhibits excellent photoelectrochemical activity for water oxidation. The system comprises a novel three-dimensionally branched WO3 nanosheet array coated with a layer of C3 N4 heterojunctions that are further decorated with CoOx nanoparticles. The photoelectrochemical activity arises from the effective light harvesting due to the 3D structure and "window effect," the excellent charge separation and transport in the heterojunction, and the fast interfacial charge collection and surface reactions due to the large surface area.

Mechanism of the reversal effect of mifepristone on drug resistance of the human cervical cancer cell line HeLa/MMC

We examined the ability of mifepristone to reverse the in vitro drug resistance of human cervical cancer cells resistant to mitomycin-C (HeLa/MMC) cells and investigated the mechanism of this effect. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed to detect the drug resistance of HeLa/MMC cells and the reversed drug resistance in vitro. Expression levels of B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and glucosylceramide synthase (GCS) were measured in HeLa and HeLa/MMC cells. The resistance index of HeLa/MMC cells on MMC was reduced from 5.02 to 1.46 after 10 mg/mL mifepristone exposure. A combination of mifepristone upregulated the Bax/Bcl-2 protein expression ratio and apoptosis in HeLa/MMC cells. GCS expression was significantly higher in HeLa/MMC cells than in HeLa cells (P < 0.01), but distinctly declined in both cell lines after mifepristone application (P < 0.01). Mifepristone reversed the resistance of HeLa/MMC cells to MMC in vitro; the overexpression of the GCS gene and the increased expression of apoptosis-related protein Bcl-2 may play important roles in the formation of multidrug resistance in cervical cancer.

Developing human capital for successful implementation of international marine scientific research projects

The oceans play a crucial role in the global environment and the sustainability of human populations, because of their involvement in climate regulation and provision of living and non-living resources to humans. Maintenance of healthy oceans in an era of increasing human pressure requires a high-level understanding of the processes occurring in the marine environment and the impacts of anthropogenic activities. Effective protection and sustainable resource management must be based, in part, on knowledge derived from successful research. Current marine research activities are being limited by a need for high-quality researchers capable of addressing critical issues in broad multidisciplinary research activities. This is particularly true for developing countries which will require the building of capacity for marine scientific research. This paper reviews the current activities aimed at increasing marine research capacity in developing and emerging countries and analyses the challenges faced, including: appropriate alignment of the research goals and societal and policy-relevant needs; training in multidisciplinary research; increasing capacity for overall synthesis of scientific data; building the capacity of technical staff; keeping highly qualified personnel in marine scientific research roles; cross-cultural issues in training; minimising duplication in training activities; improving linkages among human capital, project resources and infrastructure. Potential solutions to these challenges are provided, along with some priorities for action aimed at improving the overall research effort.

Facile synthesis of thermal- and photostable titania with paramagnetic oxygen vacancies for visible-light photocatalysis

A novel dopant-free TiO(2) photocatalyst (V(o)(.)-TiO(2)), which is self-modified by a large number of paramagnetic (single-electron-trapped) oxygen vacancies, was prepared by calcining a mixture of a porous amorphous TiO(2) precursor, imidazole, and hydrochloric acid at elevated temperature (450 °C) in air. Control experiments demonstrate that the porous TiO(2) precursor, imidazole, and hydrochloric acid are all necessary for the formation of V(o)(.)-TiO(2). Although the synthesis of V(o)(.)-TiO(2) originates from such a multicomponent system, this synthetic approach is facile, controllable, and reproducible. X-ray diffraction, XPS, and EPR spectroscopy reveal that the V(o)(.)-TiO(2) material with a high crystallinity embodies a mass of paramagnetic oxygen vacancies, and is free of other dopant species such as nitrogen and carbon. UV/Vis diffuse-reflectance spectroscopy and photoelectrochemical measurement demonstrate that V(o)(.)-TiO(2) is a stable visible-light-responsive material with photogenerated charge separation efficiency higher than N-TiO(2) and P25 under visible-light irradiation. The V(o)(.)-TiO(2) material exhibits not only satisfactory thermal- and photostability, but also superior photocatalytic activity for H(2) evolution (115 μmol h(-1) g(-1)) from water with methanol as sacrificial reagent under visible light (λ>400 nm) irradiation. Furthermore, the effects of reaction temperature, ratio of starting materials (imidazole:TiO(2) precursor) and calcination time on the photocatalytic activity and the microstructure of V(o)(.)-TiO(2) were elucidated.

Visible light-driven α-Fe₂O₃ nanorod/graphene/BiV₁-xMoxO₄ core/shell heterojunction array for efficient photoelectrochemical water splitting

We report the design, synthesis, and characterization of a novel heterojunction array of α-Fe(2)O(3)/graphene/BiV(1-x)Mo(x)O(4) core/shell nanorod for photoelectrochemical water splitting. The heterojunction array was prepared by hydrothermal deposition of α-Fe(2)O(3) nanorods onto Ti substrate, with subsequent coating of graphene interlayer and BiV(1-x)Mo(x)O(4) shell by photocatalytic reduction and a spin-coating approach, respectively. The heterojunction yielded a pronounced photocurrent density of ∼1.97 mA/cm(2) at 1.0 V vs Ag/AgCl and a high photoconversion efficiency of ∼0.53% at -0.04 V vs Ag/AgCl under the irradiation of a Xe lamp. The improved photoelectrochemical properties benefited from (1) the enhanced light absorption due to behavior of the "window effect" between the α-Fe(2)O(3) cores and BiV(1-x)Mo(x)O(4) shells, and (2) the improved separation of photogenerated carriers at the α-Fe(2)O(3) nanorod/graphene/BiV(1-x)Mo(x)O(4) interfaces. Our results demonstrate the advantages of the novel graphene-mediated core/shell heterojunction array and provide a valuable insight for the further development of such materials.

Cooperative assembly of three-ring-based zeolite-type metal-organic frameworks and Johnson-type dodecahedra

Two birds with one stone One synthetic strategy led to the preparation of both 3-ring-based zeolite-type metal-organic frameworks (NPO-type) and Johnson-type metal-organic polyhedra. The strategy is based on the cooperative assembly of 4-connected indium nodes with two symmetry-complementary ligands (one serves to generate 3-rings and the other crosslinks 3-rings). Photocatalytic H2 production experiments demonstrated these NPO-zeolite compounds behave as semiconductors and exhibit photocatalytic activity for the generation of dihydrogen from water under ultraviolet irradiation.