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"Calvin, W"
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Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis
Introduction
The incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI.
Methods
We searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated.
Results
Ten studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (
n
= 2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF< 50% were considered (
n
= 447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (
P
= 0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%,
P
< 0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy.
Conclusion
In the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.
Journal Article
Ensuring trustworthy use of artificial intelligence and big data analytics in health insurance
Technological advances in big data (large amounts of highly varied data from many different sources that may be processed rapidly), data sciences and artificial intelligence can improve health-system functions and promote personalized care and public good. However, these technologies will not replace the fundamental components of the health system, such as ethical leadership and governance, or avoid the need for a robust ethical and regulatory environment. In this paper, we discuss what a robust ethical and regulatory environment might look like for big data analytics in health insurance, and describe examples of safeguards and participatory mechanisms that should be established. First, a clear and effective data governance framework is critical. Legal standards need to be enacted and insurers should be encouraged and given incentives to adopt a human-centred approach in the design and use of big data analytics and artificial intelligence. Second, a clear and accountable process is necessary to explain what information can be used and how it can be used. Third, people whose data may be used should be empowered through their active involvement in determining how their personal data may be managed and governed. Fourth, insurers and governance bodies, including regulators and policy-makers, need to work together to ensure that the big data analytics based on artificial intelligence that are developed are transparent and accurate. Unless an enabling ethical environment is in place, the use of such analytics will likely contribute to the proliferation of unconnected data systems, worsen existing inequalities, and erode trustworthiness and trust.
Journal Article
Surveillance of Enterococcus spp. reveals distinct species and antimicrobial resistance diversity across a One-Health continuum
For a One-Health investigation of antimicrobial resistance (AMR) in
Enterococcus
spp., isolates from humans and beef cattle along with abattoirs, manured fields, natural streams, and wastewater from both urban and cattle feedlot sources were collected over two years. Species identification of
Enterococcus
revealed distinct associations across the continuum. Of the 8430 isolates collected,
Enterococcus faecium
and
Enterococcus faecalis
were the main species in urban wastewater (90%) and clinical human isolates (99%);
Enterococcus hirae
predominated in cattle (92%) and feedlot catch-basins (60%), whereas natural streams harbored environmental
Enterococcus
spp. Whole-genome sequencing of
E. faecalis
(n = 366 isolates) and
E. faecium
(n = 342 isolates), revealed source clustering of isolates, indicative of distinct adaptation to their respective environments. Phenotypic resistance to tetracyclines and macrolides encoded by
tet(M)
and
erm(B)
respectively, was prevalent among
Enterococcus
spp. regardless of source. For
E. faecium
from cattle, resistance to β-lactams and quinolones was observed among 3% and 8% of isolates respectively, compared to 76% and 70% of human clinical isolates. Clinical vancomycin-resistant
E. faecium
exhibited high rates of multi-drug resistance, with resistance to all β-lactam, macrolides, and quinolones tested. Differences in the AMR profiles among isolates reflected antimicrobial use practices in each sector of the One-Health continuum.
Journal Article
Competition at nuclear extremes explains why neutrons drip off nuclei
The neutron drip line refers to the maximum number of neutrons that can be packed into the atomic nuclei of each chemical element. A mechanism has been proposed that could explain the long-debated origin of this drip line.
The origin of the neutron drip line.
Journal Article
Bovine respiratory disease treatment failure: definition and impact
Bovine respiratory disease (BRD) treatment failure occurs when animals receiving a treatment regimen for BRD fail to directly return to health, resulting in chronic illness and a requirement for repeated treatments, sale for salvage slaughter, euthanasia or death. BRD treatment failure has both direct and indirect impacts. Direct impacts include costs to manage chronically ill animals, including those associated with BRD relapse treatment; reduced returns from animals sent for salvage slaughter, loss of the initial investment to purchase the animal and feed and other accumulated expenses to death, and costs associated with carcass disposal. Indirect impacts include costs of infrastructure requirements, and negative effects on animal welfare and employee morale.
Journal Article
Modelling the role of energy price movements toward economic stability in Malaysia: new evidence from wavelet-based analysis
Energy is one of the prime factors in influencing the sustainable development of a country. Different energy sources play important roles in driving the income growth of different economic sectors such as industrial, agricultural, and services. Fossil fuels, however, have come under strong criticism for actively accelerating climate change. As such, it is imperative to investigate the contributions of various energy sources toward sustainable growth. With Malaysia as the test-bed, the present study analyzes the impact of energy prices on economic stability using the novel wavelet-based analysis. Specifically, the study analyzed the impact of crude oil, natural gas, and gasoline prices on the economic (brown) and green growth from 1995 to 2020. The results show that in continuous wavelet transform, the cone of influence of all five factors exhibits strong short-run variance and fluctuations from 2005 to 2013. However, the intensity of brown growth is more influential than green growth. Similarly, in wavelet coherence graphs, the downward right arrows indicate positively significant associations between crude oil prices, natural gas prices, and gasoline prices with brown and green growth. Additionally, wavelet-based Granger causality reveals a bidirectional causal relationship between all variables. The results thus strongly suggest that energy prices predominantly affect the economic (brown) and green growth progression of the Malaysian economy. The study concludes with some suggested implications to augment the country's sustainable growth.
Journal Article
Financial resources and renewable energy nexus: a holistic perspective
Purpose
This study aims to explore the association among financial resources, renewable energy, environmental degradation and technological innovation in BRICS economies.
Design/methodology/approach
To estimate the long-run impacts between these variables, the AMG method of estimation, which incorporates cross-sectional reliance and slope homogeneity, is adopted in this research.
Findings
According to the empirical findings, the long-run coefficients of environmental degradation and technological innovation show a statistically significant and negative impact on renewable sources of energy. Furthermore, a 1% increase in environmental degradation reduces 0.32% of renewable sources of energy in BRICS economies. Whereas only the coefficient of GDP shows a positive and statistically significant impact on renewable sources of energy, which demonstrates that a 1% increase in economic growth causes a 0.02% incline in renewable sources of energy. Therefore, strong policy recommendations are provided to encourage green energy utilization in these economies.
Originality/value
The majority of the participating nations have inexpensive labor and an abundance of resources from nature, which strengthens their appeal. Given that population growth is still quite conservative, this presents a chance for GDP per capita to expand significantly.
Journal Article