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"Seth, S."
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Digital health technology and mobile devices for the management of diabetes mellitus: state of the art
Diabetes mellitus is a disease that can be difficult to manage and requires high levels of health literacy and numeracy, self-monitoring and frequent contact with clinicians. If not optimally controlled, diabetes can lead to kidney failure, blindness and cardiovascular complications, which, in turn, contribute to increasing healthcare costs. Although not yet widely used, mobile health (mHealth) tools have enhanced diabetes management and prevention and are likely to play an increasing role with the growth of smartphone ownership and medical device innovations. Recent mHealth interventions targeting type 1 and type 2 diabetes are diverse in their goals and components, and include insulin management applications, wearable blood glucose meters, automated text messages, health diaries and virtual health coaching. In this paper, we review the modalities and components of various impactful interventions for insulin management, diabetes education, self-management and prevention. More work is needed to investigate how individual demographic, socioeconomic, behavioural and clinical characteristics contribute to patient engagement and the efficacy of mHealth tools for diabetes.
Journal Article
Integration of Tobacco-Cessation Interventions into Tuberculosis and HIV Care
High rates of tobacco use throughout the world threaten to undermine gains in tuberculosis and HIV management achieved in recent decades.
Journal Article
A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models
Although attention deficit hyperactivity disorder (ADHD) has been associated with a broad range of deficits across various neuropsychological domains, most studies have assessed only a narrow range of neuropsychological functions. Direct cross-domain comparisons are rare, with almost all studies restricted to less than four domains. Therefore, the relationships between these various domains remain undefined. In addition, almost all studies included previously medicated participants, limiting the conclusions that can be drawn. We present the first study to compare a large cohort of medication-naive boys with ADHD with healthy controls on a broad battery of neuropsychological tasks, assessing six key domains of neuropsychological functioning.
The neuropsychological functioning of 83 medication-naive boys with well-characterized ADHD (mean age 8.9 years) was compared with that of 66 typically developing (TYP) boys (mean age 9.0 years) on a broad battery of validated neuropsychological tasks.
Data reduction using complementary factor analysis (CFA) confirmed six distinct neuropsychological domains: working memory, inhibition, delay aversion, decision making, timing and response variability. Boys with ADHD performed less well across all six domains although, for each domain, only a minority of boys with ADHD had a deficit [effect size (% with deficit) ADHD versus TYP: working memory 0.95 (30.1), inhibition 0.61 (22.9), delay aversion 0.82 (36.1), decision making 0.55 (20.5), timing 0.71 (31.3), response variability 0.37 (18.1)].
The clinical syndrome of ADHD is neuropsychologically heterogeneous. These data highlight the complexity of the relationships between the different neuropsychological profiles associated with ADHD and the clinical symptoms and functional impairment.
Journal Article
A mammalian nervous-system-specific plasma membrane proteasome complex that modulates neuronal function
A 20S proteasome complex localizes to neuronal plasma membrane, where it produces and releases extracellular peptides that induce neuronal calcium signaling.
In the nervous system, rapidly occurring processes such as neuronal transmission and calcium signaling are affected by short-term inhibition of proteasome function. It is unclear how proteasomes are able to acutely regulate such processes, as this action is inconsistent with their canonical role in proteostasis. Here we describe a mammalian nervous-system-specific membrane proteasome complex that directly and rapidly modulates neuronal function by degrading intracellular proteins into extracellular peptides that can stimulate neuronal signaling. This proteasome complex is closely associated with neuronal plasma membranes, exposed to the extracellular space, and catalytically active. Selective inhibition of the membrane proteasome complex by a cell-impermeable proteasome inhibitor blocked the production of extracellular peptides and attenuated neuronal-activity-induced calcium signaling. Moreover, we observed that membrane-proteasome-derived peptides were sufficient to induce neuronal calcium signaling. Our discoveries challenge the prevailing notion that proteasomes function primarily to maintain proteostasis, and highlight a form of neuronal communication that takes place through a membrane proteasome complex.
Journal Article
Reasons for non-acceptance of statin therapy by patients at high cardiovascular risk
Statins are a cornerstone of cardiovascular risk reduction. Nevertheless, non-acceptance of statin therapy recommendations by patients at high cardiovascular risk is common. The reasons for statin non-acceptance have not been well established. We conducted a manual record review of a randomly selected set of patients who did not accept statin therapy recommendations to identify (a) documented reasons for statin non-acceptance and (b) patients’ demographic characteristics, comorbidities and current treatment. We analyzed the relationships between patients’ characteristics and reasons for statin non-acceptance. The most common reasons for statin non-acceptance were preference for lifestyle modifications (51.5%), general aversion to medications (19.1%), polypharmacy burden (17.1%) and fear of adverse reactions (10.9%). Patients taking more medications were more likely to express a concern about polypharmacy burden (OR 1.09; 95% CI 1.005–1.18). Patients who previously had adverse reactions to non-cholesterol lowering medications were more likely to fear adverse reactions to statins (OR 1.13; 95% CI 1.001–1.28). Patients who expressed preference for lifestyle modifications had time to low density lipoprotein cholesterol (LDL-C) < 100 mg/dL similar to patients who did not accept statin therapy for other reasons (1935 vs. 1777 days,
p
= 0.26). Patients’ reasons for non-acceptance of statin therapy are often linked to their past and present medical experience. Appropriately addressing these concerns is important to maximizing cardiovascular risk reduction in individuals who may be reluctant to initiate statin therapy.
Journal Article
Factoring in ANGPTL3 When LDL Is Refractory
Patients with familial hypercholesterolemia, who have a severely increased low-density lipoprotein (LDL) cholesterol level from birth and are at high risk for premature cardiovascular disease, have inspired and contributed to major advances in lipid therapeutics. A notable example is the drug class targeting proprotein convertase subtilisin–kexin type 9 (PCSK9). Overactivity of PCSK9, which promotes LDL receptor degradation, was discovered to be a cause of familial hypercholesterolemia.
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The addition of a PCSK9 inhibitor to statin therapy can lower the LDL cholesterol level by 60% and reduce cardiovascular risk.
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Reduction of cardiovascular risk with PCSK9 inhibitors is correlated with absolute lowering of . . .
Journal Article
Smart wearable devices in cardiovascular care: where we are and how to move forward
Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical ‘ABCD’ guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.In this Review, Elshazly and colleagues summarize the basic engineering principles of common wearable sensors and discuss their broad applications in cardiovascular disease prevention, diagnosis and management.
Journal Article
Editorial policies for sex and gender analysis
According to the NIH, both \"sex and gender play a role in how health and disease processes differ among individuals, and consideration of these factors in research studies informs the development and testing of preventive and therapeutic interventions\".10-12 Publishers can work in concert with funders to secure these mandates and enhance reproducibility in science by providing clear guidance to editors and authors for the scientific reporting of sex and gender.
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