ACTION

Abstract Background The current Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification does not include the systemic inflammatory response to risk stratify patients with cardiogenic shock. Purpose To evaluate the prognostic impact of the inflammatory response, on top of the SCAI shock classification, during cardiogenic shock using C-Reactive protein (CRP). Methods We analyzed CRP levels and SCAI shock classification in consecutive patients admitted for cardiogenic shock between January 2010 and December 2020, included in the ACTION-SHOCK registry of our tertiary center. Patients with ongoing sepsis or other extracardiac causes for elevated CRP were excluded. Using logistic regression method, we assessed both the association between CRP levels at admission and all-cause mortality at 90 days, and the value of the addition of baseline CRP level to SCAI stage of shock for the prediction of 90-day mortality. Results Among 755 patients admitted with cardiogenic shock (median age 61 years, interquartile range [IQR] 50-72, 27% of female), only 128 (17%) had normal values of CRP (< 5mg/L) at admission. Median CRP at admission was 19mg/l (IQR 6-55). There was an association between 90-day mortality and baseline CRP (Odds Ratio [OR] = 1.02, 95% Confidence Interval [95%CI] 1.01-1.03 per 5mg/L of CRP, p=0.004), still significant after adjustment on clinical and biological variables associated with 90-day mortality in univariate analysis, including the SCAI shock stage (adjusted OR 1.02, 95%CI 1.01 - 1.03 per 5 mg/L, p=0.042). The addition of CRP increased the accuracy of the SCAI shock stages for the prediction of 90-day mortality (Area under the Curve increased from 0.59, 95% CI 0.50 - 0.66 to 0.65, 95% CI 0.61 - 0.72). Interestingly, the association of CRP with mortality was driven by patients in SCAI shock classes A and B (figure). Conclusions CRP elevation was frequently observed in this population of patients with any cause of cardiogenic shock and was associated with 90-day mortality. This was particularly evident for patients in lower SCAI shock stages on admission.Figure 1

Offshore wind energy development (OWED), while a key strategy for reducing carbon emissions, has potential negative effects to wildlife that should be examined to inform decision making and adaptive management as the industry expands. We present a conceptual framework to guide the long-term study of potential effects to birds and bats from OWED. This framework includes a focus on exposure and vulnerability as key determinants of risk. For birds and bats that are exposed to OWED, there are three main effects of interest that may impact survival and productivity: 1) collision mortality, 2) behavioral responses, including avoidance, displacement, and attraction, and 3) habitat-mediated effects to prey populations. If these OWED effects cause changes in survival and/or breeding success (e.g., fitness), they have the potential for population-level consequences, including changes in population size and structure. Understanding the influence of ecological drivers on exposure and effect parameters can help to disentangle the potential impacts of OWED from other stressors. We use this theoretical framework to summarize existing relevant knowledge and identify current priority research questions (n=22) for the eastern United States, where large-scale development of OWED is primarily in the planning and early construction phase. We also identify recommendations for study design and further prioritization of research topics.

Learning networks have emerged in medicine as a novel organizational structure that contains elements of quality improvement, education, and research with the goal of effecting rapid improvements in clinical care. In this article, the concept of a learning network is defined and highlighted in the field of pediatric heart failure and transplantation. Learning networks are defined, with particular attention paid to the recent creation of the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) for children with heart failure and those being supported with ventricular assist devices (VAD). The mission, goals, and organizational structure of ACTION are described, and recent initiatives promoted by ACTION are highlighted, such as stroke reduction initiatives, practice harmonization protocols, and use of ACTION data to support the recent US Food and Drug Administration approval of newer VAD for pediatric patients. The learning network, exemplified by ACTION, is distinguished from traditional clinical research collaboratives by contributions in research, quality improvement, patient-reported outcomes, and education, and serves as an effective vehicle to drive clinical improvement in the care of children with advanced heart failure.

Social signal processing and virtual social interaction technologies have allowed the creation of social skills training applications, and initial studies have shown that such solutions can lead to positive training outcomes and could complement traditional teaching methods by providing cheap, accessible, safe tools for training social skills. However, these studies evaluated social skills training systems as a whole and it is unclear to what extent which components contributed to positive outcomes. In this paper, we describe an experimental study where we compared the relative efficacy of real-time interactive feedback and after-action feedback in the context of a public speaking training application. We observed that both components provide benefits to the overall training: the real-time interactive feedback made the experience more immersive and improved participants’ motivation in using the system, while the after-action feedback led to positive training outcomes when it contained personalized feedback elements. Taken in combination, these results confirm that both social signal processing technologies and virtual social interactions are both contributing to social skills training systems’ efficiency. Additionally, we observed that several individual factors, here the subjects’ initial level of public speaking anxiety, personality and tendency to immersion significantly influenced the training experience. This finding suggests that social skills training systems could benefit from being tailored to participants’ particular individual circumstances.

Coarse-grained molecular dynamics simulations of diamond nanoparticles were performed to investigate the effects of size polydispersity on three polyhedral shapes chosen to span a diverse space of surface interactions. It was found that the resulting self-assembly was size dependent as the simulations were quenched, with the largest nanoparticles providing a clustered scaffold for subsequent smaller nanoparticle assembly. Additionally, facet-facet interactions were dominated by the {111} surface and the resulting aggregate was dominated by meso-sized porosity for monodisperse systems, broadening to larger diameters for polydisperse systems.

Ecological psychology suggests the environment is experienced by perceivers in terms of their ability to behave within it-or their affordances. The authors used the remembered-affordance paradigm to evaluate this claim in contrast to an additive model that combined lower-order, action-neutral, perceived properties of the perceiver and environment to compute an affordance. In 2 experiments, participants reported the boundary between actions that were or were not possible (overhead reaching in Experiments 1a and 1b, and minimum aperture pass-through-ability in Experiment 2) while using or not using an implement (a stick). They also reported the length of the implement independent of its use in any action. Reports of stick length were consistently different from action-relevant affordance reports, and the additive model was incapable of accounting for participants' affordance reports. The results are consistent with ecological psychology's claim that affordances are perceived directly and also with embodied and functional approaches to memory, which suggest that the environment is experienced in task-specific and action-relevant terms.

Ascorbic acid is a potent antioxidant that detoxifies reactive oxygen species when plants are exposed to unfavorable environmental conditions. In addition to its antioxidant properties, ascorbic acid and its biosynthetic precursors fulfill a variety of other physiological and molecular functions. A mutation in the ascorbic acid biosynthesis gene VTC1, which encodes GDP-mannose pyrophosphorylase, results in conditional root growth inhibition in the presence of ammonium. To isolate suppressors of vtc1-1, which is in the Arabidopsis Columbia-0 background, seeds of the mutant were subjected to ethyl methanesulfonate mutagenesis. A suppressor mutant of vtc1-1 2, svt2, with wild-type levels of ascorbic acid and root growth similar to the wild type in the presence of ammonium was isolated. Interestingly, svt2 has Arabidopsis Landsberg erecta features, although svt2 is delayed in flowering and has an enlarged morphology. Moreover, the svt2 genotype shares similarities with Ler polymorphism markers and sequences, despite the fact that the mutant derived from mutagenesis of Col-0 vtc1-1 seed. We provide evidence that svt2 is not an artifact of the experiment, a contamination of Ler seed, or a result of outcrossing of the svt2 mutant with Ler pollen. Instead, our results show that svt2 exhibits transgenerational genotypic and phenotypic instability, which is manifested in a fraction of svt2 progeny, producing revertants that have Col-like phenotypic and genotypic characteristics. Some of those Col-like revertants then revert back to svt2-like plants in the subsequent generation. Our findings have important implications for undiscovered phenomena in transmitting genetic information in addition to the Mendelian laws of inheritance. Our results suggest