UCLA Health

ABSTRACTObjectivesHeart failure is a leading cause of mortality, necessitating identification of patients at increased risk needing intervention. In this study, we investigated if Fitbit data can reveal physiological trends associated with hospital visit risk.Materials and methodsIndividuals with heart failure (n=249) were randomized into three arms for prospective 180-day monitoring. All arms received a Fit-bit and wireless weight scale. Arm 1 received devices only; Arm 2 received a mobile app with surveys; Arm 3 received the app plus financial incentives.Results51 participants had hospital visits during the study period. These individuals took fewer steps (p=.002) and reported increased symptom severity (p=.044). Resting heart rate increased three days prior to a visit (p=.022). Baseline steps revealed a higher visit probability for less active participants (p=.003).Discussion and conclusionPassive physiological monitoring can effectively identify individuals at risk of health exacerbation, demonstrating the potential of wearable devices for timely clinical intervention.

This study describes alcohol involvement in violent deaths using the National Violent Death Reporting System (NVDRS) from 2015 to 2022 in 24 states where at least 90% of decedent records had available alcohol assessment data. Using a repeated cross-sectional design, we construct a composite alcohol-involvement measure from toxicology results and NVDRS coder assessments and estimate negative binomial regression models with state-year demographic population counts as offsets to evaluate the roles of alcohol, firearms, and their intersection in violent deaths. The analytic sample included 204,739 decedents. Alcohol was present in roughly 27% of all violent deaths (27% in suicide and 25% in homicide deaths), with age- and sex-adjusted alcohol-involved mortality rates ranging from 1.6 per 100,000 in Virginia to 7.8 per 100,000 in North Dakota. Firearms and alcohol co-occurred in 19% of homicide and 14% of suicide deaths. Alcohol involvement was most common among men and younger adults (aged 20-39) with the highest rates observed for men aged 30-39 who died from suicide. There was a slight (6%) decrease in mean alcohol-involved violent death rates within a subsample of 18 states observed from 2016 to 2022, although Alaska saw a larger decrease (39%) and Oregon and Connecticut saw a near doubling of their alcohol-involved violent death rates over this period. These findings indicate that alcohol plays a substantial and complex role in violent deaths. This role differs between homicides and suicides, and varies by sex, age, state, year, and firearm involvement. Violence reduction efforts may benefit from interrupting the links between alcohol consumption and violent behaviors. Improved data collection and toxicology standardization across states would greatly enhance efforts to monitor and evaluate ongoing and future interventions.

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe and gets worse over time. People with COPD have damaged airways with swelling and increased mucus production. Ensifentrine is a novel agent that inhibits phosphodiesterase (PDE)3 and PDE4, two enzymes that affect airway muscles, inflammation, and mucus removal from the lungs. This summary of research provides an overview of a previously published article on the results from the phase3 ENHANCE trials, which studied the effect of ensifentrine in people with moderate to severe COPD who may have already been taking standard maintenance medications. Ensifentrine improved breathing, symptoms, and quality of life. It also reduced the rate and risk of flare-ups (called exacerbations) and was well tolerated. These results support the use of ensifentrine as an effective and well-tolerated treatment for people with COPD.

Predicting intracranial aneurysm growth remains difficult, with relatively few widely accepted predictors beyond aneurysm size, location, and patient age. This study investigated the relationship of vascular morphology and hemodynamics to aneurysm location and growth using a matched pairs study design that limited the influence of other predictors. Longitudinally followed ICA aneurysms identified as growing or stable were matched by size and location, based on their proximity to either the ophthalmic arteries, superior hypophyseal arteries, or posterior communicating arteries (PComA). The 34 aneurysms (17 pairs) were monitored with 3D CTA imaging for an average of 4.10 (1.98) years. Three longitudinal image studies for each aneurysm were collected and used to reconstruct models of arterial geometry. These models were used to analyze morphology and hemodynamics over time with computational fluid dynamics simulation. Results were analyzed with the Wilcoxon signed-rank test and longitudinal multivariate models were built with generalized estimating equations clustered according to each aneurysm. Higher average flow (P < .01) was observed at the aneurysm inlet and lower average pulsatility index at the outlet (P < .05) of aneurysms near the PComA. Over time, morphologic metrics related to size differed between paired aneurysms, but shape metrics did not. Pulsatility index at the aneurysm body and outlet differed between paired aneurysms (P < .01). Modeling identified correlates of aneurysm size including aneurysm flow and wall shear stress pulsatility index and generally demonstrated high correlation between different time points (0.94). The models showed a strong association between the attachment of the nearby artery to the aneurysm and growth. Significant differences in hemodynamics were observed between nearby aneurysm locations. Despite the relatively small sample size, longitudinally measured hemodynamics and general aneurysm morphology were significant correlates for aneurysm growth and size, as well as possible predictors of future aneurysm growth.

Cardiomyocyte mitochondria align with sarcomeres during heart development. Mitochondrial motility is controlled by RHOT (ras homolog family member T) 1 and RHOT2. RHOT1 and RHOT2 are atypical Rho-like small GTPases that are anchored to the outer mitochondrial membrane and couple mitochondria to kinesin and dynein motors. We hypothesized that RHOT protein expression and mitochondrial motility are required for mitochondrial positioning during cardiomyocyte development. We generated mice with cardiomyocyte-selective deletion of Rhot1 and Rhot2 during embryogenesis (cRhot1/2-KO [constitutive and embryonic cardiomyocyte-selective Rhot1/2 knockout]) or tamoxifen-inducible deletion in the adult heart (iRhot1/2-KO [inducible cardiomyocyte-selective Rhot1/2 knockout]) to assess the importance of mitochondrial motility during and after cardiomyocyte maturation. Mitochondrial motility was determined by a motor protein-driven single mitochondria motility assay. Respiratory capacity was measured in isolated mitochondria. Intracellular mitochondrial localization and ATP production in isolated cardiomyocytes were assessed by confocal microscopy and after adenoviral expression of the fluorescence resonance energy transfer-based ATP biosensor ATeam. Cardiac ultrastructure was assessed by electron micrographs; mass spectrometry was used for proteome analysis. cRhot1/2-KO mice developed fatal cardiomyopathy associated with sarcomere disarray and perinuclear accumulation of mitochondria and ATP production. Mitochondria isolated from cRhot1/2-KO hearts exhibited impaired motility but preserved respiratory capacity. Mechanistically, proteome analysis identified that RHOT proteins bind mitochondria to contractile muscle fiber proteins. In contrast, inducible deletion of Rhot1 and Rhot2 in adult iRhot1/2-KO mice did not result in heart failure. Despite impaired motility of isolated mitochondria, intracellular mitochondrial localization, local ATP production, and sarcomere structure were preserved in adult iRhot1/2-KO hearts after cardiomyocyte maturation. RHOT proteins bind mitochondria to contractile muscle fiber proteins and are required for mitochondrial positioning in cardiomyocytes during development. Our study links mitochondrial motility and local ATP production to structural and functional maturation of the heart.

Omega bands are mesoscale auroral structures that appear as eastward-moving poleward protrusions in the auroral oval. They typically appear in the post-midnight sector during periods of enhanced geomagnetic activity. Omega bands have been associated with Ps6 pulsations and rapidly time-varying magnetic fields on the ground, making them highly relevant to space weather forecasting. However, while the solar wind and magnetospheric drivers of omega bands have been previously studied, the characteristic signatures of omega band substorm events have not been identified.In this work, we compare solar wind, magnetospheric, and geomagnetic parameters measured during general substorm activity to the same parameters measured during 205 omega band events from 1997 to 2007 identified using the MIRACLE network. Non-omega substorm events are identified using spline fitting techniques to locate positive bays in the SuperMAG lower auroral electrojet index, and filtered to match the omega band substorm events in intensity. We use OMNI data to determine the solar wind drivers of these events and data from GOES and SuperMAG to identify magnetospheric and geomagnetic signatures of these events. This analysis will allow us to identify the unique solar wind drivers and magnetospheric configurations associated with omega band formation and improve our understanding of magnetosphere-ionosphere coupling dynamics during periods of enhanced geomagnetic activity.

Abstract Despite broad acceptance among economists, carbon taxes face persistent public resistance. We measure the sources and distribution of welfare losses from unexpected European carbon price changes by estimating their impact on consumer prices, labor income, financial wealth, and government transfers. A 1% carbon-policy-induced increase in energy prices leads to an average welfare loss of about 0.5% of a household’s three-year consumption, primarily driven by indirect labor-income effects. Younger, poorer, and less educated households, especially in Southern and Eastern Europe, bear a disproportionate burden. These findings suggest public opposition to carbon taxes could stem from legitimate distributional concerns.