Calcified Plaques in Patients With Acute Coronary Syndromes

OBJECTIVES: This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS). BACKGROUND: Calcified plaques as an underlying pathology in patients with ACS have not been systematically studied. METHODS: From 1,241 patients presenting with ACS who had undergone pre-intervention optical coherence tomography imaging, 157 (12.7%) patients were found to have a calcified plaque at the culprit lesion. Calcified plaque was defined as a plaque with superficial calcification at the culprit site without evidence of ruptured lipid plaque. RESULTS: Three distinct types were identified: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion (prevalence of 25.5%, 67.4%, and 7.1%, respectively). Eruptive calcified nodules were frequently located in the right coronary arteries (44.4%), whereas superficial calcific sheet was most frequently found in the left anterior descending coronary arteries (68.4%) (p = 0.012). Calcification index (mean calcification arc × calcification length) was greatest in eruptive calcified nodules, followed by superficial calcific sheet, and smallest in calcified protrusion (median 3,284.9 [interquartile range (IQR): 2,113.3 to 5,385.3] vs. 1,644.3 [IQR: 1,012.4 to 3,058.7] vs. 472.5 [IQR: 176.7 to 865.2]; p < 0.001). The superficial calcific sheet group had the highest peak post-intervention creatine kinase values among the groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 241 [IQR: 116 to 612] IU/l vs. 834 [IQR: 141 to 3,394] IU/l vs. 745 [IQR: 69 to 1,984] IU/l; p = 0.032). CONCLUSIONS: Three distinct types of calcified culprit plaques are identified in patients with ACS. Superficial calcific sheet, which is frequently located in the left anterior descending coronary artery, is the most prevalent type and is also associated with greatest post-intervention myocardial damage. (Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome; NCT03479723).status: publishe

America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

Construction And Validation Of The Interest Development Scale

There is a need to be able to assess adult interest as a variable that can develop. In contrast to vocational interest measures in which interest is assessed as a stable, trait-like characteristic of a person, the Interest Development Scale (IDS) assesses interest as a cognitive and motivational variable that develops (Hidi & Renninger, 2006). Three studies are reported on the construction and validation of the IDS, a domain general assessment of adult interest development. In each, the participant group was drawn from the diverse Amazon Mechanical Turk (MTurk), and interest was not restricted to a specific domain. Using exploratory factor analysis and parallel analysis, we used Study 1 (n = 348) to identify items and underlying factors. These factors are information seeking, motivation to reengage, persistence, self-regulation, and value. Results from Study 2 (n = 515) confirmed the factor structure identified in Study 1 and examined convergent, discriminant, and concurrent validity of the items. Findings demonstrated that the IDS was a reliable and valid measure of domain-general interest for adults. In Study 3 (n = 103), results from mixed methods further revealed that the IDS differentiated between earlier and later phases of interest development. The factor motivation to reengage differentiated among the three phases studied, and the other 4 factors distinguished between earlier and later phases of interest

Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

Aims: The aim of the study was to compare retrospectively the acute mechanical performance of the Absorb vs. DESolve scaffolds in terms of appropriate deployment with OCT. Methods and results: Final post-deployment OCT pullbacks of consecutive patients treated with either Absorb or DESolve were reviewed. The following parameters were calculated and compared: mean and minimal lumen area (MLA), residual in-scaffold area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse area, eccentricity index, asymmetry index, strut fracture and edge dissection. A total of 72 patients were included. The Absorb group consisted of 35 patients treated with 63 Absorb scaffolds and was compared to a well-matched group of 37 patients treated with 50 DESolve scaffolds. Baseline characteristics did not differ significantly between the two groups. Procedural characteristics were different with respect to maximal balloon inflation pressure (Absorb vs. DESolve: 21.5 +/- 0.4 atm vs. 16.8 +/- 3.8 atm, p&lt; 0.01) and mean NC balloon diameter used for post-dilatation (Absorb vs. DESolve 3.3 +/- 0.4 mm vs. 3.5 +/- 0.4 mm, p&lt; 0.01). OCT analysis showed similar MLA (Absorb vs. DESolve: 5.8 +/- 1.9 mm(2) vs. 6.1 +/- 2.6 mm(2), p= 0.43) and mean luminal area (Absorb vs. DESolve: 7.1 +/- 2.2 mm(2) vs. 7.2 +/- 1.9 mm(2), p= 0.77). The mean eccentricity index was 0.85 +/- 0.05 with Absorb and 0.80 +/- 0.05 with DESolve, p&lt; 0.01. There was no difference in the incidence of overall ISA. A smaller prolapse area was found with Absorb (Absorb vs. DESolve 1.0 +/- 1.1 mm(2) vs. 3.6 +/- 6.2 mm(2), p&lt; 0.01). Conclusions: The two scaffolds showed similar MLA while there was a trend towards a lower RAS and a larger maximum and minimum scaffold diameter with DESolve. The DESolve scaffold was more eccentric as compared to the Absorb. These results might be related to the DESolve's unique expansion properties or they may reflect baseline and procedural differences which cannot be excluded in a retrospective study. Randomised studies are needed to address this aspect