Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter-Defibrillators in the Cardiovascular Research Network

BACKGROUND: Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems. METHODS AND RESULTS: We linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry. Survival analysis evaluated therapy probability and predictors after ICD implant from 2006 to 2009, with attention to Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups: left ventricular ejection fraction, 31% to 35%; nonischemic cardiomyopathy \u3c 9 months\u27 duration; and New York Heart Association class IV heart failure with cardiac resynchronization therapy defibrillator. Among 2540 patients, 35% were \u3c 65 years old, 26% were women, and 59% were white. During 27 (median) months, 738 (29%) received \u3e /=1 therapy. Three-year therapy risk was 36% (appropriate, 24%; inappropriate, 12%). Appropriate therapy was more common in men (adjusted hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.43-2.35). Inappropriate therapy was more common in patients with atrial fibrillation (adjusted HR, 2.20; 95% CI, 1.68-2.87), but less common among patients \u3e /=65 years old versus younger (adjusted HR, 0.72; 95% CI, 0.54-0.95) and in recent implants (eg, in 2009 versus 2006; adjusted HR, 0.66; 95% CI, 0.46-0.95). In Centers for Medicare and Medicaid Services Coverage With Evidence Development analysis, inappropriate therapy was less common with cardiac resynchronization therapy defibrillator versus single chamber (adjusted HR, 0.55; 95% CI, 0.36-0.84); therapy risk did not otherwise differ for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups. CONCLUSIONS: In this community cohort of primary prevention patients receiving ICD, therapy delivery varied across demographic and clinical characteristics, but did not differ meaningfully for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups

White-tailed deer are susceptible to the agent of sheep scrapie by intracerebral inoculation

Interspecies transmission studies afford the opportunity to better understand the potential host range and origins of prion diseases. The purpose of this experiment was to determine susceptibility of white-tailed deer to the agent of scrapie after intracerebral inoculation and to compare clinical signs and lesions to those reported for chronic wasting disease (CWD). Deer (n = 5) were inoculated with 1 mL of a 10% (wt/vol) brain homogenate derived from a sheep clinically affected with scrapie. A non-inoculated deer was maintained as a negative control. Deer were observed daily for clinical signs of disease and euthanized and necropsied when unequivocal signs of scrapie were noted. One animal died 7 months post inoculation (pi) due to intercurrent disease. Examinations of brain tissue for the presence of the disease-associated abnormal prion protein (PrPSc) by western blot (WB) and immunohistochemistry (IHC) were negative whereas IHC of lymphoid tissues was positive. Deer necropsied at 15-22 months pi were positive for scrapie by IHC and WB. Deer necropsied after 20 months pi had clinical signs of depression and progressive weight loss. Tissues with PrPSc immunoreactivity included brain (at levels of cerebrum, hippocampus, colliculus, cerebellum, and brainstem), trigeminal ganglion, neurohypophysis, retina, spinal cord, and various lymphoid tissues including tonsil, retropharyngeal and mesenteric lymph nodes, Peyer's patches, and spleen. This work demonstrates for the first time that white-tailed deer are susceptible to sheep scrapie by intracerebral inoculation. To further test the susceptibility of white-tailed deer to scrapie these experiments will be repeated with a more natural route of inoculation

Oral health beliefs and oral hygiene behaviours among parents of urban Alaska Native children

American Indian/Alaska Native (AI/AN) children have a prevalence rate of early childhood caries 5 times that of the overall US population. Oral hygiene and oral health beliefs have not been described among AI/AN parents. This study explored constructs of the health belief model informing oral health beliefs and oral hygiene behaviours of parents of AI/AN children ages 0-6 years. The study aimed to determine the toothbrushing behaviour in parents of AI/AN childrenand the relationship between parent oral health beliefs and toothbrushing frequency. A cross-sectional survey which included the Oral Hygiene Scale, Oral Health Belief Questionnaire and the Early Childhood Oral Health Impact Scale was administered to a convenience sample of parents of AI/AN children 71 months or younger attending outpatient paediatric primary care appointments (N=100). Analyses were conducted to determine parent toothbrushing and the relationship between parent health beliefs and child toothbrushing. The odds of regular child toothbrushing were 49.10 times higher when the parent brushed their own teeth regularly (confidence interval (CI)=11.46–188.14; p\u3c0.001). Parental toothbrushing had a strong positive association with the belief that oral health is as important as physical health. This research endorses parent-focused toothbrushing interventions to reduce AI/AN early childhood caries rates

The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Oral health beliefs and oral hygiene behaviours among parents of urban Alaska Native children

American Indialaska Native (AI/AN) children have a prevalence rate of early childhood caries 5 times that of the overall US population. Oral hygiene and oral health beliefs have not been described among AI/AN parents. This study explored constructs of the health belief model informing oral health beliefs and oral hygiene behaviours of parents of AI/AN children ages 0-6 years. The study aimed to determine the toothbrushing behaviour in parents of AI/AN childrenand the relationship between parent oral health beliefs and toothbrushing frequency. A cross-sectional survey which included the Oral Hygiene Scale, Oral Health Belief Questionnaire and the Early Childhood Oral Health Impact Scale was administered to a convenience sample of parents of AI/AN children 71 months or younger attending outpatient paediatric primary care appointments (N=100). Analyses were conducted to determine parent toothbrushing and the relationship between parent health beliefs and child toothbrushing. The odds of regular child toothbrushing were 49.10 times higher when the parent brushed their own teeth regularly (confidence interval (CI)=11.46–188.14; p\u3c0.001). Parental toothbrushing had a strong positive association with the belief that oral health is as important as physical health. This research endorses parent-focused toothbrushing interventions to reduce AI/AN early childhood caries rates

Ecological Role of Blue Catfish in Chesapeake Bay Communities and Implications for Management

Rapid increase in abundance and expanded distribution of introduced blue catfish Ictalurus furcatus populations in the Chesapeake Bay watershed have raised regional management concerns. This study uses information from multiple surveys to examine expansion of blue catfish populations and document their role in tidal river communities. Originally stocked in the James, York, and Rappahannock River systems for development of commercial and recreational fisheries, blue catfish have now been documented in adjacent rivers and have expanded their within-river distribution to oligo- and mesohaline environments. Range expansions coincided with periods of peak abundance in 1996 and 2003 and with the concurrent decline in abundance of native white catfish I. catus. Blue catfish in these systems use a diverse prey base; various amphipod species typically dominate the diet of smaller individuals ([FL]), and fishes are common prey for larger blue catfish (\u3e300 mm FL). Recent studies based on stable isotope analyses suggest that adult blue catfish in these systems are apex predators that feed extensively on important fishery resources, including anadromous shads and herrings Alosa spp. and juvenile Atlantic menhaden Brevoortia tyrannus. Minimizing effects on Chesapeake Bay communities by controlling high densities of blue catfish populations is a primary goal of management, but conflicting demands of the commercial and recreational sectors must be resolved. Further, low market demand and human consumption concerns associated with purported accumulation of contaminants in blue catfish pose additional complications for regulating these fisheries.https://scholarworks.wm.edu/vimsbooks/1009/thumbnail.jp

Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter-Defibrillators in the Cardiovascular Research Network

BACKGROUND: Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems. METHODS AND RESULTS: We linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry. Survival analysis evaluated therapy probability and predictors after ICD implant from 2006 to 2009, with attention to Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups: left ventricular ejection fraction, 31% to 35%; nonischemic cardiomyopathy \u3c9 \u3emonths\u27 duration; and New York Heart Association class IV heart failure with cardiac resynchronization therapy defibrillator. Among 2540 patients, 35% wereold, 26% were women, and 59% were white. During 27 (median) months, 738 (29%) received ≥1 therapy. Three-year therapy risk was 36% (appropriate, 24%; inappropriate, 12%). Appropriate therapy was more common in men (adjusted hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.43-2.35). Inappropriate therapy was more common in patients with atrial fibrillation (adjusted HR, 2.20; 95% CI, 1.68-2.87), but less common among patients ≥65 years old versus younger (adjusted HR, 0.72; 95% CI, 0.54-0.95) and in recent implants (eg, in 2009 versus 2006; adjusted HR, 0.66; 95% CI, 0.46-0.95). In Centers for Medicare and Medicaid Services Coverage With Evidence Development analysis, inappropriate therapy was less common with cardiac resynchronization therapy defibrillator versus single chamber (adjusted HR, 0.55; 95% CI, 0.36-0.84); therapy risk did not otherwise differ for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups. CONCLUSIONS: In this community cohort of primary prevention patients receiving ICD, therapy delivery varied across demographic and clinical characteristics, but did not differ meaningfully for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups