Prevalence, Correlates, and Inter-hospital Variation of Early Outpatient Follow-up After Acute Myocardial Infarction

Computational Infrastructure and Informatics Poster SessionBackground: Early outpatient follow-up (EFU) after acute myocardial infarction (AMI) is strongly endorsed in guidelines and has been emphasized nationally as a means to improve transitions of care, medication adherence and outcomes. Currently, little is known about associations between patient characteristics and EFU or the variability in EFU across different hospitals. Methods: We compared patients with and without EFU within 1-month of discharge in the 24-center TRIUMPH registry of AMI patients. We excluded patients who died or did not complete 1-month follow-up. Since the 1-month follow-up interview occurred 4 weeks from enrollment at the time of hospital admission, we also excluded patients with long hospital stays (≥ 7 days) since these patients had less outpatient exposure time for follow-up. We used multivariable Poisson regression to identify the independent association between patient characteristics and site with EFU. Results: Of 2484 patients, 76% had EFU within 1 month of discharge. There was marked variation in the rate of EFU between hospitals (54% to 100%; Figure). Site differences remained significant after adjustment for patient characteristics. The independent patient-level correlates of achieved EFU were health insurance (RR 1.15, 95% CI 1.06-1.25) and African American race (RR 1.08, 95% CI 1.02-1.15). Other sociodemographic characteristics, co-morbidities, clinical factors, and discharge documentation of follow-up arrangements were not indpendent predictors of EFU. Conclusion: Almost 1 in 4 patients enrolled in TRIUMPH did not receive EFU after AMI. The rate of EFU varies substantially across hospitals and is related to insurance status. The lack of association between EFU and discharge documentation of follow-up arrangements suggests achieved follow-up may be a superior quality indicator. Further characterization of the approach for providing EFU is warranted

Radioactive Holmium Acetylacetonate Microspheres for Interstitial Microbrachytherapy: An In Vitro and In Vivo Stability Study

Purpose The clinical application of holmium acetylacetonate microspheres (HoAcAcMS) for the intratumoral radionuclide treatment of solid malignancies requires a thorough understanding of their stability. Therefore, an in vitro and an in vivo stability study with HoAcAcMS was conducted. Methods HoAcAcMS, before and after neutron irradiation, were incubated in a phosphate buffer at 37°C for 6 months. The in vitro release of holmium in this buffer after 6 months was 0.5%. Elemental analysis, scanning electron microscopy, infrared spectroscopy and time of flight secondary ion mass spectrometry were performed on the HoAcAcMS. Results After 4 days in buffer the acetylacetonate ligands were replaced by phosphate, without altering the particle size and surface morphology. HoAcAcMS before and after neutron irradiation were administered intratumorally in VX2 tumor-bearing rabbits. No holmium was detected in the faeces, urine, femur and blood. Histological examination of the tumor revealed clusters of intact microspheres amidst necrotic tissue after 30 days. Conclusion HoAcAcMS are stable both in vitro and in vivo and are suitable for intratumoral radionuclide treatment.Radiation, Radionuclides and ReactorsApplied Science

Contrasting Alloreactive CD4 + and CD8 + T Cells: There's More to It Than MHC Restriction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73698/1/j.1600-6143.2003.00036.x.pd

Demonstration of surface electron rejection with interleaved germanium detectors for dark matter searches

The following article appeared in Applied Physics Letters 103.16 (2013): 164105 and may be found at http://scitation.aip.org/content/aip/journal/apl/100/26/10.1063/1.4729825The SuperCDMS experiment in the Soudan Underground Laboratory searches for dark matter with a 9-kg array of cryogenic germanium detectors. Symmetric sensors on opposite sides measure both charge and phonons from each particle interaction, providing excellent discrimination between electron and nuclear recoils, and between surface and interior events. Surface event rejection capabilities were tested with two 210 Pb sources producing ∼130 beta decays/hr. In ∼800 live hours, no events leaked into the 8–115 keV signal region, giving upper limit leakage fraction 1.7 × 10−5 at 90% C.L., corresponding to < 0.6 surface event background in the future 200-kg SuperCDMS SNOLAB experiment.This work is supported in part by the National Science Foundation (Grant Nos. AST-9978911, NSF-0847342, PHY-1102795,NSF-1151869, PHY-0542066, PHY-0503729, PHY-0503629, PHY-0503641, PHY-0504224, PHY-0705052,PHY-0801708, PHY-0801712, PHY-0802575, PHY-0847342, PHY-0855299, PHY-0855525, and PHY-1205898), by the Department of Energy (Contract Nos. DE-AC03-76SF00098, DE-FG02-92ER40701, DE-FG02-94ER40823,DE-FG03-90ER40569, DE-FG03-91ER40618, and DESC0004022),by NSERC Canada (Grant Nos. SAPIN 341314 and SAPPJ 386399), and by MULTIDARK CSD2009-00064 and FPA2012-34694. Fermilab is operated by Fermi Research Alliance, LLC under Contract No. De-AC02-07CH11359, while SLAC is operated under Contract No. DE-AC02-76SF00515 with the United States Department of Energy

Speech Communication

Contains table of contents for Part IV, table of contents for Section 1 and reports on five research projects.Apple Computer, Inc.C.J. Lebel FellowshipNational Institutes of Health (Grant T32-NS07040)National Institutes of Health (Grant R01-NS04332)National Institutes of Health (Grant R01-NS21183)National Institutes of Health (Grant P01-NS23734)U.S. Navy / Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Office of Naval Research (Contract N00014-82-K-0727

Cardiac rehabilitation may not provide a quality of life benefit in coronary artery disease patients

Extent: 9p.Background: Improvements in patient-reported health-related quality of life (HRQoL) are important goals of cardiac rehabilitation (CR). In patients undergoing coronary angiography for angina and with documented coronary artery disease (CAD), the present study compared HRQoL over 6 months in CR participants and non-participants. Clinical predictors of CR participants were also assessed. Methods: A total of 221 consecutive patients undergoing angiography for angina with documented CAD and who were eligible for a CR program were recruited. CR participants were enrolled in a six-week Phase II outpatient CR course (31%, n = 68) within 2 months following angiography and the non-participants were included as a control. At baseline (angiography), one and six months post angiography, clinical and HRQoL data were obtained including the Short Form-36 (SF-36) and the Seattle Angina Questionnaire (SAQ). The response rate for the HRQoL assessment was 68% (n = 150). Cross sectional comparisons were age-adjusted and performed using logistic or linear regression as appropriate. Longitudinal changes in HRQoL were assessed using least squares regression. Finally, a multiple logistic regression was fitted with CR participant as the final outcome. Results: At angiography, the CR non-participants were older, and age-adjusted analyses revealed poorer physical (angina limitation: 54 ± 25 versus 64 ± 22, p <0.05) and mental HRQoL (significant psycho-social distress: 62%, n = 95 versus 47%, n = 32, p <0.05) compared to the CR participants. In addition, the CR participants were more likely to have undergone angiography for myocardial infarction (OR = 2.8, 95% CI 1.5-5.3, p = 0.001). By six months, all patients showed an improvement in HRQoL indices, however the rate of improvement did not differ between the controls and CR participants. Conclusion: Following angiography, CAD patients reported improvements in both generic and disease-specific HRQoL, however CR participation did not influence this outcome. This may be explained by biases in CR enrollment, whereby acute patients, who may be less limited in HRQoL compared to stable, chronic patients, are targeted for CR participation. Further investigation is required so CR programs maximize the quality of life benefits to all potential CR patients.Rosanna Tavella and John F Beltram

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Research achievements in plant resistance to insect pests of cool season food legumes

Plant resistance to at least 17 field and storage insect pests of cool season food legumes has been identified. For the most part, this resistance was located in the primary gene pools of grain legumes via conventional laboratory, greenhouse, and field screening methods. The use of analytical techniques (i.e., capillary gas chromatography) to characterize plant chemicals that mediate the host selection behavior of pest insects offers promise as a new, more rapid way to differentiate between insect-resistant and susceptible plant material. Examples of research achievements in mechanisms of resistance and host-plant resistance within the context of integrated control programs are discussed. Accelerating the development and subsequent releases of insect-resistant cultivars to pulse farmers requires more involvement from interdisciplinary teams of plant breeders, entomologists, plant pathologists, plant chemists, molecular biologists, and other scientist

How people domesticated Amazonian forests

For millennia, Amazonian peoples have managed forest resources, modifying the natural environment in subtle and persistent ways. Legacies of past human occupation are striking near archaeological sites, yet we still lack a clear picture of how human management practices resulted in the domestication of Amazonian forests. The general view is that domesticated forests are recognizable by the presence of forest patches dominated by one or a few useful species favored by long-term human activities. Here, we used three complementary approaches to understand the long-term domestication of Amazonian forests. First, we compiled information from the literature about how indigenous and traditional Amazonian peoples manage forest resources to promote useful plant species that are mainly used as food resources. Then, we developed an interdisciplinary conceptual model of how interactions between these management practices across space and time may form domesticated forests. Finally, we collected field data from 30 contemporary villages located on and near archaeological sites, along four major Amazonian rivers, to compare with the management practices synthesized in our conceptual model. We identified eight distinct categories of management practices that contribute to form forest patches of useful plants: (1) removal of non-useful plants, (2) protection of useful plants, (3) attraction of non-human animal dispersers, (4) transportation of useful plants, (5) selection of phenotypes, (6) fire management, (7) planting of useful plants, and (8) soil improvement. Our conceptual model, when ethnographically projected into the past, reveals how the interaction of these multiple management practices interferes with natural ecological processes, resulting in the domestication of Amazonian forest patches dominated by useful species. Our model suggests that management practices became more frequent as human population increased during the Holocene. In the field, we found that useful perennial plants occur in multi-species patches around archaeological sites, and that the dominant species are still managed by local people, suggesting long-term persistence of ancient cultural practices. The management practices we identified have transformed plant species abundance and floristic composition through the creation of diverse forest patches rich in edible perennial plants that enhanced food production and food security in Amazonia. © 2018 Levis, Flores, Moreira, Luize, Alves, Franco-Moraes, Lins, Konings, Peña-Claros, Bongers, Costa and Clement

Tracking bed bugs (Cimex lectularius): a study of the effect of physiological and extrinsic factors on the response to bed bug-derived volatiles.

The common bed bug, Cimex lectularius, feeds on the blood of mammal and bird hosts, and is a pest of global importance. Semiochemicals are chemicals involved in animal communication that may affect behaviour and/or physiology. Attractive semiochemicals that play a role in mediating bed bug behaviour could be exploited for the development of a highly effective novel monitoring device. Tracking software was used to record the response of bed bugs to volatiles from paper previously exposed to conspecific bugs in a still-air olfactometer illuminated by infrared lights, through a variety of activity variables. The effect of time of day as an extrinsic factor, and sex, stage, mating status and nutritional status as physiological factors on the response of bed bugs to the volatiles was examined. Bed bugs of both sexes and all stages responded to the volatiles from bed bug-exposed papers, showing significant attraction and orientation towards the volatile source whether they were starved or engorged. Confirmation that the physiological factors examined do not affect the response of bed bugs to the volatiles from bed bug-exposed papers provides evidence that these bed bug-derived volatiles contain aggregation cues, as semiochemicals that promote aggregation should by definition be detected by both sexes and all life stages. A device baited with such semiochemicals could play a major role in limiting the impact of the current bed bug resurgence by enabling timely detection of infestations, along with quantitative evaluation of control and effective surveillance of the geographical distribution of the pest species