The Addition of the Charlson Comorbidity Index to the GRACE Risk Prediction Index Improves Prediction of Outcomes in Acute Coronary Syndrome

Patients with cardiovascular disease have increased risk of poor outcomes when coexisting illnesses are present. Clinicians, administrators, and health services researchers utilize risk adjustment indices to stratify patients for various outcomes. The GRACE Risk Prediction Index (GRPI) was developed to risk stratify patients who experienced an acute coronary syndrome (ACS) event. GRPI does not account for the presence of comorbid conditions. The objective of this study was to compare the ability of the GRPI and the Charlson Comorbidity Index (CCI), used independently or combined, to predict mortality or secondary coronary events in patients admitted for ACS. Data were obtained from an academic health system's ACS registry. Outcomes included inpatient and 6-month postdischarge mortality and occurrence of secondary cardiovascular events or revascularization procedures. Logistic regression derived C statistics for CCI, GRPI, and CCI-GRPI predictive models for each outcome. Likelihood ratio tests determined the contribution of CCI when added to GRPI models. Complete data were available for 1202 patients. The GRPI model had the greatest C statistic when predicting inpatient mortality (0.73); the GRPI-CCI combined model C statistic was 0.81 when predicting death during the follow-up period; and C statistics for all 3 models were similar in predicting secondary events (0.57?0.60). The likelihood ratio analysis demonstrated that adding CCI to GRPI models was beneficial primarily for predicting secondary events. CCI is a useful addition to GRPI when predicting future cardiac-related events or mortality after an ACS event. It is an acceptable alternative to the GRPI model if data to construct GRPI are not available. (Population Health Management 2014;17:54?59)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140179/1/pop.2012.0117.pd

Raven Eye: A Mobile Computing Solution for Site Exploitation

Site exploitation (SE) remains a critical mission for operators on the battlefield.  Since SE is a fairly new operation in the military, soldiers face specific challenges that hinder them from conducting a successful SE operation.  This paper details the design of a system, Raven Eye, which endeavors to improve the efficiency and effectiveness of SE.  Raven Eye is an Android based system that collects, stores, and sends SE data.  Raven Eye allows operators to collect exploited site data by capturing photos, videos, and biometrics.  Operators can annotate and tag recorded items.  Lastly, the operators transform data stored and collected via Raven Eye to a standardized report that accelerates follow-on analysis by intelligence personnel. 

Work‐Related Outcomes After a Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90385/1/phco.24.16.1515.50946.pd

Mapping Geographic Areas of High and Low Drug Adherence in Patients Prescribed Continuing Treatment for Acute Coronary Syndrome After Discharge

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90283/1/phco.31.10.927.pd

Health‐Related Quality of Life in Patients 7 Months After a Myocardial Infarction: Factors Affecting the Short Form‐12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90293/1/phco.22.17.1616.34121.pd

Health Effects of Airborne Exposures from Concentrated Animal Feeding Operations

Toxic gases, vapors, and particles are emitted from concentrated animal feeding operations (CAFOs) into the general environment. These include ammonia, hydrogen sulfide, carbon dioxide, malodorous vapors, and particles contaminated with a wide range of microorganisms. Little is known about the health risks of exposure to these agents for people living in the surrounding areas. Malodor is one of the predominant concerns, and there is evidence that psychophysiologic changes may occur as a result of exposure to malodorous compounds. There is a paucity of data regarding community adverse health effects related to low-level gas and particulate emissions. Most information comes from studies among workers in CAFO installations. Research over the last decades has shown that microbial exposures, especially endotoxin exposure, are related to deleterious respiratory health effects, of which cross-shift lung function decline and accelerated decline over time are the most pronounced effects. Studies in naïve subjects and workers have shown respiratory inflammatory responses related to the microbial load. This working group, which was part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards—Searching for Solutions, concluded that there is a great need to evaluate health effects from exposures to the toxic gases, vapors, and particles emitted into the general environment by CAFOs. Research should focus not only on nuisance and odors but also on potential health effects from microbial exposures, concentrating on susceptible subgroups, especially asthmatic children and the elderly, since these exposures have been shown to be related to respiratory health effects among workers in CAFOs

Unconditional care in academic emergency departments

Recent news stories have explicitly stated that patients with symptoms of COVID-19 were "turned away" from emergency departments. This commentary addresses these serious allegations, with an attempt to provide the perspective of academic emergency departments (EDs) around the Nation. The overarching point we wish to make is that academic EDs never deny emergency care to any person

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

BACKGROUND: Right ventricular (RV) adaptation to acute and chronic pulmonary hypertensive syndromes is a significant determinant of short- and long-term outcomes. Although remarkable progress has been made in the understanding of RV function and failure since the meeting of the NIH Working Group on Cellular and Molecular Mechanisms of Right Heart Failure in 2005, significant gaps remain at many levels in the understanding of cellular and molecular mechanisms of RV responses to pressure and volume overload, in the validation of diagnostic modalities, and in the development of evidence-based therapies. METHODS: A multidisciplinary working group of 20 international experts from the American Thoracic Society Assemblies on Pulmonary Circulation and Critical Care, as well as external content experts, reviewed the literature, identified important knowledge gaps, and provided recommendations. RESULTS: This document reviews the knowledge in the field of RV failure, identifies and prioritizes the most pertinent research gaps, and provides a prioritized pathway for addressing these preclinical and clinical questions. The group identified knowledge gaps and research opportunities in three major topic areas: 1) optimizing the methodology to assess RV function in acute and chronic conditions in preclinical models, human studies, and clinical trials; 2) analyzing advanced RV hemodynamic parameters at rest and in response to exercise; and 3) deciphering the underlying molecular and pathogenic mechanisms of RV function and failure in diverse pulmonary hypertension syndromes. CONCLUSIONS: This statement provides a roadmap to further advance the state of knowledge, with the ultimate goal of developing RV-targeted therapies for patients with RV failure of any etiology

Smoke gets in your eyes: re-reading gender in the "nostalgia film"

Upon its release, American Graffiti (George Lucas, 1973) was much admired by critics and audiences alike. Yet, in subsequent years, the film became known for its supposed “flattening of history,” and celebration of patriarchal values. This article demonstrates that such a judgement owes much to Fredric Jameson’s historically contingent work on postmodernism, which argues that American Graffiti constitutes the paradigmatic nostalgia film. In contrast, using close textual analysis, I demonstrate that American Graffiti provides a more complex construction of the past, and of gender, than has hitherto been acknowledged. Far from blindly idealising the early 1960s, the film interrogates the processes through which the period and its gender relations come to be idealised. This article has consequences not only for our understanding of Lucas’ seminal film, but also for the American New Wave, and the “nostalgia” text

Recommendation of short tandem repeat profiling for authenticating human cell lines, stem cells, and tissues

Cell misidentification and cross-contamination have plagued biomedical research for as long as cells have been employed as research tools. Examples of misidentified cell lines continue to surface to this day. Efforts to eradicate the problem by raising awareness of the issue and by asking scientists voluntarily to take appropriate actions have not been successful. Unambiguous cell authentication is an essential step in the scientific process and should be an inherent consideration during peer review of papers submitted for publication or during review of grants submitted for funding. In order to facilitate proper identity testing, accurate, reliable, inexpensive, and standardized methods for authentication of cells and cell lines must be made available. To this end, an international team of scientists is, at this time, preparing a consensus standard on the authentication of human cells using short tandem repeat (STR) profiling. This standard, which will be submitted for review and approval as an American National Standard by the American National Standards Institute, will provide investigators guidance on the use of STR profiling for authenticating human cell lines. Such guidance will include methodological detail on the preparation of the DNA sample, the appropriate numbers and types of loci to be evaluated, and the interpretation and quality control of the results. Associated with the standard itself will be the establishment and maintenance of a public STR profile database under the auspices of the National Center for Biotechnology Information. The consensus standard is anticipated to be adopted by granting agencies and scientific journals as appropriate methodology for authenticating human cell lines, stem cells, and tissues