A NARRATIVE REVIEW OF FACTORS THAT CONTRIBUTE TO SUSTAINABILITY OF COMMUNITY-BASED FALL PREVENTION PROGRAMS

Falls are a significant problem for the geriatric population globally. As the population ages and elderly people continue to live longer with co-morbidites, they will continue to be at risk for falls. While several community-based fall prevention programs exist, they face chal lenges with sustainability. This paper is a narrative review of factors that contribute to the sustainability of community-based fall prevention programs as well as barriers to sustainabil ity. In total eight papers were included in this review. Findings from this review indicated that the following factors were keys to sustainability of community-based fall prevention pro grams: funding, external partnerships, external capacity/organization, program flexibility, community advertising and political support/policy change. The barriers that were identified in the research included funding/financial cost, frequently changing staff, lack of clear lead ership and lack of a mandate that addresses fall prevention. Findings from this review demonstrate that future research is necessary to further understand and implement best practices for sustaining community-based fall prevention programs for the geriatric population

Responses of sea urchin larvae to field and laboratory acidification

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Unexpected role of communities colonizing dead coral substrate in the calcification of coral reefs

Global and local anthropogenic stressors such as climate change, acidification, overfishing, and pollution are expected to shift the benthic community composition of coral reefs from dominance by calcifying organisms to dominance by non-calcifying algae. These changes could reduce the ability of coral reef ecosystems to maintain positive net calcium carbonate accretion. However, relationships between community composition and calcification rates remain unclear. We performed field experiments to quantify the metabolic rates of the two most dominant coral reef substrate types, live coral and dead coral substrate colonized by a mixed algal assemblage, using a novel underwater respirometer. Our results revealed that calcification rates in the daytime were similar for the live coral and dead coral substrate communities. However, in the dark, while live corals continued to calcify at slower rates, the dead coral substrate communities exhibited carbonate dissolution. Daytime net photosynthesis of the dead coral substrate communities was up to five times as much as for live corals, which we hypothesize may have created favorable conditions for the precipitation of carbonate minerals. We conclude that: (1) calcification from dead coral substrate communities can contribute to coral reef community calcification during the day, and (2) dead coral substrate communities can also contribute to carbonate mineral dissolution at night, decreasing ecosystem calcification over a diel cycle. This provides evidence that reefs could shift from slow, long-term accretion of calcium carbonate to a state where large daily cycling of calcium carbonate occurs, but with little or no long-term accumulation of the carbonate minerals needed to sustain the reef against erosional forces

Expected Limits on the Ocean Acidification Buffering Potential of a Temperate Seagrass Meadow

Ocean acidification threatens many marine organisms, especially marine calcifiers. The only global‐scale solution to ocean acidification remains rapid reduction in CO2 emissions. Nevertheless, interest in localized mitigation strategies has grown rapidly because of the recognized threat ocean acidification imposes on natural communities, including ones important to humans. Protection of seagrass meadows has been considered as a possible approach for localized mitigation of ocean acidification due to their large standing stocks of organic carbon and high productivity. Yet much work remains to constrain the magnitudes and timescales of potential buffering effects from seagrasses. We developed a biogeochemical box model to better understand the potential for a temperate seagrass meadow to locally mitigate the effects of ocean acidification. Then we parameterized the model using data from Tomales Bay, an inlet on the coast of California, USA which supports a major oyster farming industry. We conducted a series of month‐long model simulations to characterize processes that occur during summer and winter. We found that average pH in the seagrass meadows was typically within 0.04 units of the pH of the primary source waters into the meadow, although we did find occasional periods (hours) when seagrass metabolism may modify the pH by up to ±0.2 units. Tidal phasing relative to the diel cycle modulates localized pH buffering within the seagrass meadow such that maximum buffering occurs during periods of the year with midday low tides. Our model results suggest that seagrass metabolism in Tomales Bay would not provide long‐term ocean acidification mitigation. However, we emphasize that our model results may not hold in meadows where assumptions about depth‐averaged net production and seawater residence time within the seagrass meadow differ from our model assumptions. Our modeling approach provides a framework that is easily adaptable to other seagrass meadows in order to evaluate the extent of their individual buffering capacities. Regardless of their ability to buffer ocean acidification, seagrass meadows maintain many critically important ecosystem goods and services that will be increasingly important as humans increasingly affect coastal ecosystems

Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.

Aims:Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). Methods and results:A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% [confidence interval (CI): 64.8-67.6] of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT \u3e0.80 (43.8%, odds ratio 0.19, CI: 0.15-0.25, P \u3c 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT \u3e0.80 (n = 1529), whereas 19 (0.6%) MACE [hazard ratio (HR) 19.75, CI: 1.19-326, P = 0.0008] and 14 (0.3%) death/MI (HR 14.68, CI 0.88-246, P = 0.039) occurred in subjects with an FFRCT ≤0.80. Conclusions:In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days

Surgically implanted aortic valve bioprostheses deform after implantation: insights from computed tomography

Objective: Little is known about the prevalence and degree of deformation of surgically implanted aortic biological valve prostheses (bio-sAVRs). We assessed bio-sAVR deformation using multidetector-row computed tomography (MDCT). Methods: Three imaging databases were searched for patients with MDCT performed after bio-sAVR implantation. Minimal and maximal valve ring diameters were obtained in systole and/or diastole, depending on the acquired cardiac phase(s). The eccentricity index (EI) was calculated as a measure of deformation as (1 − (minimal diameter/maximal diameter)) × 100%. EI of 10% non-circular. Indications for MDCT and implanted valve type were retrieved. Results: One hundred fifty-two scans of bio-sAVRs were included. One hundred seventeen measurements were performed in systole and 35 in diastole. None or trivial deformation (EI 5%) in 56% of studied cases and were considered non-circular (eccentricity index > 10%) in 17% of studied valves. • The higher deformity rate found in bio-sAVRs with (suspected) valve pathology could suggest that geometric deformity may play a role in leaflet malformation and thrombus formation similar to that of transcatheter heart valves

Carbon Isotopic Fractionation in Organic Matter Production Consistent With Benthic Community Composition Across a Coral Reef Flat

Carbon fluxes on coral reefs (net community production and net community calcification) aggregate the collective activity of all coral reef community members. This integrated approach provides powerful community-level insights, but is unable to resolve the finer-scale contributions of different reef functional groups to the community-scale rates. Tools are required to disaggregate the community-scale approaches and evaluate the performance of co-existing reef functional groups. Such assessments are necessary to improve forecasts of coral reef responses to global and local environmental change. We present results from a coral reef field study on One Tree Island reef in the Great Barrier Reef, off northeastern Australia, in September-October 2016 where we combined observations of total alkalinity, dissolved inorganic carbon (DIC), and the stable isotopic composition of dissolved inorganic carbon (δ13CDIC) to estimate carbon isotopic fractionation during organic matter formation. Portions of the reef with greater abundance of non-calcifying algae fractionated DIC ~5‰ more (stronger preference for 12C) during organic metabolism than did portions of the reef with a greater abundance of calcifiers. These results were consistent across a wide range of assumed isotopic fractionation factors for net calcification. We attribute the observed differences in carbon isotopic fractionation to the metabolic activities of the ecological community underlying each section of the reef, rather than to environmental factors such as light availability or water temperature. The patterns in carbon isotopic fractionation were generally consistent with inferred ratios of calcification to primary production in each reef zone, giving further confidence to our inference that differences in carbon isotopic fractionation may be related to differences in the ecological community on small spatial scales

Preliminary Evaluation of Biplane Correlation (BCI) Stereographic Imaging for Lung Nodule Detection

A biplane correlation (BCI) imaging system obtains images that can be viewed in stereo, thereby minimizing overlapping structures. This study investigated whether using stereoscopic visualization provides superior lung nodule detection compared to standard postero-anterior (PA) image display. Images were acquired at two oblique views of ±3° as well as at a standard PA position from 60 patients. Images were processed using optimal parameters and displayed on a stereoscopic display. The PA image was viewed in the standard format, while the oblique views were paired to provide a stereoscopic view of the subject. A preliminary observer study was performed with four radiologists who viewed and scored the PA image then viewed and scored the BCI stereoscopic image. The BCI stereoscopic viewing of lung nodules resulted in 71 % sensitivity and 0.31 positive predictive value (PPV) index compared to PA results of 86 % sensitivity and 0.26 PPV index. The sensitivity for lung nodule detection with the BCI stereoscopic system was reduced by 15 %; however, the total number of false positives reported was reduced by 35 % resulting in an improved PPV index of 20 %. The preliminary results indicate observer dependency in terms of relative advantage of either system in the detection of lung nodules, but overall equivalency of the two methods with promising potential for BCI as an adjunct diagnostic technique

CAD-RADS™ 2.0 - 2022 Coronary Artery Disease – Reporting and Data System an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America society of cardiovascular imaging (NASCI)

Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care