Hemodynamic Classifications of Aortic Stenosis and Relevance to Prognosis

Hemodynamic classifications of aortic valve stenosis (AS) have important prognostic implications. In normal flow state, severe AS is defined as peak aortic velocity ≥ 4.0 m/s, mean transaortic gradient (MG) ≥ 40 mmHg, and aortic valve area (AVA) < 1.0 cm2. However, numerous studies have shown that severe AS (based on AVA < 1.0 cm2) with low gradient (MG < 40 mmHg) is prevalent due to low flow state, in the setting of reduced and preserved left ventricular ejection fraction (LVEF). Thus, the hemodynamic classifications of AS with AVA < 1.0 cm2 were expanded to include the transvalvular flow state and pressure gradients. These flow-gradient patterns include normal flow/very high gradient, normal flow/high gradient, low flow/high gradient, low flow/low gradient with reduced LVEF, low flow/low gradient with preserved LVEF, and normal flow/low gradient. Among these, the low-gradient AS subgroups are challenging, particularly to differentiate true-severe AS (where aortic valve replacement is necessary) and pseudo-severe AS (where conservative management is recommended). Additional diagnostic studies such as dobutamine stress echocardiography and/or cardiac computed tomography, as well as other parameters such as projected AVA and/or valvuloarterial impedance may be helpful. This chapter will review diagnostic approaches and prognostic implications of different AS subtypes

A Contextual Approach to Social Skills Assessment in the Peer Group: Who Is the Best Judge?

Using a contextual approach to social skills assessment in the peer group, this study examined the criterion- related validity of contextually relevant social skills and the incremental validity of peers and teachers as judges of children’s social skills. Study participants included 342 (180 male and 162 female) students and their classroom teachers (N = 22) from rural communities. As expected, contextually relevant social skills were significantly related to a variety of social status indicators (i.e., likability, peer- and teacher-assessed popularity, reciprocated friendships, clique centrality) and positive school functioning (i.e., school liking and academic competence). Peer-assessed social skills, not teacher-assessed social skills, demonstrated consistent incremental validity in predicting various indicators of social status outcomes; peer- and teacher-assessed social skills alike showed incremental validity in predicting positive school functioning. The relation between contextually relevant social skills and study outcomes did not vary by child gender. Findings are discussed in terms of the significance of peers in the assessment of children’s social skills in the peer group as well as the usefulness of a contextual approach to social skills assessment

A Contextual Approach to Social Skills Assessment in the Peer Group: Who Is the Best Judge?

Using a contextual approach to social skills assessment in the peer group, this study examined the criterion- related validity of contextually relevant social skills and the incremental validity of peers and teachers as judges of children’s social skills. Study participants included 342 (180 male and 162 female) students and their classroom teachers (N = 22) from rural communities. As expected, contextually relevant social skills were significantly related to a variety of social status indicators (i.e., likability, peer- and teacher-assessed popularity, reciprocated friendships, clique centrality) and positive school functioning (i.e., school liking and academic competence). Peer-assessed social skills, not teacher-assessed social skills, demonstrated consistent incremental validity in predicting various indicators of social status outcomes; peer- and teacher-assessed social skills alike showed incremental validity in predicting positive school functioning. The relation between contextually relevant social skills and study outcomes did not vary by child gender. Findings are discussed in terms of the significance of peers in the assessment of children’s social skills in the peer group as well as the usefulness of a contextual approach to social skills assessment

Two distinct modes of climate responses to the anthropogenic aerosol forcing changes

Author Posting. © American Meteorological Society, 2022. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Climate 35(11), (2022): 3445-3457, https://doi.org/10.1175/jcli-d-21-0656.1.Unlike greenhouse gases (GHGs), anthropogenic aerosol (AA) concentrations have increased and then decreased over the past century or so, with the timing of the peak concentration varying in different regions. To date, it has been challenging to separate the climate impact of AAs from that due to GHGs and background internal variability. We use a pattern recognition method, taking advantage of spatiotemporal covariance information, to isolate the forced patterns for the surface ocean and associated atmospheric variables from the all-but-one forcing Community Earth System Model ensembles. We find that the aerosol-forced responses are dominated by two leading modes, with one associated with the historical increase and future decrease of global mean aerosol concentrations (dominated by the Northern Hemisphere sources) and the other due to the transition of the primary sources of AA from the west to the east and also from Northern Hemisphere extratropical regions to tropical regions. In particular, the aerosol transition effect, to some extent compensating the global mean effect, exhibits a zonal asymmetry in the surface temperature and salinity responses. We also show that this transition effect dominates the total AA effect during recent decades, e.g., 1967–2007.All three authors are supported by U.S. National Science Foundation (OCE-2048336). The Community Earth System Model project is supported primarily by the National Science Foundation (https://www.cesm.ucar.edu/projects/community-projects/LENS/data-sets.html and https://www.cesm.ucar.edu/working_groups/CVC/simulations/cesm1-single_forcing_le.html)

The impact of weight misperception on health-related quality of life in Korean adults (KNHANES 2007–2014): a community-based cross-sectional study

Weight perception, especially misperception, might affect health-related quality of life (HRQoL); however, related research is scarce and results remain equivocal. We examined the association between HRQoL and weight misperception by comparing obesity level as measured by body mass index (BMI) and weight perception in Korean adults

The fate of North Atlantic Subtropical Mode Water in the FLAME model

Author Posting. © American Meteorological Society, 2014. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 44 (2014): 1354–1371, doi:10.1175/JPO-D-13-0202.1.North Atlantic Subtropical Mode Water, also known as Eighteen Degree Water (EDW), has the potential to store heat anomalies through its seasonal cycle: the water mass is in contact with the atmosphere in winter, isolated from the surface for the rest of the year, and reexposed the following winter. Though there has been recent progress in understanding EDW formation processes, an understanding of the fate of EDW following formation remains nascent. Here, particles are launched within the EDW of an eddy-resolving model, and their fate is tracked as they move away from the formation region. Particles in EDW have an average residence time of ~10 months, they follow the large-scale circulation around the subtropical gyre, and stratification is the dominant criteria governing the exit of particles from EDW. After sinking into the layers beneath EDW, particles are eventually exported to the subpolar gyre. The spreading of particles is consistent with the large-scale potential vorticity field, and there are signs of a possible eddy-driven mean flow in the southern portion of the EDW domain. The authors also show that property anomalies along particle trajectories have an average integral time scale of ~3 months for particles that are in EDW and ~2 months for particles out of EDW. Finally, it is shown that the EDW turnover time for the model in an Eulerian frame (~3 yr) is consistent with the turnover time computed from the Lagrangian particles provided that the effects of exchange between EDW and the surrounding waters are included.The authors are thankful for financial support from the U.S. National Science Foundation for S. F. G., M. S. L., Y.-O. K., and J. J. P.2014-11-0

Year-to-year reoutcropping of Eighteen Degree Water in an eddy-resolving ocean simulation

Author Posting. © American Meteorological Society, 2015. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 45 (2015):1189–1204, doi:10.1175/JPO-D-14-0122.1.Winter outcropping of the Eighteen Degree Water (EDW) and its subsequent dispersion are studied using a ° eddy-resolving simulation of the Family of Linked Atlantic Modeling Experiments (FLAME). Outcropped EDW columns in the model simulations are detected in each winter from 1990 to 1999, and particles are deployed in the center of each outcropped EDW column. Subsequently, the trajectories of these particles are calculated for the following 5 yr. The particles slowly spread away from the outcropping region into the nonoutcropping/subducted EDW region south of ~30°N and eventually to the non-EDW region in the greater subtropical gyre. Approximately 30% of the particles are found in non-EDW waters 1 yr after deployment; after 5 yr, only 25% of the particles are found within EDW. The reoutcropping time is defined as the number of years between when a particle is originally deployed in an outcropping EDW column and when that particle is next found in an outcropping EDW column. Of the particles, 66% are found to reoutcrop as EDW in 1 yr, and less than 5% of the particles outcrop in each of the subsequent 4 yr. While the individual trajectories exhibit significant eddy-like motions, the time scale of reoutcropping is primarily set by the mean circulation. The dominance of reoutcropping in 1 yr suggests that EDW outcropping contributes considerably to the persistence of surface temperature anomalies from one winter to the next, that is, the reemergence of winter sea surface temperature anomalies.We gratefully acknowledge the support from the NSF OCE Physical Oceanography program (NSF OCE-0961090 to Y-OK and J-JP; NSF OCE-0960776 to MSL and SFG; and NSF OCE-1242989 to Y-OK).2015-10-0

Family involvement for children with disruptive behaviors: The role of parenting stress and motivational beliefs

Children with disruptive behaviors are at risk for adverse outcomes. Family involvement is a significant predictor of positive child behavior outcomes; however, little research has investigated parent psychological variables that influence family involvement for children with disruptive behaviors. This study investigated the role of parental motivational beliefs (i.e., role construction and efficacy) as a potential mechanism by which parenting stress impacts family involvement for families of children with disruptive behaviors. Results indicated that parent role construction mediated the relation between parenting stress and all aspects of family involvement examined (i.e., home-based involvement, school-based involvement, and home–school communication). Parent efficacy mediated the relation between parenting stress and home-based involvement only. Parents of children with disruptive behaviors reporting stress may experience negative beliefs about their role and efficacy to support their child’s education, which may thereby negatively influence their actual involvement. Therefore, parent motivational beliefs may serve as an important point for intervention to support involvement of families of children with disruptive behavior

Impact of amoxicillin-clavulanate followed by autologous fecal microbiota transplantation on fecal microbiome structure and metabolic potential

The spread of multidrug resistance among pathogenic organisms threatens the efficacy of antimicrobial treatment options. The human gut serves as a reservoir for many drug-resistant organisms and their resistance genes, and perturbation of the gut microbiome by antimicrobial exposure can open metabolic niches to resistant pathogens. Once established in the gut, antimicrobial-resistant bacteria can persist even after antimicrobial exposure ceases. Strategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one’s feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of amoxicillin-clavulanic acid (Amox-Clav) exposure and autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity. Importantly, we found that metabolic capacity was perturbed even in cases where gross phylogeny remained unchanged and that autoFMT was safe and well tolerated.Strategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one’s feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity after exposure to amoxicillin-clavulanic acid (Amox-Clav). Ten healthy participants were enrolled. All received 5 days of Amox-Clav. Half were randomized to autoFMT, derived from stool collected pre-antimicrobial exposure, by enema, and half to saline enema. Participants submitted stool samples pre- and post-Amox-Clav and enema and during a 90-day follow-up period. Shotgun metagenomic sequencing revealed taxonomic composition, resistance gene content, and metabolic capacity. Amox-Clav significantly altered gut taxonomic composition in all participants (n = 10, P  0.05, compared to enrollment). Alterations to microbial metabolic capacity occurred following antimicrobial exposure even in participants without substantial taxonomic disruption, potentially creating open niches for pathogen colonization. Our findings suggest that metabolic potential is an important consideration for complete assessment of antimicrobial impact on the microbiome. AutoFMT was well tolerated and may have contributed to phylogenetic recovery. (This study has been registered at ClinicalTrials.gov under identifier NCT02046525.

Physical Activity, Physical Well-Being, and Psychological Well-Being: Associations with Life Satisfaction during the COVID-19 Pandemic among Early Childhood Educators

Seeking personal well-being and life satisfaction during a global pandemic can be daunting, such is the case for early care and education teachers who were considered non-health care essential workers during the COVID-19 pandemic. The potential changes in their physical activity, along with their overall physical and psychological well-being, may have ultimately influenced their life satisfaction. These changes included the potential for increased sedentary behaviors. Despite the high health risks associated with these factors during the pandemic, the role of physical activity in early care and education teachers’ well-being and life satisfaction remains largely unknown. The purpose of this study is to examine the associations of physical activity and sedentary behaviors with teacher well-being and life satisfaction during the COVID-19 pandemic. In doing so, we explored two competing models of the relationship between the teachers’ physical activity, well-being, and life satisfaction, one with physical activity as a mediator and the other with teachers’ well-being as a mediator. An online survey, that collected information on physical, psychological, and professional well-being, job demands, and life satisfaction, was completed by 1434 US ECE teachers in 46 states. To test our hypothesized models, we conducted confirmatory factor analyses, followed by structural equation modeling. Of the respondents, 77% were overweight or obese and only 39% met the recommended 150 min of moderate physical activity per week. They had a mean life satisfaction score that qualifies as slight satisfaction, they experience moderate stress, and, collectively, are approaching the threshold for depression yet still reflect moderate-to-high work commitment. The empirical test of our competing mediation models found the model where teacher well-being mediated the association between physical activity, sedentary behavior, and life satisfaction was the superior model. The relationships between physical activity, sedentary behavior, and overall well-being suggest that these modifiable risk factors can be addressed such that early care and education teachers can improve their overall physical and psychological well-being, along with their life satisfaction