Image-based Quantification of 3D Morphology for Bifurcations in the Left Coronary Artery: Application to Stent Design

Background Improved strategies for stent‐based treatment of coronary artery disease at bifurcations require a greater understanding of artery morphology. Objective We developed a workflow to quantify morphology in the left main coronary (LMCA), left anterior descending (LAD), and left circumflex (LCX) artery bifurcations. Methods Computational models of each bifurcation were created for 55 patients using computed tomography images in 3D segmentation software. Metrics including cross‐sectional area, length, eccentricity, taper, curvature, planarity, branching law parameters, and bifurcation angles were assessed using open‐sources software and custom applications. Geometric characterization was performed by comparison of means, correlation, and linear discriminant analysis (LDA). Results Differences between metrics suggest dedicated or multistent approaches should be tailored for each bifurcation. For example, the side branch of the LCX (i.e., obtuse marginal; OM) was longer than that of the LMCA (i.e., LCXprox) and LAD (i.e., first diagonal; D1). Bifurcation metrics for some locations (e.g., LMCA Finet ratio) provide results and confidence intervals agreeing with prior findings, while revised metric values are presented for others (e.g., LAD and LCX). LDA revealed several metrics that differentiate between artery locations (e.g., LMCA vs. D1, LMCA vs. OM, LADprox vs. D1, and LCXprox vs. D1). Conclusions These results provide a foundation for elucidating common parameters from healthy coronary arteries and could be leveraged in the future for treating diseased arteries. Collectively the current results may ultimately be used for design iterations that improve outcomes following implantation of future dedicated bifurcation stents

Coupling atmospheric mercury isotope ratios and meteorology to identify sources of mercury impacting a coastal urban‐industrial region near Pensacola, Florida, USA

Identifying the anthropogenic and natural sources of mercury (Hg) emissions contributing to atmospheric mercury on local, regional, and global scales continues to be a grand challenge. The relative importance of various direct anthropogenic emissions of mercury, in addition to natural geologic sources and reemission of previously released and deposited mercury, differs regionally and temporally. In this study, we used local‐scale, mesoscale, and synoptic‐scale meteorological analysis to couple the isotopic composition of ambient atmospheric mercury with potential sources of mercury contributing to a coastal urban‐industrial setting near a coal‐fired power plant in Pensacola, Florida, USA. We were able to broadly discern four influences on the isotopic composition of ambient atmospheric mercury impacting this coastal urban‐industrial region: (1) local to regional urban‐industrial anthropogenic emissions (mean δ202Hg = 0.44 ± 0.05‰, 1SD, n = 3), (2) marine‐influenced sources derived from the Gulf of Mexico (mean δ202Hg = 0.77 ± 0.15‰, 1SD, n = 4), (3) continental sources associated with north‐northwesterly flows from within the planetary boundary layer (mean δ202Hg = 0.65 ± 0.04‰, 1SD, n = 3), and (4) continental sources associated with north‐northeasterly flows at higher altitudes (i.e., 2000 m above ground level; mean δ202Hg = 1.10 ± 0.21‰, 1SD, n = 8). Overall, these data, in conjunction with previous studies, suggest that the background global atmospheric mercury pool is characterized by moderately positive δ202Hg values; that urban‐industrial emissions drive the isotopic composition of ambient atmospheric mercury toward lower δ202Hg values; and that air‐surface exchange dynamics across vegetation and soils of terrestrial ecosystems drive the isotopic composition of ambient atmospheric mercury toward higher positive δ202Hg values. The data further suggest that mass‐independent fractionation (MIF) of both even‐mass‐ and odd‐mass‐number isotopes, likely generated by photochemical reactions in the atmosphere or during reemission from terrestrial and aquatic ecosystems, can be obscured by mixing with anthropogenic emissions having different MIF signatures.Key PointsIsotopic composition of TGM differed among meteorologically identified sourcesBackground atmospheric TGM displayed moderately positive δ202Hg valuesAnthropogenic emissions drive TGM isotopic composition to lower δ202Hg valuesPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136364/1/gbc20349-sup-0001-Supplementary.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136364/2/gbc20349.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136364/3/gbc20349_am.pd

Comparing recruitment strategies in a study of acupuncture for chronic back pain

<p>Abstract</p> <p>Background</p> <p>Meeting recruitment goals is challenging for many clinical trials conducted in primary care populations. Little is known about how the use of different recruitment strategies affects the types of individuals choosing to participate or the conclusions of the study.</p> <p>Methods</p> <p>A secondary analysis was performed using data from participants recruited to a clinical trial evaluating acupuncture for chronic back pain among primary care patients in a large integrated health care organization. We used two recruitment methods: mailed letters of invitation and an advertisement in the health plan's magazine. For these two recruitment methods, we compared recruitment success (% randomized, treatment completers, drop outs and losses to follow-up), participant characteristics, and primary clinical outcomes. A linear regression model was used to test for interaction between treatment group and recruitment method.</p> <p>Results</p> <p>Participants recruited via mailed letters closely resembled those responding to the advertisement in terms of demographic characteristics, most aspects of their back pain history and current episode and beliefs and expectations about acupuncture. No interaction between method of recruitment and treatment group was seen, suggesting that study outcomes were not affected by recruitment strategy.</p> <p>Conclusion</p> <p>In this trial, the two recruitment strategies yielded similar estimates of treatment effectiveness. However, because this finding may not apply to other recruitment strategies or trial circumstances, trials employing multiple recruitment strategies should evaluate the effect of recruitment strategy on outcome.</p> <p>Trial registration</p> <p>Clinical Trials.gov NCT00065585.</p

Characteristics of patients with chronic back pain who benefit from acupuncture

<p>Abstract</p> <p>Background</p> <p>Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low back pain, we sought to identify subgroups of participants that were particularly responsive to acupuncture.</p> <p>Methods</p> <p>We performed a secondary analysis of data for the 638 participants in our clinical trial comparing different types of acupuncture to usual care to identify baseline characteristics that predicted responses to individualized, standardized, or simulated acupuncture treatments. After identifying factors that predicted improvements in back-related function or symptoms, we determined if these factors were more likely to predict improvement for those receiving the acupuncture treatments than for those receiving usual care. This was accomplished by testing for an interaction between the prognostic factors and treatment group in four models: functional outcomes (measured by the Roland-Morris Disability Scale) at 8 and 52 weeks post-randomization and symptom outcomes (measured with a numerical rating scale) at 8 and 52 weeks.</p> <p>Results</p> <p>Overall, the strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of an acupuncture treatment, and non-use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater with worse pre-treatment levels of back dysfunction (interaction p < 0.004 for the functional outcome, Roland Morris Disability Scale at 8 weeks). No other consistent interactions were observed.</p> <p>Conclusion</p> <p>This secondary analysis found little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short-term benefit from acupuncture.</p

Exploring Alternative Terrain in the Rehabilitation and Treatment of Offenders: Findings from a Prison-based Music Project

The arts in prison settings have provided an alternative or complimentary component to rehabilitation. Despite increased interest, studies capturing the voice of offenders participating in projects and the long-term impact are limited. Data from semistructured interviews with 18 men who had taken part in a music-based project while incarcerated, including one group of five participants who were tracked for 18 months with supplemented data from correctional staff and official documentation, is presented. Participants of the art-based projects comment on changes they believe to have derived from participating in the project, particularly relating to emotions, self-esteem, self-confidence, communication and social skills. An exoffender sample of participants reported that participation in art projects provide experiences that promote beneficial skills that have been useful for post prison life

Self-affirmation improves music performance among performers high on the impulsivity dimension of sensation seeking

In the light of evidence that self-affirmation can mitigate the negative effects of stress on outcomes, this study tested whether a self-affirmation manipulation could improve undergraduate students’ achievement in a formal musical performance examination. The study also investigated the association between impulsivity and music performance and explored whether impulsivity moderated any impact of self-affirmation on exam performance. Methods: At baseline, participants provided demographic information and completed the UPPS-P Impulsive Behaviour Scale (short-form), which assesses five dimensions of impulsivity (negative and positive urgency, lack of premeditation, lack of perseverance, and sensation seeking). In the subsequent 14 days, participants (N = 65) completed either a self-affirmation manipulation or a control task, before reading a message about the impact of practice on music performance. Music performance was formally assessed 14 days later. Findings: Sensation seeking was the only dimension of impulsivity associated with exam performance, with participants high in sensation seeking receiving lower grades. Critically, self-affirmation promoted better music performance among those high in sensation seeking. Discussion: Self-affirmation may provide a useful intervention to augment the performance of musicians who would otherwise perform worse than their counterparts under formal evaluative circumstances, such as those high in sensation seeking

Frost flowers growing in the Arctic ocean‐atmosphere–sea ice–snow interface: 2. Mercury exchange between the atmosphere, snow, and frost flowers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95146/1/jgrd17360.pd

Examining the demographic profile and attitudes of citizens, in areas where organised crime groups proliferate

Whilst studies refer to the community impact of Organized Crime (OC), no survey currently exists to examine the views of those citizens who reside in areas where Organized Crime Groups (OCGs) proliferate. 431 questionnaires from households co-existing in high density OCGs areas were analysed in relation to: a) demographic information; b) views on the community and the police; and c) how they expected other residents to react to illegal incidents. Overall respondents thought the average citizen would refuse to intervene in 10% - 48% of illegal incidents, with the specific case influencing whether and how they would respond. The analysis then compared three communities who lived in high density OCG areas with a control community (n=343). The ‘OCG’ communities were more likely to report low collective efficacy and were least likely to expect their neighbours to confront a crime in action. Conversely, whilst the control group showed higher levels of collective efficacy and expected the average resident more likely to confront illegal behaviour, this trend did not extend to street drug dealing and serious crime associated with OC. The study discusses the unreported intimidation associated with OCGs and the challenges of policing hostile environments

Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75082/1/j.1572-0241.2006.00380.x.pd

Evaluating the cost-effectiveness of biologic treatments for psoriatic arthritis: : can we make better use of patient data registries?

The primary aim of this study is to explore the extent to which registry data may fulfill the evidence requirements of cost-effectiveness analysis (CEA) studies evaluating biologic therapies for the treatment of psoriatic arthritis (PsA), where trial data are lacking or insufficient. In addition, the paper aims to identify how future data collection in PsA registries might be better tailored to inform CEA research. A review of the literature was performed to identify existing registries containing PsA patients. Where possible, information was extracted on the design and characteristics of the registries. The registries were then appraised according to a set of criteria that was formulated based on the methods currently used to model PsA in the CEA literature. A review of the literature identified 21 potentially relevant registries from around the world containing patients with PsA. There was substantial variation regarding the extent to which the registries, as a whole, were useful for the purposes of CEA studies. There were also notable disparities found in terms of the accessibility of the registries to researchers. The critical review conducted in this study showed that all of the registries identified are potentially useful, at least in some degree, for the purposes of informing CEA studies in PsA. However, no individual registry on its own was found to meet all of the evidence requirements when considering how the disease has been modeled previously