Sex and Race Differences in Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey)

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts

Outcomes in heart failure patients with preserved ejection fraction Mortality, readmission, and functional decline

AbstractObjectivesWe evaluated the six-month clinical trajectory of patients hospitalized for heart failure (HF) with preserved ejection fraction (EF), as the natural history of this condition has not been well established. We compared mortality, hospital readmission, and changes in functional status in patients with preserved versus depressed EF.BackgroundAlthough the poor prognosis of HF with depressed EF has been extensively documented, there are only limited and conflicting data concerning clinical outcomes for patients with preserved EF.MethodsWe prospectively evaluated 413 patients hospitalized for HF to determine whether EF ≥40% was an independent predictor of mortality, readmission, and the combined outcome of functional decline or death.ResultsAfter six months, 13% of patients with preserved EF died, compared with 21% of patients with depressed EF (p = 0.02). However, the rates of functional decline were similar among those with preserved and depressed EF (30% vs. 23%, respectively; p = 0.14). After adjusting for demographic and clinical covariates, preserved EF was associated with a lower risk of death (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.26 to 0.90; p = 0.02), but there was no difference in the risk of readmission (HR 1.01, 95% CI 0.72 to 1.43; p = 0.96) or the odds of functional decline or death (OR 1.01, 95% CI 0.59 to 1.72; p = 0.97).ConclusionsHeart failure with preserved EF confers a considerable burden on patients, with the risk of readmission, disability, and symptoms subsequent to hospital discharge, comparable to that of HF patients with depressed EF

Pathological implications of Th1/Th2 cytokine genetic variants in Beh\ue7et's disease: Data from a pilot study in a Sicilian population

Cytokines act as pleiotropic polypeptides able to regulate inflammatory/immune responses and to provide important signals in physiological and pathological processes. Several cytokines (Th1, Th2, and Th17) seem to be involved in the pathophysiology of Beh\ue7et's disease, a chronic immune-mediated disease characterized by oral and genital lesions and ocular inflammation. Its individual susceptibility seems to be modulated by genetic variants in genes codifying these cytokines. Th1 and Th17 seem to be involved in the disease's active phases, and Th2 seems to affect the development or severity of the disease; however, contrasting data are reported. In this study, some genetic variants of the Th1/Th2 cytokine genes were investigated in Sicilian patients and age- and gender-matched controls. Three very significant associations with Beh\ue7et's disease were detected, and combined genotypes associated with increased disease risk were identified. Results obtained point to the key role of Th1/Th2 cytokine genetic variants in disease susceptibility

Hadron Mass Predictions of the Valence Approximation to Lattice QCD

We evaluate the infinite volume, continuum limits of eight hadron mass ratios predicted by lattice QCD with Wilson quarks in the valence (quenched) approximation. Each predicted ratio differs from the corresponding observed value by less than 6\%.Comment: 13 pages of Latex + 2 PostScript files attached, IBM/HET 92-

Randomized trial of an education and support intervention to preventreadmission of patients with heart failure

AbstractObjectivesWe determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF).BackgroundDisease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known.MethodsWe conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF.ResultsAmong the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient.ConclusionsA formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF

Glueball production in radiative J/psi, Upsilon decays

Using a bound-state model of weakly bound gluons for glueballs made of two gluons and a natural generalization of the perturbative QCD formalism for exclusive hadronic processes, we present results for glueball production in radiative J/psi, Upsilon decays into several possible glueball states, including L \not= 0 ones. We perform a detailed phenomenological analysis, presenting results for the more favored experimental candidates and for decay angular distributions.Comment: RevTeX4, 26 pages, 11 eps figure

Complex mosaic structural variations in human fetal brains

Somatic mosaicism, manifesting as single nucleotide variants (SNVs), mobile element insertions and structural changes in the DNA, is a common phenomenon in human brain cells, with potential functional consequences. Using a clonal approach, we previously detected 200-400 mosaic SNVs per cell in three human fetal brains (15 to 21 weeks post-conception). However, structural variation in the human fetal brain has not yet been investigated. Here, we discover and validate four mosaic structural variants (SVs) in the same brains and resolve their precise breakpoints. The SVs were of kilobase scale and complex, consisting of deletion(s) and rearranged genomic fragments, which sometimes originated from different chromosomes. Sequences at the breakpoints of these rearrangements had microhomologies, suggesting their origin from replication errors. One SV was found in two clones and we timed its origin to ~14 weeks post-conception. No large scale mosaic copy number variants (CNVs) were detectable in normal fetal human brains, suggesting that previously reported megabase-scale CNVs in neurons arise at later stages of development. By reanalysis of public single nuclei data from adult brain neurons, we detected an extra-chromosomal circular DNA event. Our study reveals the existence of mosaic SVs in the developing human brain, likely arising from cell proliferation during mid-neurogenesis. Although relatively rare compared to SNVs, and present in ~10% neurons, SVs in developing human brain affect a comparable number of bases in the genome (~6,200 vs ~4,000 bps), implying that they may have similar functional consequences

SU(3) lattice gauge theory with a mixed fundamental and adjoint plaquette action: Lattice artefacts

We study the four-dimensional SU(3) gauge model with a fundamental and an adjoint plaquette term in the action. We investigate whether corrections to scaling can be reduced by using a negative value of the adjoint coupling. To this end, we have studied the finite temperature phase transition, the static potential and the mass of the 0^{++} glueball. In order to compute these quantities we have implemented variance reduced estimators that have been proposed recently. Corrections to scaling are analysed in dimensionless combinations such as T_c/\sqrt{\sigma} and m_{0^{++}}/T_c. We find that indeed the lattice artefacts in e.g. m_{0^{++}}/T_c can be reduced considerably compared with the pure Wilson (fundamental) gauge action at the same lattice spacing.Comment: 36 pages, 12 figure

An immunofluorescence study of the sarcoglycan sub- complex in gingival epithelium both in normal and in pathological conditions

Sarcoglycans are transmembrane glycoproteins which provide the connection between cytoskeleton and extracellular matrix. Sarcoglycans have been found in many kind of tissues as epithelial tissues where they seem to be involved in cell-cell and cell-extracellular matrix adhesion by their cadherin-like domains; by that, it was supported that sarcoglycans could be also involved in pathological condition of epithelial tissue. Moreover, we have already tested sarcoglycans in altered gingival epithelia of patients treated with bisphosphonates where we have observed that the sarcoglycans staining pattern is influenced by inflammatory condition. For these reasons we have continued our immunofluorescence study on sarcoglycans in gingival epithelia of patients treated with bisphosphonates and also in gingival epithelia of patients affected by periodontitis and scleroderma, two different pathological conditions where it is possible to observe inflammation and alteration of the gingival epithelium. Results obtained from normal samples have shown the presence of a staining pattern for each sarcoglycan in gingival epithelium; pathological results, instead, have shown that the entire sarcoglycan sub-complex changes in staining pattern level depending on the inflammation and alteration degree of the gingival epithelia. All these finding suggest us that sarcoglycans could play a key role in maintenance of epithelia architecture by their machanosignaling function, providing cell-cell and cell-extracellular matrix adhesion using their cadherin like domain

The finite temperature QCD phase transition with domain wall fermions

The domain wall formulation of lattice fermions is expected to support accurate chiral symmetry, even at finite lattice spacing. Here we attempt to use this new fermion formulation to simulate two-flavor, finite temperature QCD near the chiral phase transition. In this initial study, a variety of quark masses, domain wall heights and domain wall separations are explored using an 8^3 x 4 lattice. Both the expectation value of the Wilson line and the chiral condensate show the temperature dependence expected for the QCD phase transition. Further, the desired chiral properties are seen for the chiral condensate, suggesting that the domain wall fermion formulation may be an effective approach for the numerical study of QCD at finite temperature.Comment: 44 pages, 15 figure