Atherosclerotic carotid plaque composition: a 3T and 7T MRI-histology correlation study

Background and Purpose Carotid artery atherosclerotic plaque composition may influence plaque stability and risk of thromboembolic events, and non-invasive plaque imaging may therefore permit risk stratification for clinical management. Plaque composition was compared using non-invasive in-vivo (3T) and ex-vivo (7T) MRI and histopathological examination. Methods Thirty three endarterectomy cross sections, from 13 patients, were studied. The datasets consisted of in-vivo 3T MRI, ex-vivo 7T MRI and histopathology. Semi-automated segmentation methods were used to measure areas of different plaque components. Bland- Altman plots and mean difference with 95% confidence interval were carried out. Results There was general quantitative agreement between areas derived from semi-automated segmentation of MRI data and histology measurements. The mean differences and 95% confidence bounds in the relative to total plaque area between 3T versus Histology were: fibrous tissue 4.99 % (-4.56 to 14.56), lipid-rich/necrotic core (LR/NC) with haemorrhage - 1.81% (-14.11 to 10.48), LR/NC without haemorrhage -2.43% (-13.04 to 8.17), and calcification -3.18% (-11.55 to 5.18). The mean differences and 95% confidence bounds in the relative to total plaque area between 7T and histology were: fibrous tissue 3.17 % (-3.17 to 9.52), LR/NC with haemorrhage -0.55% (-9.06 to 7.95), LR/NC without haemorrhage - 12.62% (-19.8 to -5.45), and calcification -2.43% (-9.97 to 4.73). Conclusions This study provides evidence that semi-automated segmentation of 3T/7T MRI techniques can help to determine atherosclerotic plaque composition. In particular, the high resolution of ex-vivo 7T data was able to highlight greater detail in the atherosclerotic plaque composition. High field MRI may therefore have advantages for in vivo carotid plaque MR imaging

Role of accounting practices in the disempowerment of the Coahuiltecan Indians

This paper argues that a complex of accounting measures : account books, inventories of accumulated wealth, and detailed instructions for production performance : were used to inculcate Western values into the native population located at five Franciscan missions along the San Antonio River in New Spain (present-day Texas) from 1718 to 1794. Bolstered by the need to alleviate communications problems caused by extreme isolation, the missionaries constructed detailed mission documents that described the acquisition of scarce resources, reported the aggregation of material and spiritual mission wealth, and controlled daily production performance of the native population. In short, the resulting mission economic system, which held the Indians to certain notions of accountability, primarily by restricting their choices, nourished the Western view of income distribution based on effort. We propose that these procedures ultimately caused the Coahuiltecans to abandon their native beliefs, and gradually, to be absorbed into Spanish society. The 150 Coahuiltecan tribes ceased to exist as a distinct culture by the early 19th century. The exploitation and ultimate subjugation of the Coahuiltecan Indians parallels strikingly subsequent developments in Canada, Australia, and the Scottish Highlands

Reference Standards for Body Fat Measure Using GE Dual Energy X-Ray Absorptiometry in Caucasian Adults

Background Dual energy x-ray absorptiometry (DXA) is an established technique for the measurement of body composition. Reference values for these variables, particularly those related to fat mass, are necessary for interpretation and accurate classification of those at risk for obesityrelated health complications and in need of lifestyle modifications (diet, physical activity, etc.). Currently, there are no reference values available for GE-Healthcare DXA systems and it is known that whole-body and regional fat mass measures differ by DXA manufacturer. Objective To develop reference values by age and sex for DXA-derived fat mass measurements with GE-Healthcare systems. Methods A de-identified sample of 3,327 participants (2,076 women, 1,251 men) was obtained from Ball State University\u27s Clinical Exercise Physiology Laboratory and University of Wisconsin- Milwaukee\u27s Physical Activity & Health Research Laboratory. All scans were completed using a GE Lunar Prodigy or iDXA and data reported included percent body fat (%BF), fat mass index (FMI), and ratios of android-to-gynoid (A/G), trunk/limb, and trunk/leg fat measurements. Percentiles were calculated and a factorial ANOVA was used to determine differences in the mean values for each variable between age and sex. Results Normative reference values for fat mass variables from DXA measurements obtained from GE-Healthcare DXA systems are presented as percentiles for both women and men in 10- year age groups. Women had higher (p\u3c0.01) mean %BF and FMI than men, whereas men had higher (p\u3c0.01) mean ratios of A/G, trunk/limb, and trunk/leg fat measurements than women

Amino acid intakes are associated with bone mineral density and prevalence of low bone mass in women: evidence from discordant monozygotic twins

Although a higher protein intake, particularly from vegetable sources, has been shown to be associated with higher bone mineral density (BMD) the relative impact of specific amino acids (AA) on BMD and risk of osteoporosis remains to be determined. Mechanistic research suggests that a number of specific AA, including five non-essential AA, alanine, arginine, glutamic acid, glycine and proline, may play a role in bone health, principally through improved production of insulin and insulin-like growth factor 1 and the synthesis of collagen and muscle protein. However to date, no previous studies have examined the associations between habitual intake of AA and direct measures of BMD and prevalence of osteoporosis or osteopenia and no studies have examined this relationship in discordant identical twin-pairs. In these analyses of female monozygotic twin-pairs discordant for AA intake (n=135), twins with higher intakes of alanine and glycine had significantly higher BMD at the spine than their co-twins with within-pair differences in spine-BMD of 0.012 g/cm2 (SE 0.01 P=0.039) and 0.014g/cm2 (SE 0.01 P=0.026) respectively. Furthermore, in cross-sectional multivariable analyses of 3160 females aged 18-79y, a higher intake of total protein was significantly associated with higher DXA-measured BMD at the spine (Q4-Q1 0.017g/cm2 SE 0.01 P=0.035) and forearm (Q4-Q1 0.010g/cm2 SE 0.003 P=0.002). Intake of six AA (alanine, arginine, glutamic acid, leucine, lysine and proline) were associated with higher BMD at the spine and forearm with the strongest association observed for leucine (Q4-Q1 0.024g/cm2 SE 0.01 P=0.007). When intakes were stratified by protein source, vegetable or animal, prevalence of osteoporosis or osteopenia was 13-19% lower comparing extreme quartiles of vegetable intake for five AA (not glutamic acid or proline). These data provide evidence to suggest that intake of protein and several AA, including alanine and glycine, may be beneficial for bone health, independent of genetic background

The value of improving patient safety: Health-economic considerations for Rapid Response Systems – a Rapid Review of the Literature and Expert Round Table

Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.Results Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients’ home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital

Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial.

Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work

Absence of Staphylococcus aureus in Wild Populations of Fish Supports a Spillover Hypothesis

Staphylococcus aureus is a human commensal and opportunistic pathogen that also infects other animals. In humans and livestock, where S. aureus is most studied, strains are specialized for different host species. Recent studies have also found S. aureus in diverse wild animals. However, it remains unclear whether these isolates are also specialized for their hosts or whether their presence is due to repeated spillovers from source populations. This study focuses on S. aureus in fish, testing the spillover hypothesis in two ways. First, we examined 12 S. aureus isolates obtained from the internal and external organs of a farmed fish. While all isolates were from clonal complex 45, genomic diversity indicates repeated acquisition. The presence of a φSa3 prophage containing human immune evasion genes suggests that the source was originally human. Second, we tested for S. aureus in wild fish that were isolated from likely sources. In particular, we sampled 123 brown trout and their environment at 16 sites in the remote Scottish Highlands with variable levels of exposure to humans, birds, and livestock. This screen found no S. aureus infection in any of the wild populations or their environment. Together, these results support that the presence of S. aureus in fish and aquaculture is due to spillover from humans rather than specialization. Given the trends of increasing fish consumption, a better understanding of the dynamics of S. aureus spillover in aquaculture will mitigate future risks to fish and human health. IMPORTANCE Staphylococcus aureus is a human and livestock commensal but also an important pathogen responsible for high human mortality rates and economic losses in farming. Recent studies show that S. aureus is common in wild animals, including fish. However, we do not know whether these animals are part of the normal host range of S. aureus or whether infection is due to repeated spillover events from true S. aureus hosts. Answering this question has implications for public health and conservation. We find support for the spillover hypothesis by combining genome sequencing of S. aureus isolates from farmed fish and screens for S. aureus in isolated wild populations. The results imply that fish are unlikely to be a source of novel emergent S. aureus strains but highlight the prominence of the spillover of antibiotic-resistant bacteria from humans and livestock. This may affect both future fish disease potential and the risk of human food poisoning

Evaluation of Stress in Korean Patients with Diabetes Mellitus Using the Problem Areas in Diabetes-Korea Questionnaire

BackgroundIt is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility.MethodsThis study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress.ResultsCronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05).ConclusionWe developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea

Plant RNA virus fitness predictability: contribution of genetic and environmental factors

[EN] Forecasting plant virus emergence depends on identifying the factors that determine the distribution of genetic variants within the primary host as well as across potential new hosts. It is crucial to determine: (i) the distribution of mutational fitness effects (DMFE) on the primary host, (ii) how it changes on different hosts, (iii) the way in which multiple mutations interact in determining viral fitness in the primary host, and (iv) whether this interaction is host-dependent. To illustrate points (i) and (ii), this paper reviews recent reports showing that the DMFE for a potyvirus markedly differs between natural and non-natural hosts. Changes in genetic variance for fitness are the main cause of the observed pattern among related hosts, whereas sign pleiotropy mainly explains differences observed among unrelated hosts. To illustrate point (iii), comments are made on experiments showing significant epistasis among random pairs of mutations in the potyvirus genome. A large fraction of the interactions correspond to the reciprocal sign epistasis, meaning that the sign of the effects of mutations at two loci are mutually dependent. Finally, to illustrate point (iv), evidence is presented that epistatic interactions for an RNA virus varied among hosts, with magnitude epistasis being stronger in the primary host but becoming weaker as host's taxonomic relatedness decreased. The existence of all these interactions jeopardizes the prediction of the fitness and evolutionary fate of a given mutation, as it will depend on the genetic background but also on the host wherein the virus replicates.The authors thank Stephanie Bedhomme, Jose M. Cuevas and Susanna K. Remold for insightful discussions and suggestions. This work was supported by grants BFU2009-06993 and BFU2012-30805 from Spanish Direccion General de Investigacion Cientifica y Tecnica to SFE. JL was supported by a JAE-pre contract from CSIC.Elena Fito, SF.; Lalic, J. (2013). Plant RNA virus fitness predictability: contribution of genetic and environmental factors. Plant Pathology. 62(10-18):10-18. https://doi.org/10.1111/ppa.12102S10186210-1

Gender differences in the impact of population-level alcohol policy interventions: evidence synthesis of systematic reviews

Background: Consistent review-level evidence supports the effectiveness of population-level alcohol policies in reducing alcohol-related harms. Such policies interact with well-established social, cultural and biological differences in how men and women perceive, relate to and use alcohol, and with wider inequalities, in ways which may give rise to gender differences in policy effectiveness.  Aims: To examine the extent to which gender-specific data and analyses were considered in, and are available from, systematic reviews of population-level alcohol policy interventions, and where possible, to conduct a narrative synthesis of relevant data.  Methods: A prior systematic ‘review of reviews’ of population level alcohol interventions 2002-2012 was updated to May 2014, all gender-relevant data extracted, and the level and quality of gender reporting assessed. A narrative synthesis of extracted findings was conducted.  Results: Sixty-three systematic reviews, covering ten policy areas, were included. Five reviews (8%) consistently provided information on baseline participation by gender for each individual study in the review and twenty-nine (46%) reported some gender-specific information on the impact of the policies under consideration. Specific findings include evidence of possible gender differences in the impact of and exposure to alcohol marketing, and a failure to consider potential unintended consequences and harm to others in most reviews.  Conclusions: Gender is poorly reported in systematic reviews of population-level interventions to reduce alcohol-related harm, hindering assessment of the intended and unintended effects of such policies on women and men