The P/E Ratio And Profitability

This paper examines the relation between the forward price-to-earnings (P/E) ratio and profitability. Consistent with the theoretical predictions of Ohlson and Zhan (2006), this paper finds a U-shaped relation between the forward P/E ratio and return on equity (ROE). Besides, firms with high P/E ratios tend to have lower ROE in the subsequent years, and their ROE is very volatile and wide-distributed. Using the GSCORE from Mohanram (2005), this paper separates winners from losers among high P/E firms. Firms with high GSCORE yield higher earnings growth, sale growth, ROE, and excess stock returns in the following years

Multifocal High-Grade Pancreatic Precursor Lesions: A Case Series and Management Recommendations

Background: The risk of developing invasive cancer in the remnant pancreas after resection of multifocal high-grade pancreatic precursor lesions is not well known. We report three patients who were followed up after resection of multifocal high-grade pancreatic intraepithelial neoplasia (PanIN)-3 or intraductal papillary mucinous neoplasia (IPMN), two of whom eventually developed invasive carcinoma. Presentation: 1) 68-year-old woman who had a laparoscopic distal pancreatectomy for multifocal mixed-type IPMN, identified as high-grade on final pathology, with negative surgical margins. During semiannual monitoring, eight years from the first surgery, the patient developed suspicious features prompting surgical resection of the body with final pathology revealing invasive ductal adenocarcinoma in the setting of IPMN. 2) 48-year-old woman who had a distal pancreatectomy for severe acute/chronic symptomatic pancreatitis, with final pathology revealing multifocal high-grade PanIN-3, with negative surgical margins. Despite semiannual monitoring, two years from the first surgery, the patient developed pancreatic adenocarcinoma with liver metastasis. 3) 55-year-old woman who had a Whipple procedure for symptomatic chronic pancreatitis, with multifocal PanIN-3 on final pathology. The patient underwent completion pancreatectomy due to symptomatology and her high-risk profile, with final pathology confirming multifocal PanIN-3. Conclusion: Multifocal high-grade dysplastic lesions of the pancreas might benefit from surgical resection

Sulfur isotope analysis of cysteine and methionine via preparatory liquid chromatography and elemental analyzer isotope ratio mass spectrometry

Rationale: Sulfur isotope analysis of organic sulfur‐containing molecules has previously been hindered by challenging preparatory chemistry and analytical requirements for large sample sizes. The natural‐abundance sulfur isotopic compositions of the sulfur‐containing amino acids, cysteine and methionine, have therefore not yet been investigated despite potential utility in biomedicine, ecology, oceanography, biogeochemistry, and other fields. Methods: Cysteine and methionine were subjected to hot acid hydrolysis followed by quantitative oxidation in performic acid to yield cysteic acid and methionine sulfone. These stable, oxidized products were then separated by reversed‐phase high‐performance liquid chromatography (HPLC) and verified via offline liquid chromatography/mass spectrometry (LC/MS). The sulfur isotope ratios (δ³⁴S values) of purified analytes were then measured via combustion elemental analyzer coupled to isotope ratio mass spectrometry (EA/IRMS). The EA was equipped with a temperature‐ramped chromatographic column and programmable helium carrier flow rates. Results: On‐column focusing of SO2 in the EA/IRMS system, combined with reduced He carrier flow during elution, greatly improved sensitivity, allowing precise (0.1–0.3‰ 1 s.d.) δ³⁴S measurements of 1 to 10 μg sulfur. We validated that our method for purification of cysteine and methionine was negligibly fractionating using amino acid and protein standards. Proof‐of‐concept measurements of fish muscle tissue and bacteria demonstrated differences up to 4‰ between the δ³⁴S values of cysteine and methionine that can be connected to biosynthetic pathways. Conclusions: We have developed a sensitive, precise method for measuring the natural‐abundance sulfur isotopic compositions of cysteine and methionine isolated from biological samples. This capability opens up diverse applications of sulfur isotopes in amino acids and proteins, from use as a tracer in organisms and the environment, to fundamental aspects of metabolism and biosynthesis

The Effect of Neuropriming and Focus of Attention on Amateur Standing Long Jump Performance

International Journal of Exercise Science 15(1): 1472-1480, 2022. Non-invasive brain stimulation has been prominent in recent neurophysiology research. The use of brain stimulation has not been examined in combination with the focus of attention paradigm, an established motor control tool. Therefore, the purpose of this study was to examine the effects of both brain stimulation and focus of attention on the outcome performance, peak force, lower extremity joint kinematics, and projection angle of a standing long jump. Forty-one participants were assigned to either the brain stimulation group or placebo group via a counterbalance design based on leg length and jump distance. Participants were only accepted if they had not previously trained in the standing long jump. On a second day, participants performed a standing long jump under control, external, and internal attentional foci after having undergone either a single session of brain stimulation or a placebo warm-up. Five total jumps were performed: one baseline jump followed by two for each attentional focus condition. The results indicated that an external focus of attention and control conditions created a reduced projection angle compared to an internal focus of attention and that brain stimulation did not have any effects on the performance of a standing long jump after a single session. There were no changes evident between hip, knee, and ankle joint angles, force production, or jump distance between any of the conditions or groups

Drug Abuse Paradox Seen in Out-of-Hospital Cardiac Arrest Data

Drug Abuse Paradox Seen in Out-of-Hospital Cardiac Arrest Data Alexandra Maryashina1, Amanda Broderick1 and Jordan Williams1 James Wu, MD1,2 1Department of Surgery, Division of Cardiothoracic Surgery, Lehigh Valley Health Network 2Research Scholar Program Mentor Abstract This study aimed to determine OHCA baseline characteristics, cardiopulmonary resuscitation variables and survival-to-discharge rates for drug abusers and then compare them to those for patients without drug abuse disorders. It was a retrospective study involving 250 patients aged 18 to 70 years treated for OHCA of non-traumatic origin at the Lehigh Valley Health Network between January 2012 and May 2015. Although more drug abusers presented with unwitnessed OHCA and PEA/asystole initial rhythms, their survival-to-discharge rate was higher than that of non-drug abusers. This difference in outcomes between drug abusers and non-drug abusers may be due to a shorter CPR duration, a younger average age and lower rates of prior cardiac history among drug abusers. This study warrants further research into implementing more aggressive treatments for OHCA patients with drug abuse disorder at the Lehigh Valley Health Network. Introduction Out-of-hospital cardiac arrest (OHCA) is the largest cause of natural death in the U.S1. It is responsible for more than 350,000 deaths in the country per year — about one every minute, and many of the affected individuals are in their productive years2. As a result, OHCA remains a major public health burden. Despite numerous important improvements in cardiopulmonary resuscitation (CPR) over the past decades, survival-to-discharge rates after OHCA remain low, and are often reported to be between 5% and 10%3-4. Many factors including age, initial cardiac rhythm, duration of resuscitation, the time interval from collapse to resuscitation, and cause of the arrest may be related to the outcome3. Illicit drug use is often considered in defining cardiac arrest risk5. However, limited research has been undertaken to examine the baseline characteristics and cardiopulmonary resuscitation variables for drug abusers with OHCA. We therefore wished to determine OHCA baseline characteristics and cardiopulmonary resuscitation variables for drug abusers and compare them to those for patients without drug abuse disorders. To accomplish this, we conducted a retrospective chart review of patients who presented at the Lehigh Valley Health Network from January 2012 to May 2015 with OHCA. We also compared survival-to-discharge rates after OHCA for drug abusers and non-drug abusers. This analysis can highlight areas of potential improvements in quality of patient care at the Lehigh Valley Health Network. Methods This was a retrospective study involving 250 patients aged 18 to 70 years treated for OHCA at the Lehigh Valley Health Network between January 2012 and May 2015. This study was approved by the Lehigh Valley Health Network Institutional Review Board. Patients with OHCA were eligible for the study if the following criteria were met: (a) aged 18–70 years; (b) non-traumatic origin of the arrest; (c) arrest in the absence of a written do-not-resuscitate (DNR) order. All OHCA patients were identified from preexisting cardiac arrest database at the Lehigh Valley Health Network, which contained date of the cardiac arrest, patients’ age, gender and arrest outcomes data. Missing clinical and demographic data were obtained by reviewing individual electronic medical records and cardiopulmonary resuscitation protocols. We abstracted the following information from patient charts: demographics, prior medical history, social history, prior surgeries, cause of the cardiac arrest, whether the arrest was witnessed or not, initial cardiac rhythm, whether there was a return of spontaneous circulation (ROSC) for greater than 20 minutes or not, and a total CPR duration, which was calculated by the summation of pre-hospital CPR and in-hospital CPR durations. In addition, we reviewed admission notes for prior history of drug abuse disorders and positive urine drug screen (UDS) indicating higher likelihood of active drug abuse. Prior medical history obtained from individual electronic medical records included preexisting hypertension, hyperlipidemia, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), prior myocardial infarctions, diabetes mellitus, obesity and prior cerebrovascular accidents. We calculated body mass index (BMI) from height and weight data obtained from the admission notes. Ultimately, all the data were entered into the database (Microsoft Excel) to compile and condense relevant information for each patient in our study. All included patients were used for each analysis. Results and Discussion Of the 250 OHCA patients that were eligible for the study only 28 (11%) survived at least 30 days following their arrest. Of the 50 drug abusers 6 survived (12%), while of the 200 non-drug abusers 22 survived (11%). Thus, the survival-to-discharge rate for drug abusers was higher than that for non-drug abusers. The difference in outcomes between the two sets of patients may be due to a shorter CPR duration, a younger average age and lower rates of prior cardiac history among drug abusers. Indeed, the average age of drug abusers was 42 years, while the average age of non-drug abusers was 58 years. Previous studies have reported that the survival-to-discharge rate decreases when CPR duration exceeds 10–15 min6. Our results show that 11% of drug abusers underwent CPR for less than 15 minutes. In contrast, only 6% of non-drug abusers underwent CPR for less than 15 minutes. Moreover, 36% of drug abusers underwent CPR for more than 45 minutes, while among non-drug abusers this proportion was 46%. Analysis of prior medical history has shown that on average drug abusers were healthier. Only 29% of drug abusers had had preexisting cardiac diseases before OHCA, while among non-drug abusers 49% had had preexisting cardiac diseases. Specifically, 21% of non-drug abusers had had previously experienced a myocardial infarction, while only 10% of drug abusers had had experienced it. 39% of non-drug abusers and only 15% of drug abusers had had a prior history of coronary artery disease (CAD). 75% of non-drug abusers and 40% of drug abusers had had a prior history of hypertension. 38% of non-drug abusers and 21% of drug abusers had had a prior history of hyperlipidemia. Ultimately, 15% of non-drug abusers and only 8% of drug abusers had had a prior history of chronic obstructive pulmonary disease (COPD). Only 10% of drug abusers had had previously undergone cardiac surgeries, and, in contrast, 30% of non-drug abusers had had previously undergone cardiac surgeries. Moreover, less drug abusers had diabetes mellitus (21%) than non-drug abusers (41%) and less drug abusers had had previously experienced cerebrovascular accident (CVA) (4%) than non-drug abusers (12%). Finally, less drug abusers were obese at admission (47%) than non-drug abusers (61%). Gender ratios were found to be similar among drug abusers (68% of males) and non-drug abusers (66% of males) and gender did not seem to correlate with survival-to-discharge rates. In previous studies the initial rhythm at arrest was consistently reported as an important factor for survival. Specifically, ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach) as the initial cardiac rhythms were often associated with higher survival-to-discharge rates7. In our study the rate of pulseless electrical activity (PEA) as the initial cardiac rhythm at arrest between drug abusers and non-drug abusers was found to be similar (26% for both sets of patients). However, there was a significant difference in the rates of asystole and ventricular fibrillation (V-fib) or ventricular tachycardia (V-tach) as the initial cardiac rhythms at arrest between drug abusers and non-drug abusers. More non-drug abusers (30%) than drug abusers (16%) had ventricular fibrillation (V-fib) or ventricular tachycardia (V-tach) as the initial cardiac rhythm. In addition, non-drug abusers were less likely to have unwitnessed cardiac arrest (29%) than drug abusers (58%). Conclusion Although more drug abusers presented with unwitnessed OHCA and PEA/asystole initial rhythms, their survival-to-discharge rate was higher than that of non-drug abusers. This difference in survival-to-discharge rates between drug abusers and non-drug abusers may be due to a shorter CPR duration, a younger average age and lower rates of prior cardiac history among drug abusers. Introducing more aggressive treatments such as extracorporeal membrane oxygenation (ECMO) in the Lehigh Valley Health Network for patients with drug abuse history may be a promising way to increase the overall survival to discharge rates for OHCA. The study has several data limitations. This report is a single center experience and the number of patients is relatively small. Nevertheless, the results of the study indicate that further research on more aggressive treatments for OHCA patients with drug abuse disorder is warranted. References 1. Wilson PW, D\u27Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97:1837-1847 2. Fishman GI, Chugh SS, DiMarco JP, Albert CM, Anderson ME, Bonow RO, Buxton AE, ChenPS, Estes M, Jouven X, Kwong R, Lathrop DA, Mascette AM, Nerbonne JM, O’Rouke B,Page RL, Roden DM, Rosenbaum, DS, Sotoodehnia N, Trayanova NA, Zheng ZJ. Sudden cardiac death prediction and prevention – Report from a National, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation. 2010; 122:2335-2348 3. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58:297–308. 4. Sasson C, Rogers M, Dahl J, Kellermann A. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circulation. 2010; 3:63–81. 5. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med. 2001; 345:351-358. 6. Chen YS, Yu HY, Huang SC, et al. Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation. Crit Care Med. 2008; 36:2529–35. 7. Wang CH, Chou NK, Becker LB, Lin JW, Yu HY, Chi NH, et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest–a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014; 85:1219–24

Iron-Catalyzed Oxidative α-Amination of Ketones with Primary and Secondary Sulfonamides

We report the iron-catalyzed α-amination of ketones with sulfonamides. Using an oxidative coupling approach, ketones can be directly coupled with free sulfonamides, without the need for prefunctionalization of either substrate. Primary and secondary sulfonamides are both competent coupling partners, with yields from 55% to 88% for deoxybenzoin-derived substrates

Digital Tools for Managing Different Steps of the Systematic Review Process

Performing systematic reviews (SR) and meta-analyses is an arduous and time-consuming process that involves not only comprehensive literature searching but also record de-duplication, title/abstract and full-text screening, data extraction, quality assessment, statistical analysis, data visualization, report writing, and the creation of a bibliography. In the past several years, several digital tools and software have become available to facilitate different steps of the systematic review process. However, due to the growing number of tools, it can be difficult for systematic reviewers to make fully informed decisions about which tool(s) to use. Here, we (1) compile a comprehensive list of currently available digital tools for managing steps of the systematic review process, (2) map the functionality of each tool onto various steps of the process with further consideration of their price, training materials, and technical support