Business Aspects of Cardiovascular Computed Tomography: Tackling the Challenges

The purpose of this article is to provide a comprehensive understanding of the business issues surrounding provision of dedicated cardiovascular computed tomographic imaging. Some of the challenges include high up-front costs, current low utilization relative to scanner capability, and inadequate payments. Cardiovascular computed tomographic imaging is a valuable clinical modality that should be offered by cardiovascular centers-of-excellence. With careful consideration of the business aspects, moderate-to-large size cardiology programs should be able to implement an economically viable cardiovascular computed tomographic service

Exploring and Describing the Spatial and Temporal Dynamics of Medusahead in the Channeled Scablands of Eastern Washington Using Remote Sensing Techniques

Medusahead is a harmful weed that is invading public lands in the West. The invasion is a serious concern to the public because it can reduce forage for livestock and wildlife, increase fire frequency, alter important ecosystem cycles (like water), reduce recreational activities, and produce landscapes that are aesthetically unpleasing. Invasions can drive up costs that generally require taxpayer’s dollars. Medusahead seedlings typically spread to new areas by attaching itself to passing objects (e.g. vehicles, animals, clothing) where it can quickly begin to affect plants communities. To be effective, management plans need to be sustainable, informed, and considerate to invasion levels across large landscapes. Ecological remote sensing analysis is a method that uses airborne imagery, taken from drones, aircrafts, or satellites, to gather information about ecological systems. This Thesis strived to use remote sensing techniques to identify medusahead in the landscape and its changes through time. This was done for an extensive area of rangelands in the Channel Scabland region of eastern ashington. This Thesis provided results that would benefit land managers that include: 1) a dispersal map of medusahead, 2) a time line of medusahead cover through time, 3) “high risk’ dispersal areas, 4) climatic factors showing an influence on the time line of medusahead, 5) a strategy map that can be utilized by land managers to direct management needs. This Thesis shows how remote sensing applications can be used to detect medusahead in the landscape and understand its invasiveness through time. This information can help create sustainable and effective management plans so land managers can continue to protect and improve western public lands threatened by the invasion of medusahead

708-4 Can the Results of SPECT Scintigraphy Safely Guide Clinical Management of Patients with Active CAD?

Myocardial perfusion scintigraphy is increasingly used to categorize risk in pts with known or a high likelihood of CAD. This strategy will only be cost-effective if: 1) cardiologists will largely reserve further testing such as angiography (angio) to high-risk subsets; and 2) it is shown that less severe patterns of abnormality can be safely managed medically. We previously reported angio rates after all 4, 162 SPECT studies (excluding those with angio within 90 days beforeSPECT) at our cardiology practice-based nuclear lab: 4% (69/1663) in pts with fixed defects only and/or no ischemia; 60% (682/1141) in pts with high-risk ischemia (2 of multivessel or LAD distribution ischemia and abnormal lung uptake); and 9% (123/1352) for pts with mild-moderate ischemia. In this study, we determined outcome of the 1229 pts with mild-moderate ischemia who did not have referral for angio. Patient characteristics: mean age 65 yrs; known CAD=1061 (86%); prior CABG=344; prior MI=575; prior PTCA=674; angina=592. Twenty-eight (2%) pts were lost to follow-up. The remainder were followed for a mean of 18 months. There were 22 hard events (MI=15; cardiac death=71) (1.8%) and 54 pts required PTCA or CABG (total event rate 6.3%). Mean time to any event was 13.2 months from SPECT. Freedom from hard events at 1 yr was 99% and at 2 yrs 97%. Freedom from any event was 97% at 1 yr and 91% at 2 yrs.Conclusions1) SPECT can be a highly effective strategy for selecting pts for angio; 2) Even in a self-referral setting angio is largely reserved for pts with high-risk scans; and 3) Pts with mildly-moderately abnormal scans can be treated safely with medical therapy and close follow-u

Significant changes in the skin microbiome mediated by the sport of roller derby

Diverse bacterial communities live on and in human skin. These complex communities vary by skin location on the body, over time, between individuals, and between geographic regions. Culture-based studies have shown that human to human and human to surface contact mediates the dispersal of pathogens, yet little is currently known about the drivers of bacterial community assembly patterns on human skin. We hypothesized that participation in a sport involving skin to skin contact would result in detectable shifts in skin bacterial community composition. We conducted a study during a flat track roller derby tournament, and found that teammates shared distinct skin microbial communities before and after playing against another team, but that opposing teams’ bacterial communities converged during the course of a roller derby bout. Our results are consistent with the hypothesis that the human skin microbiome shifts in composition during activities involving human to human contact, and that contact sports provide an ideal setting in which to evaluate dispersal of microorganisms between people

Ineffectiveness of colchicine for the prevention of restenosis after coronary angioplasty

AbstractColchicine, an antimitogenic agent, has shown promise in preventing restenosis after coronary angioplasty in experimental animal models. A prospective trial was conducted involving 197 patients randomized in a 2:1 fashion to treatment with oral colchicine, 0.6 mg twice daily (130 patients), or placebo (67 patients) for 6 months after elective coronary angioplasty. Treatment in all patients began between 12 h before angioplasty and 24 h after angioplasty. Compliance monitoring revealed that 96% of all prescribed pills were ingested. Demographic characteristics were similar in colchicine- and placebo-treated groups. A mean of 2.7 lesions/patient were dilated. Side effects resulted in a 6.9% dropout rate in the colchicine-treated patients.Complete quantitative angiographic follow-up was obtained in 145 patients (74%) with 393 dilated lesions. Quantitative angiographic measurements were obtained in two orthogonal views at baseline before angioplasty and immediately and at 6 months after angioplasty. The quantitative mean lumen diameter stenosis before angioplasty was 67% both in the 152 lesions in the placebo-treated group and in the 241 lesions in the colchkine-treated group; this value was reduced to 24% immediately after angio-plasty in the lesions in both treatment groups.At the 6-month angiogram, lesions had restenosed to 47% lumen diameter narrowing in the placebo-treated group compared with 46% in the colchicine-treated group (p = NS). Forty-one percent of colchicine-treated patients developed restenosis in at least one lesion compared with 45% of the placebo-treated group (p = NS). In conclusion, colchicine was ineffective for preventing restenosis after coronary angioplasty

Astrocytic 4R tau expression drives astrocyte reactivity and dysfunction

The protein tau and its isoforms are associated with several neurodegenerative diseases, many of which are characterized by greater deposition of the 4-repeat (4R) tau isoform; however, the role of 4R tau in disease pathogenesis remains unclear. We created antisense oligonucleotides (ASOs) that alter the ratio of 3R to 4R tau to investigate the role of specific tau isoforms in disease. Preferential expression of 4R tau in human tau-expressing (hTau-expressing) mice was previously shown to increase seizure severity and phosphorylated tau deposition without neuronal or synaptic loss. In this study, we observed strong colocalization of 4R tau within reactive astrocytes and increased expression of pan-reactive and neurotoxic genes following 3R to 4R tau splicing ASO treatment in hTau mice. Increasing 4R tau levels in primary astrocytes provoked a similar response, including a neurotoxic genetic profile and diminished homeostatic function, which was replicated in human induced pluripotent stem cell-derived (iPSC-derived) astrocytes harboring a mutation that exhibits greater 4R tau. Healthy neurons cultured with 4R tau-expressing human iPSC-derived astrocytes exhibited a higher firing frequency and hypersynchrony, which could be prevented by lowering tau expression. These findings support a potentially novel pathway by which astrocytic 4R tau mediates reactivity and dysfunction and suggest that astrocyte-targeted therapeutics against 4R tau may mitigate neurodegenerative disease progression

Detection of a glitch in the pulsar J1709-4429

We report the detection of a glitch event in the pulsar J1709$-$4429 (also known as B1706$-$44) during regular monitoring observations with the Molonglo Observatory Synthesis Telescope (UTMOST). The glitch was found during timing operations, in which we regularly observe over 400 pulsars with up to daily cadence, while commensally searching for Rotating Radio Transients, pulsars, and FRBs. With a fractional size of $\Delta\nu/\nu \approx 52.4 \times10^{-9}$, the glitch reported here is by far the smallest known for this pulsar, attesting to the efficacy of glitch searches with high cadence using UTMOST.Comment: 3 pages, 1 figur

Time and event-specific deep learning for personalized risk assessment after cardiac perfusion imaging

Standard clinical interpretation of myocardial perfusion imaging (MPI) has proven prognostic value for predicting major adverse cardiovascular events (MACE). However, personalizing predictions to a specific event type and time interval is more challenging. We demonstrate an explainable deep learning model that predicts the time-specific risk separately for all-cause death, acute coronary syndrome (ACS), and revascularization directly from MPI and 15 clinical features. We train and test the model internally using 10-fold hold-out cross-validation (n = 20,418) and externally validate it in three separate sites (n = 13,988) with MACE follow-ups for a median of 3.1 years (interquartile range [IQR]: 1.6, 3.6). We evaluate the model using the cumulative dynamic area under receiver operating curve (cAUC). The best model performance in the external cohort is observed for short-term prediction - in the first six months after the scan, mean cAUC for ACS and all-cause death reaches 0.76 (95% confidence interval [CI]: 0.75, 0.77) and 0.78 (95% CI: 0.78, 0.79), respectively. The model outperforms conventional perfusion abnormality measures at all time points for the prediction of death in both internal and external validations, with improvement increasing gradually over time. Individualized patient explanations are visualized using waterfall plots, which highlight the contribution degree and direction for each feature. This approach allows the derivation of individual event probability as a function of time as well as patient- and event-specific risk explanations that may help draw attention to modifiable risk factors. Such a method could help present post-scan risk assessments to the patient and foster shared decision-making

Unsupervised learning to characterize patients with known coronary artery disease undergoing myocardial perfusion imaging

PURPOSE Patients with known coronary artery disease (CAD) comprise a heterogenous population with varied clinical and imaging characteristics. Unsupervised machine learning can identify new risk phenotypes in an unbiased fashion. We use cluster analysis to risk-stratify patients with known CAD undergoing single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). METHODS From 37,298 patients in the REFINE SPECT registry, we identified 9221 patients with known coronary artery disease. Unsupervised machine learning was performed using clinical (23), acquisition (17), and image analysis (24) parameters from 4774 patients (internal cohort) and validated with 4447 patients (external cohort). Risk stratification for all-cause mortality was compared to stress total perfusion deficit (< 5%, 5-10%, ≥10%). RESULTS Three clusters were identified, with patients in Cluster 3 having a higher body mass index, more diabetes mellitus and hypertension, and less likely to be male, have dyslipidemia, or undergo exercise stress imaging (p < 0.001 for all). In the external cohort, during median follow-up of 2.6 [0.14, 3.3] years, all-cause mortality occurred in 312 patients (7%). Cluster analysis provided better risk stratification for all-cause mortality (Cluster 3: hazard ratio (HR) 5.9, 95% confidence interval (CI) 4.0, 8.6, p < 0.001; Cluster 2: HR 3.3, 95% CI 2.5, 4.5, p < 0.001; Cluster 1, reference) compared to stress total perfusion deficit (≥10%: HR 1.9, 95% CI 1.5, 2.5 p < 0.001; < 5%: reference). CONCLUSIONS Our unsupervised cluster analysis in patients with known CAD undergoing SPECT MPI identified three distinct phenotypic clusters and predicted all-cause mortality better than ischemia alone