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The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Incidental pulmonary nodules are common. Although the majority are benign, most are indeterminate for malignancy when first encountered making their management challenging. CT remains the primary imaging modality to first characterize and follow-up incidental lung nodules. This document reviews available literature on various imaging modalities and summarizes management of indeterminate pulmonary nodules detected incidentally. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings. MR angiography can be useful in some clinical scenarios and lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

This document provides recommendations regarding the role of imaging in the staging and follow-up of esophageal cancer. For initial clinical staging, locoregional extent and nodal disease are typically assessed with esophagogastroduodenoscopy and esophageal ultrasound. FDG-PET/CT or CT of the chest and abdomen is usually appropriate for use in initial clinical staging as they provide additional information regarding distant nodal and metastatic disease. The detection of metastatic disease is critical in the initial evaluation of patients with esophageal cancer because it will direct patients to a treatment pathway centered on palliative radiation rather than surgery. For imaging during treatment, particularly neoadjuvant chemotherapy, FDG-PET/CT is usually appropriate, because some studies have found that it can provide information regarding primary lesion response, but more importantly it can be used to detect metastases that have developed since the induction of treatment. For patients who have completed treatment, FDG-PET/CT or CT of the chest and abdomen is usually appropriate for evaluating the presence and extent of metastases in patients with no suspected or known recurrence and in those with a suspected or known recurrence. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

• Patients were followed until complete symptom resolution from COVID-19 rather than at pre-set time periods. • The conclusions focus on practical advice for patients that can be used in daily practice in terms of symptom expectations. • This study found that the median symptom duration was 15 days --this suggests persons with COVID-19 may remain symptomatic longer than their isolation period. Approximately 80% of people with COVID-19 do not require hospitalization. Studies examining the outpatient experience have not tracked symptoms to resolution leading to unknown expected symptom duration. Our objectives were to (1) determine symptom duration among patients with COVID-19 who do not require hospitalization and (2) identify potential risk factors associated with prolonged symptom duration. This is a retrospective cohort study conducted across an academic healthcare system including adult patients with laboratory‐confirmed SARS-CoV-2 infection between March 18th and April 28th, 2020 who were not hospitalized. Symptom duration encompassed time from patient-reported symptom onset as documented in the chart until documented symptom resolution. We calculated the median symptom duration and tested if demographics, comorbidities, or reported symptoms were associated with symptom duration. Of 294 patients meeting inclusion criteria, 178 (60.5%) had documented symptom resolution. The median [interquartile range (IQR)] symptom duration for included patients was 15 (8-24) days. No associations were found between comorbidities and symptom duration. Factors associated with prolonged symptom duration were presence vs lack of lower respiratory symptoms [median (IQR) 16.5 (10.75-33.5) vs 14.5 (7-21.75) days respectively, P <.001] and neurologic symptoms [median (IQR) 17 (9-28) vs 9.5 (4-17) days, P <.001] at disease onset. The median symptom duration in outpatients is 15 days and over 25% of patients have symptoms longer than 21 days. [ABSTRACT FROM AUTHOR]

Appropriate collection of quality of life measurements for left ventricular assist device (LVAD) patients is challenging. Patient-Reported Outcomes Measurement Information System (PROMIS) is a popular tool that has been validated across multiple disciplines, but its applicability to the LVAD population remains unknown. This single-center, retrospective review included LVAD patients who completed a PROMIS assessment and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey at clinical encounters postoperatively. Patients completed computer adaptive PROMIS assessments for physical function, pain interference, and depression. All PROMIS domains are designed to follow a normal distribution (mean T-score 50, SD 10) in the general population. Assessments were aggregated over time and correlation between the KCCQ-12 summary score and each PROMIS domain was assessed individually. A total of 178 LVAD patients were included in the study. The median time between LVAD implantation and PRO collection was 16.5 [interquartile range, 7.9-37.8] months. Patients typically had worse physical function (T-score 38.8 [33.6-44.2]) but comparable pain (51.1 [38.7-59.2]) and depression (49.9 [41.7-57.5]) as the general population. The KCCQ-12 was more strongly correlated to PROMIS physical function (Spearman's ρ = 0.746) than pain (ρ = –0.539) or depression (ρ = –0.591). PROMIS provides a robust quality of life data collection system that can be implemented in a clinical setting without imposing a significant burden. Using this more holistic system may allow for better patient-centered care in order to address quality of life limitations imposed by LVAD support that are not directly related to heart failure symptoms. [ABSTRACT FROM AUTHOR]

Chronic cough is defined by a duration lasting at least 8 weeks. The most common causes of chronic cough include smoking-related lung disease, upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. The etiology of chronic cough in some patients may be difficult to localize to an isolated source and is often multifactorial. The complex pathophysiology, clinical presentation, and variable manifestations of chronic cough underscore the challenges faced by clinicians in the evaluation and management of these patients. Imaging plays a role in the initial evaluation, although there is a lack of high-quality evidence guiding which modalities are useful and at what point in time the clinical evaluation should be performed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

• Educating healthcare teams about Interprofessional collaborative practice (IPCP) is an effective strategy to enhance collaborative environments in rural primary care centers (PCCs) • Barriers to Interprofessional Practice in PCCs include high staff turnover, competing demands, hierarchical culture, and lack of role clarity which may be overcome with the cultivation of IPCP. • PCC's health providers need leadership support and financial reimbursement for IPCP development. • An Academic- Practice partnership may enhance IPCP implementation in rural PCCs by providing support over time to embed team skills and promote effective IPCP into practice. Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. Significant improvement (p <.035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice. [ABSTRACT FROM AUTHOR]

Studies of long-term inotrope use in advanced HF have previously provided limited and conflicting results. This study aimed to evaluate the safety and efficacy of long-term milrinone use and identify predictors of failure to bridge to orthotropic heart transplant (OHT) in a cohort of end-stage heart failure (HF) patients listed for heart transplantation and receiving inotrope therapy. The study included 150 adults listed for OHT at a single center from 2001 to 2017 who received milrinone therapy for ≥30 days. Multivariate Cox proportional hazards models were used to identify factors associated with "failure" (left ventricular assist device, intra-aortic balloon pump, status downgrade due to instability, death) vs. "success" (OHT, recovery) during bridging to OHT. "Failure" occurred in 33 (22%) patients. Factors independently associated with failure included male sex (HR = 7.6; p = 0.004), no implantable cardioverter-defibrillator (HR = 3.8; p = 0.009), and lack of guideline-directed medical therapy (GDMT) with a beta-blocker (HR = 7.8; p = 0.002) or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (HR = 6.3; p < 0.001). Patients who received fewer guideline-directed medications had a higher cumulative probability of failure. Adverse events included central line-associated bloodstream infection (2.55 per 1000 line-days) and arrhythmia (1.59 per 1000 treatment-days). Our findings suggest that long-term milrinone therapy in selected patients is associated with a high rate of successful bridging to OHT and a low rate of adverse events. Patients intolerant of GDMT are more likely to fail to bridge to OHT without mechanical support. Sex differences in outcomes associated with milrinone therapy should be explored. • Successful bridge to heart transplant occurred in 78% of patients. • Pulmonary artery pressure remained stable in success patients. • Intolerance of heart failure medications was associated with failure. • Rates of ventricular tachycardia and central line associated infection were low. [ABSTRACT FROM AUTHOR]

We report the case of a 36 year old male who demonstrated extensive high attenuation in the muscles of the chest wall and neck on a noncontrast chest CT. The high attenuation in the musculature was due to calcium, sequela from a recent episode of rhabdomyolysis. Although the diagnosis of rhabdomyolysis is made on clinical grounds, the imaging appearance can be confusing given the variability in appearance of rhabdomyolysis depending on the severity and the timeline of disease. • The imaging appearance of rhabdomyolysis can be confusing given the variability in appearance depending on the severity and the timeline of disease. • Awareness of the imaging features of rhabdomyolysis may prevent misdiagnosis and avoid additional testing. • CT findings include development of diffuse calcification of the skeletal muscle. On MR altered signal intensity and enhancement can be seen. [ABSTRACT FROM AUTHOR]

• Floret number was associated positively with dry matter accumulation during early stages of maize growth. • Not all stresses had the same impact on ear initial and floret development. • Drought was the most severe in reducing dry matter accumulation during the pre-silking stage followed by plant density and light quality. • Ear elongation and floret appearance per unit plant dry matter accumulation increased in the drought and the density stress. The number of fertilized florets around silking determines the number of kernels in maize (Zea mays L). In this study, we examined the relationship between plant dry matter accumulation, ear initial length and floret number. What does this relationship look like between the V7 to V9 growth stages and how does it change when the plants are subjected to stress events? We tested the hypothesis that if floret number per ear row, is related positively to plant dry matter accumulation during early stages of growth then the occurrence of stress during this period will result in a loss of floret number. Three modern hybrids were subjected to three different stresses, drought, plant population density and light quality. Light quality and drought stresses were applied for two seasons in our field hydroponics system, while the plant population density stress was conducted for two field seasons. The relationship between plant dry matter and floret number follows the classic relationship with a minimum dry matter level required and a plateau. Not all stresses impacted these relationships in the same manner. Drought stress was most severe resulting in a reduction in dry matter, ear length and floret number for the sampled period. Plant density stress was similar to drought, resulting in a reduction in plant dry matter and ear length, however, floret number per ear row was unchanged. Both drought and plant density stress resulted in reductions in the predicted minimum dry weight for floret number and the rate of increase of floret number per unit dry matter. Light quality defined as a reduced red-to-far red ratio caused reductions in dry matter up to and including the V7 stage of growth, however, the relationship between floret number and plant dry matter accumulation did not vary from the control. These results confirm that floret number in maize is established well in advance of flowering and also suggests that floret number is related to plant dry weight sampled between V7 to V9-10 stage of growth. This research presents new knowledge on the relationship between floret number, plant cumulative dry matter and early season stress. [ABSTRACT FROM AUTHOR]

Lung cancer remains the leading cause of cancer death in both men and women. Smoking is the single greatest risk factor for the development of lung cancer. For patients between the age of 55 and 80 with 30 or more pack years smoking history who currently smoke or who have quit within the last 15 years should undergo lung cancer screening with low-dose CT. In patients who do not meet these criteria but who have additional risk factors for lung cancer, lung cancer screening with low-dose CT is controversial but may be appropriate. Imaging is not recommended for lung cancer screening of patient younger than 50 years of age or patients older than 80 years of age or patients of any age with less than 20 packs per year history of smoking and no additional risk factor (ie, radon exposure, occupational exposure, cancer history, family history of lung cancer, history of COPD, or history of pulmonary fibrosis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The primary objective of this report is to describe a quality improvement practice designed to identify and categorize potentially preventable medication-related hospital admissions. The secondary objective is to present data collected from this practice and describe how it was used to improve a pharmacist intervention focused on reducing medication-related readmissions.Setting: This practice was developed as part of the quality improvement system supporting a pharmacist-led care transition model that was implemented across rural and urban counties in Hawaii.Practice Description: Pharmacists systematically assessed readmissions of the high-risk patients who were enrolled in the care transition model to determine the reasons for the admission and whether each was potentially preventable and medication related. This information was then used to improve the care transition model.Practice Innovation: This admission categorization system is the first based on best practice in pharmaceutical care and identifies indication, effectiveness, safety, and adherence problems, as well as subcategories within each of those domains.Evaluation: This quality improvement practice was applied to 401 readmissions. A chi-square test was used to determine if there were differences between urban and more rural areas regarding percentage of readmissions that were potentially preventable and medication related.Results: Twenty-six percent of the readmissions were determined to be potentially preventable and medication related. The most common categories were nonadherence due to patient choice (23.8%), untreated condition for which medication is indicated (13.3%), dose too high (10.5%), and dose too low (10.5%). The percentage of readmissions that were potentially preventable and medication related was significantly higher in more rural areas (30%) compared with urban areas (17%). There were no significant rural-urban differences by major category of potentially preventable medication-related admissions.Conclusion: This systematic and actionable approach to reviewing and categorizing potentially preventable medication-related admissions can facilitate improvement in care and document the value of pharmacists serving in patient care roles. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a common and potentially fatal complication of arthroplasty.Methods: We reviewed randomized trials to determine which anticoagulant has the best safety and efficacy in hip and knee arthroplasty patients. We searched PubMed, MEDLINE, and EMBASE through January 2016.Results: Compared to enoxaparin (most commonly dosed 40 mg once daily), the relative risk (RR) of VTE was lowest for edoxaban 30 mg once daily (0.49; 95% confidence interval [CI], 0.32-0.75), fondaparinux 2.5 mg once daily (0.53; 95% CI, 0.45-0.63), and rivaroxaban 10 mg once daily (0.55; 95% CI, 0.46-0.66), and highest for dabigatran 150 mg once daily (1.19; 95% CI; 0.98-1.44). The RR of major/clinically relevant bleeding was lowest for apixaban 2.5 mg twice daily (0.84; 95% CI; 0.70-0.99) and highest for rivaroxaban (1.27; 95% CI, 1.01-1.59) and fondaparinux (1.64; 95% CI, 0.24-11.35). Fondaparinux was the only agent that was more effective than enoxaparin 30 mg twice daily (VTE RR = 0.58; 95% CI, 0.43-0.76).Conclusion: With the possible exception of apixaban, newer anticoagulants that lower the risk of postoperative VTE increase bleeding. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a common cause of hospitalization and can be divided into types with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). In this subanalysis of the HABIT (Heart Failure Assessment With BNP in the Home) trial, we examined the differences between home B-type natriuretic peptide (BNP) testing and weight monitoring in patients with HFpEF and with HFrEF before decompensation.Methods and Results: This was a retrospective review of patients with HFpEF and HFrEF from the HABIT trial. The HFpEF patients compared with HFrEF patients were older and more obese and had lower baseline BNP values. Intra-individual BNP dispersion (spread of distribution over time) was greater in HFpEF than in HFrEF owing to rapid fluctuations (within 3 days). Slowly varying changes in BNP (estimated by a moving average) were equally predictive of ADHF risk in both HFpEF and HFrEF. However, in HFpEF, a rapid rise in BNP >200 pg/mL within 3 days was associated with an increased risk of acute decompensated heart failure (ADHF; hazard ratio 4.0), whereas a similar association was not observed in HFrEF. Weight gain ≥5 lb in 3 days had a high specificity but low sensitivity for ADHF in both HFpEF and HFrEF, whereas a lower threshold of ≥2 lb weight gain over 3 days in patients with HFpEF (but not HFrEF) was a moderately sensitive cutoff associated with decompensation (60% sensitivity).Conclusions: Patients with HFpEF and HFrEF have variations in their BNP and weight before decompensation. The rapid time scale behaves differently between the groups. In those with HFpEF, a 3-day period characterized by ≥2 lb weight gain and/or >200 pg/mL BNP rise was significantly associated with decompensation. Future prospective studies investigating different weight and BNP cutoffs for home monitoring of HFpEF and HFrEF patients should be performed to fully learn the value of BNP changes before clinical deompensation. [ABSTRACT FROM AUTHOR]

Heart disease is associated with re-expression of key transcription factors normally active only during prenatal development of the heart. However, the impact of this reactivation on the regulatory landscape in heart disease is unclear. Here, we use RNA-seq and ChIP-seq targeting a histone modification associated with active transcriptional enhancers to generate genome-wide enhancer maps from left ventricle tissue from up to 26 healthy controls, 18 individuals with idiopathic dilated cardiomyopathy (DCM), and five fetal hearts. Healthy individuals have a highly reproducible epigenomic landscape, consisting of more than 33,000 predicted heart enhancers. In contrast, we observe reproducible disease-associated changes in activity at 6,850 predicted heart enhancers. Combined analysis of adult and fetal samples reveals that the heart disease epigenome and transcriptome both acquire fetal-like characteristics, with 3,400 individual enhancers sharing fetal regulatory properties. We also provide a comprehensive data resource (http://heart.lbl.gov) for the mechanistic exploration of DCM etiology. [Display omitted] • Enhancer and transcriptome maps of healthy, disease-affected, and fetal heart tissue • Highly reproducible epigenomic landscape in healthy individuals • Disease-associated changes in activity at 6,850 predicted heart enhancers • 3,400 disease-associated enhancers with fetal regulatory properties Spurrell et al. analyze the transcriptomes and epigenomes of cardiac tissue from healthy individuals and patients with dilated cardiomyopathy, and identify reproducible shifts in the global regulatory landscape. Comparison with fetal heart tissue samples reveals that thousands of predicted enhancer sequences revert to fetal-like chromatin states in heart disease. [ABSTRACT FROM AUTHOR]

Dolichocolon is an anatomic variant characterized by redundant colon. While the overall incidence of this condition is unknown, cases of dolichocolon resulting in cecal volvulus are rarely reported. A high index of suspicion is required to correctly identify cecal volvulus, regardless of the cause. Mobile redundant colon seen in dolichocolon predisposes patients to volvulus. This case report demonstrates an unusual presentation of cecal volvulus in a healthy adolescent with previously undiagnosed dolichocolon. This unusual case provides diagnostic clues to identify dolichocolon and resultant volvulus in an otherwise healthy adolescent boy. [ABSTRACT FROM AUTHOR]

Drawing on test takers' attitudes to evaluate social consequences of testing is a widely recognized practice in the language testing literature. Yet studies using such approaches at the local placement level are few. To address this gap, 92 students from a large midwestern university were surveyed and 26 of these students participated in a follow-up interview. While survey results showed that students were more negative than positive towards the test, students' accounts revealed a more complex picture. First, regardless of one's attitudes toward the test, students experienced some lack of test preparation. Second, test-taking experiences were divergent even among students sharing similar perceptions about the test. Third, students sharing more positive views of the test tended to focus on ways that the test tasks represented the target domain, whereas students sharing less favorable views focused on the opposite. While there was no strong evidence of test invalidity, a need to review current test administration practices and ways of communicating test information and preparation materials is recommended. This study demonstrates that studying the attitudes of test takers and the factors contributing to such attitudes is useful not only for test validation purposes but also for establishing positive test quality. • Students did not engage in quality test preparation for the placement test. • Keyboarding and timing issues and test anxiety were variably experienced. • Perceived test task representation varied with students' attitudes toward the test. • Appraisal analysis is a useful way to evaluate students' attitudes. [ABSTRACT FROM AUTHOR]

Parental refusal and delay of childhood vaccination has increased in recent years in the United States. This phenomenon challenges maintenance of herd immunity and increases the risk of outbreaks of vaccine-preventable diseases. We examine US county-level vaccine refusal for patients under five years of age collected during the period 2012–2015 from an administrative healthcare dataset. We model these data with a Bayesian zero-inflated negative binomial regression model to capture social and political processes that are associated with vaccine refusal, as well as factors that affect our measurement of vaccine refusal. Our work highlights fine-scale socio-demographic characteristics associated with vaccine refusal nationally, finds that spatial clustering in refusal can be explained by such factors, and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Transfer of critically ill patients from outside emergency department has the potential for delaying the admission to the intensive care unit. We sought to determine the effect of outside emergency department transfer on hospital outcomes in critically ill patients with stroke. Methods: We designed a retrospective cohort analysis using a prospectively compiled and maintained registry (Cerner Project IMPACT). Patients with acute ischemic stroke and intracerebral hemorrhage admitted to our intensive care unit from our emergency department and transfers from outside emergency department within 24 hours of stroke between January 1, 2003, and December 31, 2008, were selected for the analysis. Data collected included demographics, admission physiologic variables, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II score, and total intensive care unit and hospital length of stay. Primary (poor) outcome was a composite of death or fully dependent status at hospital discharge, and secondary outcomes were intensive care unit and hospital length of stay. To assess for the impact of outside emergency department transfer on primary and secondary outcomes, demographic and admission clinical variables were used to construct logistic regression models using the outcome measure as a dependent variable. Results: A total of 448 patients were selected for analysis. The mean age was 65 ± 14 years, of which 214 (48%) were male and 282 (65%) white, 152 (34%) were patients with acute ischemic stroke, and 296 (66%) were patients with intracerebral hemorrhage. The median hospital length of stay was 7 days (interquartile range, 4-11 days) and median intensive care unit length of stay was 2 days (interquartile range, 1-3 days). Overall hospital mortality was 30%, and outside emergency department transfer increased the odds of poor outcome by 2-fold (65% vs 34%; P = .05). Multivariate regression analysis showed that age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.1), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 1.9; 95% CI, 1.3-2.7), Glasgow Coma Scale <12 (OR, 2.0; 95% CI, 1.4-2.8), do-not-resuscitate status (OR, 3.5; 95% CI, 2.2-5.9), and outside emergency department transfers (OR, 1.4; 95% CI, 1.02-1.8) were independently associated with poor outcome. Outside emergency department transfer was not significantly associated with secondary outcomes. Conclusion: These data suggest that in critically ill patients with stroke, transfer from outside emergency department is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect. [Copyright &y& Elsevier]

Abstract: An array of quaternary ammonium-functionalized POSS (Q-POSS) compounds were synthesized and their antimicrobial properties toward the Gram-negative bacterium, Escherichia coli, and the Gram-positive bacterium, Staphylococcus aureus, determined in aqueous solution. Using Q-POSS compositions that exhibited broad spectrum antimicrobial activity in solution, the utility of the Q-POSS compounds as an antimicrobial additive for polysiloxane coatings was determined. The results of the investigation showed that Q-POSSs possessing a relatively low extent of quaternization and longer alkyl chain lengths provided the highest antimicrobial activity in solution. For polysiloxane coatings containing Q-POSS molecules as an antimicrobial additive, coating surface energy, surface morphology, and antimicrobial properties were found to be strongly dependent on Q-POSS composition. Coatings based on Q-POSSs possessing the lowest extent of quaternization displayed antimicrobial activity while analogous coatings produced using Q-POSSs possessing the highest extent of quaternization showed no antimicrobial activity. The lack of antimicrobial activity exhibited by coatings possessing Q-POSSs with a relatively high extent of quaternization was attributed to agglomeration of Q-POSS molecules through the formation of intermolecular interactions involving the quaternary ammonium moieties. Agglomeration would be expected to reduce diffusivity and inhibit interaction of the Q-POSS molecules with microbial cells. [Copyright &y& Elsevier]

Abstract: Hypoxic preconditioning can protect the brain against a subsequent damaging ischaemic insult. Mild hypoxia alone seems not sufficient to cause neuronal injury, but can induce changes in gene expression and intracellular signalling pathways and the hypoxia-inducible transcription factor (HIF-1) is a key modulator of these genes. Recently, a family of HIF prolyl hydroxylase enzymes (PHDs) has been shown to regulate HIF-1 function by controlling its degradation. Since PHD-2 is thought to be the predominant isoform which regulates HIF-1, we have investigated whether preconditioning with hypoxia can affect levels of PHD-2 and HIF-1α proteins to elucidate roles for the HIF-1/PHD-2 system in the neuroprotection conferred by hypoxic preconditioning. Sprague–Dawley rats (postnatal Day 6 (p6)) were exposed to preconditioning with hypoxia (3h, 8% oxygen) or normoxia (3h, room air) at various times (0, 0.5, 2, 4, 16 and 24h) after reoxygenation, brains were obtained for Western blot and immunohistochemical analyses of PHD-2 and HIF-1α proteins. Western blotting studies demonstrate a significant increase in the expression of PHD-2 (∼1.8–2-fold increase, at 0.5, 16 and 24h after reoxygenation; p <0.01) and HIF-1α (∼1.7-fold increase immediately after hypoxia; p <0.05) proteins following hypoxic preconditioning relative to normoxic control tissue. Similar results were observed in immunohistochemical studies examining PHD-2 and HIF-1α proteins. Our study demonstrated for the first time that in vivo exposure to systemic hypoxia elevates the expression of PHD-2 protein in brain and it is likely that enhancing HIF-1 function by inhibition of PHD activity is involved in the protective effect conferred by hypoxic preconditioning in neonatal rat brain. [Copyright &y& Elsevier]

Shows the performance of an extensive mutational study to locate the CXCR3 and heparin binding sites of murine IP-10. Role of CXCR3 and GAG binding in the biological activity of IP-10; Evidence that the N-terminal residue Arg-8 as well as residues in the loop regions 22-26 and 46-47 are important for CXCR3 binding.

Phosphate depletion in the rat: Effect of bisphosphonates and the calcemic response to PTH. Background. The removal of phosphate from the diet of the growing rat rapidly produces hypercalcemia, hypophosphatemia, hypercalciuria, and hypophosphaturia. Increased calcium efflux from bone has been shown to be the important cause of the hypercalcemia and hypercalciuria. It has been proposed that the increased calcium efflux from bone is osteoclast mediated. Because bisphosphonates have been shown to inhibit osteoclast-mediated bone resorption, this study was performed to determine whether bisphosphonate-induced inhibition of osteoclast function changed the biochemical and bone effects induced by phosphate depletion. Methods. Four groups of pair-fed rats were studied: (a) low-phosphate diet (LPD; phosphate less than 0.05%), (b) LPD plus the administration of the bisphosphonate Pamidronate (APD; LPD + APD), (c) normal diet (ND, 0.6% phosphate), and (d) ND + APD. All diets contained 0.6% calcium. A high dose of APD was administered subcutaneously (0.8 mg/kg) two days before the start of the study diet and on days 2, 6, and 9 during the 11 days of the study diet. On day 10, a 24-hour urine was collected, and on day 11, rats were either sacrificed or received an additional APD dose before a 48-hour parathyroid hormone (PTH) infusion (0.066 μg/100 g/hr) via a subcutaneously implanted miniosmotic pump. Results. Serum and urinary calcium were greater in the LPD and LPD + APD groups than in the ND and ND + APD groups [serum, 11.12 ± 0.34 and 11.57 ± 0.45 vs. 9.49 ± 0.17 and 9.48 ± 0.15 mg/dl (mean ± se), P < 0.05; and urine, 8.78 ± 2.74 and 16.30 ± 4.68 vs. 0.32 ± 0.09 and 0.67 ± 0.28 mg/24 hr, P < 0.05]. Serum PTH and serum and urinary phosphorus were less in the LPD and LPD + APD than in the ND and ND + APD groups (P < 0.05). The calcemic response to PTH was less (P < 0.05) in the LPD and LPD + APD groups than in the ND group... [ABSTRACT FROM AUTHOR]

A model is developed of patient-doctor interaction under asymmetric information. It examines how both the probability of consulting and initial health status are semi-endogenously determined by a potential patient determining a threshold health level, below which he demands a consultation. It is shown that the demand elasticity with respect to socio-economic variables is lower the more severe the illness. The paper also offers a model of the supply side. A distinction is established between uncertainty and asymmetric information between the patient and the doctor. After deriving the conditions for an equilibrium of the patient-doctor interaction, payment systems for achieving medical 'adequacy' and Pareto efficiency are analysed. [ABSTRACT FROM AUTHOR]

Summary: The study of pediatric catatonia has not received much attention. During the last few years, progress has been made in delineating this syndrome in children and adolescents across a wide range of disorders. Catatonia is a potentially life-threatening but treatable syndrome that also occurs in children and adolescents with autistic, developmental, and tic disorders, and in its idiopathic form. In many of these cases, catatonia cannot be accounted for by an associated psychotic, affective, or medical disorder. These findings are imminently relevant for classification where catatonia is currently restricted to sections of the psychotic, affective, or medical disorders. Catatonia should always be the primary diagnosis in children, adolescents, and adults, as specific treatments for catatonia, i.e., benzodiazepines and electroconvulsive therapy, lower risk of worsening catatonia or precipitating Neuroleptic Malignant Syndrome when antipsychotic medications are used as first-line or sole treatment. The creation of a separate diagnostic class for catatonia is the safest approach to ensure proper diagnosis and treatment of this syndrome in patients of all ages and the best approach to promote research. [ABSTRACT FROM AUTHOR]