Search

(1) Background: In this qualitative study, we investigated the implementation of an art-based observation workshop as a tool to improve visualization and interpretation skills in a cohort of first-year dental students (N = 109) in a dental anatomy course. (2) Methods: The art workshop was held once for a total of 60 min in the pre-clinical simulation laboratory, which is the regular teaching setting for the dental anatomy course. Visualization and interpretation skills were assessed before (pre-test) and after the art-based observation workshop (post-test). The pre- and post-tests contained five images that guided students to describe dental anatomy images. The pre- and post-test had different but similar images. Dental students accessed the pre- and post-tests on CANVAS and recorded their answers. After that, the audio recording files were analyzed and compared to determine the frequency of use of dental anatomy-specific nomenclature while answering the pre- and post-test. (3) Results: Our results demonstrate that students used dental anatomy-specific nomenclature more frequently after the intervention. (4) Conclusions: we have concluded that students’ use of dental anatomy nomenclature in the first-year dental anatomy curriculum is enhanced following an art-based intervention in a regular dental simulation laboratory.

Abstract Multiple neurotoxic proteinopathies co-exist within vulnerable neuronal populations in all major neurodegenerative diseases. Interactions between these pathologies may modulate disease progression, suggesting they may constitute targets for disease-modifying treatments aiming to slow or halt neurodegeneration. Pairwise interactions between superoxide dismutase 1 (SOD1), TAR DNA-binding protein 43 (TDP-43) and ubiquitin-binding protein 62/sequestosome 1 (p62) proteinopathies have been reported in multiple transgenic cellular and animal models of amyotrophic lateral sclerosis (ALS), however corresponding examination of these relationships in patient tissues is lacking. Further, the coalescence of all three proteinopathies has not been studied in vitro or in vivo to date. These data are essential to guide therapeutic development and enhance the translation of relevant therapies into the clinic. Our group recently profiled SOD1 proteinopathy in post-mortem spinal cord tissues from familial and sporadic ALS cases, demonstrating an abundance of structurally-disordered (dis)SOD1 conformers which become mislocalized within these vulnerable neurons compared with those of aged controls. To explore any relationships between this, and other, ALS-linked proteinopathies, we profiled TDP-43 and p62 within spinal cord motor neurons of the same post-mortem tissue cohort using multiplexed immunofluorescence and immunohistochemistry. We identified distinct patterns of SOD1, TDP43 and p62 co-deposition and subcellular mislocalization between motor neurons of familial and sporadic ALS cases, which we primarily attribute to SOD1 gene status. Our data demonstrate co-deposition of p62 with mutant and wild-type disSOD1 and phosphorylated TDP-43 in familial and sporadic ALS spinal cord motor neurons, consistent with attempts by p62 to mitigate SOD1 and TDP-43 deposition. Wild-type SOD1 and TDP-43 co-deposition was also frequently observed in ALS cases lacking SOD1 mutations. Finally, alterations to the subcellular localization of the three proteins were tightly correlated, suggesting close relationships between the regulatory mechanisms governing the subcellular compartmentalization of these proteins. Our study is the first to profile spatial relationships between SOD1, TDP-43 and p62 pathologies in post-mortem spinal cord motor neurons of ALS patients, previously only studied in vitro. Our findings suggest interactions between these three key ALS-linked proteins are likely to modulate the formation of their respective proteinopathies, and perhaps the rate of motor neuron degeneration, in ALS patients.

Abstract There is a strong genetic contribution to Amyotrophic lateral sclerosis (ALS) risk, with heritability estimates of up to 60%. Both Mendelian and small effect variants have been identified, but in common with other conditions, such variants only explain a little of the heritability. Genomic structural variation might account for some of this otherwise unexplained heritability. We therefore investigated association between structural variation in a set of 25 ALS genes, and ALS risk and phenotype. As expected, the repeat expansion in the C9orf72 gene was identified as associated with ALS. Two other ALS-associated structural variants were identified: inversion in the VCP gene and insertion in the ERBB4 gene. All three variants were associated both with increased risk of ALS and specific phenotypic patterns of disease expression. More than 70% of people with respiratory onset ALS harboured ERBB4 insertion compared with 25% of the general population, suggesting respiratory onset ALS may be a distinct genetic subtype.

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the loss of upper and lower motor neurons, leading to progressive weakness of voluntary muscles, with death following from neuromuscular respiratory failure, typically within 3 to 5 years. There is a strong genetic contribution to ALS risk. In 10% or more, a family history of ALS or frontotemporal dementia is obtained, and the Mendelian genes responsible for ALS in such families have now been identified in about 50% of cases. Only about 14% of apparently sporadic ALS is explained by known genetic variation, suggesting that other forms of genetic variation are important. Telomeres maintain DNA integrity during cellular replication, differ between sexes, and shorten naturally with age. Sex and age are risk factors for ALS and we therefore investigated telomere length in ALS.MethodsSamples were from Project MinE, an international ALS whole genome sequencing consortium that includes phenotype data. For validation we used donated brain samples from motor cortex from people with ALS and controls. Ancestry and relatedness were evaluated by principal components analysis and relationship matrices of DNA microarray data. Whole genome sequence data were from Illumina HiSeq platforms and aligned using the Isaac pipeline. TelSeq was used to quantify telomere length using whole genome sequence data. We tested the association of telomere length with ALS and ALS survival using Cox regression.ResultsThere were 6,580 whole genome sequences, reducing to 6,195 samples (4,315 from people with ALS and 1,880 controls) after quality control, and 159 brain samples (106 ALS, 53 controls). Accounting for age and sex, there was a 20% (95% CI 14%, 25%) increase of telomere length in people with ALS compared to controls (p = 1.1 × 10−12), validated in the brain samples (p = 0.03). Those with shorter telomeres had a 10% increase in median survival (p = 5.0×10−7). Although there was no difference in telomere length between sporadic ALS and familial ALS (p=0.64), telomere length in 334 people with ALS due to expanded C9orf72 repeats was shorter than in those without expanded C9orf72 repeats (p = 5.0×10−4).DiscussionAlthough telomeres shorten with age, longer telomeres are a risk factor for ALS and worsen prognosis. Longer telomeres are associated with ALS.

Adoption by livestock producers of preventive non-lethal innovations forms a critical pathway towards human and large carnivore coexistence. However, it is impeded by factors such as socio-cultural contexts, governing institutions, and ‘perverse’ economic incentives that result in a ‘lock-in’ of lethal control of carnivores in grazing systems. In Australian rangelands, the dingo is the dominant predator in conflict with ‘graziers’ and is subjected to lethal control measures despite evidence indicating that its presence in agricultural landscapes can provide multiple benefits. Here we explore the barriers to the uptake of preventive innovations in livestock grazing through 21 in-depth interviews conducted with Australian graziers, researchers, and conservation and government representatives. Drawing on Donella Meadow’s leverage points for system change framework, we focus, primarily, on barriers in the ‘political sphere’ because they appear to form the greatest impediment to the adoption of non-lethal tools and practices. These barriers are then discussed in relation to characteristics of lock-in traps (self-reinforcement, persistence, path dependencies, and undesirability) to assess how they constrain the promotion of human–dingo coexistence.

Abstract Long interspersed element-1 (LINE-1/L1) is the only autonomous transposable element in the human genome that currently mobilises in both germline and somatic tissues. Recent studies have identified correlations between altered retrotransposon expression and the fatal neurodegenerative disease amyotrophic lateral sclerosis (ALS) in a subset of patients. The risk of an individual developing ALS is dependent on an interaction of genetic variants and subsequent modifiers during life. These modifiers could include environmental factors, which can lead to epigenetic and genomic changes, such as somatic mutations, occurring in the neuronal cells that degenerate as the disease develops. There are more than 1 million L1 copies in the human genome today, but only 80–100 L1 loci in the reference genome are considered to be retrotransposition-competent (RC) and an even smaller number of these RC-L1s loci are highly active. We hypothesise that RC-L1s could affect normal cellular function through their mutagenic potential conferred by their ability to retrotranspose in neuronal cells and through DNA damage caused by the endonuclease activity of the L1-encoded ORF2 protein. To investigate whether either an increase in the genomic burden of RC-L1s or epigenetic changes to RC-L1s altering their expression, could play a role in disease development, we chose a set of seven well characterised genomic RC-L1 loci that were reported earlier to be highly active in a cellular L1 retrotransposition reporter assay or serve as major source elements for germline and/or somatic retrotransposition events. Analysis of the insertion allele frequency of five polymorphic RC-L1s, out of the set of seven, for their presence or absence, did not identify an increased number individually or when combined in individuals with the disease. However, we did identify reduced levels of methylation of RC-L1s in the motor cortex of those individuals with both familial and sporadic ALS compared to control brains. The changes to the regulation of the loci encompassing these RC-L1s demonstrated tissue specificity and could be related to the disease process.

Mono-N-alkylated primary oxalamide derivatives with different sized branched alkyl tail-groups were excellent low molecular weight gelators for a variety of different organic solvents with different polarities and hydrogen-bonding abilities. Solvent-gelator interactions were analyzed using Hansen solubility parameters, while 1H NMR and FTIR spectroscopy were used to probe the driving forces for the supramolecular gelation. The molecular structures of the twin tail-groups did not significantly affect the supramolecular gelation behavior in different solvents. However, for select solvents, the molecular structures of the tail-groups did have a significant effect on gel properties such as the critical gelator concentration, thermal stability, gel stiffness, gel strength, network morphology, and molecular packing. Finally, metabolic activity studies showed that the primary alkyl oxalamide gelators had no effect on the metabolic activity of mouse immune cells, which suggests that the compounds are not cytotoxic and are suitable for use in biomedical applications.

This reflective essay follows a faculty working group as they attempt to understand barriers to access to course materials through the scholarship of teaching and learning (SoTL). Through the workgroup’s research and collaboration with students in a problem-based learning course, the workgroup uncovered elements of the hidden curriculum in assumptions regarding course material procurement. The collaboration has served as the foundation for efforts to begin to transform the way that faculty on campus make use of textbooks and course materials in their courses. This transformation should make explicit to faculty that the utilization of course materials for all aspects of the course are often hidden pedagogy and must be made explicit by each instructor.

A new series of 5-alkylamido isophthalic acid (ISA) derivatives with varying single and twin alkyl chain lengths were designed and synthesized as potential supramolecular organogelators. 5-alkylamido ISAs with linear or branched alkyl tail-groups of different lengths were effective gelators for low polarity solvents. In particular, among the presented series, a derivative with a branched, 24 carbon atom tail-group behaves as a “supergelator” with up to twenty organic solvents forming gels that are highly stable over time. The gelation behavior was analyzed using Hansen solubility parameters, and the thermal stability and viscoelastic properties of select gels were characterized. Microscopy, spectroscopy, powder X-ray diffraction, and computer modeling studies were consistent with a hierarchical self-assembly process involving the formation of cyclic H-bonded hexamers via the ISA carboxylic acid groups, which stack into elementary fibers stabilized by H-bonding of the amide linker groups and π–π stacking of the aromatic groups. These new nanomaterials exhibited potential for the phase-selective gelation of oil from oil–water mixtures and dye uptake from contaminated water. The work expands upon the design and synthesis of supramolecular self-assembled nanomaterials and their application in water purification/remediation.

Background: Measurement of hospital quality has traditionally focused on processes of care and postprocedure outcomes. Appropriateness measures for percutaneous coronary intervention (PCI) assess quality as it relates to patient selection and the decision to perform PCI. The association between patient selection for PCI and processes of care and postprocedural outcomes is unknown.Methods and Results: We included 203 531 patients undergoing nonacute (elective) PCI from 779 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between July 2009 and April 2011. We examined the association between a hospital's proportion of nonacute PCIs categorized as inappropriate by the 2009 Appropriate Use Criteria (AUC) for Coronary Revascularization and in-hospital mortality, bleeding complications, and use of optimal guideline-directed medical therapy at discharge (ie, aspirin, thienopyridines, and statins). When categorized as hospital tertiles, the range of inappropriate PCI was 0.0% to 8.1% in the lowest tertile, 8.1% to 15.2% in the middle tertile, and 15.2% to 58.6% in the highest tertile. Compared with lowest-tertile hospitals, mortality was not significantly different at middle-tertile (adjusted odds ratio [OR], 0.93; 95% confidence interval [CI], 0.73-1.19) or highest-tertile hospitals (OR, 1.12; 95% CI, 0.88-1.43; P=0.35 for differences between tertiles). Similarly, risk-adjusted bleeding did not vary significantly (middle-tertile OR, 1.13; 95% CI, 1.02-1.16; highest-tertile OR, 1.02; 95% CI, 0.91-1.16; P=0.07 for differences between tertiles) nor did use of optimal medical therapy at discharge (85.3% versus 85.7% versus 85.2%; P=0.58).Conclusions: In a national cohort of nonacute PCIs, a hospital's proportion of inappropriate PCIs was not associated with in-hospital mortality, bleeding, or medical therapy at discharge. This suggests PCI appropriateness measures aspects of hospital PCI quality that are independent of how well the procedure is performed. Therefore, PCI appropriateness and postprocedural outcomes are both important metrics to inform PCI quality. [ABSTRACT FROM AUTHOR]

Introduction -- This investigation sought to determine whether the methodological search filters in place as Clinical Queries limits in OvidSP EMBASE and OvidSP MEDLINE had been modified from those written by Haynes et al. [1] and whether the translations of these in PubMed and EBSCO MEDLINE were reliable. The translated National Library of Medicine (NLM) Systematic Reviews hedges in place in OvidSP MEDLINE and EBSCO MEDLINE were also examined. Methods - Search queries were run using the Clinical Queries and Systematic Reviews hedges incorporated into OvidSP EMBASE, OvidSP MEDLINE, PubMed, and EBSCO MEDLINE to determine the reliability of these limits in comparison with the published hedge search strings. Results -- Five of the OvidSP EMBASE Clinical Queries hedges produced results that were different from the published search strings. Three of the EBSCO MEDLINE and five of the PubMed translated Clinical Queries hedges yielded markedly different results (>10% difference) than those obtained using the OvidSP MEDLINE hedge counterparts. The OvidSP MEDLINE Systematic Reviews subject subset hedge was found to have a major error, which has been corrected. Discussion -- Translations of hedges to appropriate syntax for other database platforms may result in significantly different search results. The platform searched should ideally be the one for which the hedges were written and tested. Regardless, the hedges in place may not be the same as the published hedge search strings. Quality control testing is needed to ensure that the hedges in place as limits are the same as those that have been published. [ABSTRACT FROM AUTHOR]

With the large number of Internet sources available for health care information, finding appropriate sources can be difficult for patients. Medical-surgical nurses can guide patients to credible sites with reliable information about specific conditions, such as chronic obstructive pulmonary disease. Suggestions for evaluation of health care sites are included. [ABSTRACT FROM AUTHOR]

Metabolic reprogramming is critical to oncogenesis, but the emergence and function of this profound reorganization remain poorly understood. Here we find that cooperating oncogenic mutations drive large-scale metabolic reprogramming, which is both intrinsic to cancer cells and obligatory for the transition to malignancy. This involves synergistic regulation of several genes encoding metabolic enzymes, including the lactate dehydrogenases LDHA and LDHB and mitochondrial glutamic pyruvate transaminase 2 (GPT2). Notably, GPT2 engages activated glycolysis to drive the utilization of glutamine as a carbon source for TCA cycle anaplerosis in colon cancer cells. Our data indicate that the Warburg effect supports oncogenesis via GPT2-mediated coupling of pyruvate production to glutamine catabolism. Although critical to the cancer phenotype, GPT2 activity is dispensable in cells that are not fully transformed, thus pinpointing a metabolic vulnerability specifically associated with cancer cell progression to malignancy.

Ian Blair and colleagues use genome-wide linkage analysis and whole exome sequencing to identify mutations in the CCNF gene in large cohorts of amyotrophic lateral sclerosis and frontotemporal dementia patients. In addition to validating the mutations in international cohorts, the authors also show that mutant CCNFgene product affects ubiquitination and protein degradation in cultured cells.

Many historical narratives take for granted that a conservative “Reagan Revolution” took place in the 1980s. Though the gap between the reality and the rhetoric of the Reagan era has been subject to historiographical debate, the expression is still used today by Reagan critics and supporters alike. This article suggests that the use of revolutionary rhetoric by American conservatives is an ideological tool that tends to undermine the very meaning of revolution, thus reducing the number of politically viable alternatives that would prompt significant change. This hypothesis is explored in two ways: first, by analyzing how Ronald Reagan presented both his policy objectives and his role in American history in terms of “revolution”; and second, by measuring the extent of a selection of actual changes that took place during and after the 1980s, so as to determine how revolutionary Reagan’s legacy is.

Increased vulnerability to natural disasters has been associated with particular groups in the community. This includes those who are considered de facto vulnerable (children, older people, those with disabilities etc.) and those who own pets (not to mention pets themselves). The potential for reconfiguring pet ownership from a risk factor to a protective factor for natural disaster survival has been recently proposed. But how might this resilience-building proposition apply to vulnerable members of the community who own pets or other animals? This article addresses this important question by synthesizing information about what makes particular groups vulnerable, the challenges to increasing their resilience and how animals figure in their lives. Despite different vulnerabilities, animals were found to be important to the disaster resilience of seven vulnerable groups in Australia. Animal attachment and animal-related activities and networks are identified as underexplored devices for disseminating or ‘piggybacking’ disaster-related information and engaging vulnerable people in resilience building behaviors (in addition to including animals in disaster planning initiatives in general). Animals may provide the kind of innovative approach required to overcome the challenges in accessing and engaging vulnerable groups. As the survival of humans and animals are so often intertwined, the benefits of increasing the resilience of vulnerable communities through animal attachment is twofold: human and animal lives can be saved together.

Background:To describe the incidence of QRS prolongation, intraventricular conduction delay (IVCD), and presence of ventricular arrhythmias in patients undergoing the Norwood procedure with subsequent superior cavopulmonary anastomosis. Differences between the modified Blalock-Taussig shunt (BTS) and the right ventricle to pulmonary artery shunt (RV-PA) on these variables were investigated. Methods:Eighty-two consecutive patients underwent Norwood palliation with a BTS (n = 41) or a RV-PA (n = 41). Standard 12-lead surface ECGs were retrospectively reviewed at three separate times: (1) prior to the Norwood procedure, (2) immediately post-Norwood procedure, and (3) prior to the superior cavopulmonary anastomosis. Groups were compared at these times for the absolute QRS duration, the change in QRS duration from one time interval to the other, and the number of patients with IVCD. The presence of ventricular rhythm abnormalities requiring treatment at any time was recorded. Results:Immediately after the Norwood procedure, QRS duration was slightly longer and median QRS change slightly larger for the RV-PA than the BTS group (P = 0.04). However, there were no differences in these variables at the time of pre superior cavopulmonary anastomosis. Within both groups, there was a significant increase in median QRS duration over time; from both pre- and post-Norwood to presuperior cavopulmonary anastomosis (P < 0.001). Conclusions:IVCD is common in patients following a Norwood procedure regardless of the type of shunt received. A ventriculotomy had small effects on QRS duration in the short term, but had no effect on the incidence of treatable ventricular rhythm abnormalities. [ABSTRACT FROM AUTHOR]

The ABCA1 protein mediates the transfer of cellular cholesterol across the plasma membrane to apolipoprotein A-I. Loss-of-function mutations in the ABCA1 gene induce Tangier disease and familial hypoalphalipoproteinemia, both cardiovascular conditions characterized by abnormally low levels of serum cholesterol, increased cholesterol in macrophages, and subsequent formation of vascular plaque. Increased intracellular cholesterol levels are also frequently found in cancer cells. Here, we demonstrate anticancer activity of ABCA1 efflux function, which is compromised following inhibition of ABCA1 gene expression by oncogenic mutations or cancer-specific ABCA1 loss-of-function mutations. In concert with elevated cholesterol synthesis found in cancer cells, ABCA1 deficiency allows for increased mitochondrial cholesterol, inhibits release of mitochondrial cell death-promoting molecules, and thus facilitates cancer cell survival, suggesting that elevated mitochondrial cholesterol is essential to the cancer phenotype.

The talking book is a type of assistive technology where original print text is audio recorded and marked-up in order to make it accessible for people with print-disabilities, such as visual impairments or dyslexia. In this pilot study, we explore the implications of remediating a written text, the script of Shakespeare’s King Lear, into spoken text. We compare two readings of the play: a talking book version; and a commercial audiobook recording. We examine intonation choices in an excerpt from the play in the two readings. The analysis shows significant variation in choices of intonation, and thus the meanings that are produced in the two versions, resulting in not one but two King Lear plays. One implication of such variation might be that different styles of narration demand different ways of reading. The results point to the need to explore how intonation makes meaning for actual talking book readers in situ, where meaning-potentials are realised through the interaction and encounter between the text, the reader(s), the social settings in which they are reading, and the material properties of talking books.

Humans and animals share their lives with one another in many ways. Pets, for example, are often considered valuable members of the family. They are invited into human hearts and homes, where they share routines, food and space. Animals are not only important to human waking lives. Some of them also share human beds – be it by invitation or invasion! Yet, little is known about human-animal co-sleeping practices and their impact on humans, animals and human-animal relations. This is the first paper to critically collate the scant and disparate research on human-animal co-sleeping. Given that the research is risk-centric, the paper turns to established theories on animal attachment to propose explanations for the continued practice of human-animal co-sleeping and its benefits. To redress an anthropocentric bias in the limited existing research, an agenda for further research is outlined on human-animal co-sleeping that considers humans, animals and the human-animal relation.

Genetic mutations of FUS have been linked to many diseases including Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Lobar Degeneration. A primate specific and polymorphic retrotransposon of the SINE-VNTR-Alu (SVA) family is present upstream of the FUS gene. Here we have demonstrated that this retrotransposon can act as a classical transcriptional regulatory domain in the context of a reporter gene construct both in vitro in the human SK-N-AS neuroblastoma cell line and in vivo in a chick embryo model. We have also demonstrated that the SVA is composed of multiple distinct regulatory domains, one of which is a variable number tandem repeat (VNTR). The ability of the SVA and its component parts to direct reporter gene expression supported a hypothesis that this region could direct differential FUS expression in vivo. The SVA may therefore contribute to the modulation of FUS expression exhibited in and associated with neurological disorders including ALS where FUS regulation may be an important parameter in progression of the disease. As VNTRs are often clinical associates for disease progression we determined the extent of polymorphism within the SVA. In total 2 variants of the SVA were identified based within a central VNTR. Preliminary analysis addressed the association of these SVA variants within a small sporadic ALS cohort but did not reach statistical significance, although we did not include other parameters such as SNPs within the SVA or an environmental factor in this analysis. The latter may be particularly important as the transcriptional and epigenetic properties of the SVA are likely to be directed by the environment of the cell.

Every year, thousands of purebred domestic dogs are bred by registered dog breeders. Yet, little is known about the rearing environment of these dogs, or the attitudes and priorities surrounding breeding practices of these dog breeders. The objective of this study was to explore some of the factors that dog breeders consider important for stock selection, with a particular emphasis on issues relating to the dam. Two-hundred and seventy-four Australian purebred dog breeders, covering 91 breeds across all Australian National Kennel Club breed groups, completed an online survey relating to breeding practices. Most breeders surveyed (76%) reported specialising in one breed of dog, the median number of dogs and bitches per breeder was two and three respectively, and most breeders bred two litters or less a year. We identified four components, relating to the dam, that were considered important to breeders. These were defined as Maternal Care, Offspring Potential, Dam Temperament, and Dam Genetics and Health. Overall, differences were observed in attitudes and beliefs across these components, showing that there is variation according to breed/breed groups. In particular, the importance of Maternal Care varied according to dog breed group. Breeders of brachycephalic breeds tended to differ the most in relation to Offspring Potential and Dam Genetics and Health. The number of breeding dogs/bitches influenced breeding priority, especially in relation to Dam Temperament, however no effect was found relating to the number of puppies bred each year. Only 24% of breeders used their own sire for breeding. The finding that some breeders did not test for diseases relevant to their breed, such as hip dysplasia in Labrador Retrievers and German Shepherds, provides important information on the need to educate some breeders, and also buyers of purebred puppies, that screening for significant diseases should occur. Further research into the selection of breeding dams and sires will inform future strategies to improve the health and behaviour of our best friend.

This paper presents a brief history of the use of happiness and wellbeing rhetoric to bolster political support for the expansion of homeownership in the United States. Recent research has studied the impact of homeownership on various dimensions of wellbeing, such as crime, education, health, and civic participation. However, less attention has been given to the way in which policymakers have historically defined the pursuit of happiness as a gateway to a virtuous way of life thanks to homeownership. After exploring the relations between the right to pursue happiness and the right to own property in the American founding documents, the paper studies the happiness discourse that accompanied the rise of the suburban model of homeownership in the 20th century, followed by that which accompanied the policy shifts implemented in the late 20th century to conserve this model.

Background: Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management., Methods and Results: A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid-lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid-lowering therapy, or low-density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, P  < 0.001), ezetimibe (7.65% versus 0.8%, P  < 0.001), or proprotein convertase substilisin/kexin type 9 inhibitor (6.7% versus 0.3%, P  < 0.001) compared with those without a test. Those with an elevated lipoprotein (a) level more frequently initiated ezetimibe (11.5% versus 5.9%, P  < 0.001) or proprotein convertase substilisin/kexin type 9 inhibitor (10.9% versus 4.8%, P  < 0.001)., Conclusions: Lipoprotein (a) testing in patients with atherosclerotic cardiovascular disease is infrequent, with evidence of disparities among older or Black individuals. Testing for lipoprotein (a), regardless of level, is associated with greater initiation of any lipid-lowering therapy, while elevated lipoprotein (a) is associated with greater initiation of nonstatin lipid-lowering therapy. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for lipoprotein (a) testing, and its implications on management.

Competing Interests: Dr Bradley discloses serving as a Senior Medical Advisor, Measurement, for the American College of Cardiology. Dr Das discloses serving as an assistant editor for Circulation and as the President of the Dallas Regional Board of the American Heart Association.

Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Understanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. The aim of this study was to identify aortic aneurysm growth rate on serial echocardiography as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth., Methods: Patients identified with ascending aortic aneurysms and undergoing serial echocardiograms within 5 years were evaluated. Ascending aortic size was measured as part of routine echocardiographic examinations. Clinical and demographic variables including aortic valve type (trileaflet, bicuspid, or prosthetic) were evaluated for association with baseline aortic size as well as with aortic progression rate. Clinical events including aortic dissection and elective or emergent surgical repair were recorded., Results: A total of 3,639 patients were identified (78% men; median age, 69 years), 175 (4.8%) with bicuspid valves and 206 (5.6%) with prior aortic valve replacement. Patients with larger aortas at baseline were older, with higher tobacco use and prior prosthetic valves. Over a mean of 2.4 years, aortic growth was observed and differed by valve type (trileaflet valve, 0.08 mm/y; bicuspid valve, 0.4 mm/y; P < .001). In six patients who developed aortic dissection, the estimated average annual growth rate was 0.98 mm/y., Conclusions: In a large echocardiographic cohort, aortic aneurysm growth rate was 0.08 mm/y, though it was higher in patients with bicuspid valves (0.4 mm/y), but initial aortic size did not correlate with change in the aortic progression rate. These data may help inform recommended echocardiographic surveillance intervals., Competing Interests: Conflicts of Interest None., (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to be < 70 mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), the rate of achieving this goal remains suboptimal. We sought to understand real world contemporary practice patterns of LDL-C management in patients with ASCVD, and whether LDL-C testing influenced management across US health systems., Methods: A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance was performed on patients with an LDL-C measurement in 2021 and prior ASCVD. Multivariable regression modeling was used to determine the relationship of clinical factors with achievement of guideline directed LDL-C target. Changes in lipid lowering therapy (LLT) after LDL-C testing were also described., Results: Among 216,074 patients with ASCVD, 129,886 (60.1%) had uncontrolled LDL-C (i.e. ≥ 70 mg/dL). Compared with participants with controlled LDL-C (< 70 mg/dL), those with uncontrolled LDL-C were more frequently female (50.9% vs. 35.1%), or Black (13.7% vs. 10.3%), and less commonly had coronary artery disease as the form of vascular disease (73.0% vs. 83.5% %), heart failure (21.3% vs. 29.1% %), diabetes (34.1% vs. 48.2%), atrial fibrillation (19.3% vs. 26.1%), or chronic kidney disease (25.1% vs. 32.2%). In multivariable analyses, the factors most strongly associated with failure to achieve LDL-C control were female sex (RR 1.13 [95% CI 1.12-1.14] P < .001) and Black race (1.15 [1.14-1.17] P < .001). Among the 53,957 (41.5%) of those with uncontrolled LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline, only 21% were initiated on any LLT within 6 months of the uncontrolled LDL-C value., Conclusions: Within 5 diverse large health systems in the CardioHealth Alliance, more than half of the patients with ASCVD had uncontrolled LDL-C with significant disparities based on sex and race at baseline. The vast majority were not initiated on any lipid lowering therapy within 6 months of an elevated test result indicating persistent gaps in care that will likely worsen health inequities in outcomes. This highlights the urgent need for implementation efforts to improve equitable care., Competing Interests: Conflict of interest None reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Persons living with dementia (PLWD) experience frequent and costly emergency department (ED) visits, with poor outcomes attributed to suboptimal care and postdischarge care transitions. Yet, patient-centered data on ED care experiences and postdischarge needs are lacking. The objective of this study was to examine the facilitators and barriers to successful ED care and care transitions after discharge, according to PLWD and their caregivers., Methods: We conducted a qualitative study involving ED patients ages 65 and older with confirmed or suspected dementia and their caregivers. The semistructured interview protocol followed the National Quality Forum's ED Transitions of Care Framework and addressed ED care, care transitions, and outpatient follow-up care. Interviews were conducted during an ED visit at an urban, academic ED. Traditional thematic analysis was used to identify themes., Results: We interviewed 11 patients and 19 caregivers. Caregivers were more forthcoming than patients about facilitators and challenges experienced. Characteristics of the patients' condition (e.g., resistance to care, forgetfulness), the availability of family resources (e.g., caregiver availability, primary care access), and system-level factors (e.g., availability of timely appointments, hospital policies tailored to persons with dementia) served as facilitators and barriers to successful care. Some resources that would ameliorate care transition barriers could be easily provided in the ED, for example, offering clear discharge instructions and care coordination services and improving patient communication regarding disposition timeline. Other interventions would require investment from other parts of the health care system (e.g., respite for caregivers, broader insurance coverage)., Conclusions: ED care and care transitions for PLWD are suboptimal, and patient-level factors may exacerbate existing system-level deficiencies. Insight from patients and their caregivers may inform the development of ED interventions to design specialized care for this patient population. This qualitative study also demonstrated the feasibility of conducting ED-based studies on PLWD during their ED visit., (© 2024 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Rape myths play a role in rape denialism, in which individuals deny the prevalence and severity of sexual assault. This project aimed to address two common rape myths: that rape is uncommon and its effects are exaggerated. To test these claims, we explored two archival samples consisting of undergraduate women. Study 1, a 5-year chart review of university counseling center intake forms ( n = 883), demonstrated that 30.2% of clients had experienced "sexual violence," "sexual contact without consent," or both. Study 2, a re-analysis of an emerging adulthood resilience survey dataset ( n = 359), demonstrated that 20.6% of subjects had a history of sexual assault, and that those women reported lower life satisfaction and more severe psychological symptoms than those who did not. These findings are in line with previous literature debunking harmful rape myths that contribute to the perpetuation of rape culture. Our data help validate these rape notions as mythical; rape is indeed common and devastating., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data regarding the effect of significant TVI on outcomes after truncus arteriosus (TA) repair are limited. The aim of this meta-analysis was to summarize outcomes among patients aged ≤ 24 months undergoing TA repair with at least moderate TVI. A systematic literature search was conducted in PubMed, Scopus, and CINAHL Complete from database inception through June 1, 2022. Studies reporting outcomes of TA repair in patients with moderate or greater TVI were included. Studies reporting outcomes only for patients aged > 24 months were excluded. The primary outcome was overall mortality, and secondary outcomes included early mortality and truncal valve reoperation. Random-effects models were used to estimate pooled effects. Assessment for bias was performed using funnel plots and Egger's tests. Twenty-two single-center observational studies were included for analysis, representing 1,172 patients. Of these, 232 (19.8%) had moderate or greater TVI. Meta-analysis demonstrated a pooled overall mortality of 28.0% after TA repair among patients with significant TVI with a relative risk of 1.70 (95% CI [1.27-2.28], p < 0.001) compared to patients without TVI. Significant TVI was also significantly associated with an increased risk for early mortality (RR 2.04; 95% CI [1.36-3.06], p < 0.001) and truncal valve reoperation (RR 3.90; 95% CI [1.40-10.90], p = 0.010). Moderate or greater TVI before TA repair is associated with an increased risk for mortality and truncal valve reoperation. Management of TVI in patients remains a challenging clinical problem. Further investigation is needed to assess the risk of concomitant truncal valve surgery with TA repair in this population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)