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Background Coronary artery calcification as assessed by computed tomography (CT) is a validated predictor of cardiovascular risk, whether identified on a dedicated cardiac study or on a routine non-gated chest CT. The prevalence of incidentally detected coronary artery calcification on non-gated chest CT imaging and consistency of reporting have not been well characterized. Hypothesis Coronary calcification is present on chest CT in some patients not taking statin therapy and may be under-reported. Methods Non-gated chest CT images dated 1/1/2012 to 1/1/2013 were retrospectively reviewed. Demographics and medical history were obtained from charts. Patients with known history of coronary revascularization and/or pacemaker/defibrillator were excluded. Two independent readers with cardiac CT expertise evaluated images for the presence and anatomical distribution of any coronary calcification, blinded to all clinical information including CT reports. Original clinical CT reports were subsequently reviewed. Results Coronary calcification was identified in 204/304 (68%) chest CTs. Patients with calcification were older and had more hyperlipidemia, smoking history, and known coronary artery disease. Of patients with calcification, 43% were on aspirin and 62% were on statin medication at the time of CT. Coronary calcification was identified in 69% of reports when present. Conclusions A high prevalence of coronary calcification was found in non-gated chest CT scans performed for non-cardiac indications. In one-third, coronary calcification was not mentioned in the clinical report when actually present. In this population of patients with cardiac risk factors, standard reporting of the presence of coronary calcification may provide an opportunity for risk factor modification.

Background Diabetes mellitus (DM) and metabolic syndrome are important targets for secondary prevention in cardiovascular disease. However, the prevalence in patients undergoing elective percutaneous coronary intervention is not well defined. We aimed to analyse the prevalence and characteristics of patients undergoing percutaneous coronary intervention with previously unrecognized prediabetes, diabetes and metabolic syndrome. Methods Data were collected from 740 patients undergoing elective percutaneous coronary intervention between November 2010 and March 2013 at a tertiary referral center. Prevalence of DM and prediabetes was evaluated using Haemoglobin A1c (A1c ≥ 6.5% for DM, A1c 5.7–6.4% for prediabetes). A modified definition was used for metabolic syndrome [three or more of the following criteria: body mass index ≥30 kg/m2; triglycerides ≥ 150 mg/dL; high density lipoprotein

Congenital absence of left atrial appendage (LAA) is an extremely rare condition and its physiological consequences are unknown. We present two cases of incidental finding of a congenitally absent LAA in a 79-year-old male who presented for routine transesophageal echocardiogram (TEE) to rule out intracardiac thrombus prior to placement of biventricular implantable cardioverter-defibrillator and a 54-year old female who presented for TEE prior to radiofrequency ablation of atrial fibrillation. Characterization of patients with such an absence is important because congenitally absent LAA may be confused with flush thrombotic occlusion of the appendage. There are very few published reports of congenital absence of LAA. To our knowledge, our report is the first to demonstrate the congenital absence of LAA by 3D transesophageal echocardiography.

Stroke is a leading cause of disability in the United States and disproportionately affects minority populations. We sought to explore the quality of life in urban, minority stroke survivors through their own photos and narratives. Using the Photovoice method, seventeen stroke survivors were instructed to take pictures reflecting their experience living with and recovering from stroke. Key photographs were discussed in detail; participants brainstormed ways to improve their lives and presented their work in clinical and community sites. Group discussions were recorded, transcribed, and coded transcripts were reviewed with written narratives to identify themes. Participants conveyed recovery from stroke in three stages: learning to navigate the initial physical and emotional impact of the stroke; coping with newfound physical and emotional barriers; and long-term adaptation to physical impairment and/or chronic disease. Participants navigated this stage-based model to varying degrees of success and identified barriers and facilitators to this process. Barriers included limited access for disabled and limited healthy food choices unique to the urban setting; facilitators included presence of social support and community engagement. Using Photovoice, diverse stroke survivors were able to identify common challenges in adapting to life after stroke and important factors for recovery of quality of life.

Introduction: The American Heart Association (AHA) developed 7 health metrics to define “ideal cardiovascular health” in its 2020 Impact Goal. Sex-specific disparities in attainment of the 7 health metrics in patients undergoing elective percutaneous or peripheral interventions has not been well characterized. Methods: We interviewed 1,517 patients (1,127 males and 390 females) undergoing elective percutaneous coronary or peripheral intervention at a large tertiary care center between November 2010 and March 2015. Survey data was used to reconstruct the 7 health metrics (blood pressure, physical activity, cholesterol, diet, weight, smoking status, and metabolic control). Multivariable linear regression was performed to identify characteristics associated with ideal metric attainment in the overall cohort and when stratified by sex. Results: Overall, males were younger, less likely to be white, more likely to be married, and had higher levels of education and higher prevalence of prior coronary artery disease than females (p Conclusions: Attainment of the 7 AHA ideal health metrics is low in both males and females undergoing elective percutaneous coronary or peripheral intervention. Sex-specific disparities in risk factor control illustrate interesting areas for further exploration into the predictors of behavior that may guide future targeted interventions.

Introduction: Hands-only CPR has been associated with improved survival rates for out of hospital cardiac arrest. There is wide geographic variation in bystander CPR rates and increased barriers to CPR knowledge in minority populations. Our aim was to assess the awareness and willingness to perform hands-only CPR in an ethnically diverse population. Methods: English-speaking patients in primary care and cardiac subspecialty clinics were approached to answer a 33 question survey. Demographic information was collected, and awareness of CPR and hands-only CPR was assessed. A brief instructional video of hands-only CPR was administered and willingness to perform hands-only CPR was assessed after. Results: Of 255 approached, 127 completed the survey. 53.4% were Hispanic or Black, and 81% spoke English at home. Median age was 49 years old, and majority were male (63%). 48% had a cardiac history or had a friend or family member with heart disease. 61% had no prior CPR training. The most common reasons identified for not doing CPR were fear of doing it incorrectly (33%) and no training (28%). 52% were unaware of hands-only CPR and 52% were unsure or unwilling to do CPR on a stranger. Willingness to perform CPR on a stranger was associated with higher educational level and prior training. After viewing the hands-only CPR instructional video,93% of those who were initially unsure or unwilling to do CPR were significantly more likely to do hands-only CPR (p Conclusions: In this predominantly minority population, we found reduced awareness of hands-only CPR and demonstrated that an educational video can increase willingness to perform hands-only CPR. This educational tool can be used to target areas and populations where bystander CPR rates are low.

The medial preoptic area (MPOA) is essential for normal maternal behavior in the rat. Hormone stimulation of the MPOA facilitates the behavior and lesions of the MPOA and the adjoining ventral part of the bed nucleus of the stria terminalis (vBST) disrupt the behavior. The MPOA/vBST also show increases in Fos protein expression during maternal behavior. The present study examines the larger neural circuitry within which the MPOA/vBST might operate to influence maternal behavior. Combining Fos immunocytochemistry with unilateral excitotoxic amino acid lesions or lateral knife cuts of the MPOA/vBST, we sought to identify brain regions which might be under the influence of Fos expressing neurons in the MPOA/vBST. Two brain regions, the shell of the nucleus accumbens (NAs), and the intermediate part of the lateral septum (LSi) were identified. Both the NAs and LSi exhibited elevated Fos expression during maternal behavior, while unilateral MPOA/vBST damage resulted in an ipsilateral reduction of maternal behavior-induced Fos expression in each area, suggesting that MPOA/vBST neurons modulate Fos expression and associated neural activity in both of these structures during maternal behavior. Importantly, these unilateral preoptic lesions also depressed maternal behavior-induced Fos expression in the ipsilateral MPOA and vBST. The effects of these lesions on Fos expression in the periaqueductal gray (PAG) and other brain regions are also presented.

The American Heart Association recommends targeting 7 cardiovascular (CV) health metrics to reduce morbidity and mortality. Control of these targets in patients undergoing CV intervention is uncertain.We prospectively studied patients undergoing elective percutaneous coronary or peripheral intervention from November 2010 to May 2012. We recorded data on patient demographics, clinical characteristics, and social history. Risk factor control was categorized as ideal, intermediate, or poor according to the 7 American Heart Association-defined CV health metrics (smoking status, body mass index, physical activity, diet, cholesterol, blood pressure, and metabolic control). Linear regression model was used to evaluate the association between baseline characteristics and poor CV health.Among 830 consecutive patients enrolled, mean age is 67.3 ± 10.8 years, 74.2% are male, and 62.1% are white. The adequacy of achievement of ideal CV health is suboptimal in our cohort; the mean number of ideal CV metrics is 2.15 ± 1.06. Less than 1 in 10 (9.7%) met ≥4 ideal CV health metrics. After multivariate analysis, male sex (P = .04), nonwhite race (P = .01), prior coronary artery disease (P.01), prior peripheral arterial disease (P.01), and history of depression (P = .01) were significantly associated with poor CV health.Among patients referred for elective CV intervention, achievement of ideal CV health is poor. Elective interventions represent an opportunity to identify and target CV health for risk factor control and secondary prevention.

Background Post-traumatic stress disorder (PTSD) can occur after life-threatening events, including illness, but correlates of PTSD after stroke or transient ischemic attack (TIA) have not been well described. Methods We measured the prevalence of stroke-induced PTSD with the PTSD Checklist Specific for stroke (PCL-S) in adults who had a stroke or TIA within 5 years. A PCL-S score of 50 or more indicated likely PTSD. We tested for potential predictors of stroke-associated PTSD, including demographics, stroke history, disability, medical comorbidities, depression, and emotional support and then examined the association between poststroke PTSD and measures of physical and mental health. Results Of 535 participants, 95 (18%) had a PCL-S score of 50 or more; the mean score was 35.4 ± 13.7 (range 17-80 of 85). In logistic regression analysis, low income (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.01-3.61), recurrent stroke or TIA (OR 1.86, 1.10-3.16), more disability (OR 1.79, 1.43-2.23), and increased comorbidities (OR 1.90, 1.05-3.45) were independently associated with PTSD. Older age (OR .93, .90-.95), marriage or partnership (OR .52, .28-.98), and having emotional support (OR .25, .11-.54) were protective against developing PTSD. Participants with likely PTSD had worse physical and mental health. Conclusions In this racially and ethnically diverse cohort of stroke and TIA survivors, stroke-induced PTSD was associated with younger age, recurrent strokes, greater disability, and comorbidities. PTSD was associated with a substantially increased physical, mental, and quality of life burden in this already vulnerable population. Having social support was protective, suggesting a potential target for intervention.

Background Stroke survivors may be at increased risk for post-traumatic stress disorder (PTSD), yet detailed data on prevalence and contributing factors are lacking. Harlem residents and local researchers, alarmed by high rates of stroke in their community and frustrated by the difficulty of engaging stroke survivors in prevention programs, aimed to determine the prevalence and correlates of PTSD in a cohort of survivors of stroke and transient ischemic attack (TIA). Methods Harlem residents and researchers employed community-based participatory research to develop a recurrent stroke prevention intervention. English and Spanish speaking adults over 40 were eligible for inclusion if they reported a stroke or TIA within the past five years. Baseline assessments included blood pressure, direct LDL cholesterol and validated self-report scales for demographics, stroke impact (modified Rankin scale), medical co-morbidities (Charlson co-morbidity index), and the widely-used 17-item PTSD Checklist Specific for stroke (PCL-S). A PCL-S score of 25 connotes a positive screening test, while a score greater than 50 is highly specific for PTSD. We recruited participants from community and clinical sites. To create a model of correlates for PTSD (PCL-S score > 50), we used logistic regression. Results The 379 enrollees had a mean age of 64 years, 62% were women, 79% were Black or Latino, 28% never completed high school, and more than half earned under $15,000 yearly. Most (75%) had PCL-S scores greater than 25, including 69 (18%) who scored above 50. Using logistic regression, and controlling for gender, race, education, and income (c-statistic of 0.835, p 100 mg/ dl (59% vs. 39%, p=0.003), both major risk factors for recurrent stroke. There was no significant difference in blood pressure control between the patients with and without PTSD. Conclusion PTSD is common after stroke, especially in younger people with more disability and more co-morbidity. We recommend that clinicians screen patients for PTSD after stroke and offer supportive therapy.

Background Chronic kidney disease occurs frequently after heart transplantation and is associated with significant morbidity and mortality. Herein we describe the histopathology associated with renal failure in a cohort of heart transplant recipients. Methods Over a 4-year period all patients with an estimated GFR 2 or significant proteinuria were referred to the kidney transplant clinic for clinical evaluation. A percutaneous renal biopsy was performed as part of a standardized evaluation. Results Eighteen patients underwent renal biopsy 5.8 ± 4.1 years after transplantation. Hypertension (88.9%), Type 2 diabetes (55.6%) and allograft vasculopathy (38.9%) were prevalent. All patients were receiving calcineurin inhibitors. Mean creatinine was 2.9 ± 1.2 mg/dl with an estimated GFR 27.9 ± 9.1 ml/min/1.73 m 2 . Eight patients (44%) had proteinuria >1 g per 24 hours. The major histologic findings were nephrosclerosis plus diabetic glomerulopathy (50%), nephrosclerosis and focal segmental glomerulosclerosis (22.2%) and nephrosclerosis alone (22.2%). One patient had direct CNI toxicity consisting of nodular sub-adventitial hyalinosis. Eleven patients (61.1%) had glomerular disease and 11 patients (61.1%) had moderate or severe tubular atrophy. During follow-up, 5 patients (27.8%) started hemodialysis, 4 (22.2%) died, and 2 (11.1%) received a renal transplant. Conclusions We observed diverse histologic patterns in this series of renal biopsies suggesting that chronic kidney disease after heart transplantation has a complex and varied pathologic basis. Further defining the renal injuries that precede heart transplantation and predispose to the progression of kidney disease after transplant may assist in treating this population.

This paper focuses on the professional development needs of a selected group of international students enrolled in home economics programmes in universities in the United States. It presents a rationale for professional communication as a means for maintaining professional competencies. It reports findings from a survey of students in which they reported their interest in and their perception of the availability of professional activities after return to the home country. Implications are then discussed and recommendations are made for supporting professional development and strengthening professional communication, thereby easing professional integration problems of international students.

Family resource management research relevant to rural families in Third World countries can produce useful information for rural development projects. However, currently, most of the research is imitative of Western research and contributes neither to theory construction nor to alleviation of real problems of rural poor families. The major stumbling blocks to improve research are limited trained personnel, inadequate commitment to research, insufficient funds and ignorance of socio-economic milieu hampering identification of relevant research problems. Three broad directives are suggested to strengthen research on management by Third World families: (i) selection and application of a conceptual framework to create consensus or focus, concepts and processes; (ii) identification of contextually relevant, researchable problems, and (iii) identification and use of appropriate research methods and tools. Suggested researchable problems include basic need standards, fuel management, appropriate technologies, family size and level of living, use of time, access to and utilization of consumer services and information. Various strategies to develop a sound family resource management research base are identified.

Women's work in the developing country of India contributes to sectoral production in the national economy and household production in the family economy. A conceptual framework based on systems exchange assumption classifies women's work as formal sector, informal sector, household production and home production activities. Various economic evaluation methods related to unpaid household work can be applied to appraise the value of women's work. Farm women of Haryana have a 13-hour workday in farm, dairy and home sectors. The estimated monetary value of the 13-hour workday is Rs. 15–55.