bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between insomnia symptoms, job strain and burnout syndrome: a cross-sectional survey of 1300 financial workers
Authors: Metlaine Arnaud , Sauvet Fabien , Gomez-Merino Danielle , Elbaz Maxime , Delafosse Jean Yves , Leger Damien , Chennaoui Mounir
Published: January 2017

Objectives

Professional burnout is closely related to work stress but less frequently associated with disturbed sleep. This study determines whether job strain and sleep disturbances are associated risk factors of burnout among financial workers.

Design

Observational study.

Participants

1300 employees (725 female) of a financial company.

Primary measures

Self-reported questionnaires (Maslach Burnout Inventory, Job Content Questionnaire, Sleep questionnaire based on ICSD-3 classification), the Epworth sleepiness scale and the Hospital Anxiety and Depression Scale (HADS).

Result

The prevalence of burnout was 10.2% (9.0% moderate and 1.2% severe). 23.3% of workers were considered with high job strain, and 93.1% had a high level of job satisfaction. 16.8% of individuals had insomnia and 97% reported non-restorative sleep. The bivariate analyses demonstrate a higher risk of burnout in participants with insomnia (OR=14.7, 95% CI 9.8 to 21.9), non-restorative sleep (OR=9.9, 95% CI 5.1 to 19.5) and anxiety (OR=10.2, 95% CI 6.8 to 15.3). High job strain was associated with burnout (OR=1.9, 95% CI 1.1 to 3.6). This association was not maintained after adjustment for sleep parameters. Job satisfaction was another independent risk factor for burnout (OR=124, 95% CI 65 to 237).

Conclusions

In our sample of financial workers, job strain represents a burnout risk factor only if associated with insomnia. Insomnia can be considered as a relevant clinical marker that should be targeted in mental health prevention programmes at the workplace.
Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study
Authors: Kearns Benjamin C , Thomas Steven M
Published: January 2017

Objectives

To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease.

Design

A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices.

Setting

UK and German healthcare perspectives were considered.

Participants

Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment.

Methods

UK and German healthcare perspectives were considered, as were different strategies for re-intervention.

Interventions

Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents).

Primary outcome measures

The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs).

Results

Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs.

Conclusions

All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA.
Screening for Atrial Fibrillation using Economical and accurate TechnologY (SAFETY)—a pilot study
Authors: Lown Mark , Yue Arthur , Lewith George , Little Paul , Moore Mike
Published: January 2017

Introduction

Atrial fibrillation (AF) is a cause of stroke and a marker of atherosclerosis and of all patients with stroke, around 17% have AF. The screening and treatment of AF could prevent about 12% of all strokes. Several relatively low-cost devices with good accuracy now exist which can detect AF including WatchBP and AliveCor. However, they can only measure the ECG or pulse over short time periods. Inexpensive devices such as heart rate monitors, which are widely available, can measure heart rate for prolonged periods and may have potential in screening for AF. This study aims to determine the accuracy of AliveCor and WatchBP along with a bespoke algorithm using a heart rate monitor belt (Polar H7) and a wearable RR interval recorder (Firstbeat Bodyguard 2) for detecting AF during a single screening visit in primary care patients.

Methods/analysis

A multicentre case–control diagnostic study comparing the four different devices for the detection of AF with a reference standard consisting of a 12-lead ECG in GP surgeries across Hampshire, UK. We aim to recruit 92 participants with AF and 329 without AF aged 65 years and over. We will ask participants to rate comfort and overall impression for each device. We will collect qualitative data from participants capturing their experience of using wearable devices in order to evaluate acceptability. We will collect data from GPs to determine their views on AF screening.

Ethics and dissemination

This protocol was approved by the London—City & East Research Ethics Committee in June 2016. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and the Atrial Fibrillation Association, UK.

Trial registration number

ISRCTN17495003, Pre-results.
Bioethics and imagination: towards a narrative bioethics committed to social action and justice
Authors: Manchola Castillo Camilo Hernán , Solbakk Jan Helge
Published: January 2017

Recently, the involvement of various authors coming from the social sciences and the arts has reinforced the humanistic component of bioethics. Their contributions vary from very theoretical perspectives to rather practical ones. In this paper, Martha Nussbaum's books,The Fragility of Goodness(1986),Love's Knowledge(1990),Cultivating Humanity(1997) andCreating Capabilities(2011) are analysed from the vantage point of narrative bioethics. It is argued that Nussbaum's notions of ‘Narrative’, ‘Imagination’ and ‘Cultivation’ open up the possibility of developing an action-oriented form of narrative bioethics, that is, a bioethics committed to social action and justice.
Rock quality designation (RQD): time to rest in peace
Authors: Pells P.J. , Bieniawski Z.T. , Hencher S.R. , Pells S.E.
Published: January 2017

Rock quality designation (RQD) was introduced by Don Deere in the mid-1960s as a means of using diamond core to classify rock for engineering purposes. Subsequently, it was incorporated into the rock mass rating (RMR) and Q-system classification methods that, worldwide, now play substantial roles in rock mechanics design, whether for tunnels, foundations, rock slopes or rock excavation. It is shown that a key facet of the definition of RQD is ignored in many parts of the world, and it is noted that there are several inherent limitations to the use of RQD. Based on mapping of rock formations by 17 independent professionals at different locations in Australia and South Africa, it is shown that differences in assessed RQD values result in significant errors in computed RMR and Q ratings, and also in geological strength index (GSI) and mining rock mass rating (MRMR). The introduction of a look-up chart for assessing GSI has effectively removed the need to measure, or estimate, RQD. It has been found that GSI values derived from the look-up chart are as valid as those derived by calculation from the original component parameters, and are satisfactorily consistent between professionals from diverse backgrounds. The look-up charts provide a quick and appropriate means of assessing GSI from exposures. GSI is, in turn, a useful rock mass strength index; one new application is presented for assessing potential erosion of unlined spillways in rock. Incorporation of RQD within the RMR and Q classification systems was a matter of historical development, and its incorporation into rock mass classifications is no longer necessary.
Detection of a gas region in a human body across a therapeutic carbon beam by measuring low-energy photons
Authors: Yamaguchi Mitsutaka , Nagao Yuto , Kawachi Naoki , Satoh Takahiro , Fujimaki Shu , Kamiya Tomihiro , Torikai Kota , Shimada Hirofumi , Sugai Hiroyuki , Sakai Makoto , Arakawa Kazuo , Nakano Takashi
Published: January 2017

We studied feasibility of detection of a gap which is located across a beam track by measuring low-energy (63–68 keV) photons generated by beam irradiation. An experiment was performed with the Heavy Ion Medical Accelerator in Chiba (HIMAC). A 12C beam having 290 MeV/u was injected on a target consisting of two acrylic blocks. These two blocks were placed with a 10 mm gap along the beam axis. A detection system consisting of a semiconductor detector, a lead collimator having a slit, and borated polyethylene blocks was placed on a movable stage to detect low-energy photons emitted perpendicularly to the beam axis. The position of the detection system was moved at 2 mm intervals along the beam axis. It was found that the yield of 63–68 keV photons was clearly correlated with the position of the detection system. The position at which the yield curve had the lowest value agreed with the gap position. We also confirmed that the experimental result was well reproduced by a Monte Carlo simulation that includes generation of secondary electron bremsstrahlung.
Strigolactone Signaling and Evolution
Authors: Waters Mark T. , Gutjahr Caroline , Bennett Tom , Nelson David C.
Published: January 2017

Strigolactones are a structurally diverse class of plant hormones that control many aspects of shoot and root growth. Strigolactones are also exuded by plants into the rhizosphere, where they promote symbiotic interactions with arbuscular mycorrhizal fungi and germination of root parasitic plants in the Orobanchaceae family. Therefore, understanding how strigolactones are made, transported, and perceived may lead to agricultural innovations as well as a deeper knowledge of how plants function. Substantial progress has been made in these areas over the past decade. In this review, we focus on the molecular mechanisms, core developmental roles, and evolutionary history of strigolactone signaling. We also propose potential translational applications of strigolactone research to agriculture.
Phloem-Mobile RNAs as Systemic Signaling Agents
Authors: Ham Byung-Kook , Lucas William J.
Published: January 2017

The plant vascular system plays a central role in coordinating physiological and developmental events through delivery of both essential nutrients and long-distance signaling agents. The enucleate phloem sieve tube system of the angiosperms contains a broad spectrum of RNA species. Grafting and transcriptomics studies have indicated that several thousand mRNAs move long distances from source organs to meristematic sink tissues. Ribonucleoprotein complexes play a pivotal role as stable RNA-delivery systems for systemic translocation of cargo RNA. In this review, we assess recent progress in the characterization of phloem and plasmodesmal transport as an integrated local and systemic communication network. We discuss the roles of phloem-mobile small RNAs in epigenetic events, including meristem development and genome stability, and the delivery of mRNAs to specific tissues in response to environmental inputs. A large body of evidence now supports a model in which phloem-mobile RNAs act as critical components of gene regulatory networks involved in plant growth, defense, and crop yield at the whole-plant level.
Molecular Characteristics and Biological Functions of Surface-Active and Surfactant Proteins
Authors: Sunde Margaret , Pham Chi L.L. , Kwan Ann H.
Published: January 2017

Many critical biological processes take place at hydrophobic:hydrophilic interfaces, and a wide range of organisms produce surface-active proteins and peptides that reduce surface and interfacial tension and mediate growth and development at these boundaries. Microorganisms produce both small lipid–associated peptides and amphipathic proteins that allow growth across water:air boundaries, attachment to surfaces, predation, and improved bioavailability of hydrophobic substrates. Higher-order organisms produce surface-active proteins with a wide variety of functions, including the provision of protective foam environments for vulnerable reproductive stages, evaporative cooling, and gas exchange across airway membranes. In general, the biological functions supported by these diverse polypeptides require them to have an amphipathic nature, and this is achieved by a diverse range of molecular structures, with some proteins undergoing significant conformational change or intermolecular association to generate the structures that are surface active.
From Bits and Pieces to Whole Phage to Nanomachines: Pathogen Detection Using Bacteriophages
Authors: Anany H. , Chou Y. , Cucic S. , Derda R. , Evoy S. , Griffiths M.W.
Published: January 2017

The innate specificity of bacteriophages toward their hosts makes them excellent candidates for the development of detection assays. They can be used in many ways to detect pathogens, and each has its own advantages and disadvantages. Whole bacteriophages can carry reporter genes to alter the phenotype of the target. Bacteriophages can act as staining agents or the progeny of the infection process can be detected, which further increases the sensitivity of the detection assay. Compared with whole-phage particles, use of phage components as probes offers other advantages: for example, smaller probe size to enhance binding activity, phage structures that can be engineered for better affinity, as well as specificity, binding properties, and robustness. When no natural binding with the target exists, phages can be used as vehicles to identify new protein-ligand interactions necessary for diagnostics. This review comprehensively summarizes many uses of phages as detection tools and points the way toward how phage-based technologies may be improved.
Abusive Supervision
Authors: Tepper Bennett J. , Simon Lauren , Park Hee Man
Published: January 2017

The overarching purpose of this article is to review and synthesize the accumulated evidence that explores the causes and consequences of abusive supervision in work organizations. Our review is organized in three sections. In the first section, we discuss research trends and provide clarification regarding the pressing and not-so-pressing problems with the way that abusive supervision is ordinarily conceptualized and studied. In the second section, we highlight problems and prospects in research on the consequences of abusive supervision. In the third section, we turn our attention to the growing body of research that explores the antecedent conditions and processes that explain when abusive supervision is more or less likely to occur. Throughout the article, we offer an overview of what has been learned over the past 15-plus years and highlight unanswered questions that warrant examination in future studies.
Comparing Political Values in China and the West: What Can Be Learned and Why It Matters
Authors: Bell Daniel A.
Published: January 2017

Along with China's economic and military rise, its leading political values will increasingly shape both China and the world at large. Hence, we need to understand, compare, and learn from leading values in China's political culture. This review discusses recent efforts to systematically compare three leading values in China's philosophical traditions—meritocracy, hierarchy, and harmony—with leading values from the political culture of Western societies.
Qualitative Methods
Authors: Gerring John
Published: January 2017

One might argue that political science has gone further than any other social science in developing a rigorous field of study devoted to qualitative methods. This review article begins by discussing the time-honored qualitative/quantitative distinction. What is qualitative data and analysis, and how does it differ from quantitative data and analysis? I propose a narrow definition of “qualitative” and explore its implications. I also explore in a speculative vein some of the factors underlying the ongoing Methodenstreit between scholars who identify with quantitative and qualitative approaches to social science. In the remainder of the article I discuss areas of qualitative research that have been especially fecund over the past decade. These include case selection, causal inference, and multimethod research.
The Evolution of Data Quality: Understanding the Transdisciplinary Origins of Data Quality Concepts and Approaches
Authors: Keller Sallie , Korkmaz Gizem , Orr Mark , Schroeder Aaron , Shipp Stephanie
Published: January 2017

Data, and hence data quality, transcend all boundaries of science, commerce, engineering, medicine, public health, and policy. Data quality has historically been addressed by controlling the measurement processes, controlling the data collection processes, and through data ownership. For many data sources being leveraged into data science, this approach to data quality may be challenged. To understand that challenge, a historical and disciplinary perspective on data quality, highlighting the evolution and convergence of data concepts and applications, is presented.
Two-Part and Related Regression Models for Longitudinal Data
Authors: Farewell V.T. , Long D.L. , Tom B.D.M. , Yiu S. , Su L.
Published: January 2017

Statistical models that involve a two-part mixture distribution are applicable in a variety of situations. Frequently, the two parts are a model for the binary response variable and a model for the outcome variable that is conditioned on the binary response. Two common examples are zero-inflated or hurdle models for count data and two-part models for semicontinuous data. Recently, there has been particular interest in the use of these models for the analysis of repeated measures of an outcome variable over time. The aim of this review is to consider motivations for the use of such models in this context and to highlight the central issues that arise with their use. We examine two-part models for semicontinuous and zero-heavy count data, and we also consider models for count data with a two-part random effects distribution.
Sunitinib Stimulates Expression of VEGFC by Tumor Cells and Promotes Lymphangiogenesis in Clear Cell Renal Cell Carcinomas
Authors: Dufies Maeva , Giuliano Sandy , Ambrosetti Damien , Claren Audrey , Ndiaye Papa Diogop , Mastri Michalis , Moghrabi Walid , Cooley Lindsay S. , Ettaiche Marc , Chamorey Emmanuel , Parola Julien , Vial Valerie , Lupu-Plesu Marilena , Bernhard Jean Christophe , Ravaud Alain , Borchiellini Delphine , Ferrero Jean-Marc , Bikfalvi Andréas , Ebos John M. , Khabar Khalid Saad , Grépin Renaud , Pagès Gilles
Published: January 2017

Sunitinib is an antiangiogenic therapy given as a first-line treatment for renal cell carcinoma (RCC). While treatment improves progression-free survival, most patients relapse. We hypothesized that patient relapse can stem from the development of a lymphatic network driven by the production of the main growth factor for lymphatic endothelial cells, VEGFC. In this study, we found that sunitinib can stimulate vegfc gene transcription and increase VEGFC mRNA half-life. In addition, sunitinib activated p38 MAPK, which resulted in the upregulation/activity of HuR and inactivation of tristetraprolin, two AU-rich element–binding proteins. Sunitinib stimulated a VEGFC-dependent development of lymphatic vessels in experimental tumors. This may explain our findings of increased lymph node invasion and new metastatic sites in 30% of sunitinib-treated patients and increased lymphatic vessels found in 70% of neoadjuvant treated patients. In summary, a therapy dedicated to destroying tumor blood vessels induced the development of lymphatic vessels, which may have contributed to the treatment failure. Cancer Res; 77(5); 1212–26. ©2017 AACR.
Diabetes, Abnormal Glucose, Dyslipidemia, Hypertension, and Risk of Inflammatory and Other Breast Cancer
Authors: Schairer Catherine , Gadalla Shahinaz M. , Pfeiffer Ruth M. , Moore Steven C. , Engels Eric A.
Published: January 2017

Background: Obesity has been associated with substantially higher risk of inflammatory breast cancer (IBC) than other breast cancer. Here, we assess whether comorbidities of obesity, namely diabetes, abnormal glucose, dyslipidemia, and hypertension, are differentially related to risk of IBC and other breast cancers by tumor stage at diagnosis (localized/regional/distant/unstaged).

Methods: We used linked SEER-Medicare data, with female breast cancer cases ages 66+ years identified by SEER registries (years 1992–2011). We divided first breast cancers into IBC (N = 2,306), locally advanced non-IBC (LABC; N = 10,347), and other (N = 197,276). We selected female controls (N = 200,000) from a stratified 5% random sample of Medicare recipients alive and breast cancer free. We assessed exposures until 12 months before diagnosis/selection using Medicare claims data. We estimated odds ratios (OR) and 99.9% confidence intervals (CI) using unconditional logistic regression.

Results: Diabetes was associated with increased risk of distant IBC (98.5% of IBC cases; OR 1.44; 99.9% CI 1.21–1.71), distant (OR 1.24; 99.9% CI, 1.09–1.40) and regional (OR 1.29 (99.9% CI, 1.14–1.45) LABC, and distant (OR 1.23; 99.9% CI, 1.10–1.39) and unstaged (OR 1.32; 99.9% CI, 1.18–1.47) other breast cancers. Dyslipidemia was associated with reduced risk of IBC (OR 0.80; 95% CI, 0.67–0.94) and other breast cancers except localized disease. Results were similar by tumor estrogen receptor status. Abnormal glucose levels and hypertension had little association with risk of any tumor type.

Conclusions: Associations with diabetes and dyslipidemia were similar for distant stage IBC and other advanced tumors.

Impact: If confirmed, such findings could suggest avenues for prevention. Cancer Epidemiol Biomarkers Prev; 26(6); 862–8. ©2017 AACR.
Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report
Authors: Wang Shih Hao , Lim Chen Chee , Teng Yu Ti
Published: January 2017

A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV), intravitreal bevacizumab (1.25 mg/0.05 mL) injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.
First Two Cases of Bloom Syndrome in Russia: Lack of Skin Manifestations in a BLM c.1642C>T (p.Q548X) Homozygote as a Likely Cause of Underdiagnosis
Authors: Suspitsin Evgeny N. , Sibgatullina Farida I. , Lyazina Lydia V. , Imyanitov Evgeny N.
Published: January 2017

Bloom syndrome (BS) is an exceptionally rare hereditary disease. Typical manifestations of BS usually include growth deficiency, a characteristic facial appearance, skin hypersensitivity to ultraviolet irradiation, and a strong predisposition to early-onset cancers. We have previously described a recurrent BLM c.1642C>T (p.Q548X) mutation, which is present in heterozygous state in 0.2-0.6% of individuals of Slavic origin. Despite the high occurrence of this founder allele, BS has not yet been described in patients of Slavic ethnicity. Here, we present 2 cases of BS, which were missed by standard genetic counseling and were eventually identified entirely due to chance. Our patients show the need for further investigations to confirm whether the atypical appearance of BS is indeed characteristic for biallelic carriers of the c.1642C>T (p.Q548X) allele and whether the absence of skin manifestations contributes to the underdiagnosis of the disease in Russia. Therefore, we suggest that all Slavic patients with only one single clinical feature of BS are to be screened for this allele and subjected to further analysis wherever appropriate. In addition to identifying new BS patients, this effort will help to clarify the frequency of “atypical BS” with incomplete phenotypic manifestations.
Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction
Authors: Mikami Yoko , Jolly Umjeet , Heydari Bobak , Peng Mingkai , Almehmadi Fahad , Zahrani Mohammed , Bokhari Mahmoud , Stirrat John , Lydell Carmen P. , Howarth Andrew G. , Yee Raymond , White James A.
Published: January 2017

Background—

Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance.

Methods and Results—

Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6–54%) with mean right ventricular ejection fraction of 48±15% (range, 7–78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98;
P
=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (
P
=0.02).

Conclusions—

RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
Application of Whole Exome Sequencing in the Clinical Diagnosis and Management of Inherited Cardiovascular Diseases in Adults
Authors: Seidelmann Sara B. , Smith Emily , Subrahmanyan Lakshman , Dykas Daniel , Abou Ziki Maen D. , Azari Bani , Hannah-Shmouni Fady , Jiang Yuexin , Akar Joseph G. , Marieb Mark , Jacoby Daniel , Bale Allen E. , Lifton Richard P. , Mani Arya
Published: January 2017

Background—

With the advent of high throughput sequencing, the identification of genetic causes of cardiovascular disease (CVD) has become an integral part of medical diagnosis and management and at the forefront of personalized medicine in this field. The use of whole exome sequencing for clinical diagnosis, risk stratification, and management of inherited CVD has not been previously evaluated.

Methods and Results—

We analyzed the results of whole exome sequencing in first 200 adult patients with inherited CVD, who underwent genetic testing at the Yale Program for Cardiovascular Genetics. Genetic diagnosis was reached and reported with a success rate of 26.5% (53 of 200 patients). This compares to 18% (36 of 200) that would have been diagnosed using commercially available genetic panels (
P
=0.04). Whole exome sequencing was particularly useful for clinical diagnosis in patients with aborted sudden cardiac death, in whom the primary insult for the presence of both depressed cardiac function and prolonged QT had remained unknown. The analysis of the remaining cases using genome annotation and disease segregation led to the discovery of novel candidate genes in another 14% of the cases.

Conclusions—

Whole exome sequencing is an exceptionally valuable screening tool for its capability to establish the clinical diagnosis of inherited CVDs, particularly for poorly defined cases of sudden cardiac death. By presenting novel candidate genes and their potential disease associations, we also provide evidence for the use of this genetic tool for the identification of novel CVD genes. Creation and sharing of exome databases across centers of care should facilitate the discovery of unknown CVD genes.
Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease
Authors: Wolff Georg , Dimitroulis Dimitrios , Andreotti Felicita , Kołodziejczak Michalina , Jung Christian , Scicchitano Pietro , Devito Fiorella , Zito Annapaola , Occhipinti Michele , Castiglioni Battistina , Calveri Giuseppe , Maisano Francesco , Ciccone Marco M. , De Servi Stefano , Navarese Eliano P.
Published: January 2017

Background—

Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment.

Methods and Results—

We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61–0.72;
P
<0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62–0.85;
P
<0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75–0.90;
P
<0.001).

Conclusions—

The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.
Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity
Authors: Kim Joon-Tae , Chung Pil-Wook , Starkman Sidney , Sanossian Nerses , Stratton Samuel J. , Eckstein Marc , Pratt Frank D. , Conwit Robin , Liebeskind David S. , Sharma Latisha , Restrepo Lucas , Tenser May-Kim , Valdes-Sueiras Miguel , Gornbein Jeffrey , Hamilton Scott , Saver Jeffrey L.
Published: January 2017

Background and Purpose—

The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region.

Methods—

We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy–Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals.

Results—

Among 1632 acute cerebrovascular disease patients (age 70±13 years, male 57.5%), time from onset to prehospital LAMS was median 30 minutes (interquartile range 20–50), onset to early postarrival (EPA) LAMS was 145 minutes (interquartile range 119–180), and onset to EPA National Institutes of Health Stroke Scale was 150 minutes (interquartile range 120–180). Between the prehospital and EPA assessments, LAMS scores were stable in 40.5%, improved in 37.6%, and worsened in 21.9%. In tests of convergent validity, against the EPA National Institutes of Health Stroke Scale, correlations were
r
=0.49 for the prehospital LAMS and
r
=0.89 for the EPA LAMS. Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale,
r
=−0.22. Predictive accuracy (adjusted C statistics) for nondisabled 3-month outcome was as follows: prehospital LAMS, 0.76 (95% confidence interval 0.74–0.78); EPA LAMS, 0.85 (95% confidence interval 0.83–0.87); and EPA National Institutes of Health Stroke Scale, 0.87 (95% confidence interval 0.85–0.88).

Conclusions—

In this multicenter, prospective, prehospital study, the LAMS showed good to excellent convergent, divergent, and predictive validity, further establishing it as a validated instrument to characterize stroke severity in the field.
Subseasonal Prediction of Extreme Precipitation over Asia: Boreal Summer Intraseasonal Oscillation Perspective
Authors: Lee Sun-Seon , Moon Ja-Yeon , Wang Bin , Kim Hae-Jeong
Published: January 2017

The boreal summer intraseasonal oscillation (BSISO) is one of the most prominent modes in the tropical climate system. For better subseasonal prediction of extreme precipitation the relationship between BSISO activity and extreme precipitation events (days with daily precipitation exceeding the local 90th percentile) over Asia is investigated, especially the dependence of extreme precipitation occurrence on BSISO precipitation anomaly pattern (phase) and intensity (amplitude) in each month. At a given area and month, the probability of extreme precipitation changes from less than 10% to over 40%–50% according to BSISO phases, and it tends to be high when BSISO amplitude is large. The extreme precipitation probability estimated by BSISO activity is generally higher over ocean than over land. Over some land regions, however, occurrence of extreme precipitation is notably modulated by BSISO activity. In May, the extreme precipitation probability over southeastern China can reach about 30%–40% when BSISO precipitation anomaly arrives over the region. Similarly, in September the extreme precipitation probability over western China can reach 40%–50% when BSISO precipitation anomaly arrives there. The BSISO activity provides useful information in narrowing down the area and timing of high probability of extreme precipitation occurrence. Using real-time BSISO monitoring and forecast data provided by the Asia–Pacific Economic Cooperation (APEC) Climate Center, it is shown that 1) the best model (ECMWF) can predict the leading BSISO modes about 20 days ahead with bivariate correlation skills higher than 0.5 except in May, and 2) the empirical probability distributions of extreme precipitation that are based on BSISO activity can be captured by the BSISO forecasts for lead times longer than 2 weeks.
Revisiting Hydrometeorology Using Cloud and Climate Observations
Authors: Betts Alan K. , Tawfik Ahmed B. , Desjardins Raymond L.
Published: January 2017

This paper uses 620 station years of hourly Canadian Prairie climate data to analyze the coupling of monthly near-surface climate with opaque cloud, a surrogate for radiation, and precipitation anomalies. While the cloud–climate coupling is strong, precipitation anomalies impact monthly climate for as long as 5 months. The April climate has memory of precipitation anomalies back to freeze-up in November, mostly stored in the snowpack. The summer climate has memory of precipitation anomalies back to the beginning of snowmelt in March. In the warm season, mean temperature is strongly correlated to opaque cloud anomalies, but only weakly to precipitation anomalies. Mixing ratio anomalies are correlated to precipitation, but only weakly to cloud. The diurnal cycle of mixing ratio shifts upward with increasing precipitation anomalies. Positive precipitation anomalies are coupled to a lower afternoon lifting condensation level and a higher afternoon equivalent potential temperature; both favor increased convection and precipitation. Regression coefficients on precipitation increase from wet to dry conditions. This is consistent with increased uptake of soil water when monthly precipitation is low, until drought conditions are reached, and also consistent with gravity satellite observations. Regression analysis shows monthly opaque cloud cover is tightly correlated to three climate variables that are routinely observed: diurnal temperature range, mean temperature, and mean relative humidity. The set of correlation coefficients, derived from cloud and climate observations, could be used to evaluate the representation of the land–cloud–atmosphere system in both forecast and climate models.
Young adults’ risk of long-term benefit receipt and parents’ socioeconomic background
Authors: Schels Brigitte
Published: January 2017

This study investigates social differences in the risk of long-term benefit receipt of young adults in Germany. Although employment is a major route to end social benefit receipt, it may not result in financial independence for all social groups in their early working lives as this also depends on the status of their parents: Do young benefit recipients have unequal chances of making the transition from benefit receipt as soon as they take up employment? How stable is the impact of parents’ socioeconomic status on the transition once young adults complete their vocational education? This study conducts an empirical analysis of the careers of a cohort of 18-to-24-year-old Germans who received benefits in 2005 by combining survey data and register data for a six-year observation period. Event history analyses indicate that social differences persist when young adults claim social benefits. In particular, parents’ socioeconomic status is positively associated with their offspring’s likelihood of ending receipt of social benefits as soon as they are in full-time employment. Parents’ socioeconomic status has a relatively stable impact for young beneficiaries irrespective of whether they have completed vocational qualifications or not. The findings suggest that these social differences persist during early working life.
The Current Status of Psychoanalysis
Authors: Kernberg Otto F.
Published: January 2017

Presented here is an overview of current challenges and controversies regarding psychoanalysis as a science, competing psychoanalytic theories, convergent and divergent trends in psychoanalytic technique, psychoanalytic education, psychoanalysis as a profession. Among other issues stressed are the importance of the relation of psychoanalysis to the University, the research implications of competing theoretical and technical orientations, the need to reexamine the structure of psychoanalytic education, and the importance of international cross-fertilization in expanding the application of psychoanalysis to other fields.
Repression: The Evolution of a Psychoanalytic Concept from the 1890's to the 1990's
Authors: Jones Barbara Pendleton
Published: January 2017

The author presents a summary of Freud's concept of repression, including modifications of the concept from 1894 to 1932. Several more recent treatments are examined, including those of Piaget; Rosenblatt and Thickstun; Galin; Kissin; Shapiro and Perry; Schwartz; the cognitive and experimental psychologists, including Kihlstrom and Erdelyi; the “connectionists”; and Edelman. Finally, the author delineates several different types of repression, outlining how the different models might apply to the different types of repression.
Lewin's Manifest Dream Exercise Revisited
Authors: Allison George H. , Loeb Felix , Spain David H.
Published: January 2017

In an institute research class, the validity of Lewin's methodology in his manifest dream exercise was tested by a different approach. Class members developed a questionnaire based on two actual manifest dreams. Responses from six analytic candidates and fifteen graduate analysts were analyzed by two classroom groups, working independently. The data were assessed by two methods and the conclusions were only partially synchronous with Lewin's method of collective free association in which members of the group influenced one another. Our subjects did not influence one another, and they and research class members were “blind” to the dreams' associations, context, and meanings derived years earlier, until after data were assessed and conclusions were reached. One conclusion suggests that intuition as to “correct” meanings may be independent of the number of years of analytic experience.

This project is reported to stimulate similar research projects as a regular part of psychoanalytic education.
“In the Neighborhood”: Aspects of a Good Interpretation and a “Developmental Lag” in Ego Psychology
Authors: Busch Fred
Published: January 2017

The significance of the conscious ego in the interpretive process has increasingly come under scrutiny. It is becoming clearer that the analyst's view of the conscious ego orients his interpretive approach, and subtly sets the goals of the analysis. At various times Freud championed the analytic importance of the conscious ego, and alternately rejected its significance. Hartmann's view of the ego stimulated research into a developmental line of the ego, while investigations of the ego in clinical psychoanalysis lagged far behind. The importance of the conscious ego in understanding resistances and levels of communication are explored.
Time and temperature affect glycolysis in blood samples regardless of fluoride-based preservatives: a potential underestimation of diabetes
Authors: Stapleton Mary , Daly Niamh , O’Kelly Ruth , Turner Michael J
Published: January 2017

Background

The inhibition of glycolysis prior to glucose measurement is an important consideration when interpreting glucose tolerance tests. This is particularly important in gestational diabetes mellitus where prompt diagnosis and treatment is essential. A study was planned to investigate the effect of preservatives and temperature on glycolysis.

Methods

Blood samples for glucose were obtained from consented females. Lithium heparin and fluoride-EDTA samples transported rapidly in ice slurry to the laboratory were analysed for glucose concentration and then held either in ice slurry or at room temperature for varying time intervals. Paired fluoride-citrate samples were received at room temperature and held at room temperature, with analysis at similar time intervals.

Results

No significant difference was noted between mean glucose concentrations when comparing different sample types received in ice slurry. The mean glucose concentrations decreased significantly for both sets of samples when held at room temperature (0.4 mmol/L) and in ice slurry (0.2 mmol/L). A review of patient glucose tolerance tests reported in our hospital indicated that 17.8% exceeded the recommended diagnostic criteria for gestational diabetes mellitus. It was predicted that if the results of fasting samples were revised to reflect the effect of glycolysis at room temperature, the adjusted diagnostic rate could increase to 35.3%.

Conclusion

Preanalytical handling of blood samples for glucose analysis is vital. Fluoride-EDTA is an imperfect antiglycolytic, even when the samples are transported and analysed rapidly provides such optimal conditions. The use of fluoride-citrate tubes may offer a viable alternative in the diagnosis of diabetes mellitus.
Pediatric Chest Pain—Low-Probability Referral: A Multi-Institutional Analysis From Standardized Clinical Assessment and Management Plans (SCAMPs®), the Pediatric Health Information Systems Database, and the National Ambulatory Medical Care Survey
Authors: Harahsheh Ashraf S. , O’Byrne Michael L. , Pastor Bill , Graham Dionne A. , Fulton David R.
Published: January 2017

We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.
Mass Attitudes on Political Issues in Britain
Authors: Studlar Donley T. , Welch Susan
Published: January 2017

Although there have been several studies of attitudinal constraint in the American public, similar studies for other political systems are rare. Using the October 1974 British Election Study, the authors examine the dimensionality of attitudes among the British public. Five major dimensions—labeled socioeconomic class issues, environmental issues, ethnocentrism, morality, and law and order—emerge, though together they account for less than half the variance in the opinion set. Little variation in these issue dimensions can be explained by regional, class, education, religion, age, or sex variables. Despite the complexity of British issue attitudes, socioeconomic class attitudes dominated the issue impact on voting behavior in the October 1974 election. These findings suggest that the image of British politics as strongly class-based may owe more to the actions of political party leaders in emphasizing socioeconomic class issues than to the existence of coherent class attitudes within the electorate. The fragmentation of mass political attitudes in Britain strongly resembles the pattern in the United States, despite differences in political culture and political institutions. Such fragmentation may be inherent in a liberal democratic political system.