bluuebunny/crossref_metadata_2025 huggingface dataset:
Soft BiOBr@TiO2 nanofibrous membranes with hierarchical heterostructures as efficient and recyclable visible-light photocatalysts
Authors: Cai Yuting , Song Jun , Liu Xiaoyan , Yin Xia , Li Xiaoran , Yu Jianyong , Ding Bin
Published: September 2018

Soft hierarchical BiOBr nanoplate modified TiO2 nanofibrous membranes with enhanced visible light photocatalytic activity and good reversibility towards organic dyes.
Two novel phenanthrene-based host materials in red and green organic light-emitting devices with low efficiency roll-off
Authors: Wang Yuanyuan , Song Wenxuan , Zhou Li , Liang Wenting , Mu Haichuan , Huang Jinhai , Su Jianhua
Published: September 2018

Two novel phenanthrene-based host materials showed significant differences due to the different moieties at the same position of the phenanthrene backbone.
Thiacalix[4]arene-supported mononuclear lanthanide compounds: slow magnetic relaxation in dysprosium and erbium analogues
Authors: Ge Jing-Yuan , Chen Zhongyan , Wang Hai-Ying , Wang Haiou , Wang Peng , Duan Xing , Huo Dexuan
Published: September 2018

Four mononuclear LnIII compounds have been synthesized, and the dysprosium and erbium analogues exhibit typical field-induced SMM behavior.
One-pot synthesis of 2-naphthols from nitrones and MBH adducts via decarboxylative N–O bond cleavage
Authors: Han Sang Hoon , Pandey Ashok Kumar , Lee Heeyoung , Kim Saegun , Kang Dahye , Jung Young Hoon , Kim Hyung Sik , Hong Sungwoo , Kim In Su
Published: September 2018

The unprecedented one-pot synthesis of 2-naphthols through an acid-mediated decarboxylative N–O bond cleavage of bridged benzoxazepine intermediates is described.
Zirconia incorporated calcium looping absorbents with superior sintering resistance for carbon dioxide capture from in situ or ex situ processes
Authors: Zhao Ming , He Xu , Ji Guozhao , Song Yinqiang , Zhao Xiao
Published: September 2018

Zirconia incorporation greatly enhances the sintering resistance of CaO.
The Acoustic Environments in Which Older Adults Wear Their Hearing Aids: Insights From Datalogging Sound Environment Classification
Authors: Humes Larry E. , Rogers Sara E. , Main Anna K. , Kinney Dana L.
Published: September 2018

Purpose

This report presents data on the acoustic environments in which older adults with age-related hearing loss wear their hearing aids.

Method

This is an observational study providing descriptive data from 2 primary datasets: (a) 128 older adults wearing hearing aids for an average of 6 weeks and (b) 65 older adults wearing hearing aids for an average of 13 months. Acoustic environments were automatically and continuously classified about every 4 s, using the hearing aids' signal processing, into 1 of 7 acoustic environment categories.

Results

For both groups, older adults wore their hearing aids about 60% of the time in quiet or speech-only conditions. The automatic classification of sound environments was shown to be reliable over relatively short (6-week) and long (13-month) durations. Moreover, the results were shown to have some validity in that the obtained acoustic environment profiles matched a self-reported measure of social activity administered prior to hearing aid usage. For a subset of 56 older adults with data from both the 6-week and 13-month wear times, the daily amount of hearing aid usage diminished but the profile of sound environments frequented by the wearers remained stable.

Conclusions

Examination of the results from the automatic classification of sound environments by the hearing aids of older adults provides reliable and valid environment classifications. The present data indicate that most such wearers choose generally favorable acoustic environments for hearing aid use.
Spoofing attack and surveillance game in geo‐location database driven spectrum sharing
Authors: Nguyen‐Thanh Nhan , Ta Duc‐Tuyen , Nguyen Van‐Tam
Published: September 2018

The geo‐location database (GDB) driven is the enforcement method for dynamic spectrum sharing in TV White Space and 3.5 GHz spectrum bands, as well as, a preferred option for the other spectrum sharing applications. Although providing accurate and reliable spectrum information services, the GDB driven spectrum sharing suffers from a critical security threat of spoofing attack. Under a spoofing attack, an adversary could spoof either the identification (ID) or the location information in its request messages. This breaks the fairness and reduces the efficiency of the GDB driven spectrum sharing system. To counteract the location and ID spoofing attacks, the authors consider the location verification of request messages and the ID verification of communicating data. Since a resource manager and an adversary are independent and self‐interested, they formulate two corresponding surveillance games to analyse the conflict interaction between the spoofing attack and the countermeasures. By expressing the surveillance game on requests' location in a strategic form and representing the surveillance game on data ID in a sequence form, they find out Nash equilibrium. The analytical and numerical results show that a resource manager can mitigate the spoofing attack by adequately adapting its penalty policy and surveillance strategy.
Mitigation of sub‐synchronous control interaction of a power system with DFIG‐based wind farm under multi‐operating points
Authors: Bian Xiaoyan , Ding Yang , Jia Qingyu , Shi Lei , Zhang Xiao‐Ping , Lo Kwok L.
Published: September 2018

This study presents a probabilistic design of a power system stabiliser (PSS) for doubly‐fed induction generator (DFIG) converter and investigates its potential capability in mitigating the sub‐synchronous control interaction (SSCI) at multi‐operating points. The aim is to improve the probabilistic sub‐synchronous stability of the system with wind farm penetration. In this study, participation factors are obtained to identify the SSCI strong‐related state variables and major control loops, which are used for the preliminary siting of the DFIG‐PSS. Probabilistic sensitivity indices are then employed for accurate positioning of the PSS, selecting the input control signal and optimising the PSS parameters. The effectiveness of the proposed approach is verified on a modified two‐area power system. The results show that the designed DFIG‐PSS is capable of improving probabilistic small‐signal sub‐synchronous stability of the system at multi‐operating points and its performance is better than a DFIG‐PSS designed with the general small‐signal method.
Contribution of surface charges on high‐voltage DC silicon rubber insulators to DC flashover performance
Authors: Mahmoodi Jamshid , Mirzaie Mohammad , Akmal Amirabbas Shayegani
Published: September 2018

In this study, the results of measurement for DC flashover characteristics of silicon rubber insulators in the presence of surface charges and in terms of geometric characteristics have been examined and analysed. In the carried out experimental tests, the surface of different insulators was charged by an external corona source and both the metal end fittings were kept grounded while the needles have been connected to a certain applied negative and positive DC voltages and then surface electric charge measured. A series of flashover tests have been carried out on the charged insulators under positive DC voltages to investigate the effects of surface charges. The experimental results revealed that positive electric charges reduced flashover performance while negative charges increased the flashover voltage level. Also, the experimental modelling of DC flashover of charged insulators regarding the ratio of shed spacing to shed depth and specific leakage distance in terms of surface electric charges, revealed that flashover voltage gradient of the charged insulator is most affected by specific leakage.
CRC and NHPWM method for test bench based on cascaded converter
Authors: Hu Yaowei , Yang Ranchen , Shao Yuting , Chen Guozhu
Published: September 2018

This study describes a megawatt test bench based on the cascaded converter for the stability test of renewable energy generation system under different grid disturbances. The test bench is composed of two cascaded converters, which are used to control the output of fundamental voltage and harmonic voltage. Aiming at the defects of the traditional repetitive controller (RC) and hybrid pulse‐width modulation (HPWM) method, configurable RC (CRC) and novel HPWM (NHPWM) method are presented. By flexibly configuring the zeros and poles of CRC, the harmonic order that can be tracked accurately and the time delay of CRC can be easily changed. Besides, with NHPWM, the number of modules modulated by carrier phase‐shifted PWM can be arbitrarily configured according to the output voltage quality and switching loss. Therefore, the flexible CRC and NHPWM are beneficial to achieve high control accuracy of fundamental and harmonic voltage and fast dynamic response while considering the switching loss, which is verified by simulation. The detailed harmonic analysis and calculation method of NHPWM are given, which are also proved correct by comparison of theoretical calculation and simulation results.
Preparation of HR magnetic IONPs for drug delivery
Authors: Chen Zhongping , Lu Ailing , Zhao Yue , Zhu Li
Published: September 2018

Hypoxia is a common phenomenon in the majority of solid tumours, thereby contributing to progression, angiogenesis, invasion, and metastasis of tumours. The authors synthesised a hypoxia‐responsive (HR) magnetic iron oxide nanoparticles (IONPs) as drug delivery system by incorporating a hypoxia moiety (azobenzene) between IONPs and drug. The obtained drug delivery system showed sustained release under normoxic conditions, while a controlled release was observed under hypoxic condition due to the cleavage of azobenzene. More than 80% of the drug was released in 4 h after hypoxic treatment, leading to a high cytotoxicity. Thus, this HR magnetic drug delivery system had the potential for future applications in the treatment of hypoxic tumours and other hypoxia‐related diseases.
Numerical complete solution for random genetic drift by energetic variational approach
Authors: Duan Chenghua , Liu Chun , Wang Cheng , Yue Xingye
Published: September 2018

In this paper, we focus on numerical solutions for random genetic drift problem, which is governed by a degenerated convection-dominated parabolic equation. Due to the fixation phenomenon of genes, Dirac delta singularities will develop at boundary points as time evolves. Based on an energetic variational approach (EnVarA), a balance between the maximal dissipation principle (MDP) and least action principle (LAP), we obtain the trajectory equation. In turn, a numerical scheme is proposed using a convex splitting technique, with the unique solvability (on a convex set) and the energy decay property (in time) justified at a theoretical level. Numerical examples are presented for cases of pure drift and drift with semi-selection. The remarkable advantage of this method is its ability to catch the Dirac delta singularity close to machine precision over any equidistant grid.
The Effect of Intraoperative Glove Choice on Carpal Tunnel Pressure
Authors: Jernigan Edward W. , Smetana Brandon S. , Rummings Wayne A. , Dineen Hannah A. , Patterson J. Megan M. , Draeger Reid W.
Published: September 2018

Introduction The aim of this study was to quantify the effect of surgical gown and glove wear on carpal tunnel pressure. The authors hypothesized that gowning and gloving is associated with an increase in carpal tunnel pressure in cadaveric specimens wearing appropriately sized gloves. Furthermore, they hypothesized that increased glove thickness, double gloving, and smaller-than-appropriately sized gloves would all serve to increase carpal tunnel pressure.

Materials and Methods Baseline carpal tunnel pressure measurements were obtained in 11 cadaveric specimens. Each specimen was subsequently gowned and gloved. Carpal tunnel pressures were obtained for each specimen fitted with four different types of gloves in four scenarios: (1) appropriately sized gloves, (2) one full-size smaller, (3) one full-size larger, and (4) double gloved.

Results Mean carpal tunnel baseline value was 3.5 mm Hg. Appropriately sized single-glove wear more than doubled baseline carpal tunnel pressure. Double gloving and smaller-than-appropriately sized glove wear more than tripled baseline values. Among the single-glove subgroup, the thickest gloves (ortho) were associated with the highest increase in pressure from baseline values.

Conclusion Glove selection can have repercussions related to carpal tunnel pressure. Susceptible surgeons should consider these factors when making decisions regarding intraoperative glove wear.
Is There a Place for Thoracoscopic Enucleation of Esophageal Gastrointestinal Stromal Tumors?
Authors: Cohen Charlotte , Pop Daniel , Icard Philippe , Berthet Jean-Philippe , Venissac Nicolas , Mouroux Jérome
Published: September 2018

Background Esophageal gastrointestinal stromal tumors (E-GISTs) represent less than 1% of all GISTs. The rarity of this lesion precludes the realization of randomized studies, and its treatment remains a matter of debate. We aimed to evaluate the feasibility of enucleation by video-assisted thoracic surgery (VATS) for low- to intermediate-risk E-GIST.

Methods We performed a retrospective review of patients treated by enucleation through VATS between January 2004 and January 2014 and reviewed the literature.

Results We included five patients (four men and one woman). Mean age was 53 years (range: 49–79). Three patients were diagnosed because of dysphagia and two others incidentally. The diagnosis was made by immunostaining demonstrating CD117 expression on tumor cells. The mitotic index of all E-GISTs was low (≤ 5 per 50 high-power field). Median postoperative follow-up was 5.5 years, and there was no recurrence.

Conclusion Thoracoscopic enucleation of E-GIST seems to represent a valuable option as the postoperative morbidity/mortality is low and the oncological outcome is good for low-to-intermediate grade of malignity tumors.

This is a retrospective study focused on minimally invasive treatment of E-GIST. We evaluated the feasibility of VATS enucleation of low-to-medium grade of malignity E-GIST.
Pregnancy and Oral Health
Authors: Bansal Mohit , Gupta Rajesh
Published: September 2018

Pregnancy, the period from conception to birth, is characterised by profound hormonal changes. The tissues supporting the teeth, including the periodontium especially gingiva is affected. There are several reasons why dental professionals should focus on oral health in pregnant women. This article focus light on some of these oral diseases.
Antioxidants the Powerful New Weapons in the Fight Against Periodontal Diseases
Authors: Singh Baljeet , Bhickta Shivani , Gupta Rajesh , Goyal Sachin , Gupta Ram
Published: September 2018

The human inflammatory periodontal diseases are amongst the most common of chronic diseases. The predominant inflammatory cell (96%) within the healthy connective tissue and epithelium of the gingiva is polymorphonuclear leucocyte (PMNL). Periodontopathic bacteria in the gingivomucosal tissue may functionally activate PMNLs leading to an increased production of reactive oxygen species (ROS). Chronic inflammation subjects the nearby cells to elevated levels of free radicals (ROS) due to extracellular release from phagocytic cells. Antioxidants block the process of oxidation by neutralizing free radicals. In doing so, the antioxidant themselves become oxidized. Because of this, there is a constant need to replenish our antioxidant resources.
Geographic Tongue in A 6 Year Old Child: A Case Report with Review of Literature
Authors: Bajaj Punnet , Kapoor Charu , Garg Deepti , P.K Rajeesh , Sabharwal Robin , Vaidya Sharad
Published: September 2018

Geographic tongue is an inflammatory disorder characterized by asymptomatic erythematoud patched with serpiginous borders. Clinically the appearance is of multifocal, circinate, irregular patches bonded by slightly elevated, white colored keratotic bands. Several etiological factors have been proposed. The conditions may remain asymptomatic or patients may present with complains of pain and burning sensation. We report a case of geographic tongue in a 6 year old boy with review of current concept in causes and management.
Assessing the Efficacy of Deoxycholic Acid for the Treatment of Submental Fat: A Three-Dimensional Study
Authors: Grow Jacob Nathaniel , Holding Julie , Korentager Richard
Published: September 2018

Background

Deoxycholic acid is used for the treatment of excess submental fat, offering a potential alternative to more invasive surgical procedures. However, there is currently an absence of high-level evidence in the literature outside of Phase 3 clinical trials.

Objectives

The aim of this study was to evaluate the efficacy of deoxycholic acid for the treatment of submental adiposity by correlating objective 3-dimensional (3D) data with subjective patient assessment scores.

Methods

Thirteen patients were prospectively enrolled into the study. 3D images were obtained prior to initial treatment, at 4-week intervals, and in the acute recovery period. Volumetric changes were calculated using Vectra software. Corresponding subjective surveys using the FACE-Q tool evaluated the perceived treatment results and side effects.

Results

Objectively, there was a significant reduction in submental volume following treatment (P = 0.004), with total rounds of treatment averaging 3.4 (SD: 1.19). During the immediate recovery period, there was a statistically significant increase in submental volume, with an average increase of 8.68% (P = 0.0003). Subjectively, patient satisfaction scores improved significantly for both the aesthetics of the area under the chin and jawline (P < 0.005). Self-resolving paresthesia following treatment occurred in all study participants. There were no major complications. Participant scores of early treatment recovery also improved significantly with subsequent treatments (P < 0.005).

Conclusions

This study validates the use of deoxycholic acid for reducing supraplatysmal adiposity in the submental area. Objective volume changes showed positive correlation with subjective improvements in patient satisfaction scores. Recovery and side effect profiles were also described and may aid in future patient education and management.

Level of Evidence: 4
Heritability of Gray Matter Structural Covariation and Tool Use Skills in Chimpanzees (Pan troglodytes): A Source-Based Morphometry and Quantitative Genetic Analysis
Authors: Hopkins William D , Latzman Robert D , Mareno Mary Catherine , Schapiro Steven J , Gómez-Robles Aida , Sherwood Chet C
Published: September 2018

Nonhuman primates, and great apes in particular, possess a variety of cognitive abilities thought to underlie human brain and cognitive evolution, most notably, the manufacture and use of tools. In a relatively large sample (N = 226) of captive chimpanzees (Pan troglodytes) for whom pedigrees are well known, the overarching aim of the current study was to investigate the source of heritable variation in brain structure underlying tool use skills. Specifically, using source-based morphometry (SBM), a multivariate analysis of naturally occurring patterns of covariation in gray matter across the brain, we investigated (1) the genetic contributions to variation in SBM components, (2) sex and age effects for each component, and (3) phenotypic and genetic associations between SBM components and tool use skill. Results revealed important sex- and age-related differences across largely heritable SBM components and associations between structural covariation and tool use skill. Further, shared genetic mechanisms appear to account for a heritable link between variation in both the capacity to use tools and variation in morphology of the superior limb of the superior temporal sulcus and adjacent parietal cortex. Findings represent the first evidence of heritability of structural covariation in gray matter among nonhuman primates.
At-Home Hospital Care Reduces Readmissions and Length of Stay, Enhances Patient Satisfaction
Authors: Zolot Joan
Published: September 2018

A new payment model may pave the way for wider implementation.
Changes in Objectively Measured Activity Behavior Among Women Undergoing Breast Cancer Treatment: Longitudinal Cohort Study
Authors: Forbes Cynthia C. , Keats Melanie , Rainham Daniel , Younis Tallal , Blanchard Chris M.
Published: September 2018

Purpose:

Activity behaviors of breast cancer survivors (BCSs) during treatment are unlikely to be at levels sufficient enough to gain health benefits. Previous activity research among BCSs has been mainly posttreatment and generally cross-sectional. This study aimed to determine the prevalence and changes in objectively measured moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SED) among BCSs undergoing adjuvant/palliative therapy.

Methods:

Participants completed baseline surveys and wore accelerometers to measure activity during waking hours during treatment and again 6 months later. Hierarchal linear modeling (HLM) was used to determine changes.

Results:

In total, 77 BCSs participated. Ninety-one percent provided physical activity (PA) data for 3 or more valid days at baseline (T
1) and 72% at 6 months (T
2); 29% met PA guidelines at T
1 and 41% at T
2. Daily LPA and SED did not change from T
1 to T
2 (133 vs 138 minutes; 595 vs 597 minutes). Controlling for body mass index at the intercept, HLM revealed that MVPA significantly increased from T
1 to T
2 (+5.62; P = .015).

Conclusion:

An increase in objectively measured total daily MVPA over 6 months was found, at which time, fewer BCSs were currently receiving chemo- or radiotherapy and may theoretically be feeling better. However, fewer T
2 measures may bias and artificially inflate the results. Although total MVPA minutes increased at T
2, less than half BCSs were meeting guidelines and had high amounts of LPA/SED during treatment, with insignificant change over time (71% at T
1; 59% at T
2). Practitioner intervention may help reduce SED while increasing LPA and MVPA behavior among those currently undergoing treatment.
Hospital-, Anesthesiologist-, and Patient-level Variation in Primary Anesthesia Type for Hip Fracture Surgery
Authors: McIsaac Daniel I. , Wijeysundera Duminda N. , Bryson Gregory L. , Huang Allen , McCartney Colin J. L. , van Walraven Carl
Published: September 2018

Editor’s Perspective

What We Already Know about This Topic

What This Manuscript Tells Us That Is New

Background

Substantial variation in primary anesthesia type for hip fracture surgery exists. Previous work has demonstrated that patients cared for at hospitals using less than 20 to 25% neuraxial anesthesia have decreased survival. Therefore, the authors aimed to identify sources of variation in anesthesia type, considering patient-, anesthesiologist-, and hospital-level variables.

Methods

Following protocol registration (NCT02787031), the authors conducted a cross-sectional analysis of a population-based cohort using linked administrative data in Ontario, Canada. The authors identified all people greater than 65 yr of age who had emergency hip fracture surgery from April 2002 to March 2014. Generalized linear mixed models were used to account for hierarchal data and measure the adjusted association of hospital-, anesthesiologist-, and patient-level factors with neuraxial anesthesia use. The proportion of variation attributable to each level was estimated using variance partition coefficients and the median odds ratio for receipt of neuraxial anesthesia.

Results

Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic. The median odds ratio for receiving neuraxial anesthesia was 2.36 between randomly selected hospitals and 2.36 between randomly selected anesthesiologists. The majority (60.1%) of variation in neuraxial anesthesia use was explained by patient factors; 19.9% was attributable to the anesthesiologist providing care and 20.0% to the hospital where surgery occurred. The strongest patient-level predictors were absence of preoperative anticoagulant or antiplatelet agents, absence of obesity, and presence of pulmonary disease.

Conclusions

While patient factors explain most of the variation in neuraxial anesthesia use for hip fracture surgery, 40% of variation is attributable to anesthesiologist and hospital-level practice. Efforts to change practice patterns will need to consider hospital-level processes and anesthesiologists’ intentions and behaviors.
Quality Anesthesia
Authors: Fleisher Lee A.
Published: September 2018

Quality has been defined by six domains: effective, equitable, timely, efficient, safe, and patient centered. Quality of anesthesia care can be improved through measurement, either through local measures in quality improvement or through national measures in value-based purchasing programs. Death directly related to anesthesia care has been reduced, but must be measured beyond simple mortality. To improve perioperative care for our patients, we must take shared accountability for all surgical outcomes including complications, which has traditionally been viewed as being surgically related. Anesthesiologists can also impact public health by being engaged in improving cognitive recovery after surgery and addressing the opiate crisis. Going forward, we must focus on what patients want and deserve: improved patient-oriented outcomes and satisfaction with our care. By listening to our patients and being engaged in the entire perioperative process, we can make the greatest impact on perioperative care.
Nurse-Initiated Mobilization Practices in 2 Community Intensive Care Units
Authors: Stolldorf Deonni P. , Dietrich Mary S. , Chidume Tiffani , McIntosh Marie , Maxwell Cathy A.
Published: September 2018

Background

Critical-care nurses play a vital role in promoting safe early mobilization in intensive care unit (ICU) settings to reduce the risks associated with immobility in ICUs, including the risk of delirium, ICU-acquired weakness, and functional decline.

Objective

The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings.

Methods

This was a cross-sectional exploratory study of 18 nurses (ICU A: n = 12, ICU B: n = 6) and 124 patients (ICU A: n = 50, ICU B: n = 74). Patient-specific therapeutic intervention needs and nurse-initiated mobilization practices were tracked over a 1-month period.

Results

Differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, we found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.
Qualitative Research Methods
Authors: Cypress Brigitte
Published: September 2018

Data collection and management are often neglected subjects of qualitative research. Qualitative data collection, management, and analysis are complex and challenging for researchers especially for early career and doctoral students. These processes involve anticipating for ethical issues and developing means and methods for collecting, recording, and storing data securely. Approaches to data analysis include organizing, reading, coding, and organizing themes, representing, and interpreting the data. The unanticipated issues in accomplishing these steps and corresponding solutions are presented. Recommendations for training and mentoring of novices in qualitative research are discussed.
Cumulative Human Immunodeficiency Viremia, Antiretroviral Therapy, and Incident Myocardial Infarction
Authors: Delaney Joseph A. , Nance Robin M. , Whitney Bridget M. , Crane Heidi M. , Williams-Nguyen Jessica , Feinstein Mathew J. , Kaplan Robert C. , Hanna David B. , Budoff Matthew J. , Drozd Daniel R. , Burkholder Greer , Mugavero Michael J. , Mathews William C. , Moore Richard D. , Eron Joseph J. , Hunt Peter W. , Geng Elvin , Saag Michael S. , Kitahata Mari M. , Heckbert Susan R.
Published: September 2018

Background:

People living with HIV are at risk of increased myocardial infarction (MI). Cumulative HIV viral load (VL) has been proposed as a better measure of HIV inflammation than other measures of VL, like baseline VL, but its associations with MI are not known.

Methods:

The multisite Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort includes clinical data and centrally adjudicated MI with distinction between atheroembolic MI (type 1) and MI related to supply–demand mismatch (type 2). We examined CNICS participants who were not on antiretroviral therapy (ART) at enrollment. Cumulative VL (copy-days of virus) from 6 months after enrollment was estimated with a time-weighted sum using the trapezoidal rule. We modeled associations of cumulative and baseline VL with MI by type using marginal structural Cox models. We contrasted the 75% percentile of the VL distribution with the 25% percentile.

Results:

Among 11,324 participants, 218 MIs occurred between 1996 and 2016. Higher cumulative VL was associated with risk of all MI (hazard ratio [HR] = 1.72; 95% confidence interval [CI] = 1.26, 2.36), type 1 MI (HR = 1.23; 95% CI = 0.78, 1.96), and type 2 MI (HR = 2.52; 95% CI = 1.74, 3.66). While off ART, cumulative VL had a stronger association with type 1 MI (HR = 2.13; 95% CI = 1.15, 3.94) than type 2 MI (HR = 1.25; 95% CI = 0.70, 2.25). Baseline VL was associated with all MI (HR = 1.60; 95% CI = 1.28, 2.01), type 1 MI (HR = 1.73; 95% CI = 1.26, 2.38), and type 2 MI (HR = 1.51; 95% CI = 1.10, 2.08).

Conclusions:

Higher cumulative and baseline VL is associated with all MI, with a particularly strong association between cumulative VL and type 2 MI.
Differences in Obesity Among Black and White Children, Adolescents, and Adults With Congenital Heart Disease
Authors: Jackson Jamie L. , Harrison Tondi , Keim Sarah A.
Published: September 2018

Background:

Congenital heart disease (CHD) survivors have an elevated risk for obesity-related comorbidities, but little is known about racial differences in obesity rates for this population.

Objective:

The authors aimed to compare rates of obesity in CHD survivors to national estimates using National Health and Nutrition Examination Assessment Survey (NHANES) and to characterize racial disparities in obesity among CHD survivors across age ranges.

Methods:

Retrospective chart review included 4496 CHD survivors (4050 white and 446 black) with a range of lesion severities from a pediatric and an adult medical center.

Results:

White children with CHD had a higher prevalence of obesity compared with NHANES estimates. In contrast, white young adults with CHD had a lower prevalence of obesity compared with NHANES. Blacks with CHD had a 58% increased risk of obesity in young adulthood and a 33% increased risk in late adulthood compared with whites with CHD.

Conclusions:

Obesity interventions are needed among CHD survivors across the lifespan, particularly among adult non-Hispanic blacks.
Psychosocial Adjustment and Quality of Life in Patients With Peripartum Cardiomyopathy
Authors: Rosman Lindsey , Salmoirago-Blotcher Elena , Cahill John , Sears Samuel F.
Published: September 2018

Background:

Psychological distress can adversely affect heart failure prognosis, yet the immediate and ongoing challenges faced by women diagnosed with peripartum cardiomyopathy (PPCM) are not well studied.

Objective:

We examined psychological distress and quality of life in a large, national sample of patients with PPCM and evaluated whether these characteristics differ among newly diagnosed (0–1 year), short-term (2–4 years), and long-term (5–10 years) survivors.

Methods:

One hundred forty-nine patients with PPCM (mean age, 33.9 ± 5.0 years) recruited from a web-based registry completed questionnaires about generalized anxiety (Generalized Anxiety Disorder-7), cardiac anxiety (Cardiac Anxiety Questionnaire [CAQ]), health status (Medical Outcomes Study Short-Form 12 [SF-12] Health Survey), and PPCM-specific quality-of-life concerns. Group differences were evaluated using multivariate statistics with adjustments for disease severity and psychiatric history.

Results:

Generalized anxiety symptoms higher than the clinical cutoff were reported by 53% of patients with PPCM. Mean scores on the CAQ (1.9 ± 0.7) and CAQ subscale scores (cardiac-specific fear [2.1 ± 0.8], avoidance [1.7 ± 0.9], and heart-focused attention [1.6 ± 0.8]) were elevated in the overall sample. Psychological symptoms and quality-of-life concerns were generally similar across patients except for cardiac avoidance, which was significantly higher in newly diagnosed women after adjustments for disease severity (P = .05) and psychiatric history (P = .01). Peripartum cardiomyopathy–specific quality-of-life concerns were also prevalent; however, group differences were nonsignificant (P = .07).

Conclusions:

Generalized anxiety, cardiac anxiety, and quality-of-life concerns are prevalent among patients with PPCM at all stages of recovery. Psychological issues may be an underrecognized aspect of women’s recovery from PPCM.
Dietary Vitamin C Deficiency Is Associated With Health-Related Quality of Life and Cardiac Event-free Survival in Adults With Heart Failure
Authors: Wu Jia-Rong , Song Eun Kyeung , Moser Debra K. , Lennie Terry A.
Published: September 2018

Background:

Vitamin C deficiency is prevalent in adults with heart failure (HF). Little is known about the relationship of dietary vitamin C deficiency with health outcomes in adults with HF.

Objective:

The study’s aim was to determine the relationships of vitamin C deficiency measured at baseline with health-related quality of life (HRQOL) and cardiac event-free survival in patients with HF measured 1 year later.

Method:

A total of 251 patients with HF completed a 4-day food diary. Dietary vitamin C deficiency was defined as daily intake less than the estimated average requirement from the Institute of Medicine of 75 mg/d for men and 60 mg/d for women. Health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire at 12 months. Patients were followed for a median of 1 year to determine time to the first event of cardiac-related hospitalization or death. Data were analyzed by hierarchical linear and Cox proportional hazards regressions.

Results:

One hundred patients (40%) had vitamin C deficiency. Dietary vitamin C deficiency was associated with poorer HRQOL at 12 months (β = 0.16, P = .02) after controlling for demographic and clinical variables. During the follow-up period, 59 patients (24%) had cardiac events. In Cox regression, vitamin C deficiency predicted shorter cardiac event-free survival after adjusting for the same covariates (hazards ratio, 1.95; 95% confidence interval, 1.08–3.51).

Conclusion:

Vitamin C deficiency was associated with poorer HRQOL and shorter cardiac event-free survival in patients with HF. The findings suggest that encouraging patients with HF to consume a diet rich in fruits/vegetables to prevent vitamin C deficiency may lead to better health outcomes.
Translation and Cross-cultural Adaptation of the Chinese Version of the Self-care of Hypertension Inventory in Older Adults
Authors: Zhao Qiao , Guo Yujie , Gu Yu , Yang Lei
Published: September 2018

Background:

Hypertension is highly prevalent among the older adults. Self-care is an effective method for the secondary prevention of hypertension, but until now, there has been no specialized instrument to evaluate the ability for self-care in elderly Chinese patients with hypertension.

Objectives:

The aims of this study were to cross-culturally translate the Self-care of Hypertension Inventory into Chinese and apply it to elderly patients with preliminary hypertension.

Methods:

This is a methodological study with steps that included translation, synthesis, back-translation, back-translation review, expert committee review, pretesting, and submission to authors. We conducted preliminary psychometric analyses that included content validity, item-total correlation, internal consistency reliability, principal factor analysis, and test/retest reliability.

Results:

The translation equivalence was obtained between the adapted version and the original scale. The item-level content validity index had a range of 0.833 to 1. The scale-level content validity average method and Cronbach α were 0.986 and 0.858 for the total scale, respectively. The test/retest reliability was 0.949. Principal factor analyses showed the presence of 4, 1, and 1 latent factors in 3 separate subscales.

Conclusions:

The Self-care of Hypertension Inventory has been successfully translated and cross-culturally adapted to Chinese. It is suitable for application to elderly Chinese patients with hypertension.
Public Reporting of Cardiac Outcomes for Patients With Acute Myocardial Infarction
Authors: de Cordova Pamela B. , Johansen Mary L. , Riman Kathryn A. , Rogowski Jeannette
Published: September 2018

Background:

Percutaneous coronary intervention (PCI) is recognized by both the American Heart Association and the American College of Cardiology as an optimal therapy to treat patients experiencing acute myocardial infarction (AMI) with ST-segment elevation myocardial infarction. A health policy aimed at improving outcomes for the patient with AMI is public reporting of whether a patient received a PCI.

Objective:

A systematic review was conducted to evaluate the effect of public reporting for patients with AMI, specifically for those patients who receive PCI.

Methods:

EMBASE, MEDLINE, Academic Search Premier, Google Scholar, and PubMed were searched from inception through August 2017. Articles were selected for inclusion if researchers evaluated public reporting and included an outcome for whether a patient received a PCI during hospitalization for an AMI. Methodological quality of the included studies was evaluated, and findings were synthesized.

Results:

Eight studies of high methodological quality were included in the review. Most studies found that, in areas of public reporting, patients were less likely to undergo a PCI and high-risk patients did not undergo a PCI. Researchers also found that patients with AMI had lower in-hospital mortality after the implementation of public reporting, but only if these patients received a PCI.

Conclusions:

Although public reporting may have had intentions of improving care, there is strong evidence that this policy did not result in more timely PCIs or improved mortality of patients with AMI. In fact, public reporting resulted in unintended consequences of not providing care for the most vulnerable patients in fear of an adverse outcome.
The Experiences of Younger Individuals Living With Heart Failure
Authors: Walsh Alison , Kitko Lisa , Hupcey Judith
Published: September 2018

Background:

Heart failure (HF) impacts 1.7 million Americans between the ages of 20 and 59 years, but limited research exists addressing the issues unique to this age group.

Objective:

The aim of this study was to investigate the experiences of younger persons living with HF.

Methods:

Semistructured interviews (n = 18) were analyzed using a qualitative thematic analysis.

Results:

Six themes emerged: (1) role fulfillment: participants who perceived their roles as a parent, caregiver, spouse, employee, and friend have been negatively affected by HF; (2) autonomy: participants frequently linked their well-being to a sense of independence, productivity, and purpose; (3) financial impact: most of the sample expressed financial instability further complicated by existing disability policies; (4) perception of self: recurrent statements revealed participants feeling judged because of their HF diagnosis and younger age; (5) retrospective life changes: participants reflected on past decisions and often blamed themselves for their current health; and (6) symptom burden: participants reported higher levels of psychosocial symptoms, such as depression, anxiety, and fatigue.

Conclusions:

Younger individuals living with HF reported overwhelmingly poor health-related quality of life that was linked to the 6 themes identified previously. The effect of HF was seen on numerous life events that traditionally occur earlier in the life course such as establishing a career, meaningful relationships, family, and financial security. This directly impacted health-related quality of life by disrupting what each individual perceived as important to them, which took a toll on their overall mental health. To provide holistic care to younger patients living with HF, interventions that address the heavy burden of psychosocial symptoms and policy changes associated with financial burden and disability laws must be developed.
Comparison Between Non–High-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol to Estimate Cardiovascular Risk Using a Multivariate Model
Authors: Palazón-Bru Antonio , Carbayo-Herencia Julio Antonio , Simarro-Rueda Marta , Artigao-Ródenas Luis Miguel , Divisón-Garrote Juan Antonio , Molina-Escribano Francisca , Ponce-García Isabel ,   on behalf of GEVA (Group of Vascular Diseases From Albacete)
Published: September 2018

Background:

Although studies exist comparing low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) in the development of cardiovascular disease (CVD), most have limitations in the mathematical models used to evaluate their prognostic power adjusted for the other risk factors (cardiovascular risk).

Objective:

The aim of this study was to compare LDL-C and non-HDL-C in patients with CVD to determine whether both parameters predict CVD similarly.

Methods:

A cohort of 1322 subjects drawn from the general population of a Spanish region was followed between 1992 and 2006. The outcome was time to CVD. Secondary variables were gender, age, hypertension, diabetes, personal history of CVD, current smoker, body mass index, LDL-C, and non-HDL-C. Two CVD prediction models were constructed with the secondary variables, with only the lipid parameter varying (non-HDL-C or LDL-C). In the construction of the models, the following were considered: multiple imputation, events per variable of 10 or more, and continuous predictors as powers. The validation was conducted by bootstrapping obtaining the distribution of the C statistic (discrimination) and the probabilities observed by smooth curves. These results were compared in both models using graphical and analytical testing.

Results:

There were a total of 137 CVD events. The models showed no differences in the distributions of the C statistic (discrimination, P = .536) or in the calibration plot.

Conclusions:

In our population, LDL-C and non-HDL-C were equivalent at predicting CVD. More studies using this methodology are needed to confirm these results.
Electroencephalogram Modifications Associated With Atypical Strict Antipsychotic Monotherapies
Authors: Dias Alves Manuel , Micoulaud-Franchi Jean Arthur , Simon Nicolas , Vion-Dury Jean
Published: September 2018

Background

Antipsychotics produce electroencephalogram (EEG) modifications and increase the risk of epileptic seizure. These modifications remain sparsely studied specifically for atypical antipsychotics. In this context, our study focuses on EEG modifications associated with atypical strict antipsychotic monotherapies.

Methods

Electroencephalogram recordings of 84 psychiatric patients treated with atypical antipsychotics in strict monotherapy (clozapine, n = 22; aripiprazole, n = 22; olanzapine, n = 17; risperidone, n = 9; quetiapine, n = 8; risperidone long-acting injection, n = 4; and paliperidone long-acting injection, n = 2) were analyzed. The modifications were ranked according to both slowing and excitability scores.

Results

Electroencephalogram modifications (in 51 subjects, 60.71%) were graded according to 4 stages combining general slowing and sharp slow waves and/or epileptiform activities. The presence of sharp or epileptiform activities was significantly greater for clozapine (90.9%) compared with other second-generation antipsychotics (aripiprazole, 50%; olanzapine, 58.8%; quetiapine, 37.5%; risperidone, 44.4%). Age, duration of disease progression, and diagnosis were not associated as risk factors. Electroencephalogram modifications were associated with lower doses for treatment with quetiapine but not for specific antipsychotics. Electroencephalogram modifications and severe excitability were associated with higher chlorpromazine equivalent doses.

Conclusions

Atypical antipsychotics (clozapine, aripiprazole, quetiapine, olanzapine, and risperidone) induce EEG modifications, and these are significantly greater for clozapine and appear dependent on chlorpromazine equivalent dose. No encephalopathy was observed in these antipsychotic monotherapies, whatever dose.
Severity, Prevalence, Predictors, and Rate of Identification of Insomnia Symptoms in a Sample of Hospitalized Psychiatric Patients
Authors: Doghramji Karl , Tanielian Maria , Certa Kenneth , Zhan Tingting
Published: September 2018

Insomnia is a risk factor for new onset, exacerbation, and relapse of mental illness. The goal of this study was to examine the prevalence, severity, and predictors of insomnia in hospitalized psychiatric patients. Ninety-seven consecutive psychiatric inpatients were administered the Insomnia Severity Index (ISI) to evaluate the presence and severity of insomnia. Patients' hospital charts were reviewed for demographic and medical information. ISI scores in 79.4% of the patients reached the threshold criterion of 8 for insomnia. Insomnia was not mentioned as a clinical problem in the discharge notes problem list in any of these patients. Multivariate analysis indicated that age (p = 0.009), recent suicide attempt or ideation (P < 0.001), tobacco use (p = 0.024), and recreational drug use during the past month (p = 0.040) were significant predictors of insomnia severity. Insomnia was highly prevalent in this population. Identification and management of insomnia would be an important clinical goal in hospitalized psychiatric patients.
Eating Pathology Among Patients With Anorexia Nervosa and Bulimia Nervosa
Authors: Boucher Katrine , Côté Marilou , Gagnon-Girouard Marie-Pierre , Ratté Carole , Bégin Catherine
Published: September 2018

We sought to deepen our understanding of the relationship between pathological narcissism and eating disorders (ED) by examining specific facets that composed grandiose and vulnerable narcissism while taking into account self-esteem, a well-known and consistent risk factor for ED. Twenty-seven women diagnosed with anorexia nervosa (AN) and 23 women diagnosed with bulimia nervosa (BN) completed standardized measures of pathological narcissism, self-esteem, and dysfunctional eating attitudes and behaviors. Different patterns of associations between the facets of pathological narcissism and eating pathology arose between AN and BN diagnoses. Closer examination of the facets of pathological narcissism revealed that hiding the self, a vulnerable narcissistic facet, contributed significantly to dysfunctional eating attitudes and behaviors over and above self-esteem for women with AN. Hiding the self should continue to be explored in regard to treatment of ED.