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The effect of inflammation induced by sodium caseinate or aluminum hydroxide on the splenic plaque-forming cell (PEC) response to sheep red blood cells (SRBC) was studied in mice. Direct and indirect splenic PFC responses were enhanced when suboptimal SRBC doses (3 × 106) were injected intra-peritoneally (i.p.) within 9 hr of i.p. inflammatory stimulation; antigen administration 48 hr or more after such stimulation resulted in a slight suppression of the direct response. The inflammation had no effect on the secondary immune response, nor did intra- venous antigen administration enhance the PFC response. Enhancement occurred when early (3 hr), casein-induced peritoneal exudate cells (PEC, consist- ing mostly of neutrophils) were adoptively transferred at the same time as antigen. Treatment of the 3-hr PEC with anti-Thy-I and complement did not decrease their PFC-enhancing capability. Late (96-hr) PEC, consisting mostly of macrophages, manifested only a slight enhancing effect. We suggest that enhancement of the splenic PFC response in the presence of an ongoing inflammation, may be partially attributable to neutrophil function. [ABSTRACT FROM AUTHOR]

Aims Starter lactic acid bacteria in Cheddar cheese face physico-chemical stresses during manufacture and ageing that alter their abilities to survive and to interact with other bacterial populations. Nonstarter bacteria are derived from milk handling, cheese equipment and human contact during manufacture. Probiotic bacteria are added to foods for human health benefits that also encounter physiological stresses and microbial competition that may mitigate their survival during ageing. We added probiotic Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus paracasei and Bifidobacterium animalis subsp. lactis to full-fat, reduced-fat and low-fat Cheddar cheeses, aiming to study their survival over 270 days of ageing and to determine the role of the cheese matrix in their survival. Methods and Results Probiotic and other lactic acid bacterial populations were enumerated by quantitative PCR using primers specifically targeting the different bacterial genera or species of interest. Bifidobacteria were initially added at 106 CFU g−1 cheese and survived variably in the different cheeses over the 270-day ageing process. Probiotic lactobacilli that were added at 107 CFU g−1 cheese and incident nonstarter lactobacilli (initially at 108 CFU g−1 cheese) increased by 10- to 100-fold over 270 days. Viable bacterial populations were differentiated using propidium monoazide followed by species-specific qPCR assays, which demonstrated that the starter and probiotic microbes survived over ageing, independent of cheese type. Addition of probiotic bacteria, at levels 100-fold below that of starter bacteria, modified starter and nonstarter bacterial levels. Conclusions We demonstrated that starter lactococci, nonstarter lactobacilli and probiotic bacteria are capable of surviving throughout the cheesemaking and ageing process, indicating that delivery via hard cheeses is possible. Probiotic addition at lower levels may also alter starter and nonstarter bacterial survival. Significance and Impact of the Study We applied qPCR to study multispecies survival and viability and distinctly enumerated bacterial species in commercial-scale Cheddar cheese manufacture. [ABSTRACT FROM AUTHOR]

Patients' perceptions of care have been demonstrated to influence outcomes. VAD patients require resource intensive care which is best delivered in a multidisciplinary fashion. Although this should be patient focused and integrated, there is little data to assess how well current care models achieve this goal. We created a modified version of the Patient Perceptions of Integrated Care survey to be specific for VAD recipients (PPIC-VAD). VAD patients >6 months removed from implant were approached for informed consent in the VAD clinic. Participation required a one-time completion of the 37 item survey. Using a 4-point Likert Scale, the PPIC-VAD assessed patient perceptions in 6 domains: VAD Care Team (VCT); Primary Care Provider and Other Medical Staff (PCP-OMS); Referring Cardiologist (RC); Emergency Department (ED); Self-Assessment of Health (SAH); Evaluation Process. Data was collected from 6/1/19 - 8/1/19. 29 patients completed the PPIC-VAD. 79% were male, mean age was 55.4 years. 36% were unsure about implant strategy while 59% incorrectly identified the strategy. The VCT was assessed as being well informed regarding history, home life, and care delivered by other health professionals. PCP-OMS were found to have a lower perceived knowledge of VAD care and comfort with device knowledge while ED provider knowledge was assessed as being least optimal (Table). Patients' SAH demonstrated an improvement in perceived levels of health post implant with 90% reporting their overall level of health to be good compared to 7% prior to implant. 62% had a positive outlook regarding continued improvement in health. Although the VCT is perceived as delivering patient focused and integrated care, there remains a high proportion of patients who do not understand their implant strategy. Additionally, the care delivered by PCP-OMS and ED presents an area wherein communication, education and device awareness can be improved. Despite this, VAD patients have a positive outlook when assessing levels of health and anticipated future improvements. [ABSTRACT FROM AUTHOR]

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings. [ABSTRACT FROM AUTHOR]

Although significant cardiac reverse remodeling is a prerequisite for a left ventricular (LV) assist device (LVAD) patient to be considered for device weaning, multiple factors including patient goals, physician comfort, and center experience, weigh in on this complex decision. Existing predictive models defining recovery as device withdrawal, entail the above-mentioned confounders, and may under detect patients that could benefit from a targeted bridge to recovery strategy. We sought to derive and validate a predictive tool to identify patients prone to reverse remodel, independent of the complex decision to remove a durable, surgically deployed device. Heart failure patients (N=782) requiring LVAD were enrolled at one (n=537) and five US programs (n=245). Baseline characteristics were recorded. The primary outcome was responder incidence, defined as follow-up LV ejection fraction ≥40% and LV end-diastolic diameter ≤6 cm within one year on LVAD support. Bootstrap imputation and lasso variable selection techniques were used to derive a predictive model which was then validated using our multicenter dataset. A predictive calculator was developed, and patients were classified into groups with varying potential for reverse remodeling. Patients were predominantly white (84%), male (82%), aged 56±1 years. Overall, 14.8% patients were identified as responders. Nine preoperative variables associated with reverse remodeling were included in the multivariate model achieving an optimism corrected C-statistic of 0.77 (95% CI: 0.71-0.82) (Figure). The UCAR calculator is a machine learning-based multicenter and validated risk tool, implementing routine clinical data, that effectively stratifies patients into groups with varying potential for reverse remodeling. This tool can be useful in selecting patients to implement diagnostic and therapeutic protocols that can promote reverse remodeling and myocardial recovery. [ABSTRACT FROM AUTHOR]

The soft x-ray diagnostic is suitable for monitoring plasma activity in the tokamak core, e.g., sawtooth instability. Moreover, spatially resolved measurements can provide information about plasma position and shape, which can supplement magnetic measurements. In this contribution, fast algorithms with the potential for a real-time use are tested on the data from the COMPASS tokamak. In addition, the soft x-ray data are compared with data from other diagnostics in order to discuss possible connection between sawtooth instability on one side and the transition to higher confinement mode, edge localized modes and productions of runaway electrons on the other side. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Examine the associations between selected built environment (BE) attributes and perceived active park use among older adults in Bogota. METHODS: A cross-sectional multilevel study was conducted. Participants included 1966 older adults in 50 neighborhoods. Socio-demographic covariates and BE attributes were measured. Multilevel logistic regression models were used for the analyses. RESULTS: Residents from areas with higher park density and high land-use mix were more likely to report active park use while those from areas with high connectivity were less likely. CONCLUSIONS: This study suggests that objective attributes of the residential BE are associated with perceived active park use. However, our study also points to the importance of surrounding environment, with the result of an inverse relationship between connectivity and physical activity, which highlights the potentially necessary interventions in the realm of traffic and pedestrian safety. [ABSTRACT FROM AUTHOR]

Predicting cardiac structural and functional improvement in advanced heart failure (HF) patients before durable left ventricular assist device (LVAD) implantation remains challenging. Identifying clinical predictors could improve patient selection and impact clinical management. Advanced chronic HF patients (N=652) supported with continuous-flow LVADs were evaluated. After excluding patients with acute HF etiologies or without adequate post-LVAD follow up (<3 months), they were divided into an internal Derivation cohort (n=339, UTAH program) and an external Validation cohort (n=227, 4 US programs). Patients with post-LVAD LVEF ≥40% and LVIDd ≤6.0cm within the 1st year post-implant, were defined as Responders (R). Multivariate Cox regression was used to predict R, in the Derivation cohort, and the fit of the model was tested in the Validation cohort. In total, 10% of the LVAD patients were R. Univariate analysis showed that R were younger, had shorter HF symptoms duration, less need for diuretics and their LV were less dilated pre-LVAD. Further, R had higher acuity disease as evidenced by the higher vasoactive agents need, higher BNP and higher incidence of abnormal liver enzymes. The multivariate Cox regression (AUC=0.74; p<0.001) predicted R using 3 clinical parameters: LVIDd<6.9 cm, age<50 years, and HF duration<36 months (Table). The model's predictive accuracy was validated in the external Validation cohort (AUC=0.78; p<0.001). Younger patients with less LV dilation and shorter duration of HF are more likely to improve their cardiac function during LVAD support. Whether these characteristics also predict sustainability of improved cardiac function after LVAD weaning warrants further investigation. [ABSTRACT FROM AUTHOR]

An increase in photosynthetic activity of the northern hemisphere terrestrial vegetation, as derived from satellite observations, has been reported in previous studies. The amplitude of the seasonal cycle of the annually detrended atmospheric CO2 in the northern hemisphere (an indicator of biospheric activity) also increased during that period. We found, by analyzing the annually detrended CO2 record by season, that early summer (June) CO2 concentrations indeed decreased from 1985 to 1991, and they have continued to decrease from 1994 up to 2002. This decrease indicates accelerating springtime net CO2 uptake. However, the CO2 minimum concentration in late summer (an indicator of net growing-season uptake) showed no positive trend since 1994, indicating that lower net CO2 uptake during summer cancelled out the enhanced uptake during spring. Using a recent satellite normalized difference vegetation index data set and climate data, we show that this lower summer uptake is probably the result of hotter and drier summers in both mid and high latitudes, demonstrating that a warming climate does not necessarily lead to higher CO2 growing-season uptake, even in high-latitude ecosystems that are considered to be temperature limited. [ABSTRACT FROM AUTHOR]

There is a lack of data regarding the outcomes of patients who were subjectively assessed to have advanced heart failure (AdvHF) and therefore offered evaluation for left ventricular assist devices (LVADs) only to be determined to be "too well". We retrospectively reviewed all referrals to our Advanced Heart Failure outpatient clinic for LVAD evaluation from 1/1/13 to 12/31/17. Those individuals who were above the age of 18, subjectively determined to have a syndrome of AdvHF as assessed by a HF Faculty, but deemed "too well" for implantation after formal VAD evaluation and multidisciplinary Medical Review Board (MRB) discussion were included for analysis. 62 patients met inclusion criteria. 75% were male, median age at time of presentation to MRB was 57.5 years. Median time to MRB presentation from initial out-patient consultation was 33.5 days. Medication titration was recommended to nearly all (98%), while concomitant evaluation for stem cell therapy and inotropic support was recommended in 17% and 15% respectively. Median time to initial follow-up after MRB presentation was 29.5 days. Beyond initial follow-up 26% were lost to follow-up. Men were 31% more likely than women to be lost to follow up (p = 0.019). Of those who continued to follow in our system, survival 1 year after MRB presentation was 94%, during which time 28% required at least one unscheduled clinic visit, 25% required ED treatment and 27% required at least one hospitalization. 10 patients ultimately were represented to the MRB at a median time of 391 days after initial presentation. Of these, 3 patients were ultimately implanted with an LVAD. 26% of patients given the label of "too well" were noted to have relative contraindications precluding them from consideration. Patients determined to be "too well" for LVAD despite a subjective assessment suggestive of a syndrome of AdvHF have good 1 year survival. However, the rates of follow-up and MRB re-discussion, as well as rates of implantation at later dates for "too well" patients is relatively low, despite the known progressive nature of HF. The "too well" label may diminish the perceived need for these patients to have close follow-up with an advanced heart failure team. Additionally, its use may be inaccurate and therefore should be avoided. [ABSTRACT FROM AUTHOR]

Background: Advancement in cancer molecular diagnostics has paved the way for greater understanding of cancer biology, its heterogeneity, and its dynamics leading to development of personalised cancer care--targeted treatment tailored to the patient's personal tumour profile. Molecular profiling serves as a tool for diagnostic transformation for those refractory to standard conventional therapy with directed personalised treatment guided by tumour biology, thus maximising treatment potential for those likely to benefit, minimising the toxic effects of treatment, and improving patient outcomes. We aimed to describe the treatment outcome (based on RECIST) of patients who underwent treatment according to molecular profiling. Methods: A chart review of Filipino cancer patients who underwent molecular profiling was done, covering the period 2009-12. Age, gender, histologically proven cancer diagnosis, chemotherapeutic and biological treatment regimens, number of lines of treatment, and timing of molecular profiling were documented. Treatment outcomes based on RECIST, assessed by CT scan, were recorded after each regimen of at least three cycles or after a CT scan evaluation was deemed necessary by the clinician. Findings: Among nine patients whose treatment agents were documented to be "benefit" by molecular profiling, the following outcomes were noted: complete response (13%), partial response (63%), stable disease (13%) and progressive disease (13%). Clinical benefit ratio was 88% in this group. Among patients whose treatment agents were determined to be with "benefit" and "no benefit" agents, partial response, stable disease, and progressive disease were reported in 17%, 67% and 17%, respectively. Clinical benefit ratio was 83% in this group. Among patients whose treatment agents were of "no benefit", 100% had progressive disease. [ABSTRACT FROM AUTHOR]