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• African-specific variants in the apolipoprotein L1 (APOL1) are associated with risk of preeclampsia. • Independently, vitamin D deficiency is also associated with increased preeclampsia risk. • Prior work has not examined interaction effects between APOL1 genotype and vitamin D deficiency in risk of developing preeclampsia. • Risk of developing preeclampsia more than doubled for women with low vitamin D and carrying a child with high-risk APOL1. Preeclampsia is a hypertensive disorder in pregnancy known to increase the risk of mortality and other pregnancy-related issues, such as prematurity. Currently, there no known prophylactics or treatment options available for preeclampsia. More research is needed to better understand factors that increase preeclampsia risk. Vitamin D deficiency is consistently associated with developing preeclampsia. In addition to micronutrient deficiency, the presence of two fetal apolipoprotein L1 high-risk variants are also associated with preeclampsia risk. We hypothesized that a potential additive effect between high-risk apolipoprotein L1 genotype status and nutritional deficiencies would place individuals at a higher risk of developing preeclampsia. The objective of this study was to determine the risk of developing preeclampsia in African American women with vitamin D deficiency and maternal/fetal high-risk apolipoprotein L1 genotype. This was a case-control study using a subset of 999 African American mother and infant pairs collected from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood cohort in Memphis, TN. We performed multiple logistic regression to examine the association of preeclampsia with 2nd and 3rd trimester vitamin D concentrations. Concentrations were dichotomized into high or low categories. Vitamin D deficiency was defined as a concentration less than 20 ng/mL. Further analyses assessed whether maternal or fetal apolipoprotein genotype status modified the association between vitamin D association and preeclampsia. The reference group included individuals with both high vitamin D and low-risk apolipoprotein genotype. Pregnancies with low vitamin D in the 3rd trimester were at an increased risk for preeclampsia (odds ratio 2.10; 95 % confidence interval 1.09–4.12; P-value, 0.03). Risk for preeclampsia was greatest among pregnancies with fetal high-risk genotype and low vitamin D levels in the 2nd trimester (odds ratio, 2.79; 95 % confidence interval, 1.06–6.83; P-value, 0.03) and 3rd trimester (odds ratio 6.40; 95 % confidence interval 2.07–19.18; P-value, <0.01). Our significant findings suggest that the risk of preeclampsia associated with low vitamin D levels, especially during the 3rd trimester, is magnified by the presence of fetal high-risk apolipoprotein L1 genotype. [ABSTRACT FROM AUTHOR]

Ex vivo lung perfusion has emerged as a novel technique to safely preserve lungs before transplantation. Recent studies have demonstrated an accumulation of inflammatory molecules in the perfusate during ex vivo lung perfusion. These proinflammatory molecules, including damage-associated molecular patterns and inflammatory cytokines, may contribute to acute and chronic allograft dysfunction. At present, ex vivo lung perfusion is performed clinically at normothermic temperature (37°C). The effect of lowering temperature to the subnormothermic range during ex vivo lung perfusion has not been reported. In this study, we hypothesized that lower ex vivo lung perfusion temperature will lead to a reduction in allograft inflammation and result in improved post-transplant graft function. Lewis rat heart-lung blocs underwent 4 hours of ex vivo lung perfusion in 3 temperature groups: 37°C (MP37), 30°C (MP30), and 25°C (MP25). In the control group, lung grafts were preserved by static cold storage before transplantation. After ex vivo lung perfusion or static cold storage, the left lung was transplanted for 2 hours before the animal was killed. Sera and tissue were collected and analyzed. There were no differences in partial pressure of arterial oxygenation to fraction of inspired oxygen ratios during 4 hours of ex vivo lung perfusion between temperature groups. Tumor necrosis factor α significantly increased in the MP37 group during ex vivo lung perfusion, whereas this was not seen at lower temperatures. Extracellular DNA and high-mobility group box 1 perfusate concentrations increased significantly during ex vivo lung perfusion in all groups, but the rate of increase was diminished at lower temperature. Two hours post-transplant, there were no significant differences in partial pressure of arterial oxygenation to fraction of inspired oxygen ratios of the lung graft or serum damage-associated molecular pattern levels among groups. On histologic grading after transplantation, greater injury was observed in the MP30 and MP37 groups, but not MP25, when compared with static cold storage. Subnormothermic ex vivo lung perfusion at 25°C reduces the production of inflammatory mediators during ex vivo lung perfusion and is associated with reduced histologic graft injury after transplantation. [Display omitted] [ABSTRACT FROM AUTHOR]

Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multicenter setting. This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up. Patients were placed into 3 groups based off procurement strategy: brain-dead donor (control), brain-dead donor evaluated by EVLP, and DCD donors evaluated by EVLP. The primary outcomes were severe primary graft dysfunction at 72 hours and survival. Secondary outcomes included select perioperative outcomes, and 1-year and 3-years allograft function and quality of life measures. The DCD EVLP group had significantly higher incidence of severe primary graft dysfunction at 72 hours (P =.03), longer days on mechanical ventilation (P <.001) and in-hospital length of stay (P =.045). Survival at 3 years was 76.5% (95% CI, 69.2%-84.7%) for the control group, 68.3% (95% CI, 58.9%-79.1%) for the brain-dead donor group, and 60.7% (95% CI, 45.1%-81.8%) for the DCD group (P =.36). At 3-year follow-up, presence observed bronchiolitis obliterans syndrome or quality of life metrics did not differ among the groups. Although DCD EVLP allografts might not be appropriate to transplant in every candidate recipient, the expansion of their use might afford recipients stagnant on the waitlist a viable therapy. [Display omitted] [ABSTRACT FROM AUTHOR]

Despite improvements in pump design and durability, left ventricular assist device patients still suffer from life-threatening complications such as pump thrombosis (PT) and infection, often necessitating device exchange. Surgical exchange from HeartMate II (HM2; Abbott, Pleasanton, CA) to another HM2 is safe and associated with low mortality, but recurrent device thrombosis rates are high. Switching from axial-flow to centrifugal-flow pump, such as the HeartWare ventricular assist device (HVAD; Medtronic, Framingham, MA) may offer certain advantages due to it being a smaller, newer generation device, although there are limited data to support this strategy. Herein, we aimed to assess the surgical approach and feasibility, safety, and outcomes of surgical exchange from HM2 to HVAD. We evaluated HM2 patients who underwent device exchange to HVAD due to PT or infection at 4 large-volume left ventricular assist device implant centers. Twenty-four patients underwent HM2 to HVAD exchange due to PT (92%) and refractory infection (8%). Patients were male (75%), white (88%), with ischemic cardiomyopathy (54%), Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale level 1-3 (90%), and destination therapy (62%). The majority underwent redo-sternotomy (79%) and the remainder underwent minimally invasive thoracotomy with subcostal approach. The existing HM2 outflow graft was maintained in 79% of cases. Recurrent PT was noted in 9% of patients. Mortality was 8% at 30 days and 33% at 1 year. The surgical exchange from a HM2 to HVAD is safe and feasible, despite the differences in device specifications and surgical adaptation required. Newer-generation pumps are increasingly considered for exchange in the setting of HM2 device complication, and increasing experience with modified surgical approaches may be valuable in the current era. [ABSTRACT FROM AUTHOR]

Objectives: To develop a sustainable business model for pharmacist-provided comprehensive medication management services in a patient-centered medical home. Secondarily, to evaluate the impact that the pharmacist had on clinical (glycosylated hemoglobin [A1C], low-density lipoprotein [LDL], and blood pressure) and economic (physician productivity and cost avoidance) outcomes.Practice Description: This pilot project took place at the Palmetto Primary Care Physicians Trident office in North Charleston, South Carolina, from October 2013 to September 2014. At the time, the practice employed 5 physicians and 2 nurse practitioners and served more than 20,000 patients.Practice Innovation: The pharmacist targeted patients with diabetes, lipid disorders, hypertension, congestive heart failure, obesity, polypharmacy, and treatment regimen nonadherence for his comprehensive medication management services. The pharmacist was available for immediate consultation or referrals by appointment 5 days per week. Services provided by the pharmacist were billed as medication therapy management or "incident to" physician evaluation and management services codes.Evaluation: Number of patients seen per day, revenue collected from services rendered by the pharmacist, physician productivity and payment, cost avoidance, and health quality metrics (A1C, LDL, and blood pressure) were measured to determine the financial sustainability and clinical impact of the project.Results and Implications: The pharmacist was able to see an average of 11 patients per day, which was 72% of his capacity. The practice collected about $7400 per month for services rendered by the pharmacist. The average daily payment for services rendered by the physicians in the practice increased by 20.6%. More than 70% of uncontrolled patients had an improvement in clinical outcomes, such as A1C, LDL, and blood pressure.Conclusion: This project demonstrates the sustainable business model for embedding a pharmacist into a patient-centered medical home. [ABSTRACT FROM AUTHOR]

A meta-analysis consisting of 20 experiments (N = 3841) on the influence of pedagogical agent (PA) gesturing in multimedia environments revealed that gestures have a small-to-medium impact on near transfer of knowledge ( g  = 0.39), retention of learning ( g  = 0.28), and agent persona ( g  = 0.44), but a minimal impact on reducing cognitive load ( g  = 0.13). Moderator analysis discovered that humanoid agents had a small effect on decreasing cognitive load ( g  = 0.24), while character agents had a minimal to small effect on increasing cognitive load ( g  = - 0.18). Interestingly, a deeper analysis found that the differences in effect sizes for near transfer and retention might be due to the learning outcome measured and not the design of the PA. Overall, the findings revealed that PA gestures are beneficial for student learning and perception in multimedia learning environments. [ABSTRACT FROM AUTHOR]

Phytoplasmas are a diverse group of insect-transmitted, cell wall-less bacteria that colonize plant phloem sieve elements and cause numerous diseases in economically important crops. Living a trans-kingdom parasitic life, phytoplasmas possess dynamic genomes and evolve rapidly toward formation of distinct ecological lineages in their adaptation to specific ecological niches. In an effort aimed at identification of the etiological agent responsible for a repeatedly-occurring sweet cherry virescence (SCV) disease in China, we found that the SCV disease was consistently associated with infection by a phytoplasma belonging to subgroup B of the elm yellows phytoplasma group (16SrV-B). Further analysis of genetic loci that encode important phytoplasma cellular components, including an array of ribosomal proteins and preprotein translocase subunit SecY, revealed that the SCV phytoplasma was essentially indistinguishable from the subgroup 16SrV-B phytoplasma strains responsible for jujube witches’-broom (JWB) disease and diseases of many other plants. Evidence gathered in the present study indicated that SCV-JWB phytoplasma strains formed a highly homogenous ecological lineage. The study also revealed that a polyphagous leafhopper, Táoyīdiǎnyèchán (桃一点叶蝉 in Chinese and often being cited as Erythroneura sudra ), was able to carry the SCV phytoplasma, emphasizing a need to investigate whether this erythroneurine leafhopper plays a role in spreading the SCV phytoplasma among sweet cherry plants. [ABSTRACT FROM AUTHOR]

An integrated workflow is developed to estimate the spatial distribution of harmful algal blooms, especially cyanobacteria concentrations in inland water bodies. The methodology comprises satellite data extraction and preprocessing for atmospheric and water surface corrections, identifying feature importance, in-situ sample collection, training and testing of machine learning algorithms, and prediction. Six input bands are selected using feature importance algorithms from 12 original bands of Sentinel-2 satellite imagery. In-situ sample data that are synchronous with Sentinel-2 image capture time were obtained from a public database. These models are evaluated and compared using spider plots of different error calculations. The workflow developed in this study and the predicted spatial concentration of harmful algal blooms across the lake can be used to improve warning and advisory systems for the public and avoid exposure. The incorporation of other parameters such as water temperature, nutrient concentrations, and surface wind speed could improve the machine-learning models. • Four models are trained to predict cyanobacteria concentrations across Utah Lake • Analyzed results of in-situ samples are obtained from the state department database • Acquisition of Sentinel-2 imageries is synchronous with in-situ sample collection • Four feature importance algorithms are applied to reduce the number of input bands • Mapping harmful algae improves the warning advisory for public to avoid contact [ABSTRACT FROM AUTHOR]

Recent increases in dam removals have prompted research on ecological and geomorphic river responses, yet contaminant dynamics following dam removals are poorly understood. We investigated changes in sediment concentrations and fish-community body burdens of mercury (Hg), selenium (Se), polychlorinated biphenyls (PCB), and chlorinated pesticides before and after two lowhead dam removals in the Scioto and Olentangy Rivers (Columbus, Ohio). These changes were then related to documented shifts in fish food-web structure. Seven study reaches were surveyed from 2011 to 2015, including controls, upstream and downstream of the previous dams, and upstream restored vs. unrestored. For most contaminants, fish-community body burdens declined following dam removal and converged across study reaches by the last year of the study in both rivers. Aldrin and dieldrin body burdens in the Olentangy River declined more rapidly in the upstream-restored vs. the upstream-unrestored reach, but were indistinguishable by year three post dam removal. No upstream-downstream differences were observed in body burdens in the Olentangy River, but aldrin and dieldrin body burdens were 138 and 148% higher, respectively, in downstream reaches than in upstream reaches of the Scioto River following dam removal. The strongest relationships between trophic position and body burdens were observed with PCBs and Se in the Scioto River, and with dieldrin in the Olentangy River. Food-chain length – a key measure of trophic structure – was only weakly related to aldrin body burdens, and unrelated to other contaminants. Overall, we demonstrate that lowhead dam removal may effectively reduce ecosystem contamination, largely via shifts in fish food-web dynamics versus sediment contaminant concentrations. This study presents some of the first findings documenting ecosystem contamination following dam removal and will be useful in informing future dam removals. [ABSTRACT FROM AUTHOR]

This paper reports new fieldwork at Warsash which clarifies the terrace stratigraphic framework of the Palaeolithic archaeology of the region. Sections were recorded in former gravel pits and at coastal locations, supplemented by the use of ground penetrating radar and luminescence dating techniques. The region’s extensive borehole archive was also analysed to produce a revised terrace stratigraphy at Warsash and for the Test valley as a whole. At Warsash, some of the sediments previously identified as the Mottisfont/Lower Warsash Terrace are reassigned to the Hamble, Belbin/Upper Warsash and Ganger Wood/Mallards Moor Terraces. A luminescence dating programme, using test procedures not utilised in earlier dating studies in the region, yielded age estimates for the Hamble and Mottisfont/Lower Warsash Terraces at Warsash and also highlighted the complicated nature of the fluvial sediments of the River Test, suggesting that published luminescence ages for these deposits should be treated with some caution. This study indicates that the data used to construct terrace stratigraphies also requires careful assessment. The use of bedrock height and sediment thickness data produces more coherent long profile correlations than those produced by terrace surface data alone. The revised terrace stratigraphy provides the framework for the Palaeolithic archaeology at Warsash and clarifies correlations within and between archaeologically important sediments of the Test Valley, enabling it to contribute to discussions on the Lower-Middle Pleistocene settlement history of southern Britain. [ABSTRACT FROM AUTHOR]

Early identification is a goal for creatine transporter deficiency and will be critical for future treatment. Before their first birthday, one-half of this sample showed both a significant feeding/weight gain issue and delayed sitting or crawling. Combined, these early indicators could have alerted providers to conduct a urine screen. [ABSTRACT FROM AUTHOR]

This paper presents new work on the Lower and Middle Palaeolithic assemblages recovered from Pleistocene gravels of the River Test at Warsash, Hampshire. Historic map and artefact analyses enable the geological context to be established for substantial portions of the Warsash Palaeolithic record, which, when combined with new data relating to regional terrace stratigraphy and chronology, enables Warsash to be incorporated within regional and national Palaeolithic frameworks. Three key assemblages are identified: (1) a handaxe-dominated assemblage associated with gravels of the Lower Warsash Terrace that is likely to relate to hominin occupation during MIS 9; (2) a Levallois assemblage probably related to sediments overlying the Lower Warsash Terrace and likely to represent occupation in late MIS 8 and/or MIS 7; (3) a handaxe-dominated assemblage recovered from gravels of the Hamble Terrace, which is likely to have been reworked from older terrace fragments. The presence at Warsash of ficrons, cleavers and plano-convex handaxes is confirmed and their potential chronological significance considered. The Levallois record of the Solent Basin is discussed, highlighting its impoverished nature relative to the rich Levallois record of the Thames Valley. It is argued that preservation bias and/or collection history have not played a major role in creating these differences. Instead, it is likely to represent the limited dispersal of Neanderthal populations further into Britain from an entry point in the southern North Sea Basin. [ABSTRACT FROM AUTHOR]

Background Substantial evidence reveals tolerability and co-morbid disease resolution after bariatric surgery; however, few physicians refer morbidly obese patients for bariatric consultation. Objective To evaluate morbidly obese patient access to bariatric surgical consultation. Setting A multidisciplinary, private, bariatric center of excellence. Methods Patient surveyed in person regarding preconsultation co-morbidities, physician discussion and support for bariatric surgery, and physician referral practices. Results The patients’ (n = 388) co-morbid profile was 27.0% diabetes, 54.1% hypertension, 30.1% hyperlipidemia, and 37.1% obstructive sleep apnea. It was reported that 71.1% of patients stated that their primary care physician did not initiate a discussion about bariatric surgery. Among this group, 59.7% of patients initiated a conversation about bariatric surgery, with 80.6% of physicians supporting the decision and 18.4% referring to a bariatric practice. Overall referring specialty profile was 14.4% primary care, 4.4% cardiology, and 3.6% endocrinology. Diabetes and obstructive sleep apnea were more likely to prompt a referral ( P = .008 and P = .014, respectively). Conclusion Most primary care and subspecialists do not discuss bariatric surgical options, resulting in decreased access to bariatric care. The main barrier to referral is noncommunication by the primary care physician or subspecialist, despite the vast majority of physicians having positive attitudes about bariatric surgery. Co-morbidities of diabetes and obstructive sleep apnea are more likely to prompt a referral. Primary care physicians are most likely to refer, while endocrinologists are least likely. Improved familiarity with nationally recognized obesity management algorithms could contribute to improved referral rates. [ABSTRACT FROM AUTHOR]

Elemental profiling is a tool that has been proposed to improve the traceability of seafood products. Small sources of variation can affect the outcome of elemental profiling and therefore pose to lower the overall accuracy of analyses. Here, we investigate two potential sources of variation through three experiments: laboratory variation (intra-, interlaboratory variation, and tissue matrix) and tissue variation. Samples of whitleleg shrimp (Litopenaeus vannamei) were obtained from 20 farms in Ecuador and two farms in Alabama to be analyzed. In the first experiment of the study, samples from Ecuador were analyzed at three different laboratories and compared. Two out of the five elements reported were statistically different across the three laboratories (Cu and Se). In the second experiment, the effect of tissue matrix (ground vs whole tissue during acid digestion) was investigated. Altogether, five out of 29 elements analyzed were statistically different. In the third experiment, samples from two farms in Alabama were analyzed to understand the variation in element concentrations in different tissues (head on shell on (HOSO), headless shell on (HLSO), headless peeled (PLD) and headless peeled and deveined (PLDV)). Elemental concentrations varied across tissues, and patterns in elemental concentrations were site specific. The samples from the two farms were analyzed with a Random Forest classification model to site x tissue groupings with 94% accuracy. The result of this study highlights the following: 1. Consistency in laboratory analysis important in studies that involve element concentrations, as minor differences in methodology can propagate as significant differences in results. 2. In shrimp, elements are compartmentalized in different tissues and elemental profiling should consistently use the same type of tissue. • Sources of variation in elemental profiles were invesitgated. • Shrimp from Ecuador and Alabama were used for this investigation. • Interlaboratory variation was significant in 2 of 5 elements reported. • A classification model was 94% accurate in describing location x tissue groups. • This study provides further evidence for elemental profiling as a traceability tool. [ABSTRACT FROM AUTHOR]

Abstract: Inclined settlers may be used to improve algal-harvesting economics by enhancing the clarification rate for a fixed sedimentation velocity and areal footprint. For a fixed plate area, smaller inclination angles from horizontal result in increased settling area and clarification rate. To ensure flow of the settled-cell sediment for continuous operation, standard designs utilize a minimum angle of 55° from horizontal. If reliable, shallow-angle flow of sedimented algae is achieved, increased clarification rates may be realized (e.g., 63% enhancement at 20° versus 55° from horizontal). To study the critical sediment-flow angle, we use an angle-of-repose model, which includes an additional normal-force term to account for adhesion. The inclusion of this term is supported by observations that the critical sliding angle decreases with the sediment mass/thickness. To reduce the critical sliding angle, we evaluated the sediment flow of settled, green alga Chlorella vulgaris on several low-adhesion surfaces described in the biofouling literature and demonstrated sediment flow at angles as low as 10° using a negatively-charged surface. This surface fouled after immersion for 24h in spent culture medium, presumably due to the deposition of residual organic matter. Additionally, applied vibration is demonstrated to achieve sediment flow at angles as shallow as 20°. [Copyright &y& Elsevier]

Abstract: Algal flocculation using naturally-available ions in brackish water was evaluated as a technique to rapidly settle algae while minimizing flocculant costs. Basicity-induced flocculation using naturally-available ions with NaOH addition was used as surrogate for an autoflocculation process at photosynthetically-elevated pH. Flocculation was attempted with a variety of precipitating ions, including Mg2+, Ca2+, and CO3 2−. Satisfactory flocculation was only achieved in the presence of Mg2+, while extensive CaCO3 precipitation yielded only partial, presumably sweep, flocculation. The flocculation was characterized by the settling-rate distribution, measured via light attenuation. Using Mg2+-dependent flocculation, an optimum pH was observed at which rapid settling was achieved with minimal precipitation. Further base addition caused extensive Mg(OH)2 precipitation, formation of loose macroflocs, and a reduction of settling rate. Experiments demonstrated that both increased Mg2+ concentration during growth and the presence of extracellular organic matter necessitated a higher flocculation pH and greater Mg2+ depletion. A proof-of-concept flocculation was demonstrated in surrogate media previously developed to mimic brackish waters of the southwestern United States (Barclay et al., 1987). These flocculations achieved median settling rates of at least 100cm/h, more than 100-fold greater than the settling rate of unflocculated cells. [Copyright &y& Elsevier]

Abstract: Existing theory posits that ease of use is a fundamental driver in marketing related technology, such as computer games, of usage and purchase by users. However, there is no empirical evidence to support this proposition. Therefore, this research models the relationship between the user’s game purchase and usage behavior and ease of use. In, 2009, 493 users in New Zealand responded face-to-face to complete a structured questionnaire. The analysis tested the conceptual model with confirmatory factors analysis (CFA) and structural equation modeling (SEM). The modeling tested game usage and purchase across four competing model types: (1) the original model (all games) and alternative models: (2) Sports/Simulation/Driving, (3) Role Playing Game (RPG)/Massively Multiplayer Online Role-Playing Game (MMORPG)/Strategy and (4) Action/Adventure/Fighting. We investigated the impact of ease of use on game usage and purchase behavior, both individually and simultaneously. In our confirmatory factor analysis and structural equation modeling, all of our models had adequate model fit with the exception of the original model. Our path coefficients indicate that ease of use of a game does not impact usage and/or purchase behavior. Research implications are discussed. [Copyright &y& Elsevier]

Background: Undersized ring annuloplasty and surgical revascularization are commonly used to correct ischemic mitral regurgitation (MR), but published series have failed to demonstrate a benefit compared with revascularization alone. We hypothesized that surgical revascularization and annuloplasty lead to a durable repair, but may also lead to increased mitral gradients that could limit the benefit of the repair technique. Methods: Data were collected for 222 consecutive patients who underwent combined revascularization and repair for ischemic MR between 1999 and 2006. The most recent transthoracic echocardiogram available for each patient (namely, the study that occurred at the latest date after surgery) was reviewed to define the fate of ischemic MR. When present, the mean gradient across the mitral valve was measured. Cox regression modeling was then performed to determine whether increasing gradients were associated with decreased long-term survival or increased hospitalization for heart failure. Results: For the group of 222 patients, echocardiographic follow-up was available for 68% (149 patients). At follow-up, 1.3% had severe MR and 9.4% had moderate MR; 54% of patients (66 of 123) were found to have gradients of 5 mm or greater across the mitral valve, with 11% demonstrating gradients of 8 mm or more. Cox proportional hazards models failed to show adverse effects of increasing mitral gradient on outcomes analyzed: survival hazard ratio = 0.95 (95% confidence interval: 0.82 to 1.11, p = 0.527) and survival/heart failure hospitalization hazard ratio = 1.04 (95% confidence interval: 0.93 to 1.17, p = 0.488). Conclusions: Undersized ring annuloplasty and revascularization can provide a durable correction of ischemic mitral regurgitation. This technique frequently increases the gradient across the mitral valve, but increasing mitral gradient does not appear to adversely impact survival or heart failure hospitalization. [Copyright &y& Elsevier]

Provenance of seafood items is a concern for consumers and importers alike. Elemental profiling has been put forth as a potential tool to improve seafood traceability. Whiteleg shrimp Litopenaeus vannamei collected from farms in Ecuador, India, Indonesia, Vietnam, and Thailand were classified to country of origin based on element concentrations in muscle tissue. Shrimp were dried, digested, and analyzed via ICP-MS. Out of the 41 elements investigated, 33 are reported as being above detection limits. Twenty-eight elements were statistically different across countries, and of these 28, Ecuador had unique group membership in 7. A random forest classification model utilizing 16 elements had an overall accuracy of 91% of correctly classified samples to country of origin. A canonical discriminant analysis was conducted to understand the variation in the data and identify elements that were important to differentiation in multi-dimension space. Elements identified as important contributors were Al, As, B, Ca, Co, Cs, Sr, and V. This study shows that shrimp from Ecuador tend to be more mineralized than shrimp from Asia, and classification models can discern samples from these countries successfully. This demonstrates the potential of a traceability database for cultured shrimp products from predominant production countries. • Shrimp from 5 countries were collected from farms for elemental analysis. • Trace elements classified shrimp in discriminant analysis with 91% accuracy. • Ecuadorian shrimp have a unique profile compared to Asian shrimp. • This study provides further evidence for elemental profiling as a traceability tool. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate whether the addition of a contrast agent to dobutamine stress echocardiography (DSE) improves its diagnostic accuracy for coronary artery disease (CAD) and to determine the effect of image quality on the diagnostic impact of contrast agent use in this setting. Background: Contrast agents can improve endocardial border definition. To date, however, there are no randomized trials that have evaluated the impact of contrast agent use on the accuracy of DSE. Methods: Patients referred for stress testing with dobutamine echocardiography underwent 2 DSE studies: 1 with and 1 without a contrast agent, at least 4 h apart in a randomized order and within a 24-h period. Results: A total of 101 patients underwent both DSE studies. Similar hemodynamics were achieved during the 2 stress testing sessions. The use of a contrast agent improved the percentage of segments adequately visualized at baseline (from 72 ± 24% to 95 ± 8%) and more so at peak stress (67 ± 28% to 96 ± 7%); both p < 0.001. Interpretation of wall motion with high confidence also increased with contrast agent use from 36% to 74% (p < 0.001). Segment visualization with the use of a contrast agent improved in all views, but was more pronounced in the apical views. In unenhanced DSE, 36% of studies were normal, 51% had ischemia, and 8% were uninterpretable—all of which became interpretable with the use of a contrast agent. When compared with angiography (n = 92; 55 patients with CAD), accurate detection of ischemia was higher with contrast-enhanced studies versus nonenhanced studies (p = 0.02). As endocardial visualization and confidence of interpretation decreased in unenhanced studies, a greater impact of the use of a contrast agent on DSE accuracy was observed (p < 0.01). Conclusions: During dobutamine stress echocardiography, contrast agent administration improves endocardial visualization at rest and more so during stress, leading to a higher confidence of interpretation and greater accuracy in evaluating CAD. The lesser the endocardial border visualization, the higher the impact of contrast echocardiography on accuracy. [Copyright &y& Elsevier]

Objective: To determine the prevalence of potential dosing errors of medication dispensed to children for 22 common medications. Study design: Using automated pharmacy data from 3 health maintenance organizations (HMOs), we randomly selected up to 120 children with a new dispensing prescription for each drug of interest, giving 1933 study subjects. Errors were defined as potential overdoses or potential underdoses. Error rate in 2 HMOs that use paper prescriptions was compared with 1 HMO that uses an electronic prescription writer. Results: Approximately 15% of children were dispensed a medication with a potential dosing error: 8% were potential overdoses and 7% were potential underdoses. Among children weighing <35 kg, only 67% of doses were dispensed within recommended dosing ranges, and more than 1% were dispensed at more than twice the recommended maximum dose. Analgesics were most likely to be potentially overdosed (15%), whereas antiepileptics were most likely potentially underdosed (20%). Potential error rates were not lower at the site with an electronic prescription writer. Conclusions: Potential medication dosing errors occur frequently in outpatient pediatrics. Studies on the clinical impact of these potential errors and effective error prevention strategies are needed. [Copyright &y& Elsevier]

Objective: The purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States. Study design: A retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed. Results: During the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit. Conclusion: Our finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman. [ABSTRACT FROM AUTHOR]

: BackgroundTo evaluate the safety and effectiveness of a new biodegradable polymeric sealant to close intraoperative air leaks after pulmonary resection.: MethodsIn a multicenter prospective randomized trial, 161 patients with a median age of 67 years old (range 18–85 years old), were randomized in a 2:1 ratio to receive sealant or control for at least one significant air leak (≥ 2.0 mm in size) after pulmonary resection. In the sealant group, all significant air leaks underwent attempted repair by standard methods (sutures, staples, or cautery) prior to the application of sealant. The control group underwent only standard methods. Blood was analyzed for immunologic response. Patients were followed up 1 month after surgery.: ResultsIntraoperative air leaks were sealed in 77% of the sealant group compared with 16% in the control group (p < 0.001). The sealant group had significantly fewer patients with postoperative air leaks compared with the control group (65% vs 86%, p = 0.005). Median length of hospitalization was 6 days (range, 3–23 days) for the sealant group compared with 7 days (range 4–38 days) for controls (p = 0.028). There was no difference in mortality, morbidity, duration of chest tubes, or immune responses between the two groups.: ConclusionsThis study demonstrates the effectiveness of a biodegradable polymer when used as an adjunct to standard closure methods for sealing significant intraoperative air leaks that develop from pulmonary surgery. Use of the sealant led to a reduction in postoperative air leaks, which may have decreased the length of hospitalization. [Copyright &y& Elsevier]

Assesses the influence of consensus guidelines in the prevention of perinatal group B streptococcal disease in Washington Metropolitan Area. Determination of high-risk women; Increase in intrapartum antibiotic use; Feasibility of the guidelines.

Background: The real-life applications of machine learning clinical decision making is currently lagging behind its promise. One of the critics on machine learning is that it doesn't outperform more traditional statistical approaches in every problem.Methods and Results: Authors of "Predictive Abilities of Machine Learning Techniques May Be Limited by Dataset Characteristics: Insights From the UNOS Database" presented in the current issue of the Journal of Cardiac Failure that machine learning approaches do not provide significantly higher performance when compared to more traditional statistical approaches in predicting mortality following heart transplant. In this brief report, we provide an insight on the possible reasons for why machine learning methods do not outperform more traditional approaches for every problem and every dataset.Conclusions: Most of the performance-focused critics on machine learning are because the bar is set unfairly too high for machine learning. In most cases, machine learning methods provides at least as good results as traditional statistical methods do. It is normal for machine learning models to provide similar performance with linear models if the actual underlying input-outcome relationship is linear. Moreover, machine learning methods outperforms linear statistical models when the underlying input-output relationship is not linear and if the dataset is large enough and include predictors capturing that nonlinear relationship. [ABSTRACT FROM AUTHOR]

Aquaculture production is an important part of the global food supply and has equaled or surpassed fisheries production as the main source of aquatic foods. Aquaculture is a resource intensive practice that can use large amounts of land, water, energy, and cause pollution and degradation to the local environment. Intensive production practices have been criticized in the past for causing environmental harm; however recent studies have suggested that resource use may decrease with increasing production intensities at the farm level. Here we used a conceptual farm to access the impact of a few key production parameters on land, water, and energy use. A series of calculations were conducted at various production intensities with modifications made to the type of feed used and water exchange rate. The resulting relationships were then modeled with production intensity. Additionally, the effect of various feedstuffs on embodied resource coefficients was examined through varying protein and carbohydrate feedstuffs. Land and water use were found to have an asymptotic relationship with production intensity, with the most important factor in land use being production intensity and the most important factor in water use being the water exchange rate. Energy use was found to be higher with a diet that has fish meal as a protein source and at higher water exchange rates. The most land intensive diets used for shrimp contained high fish meal with rice as carbohydrate feedstuffs (0.550 ha/tonne). The most water intensive diet was no fish meal with corn as a carbohydrate (1863 m3/tonne), and the most energy intensive diet was high fish meal with corn as a carbohydrate (11.73 GJ/tonne). The results herein suggest that intensifying shrimp aquaculture could save resources based on per tonne of production basis. [Display omitted] • Intensive shrimp farms save land compared to extensive shrimp farms. • Water exchange is the driving factor with regards to water use at shrimp farms. • Energy use increases, but plateaus with intensification. • There are tradeoffs with different feed ingredients and production systems. [ABSTRACT FROM AUTHOR]

The Mustard procedure is a palliative surgical procedure used to repair complete transposition of the great arteries. Cardiac transplantation remains the only definitive therapy for patients who develop heart failure after a Mustard procedure. However, pulmonary hypertension represents a major hemodynamic contraindication. The use of a ventricular assist device as destination therapy has not yet been established after a Mustard procedure. Here, we present the case of a 41-year-old patient who presented with systemic right ventricular failure following Mustard procedure complicated by pulmonary hypertension. The patient received a HeartMate II (Thoratec, Pleasanton, CA) ventricular assist device as a bridge to decision. [Copyright &y& Elsevier]

Phosphodiesterase-1 (PDE-1) hydrolyzes cyclic adenosine monophosphate and cyclic guanosine monophosphate, key second messenger molecules in cardiac and vascular tissue. Selective PDE-1 inhibition with ITI-214 resulted in systemic vasodilation and positive inotropic effects (inodilator) in a canine heart failure (HF) model with minimal effects on blood pressure. The specific PDE-1 inhibitor, ITI-214, confers inodilator effects in humans with HF with reduced ejection fraction. ITI-214-104 was a Phase Ib/IIa, multi center, double-blind, randomized, placebo-controlled single ascending dose cohort study of ITI-214 in patients with stable chronic systolic HF (NYHA Class II-III, LVEF ≤ 35%) (NCT03387215). Participants were randomized 9:3 to receive either ITI-214 10, 30, or 90 mg or placebo, with transthoracic echocardiography obtained just before and 120 min after dosing. Safety outcomes included supine and orthostatic BP and HR, telemetry events and blood laboratories. Hemodynamic outcomes included mean LV power index (primary outcome), as well as exploratory outcomes: cardiac output, LV volumes, LVEF, effective arterial elastance (Ea), and estimated systemic vascular resistance (SVR). Patient mean age was 54 yr, 57% male and 57% Black with mean LVEF 25% (31% had ischemic HF). Cmax occurred at 90 - 120 min, with area under curve increasing with dose escalation. ITI-214 30 mg increased mean LV power index and cardiac output while SVR and MAP decreased at 30 and 90 mg doses at 120 minutes post dose compared to placebo (Figure). Total LV afterload (Ea) followed the same pattern as SVR change. There were 3 orthostatic hypotension and 3 hypotension adverse events, both mild to moderate. There was no change in arrhythmia on continuous telemetry monitoring and no serious adverse events. Single-dose ITI-214 confers inodilator effects in humans with systolic HF. These data confirm our previous findings in the canine HF model. Further investigation of acute and chronic PDE-1 inhibition in HF should be considered. [ABSTRACT FROM AUTHOR]

Findings on prenatal polyunsaturated fatty acid (PUFA) intake and child wheeze and asthma have been inconsistent. We sought to examine associations between prenatal PUFA status and child wheeze/asthma and modifying effects of maternal asthma/atopy, child sex, and maternal race. Analyses included 1019 mother-child dyads with omega-3 (n-3) and omega-3 (n-6) PUFAs measured in second-trimester plasma; n-6/n-3 ratios were calculated. Child wheeze/asthma outcomes ascertained at age 4 to 6 years included ever physician-diagnosed asthma, current wheeze (symptoms past 12 months), current asthma (diagnosis and medication and/or symptoms past 12 months), and current diagnosed asthma. Each PUFA indicator and outcome was analyzed in separate models using modified Poisson regression with interaction terms. In quartile (Q) analyses, higher n-6 PUFAs were associated with increased risk of ever (risk ratio [RR] high vs low [RR Q4 vs Q1], 1.70; 95% CI, 1.07-2.71) and current (RR Q4 vs Q1, 1.70; 95% CI, 1.07-2.71) diagnosed asthma, whereas n-3 PUFAs were associated with lower risk (RR Q4 vs Q1, 0.59; 95% CI, 0.33-1.03) of current diagnosed asthma (P trend <.05 for all). Higher n-6 PUFAs were associated with a higher risk of all respiratory outcomes among children born to women with asthma (P interaction <.05 for all outcomes). A significant 3-way interaction between child sex, maternal asthma, and n-6/n-3 PUFA indicated that male children born to women with asthma and a higher ratio had the highest risk across wheeze/asthma outcomes (P interaction <.05). Associations between prenatal PUFA status and childhood wheeze/asthma were modified by maternal history of asthma and child sex. [ABSTRACT FROM AUTHOR]

Introduction APOL1 genetic variants are common among African Americans (AA), and account for much of the increased risk of chronic kidney disease among AA. APOL1 is abundantly transcribed in the placenta, shows abnormal expression in preeclampsia and APOL1 transgenic mice manifest preeclampsia. As AAs are at elevated risk for preeclampsia, prematurity and low birth weight, we studied the relationship between these conditions and APOL1 status. Methods CANDLE (Conditions Affecting Neurocognitive Development and Learning in Early Childhood), is a study of 1503 mothers and infants, including 990 AA women. Gestational age was determined by ultrasound or reported last menstrual cycle. Birthweight and pregnancy complications were abstracted from mother’s medical record. APOL1 genotyping was performed with TaqMan assay and validated by Sanger sequencing. Mothers and children were categorized as having 0, 1 or 2 risk alleles (RA) (with 2 RA denoting risk variant homozygotes or compound heterozygotes). Multivariate analyses for a recessive model were performed, adjusted for maternal age, income, and gender. Population attributable risk was calculated using standard approaches. Results Among 990 AA CANDLE mothers, the mean delivery age was 24.7 y and mean gestational age was 38.7 w. Of 921 genotyped mothers, 100 (10.9%) had 2 risk alleles (RA); of 747 genotyped children, 103 (13.8%) had 2 RAs. There was no association between maternal or child APOL1 status and gestational age or birth weight among all pregnancies or when the analysis excluded mothers with electively induced labor or C-sections. An increased risk for preeclampsia was seen with the child’s APOL1 2 RA status. Among all pregnancies, mothers of children with 2 RA status had a 1.9-fold increase in risk for preeclampsia (OR 1.9; 95% CI 1.1,3.5). When electively induced labor and C-sections were excluded, the risk for preeclampsia among mothers of children with 2 RA was further increased (OR 2.1; 95% CI 1.1,4.0). Discussion Mothers of children with APOL1 2RA status are at an increased risk for preeclampsia. Our results suggest that approximately 10% of preeclampsia among AA is related to APOL1 . [ABSTRACT FROM AUTHOR]