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Aims: The objective of this study was to examine associations between elevated depressive symptoms and increased risk of adverse clinical events patients with heart failure and reduced ejection fraction (HFrEF), as well as the potential contribution of health behaviours. Methods and results: One hundred forty‐two men and women with HFrEF were enrolled through heart failure (HF) clinics and followed over time. At baseline and 6 months, depressive symptoms were assessed by the Beck Depression Inventory‐II (BDI‐II) and HFrEF disease activity by B‐type natriuretic peptide (BNP). The Self‐Care of Heart Failure Index (SCHFI) was used to assess HF self‐care behaviours. Proportional hazards regression models assessed the contribution of depressive symptoms and HFrEF disease biomarkers on death or cardiovascular hospitalization. Over a median follow‐up period of 4 years, 42 patients (30%) died, and 84 (60%) had cardiovascular hospitalizations. A 10‐point higher baseline BDI‐II score was associated with a 35% greater risk of death or cardiovascular hospitalization. Higher baseline BDI‐II scores were associated with poorer HF self‐care maintenance behaviours (R = −0.30, P < 0.001) and fewer daily steps (R = −0.19, P = 0.04), suggesting that elevated depressive symptoms may diminish important health behaviours. Increases in plasma BNP over 6 months were associated with worse outcomes. Changes in BDI‐II and plasma BNP over 6 months were positively related (R = 0.25, P = 0.004). Conclusions: This study confirms that elevated depressive symptoms are associated with an increased likelihood of adverse clinical outcomes in patients with HFrEF. Poor health behaviours may contribute to the adverse association of elevated depressive symptoms with the increased hazard of adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) has shared genetic architecture with its risk factors: atrial fibrillation (AF), body mass index (BMI), coronary heart disease (CHD), systolic blood pressure (SBP), and type 2 diabetes (T2D). We aim to assess the association and risk prediction performance of risk‐factor polygenic risk scores (PRSs) for incident HF and its subtypes in bi‐racial populations. Methods and results: Five PRSs were constructed for AF, BMI, CHD, SBP, and T2D in White participants of the Atherosclerosis Risk in Communities (ARIC) study. The associations between PRSs and incident HF and its subtypes were assessed using Cox models, and the risk prediction performance of PRSs was assessed using C statistics. Replication was performed in the ARIC study Black and Cardiovascular Health Study (CHS) White participants. In 8624 ARIC study Whites, 1922 (31% cumulative incidence) HF cases developed over 30 years of follow‐up. PRSs of AF, BMI, and CHD were associated with incident HF (P < 0.001), where PRSAF showed the strongest association [hazard ratio (HR): 1.47, 95% confidence interval (CI): 1.41–1.53]. Only the addition of PRSAF to the ARIC study HF risk equation improved C statistics for 10 year risk prediction from 0.812 to 0.829 (∆C: 0.017, 95% CI: 0.009–0.026). The PRSAF was associated with both incident HF with reduced ejection fraction (HR: 1.43, 95% CI: 1.27–1.60) and incident HF with preserved ejection fraction (HR: 1.46, 95% CI: 1.33–1.62). The associations between PRSAF and incident HF and its subtypes, as well as the improved risk prediction, were replicated in the ARIC study Blacks and the CHS Whites (P < 0.050). Protein analyses revealed that N‐terminal pro‐brain natriuretic peptide and other 98 proteins were associated with PRSAF. Conclusions: The PRSAF was associated with incident HF and its subtypes and had significant incremental value over an established HF risk prediction equation. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Obesity increases with age, is disproportionately prevalent in black populations, and is associated with heart failure with preserved ejection fraction (HFpEF). An "obesity paradox," or improved survival with obesity, has been reported in patients with HFpEF. The aim of this study was to examine whether racial differences exist in the temporal trends and outcomes associated with obesity among older patients with HFpEF. DESIGN: Community surveillance of acute decompensated heart failure (ADHF) hospitalizations, sampled by stratified design from 2005 to 2014. SETTING: Atherosclerosis Risk in Communities Study (NC, MS, MD, MN). PARTICIPANTS: A total of 10,147 weighted hospitalizations for ADHF (64% female, 74% white, mean age 77 years), with ejection fraction ≥50%. MEASUREMENTS: ADHF classified by physician review, HFpEF defined by ejection fraction ≥50%. Body mass index (BMI) calculated from weight at hospital discharge. Obesity defined by BMI ≥30 kg/m2, class III obesity by BMI ≥40 kg/m2. RESULTS: When aggregated across 2005–2014, the mean BMI was higher for black compared to white patients (34 vs 30 kg/m2; P <.0001), as was prevalence of obesity (56% vs 43%; P <.0001) and class III obesity (24% vs 13%; P <.0001). Over time, the annual mean BMI and prevalence of class III obesity remained stable for black patients, but steadily increased for white patients, with annual rates statistically differing by race (P‐interaction =.04 and P =.03, respectively). For both races, a U‐shaped adjusted mortality risk was observed across BMI categories, with the highest risk among patients with a BMI ≥40 kg/m2. CONCLUSION: Black patients were disproportionately burdened by obesity in this decade‐long community surveillance of older hospitalized patients with HFpEF. However, temporal increases in mean BMI and class III obesity prevalence among white patients narrowed the racial difference in recent years. For both races, the worst survival was observed with class III obesity. Effective strategies are needed to manage obesity in patients with HFpEF. [ABSTRACT FROM AUTHOR]

Abstract: Background: Invasive aspergillosis (IA) is a significant cause of morbidity and mortality following cardiac transplantation; however, data regarding the predictors of IA in this patient population are limited. Methods: We conducted a case‐control study to identify the risk factors for IA in patients who underwent cardiac transplantation at a single center from 1986 to 2008 (Cohort 1) and 2009 to 2015 (Cohort 2). Cases of IA were matched to two controls from the same year of transplantation, and data were collected from the date of cardiac transplantation to the date of documented Aspergillus infection for each case, or for an equivalent number of days for each control. Univariate and multivariate logistic regressions were used to identify independent predictors of IA in Cohort 1. After 2009, targeted antifungal prophylaxis with oral voriconazole was initiated in patients with risk factors for IA. The incidence of IA was compared pre‐ and postintervention. Results: IA was identified in 23 of 189 (8.0%) patients within Cohort 1. Significant risk factors for IA on multivariate analysis included an increased number of pretransplant hospitalizations (OR 1.81, 95% CI 1.19‐2.76) and posttransplant acute cellular allograft rejection (ACR) (OR 1.99, 95% 1.06‐3.75). Following the implementation of targeted antifungal prophylaxis in 2009, IA was identified in 2 of 107 (2.0%) patients in Cohort 2. Conclusions: Increased pretransplant hospitalizations and posttransplant ACR episodes represent significant risk factors for IA following cardiac transplant. Targeted antifungal prophylaxis in at‐risk patients reduces the incidence of IA. [ABSTRACT FROM AUTHOR]

Background: Modification of guideline‐directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated. Methods: The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005–2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models. Results: For 5091 hospitalizations, patient mean age was 75 years, 53% were female, 69% were white, and 81% had acute decompensated heart failure (ADHF). Regarding ejection fraction (EF), 31% of patients had HF with reduced EF (HFrEF), 24% had HF with preserved EF (HFpEF), and 44% were missing EF values. At admission, 52% of patients received angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), 66% β‐blockers (BBs), 9% aldosterone‐receptor antagonists, 16% digoxin, 10% hydralazine, and 29% nitrates. Modification of GDMT occurred in up to 23% of hospitalizations. Significant predictors of GDMT initiation included ADHF and HFrEF; discontinuation of medications was observed with select comorbidities. In HFrEF, initiation of any GDMT was associated with reduced 1‐year all‐cause mortality (adjusted hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.23–0.71) as was initiation of ACEI/ARBs, BBs, and digoxin. Discontinuation of any therapy versus maintaining GDMT was associated with greater mortality (HR 1.30, 95% CI 1.02–1.66). Similar trends were observed in HFpEF. Conclusions: Our study suggests that GDMT initiation is associated with increased survival, and discontinuation of therapy is associated with reduced survival in hospitalized patients with HF. Future studies should be conducted to confirm the impact of GDMT therapy modification in this population. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims, and objectives: Despite proven benefits for reducing incidence of major cardiac events, antihypertensive drug therapy remains underutilized in the United States. This analysis assesses antihypertensive drug adherence, utilization predictors, and associations between adherence and outcomes (a composite of cardiovascular events, Medicare inpatient payments, and inpatient days). Methods: The sample consisted of Atherosclerosis Risk in Communities Study cohort participants reporting hypertension without prevalent cardiovascular disease during 2006 to 2007 annual follow‐up calls. Atherosclerosis Risk in Communities records were linked to Medicare claims through 2012. Antihypertensive medication adherence was measured as more than 80% proportion days covered by using Medicare Part D claims. Standard and hierarchical regression models were used to evaluate adjusted associations between person characteristics and adherence and between adherence and outcomes. Results: Among 1826 hypertensive participants with Part D coverage, 31.5% had no antihypertensive class with more than 80% proportion days covered in the 3 months preceding the report of hypertension in 2006 to 2007. After adjustment for confounders, positive predictors of use included female gender and diabetes; negative predictors were African‐American race and current smoking. Adjusted association between receiving no therapy and a composite endpoint of cardiovascular outcomes through 2012 was not statistically significant (hazard ratio: 0.93; 95% confidence interval: 0.72, 1.22) nor was the adjusted association with Medicare inpatient days or payments (incremental difference at 48 months in payments: $1217; 95% CI: −$2030, $4463). Conclusions: Despite having medical and prescription coverage, nearly a third of hypertensive participants were not adherent to antihypertensive drug therapy. Differences in clinical outcomes associated with nonadherence, though not statistically significant, were consistent with results from randomized trials. The approach provides a model framework for rigorous assessment of detailed data that are increasingly available through emerging sources. [ABSTRACT FROM AUTHOR]

The exceptional solution processing potential of graphene oxide (GO) is always one of its main advantages over graphene in terms of its industrial relevance in coatings, electronics, and energy storage. However, the presence of a variety of functional groups on the basal plane and edges of GO makes understanding suspension behavior in aqueous and organic solvents, a major challenge. Acoustic spectroscopy can also measure zeta potential to provide unique insight into flocculating, meta-stable, and stable suspensions of GO in deionized water and a variety of organic solvents (including ethanol, ethylene glycol, and mineral oil). As expected, a match between solvent polarity and the polar functional groups on the GO surface favors stable colloidal suspensions accompanied by a smaller aggregate size tending toward disperse individual flakes of GO. This work is significant since it describes the characteristics of GO in solution and its ability to act as a precursor for graphene-based materials. [ABSTRACT FROM AUTHOR]

The richly functionalized basal plane bonded to polar organic moieties makes graphene oxide (GO) innately hydrophilic. Here, a methodology to synthesize fluorinated graphene oxide by oxidizing the basal plane of fluorinated graphite, allowing for tunable hydrophobicity of GO, is reported. Fluorine exists as tertiary alkyl fluorides covalently bonded to graphitic carbons, and using magic-angle spinning (MAS) 13C NMR as a primary tool chemical structures for the two types of synthesized fluorinated graphene oxides (FGOs) with significantly different fluorine contents are proposed. The low surface energy of the C-F bond drastically affects GO's wetting behavior, leading to amphiphobicity in its highly fluorinated form. Ease of solution processing enables the fabrication of inks that are spray-painted on various porous/non-porous substrates. These coatings maintain amphiphobicity for solvents with surface tensions down to 59 dyn/cm, thus bypassing existing lithographic means to create similar surfaces. The approach towards fluorinating GO and fabricating graphene-based surfaces with tunable wettability opens the path towards unique, accessible, carbon-based amphiphobic coatings. [ABSTRACT FROM AUTHOR]

Aims We examined the relationship between forced expiratory volume in 1 s (FEV1), airflow obstruction, and incident heart failure (HF) in black and white, middle-aged men and women in four US communities. Methods and results Lung volumes by standardized spirometry and information on covariates were collected on 15 792 Atherosclerosis Risk in Communities (ARIC) cohort participants in 1987–89. Incident HF was ascertained from hospital records and death certificates up to 2005 in 13 660 eligible participants. Over an average follow-up of 14.9 years, 1369 (10%) participants developed new-onset HF. The age- and height-adjusted hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV1 for both genders, race groups, and smoking status. After multivariable adjustment for traditional cardiovascular risk factors and height, the HRs [95% confidence intervals (CIs)] of HF comparing the lowest with the highest quartile of FEV1 were 3.91 (2.40–6.35) for white women, 3.03 (2.12–4.33) for white men, 2.11 (1.33–3.34) for black women, and 2.23 (1.37–3.59) for black men. The association weakened but remained statistically significant after additional adjustment for systemic markers of inflammation. The multivariable adjusted incidence of HF was higher in those with FEV1/forced vital capacity <70% vs. ≥70%: HR 1.44 (95% CI 1.20–1.74) among men and 1.40 (1.13–1.72) among women. A consistent and positive association with HF was seen for self-reported diagnosis of emphysema and chronic obstructive pulmonary disease, but not for asthma. Conclusions In this large population-based cohort with long-term follow-up, low FEV1 and an obstructive respiratory disease were strongly and independently associated with the risk of incident HF. [ABSTRACT FROM PUBLISHER]

Aims: Although studies of the accuracy of heart failure (HF) classification scoring systems are available, few have examined their performance when restricted to self-reported items. [ABSTRACT FROM PUBLISHER]

Foetal cells secrete more growth factors, generate less immune response, grow and proliferate better than adult cells. These characteristics make them desirable for recombinant modification and use in microencapsulated cellular gene therapeutics. We have established a system in vitro to obtain a pure population of primary human foetal myoblasts under several rounds of selection with non-collagen coated plates and identified by desmin staining. These primary myoblasts presented good proliferation ability and better differentiation characteristics in monolayer and after microencapsulation compared to murine myoblast C2C12 cells based on creatine phosphokinase (CPK), major histocompatibility complex (MHC) and multi-nucleated myotubule determination. The lifespan of primary myoblasts was 70 population doublings before entering into senescent state, with a population time of 18-24 hrs. Hence, we have developed a protocol for isolating human foetal primary myoblasts with excellent differentiation potential and robust growth and longevity. They should be useful for cell-based therapy in human clinical applications with microencapsulation technology. [ABSTRACT FROM AUTHOR]

In this paper, we explore how Protestant denominations use education to stratify their pastors among lower and higher income jobs and how this use of education intersects with gender. We assume that reliance on education as an indication of job qualification ultimately reflects accommodation to secular norms and hypothesize that it will be practiced most strongly in theologically liberal contexts. Next, we hypothesize that women will benefit from education more than men, a pattern that is typical of secular labor markets. And we predict that education will have a stronger effect on income in denominations where regional clergy administrators have influence in matching pastors to jobs. Data are taken from the 1994 "Ordained Women and Men Study" and consist of career information on clergy in fifteen denominations. Contrary to expectations, clergy degrees have a stronger effect on income in conservative than in liberal denominations. We further find that women clergy receive lower income returns to their degrees in denominations requiring a Muster of Divinity for ordination but receive higher returns in the others. Finally, results show that seminary prestige is more beneficial in denominations where pastors are hired directly by congregations rather than placed in congregations by regional clergy administrators. [ABSTRACT FROM AUTHOR]

This paper examines the supply of clergy relative to members and churches in fourteen denominations from 1950-1993. It finds that while in general, membership is declining and the number of churches is remaining relatively stable, the number of clergy continues to increase producing a situation of labor over supply. The paper considers explanations that locate the cause of declining occupational prestige and over supply on the entry of women into the clergy profession. However, it shows that the oversupply problem pre- dated the entry of women into ordained occupations. This pattern supports labor queuing explanations based on the work of Reskin and Roos. Looking at a subset of these denominations in 1983 and 1993, the study also seeks to uncover the consequences of the labor surplus and finds that one result of this over supply has been a dramatic increase in the percentage of clergy working in non-parish ministries. Various explanations of this shift are briefly examined. [ABSTRACT FROM AUTHOR]

Describes the prevalence and management of onychomycosis in children in North America. Role of antifungal agents in the treatment of onychomycosis; Guidelines regarding dosage regimens; Bioavailability itraconazole oral solution.

This paper examines sex differences in the transition rate of clergy from seminary graduation to parish employment. It investigates how different temporal frameworks: - the evolution of the women's movement, the organizational histories of denominations, and the timing of career decisions in the life course -- affect the transition rate for men and women, net of status attainment factors. Analyses show that while it still takes women 33% longer to find their first job, gender differences have decreased across cohorts, even in a contracting labor market Surprisingly, neither age nor career switching has adverse effects on the transition from seminary to parish employment. Analyses suggest that the entry of women into the labor market may stimulate the formalization of employment procedures, which creates benefits for both men and women. [ABSTRACT FROM AUTHOR]

Background. A study of nine Guatemalan patients with acquired perforating disease associated with chronic renal failure, diagnosed at the Guatemalan Social Security Institute, General Hospital, during the period of January 1990 to March 1993, is presented (Table 1). Methods. A dermatological examination and skin biopsy were done on all patients. Results. Six of the patients were men and three were women; one case was associated with diabetes mallitus. Three of the patients were diagnosed as Kyrle-like acquired perforating disease, and the other six as perforating folliculitis. The lesions were predominantly located in the lower extremities with hyperkeratotic papules and nodules; some of these were accompanied by pruritus and Koebner's phenomenon. Conclusion. The acquired perforating disease is a clinical cutaneous manifestation of chronic renal failure with or without treatment. The lesions can disappear spontaneously with stabilization of the renal damage. [ABSTRACT FROM AUTHOR]

Background. Onychomycosis is the most common nail disease in adults. During recent years an increase in its frequency has been reported in children. Materials and Methods. Children under 12 years were examined and a clinical diagnosis of onychomycosis was made (Figs. 1-4). Potassium hydroxide (KOH) preparations were made and a fungus culture was done in each case. Results. Twenty-six children with onychomycosis are re- ported; 16 boys (61.4%) and 10 girls (38.6%). The average age was 8 years. The most frequent variety was distal subungual onychomycosis (88.5%) and the earliest sign was distal subungual hyperkeratosis. The agent most frequently Isolated was Trichophyton rubrum which was found in 18 cases (69.2%). Conclusions. Onychomycosis in children is not exceptional. Attention should be given to any sign during physical examination to avoid dystrophy of the nails and also to eliminate any source of infection. [ABSTRACT FROM AUTHOR]

The malignant fibrous histiocytoma is a highly cellular pleomorphic tumor. Some of the cells are spindle-shaped resembling fibroblasts, while others have the appearance of histiocytes. There are also multinucleated giant cells and a variable number of mitoses. In addition to the storiform-pleomorphic type there are some other histologic variants, xanthomatous, inflammatory, myxoid, angiomatoid, and giant cell type. The differential diagnosis includes pleomorphic liposarcoma, pleomorphic rhabdomyosarcoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, epitheloid sarcoma, and fibrosarcoma.

In this article, authors comment on perforating diseases. Authors state that the process of perforation is seen in many different disorders of the most variable origin, but they do share in common the transepidermal elimination of some dermal components, foreign material, or infectious agents both bacterial and fungal. The mechanism of elimination is not completely known, but it may be said hypothetically that the altered dermal substances, foreign material, infectious agents, or tumor cells produce stimulation of the epidermal cells, which then respond with hyperplasia.

A 48-year-old man, in a chronic hemodialysis program, had numerous skin lesions develop that consisted of follicular papules and small hyperkeratotic nodules, located on the trunk, hips, and upper and lower extremities (where the lesions were more numerous). The nodules measured 3 to 5 mm and had a dark discoloration. Kyrle disease usually is not seen in the classic form, but the association of this process with diabetes and chronic renal failure is seen more often.

Presents a letter to the editor that discusses proximal White Subungual Onychomycosis in a Kidney transplant patient.