Publications by authors named "Scott D Barnett"

117 Publications

Development and Validation of a Clinical Diagnostic Scoring System for the Diagnosis of IPF.

Ann Am Thorac Soc 2021 Apr 12. Epub 2021 Apr 12.

Inova Fairfax Hospital, 23146, Advanced Lung Disease Program, Falls Church, Virginia, United States.

Rationale: Interpreting the radiological data in conjunction with an objective clinical score could help to harmonize IPF diagnostic and improve accuracy.

Objectives: We sought to establish and validate a multivariable objective scoring model based on clinical parameters, by stratifying the risk for patients to be diagnosed as IPF versus other forms of interstitial lung disease (ILD).

Methods: A clinical score was derived from review of patients evaluated at the Inova Fairfax ILD program and validated in three distinct cohorts. Based on known IPF clinical characteristics, a multivariable model was created and assessed by receiver operator curve (ROC) characteristics.

Results: There were 844 ILD patients diagnosed as either IPF (n=347, 41%) or non-IPF ILD (n=497, 59%). Based on calculated odds ratios, a score was assigned to each of the following clinical parameters: age, sex, smoking history, ethnicity, ILD family history, exposures, presence of CTD signs or symptoms, and Velcro crackles. The final Fairfax IPF clinical score (FICS) ranged from 1 to 25. The clinical diagnostic score system was accurate in predicting IPF, as measured by the area under the curve (AUC 0.88) in the derivation cohort with similar AUCs of 0.91, 0.81 and 0.71 in the respective validation cohorts.

Conclusion: The FICS appears to be an accurate tool for estimating the pretest probability of IPF in patients with ILD. How the FICS performs in conjunction with the various HRCT patterns remains to be determined. This model could ultimately be useful for increasing the degree of confidence in the final diagnosis and help to obviate the need for lung biopsy in cases of non-UIP patterns on HRCT.
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http://dx.doi.org/10.1513/AnnalsATS.202011-1430OCDOI Listing
April 2021

Selection of Screening Tool for Sleep-Disordered Breathing or Obstructive Sleep Apnea in Pediatric Patients in the Perianesthesia Setting.

J Perianesth Nurs 2021 Mar 19. Epub 2021 Mar 19.

Inova Fairfax Medical Center, Pediatric Surgery, Inova Health System, Falls Church, VA.

Purpose: This study was undertaken to select an appropriate tool to predict risk of obstructive sleep apnea (OSA) among pediatric patients in the preoperative setting.

Design/methods: A retrospective chart review and a survey of nursing staff to compare two tools that were determined to be valid in assessing risk of OSA and postanesthesia complications in pediatric patients aged 6 months to 18 years was conducted. About 300 pediatric patients presenting for elective surgery were screened for OSA using STBUR (Snoring, Trouble Breathing during sleep, struggling to Breathe during Sleep, and waking UnRefreshed) and ST(1)OP-BANG (Snoring, Tonsillar hypertrophy, sleep Obstruction, BMI, Age, Neuromuscular disorders, and Genetic/congenital deformities) concurrently. Six preoperative nurses were then surveyed to compare ease of use and time to complete the screening tools.

Findings: The STBUR tool was found to predict complications in 37.5% patients versus 22.7% patients with the pediatric ST(1)OP-BANG. Nursing staff found that although both tools were quick and easy to use, the STBUR tool was easier for parents to answer.

Conclusions: Use of a screening tool to help predict risk of OSA and postanesthetic complications also helps to dictate anesthesia technique, nursing staffing requirements, and plans of care for postoperative management of pediatric patients.
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http://dx.doi.org/10.1016/j.jopan.2020.09.006DOI Listing
March 2021

Autonomic development in preterm infants is associated with morbidity of prematurity.

Pediatr Res 2021 Mar 2. Epub 2021 Mar 2.

Children's National Hospital, Prenatal Pediatrics Institute, Washington, DC, USA.

Background: Previous studies have described an association between preterm birth and maturation of the autonomic nervous system (ANS); however, this may be impacted by multiple factors, including prematurity-related complications. Our aim was to evaluate for the effect of prematurity-related morbidity on ANS development in preterm infants in the NICU.

Methods: We compared time and frequency domains of heart rate variability (HRV) as a measure of ANS tone in 56 preterm infants from 2 NICUs (28 from each). One cohort was from a high-morbidity regional referral NICU, the other from a community-based inborn NICU with low prematurity-related morbidity. Propensity score matching was used to balance the groups by a 1:1 nearest neighbor design. ANS tone was analyzed.

Results: The two cohorts showed parallel maturational trajectory of the alpha 1 time-domain metric, with the cohort from the high-morbidity NICU having lower autonomic tone. The maturational trajectories between the two cohorts differed in all other time-domain metrics (alpha 2, RMS1, RMS2). There was no difference between groups by frequency-domain metrics.

Conclusions: Prematurity-associated morbidities correlate with autonomic development in premature infants and may have a greater impact on the extrauterine maturation of this system than birth gestational age.

Impact: Autonomic nervous system development measured by time-domain metrics of heart rate variability correlate with morbidities associated with premature birth. This study builds upon our previously published work that showed that development of autonomic tone was not impacted by gestational age at birth. This study adds to our understanding of autonomic nervous system development in a preterm extrauterine environment. Our study suggests that gestational age at birth may have less impact on autonomic nervous system development than previously thought.
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http://dx.doi.org/10.1038/s41390-021-01420-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922721PMC
March 2021

Does study subject diversity influence cardiology research site performance?: Insights from 2 U.S. National Coronary Stent Registries.

Am Heart J 2021 Feb 24;236:37-48. Epub 2021 Feb 24.

Mount Sinai Medical Center, New York, NY.

Background: Minorities and women are underrepresented in cardiovascular research. Whether their higher enrollment can be predicted or influences research site performance is unclear.

Methods: We evaluated 104 sites that enrolled 4,184 patients in the U.S. Platinum Diversity (PD) and Promus Element Plus (PE Plus) studies (2012 to 2016). Research sites were ranked from lowest to highest minority and female enrollment, respectively. United States Census Bureau division and core-based statistical area (CBSA) populations were determined for each site and the following study performance metrics compared across quartiles of minority and female enrollment, respectively: (1) study subject enrollment rate (SER), (2) time to first patient enrolled, (3) rate of follow-up visits not done, (4) rate of follow-up visits out of window, and (5) protocol deviation rate (PDR). Multivariable regression was used to predict SER and PDR.

Results: Minority enrollment varied by region (P = .025) and population (P = .024) with highest recruitment noted in the Pacific, West South Central, South Atlantic, Mid-Atlantic and East North Central divisions. Female enrollment bore no relationship to region (P = .67) or population (P = .40). Median SER was similar in sites withi the highest vs lowest quartile of minority enrollment (SER of 4 vs 5 patients per month, respectively, P =0.78) and highest vs. lowest female enrollment (SER of 4 vs 4, respectively, P = .21). Median PDR was lower in sites within the highest vs lowest minority enrollment (0.23 vs 0.50 PDs per patient per month, respectively, P = .01) and highest vs. lowest female enrollment (0.28 vs. 0.37 PDs per patient per month, respectively, P = .04). However, this relationship did not persist after multivariable adjustment. All other site performance metrics were comparable across quartiles of minority and female enrollment.

Conclusions: Minority, but not female enrollment, correlated with research site geographic region and surrounding population. High enrollment of minorities and women did not influence study performance metrics. These findings help inform future strategies aimed at increasing clinical trial diversity.

Trial Registration: The PD and PE Plus studies are registered at www.clinicaltrials.gov under identifiers NCT02240810 and NCT01589978, respectively.

Key Points: Question: Does the enrollment of more Blacks, Hispanics and women in US cardiovascular research studies influence the overall rate of study subject enrollment and/or other key study site performance metrics and can diverse enrollment be predicted?

Findings: In this pooled analysis of 104 sites that enrolled 4,184 patients in the Platinum Diversity and Promus Element Plus Post-Approval Studies, we found that the enrollment of higher proportions of underrepresented minorities and women was univariately associated with lower protocol deviation rates while having no effect on other site performance metrics. A site's geographic location and surrounding population predicted minority, but not female enrollment. Meaning: These findings suggest that cardiovascular research subject diversity may be predicted from site characteristics and enhanced without compromising key study performance metrics. These insights help inform future strategies aimed at improving clinical trial diversity.
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http://dx.doi.org/10.1016/j.ahj.2021.02.003DOI Listing
February 2021

The epidemiology of NAFLD and lean NAFLD in Japan: a meta-analysis with individual and forecasting analysis, 1995-2040.

Hepatol Int 2021 Feb 12. Epub 2021 Feb 12.

Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, CJ250K, Palo Alto, CA, 94304, USA.

Background: NAFLD is increasing in Asia including Japan, despite its lower obesity rate than the West. However, NAFLD can occur in lean people, but data are limited. We aimed to investigate the epidemiology of NAFLD in Japan with a focus on lean NAFLD.

Methods: We searched PubMed, Cochrane Library, EMBASE, Web of Science, and the Japan Medical Abstracts Society (inception to 5/15/2019) and included 73 eligible full-text original research studies (n = 258,531). We used random-effects model for pooled estimates, Bayesian modeling for trend and forecasting, contacted authors for individual patient data and analyzed 14,887 (7752 NAFLD; 7135 non-NAFLD-8 studies) patients.

Results: The overall NAFLD prevalence was 25.5%, higher in males (p < 0.001), varied by regions (p < 0.001), and increased over time (p = 0.015), but not by per-person income or gross prefectural productivity, which increased by 0.64% per year (1983-2012) and is forecasted to reach 39.3% in 2030 and 44.8% in 2040. The incidence of NAFLD, HCC, and overall mortality were 23.5, 7.6 and 5.9 per 1000 person-years, respectively. Individual patient-level data showed a lean NAFLD prevalence of 20.7% among the NAFLD population, with lean NAFLD persons being older and with a higher all-cause mortality rate (8.3 vs. 5.6 per 1000 person-years for non-lean NAFLD, p = 0.02). Older age, male sex, diabetes, and FIB-4 were independent predictors of mortality, but not lean NAFLD.

Conclusion: NAFLD prevalence has increased in Japan and may affect half of the population by 2040. Lean NAFLD individuals makeup 20% of the NAFLD population, were older, and had higher mortality.
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http://dx.doi.org/10.1007/s12072-021-10143-4DOI Listing
February 2021

Novel Tocolytic Strategy: Modulating Cx43 Activity by -Nitrosation.

J Pharmacol Exp Ther 2021 03 31;376(3):444-453. Epub 2020 Dec 31.

Department of Pharmacology, Myometrial Function Group, University of Nevada, Reno School of Medicine, Reno, NV.

Currently available tocolytics are ineffective at significantly delaying preterm birth. This is due in part to our failure to better understand the mechanisms that drive spontaneous preterm labor (sPTL). Cyclic nucleotides are not the primary contributors to myometrial quiescence, but instead nitric oxide (NO)-mediated protein -nitrosation (SNO) is integral to the relaxation of the tissue. Connexin-43 (Cx43), a myometrial "contractile-associated protein" that functions as either a gap junction channel or an hemichannel (HC), was the focus of this study. Protein analysis determined that Cx43 is downregulated in sPTL myometrium. Furthermore, Cx43 is -nitrosated by NO, which correlates with an increase of phosphorylated Cx43 at serine 368 (Cx43-pS368 -gap junction inhibition) as well as an increase in the HC open-state probability (quiescence). Pharmacologic inhibition of Cx43 with 18-glycyrrhetinic acid (18-GA) exhibits a negative inotropic effect on the myometrium in a dose-dependent manner, as does administration of nebivolol, an NO synthase activator that increases total protein SNOs. When 18-GA and nebivolol were coadministered at their IC values, the effect on contractile dynamics was additive and all but eliminated contractions. The development of new tocolytics demands a better understanding of the underlying mechanisms of sPTL. Here it has been shown that 18-GA and nebivolol leverage dysregulated pathways in the myometrium, resulting in a novel approach for the treatment of sPTL. SIGNIFICANCE STATEMENT: Although there are many known causes of preterm labor (PTL), the mechanisms of "spontaneous" PTL (sPTL) remain obfuscated, which is why treating this condition is so challenging. Here we have identified that connexin-43 (Cx43), an important contractile-associated protein, is dysregulated in sPTL myometrium and that the pharmacologic inhibition of Cx43 and its -nitrosation with 18-glycyrrhetinic acid and nebivolol, respectively, significantly blunts contraction in human myometrial tissue, presenting a novel approach to tocolysis that leverages maladjusted pathways in women who experience sPTL.
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http://dx.doi.org/10.1124/jpet.120.000427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919864PMC
March 2021

Development and Psychometric Testing of the Remote Visual Monitoring Acceptance Tool.

J Nurs Meas 2020 12 16;28(3):439-454. Epub 2020 Nov 16.

Inova System Office, Falls Church, Virginia

Background And Purpose: Using remote visual monitoring (RVM) technology to observe patients at high risk for falls can effectively reduce falls and sitter costs. However, RVM is underutilized by direct care nurses. This study describes the development and testing of a new tool to measure nurses' acceptance of RVM technology.

Methods: The RVM Acceptance Tool (RVMAT) was tested among nurses recruited from a large health system.

Results: Three factors accounted for 70.38% of the total variance: Value, Patient Selection, and Availability and Intent to Use. The overall 25-item scale had good internal consistency (Cronbach's alpha = .98).

Conclusion: The RVMAT is a theoretically grounded, valid, and reliable tool. Further research is needed to test its use in predicting nurses' acceptance and intent to incorporate new technology into daily nursing care.
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http://dx.doi.org/10.1891/JNM-D-19-00092DOI Listing
December 2020

ALT Levels for Asians With Metabolic Diseases: A Meta-analysis of 86 Studies With Individual Patient Data Validation.

Hepatol Commun 2020 Nov 9;4(11):1624-1636. Epub 2020 Sep 9.

Division of Gastroenterology and Hepatology Stanford University Medical Center Palo Alto CA USA.

The current alanine aminotransferase (ALT) upper limit of normal was defined using selected healthy Caucasian blood donors. Given the global rise in obesity and different body habitus in Asians, we aimed to perform a systematic review and meta-analysis combined with bootstrap modeling and individual patient data validation to estimate the ALT upper threshold for Asians, including the overweight and diabetics. We included studies from PubMed, Embase, and Cochrane database searches that identified individuals without known liver diseases (i.e., viral hepatitis, alcohol, and ultrasound-detected nonalcoholic fatty liver disease). The mean ALT (U/L) was estimated using a random-effects mixed model and upper threshold (95th-percentile value, U/L) via a bootstrap model with 10,000 resamples. We screened 4,995 studies and identified 86 studies that reported ALT values for 526,641 individuals without excessive alcohol intake or known liver diseases, yielding a mean ALT of 19 and ALT upper threshold of 32. The ALT upper threshold was 37 in males versus 31 in females, 39 in overweight versus 28 in normal-weight individuals, and 36 for diabetics versus 33 for nondiabetics. We validated our study level data with individual patient level data in 6,058 individuals from five study centers in Japan. Consistent with our study-level data, we found that the ALT upper threshold in our individual patient data analysis was indeed higher in overweight versus normal-weight individuals (39 vs. 32) and in diabetics versus nondiabetics (42 vs. 33). We provide validated reference ranges for ALT upper threshold derived from Asians without known liver disease, including individuals with ultrasound-detected nonalcoholic fatty liver disease who are normal weight, overweight, nondiabetic, and diabetic, to inform practice.
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http://dx.doi.org/10.1002/hep4.1593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603525PMC
November 2020

The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis.

Respir Med 2020 Aug - Sep;170:106068. Epub 2020 Jun 20.

Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.

Background: The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects.

Methods: We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.

Results: There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 10 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05-1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09-2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92).

Conclusions: Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.
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http://dx.doi.org/10.1016/j.rmed.2020.106068DOI Listing
June 2020

Transradial access in acute myocardial infarction complicated by cardiogenic shock: Stratified analysis by shock severity.

Catheter Cardiovasc Interv 2020 Aug 3. Epub 2020 Aug 3.

Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia.

Background: Transradial access (TRA) is associated with improved survival and reduced vascular complications in acute myocardial infarction (AMI). Limited data exist regarding TRA utilization and outcomes for AMI complicated by cardiogenic shock (CS). We sought to assess the safety, feasibility, and clinical outcomes of TRA in AMI-CS.

Methods: One-hundred and fifty-three patients with AMI-CS were stratified into tertiles of disease severity using the CardShock score. The primary endpoint was successful percutaneous coronary intervention (PCI), defined as Thrombolysis in Myocardial Infarction III flow with survival to 30 days.

Results: Mean age was 66 years, 72% were men, and 47% had diabetes. TRA was the preferred access site in patients with low and intermediate disease severity. Overall, 50 (32%) patients experienced major adverse cardiac and cerebrovascular events; most events (78%) occurred in patients undergoing transfemoral access (TFA) in the intermediate-high tertiles of CS severity. Of the 41 (27%) total bleeding events, 32% occurred at the coronary angiography access site, of which 92% were in the TFA group. The use of ultrasound (US) guidance for TFA resulted in reduced coronary access-site bleeding (8.5 vs. 33.0%, p = .01). In a hierarchical logistic regression model, utilizing TRA did not result in lower odds of successful PCI (Odds ratio [OR]: 1.36; 95% confidence interval [CI]: 0.54-3.40).

Conclusion: This study suggests that TRA is feasible across the entire spectrum of AMI-CS and is associated with reduced coronary access-site bleeding. In addition, US-guided TFA is associated with reductions in access-site bleeding and vascular complications. Concerted efforts should be made to incorporate vascular access protocols into existing CS algorithms in dedicated shock care centers.
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http://dx.doi.org/10.1002/ccd.29098DOI Listing
August 2020

An Ex Vivo Study to Evaluate the Effect of Tegaserod on Platelet Activation and Aggregation.

J Cardiovasc Pharmacol Ther 2021 Jan 16;26(1):40-50. Epub 2020 Jul 16.

Sinai Center for Thrombosis Research, 23303Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, MD, USA.

Introduction: Tegaserod, an orally active, potent 5-hydroxytryptamine-4 serotonin receptor agonist, was previously indicated for irritable bowel syndrome but was voluntarily withdrawn due to potential cardiovascular side effects. In vitro studies suggested that tegaserod increased platelet aggregation, but these results were not reproduced or were inconclusive. We sought to assess ex vivo effects of tegaserod on platelet aggregation.

Methods: In this double-blind, placebo-controlled, crossover study, we randomized a majority of healthy patients with no history of cardiovascular risk factors (n = 21) to receive tegaserod or matching placebo for 7 + 2 days followed by a 7- to 10-day washout period, and then patients were crossed over to the other study drug for the next 7 + 2 days. Unstimulated and agonist-stimulated platelet aggregation; P-selectin expression; serum thromboxane (Tx)B and urinary 11-dehydro (11-dh) TxB; and tegaserod and M29.0 concentrations were serially assessed.

Results: There was no significant difference in percentage change in unstimulated or adenosine diphosphate (ADP)- and ADP + serotonin-, collagen- and thrombin receptor activating peptide-induced maximum platelet aggregation and in platelet P-selectin expression in the presence of tegaserod at any time point when compared to placebo. Similarly, there was no significant difference in percentage change in serum TxB or urinary 11-dhTxB levels between placebo and tegaserod. No new or unexpected findings were observed in evaluations of safety or pharmacokinetic parameters.

Conclusion: This comprehensive pharmacodynamic study, by employing established markers used in prior investigations, which have been considered by the Food and Drug Administration to indicate drug-related platelet effects, does not demonstrate any influence of tegaserod treatment on platelet function.
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http://dx.doi.org/10.1177/1074248420942004DOI Listing
January 2021

Factors associated with past and current employment of veterans with spinal cord injury.

J Spinal Cord Med 2020 Jul 7:1-11. Epub 2020 Jul 7.

James A. Haley Veterans' Hospital and Clinics, Tampa, Florida, USA.

The purpose of this study was to examine variables predictive of post-SCI return to employment and current employment among a large cohort of veterans with Spinal Cord Injury (SCI) treated within the Veterans Health Administration (VHA) SCI System of Care. Cross sectional analysis of data obtained during in-person baseline interviews and follow-up phone interviews. Seven SCI Centers within Veteran Affairs Medical Centers. 1047 veterans with SCI receiving inpatient or outpatient care in VHA. Only 29.8% were employed post-SCI, 27.9% reported employment within the immediate 5 years before the baseline interview, but only 9.2% reported current employment at the time of the baseline interview. Significant predictors of current employment among these veterans with SCI included recent employment experience, history of legal problems, duration of SCI, education, and life satisfaction. The baseline employment rate following SCI of a large, representative sample, was 29.8%. Greater duration of SCI predicted unemployment, likely due to the older age of this population. Additional years of education promoted current and post-SCI employment, while a history of legal problems was a barrier to employment.
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http://dx.doi.org/10.1080/10790268.2020.1769950DOI Listing
July 2020

Physiological predictors of survival in patients with sarcoidosis-associated pulmonary hypertension: results from an international registry.

Eur Respir J 2020 05 14;55(5). Epub 2020 May 14.

University of Cincinnati Medical Center, Cincinnati, OH, USA.

Introduction: Sarcoidosis-associated pulmonary hypertension (SAPH) is associated with reduced survival in single-centre studies. The international Registry for SAPH (ReSAPH) with long-term follow-up was established to enrich our knowledge of this complication of sarcoidosis. This analysis aims to elucidate factors associated with reduced transplant-free survival in SAPH patients.

Methods: ReSAPH contains prospectively collected outcomes of SAPH patients since the time of registry enrolment. Information analysed includes right heart catheterisation data, pulmonary function testing, chest radiography, Scadding stage and 6-min walk distance (6MWD), among others. Cox regression models were used to identify independent predictors of transplant-free survival.

Results: Data from 215 patients followed for a mean±sd 2.5±1.9 years were available for analysis. In the 159 precapillary patients, the Kaplan-Meier-adjusted 1-, 3- and 5-year transplant-free survival was 89.2%, 71.7% and 62.0%, respectively. Kaplan-Meier-adjusted 1-, 3- and 5-year transplant-free survival in the incident group was 83.5%, 70.3% and 58.3%, respectively, and in the prevalent group was 94.7%, 72.2% and 66.3%, respectively. Patients with reduced diffusing capacity of the lung for carbon monoxide () (<35% predicted) and 6MWD <300 m in the precapillary cohort had significantly worse transplant-free survival. Reduced 6MWD and preserved forced expiratory volume (FEV)/forced vital capacity (FVC) ratio were identified as independent risk factors for reduced transplant-free survival in the precapillary cohort.

Conclusion: Reduced (<35% pred) and 6MWD (<300 m) at the time of registry enrolment were associated with reduced transplant-free survival in the overall precapillary cohort. Preserved FEV/FVC ratio was identified as an independent risk factor for worsened outcomes.
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http://dx.doi.org/10.1183/13993003.01747-2019DOI Listing
May 2020

Hepatitis C Virus Cure Rates Are Reduced in Patients With Active but Not Inactive Hepatocellular Carcinoma: A Practice Implication.

Clin Infect Dis 2020 Dec;71(11):2840-2848

Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA.

Background: Cure rates of hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) for patients with active and inactive hepatocellular carcinoma (HCC) may differ, but well-controlled studies are limited. We aimed to evaluate DAA outcomes in a large East Asian HCV/HCC population compared with HCV/non-HCC patients.

Methods: Using data from the Real-World Evidence from the Asia Liver Consortium (REAL-C) registry (Hong Kong, Japan, South Korea, and Taiwan), we used propensity score matching (PSM) to match HCC and non-HCC (1:1) groups for age, sex, cirrhosis, prior treatment, HCV genotype, treatment regimen, baseline platelet count, HCV RNA, total bilirubin, alanine aminotransferase, and albumin levels to evaluate DAA treatment outcomes in a large population of HCV/HCC compared with HCV/non-HCC patients.

Results: We included 6081 patients (HCC, n = 465; non-HCC, n = 5 616) treated with interferon-free DAAs. PSM of the entire study population yielded 436 matched pairs with similar baseline characteristics. There was no statistically significant difference in the overall SVR rate of HCC (92.7%) and non-HCC (95.0%) groups. Rates of treatment discontinuation, adverse effects, and death were also similar between HCC and non-HCC groups. Among patients with HCC, those with active HCC had a lower SVR than inactive HCC cases (85.5% vs 93.7%; P = .03). On multivariable analysis, active HCC, but not inactive HCC, was significantly associated with lower SVR (OR, 0.28; P = .01) when compared with non-HCC.

Conclusions: Active HCC but not inactive HCC was independently associated with lower SVR compared with non-HCC patients undergoing DAA therapy, although cure rate was still relatively high (85%) in active HCC patients.
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http://dx.doi.org/10.1093/cid/ciz1160DOI Listing
December 2020

Examination of a Proposed 30-day Readmission Risk Score on Discharge Location and Cost.

Ann Thorac Surg 2020 06 7;109(6):1797-1803. Epub 2019 Nov 7.

Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.

Background: Readmissions cost an estimated $41 billion in the United States each year. To address this, a single institution recently developed a new risk model predictive of 30-day readmission after adult cardiac surgery. The purpose of this study is to validate and refine this new readmission risk model using a statewide database.

Methods: A total of 19,964 patients were analyzed using a statewide Society of Thoracic Surgeons database (2014-2017). The aforementioned multivariate model was replicated (model 1): race, hospital length of stay, chronic lung disease, operation type, and renal failure. Model 2 also included discharge location. Thirty-day readmission risk scores and low-risk (0%-10%), moderate-risk (10%-13%), and high-risk (≥13%) categories were calculated.

Results: The overall 30-day readmission rate was 11.1% with both models 1 and 2 predicting readmission (odds ratio, 1.09; 95% confidence interval, 1.08-1.11 vs odds ratio, 1.10; 95% confidence interval, 1.08-1.11). Statistically significant differences were observed across all risk categories in discharge location and total cost. For models 1 and 2, 86% of low-risk patients were discharged to home vs 66.9% and 42.9% of patients in high-risk groups, respectively (P < .001). The largest increases were observed with a hospice discharge location for both model 1 (from $37,930 to $89,285) and model 2 (from $37,930 to $89,230).

Conclusions: Both risk models significantly predicted 30-day readmission in our multiinstitutional dataset, confirming the score is valid and a generalizable quality improvement tool. The addition of discharge location and total cost adds valuable information of the ongoing efforts to identify patients at high risk for readmission.
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http://dx.doi.org/10.1016/j.athoracsur.2019.09.048DOI Listing
June 2020

Connective tissue disease-associated interstitial lung disease and outcomes after hospitalization: A cohort study.

Respir Med 2019 Jul - Aug;154:1-5. Epub 2019 Jun 4.

Advanced Lung Disease and Transplant Program. Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address:

Background: The impact of hospitalization on patient outcomes is increasingly recognized and considered in the prognostication of many pulmonary disorders. We sought to evaluate the impact of hospitalization on survival in connective tissue disease-interstitial lung disease (CTD-ILD) patients.

Methods: A chart review of patients with CTD-ILD followed at a tertiary care center was performed. Patients were stratified into two groups based on hospitalization status. Outcomes of the groups were compared using Kaplan-Meier survival analyses as well as multivariate competing risk analysis.

Results: There were 137 patients identified with confirmed CTD-ILD. Patients who underwent hospitalization for any reason had a significant decrease in transplant-free survival compared to the never hospitalized cohort (3-year survival 60% vs. 94%; p = 0.0001). Hospitalization for ≥7 days was associated with worse outcomes than those hospitalized for <7 days (median survival 1.59 years vs. 7.17 years, p = 0.0012). Based on multivariate competing risk analysis, factors associated with death, with lung transplantation as a competing risk, were age (HR = 1.05 [95% 1.01-1.09]; P = 0.0443), male gender (HR = 4.94 [95% CI: 1.58-15.41]; P = 0.006), and all cause hospitalization (HR = 11.97 [95% CI: 1.36-105.49]; P = 0.0253).

Conclusion: This study highlights the impact of hospitalization on subsequent outcomes in the CTD-ILD population with a significantly reduced transplant-free survival demonstrated, especially after cardiopulmonary hospitalization events.
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http://dx.doi.org/10.1016/j.rmed.2019.05.020DOI Listing
August 2020

Stroke and death risk in ventricular assist device patients varies by ISHLT infection category: An INTERMACS analysis.

J Heart Lung Transplant 2019 07 12;38(7):721-730. Epub 2019 Feb 12.

Department of Heart Failure and Transplantation, Henry Ford Medical Center, Detroit, Michigan, USA.

Background: Ventricular assist device (VAD) patients often experience infections, which increase the risk of stroke and mortality. Using the definitions of the International Society for Heart and Lung Transplantation (ISHLT), we have characterized differences in clinical outcomes for categories of infection: VAD-specific (e.g., pump component related); VAD-related (e.g., bloodstream infection, BSI); and non-VAD infections (e.g., pneumonia).

Methods: Querying of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) identified 16,597 continuous-flow VAD recipients. Categories of infection were tested in multivariate models to determine the risk of stroke and death.

Results: After implant, 7,046 patients (42%) developed an infection at a median of 69 (interquartile range 12 to 272) days. A majority were non-VAD infections (49%), followed by VAD-related (26%) and VAD-specific infections (25%). BSIs were the most common form of VAD-related infection (92%), and the majority (59%) had no associated infection, that is, idiopathic bacteremia. Internal pump component infections were rare (0.003 event per patient-year [EPPY]). Infected VAD patients had a higher prevalence of stroke compared to patients without an infection (18% vs 11%, p < 0.001). The lowest stroke rate occurred after a VAD-specific infection (0.11 EPPY) compared with VAD-related (0.17 EPPY) and non-VAD infections (0.15 EPPY, p < 0.001). Hemorrhagic strokes were more common than ischemic strokes in all infection groups and highest after a VAD-related infection (0.13 EPPY). One-year survival after an infection was 87% in VAD-specific infections, as compared with VAD-related (71%) and non-VAD infections (72%, p < 0.001).

Conclusions: The ISHLT categorization of VAD infections unveils notable differences in associated risk of stroke and mortality. A re-assessment of transplant prioritization for eligible infected VAD patients may be useful to increase transplant-related survival benefit.
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http://dx.doi.org/10.1016/j.healun.2019.02.006DOI Listing
July 2019

Frailty in the Cardiac Surgical Patient: Comparison of Frailty Tools and Associated Outcomes.

Ann Thorac Surg 2019 07 3;108(1):16-22. Epub 2019 Apr 3.

Cardiac Surgery Research Department, Inova Heart and Vascular Institute, Falls Church, Virginia.

Background: Frailty measurement in cardiac surgery is poorly studied. The study purposes were to identify a simple but accurate frailty tool by comparing the simplified frailty index, Study of Osteoporotic Fractures (SOF), to a more complex frailty index, the Cardiovascular Health Study (CHS), and outcomes of frail patients to nonfrail patients.

Methods: Patients aged 65 years or older admitted for elective coronary artery bypass grafting (CABG), valvular surgery (valve), or a combination of CABG/valve were recruited and administered the SOF and CHS indexes. Surgical outcomes were defined by The Society of Thoracic Surgeons. A hand-held dynamometer assessed grip strength. Health-related quality of life was assessed by the 12-Item Short Form Health Survey.

Results: Patients (n = 167) were primarily male (75%), white (88%), and CABG (23%), valve (50%), or CABG/valve (25%). Frailty agreement between the CHS (frail, n = 47) and SOF (frail, n = 15) was poor (κ = 0.185). SOF frail patients had poorer health, were men (67% vs 61%), had a decreased ejection fraction (0.467 vs 0.537), an increased Society of Thoracic Surgeons Risk (5.0 vs 3.5), and increased European System for Cardiac Operative Risk Evaluation score (8.2 vs 5.2). All SOF frail patients reported lack of energy vs 8.7% CHS frail patients, and 80% vs 23.9% reported an unintentional weight loss of 5% or more. SOF frail patients were significantly more likely to experience prolonged ventilation (20% vs 6.5%), pneumonia (20% vs 6.5%), prolonged intensive care unit hours (158.6 vs 85.01), and readmission within 30 days (20% vs 8.7%). All frail patients reported a significantly lower physical health-related quality of life.

Conclusions: The SOF tool better identified patients considered "frail." Frail patients had more adverse outcomes and poorer health-related quality of life.
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http://dx.doi.org/10.1016/j.athoracsur.2019.03.009DOI Listing
July 2019

Standardized Team-Based Care for Cardiogenic Shock.

J Am Coll Cardiol 2019 04;73(13):1659-1669

INOVA Heart and Vascular Institute, Falls Church, Virginia. Electronic address:

Background: Cardiogenic shock (CS) is a multifactorial, hemodynamically complex syndrome associated with high mortality. Despite advances in reperfusion and mechanical circulatory support, management remains highly variable and outcomes poor.

Objectives: This study investigated whether a standardized team-based approach can improve outcomes in CS and whether a risk score can guide clinical decision making.

Methods: A total of 204 consecutive patients with CS were identified. CS etiology, patient demographic characteristics, right heart catheterization, mechanical circulatory support use, and survival were determined. Cardiac power output (CPO) and pulmonary arterial pulsatility index (PAPi) were measured at baseline and 24 h after the CS diagnosis. Thresholds at 24 h for lactate (<3.0 mg/dl), CPO (>0.6 W), and PAPi (>1.0) were determined. Using logistic regression analysis, a validated risk stratification score was developed.

Results: Compared with 30-day survival of 47% in 2016, 30-day survival in 2017 and 2018 increased to 57.9% and 76.6%, respectively (p < 0.01). Independent predictors of 30-day mortality were age ≥71 years, diabetes mellitus, dialysis, ≥36 h of vasopressor use at time of diagnosis, lactate levels ≥3.0 mg/dl, CPO <0.6 W, and PAPi <1.0 at 24 h after diagnosis and implementation of therapies. Either 1 or 2 points were assigned to each variable, and a 3-category risk score was determined: 0 to 1 (low), 2 to 4 (moderate), and ≥5 (high).

Conclusions: This observational study suggests that a standardized team-based approach may improve CS outcomes. A score incorporating demographic, laboratory, and hemodynamic data may be used to quantify risk and guide clinical decision-making for all phenotypes of CS.
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http://dx.doi.org/10.1016/j.jacc.2018.12.084DOI Listing
April 2019

The Design and Testing of the Psychometric Properties of the Person Engagement Index Instrument to Measure a Person's Capacity to Engage in Health Care.

J Nurs Meas 2018 08 1;26(2):278-295. Epub 2018 Aug 1.

O'Neil Center/GetWellNetwork, Bethesda, Maryland.

Background And Purpose: Patient engagement has been considered a powerful tool to improve health outcomes. A composite instrument to measure the factors that impact a person's capacity to engage in his or her health care was an identified gap in the literature. This study developed and tested the psychometric properties of the Person Engagement Index (PEI) instrument.

Methods: The instrument was tested among 338 medical-surgical inpatients at four health care systems (five facilities), with psychometric evaluation for validity, reliability, and exploratory factor analysis.

Results: Exploratory factor analysis revealed a four-factor solution that accounted for 63.9% of the total variance. Internal consistency results were Cronbach's = .896 for the overall scale and each subscale: Engagement in Health Care = .885, Technology Use in Health Care = .854, Proactive Approach to Health Care = .728, and Psychosocial Support = .880.

Conclusions: The results of the PEI study indicate that it is a valid and reliable instrument among the adult medical-surgical population. Further testing of the instrument is recommended among other populations and across the care continuum.
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http://dx.doi.org/10.1891/1061-3749.26.2.278DOI Listing
August 2018

Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS).

Top Spinal Cord Inj Rehabil 2018 3;24(4):325-335. Epub 2018 May 3.

VA HSR&D Center for Health Information & Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.

Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). : To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.
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http://dx.doi.org/10.1310/sci17-00046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241224PMC
December 2018

Confirmatory factor analysis of the Minnesota living with heart failure questionnaire among patients following open heart surgery for valve dysfunction.

Qual Life Res 2019 Jan 2;28(1):267-275. Epub 2018 Nov 2.

Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, 3300 Gallows Rd, Suite 3100, Falls Church, VA, 22042, USA.

Introduction: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was designed to assess the impact of the adverse effects of heart failure (HF). Numerous reports suggest an additional third factor with the proposed third factor representing a social dimension. The purpose of this study was to use confirmatory factor analysis (CFA) to validate the factor structure of the MLWHFQ, and examine a proposed third factor structure.

Methods: Participants were 1290 individuals with open heart surgery for isolated valve repair or replacement between September 2005 and May 2016. Confirmatory factor analysis was used to assess both initial and proposed alternate factor structures.

Results: CFA indicated a poor fit for the original proposed 2-factor solution [root mean square error of approximation (RMSEA) = 0.116], whereas separate proposed 3-factor solutions with varying item scoring fit marginally well (RMSEA = 0.080, 0.089). The CFA suggests the existence of a third dimension, social, beyond the established original two-factor solution. Results suggest in a direct comparison of proposed social dimensions, both Garin's four item solution and Munyombwe's six-item solution provide similar results.

Conclusions: Results suggest support for an additional third factor among patients undergoing isolated valve replacement surgery. We suggest given the inclusion of items important to our population, relatively strong fit indices, and correlation with the SF-12, the social dimension proposed by Munyombwe best fits our population.
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http://dx.doi.org/10.1007/s11136-018-2022-1DOI Listing
January 2019

Hiding in Plain Sight: Nebivolol Exhibits Compelling Tocolytic Properties.

J Cell Mol Med 2018 12 6;22(12):6391-6395. Epub 2018 Sep 6.

Pharmacology, University of Nevada, Reno School of Medicine, Reno, Nevada.

Preterm birth before 37 weeks of completed gestation results in numerous health consequences for the foetus. Preterm labour leads to preterm birth in over 50% of cases, and no FDA-approved treatment can prevent labour or help a foetus remain in the womb until term. Examination of nitric oxide mediated relaxation signaling in the uterine smooth muscle reveals a role for protein S-nitrosation. The recent discovery of upregulated S-nitrosoglutathione reductase (GSNOR) in spontaneously preterm labouring women has emphasized the need to explore the function of S-nitrosation regulation in the maintenance of uterine quiescence. Here we have examined the ability of nebivolol to relax uterine smooth muscle and tested recent claims that nebivolol is a GSNOR inhibitor. In uterine smooth muscle strips from both mouse and human, nebivolol relaxes oxytocin-induced contractions in a dose dependent manner. Our data indicates that nebivolol has no effect on GSNOR activity, nor does nebivolol inhibit thioredoxin reductase, two of the major protein denitrosylases. The ability of nebivolol to relax uterine smooth muscle is likely the combined effects of increased nitric oxide synthase activity and β3-adregnegic stimulation.
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http://dx.doi.org/10.1111/jcmm.13883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237580PMC
December 2018

An interactive faculty development workshop designed to improve knowledge, skills (competence), attitudes, and practice in interprofessional continuing education.

Med Teach 2018 09 3;40(9):896-903. Epub 2018 Jul 3.

c Department of Cardiac Surgery, Cardiac Surgery Research, Inova Heart and Vascular Institute , Falls Church , VA , USA.

Purpose: Interprofessional continuing education (IPCE) health care educators must plan activities as members of interprofessional teams and deliver activities to an interprofessional audience. Evidence in the literature suggests they are not well prepared to meet this challenge. This paper reviews one strategy to improve the knowledge, skills, attitudes, and practices of IPCE educators.

Methods: Seven faculty development workshops were conducted within the USA, Europe, Asia, and the Middle East. Approximately 250 learners participated in the workshops in total, with 107 in an IRB-approved research study.

Results: From the research cohorts demonstrated improved knowledge and skills over a 12-month period. Knowledge and skills scores increased most significantly from baseline to 3 months and remained above baseline at 6-12 months. The workshop was not an effective strategy to improve attitudes towards IPCE, though attitude scores were already high prior to participating.

Conclusions: All participants actively engaged in the workshops. There were no observed differences in engagement by geographic region, gender, age, or profession. Participants stated they were better able to understand the roles of other team members; perspectives of patients, families, and caregivers; and their own roles on clinical teams. Participants described gaining a new appreciation for the complexity of designing IPCE.
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http://dx.doi.org/10.1080/0142159X.2018.1481286DOI Listing
September 2018

Gender differences in depression among veterans with spinal cord injury.

Rehabil Psychol 2018 05;63(2):221-229

Health Services Research & Development, Center of Innovation on Disability & Rehabilitation Research, James A. Haley Veterans' Hospital.

Purpose: Little is known about gender differences in depression among veterans with spinal cord injury (SCI). Accordingly, the main objectives of this study were (a) to examine demographic and clinical characteristics of veterans with SCI; (b) to investigate gender differences in lifetime depression and depressive symptom severity, including probable major depressive disorder (MDD); and (c) to identify contributory factors (e.g., pain, life satisfaction) for gender differences in depression.

Method: An exploratory secondary analysis was performed on a cross-sectional data set (N = 1,047) from a longitudinal study of health and employment among veterans with SCI. Community-dwelling veterans (N = 135) included women (n = 45) case-matched 1:2 to men (n = 90) based on age, injury level, and time since injury. Group comparisons and regression analyses were used to explore gender differences.

Results: Veterans with SCI had significantly higher rates of lifetime depression as compared with the general population. Women, as compared with men, had higher rates of lifetime depression diagnosis and endorsed more depressive symptoms, as measured by the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Among women, satisfaction with life was a significant predictor of QIDS-SR scores. A similar pattern was seen among men, with the addition of bodily pain as a significant predictor.

Conclusions: Given the relationship between depressive symptoms and life satisfaction for women, follow-up depression screenings among veterans with SCI should include quality of life assessments. Additionally, assessment of somatic symptoms, such as pain, in relation to depressive symptomatology is recommended, particularly among men. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000221DOI Listing
May 2018

S-Nitrosoglutathione Reductase Underlies the Dysfunctional Relaxation to Nitric Oxide in Preterm Labor.

Sci Rep 2018 04 4;8(1):5614. Epub 2018 Apr 4.

Myometrial Function Laboratory, University of Nevada Reno, School of Medicine, Reno, Nevada, United States.

Tocolytics show limited efficacy to prevent preterm delivery. In uterine smooth muscle cGMP accumulation following addition of nitric oxide (NO) has little effect on relaxation suggesting a role for protein S-nitrosation. In human myometrial tissues from women in labor at term (TL), or spontaneously in labor preterm (sPTL), direct stimulation of soluble guanylyl cyclase (sGC) fails to relax myometrium, while the same treatment relaxes vascular smooth muscle completely. Unlike term myometrium, effects of NO are not only blunted in sPTL, but global protein S-nitrosation is also diminished, suggesting a dysfunctional response to NO-mediated protein S-nitrosation. Examination of the enzymatic regulator of endogenous S-nitrosoglutathione availability, S-nitrosoglutathione reductase, reveals increased expression of the reductase in preterm myometrium associated with decreased total protein S-nitrosation. Blockade of S-nitrosoglutathione reductase relaxes sPTL tissue. Addition of NO donor to the actin motility assay attenuates force. Failure of sGC activation to mediate relaxation in sPTL tissues, together with the ability of NO to relax TL, but not sPTL myometrium, suggests a unique pathway for NO-mediated relaxation in myometrium. Our results suggest that examining the action of S-nitrosation on critical contraction associated proteins central to the regulation of uterine smooth muscle contraction can reveal new tocolytic targets.
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http://dx.doi.org/10.1038/s41598-018-23371-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884813PMC
April 2018

Relationship Between Comorbidities and Employment Among Veterans with Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2018 27;24(1):44-53. Epub 2017 Sep 27.

VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, Florida.

To determine the relationship between medical and mental health comorbidities in a large cohort of veterans with spinal cord injury (SCI). Data were collected from interviews and electronic medical records of veterans with SCI ( = 1,047) who received care at 7 geographically diverse SCI centers within the Department of Veterans Affairs across the country (https://clinicaltrials.gov/ct2/show/NCT01141647). Employment, medical, functional, and psychosocial data underwent cross-sectional analysis. Lack of any documented mental health diagnosis correlated strongly with being employed at the time of enrollment. No single comorbidity was associated with employment at enrollment, but an increased number of medical and/or mental health comorbidities ("health burden") were associated with a decreased likelihood of employment at the time of enrollment. Further investigation is needed to clarify whether comorbidity severity or combinations of specific comorbidities predict rehabilitation outcome, including employment.
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http://dx.doi.org/10.1310/sci16-00047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791923PMC
August 2018

Examination of traumatic brain injury exposure among veterans with spinal cord injury.

Rehabil Psychol 2017 08 8;62(3):345-352. Epub 2017 Jun 8.

VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital.

Objective: The authors investigated lifetime exposure to traumatic brain injury (TBI) among veterans with spinal cord injury (SCI) in order to describe outcome differences as a function of self-reported TBI history.

Design: Cross sectional study, veterans with SCI (N = 857) completed the Ohio State University TBI Identification interview method (OSU-TBI); Veterans RAND 36-Item Health Survey (VR-36); Quick Inventory for Depressive Symptomatology, Self-Report (QIDS-SR); Patient Health Questionnaire-9; Satisfaction with Life Scale; Craig Handicap Assessment and Reporting Technique (CHART; along with clinician-rated Functional Independence Measure (FIM) Total, Motor, and Cognitive scores.

Results: Probable TBI exposure was described by 77.6% of participants, with 38% reporting sustaining more than one injury. Self-reported TBIs classified as moderate/severe comprised 49.5% of injuries. Participants with self-reported TBI obtained significantly lower scores on the FIM-Cognitive and CHART Cognitive Independence scales and reported more alcohol use. A history of multiple TBIs was additionally associated with lower mental well-being on the VR-36.

Conclusions: These findings highlight the need to consider more than co-occurring injuries and the potential utility of the OSU-TBI for this purpose. Recognizing lifetime exposure to TBI among veterans with SCI may help identify those with broader impairments and enhance the rehabilitation process. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000129DOI Listing
August 2017

Does functional motor incomplete (AIS D) spinal cord injury confer unanticipated challenges?

Rehabil Psychol 2017 Aug 5;62(3):401-406. Epub 2017 Jun 5.

VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital.

Purpose/objective: Examine psychological challenges associated with Spinal Cord Injury (SCI) among a cohort of Veterans. Research Method/Design: Cross-sectional descriptive study. SCI Centers participating in a multisite evaluation of longitudinal employment, quality of life, and economic outcomes among a large cohort of veterans with SCI, the Predictive Outcome Model Over Time for Employment (PrOMOTE) project. A total of 1,047 patients from participating SCI Centers provided baseline interviews. Main outcome measures included the Veterans RAND 36-Item Health Survey (VR-36) Mental Component Score (MCS); VR-36 Mental Health Scale; VR-36 Vitality Scale; VR-36 Bodily Pain Scale; Quick Inventory for Depressive Symptomatology, Self-Report (QIDS-SR); Patient Health Questionnaire-Depression Scale (PHQ-9); and Diener Satisfaction with Life Scale (SWLS).

Results: ANOVA analysis showed that persons with AIS D SCI evidenced higher self-reported depressive symptoms, higher pain, and a lower subjective quality of life.

Conclusions/implications: Individuals with functional motor incomplete spinal cord injury are more vulnerable to psychological distress and a low subjective quality of life than might be expected based on functional outcomes. Further study appears warranted to ascertain potential explanations for these findings. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000146DOI Listing
August 2017