How comprehensive is our comprehensive geriatric assessment in clinical practice? An Irish perspective.

PURPOSE: Comprehensive geriatric assessment (CGA) is the cornerstone of high-quality care for older adults. There is no current gold standard to guide what should be included as the baseline measure for CGAs. We examined what metrics are being captured in CGA baseline assessments completed by community based integrated care teams in Ireland. METHODS: CGA's care pathways in Ireland are usually initiated with a written document that establish patients baseline in various assessment areas. These documents were the focus of this study. We completed a cross-sectional study of the components captured in CGA baseline assessments completed in a community setting. We contacted operational leads in each of the community health organisations in Ireland and requested a copy of their current initial baseline screening document for CGA. RESULTS: We reviewed 16 individual CGA baseline documents for analysis in this study. Common assessment areas in all documents included frailty (with the Rockwood Clinical frailty scale used in 94%, n = 15), cognition (4AT-56% of CGAs, MMSE-25%, MOCA-25%, AMTS-19%, AD8-19%, Addenbrookes-13%, 6CIT-13%, mini cog-6%), mobility (100%, n = 16), falls (100%, n = 16), continence (100% n = 16), nutrition (100% n = 16). Mood (94%, n = 15), pain (44%, n = 7), bone health (63%, n = 10), sleep (62%, n = 10) and skin integrity (56%, n = 9). Formal functional assessment was completed in 94% (n = 15) of CGAs with the Barthel index being the tool most used 81% (n = 13). Half of the CGAs included a section describing carer strain (50%, n = 8). The majority of CGAs included a patient centred question which was some variation of 'what matters most to me' (75% n = 11). 87.5% of assessments included a care plan summary (n = 14). CONCLUSIONS: This report highlights that the core tenets of CGA are being assessed across different community based initial CGA screening instruments. There was significant variability in the discussion of challenging topics such as carer strain and social well-being. Our results should prompt a discussion about whether a minimum dataset should be developed for inclusion in nationwide initial baseline CGA document, aiming to improve standardisation of assessments, which will impact areas highlighted for intervention and ultimately guide population health policy.

Extreme Dewetting Resistance and Improved Visible Transmission of Ag Layers Using Sub-Nanometer Ti Capping Layers.

As technology development drives the thickness of thin film depositions down into the nano regime, understanding and controlling the dewetting of thin films has become essential for many applications. The dewetting of ultra-thin Ag (9 nm) films with Ti (0.5 nm) adhesion and capping layers on glass substrates was investigated in this work. Various thin film stacks were created using magnetron sputtering and were analyzed using scanning electron microscopy/energy dispersive X-rays, Vis/IR spectrometry, and four four-point probe resistivity measurements. Upon annealing for 5 h in air at 250 °C, the addition of a 0.5 nm thick Ti capping layer reduced the dewet area by an order of magnitude. This is reflected in film resistivity, which remained 2 orders of magnitude lower than uncapped variants. This Ti/Ag/Ti structure was then deployed in a typical low-emissivity window coating structure with additional antireflective layers of AZO, resulting in a superior performance upon annealing. These results demonstrate an easy, manufacturable process that improves the longevity of devices and products containing thin Ag films.

Comparing functional and quality of life outcomes in transcatheter aortic valve implantation and surgical aortic valve replacement for aortic stenosis: a systematic review and meta-analysis.

BACKGROUND: To compare functional and health related quality of life outcomes post-transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with critical aortic stenosis (AS) across low to high-risk surgical candidates. These patient-centred factors will be compared between both groups in the short to medium term time frames and will aid in shared decision making between patients and healthcare workers. MATERIALS AND METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials which compared TAVI with SAVR and reported on quality of life (QoL) and functional scores. The scores used were the Kansas City Cardiomyopathy Questionnaire (KCCQ), Euroqol-5DL (EQ5DL), the short form-36/12 (SF-36/12) and the NYHA. RESULTS: We identified eight trials with a total of 8898 participants. Both groups showed improvements from baseline at one month. At one month there was a statistically significant difference in standardised mean difference (SMD) in favour of TAVI for EQ5DL (SMD 0.37, 95% CI 0.26,0.49), KCCQ (SMD 0.53,95% CI 0.48, 0.58), SF physical summary (SMD 0.55, 95% CI 0.31 - 0.78) and SF mental summary (SMD 0.34, 95% CI 0.27 - 0.40). At one year there was no statistically significant difference between any of these QoL metrics. For NYHA, no significant difference in odds ratio of class III/IV was observed at one month between TAVI and SAVR (OR 0.94, 95% CI 0.83, 1.07), however, TAVI was associated with reduced odds ratio of NYHA class I/II at one year (OR 0.87, 95% CI 0.78, 0.98). CONCLUSION: Both groups were associated with improvements in QoL and functional outcomes with TAVI reporting more significant improvements in QoL at one-month post-procedures. No significant improvements between groups were seen at one year. This is the largest meta-analysis comparing post-operative health-related quality of life outcomes post SAVR and TAVI and has major implications in shared decision making for the treatment of aortic stenosis.

Adverse Childhood Experiences and Burnout in Athletic Trainers: An Exploratory Study.

CONTEXT: Burnout, a state of physical or emotional exhaustion, is a concern within athletic training, as between 17% and 40% of athletic trainers (ATs) report high levels of burnout. Adverse childhood experiences (ACEs) are linked with higher levels of burnout in other health professions. OBJECTIVE: To compare burnout with ACEs in ATs. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: One thousand ATs were selected at random to participate in the study. Of these, 78 ATs started the survey, and 75 ATs completed it. MAIN OUTCOME MEASURE(S): Burnout, as measured by the Copenhagen Burnout Inventory (CBI) overall and subscale scores, was compared across groups based on the number of adverse experiences as measured by the ACEs survey. Multiple analysis of variance tests were used to determine the association between ACEs score and overall, personal, work-related, and patient-related burnout. RESULTS: At least 1 adverse experience was reported by 37 (49.33%) participants. Those with ≥4 ACEs had higher odds of describing overall, personal, and work-related burnout than those with 0 to 3 ACEs. Moderate burnout (CBI score ≥ 50.00) was noted in 27 (36.00%, overall), 44 (58.67%, personal), 34 (45.3%, work related), and 15 (20.00%, patient related) ATs. Participants with 4 ACEs had higher overall burnout (67.11 ± 19.89; F6,68 = 2.59, P = .03) than those with 0 (40.53 ± 17.12, P = .04), 1 (38.42 ± 20.99, P = .04), or 7 (19.08 ± 12.09, P = .03) ACEs. The same pattern existed with personal burnout, as participants with 4 ACEs (76.67 ± 17.33) had higher scores (F6,68 = 3.40, P = .00) than those with 0 (46.60 ± 17.49, P = .02), 1 (42.78 ± 21.48, P = .01), or 7 (27.08 ± 20.62, P = .03) ACEs. No other differences were observed. CONCLUSIONS: Between 20.00% and 58.67% of ATs surveyed reported some form of burnout. Higher levels of overall and personal burnout were found in those with 4 ACEs. Although we expected to see lower levels of burnout in those with fewer ACEs, it was surprising that those with 7 ACEs had some of the lowest CBI scores. Athletic trainers with childhood trauma may find it beneficial to engage in self-regulation exercises to reduce or limit triggers and burnout. Additionally, employers should explore developing trauma-informed workplaces to better support employees.

The trehalose glycolipid C18Brar promotes antibody and T-cell immune responses to Mannheimia haemolytica and Mycoplasma ovipneumoniae whole cell antigens in sheep.

Bronchopneumonia is a common respiratory disease in livestock. Mannheimia haemolytica is considered the main causative pathogen leading to lung damage in sheep, with Mycoplasma ovipneumoniae and ParaInfluenza virus type 3, combined with adverse physical and physiological stress, being predisposing factors. A balance of humoral and cellular immunity is thought to be important for protection against developing respiratory disease. In the current study, we compared the ability of the trehalose glycolipid adjuvant C18Brar (C18-alkylated brartemicin analogue) and three commercially available adjuvant systems i.e., Quil-A, Emulsigen-D, and a combination of Quil-A and aluminium hydroxide gel, to stimulate antibody and cellular immune responses to antigens from inactivated whole cells of M. haemolytica and M. ovipneumoniae in sheep. C18Brar and Emulsigen-D induced the strongest antigen-specific antibody responses to both M. haemolytica and M. ovipneumoniae, while C18Brar and Quil-A promoted the strongest antigen-specific IL-17A responses. The expression of genes with known immune functions was determined in antigen-stimulated blood cultures using Nanostring nCounter technology. The expression levels of CD40, IL22, TGFB1, and IL2RA were upregulated in antigen-stimulated blood cultures from animals vaccinated with C18Brar, which is consistent with T-cell activation. Collectively, the results demonstrate that C18Brar can promote both antibody and cellular responses, notably Th17 immune responses in a ruminant species.

The State of the Science on Adverse Childhood Experiences.

The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the "Positive Childhood Experiences" (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.

Manipulation of multiple floral traits demonstrates role in pollinator disease transmission.

Plants modulate multitrophic ecological interactions, and variation in plant traits can affect these interactions. Pollinators are exposed to pathogens at flowers and acquire or transmit pathogens at different rates on different plant species, but the traits mediating those interactions are almost entirely unknown. We experimentally manipulated five plant traits that span scales including flower, inflorescence, and plant, to determine their effects on pathogen transmission between foraging bees. Specifically, we manipulated two morphological traits (corolla lip length and flower orientation within an inflorescence) and three resource distribution traits (inflorescence nectar, plant patch nectar, and plant aggregation) in tents to test how plant traits affect bee pathogen transmission. We also quantified foraging behavior and fecal deposition patterns as potential mechanisms driving differences in transmission, and assessed trait manipulation consequences for bee reproduction. We found that pathogen transmission was reduced when we trimmed the corolla lip, evenly dispersed nectar distribution within an inflorescence, or aggregated plants in space. Some traits also affected bee reproduction; tents with trimmed corollas had more larval production than control tents, and tents with evenly distributed nectar across plant patches had more larval production than tents with clumped resources. Thus, some trait manipulations both reduced transmission and increased bee microcolony reproduction, although our design does not allow us to discern whether these are related or separate effects. Taken together, our results demonstrate causal effects of several floral traits on pathogen transmission and pollinator reproduction, indicating the importance of intraspecific plant trait variation for pollinator health and population dynamics.

Quantification of Angiogenesis in Laser Choroidal Neovascularization.

Murine laser-induced laser choroidal neovascularization is a widely used and robust model of wet (exudative) age-related macular degeneration (wAMD). wAMD is one of the leading causes of blindness in the Western world. In brief, a focused laser beam is used to penetrate Bruch's membrane, which separates the choriocapillaris (well-vascularized choroid layer) from the pigmented layers of the retina. Damage to the integrity of this membrane during diabetes leads to fluid accumulation and vascular invasion into the subretinal layers resulting in a progressive worsening of vision. Here we describe a 14-day model using untreated C57/Bl6 mice, but it is equally applicable to incorporation into transgenic studies and therapeutic agent development (such as eye drops), injection of therapeutic agents (including antibodies), and for longer time course studies. In vivo functional analysis or lesioned choroids can be studied with further immunohistochemical staining for further analyses.

Simple Gene Knockdown in Endothelial Cells Using Short Interfering RNA Oligonucleotides.

Cell transfection using short interfering RNAs (siRNAs) is a widely used technique to perform loss of function studies by "knocking down" genes of interest. Oftentimes, primary cells can be difficult to transfect, but here we provide a simple and robust method using cultured endothelial cells and routine transfection reagents. Knockdown studies can be used to complement overexpression studies and validate biochemical pathway analysis, as well as functional assays. The enclosed protocol will compliment other in vitro assays detailed in this edition.

Amide-linked brartemicin glycolipids exhibit Mincle-mediated agonist activity in vitro.

Lipidated derivatives of the natural product brartemicin show much promise as vaccine adjuvants due to their ability to signal through the Macrophage Inducible C-type Lectin (Mincle). We synthesised three lipophilic amide-linked brartemicin derivatives and compared their agonist activity to that of their ester-linked counterparts in vitro. We demonstrate that the brartemicin amide derivatives activate bone-marrow-derived macrophages (BMDMs) in a Mincle-dependent manner, as evidenced by the production of the pro-inflammatory cytokine IL-1ß in wildtype but not Mincle-/- cells. The amide derivatives showed activity that was as good as, if not better than, their ester counterparts. Two of the amide derivatives, but none of the ester-derivatives, also led to the production of IL-1ß by human-derived monocytes. As the production of IL-1ß is a good indicator of vaccine adjuvanticity potential, these findings suggest that amide-linked brartemicin derivatives show particular promise as vaccine adjuvants.

Trehalose diamide glycolipids augment antigen-specific antibody responses in a Mincle-dependent manner.

Many studies have investigated how trehalose glycolipid structures can be modified to improve their Macrophage inducible C-type lectin (Mincle)-mediated adjuvanticity. However, in all instances, the ester-linkage of α,ά-trehalose to the lipid of choice remained. We investigated how changing this ester-linkage to an amide influences Mincle signalling and agonist activity and demonstrated that Mincle tolerates this functional group change. In in vivo vaccination studies in murine and ovine model systems, using OVA or Mannheimia haemolytica and Mycoplasma ovipneumoniae as vaccine antigens, respectively, it was demonstrated that a representative trehalose diamide glycolipid was able to enhance antibody-specific immune responses. Notably, IgG titres against M. ovipneumoniae were significantly greater when using trehalose dibehenamide (A-TDB) compared to trehalose dibehenate (TDB). This is particularly important as infection with M. ovipneumoniae predisposes sheep to pneumonia.

Characterization of extracellular matrix modified poly(ε-caprolactone) electrospun scaffolds with differing fiber orientations for corneal stroma regeneration.

Alternatives to donor cornea transplantation based on tissue engineering are desirable to overcome the current severe donor tissue shortage. Many natural polymers have good biological properties but poor mechanical properties and degradation resistance; while synthetic polymers have good mechanical properties but do not contain biochemical molecules normally found in the real tissue. In addition, both fiber orientation and composition play a key role in dictating cell behavior within a scaffold. In this study, the effect on corneal stromal cells of adding decellularized corneal extracellular matrix (ECM) to an electrospun polymer with differing fiber organizations was explored. Electrospun matrices were generated using polycaprolactone (PCL) and PCL combined with ECM and electrospun into random, radial and perpendicularly aligned fiber scaffolds. Human corneal stromal cells were seeded onto these scaffolds and the effect of composition and orientation on the cells phenotype was assessed. Incorporation of ECM into PCL increased hydrophilicity of scaffolds without an adverse effect on Young's modulus. Cells seeded on these matrices adopted different morphologies that followed the orientation of the fibers. Keratocyte markers were increased in all types of scaffolds compared to tissue culture plastic. Scaffolds with radial and perpendicularly aligned fibers promoted enhanced cell migration. Aligned scaffolds with incorporated ECM show promise for their use as cell-free implants that promote endogenous repopulation by neighboring cells.

Activation of Notch signaling by soluble Dll4 decreases vascular permeability via a cAMP/PKA-dependent pathway.

The Notch ligand delta-like ligand 4 (Dll4), upregulated by VEGF, is a key regulator of vessel morphogenesis and function, controlling tip and stalk cell selection during sprouting angiogenesis. Inhibition of Dll4 results in hypersprouting, nonfunctional, poorly perfused vessels, suggesting a role for Dll4 in the formation of mature, reactive, functional vessels, with low permeability and able to restrict fluid and solute exchange. We tested the hypothesis that Dll4 controls transvascular fluid exchange. A recombinant protein expressing only the extracellular portion of Dll4 [soluble Dll4 (sDll4)] induced Notch signaling in endothelial cells (ECs), resulting in increased expression of vascular-endothelial cadherin, but not the tight junctional protein zonula occludens 1, at intercellular junctions. sDll4 decreased the permeability of FITC-labeled albumin across EC monolayers, and this effect was abrogated by coculture with the γ-secretase inhibitor N-[N-(3,5-difluorophenacetyl)-l-alanyl]-S-phenylglycine t-butyl ester. One of the known molecular effectors responsible for strengthening EC-EC contacts is PKA, so we tested the effect of modulation of PKA on the sDll4-mediated reduction of permeability. Inhibition of PKA reversed the sDll4-mediated reduction in permeability and reduced expression of the Notch target gene Hey1. Knockdown of PKA reduced sDLL4-mediated vascular-endothelial cadherin junctional expression. sDll4 also caused a significant decrease in the hydraulic conductivity of rat mesenteric microvessels in vivo. This reduction was abolished upon coperfusion with the PKA inhibitor H89 dihydrochloride. These results indicate that Dll4 signaling through Notch activation acts through a cAMP/PKA pathway upon intercellular adherens junctions, but not tight junctions, to regulate endothelial barrier function. NEW & NOTEWORTHY Notch signaling reduces vascular permeability through stimulation of cAMP-dependent protein kinase A.

Health Impact of Participation for Vulnerable Youth With Disabilities.

OBJECTIVE: We investigated the mental health impact of participation for youth with disabilities (YWD) in the child welfare system who had experienced victimization in the previous year. METHOD: Nationally representative data were obtained from the second National Survey of Child and Adolescent Well-Being. Our sample consisted of 247 YWD ages 11-17 yr. Multivariable probit regression analysis and a robust variance estimator were used to test the relationships among disability status, participation, and clinical depression. RESULTS: The probability of reporting clinical depression was 4 times higher for victimized YWD who reported lower breadth of participation than for victimized YWD who reported higher breadth of participation (6% vs. 26%; p = .03). CONCLUSION: Occupational therapy aimed at increasing opportunities for engagement in activities may enhance the mental health of the most vulnerable YWD. Participation in meaningful activities can improve both overall health and transition to independence for vulnerable YWD.

Lipidated Brartemicin Analogues Are Potent Th1-Stimulating Vaccine Adjuvants.

Effective Th1-stimulating vaccine adjuvants typically activate antigen presenting cells (APCs) through pattern recognition receptors (PRRs). Macrophage inducible C-type lectin (Mincle) is a PRR expressed on APCs and has been identified as a target for Th1-stimulating adjuvants. Herein, we report on the synthesis and adjuvanticity of rationally designed brartemicin analogues containing long-chain lipids and demonstrate that they are potent Mincle agonists that activate APCs to produce inflammatory cytokines in a Mincle-dependent fashion. Mincle binding, however, does not directly correlate to a functional immune response. Mutation studies indicated that the aromatic residue of lead compound 9a has an important interaction with Mincle Arg183. In vivo assessment of 9a highlighted the capability of this analogue to augment the Th1 response to a model vaccine antigen. Taken together, our results show that lipophilic brartemicin analogues are potent Mincle agonists and that 9a has superior in vivo adjuvant activity compared to TDB.

Retinoic Acid Enhances the Differentiation of Adipose-Derived Stem Cells to Keratocytes In Vitro.

PURPOSE: All-trans retinoic acid (RA) supplementation was investigated as a method of enhancing the differentiation of human adipose-derived stem cells (ASCs) to corneal keratocytes in vitro, in combination with a chemically defined serum-free medium. METHODS: Adipose-derived stem cells were cultured in monolayer and supplemented with 0.1, 1, or 10 µM RA for 14 days. The effects of RA on cell proliferation, migration, and extracellular matrix (ECM) accumulation were evaluated. In addition, the expression of phenotypic keratocyte markers was examined by reverse transcription polymerase chain reaction (PCR), immunocytochemistry, and Western blotting. RESULTS: Adipose-derived stem cells cultured with RA showed improved cell proliferation and ECM production. In addition, RA enhanced the expression of keratocyte-specific markers, keratocan, aldehyde dehydrogenase 3A1, lumican, and decorin, when compared to serum-free media alone. Furthermore, the presence of RA increased the amount of collagen type I while reducing the expression of fibrotic marker, α-smooth muscle actin. CONCLUSIONS: These findings indicate that RA is a useful supplement for promoting a keratocyte phenotype in ASC. TRANSLATIONAL RELEVANCE: This study is particularly important for the generation of biological corneal substitutes and next generation cell based therapies for corneal conditions.

Promotility Action of the Probiotic Bifidobacterium lactis HN019 Extract Compared with Prucalopride in Isolated Rat Large Intestine.

Attention is increasingly being focussed on probiotics as potential agents to restore or improve gastrointestinal (GI) transit. Determining mechanism of action would support robust health claims. The probiotic bacterium Bifidobacterium lactis HN019 reduces transit time, but its mechanisms of action and effects on motility patterns are poorly understood. The aim of this study was to investigate changes in GI motility induced by an extract of HN019 on distinct patterns of colonic motility in isolated rat large intestine, compared with a known promotility modulator, prucalopride. The large intestines from male Sprague Dawley rats (3-6 months) were perfused with Kreb's buffer at 37°C in an oxygenated tissue bath. Isometric force transducers recorded changes in circular muscle activity at four independent locations assessing contractile propagation between the proximal colon and the rectum. HN019 extract was perfused through the tissue bath and differences in tension and frequency quantified relative to pre-treatment controls. Prucalopride (1 µM) increased the frequency of propagating contractions (by 75 ± 26%) in the majority of preparations studied (10/12), concurrently decreasing the frequency of non-propagating contractions (by 50 ± 11%). HN019 extract had no effect on contractile activity during exposure (n = 8). However, following wash out, contraction amplitude of propagating contractions increased (by 55 ± 18%) in the distal colon, while the frequency of non-propagating proximal contractions decreased by 57 ± 7%. The prokinetic action of prucalopride increased the frequency of synchronous contractions along the length of colon, likely explaining increased colonic rate of transit in vivo. HN019 extract modified motility patterns in a different manner by promoting propagating contractile amplitude and inhibiting non-propagations, also demonstrating prokinetic activity consistent with the reduction of constipation by B. lactis HN019 in humans.

The effect of growth factor supplementation on corneal stromal cell phenotype in vitro using a serum-free media.

In order to expand cells quickly and in high numbers for corneal tissue engineering applications corneal stromal cells, or keratocytes, are often cultured in the presence of serum. However, keratocytes become fibroblastic when exposed to serum leading to a downregulation of corneal stromal specific markers. The purpose of this current study was to determine if corneal stromal cells, made fibroblastic by serum, could display native quiescent keratocyte characteristics when cultured under serum-free conditions supplemented by different growth factors. Markers specific to a native keratocyte phenotype such as keratocan and aldehyde dehydrogenase 3A1 (ALDH3A1) and those specific to a fibrotic phenotype such as α-smooth muscle actin (αSMA) and collagen type III were examined. Cells were cultured in monolayer, self-assembled pellets or collagen hydrogels. Growth factors known to modulate keratocyte phenotype were chosen to supplement the serum free media, specifically insulin-like growth factor 1 (IGF-1) and transforming growth factor beta 1 and 3 (Tß1 and Tß3). The effects of serum-free media, growth factors and culture system on cell proliferation and morphology and extracellular matrix (ECM) synthesis were evaluated. The expression of keratocyte markers was evaluated by real-time PCR, immunofluorescent staining and western blotting. In addition, cell migration was tested using scratch assays. When serum was removed from the cells they displayed a reduction in proliferation and ECM synthesis (not significant), in addition to a significant decrease in migratory capacity (p < 0.05). Serum-free media promoted increased expression of keratocan (130.68 ± 47.44-fold increase; p < 0.05) and collagen type I (15.58 ± 9.49-fold increase; p < 0.05). However, there was no significant change in ALDH3A1 and αSMA expression, while collagen type III expression was significantly increased (44.66 ± 25.61-fold increase; p < 0.05). In addition, cells retained an elongated fibroblastic morphology. In monolayer, the addition of Tß1 and Tß3 to serum free media resulted in reduced expression of keratocan, ALDH3A1 and collagen type I and III, increased expression of αSMA (p < 0.05) and an increase in cell proliferation and ECM synthesis. Pellet cultured cells demonstrated a significant increase in ALDH3A1 and collagen type I over 14 days relative to day 5 (p < 0.05), however the expression of fibrotic markers was also enhanced. Cells in collagen hydrogels did not increase expression of keratocyte markers in serum free conditions and underwent contraction in Tß1 and Tß3 supplemented media. These results demonstrate that corneal fibroblasts only partially express the phenotypic characteristics of keratocytes when cultured in serum-free medium. While growth factors did not significantly enhance this phenotype, it appears that pellet or self-assembled culture could be more beneficial to promoting a keratocyte phenotype.

The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence.