Prognostic value of strain by feature-tracking cardiac magnetic resonance in arrhythmogenic right ventricular cardiomyopathy.

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Adequate arrhythmic risk assessment is important to prevent sudden cardiac death. We aimed to study the incremental value of strain by feature-tracking cardiac magnetic resonance imaging (FT-CMR) in predicting sustained VA in ARVC patients. METHODS AND RESULTS: CMR images of 132 ARVC patients (43% male, 40.6 ± 16.0 years) without prior VA were analysed for global and regional right and left ventricular (RV, LV) strain. Primary outcome was sustained VA during follow-up. We performed multivariable regression assessing strain, in combination with (i) RV ejection fraction (EF); (ii) LVEF; and (iii) the ARVC risk calculator. False discovery rate adjusted P-values were given to correct for multiple comparisons and c-statistics were calculated for each model. During 4.3 (2.0-7.9) years of follow-up, 19% of patients experienced sustained VA. Compared to patients without VA, those with VA had significantly reduced RV longitudinal (P ≤ 0.03) and LV circumferential (P ≤ 0.04) strain. In addition, patients with VA had significantly reduced biventricular EF (P ≤ 0.02). After correcting for RVEF, LVEF, and the ARVC risk calculator separately in multivariable analysis, both RV and LV strain lost their significance [hazard ratio 1.03-1.18, P > 0.05]. Likewise, while strain improved the c-statistic in combination with RVEF, LVEF, and the ARVC risk calculator separately, this did not reach statistical significance (P ≥ 0.18). CONCLUSION: Both RV longitudinal and LV circumferential strain are reduced in ARVC patients with sustained VA during follow-up. However, strain does not have incremental value over RVEF, LVEF, and the ARVC VA risk calculator.

Evaluation of the BOD POD for estimating percentage body fat in a heterogeneous group of adult humans.

The primary purpose of this investigation was to compare estimations of percentage body fat (%fat) using air displacement plethysmography (ADP) and hydrostatic weighing (HW) in a heterogeneous (age and %fat) sample of the population. Of secondary importance was to determine whether there were differences between the two methods among lean (n = 32), average (n = 34) and overweight (n = 29) subsets of this sample. A total of 95 adults (men 27, women 68) ranging in age from 18-52 years volunteered for this study. Test-retest reliability for %fat ADP (n = 16) was 0.99 with a technical error of 0.75%fat and a coefficient of variation of 3.4%fat. Mean body density using ADP [1.048 (SD 0.016) g.ml-1] was not significantly different when compared to HW [1.049 (SD 0.017) g.ml-1], which corresponded to a non-significant difference in %fat [22.5 (SD 7.3)% ADP compared to 22.0 (SD 7.6)% HW]. Regression analysis provided the equation: %fat HW = 0.9121%fat ADP + 1.5123; r = 0.88, SEE = 3.6, which did not differ significantly from the line of identity. Data for the subsets revealed a significant overestimation of %fat ADP [16.4 (SD 4.8)%] compared to HW [14.1 (SD 3.2)%] (P = 0.001) for lean individuals while no difference was found in the average [21.9 (SD 4.4)%fat ADP compared to 22.0 (SD 3.4)%fat HW] or overweight [29.9 (SD 5.5)%fat ADP compared to 30.8 (SD 4.1)%fat HW] subsets. Measuring %fat by ADP is a highly reliable method and valid when compared to HW for a heterogeneous sample of adults. The ADP method requires little expertise to operate, is quick to perform, and may be more accommodating for certain individuals compared to HW. However, in this study ADP was less valid for lean individuals. Further investigation is warranted to determine the bias of this method for subsets of the population which may be outside the average range of %fat (men 15.4%-22.0%, women 18.4%-28.5%).

Psychache in context:states'spending for public welfare and their suicide rates.

This analysis draws together the concept of psychache that describes the psychological pain associated with suicide and Durkheim's social integration theory in analyzing the relationship between states' spending for public welfare and their suicide rates over a 30-year period, from 1960, 1970, 1980, 1985, and 1990. Given that the threshold for enduring psychological pain varies from person to person, the questions were: Does suicide also vary with social context and has this changed over time? The answer to both questions was yes. Whereas the prevalence of divorce in combination with low population density and high rates of population change provided the context for interstate differences in suicide rates over the entire observational period and accounted for their increased variability in 1970 and 1980, this was not the case in 1985 or 1990. In both 1985 and 1990, the two variables that were important in this regard were states' spending for public welfare and race. In 1990, not only were suicide rates higher in states that spent less for public welfare than in states that spent more, but states' spending for public welfare was the only variable that accounted for the widening of differences in states' suicide rates. Given the strong prevailing skepticism that government can help solve people's problems and widespread antagonism toward government social spending, these findings carry an important message.

The connection between macro and micro levels: states' spending for hospitals and their suicide rates.

A trend analysis of states' spending for hospitals and their suicide rates in 1960, 1970, 1980, and 1984 showed that states' spending for hospitals was not directly related to their suicide rates until 1984. The analysis also showed that in 1984, states' spending for hospitals was not only directly and inversely related to their suicide rates, but also accounted for a 5% increase in their variance. Drawing on Durkheim's theory of social integration, the analysis took into account the effects of states' divorce rates, rates of population change, population density, and the economic level and racial composition of states' population. Following policy trends in health care more generally, the findings call attention to the wider implications of institutional norms of cost containment at all costs and states' suicide rates, and thus to the largely ignored connection between macro and micro levels.

States' public welfare expenditures as predictors of state suicide rates.

This exploratory multiple-regression study took its cue from social integration theory to examine the relative importance of state per capita expenditures for public welfare in predicting state suicide rates when controlling for the effects of state divorce rates, state population change rates, and the percentage of persons with annual incomes between $10,000 and $19,999. While the four variables together accounted for .73 of the explained variance in state suicide rates, the effects of state per capita expenditures for public welfare were not very important when those of the other variables were taken into account. This, however, does not mean that state per capita expenditures for public welfare are inconsequential with respect to state suicide rates, inasmuch as they were inversely related to each of the other three independent variables, each of which was positively related to state suicide rates. This means that state per capita expenditures are indirectly related to suicide--in a negative direction. The implications of the findings for policy and suicide prevention are briefly discussed.

State-level public policy as a predictor of individual and family well-being.

This exploratory study examines the relationship between state-level public policy and individual and family well-being and factors that affect it. The inquiry, based on exchange and choice theories, assumes that state-level public policy reflects states' awareness of the needs of individuals and families, their ability to predict the future in failing to meet them, and the extent to which the norm of reciprocity prevails in the 50 states. Measures of states' collective choices were states' per capita expenditures for public welfare, education, and health, and per capita taxes in 1980; measures of states' individual and well- or ill-being, or social malaise, were states' teenage birthrates, infant death rates, and suicide rates. Taken into account as antecedent and intervening variables were age, gender, and racial composition, income distribution, marital, socioeconomic, and employment status of states' populations, and attitudes toward public spending. The findings show that higher state expenditures for public welfare and for education indeed contribute to individual and family well-being as measured by lower state rates of suicide and teenage births. States per capita spending for education, which together with state per capita spending for public welfare was a positive predictor of school completion rates and positively associated with states' income level, accounted for almost all of the variance in states' per capita taxes. State spending for public welfare was not a predictor of state per capita taxes. These findings are cause for considerable concern given the reduced role of the federal government in human affairs, particularly in states whose choices violate the assumptions underlying exchange and choice theories and the norm of reciprocity which says that people should help, not hurt, others.

Differentiating DST suppressors from nonsuppressors: a discriminant function analysis of clinical symptoms.

Ninety-seven patients who presented with depressive complaints were studied in an attempt to cross-validate a statistical model that uses items from the Hamilton Rating Scale for Depression (HRSD) to differentiate dexamethasone suppressors from nonsuppressors. Two split-sample discriminant function analyses (DFA) of data from this sample showed little agreement with either the original model or with each other. Accuracy of classification was acceptable for the derivation samples but was no better than chance for the validation samples. No single HRSD item was identified by all three DFAs as distinguishing between groups. The HRSD does not appear to be a reliable instrument for clinically distinguishing dexamethasone suppressors from nonsuppressors.

Public policies and family outcomes: empirical evidence or ideology?

Research findings and other data dealing with government policies and programs such as Social Security, supplemental security income, welfare reform, deinstitutionalization, abortion, and compensatory preschool education show that these programs have promoted family well-being and not hindered family interests.