Strongest Predictor Of Change Research Articles

Elaboração e validação do questionário de satisfação dos pacientes pseudofácicos em português

OBJETIVO: Elaborar e validar o questionario de qualidade de vida na versao do idioma portugues. METODOS: O questionario Cataract TyPESpecification modificado foi desenvolvido especificamente para avaliar a qualidade de vida pos-cirurgia de catarata. O questionario avaliou 10 itens status funcionais por meio de 18 perguntas. Foi aplicado por um unico examinador, com o objetivo de graduar a satisfacao visual de 0 a 10 (0 muito insatisfeito; 5 neutro; 10 muito satisfeito). Houve estudo prospectivo comparativo, nao randomizado, que incluiu 142 olhos de 71 pacientes com catarata da Universidade de Sao Paulo. A avaliacao oftalmologica contou com medida da acuidade visual para longa, intermediaria e curta distâncias, sem correcao e com a melhor correcao optica e questionario de satisfacao. Foi submetido a um questionario de satisfacao quanto a acuidade visual e fenomenos foticos. Todos os exames foram realizados com 6 meses de pos-operatorio. RESULTADOS: A media de idade dos pacientes foi de 60,7 ± 6,6 anos no grupo Tecnis, 63,1 ± 4,4 anos no grupo Restor e 63,7 ± 4,2 anos no grupo SN60AT/SN60WF. A acuidade visual para perto nao-corrigida e a corrigida para longe foram estatisticamente superiores nos grupos Restor® e Tecnis® comparadas ao grupo SN60AT/SN60WF (p<0,001). Nao houve diferenca estatistica entre os grupos quando comparadas a acuidade visual para longe nao-corrigida e a melhor corrigida (p=0,56). O questionario de satisfacao apresentou maior independencia de oculos a favor da Tecnis® (9,3/10) e Restor® (8,7/10), mas com mais queixas de halos (Restor® 18,8%; Tecnis® 21,7%) e glare (Restor® 25%; Tecnis® 26,1%) do que no grupo SN60AT/SN60WF. CONCLUSAO: A Restor® e Tecnis® apresentaram melhor acuidade visual para perto do que o grupo SN60AT/SN60WF. As lentes Restor® e Tecnis® apresentaram maior satisfacao na visao de perto e independencia do uso de oculos e fenomenos foticos do que as lentes monofocais. O questionario Cataract TyPESpecification foi uma variavel importante na qualidade de vida e satisfacao do paciente apos a cirurgia de catarata.

The Effect of Low‐Dose Carvedilol, Nebivolol, and Metoprolol on Central Arterial Pressure and Its Determinants: A Randomized Clinical Trial

In this prospective, open-label, randomized, controlled clinical trial the effects of low-dose carvedilol, nebivolol, and metoprolol on central arterial pressure and augmentation index (AIx) and its heart rate-corrected value (AIx@75) were assessed. The authors randomized 75 hypertensive patients (18-70years) to carvedilol 12.5/25mg, metoprolol 50/100mg, or nebivolol 2.5/5mg daily and followed them up for 3months. Central arterial pressure and AIx were measured with applanation tonometry at baseline and at the end of follow-up. Analyses were restricted to 60 completers. Central systolic pressure decreased equally in all 3 treatment arms. AIx remained unchanged, while AIx@75 decreased significantly by 5.4%±2.5% in the nebivolol group. According to general linear models, individual change in heart rate was a strong predictor of change in AIx in the carvedilol group (r(2) =0.23, P=.03) although no similar association was found in the nebivolol group (r(2) =0.09). The impact of β-blockers with vasodilator effects on pressure augmentation seems to be different with nebivolol having the largest potential of decreasing AIx@75. While AIx changes associated with carvedilol treatment are strongly driven by heart rate changes, those associated with nebivolol treatment seem to be the result of other mechanisms.

Pancreatic β-cell Function Is a Stronger Predictor of Changes in Glycemic Control After an Aerobic Exercise Intervention Than Insulin Sensitivity

Understanding intersubject variability in glycemic control following exercise training will help individualize treatment. Our aim was to determine whether this variability is related to training-induced changes in insulin sensitivity or pancreatic β-cell function. We conducted an observational clinical study of 105 subjects with impaired glucose tolerance or type 2 diabetes. Individual subject changes in fitness (VO2max), glycemia (glycosylated hemoglobin, fasting glucose, oral glucose tolerance test), insulin sensitivity (hyperinsulinemic-euglycemic clamp), oral glucose-stimulated insulin secretion (GSIS), and disposition index (DI) were measured following 12 to 16 weeks of aerobic exercise training. Regression analyses were used to identify relationships between variables. After training, 86% of subjects increased VO2max and lost weight. Glycosylated hemoglobin, fasting glucose, and 2-hour oral glucose tolerance test were reduced in 69%, 62%, and 68% of subjects, respectively, while insulin sensitivity improved in 90% of the participants. Changes in glycemic control were congruent with changes in GSIS such that 66% of subjects had a reduction in first-phase GSIS, and 46% had reduced second-phase GSIS. Training increased first- and second-phase DI in 83% and 74% of subjects. Training-induced changes in glycemic control were related to changes in GSIS (P < .05), but not insulin sensitivity or DI, and training-induced improvements in glycemic control were largest in subjects with greater pretraining GSIS. Intersubject variability in restoring glycemic control following exercise is explained primarily by changes in insulin secretion. Thus, baseline and training-induced changes in β-cell function may be a key determinant of training-induced improvements in glycemic control.

Income and individual deprivation as predictors of health over time

Poverty, often defined as a lack of resources to achieve a living standard that is deemed acceptable by society, may be assessed using level of income or a measure of individual deprivation. However, the relationship between low income and deprivation is complex--for example, not everyone who has low income is deprived (and vice versa). In addition, longitudinal studies show only a small relationship between short-term changes in income and health but an alternative measure of poverty, such as deprivation, may have a stronger association with health over time. We aim to compare low income and individual deprivation as predictors of self-rated health (SRH), using longitudinal survey data, to test the hypothesis that different measures of poverty may have different associations with health. We used three waves from the longitudinal Survey of Family, Income and Employment and fixed-effect linear regression models to compare low income (<50% median income at each wave) and deprivation (reporting three or more items from the New Zealand individual deprivation index) as predictors of SRH (coded 1-5; SD 1.1-1.2). We also compared the impact of duration of low income and deprivation on SRH using mixed linear models. In the fixed-effect models, moving into deprivation between waves was associated with a larger decline in SRH compared to moving into low income, which persisted in models including both low income and deprivation. Similar findings were observed for duration of low income and deprivation in mixed models. Moving into high levels of individual deprivation is a stronger predictor of changes in SRH than moving into low income. When investigating the association of hardship poverty with health, using alternative measures, in addition to income, is advisable.

Effect of QRS Duration and Morphology on Cardiac Resynchronization Therapy Outcomes in Mild Heart Failure

Background— Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure. We aimed to assess the impact of baseline QRS duration and morphology and the change in QRS duration with pacing on CRT outcomes in mild heart failure. Methods and Results— Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) was a multicenter randomized trial of CRT among 610 patients with mild heart failure. Baseline and CRT-paced QRS durations and baseline QRS morphology were evaluated by blinded core laboratories. The mean baseline QRS duration was 151±23 milliseconds, and 60.5% of subjects had left bundle-branch block (LBBB). Patients with LBBB experienced a 25.3-mL/m 2 mean reduction in left ventricular end-systolic volume index ( P &lt;0.0001), whereas non-LBBB patients had smaller decreases (6.7 mL/m 2 ; P =0.18). Baseline QRS duration was also a strong predictor of change in left ventricular end-systolic volume index with monotonic increases as QRS duration prolonged. Similarly, the clinical composite score improved with CRT for LBBB subjects (odds ratio, 0.530; P =0.0034) but not for non-LBBB subjects (odds ratio, 0.724; P =0.21). The association between clinical composite score and QRS duration was highly significant (odds ratio, 0.831 for each 10-millisecond increase in QRS duration; P &lt;0.0001), with improved response at longer QRS durations. The change in QRS duration with CRT pacing was not an independent predictor of any outcomes after correction for baseline variables. Conclusion— REVERSE demonstrated that LBBB and QRS prolongation are markers of reverse remodeling and clinical benefit with CRT in mild heart failure. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00271154.

Glycemic Control Patterns and Kidney Disease Progression among Primary Care Patients with Diabetes Mellitus

Reducing glycosylated hemoglobin (HbA1c) to near or less than 7% in patients with diabetes is associated with diminished microvascular complications, but this level is not consistently achieved. The purpose of this study was to examine the relationship between fluctuations in HbA1c and changes in estimated glomerular filtration rate (eGFR) and estimated stage of chronic kidney disease (CKD) in an academic primary care practice. We analyzed data from 791 diabetic primary care patients (25% white; 75% African American) enrolled between 1998 to 2002 and followed through 2008 (mean follow-up, 7.6 ± 1.9 years). We calculated baseline and final follow-up eGFR using the Modification of Diet in Renal Disease equation. We examined the relationship between fluctuations in HbA1c and changes in eGFR and stage of CKD using multivariable linear and logistic regression models that controlled for demographic and clinical variables associated with CKD progression. From baseline to follow-up, mean eGFR in African Americans declined to a greater extent and more rapidly than in whites. Age, mean systolic blood pressure, initial HbA1c, initial eGFR, and number of HbA1c values (all P<.01) were significant predictors of change in eGFR. Among HbA1c fluctuation measures, the strongest predictor of change in eGFR was the proportion of HbA1c values >7% (P=.02); however, this contributed little to explaining model variance. These data suggest that traditional demographic and clinical risk factors remain significantly associated with changes in eGFR and that the pattern of variability in HbA1c is only modestly important in contributing to changes in eGFR among African-American and white diabetic patients in primary care.

Safety of investigative bronchoscopy in the Severe Asthma Research Program

Investigative bronchoscopy was performed in a subset of participants in the Severe Asthma Research Program to gain insights into the pathobiology of severe disease. We evaluated the safety aspects of this procedure in this cohort with specific focus on patients with severe asthma. To evaluate prospectively changes in lung function and the frequency of adverse events related to investigative bronchoscopy. Bronchoscopy was performed by using a common manual of procedures. A subset of very severe asthma was defined by severe airflow obstruction, chronic oral corticosteroid use, and recent asthma exacerbations. Subjects were monitored for changes in lung function and contacted by telephone for 3 days after the procedure. A total of 436 subjects underwent bronchoscopy (97 normal, 196 not severe, 102 severe, and 41 very severe asthma). Nine subjects were evaluated in hospital settings after bronchoscopy; 7 of these were respiratory-related events. Recent emergency department visits, chronic oral corticosteroid use, and a history of pneumonia were more frequent in subjects who had asthma exacerbations after bronchoscopy. The fall in FEV₁ after bronchoscopy was similar in the severe and milder asthma groups. Prebronchodilator FEV₁ was the strongest predictor of change in FEV₁ after bronchoscopy with larger decreases observed in subjects with better lung function. Bronchoscopy in subjects with severe asthma was well tolerated. Asthma exacerbations were rare, and reduction in pulmonary function after the procedure was similar to that in subjects with less severe asthma. With proper precautions, investigative bronchoscopy can be performed safely in severe asthma.

The role of urgency, frequency, and nocturia in defining overactive bladder adaptive behavior

To determine the relation between urgency alone, or in combination with frequency and nocturia, and adaptive behavior in overactive bladder (OAB) syndrome. We used survey data from the General Longitudinal Overactive Bladder Evaluation (GLOBE) of primary care patients over 40. Participants (n=2,752: 1,557 females; 1,195 males) completed the same survey at two time points, 6 months apart. Questions assessed OAB symptoms and adaptive behavior. We estimated correlation coefficients (R(2)) between urgency, frequency, and nocturia symptom scores (alone and in combination) and adaptive behavior measures at baseline and change in symptom scores and behavioral measures from baseline to 6 months. At baseline, urgency was the dominant predictor of all behavioral measures for females (R(2)=0.19-0.48) and males (R(2)=0.15-0.39). Lower R(2) values were observed for the change in measures from baseline to 6 months, but again change in urgency was the strongest predictor of change in adaptive behavior (R(2)=0.04-0.13 in females, and 0.02-0.08 in males). The correlation between symptoms and measures of adaptive behavior was almost completely explained by the urgency score. Frequency and nocturia did not substantially improve the overall correlation. The relation between measures of OAB symptoms and adaptive behavior at baseline and over time are largely explained by urgency, not by frequency and nocturia.

Readiness to use compensatory strategies among older adults with functional difficulties

Compensatory strategies (behavioral/environmental modifications) can reduce the difficulties of performing daily living activities, fear of falling, and mortality risk. However, individuals vary in their readiness to use strategies. We examined characteristics associated with readiness to use compensatory strategies, the extent to which level of readiness changed from participation in an intervention (Advancing Better Living for Elders (ABLE)) providing compensatory strategies, and factors predictive of change in readiness level. Data from a randomized trial were used. Participants were 148 older adults assigned to the ABLE intervention designed to enhance daily function through compensatory strategy use. Baseline measures included demographic characteristics, functional difficulty level, presence/absence of depressive symptoms, compensatory strategy use, and social support. At initial (2 weeks from baseline) and final (6 months) ABLE sessions, interventionists rated readiness (1 = precontemplation; 2 = contemplation; 3 = preparation; 4 = action/maintenance) of participants to use strategies. Ordinal logistic regression was used to identify baseline characteristics associated with initial readiness rating. A McNemar-Bowker test of symmetry was used to describe change in readiness, and binary logistic regression was used to identify baseline predictors of change in readiness (from initial to final intervention session). At the initial intervention session, 70.3% (N = 104) scored in pre-action (precontemplation/contemplation, preparation), and 29.7% (N = 44) in action/maintenance. Depressive symptomatology (χ2(2) = 9.08, p = 0.011) and low compensatory strategy use (F(2, 147) = 8.44, p = 0.001) at baseline were associated with lower readiness levels at initial ABLE session. By final ABLE session, most participants demonstrated greater readiness: 72% (N = 105) in action/maintenance, 28% (N = 41) in pre-action (two participants dropped out). A significant baseline predictor of positive change in readiness (from initial to final session) was higher social support levels (b = 0.10, SE = 0.05, Wald = 4.98, p = 0.026). Whereas presence of depressive symptomatology and lower use of compensatory strategies at baseline were associated with lower readiness at initial intervention session, neither predicted change in readiness level. Thus, mood and prior compensatory strategy use do not effect enhancements in readiness to use strategies provided in an intervention. Baseline social support was the strongest predictor of change in readiness suggesting that interventions may need to involve older adults' social networks to enhance acceptability of compensatory strategy use.

Demographic Predictors of Relationship and Marriage Education Participants' Pre- and Post-Program Relational and Individual Functioning

Limited knowledge exists regarding differences in relationship and marriage education (RME) experiences based on social address. The current study examines pre- and post-program data from 1293 ethnically and economically diverse adults participating in RME programs. Investigations centered on whether race, income, marital status, and attendance status (i.e., attend with partner or singly) predicted baseline levels and change in a broad range of indicators of individual functioning, couple functioning, and confidence in one's relationship for men and women. Income was the strongest predictor of baseline levels; higher income was associated with higher entry levels in all three target areas. In addition, race predicted unique variance in individual functioning, and marital status and attendance status predicted unique variance in relational targets. Men and women demonstrated positive changes in all target areas following RME participation. Attending with a partner was the only predictor of change in target outcomes for women and was the strongest predictor of change in target outcomes for men. Lower income and being married also predicted greater change in relational functioning among men. Implications for providing RME with diverse audiences are discussed.

Effect of Statin on the Reference Segments after Bare-Metal Stent Implantation

Effect of Statin on the Reference Segments after Bare-Metal Stent Implantation

132 Assessment of Microvascular Obstruction after Acute Myocardial Infarction using Cardiac Magnetic Renonance (CMR) imaging

Infarct size (IS) and presence of microvascular obstruction (MO) detected by cardiac magnetic resonance imaging (CMR) are of prognostic relevance in ST-elevation myocardial infarction (STEMI) patients. We sought to evaluate different cardiovascular magnetic resonance techniques for detection of MO to predict LV remodeling, in patients with first AMI who were treated within 12 hours with primary stenting. Forty-three patients with first STEMI underwent cine CMR at 4 days and 6 months after AMI to calculate LV volumes and ejection fraction (LVEF). Presence of MO was qualitatively evaluated at baseline 1) using a classic first pass perfusion sequence (FP-MO); single shot SR GE at 1‘09±0’07 min, 2) using a 2D segmented IR GE pulse sequence (DHE-MO) at 8‘±1’30 min after contrast administration. CNR's were calculated from the SNR of infarcted myocardium and the MO region. MO was detected by both methods in 24% of patients (n= 11). DHE-MO was the strongest predictor of change in LV end-diastolic and end-systolic volumes over time (p<0.01), whereas FP-MO and DHE-MO had a comparable predicted value of change in LVEF (β=-3.1, p=0.03 and β=-2.8, p=0.04). CNR corrected for spatial resolution was significantly higher for detection of DHE-MO, compared to first pass defect (104±51 vs 8±4, p<0.001). DHE-MO is the best prognostic marker of LV remodeling, as determined by CMR within the first week of acute STEMI patients.

Novel inflammatory markers in overweight women with and without polycystic ovary syndrome and following pharmacological intervention

Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities. The aim of this study was to assess novel inflammatory markers [adipokines leptin, adiponectin, and leptinadiponectin ratio (L/A)] in overweight women with and without PCOS and to examine alterations in these markers [aldosterone, leptin, adiponectin, and L/A] with pharmacological interventions modulating insulin resistance (IR) in PCOS. Overweight age, and body mass index (BMI)-matched women with (no.=80) or without PCOS (no.=27) were assessed cross-sectionally. Subjects with PCOS were then randomised to 6 months metformin (1 g b.d, no.=26) or oral contraceptive pill (OCP) (35 g ethinyl estradiol/2 mg cytoproterone acetate, no.=30). Outcome measures were leptin, adiponectin, L/A, aldosterone, highly sensitive C-reactive protein, lipid profile, IR, and androgen levels. Leptin levels were lower (156.4+/-85.9 vs 208.5+/-105.2 ng/ml, p=0.015) while adiponectin and L/A were not different between women with and without PCOS. Following intervention, IR increased for the OCP and decreased for metformin, however leptin and aldosterone decreased equivalently with the OCP and metformin with no difference between each treatment (p=0.583 and p=0.801, respectively). There was no change in adiponectin or L/A with the OCP or metformin. On multiple regression, the only baseline predictor of leptin was BMI (r(2)=0.485, p<0.001) and the strongest predictor of change in leptin was change in weight (r(2)=0.402, p<0.001). Alterations in leptin between women with and without PCOS and following pharmacological interventions are primarily related to adiposity and not IR. Aldosterone was reduced equivalently with metformin and the OCP despite differential effects on IR.

Interaction of Left Ventricular Geometry and Myocardial Ischemia in the Response of Myocardial Deformation to Stress

Myocardial deformation parameters are sensitive markers of global left ventricular (LV) systolic function, but their interaction with LV geometry is unknown. We sought to investigate the effect of LV geometry on myocardial deformation and its interaction with coronary artery disease (CAD). A total of 126 patients with normal resting LV function who underwent dobutamine stress echocardiography subsequently underwent coronary angiography within 6 months. Longitudinal myocardial deformation was calculated using tissue Doppler echocardiography. The extent of CAD was identified by quantitative coronary angiography. Patients with an increased relative wall thickness had a significantly lower peak strain rate (SR) and a smaller change in SR with stress, with no differences in the at rest values. Those with CAD, had significantly lower peak SR values and change in SR with no difference in resting measures. A linear regression model showed that the relative wall thickness and extent of CAD were the strongest predictors of change in SR. An increasing extent of CAD caused a steady degradation in the peak SR and change in peak SR. Markers of longitudinal myocardial deformation at peak stress reflect both myocardial and interstitial properties. In conclusion, a major determinant of subendocardial function is the wall thickness, as measured by the relative wall thickness, and not LV hypertrophy.

Ego‐pathology, body experience, and body psychotherapy in chronic schizophrenia

In a recent pilot RCT, looking at the efficacy of body oriented psychological therapy (BPT) in patients with chronic schizophrenia, a marked improvement in negative symptoms was found in the treatment group. To date, there have been no studies to evaluate the therapeutic processes, correlates and predictors of change in-patients receiving BPT. The aims of this study are to address three specific questions, namely how: (1) Ego-pathology and (2) Body experiences, may change during the treatment (BPT). We also looked at: (3) If these pathologies, and/or changes in them, or other characteristics are associated with specific clinical outcomes. Analysis of data obtained within a pilot randomized controlled trial. In a sample of patients with a diagnosis of chronic schizophrenia, allocated to receive a course of body oriented group psychotherapy, certain parameters were assessed pre- and post-treatment: (1) Ego-pathology, using the ego-pathology inventory (EPI); (2) Body experiences, (size perception/image marking procedure - IMP, body image/body distortion questionnaire - BDQ, and body cathexis/visual-analogue-scales - VAS); and (3) Common symptom factors, using the Positive And Negative Symptom Scale (PANSS). Subjective experiences were also recorded. Four out of six ego-pathology symptom scores improved over the course of therapy (t=2.9-3.5, p<.05-.01). Amongst the measures of body experiences, only the body perception indices of the lower extremities changed significantly from underestimation pre-therapy (BPI median 92.3), becoming accurate estimates post therapy (BPI median 101.1). Contrary to the hypothesis a reduction of negative symptoms in chronic schizophrenia patients was not associated with systematic improvements of ego-pathology or body experiences. The strongest predictor of change was a high score of ego-demarcation pre-treatment (beta=0.89, p<.001). In patients with chronic schizophrenia, body oriented psychological interventions may be effective for both positive therapeutic changes in ego-pathology and negative symptoms, even though these effects are not necessarily related. High scores of ego-pathology at baseline predicted a poor treatment outcome. This finding deserves more systematic studies, as it could potentially identify patients with poorer prognosis and underpin the development of new intervention strategies. Further studies are required to clarify more precisely the exact nature of the processes in BPT.

The recent palaeolimnology of a remote Scottish loch with special reference to the relative impacts of regional warming and atmospheric contamination

Summary 1. High‐resolution palaeolimnological multiproxy data were obtained from an unacidified remote Scottish loch, Loch Coire Fionnaraich (LCFR). The sediment record of spheroidal carbonaceous particles (SCPs) was used to define the onset of low‐level atmospheric industrial contamination (c. 1830 AD) and discriminate between “pre‐industrial” and “industrial” eras. 2. The diatom and chrysophyte cyst fossil assemblages indicated that LCFR was ecologically stable at a decadal to centennial scale prior to the 19th century. However, the species composition of both proxies changed progressively over the last 200 years. Diatom species shifts were taxonomically consistent with those reported for other remote oligotrophic lakes where regional climate warming has been proposed as the dominant driver. 3. We examined the character of species variation across the full core record and within pre‐industrial and industrial periods in isolation to test competing hypotheses of climate (air temperature) and air pollution as drivers of biological change in this remote lake. We also applied SCP flux and Central England Temperature Series (CET) data as potential explanatory variables of species variation. 4. Marked decadal‐ to centennial‐scale variability in climate is not unique to the industrial era. We hypothesised, therefore, that if climate change was the principal driver of species change in LCFR, the species diagnostic of change should provide evidence of similar counter‐variation in the pre‐industrial section of the core. Alternatively, were anthropogenic atmospheric contamination of primary importance, then the species dominating variation in the pre‐industrial and industrial sections should differ markedly. 5. The principal component of variation in both proxies was significantly correlated with a range of CET variables. However, SCP flux was a far stronger predictor of change in diatom composition and CET variables did not account significantly for any residual variation. In contrast, while SCP flux was also the strongest individual predictor of change in chrysophyte cyst composition, CET variables remained significant when SCP flux was held covariable. 6. Species dominating the principal component of variation in diatoms in the pre‐industrial period were unrelated to those dominating the principal change in the flora, but were closely related to the second component in the full core. Similarity between the second component and diatom inferred pH and DOC, therefore, indicated tentatively that pre‐industrial variation in species was dominated by hydrologically driven variation and that this influence had persisted as the sub‐dominant mode to the present. 7. While the overall trajectories of community change in the two assemblages were similar, changes in diatom community (largely benthic) could be linked only to the effects of atmospheric deposition, possibly through effects of nitrogen enrichment. However, shifts in the chrysophyte community (largely planktonic) were most likely explained by an interaction between atmospheric pollutants and warming. We conclude that, although the two proxies exhibit broadly similar patterns of long term change, only change in the planktonic proxy can be linked to climate change, and even here chemical contamination from the atmosphere is likely to have dominated the biological response.

Assessment of Microvascular Obstruction and Prediction of Short-term Remodeling after Acute Myocardial Infarction: Cardiac MR Imaging Study

To evaluate which cardiac magnetic resonance (MR) imaging technique for detection of microvascular obstruction (MVO) best predicts left ventricular (LV) remodeling after acute myocardial infarction (MI). This study had local ethics committee approval; all patients gave written informed consent. Sixty-three patients with first acute MI, treated with primary stent placement and optimal medical therapy, underwent cine MR imaging at 4-7 days and at 4 months after MI. Presence of MVO was qualitatively evaluated at baseline by using three techniques: (a) a single-shot saturation-recovery gradient-echo first-pass perfusion sequence (early hypoenhancement), mean time, 1.09 minutes +/- 0.07 (standard deviation) after contrast material administration; (b) a three-dimensional segmented saturation-recovery gradient-echo sequence (intermediate hypoenhancement), mean time, 2.17 minutes +/- 0.26; and (c) a two-dimensional segmented inversion-recovery gradient-echo late gadolinium enhancement sequence (late hypoenhancement), mean time, 13.32 minutes +/- 1.26. Contrast-to-noise ratios (CNRs) were calculated from the signal-to-noise ratios of the infarcted myocardium and MVO areas. Univariable linear regression analysis was used to identify the predictive value of each MR imaging technique. Early hypoenhancement was detected in 44 (70%) of 63 patients; intermediate hypoenhancement, in 39 (62%); and late hypoenhancement, in 37 (59%). Late hypoenhancement was the strongest predictor of change in LV end-diastolic and end-systolic volumes over time (beta = 14.3, r = 0.40, P = .001 and beta = 11.3, r = 0.44, P < .001, respectively), whereas intermediate and late hypoenhancement had comparable predictive values of change in LV ejection fraction (beta = -3.1, r = -0.29, P = .02 and beta = -2.8, r = -0.27, P = .04, respectively). CNR corrected for spatial resolution was significantly superior for late enhancement compared with the other sequences (P < .001). By using cardiac MR imaging, late hypoenhancement is the best prognostic marker of LV remodeling, with highest CNR between the infarcted myocardium and MVO regions.

The influence of hip abduction and external rotation on sacroiliac motion

Although the sacroiliac joint (SIJ) is conventionally accepted as a sagittal joint with little mobility in other planes, recent research has shown evidence for reduced hip abduction and axial rotation in patients with sacroiliac pain. A sample of healthy individuals was investigated to determine whether innominate motion about the sacroiliac joint can be predicted from abduction and external rotation displacement of the femur. The motion of the innominate and femur were tracked as the hip was passively rotated by standardized increments of 10° into (1) abduction; (2) external rotation; and (3) a combination of external rotation and abduction. Although sagittal and transverse plane innominate motion both increased significantly as the hip was rotated further into either abduction or external rotation, external rotation was the strongest predictor of change in innominate angle. A combination of external rotation and abduction led to greater increases in these innominate angles at a smaller degree of hip rotation. The results support the use of abduction and external rotation hip displacements (both singularly and in combination) for assessing SIJ mobility at least in the axes investigated. Further research that investigates the use of these tests in people with SIJ disorders is warranted.

Change in body mass index is a stronger predictor of change in fat mass than lean mass in elderly black and white women

The aim of this study was to determine the relation between change in body mass index (BMI) and changes in fat mass (FM), lean soft tissue (LST), and percentage body fat (%Fat) in elderly (67.6 +/- 6.0 years) women varying in race (53 black, 144 white) who underwent measurements of BMI, FM, LST, and %Fat at baseline and after 2 years. The group did not markedly change body composition over 2 years (BMI = -0.1 +/- 1.5 kg/m(2), P = 0.53; FM = 0.0 +/- 2.8 kg, P = 0.95; LST = -0.4 +/- 1.7 kg, P < 0.001; %Fat = 0.3 +/- 2.0%, P = 0.06). Change in BMI predicted change in FM (r = 0.90, SEE = 1.19 kg FM, P < 0.001) but was less predictive of change in %Fat (r = 0.64, SEE = 1.54%Fat, P < 0.001). Change in BMI was curvilinearly related to change in LST adjusted for change in height (R = 0.76, SEE = 1.10 kg LST, P < 0.001). Change in BMI more strongly predicts change in FM than LST and could be used to monitor change in FM in community-dwelling women.

Tracking Body Composition Changes Over Time: Comparison of Methods

Tracking changes in body composition (BC) is critical for observational and intervention studies. Little is known about the best approaches to tracking BC changes. PURPOSE: To compare air plethysmography (AP) and bioelectrical impedance (BI) estimates of BC in a group of college students, some who lose and some who gain body mass (BM). METHODS: 66 college students (26 males, 40 females, 18.1 y) were measured at the beginning and end of their first year at college. AP and BI were used to estimate fat mass (FM), fat-free mass (FFM), and body fat percentage (%BF). BI also assessed kg of trunk fat. BM, body mass index (BMI), and waist circumference (WC) were measured using standard procedures. Repeated measures ANOVA determined whether AP and BI yielded similar results. Bivariate correlation and multiple regression determined which variables were related to changes in BM, BMI and WC. RESULTS: There was wide variation in BC change, but the majority of individuals gained in BM, WC, and FM. On average, subjects gained 1.6±2.9 kg in BM, 1.24±3.02 cm in WC, and 0.35±1.03 kg/m2 in BMI. %BF increased by 0.64±3.42 and 1.37±2.76% according to AP and BI, respectively. AP yielded higher estimates of %BF than BI (24.0 ± 10.5% vs. 22.8 ± 8.6%, p=0.029). The change in FM estimated from AP was highly and significantly (p<0.01) related to change in BM (r=0.81), BMI (r=0.77), and WC (r=0.61). Change in FM estimated from AP was a stronger predictor of change in WC, BMI, and BM than the AP-derived change in FFM or %BF or any of the variables estimated by BI. CONCLUSION: AP and BI both reflect an increase in FM over time in college students. However, differences in estimates from the 2 methods do not allow them to be used interchangeably. The changes in FM according to AP are most reflective of the changes in BM, BMI, and WC.