Marion Local Schools

Written by Weiqi Gao

Written by Johan Vos and José Pereda

Introduction: Myocardial perfusion relative to left-ventricular workload may be estimated by the sub-endocardial viability index (SVI). This can be calculated myocardial oxygen supply-demand balance, which is the ratio of diastolic to systolic pressure-time indices, i.e. [(DBP - PAWP) x (60sec/heart rate - 0.2sec)] / (SBP x 0.2sec), assuming fixed 0.2sec for systole. Low SVI indicates reduced sub-endocardial perfusion and was hypothesized to associate with negative outcomes in HFrEF patients. Methods: HF-ACTION was a randomized trial evaluating the efficacy of aerobic exercise training and usual care versus usual care in chronic HFrEF patients. SVI was calculated in HF-ACTION trial patients with complete hemodynamic data. PAWP was calculated using the Nagueh formula from echocardiographic-derived measurements ([PAWP=1.24*(E/e’) +1.9] with e’ = [(e’lateral + e’septal)/2]). The association of SVI with the combined endpoint of death or hospitalization, as well as all-cause death, was assessed. Results: Of 2331 patients in HF-ACTION, 807 had complete data. The mean SVI was 1.59 ± 0.47. The Cox proportional hazards model for the combined endpoint and all-cause death had HR of 0.66 per unit increase in SVI (p<0.00001, 95% CI 0.55-0.79) and 0.67 (p=0.04, 95% CI 0.46-0.98), respectively. Survival during 4 year follow-up was worse below the mean SVI (p=0.0073) ( Figure 1) . In 26 patients below the critical sub-endocardial ischemia SVI of 0.7, survival was worse (p=0.0013) ( Figure 2) . Conclusion: Reduced SVI, a metric of the adequacy of sub-endocardial perfusion, is associated with negative outcomes in HFrEF patients. Figure 1. Figure 2.

Written by Eugene Ryzhikov

Written by William Antônio Siqueira

As a means to short-term adaptation/long-term demise, the human mind is a classic example of the “Neurotic Paradox” in...

Fortunately for sensitive egos, people do not have to acknowledge criticism in order to react to it. Corrective reactions may be undertaken without anyone admitting anything was wrong. Demonstrating the power of negative thinking, the accompanying verbal response to warranted but unwelcome criticism is usually to the effect that, “We have not done anything wrong and will not do it again”.

Considering how little intelligence and how much stupidity there is, it really is incredible that the extent imbalance regarding these two phenomena in the scientific literature has existed for so long.

The purpose of this project was to understand the hopes of parents with children with ASD. Particularly understudied are the hopes parents have for long-term outcomes for their child. A cross-sectional focus group design was used and six focus groups were completed. These groups included parents of (1) preschool aged children who were recently diagnosed, (2) children in early elementary school, (3) children in later elementary school, (4) children in middle school, (5) children in high school, and (6) children who are adults with ASD. Results indicated 77.4% of the data were devoted to hopes for the children's independence, happiness, and skill improvement; increased authentic socially significant relationships; and future employment.

Written by José Pereda