Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)

The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection.

Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document

The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection.

Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document

The aim of the current Valvular Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)- clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand understanding of patient risk stratification and case selection.

Clinical endpoint adjudication in a contemporary all-comers coronary stent investigation: methodology and external validation

Globalisation in coronary stent research calls for harmonization of clinical endpoint definitions and event adjudication. Little has been published about the various processes used for event adjudication or their impact on outcome reporting.

Government Influence and the Failure of Fannie Mae and Freddie Mac

In 2008 two government-sponsored enterprises, Fannie Mae and Freddie Mac, were placed into conservatorship due to insolvency. The financial bailout of the two publically traded corporations came at the expense of the American tax payer. This study investigates the relationship between direct and indirect government influence and the increasing risk taking of Fannie Mae and Freddie Mac from the late 1990’s through their conservatorship in 2008. As government-sponsored enterprises Fannie Mae and Freddie Mac have many special advantages that other publically traded companies did not possess. These advantages allowed Fannie Mae and Freddie Mac to increase their profitability. Theoretical literature regarding Congress and the bureaucracy suggests that the actions of bureaucrats can be linked to the preferences of Congressional members because bureaucrats are responsive to potential threats or perceived threats from the legislature. This theory is applicable to Fannie Mae and Freddie Mac, and is used to explain why the government was able to directly and indirectly influence the government-sponsored enterprises. Overall this investigation has determined that the United States government pursued a clear mission that determined to increase the availability of housing to all Americans, specifically to low-income and under-served individuals, through the use of the government-sponsored enterprises. Despite this link there is no conclusive data to show that the pursuit of this housing mission led Fannie Mae and Freddie Mac to operate in riskier business segments. This study has also found that motivation regarding profit-seeking and compensation structure provide a more plausible explanation for why the government-sponsored enterprises began to engage in riskier business practices that led to their insolvency.

Performance of the Halex in Logitudinal Studies of Older Adults

Goal: The Halex is an indicator of health status that combines self-rated health and activity limitations, which has been used by NCHS to predict future years of healthy life. The scores for each health state were developed based on strong assumptions, notably that a person in excellent health with ADL disabilities is as healthy as a person in poor health with no disabilities. Our goal was to examine the performance of the Halex as a longitudinal measure of health for older adults, and to improve the scoring if necessary. Methods: We used data from the Cardiovascular Health Study (CHS) to compare the relationship of baseline health to health 2 years later. Subject ages ranged from 65 to 103 (mean age 75). A total of 40,827 transitions were available for analysis. We examined whether Halex scores at time 0 were related monotonically to scores two years later, and iterated the original scores to improve the fit over time. Findings: The original Halex scores were not consistent over time. Persons in excellent health with ADL limitations were much healthier 2 years later than people in poor health with no limitations, even though they had been assumed to have identical health. People with ADL limitations had higher scores than predicted. The assumptions made in creating the Halex were not upheld in the data. Conclusions: The new iterated scores are specific to older adults, are appropriate for longitudinal data, and are relatively assumption-free. We recommend the use of these new scores for longitudinal studies of older adults that use the Halex health states.

High molecular weight kininogen regulates platelet-leukocyte interactions by bridging Mac-1 and glycoprotein Ib

Leukocyte-platelet interaction is important in mediating leukocyte adhesion to a thrombus and leukocyte recruitment to a site of vascular injury. This interaction is mediated at least in part by the beta2-integrin Mac-1 (CD11b/CD18) and its counter-receptor on platelets, glycoprotein Ibalpha (GPIbalpha). High molecular weight kininogen (HK) was previously shown to interact with both GPIbalpha and Mac-1 through its domains 3 and 5, respectively. In this study we investigated the ability of HK to interfere with the leukocyte-platelet interaction. In a purified system, HK binding to GPIbalpha was inhibited by HK domain 3 and the monoclonal antibody (mAb) SZ2, directed against the epitope 269-282 of GPIbalpha, whereas mAb AP1, directed to the region 201-268 of GPIbalpha had no effect. In contrast, mAb AP1 inhibited the Mac-1-GPIbalpha interaction. Binding of GPIbalpha to Mac-1 was enhanced 2-fold by HK. This effect of HK was abrogated in the presence of HK domains 3 or 5 or peptides from the 475-497 region of the carboxyl terminus of domain 5 as well as in the presence of mAb SZ2 but not mAb AP1. Whereas no difference in the affinity of the Mac-1-GPIbalpha interaction was observed in the absence or presence of HK, maximal binding of GPIbalpha to Mac-1 doubled in the presence of HK. Moreover, HK/HKa increased the Mac-1-dependent adhesion of myelomonocytic U937 cells and K562 cells transfected with Mac-1 to immobilized GPIbalpha or to GPIbalpha-transfected Chinese hamster ovary cells. Finally, Mac-1-dependent adhesion of neutrophils to surface-adherent platelets was enhanced by HK. Thus, HK can bridge leukocytes with platelets by interacting via its domain 3 with GPIbalpha and via its domain 5 with Mac-1 thereby augmenting the Mac-1-GPIbalpha interaction. These distinct molecular interactions of HK with leukocytes and platelets contribute to the regulation of the adhesive behavior of vascular cells and provide novel molecular targets for reducing atherothrombotic pathologies.

Patterned-ground plant communities along a bioclimate gradient in the High Arctic, Canada

Non-sorted circles, non-sorted polygons, and earth hummocks are common ground-surface features ill arctic regions. The), are caused by a variety of physical processes that Occur in permafrost regions including contraction cracking and frost heave. Here we describe the vegetation of patterned-ground forms on zonal sites at three location!: along an N-S transect through the High Arctic of Canada. We made 75 releves on patterned-ground features (circles, polygons, earth hummocks) and adjacent tundra (Interpolygon, intercircle, interhummock areas) and identified and classified the vegetation according to the Braun-Blanquet Method. Environmental factors were correlated with the vegetation data using a nonmetric multidimensional scaling ordination (NMDS). We identified eleven commnunities: (1) Puccinellia angustata-Papaver radicalum community in xeromesic non-sorted polygons of subzone A of the Circumpolar Arctic Vegetation Map; (2) Saxifraga-Parmelia omphalodes ssp. glacialis community in hydromesic interpolygon areas of subzone A; (3) Hypogymnia subobscura-Lecanora epibryon community In xeromesic non-sorted polygons of subzone B; (4) Orthotrichum speciosum-Salix arctica community In xeromesic interpolygon areas of subzone B; (5) Cochlearia groenlandica-Luzula nivalis community in hydromesic earth Mocks Of subzone B; (6) Salix arctica-Eriophorum angustifolium ssp. triste community in hygric earth hummocks of subzone 13; (7) Puccinellia angustata-Potentilla vahliana community in xeromesic non-sorted circles and bare patches of subzone Q (8) Dryas integrifolia-Carex rupestris community in xeromesic intercircle areas and vegetated patches of subzone C; (9) Braya glabella ssp. purpurascens-Dryas integrifolia community In hydromesic non-sorted circles of subzone Q (10) Dryas integrifolia-Carex aquatilis community in hydromesic intercircle areas of subzone C; and (11) Eriophorum angustifolium ssp. triste-Carex aquatilis community ill hygric intercircle areas of subzone C. The NMDS ordination displayed the vegetation types with respect to complex environmental gradients. The first axis of the ordination corresponds to a complex soil moisture gradient and the second axis corresponds to a complex geology/elevation/climate gradient. The tundra plots have a greater moss and graminoid cover than the adjacent frost-heave communities. In general, frost-heave features have greater thaw depths, more bare ground, thinner organic horizons, and lower soil moisture than the surrounding tundra. The morphology of the investigated patterned ground forms changes along the climatic gradient, with non-sorted pollygons dominating in the northernmost sites and non-sorted circles dominating, in the southern sites.

The Bison: 1954

This digital object was funded in part through a grant from the Andrew W. Mellon Foundation. The digitalization of this object was part of a collaborative effort with the Washington Research Library Consortium and George Washington University.