Gender-related safety and efficacy of cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established therapy for patients with chronic heart failure (CHF) and a broad QRS complex. Gender-related safety and efficacy data are necessary for informed patient decision-making for female patients with CHF. The aim of the study was to assess the effects of gender on the outcome of CRT in highly symptomatic heart failure patients. HYPOTHESIS: Gender may have an effect on the outcome of heart failure patients undergoing cardiac resynchronisation therapy. METHODS: The study analyzed the 2-year follow-up of 393 New York Heart Association (NYHA) class III/IV patients with a class I CRT indication enrolled in the Management of Atrial Fibrillation Suppression in AF-HF Comorbidity Therapy (MASCOT) study. RESULTS: In female patients (n = 82), compared with male patients (n = 311), CHF was more often due to dilated cardiomyopathy (74% vs 44%, respectively; P < 0.0001). Females also had a more impaired quality-of-life score and a smaller left ventricular end-diastolic diameter (LVEDD). Women were less likely than men to have received a CRT defibrillator (35% vs 61%, respectively; P < 0.0001). After 2 years, the devices had delivered more biventricular pacing in women than in men (96% ± 13% vs 94% ± 13%, respectively; P < 0.0004). Women had a greater reduction in LVEDD than did men (-8.2 mm ± 11.1 mm vs -1.1 mm ± 22.1 mm, respectively; P < 0.02). Both genders improved similarly in NYHA functional class. Women reported greater improvement than men in quality-of-life score (-21.1 ± 26.5 vs -16.2 ± 22.1, respectively; P < 0.0001). After adjustment for cardiovascular history, women had lower all-cause mortality (P = 0.0007), less cardiac death (P = 0.04), and fewer hospitalizations for worsening heart failure (P = 0.01). CONCLUSIONS: Females exhibited a better response to CRT than did males. Because females have such impressive benefits from CRT, improved screening and advocacy for CRT implantation in women should be considered.

Olfactory assessment using the NIH Toolbox.

The human olfactory system provides us with information about our environment that is critical to our physical and psychological well-being. Individuals can vary widely in their ability to detect, recognize, and identify odors, but still be within the range of normal function. Although several standardized tests of odor identification are available, few specifically address the issues in testing very young children, most of whom are likely to be unfamiliar with many of the odor stimuli used in adult tests and have limited ability to read and identify labels to select among choices. Based on the format of the San Diego Odor Identification Test and the delivery system of the University of Pennsylvania Smell Identification Test, we developed 2 versions of an odor identification test using standardized odor stimuli in a scratch-and-sniff format in which participants match 5 (children) or 9 (adults) odors to pictures representing the odor source. Results from normative testing and validation showed that for most participants, the test could be completed in 5 minutes or less and that the poorer performance among the youngest children and the elderly was consistent with data from tests with larger numbers of items. Expanding on the pediatric version of the test with adult-specific and public health-relevant odors increased the ecological validity of the test and facilitated comparisons of intraindividual performance across developmental stages.

Detecting the trustworthiness of novel partners in economic exchange.

Because trusting strangers can entail high risk, an ability to infer a potential partner's trustworthiness would be highly advantageous. To date, however, little evidence indicates that humans are able to accurately assess the cooperative intentions of novel partners by using nonverbal signals. In two studies involving human-human and human-robot interactions, we found that accuracy in judging the trustworthiness of novel partners is heightened through exposure to nonverbal cues and identified a specific set of cues that are predictive of economic behavior. Employing the precision offered by robotics technology to model and control humanlike movements, we demonstrated not only that experimental manipulation of the identified cues directly affects perceptions of trustworthiness and subsequent exchange behavior, but also that the human mind will utilize such cues to ascribe social intentions to technological entities.

The Easterlin paradox revisited.

The traditional view that well-being depends on both absolute and relative income was challenged in a 1974 paper by Richard Easterlin (Does economic growth improve the human lot? In P. David and M. Reder (Eds.), Nations and households in economic growth: Essays in honor of Moses Abramovitz (pp. 89-125), New York: Academic Press). He noted that although individual well-being is strongly positively associated with income within any country at a given point in time, the average level of measured well-being for a country changes little over time, even in the face of substantial growth in average incomes. For decades, social scientists have struggled to explain this "Easterlin Paradox." In a 2008 paper, Betsey Stephenson and Justin Wolfers (Economic growth and subjective well-being: Reassessing the Easterlin Paradox, Brookings Papers on Economic Activity, Vol. 39, pp. 1-87) argued that the Easterlin Paradox was a statistical illusion. Using richer data sets that facilitate more precise estimates of the various links between income and well-being, they assert that average well-being in a country does, in fact, rise as average income rises over time, and that rich countries are happier than slightly poorer ones. They also suggest that the link between income and well-being may run through absolute income alone-that is, that individual well-being may be completely independent of relative income. In this article, I argue that there have always been good reasons to believe that well-being is positively linked to absolute income. I also argue, however, that there is no reason to believe that individual well-being is independent of relative income.

Investing in our future: unrealized opportunities for funding graduate psychology training.

PURPOSE: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

Brain injury and health policy: twenty-five years of progress.

Legislative advocacy is a prerequisite for the development of research and community services benefiting individuals with traumatic brain injury (TBI). Dr Mitchell Rosenthal and other leaders in rehabilitation began the process of advocating for TBI services more than 25 years ago, before many in the field fully appreciated the necessity of these efforts. Since that time, substantial gains have been made through advocacy efforts on behalf of individuals with TBI and their families. This article provides an overview of the TBI advocacy movement, highlighting federal legislation resulting in appropriations for TBI services and protecting the rights of individuals with TBI. Key government entities engaged in developing states' TBI infrastructure and providing services to individuals with TBI and their families are also discussed. In addition to celebrating some of the successes that were initiated by the efforts of Dr Rosenthal and other visionaries, select shortcoming of current legislation is noted to provide insights regarding future advocacy needs.

Assessment of the influence of cognition and cognitive processing speed on three tests of olfaction.

The extent to which measures of working memory, cognitive speed, and verbal retrieval are associated with performance on tests of olfaction was evaluated in a sample of 138 older adults. Structural equation modeling techniques indicated that verbal retrieval difficulties significantly affect performance on the University of Pennsylvania Smell Identification Test (UPSIT). Further, poor working memory and slow cognitive speed significantly affect performance on the UPSIT and the phenyl ethyl alcohol threshold test. The Sniff Magnitude Test was not influenced by any of the cognitive variables. Odor threshold and identification tasks may overestimate olfactory loss when cognitive impairment is not taken into account.

Cooperation through moral commitment.

Actions that promote fairness are sometimes consistent with the pursuit of individual self-interest, sometimes not. The diner who leaves a generous tip at a favourite local restaurant, for example, may do so partly out of a sense of obligation to the waiter. But we need not invoke fairness to explain the tip, which is, after all, a prudent investment in obtaining good service in the future. In contrast, narrow self-interest cannot explain why travellers might leave tips in restaurants located along interstate highways. Because it is unlikely that they will ever visit these restaurants again, their failure to tip cannot affect the quality of service they expect to receive in the future. So it is hard to escape the conclusion that concerns about fairness must be implicated when diners tip on the road. Of course, merely to assert the existence of a sense of fairness does not really explain why people often set aside concern for narrow self-interest. It simply raises the more fundamental question of why people have a sense of fairness in the first place. It is this question I will discuss.

Cystic fibrosis--a genetic dilemma.

Cystic fibrosis is a common genetic disease that usually presents in early childhood as a devastating disease affecting pulmonary function and at times gastrointestinal functioning and nutritional status. Variant forms of this disease have been described, which may have a delayed age of onset or a milder clinical course. Numerous genetic mutations have been described in cystic fibrosis. There are several mutations that are known to be associated with late onset disease or mild clinical disease. Research continues into these genetic mutations and various modifiers that may help to more accurately predict the final phenotypic presentation.

Assessment of the Sniff Magnitude Test as a clinical test of olfactory function.

Olfactory threshold and odor identification tasks currently serve as the standard approaches to the clinical assessment of olfactory function. Although these methods can be used effectively with the average patient, they suffer from some limitations when used to evaluate children, people with cognitive impairment, or people from diverse cultural backgrounds. A novel approach to the clinical evaluation of olfactory function, the Sniff Magnitude Test, attempts to minimize the cognitive demands of an olfactory test and thereby overcome some of the limitations of alternative tests. This is achieved by measuring the reflex-like reduction in sniffing that occurs when a malodor is encountered. The reliability and the validity of the Sniff Magnitude Test were assessed by testing people on two occasions using the University of Pennsylvania Smell Identification Test (UPSIT), a butanol threshold task, the Alcohol Sniff Test, and the Sniff Magnitude Test. The test-retest reliability of the Sniff Magnitude Test was r=.80, higher than the butanol thresholds and Alcohol Sniff Test but somewhat lower than the UPSIT. Performance on the Sniff Magnitude Test (the sniff magnitude to a malodor relative to nonodorized air) was correlated between r=-.61 and r=-.66 with the other measures of olfactory function. This range of correlations was comparable to that observed between the butanol threshold, the UPSIT, and the Alcohol Sniff Test. Finally, evidence for the advantages of the Sniff Magnitude Test, as compared to the UPSIT, was provided by a study with young children. It is concluded that the Sniff Magnitude Test has significant potential as a clinical measure of olfactory function, and that further testing and development of this method are warranted.

Autoimmune hepatitis.

Autoimmune hepatitis is an uncommon disease causing chronic inflammation of the liver and associated with various circulating autoantibodies. It shares some characteristics with other autoimmune liver diseases, such as primary biliary cirrhosis and sclerosing cholangitis. There has been confusion in past years regarding this entity, but there are now recognized diagnostic criteria by which to make a proper diagnosis. The disease is usually treatable with steroids. Certain proportions of treated patients become cured, although relapse is a problem often requiring chronic administration of steroid therapy. The expected mortality is close to normal in individuals who are cured or have only mild disease.