Little attention has been given to the flow of liquidity internationally between regions with dif... more Little attention has been given to the flow of liquidity internationally between regions with different levels of temporary financial constraints. Examining approximately 18,000 firm-years from China, we find that foreign controlling ownership of Chinese firms was associated with an extraordinary increase in dividend payouts during the 2007–2009 global financial crisis (GFC), with concomitant underinvestment. This evidence is robust to a matched sample of domestically controlled firms selected using propensity-score matching; as well as to an alternative control sample of firms invested by Qualified Foreign Institutional Investors (QFIIs). We interpret our results as not due to a general clientele effect, but suggesting foreign controlling shareholders in China acted specifically to expropriate (export) liquidity through dividends. These findings reveal a principal-principal agency cost
We find that the major determinants of the dividend payout premium of firms after privatization a... more We find that the major determinants of the dividend payout premium of firms after privatization are improved firm operating performance, growth opportunities and a prevalence of agency costs which are mitigated by higher pay-outs. We examine up to 83,468 firm-years (up to 358 privatized and 4,894 nonprivatized firms) across 26 countries and find a strong positive relation between firm efficiency, operating performance, and the dividend premium by privatized firms. While we find privatized firm dividend premium in both civiland common-law countries, it is significantly higher in civil law countries and is inversely related to the proportion of closely held shares and firm leverage. However, the strong relation between firm efficiency, operating performance, and the dividend premium remains unchanged across all sub-samples. Our findings also suggest that the higher dividends by privatized firms cannot be explained by the life-cycle or the maturity hypotheses. In addition, our main fin...
We document that global board reforms are associated with a significant reduction in the underpri... more We document that global board reforms are associated with a significant reduction in the underpricing of initial public offerings (IPOs). The effect is amplified for IPOs with greater agency problems and mitigated for IPOs certified by reputable intermediaries, IPOs with greater disclosure specificity, and IPOs in countries with better shareholder protection and stringent financial reporting regulations. Furthermore, global board reforms have led to an improvement in the long-term market performance, proceeds, and subscription level of IPOs and have enhanced board independence in the issuing firms. Our findings suggest that global board reforms have strengthened board oversight in the issuing firms, leading to less underpriced IPOs.
Purpose Colorectal cancer (CRC) is the third most common cancer in the USA, and the incidence in ... more Purpose Colorectal cancer (CRC) is the third most common cancer in the USA, and the incidence in young adults has been increasing over the past decade. We studied the clinical characteristics and presentations of CRC in young African American (AA) adults because available data on how age and ethnicity influence its pattern of presentation is limited. Patients and methods We conducted a retrospective study of 109 young adults (75 African Americans) below 50 years, who were diagnosed with CRC between 1 January 1997 and 31 December 2016. Proximal CRC was defined as lesions proximal to the splenic flexure. Independent t-tests and &khgr;2-test or Fisher’s exact test were performed where appropriate to determine the differences between AA and non-AA patients. Results The mean age at diagnosis was 42 years (range: 20–49 years). Compared with non-AAs, AAs had more frequent proximal CRC (38.7 vs. 14.7%, P=0.003), lower hemoglobin (10.5 vs. 12.7 g/dl, P<0.001), and more frequent weight loss (21.3 vs. 2.9% P=0.014). Non-AAs presented more frequently with rectal bleeding (52.9 vs. 32.0% P=0.037). There was no statistically significant difference in histology, stage, grade, tumor size, and carcinoembryonic antigen level between groups. When we stratified between proximal and distal disease among patients with CRC, we found larger tumor size in distal disease, which presented more with rectal bleeding and bowel habit changes. Proximal disease presented more as abdominal pain and weight loss. Conclusion There should be a higher index of suspicion for CRC in young AA adults presenting with anemia, abdominal pain, and weight loss. Early screening colonoscopy should be advocated in AAs because of the predominance of proximal disease.
Using Chinese split‐share structure reform as backdrop, we study the alternative theories explain... more Using Chinese split‐share structure reform as backdrop, we study the alternative theories explaining the change in objectives of internal capital markets (ICMs) after regulatory intervention. Focusing on related party merger and acquisitions, as the primary form of ICM transactions in China, we document significantly positive performance improvement among the acquiring firms around related party than nonrelated party merger and acquisitions in the period following the split‐share structure reform. This evidence is particularly stronger among acquirers with lower institutional shareholding. Our findings are invariant to the length of performance evaluation window, matched samples, model specifications, acquirers' ownership structure, and business group affiliations. After controlling for alternative channels of tunnelling and propping, contrary to the popular belief, our findings support the bright‐side view of ICMs postregulatory intervention in an emerging market set‐up.
Somatic mutations in TET2 are common in myelodysplastic syndromes (MDS), myeloproliferative, and ... more Somatic mutations in TET2 are common in myelodysplastic syndromes (MDS), myeloproliferative, and overlap syndromes. TET2 mutant (TET2 ) clones are also found in asymptomatic elderly individuals, a condition referred to as clonal hematopoiesis of indeterminate potential (CHIP). In various entities of TET2 neoplasia, we examined the phenotype in relation to the strata of TET2 hits within the clonal hierarchy. Using deep sequencing, 1781 mutations were found in 1205 of 4930 patients; 40% of mutant cases were biallelic. Hierarchical analysis revealed that of TET2 cases >40% were ancestral, e.g., representing 8% of MDS. Higher (earlier) TET2 lesion rank within the clonal hierarchy (greater clonal burden) was associated with impaired survival. Moreover, MDS driven by ancestral TET2 is likely derived from TET2 CHIP with a penetrance of ~1%. Following ancestral TET2 mutations, individual disease course is determined by secondary hits. Using multidimensional analyses, we demonstrate how h...
We investigate the determinants of microfinance institution (MFI) financial transparency and repo... more We investigate the determinants of microfinance institution (MFI) financial transparency and report a positive association of transparency with MFI performance. However, subsequent structural-equation modeling and other tests conclude that causality is in the direction of transparency levels determining portfolio quality. Regarding stakeholders, we find greater transparency is positively associated with MFIs being for-profit and negatively associated with taking deposits, even when controlling for prudential regulation and other factors. We conclude that MFI transparency is positively responsive to for-profit stakeholders but negatively responsive to depositor discipline. Finally, at the country level, we observe that MFI transparency is positively associated with social trust and de jure regulation and negatively associated with de facto national governance.
Background Although guidelines and performance measures exist for patients with diabetes mellitus... more Background Although guidelines and performance measures exist for patients with diabetes mellitus, achievement of these metrics is not well known. The Diabetes Collaborative Registry ® (DCR) was formed to understand the quality of diabetes mellitus care across the primary and specialty care continuum in the United States. Methods and Results We assessed the frequency of achievement of 7 diabetes mellitus–related quality metrics and variability across the Diabetes Collaborative Registry ® sites. Among 574 972 patients with diabetes mellitus from 259 US practices, median (interquartile range) achievement of the quality metrics across the practices was the following: (1) glycemic control: 19% (5–47); (2) blood pressure control: 80% (67–88); (3) angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers in patients with coronary artery disease: 62% (51–69); (4) nephropathy screening: 62% (53–71); (5) eye examination: 0.7% (0.0–79); (6) foot examination: 0.0% (0.0–2.3); an...
Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcome... more Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcomes. Using the SPRINT trial data set, we explored the relationship between blood pressure variability, cardiovascular outcomes, and hypoperfusion-related adverse events of antihypertensive therapy in patients with chronic kidney disease (CKD) enrolled in the study. The analyses included patients with CKD randomized in SPRINT who reached the target systolic blood pressure for their respective groups (intensive &lt;120 mm Hg; standard &lt;140 mm Hg). Coefficients of variation (CV) for diastolic blood pressure (DBP) for each subject characterized variability. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome (including acute coronary syndrome, stroke, acute heart failure, and death from cardiovascular causes) and the 3 major side effects of therapy-hypotension, syncope, and acute kidney injury (AKI). P &lt;0.15 on univariate analysis was required to enter the model, and P &lt;0.05 to remain in it. Overall, 2,488 subjects (1,273 standard; 1,124 intensive) met inclusion criteria. DBP CV predicted a greater hazard for primary outcome (hazard ratio [HR] 1.126, P &lt; 0.0001) in the overall model as well as in separate analyses by treatment arms (standard group HR 1.107, P &lt; 0.0001; intensive group HR 1.100, P = 0.0004). DBP CV also independently predicted a greater hazard for AKI (HR 1.117), syncope (HR 1.111), and hypotensive events (HR 1.104). Visit-to-visit DBP variability independently predicts worse cardiovascular outcomes and hypoperfusion-related adverse events in patients with CKD enrolled in SPRINT.
Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in Diabetes: Evaluation of... more Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]) have shown improved cardiovascular (CV) mortality with specific currently available glucose-lowering medications (empagliflozin and liraglutide, respectively), but were limited to selected patient populations. We sought to evaluate the current use and potential real-world impact of empagliflozin (and other sodium-glucose co-transporter 2 inhibitors [SGLT2is]) and liraglutide (and other glucagonlike peptide-1 receptor agonist [GLP-1 RAs]) among patients in the Diabetes Collaborative Registry (DCR). Methods and results We evaluated 182,525 patients from the DCR - a large, US-based outpatient registry of individuals with type 2 diabetes from 313 sites that included cardiology, endocrinology and primary care practices. Among these patients, 26.2% met major eligibility criteria for EMPA-REG OUTCOME and 48.0% met major eligibility criteria for LEADER. Of these potentially eligible patients, only a small minority were actually prescribed these agents: 5.2% on an SGLT2i and 6.0% on a GLP-1 RA, respectively. Patients receiving these studied medications or medication classes, in general, had lower CV disease burden compared with those not on these agents. Assuming similar risk reductions as in the clinical trials, if all potentially trial-eligible patients in the DCR were treated for 1 year with empagliflozin (or other SGLT2is, assuming a class effect) or liraglutide (or other GLP-1 RAs, assuming a class effect), this may have prevented 354 CV deaths, 231 heart failure hospitalizations, 329 CV deaths and 247 myocardial infarctions, respectively. Conclusion In a large, US-based outpatient registry, we found a significant number of patients would have been potentially eligible for glucose-lowering agents that demonstrated CV benefit in recent clinical trials. In view of these findings, a broader and better-targeted use of these medications in evidence-based patient populations should be considered.
Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at hig... more Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%-49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years. After excluding those with obstructive LM CAD, 5166 patients were categorized as having normal LM or nonobstructive LM (18% of cohort). Cumulative 5-year incidence of death, myocardial infarction, or revascularization was higher among patients with nonobstructive LM than normal LM in both women and men: women (34.3% versus 15.4%; P<0.0001); men (24.6% versus 18.2%; P<...
The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penaliz... more The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes. Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. The ERR for MI (MI-ERR) in 2011. Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 ye...
A hallmark feature of chronic pain is its ability to impact other sensory and affective experienc... more A hallmark feature of chronic pain is its ability to impact other sensory and affective experiences. It is notably associated with hypersensitivity at the site of tissue injury. It is less clear, however, if chronic pain can also induce a generalized site-nonspecific enhancement in the aversive response to nociceptive inputs. Here, we showed that chronic pain in one limb in rats increased the aversive response to acute pain stimuli in the opposite limb, as assessed by conditioned place aversion. Interestingly, neural activities in the anterior cingulate cortex (ACC) correlated with noxious intensities, and optogenetic modulation of ACC neurons showed bidirectional control of the aversive response to acute pain. Chronic pain, however, altered acute pain intensity representation in the ACC to increase the aversive response to noxious stimuli at anatomically unrelated sites. Thus, chronic pain can disrupt cortical circuitry to enhance the aversive experience in a generalized anatomical...
Little attention has been given to the flow of liquidity internationally between regions with dif... more Little attention has been given to the flow of liquidity internationally between regions with different levels of temporary financial constraints. Examining approximately 18,000 firm-years from China, we find that foreign controlling ownership of Chinese firms was associated with an extraordinary increase in dividend payouts during the 2007–2009 global financial crisis (GFC), with concomitant underinvestment. This evidence is robust to a matched sample of domestically controlled firms selected using propensity-score matching; as well as to an alternative control sample of firms invested by Qualified Foreign Institutional Investors (QFIIs). We interpret our results as not due to a general clientele effect, but suggesting foreign controlling shareholders in China acted specifically to expropriate (export) liquidity through dividends. These findings reveal a principal-principal agency cost
We find that the major determinants of the dividend payout premium of firms after privatization a... more We find that the major determinants of the dividend payout premium of firms after privatization are improved firm operating performance, growth opportunities and a prevalence of agency costs which are mitigated by higher pay-outs. We examine up to 83,468 firm-years (up to 358 privatized and 4,894 nonprivatized firms) across 26 countries and find a strong positive relation between firm efficiency, operating performance, and the dividend premium by privatized firms. While we find privatized firm dividend premium in both civiland common-law countries, it is significantly higher in civil law countries and is inversely related to the proportion of closely held shares and firm leverage. However, the strong relation between firm efficiency, operating performance, and the dividend premium remains unchanged across all sub-samples. Our findings also suggest that the higher dividends by privatized firms cannot be explained by the life-cycle or the maturity hypotheses. In addition, our main fin...
We document that global board reforms are associated with a significant reduction in the underpri... more We document that global board reforms are associated with a significant reduction in the underpricing of initial public offerings (IPOs). The effect is amplified for IPOs with greater agency problems and mitigated for IPOs certified by reputable intermediaries, IPOs with greater disclosure specificity, and IPOs in countries with better shareholder protection and stringent financial reporting regulations. Furthermore, global board reforms have led to an improvement in the long-term market performance, proceeds, and subscription level of IPOs and have enhanced board independence in the issuing firms. Our findings suggest that global board reforms have strengthened board oversight in the issuing firms, leading to less underpriced IPOs.
Purpose Colorectal cancer (CRC) is the third most common cancer in the USA, and the incidence in ... more Purpose Colorectal cancer (CRC) is the third most common cancer in the USA, and the incidence in young adults has been increasing over the past decade. We studied the clinical characteristics and presentations of CRC in young African American (AA) adults because available data on how age and ethnicity influence its pattern of presentation is limited. Patients and methods We conducted a retrospective study of 109 young adults (75 African Americans) below 50 years, who were diagnosed with CRC between 1 January 1997 and 31 December 2016. Proximal CRC was defined as lesions proximal to the splenic flexure. Independent t-tests and &khgr;2-test or Fisher’s exact test were performed where appropriate to determine the differences between AA and non-AA patients. Results The mean age at diagnosis was 42 years (range: 20–49 years). Compared with non-AAs, AAs had more frequent proximal CRC (38.7 vs. 14.7%, P=0.003), lower hemoglobin (10.5 vs. 12.7 g/dl, P<0.001), and more frequent weight loss (21.3 vs. 2.9% P=0.014). Non-AAs presented more frequently with rectal bleeding (52.9 vs. 32.0% P=0.037). There was no statistically significant difference in histology, stage, grade, tumor size, and carcinoembryonic antigen level between groups. When we stratified between proximal and distal disease among patients with CRC, we found larger tumor size in distal disease, which presented more with rectal bleeding and bowel habit changes. Proximal disease presented more as abdominal pain and weight loss. Conclusion There should be a higher index of suspicion for CRC in young AA adults presenting with anemia, abdominal pain, and weight loss. Early screening colonoscopy should be advocated in AAs because of the predominance of proximal disease.
Using Chinese split‐share structure reform as backdrop, we study the alternative theories explain... more Using Chinese split‐share structure reform as backdrop, we study the alternative theories explaining the change in objectives of internal capital markets (ICMs) after regulatory intervention. Focusing on related party merger and acquisitions, as the primary form of ICM transactions in China, we document significantly positive performance improvement among the acquiring firms around related party than nonrelated party merger and acquisitions in the period following the split‐share structure reform. This evidence is particularly stronger among acquirers with lower institutional shareholding. Our findings are invariant to the length of performance evaluation window, matched samples, model specifications, acquirers' ownership structure, and business group affiliations. After controlling for alternative channels of tunnelling and propping, contrary to the popular belief, our findings support the bright‐side view of ICMs postregulatory intervention in an emerging market set‐up.
Somatic mutations in TET2 are common in myelodysplastic syndromes (MDS), myeloproliferative, and ... more Somatic mutations in TET2 are common in myelodysplastic syndromes (MDS), myeloproliferative, and overlap syndromes. TET2 mutant (TET2 ) clones are also found in asymptomatic elderly individuals, a condition referred to as clonal hematopoiesis of indeterminate potential (CHIP). In various entities of TET2 neoplasia, we examined the phenotype in relation to the strata of TET2 hits within the clonal hierarchy. Using deep sequencing, 1781 mutations were found in 1205 of 4930 patients; 40% of mutant cases were biallelic. Hierarchical analysis revealed that of TET2 cases >40% were ancestral, e.g., representing 8% of MDS. Higher (earlier) TET2 lesion rank within the clonal hierarchy (greater clonal burden) was associated with impaired survival. Moreover, MDS driven by ancestral TET2 is likely derived from TET2 CHIP with a penetrance of ~1%. Following ancestral TET2 mutations, individual disease course is determined by secondary hits. Using multidimensional analyses, we demonstrate how h...
We investigate the determinants of microfinance institution (MFI) financial transparency and repo... more We investigate the determinants of microfinance institution (MFI) financial transparency and report a positive association of transparency with MFI performance. However, subsequent structural-equation modeling and other tests conclude that causality is in the direction of transparency levels determining portfolio quality. Regarding stakeholders, we find greater transparency is positively associated with MFIs being for-profit and negatively associated with taking deposits, even when controlling for prudential regulation and other factors. We conclude that MFI transparency is positively responsive to for-profit stakeholders but negatively responsive to depositor discipline. Finally, at the country level, we observe that MFI transparency is positively associated with social trust and de jure regulation and negatively associated with de facto national governance.
Background Although guidelines and performance measures exist for patients with diabetes mellitus... more Background Although guidelines and performance measures exist for patients with diabetes mellitus, achievement of these metrics is not well known. The Diabetes Collaborative Registry ® (DCR) was formed to understand the quality of diabetes mellitus care across the primary and specialty care continuum in the United States. Methods and Results We assessed the frequency of achievement of 7 diabetes mellitus–related quality metrics and variability across the Diabetes Collaborative Registry ® sites. Among 574 972 patients with diabetes mellitus from 259 US practices, median (interquartile range) achievement of the quality metrics across the practices was the following: (1) glycemic control: 19% (5–47); (2) blood pressure control: 80% (67–88); (3) angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers in patients with coronary artery disease: 62% (51–69); (4) nephropathy screening: 62% (53–71); (5) eye examination: 0.7% (0.0–79); (6) foot examination: 0.0% (0.0–2.3); an...
Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcome... more Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcomes. Using the SPRINT trial data set, we explored the relationship between blood pressure variability, cardiovascular outcomes, and hypoperfusion-related adverse events of antihypertensive therapy in patients with chronic kidney disease (CKD) enrolled in the study. The analyses included patients with CKD randomized in SPRINT who reached the target systolic blood pressure for their respective groups (intensive &lt;120 mm Hg; standard &lt;140 mm Hg). Coefficients of variation (CV) for diastolic blood pressure (DBP) for each subject characterized variability. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome (including acute coronary syndrome, stroke, acute heart failure, and death from cardiovascular causes) and the 3 major side effects of therapy-hypotension, syncope, and acute kidney injury (AKI). P &lt;0.15 on univariate analysis was required to enter the model, and P &lt;0.05 to remain in it. Overall, 2,488 subjects (1,273 standard; 1,124 intensive) met inclusion criteria. DBP CV predicted a greater hazard for primary outcome (hazard ratio [HR] 1.126, P &lt; 0.0001) in the overall model as well as in separate analyses by treatment arms (standard group HR 1.107, P &lt; 0.0001; intensive group HR 1.100, P = 0.0004). DBP CV also independently predicted a greater hazard for AKI (HR 1.117), syncope (HR 1.111), and hypotensive events (HR 1.104). Visit-to-visit DBP variability independently predicts worse cardiovascular outcomes and hypoperfusion-related adverse events in patients with CKD enrolled in SPRINT.
Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in Diabetes: Evaluation of... more Aims Recent trials (EMPA-REG OUTCOME and Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]) have shown improved cardiovascular (CV) mortality with specific currently available glucose-lowering medications (empagliflozin and liraglutide, respectively), but were limited to selected patient populations. We sought to evaluate the current use and potential real-world impact of empagliflozin (and other sodium-glucose co-transporter 2 inhibitors [SGLT2is]) and liraglutide (and other glucagonlike peptide-1 receptor agonist [GLP-1 RAs]) among patients in the Diabetes Collaborative Registry (DCR). Methods and results We evaluated 182,525 patients from the DCR - a large, US-based outpatient registry of individuals with type 2 diabetes from 313 sites that included cardiology, endocrinology and primary care practices. Among these patients, 26.2% met major eligibility criteria for EMPA-REG OUTCOME and 48.0% met major eligibility criteria for LEADER. Of these potentially eligible patients, only a small minority were actually prescribed these agents: 5.2% on an SGLT2i and 6.0% on a GLP-1 RA, respectively. Patients receiving these studied medications or medication classes, in general, had lower CV disease burden compared with those not on these agents. Assuming similar risk reductions as in the clinical trials, if all potentially trial-eligible patients in the DCR were treated for 1 year with empagliflozin (or other SGLT2is, assuming a class effect) or liraglutide (or other GLP-1 RAs, assuming a class effect), this may have prevented 354 CV deaths, 231 heart failure hospitalizations, 329 CV deaths and 247 myocardial infarctions, respectively. Conclusion In a large, US-based outpatient registry, we found a significant number of patients would have been potentially eligible for glucose-lowering agents that demonstrated CV benefit in recent clinical trials. In view of these findings, a broader and better-targeted use of these medications in evidence-based patient populations should be considered.
Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at hig... more Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%-49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years. After excluding those with obstructive LM CAD, 5166 patients were categorized as having normal LM or nonobstructive LM (18% of cohort). Cumulative 5-year incidence of death, myocardial infarction, or revascularization was higher among patients with nonobstructive LM than normal LM in both women and men: women (34.3% versus 15.4%; P<0.0001); men (24.6% versus 18.2%; P<...
The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penaliz... more The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes. Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. The ERR for MI (MI-ERR) in 2011. Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 ye...
A hallmark feature of chronic pain is its ability to impact other sensory and affective experienc... more A hallmark feature of chronic pain is its ability to impact other sensory and affective experiences. It is notably associated with hypersensitivity at the site of tissue injury. It is less clear, however, if chronic pain can also induce a generalized site-nonspecific enhancement in the aversive response to nociceptive inputs. Here, we showed that chronic pain in one limb in rats increased the aversive response to acute pain stimuli in the opposite limb, as assessed by conditioned place aversion. Interestingly, neural activities in the anterior cingulate cortex (ACC) correlated with noxious intensities, and optogenetic modulation of ACC neurons showed bidirectional control of the aversive response to acute pain. Chronic pain, however, altered acute pain intensity representation in the ACC to increase the aversive response to noxious stimuli at anatomically unrelated sites. Thus, chronic pain can disrupt cortical circuitry to enhance the aversive experience in a generalized anatomical...
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