The 2010 audits provided evidence that many fields in the NCDR accurately represent the data from the medical charts. The American College of Cardiology Foundation is undertaking a series of initiatives aimed at creating a quality assurance rapid learning system, which, when complete, will monitor, evaluate, and improve data quality.

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The NCDR provides a unique opportunity to understand the characteristics of large populations of patients with CVD, the centers that provide their care, quality of care provided, and important patient outcomes.

How can urban nature contribute to the reduction of chronic stress? We twice measured the concentration of the “stress hormone” cortisol in the hair of 85 volunteer gardeners (six months apart), relating cortisol level change to (self-reported) characteristics of their recreational activities. Both time spent in nature and physical activity led to decreases in cortisol, while time spent being idle led to an increase. At high levels of present stressors, however, the relationship for time spent in nature and for idleness was reversed. Time spent with social interaction had no effect on cortisol levels. Our results indicate that physical activity is an effective means of mitigating the negative effects of chronic stress. The results regarding the time spent in nature and time spent being idle are less conclusive, suggesting the need for more research. We conclude that if chronic stress cannot be abolished by eradicating its sources, public health may take to measures to reduce it—providing urban nature being one effective possibility.

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1 Bursaphelenchus xylophilus (Steiner & Buhrer) (Nematoda: Aphelenchoididae), the pinewood nematode and the causal agent of the pine wilt disease, is a globally important invasive pathogen of pine forests. It is phoretic in woodborer beetles of the genus Monochamus (Megerle) (Coleoptera, Cerambycidae) and has been able to exploit novel indigenous species of Monochamus (but only Monochamus) in newly-invaded areas. North America (NA) is the continent of origin for the B. xylophilus/Monochamus spp. phoretic system. NA also contains the largest number of Monochamus species known to act as vectors for B. xylophilus. Understanding this phoretic system in its native geographical area helps to explain the evolutionary ecology of pine wilt disease. 2 In the present study, we measured the flight phenology, size, sex ratios and species identity of Monochamus species in five geographically distant forests in NA. We also measured phoresy by B. xylophilus. 3 We found the nematode to be abundant across eastern NA but rare or absent in western NA. In eastern forests, nematode phoresy was highest on the Monochamus species that flew earliest in the year. However, in the southeast, where Monochamus is most likely multivoltine with a long flight season, we found vectors with high nematode loads throughout the season, indicating that B. xylophilus can be transmitted to new hosts during most part of the year. The frequency distribution of nematode dauers on Monochamus was highly aggregated. Bursaphelenchus xylophilus in NA appears to be able to use all available Monochamus species as vectors. 4 In native NA pine forests, the pinewood nematode appears to have an ecology that is sufficiently flexible to exploit different species (and both genders) of Monochamus, and disperse at different times of the year. This flexibility may contribute to its recent success in invading Eurasian pine forests.

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These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making.