Evaluation of Quality of Life in Patients with and without Heart Failure in Primary Care.

PubMed

Jorge, Antonio José Lagoeiro; Rosa, Maria Luiza Garcia; Correia, Dayse Mary da Silva; Martins, Wolney de Andrade; Ceron, Diana Maria Martinez; Coelho, Leonardo Chaves Ferreira; Soussume, William Shinji Nobre; Kang, Hye Chung; Moscavitch, Samuel Datum; Mesquita, Evandro Tinoco

2017-09-01

Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL). To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community. Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF - n = 35) and HF with reduced ejection fraction (HFrEF - n = 24). Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity - ability and difficulty to perform common activities of everyday life - was significantly worse (p < 0.0001) in patients with HF independently of sex and age. There was no difference between HFpEF and HFrEF. Patients with HF had low quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex.

PubMed

Oparil, Suzanne; Davis, Barry R; Cushman, William C; Ford, Charles E; Furberg, Curt D; Habib, Gabriel B; Haywood, L Julian; Margolis, Karen; Probstfield, Jeffrey L; Whelton, Paul K; Wright, Jackson T

2013-05-01

To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with chlorthalidone, and rates of HF were significantly higher for amlodipine compared with chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542.

Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people.

PubMed

Koudstaal, Stefan; Pujades-Rodriguez, Mar; Denaxas, Spiros; Gho, Johannes M I H; Shah, Anoop D; Yu, Ning; Patel, Riyaz S; Gale, Chris P; Hoes, Arno W; Cleland, John G; Asselbergs, Folkert W; Hemingway, Harry

2017-09-01

The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts. This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age- and sex-matched general population. In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients. NCT02551016. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Renin-Angiotensin System Inhibition, Worsening Renal Function, and Outcome in Heart Failure Patients With Reduced and Preserved Ejection Fraction: A Meta-Analysis of Published Study Data.

PubMed

Beldhuis, Iris E; Streng, Koen W; Ter Maaten, Jozine M; Voors, Adriaan A; van der Meer, Peter; Rossignol, Patrick; McMurray, John J V; Damman, Kevin

2017-02-01

Renin-angiotensin aldosterone system (RAAS) inhibitors significantly improve outcome in heart failure (HF) patients with reduced ejection fraction (HFREF), irrespective of the occurrence of worsening renal function (WRF). However, in HF patients with preserved ejection fraction (HFPEF), RAAS inhibitors have not been shown to improve outcome but are still frequently prescribed. Random effect meta-analysis was performed to investigate the relationship between RAAS inhibitor therapy, WRF in both HF phenotypes, and mortality. Studies were selected based on literature search in MEDLNE and included randomized, placebo controlled trials of RAAS inhibitors in chronic HF. The primary outcome consisted of the interaction analysis for the association between RAAS inhibition-induced WRF, HF phenotype and outcome. A total of 8 studies (6 HFREF and 2 HFPEF, including 28 961 patients) were included in our analysis. WRF was more frequent in the RAAS inhibitor group, compared with the placebo group, in both HFREF and HFPEF. In HFREF, WRF induced by RAAS inhibitor therapy was associated with a less increased relative risk of mortality (relative risk, 1.19 (1.08-1.31); P <0.001), compared with WRF induced by placebo (relative risk, 1.48 (1.35-1.62); P <0.001; P for interaction 0.005). In contrast, WRF induced by RAAS inhibitor therapy was strongly associated with worse outcomes in HFPEF (relative risk, 1.78 (1.43-2.21); P <0.001), whereas placebo-induced WRF was not (relative risk, 1.25 (0.88-1.77); P =0.21; P for interaction 0.002). RAAS inhibitors induce renal dysfunction in both HFREF and HFPEF. However, in contrast to patients with HFREF where mortality increase with WRF is small, HFPEF patients with RAAS inhibitor-induced WRF have an increased mortality risk, without experiencing improved outcome with RAAS inhibition. © 2017 American Heart Association, Inc.

Worsening renal function and outcome in heart failure patients with reduced and preserved ejection fraction and the impact of angiotensin receptor blocker treatment: data from the CHARM-study programme.

PubMed

Damman, Kevin; Solomon, Scott D; Pfeffer, Marc A; Swedberg, Karl; Yusuf, Salim; Young, James B; Rouleau, Jean L; Granger, Christopher B; McMurray, John J V

2016-12-01

We investigated the association between worsening renal function (WRF) that occurs during renin-angiotensin-aldosterone system inhibition initation and outcome in heart failure (HF) patients with preserved ejection fraction (HFPEF) and compared this with HF patients with reduced ejection fraction (HFREF). We examined changes in estimated glomerular filtration rate (GFR) and the relationship between WRF (defined as ≥26.5 µmol/L and ≥25% increase in serum creatinine from baseline to 6 weeks) and outcome, according to randomized treatment, in patients with HFREF (EF <45%; n = 1569) and HFPEF (EF ≥45%; n = 836) in the CHARM programme. The primary outcome was cardiovascular death or HF hospitalization. Estimated GFR decreased 9.0 ± 21 vs. 4.0 ± 21 mL/min/1.73 m 2 with candesartan and placebo, respectively, and this was similar in HFREF and HFPEF. WRF developed more frequently with candesartan, 16% vs. 7%, P < 0.001, with similar findings in patients with HFREF and HFPEF. WRF was associated with a higher risk of the primary outcome: multivariable hazard ratio (HR) 1.26, 95% confidence interval 1.03-1.54, P = 0.022, in both treatment groups, and in both HFREF and HFPEF (P for interaction 0.98). In HFREF, WRF was mostly related to HF hospitalization, while in HFPEF, WRF seemed more associated with mortality. GFR decreased more and WRF was more common with candesartan compared with placebo, and this was similar in HFREF and HFPEF. WRF was associated with worse outcomes in HFREF and HFPEF. Although no formal interaction was present, the association between candesartan treatment, WRF, and type of clinical outcome was slightly different between HFREF and HFPEF. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association.

PubMed

Doehner, Wolfram; Ural, Dilek; Haeusler, Karl Georg; Čelutkienė, Jelena; Bestetti, Reinaldo; Cavusoglu, Yuksel; Peña-Duque, Marco A; Glavas, Duska; Iacoviello, Massimo; Laufs, Ulrich; Alvear, Ricardo Marmol; Mbakwem, Amam; Piepoli, Massimo F; Rosen, Stuart D; Tsivgoulis, Georgios; Vitale, Cristiana; Yilmaz, M Birhan; Anker, Stefan D; Filippatos, Gerasimos; Seferovic, Petar; Coats, Andrew J S; Ruschitzka, Frank

2018-02-01

Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Effect of doublecortin on self-renewal and differentiation in brain tumor stem cells

PubMed Central

Santra, Manoranjan; Santra, Sutapa; Buller, Ben; Santra, Kastuv; Nallani, Ankita; Chopp, Michael

2011-01-01

Analysis of Affymetrix Probe data from glioma patient samples in conjuction with patient Kaplan-Meier Survival Plot indicate that expression of a glioma suppressor gene doublecortin (DCX) favors glioma patient survival. From neurosphere formation in culture, Time-Lapse Microscopy video recording and tumor xenograft, we show that DCX synthesis significantly reduces self-renewal of brain tumor stem cells (BTSCs) in human primary glioma (YU-PG, HF66) cells from surgically-removed human glioma specimens and U87 cells in vitro and in vivo. Time-Lapse Microscopic video recording revealed that double transfection of YU-PG, HF66 and U87 cells with DCX and neurabin II caused incomplete cell cycle with failure of cytokinesis, i.e. endomitosis by dividing into three daughter cells from one mother BTSC. Activation of c-jun NH2-terminal kinase 1 (JNK1) after simvastatin (10nM) treatment of DCX+neurabin II+ BTSCs from YU-PG, HF66 and U87 cells induced terminal differentiation into neuron-like cells. TUNEL staining data demonstrated that JNK1 activation also induced apoptosis only in double transfected BTSCs with DCX and neurabin II, but not in single transfected BTSCs from YU-PG, HF66 and U87 cells. Western blot analysis showed that procaspase-3 was induced after DCX transfection and activated after simvastatin treatment in YU-PG, HF66 and U87 BTSCs. Sequential immunoprecipitation and Western blot data revealed that DCX synthesis blocked protein phosphatase-1 (PP1)/caspase-3 protein-protein interaction and increased PP1-DCX interaction. These data demonstrate that DCX synthesis induces apoptosis in BTSCs via a novel JNK1/neurabin II/DCX/PP1/caspase-3 pathway. PMID:21477071

Effect of doublecortin on self-renewal and differentiation in brain tumor stem cells.

PubMed

Santra, Manoranjan; Santra, Sutapa; Buller, Ben; Santra, Kastuv; Nallani, Ankita; Chopp, Michael

2011-07-01

Analysis of microarray probe data from glioma patient samples, in conjunction with patient Kaplan-Meier survival plots, indicates that expression of a glioma suppressor gene doublecortin (DCX) favors glioma patient survival. From neurosphere formation in culture, time-lapse microscopic video recording, and tumor xenograft, we show that DCX synthesis significantly reduces self-renewal of brain tumor stem cells (BTSC) in human primary glioma (YU-PG, HF66) cells from surgically removed human glioma specimens and U87 cells in vitro and in vivo. Time-lapse microscopic video recording revealed that double transfection of YU-PG, HF66, and U87 cells with DCX and neurabin II caused incomplete cell cycle with failure of cytokinesis, that is, endomitosis by dividing into three daughter cells from one mother BTSC. Activation of c-jun NH2-terminal kinase 1 (JNK1) after simvastatin (10 nM) treatment of DCX(+) neurabin II(+) BTSC from YU-PG, HF66, and U87 cells induced terminal differentiation into neuron-like cells. dUTP nick end labeling data indicated that JNK1 activation also induced apoptosis only in double transfected BTSC with DCX and neurabin II, but not in single transfected BTSC from YU-PG, HF66, and U87 cells. Western blot analysis showed that procaspase-3 was induced after DCX transfection and activated after simvastatin treatment in YU-PG, HF66, and U87 BTSC. Sequential immunoprecipitation and Western blot data revealed that DCX synthesis blocked protein phosphatase-1 (PP1)/caspase-3 protein-protein interaction and increased PP1-DCX interaction. These data show that DCX synthesis induces apoptosis in BTSC through a novel JNK1/neurabin II/DCX/PP1/caspase-3 pathway. © 2011 Japanese Cancer Association.

Prevalence of Heart Failure Signs and Symptoms in a Large Primary Care Population Identified Through the Use of Text and Data Mining of the Electronic Health Record

PubMed Central

Vijayakrishnan, Rajakrishnan; Steinhubl, Steven R.; Ng, Kenney; Sun, Jimeng; Byrd, Roy J.; Daar, Zahra; Williams, Brent A.; deFilippi, Christopher; Ebadollahi, Shahram; Stewart, Walter F.

2014-01-01

Background The electronic health record contains a tremendous amount of data that if appropriately detected can lead to earlier identification of disease states such as heart failure (HF). Using a novel text and data analytic tool we explored the longitudinal EHR of over 50,000 primary care patients to identify the documentation of the signs and symptoms of HF in the years preceding its diagnosis. Methods and Results Retrospective analysis consisting of 4,644 incident HF cases and 45,981 group-matched controls. Documentation of Framingham HF signs and symptoms within encounter notes were carried out using a previously validated natural language processing procedure. A total of 892,805 affirmed criteria were documented over an average observation period of 3.4 years. Among eventual HF cases, 85% had at least one criterion within a year prior to their HF diagnosis (as did 55% of controls). Substantial variability in the prevalence of individual signs and symptoms were found in both cases and controls. Conclusions HF signs and symptoms are frequently documented in a primary care population as identified through automated text and data mining of EHRs. Their frequent identification demonstrates the rich data available within EHRs that will allow for future work on automated criterion identification to help develop predictive models for HF. PMID:24709663

[Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].

PubMed

del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación

2016-02-01

To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Bidirectional Cardio-Respiratory Interactions in Heart Failure.

PubMed

Radovanović, Nikola N; Pavlović, Siniša U; Milašinović, Goran; Kirćanski, Bratislav; Platiša, Mirjana M

2018-01-01

We investigated cardio-respiratory coupling in patients with heart failure by quantification of bidirectional interactions between cardiac (RR intervals) and respiratory signals with complementary measures of time series analysis. Heart failure patients were divided into three groups of twenty, age and gender matched, subjects: with sinus rhythm (HF-Sin), with sinus rhythm and ventricular extrasystoles (HF-VES), and with permanent atrial fibrillation (HF-AF). We included patients with indication for implantation of implantable cardioverter defibrillator or cardiac resynchronization therapy device. ECG and respiratory signals were simultaneously acquired during 20 min in supine position at spontaneous breathing frequency in 20 healthy control subjects and in patients before device implantation. We used coherence, Granger causality and cross-sample entropy analysis as complementary measures of bidirectional interactions between RR intervals and respiratory rhythm. In heart failure patients with arrhythmias (HF-VES and HF-AF) there is no coherence between signals ( p < 0.01), while in HF-Sin it is reduced ( p < 0.05), compared with control subjects. In all heart failure groups causality between signals is diminished, but with significantly stronger causality of RR signal in respiratory signal in HF-VES. Cross-sample entropy analysis revealed the strongest synchrony between respiratory and RR signal in HF-VES group. Beside respiratory sinus arrhythmia there is another type of cardio-respiratory interaction based on the synchrony between cardiac and respiratory rhythm. Both of them are altered in heart failure patients. Respiratory sinus arrhythmia is reduced in HF-Sin patients and vanished in heart failure patients with arrhythmias. Contrary, in HF-Sin and HF-VES groups, synchrony increased, probably as consequence of some dominant neural compensatory mechanisms. The coupling of cardiac and respiratory rhythm in heart failure patients varies depending on the presence of atrial/ventricular arrhythmias and it could be revealed by complementary methods of time series analysis.

A comparison of HFrEF vs HFpEF's clinical workload and cost in the first year following hospitalization and enrollment in a disease management program.

PubMed

Murphy, T M; Waterhouse, D F; James, S; Casey, C; Fitzgerald, E; O'Connell, E; Watson, C; Gallagher, J; Ledwidge, M; McDonald, K

2017-04-01

Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype. 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic-visits, telephonic contact, medication changes over 1year using a mixture of casemix and micro-costing techniques. The total average annual cost per patient was marginally higher in patients with HFrEF €13,011 (12,011, 14,078) than HFpEF, €12,206 (11,009, 13,518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12months) & €655 (318, 1073) vs €584 (396, 812). In the first 3months of the outpatient HF-DMP the HFrEF population cost more on average €791 (764, 819) vs €693 (660, 728). There are greater short-term (3-month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3-12month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address prevention of non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Effects of high-frequency activity on latent heat flux of MJO

NASA Astrophysics Data System (ADS)

Gao, Yingxia; Hsu, Pang-Chi; Li, Tim

2018-04-01

The effect of high-frequency (HF) variability on latent heat flux (LHF) associated with the Madden-Julian Oscillation (MJO) during the boreal winter is investigated through diagnosis using two reanalysis datasets and numerical experiments of an atmospheric general circulation model (AGCM). The diagnostic results show that the HF activities exert an impact on the variability of MJO LHF mainly through their interactions with the longer than 90-day low-frequency background state (LFBS). The contribution of intraseasonal LHF induced by the interactions between LFBS and HF activities accounts for more than 20% of the total intraseasonal LHF over active MJO regions. The intraseasonal LHF induced by the LFBS-HF interaction is in phase with the MJO convection, while the total intraseasonal LHF appears at and to the west of the MJO convection center. This suggests that the intraseasonal LHF via the feedback of HF activity interacting with LFBS is conducive to the maintenance and eastward propagation of MJO convection. To confirm the role of HF disturbances in MJO convection activity, we carry out a series of experiments using the AGCM of ECHAM4, which captures well the general features of MJO. We select a number of MJO cases with enhanced convective signals and significant eastward propagation from a 30-year climatological simulation. Once the HF components of surface wind and moisture fields in LHF are excluded in model integration for each MJO case, most of the simulated MJO convection shows weakened activity and a slower propagation speed compared to the simulations containing all time-scale components. The outputs of these sensitivity experiments support the diagnostic results that HF activities contribute to the maintenance and propagation of MJO convection through the intraseasonal LHF induced by the scale interaction of HF activities with lower frequency variability.

Perceptions of Older Adults with Heart Failure on Playing an Interactive Digital e-Health Game (IDEG) for Learning About Heart Failure (HF): Prototype Development and Usability Testing.

PubMed

Radhakrishnan, Kavita; Toprac, Paul; O'Hair, Matt; Bias, Randolph; Mackert, Mike; Xie, Bo; Kim, Miyong; Bradley, Paul

2016-01-01

Effective self-management can decrease up to 50% of heart failure (HF) hospitalizations. However, self-management by patients with HF remains poor. We describe the development and usability testing of an interactive digital e-health game (IDEG) for older patients with HF in Central Texas, USA. Majority of the participants (5 out of 6) who participated in the usability testing found the game interesting, enjoyable and helpful to play. Developing an IDEG that is satisfying and acceptable to older adults with HF is feasible.

Transfer and dissipation of energy during wave group propagation on a gentle beach slope

NASA Astrophysics Data System (ADS)

Padilla, Enrique M.; Alsina, José M.

2017-08-01

The propagation of bichromatic wave groups over a constant 1:100 beach slope and the influence of the group modulation is presented. The modulation is controlled by varying the group frequency, fg, which is shown to remarkably affect the energy transfer to high and low frequency components. The growth of the high frequency (hf) wave skewness increases when fg decreases. This is explained by nonlinear coupling between the primary frequencies, which results in a larger growth of hf components as fg decreases, causing the hf waves to break earlier. Due to high spatial resolution, wave tracking has provided an accurate measurement of the varying breakpoint. These breaking locations are very well described (R2>0.91) by the wave-height to effective-depth ratio (γ). However, for any given Iribarren number, this γ is shown to increase with fg. Therefore, a modified Iribarren number is proposed to include the grouping structure, leading to a considerable improvement in reproducing the measured γ-values. Within the surf zone, the behavior of the Incident Long Wave also depends on the group modulation. For low fg conditions, the lf wave decays only slightly by transferring energy back to the hf wave components. However, for high fg wave conditions, strong dissipation of low frequency (lf) components occurs close to the shoreline associated with lf wave breaking. This mechanism is explained by the growth of the lf wave height, induced partly by the self-self interaction of fg, and partly by the nonlinear coupling between the primary frequencies and fg.

The effect of the hydrogen fluoride chain on the aromaticity of C6H6 in the C6H6...(HF)1-4 complexes

NASA Astrophysics Data System (ADS)

Jouypazadeh, Hamidreza; Farrokhpour, Hossein; Solimannejad, Mohammad

2018-02-01

The effect of the hydrogen fluoride chain ((HF)n) on the aromaticity and π character of C-C bonds of C6H6 in the C6H6...(HF)n (n = 1-4) complexes were investigated using density functional theory employing RM05 functional. It was found that the binding energy between C6H6 and different (HF)n chains showed a maximum at n = 3 (C6H6...(HF)3). Also, the π-hydrogen interaction (πHI) and the bifurcated fluorine interaction (BFI) increased and decreased the π character of the C-C bond of C6H6, respectively. In addition, the change of aromaticity of the C6H6 due to the interaction with the HF chains was also studied using three different aspects such as aromatic fluctuation index (FLU), average two centre index (ATI) and proton nuclear magnetic resonance (HNMR) spectrum. The most change in the aromaticity happens when the C6H6 interacts with (HF)3 chain. The variation of aromaticity with the binding energy and the summation of two-body terms were investigated and very good linear correlations were observed.

Hyperforin Exhibits Antigenotoxic Activity on Human and Bacterial Cells.

PubMed

Imreova, Petronela; Feruszova, Jana; Kyzek, Stanislav; Bodnarova, Kristina; Zduriencikova, Martina; Kozics, Katarina; Mucaji, Pavel; Galova, Eliska; Sevcovicova, Andrea; Miadokova, Eva; Chalupa, Ivan

2017-01-21

Hyperforin (HF), a substance that accumulates in the leaves and flowers of Hypericum perforatum L. (St. John's wort), consists of a phloroglucinol skeleton with lipophilic isoprene chains. HF exhibits several medicinal properties and is mainly used as an antidepressant. So far, the antigenotoxicity of HF has not been investigated at the level of primary genetic damage, gene mutations, and chromosome aberrations, simultaneously. The present work is designed to investigate the potential antigenotoxic effects of HF using three different experimental test systems. The antigenotoxic effect of HF leading to the decrease of primary/transient promutagenic genetic changes was detected by the alkaline comet assay on human lymphocytes. The HF antimutagenic effect leading to the reduction of gene mutations was assessed using the Ames test on the standard Salmonella typhimurium (TA97, TA98, and TA100) bacterial strains, and the anticlastogenic effect of HF leading to the reduction of chromosome aberrations was evaluated by the in vitro mammalian chromosome aberration test on the human tumor cell line HepG2 and the non-carcinogenic cell line VH10. Our findings provided evidence that HF showed antigenotoxic effects towards oxidative mutagen zeocin in the comet assay and diagnostic mutagen (4-nitroquinoline-1-oxide) in the Ames test. Moreover, HF exhibited an anticlastogenic effect towards benzo(a)pyrene and cisplatin in the chromosome aberration test.

MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care.

PubMed

Monahan, Mark; Barton, Pelham; Taylor, Clare J; Roalfe, Andrea K; Hobbs, F D Richard; Cowie, Martin; Davis, Russell; Deeks, Jon; Mant, Jonathan; McCahon, Deborah; McDonagh, Theresa; Sutton, George; Tait, Lynda

2017-08-15

Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Refining the Use of Nasal High-Flow Therapy as Primary Respiratory Support for Preterm Infants.

PubMed

Manley, Brett J; Roberts, Calum T; Frøisland, Dag H; Doyle, Lex W; Davis, Peter G; Owen, Louise S

2018-05-01

To identify clinical and demographic variables that predict nasal high-flow (nHF) treatment failure when used as a primary respiratory support for preterm infants. This secondary analysis used data from a multicenter, randomized, controlled trial comparing nHF with continuous positive airway pressure as primary respiratory support in preterm infants 28-36 completed weeks of gestation. Treatment success or failure with nHF was determined using treatment failure criteria within the first 72 hours after randomization. Infants in whom nHF treatment failed received continuous positive airway pressure, and were then intubated if failure criteria were again met. There were 278 preterm infants included, with a mean gestational age (GA) of 32.0 ± 2.1 weeks and a birth weight of 1737 ± 580 g; of these, nHF treatment failed in 71 infants (25.5%). Treatment failure was moderately predicted by a lower GA and higher prerandomization fraction of inspired oxygen (FiO 2 ): area under a receiver operating characteristic curve of 0.76 (95% CI, 0.70-0.83). Nasal HF treatment success was more likely in infants born at ≥30 weeks GA and with prerandomization FiO 2 <0.30. In preterm infants ≥28 weeks' GA enrolled in a randomized, controlled trial, lower GA and higher FiO 2 before randomization predicted early nHF treatment failure. Infants were more likely to be successfully treated with nHF from soon after birth if they were born at ≥30 weeks GA and had a prerandomization FiO 2 <0.30. However, even in this select population, continuous positive airway pressure remains superior to nHF as early respiratory support in preventing treatment failure. Australian New Zealand Clinical Trials Registry: ACTRN12613000303741. Copyright © 2018 Elsevier Inc. All rights reserved.

Lu-Hf constraints on the evolution of lunar basalts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fujimaki, H.; Tatsumoto, M.

1984-02-15

Very low Ti basalts andd green glass samples from the moon show high Lu/Hf ratios and low Hf concentrations. Low-Ti lunar basalts show high and variable Lu/Hf ratios and higher Hf concentrations, whereas high-Ti lunar basalts show low Lu/Hf ratios and high Hf concentrations. KREEP basalts have constant Lu/Hf ratios and high but variable Hf concentrations. Using the Lu-Hf behavior as a constraint, we propose a model for the mare basalts evolution. This constraint requires extensive crystallization of the primary lunar magma ocean prior to formation of the lunar mare basalt sources and the KREEP basalts. Mare basalts are producedmore » by the melting of the cumulate rocks, and KREEP basalts represent the residual liquid of the magma ocean.« less

Heart failure as a general pandemic in Asia.

PubMed

Shimokawa, Hiroaki; Miura, Masanobu; Nochioka, Kotaro; Sakata, Yasuhiko

2015-09-01

Heart failure (HF) is an epidemic in healthcare worldwide, including Asia. It appears that HF will become more serious in the near future, with the epidemiological transition and ageing of the population. However, in contrast to Western countries, information on HF epidemiology is still limited in Asia, particularly in South Asia. In this review, we will briefly summarize available information regarding the current and future burden of HF in Asia, which indicates the importance of both primary prevention of underlying diseases of HF and secondary prevention, including management of ischaemic HF, HF with preserved EF, and HF in the elderly. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

UHF Radar observations at HAARP with HF pump frequencies near electron gyro-harmonics and associated ionospheric effects

NASA Astrophysics Data System (ADS)

Watkins, Brenton; Fallen, Christopher; Secan, James

Results for HF modification experiments at the HAARP facility in Alaska are presented for experiments with the HF pump frequency near third and fourth electron gyro-harmonics. A UHF diagnostic radar with range resolution of 600 m was used to determine time-dependent altitudes of scattering from plasma turbulence during heating experiments. Experiments were conducted with multiple HF frequencies stepped by 20 kHz above and below the gyro-harmonic values. During times of HF heating the HAARP facility has sufficient power to enhance large-scale ionospheric densities in the lower ionosphere (about 150-200 km altitude) and also in the topside ionosphere (above about 350 km). In the lower ionosphere, time-dependent decreases of the altitude of radar scatter result from electron density enhancements. The effects are substantially different even for relatively small frequency steps of 20 kHz. In all cases the time-varying altitude decrease of radar scatter stops about 5-10 km below the gyro-harmonic altitude that is frequency dependent; we infer that electron density enhancements stop at this altitude where the radar signals stop decreasing with altitude. Experiments with corresponding total electron content (TEC) data show that for HF interaction altitudes above about 170 km there is substantial topside electron density increases due to upward electron thermal conduction. For lower altitudes of HF interaction the majority of the thermal energy is transferred to the neutral gas and no significant topside density increases are observed. By selecting an appropriate HF frequency a little greater than the gyro-harmonic value we have demonstrated that the ionospheric response to HF heating is a self-oscillating mode where the HF interaction altitude moves up and down with a period of several minutes. If the interaction region is above about 170 km this also produces a continuously enhanced topside electron density and upward plasma flux. Experiments using an FM scan with the HF frequency increasing near the gyro-harmonic value were conducted. The FM scan rate was sufficiently slow that the electron density was approximately in an equilibrium state. For these experiments the altitude of the HF interaction follows a near straight line downward parallel to the altitude-dependent gyro-harmonic level.

The effects of maternal and post-weaning diet interaction on glucose metabolism and gut microbiota in male mice offspring

PubMed Central

Zheng, Jia; Xiao, Xinhua; Zhang, Qian; Yu, Miao; Xu, Jianping; Qi, Cuijuan; Wang, Tong

2016-01-01

Substantial studies demonstrated that maternal nutrition can significantly determine the susceptibility to developing some metabolic diseases in offspring. However, investigations into the later-life effects of these diets on gut microbiota in the offspring are limited. Our objective was to explore the effects of maternal and post-weaning diet interaction on offspring's gut microbiota and glucose metabolism in later life. The male offspring of dams fed on either a high-fat (HF) diet or control (C) diet and then weaned to either a HF or C diet, generating four groups: C–C, HF–C, C–HF and HF–HF (n=8 in each group). The C–C offspring had lower body weight than C–HF group at 16 weeks of age (P<0.01) and both C–HF and HF–HF offspring had higher body weight than C–C group at 24 and 32 weeks of age (P<0.001 respectively). The blood glucose (BG) levels of the male offspring from the C and HF dams weaned HF diet were significantly higher at 30 min, 60 min and 120 min (P<0.001) after intraperitoneal glucose administration compared with those of the C–C group. The C–HF group had higher BG at 30 min than HF–HF group (P<0.01). Furthermore, area under the curve (AUC) in C–HF and HF–HF groups was also significantly larger than C–C group (P<0.001). Fasting BG and homoeostasis model assessment of insulin resistance (HOMA-IR) of the offspring were significantly higher in C–HF and HF–HF groups than C–C group at 32 weeks of age (P<0.05). Operational taxonomic unit (OTU), Chao and Shannon indexes showed a significantly lower diversity in C–HF offspring compared with HF–C and C–C groups (P<0.05). The dominant phyla of all the groups were Bacteroidetes, Firmicutes and Proteobacteria, which also showed significantly different percentages in the group (P<0.05). Furthermore, it is indicated that Lactobacillus and Bacteroides were significantly associated with glucose response to a glucose load (P<0.05). In conclusion, maternal and post-weaning diet interaction predisposes the offspring to aberrant glucose metabolism and alterations of gut microbiota in later life. Our study is novel in focusing on the effects of maternal and post-weaning diet interaction on offspring gut microbiota and glucose metabolism in later life. PMID:27129301

Depressive symptoms and outcomes in patients with heart failure: data from the COACH study.

PubMed

Lesman-Leegte, Ivonne; van Veldhuisen, Dirk J; Hillege, Hans L; Moser, Debra; Sanderman, Robbert; Jaarsma, Tiny

2009-12-01

To study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level. We studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 +/- 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% +/- 14%, and median BNP level: 454 pg/mL (75% CI, 195-876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score >or=16] and 200 (21%) had severe depressive symptoms (score >or=24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P = 0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P = 0.02) and mortality (HR 1.169, P = 0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death. In patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes. The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.

The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials

PubMed Central

Preiss, David; Campbell, Ross T.; Murray, Heather M.; Ford, Ian; Packard, Chris J.; Sattar, Naveed; Rahimi, Kazem; Colhoun, Helen M.; Waters, David D.; LaRosa, John C.; Amarenco, Pierre; Pedersen, Terje R.; Tikkanen, Matti J.; Koren, Michael J.; Poulter, Neil R.; Sever, Peter S.; Ridker, Paul M.; MacFadyen, Jean G.; Solomon, Scott D.; Davis, Barry R.; Simpson, Lara M.; Nakamura, Haruo; Mizuno, Kyoichi; Marfisi, Rosa M.; Marchioli, Roberto; Tognoni, Gianni; Athyros, Vasilios G.; Ray, Kausik K.; Gotto, Antonio M.; Clearfield, Michael B.; Downs, John R.; McMurray, John J.

2015-01-01

Aims The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events. Methods and results We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring <30 days after within-trial myocardial infarction (MI) were excluded. We calculated risk ratios (RR) with fixed-effects meta-analyses. In up to 17 trials with 132 538 participants conducted over 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced LDL-cholesterol by 0.97 mmol/L (weighted SD 0.38 mmol/L). Statins reduced the numbers of patients experiencing non-fatal HF hospitalization (1344/66 238 vs. 1498/66 330; RR 0.90, 95% confidence interval, CI 0.84–0.97) and the composite HF outcome (1234/57 734 vs. 1344/57 836; RR 0.92, 95% CI 0.85–0.99) but not HF death (213/57 734 vs. 220/57 836; RR 0.97, 95% CI 0.80–1.17). The effect of statins on first non-fatal HF hospitalization was similar whether this was preceded by MI (RR 0.87, 95% CI 0.68–1.11) or not (RR 0.91, 95% CI 0.84–0.98). Conclusion In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not. PMID:25802390

Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.

PubMed

García-González, P; Fabregat-Andrés, Ó; Cozar-Santiago, P; Sánchez-Jurado, R; Estornell-Erill, J; Valle-Muñoz, A; Quesada-Dorador, A; Payá-Serrano, R; Ferrer-Rebolleda, J; Ridocci-Soriano, F

2016-01-01

Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD). Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF. During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023). Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Nonlinear plasma experiments in geospace with gigawatts of RF power at HAARP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sheerin, J. P., E-mail: jsheerin@emich.edu; Cohen, Morris B., E-mail: mcohen@gatech.edu

2015-12-10

The ionosphere is the ionized uppermost layer of our atmosphere (from 70 – 500 km altitude) where free electron densities yield peak critical frequencies in the HF (3 – 30 MHz) range. The ionosphere thus provides a quiescent plasma target, stable on timescales of minutes, for a whole host of active plasma experiments. High power RF experiments on ionospheric plasma conducted in the U.S. have been reported since 1970. The largest HF transmitter built to date is the HAARP phased-array HF transmitter near Gakona, Alaska which can deliver up to 3.6 Gigawatts (ERP) of CW RF power in the range of 2.8more » – 10 MHz to the ionosphere with microsecond pointing, power modulation, and frequency agility. With an ionospheric background thermal energy in the range of only 0.1 eV, this amount of power gives access to the highest regimes of the nonlinearity (RF intensity to thermal pressure) ratio. HAARP’s unique features have enabled the conduct of a number of unique nonlinear plasma experiments in the interaction region of overdense ionospheric plasma including generation of artificial aurorae, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, parametric instabilities, stimulated electromagnetic emissions (SEE), strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and telescopes and cameras for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the HF-enhanced plasma line, and production of suprathermal electrons. One of the primary missions of HAARP, has been the generation of ELF (300 – 3000 Hz) and VLF (3 – 30 kHz) radio waves which are guided to global distances in the Earth-ionosphere waveguide. We review recent efforts to improve the efficiency of the generation ELF/VLF and develop alternative mechanisms that do not require a natural ionospheric current. Applications include the controlled study of ionospheric irregularities affecting spacecraft communication and navigation systems.« less

Nonlinear plasma experiments in geospace with gigawatts of RF power at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Cohen, Morris B.

2015-12-01

The ionosphere is the ionized uppermost layer of our atmosphere (from 70 - 500 km altitude) where free electron densities yield peak critical frequencies in the HF (3 - 30 MHz) range. The ionosphere thus provides a quiescent plasma target, stable on timescales of minutes, for a whole host of active plasma experiments. High power RF experiments on ionospheric plasma conducted in the U.S. have been reported since 1970. The largest HF transmitter built to date is the HAARP phased-array HF transmitter near Gakona, Alaska which can deliver up to 3.6 Gigawatts (ERP) of CW RF power in the range of 2.8 - 10 MHz to the ionosphere with microsecond pointing, power modulation, and frequency agility. With an ionospheric background thermal energy in the range of only 0.1 eV, this amount of power gives access to the highest regimes of the nonlinearity (RF intensity to thermal pressure) ratio. HAARP's unique features have enabled the conduct of a number of unique nonlinear plasma experiments in the interaction region of overdense ionospheric plasma including generation of artificial aurorae, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, parametric instabilities, stimulated electromagnetic emissions (SEE), strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and telescopes and cameras for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the HF-enhanced plasma line, and production of suprathermal electrons. One of the primary missions of HAARP, has been the generation of ELF (300 - 3000 Hz) and VLF (3 - 30 kHz) radio waves which are guided to global distances in the Earth-ionosphere waveguide. We review recent efforts to improve the efficiency of the generation ELF/VLF and develop alternative mechanisms that do not require a natural ionospheric current. Applications include the controlled study of ionospheric irregularities affecting spacecraft communication and navigation systems.

A Prospective Comparison Study of Heart Rate Variability During Menses in Young Women With Dysmenorrhea.

PubMed

Wang, Yu-Jen; Wang, Yi-Zen; Yeh, Mei-Ling

2016-07-01

Numerous studies have demonstrated autonomic abnormalities in various pain conditions. However, few have investigated heart rate variability (HRV) in young women with primary dysmenorrhea, and the conclusions have been inconsistent. More evidence is required to confirm the reported trend for consistent fluctuation of HRV parameters in dysmenorrhea. The study's aim was to determine whether significant differences exist between young women with and without dysmenorrhea for heart rate (HR), blood pressure (BP), and HRV parameters during menses. A prospective comparison design with repeated measures was used. Sixty-six women aged 18-25 with dysmenorrhea and 54 eumenorrheic women were recruited from a university in northern Taiwan. High-frequency and low-frequency HRV parameters (HF and LF), LF/HF ratio, BP, and HR were measured daily between 8 p.m. and 10 p.m. from Day 1 to Day 6 during menses. The generalized estimating equation was used to analyze the effects of group, time, and Group × Time interaction on these variables. HF values were significantly lower in the dysmenorrhea than in the eumenorrhea group, but there were no differences in BP, HR, LF, or LF/HF ratio. Reduced HF values reflect reduced parasympathetic activity and autonomic instability in young women with dysmenorrhea. Future longitudinal studies are warranted to examine autonomic regulation in menstrual pain of varying intensities associated with dysmenorrhea-related symptoms and to clarify the causal relationship between dysmenorrhea and HRV fluctuations. © The Author(s) 2016.

Partitioning dynamic electron correlation energy: Viewing Møller-Plesset correlation energies through Interacting Quantum Atom (IQA) energy partitioning

NASA Astrophysics Data System (ADS)

McDonagh, James L.; Vincent, Mark A.; Popelier, Paul L. A.

2016-10-01

Here MP2, MP3 and MP4(SDQ) are energy-partitioned for the first time within the Interacting Quantum Atoms (IQA) context, as proof-of-concept for H2, He2 and HF. Energies are decomposed into four primary energy contributions: (i) atomic self-energies, and atomic interaction energies comprising of (ii) Coulomb, (iii) exchange and (iv) dynamic election correlation terms. We generate and partition one- and two-particle density-matrices to obtain all atomic energy components. This work suggests that, in terms of Van der Waals dispersion, the correlation energies represent an atomic stabilisation, by proximity to other atoms, as opposed to direct interactions with other nearby atoms.

Gall midges (Hessian flies) as plant pathogens.

PubMed

Stuart, Jeff J; Chen, Ming-Shun; Shukle, Richard; Harris, Marion O

2012-01-01

Gall midges constitute an important group of plant-parasitic insects. The Hessian fly (HF; Mayetiola destructor), the most investigated gall midge, was the first insect hypothesized to have a gene-for-gene interaction with its host plant, wheat (Triticum spp.). Recent investigations support that hypothesis. The minute larval mandibles appear to act in a manner that is analogous to nematode stylets and the haustoria of filamentous plant pathogens. Putative effector proteins are encoded by hundreds of genes and expressed in the HF larval salivary gland. Cultivar-specific resistance (R) genes mediate a highly localized plant reaction that prevents the survival of avirulent HF larvae. Fine-scale mapping of HF avirulence (Avr) genes provides further evidence of effector-triggered immunity (ETI) against HF in wheat. Taken together, these discoveries suggest that the HF, and other gall midges, may be considered biotrophic, or hemibiotrophic, plant pathogens, and they demonstrate the potential that the wheat-HF interaction has in the study of insect-induced plant gall formation.

Do plasma concentrations of apelin predict prognosis in patients with advanced heart failure?

PubMed

Dalzell, Jonathan R; Jackson, Colette E; Chong, Kwok S; McDonagh, Theresa A; Gardner, Roy S

2014-01-01

Apelin is an endogenous vasodilator and inotrope, plasma concentrations of which are reduced in advanced heart failure (HF). We determined the prognostic significance of plasma concentrations of apelin in advanced HF. Plasma concentrations of apelin were measured in 182 patients with advanced HF secondary to left ventricular systolic dysfunction. The predictive value of apelin for the primary end point of all-cause mortality was assessed over a median follow-up period of 544 (IQR: 196-923) days. In total, 30 patients (17%) reached the primary end point. Of those patients with a plasma apelin concentration above the median, 14 (16%) reached the primary end point compared with 16 (17%) of those with plasma apelin levels below the median (p = NS). NT-proBNP was the most powerful prognostic marker in this population (log rank statistic: 10.37; p = 0.001). Plasma apelin concentrations do not predict medium to long-term prognosis in patients with advanced HF secondary to left ventricular systolic dysfunction.

Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF

PubMed Central

Jhund, Pardeep S.; Fu, Michael; Bayram, Edmundo; Chen, Chen-Huan; Negrusz-Kawecka, Marta; Rosenthal, Arvo; Desai, Akshay S.; Lefkowitz, Martin P.; Rizkala, Adel R.; Rouleau, Jean L.; Shi, Victor C.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; McMurray, John J.V.; Packer, Milton

2015-01-01

Background The age at which heart failure develops varies widely between countries and drug tolerance and outcomes also vary by age. We have examined the efficacy and safety of LCZ696 according to age in the Prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Methods In PARADIGM-HF, 8399 patients aged 18–96 years and in New York Heart Association functional class II–IV with an LVEF ≤40% were randomized to either enalapril or LCZ696. We examined the pre-specified efficacy and safety outcomes according to age category (years): <55 (n = 1624), 55–64 (n = 2655), 65–74 (n = 2557), and ≥75 (n = 1563). Findings The rate (per 100 patient-years) of the primary outcome of cardiovascular (CV) death or heart failure hospitalization (HFH) increased from 13.4 to 14.8 across the age categories. The LCZ696:enalapril hazard ratio (HR) was <1.0 in all categories (P for interaction between age category and treatment = 0.94) with an overall HR of 0.80 (0.73, 0.87), P < 0.001. The findings for HFH were similar for CV and all-cause mortality and the age category by treatment interactions were not significant. The pre-specified safety outcomes of hypotension, renal impairment and hyperkalaemia increased in both treatment groups with age, although the differences between treatment (more hypotension but less renal impairment and hyperkalaemia with LCZ696) were consistent across age categories. Interpretation LCZ696 was more beneficial than enalapril across the spectrum of age in PARADIGM-HF with a favourable benefit–risk profile in all age groups. PMID:26231885

Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)

PubMed Central

Mentz, Robert J.; Bittner, Vera; Schulte, Phillip J.; Fleg, Jerome L.; Piña, Ileana L.; Keteyian, Steven J.; Moe, Gordon; Nigam, Anil; Swank, Ann M.; Onwuanyi, Anekwe E.; Fitz-Gerald, Meredith; Kao, Andrew; Ellis, Stephen J.; Kraus, William E.; Whellan, David J.; O'Connor, Christopher M.

2014-01-01

Background The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF. Methods We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training. Results There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01–1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20–1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27–1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P >.5). Conclusions Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training. PMID:24016498

Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study

PubMed Central

Verdú-Rotellar, Jose María; Frigola-Capell, Eva; Alvarez-Pérez, Rosa; da Silva, Daniela; Enjuanes, Cristina; Domingo, Mar; Mena, Amparo; Muñoz, Miguel-Angel

2017-01-01

Abstract Background: Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration. Objectives: To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors. Methods: A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014. Results: Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95–0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46–5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36–2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34–3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14–4.89). Conclusion: Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis. PMID:28376668

Re-Os and Lu-Hf isotopic constraints on the formation and age of mantle pyroxenites from the Bohemian Massif

NASA Astrophysics Data System (ADS)

Ackerman, Lukáš; Bizimis, Michael; Haluzová, Eva; Sláma, Jiří; Svojtka, Martin; Hirajima, Takao; Erban, Vojtěch

2016-07-01

We report on the Lu-Hf and Re-Os isotope systematics of a well-characterized suite of spinel and garnet pyroxenites from the Gföhl Unit of the Bohemian Massif (Czech Republic, Austria). Lu-Hf mineral isochrons of three pyroxenites yield undistinguishable values in the range of 336-338 Ma. Similarly, the slope of Re-Os regression for most samples yields an age of 327 ± 31 Ma. These values overlap previously reported Sm-Nd ages on pyroxenites, eclogites and associated peridotites from the Gföhl Unit, suggesting contemporaneous evolution of all these HT-HP rocks. The whole-rock Hf isotopic compositions are highly variable with initial εHf values ranging from - 6.4 to + 66. Most samples show a negative correlation between bulk rock Sm/Hf and εHf and, when taking into account other characteristics (e.g., high 87Sr/86Sr), this may be explained by the presence of recycled oceanic sediments in the source of the pyroxenite parental melts. A pyroxenite from Horní Kounice has decoupled Hf-Nd systematics with highly radiogenic initial εHf of + 66 for a given εNd of + 7.8. This decoupling is consistent with the presence of a melt derived from a depleted mantle component with high Lu/Hf. Finally, one sample from Bečváry plots close to the MORB field in Hf-Nd isotope space consistent with its previously proposed origin as metamorphosed oceanic gabbro. Some of the websterites and thin-layered pyroxenites have variable, but high Os concentrations paralleled by low initial γOs. This reflects the interaction of the parental pyroxenitic melts with a depleted peridotite wall rock. In turn, the radiogenic Os isotope compositions observed in most pyroxenite samples is best explained by mixing between unradiogenic Os derived from peridotites and a low-Os sedimentary precursor with highly radiogenic 187Os/188Os. Steep increase of 187Os/188Os at nearly uniform 187Re/188Os found in a few pyroxenites may be connected with the absence of primary sulfides, but the presence of minor late stage sulfide-bearing veinlets likely associated with HT-HP metamorphism at crustal conditions.

Development of Motivate4Change Using the Intervention Mapping Protocol: An Interactive Technology Physical Activity and Medication Adherence Promotion Program for Hospitalized Heart Failure Patients.

PubMed

Oosterom-Calo, Rony; Te Velde, Saskia J; Stut, Wim; Brug, Johannes

2015-07-20

It is important that heart failure (HF) patients adhere to their medication regimen and engage in physical activity. Evidence shows that adherence to these HF self-management behaviors can be improved with appropriate interventions. To further promote medication adherence and physical activity among HF patients, we developed an intervention for hospitalized HF patients. The intervention mapping protocol was applied in the development of the intervention. This entailed performing a needs assessment, defining change objectives, selecting determinants and strategies, and developing the materials. The resulting intervention, Motivate4Change, makes use of interactive technology and provides HF patients with personalized feedback and advice. Specific change objectives were defined. The relevant behavioral determinants for the physical activity program were practical knowledge on physical activity performance and self-efficacy for, and perceived benefits of, physical activity. For medication-taking, the selected determinants were practical knowledge on medication-taking, perceived barriers to medication-taking, beliefs about the necessity and harm regarding the medication prescribed, and beliefs about overprescribing and harm of medication in general. The change objectives and behavior change determinants were translated in feedback and advice strategies in an interactive technology program that included tailored feedback and advice, and role models in videos in which the behaviors and overcoming barriers were demonstrated. Relevant stakeholders were involved in the interventions development process. The intervention was pretested among HF patients and adjustments were made accordingly. The interactive technology physical activity and medication adherence promotion program for hospitalized HF patients was systematically developed using the intervention mapping protocol and was based on the available theory and evidence regarding HF self-management behavior change. The intervention's efficacy is yet to be determined in evaluation research.

Spinal Cord Stimulation for Treating Chronic Pain: Reviewing Preclinical and Clinical Data on Paresthesia-Free High-Frequency Therapy.

PubMed

Chakravarthy, Krishnan; Richter, Hira; Christo, Paul J; Williams, Kayode; Guan, Yun

2018-01-01

Traditional spinal cord stimulation (SCS) requires that paresthesia overlaps chronic painful areas. However, the new paradigm high-frequency SCS (HF-SCS) does not rely on paresthesia. A review of preclinical and clinical studies regarding the use of paresthesia-free HF-SCS for various chronic pain states. We reviewed available literatures on HF-SCS, including Nevro's paresthesia-free ultra high-frequency 10 kHz therapy (HF10-SCS). Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, and manual searches of the bibliographies of known primary and review articles. The primary goal is to describe the present developing conceptions of preclinical mechanisms of HF-SCS and to review clinical efficacy on paresthesia-free HF10-SCS for various chronic pain states. HF10-SCS offers a novel pain reduction tool without paresthesia for failed back surgery syndrome and chronic axial back pain. Preclinical findings indicate that potential mechanisms of action for paresthesia-free HF-SCS differ from those of traditional SCS. To fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology. © 2017 International Neuromodulation Society.

Design for the sacubitril/valsartan (LCZ696) compared with enalapril study of pediatric patients with heart failure due to systemic left ventricle systolic dysfunction (PANORAMA-HF study).

PubMed

Shaddy, Robert; Canter, Charles; Halnon, Nancy; Kochilas, Lazaros; Rossano, Joseph; Bonnet, Damien; Bush, Christopher; Zhao, Ziqiang; Kantor, Paul; Burch, Michael; Chen, Fabian

2017-11-01

Sacubitril/valsartan (LCZ696) is an angiotensin receptor neprilysin inhibitor approved for the treatment of adult heart failure (HF); however, the benefit of sacubitril/valsartan in pediatric HF patients is unknown. This global multi-center study will use an adaptive, seamless two-part design. Part 1 will assess the pharmacokinetics/pharmacodynamics of single ascending doses of sacubitril/valsartan in pediatric (1 month to <18 years) HF patients with systemic left ventricle and reduced left ventricular systolic function stratified into 3 age groups (Group 1: 6 to <18 years; Group 2: 1 to <6 years; Group 3: 1 month to <1 year). Part 2 is a 52-week, efficacy and safety study where 360 eligible patients will be randomized to sacubitril/valsartan or enalapril. A novel global rank primary endpoint derived by ranking patients (worst-to-best outcome) based on clinical events such as death, initiation of mechanical life support, listing for urgent heart transplant, worsening HF, measures of functional capacity (NYHA/Ross scores), and patient-reported HF symptoms will be used to assess efficacy. The PANORAMA-HF study, which will be the largest prospective pediatric HF trial conducted to date and the first to use a global rank primary endpoint, will determine whether sacubitril/valsartan is superior to enalapril for treatment of pediatric HF patients with reduced systemic left ventricular systolic function. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

[Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments].

PubMed

Fernández Alonso, Cesáreo; Aguilar Mulet, Juan Mariano; Romero Pareja, Rodolfo; Rivas García, Arístides; Fuentes Ferrer, Manuel Enrique; González Armengol, Juan Jorge

2018-04-01

To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED). This was an observational, retrospective, multicentre cohort study. The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain. Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year. A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P=.049), taking >3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P=.025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P=.026). Among HF patients in the ED, the fact that of being over 65 years, taking 3or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Prognostic Significance of Interleukin-34 (IL-34) in Patients With Chronic Heart Failure With or Without Renal Insufficiency.

PubMed

Tao, Rong; Fan, Qin; Zhang, Hang; Xie, Hongyang; Lu, Lin; Gu, Gang; Wang, Fang; Xi, Rui; Hu, Jian; Chen, Qiujing; Niu, Wenquan; Shen, Weifeng; Zhang, Ruiyan; Yan, Xiaoxiang

2017-04-01

Renal dysfunction, commonly associated with cardiac dysfunction, has predictive value for adverse long-term outcomes in heart failure (HF). We previously identified a novel renal biomarker, interleukin-34 (IL-34), elevated in HF patients and associated with kidney dysfunction and coronary artery disease during HF. However, the prognostic value of IL-34 in HF remains unclear, so that the present study aimed to determine it. This prospective, observational study included 510 consecutive HF patients with their serum IL-34 as well as other variables measured at baseline, and they were followed up for 2 years. The primary end point was a composite of cardiovascular death or a first HF hospitalization, with cardiovascular death, HF hospitalization, and all-cause mortality as secondary outcomes. There was a significant and gradual increase in risk as IL-34 increased, determined by log-rank tests with Kaplan-Meier curves. Serum IL-34 was also a significant prognostic predictor of the primary end point (1.301 [1.115-1.518]; P =0.001), cardiovascular death (1.347 [1.096-1.655]; P =0.005), HF hospitalization (1.234 [1.018-1.494]; P =0.032), and all-cause mortality (1.343 [1.115-1.618]; P =0.002) in HF as per SD increase in the log IL-34 level after adjusting for age, sex, traditional risk factors, and N-terminal pro-brain natriuretic peptide. Especially, IL-34 had a more-significant prognostic value in HF patients with kidney impairment than those without. IL-34 is a significant predictor of cardiovascular death, HF hospitalization, and all-cause mortality in chronic HF, especially when concomitant with renal dysfunction. Serum IL-34 measurement may provide new insights linking kidney impairment to poor HF outcomes beyond other renal markers. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities.

PubMed

Kavalieratos, Dio; Gelfman, Laura P; Tycon, Laura E; Riegel, Barbara; Bekelman, David B; Ikejiani, Dara Z; Goldstein, Nathan; Kimmel, Stephen E; Bakitas, Marie A; Arnold, Robert M

2017-10-10

Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course. Published by Elsevier Inc.

Multi-angle Spectra Evolution of Ionospheric Turbulence Excited by RF Interactions at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Rayyan, N.; Watkins, B. J.; Watanabe, N.; Golkowski, M.; Bristow, W. A.; Bernhardt, P. A.; Briczinski, S. J., Jr.

2014-12-01

The high power HAARP HF transmitter is employed to generate and study strong Langmuir turbulence (SLT) in the interaction region of overdense ionospheric plasma. Diagnostics included the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, and HF receivers to record stimulated electromagnetic emissions (SEE). Dependence of diagnostic signals on HAARP HF parameters, including pulselength, duty-cycle, aspect angle, and frequency were recorded. Short pulse, low duty cycle experiments demonstrate control of artificial field-aligned irregularities (AFAI) and isolation of ponderomotive effects. For the first time, simultaneous multi-angle radar measurements of plasma line spectra are recorded demonstrating marked dependence on aspect angle with the strongest interaction region observed displaced southward of the HF zenith pointing angle. For a narrow range of HF pointing between Spitze and magnetic zenith, a reduced threshold for AFAI is observed. High time resolution studies of the temporal evolution of the plasma line reveal the appearance of an overshoot effect on ponderomotive timescales. Numerous measurements of the outshifted plasma line are observed. Experimental results are compared to previous high latitude experiments and predictions from recent modeling efforts

Within-Site Variation in Feather Stable Hydrogen Isotope (δ2Hf) Values of Boreal Songbirds: Implications for Assignment to Molt Origin.

PubMed

Nordell, Cameron J; Haché, Samuel; Bayne, Erin M; Sólymos, Péter; Foster, Kenneth R; Godwin, Christine M; Krikun, Richard; Pyle, Peter; Hobson, Keith A

2016-01-01

Understanding bird migration and dispersal is important to inform full life-cycle conservation planning. Stable hydrogen isotope ratios from feathers (δ2Hf) can be linked to amount-weighted long-term, growing season precipitation δ2H (δ2Hp) surfaces to create δ2Hf isoscapes for assignment to molt origin. However, transfer functions linking δ2Hp with δ2Hf are influenced by physiological and environmental processes. A better understanding of the causes and consequences of variation in δ2Hf values among individuals and species will improve the predictive ability of geographic assignment tests. We tested for effects of species, land cover, forage substrate, nest substrate, diet composition, body mass, sex, and phylogenetic relatedness on δ2Hf from individuals at least two years old of 21 songbird species captured during the same breeding season at a site in northeastern Alberta, Canada. For four species, we also tested for a year × species interaction effect on δ2Hf. A model including species as single predictor received the most support (AIC weight = 0.74) in explaining variation in δ2Hf. A species-specific variance parameter was part of all best-ranked models, suggesting variation in δ2Hf was not consistent among species. The second best-ranked model included a forage substrate × diet interaction term (AIC weight = 0.16). There was a significant year × species interaction effect on δ2Hf suggesting that interspecific differences in δ2Hf can differ among years. Our results suggest that within- and among-year interspecific variation in δ2Hf is the most important source of variance typically not being explicitly quantified in geographic assignment tests using non-specific transfer functions to convert δ2Hp into δ2Hf. However, this source of variation is consistent with the range of variation from the transfer functions most commonly being propagated in assignment tests of geographic origins for passerines breeding in North America.

The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials.

PubMed

Preiss, David; Campbell, Ross T; Murray, Heather M; Ford, Ian; Packard, Chris J; Sattar, Naveed; Rahimi, Kazem; Colhoun, Helen M; Waters, David D; LaRosa, John C; Amarenco, Pierre; Pedersen, Terje R; Tikkanen, Matti J; Koren, Michael J; Poulter, Neil R; Sever, Peter S; Ridker, Paul M; MacFadyen, Jean G; Solomon, Scott D; Davis, Barry R; Simpson, Lara M; Nakamura, Haruo; Mizuno, Kyoichi; Marfisi, Rosa M; Marchioli, Roberto; Tognoni, Gianni; Athyros, Vasilios G; Ray, Kausik K; Gotto, Antonio M; Clearfield, Michael B; Downs, John R; McMurray, John J

2015-06-21

The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events. We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first non-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring <30 days after within-trial myocardial infarction (MI) were excluded. We calculated risk ratios (RR) with fixed-effects meta-analyses. In up to 17 trials with 132 538 participants conducted over 4.3 [weighted standard deviation (SD) 1.4] years, statin therapy reduced LDL-cholesterol by 0.97 mmol/L (weighted SD 0.38 mmol/L). Statins reduced the numbers of patients experiencing non-fatal HF hospitalization (1344/66 238 vs. 1498/66 330; RR 0.90, 95% confidence interval, CI 0.84-0.97) and the composite HF outcome (1234/57 734 vs. 1344/57 836; RR 0.92, 95% CI 0.85-0.99) but not HF death (213/57 734 vs. 220/57 836; RR 0.97, 95% CI 0.80-1.17). The effect of statins on first non-fatal HF hospitalization was similar whether this was preceded by MI (RR 0.87, 95% CI 0.68-1.11) or not (RR 0.91, 95% CI 0.84-0.98). In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure.

PubMed

Pitts, Reynaria; Gunzburger, Elise; Ballantyne, Christie M; Barter, Philip J; Kallend, David; Leiter, Lawrence A; Leitersdorf, Eran; Nicholls, Stephen J; Shah, Prediman K; Tardif, Jean-Claude; Olsson, Anders G; McMurray, John J V; Kittelson, John; Schwartz, Gregory G

2017-01-10

Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk. To address this question, we examined data from the dal-OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF <40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow-up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78-1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96-1.99, P=0.08) in Cox regression models adjusted for covariates. In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Comparative Transcriptome Analysis of Fetal Skin Reveals Key Genes Related to Hair Follicle Morphogenesis in Cashmere Goats.

PubMed

Gao, Ye; Wang, Xiaolong; Yan, Hailong; Zeng, Jie; Ma, Sen; Niu, Yiyuan; Zhou, Guangxian; Jiang, Yu; Chen, Yulin

2016-01-01

Cashmere goat skin contains two types of hair follicles (HF): primary hair follicles (PHF) and secondary hair follicles (SHF). Although multiple genetic determinants associated with HF formation have been identified, the molecules that determine the independent morphogenesis of HF in cashmere goats remain elusive. The growth and development of SHF directly influence the quantity and quality of cashmere production. Here, we report the transcriptome profiling analysis of nine skin samples from cashmere goats using 60- and 120-day-old embryos (E60 and E120, respectively), as well as newborns (NB), through RNA-sequencing (RNA-seq). HF morphological changes indicated that PHF were initiated at E60, with maturation from E120, while differentiation of SHF was identified at E120 until formation of cashmere occurred after birth (NB). The RNA-sequencing analysis generated over 20.6 million clean reads from each mRNA library. The number of differentially expressed genes (DEGs) in E60 vs. E120, E120 vs. NB, and E60 vs. NB were 1,024, 0 and 1,801, respectively, indicating that no significant differences were found at transcriptomic levels between E120 and NB. Key genes including B4GALT4, TNC, a-integrin, and FGFR1, were up-regulated and expressed in HF initiation from E60 to E120, while regulatory genes such as GPRC5D, PAD3, HOXC13, PRR9, VSIG8, LRRC15, LHX2, MSX-2, and FOXN1 were up-regulated and expressed in HF keratinisation and hair shaft differentiation from E120 and NB to E60. Several genes belonging to the KRT and KRTAP gene families were detected throughout the three HF developmental stages. The transcriptional trajectory analyses of all DEGs indicated that immune privilege, glycosaminoglycan biosynthesis, extracellular matrix receptor interaction, and growth factor receptors all played dominant roles in the epithelial-mesenchymal interface and HF formation. We found that the Wnt, transforming growth factor-beta/bone morphogenetic protein, and Notch family members played vital roles in HF differentiation and maturation. The DEGs we found could be attributed to the generation and development of HF, and thus will be critically important for improving the quantity and quality of fleece production in animals for fibres.

The association between metabolic syndrome and its components and heart failure in patients referred to a primary care facility.

PubMed

Coelho, Flávio Augusto Colucci; Moutinho, Marco Aurélio Espósito; Miranda, Verônica Alcooforado de; Tavares, Leandro Reis; Rachid, Maurício; Rosa, Maria Luiza Garcia; Mesquita, Evandro Tinoco

2007-07-01

Metabolic syndrome (MS) is characterized by a collection of risk factors that are associated with elevated rates of cardiovascular events and the risk of developing heart failure (HF). In our field, the association of MS in stable chronic HF patients has not been established. To determine the prevalence of MS in relation to gender and HF type in patients treated at a Primary Care Facility. Between January 2005 and August 2006, 144 patients were included in a cross sectional study. An echocardiogram, using the modified criteria of the EPICA study, was performed to determine whether or not the patient had HF, and of which type. Statistical analysis was conducted using the software SAS System, version 6.04, and statistical significance was established as 5%. MS was observed in 111 patients (77%), of which 73 (66%) were females: odds ratio (OR) 0.195--(confidence interval--CI = 0.08 - 0.46) and p< 0.0001. HF was identified in 102 patients (71%) with a great correlation between females and the presence of MS: 51 patients (65%); OR 0.116 (CI = 0.36- 0.37) and p < 0.0001. Among the HF patients, 61 (42%) presented HF with preserved systolic function and 41 (29%) with systolic dysfunction; p = ns. HF with preserved systolic function was associated with the presence of MS in 53 (87%) of the 61 patients, p = 0.022. In our community, MS is closely related to HF with preserved systolic function and to the female gender.

Addition of Supervised Exercise Training to a Post-Hospital Disease Management Program for Patients Recently Hospitalized With Acute Heart Failure: The EJECTION-HF Randomized Phase 4 Trial.

PubMed

Mudge, Alison M; Denaro, Charles P; Scott, Adam C; Meyers, Deborah; Adsett, Julie A; Mullins, Robert W; Suna, Jessica M; Atherton, John J; Marwick, Thomas H; Scuffham, Paul; O'Rourke, Peter

2018-02-01

This study sought to measure the impact on all-cause death or readmission of adding center-based exercise training (ET) to disease management programs for patients with a recent acute heart failure (HF) hospitalization. ET is recommended for patients with HF, but evidence is based mainly on ET as a single intervention in stable outpatients. A randomized, controlled trial with blinded outcome assessor, enrolling adult participants with HF discharged from 5 hospitals in Queensland, Australia. All participants received HF-disease management program plus supported home exercise program; intervention participants were offered 24 weeks of supervised center-based ET. Primary outcome was all-cause 12-month death or readmission. Pre-planned subgroups included age (<70 years vs. older), sex, left ventricular ejection fraction (≤40% vs. >40%), and exercise adherence. Between May 2008 and July 2013, 278 participants (140 intervention, 138 control) were enrolled: 98 (35.3%) age ≥70 years, 71 (25.5%) females, and 62 (23.3%) with a left ventricular ejection fraction of >40%. There were no adverse events associated with ET. There was no difference in primary outcome between groups (84 of 140 [60.0%] intervention vs. 90 of 138 [65.2%] control; p = 0.37), but a trend toward greater benefit in participants age <70 years (OR: 0.56 [95% CI: 0.30 to 1.02] vs. OR: 1.56 [95% CI: 0.67 to 3.64]; p for interaction = 0.05). Participants who exercised to guidelines (72 of 101 control and 92 of 117 intervention at 3 months) had a significantly lower rate of death and readmission (91 of 164 [55.5%] vs. 41 of 54 [75.9%]; p = 0.008). Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management?; ACTRN12608000263392). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Risk Factor Burden, Heart Failure, and Survival in Women of Different Ethnic Groups: Insights From the Women's Health Initiative.

PubMed

Breathett, Khadijah; Leng, Iris; Foraker, Randi E; Abraham, William T; Coker, Laura; Whitfield, Keith E; Shumaker, Sally; Manson, JoAnn E; Eaton, Charles B; Howard, Barbara V; Ijioma, Nkechinyere; Cené, Crystal W; Martin, Lisa W; Johnson, Karen C; Klein, Liviu

2018-05-01

The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11 996), white (n=18 479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased ( P <0.0001, interaction of race/ethnicity and RF number P =0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs ( P <0.0001) but differed by racial/ethnic group (interaction P =0.001). The number of RFs was not associated with the risk of death after developing HF in any group ( P =0.25; interaction P =0.48). Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups. © 2018 American Heart Association, Inc.

Ionospheric Turbulence and the Evolution of Artificial Irregularities Excited by RF Interactions at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Rayyan, N.; Watkins, B. J.; Bristow, W. A.; Bernhardt, P. A.

2015-12-01

The HAARP phased-array HF transmitter at Gakona, AK delivers up to 3.6 GW (ERP) of HF power in the range of 2.8 - 10 MHz to the ionosphere with millisecond pointing, power modulation, and frequency agility. HAARP's unique features have enabled the conduct of a number of nonlinear plasma experiments in the interaction region of overdense ionospheric plasma including stimulated electromagnetic emissions (SEE), artificial aurora, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and telescopes and cameras for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the plasma line, and suprathermal electrons. For a narrow range of HF pointing between Spitze and magnetic zenith, a reduced threshold for AFAI is observed. Applications are made to the study of irregularities relevant to spacecraft communication and navigation systems.

Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis.

PubMed

Jonkman, Nini H; Westland, Heleen; Groenwold, Rolf H H; Ågren, Susanna; Atienza, Felipe; Blue, Lynda; Bruggink-André de la Porte, Pieta W F; DeWalt, Darren A; Hebert, Paul L; Heisler, Michele; Jaarsma, Tiny; Kempen, Gertrudis I J M; Leventhal, Marcia E; Lok, Dirk J A; Mårtensson, Jan; Muñiz, Javier; Otsu, Haruka; Peters-Klimm, Frank; Rich, Michael W; Riegel, Barbara; Strömberg, Anna; Tsuyuki, Ross T; van Veldhuisen, Dirk J; Trappenburg, Jaap C A; Schuurmans, Marieke J; Hoes, Arno W

2016-03-22

Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently. A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients <65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01). This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients. © 2016 American Heart Association, Inc.

Spironolactone Therapy in Chronic Stable Right HF Trial

ClinicalTrials.gov

2018-04-12

Chronic Right-Sided Heart Failure; Pulmonary Arterial Hypertension; Pulmonary Hypertension, Primary, 2; Pulmonary Hypertension, Primary, 3; Pulmonary Hypertension, Primary, 4; Cardiomyopathy Right Ventricular

Rapid Mobilization of Membrane Lipids in Wheat Leaf-Sheaths during Incompatible Interactions with Hessian Fly*

PubMed Central

Zhu, Lieceng; Liu, Xuming; Wang, Haiyan; Khajuria, Chitvan; Reese, John C.; Whitworth, R. Jeff; Welti, Ruth; Chen, Ming-Shun

2013-01-01

Hessian fly (HF) is a biotrophic insect that interacts with wheat on a gene-for-gene basis. We profiled changes in membrane lipids in two isogenic wheat lines: a susceptible line and its backcrossed offspring containing the resistance gene H13. Our results revealed a 32 to 45% reduction in total concentrations of 129 lipid species in resistant plants during incompatible interactions within 24 h after HF attack. A smaller and delayed response was observed in susceptible plants during compatible interactions. Microarray and real-time PCR analyses of 168 lipid-metabolism related transcripts revealed that the abundance of many of these transcripts increased rapidly in resistant plants after HF attack, but did not change in susceptible plants. In association with the rapid mobilization of membrane lipids, the concentrations of some fatty acids and 12-oxo-phytodienoic acid (OPDA) increased specifically in resistant plants. Exogenous application of OPDA increased mortality of HF larvae significantly. Collectively, our data, along with previously published results, indicate that the lipids were mobilized through lipolysis, producing free fatty acids, which were likely further converted into oxylipins and other defense molecules. Our results suggest that rapid mobilization of membrane lipids constitutes an important step for wheat to defend against HF attack. PMID:22668001

Statistical Modeling of Zr/Hf Extraction using TBP-D2EHPA Mixtures

NASA Astrophysics Data System (ADS)

Rezaeinejhad Jirandehi, Vahid; Haghshenas Fatmehsari, Davoud; Firoozi, Sadegh; Taghizadeh, Mohammad; Keshavarz Alamdari, Eskandar

2012-12-01

In the present work, response surface methodology was employed for the study and prediction of Zr/Hf extraction curves in a solvent extraction system using D2EHPA-TBP mixtures. The effect of change in the levels of temperature, nitric acid concentration, and TBP/D2EHPA ratio (T/D) on the Zr/Hf extraction/separation was studied by the use of central composite design. The results showed a statistically significant effect of T/D, nitric acid concentration, and temperature on the extraction percentage of Zr and Hf. In the case of Zr, a statistically significant interaction was found between T/D and nitric acid, whereas for Hf, both interactive terms between temperature and T/D and nitric acid were significant. Additionally, the extraction curves were profitably predicted applying the developed statistical regression equations; this approach is faster and more economical compared with experimentally obtained curves.

Hydraulic fracture height limits and fault interactions in tight oil and gas formations

NASA Astrophysics Data System (ADS)

Flewelling, Samuel A.; Tymchak, Matthew P.; Warpinski, Norm

2013-07-01

widespread use of hydraulic fracturing (HF) has raised concerns about potential upward migration of HF fluid and brine via induced fractures and faults. We developed a relationship that predicts maximum fracture height as a function of HF fluid volume. These predictions generally bound the vertical extent of microseismicity from over 12,000 HF stimulations across North America. All microseismic events were less than 600 m above well perforations, although most were much closer. Areas of shear displacement (including faults) estimated from microseismic data were comparatively small (radii on the order of 10 m or less). These findings suggest that fracture heights are limited by HF fluid volume regardless of whether the fluid interacts with faults. Direct hydraulic communication between tight formations and shallow groundwater via induced fractures and faults is not a realistic expectation based on the limitations on fracture height growth and potential fault slip.

Meter-scale Hf isotopic changes in the MORB mantle by interaction with pyroxenite-derived melts: insight from the Ligurian Ophiolites (Italy)

NASA Astrophysics Data System (ADS)

Rampone, E.; Borghini, G.; Class, C.; Goldstein, S. L.; Cai, Y.; Cipriani, A.; Zanetti, A.; Hofmann, A. W.

2017-12-01

Melt percolation and melt-peridotite interaction are efficient processes in creating chemical and isotopic heterogeneity in the upper mantle at variable scale. Such processes can generate a pyroxenite-bearing veined mantle often invoked as source of the oceanic magmatism. Natural examples of such veined mantle are however scarce, as well as studies combining geochemical and isotopic investigations with detailed field control and sampling. Mantle lherzolites in the External Liguride ophiolites (Northern Apennines) contain cm-thick pyroxenite layers that originated by deep infiltration of MORB-type melts (Borghini et al., 2016, J.Petrology 57). In a previous study (Borghini et al, 2013, Geology 41), we showed that geochemical gradients are preserved across the pyroxenite-peridotite contact, and the host peridotites have been modified in terms of modal, chemical and Nd isotopic composition, by reaction with pyroxenite-derived melts. Such interaction caused systematic lowering of the Sm/Nd ratios in clinopyroxene of the host peridotite at >0.1 m scale, and over time this resulted in decimeter-scale Nd isotopic heterogeneity, larger than the Nd isotopic variability of global abyssal peridotites. In this paper, we show the results of Lu-Hf isotopic investigations, performed on the same peridotite-pyroxenite profiles, aimed to test the existence of Hf isotopic changes in mantle peridotite induced by a pyroxenite component. In both peridotites and pyroxenites, initial (160Ma) EpsilonHf versus EpsilonNd values define an overall positive correlation, almost covering the entire MORB variation, and extending beyond the depleted end of the MORB field. As documented for Nd isotopes, the lowest 176Lu/177Hf and 176Hf/177Hf ratios are shown by peridotites adjacent to pyroxenite layers, as a result of reaction with pyroxenite-derived melts. Internal Lu-Hf isochrones on two pyroxenite-peridotite profiles have yielded Ordovician ages of pyroxenite emplacement, consistent with previous Sm-Nd investigations (Borghini et al., 2013). Our results point to predominant coherent behaviour of Hf and Nd isotopes during melt percolation and melt-peridotite interaction, and corroborate the role of such processes in creating the enriched mantle components often invoked to explain the isotopic variability of MORBs.

Screening approach for identifying candidate drugs and drug-drug interactions related to hip fracture risk in persons with Alzheimer disease.

PubMed

Tolppanen, Anna-Maija; Taipale, Heidi; Koponen, Marjaana; Tanskanen, Antti; Lavikainen, Piia; Paananen, Jussi; Tiihonen, Jari; Hartikainen, Sirpa

2017-08-01

To assess whether a "drugome-wide" screen with case-crossover design is a feasible approach for identifying candidate drugs and drug-drug interactions. All community-dwelling residents of Finland who received a clinically verified Alzheimer disease diagnosis in 2005 to 2011 and experienced incident hip fracture (HF) afterwards (N = 4851). Three scenarios were used to test the sensitivity of this approach (1) hazard period 0 to 30 and control period 31 to 61 days before HF, (2) hazard period 0 to 30 and control period 336 to 366 days before HF, and (3) hazard period 0 to 14 and control period 16 to 30 days before HF. Nine, 44, and 5 drugs were associated with increased HF risk and 8, 23, and 4 with decreased risk in scenarios 1, 2, and 3, respectively. Six drugs were identified with scenario 1 only and 54 and 1 with scenarios 2 and 3, respectively. Only six drugs (metoprolol, simvastatin, trimethoprim, codeine combinations, fentanyl, and paracetamol) were associated with HF in all scenarios, four with 1 and 2 (cefalexin, buprenorphine, olanzapine, and memantine), and one with 1 and 3 (enalapril) or 2 and 3 (ciprofloxacin). The direction of associations was the same in all/both scenarios. The interaction results were equally versatile, with hydroxocobalamin*oxazepam being the only interaction observed in all scenarios. Case-crossover analysis is a potential approach for identifying candidate drugs and drug-drug interactions associated with adverse events as it implicitly controls for fixed confounders. The results are highly dependent on applied hazard and control periods, but the choice of periods can help in targeting the analyses to different phases of drug use. Copyright © 2017 John Wiley & Sons, Ltd.

Magma-magma interaction in the mantle beneath eastern China

NASA Astrophysics Data System (ADS)

Zeng, Gang; Chen, Li-Hui; Yu, Xun; Liu, Jian-Qiang; Xu, Xi-Sheng; Erdmann, Saskia

2017-04-01

In addition to magma-rock and rock-rock reaction, magma-magma interaction at mantle depth has recently been proposed as an alternative mechanism to produce the compositional diversity of intraplate basalts. However, up to now no compelling geochemical evidence supports this novel hypothesis. Here we present geochemistry for the Longhai basalts from Fujian Province, southeastern China, which demonstrates the interaction between two types of magma at mantle depth. At Longhai, the basalts form two groups, low-Ti basalts (TiO2/MgO < 0.25) and high-Ti basalts (TiO2/MgO > 0.25). Calculated primary compositions of the low-Ti basalts have compositions close to L + Opx + Cpx + Grt cotectic, and they also have low CaO contents (7.1-8.1 wt %), suggesting a mainly pyroxenite source. Correlations of Ti/Gd and Zr/Hf with the Sm/Yb ratios, however, record binary mixing between the pyroxenite-derived melt and a second, subordinate source-derived melt. Melts from this second source component have low Ti/Gd and high Zr/Hf and Ca/Al ratios, thus likely representing a carbonated component. The Sr, Nd, Hf, and Pb isotopic compositions of the high-Ti basalts are close to the low-Ti basalts. The Sm/Yb ratio of the high-Ti basalts, however, is markedly elevated and characterized by crossing rare earth element patterns at Ho, suggesting that they have source components comparable to the low-Ti basalts, but that they have experienced garnet and clinopyroxene fractionation. We posit that mingling of SiO2-saturated tholeiitic magma with SiO2-undersaturated alkaline magma might trigger such fractionation. Therefore, the model of magma-magma interaction and associated deep evolution of magma in the mantle is proposed to explain the formation of Longhai basalts. It may, moreover, serve as a conceptual model for the formation of tholeiitic to alkaline intraplate basalts worldwide.

Impact of worsening renal function related to medication in heart failure.

PubMed

Brunner-La Rocca, Hans-Peter; Knackstedt, Christian; Eurlings, Luc; Rolny, Vinzent; Krause, Friedemann; Pfisterer, Matthias E; Tobler, Daniel; Rickenbacher, Peter; Maeder, Micha T

2015-02-01

Renal failure is a major challenge in treating heart failure (HF) patients. HF medication may deteriorate renal function, but the impact thereof on outcome is unknown. We investigated the effects of HF medication on worsening renal function (WRF) and the relationship to outcome. This post-hoc analysis of TIME-CHF (NT-proBNP-guided vs. symptom-guided management in chronic HF) included patients with LVEF ≤45% and ≥1 follow-up visit (n = 462). WRF III was defined as a rise in serum creatinine ≥0.5 mg/dL (i.e. 44.2 µmol/L) at any time during the first 6 months. Four classes of medication were considered: loop diuretics, beta-blockers, renin-angiotensin system (RAS)-blockers, and spironolactone. Functional principal component analysis of daily doses was used to comprehend medication over time. All-cause mortality after 18 months was the primary outcome. Interactions between WRF, medication, and outcome were tested. Patients with WRF III received on average higher loop diuretic doses (P = 0.0002) and more spironolactone (P = 0.02), whereas beta-blockers (P = 0.69) did not differ and lower doses of RAS-blockers were given (P = 0.09). There were significant interactions between WRF III, medicationn and outcome. Thus, WRF III was associated with poor prognosis if high loop diuretic doses were given (P = 0.001), but not with low doses (P = 0.29). The opposite was found for spironolactone (poor prognosis in the case of WRF III with no spironolactone, P <0.0001; but not with spironolactone, P = 0.31). Beta-blockers were protective in all patients (P <0.001), but most in those with WRF III (P <0.05 for interaction). RAS-blockade was associated with improved outcome (P = 0.006), irrespective of WRF III. Based on this analysis, it may be hypothesized that high doses of loop diuretics might have detrimental effects, particularly in combination with significant WRF, whereas spironolactone and beta-blockers might be protective in patients with WRF. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

Mediterranean diet and risk of heart failure: results from the PREDIMED randomized controlled trial.

PubMed

Papadaki, Angeliki; Martínez-González, Miguel Ángel; Alonso-Gómez, Angel; Rekondo, Javier; Salas-Salvadó, Jordi; Corella, Dolores; Ros, Emilio; Fitó, Montse; Estruch, Ramon; Lapetra, José; García-Rodriguez, Antonio; Fiol, Miquel; Serra-Majem, Lluís; Pintó, Xavier; Ruiz-Canela, Miguel; Bulló, Monica; Serra-Mir, Mercè; Sorlí, Jose V; Arós, Fernando

2017-09-01

The aim of this study was to evaluate the effect of the Mediterranean diet (MedDiet) on the incidence of heart failure (HF), a pre-specified secondary outcome in the PREDIMED (PREvención con DIeta MEDiterránea) primary nutrition-intervention prevention trial. Participants at high risk of cardiovascular disease were randomly assigned to one of three diets: MedDiet supplemented with extra-virgin olive oil (EVOO), MedDiet supplemented with nuts, or a low-fat control diet. Incident HF was ascertained by a Committee for Adjudication of events blinded to group allocation. Among 7403 participants without prevalent HF followed for a median of 4.8 years, we observed 29 new HF cases in the MedDiet with EVOO group, 33 in the MedDiet with nuts group, and 32 in the control group. No significant association with HF incidence was found for the MedDiet with EVOO and MedDiet with nuts, compared with the control group [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.41-1.13, and HR 0.92; 95% CI 0.56-1.49, respectively]. In this sample of adults at high cardiovascular risk, the MedDiet did not result in lower HF incidence. However, this pre-specified secondary analysis may have been underpowered to provide valid conclusions. Further randomized controlled trials with HF as a primary outcome are needed to better assess the effect of the MedDiet on HF risk. ISRCTN35739639. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Signaling Networks among Stem Cell Precursors, Transit-Amplifying Progenitors, and their Niche in Developing Hair Follicles.

PubMed

Rezza, Amélie; Wang, Zichen; Sennett, Rachel; Qiao, Wenlian; Wang, Dongmei; Heitman, Nicholas; Mok, Ka Wai; Clavel, Carlos; Yi, Rui; Zandstra, Peter; Ma'ayan, Avi; Rendl, Michael

2016-03-29

The hair follicle (HF) is a complex miniorgan that serves as an ideal model system to study stem cell (SC) interactions with the niche during growth and regeneration. Dermal papilla (DP) cells are required for SC activation during the adult hair cycle, but signal exchange between niche and SC precursors/transit-amplifying cell (TAC) progenitors that regulates HF morphogenetic growth is largely unknown. Here we use six transgenic reporters to isolate 14 major skin and HF cell populations. With next-generation RNA sequencing, we characterize their transcriptomes and define unique molecular signatures. SC precursors, TACs, and the DP niche express a plethora of ligands and receptors. Signaling interaction network analysis reveals a bird's-eye view of pathways implicated in epithelial-mesenchymal interactions. Using a systematic tissue-wide approach, this work provides a comprehensive platform, linked to an interactive online database, to identify and further explore the SC/TAC/niche crosstalk regulating HF growth. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The Structure of Liquid and Amorphous Hafnia.

PubMed

Gallington, Leighanne C; Ghadar, Yasaman; Skinner, Lawrie B; Weber, J K Richard; Ushakov, Sergey V; Navrotsky, Alexandra; Vazquez-Mayagoitia, Alvaro; Neuefeind, Joerg C; Stan, Marius; Low, John J; Benmore, Chris J

2017-11-10

Understanding the atomic structure of amorphous solids is important in predicting and tuning their macroscopic behavior. Here, we use a combination of high-energy X-ray diffraction, neutron diffraction, and molecular dynamics simulations to benchmark the atomic interactions in the high temperature stable liquid and low-density amorphous solid states of hafnia. The diffraction results reveal an average Hf-O coordination number of ~7 exists in both the liquid and amorphous nanoparticle forms studied. The measured pair distribution functions are compared to those generated from several simulation models in the literature. We have also performed ab initio and classical molecular dynamics simulations that show density has a strong effect on the polyhedral connectivity. The liquid shows a broad distribution of Hf-Hf interactions, while the formation of low-density amorphous nanoclusters can reproduce the sharp split peak in the Hf-Hf partial pair distribution function observed in experiment. The agglomeration of amorphous nanoparticles condensed from the gas phase is associated with the formation of both edge-sharing and corner-sharing HfO 6,7 polyhedra resembling that observed in the monoclinic phase.

[Heart failure in primary care in Italy: analysis of management and needs by general practitioners].

PubMed

Tarantini, Luigi; Cioffi, Giovanni; Pulignano, Giovanni; Del Sindaco, Donatella; Aspromontes, Nadia; Valle, Roberto; Di Tano, Giuseppe; Misuraca, Gianfranco; Clemenza, Francesco; Di Lenarda, Andrea

2010-09-01

Heart failure (HF) is a major clinical problem and a challenge for healthcare systems. Primary care physicians (PCPs) play an important role in the clinical management of HF patients. The aim of the present investigation was to evaluate the behaviors and problems of Italian PCPs in managing patients with HF. Clinical behaviors and perceived obstacles were evaluated through the administration of a modified version of the Euro-HF questionnaire to a nationwide sample of 385 PCPs. Out of 389 042 persons entitled to receive their medical assistance, all PCPs declared to care 9263 patients with HF (prevalence of HF 2.4%, 24 HF patients/PCP). HF was diagnosed either by symptoms only (14% of cases), or by analysis of symptoms plus signs (57%), by combining the evidence of cardiac dysfunction by echocardiography to the assessment of symptoms and signs (12%) or by adding consultation by a cardiologist to the clinical assessment in the PCP office (17%). Forty-two percent of the PCPs participating in the survey had a free access to echocardiography whereas measurement of natriuretic peptide serum levels was freely available to 14% of PCPs. Pharmacological therapy for HF prescribed by the PCPs included in this survey included: diuretics (91%), inhibitors of the renin-angiotensin system (87%), digitalis (34%), beta-blockers (33%), aldosterone antagonists (23%). Drugs considered to potentially leading to major side effects were: digitalis (51%), beta-blockers (48%) and diuretics (47%), much less angiotensin-converting enzyme-inhibitors (17%) and aldosterone antagonists (14%). Consultation with a cardiologist for starting beta-blocker treatment was judged mandatory by 57% of PCPs. Management of HF patients was considered sufficient by 70% of PCPs. Improvement in the access to echocardiography, laboratory data and consultation with a specialist were the priorities indicated by PCPs for optimizing the management of HF patients. PCPs have a suboptimal approach to the diagnostic evaluation of HF patients and to implementation and management of beta-blocker therapy. These behaviors derive from a difficult access to echocardiography, laboratory parameters and consultation with a cardiologist.

Effect of multimorbidity on survival of patients diagnosed with heart failure: a retrospective cohort study in Singapore.

PubMed

Kaur, Palvinder; Saxena, Nakul; You, Alex Xiaobin; Wong, Raymond C C; Lim, Choon Pin; Loh, Seet Yoong; George, Pradeep Paul

2018-05-20

Multimorbidity in patients with heart failure (HF) results in poor prognosis and is an increasing public health concern. We aim to examine the effect of multimorbidity focusing on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) on all-cause and cardiovascular disease (CVD)-specific mortality among patients diagnosed with HF in Singapore. Retrospective cohort study. Primary and tertiary care in three (out of six) Regional Health Systems in Singapore. Patients diagnosed with HF between 2003 and 2016 from three restructured hospitals and nine primary care polyclinics were included in this retrospective cohort study. All-cause mortality and CVD-specific mortality. A total of 34 460 patients diagnosed with HF from 2003 to 2016 were included in this study and were followed up until 31 December 2016. The median follow-up time was 2.1 years. Comorbidities prior to HF diagnosis were considered. Patients were categorised as (1) HF only, (2) T2DM+HF, (3) CKD+HF and (4) T2DM+CKD+HF. Cox regression model was used to determine the effect of multimorbidity on (1) all-cause mortality and (2) CVD-specific mortality. Adjusting for demographics, other comorbidities, baseline treatment and duration of T2DM prior to HF diagnosis, 'T2DM+CKD+HF' patients had a 56% higher risk of all-cause mortality (HR: 1.56, 95% CI 1.48 to 1.63) and a 44% higher risk of CVD-specific mortality (HR: 1.44, 95% CI 1.32 to 1.56) compared with patients diagnosed with HF only. All-cause and CVD-specific mortality risks increased with increasing multimorbidity. This study highlights the need for a new model of care that focuses on holistic patient management rather than disease management alone to improve survival among patients with HF with multimorbidity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Characterization of Ceramic Plasma-Sprayed Coatings, and Interaction Studies Between U-Zr Fuel and Ceramic Coated Interface at an Elevated Temperature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ki Hwan Kim; Chong Tak Lee; R. S. Fielding

2011-08-01

Candidate coating materials for re-usable metallic nuclear fuel crucibles, HfN, TiC, ZrC, and Y2O3, were plasma-sprayed onto niobium substrates. The coating microstructure and the thermal cycling behavior were characterized, and U-Zr melt interaction studies carried out. The Y2O3 coating layer had a uniform thickness and was well consolidated with a few small pores scattered throughout. While the HfN coating was not well consolidated with a considerable amount of porosity, but showed somewhat uniform thickness. Thermal cycling tests on the HfN, TiC, ZrC, and Y2O3 coatings showed good cycling characteristics with no interconnected cracks forming even after 20 cycles. Interaction studiesmore » done on the coated samples by dipping into a U-20wt.%Zr melt indicated that HfN and Y2O3 did not form significant reaction layers between the melt and the coating while the TiC and the ZrC coatings were significantly degraded. Y2O3 exhibited the most promising performance among HfN, TiC, ZrC, and Y2O3 coatings.« less

hfAIM: A reliable bioinformatics approach for in silico genome-wide identification of autophagy-associated Atg8-interacting motifs in various organisms

PubMed Central

Xie, Qingjun; Tzfadia, Oren; Levy, Matan; Weithorn, Efrat; Peled-Zehavi, Hadas; Van Parys, Thomas; Van de Peer, Yves; Galili, Gad

2016-01-01

ABSTRACT Most of the proteins that are specifically turned over by selective autophagy are recognized by the presence of short Atg8 interacting motifs (AIMs) that facilitate their association with the autophagy apparatus. Such AIMs can be identified by bioinformatics methods based on their defined degenerate consensus F/W/Y-X-X-L/I/V sequences in which X represents any amino acid. Achieving reliability and/or fidelity of the prediction of such AIMs on a genome-wide scale represents a major challenge. Here, we present a bioinformatics approach, high fidelity AIM (hfAIM), which uses additional sequence requirements—the presence of acidic amino acids and the absence of positively charged amino acids in certain positions—to reliably identify AIMs in proteins. We demonstrate that the use of the hfAIM method allows for in silico high fidelity prediction of AIMs in AIM-containing proteins (ACPs) on a genome-wide scale in various organisms. Furthermore, by using hfAIM to identify putative AIMs in the Arabidopsis proteome, we illustrate a potential contribution of selective autophagy to various biological processes. More specifically, we identified 9 peroxisomal PEX proteins that contain hfAIM motifs, among which AtPEX1, AtPEX6 and AtPEX10 possess evolutionary-conserved AIMs. Bimolecular fluorescence complementation (BiFC) results verified that AtPEX6 and AtPEX10 indeed interact with Atg8 in planta. In addition, we show that mutations occurring within or nearby hfAIMs in PEX1, PEX6 and PEX10 caused defects in the growth and development of various organisms. Taken together, the above results suggest that the hfAIM tool can be used to effectively perform genome-wide in silico screens of proteins that are potentially regulated by selective autophagy. The hfAIM system is a web tool that can be accessed at link: http://bioinformatics.psb.ugent.be/hfAIM/. PMID:27071037

A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States.

PubMed

Voigt, Jeff; Sasha John, M; Taylor, Andrew; Krucoff, Mitchell; Reynolds, Matthew R; Michael Gibson, C

2014-05-01

The annual cost of heart failure (HF) is estimated at $39.2 billion. This has been acknowledged to underestimate the true costs for care. The objective of this analysis is to more accurately assess these costs. Publicly available data sources were used. Cost calculations incorporated relevant factors such as Medicare hospital cost-to-charge ratios, reimbursement from both government and private insurance, and out-of-pocket expenditures. A recently published Atherosclerosis Risk in Communities (ARIC) HF scheme was used to adjust the HF classification scheme. Costs were calculated with HF as the primary diagnosis (HF in isolation, or HFI) or HF as one of the diagnoses/part of a disease milieu (HF syndrome, or HFS). Total direct costs for HF were calculated at $60.2 billion (HFI) and $115.4 billion (HFS). Indirect costs were $10.6 billion for both. Costs attributable to HF may represent a much larger burden to US health care than what is commonly referenced. These revised and increased costs have implications for policy makers.

Efficacy of Sacubitril/Valsartan Relative to a Prior Decompensation: The PARADIGM-HF Trial.

PubMed

Solomon, Scott D; Claggett, Brian; Packer, Milton; Desai, Akshay; Zile, Michael R; Swedberg, Karl; Rouleau, Jean; Shi, Victor; Lefkowitz, Martin; McMurray, John J V

2016-10-01

This study assessed whether the benefit of sacubtril/valsartan therapy varied with clinical stability. Despite the benefit of sacubitril/valsartan therapy shown in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, it has been suggested that switching from an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker should be delayed until occurrence of clinical decompensation. Outcomes were compared among patients who had prior hospitalization within 3 months of screening (n = 1,611 [19%]), between 3 and 6 months (n = 1,009 [12%]), between 6 and 12 months (n = 886 [11%]), >12 months (n = 1,746 [21%]), or who had never been hospitalized (n = 3,125 [37%]). Twenty percent of patients without prior HF hospitalization experienced a primary endpoint of cardiovascular death or heart failure (HF) hospitalization during the course of the trial. Despite the increased risk associated with more recent hospitalization, the efficacy of sacubitril/valsartan therapy did not differ from that of enalapril according to the occurrence of or time from hospitalization for HF before screening, with respect to the primary endpoint or with respect to cardiovascular or all-cause mortality. Patients with recent HF decompensation requiring hospitalization were more likely to experience cardiovascular death or HF hospitalization than those who had never been hospitalized. Patients who were clinically stable, as shown by a remote HF hospitalization (>3 months prior to screening) or by lack of any prior HF hospitalization, were as likely to benefit from sacubitril/valsartan therapy as more recently hospitalized patients. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Older adults with heart failure treated with carvedilol, bisoprolol, or metoprolol tartrate: risk of mortality.

PubMed

Perreault, Sylvie; de Denus, Simon; White, Michel; White-Guay, Brian; Bouvier, Michel; Dorais, Marc; Dubé, Marie-Pierre; Rouleau, Jean-Lucien; Tardif, Jean-Claude; Jenna, Sarah; Haibe-Kains, Benjamin; Leduc, Richard; Deblois, Denis

2017-01-01

The long-term use of β-blockers has been shown to improve clinical outcomes among patients with heart failure (HF). However, a lack of data persists in assessing whether carvedilol or bisoprolol are superior to metoprolol tartrate in clinical practice. We endeavored to compare the effectiveness of β-blockers among older adults following a primary hospital admission for HF. We conducted a cohort study using Quebec administrative databases to identify patients who were using β-blockers, carvedilol, bisoprolol, or metoprolol tartrate after the diagnosis of HF. We characterized the patients by the type of β-blocker prescribed at discharge of their first HF hospitalization. An adjusted multivariate Cox proportional hazards model was used to compare the primary outcome of all-cause mortality. We also conducted analyses by matching for a propensity score for initiation of β-blocker therapy and assessed the effect on primary outcome. Among 3197 patients with HF with a median follow-up of 2.8 years, the crude annual mortality rates (per 100 person-years) were at 16, 14.9, and 17.7 for metoprolol tartrate, carvedilol, and bisoprolol, respectively. Adjusted hazard ratios of carvedilol (hazard ratio 0.92; 0.78-1.09) and bisoprolol (hazard ratio 1.04; 0.93-1.16) were not significantly different from that of metoprolol tartrate in improving survival. After matching for propensity score, carvedilol and bisoprolol showed no additional benefit with respect to all-cause mortality compared with metoprolol tartrate. Our evidence suggests no differential effect of β-blockers on all-cause mortality among older adults with HF. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Tracking magmatic processes through Zr/Hf ratios in rocks and Hf and Ti zoning in zircons: An example from the Spirit Mountain batholith, Nevada

USGS Publications Warehouse

Lowery, Claiborne L.E.; Miller, C.F.; Walker, B.A.; Wooden, J.L.; Mazdab, F.K.; Bea, F.

2006-01-01

Zirconium and Hf are nearly identical geochemically, and therefore most of the crust maintains near-chondritic Zr/Hf ratios of ???35-40. By contrast, many high-silica rhyolites and granites have anomalously low Zr/Hf (15-30). As zircon is the primary reservoir for both Zr and Hf and preferentially incorporates Zr, crystallization of zircon controls Zr/ Hf, imprinting low Zr/Hf on coexisting melt. Thus, low Zr/Hf is a unique fingerprint of effective magmatic fractionation in the crust. Age and compositional zonation in zircons themselves provide a record of the thermal and compositional histories of magmatic systems. High Hf (low Zr/ Hf) in zircon zones demonstrates growth from fractionated melt, and Ti provides an estimate of temperature of crystallization (TTiZ) (Watson and Harrison, 2005). Whole-rock Zr/Hf and zircon zonation in the Spirit Mountain batholith, Nevada, document repeated fractionation and thermal fluctuations. Ratios of Zr/Hf are ???30-40 for cumulates and 18-30 for high-SiO2 granites. In zircons, Hf (and U) are inversely correlated with Ti, and concentrations indicate large fluctuations in melt composition and TTiZ (>100??C) for individual zircons. Such variations are consistent with field relations and ion-probe zircon geochronology that indicate a >1 million year history of repeated replenishment, fractionation, and extraction of melt from crystal mush to form the low Zr/Hf high-SiO2 zone. ?? 2006 The Mineralogical Society.

Architecting Systems for Human Space Flight

NASA Technical Reports Server (NTRS)

Wocken, Gerald

2002-01-01

Human-system interactions have been largely overlooked in the traditional systems engineering process. Awareness of human factors (HF) has increased in the past few years, but the involvement of HF specialists is still often too little and too late. In systems involving long-duration human space flight, it is essential that the human component be properly considered in the initial architectural definition phase, as well as throughout the system design process. HF analysis must include not only the strengths and limitations of humans in general, but the variability between individuals and within an individual over time, and the dynamics of group interactions.

Lu-Hf isotopic memory of plume-lithosphere interaction in the source of layered mafic intrusions, Windimurra Igneous Complex, Yilgarn Craton, Australia

NASA Astrophysics Data System (ADS)

Nebel, O.; Arculus, R. J.; Ivanic, T. J.; Nebel-Jacobsen, Y. J.

2013-10-01

Most layered mafic intrusions (LMI) are formed via multiple magma injections into crustal magma chambers. These magmas are originally sourced from the mantle, likely via plume activity, but may interact with the overriding lithosphere during ascent and emplacement in the crust. The magma injections lead to the establishment of different layers and zones with complex macroscopic, microscopic and cryptic compositional layering through magmatic differentiation and associated cumulate formation, sometimes accompanied by crustal assimilation. These complex mineralogical and petrological processes obscure the nature of the mantle sources of LMI, and typically have limited the degree to which parental liquids can be fully characterised. Here, we present Lu-Hf isotope data for samples from distinct layers of the Upper Zone of the Windimurra Igneous Complex (WIC), an immense late-Archean LMI in the West Australian Yilgarn Craton. Lu-Hf isotope systematics of whole rocks are well correlated (MSWD=5.6, n=17) with an age of ˜3.05±0.05 Ga and initial ɛHf˜+8. This age, however, is older than whole rock Sm-Nd and zircon U-Pb ages of the intrusion, both of which are ca. 2.8 Ga. Stratigraphically-controlled initial Hf isotope variations (associated with multiple episodes of emplacement at ca. 2.8 Ga) indicate isotope mixing between a near-chondritic and an ultra-radiogenic component, the latter with ɛHf[2.8 Ga]>+15. This Hf isotope mixing creates a pseudochron-relationship at the time of intrusion of ˜250 Myr that is superimposed on subsequent radiogenic ingrowth after crystallisation, generating an age that predates the actual emplacement event. Mixing between late-stage crystallisation products (melt + crystals) from the Middle Zone and replenishing, plume-derived liquids was followed by crystal accumulation in a chemically evolving magma chamber. The ultra-radiogenic Hf isotope endmember in the WIC mantle source requires parent-daughter ratios consistent with very early formation in Earth history, akin to early Archean komatiitic plume sources. We propose that plume-derived melts that formed the Windimurra LMI reacted with ancient refractory lithospheric keels already underpinning ancient cratons, creating a melt with extremely high ɛHf[t]. Melting a refractory component with super-chondritic, time-integrated high Lu/Hf, in this case by plume-lithosphere interaction, simultaneously accounts for the extreme Hf isotope signals, Hf-Nd isotope decoupling, and difference in radiometric Lu-Hf and Sm-Nd ages.

Comorbidities and polypharmacy.

PubMed

von Lueder, Thomas G; Atar, Dan

2014-04-01

Heart failure (HF) is predominantly a disease that affects the elderly population, a cohort in which comorbidities are common. The majority of comorbidities and the degree of their severity have prognostic implications in HF. Polypharmacy in HF is common, has increased throughout the past 2 decades, and may pose a risk for adverse drug interactions, accidental overdosing, or medication nonadherence. Polypharmacy, in particular in the elderly, is rarely assessed in traditional clinical trials, highlighting a need for entirely novel HF research strategies. Copyright © 2014 Elsevier Inc. All rights reserved.

Hyperforin inhibits Akt1 kinase activity and promotes caspase-mediated apoptosis involving Bad and Noxa activation in human myeloid tumor cells.

PubMed

Merhi, Faten; Tang, Ruoping; Piedfer, Marion; Mathieu, Julie; Bombarda, Isabelle; Zaher, Murhaf; Kolb, Jean-Pierre; Billard, Christian; Bauvois, Brigitte

2011-01-01

The natural phloroglucinol hyperforin HF displays anti-inflammatory and anti-tumoral properties of potential pharmacological interest. Acute myeloid leukemia (AML) cells abnormally proliferate and escape apoptosis. Herein, the effects and mechanisms of purified HF on AML cell dysfunction were investigated in AML cell lines defining distinct AML subfamilies and primary AML cells cultured ex vivo. HF inhibited in a time- and concentration-dependent manner the growth of AML cell lines (U937, OCI-AML3, NB4, HL-60) by inducing apoptosis as evidenced by accumulation of sub-G1 population, phosphatidylserine externalization and DNA fragmentation. HF also induced apoptosis in primary AML blasts, whereas normal blood cells were not affected. The apoptotic process in U937 cells was accompanied by downregulation of anti-apoptotic Bcl-2, upregulation of pro-apoptotic Noxa, mitochondrial membrane depolarization, activation of procaspases and cleavage of the caspase substrate PARP-1. The general caspase inhibitor Z-VAD-fmk and the caspase-9- and -3-specific inhibitors, but not caspase-8 inhibitor, significantly attenuated apoptosis. HF-mediated apoptosis was associated with dephosphorylation of active Akt1 (at Ser(473)) and Akt1 substrate Bad (at Ser(136)) which activates Bad pro-apoptotic function. HF supppressed the kinase activity of Akt1, and combined treatment with the allosteric Akt1 inhibitor Akt-I-VIII significantly enhanced apoptosis of U937 cells. Our data provide new evidence that HF's pro-apoptotic effect in AML cells involved inhibition of Akt1 signaling, mitochondria and Bcl-2 members dysfunctions, and activation of procaspases -9/-3. Combined interruption of mitochondrial and Akt1 pathways by HF may have implications for AML treatment.

Hyperforin Inhibits Akt1 Kinase Activity and Promotes Caspase-Mediated Apoptosis Involving Bad and Noxa Activation in Human Myeloid Tumor Cells

PubMed Central

Merhi, Faten; Tang, Ruoping; Piedfer, Marion; Mathieu, Julie; Bombarda, Isabelle; Zaher, Murhaf; Kolb, Jean-Pierre; Billard, Christian; Bauvois, Brigitte

2011-01-01

Background The natural phloroglucinol hyperforin HF displays anti-inflammatory and anti-tumoral properties of potential pharmacological interest. Acute myeloid leukemia (AML) cells abnormally proliferate and escape apoptosis. Herein, the effects and mechanisms of purified HF on AML cell dysfunction were investigated in AML cell lines defining distinct AML subfamilies and primary AML cells cultured ex vivo. Methodology and Results HF inhibited in a time- and concentration-dependent manner the growth of AML cell lines (U937, OCI-AML3, NB4, HL-60) by inducing apoptosis as evidenced by accumulation of sub-G1 population, phosphatidylserine externalization and DNA fragmentation. HF also induced apoptosis in primary AML blasts, whereas normal blood cells were not affected. The apoptotic process in U937 cells was accompanied by downregulation of anti-apoptotic Bcl-2, upregulation of pro-apoptotic Noxa, mitochondrial membrane depolarization, activation of procaspases and cleavage of the caspase substrate PARP-1. The general caspase inhibitor Z-VAD-fmk and the caspase-9- and -3-specific inhibitors, but not caspase-8 inhibitor, significantly attenuated apoptosis. HF-mediated apoptosis was associated with dephosphorylation of active Akt1 (at Ser473) and Akt1 substrate Bad (at Ser136) which activates Bad pro-apoptotic function. HF supppressed the kinase activity of Akt1, and combined treatment with the allosteric Akt1 inhibitor Akt-I-VIII significantly enhanced apoptosis of U937 cells. Significance Our data provide new evidence that HF's pro-apoptotic effect in AML cells involved inhibition of Akt1 signaling, mitochondria and Bcl-2 members dysfunctions, and activation of procaspases -9/-3. Combined interruption of mitochondrial and Akt1 pathways by HF may have implications for AML treatment. PMID:21998731

Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink).

PubMed

Brachmann, Johannes; Böhm, Michael; Rybak, Karin; Klein, Gunnar; Butter, Christian; Klemm, Hanno; Schomburg, Rolf; Siebermair, Johannes; Israel, Carsten; Sinha, Anil-Martin; Drexler, Helmut

2011-07-01

The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment. Methods Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink 'on' vs. 'off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power. The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014.

Acupuncture analgesia involves modulation of pain-induced gamma oscillations and cortical network connectivity.

PubMed

Hauck, Michael; Schröder, Sven; Meyer-Hamme, Gesa; Lorenz, Jürgen; Friedrichs, Sunja; Nolte, Guido; Gerloff, Christian; Engel, Andreas K

2017-11-24

Recent studies support the view that cortical sensory, limbic and executive networks and the autonomic nervous system might interact in distinct manners under the influence of acupuncture to modulate pain. We performed a double-blind crossover design study to investigate subjective ratings, EEG and ECG following experimental laser pain under the influence of sham and verum acupuncture in 26 healthy volunteers. We analyzed neuronal oscillations and inter-regional coherence in the gamma band of 128-channel-EEG recordings as well as heart rate variability (HRV) on two experimental days. Pain ratings and pain-induced gamma oscillations together with vagally-mediated power in the high-frequency bandwidth (vmHF) of HRV decreased significantly stronger during verum than sham acupuncture. Gamma oscillations were localized in the prefrontal cortex (PFC), mid-cingulate cortex (MCC), primary somatosensory cortex and insula. Reductions of pain ratings and vmHF-power were significantly correlated with increase of connectivity between the insula and MCC. In contrast, connectivity between left and right PFC and between PFC and insula correlated positively with vmHF-power without a relationship to acupuncture analgesia. Overall, these findings highlight the influence of the insula in integrating activity in limbic-saliency networks with vagally mediated homeostatic control to mediate antinociception under the influence of acupuncture.

Heart failure in sub-Saharan Africa: A clinical approach.

PubMed

Kraus, S; Ogunbanjo, G; Sliwa, K; Ntusi, N A B

2016-01-01

Despite medical advances, heart failure (HF) remains a global health problem and sub-Saharan Africa (SSA) is no exception, with decompensated HF being the most common primary diagnosis for patients admitted to hospital with heart disease. In SSA the in-hospital mortality rate of decompensated HF is up to 8.3%. HF is a clinical syndrome that is caused by a diverse group of aetiologies, each requiring unique management strategies, highlighting the need for diagnostic certainty and a broad understanding of the complex pathophysiology of this condition. While there are a number of advanced medical, device and surgical interventions being tailored for HF internationally, the fundamental basic principles of HF management, such as patient education, effective management of congestion and initiation of disease-modifying medical therapies, remain a challenge on our continent. This review addresses both the epidemiology of HF in SSA and principles of management that focus specifically on symptom relief, prevention of hospitalisation and improving survival in this population.

Rugged, Portable, Real-Time Optical Gaseous Analyzer for Hydrogen Fluoride

NASA Technical Reports Server (NTRS)

Pilgrim, Jeffrey; Gonzales, Paula

2012-01-01

Hydrogen fluoride (HF) is a primary evolved combustion product of fluorinated and perfluorinated hydrocarbons. HF is produced during combustion by the presence of impurities and hydrogen- containing polymers including polyimides. This effect is especially dangerous in closed occupied volumes like spacecraft and submarines. In these systems, combinations of perfluorinated hydrocarbons and polyimides are used for insulating wiring. HF is both highly toxic and short-lived in closed environments due to its reactivity. The high reactivity also makes HF sampling problematic. An infrared optical sensor can detect promptly evolving HF with minimal sampling requirements, while providing both high sensitivity and high specificity. A rugged optical path length enhancement architecture enables both high HF sensitivity and rapid environmental sampling with minimal gaseous contact with the low-reactivity sensor surfaces. The inert optical sample cell, combined with infrared semiconductor lasers, is joined with an analog and digital electronic control architecture that allows for ruggedness and compactness. The combination provides both portability and battery operation on a simple camcorder battery for up to eight hours. Optical detection of gaseous HF is confounded by the need for rapid sampling with minimal contact between the sensor and the environmental sample. A sensor is required that must simultaneously provide the required sub-parts-permillion detection limits, but with the high specificity and selectivity expected of optical absorption techniques. It should also be rugged and compact for compatibility with operation onboard spacecraft and submarines. A new optical cell has been developed for which environmental sampling is accomplished by simply traversing the few mm-thick cell walls into an open volume where the measurement is made. A small, low-power fan or vacuum pump may be used to push or pull the gaseous sample into the sample volume for a response time of a few seconds. The optical cell simultaneously provides for an enhanced optical interaction path length between the environmental sample and the infrared laser. Further, the optical cell itself is comprised of inert materials that render it immune to attack by HF. In some cases, the sensor may be configured so that the optoelectronic devices themselves are protected and isolated from HF by the optical cell. The optical sample cell is combined with custom-developed analog and digital control electronics that provide rugged, compact operation on a platform that can run on a camcorder battery. The sensor is inert with respect to acidic gases like HF, while providing the required sensitivity, selectivity, and response time. Certain types of combustion events evolve copious amounts of HF, very little of other gases typically associated with combustion (e.g., carbon monoxide), and very low levels of aerosols and particulates (which confound traditional smoke detectors). The new sensor platform could warn occupants early enough to take the necessary countermeasures.

Translating and testing the ENABLE: CHF-PC concurrent palliative care model for older adults with heart failure and their family caregivers.

PubMed

Dionne-Odom, J Nicholas; Kono, Alan; Frost, Jennifer; Jackson, Lisa; Ellis, Daphne; Ahmed, Ali; Azuero, Andres; Bakitas, Marie

2014-09-01

Heart failure (HF) and palliative care (PC) organizations recommend early PC to improve the quality of life of patients living with HF. We conducted a two-phase formative evaluation study to translate a cancer-focused concurrent PC intervention into one that would be appropriate for rural-dwelling adults with New York Heart Association Class III-IV HF and their primary caregivers. Phase I: We tailored the intervention for an HF population via literature review, expert consultation, and clinician (N=15) small group interviews. Phase II: We enrolled 11 patient/caregiver dyads to assess intervention feasibility and satisfaction. We assessed participants' experiences and satisfaction after session/week three and session/week six via digitally recorded interviews. Clinician and participant interviews were transcribed and content analyzed. Outcome measures were evaluated for completion rates and effect sizes. Phase I: Clinicians described barriers to initiating PC in HF, triggers for initiating PC, and suggestions for intervention improvement. Phase II: Participants were able to complete the majority of study sessions, measures, and interviews. Satisfaction interviews revealed the content to be relevant and comprehensive in addressing HF patient and caregiver primary concerns; however, participants unanimously suggested making the intervention available earlier in the illness trajectory. Efficacy measures demonstrated small to medium effect sizes. We tailored and demonstrated feasibility of providing an early, concurrent palliative care intervention to patients with advanced HF and their caregivers. Based on this experience we are now conducting an efficacy trial in a racially diverse sample.

Multi-angle Spectra Evolution of Langmuir Turbulence Excited by RF Ionospheric Interactions at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Rayyan, N.; Watkins, B. J.; Bristow, W. A.; Spaleta, J.; Watanabe, N.; Golkowski, M.; Bernhardt, P. A.

2013-12-01

The high power HAARP HF transmitter is employed to generate and study strong Langmuir turbulence (SLT) in the interaction region of overdense ionospheric plasma. Diagnostics included the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, and HF receivers to record stimulated electromagnetic emissions (SEE). Dependence of diagnostic signals on HAARP HF parameters, including pulselength, duty-cycle, aspect angle, and frequency were recorded. Short pulse, low duty cycle experiments demonstrate control of artificial field-aligned irregularities (AFAI) and isolation of ponderomotive effects. Among the effects observed and studied are: SLT spectra including cascade, collapse, and co-existence spectra and an outshifted plasma line under certain ionospheric conditions. High time resolution studies of the temporal evolution of the plasma line reveal the appearance of an overshoot effect on ponderomotive timescales. Bursty turbulence is observed in the collapse and cascade lines. For the first time, simultaneous multi-angle radar measurements of plasma line spectra are recorded demonstrating marked dependence on aspect angle with the strongest interaction region observed displaced southward of the HF zenith pointing angle. Numerous measurements of the outshifted plasma line are observed. Experimental results are compared to previous high latitude experiments and predictions from recent modeling efforts.

Assessment and Management of Volume Overload and Congestion in Chronic Heart Failure: Can Measuring Blood Volume Provide New Insights?

PubMed

Miller, Wayne L

2017-01-01

Volume overload and fluid congestion remain primary clinical challenges in the assessment and management of patients with chronic heart failure (HF). The pathophysiology of volume regulation is complex, and the simple concept of passive intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to the central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in chronic HF. The quantitative assessment of intravascular volume is an effective tool to help guide individualized, appropriate therapy. Not all volume overload is the same, and the measurement of intravascular volume identifies heterogeneity to guide tailored therapy.

Extreme Hafnium Values in Archean Banded Iron Formations: Evidence for Sedimentary Lu/Hf Fractionation at 3.2 Ga or Diagenesis?

NASA Astrophysics Data System (ADS)

Foster, I. S.; Agranier, A.; Heubeck, C. E.; Köhler, I.; Homann, M.; Tripati, A. K.; Nonnotte, P.; Ponzevera, E.; Lalonde, S.

2017-12-01

The emergence of continental crust above sea level in the early Precambrian would have created the first terrestrial habitats, and initiated atmosphere-driven weathering of the continents, yet the history of continental emergence is largely unknown[1]. Precambrian chemical sediments, specifically Banded Iron Formation (BIF), appear to have sampled the Hf-Nd isotope composition of ancient seawater, and may preserve a historical record of the emergence of the continental landmass[2] via Lu/Hf fractionation induced by subaerial differential weathering[3,4]. However, paired Hf-Nd isotope data are available for only one BIF to date, indicating appreciable emerged continental landmass ca. 2.7 Ga[2]. Our work extends this record back into the Eo- and Meso-Archean using samples of 3.8 Ga BIF from Isua, Greenland, and 3.2 Ga BIF from the Moodies Group, S. Africa. Isua samples appear to have been altered by amphibolite-grade metamorphism, however Moodies Group samples appear primary, having experienced significantly lower metamorphic grades. Moodies samples appear to retain their primary seawater signatures, however, their range of ˜Hf(i) values, from -54.6 to +40.7, is among the most extreme ever reported. Such extreme values may be indicative of one of several possibilities: unusual and intense sedimentary Lu/Hf fractionation during the Mesoarchean relative to today, sampling of a continuum of compositions from two sources with distinct Hf-compositions, or the result of early diagenetic processes occurring soon after the deposition of the Moodies Group BIF. These results suggest that interpretation of ˜Hf and ˜Nd data from BIF is not as straightforward as previously suggested[2], and positive ˜Hf values are not necessarily indicative of emerged continental crust. [1] Flament et al. (2013), Precambrian Research, 229, 177-188. [2] Veihmann et al. (2014), Geology, 42, 115-118. [3] Bayon et al. (2006), Geology, 34, 433-436. [4] Vervoort et al. (2011), Geochimica et Cosmochimica Acta, 75, 5903-5926.

Nature, nurture or nutrition? Impact of maternal nutrition on maternal care, offspring development and reproductive function

PubMed Central

Connor, K L; Vickers, M H; Beltrand, J; Meaney, M J; Sloboda, D M

2012-01-01

We have previously reported that offspring of mothers fed a high fat (HF) diet during pregnancy and lactation enter puberty early and are hyperleptinaemic, hyperinsulinaemic and obese as adults. Poor maternal care and bonding can also impact offspring development and disease risk. We therefore hypothesized that prenatal nutrition would affect maternal care and that an interaction may exist between a maternal HF diet and maternal care, subsequently impacting on offspring phenotype. Wistar rats were mated and randomized to control dams fed a control diet (CON) or dams fed a HF diet from conception until the end of lactation (HF). Maternal care was assessed by observing maternal licking and grooming of pups between postnatal day (P)3 and P8. Postweaning (P22), offspring were fed a control (–con) or HF (–hf) diet. From P27, pubertal onset was assessed. At ∼P105 oestrous cyclicity was investigated. Maternal HF diet reduced maternal care; HF-fed mothers licked and groomed pups less than CON dams. Maternal fat:lean ratio was higher in HF dams at weaning and was associated with higher maternal plasma leptin and insulin concentrations, but there was no effect of maternal care on fat:lean ratio or maternal hormone levels. Both female and male offspring of HF dams were lighter from birth to P11 than offspring of CON dams, but by P19, HF offspring were heavier than controls. Prepubertal retroperitoneal fat mass was greater in pups from HF-fed dams compared to CON and was associated with elevated circulating leptin concentrations in females only, but there was neither an effect of maternal care, nor an interaction between maternal diet and care on prepubertal fat mass. Pups from HF-fed dams went into puberty early and this effect was exacerbated by a postweaning HF diet. Maternal and postweaning HF diets independently altered oestrous cyclicity in females: female offspring of HF-fed mothers were more likely to have prolonged or persistent oestrus, whilst female offspring fed a HF diet postweaning were more likely to have irregular oestrous cycles and were more likely to have prolonged or persistent oestrus. These data indicate that maternal HF nutrition during pregnancy and lactation results in a maternal obese phenotype and has significant impact on maternal care during lactation. Maternal and postweaning nutritional signals, independent of maternal care, alter offspring body fat pre-puberty and female reproductive function in adulthood, which may be associated with advanced ovarian ageing and altered fertility. PMID:22411006

Nonlinear Interactions within the D-Region Ionosphere

NASA Astrophysics Data System (ADS)

Moore, Robert

2016-07-01

This paper highlights the best results obtained during D-region modification experiments performed by the University of Florida at the High-frequency Active Auroral Research Program (HAARP) observatory between 2007 and 2014. Over this period, we saw a tremendous improvement in ELF/VLF wave generation efficiency. We identified methods to characterize ambient and modified ionospheric properties and to discern and quantify specific types of interactions. We have demonstrated several important implications of HF cross-modulation effects, including "Doppler Spoofing" on HF radio waves. Throughout this talk, observations are compared with the predictions of an ionospheric HF heating model to provide context and guidance for future D-region modification experiments.

Hydrogen doping in HfO{sub 2} resistance change random access memory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duncan, D.; Magyari-Köpe, B.; Nishi, Y.

2016-01-25

The structures and energies of hydrogen-doped monoclinic hafnium dioxide were calculated using density-functional theory. The electronic interactions are described within the LDA + U formalism, where on-site Coulomb corrections are applied to the 5d orbital electrons of Hf atoms and 2p orbital electrons of the O atoms. The effects of charge state, defect-defect interactions, and hydrogenation are investigated and compared with experiment. It is found that hydrogenation of HfO{sub 2} resistance-change random access memory devices energetically stabilizes the formation of oxygen vacancies and conductive vacancy filaments through multiple mechanisms, leading to improved switching characteristic and device yield.

Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients.

PubMed

Fox, Henrik; Bitter, Thomas; Horstkotte, Dieter; Oldenburg, Olaf

2017-06-01

Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

The Palliative Care in Heart Failure (PAL-HF) Trial: Rationale and Design

PubMed Central

Mentz, Robert J.; Tulsky, James A.; Granger, Bradi B.; Anstrom, Kevin J.; Adams, Patricia A.; Dodson, Gwen C.; Fiuzat, Mona; Johnson, Kimberly S.; Patel, Chetan B.; Steinhauser, Karen E.; Taylor, Donald H.; O’Connor, Christopher M.; Rogers, Joseph G.

2014-01-01

Background The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. Methods The Palliative Care in Heart Failure trial (PAL-HF) is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or re-hospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns and advanced care planning. The primary endpoint is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary endpoints include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization and quality of life. Conclusions PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost-effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic endpoints. PMID:25440791

Relation of Angina Pectoris to Outcomes, Quality of Life and Response to Exercise Training in Patients with Chronic Heart Failure (from HF-ACTION)

PubMed Central

Parikh, Kishan S.; Coles, Adrian; Schulte, Phillip J.; Kraus, William E.; Fleg, Jerome L.; Keteyian, Steven J.; Piña, Ileana L.; Fiuzat, Mona; Whellan, David J.; O’Connor, Christopher M.; Mentz, Robert J.

2016-01-01

Angina pectoris (AP) is associated with worse outcomes in heart failure (HF). We investigated the association of AP with health-related quality of life (HRQoL), exercise capacity, and clinical outcomes, and its interaction with exercise training in a HF population. We grouped 2,331 HF patients with reduced ejection fraction (EF) in the HF-ACTION trial of usual care +/− exercise training according to whether they had self-reported AP by Canadian classification score (CCS). HRQoL and clinical outcomes were assessed by AP status. In HF-ACTION, 406 (17%) patients had AP at baseline (44% with CCS ≥ II) with HF severity similar to those without AP. Patients with AP had similar baseline exercise capacity but worse depressive symptoms and HRQoL. AP was associated with 22% greater adjusted risk for all-cause mortality/hospitalizations, driven by hospitalizations. There was significant interaction between baseline AP and exercise training peak VO2 change (P=0.019), but not other endpoints. Exercise training was associated with greater peak VO2 improvement after 3 months in patients with AP (treatment effect=1.25 mL/kg/min, 95% CI=0.6–1.9). In conclusion, AP was associated with worse HRQoL and depressive symptoms. Despite greater peak VO2 improvement with exercise training, patients with AP experienced more adverse outcomes. PMID:27561194

Rationale, design, and baseline characteristics of the DANish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillators in patients with non-ischemic Systolic Heart failure on mortality (DANISH).

PubMed

Thune, Jens Jakob; Pehrson, Steen; Nielsen, Jens Cosedis; Haarbo, Jens; Videbæk, Lars; Korup, Eva; Jensen, Gunnar; Hildebrandt, Per; Steffensen, Flemming Hald; Bruun, Niels Eske; Eiskjær, Hans; Brandes, Axel; Thøgersen, Anna Margrethe; Egstrup, Kenneth; Hastrup-Svendsen, Jesper; Høfsten, Dan Eik; Torp-Pedersen, Christian; Køber, Lars

2016-09-01

The effect of an implantable cardioverter defibrillator (ICD) in patients with symptomatic systolic heart failure (HF) caused by coronary artery disease is well documented. However, the effect of primary prophylactic ICDs in patients with systolic HF not due to coronary artery disease is much weaker. In addition, HF management has improved, since the landmark ICD trials and a large proportion of patients now receive cardiac resynchronization therapy (CRT) where the effect of ICD treatment is unknown. In the DANISH study, 1,116 patients with symptomatic systolic HF not caused by coronary artery disease have been randomized to receive an ICD or not, in addition to contemporary standard therapy. The primary outcome of the trial is time to all-cause death. Follow-up will continue until June 2016 with a median follow-up period of 5 years. Baseline characteristics show that enrolled patients are treated according to current guidelines. At baseline, 97% of patients received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 92% received a β-blocker, 58% a mineralocorticoid receptor antagonist, and 58% were scheduled to receive CRT. Median age was 63 years (range, 21-84 years) at baseline, and 28% were women. DANISH will provide pertinent information about the effect on all-cause mortality of a primary prophylactic ICD in patients with symptomatic systolic HF not caused by coronary artery disease on contemporary standard therapy including CRT. Copyright © 2016 Elsevier Inc. All rights reserved.

The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF.

PubMed

Mogensen, Ulrik M; Køber, Lars; Kristensen, Søren L; Jhund, Pardeep S; Gong, Jianjian; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Swedberg, Karl; Zile, Michael R; Solomon, Scott D; Packer, Milton; McMurray, John J V

2017-06-01

Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73-0.87], P<.001), the broader composite (HR 0.83 [0.76-0.90], P<.001) and the coronary composite (HR 0.83 [0.75-0.92], P<.001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited. Copyright © 2017 Elsevier Inc. All rights reserved.

Hair follicle is a target of stress hormone and autoimmune reactions.

PubMed

Ito, Taisuke

2010-11-01

Interest in the hair follicle (HF) has recently increased, yet the detailed mechanisms of HF function and immune privilege (IP) have not yet been elucidated. This review discusses the critical points of immunobiology and hormonal aspects of HFs. The HF is a unique mini-organ because it has its own immune system and hormonal milieu. In addition, the HF immune and hormonal systems may greatly affect skin immunobiology. Therefore, knowledge of HF immunobiology and hormonal aspects will lead to a better understanding of skin biology. The HF has a unique hair cycle (anagen, catagen and telogen) and contains stem cells in the bulge area. The HF is closely related to sebaceous glands and the nervous system. This article reviews the interaction between the endocrine/immune system and HFs, including the pathogenesis of alopecia areata associated with stress. Copyright © 2010 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

Spectroscopic study of 3-Hydroxyflavone - protein interaction in lipidic bi-layers immobilized on silver nanoparticles

NASA Astrophysics Data System (ADS)

Voicescu, Mariana; Ionescu, Sorana; Nistor, Cristina L.

2017-01-01

The interaction of 3-Hydroxyflavone with serum proteins (BSA and HSA) in lecithin lipidic bi-layers (PC) immobilized on silver nanoparticles (SNPs), was studied by fluorescence and Raman spectroscopy. BSA secondary structure was quantified with a deconvolution algorithm, showing a decrease in α-helix structure when lipids were added to the solution. The effect of temperature on the rate of the excited-state intra-molecular proton transfer and on the dual fluorescence emission of 3-HF in the HSA/PC/SNPs systems was discussed. Evaluation of the antioxidant activity of 3-HF in HSA/PC/SNPs systems was also studied. The antioxidant activity of 3-HF decreased in the presence of SNPs. The results are discussed with relevance to the secondary structure of proteins and of the 3-HF based nano-systems to a topical formulation useful in the oxidative stress process.

Joint Commission Requirements for Discharge Instructions in Patients with Heart Failure: Is Understanding Important for Preventing Readmissions?

PubMed Central

Regalbuto, Ricky; Maurer, Mathew S.; Chapel, David; Mendez, Jenniliz; Shaffer, Jonathan A.

2014-01-01

Background Many approaches have been considered to reduce heart failure (HF) readmissions. The Joint Commission (JCO) requires hospitals to provide patients admitted for HF with discharge instructions that address six topics related to HF management: diet, exercise, weight monitoring, worsening symptoms, medications, and follow up appointments. These guidelines were developed based on expert opinion, but no one has tested whether patients’ understanding of these instructions affects 30-day readmission rates. Methods and Results We conducted a prospective cohort study of patients admitted for decompensated HF. Patients completed an understanding survey immediately after their nurse read their discharge papers. The survey contained one question for each of the six JCO topics. Of the 145 patients in the study, only 14 (10%) understood all 6 discharge instructions. Patients with complete comprehension of their discharge instructions were significantly less likely to be readmitted within 30 days than those with non-perfect understanding (p = 0.044), but this association was no longer significant after controlling for level of education and use of English as a primary language. Conclusions HF patients’ comprehension of discharge instructions is inadequate. Patients with limited education and those that do not speak English as a primary language are more likely to have poorer discharge understanding and higher rates of 30-day readmissions. PMID:24996200

Do Hf isotopes in magmatic zircons represent those of their host rocks?

NASA Astrophysics Data System (ADS)

Wang, Di; Wang, Xiao-Lei; Cai, Yue; Goldstein, Steven L.; Yang, Tao

2018-04-01

Lu-Hf isotopic system in zircon is a powerful and widely used geochemical tracer in studying petrogenesis of magmatic rocks and crustal evolution, assuming that zircon Hf isotopes can represent initial Hf isotopes of their parental whole rock. However, this assumption may not always be valid. Disequilibrium partial melting of continental crust would preferentially melt out non-zircon minerals with high time-integrated Lu/Hf ratios and generate partial melts with Hf isotope compositions that are more radiogenic than those of its magma source. Dissolution experiments (with hotplate, bomb and sintering procedures) of zircon-bearing samples demonstrate this disequilibrium effect where partial dissolution yielded variable and more radiogenic Hf isotope compositions than fully dissolved samples. A case study from the Neoproterozoic Jiuling batholith in southern China shows that about half of the investigated samples show decoupled Hf isotopes between zircons and the bulk rocks. This decoupling could reflect complex and prolonged magmatic processes, such as crustal assimilation, magma mixing, and disequilibrium melting, which are consistent with the wide temperature spectrum from ∼630 °C to ∼900 °C by Ti-in-zircon thermometer. We suggest that magmatic zircons may only record the Hf isotopic composition of their surrounding melt during crystallization and it is uncertain whether their Hf isotopic compositions can represent the primary Hf isotopic compositions of the bulk magmas. In this regard, using zircon Hf isotopic compositions to trace crustal evolution may be biased since most of these could be originally from disequilibrium partial melts.

Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink)

PubMed Central

Brachmann, Johannes; Böhm, Michael; Rybak, Karin; Klein, Gunnar; Butter, Christian; Klemm, Hanno; Schomburg, Rolf; Siebermair, Johannes; Israel, Carsten; Sinha, Anil-Martin; Drexler, Helmut

2011-01-01

Aims The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment. Methods Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink ‘on' vs. ‘off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power. Conclusion The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014. ClinicalTrials.gov Identifier: NCT00769457 PMID:21555324

Human factors in aviation

NASA Technical Reports Server (NTRS)

Wiener, Earl L. (Editor); Nagel, David C. (Editor)

1988-01-01

The fundamental principles of human-factors (HF) analysis for aviation applications are examined in a collection of reviews by leading experts, with an emphasis on recent developments. The aim is to provide information and guidance to the aviation community outside the HF field itself. Topics addressed include the systems approach to HF, system safety considerations, the human senses in flight, information processing, aviation workloads, group interaction and crew performance, flight training and simulation, human error in aviation operations, and aircrew fatigue and circadian rhythms. Also discussed are pilot control; aviation displays; cockpit automation; HF aspects of software interfaces; the design and integration of cockpit-crew systems; and HF issues for airline pilots, general aviation, helicopters, and ATC.

Prognostic impact of intestinal wall thickening in hospitalized patients with heart failure.

PubMed

Ikeda, Yuki; Ishii, Shunsuke; Fujita, Teppei; Iida, Yuichiro; Kaida, Toyoji; Nabeta, Takeru; Maekawa, Emi; Yanagisawa, Tomoyoshi; Koitabashi, Toshimi; Takeuchi, Ichiro; Inomata, Takayuki; Ako, Junya

2017-03-01

Intestine-cardiovascular relationship has been increasingly recognized as a key factor in patients with heart disease. We aimed to identify the relationships among intestinal wall edema, cardiac function, and adverse clinical events in hospitalized heart failure (HF) patients. Abdominal computed tomographic images of 168 hospitalized HF patients were retrospectively investigated for identification of average colon wall thickness (CWT) from the ascending to sigmoid colon. Relationships between average CWT and echocardiographic parameters, blood sampling data, and primary outcomes including readmission for deteriorated HF and all-cause mortality were evaluated. Among the echocardiographic parameters, lower left ventricular diastolic function was correlated with higher average CWT. In multivariate analysis, higher logarithmic C-reactive protein level, lower estimated glomerular filtration rate, lower peripheral blood lymphocyte count, higher E/E' ratio, and extremely higher/lower defecation frequency were independently correlated with higher average CWT. Multivariate Cox-hazard analysis demonstrated that higher average CWT was independently related to higher incidence of primary outcomes. In hospitalized HF patients, increased CWT was associated with lower cardiac performance, and predicted poorer long-term clinical outcomes. Copyright © 2016. Published by Elsevier B.V.

[Diuretic therapy in heart failure].

PubMed

Trullàs, Joan Carles; Morales-Rull, José Luís; Formiga, Francesc

2014-02-20

Many of the primary clinical manifestations of heart failure (HF) are due to fluid retention, and treatments targeting congestion play a central role in HF management. Diuretic therapy remains the cornerstone of congestion treatment, and diuretics are prescribed to the majority of HF patients. Despite this ubiquitous use, there is limited evidence from prospective randomized studies to guide the use of diuretics. With the chronic use of diuretic and usually in advanced stages of HF, diuretics may fail to control salt and water retention. This review describes the mechanism of action of available diuretic classes, reviews their clinical use based on scientific evidence and discusses strategies to overcome diuretic resistance. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Depression impacts the physiological responsiveness of mother-daughter dyads during social interaction.

PubMed

Amole, Marlissa C; Cyranowski, Jill M; Wright, Aidan G C; Swartz, Holly A

2017-02-01

Maternal depression is associated with increased risk of psychiatric illness in offspring. While risk may relate to depressed mothers' difficulties regulating emotions in the context of interacting with offspring, physiological indicators of emotion regulation have rarely been examined during mother-child interactions-and never among mother-adolescent dyads in which both mother and adolescent have histories of major depressive disorder (MDD). We examined changes in high-frequency heart rate variability (HF-HRV), an indicator of parasympathetic (vagal) function that has been related to depression, stress, social engagement, and emotion regulation, in 46 mother-daughter dyads (23 in which both mother and daughter had an MDD history and 23 never-depressed controls). Hierarchical linear models evaluated changes in HF-HRV while mother-daughter dyads engaged in discussions about shared pleasant events and relationship conflicts. While control dyads displayed positive slopes (increases) in HF-HRV during both discussions, MDD dyads displayed minimal change in HF-HRV across discussions. Among controls, HF-HRV slopes were positively correlated between mothers and daughters during the pleasant events' discussion. In contrast, HF-HRV slopes were negatively correlated between MDD mothers and daughters during both discussions. Vagal responses observed in control mother-daughter dyads suggest a pattern of physiological synchrony and reciprocal positive social engagement, which may play a role in adolescent development of secure social attachments and healthy emotion regulation. In contrast, MDD mothers and daughters displayed diminished and discordant patterns of vagal responsiveness. More research is needed to understand the development and consequences of these patterns of parasympathetic responses among depressed mother-daughter dyads. © 2016 Wiley Periodicals, Inc.

Mechanical degradation of TiO2 nanotubes with and without nanoparticulate silver coating

PubMed Central

Shivaram, Anish; Bose, Susmita; Bandyopadhyay, Amit

2016-01-01

The primary objective of this research was to evaluate the extent of mechanical degradation on TiO2 nanotubes on Ti with and without nano-particulate silver coating using two different lengths of TiO2 nanotubes- 300nm and ~ 1µm, which were fabricated on commercially pure Titanium (cp-Ti) rods using anodization method using two different electrolytic mediums - (1) deionized (DI) water with 1% HF, and (2) ethylene glycol with 1% HF, 0.5 wt%. NH4F and 10% DI water. Nanotubes fabricated rods were implanted into equine cadaver bone to evaluate mechanical damage at the surface. Silver was electrochemically deposited on these nanotubes and using a release study, silver ion concentrations were measured before and after implantation, followed by surface characterization using a Field Emission Scanning Electron Microscope (FESEM). In vitro cell-material interaction study was performed using human fetal osteoblast cells (hFOB) to understand the effect of silver coating using an MTT assay for proliferation and to determine any cytotoxic effect on the cells and to study its biocompatibility. No significant damage due to implantation was observed for nanotubes up to ~1 µm length under current experimental conditions. Cell-materials interaction showed no cytotoxic effects on the cells due to silver coating and anodization of samples. PMID:27017285

Study on the removal of hormones from domestic wastewaters with lab-scale constructed wetlands with different substrates and flow directions.

PubMed

Herrera-Melián, José Alberto; Guedes-Alonso, Rayco; Borreguero-Fabelo, Alejandro; Santana-Rodríguez, José Juan; Sosa-Ferrera, Zoraida

2017-05-31

Eight wastewater samples from a university campus were analysed between May and July of 2014 to determine the concentration of 14 natural and synthetic steroid hormones. An on-line solid-phase extraction combined with ultra-high performance liquid chromatography coupled with mass spectrometry (on-line SPE-UHPLC-MS/MS) was used as extraction, pre-concentration and detection method. In the samples studied, three oestrogens (17β-estradiol, estrone and estriol), two androgens (boldenone and testosterone), three progestogens (norgestrel, progesterone and norethisterone) and one glucocorticoid (prednisone) were detected. The removal of hormones was studied in primary and secondary constructed wetland mesocosms. The porous media of the primary constructed wetlands were palm tree mulch. These reactors were used to study the effect of water flow, i.e. horizontal (HF1) vs vertical (VF1). The latter was more efficient in the removal of 17β-estradiol (HF1: 30%, VF1: 50%), estrone (HF1: 63%, VF1: 85%), estriol (100% both), testosterone (HF1: 45%, VF1: 73%), boldenone (HF1:-77%, VF1: 100%) and progesterone (HF1: 84%, VF1: 99%). The effluent of HF1 was used as influent of three secondary constructed wetland mesocosms: two double-stage vertical flow constructed wetlands, one with gravel (VF2gravel) and one with palm mulch (VF2mulch), and a mineral-based, horizontal flow constructed wetland (HFmineral). VF2mulch was the most efficient of the secondary reactors, since it achieved the complete removal of the hormones studied with the exception of 17ß-estradiol. The significantly better removal of BOD and ammonia attained by VF2mulch suggests that the better aeration of mulch favoured the more efficient removal of hormones.

Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The "Bayes' Syndrome-HF" study.

PubMed

Escobar-Robledo, Luis Alberto; Bayés-de-Luna, Antoni; Lupón, Josep; Baranchuk, Adrian; Moliner, Pedro; Martínez-Sellés, Manuel; Zamora, Elisabet; de Antonio, Marta; Domingo, Mar; Cediel, Germán; Núñez, Julio; Santiago-Vacas, Evelyn; Bayés-Genís, Antoni

2018-05-18

Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as "Bayes' Syndrome", and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. The prospective observational "Bayes' Syndrome-HF" study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpoint. Comprehensive multivariable Cox regression analyses were performed. Among 1050 consecutive patients, 536 (51.0%) were in sinus rhythm, 464 with a measurable P wave are the focus of this study. Two-hundred and sixty patients (56.0%) had normal atrial conduction, 95 (20.5%) partial IAB, and 109 (23.5%) advanced IAB. During a mean follow-up of 4.5 ± 2.1 years, 235 patients experienced all-cause death, new-onset AF, or stroke. In multivariable comprehensive Cox regression analyses, advanced IAB was associated with new-onset AF (HR 2.71 [1.61-4.56], P < 0.001), ischemic stroke (HR 3.02 [1.07-8.53], P = 0.04), and the composite of both (HR 2.42 [1.41-4.15], P < 0.001). In patients with HF advanced IAB predicts new-onset AF and ischemic stroke. Future studies must assess whether anticoagulant treatment in Bayes' Syndrome leads to better outcomes in HF. Copyright © 2017 Elsevier B.V. All rights reserved.

Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: a systematic review.

PubMed

Goel, Kashish; Pinto, Duane S; Gibson, C Michael

2013-04-01

Shorter time to reperfusion is associated with a significant reduction in mortality; however, its association with heart failure (HF) is not clearly documented. We conducted a systematic review to examine the association between time to reperfusion and incident HF and/or left ventricular dysfunction. MEDLINE/OVID, EMBASE, Cochrane Library, and Web of Science databases were searched from January 1974 to May 2012 for studies that reported the association between time to reperfusion and incident HF or left ventricular ejection fraction (LVEF) in patients undergoing primary percutaneous coronary intervention. Of 362 nonduplicate abstracts, 71 studies were selected for full-text review. Thirty-three studies were included in the final review, of which 16 were single-center studies, 7 were population-based studies, 7 were subanalyses from randomized controlled trials, and 3 were based on national samples. The pooled data demonstrate that every 1-hour delay in time to reperfusion is associated with a 4% to 12% increased risk of new-onset HF and a 4% relative increase in the risk of incident HF during follow-up. Early reperfusion was associated with a 2% to 8% greater LVEF before discharge and a 3% to 12% larger improvement in absolute LVEF at follow-up compared with the index admission. This systematic review presents evidence that longer time to reperfusion is not only associated with worsened left ventricular systolic function and new-onset HF at the time of index admission, but also with increased risk of HF and reduced improvement in left ventricular systolic function during follow-up. Copyright © 2013 Mosby, Inc. All rights reserved.

The experimental charge-density approach in the evaluation of intermolecular interactions. Application of a new module of the XD programming package to several solids including a pentapeptide.

PubMed

Abramov, Y A; Volkov, A; Wu, G; Coppens, P

2000-11-01

A new module interfaced to the XD programming package has been used in the evaluation of intermolecular interactions and lattice energies of the crystals of p-nitroaniline, L-asparagine monohydrate and the pentapeptide Boc-Gln-D-Iva-Hyp-Ala-Phol (Boc = butoxycarbonyl, Iva = isovaline = ethylalanine, Phol = phenylalaninol). The electrostatic interactions are evaluated with the atom-centered distributed multipoles from KRMM (kappa'-restricted multipole model) refinements, using the Buckingham expression for non-overlapping charge densities. Results for p-nitroaniline are compared with Hartree-Fock (HF), density functional (DFT) and Moller-Plesset (MP2) supermolecular calculations and with HF and DFT periodic calculations. The HF and DFT methods fail to predict the stability of the p-nitroaniline crystal but the results of the experimental charge-density approach (ECDA) are in good agreement with both MP2 interaction energies and the experimental lattice energy. ECDA results for L-asparagine monohydrate compare well with those from DFT supermolecular and periodic HF calculations. The disorder of the terminal group in the pentapeptide, which persists at the experimental temperature of 20 K, corresponds to an energy difference of only 0.35 kJ mol(-1), which is too small to be reproduced with current methods.

High Power Radio Wave Interactions within the D-Region Ionosphere

NASA Astrophysics Data System (ADS)

Moore, R. C.

2014-12-01

This paper highlights the best results obtained during D-region modification experiments performed by the University of Florida at the High-frequency Active Auroral Research Program (HAARP) observatory between 2007 and 2014. Over this period, we have seen a tremendous improvement in ELF/VLF wave generation efficiency. We have identified methods to characterize ambient and modified ionospheric properties and to discern and quantify specific types of interactions. We have demonstrated several important implications of HF cross-modulation effects, including "Doppler Spoofing" on HF radio waves. Throughout this talk, observations are compared with the predictions of an ionospheric HF heating model to provide context and guidance for future D-region modification experiments.

The palliative care in heart failure trial: rationale and design.

PubMed

Mentz, Robert J; Tulsky, James A; Granger, Bradi B; Anstrom, Kevin J; Adams, Patricia A; Dodson, Gwen C; Fiuzat, Mona; Johnson, Kimberly S; Patel, Chetan B; Steinhauser, Karen E; Taylor, Donald H; O'Connor, Christopher M; Rogers, Joseph G

2014-11-01

The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of Crataegus oxycantha Special Extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure.

PubMed

Zick, Suzanna M; Gillespie, Brenda; Aaronson, Keith D

2008-06-01

To examine whether hawthorn (Crataegus Special Extract WS 1442 {CSE}) inhibits progression in heart failure (HF) patients. We performed a retrospective analysis of data from the HERB CHF study in which patients with mild to moderate HF were randomised to either CSE 900 mg or placebo for 6 months. The primary outcome was time to progression of HF (HF death, hospitalisation, or sustained increase in diuretics) as assessed by log-rank tests and by Cox modelling. Progression of HF occurred in 46.6% of the CSE and 43.3% of the placebo groups (OR 1.14, 95% CI=0.56, 2.35: p=0.86). Patients receiving CSE were 3.9 times (95% CI=1.1-13.7: p=0.035) more likely to experience HF progression at baseline. In adjusted analysis, the risk of having early HF progression in the CSE group increased to 6.4 (95% CI=1.5, 26.5: p=0.011). In patients with LVEF< or =35%, those taking CSE were at significantly greater risk (3.2, 95% CI=1.3, 8.3: p=0.02) than the placebo group. CSE does not reduce heart failure progression in patients who have HF. CSE appears to increase the early risk of HF progression.

Symbolic computation of the Hartree-Fock energy from a chiral EFT three-nucleon interaction at N 2LO

NASA Astrophysics Data System (ADS)

Gebremariam, B.; Bogner, S. K.; Duguet, T.

2010-06-01

We present the first of a two-part Mathematica notebook collection that implements a symbolic approach for the application of the density matrix expansion (DME) to the Hartree-Fock (HF) energy from a chiral effective field theory (EFT) three-nucleon interaction at N 2LO. The final output from the notebooks is a Skyrme-like energy density functional that provides a quasi-local approximation to the non-local HF energy. In this paper, we discuss the derivation of the HF energy and its simplification in terms of the scalar/vector-isoscalar/isovector parts of the one-body density matrix. Furthermore, a set of steps is described and illustrated on how to extend the approach to other three-nucleon interactions. Program summaryProgram title: SymbHFNNN Catalogue identifier: AEGC_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEGC_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Standard CPC licence, http://cpc.cs.qub.ac.uk/licence/licence.html No. of lines in distributed program, including test data, etc.: 96 666 No. of bytes in distributed program, including test data, etc.: 378 083 Distribution format: tar.gz Programming language: Mathematica 7.1 Computer: Any computer running Mathematica 6.0 and later versions Operating system: Windows Xp, Linux/Unix RAM: 256 Mb Classification: 5, 17.16, 17.22 Nature of problem: The calculation of the HF energy from the chiral EFT three-nucleon interaction at N 2LO involves tremendous spin-isospin algebra. The problem is compounded by the need to eventually obtain a quasi-local approximation to the HF energy, which requires the HF energy to be expressed in terms of scalar/vector-isoscalar/isovector parts of the one-body density matrix. The Mathematica notebooks discussed in this paper solve the latter issue. Solution method: The HF energy from the chiral EFT three-nucleon interaction at N 2LO is cast into a form suitable for an automatic simplification of the spin-isospin traces. Several Mathematica functions and symbolic manipulation techniques are used to obtain the result in terms of the scalar/vector-isoscalar/isovector parts of the one-body density matrix. Running time: Several hours

The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial.

PubMed

Armour, Mike; Dahlen, Hannah G; Zhu, Xiaoshu; Farquhar, Cindy; Smith, Caroline A

2017-01-01

We examined the effect of changing treatment timing and the use of manual, electro acupuncture on the symptoms of primary dysmenorrhea. A randomised controlled trial was performed with four arms, low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro acupuncture (LF-EA) and high frequency electro acupuncture (HF-EA). A manualised trial protocol was used to allow differentiation and individualized treatment over three months. A total of 74 women were randomly assigned to one of the four groups (LF-MA n = 19, HF-MA n = 18, LF-EA n = 18, HF-EA n = 19). Twelve treatments were performed over three menstrual cycles, either once per week (LF groups) or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry. During the treatment period and nine month follow-up all groups showed statistically significant (p < .001) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups (p > 0.05). Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups (p = 0.02). HF-MA was most effective in reducing secondary menstrual symptoms compared to both-EA groups (p<0.05). Acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry. The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant. This may be due to a lack of power. The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials.

The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial

PubMed Central

Dahlen, Hannah G.; Zhu, Xiaoshu; Farquhar, Cindy; Smith, Caroline A.

2017-01-01

Objectives We examined the effect of changing treatment timing and the use of manual, electro acupuncture on the symptoms of primary dysmenorrhea. Methods A randomised controlled trial was performed with four arms, low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro acupuncture (LF-EA) and high frequency electro acupuncture (HF-EA). A manualised trial protocol was used to allow differentiation and individualized treatment over three months. A total of 74 women were randomly assigned to one of the four groups (LF-MA n = 19, HF-MA n = 18, LF-EA n = 18, HF-EA n = 19). Twelve treatments were performed over three menstrual cycles, either once per week (LF groups) or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry. Results During the treatment period and nine month follow-up all groups showed statistically significant (p < .001) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups (p > 0.05). Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups (p = 0.02). HF-MA was most effective in reducing secondary menstrual symptoms compared to both–EA groups (p<0.05). Conclusion Acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry. The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant. This may be due to a lack of power. The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials. PMID:28700680

Computational studies of molecular charge transfer complexes of heterocyclic 4-methylepyridine-2-azomethine-p-benzene derivatives with picric acid and m-dinitrobenzene.

PubMed

Al-Harbi, L M; El-Mossalamy, E H; Obaid, A Y; Al-Jedaani, A H

2014-01-01

Charge transfer complexes of substituted aryl Schiff bases as donors with picric acid and m-dinitrobenzene as acceptors were investigated by using computational analysis calculated by Configuration Interaction Singles Hartree-Fock (CIS-HF) at standard 6-31G∗ basis set and Time-Dependent Density-Functional Theory (TD-DFT) levels of theory at standard 6-31G∗∗ basis set, infrared spectra, visible and nuclear magnetic resonance spectra are investigated. The optimized geometries and vibrational frequencies were evaluated. The energy and oscillator strength were calculated by Configuration Interaction Singles Hartree-Fock method (CIS-HF) and the Time-Dependent Density-Functional Theory (TD-DFT) results. Electronic properties, such as HOMO and LUMO energies and band gaps of CTCs set, were studied by the Time-Dependent density functional theory with Becke-Lee-Young-Parr (B3LYP) composite exchange correlation functional and by Configuration Interaction Singles Hartree-Fock method (CIS-HF). The ionization potential Ip and electron affinity EA were calculated by PM3, HF and DFT methods. The columbic force was calculated theoretically by using (CIS-HF and TD-DFT) methods. This study confirms that the theoretical calculation of vibrational frequencies for (aryl Schiff bases--(m-dinitrobenzene and picric acid)) complexes are quite useful for the vibrational assignment and for predicting new vibrational frequencies. Copyright © 2013 Elsevier B.V. All rights reserved.

Influence of Prior Heart Failure Hospitalization on Cardiovascular Events in Patients with Reduced and Preserved Ejection Fraction

PubMed Central

Bello, Natalie A.; Claggett, Brian; Desai, Akshay S.; McMurray, John J.V.; Granger, Christopher B.; Yusuf, Salim; Swedberg, Karl; Pfeffer, Marc A.; Solomon, Scott D.

2014-01-01

Background Hospitalization for acute heart failure (HF) is associated with high rates of subsequent mortality and readmission. We assessed the influence of the time interval between prior HF hospitalization and randomization in the CHARM trials on clinical outcomes in patients with both reduced and preserved ejection fraction. Methods and Results CHARM enrolled 7,599 patients with NYHA class II-IV heart failure, of whom 5,426 had a history of prior HF hospitalization. Cox proportional hazards regression models were utilized to assess the association between time from prior HF hospitalization and randomization and the primary outcome of cardiovascular death or unplanned admission to hospital for the management of worsening HF over a median of 36.6 months. For patients with HF and reduced (HFrEF) or preserved (HFpEF) ejection fraction, rates of CV mortality and HF hospitalization were higher among patients with prior HF hospitalization than those without. The risk for mortality and hospitalization varied inversely with the time interval between hospitalization and randomization. Rates were higher for HFrEF patients within each category. Event rates for those with HFpEF and a HF hospitalization in the 6 months prior to randomization were comparable to the rate in HFrEF patients with no prior HF hospitalization. Conclusions Rates of CV death or HF hospitalization are greatest in those who have been previously hospitalized for HF. Independent of EF, rates of death and readmission decline as time from HF hospitalization to trial enrollment increased. Recent HF hospitalization identifies a high risk population for future clinical trials in HFrEF and HFpEF. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00634400. PMID:24874200

Hf-Nd isotope decoupling in the oceanic lithosphere: constraints from spinel peridotites from Oahu, Hawaii

NASA Astrophysics Data System (ADS)

Bizimis, Michael; Sen, Gautam; Salters, Vincent J. M.

2004-01-01

We present a detailed geochemical investigation on the Hf, Nd and Sr isotope compositions and trace and major element contents of clinopyroxene mineral separates from spinel lherzolite xenoliths from the island of Oahu, Hawaii. These peridotites are believed to represent the depleted oceanic lithosphere beneath Oahu, which is a residue of a MORB-related melting event some 80-100 Ma ago at a mid-ocean ridge. Clinopyroxenes from peridotites from the Salt Lake Crater (SLC) show a large range of Hf isotopic compositions, from ɛHf=12.2 (similar to the Honolulu volcanics series) to extremely radiogenic, ɛHf=65, at nearly constant 143Nd/ 144Nd ratios ( ɛNd=7-8). None of these samples show any isotopic evidence for interaction with Koolau-type melts. A single xenolith from the Pali vent is the only sample with Hf and Nd isotopic compositions that falls within the MORB field. The Hf isotopes correlate positively with the degree of depletion in the clinopyroxene (e.g. increasing Mg#, Cr#, decreasing Ti and heavy REE contents), but also with increasing Zr and Hf depletions relative to the adjacent REE in a compatibility diagram. The Lu/Hf isotope systematics of the SLC clinopyroxenes define apparent ages of 500 Ma or older and these compositions cannot be explained by mixing between any type of Hawaiian melts and the depleted Pacific lithosphere. Metasomatism of an ancient (e.g. 1 Ga or older) depleted peridotite protolith can, in principle, explain these apparent ages and the Nd-Hf isotope decoupling, but requires that the most depleted samples were subject to the least amount of metasomatism. Alternatively, the combined isotope, trace and major element compositions of these clinopyroxenes are best described by metasomatism of the 80-100 Ma depleted oceanic lithosphere by melts products of extensive mantle-melt interaction between Honolulu Volcanics-type melts and the depleted lithosphere.

Development of heart failure is independent of K+ channel-interacting protein 2 expression

PubMed Central

Speerschneider, Tobias; Grubb, Søren; Metoska, Artina; Olesen, Søren-Peter; Calloe, Kirstine; Thomsen, Morten B

2013-01-01

Abnormal ventricular repolarization in ion channelopathies and heart disease is a major cause of ventricular arrhythmias and sudden cardiac death. K+ channel-interacting protein 2 (KChIP2) expression is significantly reduced in human heart failure (HF), contributing to a loss of the transient outward K+ current (Ito). We aim to investigate the possible significance of a changed KChIP2 expression on the development of HF and proarrhythmia. Transverse aortic constrictions (TAC) and sham operations were performed in wild-type (WT) and KChIP2−/− mice. Echocardiography was performed before and every 2 weeks after the operation. Ten weeks post-surgery, surface ECG was recorded and we paced the heart in vivo to induce arrhythmias. Afterwards, tissue from the left ventricle was used for immunoblotting. Time courses of HF development were comparable in TAC-operated WT and KChIP2−/− mice. Ventricular protein expression of KChIP2 was reduced by 70% after 10 weeks TAC in WT mice. The amplitudes of the J and T waves were enlarged in KChIP2−/− control mice. Ventricular effective refractory period, RR, QRS and QT intervals were longer in mice with HF compared to sham-operated mice of either genotype. Pacing-induced ventricular tachycardia (VT) was observed in 5/10 sham-operated WT mice compared with 2/10 HF WT mice with HF. Interestingly, and contrary to previously published data, sham-operated KChIP2−/− mice were resistant to pacing-induced VT resulting in only 1/10 inducible mice. KChIP2−/− with HF mice had similar low vulnerability to inducible VT (1/9). Our results suggest that although KChIP2 is downregulated in HF, it is not orchestrating the development of HF. Moreover, KChIP2 affects ventricular repolarization and lowers arrhythmia susceptibility. Hence, downregulation of KChIP2 expression in HF may be antiarrhythmic in mice via reduction of the fast transient outward K+ current. PMID:24099801

What do human factors and ergonomics professionals value in research publications? Re-examining the research-practice gap.

PubMed

Chung, Amy Z Q; Williamson, Ann; Shorrock, Steven T

2014-01-01

The research-practice gap is of concern in human factors/ergonomics (HF/E) as there is a belief that HF/E research may not be making an impact on practice in the 'real world'. A potential issue is what researchers and practitioners perceive as important in HF/E journal articles as a primary means of conveying research findings to practitioners. This study examined the characteristics that make scientific journal articles appeal to HF/E researchers and practitioners using a web-based survey. HF/E researchers and practitioners were more similar than expected in judgements of important attributes and the selection of articles. Both practitioners and researchers considered practical significance to be more important than theoretical significance, in direct contrast to professionals from a related discipline--psychology. Well-written articles were appreciated across disciplines. The results signal a strong interest in practical applications in HF/E, but a relative lack of focus on development of theories that should be the basis for practical applications.

The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study.

PubMed

Kraai, Imke; de Vries, Arjen; Vermeulen, Karin; van Deursen, Vincent; van der Wal, Martje; de Jong, Richard; van Dijk, René; Jaarsma, Tiny; Hillege, Hans; Lesman, Ivonne

2016-01-01

It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01). ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Probability of Accurate Heart Failure Diagnosis and the Implications for Hospital Readmissions.

PubMed

Carey, Sandra A; Bass, Kyle; Saracino, Giovanna; East, Cara A; Felius, Joost; Grayburn, Paul A; Vallabhan, Ravi C; Hall, Shelley A

2017-04-01

Heart failure (HF) is a complex syndrome with inherent diagnostic challenges. We studied the scope of possibly inaccurately documented HF in a large health care system among patients assigned a primary diagnosis of HF at discharge. Through a retrospective record review and a classification schema developed from published guidelines, we assessed the probability of the documented HF diagnosis being accurate and determined factors associated with HF-related and non-HF-related hospital readmissions. An arbitration committee of 3 experts reviewed a subset of records to corroborate the results. We assigned a low probability of accurate diagnosis to 133 (19%) of the 712 patients. A subset of patients were also reviewed by an expert panel, which concluded that 13% to 35% of patients probably did not have HF (inter-rater agreement, kappa = 0.35). Low-probability HF was predictive of being readmitted more frequently for non-HF causes (p = 0.018), as well as documented arrhythmias (p = 0.023), and age >60 years (p = 0.006). Documented sleep apnea (p = 0.035), percutaneous coronary intervention (p = 0.006), non-white race (p = 0.047), and B-type natriuretic peptide >400 pg/ml (p = 0.007) were determined to be predictive of HF readmissions in this cohort. In conclusion, approximately 1 in 5 patients documented to have HF were found to have a low probability of actually having it. Moreover, the determination of low-probability HF was twice as likely to result in readmission for non-HF causes and, thus, should be considered a determinant for all-cause readmissions in this population. Copyright © 2017 Elsevier Inc. All rights reserved.

Expert Comment: Is Medication Titration in Heart Failure too Complex?

PubMed Central

Hickey, Annabel

2017-01-01

Abstract Large-scale randomised controlled trials (RCTs) have demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers decrease mortality and hospitalisation in patients with heart failure (HF) associated with a reduced left ventricular ejection fraction. This has led to high prescription rates; however, these drugs are generally prescribed at much lower doses than the doses achieved in the RCTs. A number of strategies have been evaluated to improve medication titration in HF, including forced medication up-titration protocols, point-of-care decision support and extended scope of clinical practice for nurses and pharmacists. Most successful strategies have been multifaceted and have adapted existing multidisciplinary models of care. Furthermore, given the central role of general practitioners in long-term monitoring and care coordination in HF patients, these strategies should engage with primary care to facilitate the transition between the acute and primary healthcare sectors. PMID:28785472

Non-expanded dispersion and induction energies, and damping functions, for molecular interactions with application to HF-He

NASA Astrophysics Data System (ADS)

Knowles, Peter J.; Meath, William J.

The evaluation of second order non-expanded dispersion and induction energies, and the associated damping functions, for interactions involving molecules is discussed with emphasis placed on using the time-dependent coupled Hartree-Fock method. Results are given for the HF-He interaction for all individual partial wave non-expanded dispersion and induction energies varying asymptotically for large R through O(R-8) and O(R-10) respectively and for most of the individual dispersion energies varying as R-9 and R-10. They are used to illustrate various features of charge overlap effects and the damping functions for molecular interactions, which are considerably more complicated than for atom-atom interactions.

Low-dose aspartame consumption differentially affects gut microbiota-host metabolic interactions in the diet-induced obese rat.

PubMed

Palmnäs, Marie S A; Cowan, Theresa E; Bomhof, Marc R; Su, Juliet; Reimer, Raylene A; Vogel, Hans J; Hittel, Dustin S; Shearer, Jane

2014-01-01

Aspartame consumption is implicated in the development of obesity and metabolic disease despite the intention of limiting caloric intake. The mechanisms responsible for this association remain unclear, but may involve circulating metabolites and the gut microbiota. Aims were to examine the impact of chronic low-dose aspartame consumption on anthropometric, metabolic and microbial parameters in a diet-induced obese model. Male Sprague-Dawley rats were randomized into a standard chow diet (CH, 12% kcal fat) or high fat (HF, 60% kcal fat) and further into ad libitum water control (W) or low-dose aspartame (A, 5-7 mg/kg/d in drinking water) treatments for 8 week (n = 10-12 animals/treatment). Animals on aspartame consumed fewer calories, gained less weight and had a more favorable body composition when challenged with HF compared to animals consuming water. Despite this, aspartame elevated fasting glucose levels and an insulin tolerance test showed aspartame to impair insulin-stimulated glucose disposal in both CH and HF, independently of body composition. Fecal analysis of gut bacterial composition showed aspartame to increase total bacteria, the abundance of Enterobacteriaceae and Clostridium leptum. An interaction between HF and aspartame was also observed for Roseburia ssp wherein HF-A was higher than HF-W (P<0.05). Within HF, aspartame attenuated the typical HF-induced increase in the Firmicutes:Bacteroidetes ratio. Serum metabolomics analysis revealed aspartame to be rapidly metabolized and to be associated with elevations in the short chain fatty acid propionate, a bacterial end product and highly gluconeogenic substrate, potentially explaining its negative affects on insulin tolerance. How aspartame influences gut microbial composition and the implications of these changes on the development of metabolic disease require further investigation.

Low-Dose Aspartame Consumption Differentially Affects Gut Microbiota-Host Metabolic Interactions in the Diet-Induced Obese Rat

PubMed Central

Palmnäs, Marie S. A.; Cowan, Theresa E.; Bomhof, Marc R.; Su, Juliet; Reimer, Raylene A.; Vogel, Hans J.; Hittel, Dustin S.; Shearer, Jane

2014-01-01

Aspartame consumption is implicated in the development of obesity and metabolic disease despite the intention of limiting caloric intake. The mechanisms responsible for this association remain unclear, but may involve circulating metabolites and the gut microbiota. Aims were to examine the impact of chronic low-dose aspartame consumption on anthropometric, metabolic and microbial parameters in a diet-induced obese model. Male Sprague-Dawley rats were randomized into a standard chow diet (CH, 12% kcal fat) or high fat (HF, 60% kcal fat) and further into ad libitum water control (W) or low-dose aspartame (A, 5–7 mg/kg/d in drinking water) treatments for 8 week (n = 10–12 animals/treatment). Animals on aspartame consumed fewer calories, gained less weight and had a more favorable body composition when challenged with HF compared to animals consuming water. Despite this, aspartame elevated fasting glucose levels and an insulin tolerance test showed aspartame to impair insulin-stimulated glucose disposal in both CH and HF, independently of body composition. Fecal analysis of gut bacterial composition showed aspartame to increase total bacteria, the abundance of Enterobacteriaceae and Clostridium leptum. An interaction between HF and aspartame was also observed for Roseburia ssp wherein HF-A was higher than HF-W (P<0.05). Within HF, aspartame attenuated the typical HF-induced increase in the Firmicutes:Bacteroidetes ratio. Serum metabolomics analysis revealed aspartame to be rapidly metabolized and to be associated with elevations in the short chain fatty acid propionate, a bacterial end product and highly gluconeogenic substrate, potentially explaining its negative affects on insulin tolerance. How aspartame influences gut microbial composition and the implications of these changes on the development of metabolic disease require further investigation. PMID:25313461

Power-Stepped HF Cross-Modulation Experiments: Simulations and Experimental Observations

NASA Astrophysics Data System (ADS)

Greene, S.; Moore, R. C.

2014-12-01

High frequency (HF) cross modulation experiments are a well established means for probing the HF-modified characteristics of the D-region ionosphere. The interaction between the heating wave and the probing pulse depends on the ambient and modified conditions of the D-region ionosphere. Cross-modulation observations are employed as a measure of the HF-modified refractive index. We employ an optimized version of Fejer's method that we developed during previous experiments. Experiments were performed in March 2013 at the High Frequency Active Auroral Research Program (HAARP) observatory in Gakona, Alaska. During these experiments, the power of the HF heating signal incrementally increased in order to determine the dependence of cross-modulation on HF power. We found that a simple power law relationship does not hold at high power levels, similar to previous ELF/VLF wave generation experiments. In this paper, we critically compare these experimental observations with the predictions of a numerical ionospheric HF heating model and demonstrate close agreement.

Low-temperature fabrication of an HfO2 passivation layer for amorphous indium-gallium-zinc oxide thin film transistors using a solution process.

PubMed

Hong, Seonghwan; Park, Sung Pyo; Kim, Yeong-Gyu; Kang, Byung Ha; Na, Jae Won; Kim, Hyun Jae

2017-11-24

We report low-temperature solution processing of hafnium oxide (HfO 2 ) passivation layers for amorphous indium-gallium-zinc oxide (a-IGZO) thin-film transistors (TFTs). At 150 °C, the hafnium chloride (HfCl 4 ) precursor readily hydrolyzed in deionized (DI) water and transformed into an HfO 2 film. The fabricated HfO 2 passivation layer prevented any interaction between the back surface of an a-IGZO TFT and ambient gas. Moreover, diffused Hf 4+ in the back-channel layer of the a-IGZO TFT reduced the oxygen vacancy, which is the origin of the electrical instability in a-IGZO TFTs. Consequently, the a-IGZO TFT with the HfO 2 passivation layer exhibited improved stability, showing a decrease in the threshold voltage shift from 4.83 to 1.68 V under a positive bias stress test conducted over 10,000 s.

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial.

PubMed

Bekelman, David B; Plomondon, Mary E; Sullivan, Mark D; Nelson, Karin; Hattler, Brack; McBryde, Connor; Lehmann, Kenneth G; Potfay, Jonathan; Heidenreich, Paul; Rumsfeld, John S

2013-07-09

Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status. Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful. Unique identifier: NCT00461513.

Dairy cow breed interacts with stocking rate in temperate pasture-based dairy production systems.

PubMed

Spaans, O K; Macdonald, K A; Lancaster, J A S; Bryant, A M; Roche, J R

2018-05-01

Economic optimum stocking rates for grazing dairy systems have been defined by accounting for the pasture production potential of the farm [t of dry matter (DM)/ha], the amount of feed imported from outside the farm (t of DM/ha), and the size of the cow (kg). These variables were combined into the comparative stocking rate [CSR; kg of body weight (BW)/t of feed DM available] measure. However, CSR assumes no effect of cow genetics beyond BW, and there is increasing evidence of within-breed differences in residual feed intake and between-breed differences in the gross efficiency with which cows use metabolizable energy for milk production. A multiyear production system experiment was established to determine whether Jersey (J) and Holstein-Friesian (HF) breeds performed similarly at the same CSR. Fifty-nine J cows and 51 HF cows were randomly allocated to 1 of 2 CSR in a 2 × 2 factorial arrangement; systems were designed to have a CSR of either 80 or 100 kg of BW/t of feed DM (J-CSR80, J-CSR100, HF-CSR80, and HF-CSR100 treatment groups). Data were analyzed for consistency of farmlet response over years using ANOVA procedures, with year and farmlet as fixed effects and the interaction of farmlet with year as a random effect. The collated biological data and financial data extracted from a national economic database were used to model the financial performance for the different breed and CSR treatments. On average, annual and individual season pasture DM production was greater for the J farmlets and was less in the CSR100 treatment; however, the effect of CSR was primarily driven by a large decline in pasture DM production in the HF-CSR100 treatment (breed × CSR interaction). This interaction in feed availability resulted in a breed × CSR interaction for the per-cow and per-hectare milk production variables, with HF cows producing more milk and milk components per cow in the CSR80 treatment but the same amount as the J cows in the CSR100 treatment. On a per-hectare basis, HF cows produced the same amount of 4% fat-corrected milk and lactose as J cows in the CSR80 treatment, but less fat; at CSR100, J cows produced more 4% fat-corrected milk, fat, and protein per hectare than HF cows. Our results support a greater gross efficiency for use of metabolizable energy by the J cow; 11% less total metabolizable energy was required to produce 1 kg of fat and protein at a system level. Economic modeling indicated that profitability of both breeds was less at CSR100, but the decline in profitability with increasing stocking rate was much greater in the HF breed. Holstein-Friesian cows were more profitable at CSR80 but were less profitable at CSR100. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Heart failure in primary care: co-morbidity and utilization of health care resources.

PubMed

Carmona, Montserrat; García-Olmos, Luis M; García-Sagredo, Pilar; Alberquilla, Ángel; López-Rodríguez, Fernando; Pascual, Mario; Muñoz, Adolfo; Salvador, Carlos H; Monteagudo, José L; Otero-Puime, Ángel

2013-10-01

In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.

Studies of High Power RF-induced Turbulence in the Ionosphere over HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Watkins, B. J.; Bristow, W. A.; Bernhardt, P. A.

2016-12-01

The HAARP phased-array HF transmitter at Gakona, AK delivers up to 3.6 GW (ERP) of HF power in the range of 2.8 - 10 MHz to the ionosphere with millisecond pointing, power modulation, and frequency agility. HAARP's unique features have enabled the conduct of a number of nonlinear plasma experiments in the interaction region of overdense ionospheric plasma including stimulated electromagnetic emissions (SEE), artificial aurora, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and telescopes and cameras for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the plasma line, and production of suprathermal electrons. For a narrow range of HF pointing between Spitze and magnetic zenith, a reduced threshold for AFAI is observed. Recent results of simulations of these experiments enable interpretation of many observed features. Applications are made to the study of irregularities relevant to spacecraft communication and navigation systems.

Gender-Specific Physical Symptom Biology in Heart Failure.

PubMed

Lee, Christopher S; Hiatt, Shirin O; Denfeld, Quin E; Chien, Christopher V; Mudd, James O; Gelow, Jill M

2015-01-01

There are several gender differences that may help explain the link between biology and symptoms in heart failure (HF). The aim of this study was to examine gender-specific relationships between objective measures of HF severity and physical symptoms. Detailed clinical data, including left ventricular ejection fraction and left ventricular internal end-diastolic diameter, and HF-specific physical symptoms were collected as part of a prospective cohort study. Gender interaction terms were tested in linear regression models of physical symptoms. The sample (101 women and 101 men) averaged 57 years of age and most participants (60%) had class III/IV HF. Larger left ventricle size was associated with better physical symptoms for women and worse physical symptoms for men. Decreased ventricular compliance may result in worse physical HF symptoms for women and dilation of the ventricle may be a greater progenitor of symptoms for men with HF.

A phenomenological study of day-to-day experiences of living with heart failure: do cultural differences matter?

PubMed

Chiaranai, Chantira

2014-07-01

Although there is a significant body of literature addressing heart failure (HF) epidemiology, physiology, and treatment, little is known about the experiences of Thai patients living with this chronic condition. The primary goal of this study was to gain a better understanding of how Thai patients with HF live with chronic and debilitating illness. A phenomenological approach was chosen to investigate the experience of living with HF. Fifteen Thai men and women with HF in New York Heart Association classes I to III, aged between 47 and 75 years, were interviewed with open-ended questions. Data were analyzed using qualitative inductive content analysis. Three themes emerged from the data analysis: identifying losses or changes in their lives, accepting the losses, and regaining some control. Unlike their western counterparts, the Thai patients with HF incorporated their karma, a Buddhist belief system, as a tool to rationalize the occurrence of their HF experience. The participants of this study used kreng jai as a cultural desire not to disrupt the happiness of others, even at the expense of efficiency, or to burden others, which might affect their own quality of life. The Thai patients with HF faced many limitations. The Thai patients with HF use religion and traditional culture to overcome their life situations. To support Thai patients with HF, healthcare providers must have an understanding of cultural differences.

The Effect of Crataegus oxycantha Special Extract WSS 1442 on Clinical Progression in Patients with Mild to Moderate Symptoms of Heart Failure

PubMed Central

Zick, Suzanna M.; Gillespie, Brenda; Aaronson, Keith D.

2008-01-01

Aim To examine whether hawthorn (Crataegus Special Extract WS 1442 {CSE}) inhibits progression in heart failure (HF) patients. Methods We performed a retrospective analysis of data from the HERB CHF study in which patients with mild to moderate HF were randomised to either CSE 900 mg or placebo for 6 months. The primary outcome was time to progression of HF (HF death, hospitalisation, or sustained increase in diuretics) as assessed by log-rank tests and by Cox modelling. Results Progression of HF occurred in 46.6% of the CSE and 43.3% of the placebo groups (OR 1.14, 95% CI = 0.56, 2.35: p = 0.86). Patients receiving CSE were 3.9 times (95% CI = 1.1 – 13.7: p = 0.035) more likely to experience HF progression at baseline. In adjusted analysis, the risk of having early HF progression in the CSE group increased to 6.4 (95% CI = 1.5, 26.5: p = 0.011). In patients with LVEF 35%, those taking CSE were at significantly greater risk (3.2, 95% CI = 1.3, 8.3: p = 0.02) than the placebo group. Conclusions CSE does not reduce heart failure progression in patients who have HF. CSE appears to increase the early risk of HF progression. PMID:18490196

Comment on "Reconciliation of the excess 176Hf conundrum in meteorites: Recent disturbances of the Lu-Hf and Sm-Nd isotope systematics" [Geochim. Cosmochim. Acta 212 (2017) 303-323

NASA Astrophysics Data System (ADS)

Bloch, Elias; Watkins, James; Ganguly, Jibamitra

2018-06-01

In a recent paper, Bast et al. (2017) present an impressive set of mineral and whole rock isochrons and use them to investigate the cause(s) of excess 176Hf in eucrite and angrite meteorites. They argue that during terrestrial weathering of these samples, phosphates present as isolated grains or inclusions underwent partial dissolution during which Lu was mobilized more effectively than Hf. If this residual, unsupported Hf were not effectively excluded from analyses, then the data points would be shifted above the actual isochron, creating scatter and potentially spurious Lu-Hf ages. Bast et al. (2017) conclude that: (1) diffusive fractionation of Lu from Hf during a thermal metamorphic event on the parent body, as suggested by Bloch et al. (2017) and Debaille et al. (2011), did not contribute significantly to the anomalous Lu-Hf ages, and (2) terrestrial weathering effects are the primary cause of the older-than-solar-system Lu-Hf mineral ages retrieved from some eucrites and angrites (e.g. Bast et al., 2012; Bizzarro et al., 2012; Lapen et al., 2015; Sanborn et al., 2015). We find these conclusions to be unjustified in light of the authors' selective and incomplete consideration of results from the modeling by Bloch et al. (2017).

Nonlinear Plasma Experiments in Geospace with Gigawatts of RF Power at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, J. P.; Rayyan, N.; Watkins, B. J.; Bristow, W. A.; Bernhardt, P. A.

2014-10-01

The HAARP phased-array HF transmitter at Gakona, AK delivers up to 3.6 GW (ERP) of HF power in the range of 2.8 - 10 MHz to the ionosphere with millisecond pointing, power modulation, and frequency agility. HAARP's unique features have enabled the conduct of a number of nonlinear plasma experiments in the interaction region of overdense ionospheric plasma including stimulated electromagnetic emissions (SEE), artificial aurora, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and telescopes and cameras for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the plasma line, and suprathermal electrons. Applications are made to the study and control of irregularities affecting spacecraft communication and navigation systems.

Critical Questions about PARADIGM-HF and the Future

PubMed Central

Chen, Chen-Huan

2016-01-01

Cardiovascular (CV) diseases in general and heart failure (HF) in particular are major contributors to death and morbidity and are also recognized as important drivers of health care expenditure. The PARADIGM-HF trial was a pivotal trial designed to compare the long-term effects of LCZ696 with enalapril in patients with symptomatic HF with reduced ejection fraction (HFrEF). This review article presents an in-depth view of the PARADIGM-HF trial and the implications of the results in the management of patients with HF and is based on peer reviewed manuscripts, editorials, perspectives and opinions written about the PARADIGM-HF trial. The article presents the key safety and efficacy results of the trial with specific emphasis on the clinical implications of these findings. The review highlights the highly statistically significant, 20% reduction in the primary composite endpoint of cardiovascular death or HF hospitalization, and a 16% reduction in the risk of death from any cause. It also provides an overview of the design, clinical findings, limitations and special areas of clinical interest. The review discusses the future of LCZ696 and additional trials that seek to answer questions in other sub-populations of patients with HF. The article reiterates what has been concluded by many experts in the field of HF- the introduction of LCZ696 into routine clinical care, while dependent on the regulatory approvals in various countries as well as acceptance by physicians, payers and patients, will change the treatment landscape for patients with HFrEF. PMID:27471351

A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation.

PubMed

Abraham, William T; Kuck, Karl-Heinz; Goldsmith, Rochelle L; Lindenfeld, JoAnn; Reddy, Vivek Y; Carson, Peter E; Mann, Douglas L; Saville, Benjamin; Parise, Helen; Chan, Rodrigo; Wiegn, Phi; Hastings, Jeffrey L; Kaplan, Andrew J; Edelmann, Frank; Luthje, Lars; Kahwash, Rami; Tomassoni, Gery F; Gutterman, David D; Stagg, Angela; Burkhoff, Daniel; Hasenfuß, Gerd

2018-05-05

The authors sought to confirm a subgroup analysis of the prior FIX-HF-5 (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure) study showing that cardiac contractility modulation (CCM) improved exercise tolerance (ET) and quality of life in patients with ejection fractions between 25% and 45%. CCM therapy for New York Heart Association (NYHA) functional class III and IV heart failure (HF) patients consists of nonexcitatory electrical signals delivered to the heart during the absolute refractory period. A total of 160 patients with NYHA functional class III or IV symptoms, QRS duration <130 ms, and ejection fraction ≥25% and ≤45% were randomized to continued medical therapy (control, n = 86) or CCM (treatment, n = 74, unblinded) for 24 weeks. Peak VO 2 (primary endpoint), Minnesota Living With Heart Failure questionnaire, NYHA functional class, and 6-min hall walk were measured at baseline and at 12 and 24 weeks. Bayesian repeated measures linear modeling was used for the primary endpoint analysis with 30% borrowing from the FIX-HF-5 subgroup. Safety was assessed by the percentage of patients free of device-related adverse events with a pre-specified lower bound of 70%. The difference in peak VO 2 between groups was 0.84 (95% Bayesian credible interval: 0.123 to 1.552) ml O 2 /kg/min, satisfying the primary endpoint. Minnesota Living With Heart Failure questionnaire (p < 0.001), NYHA functional class (p < 0.001), and 6-min hall walk (p = 0.02) were all better in the treatment versus control group. There were 7 device-related events, yielding a lower bound of 80% of patients free of events, satisfying the primary safety endpoint. The composite of cardiovascular death and HF hospitalizations was reduced from 10.8% to 2.9% (p = 0.048). CCM is safe, improves exercise tolerance and quality of life in the specified group of HF patients, and leads to fewer HF hospitalizations. (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure; NCT01381172). Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Hyperfine interaction in the Autler-Townes effect: The formation of bright, dark, and chameleon states

NASA Astrophysics Data System (ADS)

Kirova, T.; Cinins, A.; Efimov, D. K.; Bruvelis, M.; Miculis, K.; Bezuglov, N. N.; Auzinsh, M.; Ryabtsev, I. I.; Ekers, A.

2017-10-01

This paper is devoted to clarifying the implications of hyperfine (HF) interaction in the formation of adiabatic (i.e., "laser-dressed") states and their expression in the Autler-Townes (AT) spectra. We first use the Morris-Shore model [J. R. Morris and B. W. Shore, Phys. Rev. A 27, 906 (1983), 10.1103/PhysRevA.27.906] to illustrate how bright and dark states are formed in a simple reference system where closely spaced energy levels are coupled to a single state with a strong laser field with the respective Rabi frequency ΩS. We then expand the simulations to realistic hyperfine level systems in Na atoms for a more general case when non-negligible HF interaction can be treated as a perturbation in the total system Hamiltonian. A numerical analysis of the adiabatic states that are formed by coupling of the 3 p3 /2 and 4 d5 /2 states by the strong laser field and probed by a weak laser field on the 3 s1 /2-3 p3 /2 transition yielded two important conclusions. Firstly, the perturbation introduced by the HF interaction leads to the observation of what we term "chameleon" states—states that change their appearance in the AT spectrum, behaving as bright states at small to moderate ΩS, and fading from the spectrum similarly to dark states when ΩS is much larger than the HF splitting of the 3 p3 /2 state. Secondly, excitation by the probe field from two different HF levels of the ground state allows one to address orthogonal sets of adiabatic states; this enables, with appropriate choice of ΩS and the involved quantum states, a selective excitation of otherwise unresolved hyperfine levels in excited electronic states.

Serum Chloride and Sodium Interplay in Patients With Acute Myocardial Infarction and Heart Failure With Reduced Ejection Fraction: An Analysis From the High-Risk Myocardial Infarction Database Initiative.

PubMed

Ferreira, João Pedro; Girerd, Nicolas; Duarte, Kevin; Coiro, Stefano; McMurray, John J V; Dargie, Henry J; Pitt, Bertram; Dickstein, Kenneth; Testani, Jeffrey M; Zannad, Faiez; Rossignol, Patrick

2017-02-01

Serum chloride levels were recently found to be independently associated with mortality in heart failure (HF). We investigated the relationship between serum chloride and clinical outcomes in 7195 subjects with acute myocardial infarction complicated by reduced left ventricular function and HF. The studied outcomes were all-cause mortality, cardiovascular mortality, and hospitalization for HF. Both chloride and sodium had a nonlinear association with the studied outcomes (P<0.05 for linearity). Patients in the lowest chloride tertile (chloride ≤100) were older, had more comorbidities, and had lower sodium levels (P<0.05 for all). Serum chloride showed a significant interaction with sodium with regard to all studied outcomes (P for interaction <0.05 for all). The lowest chloride tertile (≤100 mmol/L) was associated with increased mortality rates in the context of lower sodium (≤138 mmol/L; adjusted hazard ratio [95% confidence interval] for all-cause mortality=1.42 (1.14-1.77); P=0.002), whereas in the context of higher sodium levels (>141 mmol/L), the association with mortality was lost. Spline-transformed chloride and its interaction with sodium did not add significant prognostic information on top of other well-established prognostic variables (P>0.05 for all outcomes). In post-myocardial infarction with systolic dysfunction and HF, low serum chloride was associated with mortality (but not hospitalization for HF) in the setting of lower sodium. Overall, chloride and its interaction with sodium did not add clinically relevant prognostic information on top of other well-established prognostic variables. Taken together, these data support an integrated and critical consideration of chloride and sodium interplay. © 2017 American Heart Association, Inc.

Diuretics in the treatment of hypertension. Part 2: loop diuretics and potassium-sparing agents.

PubMed

Tamargo, Juan; Segura, Julian; Ruilope, Luis M

2014-04-01

Diuretics enhance the renal excretion of Na(+) and water due to a direct action at different tubular sites of the nephron where solute re-absorption occurs. This paper focuses on the mechanism of action, pharmacodynamics, antihypertensive effects, adverse effects, interactions and contraindications of loop diuretics and potassium-sparing agents (including mineralocorticoid receptor antagonists (MRAs) and epithelial Na(+) channel blockers). Loop diuretics are less effective than thiazide diuretics in lowering blood pressure, so that their major use is in edematous patients with congestive heart failure (HF), cirrhosis with ascites and nephritic edema. MRAs represent a major advance in the treatment of resistant hypertension, primary and secondary hyperaldosteronism and in patients with systolic HF to reduce the risks of hospitalization and of premature death. Potassium-sparing diuretics when coadministered with diuretics (thiazides and loop diuretics) working at more proximal nephron locations reduce the risk of hypokalemia and hypomagnesemia and the risk of cardiac arrhythmias. At the end of the article, the basis for the combination of diuretics with other antihypertensive drugs to achieve blood pressure targets is presented.

Heart rate variability: Pre-deployment predictor of post-deployment PTSD symptoms

PubMed Central

Pyne, Jeffrey M.; Constans, Joseph I.; Wiederhold, Mark D.; Gibson, Douglas P.; Kimbrell, Timothy; Kramer, Teresa L.; Pitcock, Jeffery A.; Han, Xiaotong; Williams, D. Keith; Chartrand, Don; Gevirtz, Richard N.; Spira, James; Wiederhold, Brenda K.; McCraty, Rollin; McCune, Thomas R.

2017-01-01

Heart rate variability is a physiological measure associated with autonomic nervous system activity. This study hypothesized that lower pre-deployment HRV would be associated with higher post-deployment post-traumatic stress disorder (PTSD) symptoms. Three-hundred-forty-three Army National Guard soldiers enrolled in the Warriors Achieving Resilience (WAR) study were analyzed. The primary outcome was PTSD symptom severity using the PTSD Checklist – Military version (PCL) measured at baseline, 3- and 12-month post-deployment. Heart rate variability predictor variables included: high frequency power (HF) and standard deviation of the normal cardiac inter-beat interval (SDNN). Generalized linear mixed models revealed that the pre-deployment PCL*ln(HF) interaction term was significant (p < 0.0001). Pre-deployment SDNN was not a significant predictor of post-deployment PCL. Covariates included age, pre-deployment PCL, race/ethnicity, marital status, tobacco use, childhood abuse, pre-deployment traumatic brain injury, and previous combat zone deployment. Pre-deployment heart rate variability predicts post-deployment PTSD symptoms in the context of higher pre-deployment PCL scores. PMID:27773678

Long-Term Survival With Implantable Cardioverter-Defibrillator in Different Symptomatic Functional Classes of Heart Failure.

PubMed

Biton, Yitschak; Rosero, Spencer; Moss, Arthur; Zareba, Wojciech; Kutyifa, Valentina; Baman, Jayson; Barsheshet, Alon; McNitt, Scott; Polonsky, Bronislava; Goldenberg, Ilan

2018-03-01

The ACC/AHA/HRS (American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society) guidelines recommend implantable cardioverter-defibrillator (ICD) therapy primary prevention in all patients with severely reduced left ventricular ejection fraction (≤30%) regardless of New York Heart Association (NYHA) functional class, whereas recent European guidelines limit the indication to those with symptomatic heart failure (NYHA ≥ II). We therefore aimed to evaluate the long-term survival benefit of primary ICD therapy among postmyocardial infarction patients with and without heart failure (HF) symptoms who were enrolled in MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II). We classified 1,164 MADIT-II patient groups according to the baseline NYHA class (NYHA I [n = 442], NYHA II [n = 425], and NYHA III [n = 297]); patients with NYHA IV were excluded. Multivariate Cox proportional hazards regression modeling was performed to compare the mortality reduction with ICD versus non-ICD therapy during 8 years of follow-up between the 3 NYHA groups. The median (interquartile range) follow-up time was 7.6 (3.5 to 9) years. At 8 years of follow-up, the cumulative probability of mortality in the non-ICD treatment arm was 57% for NYHA I, 57% for NYHA II, and 76% for NYHA III (p <0.001). Multivariate models demonstrated similar long-term mortality risk reduction with ICD compared with the non-ICD treatment arm regardless of HF symptoms: NYHA I (HR = 0.63, 0.46 to 0.85, p = 0.003), NYHA II (HR = 0.68, 0.50 to 0.93, p = 0.017), and NYHA III (HR = 0.68, 0.50 to 0.94, p = 0.018); p for NYHA class by treatment arm interaction >0.10. In conclusion, primary ICD therapy provides consistent long-term survival benefit among patients with previous myocardial infarction and severe left ventricular dysfunction, regardless of HF symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

A real-world cohort study on the quality of potassium and creatinine monitoring during initiation of mineralocorticoid receptor antagonists in patients with heart failure.

PubMed

Nilsson, Erik; De Deco, Pietro; Trevisan, Marco; Bellocco, Rino; Lindholm, Bengt; Lund, Lars H; Coresh, Josef; Carrero, Juan J

2018-05-02

Clinical heart failure (HF) guidelines recommend monitoring of creatinine and potassium throughout the initial weeks of mineralocorticoid receptor antagonists (MRAs) therapy. We here assessed the extent to which this occurs in our healthcare. Observational study in 2007-2010 HF patients starting MRA therapy in Stockholm, Sweden. Outcomes included potassium and creatinine laboratory testing before MRA initiation and in the early (days 1-10) and extended (days 11-90) post-initiation periods. Exclusion criteria considered death/hospitalization within 90 days, and lack of a second MRA dispense. Of 4,036 HF patients starting on MRA, 45% were initiated from a hospital, 24% from a primary care center and 30% from other private centers. Overall, 89% underwent pre-initiation testing, being more common among hospital (97%) than for primary care (74%) initiations. Only 24% were adequately monitored in all three recommended intervals, being again more frequent following hospital (33%) than private (21%) or primary care (17%) initiations. In multivariable analyses, adequate monitoring was more likely for hospital [odds ratio (OR), 95% confidence interval; 2.85, 2.34-3.56] initiations, and for patients with chronic kidney disease (OR 1.79, 1.30-2.43) and concomitant use of ACE (OR 1.27, 1.05-1.52), ARBs (OR 1.19, 1.01-1.40) or beta blockers (OR 1.65, 1.22-2.26). Age, sex and prescribing center explained a small portion of adequate monitoring (c-statistic, 0.63). Addition of comorbidities and medications improved prediction marginally (c-statistic, 0.65). Although serum potassium and creatinine monitoring before MRA initiation for HF is frequent, rates of post-initiation monitoring remain suboptimal, especially among primary care centers.

Low-Temperature Reactivities of Ultra-High Temperature Ceramics (Hf-X System)

DTIC Science & Technology

2005-12-01

as interacting fillers with the preceramic polymer formulations. In situ formation of the SiC phase was also evaluated as a practical approach in...led to a renewal of activities to fabricate MB2/ SiC composites as the materials of choice, because of their high thermal and oxidation resistance...HfB2/ SiC composite microstructures (and also HfC, ZrB2, and ZrC composites ) under pressureless conditions. These can be employed in reactive and

Real-world heart failure management in 10,910 patients with chronic heart failure in the Netherlands : Design and rationale of the Chronic Heart failure ESC guideline-based Cardiology practice Quality project (CHECK-HF) registry.

PubMed

Brugts, J J; Linssen, G C M; Hoes, A W; Brunner-La Rocca, H P

2018-05-01

Data from patient registries give insight into the management of patients with heart failure (HF), but actual data from unselected real-world HF patients are scarce. Therefore, we performed a cross sectional study of current HF care in the period 2013-2016 among more than 10,000 unselected HF patients at HF outpatient clinics in the Netherlands. In 34 participating centres, all 10,910 patients with chronic HF treated at cardiology centres were included in the CHECK-HF registry. Of these, most (96%) were managed at a specific HF outpatient clinic. Heart failure was typically diagnosed according to the ESC guidelines 2012, based on signs, symptoms and structural and/or functional cardiac abnormalities. Information on diagnostics, treatment and co-morbidities were recorded, with specific focus on drug therapy and devices. In our cohort, the mean age was 73 years (SD 12) and 60% were male. Frequent co-morbidities reported in the patient records were diabetes mellitus 30%, hypertension 43%, COPD 19%, and renal insufficiency 58%. In 47% of the patients, ischaemia was the origin of HF. In our registry, the prevalence of HF with preserved ejection fraction was 21%. The CHECK-HF registry will provide insight into the current, real world management of patient with chronic HF, including HF with reduced ejection fraction, preserved ejection fraction and mid-range ejection fraction, that will help define ways to improve quality of care. Drug and device therapy and guideline adherence as well as interactions with age, gender and co-morbidities will receive specific attention.

Contemporary Epidemiology of Heart Failure in Fee-For-Service Medicare Beneficiaries Across Healthcare Settings.

PubMed

Khera, Rohan; Pandey, Ambarish; Ayers, Colby R; Agusala, Vijay; Pruitt, Sandi L; Halm, Ethan A; Drazner, Mark H; Das, Sandeep R; de Lemos, James A; Berry, Jarett D

2017-11-01

To assess the current landscape of the heart failure (HF) epidemic and provide targets for future health policy interventions in Medicare, a contemporary appraisal of its epidemiology across inpatient and outpatient care settings is needed. In a national 5% sample of Medicare beneficiaries from 2002 to 2013, we identified a cohort of 2 331 939 unique fee-for-service Medicare beneficiaries ≥65-years-old followed for all inpatient and outpatient encounters over a 10-year period (2004-2013). Preexisting HF was defined by any HF encounter during the first year, and incident HF with either 1 inpatient or 2 outpatient HF encounters. Mean age of the cohort was 72 years; 57% were women, and 86% and 8% were white and black, respectively. Within this cohort, 518 223 patients had preexisting HF, and 349 826 had a new diagnosis of HF during the study period. During 2004 to 2013, the rates of incident HF declined 32%, from 38.7 per 1000 (2004) to 26.2 per 1000 beneficiaries (2013). In contrast, prevalent (preexisting + incident) HF increased during our study period from 162 per 1000 (2004) to 172 per 1000 beneficiaries (2013) ( P trend <0.001 for both). Finally, the overall 1-year mortality among patients with incident HF is high (24.7%) with a 0.4% absolute decline annually during the study period, with a more pronounced decrease among those diagnosed in an inpatient versus outpatient setting ( P interaction <0.001) CONCLUSIONS: In recent years, there have been substantial changes in the epidemiology of HF in Medicare beneficiaries, with a decline in incident HF and a decrease in 1-year HF mortality, whereas the overall burden of HF continues to increase. © 2017 American Heart Association, Inc.

Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial.

PubMed

Comín-Colet, Josep; Enjuanes, Cristina; Verdú-Rotellar, José M; Linas, Anna; Ruiz-Rodriguez, Pilar; González-Robledo, Gina; Farré, Núria; Moliner-Borja, Pedro; Ruiz-Bustillo, Sonia; Bruguera, Jordi

2016-07-01

The role of telemedicine in the management of patients with chronic heart failure (HF) has not been fully elucidated. We hypothesized that multidisciplinary comprehensive HF care could achieve better results when it is delivered using telemedicine. In this study, 178 eligible patients with HF were randomized to either structured follow-up on the basis of face-to-face encounters (control group, 97 patients) or delivering health care using telemedicine (81 patients). Telemedicine included daily signs and symptoms based on telemonitoring and structured follow-up by means of video or audio-conference. The primary end-point was non-fatal HF events after six months of follow-up. The median age of the patients was 77 years, 41% were female, and 25% were frail patients. The hazard ratio for the primary end-point was 0.35 (95% confidence interval (CI), 0.20-0.59; p-value < 0.001) in favour of telemedicine. HF readmission (hazard ratio 0.39 (0.19-0.77); p-value=0.007) and cardiovascular readmission (hazard ratio 0.43 (0.23-0.80); p-value=0.008) were also reduced in the telemedicine group. Mortality was similar in both groups (telemedicine: 6.2% vs control: 12.4%, p-value > 0.05). The telemedicine group experienced a significant mean net reduction in direct hospital costs of €3546 per patient per six months of follow-up. Among patients managed in the setting of a comprehensive HF programme, the addition of telemedicine may result in better outcomes and reduction of costs. © The Author(s) 2015.

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial

PubMed Central

2013-01-01

Background Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status. Methods/design Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. Discussion The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an ‘effectiveness trial’ to support broader implementation in the healthcare system if it is successful. Trial registration Unique identifier: NCT00461513 PMID:23837415

On the application of motivation theory to human factors/ergonomics: motivational design principles for human-technology interaction.

PubMed

Szalma, James L

2014-12-01

Motivation is a driving force in human-technology interaction. This paper represents an effort to (a) describe a theoretical model of motivation in human technology interaction, (b) provide design principles and guidelines based on this theory, and (c) describe a sequence of steps for the. evaluation of motivational factors in human-technology interaction. Motivation theory has been relatively neglected in human factors/ergonomics (HF/E). In both research and practice, the (implicit) assumption has been that the operator is already motivated or that motivation is an organizational concern and beyond the purview of HF/E. However, technology can induce task-related boredom (e.g., automation) that can be stressful and also increase system vulnerability to performance failures. A theoretical model of motivation in human-technology interaction is proposed, based on extension of the self-determination theory of motivation to HF/E. This model provides the basis for both future research and for development of practical recommendations for design. General principles and guidelines for motivational design are described as well as a sequence of steps for the design process. Human motivation is an important concern for HF/E research and practice. Procedures in the design of both simple and complex technologies can, and should, include the evaluation of motivational characteristics of the task, interface, or system. In addition, researchers should investigate these factors in specific human-technology domains. The theory, principles, and guidelines described here can be incorporated into existing techniques for task analysis and for interface and system design.

Hydrothermal mobilization of pegmatite-hosted REE and Zr at Strange Lake, Canada: A reaction path model

NASA Astrophysics Data System (ADS)

Gysi, Alexander P.; Williams-Jones, Anthony E.

2013-12-01

Petrological and geochemical observations of pegmatites in the Strange Lake pluton, Canada, have been combined with numerical simulations to improve our understanding of fluid-rock interaction in peralkaline granitic systems. In particular, they have made it possible to evaluate reaction paths responsible for hydrothermal mobilization and mineralization of rare earth elements (REE) and Zr. The focus of the study was the B-Zone in the northwest of the pluton, which contains a pegmatite swarm and is the target of exploration for an economically exploitable REE deposit. Many of the pegmatites are mineralogically zoned into a border consisting of variably altered primary K-feldspar, arfvedsonite, quartz, and zirconosilicates, and a core rich in quartz, fluorite and exotic REE minerals. Textural relationships indicate that the primary silicate minerals in the pegmatites were leached and/or replaced during acidic alteration by K-, Fe- and Al-phyllosilicates, aegirine, hematite, fluorite and/or quartz, and that primary zirconosilicates (e.g., elpidite) were replaced by gittinsite and/or zircon. Reaction textures recording coupled dissolution of silicate minerals and crystallization of secondary REE-silicates indicate hydrothermal mobilization of the REE. The mobility of the light (L)REE was limited by the stability of REE-F-(CO2)-minerals (basnäsite-(Ce) and fluocerite-(Ce)), whereas zirconosilicates and secondary gadolinite-group minerals controlled the mobility of Zr and the heavy (H)REE. Hydrothermal fluorite and fluorite-fluocerite-(Ce) solid solutions are interpreted to indicate the former presence of F-bearing saline fluids in the pegmatites. Numerical simulations show that the mobilization of REE and Zr in saline HCl-HF-bearing fluids is controlled by pH, ligand activity and temperature. Mobilization of Zr is significant in both saline HF- and HCl-HF-bearing fluids at low temperature (250 °C). In contrast, the REE are mobilized by saline HCl-bearing fluids, particularly at high temperature (400 °C). The LREE are more mobile than the HREE in saline HCl-bearing fluids due to the greater stability of LREE-chloride complexes. The simulated mineralogy is consistent with the zonation observed in the pegmatites and with fluid-rock interaction at conditions that were rock-buffered in the pegmatite borders (low fluid/rock ratio; and pH > 4) and fluid-buffered in the cores (high fluid/rock ratio; pH ⩽ 2). We propose a model in which saline HCl-HF-bearing fluids created pathways during acidic alteration from the pegmatite cores outward. This led to the mobilization of REE and Zr due to progressive alteration of primary silicate minerals and increased acidity upon cooling. The key requirement for REE and Zr mobilization in peralkaline igneous intrusions is the formation of an acidic subsystem with high fluid/rock ratios that increases the overall permeability of the rocks. In these zones, the extent of late stage hydrothermal redistribution and concentration of REE and Zr depends on the buffering capacity of the rocks and the availability of fluids that may produce autometasomatic rock alteration, interact with external rock units and/or mix with fluids from other sources. b The detection limits of Yb were 1043 ppm for zircon, 380 ppm for gadolinite-group minerals and 380 ppm for REE-F-(CO2)-minerals. bAja et al. (1995). cMigdisov et al. (2011). dTagirov et al. (1997). eTagirov and Schott (2001). fMigdisov et al. (2009) with REE (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, Lu). b Calculated using the methods of the Chermak and Rimstidt (1989), Berman and Brown (1985) and Holland (1989) with molar volume of arfvedsonite from Hawthorne (1976). cZotov et al. (1998). d GEM-Selektor v.3 database (http://gems.web.psi.ch). eMigdisov et al. (2009).

Plant Responses to High Frequency Electromagnetic Fields

PubMed Central

Vian, Alain; Davies, Eric; Gendraud, Michel; Bonnet, Pierre

2016-01-01

High frequency nonionizing electromagnetic fields (HF-EMF) that are increasingly present in the environment constitute a genuine environmental stimulus able to evoke specific responses in plants that share many similarities with those observed after a stressful treatment. Plants constitute an outstanding model to study such interactions since their architecture (high surface area to volume ratio) optimizes their interaction with the environment. In the present review, after identifying the main exposure devices (transverse and gigahertz electromagnetic cells, wave guide, and mode stirred reverberating chamber) and general physics laws that govern EMF interactions with plants, we illustrate some of the observed responses after exposure to HF-EMF at the cellular, molecular, and whole plant scale. Indeed, numerous metabolic activities (reactive oxygen species metabolism, α- and β-amylase, Krebs cycle, pentose phosphate pathway, chlorophyll content, terpene emission, etc.) are modified, gene expression altered (calmodulin, calcium-dependent protein kinase, and proteinase inhibitor), and growth reduced (stem elongation and dry weight) after low power (i.e., nonthermal) HF-EMF exposure. These changes occur not only in the tissues directly exposed but also systemically in distant tissues. While the long-term impact of these metabolic changes remains largely unknown, we propose to consider nonionizing HF-EMF radiation as a noninjurious, genuine environmental factor that readily evokes changes in plant metabolism. PMID:26981524

Geographic differences in heart failure trials.

PubMed

Ferreira, João Pedro; Girerd, Nicolas; Rossignol, Patrick; Zannad, Faiez

2015-09-01

Randomized controlled trials (RCTs) are essential to develop advances in heart failure (HF). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs. The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial-specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction (HF-PEF), heart failure with reduced ejection fraction (HF-REF), and acute heart failure (AHF). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF-PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes

PubMed Central

Senni, Michele; Paulus, Walter J.; Gavazzi, Antonello; Fraser, Alan G.; Díez, Javier; Solomon, Scott D.; Smiseth, Otto A.; Guazzi, Marco; Lam, Carolyn S. P.; Maggioni, Aldo P.; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L.; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J.; Filippatos, Gerasimos S.; Gheorghiade, Mihai; Anker, Stefan D.; Levy, Daniel; Pfeffer, Marc A.; Stough, Wendy Gattis; Pieske, Burkert M.

2014-01-01

The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. PMID:25104786

Hydrolyzed Formula With Reduced Protein Content Supports Adequate Growth: A Randomized Controlled Noninferiority Trial.

PubMed

Ahrens, Birgit; Hellmuth, Christian; Haiden, Nadja; Olbertz, Dirk; Hamelmann, Eckard; Vusurovic, Milica; Fleddermann, Manja; Roehle, Robert; Knoll, Anette; Koletzko, Berthold; Wahn, Ulrich; Beyer, Kirsten

2018-05-01

A high protein content of nonhydrolyzed infant formula exceeding metabolic requirements can induce rapid weight gain and obesity. Hydrolyzed formula with too low protein (LP) content may result in inadequate growth. The aim of this study was to investigate noninferiority of partial and extensively hydrolyzed formulas (pHF, eHF) with lower hydrolyzed protein content than conventionally, regularly used formulas, with or without synbiotics for normal growth of healthy term infants. In an European multi-center, parallel, prospective, controlled, double-blind trial, 402 formula-fed infants were randomly assigned to four groups: LP-formulas (1.9 g protein/100 kcal) as pHF with or without synbiotics, LP-eHF formula with synbiotics, or regular protein eHF (2.3 g protein/100 kcal). One hundred and one breast-fed infants served as observational reference group. As primary endpoint, noninferiority of daily weight gain during the first 4 months of life was investigated comparing the LP-group to a regular protein eHF group. A comparison of daily weight gain in infants receiving LPpHF (2.15 g/day CI -0.18 to inf.) with infants receiving regular protein eHF showed noninferior weight gain (-3.5 g/day margin; per protocol [PP] population). Noninferiority was also confirmed for the other tested LP formulas. Likewise, analysis of metabolic parameters and plasma amino acid concentrations demonstrated a safe and balanced nutritional composition. Energetic efficiency for growth (weight) was slightly higher in LPeHF and synbiotics compared with LPpHF and synbiotics. All tested hydrolyzed LP formulas allowed normal weight gain without being inferior to regular protein eHF in the first 4 months of life. This trial was registered at clinicaltrials.gov, NCT01143233.

The Singapore Heart Failure Outcomes and Phenotypes (SHOP) study and Prospective Evaluation of Outcome in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction (PEOPLE) study: rationale and design.

PubMed

Santhanakrishnan, Rajalakshmi; Ng, Tze P; Cameron, Vicky A; Gamble, Greg D; Ling, Lieng H; Sim, David; Leong, Gerard Kui Toh; Yeo, Poh Shuan Daniel; Ong, Hean Yee; Jaufeerally, Fazlur; Wong, Raymond Ching-Chiew; Chai, Ping; Low, Adrian F; Lund, Mayanna; Devlin, Gerry; Troughton, Richard; Richards, A Mark; Doughty, Robert N; Lam, Carolyn S P

2013-03-01

Heart failure (HF) with preserved ejection fraction (EF) accounts for a substantial proportion of cases of HF, and to date no treatments have clearly improved outcome. There are also little data comparing HF cohorts of differing ethnicity within the Asia-Pacific region. The Singapore Heart Failure Outcomes and Phenotypes (SHOP) study and Prospective Evaluation of Outcome in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction (PEOPLE) study are parallel prospective studies using identical protocols to enroll patients with HF across 6 centers in Singapore and 4 in New Zealand. The objectives are to determine the relative prevalence, characteristics, and outcomes of patients with HF and preserved EF (EF ≥50%) compared with those with HF and reduced EF, and to determine initial data on ethnic differences within and between New Zealand and Singapore. Case subjects (n = 2,500) are patients hospitalized with a primary diagnosis of HF or attending outpatient clinics for management of HF within 6 months of HF decompensation. Control subjects are age- and gender-matched community-based adults without HF from Singapore (n = 1,250) and New Zealand (n = 1,073). All participants undergo detailed clinical assessment, echocardiography, and blood biomarker measurements at baseline, 6 weeks, and 6 months, and are followed over 2 years for death or hospitalization. Substudies include vascular assessment, cardiopulmonary exercise testing, retinal imaging, and cardiac magnetic resonance imaging. The SHOP and PEOPLE studies are the first prospective multicenter studies defining the epidemiology and interethnic differences among patients with HF in the Asia-Oceanic region, and will provide unique insights into the pathophysiology and outcomes for these patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Double and Triple Si-H-M Bridge Bonds: Matrix Infrared Spectra and Theoretical Calculations for Reaction Products of Silane with Ti, Zr, and Hf Atoms.

PubMed

Xu, Bing; Shi, Peipei; Huang, Tengfei; Wang, Xuefeng; Andrews, Lester

2017-05-25

Infrared spectra of matrix isolated dibridged Si(μ-H) 2 MH 2 and tribridged Si(μ-H) 3 MH molecules (M = Zr and Hf) were observed following the laser-ablated metal atom reactions with SiH 4 during condensation in excess argon and neon, but only the latter species was observed with titanium. Assignments of the major vibrational modes, which included terminal MH, MH 2 and hydrogen bridge Si-H-M stretching modes, were confirmed by the appropriate SiD 4 isotopic shifts and density functional vibrational frequency calculations (B3LYP and BPW91). The Si-H-M hydrogen bridge bond is calculated as weak covalent interaction and compared with the C-H···M agostic interaction in terms of electron localization function (ELF) analysis and noncovalent interaction index (NCI) calculations. Furthermore, the different products of Ti, Zr, and Hf reactions with SiH 4 are discussed in detail.

Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: time to go beyond the initial shock.

PubMed

Mishkin, Joseph D; Saxonhouse, Sherry J; Woo, Gregory W; Burkart, Thomas A; Miles, William M; Conti, Jamie B; Schofield, Richard S; Sears, Samuel F; Aranda, Juan M

2009-11-24

Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not provide a clear stepwise approach to managing these high-risk patients. An ICD shock increases HF event risk and should trigger a thorough evaluation to determine the etiology of the shock and guide subsequent therapeutic interventions. Several combinations of pharmacologic and device-based interventions such as adding amiodarone to baseline beta-blocker therapy, adjusting ICD sensitivity, and employing antitachycardia pacing may reduce future appropriate and inappropriate shocks. Aggressive HF surveillance and management is required after an ICD shock, as the risk of sudden cardiac death is transformed to an increased HF event risk.

Extrusion of Debris from Primary Molar Root Canals following Instrumentation with Traditional and New File Systems.

PubMed

Thakur, Bhagyashree; Pawar, Ajinkya M; Kfir, Anda; Neelakantan, Prasanna

2017-11-01

To assess the amount of debris extruded apically during instrumentation of distal canals of extracted primary molars by three instrument systems [ProTaper Universal (PTU), ProTaper NEXT (PTN), and self-adjusting file (SAF)] compared with conventional stainless steel hand K-files (HF, control). Primary mandibular molars (n = 120) with a single distal canal were selected and randomly divided into four groups (n = 30) for root canal instrumentation using group I, HF (to size 0.30/0.02 taper), group II, PTU (to size F3), group III, PTN (to size X3), and group IV, SAF. Debris extruded during instrumentation was collected in preweighed Eppendorf tubes, stored in an incubator at 70°C for 5 days and then weighed. Statistical analysis was performed by one-way analysis of variance (ANOVA), followed by Turkey's post hoc test (p = 0.05). All the groups resulted in extrusion of debris. There was statistically significant difference (p < 0.001) in the debris extrusion between the three groups: HF (0.00133 ± 0.00012), PTU (0.00109 ± 0.00005), PTN (0.00052 ± 0.00008), and SAF (0.00026 ± 0.00004). Instrumentation with SAF resulted in the least debris extrusion when used for shaping root canals of primary molar teeth. Debris extrusion in primary teeth poses an adverse effect on the stem cells and may also alter the permanent dental germ. Debris extrusion is rarely reported for primary teeth and it is important for the clinician to know which endodontic instrumentation leads to less extrusion of debris.

Cardiovascular and cardiorespiratory phase synchronization in normovolemic and hypovolemic humans.

PubMed

Zhang, Qingguang; Patwardhan, Abhijit R; Knapp, Charles F; Evans, Joyce M

2015-02-01

We investigated whether and how cardiovascular and cardiorespiratory phase synchronization would respond to changes in hydration status and orthostatic stress. Four men and six women were tested during graded head-up tilt (HUT) in both euhydration and dehydration (DEH) conditions. Continuous R-R intervals (RRI), systolic blood pressure (SBP) and respiration were investigated in low (LF 0.04-0.15 Hz) and high (HF 0.15-0.4 Hz) frequency ranges using a phase synchronization index (λ) ranging from 0 (complete lack of interaction) to 1 (perfect interaction) and a directionality index (d), where a positive value of d reflects oscillator 1 driving oscillator 2, and a negative value reflects the opposite driving direction. Surrogate data analysis was used to exclude relationships that occurred by chance. In the LF range, respiration was not synchronized with RRI or SBP, whereas RRI and SBP were phase synchronized. In the HF range, phases among all variables were synchronized. DEH reduced λ among all variables in the HF and did not affect λ between RRI and SBP in the LF region. DEH reduced d between RRI and SBP in the LF and did not affect d among all variables in the HF region. Increasing λ and decreasing d between SBP and RRI were observed in the LF range during HUT. Decreasing λ between SBP and RRI, respiration and RRI, and decreasing d between respiration and SBP were observed in the HF range during HUT. These results show that orthostatic stress disassociated interactions among RRI, SBP and respiration, and that DEH exacerbated the disconnection.

MODELS OF INSULIN RESISTANCE AND HEART FAILURE

PubMed Central

Velez, Mauricio; Kohli, Smita; Sabbah, Hani N.

2013-01-01

The incidence of heart failure (HF) and diabetes mellitus is rapidly increasing and is associated with poor prognosis. In spite of the advances in therapy, HF remains a major health problem with high morbidity and mortality. When HF and diabetes coexist, clinical outcomes are significantly worse. The relationship between these two conditions has been studied in various experimental models. However, the mechanisms for this interrelationship are complex, incompletely understood, and have become a matter of considerable clinical and research interest. There are only few animal models that manifest both HF and diabetes. However, the translation of results from these models to human disease is limited and new models are needed to expand our current understanding of this clinical interaction. In this review, we discuss mechanisms of insulin signaling and insulin resistance, the clinical association between insulin resistance and HF and its proposed pathophysiologic mechanisms. Finally, we discuss available animal models of insulin resistance and HF and propose requirements for future new models. PMID:23456447

Predictors of heart failure in patients with stable coronary artery disease: a PEACE study.

PubMed

Lewis, Eldrin F; Solomon, Scott D; Jablonski, Kathleen A; Rice, Madeline Murguia; Clemenza, Francesco; Hsia, Judith; Maggioni, Aldo P; Zabalgoitia, Miguel; Huynh, Thao; Cuddy, Thomas E; Gersh, Bernard J; Rouleau, Jean; Braunwald, Eugene; Pfeffer, Marc A

2009-05-01

Heart failure (HF) is a disease commonly associated with coronary artery disease. Most risk models for HF development have focused on patients with acute myocardial infarction. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition population enabled the development of a risk model to predict HF in patients with stable coronary artery disease and preserved ejection fraction. In the 8290, Prevention of Events with Angiotensin-Converting Enzyme Inhibition patients without preexisting HF, new-onset HF hospitalizations, and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if P<0.05. A risk score was developed and converted to an integer-based scoring system. Among the Prevention of Events with Angiotensin-Converting Enzyme Inhibition population (age, 64+/-8; female, 18%; prior myocardial infarction, 55%), there were 268 cases of fatal and nonfatal HF. Twelve characteristics were associated with increased risk of HF along with several baseline medications, including older age, history of hypertension, and diabetes. Randomization to trandolapril independently reduced the risk of HF. There was no interaction between trandolapril treatment and other risk factors for HF. The risk score (range, 0 to 21) demonstrated excellent discriminatory power (c-statistic 0.80). Risk of HF ranged from 1.75% in patients with a risk score of 0% to 33% in patients with risk score >or=16. Among patients with stable coronary artery disease and preserved ejection fraction, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved ejection fraction.

Age at Menopause and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis

PubMed Central

Ebong, Imo A.; Watson, Karol E.; Goff, David C.; Bluemke, David A.; Srikanthan, Preethi; Horwich, Tamara; Bertoni, Alain G.

2014-01-01

Objective To evaluate associations of early menopause (menopause occurring before 45 years of age) and age at menopause with incident heart failure (HF) in post-menopausal women. We also explored associations of early, and age at menopause with left ventricular (LV) measures of structure and function in post-menopausal women. Methods We included 2947 post-menopausal women, aged 45-84 years, without known cardiovascular disease (2000-2002), from the Multi-Ethnic study of Atherosclerosis. Cox-Proportional hazards models were used to examine associations of early, and age at menopause with incident HF. In 2123 post-menopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored associations of early, and age at menopause with LV measures using multivariable linear regression. Results Over a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction>0.05). In adjusted analysis, early menopause was associated with increased risk of incident HF [1.66 (1.01-2.73)], while each year increase in age at menopause was associated with decreased risk of incident HF [0.96 (0.94-0.99)]. We observed significant interactions between early menopause and ethnicity for LV mass to volume ratio (LVMVR), Pinteraction=0.02. In Chinese-American women, early menopause was associated with higher LVMVR (+0.11, p=0.0002), while each year increase in age at menopause was associated with lower LVMVR (−0.004, p=0.04) at baseline. Conclusion An older menopausal age is independently associated with decreased risk of incident HF. Concentric LV remodelling, indicated by a higher LVMVR was present in Chinese-American women with early menopause at baseline. PMID:24423934

Acute effect of Vagus nerve stimulation parameters on cardiac chronotropic, inotropic, and dromotropic responses

NASA Astrophysics Data System (ADS)

Ojeda, David; Le Rolle, Virginie; Romero-Ugalde, Hector M.; Gallet, Clément; Bonnet, Jean-Luc; Henry, Christine; Bel, Alain; Mabo, Philippe; Carrault, Guy; Hernández, Alfredo I.

2017-11-01

Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy and depression, and is considered as a potential therapy for other pathologies, including Heart Failure (HF) or inflammatory diseases. In the case of HF, several experimental studies on animals have shown an improvement in the cardiac function and a reverse remodeling of the cardiac cavity when VNS is applied. However, recent clinical trials have not been able to reproduce the same response in humans. One of the hypothesis to explain this lack of response is related to the way in which stimulation parameters are defined. The combined effect of VNS parameters is still poorly-known, especially in the case of VNS synchronously delivered with cardiac activity. In this paper, we propose a methodology to analyze the acute cardiovascular effects of VNS parameters individually, as well as their interactive effects. A Latin hypercube sampling method was applied to design a uniform experimental plan. Data gathered from this experimental plan was used to produce a Gaussian process regression (GPR) model in order to estimate unobserved VNS sequences. Finally, a Morris screening sensitivity analysis method was applied to each obtained GPR model. Results highlight dominant effects of pulse current, pulse width and number of pulses over frequency and delay and, more importantly, the degree of interactions between these parameters on the most important acute cardiovascular responses. In particular, high interacting effects between current and pulse width were found. Similar sensitivity profiles were observed for chronotropic, dromotropic and inotropic effects. These findings are of primary importance for the future development of closed-loop, personalized neuromodulator technologies.

Interaction between worsening renal function and persistent congestion in acute decompensated heart failure.

PubMed

Wattad, Malak; Darawsha, Wisam; Solomonica, Amir; Hijazi, Maher; Kaplan, Marielle; Makhoul, Badira F; Abassi, Zaid A; Azzam, Zaher S; Aronson, Doron

2015-04-01

Worsening renal function (WRF) and congestion are inextricably related pathophysiologically, suggesting that WRF occurring in conjunction with persistent congestion would be associated with worse clinical outcome. We studied the interdependence between WRF and persistent congestion in 762 patients with acute decompensated heart failure (HF). WRF was defined as ≥0.3 mg/dl increase in serum creatinine above baseline at any time during hospitalization and persistent congestion as ≥1 sign of congestion at discharge. The primary end point was all-cause mortality with mean follow-up of 15 ± 9 months. Readmission for HF was a secondary end point. Persistent congestion was more common in patients with WRF than in patients with stable renal function (51.0% vs 26.6%, p <0.0001). Both persistent congestion and persistent WRF were significantly associated with mortality (both p <0.0001). There was a strong interaction (p = 0.003) between persistent WRF and congestion, such that the increased risk for mortality occurred predominantly with both WRF and persistent congestion. The adjusted hazard ratio for mortality in patients with persistent congestion as compared with those without was 4.16 (95% confidence interval [CI] 2.20 to 7.86) in patients with WRF and 1.50 (95% CI 1.16 to 1.93) in patients without WRF. In conclusion, persisted congestion is frequently associated with WRF. We have identified a substantial interaction between persistent congestion and WRF such that congestion portends increased mortality particularly when associated with WRF. Copyright © 2015 Elsevier Inc. All rights reserved.

Prevalence and Clinical Significance of Diabetes in Asian Versus White Patients With Heart Failure.

PubMed

Bank, Ingrid E M; Gijsberts, Crystel M; Teng, Tiew-Hwa K; Benson, Lina; Sim, David; Yeo, Poh Shuan Daniel; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Dahlström, Ulf; Lund, Lars H; Lam, Carolyn S P

2017-01-01

The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; p interaction  = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; p interaction  = 0.045). Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines.

PubMed

van Nimwegen, Frederika A; Ntentas, Georgios; Darby, Sarah C; Schaapveld, Michael; Hauptmann, Michael; Lugtenburg, Pieternella J; Janus, Cecile P M; Daniels, Laurien; van Leeuwen, Flora E; Cutter, David J; Aleman, Berthe M P

2017-04-20

Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n = 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n = 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls ( P difference = .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ≥26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively ( P trend < .001). Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD ( P interaction = .09). Twenty-five-year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ≥21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up. © 2017 by The American Society of Hematology.

Efficacy of the device combining high-frequency transcutaneous electrical nerve stimulation and thermotherapy for relieving primary dysmenorrhea: a randomized, single-blind, placebo-controlled trial.

PubMed

Lee, Banghyun; Hong, Seung Hwa; Kim, Kidong; Kang, Wee Chang; No, Jae Hong; Lee, Jung Ryeol; Jee, Byung Chul; Yang, Eun Joo; Cha, Eun-Jong; Kim, Yong Beom

2015-11-01

To investigate the efficacy and safety of the combined therapy with high-frequency transcutaneous electrical nerve stimulation (hf-TENS) and thermotherapy in relieving primary dysmenorrheal pain. In this randomized, single-blind, placebo-controlled study, 115 women with moderate or severe primary dysmenorrhea were assigned to the study or control group at a ratio of 1:1. Subjects in the study group used an integrated hf-TENS/thermotherapy device, whereas control subjects used a sham device. A visual analog scale was used to measure pain intensity. Variables related to pain relief, including reduction rate of dysmenorrheal score, were compared between the groups. The dysmenorrheal score was significantly reduced in the study group compared to the control group following the use of the devices. The duration of pain relief was significantly increased in the study group compared to the control group. There were no differences between the groups in the brief pain inventory scores, numbers of ibuprofen tablets taken orally, and World Health Organization quality of life-BREF scores. No adverse events were observed related to the use of the study device. The combination of hf-TENS and thermotherapy was effective in relieving acute pain in women with moderate or severe primary dysmenorrhea. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

GPU simulation of nonlinear propagation of dual band ultrasound pulse complexes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kvam, Johannes, E-mail: johannes.kvam@ntnu.no; Angelsen, Bjørn A. J., E-mail: bjorn.angelsen@ntnu.no; Elster, Anne C., E-mail: elster@ntnu.no

In a new method of ultrasound imaging, called SURF imaging, dual band pulse complexes composed of overlapping low frequency (LF) and high frequency (HF) pulses are transmitted, where the frequency ratio LF:HF ∼ 1 : 20, and the relative bandwidth of both pulses are ∼ 50 − 70%. The LF pulse length is hence ∼ 20 times the HF pulse length. The LF pulse is used to nonlinearly manipulate the material elasticity observed by the co-propagating HF pulse. This produces nonlinear interaction effects that give more information on the propagation of the pulse complex. Due to the large difference inmore » frequency and pulse length between the LF and the HF pulses, we have developed a dual level simulation where the LF pulse propagation is first simulated independent of the HF pulse, using a temporal sampling frequency matched to the LF pulse. A separate equation for the HF pulse is developed, where the the presimulated LF pulse modifies the propagation velocity. The equations are adapted to parallel processing in a GPU, where nonlinear simulations of a typical HF beam of 10 MHz down to 40 mm is done in ∼ 2 secs in a standard GPU. This simulation is hence very useful for studying the manipulation effect of the LF pulse on the HF pulse.« less

Synergistic effect of combined HMG-CoA reductase inhibitor and angiotensin-II receptor blocker therapy in patients with chronic heart failure: the HF-COSTAR trial.

PubMed

Maejima, Yasuhiro; Nobori, Kiyoshi; Ono, Yuichi; Adachi, Susumu; Suzuki, Jun-Ichi; Hirao, Kenzo; Isobe, Mitsuaki; Ito, Hiroshi

2011-01-01

It is known that HMG-CoA reductase inhibitors (statins) may have a therapeutic benefit in patients with heart failure (HF). However, no studies have yet evaluated the possible interaction of statins and angiotensin-II receptor blockers (ARBs) on left ventricular (LV) function in patients with HF. We hypothesized that statins might alter the effect of ARBs on cardiac function in patients with HF. We prospectively randomized patients with chronic HF who received the ARB, losartan (LOS group), or the statin, simvastatin (SIM), in combination with LOS (SIM+LOS group) at our hospitals and assessed before and after treatment for 6 months. Although no significant improvement of HF symptoms as evaluated by the New York Heart Association (NYHA) classification was observed in the LOS group, HF symptoms in the SIM+LOS group significantly improved. The percent increase of LV ejection fraction after treatment in the SIM+LOS group was significantly larger than in the LOS group. Furthermore, the plasma brain natriuretic peptide level was significantly lower after treatment in the SIM+LOS group than in the LOS group. Combined statin and ARB therapy significantly improves both symptoms and LV function over time in patients with HF. Thus, the combination of an ARB with a statin may be a useful therapeutic strategy for HF.

Nurse-led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials and Outcomes Used in the Clinical Trial

PubMed Central

Smith, C. E.; Piamjariyakul, U.; Dalton, K. M.; Russell, C.; Wick, J.; Ellerbeck, E.F.

2015-01-01

Background The Self-Management and Care of Heart Failure through Group Clinics Trial (SMAC-HF) evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high risk heart failure (HF) patients. Objective The purpose of this article is to: (1) describe key SMAC-HF group clinic interactive learning strategies; (2) describe resources and materials used in the group clinic appointment; and (3) present results supporting this patient-centered group intervention. Methods This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients’: (1) group clinic session evaluations; (2) HF Self-Care Behaviors Skills; (3) HF related discouragement and quality of life scores and (4) HF related reshopitalizations during the 12 month follow-up. Also the costs of delivery of the group clinical appointments were tabulated. Results Overall, patients rated group appointments as 4.8 out of 5 on the “helpfulness” in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio (IRR) = 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ2(1) = 3.9, p = 0.04). The total cost for implementing five group appointments was $243.58 per patient. Conclusion The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF related hospitalizations. PMID:25774836

Pharmacovigilance Evaluation of the Association Between DPP-4 Inhibitors and Heart Failure: Stimulated Reporting and Moderation by Drug Interactions.

PubMed

Fadini, Gian Paolo; Sarangdhar, Mayur; Avogaro, Angelo

2018-04-01

In the SAVOR-TIMI trial, the risk of heart failure (HF) was increased by 27% in T2D patients randomized to the dipeptidyl peptidase-4 inhibitor (DPP4i) saxagliptin. Other studies have provided inconsistent results regarding this association. Herein, we performed a pharmacovigilance analysis of the rate of HF associated with DPP4is, focusing on stimulated reporting and moderation by drug-drug interactions. We mined the FDA adverse event (AE) reporting system (FAERS) from 2004q1 to 2017q3, including a total of 9906,642 AE reports. Rates (/1000 reports) of HF within the reports for DPP4is and reports for other antidiabetic drugs were calculated for the period up to 2013q3 (date of publication of the SAVOR-TIMI trial results) and from 2013q4 to 2017q3. Analyses were refined by filtering according to therapeutic area, concomitant diseases and drugs, and competing AEs. The rate of HF among the AE reports filed for DPP4is significantly increased after 2013q3, especially for saxagliptin. When compared to non-insulin non-glitazone antidiabetic drugs, the proportional reporting ratio (PRR) of HF for DPP4is was 0.62 (95% CI 0.56-0.68) up to 2013q3 and 2.12 (95% CI 1.96-2.28) from 2013q4 to 2017q3. This stimulated reporting was consistent in subanalyses based on the presence/absence of cardiac disorders and after controlling for competing AEs. The rate of HF among AE reports for DPP4is was modestly moderated by the concomitant use of metformin (- 15%) and strongly moderated by the concomitant use of SGLT2 inhibitors (- 63%), even after excluding competing AEs. Within the FAERS, the association between HF and DPP4is was biased by stimulated reporting, implying that the publication of the SAVOR-TIMI trial and the subsequent regulatory warnings primed clinicians to report HF events in DPP4i users as drug-related AEs. The rate of HF associated with DPP4is was moderated when they were used in combination with SGLT2 inhibitors.

[Cardio-hepatic Syndrome in Heart Failure: Prevalence, Pathogenesis and Prognostic Significance].

PubMed

Kobalava, Zh D; Villevalde, S V; Soloveva, A E

2016-12-01

In a framework of the concept of organ interactions great attention has been paid during recent years to interaction of the heart and liver. The term cardio-hepatic syndrome (CHS) designates the combination of clinical-laboratory signs of liver dysfunction and acute or chronic cardiac pathology. In this article, we present mechanisms and characteristics of CHS in acute and chronic heart failure (HF), data of large clinical studies and registries on prevalence, associations, and prognostic significance of cardiogenic disturbances of liver function in patients with HF.

Evaluation of the effects of alteration and leaching on Sm Nd and Lu Hf systematics in submarine mafic rocks

NASA Astrophysics Data System (ADS)

Thompson, Patricia M. E.; Kempton, Pamela D.; Kerr, Andrew C.

2008-08-01

Nd and Hf isotope systematics of oceanic basaltic rocks are often assumed to be largely immune to the effects of hydrothermal alteration. We have tested this assumption by comparing Nd and Hf isotope data for acid-leached Cretaceous oceanic basalts from Gorgona and DSDP Leg 15 with unleached data on the same rocks. Hf isotope values and Lu/Hf ratios are relatively unaffected by leaching, but 143Nd/ 144Nd values of leached samples are significantly higher than those of unleached fractions of the same sample in most cases. Furthermore, the Sm/Nd ratios of the majority of leached samples are 10-40% greater than those of unleached samples. X-ray diffraction studies indicate that selective removal of secondary minerals, such as smectite, during the acid leaching process is responsible for the fractionation of Sm/Nd ratios. These results have implications for interpretation of the Hf-Nd isotope systematics of ancient submarine rocks (older than ~ 50 Ma), as (1) the age-corrected 143Nd/ 144Nd ratio may not be representative of the primary magmatic signature and (2) the uncertainty of the age-corrected ɛNd value may exceed the assumed analytical precision.

Employment status at time of first hospitalization for heart failure is associated with a higher risk of death and rehospitalization for heart failure.

PubMed

Rørth, Rasmus; Fosbøl, Emil L; Mogensen, Ulrik M; Kragholm, Kristian; Numé, Anna-Karin; Gislason, Gunnar H; Jhund, Pardeep S; Petrie, Mark C; McMurray, John J V; Torp-Pedersen, Christian; Køber, Lars; Kristensen, Søren L

2018-02-01

Employment status at time of first heart failure (HF) hospitalization may be an indicator of both self-perceived and objective health status. In this study, we examined the association between employment status and the risk of all-cause mortality and recurrent HF hospitalization in a nationwide cohort of patients with HF. We identified all patients of working age (18-60 years) with a first HF hospitalization in the period 1997-2015 in Denmark, categorized according to whether or not they were part of the workforce at time of the index admission. The primary outcome was death from any cause and the secondary outcome was readmission for HF. Cumulative incidence curves, binomial regression and Cox regression models were used to assess outcomes. Of 25 571 patients with a first hospitalization for HF, 15 428 (60%) were part of the workforce at baseline. Patients in the workforce were significantly younger (53 vs. 55 years) more likely to be male (75% vs 64%) and less likely to have diabetes (13% vs 22%) and chronic obstructive pulmonary disease (5% vs 10%) (all P < 0.0001). Not being part of the workforce was associated with a significantly higher risk of death [hazard ratio (HR) 1.59; 95% confidence interval (CI) 1.50-1.68] and rehospitalization for HF (HR 1.09; 95% CI 1.05-1.14), in analyses adjusted for age, sex, co-morbidities, education level, calendar time, and duration of first HF hospitalization. Not being part of the workforce at time of first HF hospitalization was independently associated with increased mortality and recurrent HF hospitalization. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Mortality Among Patients Hospitalized With Heart Failure and Diabetes Mellitus: Results From the National Inpatient Sample 2000 to 2010.

PubMed

Win, Theingi Tiffany; Davis, Herbert T; Laskey, Warren K

2016-05-01

Case fatality and hospitalization rates for US patients with heart failure (HF) have steadily decreased during the past several decades. Diabetes mellitus (DM), a risk factor for, and frequent coexisting condition with, HF continues to increase in the general population. We used the National Inpatient Sample to estimate overall as well as age-, sex-, and race/ethnicity-specific trends in HF hospitalizations, DM prevalence, and in-hospital mortality among 2.5 million discharge records from 2000 to 2010 with HF as primary discharge diagnosis. Multivariable logistic and Poisson regression were used to assess the impact of the above demographic characteristics on in-hospital mortality. Age-standardized hospitalizations decreased significantly in HF overall and in HF with DM. Age-standardized in-hospital mortality with HF declined from 2000 to 2010 (4.57% to 3.09%, Ptrend<0.0001), whereas DM prevalence in HF increased (38.9% to 41.9%, Ptrend<0.0001) as did comorbidity burden. Age-standardized in-hospital mortality in HF with DM also decreased significantly (3.53% to 2.27%, Ptrend<0.0001). After adjusting for year, age, and comorbid burden, males remained at 17% increased risk versus females, non-Hispanics remained at 12% increased risk versus Hispanics, and whites had a 30% higher mortality versus non-white minorities. Absolute mortality rates were lower in younger versus older patients, although the rate of decline was attenuated in younger patients. In-hospital mortality in HF patients with DM significantly decreased during the past decade, despite increases in DM prevalence and comorbid conditions. Mortality rate decreases among younger patients were significantly attenuated, and mortality disparities remain among important demographic subgroups. © 2016 American Heart Association, Inc.

Acculturation and Outcomes among Patients with Heart Failure

PubMed Central

Peterson, Pamela N.; Campagna, Elizabeth J.; Maravi, Moises; Allen, Larry A.; Bull, Sheana; Steiner, John F.; Havranek, Edward P.; Dickinson, L. Miriam; Masoudi, Frederick A

2013-01-01

Background Acculturation to U.S. society among minority patients may influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges interacting with the health care system and thus be at greater risk for adverse outcomes. Methods and Results We studied patients hospitalized with a principal discharge diagnosis of HF between January 2000 and December 2007 in an integrated delivery system that cares for minority patients. Individuals were defined as having low acculturation if their primary language was not English and their country of birth was outside of the U.S. Multivariable logistic regression and Cox proportional hazards regression were used to determine the independent risk of 30-day rehospitalization and 1-year mortality, respectively. Candidate adjustment variables included demographics (age, gender, race/ethnicity), coexisting illnesses, laboratory values, left ventricular systolic function, and characteristics of the index admission. Of 1,268 patients, 30% (n=379) were Black, 39% (n=498) Hispanic, and 27% (n= 348) White. Eighteen percent (n=228) had low acculturation. After adjustment, low acculturation was associated with a higher risk of readmission at 30 days (OR 1.70; 95% CI 1.07-2.68) but not 1-year all-cause mortality (HR 0.69; 95% CI 0.42-1.14). Conclusions Patients with HF who are foreign-born and do not speak English as their primary language have a greater risk of rehospitalization, independent of clinical factors and race/ethnicity. Future studies should evaluate whether culturally concordant interventions focusing on such patients may improve outcomes for this patient population. PMID:22247483

Lipophilic versus hydrophilic statin therapy for heart failure: a protocol for an adjusted indirect comparison meta-analysis

PubMed Central

2013-01-01

Background Statins are known to reduce cardiovascular morbidity and mortality in primary and secondary prevention studies. Subsequently, a number of nonrandomised studies have shown statins improve clinical outcomes in patients with heart failure (HF). Small randomised controlled trials (RCT) also show improved cardiac function, reduced inflammation and mortality with statins in HF. However, the findings of two large RCTs do not support the evidence provided by previous studies and suggest statins lack beneficial effects in HF. Two meta-analyses have shown statins do not improve survival, whereas two others showed improved cardiac function and reduced inflammation in HF. It appears lipophilic statins produce better survival and other outcome benefits compared to hydrophilic statins. But the two types have not been compared in direct comparison trials in HF. Methods/design We will conduct a systematic review and meta-analysis of lipophilic and hydrophilic statin therapy in patients with HF. Our objectives are: 1. To determine the effects of lipophilic statins on (1) mortality, (2) hospitalisation for worsening HF, (3) cardiac function and (4) inflammation. 2. To determine the effects of hydrophilic statins on (1) mortality, (2) hospitalisation for worsening HF, (3) cardiac function and (4) inflammation. 3. To compare the efficacy of lipophilic and hydrophilic statins on HF outcomes with an adjusted indirect comparison meta-analysis. We will conduct an electronic search of databases for RCTs that evaluate statins in patients with HF. The reference lists of all identified studies will be reviewed. Two independent reviewers will conduct the search. The inclusion criteria include: 1. RCTs comparing statins with placebo or no statin in patients with symptomatic HF. 2. RCTs that employed the intention-to-treat (ITT) principle in data analysis. 3. Symptomatic HF patients of all aetiologies and on standard treatment. 4. Statin of any dose as intervention. 5. Placebo or no statin arm as control. The exclusion criteria include: 1. RCTs involving cerivastatin in HF patients. 2. RCTs with less than 4 weeks of follow-up. Discussion We will perform an adjusted indirect comparison meta-analysis of lipophilic versus hydrophilic statins in patients with HF using placebo or no statin arm as common comparator. PMID:23618535

Depression impacts the physiological responsiveness of mother–daughter dyads during social interaction

PubMed Central

Amole, Marlissa C.; Cyranowski, Jill M.; Wright, Aidan G. C.; Swartz, Holly A.

2017-01-01

Background Maternal depression is associated with increased risk of psychiatric illness in offspring. While risk may relate to depressed mothers' difficulties regulating emotions in the context of interacting with offspring, physiological indicators of emotion regulation have rarely been examined during mother–child interactions—and never among mother–adolescent dyads in which both mother and adolescent have histories of major depressive disorder (MDD). Methods We examined changes in high-frequency heart rate variability (HF-HRV), an indicator of parasympathetic (vagal) function that has been related to depression, stress, social engagement, and emotion regulation, in 46 mother–daughter dyads (23 in which both mother and daughter had an MDD history and 23 never-depressed controls). Hierarchical linear models evaluated changes in HF-HRV while mother–daughter dyads engaged in discussions about shared pleasant events and relationship conflicts. Results While control dyads displayed positive slopes (increases) in HF-HRV during both discussions, MDD dyads displayed minimal change in HF-HRV across discussions. Among controls, HF-HRV slopes were positively correlated between mothers and daughters during the pleasant events' discussion. In contrast, HF-HRV slopes were negatively correlated between MDD mothers and daughters during both discussions. Conclusions Vagal responses observed in control mother–daughter dyads suggest a pattern of physiological synchrony and reciprocal positive social engagement, which may play a role in adolescent development of secure social attachments and healthy emotion regulation. In contrast, MDD mothers and daughters displayed diminished and discordant patterns of vagal responsiveness. More research is needed to understand the development and consequences of these patterns of parasympathetic responses among depressed mother–daughter dyads. PMID:28060443

Mechanistic insight into prolonged electromechanical delay in dyssynchronous heart failure: a computational study

PubMed Central

Constantino, Jason; Hu, Yuxuan; Lardo, Albert C.

2013-01-01

In addition to the left bundle branch block type of electrical activation, there are further remodeling aspects associated with dyssynchronous heart failure (HF) that affect the electromechanical behavior of the heart. Among the most important are altered ventricular structure (both geometry and fiber/sheet orientation), abnormal Ca2+ handling, slowed conduction, and reduced wall stiffness. In dyssynchronous HF, the electromechanical delay (EMD), the time interval between local myocyte depolarization and myofiber shortening onset, is prolonged. However, the contributions of the four major HF remodeling aspects in extending EMD in the dyssynchronous failing heart remain unknown. The goal of this study was to determine the individual and combined contributions of HF-induced remodeling aspects to EMD prolongation. We used MRI-based models of dyssynchronous nonfailing and HF canine electromechanics and constructed additional models in which varying combinations of the four remodeling aspects were represented. A left bundle branch block electrical activation sequence was simulated in all models. The simulation results revealed that deranged Ca2+ handling is the primary culprit in extending EMD in dyssynchronous HF, with the other aspects of remodeling contributing insignificantly. Mechanistically, we found that abnormal Ca2+ handling in dyssynchronous HF slows myofiber shortening velocity at the early-activated septum and depresses both myofiber shortening and stretch rate at the late-activated lateral wall. These changes in myofiber dynamics delay the onset of myofiber shortening, thus giving rise to prolonged EMD in dyssynchronous HF. PMID:23934857

Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial.

PubMed

Sidebottom, Abbey C; Jorgenson, Ann; Richards, Hallie; Kirven, Justin; Sillah, Arthur

2015-02-01

Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models. Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services. Patients hospitalized with acute HF were randomized to receive a PC consult with follow-up as determined by provider or standard care. Two hundred thirty-two patients (116 intervention/116 control) from a large tertiary-care urban hospital were recruited over a 10-month period. Primary outcomes were symptom burden, depressive symptoms, and QOL measured at baseline, 1, and 3 months. Secondary outcomes included advance care planning (ACP), inpatient 30-day readmission, hospice use, and death. Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age, gender, and marital status differences between study groups. QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month (difference+4.92, p<0.001). Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month (+3.69, p<0.001). ACP was the only secondary outcome associated with the intervention (hazard ratio [HR] 2.87, p=0.033). An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.

A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context.

PubMed

Tierney, Stephanie; Kislov, Roman; Deaton, Christi

2014-09-18

There is currently a growing emphasis in primary care on upscaling the provision of evidence-based services for specific conditions, such as heart failure (HF), which have traditionally been seen as part of a specialist's domain. While contextual challenges associated with improvement in primary care have been documented previously, we still know relatively little about how the intentional, theory-informed facilitation of evidence-based change is shaped by contextual factors within this healthcare setting. Hence, a qualitative study was conducted to address the question: How is the process of facilitating evidence-based practice affected by the context of primary care? Data collection took place across general practices in northwest England as part of a process evaluation of the Greater Manchester HF Investigation Tool (GM-HFIT) - a programme of work aiming to improve the management of HF in primary care. Semi-structured interviews, with purposefully selected GM-HFIT team members (n = 9) and primary care practitioners (n = 7), were supplemented by observational data and a three-month diary reflecting on facilitation activities. Framework analysis was used to manage and interpret data. We describe a complex and dynamic interplay between facilitation and context, focusing on three major themes: (1) Addressing macro and micro agendas; (2) Forming a facilitative unit; (3) Maintaining momentum. We show that HF specialist nurses (HFSNs) have a high level of professional credibility, which allows them to play a key role in making recommendations to practices for improving patient care. At the same time, we argue that contextual factors, such as top-level endorsement, the necessity to comply with a performance measurement system, and the varying involvement of practice nurses produce tensions that can have both an enabling and constraining effect on the process of facilitation. When facilitating the transfer of evidence, context is an important aspect to consider at a macro and micro level; a complex interplay can exist between these levels, which may constrain or enable efforts to amend practice. Those involved in facilitating change within primary care have to manage tensions arising from the interplay of these different contextual forces to minimise their impact on efforts to alter practice based on best evidence.

The effects of organic matter-mineral interactions and organic matter chemistry on diuron sorption across a diverse range of soils.

PubMed

Smernik, Ronald J; Kookana, Rai S

2015-01-01

Sorption of non-ionic organic compounds to soil is usually expressed as the carbon-normalized partition coefficient (KOC), because it is assumed that the main factor that influences the amount sorbed is the organic carbon content of the soil. However, KOC can vary by a factor of at least ten across a range of soils. We investigated two potential causes of variation in diuron KOC - organic matter-mineral interactions and organic matter chemistry - for a diverse set of 34 soils from Sri Lanka, representing a wide range of soil types. Treatment with hydrofluoric acid (HF-treatment) was used to concentrate soil organic matter. HF-treatment increased KOC for the majority of soils (average factor 2.4). We attribute this increase to the blocking of organic matter sorption sites in the whole soils by minerals. There was no significant correlation between KOC for the whole soils and KOC for the HF-treated soils, indicating that the importance of organic matter-mineral interactions varied greatly amongst these soils. There was as much variation in KOC across the HF-treated soils as there was across the whole soils, indicating that the nature of soil organic matter is also an important contributor to KOC variability. Organic matter chemistry, determined by solid-state (13)C nuclear magnetic resonance (NMR) spectroscopy, was correlated with KOC for the HF-treated soils. In particular, KOC increased with the aromatic C content (R=0.64, p=1×10(-6)), and decreased with O-alkyl C (R=-0.32, p=0.03) and alkyl C (R=-0.41, p=0.004) content. Copyright © 2014 Elsevier Ltd. All rights reserved.

Expression profiling and bioinformatic analyses suggest new target genes and pathways for human hair follicle related microRNAs.

PubMed

Hochfeld, Lara M; Anhalt, Thomas; Reinbold, Céline S; Herrera-Rivero, Marisol; Fricker, Nadine; Nöthen, Markus M; Heilmann-Heimbach, Stefanie

2017-02-22

Human hair follicle (HF) cycling is characterised by the tight orchestration and regulation of signalling cascades. Research shows that micro(mi)RNAs are potent regulators of these pathways. However, knowledge of the expression of miRNAs and their target genes and pathways in the human HF is limited. The objective of this study was to improve understanding of the role of miRNAs and their regulatory interactions in the human HF. Expression levels of ten candidate miRNAs with reported functions in hair biology were assessed in HFs from 25 healthy male donors. MiRNA expression levels were correlated with mRNA-expression levels from the same samples. Identified target genes were tested for enrichment in biological pathways and accumulation in protein-protein interaction (PPI) networks. Expression in the human HF was confirmed for seven of the ten candidate miRNAs, and numerous target genes for miR-24, miR-31, and miR-106a were identified. While the latter include several genes with known functions in hair biology (e.g., ITGB1, SOX9), the majority have not been previously implicated (e.g., PHF1). Target genes were enriched in pathways of interest to hair biology, such as integrin and GnRH signalling, and the respective gene products showed accumulation in PPIs. Further investigation of miRNA expression in the human HF, and the identification of novel miRNA target genes and pathways via the systematic integration of miRNA and mRNA expression data, may facilitate the delineation of tissue-specific regulatory interactions, and improve our understanding of both normal hair growth and the pathobiology of hair loss disorders.

Understanding palliative care on the heart failure care team: an innovative research methodology.

PubMed

Lingard, Lorelei A; McDougall, Allan; Schulz, Valerie; Shadd, Joshua; Marshall, Denise; Strachan, Patricia H; Tait, Glendon R; Arnold, J Malcolm; Kimel, Gil

2013-05-01

There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team. To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team. This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams. We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps. We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Primary Data on U/Pb-Isotope Ages and Lu/Hf-Isotope Geochemical Systematization of Detrital Zircons from the Lopatinskii Formation (Vendian-Cambrian Transition Levels) and the Tectonic Nature of Teya-Chapa Depression (Northeastern Yenisei Ridge)

NASA Astrophysics Data System (ADS)

Kuznetsov, N. B.; Priyatkina, N. S.; Rud'ko, S. V.; Shatsillo, A. V.; Collins, W. J.; Romanyuk, T. V.

2018-03-01

The main results are presented on U/Pb-isotope dating of 100 detrital zircons and, selectively, on the Lu/Hf-isotope system of 43 grains from sandstones of the Lopatinskii formation (the lower stratigraphic level of the Chingasan group). Ages from 896 ± 51 to 2925 ± 38 Ma were obtained with a pronounced maximum of 1890 Ma in the curve of probability density, along with ɛHf estimates from +8.4 to-15.1, which allow one to throw doubt upon the molasse nature of the Lopatinskii formation.

High-resolution studies of the HF ionospheric modification interaction region

NASA Technical Reports Server (NTRS)

Duncan, L. M.; Sheerin, J. P.

1985-01-01

The use of the pulse edge analysis technique to explain ionospheric modifications caused by high-power HF radio waves is discussed. The technique, implemented at the Arecibo Observatory, uses long radar pulses and very rapid data sampling. A comparison of the pulse leading and trailing edge characteristics is obtained and the comparison is used to estimate the relative changes in the interaction region height and layer width; an example utilizing this technique is provided. Main plasma line overshoot and miniovershoot were studied from the pulse edge observations; the observations at various HF pulsings and radar resolutions are graphically presented. From the pulse edge data the development and the occurrence of main plasma line overshoot and miniovershoot are explained. The theories of soliton formation and collapse, wave ducting, profile modification, and parametric instabilities are examined as a means of explaining main plasma line overshoots and miniovershoots.

Application of diffusion barriers to high modulus fibers

NASA Technical Reports Server (NTRS)

Veltri, R. D.; Douglas, F. C.; Paradis, E. L.; Galasso, F. S.

1977-01-01

Barrier layers were coated onto high-modulus fibers, and nickel and titanium layers were overcoated as simulated matrix materials. The objective was to coat the high-strength fibers with unreactive selected materials without degrading the fibers. The fibers were tungsten, niobium, and single-crystal sapphire, while the materials used as barrier coating layers were Al2O3, Y2O3, TiC, ZrC, WC with 14% Co, and HfO2. An ion-plating technique was used to coat the fibers. The fibers were subjected to high-temperature heat treatments to evaluate the effectiveness of the barrier layer in preventing fiber-metal interactions. Results indicate that Al2O3, Y2O3, and HfO2 can be used as barrier layers to minimize the nickel-tungsten interaction. Further investigation, including thermal cycling tests at 1090 C, revealed that HfO2 is probably the best of the three.

Oxygen vacancy defect engineering using atomic layer deposited HfAlOx in multi-layered gate stack

NASA Astrophysics Data System (ADS)

Bhuyian, M. N.; Sengupta, R.; Vurikiti, P.; Misra, D.

2016-05-01

This work evaluates the defects in high quality atomic layer deposited (ALD) HfAlOx with extremely low Al (<3% Al/(Al + Hf)) incorporation in the Hf based high-k dielectrics. The defect activation energy estimated by the high temperature current voltage measurement shows that the charged oxygen vacancies, V+/V2+, are the primary source of defects in these dielectrics. When Al is added in HfO2, the V+ type defects with a defect activation energy of Ea ˜ 0.2 eV modify to V2+ type to Ea ˜ 0.1 eV with reference to the Si conduction band. When devices were stressed in the gate injection mode for 1000 s, more V+ type defects are generated and Ea reverts back to ˜0.2 eV. Since Al has a less number of valence electrons than do Hf, the change in the co-ordination number due to Al incorporation seems to contribute to the defect level modifications. Additionally, the stress induced leakage current behavior observed at 20 °C and at 125 °C demonstrates that the addition of Al in HfO2 contributed to suppressed trap generation process. This further supports the defect engineering model as reduced flat-band voltage shifts were observed at 20 °C and at 125 °C.

Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

PubMed Central

Segall, Liviu; Nistor, Ionut; Covic, Adrian

2014-01-01

Introduction. Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is strongly associated with mortality in these patients. However, the treatment of HF in this population is largely unclear. Study Design. We conducted a systematic integrative review of the literature to assess the current evidence of HF treatment in CKD patients, searching electronic databases in April 2014. Synthesis used narrative methods. Setting and Population. We focused on adults with a primary diagnosis of CKD and HF. Selection Criteria for Studies. We included studies of any design, quantitative or qualitative. Interventions. HF treatment was defined as any formal means taken to improve the symptoms of HF and/or the heart structure and function abnormalities. Outcomes. Measures of all kinds were considered of interest. Results. Of 1,439 results returned by database searches, 79 articles met inclusion criteria. A further 23 relevant articles were identified by hand searching. Conclusions. Control of fluid overload, the use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and optimization of dialysis appear to be the most important methods to treat HF in CKD and ESRD patients. Aldosterone antagonists and digitalis glycosides may additionally be considered; however, their use is associated with significant risks. The role of anemia correction, control of CKD-mineral and bone disorder, and cardiac resynchronization therapy are also discussed. PMID:24959595

[Heart failure patterns in Djibouti: epidemiologic transition].

PubMed

Massoure, P L; Roche, N C; Lamblin, G; Topin, F; Dehan, C; Kaiser, E; Fourcade, L

2013-05-01

The features of heart failure (HF) in Djibouti have not been well described. We sought to document the current patterns of HF here. We prospectively included Djiboutian adults hospitalized for HF in the French Military Hospital (Djibouti) from August 2008 through December 2010. Of 1688 adults hospitalized in the medical department, 45 (2.7%) had symptomatic HF: 38 (84%) men, mean age 55.8 years (range 27-75). Twenty-five (56%) patients were initially hospitalized for acute pulmonary edema. The underlying diseases included coronary artery disease (CAD) (62%), hypertensive heart disease (18%), rheumatic valvular disease (13%), and primary dilated cardiomyopathy (7%). Their cardiovascular risk factors included tobacco use (53%), hypertension (69%), diabetes (47%), and hypercholesterolemia (51%). Patients in the CAD group were older, and had diabetes more often (p<0.01). All khat chewers (53%) were males and smokers. Mean left ventricular ejection fraction (LVEF) was 39 ± 14%. During follow-up (14.4 ± 9 months), 8 (18%) patients died, 9 (20%) were again hospitalized for HF, and 3 (7%) had ischemic strokes. One month after discharge, the New York Heart Association (NYHA) class was II for 40%, III for 44%, and IV for 16%. Higher NYHA classes and dilated cardiomyopathy were both associated with poorer outcomes (p<0.03). In hospitalized Djiboutians, most HF patterns are similar to those in industrialized countries. CAD is more prevalent than previously reported in African patients with HF.

Sacubitril/valsartan in heart failure: latest evidence and place in therapy

PubMed Central

Kaplinsky, Edgardo

2016-01-01

Despite significant therapeutic advances, patients with chronic heart failure (HF) remain at high risk for HF progression and death. Sacubitril/valsartan (previously known as LCZ696) is a first-in-class medicine that contains a neprilysin (NEP) inhibitor (sacubitril) and an angiotensin II (Ang-II) receptor blocker (valsartan). NEP is an endopeptidase that metabolizes different vasoactive peptides including natriuretic peptides, bradykinin and Ang-II. In consequence, its inhibition increases mainly the levels of both, natriuretic peptides (promoting diuresis, natriuresis and vasodilatation) and Ang-II whose effects are blocked by the angiotensin receptor blocker, valsartan (reducing vasoconstriction and aldosterone release). Results from the 8442 patient PARADIGM-HF study showed in patients with New York Heart Association (NYHA) class II–IV and reduced ejection fraction treated with LCZ696 (versus enalapril), the following benefits: reduction of the risk of death from cardiovascular causes by 20%; reduction of HF hospitalizations by 21%; reduction of the risk of all-cause mortality by 16%. Overall there was a 20% risk reduction on the primary endpoint, composite measure of cardiovascular (CV) death or time to first HF hospitalization. PARADIGM-HF was stopped early after a median follow up of 27 months. Post hoc analyses of PARADIGM-HF as well as the place in therapy of sacubitril/valsartan, including future directions, are included in the present review. PMID:27803793

Evaluation of DFT methods for computing the interaction energies of homomolecular and heteromolecular dimers of monosubstituted benzene

NASA Astrophysics Data System (ADS)

Godfrey-Kittle, Andrew; Cafiero, Mauricio

We present density functional theory (DFT) interaction energies for the sandwich and T-shaped conformers of substituted benzene dimers. The DFT functionals studied include TPSS, HCTH407, B3LYP, and X3LYP. We also include Hartree-Fock (HF) and second-order Møller-Plesset perturbation theory calculations (MP2), as well as calculations using a new functional, P3LYP, which includes PBE and HF exchange and LYP correlation. Although DFT methods do not explicitly account for the dispersion interactions important in the benzene-dimer interactions, we find that our new method, P3LYP, as well as HCTH407 and TPSS, match MP2 and CCSD(T) calculations much better than the hybrid methods B3LYP and X3LYP methods do.

Interactions of hydrogen with amorphous hafnium oxide

NASA Astrophysics Data System (ADS)

Kaviani, Moloud; Afanas'ev, Valeri V.; Shluger, Alexander L.

2017-02-01

We used density functional theory (DFT) calculations to study the interaction of hydrogen with amorphous hafnia (a -HfO2 ) using a hybrid exchange-correlation functional. Injection of atomic hydrogen, its diffusion towards electrodes, and ionization can be seen as key processes underlying charge instability of high-permittivity amorphous hafnia layers in many applications. Hydrogen in many wide band gap crystalline oxides exhibits negative-U behavior (+1 and -1 charged states are thermodynamically more stable than the neutral state) . Our results show that in a -HfO2 hydrogen is also negative-U, with charged states being the most thermodynamically stable at all Fermi level positions. However, metastable atomic hydrogen can share an electron with intrinsic electron trapping precursor sites [Phys. Rev. B 94, 020103 (2016)., 10.1103/PhysRevB.94.020103] forming a [etr -+O -H ] center, which is lower in energy on average by about 0.2 eV. These electron trapping sites can affect both the dynamics and thermodynamics of the interaction of hydrogen with a -HfO2 and the electrical behavior of amorphous hafnia films in CMOS devices.

Influence of Etching Protocol and Silane Treatment with a Universal Adhesive on Lithium Disilicate Bond Strength.

PubMed

Kalavacharla, V K; Lawson, N C; Ramp, L C; Burgess, J O

2015-01-01

To measure the effects of hydrofluoric acid (HF) etching and silane prior to the application of a universal adhesive on the bond strength between lithium disilicate and a resin. Sixty blocks of lithium disilicate (e.max CAD, Ivoclar Vivadent) were sectioned into coupons and polished. Specimens were divided into six groups (n=10) based on surface pretreatments, as follows: 1) no treatment (control); 2) 5% HF etch for 20 seconds (5HF); 3) 9.5% HF etch for 60 seconds (9.5HF); 4) silane with no HF (S); 5) 5% HF for 20 seconds + silane (5HFS); and 6) 9.5% HF for 60 seconds + silane (9.5HFS). All etching was followed by rinsing, and all silane was applied in one coat for 20 seconds and then dried. The universal adhesive (Scotchbond Universal, 3M ESPE) was applied onto the pretreated ceramic surface, air thinned, and light cured for 10 seconds. A 1.5-mm-diameter plastic tube filled with Z100 composite (3M ESPE) was applied over the bonded ceramic surface and light cured for 20 seconds on all four sides. The specimens were thermocycled for 10,000 cycles (5°C-50°C/15 s dwell time). Specimens were loaded until failure using a universal testing machine at a crosshead speed of 1 mm/min. The peak failure load was used to calculate the shear bond strength. Scanning electron microscopy images were taken of representative e.max specimens from each group. A two-way analysis of variance (ANOVA) determined that there were significant differences between HF etching, silane treatment, and the interaction between HF and silane treatment (p<0.01). Silane treatment provided higher shear bond strength regardless of the use or concentration of the HF etchant. Individual one-way ANOVA and Tukey post hoc analyses were performed for each silane group. Shear bond strength values for each etch time were significantly different (p<0.01) and could be divided into significantly different groups based on silane treatment: no silane treatment: 0 HF < 5% HF < 9.5% HF; and RelyX silane treatment: 0 HF < 5% HF and 9.5% HF. Both HF and silane treatment significantly improved the bond strength between resin and lithium disilicate when used with a universal adhesive.

Systolic Blood Pressure and Incident Heart Failure in the Elderly

PubMed Central

Butler, Javed; Kalogeropoulos, Andreas P.; Georgiopoulou, Vasiliki V.; Bibbins-Domingo, Kirsten; Najjar, Samer S.; Sutton-Tyrrell, Kim C.; Harris, Tamara B.; Kritchevsky, Stephen B.; Lloyd-Jones, Donald M.; Newman, Anne B.; Psaty, Bruce M.

2013-01-01

Objectives The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive medications. Our aim was to examine the association between SBP and HF risk in the elderly. Design Competing-risks proportional hazards modeling of incident HF risk, utilizing 10-year follow-up data from two NIH-sponsored cohort studies; the Cardiovascular Health Study (inception: 1989-90 and 1992-93) and the Health ABC Study (inception: 1997-98). Setting Community-based cohorts. Participants 4408 participants (age, 72.8 [4.9] years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive medications at baseline. Main outcome measures Incident HF, defined as first adjudicated hospitalisation for HF. Results Over 10 years, 493 (11.1%) participants developed HF. Prehypertension (120-139 mmHg), stage 1 (140-159 mmHg), and stage 2 (≥160 mmHg) hypertension were associated with escalating HF risk; hazard ratios vs. optimal SBP (<120 mmHg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI, 1.23-2.16; P=0.001), 2.21 (95% CI, 1.65-2.96; P<0.001), and 2.60 (95% CI, 1.85-364; P<0.001), respectively. Overall 255 of 493 (51.7%) HF events occurred in participants with SBP <140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than men; no race-SBP interaction was observed. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mmHg in men and 112 mmHg in women. Conclusions There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mmHg; over half of incident HF events occur in individuals with SBP <140 mmHg. PMID:21636845

The WAP four-disulfide core domain protein HE4: a novel biomarker for heart failure.

PubMed

de Boer, Rudolf A; Cao, Qi; Postmus, Douwe; Damman, Kevin; Voors, Adriaan A; Jaarsma, Tiny; van Veldhuisen, Dirk J; Arnold, William D; Hillege, Hans L; Silljé, Herman H W

2013-04-01

This study investigated clinical determinants and added prognostic value of HE4 as a biomarker not previously described in heart failure (HF). Identification of plasma biomarkers that help to risk stratify HF patients may help to improve treatment. Plasma HE4 levels were determined in 567 participants of the COACH (Coordinating study evaluating outcomes of Advising and Counseling in Heart failure). Patients had been hospitalized for HF and were followed for 18 months. The primary endpoint of this study was a composite of all-cause mortality and HF hospitalization. HE4 showed a strong correlation with HF severity, according to New York Heart Association functional class and brain natriuretic peptide (BNP) levels (p < 0.001). HE4 also showed a positive correlation with GDF15 (p < 0.001) and, in addition, correlated with kidney function (estimated glomerular filtration rate [eGFR]; p < 0.001). Cox regression analysis revealed that a doubling of HE4 levels was associated with a hazard ratio (HR) of 1.73 (95% confidence interval [CI]: 1.53 to 1.95) for the primary outcome (p < 0.001). After correction for age, gender, BNP, and eGFR, the HR was 1.46 (95% CI: 1.23 to 1.72; p < 0.001), and after additional adjustment for GDF15, the HR lowered to 1.30 (95% CI: 1.07 to 1.59; p = 0.009). The area under the curve in the receiver-operating characteristic curve analysis increased from 0.727 to 0.752 when HE4 was included in the clinical evaluation (p = 0.051). The integrated discrimination improvement and net reclassification index for reclassification showed significant improvements when HE4 was added to the clinical model, and this remained significant after BNP inclusion in the model. HE4 plasma levels are correlated with markers of HF severity, show prognostic value, and can improve risk assessment in HF. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Rationale and design of the Children's Oncology Group (COG) study ALTE1621: a randomized, placebo-controlled trial to determine if low-dose carvedilol can prevent anthracycline-related left ventricular remodeling in childhood cancer survivors at high risk for developing heart failure.

PubMed

Armenian, Saro H; Hudson, Melissa M; Chen, Ming Hui; Colan, Steven D; Lindenfeld, Lanie; Mills, George; Siyahian, Aida; Gelehrter, Sarah; Dang, Ha; Hein, Wendy; Green, Daniel M; Robison, Leslie L; Wong, F Lennie; Douglas, Pamela S; Bhatia, Smita

2016-10-04

Anthracyclines are widely used in the treatment of childhood cancer. One of the well-recognized side-effects of anthracycline therapy is dose-dependent cardiomyopathy that may progress to heart failure (HF) years after completion of cancer-directed therapy. This study will evaluate the efficacy of low-dose beta-blocker (carvedilol) for HF risk reduction in childhood cancer survivors at highest risk for HF. The proposed intervention has the potential to significantly reduce chronic cardiac injury via interruption of neurohormonal systems responsible for left ventricular (LV) remodeling, resulting in improved cardiac function and decreased risk of HF. The intervention is informed by previous studies demonstrating efficacy in pediatric and adult non-oncology populations, yet remains unstudied in the pediatric oncology population. The primary objective of the trial is to determine impact of the intervention on echocardiographic markers of cardiac remodeling and HF risk, including: LV wall thickness/ dimension ratio (LVWT/D; primary endpoint), as well as LV ejection fraction, volume, and blood biomarkers (natriuretic peptides, galectin-3) associated with HF risk. Secondary objectives are to establish safety and tolerability of the 2-year course of carvedilol using: 1) objective measures: hepatic and cardiovascular toxicity, treatment adherence, and 2) subjective measures: participant self-reported outcomes. Two hundred and fifty survivors of childhood cancer (diagnosed <21 years of age), and previously treated with high-dose (≥300 mg/m 2 ) anthracyclines will be enrolled in a randomized, double-blind, placebo controlled trial. After baseline assessments, participants will be randomized in a 1:1 ratio to low-dose carvedilol (maximum dose: 12.5 mg/day) or placebo. Carvedilol or placebo is up-titrated (starting dose: 3.125 mg/day) according to tolerability. When completed, this study will provide much-needed information regarding a physiologically plausible pharmacological risk-reduction strategy for childhood cancer survivors at high risk for developing anthracycline-related HF. ClinicalTrials.gov; NCT02717507.

Increasing Interactive Activity: Using Technology to Enhance Interaction between Teachers, Students and Learning Material.

ERIC Educational Resources Information Center

Bucknall, Ruary

1996-01-01

Overview of the interactive technologies used by the Northern Territory Secondary Correspondence School in Australia: print media utilizing desktop publishing and electronic transfer; telephone or H-F radio; interactive television; and interactive computing. More fully describes its interactive CD-ROM courses. Emphasizes that the programs are…

Exact exchange and Wilson-Levy correlation: a pragmatic device for studying complex weakly-bonded systems.

PubMed

Walsh, T R

2005-02-07

The Wilson-Levy (WL) correlation functional is used together with Hartree-Fock (HF) theory to evaluate interaction energies at intermediate separations (i.e. around equilibrium separation) for several weakly-bonded systems. The HF+WL approach reproduces binding trends for all complexes studied: selected rare-gas dimers, isomers of the methane dimer, benzene dimer and naphthalene dimer, and base-pair stacking structures for pyrimidine, cytosine, uracil and guanine dimers. These HF+WL data are contrasted against results obtained from some popular functionals (including B3LYP and PBE), as well as two newly-developed functionals, X3LYP and xPBE. The utility of HF+WL, with reference to exact-exchange (EXX) density-functional theory, is discussed in terms of a suggested EXXWL exchange-correlation functional.

Cardiac Vagal Control and Depressive Symptoms: The Moderating Role of Sleep Quality

PubMed Central

Werner, Gabriela G.; Ford, Brett Q.; Mauss, Iris B.; Schabus, Manuel; Blechert, Jens; Wilhelm, Frank H.

2017-01-01

Lower cardiac vagal control (CVC) has been linked to greater depression. However, this link has not been consistently demonstrated, suggesting the presence of key moderators. Sleep plausibly is one such factor. Therefore, we investigated whether sleep quality moderates the link between CVC (quantified by high-frequency heart rate variability, HF-HRV) and depressive symptoms (assessed using established questionnaires) in 29 healthy women. Results revealed a significant interaction between HF-HRV and sleep quality in predicting depressive symptoms: participants with lower HF-HRV reported elevated depressive symptoms only when sleep quality was also low. In contrast, HF-HRV was not associated with depressive symptoms when sleep quality was high, suggesting a protective function of high sleep quality in the context of lower CVC. PMID:27149648

Halofuginone suppresses growth of human uterine leiomyoma cells in a mouse xenograft model.

PubMed

Koohestani, Faezeh; Qiang, Wenan; MacNeill, Amy L; Druschitz, Stacy A; Serna, Vanida A; Adur, Malavika; Kurita, Takeshi; Nowak, Romana A

2016-07-01

Does halofuginone (HF) inhibit the growth of human uterine leiomyoma cells in a mouse xenograft model? HF suppresses the growth of human uterine leiomyoma cells in a mouse xenograft model through inhibiting cell proliferation and inducing apoptosis. Uterine leiomyomas are the most common benign tumors of the female reproductive tract. HF can suppress the growth of human uterine leiomyoma cells in vitro. The mouse xenograft model reflects the characteristics of human leiomyomas. Primary leiomyoma smooth muscle cells from eight patients were xenografted under the renal capsule of adult, ovariectomized NOD-scid IL2Rγ(null) mice (NSG). Mice were treated with two different doses of HF or vehicle for 4 weeks with six to eight mice per group. Mouse body weight measurements and immunohistochemical analysis of body organs were carried out to assess the safety of HF treatment. Xenografted tumors were measured and analyzed for cellular and molecular changes induced by HF. Ovarian steroid hormone receptors were evaluated for possible modulation by HF. Treatment of mice carrying human UL xenografts with HF at 0.25 or 0.50 mg/kg body weight for 4 weeks resulted in a 35-40% (P < 0.05) reduction in tumor volume. The HF-induced volume reduction was accompanied by increased apoptosis and decreased cell proliferation. In contrast, there was no significant change in the collagen content either at the transcript or protein level between UL xenografts in control and HF groups. HF treatment did not change the expression level of ovarian steroid hormone receptors. No adverse pathological effects were observed in other tissues from mice undergoing treatment at these doses. While this study did test the effects of HF on human leiomyoma cells in an in vivo model, HF was administered to mice whose tolerance and metabolism of the drug may differ from that in humans. Also, the longer term effects of HF treatment are yet unclear. The results of this study showing the effectiveness of HF in reducing UL tumor growth by interfering with the main cellular processes regulating cell proliferation and apoptosis are in agreement with previous studies on the effects of HF on other fibrotic diseases. HF can be considered as a candidate for reducing the size of leiomyomas, particularly prior to surgery. This project was funded by NIH PO1HD057877 and R01 HD064402. Authors report no competing interests. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The role of pegmatites and acid fluids for REE/HFSE mobilization in the Strange Lake peralkaline granitic pluton, Canada

NASA Astrophysics Data System (ADS)

Gysi, A. P.; Williams-Jones, A.

2012-12-01

The Strange Lake pluton in Canada is a mid-Proterozoic peralkaline granitic intrusion that is host to a world-class rare earth element (REE), yttrium (Y) and high-field strength element (HFSE) deposit containing more than 50 Mt ore at >1.5 wt.% REE and >3 wt.% Zr. The highest REE/HFSE concentrations are found in pegmatite-rich zones characterized by intense alteration. Previous studies of Strange Lake and other peralkaline and alkaline intrusions, such as Khan Bogd (Mongolia) and Tamazeght (Morocco) plutons have shown that hydrothermal alteration may play an important role in the mobility of the REE/HFSE. However, the fluid chemistry and conditions of alteration (i.e., P, T, pH, fO2, ligand activity) in these systems still need to be constrained to evaluate the importance and scale of such hydrothermal mobilization. We present new data from the B-zone, a pegmatite-rich zone located in NW Strange Lake. The pegmatites are generally zoned and form two main types. The border-type pegmatites consist of quartz, K-feldspar and hematized aegirine, whereas volatile-rich pegmatites consist of hydrothermal quartz and fluorite. Transitions between both types were also observed, with the K-feldspar being partly altered and replaced by Al-Si-rich phyllosilicates. The heavy (H)REE and Zr were primarily concentrated in zirconosilicates such as elpidite, now pseudomorphed by zircon or gittinsite, whereas light (L)REE and Y were concentrated in REE-F-(CO2)-minerals such as fluocerite and bastnäsite. Textural and mineralogical observations indicate that these minerals are primary and were partly to completely leached upon fluid-rock interaction in the pegmatites. Secondary phases include Ca-F-Y-rich minerals, mainly hydrothermal fluorite, that fill vugs and replaced primary REEHFSE minerals. The presence of hydrothermal fluorite veins, micro-veins, vugs and micro-breccia in the most altered parts of the B-zone are interpreted to reflect interaction of the rocks with a F-rich fluid. We modeled the interaction of HF-NaCl and HF-HCl-NaCl fluids with a Strange Lake pegmatite at 400-250 °C to test different alteration scenarios. The simulations indicated that a stronger acid than HF is needed to shift the system towards fluid buffered pH values, which are required to remobilize the REE and Zr. Comparison of the field study with numerical simulation indicates that for the effective hydrothermal remobilization of REE/HFSE, the system needs a source of elevated acidity and high fluid/rock ratios. We propose a model in which the Strange Lake pegmatites were a source of acidic fluids and upon cooling were affected by autometasomatic alteration due to increased acidity of the fluids, creating pathways for REE/HFSE mobilization.

Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF).

PubMed

Angermann, Christiane E; Assmus, Birgit; Anker, Stefan D; Brachmann, Johannes; Ertl, Georg; Köhler, Friedrich; Rosenkranz, Stephan; Tschöpe, Carsten; Adamson, Philip B; Böhm, Michael

2018-05-19

Wireless monitoring of pulmonary artery (PA) pressures with the CardioMEMS HF™ system is indicated in patients with New York Heart Association (NYHA) class III heart failure (HF). Randomized and observational trials have shown a reduction in HF-related hospitalizations and improved quality of life in patients using this device in the United States. MEMS-HF is a prospective, non-randomized, open-label, multicenter study to characterize safety and feasibility of using remote PA pressure monitoring in a real-world setting in Germany, The Netherlands and Ireland. After informed consent, adult patients with NYHA class III HF and a recent HF-related hospitalization are evaluated for suitability for permanent implantation of a CardioMEMS™ sensor. Participation in MEMS-HF is open to qualifying subjects regardless of left ventricular ejection fraction (LVEF). Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy as tolerated. The study will enroll 230 patients in approximately 35 centers. Expected duration is 36 months (24-month enrolment plus ≥ 12-month follow-up). Primary endpoints are freedom from device/system-related complications and freedom from pressure sensor failure at 12-month post-implant. Secondary endpoints include the annualized rate of HF-related hospitalization at 12 months versus the rate over the 12 months preceding implant, and health-related quality of life. Endpoints will be evaluated using data obtained after each subject's 12-month visit. The MEMS-HF study will provide robust evidence on the clinical safety and feasibility of implementing haemodynamic monitoring as a novel disease management tool in routine out-patient care in selected European healthcare systems. ClinicalTrials.gov; NCT02693691.

Recovery free of heart failure after acute coronary syndrome and coronary revascularization.

PubMed

Falkenham, Alec; Saraswat, Manoj K; Wong, Chloe; Gawdat, Kareem; Myers, Tanya; Begum, Jahanara; Buth, Karen J; Haidl, Ian; Marshall, Jean; Légaré, Jean-Francois

2018-02-01

Previous studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies. Nova Scotia residents (1995-2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long-term analysis. During follow-up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF. Our findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post-ACS inflammation. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study.

PubMed

Böhm, Michael; Borer, Jeffrey; Ford, Ian; Gonzalez-Juanatey, Jose R; Komajda, Michel; Lopez-Sendon, Jose; Reil, Jan-Christian; Swedberg, Karl; Tavazzi, Luigi

2013-01-01

We analysed the effect of ivabradine on outcomes in heart failure (HF) patients on recommended background therapies with heart rates ≥75 bpm and <75 bpm in the SHIFT trial. A cut-off value of ≥75 bpm was chosen by the EMEA for approval for the use of ivabradine in chronic heart failure. The SHIFT population was divided by baseline heart rate ≥75 or <75 bpm. The effect of ivabradine was analysed for primary composite endpoint (cardiovascular death or HF hospitalization) and other endpoints. In the ≥75 bpm group, ivabradine reduced primary endpoint (HR 0.76, 95 % CI 0.68-0.85, P < 0.0001), all-cause mortality (HR 0.83, 95 % CI, 0.72-0.96, P = 0.0109), cardiovascular mortality (HR 0.83, 95 % CI, (0.71-0.97, P = 0.0166), HF death (HR 0.61, 95 % CI, 0.46-0.81, P < 0.0006), and HF hospitalization (HR 0.70, 95 % CI, 0.61-0.80, P < 0.0001). Risk reduction depended on heart rate after 28 days, with the best protection for heart rates <60 bpm or reductions >10 bpm. None of the endpoints was significantly reduced in the <75 bpm group, though there were trends for risk reductions in HF death and hospitalization for heart rate <60 bpm and reductions >10 bpm. Ivabradine was tolerated similarly in both groups. The effect of ivabradine on outcomes is greater in patients with heart rate ≥75 bpm with heart rates achieved <60 bpm or heart rate reductions >10 bpm predicting best risk reduction. Our findings emphasize the importance of identification of high-risk HF patients by high heart rates and their treatment with heart rate-lowering drugs such as ivabradine.

Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population

PubMed Central

Stockburger, Martin; Boveda, Serge; Moreno, Javier; Da Costa, Antoine; Hatala, Robert; Brachmann, Johannes; Butter, Christian; Garcia Seara, Javier; Rolando, Mara; Defaye, Pascal

2015-01-01

Aim Right ventricular pacing (VP) has been hypothesized to increase the risk in heart failure (HF) and atrial fibrillation (AF). The ANSWER study evaluated, whether an AAI-DDD changeover mode to minimize VP (SafeR) improves outcome compared with DDD in a general dual-chamber pacemaker population. Methods and results ANSWER was a randomized controlled multicentre trial assessing SafeR vs. standard DDD in sinus node disease (SND) or AV block (AVB) patients. After a 1-month run-in period, they were randomized (1 : 1) and followed for 3 years. Pre-specified co-primary end-points were VP and the composite of hospitalization for HF, AF, or cardioversion. Pre-specified secondary end-points were cardiac death or HF hospitalizations and cardiovascular hospitalizations. ANSWER enrolled 650 patients (52.0% SND, 48% AVB) at 43 European centres and randomized in SafeR (n = 314) or DDD (n = 318). The SafeR mode showed a significant decrease in VP compared with DDD (11.5 vs. 93.6%, P < 0.0001 at 3 years). Deaths and syncope did not differ between randomization arms. No significant difference between groups [HR = 0.78; 95% CI (0.48–1.25); P = 0.30] was found in the time to event of the co-primary composite of hospitalization for HF, AF, or cardioversion, nor in the individual components. SafeR showed a 51% risk reduction (RR) in experiencing cardiac death or HF hospitalization [HR = 0.49; 95% CI (0.27–0.90); P = 0.02] and 30% RR in experiencing cardiovascular hospitalizations [HR = 0.70; 95% CI (0.49–1.00); P = 0.05]. Conclusion SafeR safely and significantly reduced VP in a general pacemaker population though had no effect on hospitalization for HF, AF, or cardioversion, when compared with DDD. PMID:25179761

Coronary angiography in worsening heart failure: determinants, findings and prognostic implications.

PubMed

Ferreira, João Pedro; Rossignol, Patrick; Demissei, Biniyam; Sharma, Abhinav; Girerd, Nicolas; Anker, Stefan D; Cleland, John G; Dickstein, Kenneth; Filippatos, Gerasimos; Hillege, Hans L; Lang, Chim C; Metra, Marco; Ng, Leong L; Ponikowski, Piotr; Samani, Nilesh J; van Veldhuisen, Dirk J; Zwinderman, Aeilko H; Voors, Adriaan; Zannad, Faiez

2018-04-01

Coronary angiography is regularly performed in patients with worsening signs and/or symptoms of heart failure (HF). However, little is known on the determinants, findings and associated clinical outcomes of coronary angiography performed in patients with worsening HF. The BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) programme enrolled 2516 patients with worsening symptoms and/or signs of HF, either hospitalised or in the outpatient setting. All patients were included in the present analysis. Of the 2516 patients included, 315 (12.5%) underwent coronary angiography within the 30 days after the onset of worsening symptoms and/or signs of HF. Subjects who underwent angiography were more often observed as inpatients, had more often an overt acute coronary syndrome, had higher troponin I levels, were younger and had better renal function (all p≤0.01). Patients who underwent coronary angiography had a lower risk of the primary outcome of death and/or HF hospitalisation (adjusted HR=0.71, 95% CI 0.57 to 0.89, p=0.003) and death (adjusted HR=0.59, 95% CI 0.43 to 0.80, p=0.001). Among the patients who underwent coronary angiography, those with a coronary stenosis (39%) had a worse prognosis than those without stenosis (adjusted HR for the primary outcome=1.71, 95% CI 1.10 to 2.64, p=0.016). Coronary angiography was performed in <13% of patients with symptoms and/or signs of worsening HF. These patients were remarkably different from those who did not undergo coronary angiography and had a lower risk of subsequent events. The presence of coronary stenosis on coronary angiography was associated with a worse prognosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Short-term overeating results in incomplete energy intake compensation regardless of energy density or macronutrient composition.

PubMed

Apolzan, John W; Bray, George A; Hamilton, Marc T; Zderic, Theodore W; Han, Hongmei; Champagne, Catherine M; Shepard, Desti; Martin, Corby K

2014-01-01

To evaluate the effects of overeating (140% of energy requirements) a high-fat low-energy density diet (HF/LED, 1.05 kcal/g), high-fat high-energy density diet (HF/HED, 1.60 kcal/g), and high-carbohydrate (HC) LED (1.05 kcal/g) for 2-days on subsequent 4-day energy intake (EI), activity levels, appetite, and mood. Using a randomized cross-over design, energy expenditure and EI were standardized during overeating. In 20 adults with a mean ± SD BMI of 30.7 ± 4.6 kg/m(2) , EI was not suppressed until the second day after overeating and accounted for ∼30% of the excess EI. Reductions in EI did not differ among the three diets or across days. Overeating had no effect on subsequent energy expenditure but steps/day decreased after the HC/LED and HF/HED. Sleep time was increased after the HF/HED compared to both LEDs. After overeating a HF/HED vs. HF/LED, carbohydrate cravings, hunger, prospective food consumption, and sadness increased and satisfaction, relaxation, and tranquility decreased. Diet type, time, or their interaction had no impact on compensation over 4 days. No adaptive thermogenesis was observed. The HF/HED vs. HF/LED had detrimental effects on food cravings, appetite, and mood. These results suggest short-term overeating is associated with incomplete compensation. Copyright © 2013 The Obesity Society.

Short-term overeating results in incomplete energy intake compensation regardless of energy density or macronutrient composition

PubMed Central

Apolzan, John W.; Bray, George A.; Hamilton, Marc T.; Zderic, Theodore W.; Han, Hongmei; Champagne, Catherine M.; Shepard, Desti; Martin, Corby K.

2013-01-01

Objective To evaluate the effects of overeating (140% of energy requirements) a high-fat low-energy density diet (HF/LED, 1.05kcal/g), high-fat high-energy density diet (HF/HED, 1.60kcal/g), and high-carbohydrate (HC) LED (1.05kcal/g) for 2-days on subsequent 4-day energy intake (EI), activity levels, appetite, and mood. Design and Methods Using a randomized cross-over design, energy expenditure and EI were standardized during overeating. Results In 20 adults with a mean±SD BMI of 30.7±4.6kg/m2, EI was not suppressed until the second day after overeating and accounted for ~30% of the excess EI. Reductions in EI did not differ among the 3 diets or across days. Overeating had no effect on subsequent energy expenditure but steps/day decreased after the HC/LED and HF/HED. Sleep time was increased after the HF/HED compared to both LEDs. After overeating a HF/HED vs. HF/LED, carbohydrate cravings, hunger, prospective food consumption, and sadness increased and satisfaction, relaxation, and tranquility decreased. Conclusions Diet type, time, or their interaction had no impact on compensation over 4 days. No adaptive thermogenesis was observed. The HF/HED vs. HF/LED had detrimental effects on food cravings, appetite, and mood. These results suggest short-term overeating is associated with incomplete compensation. PMID:23913807

Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease

PubMed Central

Pello Lázaro, Ana María; Cristóbal, Carmen; Franco-Peláez, Juan Antonio; Tarín, Nieves; Aceña, Álvaro; Carda, Rocío; Huelmos, Ana; Martín-Mariscal, María Luisa; Fuentes-Antras, Jesús; Martínez-Millá, Juan; Alonso, Joaquín; Lorenzo, Óscar; Egido, Jesús; López-Bescós, Lorenzo; Tuñón, José

2017-01-01

Objectives Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD. Methods We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death. Results Patients on PPIs were older [62.0 (53.0–73.0) vs. 58.0 (50.0–70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244–4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628–20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results. Conclusions In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings. PMID:28103324

Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease.

PubMed

Pello Lázaro, Ana María; Cristóbal, Carmen; Franco-Peláez, Juan Antonio; Tarín, Nieves; Aceña, Álvaro; Carda, Rocío; Huelmos, Ana; Martín-Mariscal, María Luisa; Fuentes-Antras, Jesús; Martínez-Millá, Juan; Alonso, Joaquín; Lorenzo, Óscar; Egido, Jesús; López-Bescós, Lorenzo; Tuñón, José

2017-01-01

Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD. We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death. Patients on PPIs were older [62.0 (53.0-73.0) vs. 58.0 (50.0-70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244-4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628-20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results. In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.

Electrical treatment of atrial arrhythmias in heart failure patients implanted with a dual defibrillator CRT device. Results from the TRADE-HF study.

PubMed

Botto, Giovanni Luca; Padeletti, Luigi; Covino, Gregorio; Pieragnoli, Paolo; Liccardo, Mattia; Mariconti, Barbara; Favale, Stefano; Molon, Giulio; De Filippo, Paolo; Bolognese, Leonardo; Landolina, Maurizio; Raciti, Giovanni; Boriani, Giuseppe

2017-06-01

Ventricular and atrial arrhythmias commonly occur in heart failure patients and are a significant source of symptoms, morbidity and mortality. Some specific generators referred to as dual defibrillators, Dual CRT-Ds, have the ability to treat atrial and ventricular arrhythmias. TRADE-HF is a prospective two-arm randomized study aimed at assessing the benefits of complete automatic management of atrial arrhythmias in patients implanted with a dual CRT-D. Primary objective of the TRADE-HF study was to document reduction of unplanned hospital admission for cardiac reasons or death for cardiovascular causes or progression to permanent AF, by comparing fully-automatic device driven therapy for atrial tachycardia or fibrillation (AT/AF) to an in-hospital approach for treatment of symptomatic AT/AF. Randomized Patients were followed every 6months for 3years to assess the primary objective. Four-hundred-twenty patients have been enrolled in the study. At the end of the study 30 subjects died for cardiovascular causes, 60 had at least one hospitalization for cardiovascular causes and 14 developed permanent AF. Eighty-seven patients experienced a composite event. Hazard Ratio for device-managed automatic therapy arm compared to traditional was 0.987 (95% CI: 0.684-1.503; p=0.951). The primary endpoint analysis resulted in no difference between the device managed and in-hospital treatment arm. The TRADE-HF study failed to demonstrate a reduction in the composite of unplanned hospitalizations for cardiovascular causes or death for cardiovascular causes or progression to permanent AF using automatic atrial therapy compared to a traditional approach including hospitalization for symptomatic episodes and/or in-hospital treatment of AT/AF. Copyright © 2017 Elsevier B.V. All rights reserved.

Magnetic Field Generation and B-Dot Sensor Characterization in the High Frequency Band

DTIC Science & Technology

2012-03-01

date Dr. Andrew J, Terzuoli, PhD (Member) date Dr. Michael J. Havrilla, PhD (Member) date AFIT/GE/ENG/12-20 Abstract Designing a high frequency ( HF ...large wavelengths in the HF range make it difficult to accurately estimate from which direction a magnetic field is emitting. Accurate DF estimates are...necessary for search and rescue operations and geolocating RF emitters of interest. The primary goal of this research is to characterize the

Hyperfine Fields of 181Ta in UFe4Al8

NASA Astrophysics Data System (ADS)

Marques, J. G.; Barradas, N. P.; Alves, E.; Ramos, A. R.; Gonçalves, A. P.; da Silva, M. F.; Soares, J. C.

2001-11-01

The γ γ Perturbed Angular Correlation technique was used to study the hyperfine interaction of 181Ta at the Hf site(s) in UFe4Al8 at room temperature and 12 K. The data at room temperature are well described by two electric field gradients, while at low temperature two combined hyperfine interactions have to be considered, one with the magnetic hyperfine field collinear with the c-axis and another with the magnetic hyperfine field in the basal plane. The results are compared with previous Mössbauer and neutron diffraction experiments and the lattice site of Hf is discussed.

Precipitating Factors for Acute Heart Failure Hospitalization and Long-Term Survival

PubMed Central

Berkovitch, Anat; Maor, Elad; Sabbag, Avi; Chernomordik, Fernando; Elis, Avishay; Arbel, Yaron; Goldenberg, Ilan; Grossman, Ehud; Klempfner, Robert

2015-01-01

Abstract Heart failure (HF) patients have frequent exacerbations leading to high consumption of medical services and recurrent hospitalizations. Different precipitating factors have various effects on long-term survival. We investigated 2212 patients hospitalized with a diagnosis of either acute HF or acute exacerbation of chronic HF. Patients were divided into 2 primary precipitant groups: ischemic (N = 979 [46%]) and nonischemic (N = 1233 [54%]). The primary endpoint was all-cause mortality. Multivariate analysis demonstrated that the presence of a nonischemic precipitant was associated with a favorable in-hospital outcome (OR 0.64; CI 0.43–0.94), but with a significant increase in the risk of 10-year mortality (HR 1.12; CI 1.01–1.21). Consistently, the cumulative probability of 10-year mortality was significantly higher among patients with a nonischemic versus ischemic precipitant (83% vs 90%, respectively; Log-rank P value <0.001). Subgroup analysis showed that among the nonischemic precipitant, the presence of renal dysfunction and infection were both associated with poor short-term outcomes (OR 1.56, [P < 0.001] and OR 1.35 [P < 0.001], respectively), as well as long-term (HR 1.59 [P < 0.001] and HR 1.24 [P < 0.001], respectively). Identification of precipitating factors for acute HF hospitalization has important short- and long-term implications that can be used for improved risk stratification and management. PMID:26717369

A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

PubMed Central

Pope, Charlene A.; Davis, Boyd H.; Wine, Leticia; Nemeth, Lynne S.; Axon, Robert N.

2018-01-01

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving. PMID:29482411

Mantle metasomatism vs host magma interaction at Sal Island (Cape Verde Archipelago)

NASA Astrophysics Data System (ADS)

Bonadiman, Costanza; Coltorti, Massimo; Beccaluva, Luigi; Siena, Franca

2010-05-01

The Cape Verde Islands lie in the Atlantic Ocean off West Africa, in a clearly oceanic setting. Xenoliths from Miocene (16Ma) neck in the northern part of Sal Island bear extensive evidence of metasomatic reactions, characterized by secondary parageneses (ol+sp+cpx+glass+K-feld) around primary orthopyroxene, clinopyroxenes and spinel. These textures are commonly observed in many xenolith populations worldwide, independently of the nature of the carrying alkaline magma (i.e. basalts, lamproitic or kimberlitic melt). The interpretation as a product of metasomatism has been recently put under discussion by Shaw et al. (2006) and Shaw & Dingwell (2008) who consider that most of these textures are imposed on the xenoliths during magma transport and/or residence in a magma chamber. This contribution aims at emphasizing the criteria which allow to discriminate between the metasomatic and host magma infiltration processes, reinforcing the concept and validity of metasomatism within the mantle. To pursue this, various petrographic and geochemical criteria from a selected well-studied suite of mantle xenoliths that clearly testify for an interaction of the peridotites with silicate melts at depth (metasomatised samples) or during the transport to the surface (host basalt infiltration samples) will be presented. Few pristine samples (two lherzolites and one harburgite) devoid of any textural evidences for basaltic infiltration or metasomatic processes were also used for comparison. The metasomatised samples are constituted by three lherzolites and one harzburgite whose metasomatic textures include glassy pools, patches or veins with secondary parageneses made up of ol, cpx, sp and K-feld or spongy rims and sieved crystals of pyroxenes and spinels. The infiltrated samples are represented by one lherzolite and one harzburgite cut by glassy veinlets filled with euhedral to subeuhedral ol + plag + magnetites crystallites. In the metasomatic samples the secondary olivines at similar mg# [Mg/(Mg + Fe) • 100 = 86.7 - 91.5).] tend to have higher Ca and lower Ni contents with respect to the primary unmetasomatised grains. Feldspar are characterized by very high K2O content (up to 10.50 wt%, Bonadiman et al., 2005) very peculiar for mantle environment even for continental settings. Glasses are rather homogeneous in composition and characterized by relatively high SiO2 (55.73-67.13 wt %), Al2O3 (14.33-21.4 wt %) and alkali contents (Na2O 2.49-7.14 wt %; K2O 5.50-8.78 wt %). Their compositions are similar to those of most mantle xenolith glasses worldwide, apart from the exceptionally high K2O contents, which have never been found in oceanic settings before and have rarely been matched even in continental xenoliths. In the infiltrated samples secondary olivine are distinctively enriched in FeO relative to those primary and secondary of the peridotite assemblage. NiO -Fo composition of these crystallites are compatible with those calculated for olivine in equilibrium with a progressively fractionated melt. Feldspars are Ca-rich plagioclase (An 75)). Glasses of the infiltrated samples are systematically richer in FeO (and MgO), TiO2 and depleted in K2O with respect those of metasomatised samples. Hf and Nd isotopic analyses on separated cpxs from pristine and metasomatized samples are distinctly higher of those recorded both southern and northern lavas of Cape Verde Archipelago (Martins et al., 2010) [Xenoliths: 176Hf/177Hf 0.283038- 0.2831012; 143Nd/144Nd 0.512837 to 0.512955. Lavas: 176Hf/177Hf=0.28284-0.28297; 43Nd/144Nd=0.51261-0.51287]. References: Bonadiman et al. (2005), J. Petrol. 46, 2465-2493 Martins et al. (2010), Mineralogy & Petrology, OnlineFirst. Shaw & Dingwell (2008). Contrib. Mineral. Petrol., 155, 199-214 Shaw et al. (2006). Contrib. Mineral. Petrol., 151,681-697.

Age at menopause and incident heart failure: the Multi-Ethnic Study of Atherosclerosis.

PubMed

Ebong, Imo A; Watson, Karol E; Goff, David C; Bluemke, David A; Srikanthan, Preethi; Horwich, Tamara; Bertoni, Alain G

2014-06-01

This study aims to evaluate the associations of early menopause (menopause occurring before age 45 years) and age at menopause with incident heart failure (HF) in postmenopausal women. We also explored the associations of early menopause and age at menopause with left ventricular (LV) measures of structure and function in postmenopausal women. We included 2,947 postmenopausal women, aged 45 to 84 years without known cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were used to examine the associations of early menopause and age at menopause with incident HF. In 2,123 postmenopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored the associations of early menopause and age at menopause with LV measures using multivariable linear regression. Across a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction > 0.05). In adjusted analysis, early menopause was associated with an increased risk of incident HF (hazard ratio, 1.66; 95% CI, 1.01-2.73), whereas every 1-year increase in age at menopause was associated with a decreased risk of incident HF (hazard ratio, 0.96; 95% CI, 0.94-0.99). We observed significant interactions between early menopause and ethnicity for LV mass-to-volume ratio (LVMVR; Pinteraction = 0.02). In Chinese-American women, early menopause was associated with a higher LVMVR (+0.11; P = 0.0002), whereas every 1-year increase in age at menopause was associated with a lower LVMVR (-0.004; P = 0.04) at baseline. Older age at menopause is independently associated with a decreased risk of incident HF. Concentric LV remodeling, indicated by a higher LVMVR, is present in Chinese-American women who experienced early menopause at baseline.

The Heart Failure Adherence and Retention Trial (HART): Design and Rationale

PubMed Central

Powell, Lynda H.; Calvin, James E.; Mendes de Leon, Carlos F.; Richardson, Dejuran; Grady, Kathleen L.; Flynn, Kristin J.; Rucker-Whitaker, Cheryl S.; Janssen, Imke; Kravitz, Glenda; Eaton, Claudia

2008-01-01

Background Heart failure (HF) is increasing in prevalence and associated with prolonged morbidity, repeat hospitalizations, and high costs. Drug therapies and lifestyle changes can reduce hospitalizations, but non-adherence is high, ranging from 30–80%. There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations. Trial Design HART evaluated the benefit of patient self-management (SM) skills training in combination with HF education, over HF education alone, on the composite endpoints of death/HF hospitalizations and death/all-cause hospitalizations in patients with mild to moderate systolic or diastolic dysfunction. Secondary endpoints included progression of HF, quality of life, adherence to drug and lifestyle regimens, and psychosocial function. The HART cohort was comprised of 902 patients including 47% women, 40% minorities, and 23% with diastolic dysfunction. After a baseline exam, patients were randomized to SM or education control, received 18 treatment contacts over one year, annual follow-ups, and 3-month phone calls to assess primary endpoints. SM treatment was conducted in small groups and aimed to activate the patient to implement HF education through training in problem-solving and 5 SM skills. The education control received HF education in the mail followed by a phone call to check comprehension. Conclusions The significance of HART lies in its ability to determine the clinical value of activating the patient to collaborate in his/her care. Support for the trial hypotheses would encourage interdisciplinary HF treatment, drawing on an evidence base not only from medicine but also from the behavioral sciences. PMID:18760125

Impact of a Pharmacist-Managed Heart Failure Postdischarge (Bridge) Clinic for Veterans.

PubMed

Hale, Genevieve M; Hassan, Sonia L; Hummel, Scott L; Lewis, Carrie; Ratz, David; Brenner, Michael

2017-07-01

Hospitals that provide early postdischarge follow-up after heart failure (HF) hospitalization tend to have lower rates of readmission. However, HF postdischarge (bridge) clinics have not been extensively evaluated. To assess the impact of a pharmacist-managed HF bridge clinic in a veteran population. HF patients hospitalized from November 2010 to August 2013 were identified. Retrospective chart review was conducted of 122 HF patients seen at bridge clinic compared with 122 randomly selected HF patients not seen at this clinic (usual care). Primary end point was 90-day all-cause readmission and death. Secondary outcomes were 30-day all-cause readmission and death, time to first postdischarge follow-up, first all-cause readmission. Bridge clinic patients were at higher baseline risk of readmission and death; other characteristics were similar. 90-day death and all-cause readmission trended lower in bridge clinic patients (adjusted hazard ratio [HR] = 0.64; 95% CI = 0.40-1.02; P = 0.06). Time to first follow-up was shorter in bridge clinic patients (11 ± 6 vs 20 ± 23 days; P < 0.001); time to first all-cause readmission trended longer (40 ± 20 vs 33 ± 25days; P = 0.11). 30-day death and all-cause readmission was significantly lower in bridge clinic patients (adjusted HR = 0.44; 95% CI = 0.22-0.88; P = 0.02). In veteran patients hospitalized for HF, pharmacist-managed HF bridge clinic significantly reduced the time to initial follow-up compared with usual care. Improved short-term outcomes and trend toward improvement of longer-term outcomes in bridge clinic patients was shown.

Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis.

PubMed

Agbor, Valirie N; Essouma, Mickael; Ntusi, Ntobeko A B; Nyaga, Ulrich Flore; Bigna, Jean Joel; Noubiap, Jean Jacques

2018-04-15

To summarise available data on the prevalence, aetiology, treatment and prognosis of heart failure (HF) in sub-Saharan Africa (SSA). This systematic review and meta-analysis included data from individuals recruited in primary to tertiary health facilities in SSA. All published and unpublished literatures between January 1, 1996 and June 23, 2017, of individuals aged 12years and older and residing in sub-Saharan Africa. They must be of African descent. Number of heart failure admissions into general wards or HF clinics; number of cases of the different aetiologies of HF; number of participants on the different medications for HF; number of cases of all-cause mortality in participants with HF, and the predictors of all-cause mortality. Due to a limited word count, only results on the aetiologies of HF will be presented in the abstract. Thirty five full text articles were selected after screening of an initial 3785 titles and abstract. Hypertensive heart disease (HHD) (39.2% [95% CI=32.6-45.9]) was the commonest cause of HF in SSA, followed by cardiomyopathies (CMO) (21.4% [95% CI=16.0-27.2]) and rheumatic heart disease (RHD) (14.1% [95% CI=10.0-18.8]). Ischaemic heart disease (7.2% [95% CI=4.1-11.0]) was rare. HHD, CMO and RHD are the most common causes of HF in SSA, with HHD and CMO responsible for over 50% of the cases. Also, the last two decades have witnessed a relative reduction in the prevalence of RHD below 15.0%. Copyright © 2017 Elsevier B.V. All rights reserved.

Dialyzer Reuse and Outcomes of High Flux Dialysis.

PubMed

Argyropoulos, Christos; Roumelioti, Maria-Eleni; Sattar, Abdus; Kellum, John A; Weissfeld, Lisa; Unruh, Mark L

2015-01-01

The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. In HEMO, minimally reused (< 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48-0.92, p = 0.015), 0.64 (95%CI: 0.44 - 0.95, p = 0.03), 0.61 (95%CI: 0.41 - 0.90, p = 0.012), 0.53 (95%CI: 0.28 - 1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51-0.78) for non-reused HF dialyzers compared with non-reused LF membranes. This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.

An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard.

PubMed

Banerjee, Dipanjan; Thompson, Christine; Kell, Charlene; Shetty, Rajesh; Vetteth, Yohan; Grossman, Helene; DiBiase, Aria; Fowler, Michael

2017-05-01

Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort. We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF. After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF. The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P  = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% ( P  = .0001), and the percentage of patients receiving our interventions, such as patient education, also improved significantly from 22% to 100% over time ( P  < .0001). In an institution with a quality improvement program already in place to reduce 30-day readmission rates for HF, an EMR-based approach further significantly reduced 30-day index hospital readmission rates. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Neurohormones and heart failure.

PubMed

Mendzef, Scott D; Slovinski, Jennifer R

2004-12-01

The management of several neurohormonal pathways is crucial to treating the progression of HF, in addition to improving the quality of life for patients diagnosed with HF. Stimulation of the sympathetic and retin-angiogensin-aldosterone systems begins the initial and primary neurohormonal stimulation associated with the progression of this disease. However, it is becoming increasingly evident that other systems, including the cellular immune, endothelin-NO pathway, kallikrein-kinin system, the arachidonic acid cascade, and the natriuretic peptides need to be considered by clinicians when treating HF. Once treated solely with nitrates, diuretics, and morphine, the management of HF is becoming a more complex and intricate balancing act among several interdependent neurohormonal systems. Understanding the complex nature and proper management of these systems are crucial if patients with HF are to enjoy a better quality of life and experience an improvement in their symptoms. Current recommendations for the treatment and management of HF use several medications, which affect multiple neurohormonal pathways. The Heart Failure Society of America and the American Heart Association both recommend in their recent guidelines for management of HF the use of beta-adrenergic receptor blockers (beta-blockers), loop diuretics, digitalis glycosides(digoxin), ACE-I, aldactone antagonists (spironolactone), and in selected instances, ARBs and the combination of hydralazine and isosorbide dinitrate. No discussion of HF is complete without mention of the larger challenges associated with the management of HF. It is a complex syndrome that requires a multidisciplinary approach with expertise in nutrition, exercise, pharmacology, education, and the basic pathophysiology of complex neurohormonal systems. Patients with uncompensated HF are frightened, vulnerable, and require frequent medication adjustments as well as substantial time dedicated to counseling, physical assessment, and innovative educational programs for them and their families. In fact, a majority of hospital readmissions for HF occur because of patients' dietary indiscretions, medication noncompliance, or ignorance about when to call their health providers. The management of HF represents a careful balancing act between powerful neurohormonal pathways and medications but also between the basics of diet, exercise, educating both family and patient, and most importantly, caring.

Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients.

PubMed

Platz, Elke; Lewis, Eldrin F; Uno, Hajime; Peck, Julie; Pivetta, Emanuele; Merz, Allison A; Hempel, Dorothea; Wilson, Christina; Frasure, Sarah E; Jhund, Pardeep S; Cheng, Susan; Solomon, Scott D

2016-04-14

Pulmonary congestion is a common and important finding in heart failure (HF). While clinical examination and chest radiography are insensitive, lung ultrasound (LUS) is a novel technique that may detect and quantify subclinical pulmonary congestion. We sought to independently relate LUS and clinical findings to 6-month HF hospitalizations and all-cause mortality (composite primary outcome). We used LUS to examine 195 NYHA class II-IV HF patients (median age 66, 61% men, 74% white, ejection fraction 34%) during routine cardiology outpatient visits. Lung ultrasound was performed in eight chest zones with a pocket ultrasound device (median exam duration 2 min) and analysed offline. In 185 patients with adequate LUS images in all zones, the sum of B-lines (vertical lines on LUS) ranged from 0 to 13. B-lines, analysed by tertiles, were associated with clinical and laboratory markers of congestion. Thirty-two per cent of patients demonstrated ≥3 B-lines on LUS, yet 81% of these patients had no findings on auscultation. During the follow-up period, 50 patients (27%) were hospitalized for HF or died. Patients in the third tertile (≥3 B-lines) had a four-fold higher risk of the primary outcome (adjusted HR 4.08, 95% confidence interval, CI 1.95, 8.54; P < 0.001) compared with those in the first tertile and spent a significantly lower number of days alive and out of the hospital (125 days vs. 165 days; adjusted P < 0.001). Pulmonary congestion assessed by ultrasound is prevalent in ambulatory patients with chronic HF, is associated with other features of clinical congestion, and identifies those who have worse prognosis. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Effects of chronic treatment with the new ultra-long-acting β2 -adrenoceptor agonist indacaterol alone or in combination with the β1 -adrenoceptor blocker metoprolol on cardiac remodelling.

PubMed

Rinaldi, Barbara; Donniacuo, Maria; Sodano, Loredana; Gritti, Giulia; Martuscelli, Eugenio; Orlandi, Augusto; Rafaniello, Concetta; Rossi, Francesco; Calzetta, Luigino; Capuano, Annalisa; Matera, Maria Gabriella

2015-07-01

The ability of a chronic treatment with indacaterol, a new ultra-long-acting β2 -adrenoceptor agonist, to reverse cardiac remodelling and its effects in combination with metoprolol, a selective β1 -adrenoceptor antagonist, were investigated on myocardial infarction in a rat model of heart failure (HF). We investigated the effects of indacaterol and metoprolol, administered alone or in combination, on myocardial histology, β-adrenoceptor-mediated pathways, markers of remodelling and haemodynamic parameters in a rat model of HF. Five groups of rats were assessed: sham-operated rats; HF rats; HF + indacaterol 0.3 mg·kg(-1) ·day(-1) ; HF + metoprolol 100 mg·kg(-1) ·day(-1) ; HF + metoprolol + indacaterol. All pharmacological treatments continued for 15 weeks. Treatment with either indacaterol or metoprolol significantly reduced the infarct size in HF rats. However, the combination of indacaterol and metoprolol reduced the infarct size even further, reduced both BP and heart rate, reversed the decrease in ejection fraction, normalized left ventricular systolic and diastolic internal diameters, normalized the decreased β1 adrenoceptor mRNA expression as well as cardiac cAMP levels and reduced cardiac GPCR kinase 2 expression, compared with the untreated HF group. The results of our study demonstrated an additive interaction between indacaterol and metoprolol in normalizing and reversing cardiac remodelling in our experimental model of HF. The translation of these findings to clinical practice might be of interest, as this combination of drugs could be safer and more effective in patients suffering from HF and COPD. © 2015 The British Pharmacological Society.

Exposure to sennoside-digoxin interaction and risk of digoxin toxicity: a population-based nested case-control study.

PubMed

Wang, Meng-Ting; Li, I-Hsun; Lee, Wan-Ju; Huang, Tien-Yu; Leu, Hsin-Bang; Chan, Agnes L F

2011-11-01

Digoxin is an important medication for heart failure (HF) patients and sennosides are widely used to treat constipation. Recently, safety concerns have been raised about a possible interaction between sennosides and digoxin, an issue that has not been studied empirically. This study therefore aimed to evaluate whether exposure to sennoside-digoxin interaction is associated with an increased risk of digoxin toxicity. This was a population-based nested case-control study that analysed data obtained from the Taiwan National Health Insurance Research Database between 1 January 2001 and 31 December 2004. All HF patients treated with digoxin for the first time were included as the study cohort. Of these, cases were identified as subjects hospitalized for digoxin toxicity (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM 972.1), and matched to randomly selected controls. Use of sennosides was compared between the two groups. Odds ratios (ORs) were employed to quantify the risk associated with exposure to sennoside-digoxin interaction by conditional logistic regression. The study cohort comprised 222,527 HF patients, of whom 524 were identified as cases and 2,502 as matched controls. Use of sennosides during the 14 days preceding the index date was found to be associated with a 1.61-fold increased risk of digoxin toxicity [95% confidence interval (CI) = 1.15, 2.25]. Additionally, a greater risk was observed for sennosides prescribed at an average daily dose ≥ 24 mg (adjusted OR = 1.93; 95% CI = 1.27, 2.94). The combined use of sennosides and digoxin was found to be associated with a modest increased risk of digoxin toxicity in HF patients.

Role of Hf on Phase Formation in Ti45Zr(38-x)Hf(x)Ni17 Liquids and Solids

NASA Technical Reports Server (NTRS)

Wessels, V.; Sahu, K. K.; Gangopadhyay, A. K.; Huett, V. T.; Canepari, S.; Goldman, A. I.; Hyers, R. W.; Kramer, M. J.; Rogers, J. R.; Kelton, K. F.;

Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF).

PubMed

McMurray, John J V; Packer, Milton; Desai, Akshay S; Gong, Jim; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean; Shi, Victor C; Solomon, Scott D; Swedberg, Karl; Zile, Michael R

2013-09-01

Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin-angiotensin-aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAAS and sympathetic nervous system, and augment parasympathetic activity. The best understood of these mediators are the natriuretic peptides which are metabolized by the enzyme neprilysin. LCZ696 belongs to a new class of drugs, the angiotensin receptor neprilysin inhibitors (ARNIs), which both block the RAAS and augment natriuretic peptides. Patients with chronic HF, NYHA class II-IV symptoms, an elevated plasma BNP or NT-proBNP level, and an LVEF of ≤40% were enrolled in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial (PARADIGM-HF). Patients entered a single-blind enalapril run-in period (titrated to 10 mg b.i.d.), followed by an LCZ696 run-in period (100 mg titrated to 200 mg b.i.d.). A total of 8436 patients tolerating both periods were randomized 1:1 to either enalapril 10 mg b.i.d. or LCZ696 200 mg b.i.d. The primary outcome is the composite of cardiovascular death or HF hospitalization, although the trial is powered to detect a 15% relative risk reduction in cardiovascular death. PARADIGM-HF will determine the place of the ARNI LCZ696 as an alternative to enalapril in patients with systolic HF. PARADIGM-HF may change our approach to neurohormonal modulation in HF. NCT01035255.

Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF)

PubMed Central

McMurray, John J. V.; Packer, Milton; Desai, Akshay S.; Gong, Jim; Lefkowitz, Martin P.; Rizkala, Adel R.; Rouleau, Jean; Shi, Victor C.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.

2013-01-01

Aims Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin–angiotensin–aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAAS and sympathetic nervous system, and augment parasympathetic activity. The best understood of these mediators are the natriuretic peptides which are metabolized by the enzyme neprilysin. LCZ696 belongs to a new class of drugs, the angiotensin receptor neprilysin inhibitors (ARNIs), which both block the RAAS and augment natriuretic peptides. Methods Patients with chronic HF, NYHA class II–IV symptoms, an elevated plasma BNP or NT-proBNP level, and an LVEF of ≤40% were enrolled in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial (PARADIGM-HF). Patients entered a single-blind enalapril run-in period (titrated to 10 mg b.i.d.), followed by an LCZ696 run-in period (100 mg titrated to 200 mg b.i.d.). A total of 8436 patients tolerating both periods were randomized 1:1 to either enalapril 10 mg b.i.d. or LCZ696 200 mg b.i.d. The primary outcome is the composite of cardiovascular death or HF hospitalization, although the trial is powered to detect a 15% relative risk reduction in cardiovascular death. Perspectives PARADIGM-HF will determine the place of the ARNI LCZ696 as an alternative to enalapril in patients with systolic HF. PARADIGM-HF may change our approach to neurohormonal modulation in HF. Trial registration NCT01035255 PMID:23563576

The neprilysin pathway in heart failure: a review and guide on the use of sacubitril/valsartan

PubMed Central

Jhund, Pardeep S; McMurray, John J V

2016-01-01

Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central to the understanding and treatment of heart failure (HF). Conversely, until recently, potentially beneficial augmentation of neurohumoural systems such as the natriuretic peptides has had limited therapeutic success. Administration of synthetic natriuretic peptides has not improved outcomes in acute HF but modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic (and other vasoactive) peptides, neprilysin, has proven to be successful. After initial failures with neprilysin inhibition alone or dual neprilysin-angiotensin converting enzyme (ACE) inhibition, the Prospective comparison of angiotensin receptor neprilysin inhibitor (ARNI) with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF) trial demonstrated that morbidity and mortality can be improved with the angiotensin receptor blocker neprilysin inhibitor sacubitril/valsartan (formerly LCZ696). In comparison to the ACE inhibitor enalapril, sacubitril/valsartan reduced the occurrence of the primary end point (cardiovascular death or hospitalisation for HF) by 20% with a 16% reduction in all-cause mortality. These findings suggest that sacubitril/valsartan should replace an ACE inhibitor or angiotensin receptor blocker as the foundation of treatment of symptomatic patients (NYHA II–IV) with HF and a reduced ejection fraction. This review will explore the background to neprilysin inhibition in HF, the results of the PARADIGM-HF trial and offer guidance on how to use sacubitril/valsartan in clinical practice. PMID:27207980

Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.

PubMed

Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret

2018-04-01

Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P < .01). In comparison, rate of palliative care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P < .01). In a multivariate logistic regression model, higher socioeconomic status (SES) was associated with increased access to palliative care ( P < .01). Racial differences were also observed in rates of referral to palliative care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.

Insufficient Hartree–Fock Exchange in Hybrid DFT Functionals Produces Bent Alkynyl Radical Structures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oyeyemi, Victor B.; Keith, John A.; Pavone, Michele

2012-01-11

Density functional theory (DFT) is often used to determine the electronic and geometric structures of molecules. While studying alkynyl radicals, we discovered that DFT exchange-correlation (XC) functionals containing less than ~22% Hartree–Fock (HF) exchange led to qualitatively different structures than those predicted from ab initio HF and post-HF calculations or DFT XCs containing 25% or more HF exchange. We attribute this discrepancy to rehybridization at the radical center due to electron delocalization across the triple bonds of the alkynyl groups, which itself is an artifact of self-interaction and delocalization errors. Inclusion of sufficient exact exchange reduces these errors and suppressesmore » this erroneous delocalization; we find that a threshold amount is needed for accurate structure determinations. Finally, below this threshold, significant errors in predicted alkyne thermochemistry emerge as a consequence.« less

Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study.

PubMed

Radhakrishnan, Kavita; Toprac, Paul; O'Hair, Matt; Bias, Randolph; Kim, Miyong T; Bradley, Paul; Mackert, Michael

2016-12-01

To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology. The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game. During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information. It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.

Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study

PubMed Central

Toprac, Paul; O'Hair, Matt; Bias, Randolph; Kim, Miyong T.; Bradley, Paul; Mackert, Michael

2016-01-01

Abstract Objective: To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology. Materials and Methods: The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest–post-test design, validated instruments—the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index—were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game. Results: During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information. Conclusion: It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge. PMID:27976955

Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial.

PubMed

Smith, Carol E; Piamjariyakul, Ubolrat; Dalton, Kathleen M; Russell, Christy; Wick, Jo; Ellerbeck, Edward F

2015-01-01

The Self-management and Care of Heart Failure through Group Clinics Trial evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high-risk heart failure (HF) patients. The purpose of this article is to (1) describe key Self-management and Care of Heart Failure through Group Clinics Trial group clinic interactive learning strategies, (2) describe resources and materials used in the group clinic appointment, and (3) present results supporting this patient-centered group intervention. This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients' (1) group clinic session evaluations, (2) HF self-care behaviors skills, (3) HF-related discouragement and quality of life scores, and (4) HF-related reshopitalizations during the 12-month follow-up. Also, the costs of delivery of the group clinical appointments were tabulated. Overall, patients rated group appointments as 4.8 of 5 on the "helpfulness" in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio, 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ(2)1=3.9, P=.04). The total cost for implementing 5 group appointments was $243.58 per patient. The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF-related hospitalizations.

A multicentre, randomised controlled, non-inferiority trial, comparing nasal high flow with nasal continuous positive airway pressure as primary support for newborn infants with early respiratory distress born in Australian non-tertiary special care nurseries (the HUNTER trial): study protocol

PubMed Central

Manley, Brett J; Roberts, Calum T; Arnolda, Gaston R B; Wright, Ian M R; Owen, Louise S; Dalziel, Kim M; Foster, Jann P; Davis, Peter G; Buckmaster, Adam G

2017-01-01

Introduction Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. Methods and analysis The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial. Infants are eligible if born at a gestational age ≥31 weeks with birth weight ≥1200 g and admitted to a participating non-tertiary SCN, are <24 hours old at randomisation and require non-invasive respiratory support or supplemental oxygen for >1 hour. Infants are randomised to treatment with either nHF or CPAP. The primary outcome is treatment failure within 72 hours of randomisation, as determined by objective oxygenation, apnoea or blood gas criteria or by a clinical decision that urgent intubation and mechanical ventilation, or transfer to a tertiary NICU, is required. Secondary outcomes include incidence of pneumothorax requiring drainage, duration of respiratory support, supplemental oxygen and hospitalisation, costs associated with hospital care, cost-effectiveness, parental stress and satisfaction and nursing workload. Ethics and dissemination Multisite ethical approval for the study has been granted by The Royal Children’s Hospital, Melbourne, Australia (Trial Reference No. 34222), and by each participating site. The trial is currently recruiting in eight centres in Victoria and New South Wales, Australia, with one previous site no longer recruiting. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences. Trial registration number Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001203640; pre-results. PMID:28645982

A multicentre, randomised controlled, non-inferiority trial, comparing nasal high flow with nasal continuous positive airway pressure as primary support for newborn infants with early respiratory distress born in Australian non-tertiary special care nurseries (the HUNTER trial): study protocol.

PubMed

Manley, Brett J; Roberts, Calum T; Arnolda, Gaston R B; Wright, Ian M R; Owen, Louise S; Dalziel, Kim M; Foster, Jann P; Davis, Peter G; Buckmaster, Adam G

2017-06-23

Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial. Infants are eligible if born at a gestational age ≥31 weeks with birth weight ≥1200 g and admitted to a participating non-tertiary SCN, are <24 hours old at randomisation and require non-invasive respiratory support or supplemental oxygen for >1 hour. Infants are randomised to treatment with either nHF or CPAP. The primary outcome is treatment failure within 72 hours of randomisation, as determined by objective oxygenation, apnoea or blood gas criteria or by a clinical decision that urgent intubation and mechanical ventilation, or transfer to a tertiary NICU, is required. Secondary outcomes include incidence of pneumothorax requiring drainage, duration of respiratory support, supplemental oxygen and hospitalisation, costs associated with hospital care, cost-effectiveness, parental stress and satisfaction and nursing workload. Multisite ethical approval for the study has been granted by The Royal Children's Hospital, Melbourne, Australia (Trial Reference No. 34222), and by each participating site. The trial is currently recruiting in eight centres in Victoria and New South Wales, Australia, with one previous site no longer recruiting. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences. Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001203640; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

INTERACTION OF RADIATION WITH MATTER. LASER PLASMA: Increase in the amplitude of hf currents during exposure of a neutral target to microsecond CO2 laser pulses

NASA Astrophysics Data System (ADS)

Antipov, A. A.; Losev, Leonid L.; Meshalkin, E. A.

1988-09-01

High-frequency electric currents were generated by irradiation of a metal target with CO2 laser pulses. It was found that the region where the ambient gas was photoionized had a decisive influence on the hf current amplitude. A method for increasing the amplitude of the current by creating an auxiliary laser jet on the target was proposed and used. An hf current of up to 1 A amplitude was observed at a frequency of 75 MHz and this current lasted for 1.5 μs.

Slow DNA Transport through Nanopores in Hafnium Oxide Membranes

PubMed Central

Bell, David C.; Cohen-Karni, Tzahi; Rosenstein, Jacob K.; Wanunu, Meni

2016-01-01

We present a study of double- and single-stranded DNA transport through nanopores fabricated in ultrathin (2–7 nm thick) free-standing hafnium oxide (HfO2) membranes. The high chemical stability of ultrathin HfO2 enables long-lived experiments with <2 nm diameter pores that last several hours, in which we observe >50 000 DNA translocations with no detectable pore expansion. Mean DNA velocities are slower than velocities through comparable silicon nitride pores, providing evidence that HfO2 nanopores have favorable physicochemical interactions with nucleic acids that can be leveraged to slow down DNA in a nanopore. PMID:24083444

Ferromagnetic properties of Mn-doped HfS2 monolayer under strain

NASA Astrophysics Data System (ADS)

Ma, Xu; Zhao, Xu; Wu, Ninghua; Xin, Qianqian; Liu, Xiaomeng; Wang, Tianxing; Wei, Shuyi

2017-12-01

Using the first-principles calculations, we investigated electronic and magnetic properties of Mn-doped HfS2 monolayer for 4% and 8% Mn concentration. We study the strain tuning of electronic and magnetic properties of 4% Mn-doped HfS2 monolayer firstly. Our results show that the Mn-doped HfS2 monolayer is magnetic nanomaterial without strain. It keeps this character until the compressive strain comes to -8%, and the magnetism disappear with lager compressive strain. With the increasing tensile strain, the doped system transforms from semiconductor to half-metallic when the tensile strain is equivalent to or greater than 5%. The largest half-metallic gap is 1.307 eV at 5% tensile strain and the magnetic moment always keeps about 3μB, which indicates that Mn-doped HfS2 monolayer can be a candidate for superior half-metallic namomaterial. Furthermore, we find two Mn dopants couple ferromagnetically via antiferromagnetic (AFM) p-d exchange interaction at the environment of 8% concentration. It keeps the properties of magnetic semiconductor under two Mn-doped configurations with different Mn-Mn separations. Our studies predict Mn-doped HfS2 monolayer under strain to be candidates for dilute magnetic semiconductors.

Mixing effects in a ternary Hf-Zr-Ni metallic melt

NASA Astrophysics Data System (ADS)

Nowak, B.; Holland-Moritz, D.; Yang, F.; Evenson, Z.; Meyer, A.

2018-03-01

We study the effect of the substitution of Zr by Hf on the dynamical behavior in the Zr36Ni64 melt. A reduced measured self-diffusion coefficient and a higher measured melt viscosity for an increased amount of Hf were observed. The ternary Hf10Zr25Ni65 melt, which exhibits a pronounced deviation from Arrhenius behavior over a studied temperature range of 550 K, can be accurately described by the scaling law of mode-coupling theory (MCT) with almost equal parameters for the self-diffusion and the viscosity. Although we only substitute alloy components with a nearly equal atomic size and the measured overall packing fraction remains almost unchanged, the dynamics in Hf10Zr25Ni65 are slower compared to Zr36Ni64 . This corresponds also to a higher critical temperature Tc and might be induced by different chemical interactions in the melts. The increased Tc results in a significantly smaller difference between liquidus and critical temperature Δ TLC=TL-Tc for the ternary melt in comparison with Zr36Ni64 , which may favor the glass formation in the Hf10Zr25Ni65 melt.

Plasticity mechanisms in HfN at elevated and room temperature.

PubMed

Vinson, Katherine; Yu, Xiao-Xiang; De Leon, Nicholas; Weinberger, Christopher R; Thompson, Gregory B

2016-10-06

HfN specimens deformed via four-point bend tests at room temperature and at 2300 °C (~0.7 T m ) showed increased plasticity response with temperature. Dynamic diffraction via transmission electron microscopy (TEM) revealed ⟨110⟩{111} as the primary slip system in both temperature regimes and ⟨110⟩{110} to be a secondary slip system activated at elevated temperature. Dislocation line lengths changed from a primarily linear to a curved morphology with increasing temperature suggestive of increased dislocation mobility being responsible for the brittle to ductile temperature transition. First principle generalized stacking fault energy calculations revealed an intrinsic stacking fault (ISF) along ⟨112⟩{111}, which is the partial dislocation direction for slip on these close packed planes. Though B1 structures, such as NaCl and HfC predominately slip on ⟨110⟩{110}, the ISF here is believed to facilitate slip on the {111} planes for this B1 HfN phase.

Effect of heat treatment on properties of HfO2 film deposited by ion-beam sputtering

NASA Astrophysics Data System (ADS)

Liu, Huasong; Jiang, Yugang; Wang, Lishuan; Li, Shida; Yang, Xiao; Jiang, Chenghui; Liu, Dandan; Ji, Yiqin; Zhang, Feng; Chen, Deying

2017-11-01

The effects of atmosphere heat treatment on optical, stress, and microstructure properties of an HfO2 film deposited by ion-beam sputtering were systematically researched. The relationships among annealing temperature and refractive index, extinction coefficient, physical thickness, forbidden-band width, tape trailer width, Urbach energy, crystal phase structure, and stress were assessed. The results showed that 400 °C is the transformation point, and the microstructure of the HfO2 film changed from an amorphous into mixed-phase structure. Multistage phonons appeared on the HfO2 film, and the trends of the refractive index, extinction coefficient, forbidden-band width change, and Urbach energy shifted from decrease to increase. With the elevation of the annealing temperature, the film thickness increased monotonously, the compressive stress gradually turned to tensile stress, and the transformation temperature point for the stress was between 200 °C and 300 °C. Therefore, the change in the stress is the primary cause for the shifts in thin-film thickness.

Multi-Isotopic evidence from West Eifel Xenoliths

NASA Astrophysics Data System (ADS)

Thiemens, M. M.; Sprung, P.

2015-12-01

Mantle Xenoliths from the West Eifel intraplate volcanic field of Germany provide insights into the nature and evolution of the regional continental lithospheric mantle. Previous isotope studies have suggested a primary Paleoproterozoic depletion age, a second partial melting event in the early Cambrian, and a Variscan metasomatic overprint. Textural and Sr-Nd isotopic observations further suggest two episodes of melt infiltration of early Cretaceous and Quaternary age. We have investigated anhydrous, vein-free lherzolites from this region, focusing on the Dreiser Weiher and Meerfelder Maar localities. Hand separated spinel, olivine, ortho- and clinopryoxene, along with host and bulk rocks were dissolved and purified for Rb-Sr, Sm-Nd, and Lu-Hf analysis on the Cologne/Bonn Neptune MC-ICP-MS. We find an unexpected discontinuity between mineral separates and whole rocks. While the latter have significantly more radiogenic ɛNd and ɛHf, mineral separates imply close-to chondritic compositions. Our Lu-Hf data imply resetting of the Lu-Hf systematic after 200 Ma. Given the vein-free nature of the lherzolites, this appears to date to the second youngest metasomatic episode. We suggest that markedly radiogenic Nd and Hf were introduced during the Quarternary metasomatic episode and most likely reside on grain boundaries.

The mantle source of island arc magmatism during early subduction: Evidence from Hf isotopes in rutile from the Jijal Complex (Kohistan arc, Pakistan)

NASA Astrophysics Data System (ADS)

Ewing, Tanya A.; Müntener, Othmar

2018-05-01

The Cretaceous-Paleogene Kohistan arc complex, northern Pakistan, is renowned as one of the most complete sections through a preserved paleo-island arc. The Jijal Complex represents a fragment of the plutonic roots of the Kohistan arc, formed during its early intraoceanic history. We present the first Hf isotope determinations for the Jijal Complex, made on rutile from garnet gabbros. These lithologies are zircon-free, but contain rutile that formed as an early phase. Recent developments in analytical capabilities coupled with a careful analytical and data reduction protocol allow the accurate determination of Hf isotope composition for rutile with <30 ppm Hf for the first time. Rutile from the analysed samples contains 5-35 ppm Hf, with sample averages of 13-17 ppm. Rutile from five samples from the Jijal Complex mafic section, sampling 2 km of former crustal thickness, gave indistinguishable Hf isotope compositions with εHf(i) ranging from 11.4 ± 3.2 to 20.1 ± 5.7. These values are within error of or only slightly more enriched than modern depleted mantle. The analysed samples record variable degrees of interaction with late-stage melt segregations, which produced symplectitic overprints on the main mineral assemblage as well as pegmatitic segregations of hydrous minerals. The indistinguishable εHf(i) across this range of lithologies demonstrates the robust preservation of the Hf isotope composition of rutile. The Hf isotope data, combined with previously published Nd isotope data for the Jijal Complex garnet gabbros, favour derivation from an inherently enriched, Indian Ocean type mantle. This implies a smaller contribution from subducted sediments than if the source was a normal (Pacific-type) depleted mantle. The Jijal Complex thus had only a limited recycled continental crustal component in its source, and represents a largely juvenile addition of new continental crust during the early phases of intraoceanic magmatism. The ability to determine the Hf isotope composition of rutile with low Hf contents is an important development for zircon-free mafic lithologies. This study highlights the potential of Hf isotope analysis of rutile to characterise the most juvenile deep arc crust cumulates worldwide.

Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure.

PubMed

Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

2013-08-01

Central sleep apnoea/Cheyne-Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave, AutoSet CS; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. ISRCTN19572887.

Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study.

PubMed

Wannamethee, S Goya; Papacosta, Olia; Lennon, Lucy; Whincup, Peter H

2016-09-01

To examine the associations between self-reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). Population-based prospective study. General practices in 24 British towns. Men aged 60-79 without prevalent HF followed for 9 years (N = 3,723). Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self-reported sleep duration at night and daytime napping. Self-reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self-reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06-2.71) than in those who reported no daytime napping. Self-reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31-6.45; 6 hours: aHR = 1.89, 95% CI = 0.89-4.03; 8 hours: aHR = 1.29, 95% CI = 0.61-2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71-4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk. Self-reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self-reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

The effect of multidisciplinary heart failure clinic characteristics on 1-year postdischarge health care costs: a population-based study.

PubMed

Wijeysundera, Harindra C; Austin, Peter C; Wang, Xuesong; Bennell, Maria C; Abrahamyan, Lusine; Ko, Dennis T; Tu, Jack V; Krahn, Murray

2014-03-01

Although multidisciplinary heart failure (HF) clinics are efficacious, it is not known how patient factors or HF clinic structural indicators and process measures have an impact on the cumulative health care costs. In this retrospective cohort study using administrative databases in Ontario, Canada, we identified 1216 HF patients discharged alive after an acute care hospitalization in 2006 and treated at a HF clinic. The primary outcome was the cumulative 1-year health care costs. A hierarchical generalized linear model with a logarithmic link and gamma distribution was developed to determine patient-level and clinic-level predictors of cost. The mean 1-year cost was $27,809 (range, $69 to $343,743). There was a 7-fold variation in the mean costs by clinic, from $14,670 to $96,524. Delays in being seen at a HF clinic were a significant patient-level predictor of costs (rate ratio 1.0015 per day; P<0.001). Being treated at a clinic with >3 physicians was associated with lower costs (rate ratio 0.78; P=0.035). Unmeasured patient-level differences accounted for 97.4% of the between-patient variations in cost. The between-clinic variation in costs decreased by 16.3% when patient-level factors were accounted for; it decreased by a further 49.8% when clinic-level factors were added. From a policy perspective, the wide spectrum of HF clinic structure translates to inefficient care. Greater guidance as to the type of patient seen at a HF clinic, the timeliness of the initial visit, and the most appropriate structure of the HF clinics may potentially result in more cost-effective care.

Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients', carers' and clinicians' understanding of heart failure prognosis and its management.

PubMed

Stocker, Rachel; Close, Helen; Hancock, Helen; Hungin, A Pali S

2017-12-01

Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF. We carried out a longitudinal grounded theory study, employing in-depth interviews with 14 clinicians (primary and secondary care) and observations of clinic and home appointments, followed by a series of interviews with 13 patients with HF and 9 carers. Overall, the majority of participants rejected notions of HF as a terminal illness in favour of a focus on day-to-day management and maintenance, despite obvious deterioration in disease stage and needs over time. Clinicians revealed frustration about the uncertain nature of HF prognosis, leading to difficulties in planning. Others highlighted the need to deliver problem-based, individualised care but felt constrained sometimes by the lack of multidisciplinary ACP. Patients reported an absence of prognostic discussions with clinicians. This is the first study exploring the experiences of prognostic communication at all stages of HF. Findings raise questions regarding the pragmatic utility of the concept of HF as a terminal illness and have implications for future HF care pathway development. Findings support the incorporation of a problem-based approach to management, which recognises the importance of everyday functioning for patients and carers as well as the opportunity for ACP. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Benjamin D., E-mail: bsmith3@mdanderson.org; Bentzen, Soren M.; Correa, Candace R.

Purpose: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. Methods and Materials: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. Results: The majority of patients in randomized trials weremore » aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within {+-}7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. Conclusion: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.« less

The effect of care pathways for hip fractures: a systematic review.

PubMed

Leigheb, Fabrizio; Vanhaecht, Kris; Sermeus, Walter; Lodewijckx, Cathy; Deneckere, Svin; Boonen, Steven; Boto, Paulo Alexandre Faria; Mendes, Rita Veloso; Panella, Massimiliano

2012-07-01

We performed a systematic review for primary studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO host, and The Cochrane Library (Cochrane Central Register of Clinical Trials, Health Technology Assessment Database, NHS Economic Evaluation Database) were searched. Two researchers reviewed the literature independently. Primary studies that met predefined inclusion criteria were assessed for their methodological quality. A total of 15 publications were included: 15 primary studies corresponding with 12 main investigations. Primary studies were evaluated for clinical outcomes, process outcomes, and economic outcomes. The studies assessed a wide range of outcome measures. While a number of divergent clinical outcomes were reported, most studies showed positive results of process management and health-services utilization. In terms of mortality, the results provided evidence for a positive impact of CPs on in-hospital mortality. Most studies also showed a significantly reduced risk of complications, including medical complications, wound infections, and pressure sores. Moreover, time-span process measures showed that an improvement in the organization of care was achieved through the use of CPs. Conflicting results were observed with regard to functional recovery and mobility between patients treated with CPs compared to usual care. Although our review suggests that CPs can have positive effects in patients with HF, the available evidence is insufficient for formal recommendations. There is a need for more research on CPs with selected process and outcome indicators, for in-hospital and postdischarge management of HF, with an emphasis on well-designed randomized trials.

Hartree-Fock treatment of Fermi polarons using the Lee-Low-Pine transformation

NASA Astrophysics Data System (ADS)

Kain, Ben; Ling, Hong Y.

2017-09-01

We consider the Fermi polaron problem at zero temperature, where a single impurity interacts with noninteracting host fermions. We approach the problem starting with a Fröhlich-like Hamiltonian where the impurity is described with canonical position and momentum operators. We apply the Lee-Low-Pine (LLP) transformation to change the fermionic Fröhlich Hamiltonian into the fermionic LLP Hamiltonian, which describes a many-body system containing host fermions only. We adapt the self-consistent Hartree-Fock (HF) approach, first proposed by Edwards, to the fermionic LLP Hamiltonian in which a pair of host fermions with momenta k and k' interact with a potential proportional to k .k' . We apply the HF theory, which has the advantage of not restricting the number of particle-hole pairs, to repulsive Fermi polarons in one dimension. When the impurity and host fermion masses are equal our variational ansatz, where HF orbitals are expanded in terms of free-particle states, produces results in excellent agreement with McGuire's exact analytical results based on the Bethe ansatz. This work raises the prospect of using the HF ansatz and its time-dependent generalization as building blocks for developing all-coupling theories for both equilibrium and nonequilibrium Fermi polarons in higher dimensions.

Uptake of skilled attendance along the continuum of care in rural Western Kenya: selected analysis from Global Health initiative survey-2012.

PubMed

Mwangi, Winfred; Gachuno, Onesmus; Desai, Meghna; Obor, David; Were, Vincent; Odhiambo, Frank; Nyaguara, Amek; Laserson, Kayla F

2018-05-16

Examining skilled attendance throughout pregnancy, delivery and immediate postnatal period is proxy indicator on the progress towards reduction of maternal and neonatal mortality in developing countries. We conducted a cross-sectional baseline survey of households of mothers with at least 1 child under-5 years in 2012 within the KEMRI/CDC health and demographic surveillance system (HDSS) area in rural western Kenya. Out of 8260 mother-child pairs, data on antenatal care (ANC) in the most recent pregnancy was obtained for 89% (n = 8260); 97% (n = 7387) reported attendance. Data on number of ANC visits was available for 89% (n = 7140); 52% (n = 6335) of mothers reported ≥4 ANC visits. Data on gestation month at first ANC was available for 94% (n = 7140) of mothers; 14% (n = 6690) reported first visit was in1 st trimester (0-12 weeks), 73% in 2nd trimester (14-28 weeks) and remaining 13% in third trimester. Forty nine percent (n = 8259) of mothers delivered in a Health Facility (HF), 48% at home and 3% en route to HF. Forty percent (n = 7140) and 63% (n = 4028) of mothers reporting ANC attendance and HF delivery respectively also reported receiving postnatal care (PNC). About 36% (n = 8259) of mothers reported newborn assessment (NBA). Sixty eight percent (n = 3966) of mothers that delivered at home reported taking newborn for HF check-up, with only 5% (n = 2693) doing so within 48 h of delivery. Being ≤34 years (OR 1.8; 95% CI 1.4-2.4) and at least primary education (OR 5.3; 95% CI 1.8-15.3) were significantly associated with ANC attendance. Being ≤34 years (OR 1.7; 95% CI 1.5-2.0), post-secondary vs primary education (OR 10; 95% CI 4.4-23.4), ANC attendance (OR 4.5; 95% CI 3.2-6.1), completing ≥4 ANC visits (OR 2.0; 95% CI 1.8-2.2), were strongly associated with HF delivery. The continuum of care was such that 97% (n = 7387) mothers reported ANC attendance, 49% reported both ANC and HF delivery attendance, 34% reported ANC, HF delivery and PNC attendance and only 18% reported ANC, HF delivery, PNC and NBA attendance. Uptake of services drastically declined from antenatal to postnatal period, along the continuum of care. Age and education were key determinants of uptake.

Long Term Effects of Percutaneous Coronary Intervention of the Totally Occluded Infarct-Related Artery in the Subacute Phase after Myocardial Infarction

PubMed Central

Hochman, Judith S; Reynolds, Harmony R; Džavík, Vladimír; Buller, Christopher E; Ruzyllo, Witold; Sadowski, Zygmunt P; Maggioni, Aldo P; Carvalho, Antonio C; Rankin, James M.; White, Harvey D.; Goldberg, Suzanne; Forman, Sandra A; Mark, Daniel B; Lamas, Gervasio A

2011-01-01

Background Despite observations suggesting a benefit for late opening of occluded infarct-related arteries (IRA) post-myocardial infarction (MI), the Occluded Artery Trial (OAT) demonstrated no reduction in the composite of death, reinfarction and class IV heart failure (HF) over 2.9-yearmean follow-up. Follow-up was extended to determine whether late trends would favor either treatment group. Methods and Results OAT randomized 2201 stable patients with IRA occlusion >24hours (calendar days3-28) after MI. Severe inducible ischemia, rest angina, class III-IV HF and 3-vessel/left main disease were excluded. We conducted extended followed up of enrolled patients for an additional 3 years for the primary endpoint and angina (6-year median survivor follow up, longest 9 years, 12,234 patient-years).Rates of the primary endpoint (HR 1.06, 95% CI 0.88-1.28), fatal and nonfatal MI (HR 1.25, 95% CI 0.89-1.75), death and class IV HF were similar for PCI vs. MED groups. No interaction between baseline characteristics and treatment group on outcomes were observed. The vast majority of patients at each follow-up visit did not report angina. There was less angina in the PCI group through early in follow-up; by 3 years the between group difference was consistently <4 patients per 100 treated and not significantly different though there was a trend toward less angina in the PCI group at 3 and 5 years. The 7-year rate of PCI of the IRA during follow up was 11.1% for the PCI group compared to 14.7% for the MED group (HR 0.79, 95% CI 0.61-1.01. p=0.06). Conclusions Extended follow up of the OAT cohort provides robust evidence for no reduction of long-term rates of clinical events after routine PCI in stable patients with an occluded IRA and without severe inducible ischemia in the subacute phase post-MI. PMID:22025606

Effect of Ferric Carboxymaltose on Exercise Capacity in Patients With Chronic Heart Failure and Iron Deficiency.

PubMed

van Veldhuisen, Dirk J; Ponikowski, Piotr; van der Meer, Peter; Metra, Marco; Böhm, Michael; Doletsky, Artem; Voors, Adriaan A; Macdougall, Iain C; Anker, Stefan D; Roubert, Bernard; Zakin, Lorraine; Cohen-Solal, Alain

2017-10-10

Iron deficiency is common in patients with heart failure (HF) and is associated with reduced exercise capacity and poor outcomes. Whether correction of iron deficiency with (intravenous) ferric carboxymaltose (FCM) affects peak oxygen consumption [peak VO 2 ], an objective measure of exercise intolerance in HF, has not been examined. We studied patients with systolic HF (left ventricular ejection fraction ≤45%) and mild to moderate symptoms despite optimal HF medication. Patients were randomized 1:1 to treatment with FCM for 24 weeks or standard of care. The primary end point was the change in peak VO 2 from baseline to 24 weeks. Secondary end points included the effect on hematinic and cardiac biomarkers, quality of life, and safety. For the primary analysis, patients who died had a value of 0 imputed for 24-week peak VO 2 . Additional sensitivity analyses were performed to determine the impact of imputation of missing peak VO 2 data. A total of 172 patients with HF were studied and received FCM (n=86) or standard of care (control group, n=86). At baseline, the groups were well matched; mean age was 64 years, 75% were male, mean left ventricular ejection fraction was 32%, and peak VO 2 was 13.5 mL/min/kg. FCM significantly increased serum ferritin and transferrin saturation. At 24 weeks, peak VO 2 had decreased in the control group (least square means -1.19±0.389 mL/min/kg) but was maintained on FCM (-0.16±0.387 mL/min/kg; P =0.020 between groups). In a sensitivity analysis, in which missing data were not imputed, peak VO 2 at 24 weeks decreased by -0.63±0.375 mL/min/kg in the control group and by -0.16±0.373 mL/min/kg in the FCM group; P =0.23 between groups). Patients' global assessment and functional class as assessed by the New York Heart Association improved on FCM versus standard of care. Treatment with intravenous FCM in patients with HF and iron deficiency improves iron stores. Although a favorable effect on peak VO 2 was observed on FCM, compared with standard of care in the primary analysis, this effect was highly sensitive to the imputation strategy for peak VO 2 among patients who died. Whether FCM is associated with an improved outcome in these high-risk patients needs further study. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01394562. © 2017 The Authors.

Effect of Ferric Carboxymaltose on Exercise Capacity in Patients With Chronic Heart Failure and Iron Deficiency

PubMed Central

Ponikowski, Piotr; van der Meer, Peter; Metra, Marco; Böhm, Michael; Doletsky, Artem; Voors, Adriaan A.; Macdougall, Iain C.; Anker, Stefan D.; Roubert, Bernard; Zakin, Lorraine; Cohen-Solal, Alain

2017-01-01

Background: Iron deficiency is common in patients with heart failure (HF) and is associated with reduced exercise capacity and poor outcomes. Whether correction of iron deficiency with (intravenous) ferric carboxymaltose (FCM) affects peak oxygen consumption [peak VO2], an objective measure of exercise intolerance in HF, has not been examined. Methods: We studied patients with systolic HF (left ventricular ejection fraction ≤45%) and mild to moderate symptoms despite optimal HF medication. Patients were randomized 1:1 to treatment with FCM for 24 weeks or standard of care. The primary end point was the change in peak VO2 from baseline to 24 weeks. Secondary end points included the effect on hematinic and cardiac biomarkers, quality of life, and safety. For the primary analysis, patients who died had a value of 0 imputed for 24-week peak VO2. Additional sensitivity analyses were performed to determine the impact of imputation of missing peak VO2 data. Results: A total of 172 patients with HF were studied and received FCM (n=86) or standard of care (control group, n=86). At baseline, the groups were well matched; mean age was 64 years, 75% were male, mean left ventricular ejection fraction was 32%, and peak VO2 was 13.5 mL/min/kg. FCM significantly increased serum ferritin and transferrin saturation. At 24 weeks, peak VO2 had decreased in the control group (least square means −1.19±0.389 mL/min/kg) but was maintained on FCM (−0.16±0.387 mL/min/kg; P=0.020 between groups). In a sensitivity analysis, in which missing data were not imputed, peak VO2 at 24 weeks decreased by −0.63±0.375 mL/min/kg in the control group and by −0.16±0.373 mL/min/kg in the FCM group; P=0.23 between groups). Patients’ global assessment and functional class as assessed by the New York Heart Association improved on FCM versus standard of care. Conclusions: Treatment with intravenous FCM in patients with HF and iron deficiency improves iron stores. Although a favorable effect on peak VO2 was observed on FCM, compared with standard of care in the primary analysis, this effect was highly sensitive to the imputation strategy for peak VO2 among patients who died. Whether FCM is associated with an improved outcome in these high-risk patients needs further study. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01394562. PMID:28701470

A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Study.

PubMed

Lang, Chim C; Smith, Karen; Wingham, Jennifer; Eyre, Victoria; Greaves, Colin J; Warren, Fiona C; Green, Colin; Jolly, Kate; Davis, Russell C; Doherty, Patrick Joseph; Miles, Jackie; Britten, Nicky; Abraham, Charles; Van Lingen, Robin; Singh, Sally J; Paul, Kevin; Hillsdon, Melvyn; Sadler, Susannah; Hayward, Christopher; Dalal, Hayes M; Taylor, Rod S

2018-04-09

Home-based cardiac rehabilitation may overcome suboptimal rates of participation. The overarching aim of this study was to assess the feasibility and acceptability of the novel Rehabilitation EnAblement in CHronic Hear Failure (REACH-HF) rehabilitation intervention for patients with heart failure with preserved ejection fraction (HFpEF) and their caregivers. Patients were randomised 1:1 to REACH-HF intervention plus usual care (intervention group) or usual care alone (control group). REACH-HF is a home-based comprehensive self-management rehabilitation programme that comprises patient and carer manuals with supplementary tools, delivered by trained healthcare facilitators over a 12 week period. Patient outcomes were collected by blinded assessors at baseline, 3 months and 6 months postrandomisation and included health-related quality of life (primary) and psychological well-being, exercise capacity, physical activity and HF-related hospitalisation (secondary). Outcomes were also collected in caregivers.We enrolled 50 symptomatic patients with HF from Tayside, Scotland with a left ventricular ejection fraction ≥45% (mean age 73.9 years, 54% female, 100% white British) and 21 caregivers. Study retention (90%) and intervention uptake (92%) were excellent. At 6 months, data from 45 patients showed a potential direction of effect in favour of the intervention group, including the primary outcome of Minnesota Living with Heart Failure Questionnaire total score (between-group mean difference -11.5, 95% CI -22.8 to 0.3). A total of 11 (4 intervention, 7 control) patients experienced a hospital admission over the 6 months of follow-up with 4 (control patients) of these admissions being HF-related. Improvements were seen in a number intervention caregivers' mental health and burden compared with control. Our findings support the feasibility and rationale for delivering the REACH-HF facilitated home-based rehabilitation intervention for patients with HFpEF and their caregivers and progression to a full multicentre randomised clinical trial to test its clinical effectiveness and cost-effectiveness. ISRCTN78539530. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Autonomic Recovery Is Delayed in Chinese Compared with Caucasian following Treadmill Exercise.

PubMed

Sun, Peng; Yan, Huimin; Ranadive, Sushant M; Lane, Abbi D; Kappus, Rebecca M; Bunsawat, Kanokwan; Baynard, Tracy; Hu, Min; Li, Shichang; Fernhall, Bo

2016-01-01

Caucasian populations have a higher prevalence of cardiovascular disease (CVD) when compared with their Chinese counterparts and CVD is associated with autonomic function. It is unknown whether autonomic function during exercise recovery differs between Caucasians and Chinese. The present study investigated autonomic recovery following an acute bout of treadmill exercise in healthy Caucasians and Chinese. Sixty-two participants (30 Caucasian and 32 Chinese, 50% male) performed an acute bout of treadmill exercise at 70% of heart rate reserve. Heart rate variability (HRV) and baroreflex sensitivity (BRS) were obtained during 5-min epochs at pre-exercise, 30-min, and 60-min post-exercise. HRV was assessed using frequency [natural logarithm of high (LnHF) and low frequency (LnLF) powers, normalized high (nHF) and low frequency (nLF) powers, and LF/HF ratio] and time domains [Root mean square of successive differences (RMSSD), natural logarithm of RMSSD (LnRMSSD) and R-R interval (RRI)]. Spontaneous BRS included both up-up and down-down sequences. At pre-exercise, no group differences were observed for any HR, HRV and BRS parameters. During exercise recovery, significant race-by-time interactions were observed for LnHF, nHF, nLF, LF/HF, LnRMSSD, RRI, HR, and BRS (up-up). The declines in LnHF, nHF, RMSSD, RRI and BRS (up-up) and the increases in LF/HF, nLF and HR were blunted in Chinese when compared to Caucasians from pre-exercise to 30-min to 60-min post-exercise. Chinese exhibited delayed autonomic recovery following an acute bout of treadmill exercise. This delayed autonomic recovery may result from greater sympathetic dominance and extended vagal withdrawal in Chinese. Chinese Clinical Trial Register ChiCTR-IPR-15006684.

Autonomic Recovery Is Delayed in Chinese Compared with Caucasian following Treadmill Exercise

PubMed Central

Sun, Peng; Yan, Huimin; Ranadive, Sushant M.; Lane, Abbi D.; Kappus, Rebecca M.; Bunsawat, Kanokwan; Baynard, Tracy; Hu, Min; Li, Shichang; Fernhall, Bo

2016-01-01

Caucasian populations have a higher prevalence of cardiovascular disease (CVD) when compared with their Chinese counterparts and CVD is associated with autonomic function. It is unknown whether autonomic function during exercise recovery differs between Caucasians and Chinese. The present study investigated autonomic recovery following an acute bout of treadmill exercise in healthy Caucasians and Chinese. Sixty-two participants (30 Caucasian and 32 Chinese, 50% male) performed an acute bout of treadmill exercise at 70% of heart rate reserve. Heart rate variability (HRV) and baroreflex sensitivity (BRS) were obtained during 5-min epochs at pre-exercise, 30-min, and 60-min post-exercise. HRV was assessed using frequency [natural logarithm of high (LnHF) and low frequency (LnLF) powers, normalized high (nHF) and low frequency (nLF) powers, and LF/HF ratio] and time domains [Root mean square of successive differences (RMSSD), natural logarithm of RMSSD (LnRMSSD) and R–R interval (RRI)]. Spontaneous BRS included both up-up and down-down sequences. At pre-exercise, no group differences were observed for any HR, HRV and BRS parameters. During exercise recovery, significant race-by-time interactions were observed for LnHF, nHF, nLF, LF/HF, LnRMSSD, RRI, HR, and BRS (up-up). The declines in LnHF, nHF, RMSSD, RRI and BRS (up-up) and the increases in LF/HF, nLF and HR were blunted in Chinese when compared to Caucasians from pre-exercise to 30-min to 60-min post-exercise. Chinese exhibited delayed autonomic recovery following an acute bout of treadmill exercise. This delayed autonomic recovery may result from greater sympathetic dominance and extended vagal withdrawal in Chinese. Trial Registration: Chinese Clinical Trial Register ChiCTR-IPR-15006684 PMID:26784109

Post-weaning high-fat diet results in growth cartilage lesions in young male rats

PubMed Central

Haysom, Samuel S.; Vickers, Mark H.; Yu, Lennex H.; Reynolds, Clare M.; Firth, Elwyn C.

2017-01-01

To determine if a high-fat diet (HF) from weaning would result in a pro-inflammatory state and affect joint cartilage, we fed male rats either HF or Chow diet post-weaning, and voluntary wheel exercise (EX) or cage only activity (SED) after 9 weeks of age. At 17 weeks body composition, plasma biomarkers and histomorphology scores of femoro-tibial cartilages of HF-SED, HF-EX, Chow-SED and Chow-EX groups were compared. Food intake and activity were not significantly different between groups. HF diet resulted in significantly higher weight gain, %fat, fat:lean ratio, and plasma leptin, insulin and TNFα concentrations, with significant interactions between diet and exercise. No abnormal features were detected in the hyaline articular cartilage or in the metaphyseal growth plate in all four groups. However, collagen type X- positive regions of retained epiphyseal growth cartilage (EGC) was present in all HF-fed animals and significantly greater than that observed in Chow-fed sedentary rats. Most lesions were located in the lateral posterior aspect of the tibia and/or femur. The severity of lesions was greater in HF-fed animals. Although exercise had a significantly greater effect in reducing adiposity and associated systemic inflammation in HF-fed rats, it had no effect on lesion incidence or severity. Lesion incidence was also significantly associated with indices of obesity and plasma markers of chronic inflammation. Clinically, EGC lesions induced by HF feeding in rats from very early in life, and possibly by insufficient activity, is typical of osteochondrosis in animals. Such lesions may be the precursor of juvenile osteochondritis dissecans requiring surgery in children/adolescents, conservative management of which could benefit from improved understanding of early changes in cellular and gene expression. PMID:29166409

Role of gender in heart failure with normal left ventricular ejection fraction.

PubMed

Regitz-Zagrosek, Vera; Brokat, Sebastian; Tschope, Carsten

2007-01-01

Heart failure with normal ejection fraction (HF-NEF) is frequently believed to be more common in women than in men. However, the interaction of gender and age has rarely been analyzed in detail, and knowledge of the distinction between pre- and postmenopausal women is lacking. Some of the studies that have described a higher prevalence of HF-NEF in women relied on clinical diagnoses of HF together with normal systolic function and did not measure diastolic function. This applies to the analysis of patients hospitalized for HF and some epidemiological investigations that agree on the greater prevalence of HF-NEF in women. Population-based studies with echocardiographic determination of diastolic function have suggested equal or greater prevalence of diastolic dysfunction in men. Major risk factors for HF-NEF include hypertension, aging, obesity, diabetes, and ischemia. Hypertension is more frequent in women and can contribute to left ventricular and arterial stiffening in a gender-specific way. Aging, obesity, and diabetes affect myocardial and vascular stiffness differently and lead to different forms of myocardial hypertrophy in women and men. In contrast, ischemia may play a greater role in men. Gender differences in ventricular diastolic distensibility, in vascular stiffness and ventricular/vascular coupling, in skeletal muscle adaptation to HF, and in the perception of symptoms may contribute to a greater rate of HF-NEF in women. The underlying molecular mechanisms include gender differences in calcium handling, in the NO system, and in natriuretic peptides. Estrogen affects collagen synthesis and degradation and inhibits the renin-angiotensin system. Effects of estrogen may provide benefit to premenopausal women, and the loss of its protective mechanisms may render the heart of postmenopausal women more vulnerable. Thus, a number of molecular mechanisms can contribute to the gender differences in HF-NEF.

Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease.

PubMed

Onishi, Katsuya

2017-08-01

Patients with cardiovascular disease (CVD) often have multiple comorbid conditions that may interact with each other, confound the choice of treatments, and reduce mortality. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. COPD shares common risk factors such as tobacco smoking and aging with CVD, is associated with less physical activity, and produces systemic inflammation and oxidative stress. Overall, patients with COPD have a 2-3-fold increased risk of CVD as compared to age-matched controls when adjusted for tobacco smoking. Chronic heart failure (HF) is a frequent and important comorbidity which has a significant impact on prognosis in COPD, and vice versa. HF overlaps in symptoms and signs and has a common comorbidity with COPD, so that diagnosis of COPD is difficult in patients with HF. The combination of HF and COPD presents many therapeutic challenges including beta-blockers (BBs) and beta-agonists. Inhaled long-acting bronchodilators including beta2-agonists and anticholinergics for COPD would not worsen HF. Diuretics are relatively safe, and angiotensin-converting enzyme inhibitors are preferred to treat HF accompanied with COPD. BBs are only relatively contraindicated in asthma, but not in COPD. Low doses of cardioselective BBs should be aggressively initiated in clinically stable patients with HF accompanied with COPD combined with close monitoring for signs of airway obstruction and gradually up-titrated to the maximum tolerated dose. Encouraging appropriate and aggressive treatment for both HF and COPD should be recommended to improve quality of life and mortality in HF patients with COPD. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Interactions between the colonic transcriptome, metabolome, and microbiome in mouse models of obesity-induced intestinal cancer.

PubMed

Pfalzer, Anna C; Kamanu, Frederick K; Parnell, Laurence D; Tai, Albert K; Liu, Zhenhua; Mason, Joel B; Crott, Jimmy W

2016-08-01

Obesity is a significant risk factor for colorectal cancer (CRC); however, the relative contribution of high-fat (HF) consumption and excess adiposity remains unclear. It is becoming apparent that obesity perturbs both the intestinal microbiome and metabolome, and each has the potential to induce protumorigenic changes in the epithelial transcriptome. The physiological consequences and the degree to which these different biologic systems interact remain poorly defined. To understand the mechanisms by which obesity drives colonic tumorigenesis, we profiled the colonic epithelial transcriptome of HF-fed and genetically obese (DbDb) mice with a genetic predisposition to intestinal tumorigenesis (Apc(1638N)); 266 and 584 genes were differentially expressed in the colonic mucosa of HF and DbDb mice, respectively. These genes mapped to pathways involved in immune function, and cellular proliferation and cancer. Furthermore, Akt was central within the networks of interacting genes identified in both gene sets. Regression analyses of coexpressed genes with the abundance of bacterial taxa identified three taxa, previously correlated with tumor burden, to be significantly correlated with a gene module enriched for Akt-related genes. Similarly, regression of coexpressed genes with metabolites found that adenosine, which was negatively associated with inflammatory markers and tumor burden, was also correlated with a gene module enriched with Akt regulators. Our findings provide evidence that HF consumption and excess adiposity result in changes in the colonic transcriptome that, although distinct, both appear to converge on Akt signaling. Such changes could be mediated by alterations in the colonic microbiome and metabolome.

Active experiments in geospace plasmas with gigawatts of RF power at HAARP

NASA Astrophysics Data System (ADS)

Sheerin, James

2016-07-01

The ionosphere provides a relatively quiescent plasma target, stable on timescales of minutes, for a whole host of active plasma experiments. The largest HF transmitter built to date is the HAARP phased-array HF transmitter near Gakona, Alaska which can deliver up to 3.6 Gigawatts (ERP) of CW RF power in the range of 2.8 - 10 MHz to the ionosphere with millisecond pointing, power modulation, and frequency agility. With an ionospheric background thermal energy in the range of only 0.1 eV, this amount of power gives access to the highest regimes of the nonlinearity (RF intensity to thermal pressure) ratio. HAARP's unique features have enabled the conduct of a number of nonlinear plasma experiments in the inter¬action region of overdense ionospheric plasma including generation of artificial aurorae, artificial ionization layers, VLF wave-particle interactions in the magnetosphere, parametric instabilities, stimulated electromagnetic emissions (SEE), strong Langmuir turbulence (SLT) and suprathermal electron acceleration. Diagnostics include the Modular UHF Ionospheric Radar (MUIR) sited at HAARP, the SuperDARN-Kodiak HF radar, spacecraft radio beacons, HF receivers to record stimulated electromagnetic emissions (SEE) and optics for optical emissions. We report on short timescale ponderomotive overshoot effects, artificial field-aligned irregularities (AFAI), the aspect angle dependence of the intensity of the HF-enhanced plasma line, and production of suprathermal electrons. Applications are made to the controlled study of fundamental nonlinear plasma processes of relevance to laboratory plasmas, ionospheric irregularities affecting spacecraft communication and navigation systems, artificial ionization mirrors, wave-particle interactions in the magnetosphere, active global magnetospheric experiments, and many more.

Isoenergetic feeding of low carbohydrate-high fat diets does not increase brown adipose tissue thermogenic capacity in rats.

PubMed

Betz, Matthias J; Bielohuby, Maximilian; Mauracher, Brigitte; Abplanalp, William; Müller, Hans-Helge; Pieper, Korbinian; Ramisch, Juliane; Tschöp, Matthias H; Beuschlein, Felix; Bidlingmaier, Martin; Slawik, Marc

2012-01-01

Low-carbohydrate, high-fat (LC-HF) diets are popular for inducing weight loss in overweighed adults. Adaptive thermogenesis increased by specific effects of macronutrients on energy expenditure has been postulated to induce this weight loss. We studied brown adipose tissue (BAT) morphology and function following exposure to different LC-HF diets. Male Wistar rats were fed a standard control diet ad libitum or pair-fed isoenergetic amounts of three experimental diets for 4 weeks. The diets had the following macronutrient composition (% metabolizable energy: carbohydrates, fat, protein): control (64.3/16.7/19), LC-HF-low protein (LC-HF-LP, 1.7/92.8/5.5), LC-HF-normal-protein (LC-HF-NP, 2.2/78.7/19.1), and a high fat diet with carbohydrates ("high fat", 19.4/61.9/18.7). Body weight gain was reduced in all pair-fed experimental groups as compared to rats fed the control diet, with more pronounced effect in rats on LC-HF diets than on the high fat diet with carbohydrates. High fat diets increased expression of PGC1α and ADRB3 in BAT indicating higher SNS outflow. However, UCP1 mRNA expression and expression of UCP1 assessed by immunohistochemistry was not different between diet groups. In accordance, analysis of mitochondrial function in-vitro by extracellular flux analyser (Seahorse Bioscience) and measurement of inducible thermogenesis in vivo (primary endpoint), explored by indirect calorimetry following norepinephrine injection, did not show significant differences between groups. Histology of BAT revealed increased lipid droplet size in rats fed the high-fat diet and both LC-HF diets. All experimental diets upregulated expression of genes which are indicative for increased BAT activity. However, the functional measurements in vivo revealed no increase of inducible BAT thermogenesis. This indicates that lower body weight gain with LC-HF diets and a high fat diet in a pair-feeding setting is not caused by increased adaptive thermogenesis in BAT.

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing.

PubMed

Merchant, Faisal M; Hoskins, Michael H; Musat, Dan L; Prillinger, Julie B; Roberts, Gregory J; Nabutovsky, Yelena; Mittal, Suneet

2017-06-01

Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB. Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P <0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P <0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. © 2017 American Heart Association, Inc.

Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction.

PubMed

Sun, Louise Y; Tu, Jack V; Bader Eddeen, Anan; Liu, Peter P

2018-06-16

Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting. We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population-based database of all Ontarians with physician-diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all-cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan-Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age-standardized HFpEF mortality rates at 4±2 years of follow-up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men. We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow-up should be focused on women and men with HF rather than on rEF alone. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Optimized management of heart failure patients aged 80 years or more improves outcomes versus usual care: The HF80 randomized trial.

PubMed

Vorilhon, Charles; Jean, Frédéric; Mulliez, Aurélien; Clerfond, Guillaume; Pereira, Bruno; Sapin, Vincent; Souteyrand, Géraud; Citron, Bernard; Motreff, Pascal; Lusson, Jean-René; Eschalier, Romain

2016-12-01

The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care). All patients benefitted from the same in-hospital management. Optimized group patients were also managed at 3, 6 and 9 weeks, and 3, 6, 9 and 12 months after initial hospitalization, to optimize HF-REF treatment. The primary endpoint was quality of life at 6 months. The trial was stopped prematurely, according to prespecified rules and an independent data monitoring board, after 34 patients were included (n=17 in each group). There was no difference in quality of life at baseline and at 6 months between the two groups (P=0.14 and 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimized group compared with the control group: -20.2±25.2 (P=0.01) versus -9.9±19.0 (P=0.19). Mortality at 12 months was lower in the optimized group (17.7% vs 47.1%; P=0.03). There was no increase in acute renal failure, hyperkalaemia or falls in the optimized group (P=0.49, 1 and 1, respectively). Optimizing the management of HF-REF in patients aged 80 years or more, according to the modalities of the HF80 study, seems to be both effective and safe. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox.

PubMed

Shah, Ravi; Gayat, Etienne; Januzzi, James L; Sato, Naoki; Cohen-Solal, Alain; diSomma, Salvatore; Fairman, Enrique; Harjola, Veli-Pekka; Ishihara, Shiro; Lassus, Johan; Maggioni, Aldo; Metra, Marco; Mueller, Christian; Mueller, Thomas; Parenica, Jiri; Pascual-Figal, Domingo; Peacock, William Frank; Spinar, Jindrich; van Kimmenade, Roland; Mebazaa, Alexandre

2014-03-04

This study sought to define the relationship between body mass index (BMI) and mortality in heart failure (HF) across the world and to identify specific groups in whom BMI may differentially mediate risk. Obesity is associated with incident HF, but it is paradoxically associated with better prognosis during chronic HF. We studied 6,142 patients with acute decompensated HF from 12 prospective observational cohorts followed-up across 4 continents. Primary outcome was all-cause mortality. Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality. Normal-weight patients (BMI 18.5 to 25 kg/m(2)) were older with more advanced HF and lower cardiometabolic risk. Despite worldwide heterogeneity in clinical features across obesity categories, a higher BMI remained associated with decreased 30-day and 1-year mortality (11% decrease at 30 days; 9% decrease at 1 year per 5 kg/m(2); p < 0.05), after adjustment for clinical risk. The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk (net reclassification index 0.119, p < 0.001). Notably, the "protective" association of BMI with mortality was confined to persons with older age (>75 years; hazard ratio [HR]: 0.82; p = 0.006), decreased cardiac function (ejection fraction <50%; HR: 0.85; p < 0.001), no diabetes (HR: 0.86; p < 0.001), and de novo HF (HR: 0.89; p = 0.004). A lower BMI is associated with age, disease severity, and a higher risk of death in acute decompensated HF. The "obesity paradox" is confined to older persons, with decreased cardiac function, less cardiometabolic illness, and recent-onset HF, suggesting that aging, HF severity/chronicity, and metabolism may explain the obesity paradox. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Elevated Potassium Levels in Patients With Congestive Heart Failure: Occurrence, Risk Factors, and Clinical Outcomes: A Danish Population-Based Cohort Study.

PubMed

Thomsen, Reimar Wernich; Nicolaisen, Sia Kromann; Hasvold, Pål; Garcia-Sanchez, Ricardo; Pedersen, Lars; Adelborg, Kasper; Egfjord, Martin; Egstrup, Kenneth; Sørensen, Henrik Toft

2018-05-22

Data on the true burden of hyperkalemia in patients with heart failure (HF) in a real-world setting are limited. Incidence rates of hyperkalemia (first blood test with a potassium level >5.0 mmol/L) in primary or hospital care were assessed in a population-based cohort of patients with incident HF diagnoses in northern Denmark from 2000 to 2012. Risk factors and clinical outcomes were compared in patients with HF with versus without hyperkalemia. Of 31 649 patients with HF, 39% experienced hyperkalemia (mean follow-up, 2.2 years). Risks of experiencing a second, third, or fourth event were 43%, 54%, and 60%, respectively. Among patients with HF with stage 3A, 3B, 4, or 5 kidney dysfunction, 26%, 35%, 44%, and 48% experienced hyperkalemia within the first year. Important hyperkalemia risk factors included chronic kidney disease (prevalence ratio, 1.46; 95% confidence interval [CI], 1.43-1.49), diabetes mellitus (prevalence ratio, 1.38; 95% CI, 1.32-1.45), and spironolactone use (prevalence ratio, 1.48; 95% CI, 1.42-1.54). In patients with HF who developed hyperkalemia, 53% had any acute-care hospitalization 6 months before the hyperkalemia event, increasing to 74% 6 months after hyperkalemia (before-after risk ratio, 1.41; 95% CI, 1.38-1.44). Compared with matched patients with HF without hyperkalemia, adjusted 6-month hazard ratios in patients with hyperkalemia were 2.75-fold (95% CI, 2.65-2.85) higher for acute-care hospitalization and 3.39-fold (95% CI, 3.19-3.61) higher for death. Almost 4 in 10 patients with HF develop hyperkalemia, and many patients have recurrent hyperkalemia episodes. Hyperkalemia risk is strongly associated with degree of reduced kidney function and use of spironolactone. Hyperkalemia is associated with severe clinical outcomes and death in HF. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Analysis of thermal stresses in HfO2/SiO2 high reflective optical coatings for high power laser applications

NASA Astrophysics Data System (ADS)

Gao, Chunxue; Zhao, Zhiwei; Zhu, Zhuoya; Li, Shuang; Mi, Changwen

2015-02-01

HfO2/SiO2 high reflective optical coatings are widely used in high power laser applications because of their high laser damage resistance and appropriate spectral performance. The residual stresses strongly influence the performance and longevity of the optical coatings. Thermal stresses are the primary components of the residual stresses. In the present work, the distribution of thermal stresses in HfO2/SiO2 high reflective optical coatings was investigated using two different computational methods: finite element method (FEM) and an analytical method based on force and moment balances and classical beam bending theory. The results by these two methods were compared and found to be in agreement with each other, demonstrating that these two methods are effective and accurate ways to predict the thermal stresses in HfO2/SiO2 optical coatings. In addition, these two methods were also used to obtain the thermal stresses in HfO2/SiO2 optical coatings with different layer number to investigate the effect of the layer number on the thermal stresses of the HfO2/SiO2 optical coatings. The results show that with the increase of the layer number, the stresses in the substrate increase, while the stresses in the respective SiO2 and HfO2 layers decrease. Besides, it was also found that the radius of curvature of the coating system decreases as the layer number increases, leading to larger bending curvature in the system.

Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial design.

PubMed

Bartunek, Jozef; Davison, Beth; Sherman, Warren; Povsic, Thomas; Henry, Timothy D; Gersh, Bernard; Metra, Marco; Filippatos, Gerasimos; Hajjar, Roger; Behfar, Atta; Homsy, Christian; Cotter, Gad; Wijns, William; Tendera, Michal; Terzic, Andre

2016-02-01

Cardiopoiesis is a conditioning programme that aims to upgrade the cardioregenerative aptitude of patient-derived stem cells through lineage specification. Cardiopoietic stem cells tested initially for feasibility and safety exhibited signs of clinical benefit in patients with ischaemic heart failure (HF) warranting definitive evaluation. Accordingly, CHART-1 is designed as a large randomized, sham-controlled multicentre study aimed to validate cardiopoietic stem cell therapy. Patients (n = 240) with chronic HF secondary to ischaemic heart disease, reduced LVEF (<35%), and at high risk for recurrent HF-related events, despite optimal medical therapy, will be randomized 1:1 to receive 600 × 10(6) bone marrow-derived and lineage-directed autologous cardiopoietic stem cells administered via a retention-enhanced intramyocardial injection catheter or a sham procedure. The primary efficacy endpoint is a hierarchical composite of mortality, worsening HF, Minnesota Living with Heart Failure Questionnaire score, 6 min walk test, LV end-systolic volume, and LVEF at 9 months. The secondary efficacy endpoint is the time to cardiovascular death or worsening HF at 12 months. Safety endpoints include mortality, readmissions, aborted sudden deaths, and serious adverse events at 12 and 24 months. The CHART-1 clinical trial is powered to examine the therapeutic impact of lineage-directed stem cells as a strategy to achieve cardiac regeneration in HF populations. On completion, CHART-1 will offer a definitive evaluation of the efficacy and safety of cardiopoietic stem cells in the treatment of chronic ischaemic HF. NCT01768702. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Apically extruded debris in filling removal of curved canals using 3 NiTi systems and hand files.

PubMed

Delai, Débora; Boijink, Daiana; Hoppe, Carolina Bender; Grecca, Abiana Soares; Kopper, Patrícia Maria Poli

2018-01-01

The aim of this study was to assess the amount of apically extruded debris during filling removal with WaveOne Gold (WOG), ProTaper Universal Retreatment (PTR), D-RaCe Retreatment (DRR) or hand files (HF), to compare the working time during filling removal, and to describe failures of NiTi instruments. Forty mesiobuccal roots of maxillary first molars were prepared with WOG Primary, obturated and divided into 4 groups (n=10), according to the instruments used: WOG, PTR, DRR or HF. Distilled water was used as irrigant and the extruded debris were collected in Eppendorf tubes and dried. The amount of extruded debris was determined by subtracting the final from the initial weight. The time of filling removal for each canal was recorded and the instruments used were analyzed pre and post-operatively by SEM. Kruskal-Wallis and Dunn's test analyzed extruded debris data and ANOVA, followed by Tukey's test, compared the working time data (a=0.05). Instrument deformation and fracture were described. WOG produced significantly less debris compared with HF and DRR (p<0.05), and similar to PTR (p>0.05). HF, PTR and DRR showed no significant difference (p>0.05). Working time in HF group was significantly higher than others (p<0.05). SEM analyses showed, from the 18 instruments evaluated, 3 fractures and 10 deformations. All instruments tested caused debris extrusion. WOG was associated with less extrusion than DRR and HF. Filling removal with HF was slower than with the other instruments. All NiTi systems presented fracture and deformation.

Oxygen vacancy defect engineering using atomic layer deposited HfAlO{sub x} in multi-layered gate stack

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bhuyian, M. N., E-mail: mnb3@njit.edu; Misra, D.; Sengupta, R.

2016-05-02

This work evaluates the defects in high quality atomic layer deposited (ALD) HfAlO{sub x} with extremely low Al (<3% Al/(Al + Hf)) incorporation in the Hf based high-k dielectrics. The defect activation energy estimated by the high temperature current voltage measurement shows that the charged oxygen vacancies, V{sup +}/V{sup 2+}, are the primary source of defects in these dielectrics. When Al is added in HfO{sub 2}, the V{sup +} type defects with a defect activation energy of E{sub a} ∼ 0.2 eV modify to V{sup 2+} type to E{sub a} ∼ 0.1 eV with reference to the Si conduction band. When devices were stressedmore » in the gate injection mode for 1000 s, more V{sup +} type defects are generated and E{sub a} reverts back to ∼0.2 eV. Since Al has a less number of valence electrons than do Hf, the change in the co-ordination number due to Al incorporation seems to contribute to the defect level modifications. Additionally, the stress induced leakage current behavior observed at 20 °C and at 125 °C demonstrates that the addition of Al in HfO{sub 2} contributed to suppressed trap generation process. This further supports the defect engineering model as reduced flat-band voltage shifts were observed at 20 °C and at 125 °C.« less

Geochronology and geochemistry of early Paleozoic intrusive rocks from the Khanka Massif in the Russian Far East: Petrogenesis and tectonic implications

NASA Astrophysics Data System (ADS)

Xu, Ting; Xu, Wen-Liang; Wang, Feng; Ge, Wen-Chun; Sorokin, A. A.

2018-02-01

This paper presents new geochronological and geochemical data for early Paleozoic intrusive rocks from the Khanka Massif in the Russian Far East, with the aim of elucidating the Paleozoic evolution and tectonic attributes of the Khanka Massif. New U-Pb zircon data indicate that early Paleozoic magmatism within the Khanka Massif can be subdivided into at least four stages: 502, 492, 462-445, and 430 Ma. The 502 Ma pyroxene diorites contain 58.28-59.64 wt% SiO2, 2.84-3.69 wt% MgO, and relatively high Cr and Ni contents. Negative εHf(t) values (- 1.8 to - 0.4), along with other geochemical data, indicate that the primary magma was derived from partial melting of mafic lower crust with the addition of mantle material. The 492 Ma syenogranites have high SiO2 and K2O contents, and show positive Eu anomalies, indicating the primary magma was generated by partial melting of lower crust at relatively low pressure. The 445 Ma Na-rich trondhjemites display high Sr/Y ratios and positive εHf(t) values (+ 1.8 to + 3.9), indicating the primary magma was generated by partial melting of thickened hydrous mafic crust. The 430 Ma granitoids have high SiO2 and K2O contents, zircon εHf(t) values of - 5.4 to + 5.8, and two-stage model ages of 1757-1045 Ma, suggesting the primary magma was produced by partial melting of heterogeneous Proterozoic lower crustal material. The geochemistry of these early Paleozoic intrusive assemblages indicates their formation in an active continental margin setting associated with the subduction of a paleo-oceanic plate beneath the Khanka Massif. The εHf(t) values show an increasingly negative trend with increasing latitude, revealing a lateral heterogeneity of the lower crust beneath the Khanka Massif. Regional comparisons of the magmatic events indicate that the Khanka Massif in the Russian Far East has a tectonic affinity to the Songnen-Zhangguangcai Range Massif rather than the adjacent Jiamusi Massif.

Effects of an electric field on interaction of aromatic systems.

PubMed

Youn, Il Seung; Cho, Woo Jong; Kim, Kwang S

2016-04-30

The effect of uniform external electric field on the interactions between small aromatic compounds and an argon atom is investigated using post-HF (MP2, SCS-MP2, and CCSD(T)) and density functional (PBE0-D3, PBE0-TS, and vdW-DF2) methods. The electric field effect is quantified by the difference of interaction energy calculated in the presence and absence of the electric field. All the post-HF methods describe electric field effects accurately although the interaction energy itself is overestimated by MP2. The electric field effect is explained by classical electrostatic models, where the permanent dipole moment from mutual polarization mainly determines its sign. The size of π-conjugated system does not have significant effect on the electric field dependence. We found out that PBE0-based methods give reasonable interaction energies and electric field response in every case, while vdW-DF2 sometimes shows spurious artifact owing to its sensitivity toward the real space electron density. © 2015 Wiley Periodicals, Inc.

Dialyzer Reuse and Outcomes of High Flux Dialysis

PubMed Central

Argyropoulos, Christos; Roumelioti, Maria-Eleni; Sattar, Abdus; Kellum, John A.; Weissfeld, Lisa; Unruh, Mark L.

2015-01-01

Background The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Methods Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. Findings In HEMO, minimally reused (< 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48–0.92, p = 0.015), 0.64 (95%CI: 0.44 – 0.95, p = 0.03), 0.61 (95%CI: 0.41 – 0.90, p = 0.012), 0.53 (95%CI: 0.28 – 1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51–0.78) for non-reused HF dialyzers compared with non-reused LF membranes. Conclusions This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes. PMID:26057383

Longitudinal Plasmoid in High-Speed Vortex Gas Flow Created by Capacity HF Discharge

DTIC Science & Technology

2010-10-28

interferometer with high space resolution, PIV method, FTIR spectrometer, optical spectrometer, pressure sensors with high time resolution, IR pyrometer and...of strong LP-vortex interaction. Intensive acoustic waves are created by CHFD in swirl flow in this regime. 38. Study of control of a longitudinal...quartz tube, 4- HF ball electrode, 5- Tesla’s transformer, 6- microwave interferometer, 7- video camera, 8-optical pyrometer , 9-pressure sensor, 10

Interaction between milk allowance and fat content of the starter feed on performance of Holstein calves.

PubMed

Araujo, G; Terré, M; Bach, A

2014-10-01

Sixty-six Holstein male calves [42 ± 6.0 kg of body weight (BW) and 12 ± 3.1 d of age] were housed individually and allocated to 1 of 4 treatments following a 2 × 2 factorial complete randomized design to assess the potential interaction between milk replacer (MR) allowance and fat content in the starter feed. Thus, 4 treatments were evaluated: a low-fat (4.1% fat; LF) starter feed offered along with 4 L/d of MR (4 LF), a high-fat (11.2% fat; HF) starter feed plus 4 L/d of MR (4 HF), a LF starter feed offered with 6 L/d of MR (6LF), and an HF starter feed offered with 6 L/d of MR (6 HF). Calves were fed either 4 or 6 L/d of MR (25% crude protein and 19.2% fat) in 2 offers (0800 and 1630 h) and had ad libitum access to either an LF or an HF starter feed (21.4 and 22.3% crude protein). Calves were weaned at wk 6 of study by halving the daily MR allowance for 1 wk. Individual MR and starter feed intakes were recorded daily and BW was determined weekly. A glucose tolerance test was performed on d 30 of study to evaluate the effects of increased energy provision on glucose metabolism. Apparent feed digestibility was measured for the last 5 d of study. Overall, fat content of starter feed had no effect on solid feed intake. However, during wk 8 of study (after weaning), calves in the LF treatment had greater starter feed intake than HF calves. Calves on 6 L/d of MR had greater BW than calves fed 4 L/d from the second week of study until weaning. After weaning, 6 LF calves had lesser BW than 6 HF calves. Calves on 6 L/d of MR had greater average daily gain than calves fed 4 L/d, and 6 HF calves tended to have the greatest average daily gain. Glucose clearance rate tended to be lesser for HF than for LF calves. In conclusion, offering 6 L/d of MR increased growth performance before weaning and, when offering 6 L/d of MR, feeding a high-fat starter feed resulted in the greatest BW after weaning. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Islet inflammation, hemosiderosis, and fibrosis in intrauterine growth-restricted and high fat-fed Sprague-Dawley rats.

PubMed

Delghingaro-Augusto, Viviane; Madad, Leili; Chandra, Arin; Simeonovic, Charmaine J; Dahlstrom, Jane E; Nolan, Christopher J

2014-05-01

Prenatal and postnatal factors such as intrauterine growth restriction (IUGR) and high-fat (HF) diet contribute to type 2 diabetes. Our aim was to determine whether IUGR and HF diets interact in type 2 diabetes pathogenesis, with particular attention focused on pancreatic islet morphology including assessment for inflammation. A surgical model of IUGR (bilateral uterine artery ligation) in Sprague-Dawley rats with sham controls was used. Pups were fed either HF or chow diets after weaning. Serial measures of body weight and glucose tolerance were performed. At 25 weeks of age, rat pancreases were harvested for histologic assessment. The birth weight of IUGR pups was 13% lower than that of sham pups. HF diet caused excess weight gain, dyslipidemia, hyperinsulinemia, and mild glucose intolerance, however, this was not aggravated further by IUGR. Markedly abnormal islet morphology was evident in 0 of 6 sham-chow, 5 of 8 sham-HF, 4 of 8 IUGR-chow, and 8 of 9 IUGR-HF rats (chi-square, P = 0.007). Abnormal islets were characterized by larger size, irregular shape, inflammation with CD68-positive cells, marked fibrosis, and hemosiderosis. β-Cell mass was not altered by IUGR. In conclusion, HF and IUGR independently contribute to islet injury characterized by inflammation, hemosiderosis, and fibrosis. This suggests that both HF and IUGR can induce islet injury via converging pathways. The potential pathogenic or permissive role of iron in this process of islet inflammation warrants further investigation. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Electronic cigarettes: incorporating human factors engineering into risk assessments

PubMed Central

Yang, Ling; Rudy, Susan F; Cheng, James M; Durmowicz, Elizabeth L

2014-01-01

Objective A systematic review was conducted to evaluate the impact of human factors (HF) on the risks associated with electronic cigarettes (e-cigarettes) and to identify research gaps. HF is the evaluation of human interactions with products and includes the analysis of user, environment and product complexity. Consideration of HF may mitigate known and potential hazards from the use and misuse of a consumer product, including e-cigarettes. Methods Five databases were searched through January 2014 and publications relevant to HF were incorporated. Voluntary adverse event (AE) reports submitted to the US Food and Drug Administration (FDA) and the package labelling of 12 e-cigarette products were analysed. Results No studies specifically addressing the impact of HF on e-cigarette use risks were identified. Most e-cigarette users are smokers, but data on the user population are inconsistent. No articles focused specifically on e-cigarette use environments, storage conditions, product operational requirements, product complexities, user errors or misuse. Twelve published studies analysed e-cigarette labelling and concluded that labelling was inadequate or misleading. FDA labelling analysis revealed similar concerns described in the literature. AE reports related to design concerns are increasing and fatalities related to accidental exposure and misuse have occurred; however, no publications evaluating the relationship between AEs and HF were identified. Conclusions The HF impacting e-cigarette use and related hazards are inadequately characterised. Thorough analyses of user–product–environment interfaces, product complexities and AEs associated with typical and atypical use are needed to better incorporate HF engineering principles to inform and potentially reduce or mitigate the emerging hazards associated with e-cigarette products. PMID:24732164

Prognostic value of indeterminable anaerobic threshold in heart failure.

PubMed

Agostoni, Piergiuseppe; Corrà, Ugo; Cattadori, Gaia; Veglia, Fabrizio; Battaia, Elisa; La Gioia, Rocco; Scardovi, Angela B; Emdin, Michele; Metra, Marco; Sinagra, Gianfranco; Limongelli, Giuseppe; Raimondo, Rosa; Re, Federica; Guazzi, Marco; Belardinelli, Romualdo; Parati, Gianfranco; Magrì, Damiano; Fiorentini, Cesare; Cicoira, Mariantonietta; Salvioni, Elisabetta; Giovannardi, Marta; Mezzani, Alessandro; Scrutinio, Domenico; Di Lenarda, Andrea; Mantegazza, Valentina; Ricci, Roberto; Apostolo, Anna; Iorio, Annamaria; Paolillo, Stefania; Palermo, Pietro; Contini, Mauro; Vassanelli, Corrado; Passino, Claudio; Piepoli, Massimo F

2013-09-01

In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient ≤1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001; hazard ratio [HR]=0.977; confidence interval [CI]=0.97-0.98), ventilatory efficiency slope (P=0.01; HR=1.02; CI=1.01-1.03), hemoglobin (P<0.05; HR=0.931; CI=0.87-1.00), left ventricular ejection fraction (P<0.001; HR=0.948; CI=0.94-0.96), renal function (modification of diet in renal disease; P<0.001; HR=0.990; CI=0.98-0.99), sodium (P<0.05; HR=0.967; CI=0.94-0.99), and AT nonidentification (P<0.05; HR=1.41; CI=1.06-1.89). Nonidentification of AT remained associated to prognosis also when compared with metabolic exercise and cardiac and kidney index score (P<0.01; HR=1.459; CI=1.09-1.10). Similar results were obtained for the secondary study end point. The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF.

Real-time, high frequency (1 Hz), in situ measurement of HCl and HF gases in volcanic plumes with a novel cavity-enhanced, laser-based instrument

NASA Astrophysics Data System (ADS)

Kelly, P. J.; Sutton, A. J.; Elias, T.; Kern, C.; Clor, L. E.; Baer, D. S.

2017-12-01

Primary magmatic halogen-containing gases (HCl, HF, HBr, HI in characteristic order of abundance) are of great interest for volcano monitoring and research because, in general, they are more soluble in magma than other commonly-monitored volcanic volatiles (e.g. CO2, SO2, H2S) and thereby can offer unique insights into shallow magmatic processes. Nevertheless, difficulties in obtaining observations of primary volcanic halogens in gas plumes with traditional methods (e.g. direct sampling, Open-Path Fourier Transform Infrared spectroscopy, filter packs) have limited the number of observations reported worldwide, especially from explosive arc volcanoes. With this in mind, the USGS and Los Gatos Research, Inc. collaborated to adapt a commercially-available industrial in situ HCl-HF analyzer for use in airborne and ground-based measurements of volcanic gases. The new, portable instrument is based around two near-IR tunable diode lasers and uses a vibration-tolerant, enhanced-cavity approach that is well-suited for rugged field applications and yields fast (1 Hz) measurements with a wide dynamic range (0 -2 ppm) and sub-ppb precision (1σ: HCl: <0.4 ppb; HF: <0.1 ppb). In spring 2017 we conducted field tests at Kīlauea Volcano, Hawaii, to benchmark the performance of the new instrument and to compare it with an accepted method for halogen measurements (OP-FTIR). The HCl-HF instrument was run in parallel with a USGS Multi-GAS to obtain in situ H2O-CO2-SO2-H2S-HCl-HF plume compositions. The results were encouraging and quasi-direct comparisons of the in situ and remote sensing instruments showed good agreement (e.g. in situ SO2/HCl = 72 vs. OP-FTIR SO2/HCl = 88). Ground-based and helicopter-based measurements made 0 - 12 km downwind from the vent (plume age 0 - 29 minutes) show that plume SO2/HCl ratios increase rapidly from 60 to 300 around the plume edges, possibly due to uptake of HCl onto aerosols.

Mindfulness meditation, well-being, and heart rate variability: a preliminary investigation into the impact of intensive Vipassana meditation.

PubMed

Krygier, Jonathan R; Heathers, James A J; Shahrestani, Sara; Abbott, Maree; Gross, James J; Kemp, Andrew H

2013-09-01

Mindfulness meditation has beneficial effects on brain and body, yet the impact of Vipassana, a type of mindfulness meditation, on heart rate variability (HRV) - a psychophysiological marker of mental and physical health - is unknown. We hypothesised increases in measures of well-being and HRV, and decreases in ill-being after training in Vipassana compared to before (time effects), during the meditation task compared to resting baseline (task effects), and a time by task interaction with more pronounced differences between tasks after Vipassana training. HRV (5-minute resting baseline vs. 5-minute meditation) was collected from 36 participants before and after they completed a 10-day intensive Vipassana retreat. Changes in three frequency-domain measures of HRV were analysed using 2 (Time; pre- vs. post-Vipassana)× 2 (Task; resting baseline vs. meditation) within subjects ANOVA. These measures were: normalised high-frequency power (HF n.u.), a widely used biomarker of parasympathetic activity; log-transformed high frequency power (ln HF), a measure of RSA and required to interpret normalised HF; and Traube-Hering-Mayer waves (THM), a component of the low frequency spectrum linked to baroreflex outflow. As expected, participants showed significantly increased well-being, and decreased ill-being. ln HF increased overall during meditation compared to resting baseline, while there was a time∗task interaction for THM. Further testing revealed that pre-Vipassana only ln HF increased during meditation (vs. resting baseline), consistent with a change in respiration. Post-Vipassana, the meditation task increased HF n.u. and decreased THM compared to resting baseline, suggesting post-Vipassana task-related changes are characterised by a decrease in absolute LF power, not parasympathetic-mediated increases in HF power. Such baroreflex changes are classically associated with attentional load, and our results are interpreted in light of the concept of 'flow' - a state of positive and full immersion in an activity. These results are also consistent with changes in normalised HRV reported in other meditation studies. Copyright © 2013 Elsevier B.V. All rights reserved.

High Functioning Autism Spectrum Disorders in Adults: Consequences for Primary Caregivers Compared to Schizophrenia and Depression

ERIC Educational Resources Information Center

Grootscholten, Inge A. C.; van Wijngaarden, Bob; Kan, Cornelis C.

2018-01-01

Primary caregivers experience consequences from being in close contact to a person with autism spectrum disorder (ASD). This study used the Involvement Evaluation Questionnaire to explore the level of consequences of 104 caregivers involved with adults with High Functioning ASD (HF-ASD) and compared these with the consequences reported by…

Sex and performance level effects on brain activation during a verbal fluency task: a functional magnetic resonance imaging study.

PubMed

Gauthier, Christophe T; Duyme, Michel; Zanca, Michel; Capron, Christiane

2009-02-01

Neuroimaging studies investigating the neural correlates of verbal fluency (VF) focused on sex differences without taking into account behavioural variation. Nevertheless, group differences in this verbal ability might account for neurocognitive differences elicited between men and women. The aim of this study was to test sex and performance level effects and the combination of these on cerebral activation. Four samples of 11 healthy students (N=44) selected on the basis of sex and contrasted VF scores, high fluency (HF) versus low fluency (LF), performed a covert phonological VF task during scans. Within- and between-group analyses were conducted. Consistent with previous studies, for each sample, the whole-group analysis reported activation in the inferior frontal gyrus (IFG), insula, anterior cingulate cortex (ACC), medial frontal gyrus (mFG), superior (SPL) and inferior parietal lobules (IPL), inferior visual areas, cerebellum, thalamus and basal ganglia. Between-group analyses showed an interaction between sexes and performances in the right precuneus, left ACC, right IFG and left dorsolateral prefrontal cortex (dlPFC). HF men showed more activation than LF ones in the right precuneus and left dlPFC. LF men showed more activation in the right IFG than HF ones and LF women elicited more activation in the left ACC than HF ones. A sex main effect was found regardless of performance in the left inferior temporal gyrus (ITG), cerebellum, anterior and posterior cingulate cortexes and in the right superior frontal gyrus (SFG) and dlPFC, lingual gyrus and ACC, with men eliciting significantly greater activations than women. A performance main effect was found for the left ACC and the left cerebellum regardless of sex. LF subjects had stronger activations than HF ones in the ACC whereas HF subjects showed stronger activations in the cerebellum. Activity in three discrete subregions of the ACC is related to sex, performance and their interaction, respectively. Our findings emphasize the need to consider sex and performance level in functional imaging studies of VF.

Glass-water interactions: Effect of high-valence cations on glass structure and chemical durability

DOE PAGES

Pierce, Eric M.; Kerisit, Sebastien N.; Charpentier, Thibault; ...

2016-02-27

Spectroscopic measurements, dissolution experiments, and Monte Carlo simulations were performed to investigate the effect of high valence cations (HVC) on the mechanisms of glass dissolution under dilute and near-saturated conditions. Raman and NMR spectroscopy were used to determine the structural changes that occur in glass, specifically network formers (e.g., Al, Si, and B), with the addition of the HVC element hafnium in the Na 2O Al 2O 3 B 2O 3 HfO 2 SiO 2 system (e.g., Na/(Al+B) = 1.0 and HfO 2/SiO 2 from 0.0 to 0.42). Spectroscopic measurements revealed that increasing hafnium content decreases N 4 and increasesmore » the amount of Si–O–Hf moieties in the glass. Results from flow through experiments conducted under dilute and near saturated conditions show a decrease of approximately 100 or more in the dissolution rate over the series from 0 to 20 mol% HfO 2. Comparing the average steady-state rates obtained under dilute conditions to the rates obtained for near-saturated conditions reveal a divergence in the magnitude between the average steady state rates measured in these different conditions. The reason for this divergence was investigated more thoroughly using Monte Carlo simulations. Simulations indicate that the divergence in glass dissolution behavior under dilute and near-saturated conditions result from the formation of a low coordination Si sites when Si from the saturated solution adsorbs to Hf on the glass surface. The residence time of the newly formed low coordination Si sites is longer at the glass surface and increases the density of anchor sites from which altered layers with higher Si densities can form than in the absence of Hf. These results illustrate the importance of understanding solid water/solid-fluid interactions by linking macroscopic reaction kinetics to nanometer scale interfacial processes.« less

Insights in spatio-temporal characterization of human fetal neural stem cells.

PubMed

Martín-Ibáñez, Raquel; Guardia, Inés; Pardo, Mónica; Herranz, Cristina; Zietlow, Rike; Vinh, Ngoc-Nga; Rosser, Anne; Canals, Josep M

2017-05-01

Primary human fetal cells have been used in clinical trials of cell replacement therapy for the treatment of neurodegenerative disorders such as Huntington's disease (HD). However, human fetal primary cells are scarce and difficult to work with and so a renewable source of cells is sought. Human fetal neural stem cells (hfNSCs) can be generated from human fetal tissue, but little is known about the differences between hfNSCs obtained from different developmental stages and brain areas. In the present work we characterized hfNSCs, grown as neurospheres, obtained from three developmental stages: 4-5, 6-7 and 8-9weeks post conception (wpc) and four brain areas: forebrain, cortex, whole ganglionic eminence (WGE) and cerebellum. We observed that, as fetal brain development proceeds, the number of neural precursors is diminished and post-mitotic cells are increased. In turn, primary cells obtained from older embryos are more sensitive to the dissociation process, their viability is diminished and they present lower proliferation ratios compared to younger embryos. However, independently of the developmental stage of derivation proliferation ratios were very low in all cases. Improvements in the expansion rates were achieved by mechanical, instead of enzymatic, dissociation of neurospheres but not by changes in the seeding densities. Regardless of the developmental stage, neurosphere cultures presented large variability in the viability and proliferation rates during the initial 3-4 passages, but stabilized achieving significant expansion rates at passage 5 to 6. This was true also for all brain regions except cerebellar derived cultures that did not expand. Interestingly, the brain region of hfNSC derivation influences the expansion potential, being forebrain, cortex and WGE derived cells the most expandable compared to cerebellar. Short term expansion partially compromised the regional identity of cortical but not WGE cultures. Nevertheless, both expanded cultures were multipotent and kept the ability to differentiate to region specific mature neuronal phenotypes. Copyright © 2017 Elsevier Inc. All rights reserved.

Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort.

PubMed

Morbach, Caroline; Wagner, Martin; Güntner, Stefan; Malsch, Carolin; Oezkur, Mehmet; Wood, David; Kotseva, Kornelia; Leyh, Rainer; Ertl, Georg; Karmann, Wolfgang; Heuschmann, Peter U; Störk, Stefan

2017-05-05

Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review.

PubMed

Sanches Machado d'Almeida, Karina; Ronchi Spillere, Stefanny; Zuchinali, Priccila; Corrêa Souza, Gabriela

2018-01-10

Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review

PubMed Central

Sanches Machado d’Almeida, Karina; Ronchi Spillere, Stefanny; Zuchinali, Priccila; Corrêa Souza, Gabriela

2018-01-01

Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence. PMID:29320401

Artificial Ionization and UHF Radar Response Associated with HF Frequencies near Electron Gyro-Harmonics (Invited)

NASA Astrophysics Data System (ADS)

Watkins, B. J.; Fallen, C. T.; Secan, J. A.

2013-12-01

We present new results from O-mode ionospheric heating experiments at the HAARP facility in Alaska to demonstrate that the magnitude of artificial ionization production is critically dependent on the choice of HF frequency near gyro-harmonics. For O-mode heating in the lower F-region ionosphere, typically about 200 km altitude, artificial ionization enhancements are observed in the lower ionosphere (about 150 - 220 km) and also in the topside ionosphere above about 500 km. Lower ionosphere density enhancements are inferred from HF-enhanced ion and plasma-line signals observed with UHF radar. Upper ionospheric density enhancements have been observed with TEC (total electron content) experiments by monitoring satellite radio beacons where signal paths traverse the HF-modified ionosphere. Both density enhancements and corresponding upward plasma fluxes have also been observed in the upper ionosphere via in-situ satellite observations. The data presented focus mainly on observations near the third and fourth gyro-harmonics. The specific values of the height-dependent gyro-harmonics have been computed from a magnetic model of the field line through the HF heated volume. Experiments with several closely spaced HF frequencies around the gyro-harmonic frequency region show that the magnitude of the lower-ionosphere artificial ionization production maximizes for HF frequencies about 1.0 - 1.5 MHz above the gyro-harmonic frequency. The response is progressively larger as the HF frequency is increased in the frequency region near the gyro-harmonics. For HF frequencies that are initially greater than the gyro-harmonic value the UHF radar scattering cross-section is relatively small, and non-existent or very weak signals are observed; as the signal returns drop in altitude due to density enhancements the HF interaction region passes through lower altitudes where the HF frequency is less than the gyro-harmonic value, for these conditions the radar scattering cross-section is significantly increased and strong signals persist while the high-power HF is present . Simultaneous observations of topside TEC measurements and lower-ionosphere UHF radar observations suggest there is an optimum altitude region to heat the lower F-region in order to produce topside ionosphere density enhancements. The observations are dependent on HF power levels and we show several examples where heating results are only observed for the high-power levels attainable with the HAARP facility.

Differences of skin morphology in Bos indicus, Bos taurus, and their crossbreds

NASA Astrophysics Data System (ADS)

Jian, Wang; Duangjinda, M.; Vajrabukka, C.; Katawatin, Suporn

2014-08-01

Cutaneous evaporation is the main avenue by which cattle dissipate heat via the involvement of sweat glands and other skin components. The difference in skin morphology between B. indicus and B. taurus has been recognized, as well as differences in their ability to tolerate heat. The objective of this study was to compare skin morphology between B. indicus, B. taurus, and their crossbreds. Skin samples of Sahiwal ( B. indicus) ( n = 10, reddish brown skin) and Holstein Friesian (HF) ( B. taurus) ( n = 10, black and white skin) and crossbred of HF75% ( n = 10, black and white skin) and HF87.5 % ( n = 10, black and white skin) were biopsied for histological study, followed by measurement of skin components. The results indicated that breed significantly affected sweat gland morphology. The shape of the sweat gland, as indicated by the ratio of length/diameter, in Sahiwal was baggier in shape compared to HF (5.99 and 9.52) while values for crossbreds were intermediate (7.82, 8.45). The density and volume of sweat glands in Sahiwal (1,058 glands/cm2; 1.60 μ3 × 10-6) were higher than in HF (920 glands/cm2; 0.51 μ3x10-6) and crossbreds, both HF 75 % (709 glands/cm2; 0.68 μ3 × 10-6) and HF 87.5 % (691 glands/cm2; 0.61 μ3 × 10-6) respectively. However, capillary surface area was greater for HF (2.07 cm2) compared to Sahiwal (1.79 cm2); accordingly, the lower genetic fraction of HF in crossbred cattle showed less capillary surface area (1.83 and 1.9 cm2 for HF75% and HF87.5 %) ( P < 0.01). Nerve density was not significantly different between Sahiwal and HF but was higher in the crossbred ( P < 0.01) cattle. Moreover, the effect of skin color (black and white) was evaluated and it was found that there was an interaction ( P < 0.01) between breed and skin color on the skin components. This study reveals that there are differences in skin morphology among B. indicus, B. taurus and their crossbreds, with these differences being more or less related to the genetic fraction of HF. This may imply that capability for cutaneous evaporative heat loss and tolerance to heat in crossbred cattle could be related to skin morphology.

Ar(n)HF van der Waals clusters revisited: II. Energetics and HF vibrational frequency shifts from diffusion Monte Carlo calculations on additive and nonadditive potential-energy surfaces for n=1-12.

PubMed

Jiang, Hao; Xu, Minzhong; Hutson, Jeremy M; Bacić, Zlatko

2005-08-01

The ground-state energies and HF vibrational frequency shifts of Ar(n)HF clusters have been calculated on the nonadditive potential-energy surfaces (PESs) for n=2-7 and on the pairwise-additive PESs for the clusters with n=1-12, using the diffusion Monte Carlo (DMC) method. For n>3, the calculations have been performed for the lowest-energy isomer and several higher-lying isomers which are the closest in energy. They provide information about the isomer dependence of the HF redshift, and enable direct comparison with the experimental data recently obtained in helium nanodroplets. The agreement between theory and experiment is excellent, in particular, for the nonadditive DMC redshifts. The relative, incremental redshifts are reproduced accurately even at the lower level of theory, i.e., the DMC and quantum five-dimensional (rigid Ar(n)) calculations on the pairwise-additive PESs. The nonadditive interactions make a significant contribution to the frequency shift, on the order of 10%-12%, and have to be included in the PESs in order for the theory to yield accurate magnitude of the HF redshift. The energy gaps between the DMC ground states of the cluster isomers are very different from the energy separation of their respective minima on the PES, due to the considerable variations in the intermolecular zero-point energy of different Ar(n)HF isomers.

Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services.

PubMed

Salata, Brian M; Sterling, Madeline R; Beecy, Ashley N; Ullal, Ajayram V; Jones, Erica C; Horn, Evelyn M; Goyal, Parag

2018-05-01

Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF. Copyright © 2018 Elsevier Inc. All rights reserved.

Generation of whistler waves by continuous HF heating of the upper ionosphere

NASA Astrophysics Data System (ADS)

Vartanyan, A.; Milikh, G. M.; Eliasson, B.; Najmi, A. C.; Parrot, M.; Papadopoulos, K.

2016-07-01

Broadband VLF waves in the frequency range 7-10 kkHz and 15-19 kHz, generated by F region CW HF ionospheric heating in the absence of electrojet currents, were detected by the DEMETER satellite overflying the High Frequency Active Auroral Research Program (HAARP) transmitter during HAARP/BRIOCHE campaigns. The VLF waves are in a frequency range corresponding to the F region lower lybrid (LH) frequency and its harmonic. This paper aims to show that the VLF observations are whistler waves generated by mode conversion of LH waves that were parametrically excited by HF-pump-plasma interaction at the upper hybrid layer. The paper discusses the basic physics and presents a model that conjectures (1) the VLF waves observed at the LH frequency are due to the interaction of the LH waves with meter-scale field-aligned striations—generating whistler waves near the LH frequency; and (2) the VLF waves at twice the LH frequency are due to the interaction of two counterpropagating LH waves—generating whistler waves near the LH frequency harmonic. The model is supported by numerical simulations that show good agreement with the observations. The (Detection of Electromagnetic Emissions Transmitted from Earthquake Regions results and model discussions are complemented by the Kodiak radar, ionograms, and stimulated electromagnetic emission observations.

Optical Emissions Enhanced by O and X Mode Ionosphere HF Pumping: Similarities and Differences

NASA Astrophysics Data System (ADS)

Sergienko, T.; Brandstrom, U.; Gustavsson, B.; Blagoveshchenskaya, N. F.

2013-12-01

Strong enhancement of the optical emissions with excitation thresholds from 1.96 eV up to 18.75 eV have been observed during experiments of ionosphere modification by high power HF radio waves since the early 1970s. Up to now all these emissions were observed only during the interaction of the O-mode HF radio wave with the ionospheric plasma. On 19 October 2012, during an EISCAT heating experiment, strong optical emissions were observed by ALIS, in first time, for X-mode ionosphere pumping. While for O-mode heating the optical emission enhancements can be explained by the ionospheric electron heating and acceleration due to the nonlinear interaction of the powerful radio wave with ionosphere, the mechanism responsible for the emission enhancements during the X-mode heating is not known. In the experiment optical emissions have been measured in three different wave-lengths simultaneously from four ALIS stations. The emission intensity ratios as well as the characteristics of the spatial distribution of the enhanced optical emissions provide important information on the possible mechanisms of the radio wave - ionosphere interaction. In this report we present the results of comparison of the characteristics of the optical emissions caused by X-mode heating with the characteristics of the emissions enhanced by O-mode measured during same experiment.

Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?

PubMed

Bonilla-Palomas, J L; Gámez-López, A L; Castillo-Domínguez, J C; Moreno-Conde, M; López-Ibáñez, M C; Anguita-Sánchez, M

2018-03-01

To assess the long-term effect of nutritional intervention on malnourished, hospitalised patients with heart failure (HF). A total of 120 malnourished patients hospitalized for HF were randomised to undergo (or not) an individual nutritional intervention for 6 months. The primary event was the combination of all-cause death and readmission for HF. We performed an intent-to-treat analysis and assessed the effect of the intervention at 24 months. The combined event occurred in 47.5% of the intervention group and in 73.8% of the control group (hazard ratio: 0.45; 95% confidence interval: 0.28-0.72; P=.001). Thirty-nine percent of the intervention group and 59% of the control group died (hazard ratio: 0.53; 95% confidence interval: 0.31-0.89; P=.017). A nutritional intervention for malnourished patients hospitalised for HF maintains its prognostic benefit in the long-term follow-up. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Race and Association of ACE/ARB Exposure with Outcome in Heart Failure

PubMed Central

El-Refai, Mostafa; Hrobowski, Tara; Peterson, Edward L.; Wells, Karen; Spertus, John A.; Williams, L. Keoki; Lanfear, David E.

2015-01-01

Purpose Angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) have been established as a mainstay of heart failure (HF) treatment. Current data are limited and conflicting regarding the consistency of ACE/ARB benefit across race groups in HF. This study aims to clarify this point. Methods A retrospective study of insured patients with a documented ejection fraction of<50%, hospitalized for HF between January, 2000 and June, 2008. Pharmacy claims data was used to estimate ACE/ARB exposure over six-month rolling windows. The association between ACE/ARB exposure and all-cause hospitalization or death was assessed by proportional hazards regression, with adjustment for baseline covariates and beta blocker exposure. Further analyses were stratified by race, and included an ACE/ARB*Race interaction term. Results A total of 1,095 patients met inclusion criteria (619 African American individuals). Median follow up was 2.1 years. In adjusted models ACE/ARB exposure was associated with lower risk of death or hospitalization in both groups (African Americans HR 0.47, p<0.001; Caucasians HR 0.55, p<0.001). A formal test for interaction was consistent with similar effects in each group (p=0.861, β=0.04). Conclusion ACE/ARB exposure was equally associated with a protective effect in preventing death or re-hospitalization among HF patients with systolic dysfunction in both African American patients and Caucasians. PMID:24842464

Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

PubMed Central

2011-01-01

Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient's home. The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions. Methods/design A primary care-based randomised controlled trial will be carried out to assess the impact of a telemonitoring intervention aimed at home care patients with heart failure (HF) and/or chronic lung disease (CLD). The results will be compared with those obtained with standard health care practice. The duration of the study will be of one year. Sixty patients will be recruited for the study. In-home patients, diagnosed with HF and/or CLD, aged 14 or above and with two or more hospital admissions in the previous year will be eligible. For the intervention group, telemonitoring will consist of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight and body temperature. Additionally, the patients will complete a qualitative symptom questionnaire daily using the telemonitoring system. Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits. The control group will receive usual care. The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-randomisation. The secondary outcome measures are: duration of hospital stay, hospital admissions due to HF or CLD, mortality rate, use of health care resources, quality of life, cost-effectiveness, compliance and patient and health care professional satisfaction with the new technology. Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting. The study may contribute to enhance the understanding of alternative modes of health care provision for medically unstable elderly patients, who bear a high degree of physical and functional deterioration. Trial Registration ISRCTN: ISRCTN89041993 PMID:21385401

Heart failure in women and men during acute coronary syndrome and long-term cardiovascular mortality (the ABC-3* Study on Heart Disease) (*Adria, Bassano, Conegliano, and Padova Hospitals).

PubMed

Berton, Giuseppe; Cordiano, Rocco; Cavuto, Fiorella; Bagato, Francesco; Pellegrinet, Marco; Cati, Arianna

2016-10-01

We investigated the gender-based differences in the association between heart failure (HF) during acute coronary syndrome (ACS) and post-discharge, long-term cardiovascular (CV) mortality. The present study included 557 patients enrolled in three intensive coronary care units and discharged alive. HF during ACS was evaluated by Killip class and left ventricular ejection fraction (LVEF). Interaction between gender and HF after 15years of follow up was studied using Cox models including a formal interaction term. Median age was 67 (interquartile range [IQR], 59-75) years, 29% were females, 37% had non-ST elevation myocardial infarction and 32% Killip class>1, and median LVEF was 53% (IQR 46-61). All but five patients were followed up to 15years, representing 5332 person-years. Of these, 40.2% died of CV-related causes. Crude CV mortality rate was higher among women (52.2%) than men (35.3%; P<0.0001). At a univariable level, a negative interaction between female gender and Killip class for CV mortality was found [hazard ratio (HR)=0.51 (0.34-0.77), P=0.002]. In five multivariable models after controlling for age, main CV risk factors, clinical features, post-discharge medical treatment, and mechanical coronary reperfusion, the interaction was significant across all models [HR=0.63 (0.42-0.95), P=0.02 in the fully adjusted model]. LVEF showed no significant hazard associated with female gender on univariable analysis [HR=1.4 (0.9-0.2.0), P=0.11] but did so in all adjusted models [HR=1.7 (1.2-2.5), P=0.005 in the fully adjusted model]. Gender is a consistent, independent effect modifier in the association between HF and long-term CV mortality after ACS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) Trial: Design and Rationale

PubMed Central

Reeves, Gordon R.; Whellan, David J.; Duncan, Pamela; O’Connor, Christopher M.; Pastva, Amy M.; Eggebeen, Joel D; Hewston, Leigh Ann; Morgan, Timothy M.; Reed, Shelby D.; Rejeski, W. Jack; Mentz, Robert J.; Rosenberg, Paul B.; Kitzman, Dalane W.

2017-01-01

Background Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. Hypothesis Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. Study Design Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) is a multi-center clinical trial in which 360 patients ≥ 60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. Conclusions REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities. PMID:28267466

The neprilysin pathway in heart failure: a review and guide on the use of sacubitril/valsartan.

PubMed

Jhund, Pardeep S; McMurray, John J V

2016-09-01

Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central to the understanding and treatment of heart failure (HF). Conversely, until recently, potentially beneficial augmentation of neurohumoural systems such as the natriuretic peptides has had limited therapeutic success. Administration of synthetic natriuretic peptides has not improved outcomes in acute HF but modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic (and other vasoactive) peptides, neprilysin, has proven to be successful. After initial failures with neprilysin inhibition alone or dual neprilysin-angiotensin converting enzyme (ACE) inhibition, the Prospective comparison of angiotensin receptor neprilysin inhibitor (ARNI) with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF) trial demonstrated that morbidity and mortality can be improved with the angiotensin receptor blocker neprilysin inhibitor sacubitril/valsartan (formerly LCZ696). In comparison to the ACE inhibitor enalapril, sacubitril/valsartan reduced the occurrence of the primary end point (cardiovascular death or hospitalisation for HF) by 20% with a 16% reduction in all-cause mortality. These findings suggest that sacubitril/valsartan should replace an ACE inhibitor or angiotensin receptor blocker as the foundation of treatment of symptomatic patients (NYHA II-IV) with HF and a reduced ejection fraction. This review will explore the background to neprilysin inhibition in HF, the results of the PARADIGM-HF trial and offer guidance on how to use sacubitril/valsartan in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cardiorespiratory fitness and muscle strength in late adolescence and long-term risk of early heart failure in Swedish men.

PubMed

Lindgren, Martin; Åberg, Maria; Schaufelberger, Maria; Åberg, David; Schiöler, Linus; Torén, Kjell; Rosengren, Annika

2017-05-01

Aims To investigate the association between cardiorespiratory fitness (CRF) and muscle strength in late adolescence and the long-term risk of heart failure (HF). Methods A cohort was created of Swedish men enrolled in compulsory military service between 1968 and 2005 with measurements for CRF and muscle strength ( n = 1,226,623; mean age 18.3 years). They were followed until 31 December 2014 for HF hospitalization as recorded in the Swedish national inpatient registry. Results During the follow-up period (median (interquartile range) 28.4 (22.0-37.0) years), 7656 cases of first HF hospitalization were observed (mean ± SD age at diagnosis 50.1 ± 7.9 years). CRF and muscle strength were estimated by maximum capacity cycle ergometer testing and strength exercises (knee extension, elbow flexion and hand grip). Inverse dose-response relationships were found between CRF and muscle strength with HF as a primary or contributory diagnosis with an adjusted hazards ratio (95% confidence interval) of 1.60 (1.44-1.77) for low CRF and 1.45 (1.32-1.58) for low muscle strength categories. The associations of incident HF with CRF and muscle strength persisted, regardless of adjustments for the other potential confounders. The highest risk was observed for HF associated with coronary heart disease, diabetes or hypertension. Conclusions In this longitudinal study of young men, we found inverse and mutually independent associations between CRF and muscle strength with risk of hospitalization for HF. If causal, these results may emphasize the importance of the promotion of CRF and muscle strength in younger populations.

Electron correlation in the interacting quantum atoms partition via coupled-cluster lagrangian densities.

PubMed

Holguín-Gallego, Fernando José; Chávez-Calvillo, Rodrigo; García-Revilla, Marco; Francisco, Evelio; Pendás, Ángel Martín; Rocha-Rinza, Tomás

2016-07-15

The electronic energy partition established by the Interacting Quantum Atoms (IQA) approach is an important method of wavefunction analyses which has yielded valuable insights about different phenomena in physical chemistry. Most of the IQA applications have relied upon approximations, which do not include either dynamical correlation (DC) such as Hartree-Fock (HF) or external DC like CASSCF theory. Recently, DC was included in the IQA method by means of HF/Coupled-Cluster (CC) transition densities (Chávez-Calvillo et al., Comput. Theory Chem. 2015, 1053, 90). Despite the potential utility of this approach, it has a few drawbacks, for example, it is not consistent with the calculation of CC properties different from the total electronic energy. To improve this situation, we have implemented the IQA energy partition based on CC Lagrangian one- and two-electron orbital density matrices. The development presented in this article is tested and illustrated with the H2 , LiH, H2 O, H2 S, N2 , and CO molecules for which the IQA results obtained under the consideration of (i) the CC Lagrangian, (ii) HF/CC transition densities, and (iii) HF are critically analyzed and compared. Additionally, the effect of the DC in the different components of the electronic energy in the formation of the T-shaped (H2 )2 van der Waals cluster and the bimolecular nucleophilic substitution between F(-) and CH3 F is examined. We anticipate that the approach put forward in this article will provide new understandings on subjects in physical chemistry wherein DC plays a crucial role like molecular interactions along with chemical bonding and reactivity. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Excited State Proton Transfer of Natural Flavonoids and Their Chromophores in Duplex and Tetraplex DNAs

PubMed Central

2015-01-01

Fisetin (3,7,3′,4′-tetrahydroxyflavone) and quercetin (3,5,7,3′,4′-pentahydroxyflavone) are the bioactive plant flavonoids that are potentially useful therapeutic drugs for the treatment of a broad spectrum of diseases, including atherosclerosis, cardiovascular disease, obesity, hypertension, and cancer. 3-Hydroxyflavone (3HF) and 7-hydroxyflavone (7HF) are the synthetic chromophores of fisetin and quercetin. We have exploited dual luminescence properties of fisetin and quercetin along with 3-HF and 7HF to examine their efficacy of binding and compare their interactions with DNA, which is one of the macromolecular targets of flavonoids in physiological systems. Following the sequence of the human telomeric DNA 5′-d (CCCTAA-)n/(-TTAGGG)n-5′, two single-stranded DNA oligonucleotides, 5′-d(C3TA2)3C3-3′ and 5′-d(T2AG3)4-3′, and their duplex were used as receptors to study binding by the ligands quercetin, fisetin, and their chromophores. Circular dichroism, differential absorption, UV thermal melting, and size exclusion chromatographic studies indicated the formation of unusual DNA structures (such as C4 and G4 tetraplexes) for both the C- and G-rich single-stranded DNAs. Upon binding to DNA, dramatic changes were observed in the intrinsic fluorescence behavior of the flavonoids. Molecular docking studies were performed to describe the likely binding sites for the ligands. The spectroscopic studies on flavonoid–DNA interactions described herein demonstrate a powerful approach for examining their DNA binding through exploiting the highly sensitive intrinsic fluorescence properties of the flavonoids as their own “reporter” for their interactions with macromolecular targets. PMID:25393681

The Structure of Liquid and Amorphous Hafnia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gallington, Leighanne; Ghadar, Yasaman; Skinner, Lawrie

Understanding the atomic structure of amorphous solids is important in predicting and tuning their macroscopic behavior. Here, we use a combination of high-energy X-ray diffraction, neutron diffraction, and molecular dynamics simulations to benchmark the atomic interactions in the high temperature stable liquid and low-density amorphous solid states of hafnia. The diffraction results reveal an average Hf–O coordination number of ~7 exists in both the liquid and amorphous nanoparticle forms studied. The measured pair distribution functions are compared to those generated from several simulation models in the literature. We have also performed ab initio and classical molecular dynamics simulations that showmore » density has a strong effect on the polyhedral connectivity. The liquid shows a broad distribution of Hf–Hf interactions, while the formation of low-density amorphous nanoclusters can reproduce the sharp split peak in the Hf–Hf partial pair distribution function observed in experiment. The agglomeration of amorphous nanoparticles condensed from the gas phase is associated with the formation of both edge-sharing and corner-sharing HfO 6,7 polyhedra resembling that observed in the monoclinic phase.« less

The Structure of Liquid and Amorphous Hafnia

DOE PAGES

Gallington, Leighanne; Ghadar, Yasaman; Skinner, Lawrie; ...

2017-11-10

Understanding the atomic structure of amorphous solids is important in predicting and tuning their macroscopic behavior. Here, we use a combination of high-energy X-ray diffraction, neutron diffraction, and molecular dynamics simulations to benchmark the atomic interactions in the high temperature stable liquid and low-density amorphous solid states of hafnia. The diffraction results reveal an average Hf–O coordination number of ~7 exists in both the liquid and amorphous nanoparticle forms studied. The measured pair distribution functions are compared to those generated from several simulation models in the literature. We have also performed ab initio and classical molecular dynamics simulations that showmore » density has a strong effect on the polyhedral connectivity. The liquid shows a broad distribution of Hf–Hf interactions, while the formation of low-density amorphous nanoclusters can reproduce the sharp split peak in the Hf–Hf partial pair distribution function observed in experiment. The agglomeration of amorphous nanoparticles condensed from the gas phase is associated with the formation of both edge-sharing and corner-sharing HfO 6,7 polyhedra resembling that observed in the monoclinic phase.« less

Activin-A, transforming growth factor-beta, and myostatin signaling pathway in experimental dilated cardiomyopathy.

PubMed

Mahmoudabady, Maryam; Mathieu, Myrielle; Dewachter, Laurence; Hadad, Ielham; Ray, Lynn; Jespers, Pascale; Brimioulle, Serge; Naeije, Robert; McEntee, Kathleen

2008-10-01

The pathogenic mechanisms of dilated cardiomyopathy are still uncertain. A number of cytokines and growth factors participate in the remodeling process of the disease. We investigated the cardiac myostatin, transforming growth factor (TGF)beta, and activin-A/Smad growth inhibitory signaling pathway in experimental dilated cardiomyopathy. Transvenous endomyocardial biopsies of the interventricular septum were taken weekly in 15 beagle dogs during the development of heart failure (HF) induced by rapid pacing over a period of 7 weeks. Genes involved in the myostatin-TGFbeta-activin-A/Smad signaling pathway and the cardiac hypertrophic process were quantified by real-time quantitative polymerase chain reaction. Left ventricular volume, function, and mass were evaluated by echocardiography. Overpacing was associated with increased left ventricular volumes and decreased ejection fraction, whereas the left ventricular mass remained unchanged. TGFbeta was increased in moderate HF. Activin-A mRNA expression was 4-fold higher in overt congestive HF than at baseline. A 2-fold decrease of activin type II receptors and activin receptor interacting protein 2 gene expressions were observed, as well as a transient decrease of follistatin. Activin type I receptors, activin receptor interacting protein 1, follistatin-related gene, and myostatin remained unchanged. The inhibitory Smad 7, a negative feedback loop regulator of the Smad pathway, was overexpressed in severe HF. Gene expression of the cyclin-dependent kinase inhibitor p21, a direct target gene of the Smad pathway, was 8-fold up-regulated in HF, whereas cyclin D1 was down-regulated. We conclude that tachycardia-induced dilated cardiomyopathy is characterized by gene overexpression of the TGFbeta-activin-A/Smad signaling pathway and their target gene p21 and by the absence of ventricular hypertrophy.

Quality of life predicts outcome in a heart failure disease management program.

PubMed

O'Loughlin, Christina; Murphy, Niamh F; Conlon, Carmel; O'Donovan, Aoife; Ledwidge, Mark; McDonald, Ken

2010-02-18

Chronic heart failure (HF) is associated with a poor Health Related Quality of Life (HRQoL). HRQoL has been shown to be a predictor of HF outcomes however, variability in the study designs make it difficult to apply these findings to a clinical setting. The aim of this study was to establish if HRQoL is a predictor of long-term mortality and morbidity in HF patients followed-up in a disease management program (DMP) and if a HRQoL instrument could be applied to aid in identifying high-risk patients within a clinical context. This is a retrospective analysis of HF patients attending a DMP with 18+/-9 months follow-up. Clinical and biochemical parameters were recorded on discharge from index HF admission and HRQoL measures were recorded at 2 weeks post index admission. 225 patients were enrolled into the study (mean age=69+/-12 years, male=61%, and 78%=systolic HF). In multivariable analysis, all dimensions of HRQoL (measured by the Minnesota Living with HF Questionnaire) were independent predictors of both mortality and readmissions particularly in patients <80 years. A significant interaction between HRQoL and age (Total((HRQoL))age: p<0.001) indicated that the association of HRQoL with outcomes diminished as age increased. These data demonstrate that HRQoL is a predictor of outcome in HF patients managed in a DMP. Younger patients (<65 years) with a Total HRQoL score of > or =50 are at high risk of an adverse outcome. In older patients > or =80 years HRQoL is not useful in predicting outcome. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

High-Frequency Heart Rate Variability Reactivity and Trait Worry Interact to Predict the Development of Sleep Disturbances in Response to a Naturalistic Stressor.

PubMed

MacNeil, Sasha; Deschênes, Sonya S; Caldwell, Warren; Brouillard, Melanie; Dang-Vu, Thien-Thanh; Gouin, Jean-Philippe

2017-12-01

High-frequency heart rate variability (HF-HRV) reactivity was proposed as a vulnerability factor for stress-induced sleep disturbances. Its effect may be amplified among individuals with high trait worry or sleep reactivity. This study evaluated whether HF-HRV reactivity to a worry induction, sleep reactivity, and trait worry predict increases in sleep disturbances in response to academic stress, a naturalistic stressor. A longitudinal study following 102 undergraduate students during an academic semester with well-defined periods of lower and higher academic stress was conducted. HF-HRV reactivity to a worry induction, trait worry using the Penn State Worry Questionnaire, and sleep reactivity using the Ford Insomnia Stress Reactivity Test were measured during the low stress period. Sleep disturbances using the Pittsburgh Sleep Quality Index were assessed twice during the lower stress period and three times during the higher stress period. Greater reductions in HF-HRV in response to the worry induction predicted increases in sleep disturbances from the lower to the higher academic stress period. Trait worry moderated this association: individuals with both higher trait worry and greater HF-HRV reactivity to worry had larger increases in stress-related sleep disturbances over time, compared to participants with lower trait worry and HF-HRV reactivity. A similar, but marginally significant effect was found for sleep reactivity. This study supports the role of HF-HRV reactivity as a vulnerability factor for stress-induced sleep disturbances. The combination of high trait worry and high HF-HRV reactivity to worry might identify a subgroup of individuals most vulnerable to stress-related sleep disturbances.

Heart Rate Variability, Insulin Resistance, and Insulin Sensitivity in Japanese Adults: The Toon Health Study

PubMed Central

Saito, Isao; Hitsumoto, Shinichi; Maruyama, Koutatsu; Nishida, Wataru; Eguchi, Eri; Kato, Tadahiro; Kawamura, Ryoichi; Takata, Yasunori; Onuma, Hiroshi; Osawa, Haruhiko; Tanigawa, Takeshi

2015-01-01

Background Although impaired cardiac autonomic function is associated with an increased risk of type 2 diabetes in Caucasians, evidence in Asian populations with a lower body mass index is limited. Methods Between 2009–2012, the Toon Health Study recruited 1899 individuals aged 30–79 years who were not taking medication for diabetes. A 75-g oral glucose tolerance test was used to diagnose type 2 diabetes, and fasting and 2-h-postload glucose and insulin concentrations were measured. We assessed the homeostasis model assessment index for insulin resistance (HOMA-IR) and Gutt’s insulin sensitivity index (ISI). Pulse was recorded for 5 min, and time-domain heart rate variability (HRV) indices were calculated: the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive difference (RMSSD). Power spectral analysis provided frequency domain measures of HRV: high frequency (HF) power, low frequency (LF) power, and the LF:HF ratio. Results Multivariate-adjusted logistic regression models showed decreased SDNN, RMSSD, and HF, and increased LF:HF ratio were associated significantly with increased HOMA-IR and decreased ISI. When stratified by overweight status, the association of RMSSD, HF, and LF:HF ratio with decreased ISI was also apparent in non-overweight individuals. The interaction between LF:HF ratio and decreased ISI in overweight individuals was significant, with the odds ratio for decreased ISI in the highest quartile of LF:HF ratio in non-overweight individuals being 2.09 (95% confidence interval, 1.41–3.10). Conclusions Reduced HRV was associated with insulin resistance and lower insulin sensitivity. Decreased ISI was linked with parasympathetic dysfunction, primarily in non-overweight individuals. PMID:26277879

Incidence, Predictors, and Outcomes Associated With Hypotensive Episodes Among Heart Failure Patients Receiving Sacubitril/Valsartan or Enalapril: The PARADIGM-HF Trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure).

PubMed

Vardeny, Orly; Claggett, Brian; Kachadourian, Jessica; Pearson, Scott M; Desai, Akshay S; Packer, Milton; Rouleau, Jean; Zile, Michael R; Swedberg, Karl; Lefkowitz, Martin; Shi, Victor; McMurray, John J V; Solomon, Scott D

2018-04-01

In PARADIGM-HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure), heart failure treatment with sacubitril/valsartan reduced the primary composite outcome of cardiovascular death or heart failure hospitalization compared with enalapril but resulted in more symptomatic hypotension. Concern on hypotension may be limiting use of sacubitril/valsartan in appropriate patients. We characterized patients in PARADIGM-HF by whether they reported hypotension during study run-in periods (enalapril, followed by sacubitril/valsartan) and after randomization and assessed whether hypotension modified the efficacy of sacubitril/valsartan. Of the 10 513 patients entering the enalapril run-in, 136 (1.3%) experienced hypotension and 93 (68%) were unable to continue to the next phase; of 9419 patients entering the sacubitril/valsartan run-in period, 228 (2.4%) patients experienced hypotension and 51% were unable to successfully complete the run-in. After randomization, 388 (9.2%) participants had 501 hypotensive events with enalapril, and 588 (14.0%) participants had 803 hypotensive events with sacubitril/valsartan ( P <0.001). There was no difference between randomized treatment groups in the number of participants who discontinued therapy because of hypotension. Individuals with a hypotensive event in either group were older, had lower blood pressure at randomization, and were more likely to have an implantable cardioverter defibrillator. Participants with hypotensive events during run-in who were ultimately randomized derived similar efficacy from sacubitril/valsartan compared with enalapril as those without hypotensive events ( P interaction>0.90). Hypotension was more common with sacubitril/valsartan relative to enalapril in PARADIGM-HF but did not differentially affect permanent discontinuations. Patients with hypotension during run-in derived similar benefit from sacubitril/valsartan compared with enalapril as those who did not experience hypotension. © 2018 American Heart Association, Inc.

Ionospheric modifications in high frequency heating experiments

NASA Astrophysics Data System (ADS)

Kuo, Spencer P.

2015-01-01

Featured observations in high-frequency (HF) heating experiments conducted at Arecibo, EISCAT, and high frequency active auroral research program are discussed. These phenomena appearing in the F region of the ionosphere include high-frequency heater enhanced plasma lines, airglow enhancement, energetic electron flux, artificial ionization layers, artificial spread-F, ionization enhancement, artificial cusp, wideband absorption, short-scale (meters) density irregularities, and stimulated electromagnetic emissions, which were observed when the O-mode HF heater waves with frequencies below foF2 were applied. The implication and associated physical mechanism of each observation are discussed and explained. It is shown that these phenomena caused by the HF heating are all ascribed directly or indirectly to the excitation of parametric instabilities which instigate anomalous heating. Formulation and analysis of parametric instabilities are presented. The results show that oscillating two stream instability and parametric decay instability can be excited by the O-mode HF heater waves, transmitted from all three heating facilities, in the regions near the HF reflection height and near the upper hybrid resonance layer. The excited Langmuir waves, upper hybrid waves, ion acoustic waves, lower hybrid waves, and field-aligned density irregularities set off subsequent wave-wave and wave-electron interactions, giving rise to the observed phenomena.

Relation of Stature to Outcomes in Korean Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction (from the INTERSTELLAR Registry).

PubMed

Moon, Jeonggeun; Suh, Jon; Oh, Pyung Chun; Lee, Kyounghoon; Park, Hyun Woo; Jang, Ho-Jun; Kim, Tae-Hoon; Park, Sang-Don; Kwon, Sung Woo; Kang, Woong Chol

2016-07-15

Although epidemiologic studies have shown the impact of height on occurrence and/or prognosis of cardiovascular diseases, the underlying mechanism is unclear. In addition, the relation in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains unknown. We sought to assess the influence of height on outcomes of patients with acute STEMI undergoing primary PCI and to provide a pathophysiological explanation. All 1,490 patients with STEMI undergoing primary PCI were analyzed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned hospitalization for heart failure (HF). Patients were divided into (1) MACCE (+) versus MACCE (-) and (2) first- to third-tertile groups according to height. MACCE (+) group was shorter than MACCE (-) group (164 ± 8 vs 166 ± 8 cm, p = 0.012). Prognostic impact of short stature was significant in older (≥70 years) male patients even after adjusting for co-morbidities (hazard ratio 0.951, 95% confidence interval 0.912 to 0.991, p = 0.017). The first-tertile group showed the worst MACCE-free survival (p = 0.035), and most cases of MACCE were HF (n, 17 [3%] vs 6 [1%] vs 2 [0%], p = 0.004). On post-PCI echocardiography, left atrial volume and early diastolic mitral velocity to early diastolic mitral annulus velocity ratio showed an inverse relation with height (p <0.001 for all) despite similar left ventricular ejection fraction. In conclusion, short stature is associated with occurrence of HF after primary PCI for STEMI, and its influence is prominent in aged male patients presumably for its correlation with diastolic dysfunction. Copyright © 2016 Elsevier Inc. All rights reserved.

Omega 3 Fatty Acids Promote Macrophage Reverse Cholesterol Transport in Hamster Fed High Fat Diet

PubMed Central

Kasbi Chadli, Fatima; Nazih, Hassane; Krempf, Michel; Nguyen, Patrick; Ouguerram, Khadija

2013-01-01

The aim of this study was to investigate macrophage reverse cholesterol transport (RCT) in hamster, a CETP-expressing species, fed omega 3 fatty acids (ω3PUFA) supplemented high fat diet (HFD). Three groups of hamsters (n = 6/group) were studied for 20 weeks: 1) control diet: Control, 2) HFD group: HF and 3) HFD group supplemented with ω3PUFA (EPA and DHA): HFω3. In vivo macrophage-to-feces RCT was assessed after an intraperitoneal injection of 3H-cholesterol-labelled hamster primary macrophages. Compared to Control, HF presented significant (p<0.05) increase in body weight, plasma TG (p<0.01) and cholesterol (p<0.001) with an increase in VLDL TG and in VLDL and LDL cholesterol (p<0.001). Compared to HF, HFω3 presented significant decrease in body weight. HFω3 showed less plasma TG (p<0.001) and cholesterol (p<0.001) related to a decrease in VLDL TG and HDL cholesterol respectively and higher LCAT activity (p<0.05) compared to HF. HFω3 showed a higher fecal bile acid excretion (p<0.05) compared to Control and HF groups and higher fecal cholesterol excretion (p<0.05) compared to HF. This increase was related to higher gene expression of ABCG5, ABCA1 and SR-B1 in HFω3 compared to Control and HF groups (<0.05) and in ABCG1 and CYP7A1 compared to HF group (p<0.05). A higher plasma efflux capacity was also measured in HFω3 using 3H- cholesterol labeled Fu5AH cells. In conclusion, EPA and DHA supplementation improved macrophage to feces reverse cholesterol transport in hamster fed HFD. This change was related to the higher cholesterol and fecal bile acids excretion and to the activation of major genes involved in RCT. PMID:23613796

Causes and Temporal Patterns of 30-Day Readmission Among Older Adults Hospitalized With Heart Failure With Preserved or Reduced Ejection Fraction.

PubMed

Goyal, Parag; Loop, Matthew; Chen, Ligong; Brown, Todd M; Durant, Raegan W; Safford, Monika M; Levitan, Emily B

2018-04-23

It is unknown whether causes and temporal patterns of 30-day readmission vary between heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to address this question by examining a 5% national sample of Medicare beneficiaries. We included individuals who experienced a hospitalization for HFpEF or HFrEF between 2007 and 2013. We identified causes of 30-day readmission based on primary discharge diagnosis and further classified causes of readmission as HF-related, non-HF cardiovascular-related, and non-cardiovascular-related. We calculated the cumulative incidence of these classifications for HFpEF and HFrEF in a competing risks model and calculated subdistribution hazard ratios of these classifications by comparing those with HFpEF and those with HFrEF. Among 60 640 Medicare beneficiaries, we identified 13 785 unique older adults hospitalized with HFpEF and 15 205 who were hospitalized with HFrEF. Noncardiovascular diagnoses represented the most common causes of 30-day readmission (HFpEF: 59%; HFrEF: 47%), a pattern that was observed for each week of the 30-day study period for both HFpEF and HFrEF participants. In comparing readmission diagnoses in an adjusted model, non-cardiovascular-related diagnoses were more common and HF-related diagnoses were less common in HFpEF participants. Non-cardiovascular-related diagnoses represented the most common causes of 30-day readmission following HF hospitalization for each week of the 30-day postdischarge period. HF diagnoses were less common among those with HFpEF compared with HFrEF. Future interventions aimed at reducing 30-day readmissions following an HF hospitalization would benefit from an increased focus on noncardiovascular comorbidity and interventions that target HFpEF and HFrEF separately. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Prebiotic-supplemented partially hydrolysed cow's milk formula for the prevention of eczema in high-risk infants: a randomized controlled trial.

PubMed

Boyle, R J; Tang, M L-K; Chiang, W C; Chua, M C; Ismail, I; Nauta, A; Hourihane, J O B; Smith, P; Gold, M; Ziegler, J; Peake, J; Quinn, P; Rao, R; Brown, N; Rijnierse, A; Garssen, J; Warner, J O

2016-05-01

Prevention guidelines for infants at high risk of allergic disease recommend hydrolysed formula if formula is introduced before 6 months, but evidence is mixed. Adding specific oligosaccharides may improve outcomes. To evaluate whether partially hydrolysed whey formula containing oligosaccharides (0.8 g/100 ml) (pHF-OS) can prevent eczema in high-risk infants [ISRCTN65195597]. We conducted a parallel-group, multicentre, randomized double-blind controlled trial of pHF-OS vs standard cow's milk formula. Infants with a family history of allergic disease were randomized (stratified by centre/maternal allergy) to active (n = 432) or control (n = 431) formula until 6 months of age if formula was introduced before 18 weeks. Primary outcome was cumulative incidence of eczema by 12 months in infants randomized at 0-4 weeks (375 pHF-OS, 383 control). Secondary outcomes were cumulative incidence of eczema by 12 or 18 months in all infants randomized, immune markers at 6 months and adverse events. Eczema occurred by 12 months in 84/293 (28.7%) infants allocated to pHF-OS at 0-4 weeks of age, vs 93/324 (28.7%) control (OR 0.98 95% CI 0.68, 1.40; P = 0.90), and 107/347 (30.8%) pHF-OS vs 112/370 (30.3%) control in all infants randomized (OR 0.99 95% CI 0.71, 1.37; P = 0.94). pHF-OS did not change most immune markers including total/specific IgE; however, pHF-OS reduced cow's milk-specific IgG1 (P < 0.0001) and increased regulatory T-cell and plasmacytoid dendritic cell percentages. There was no group difference in adverse events. pHF-OS does not prevent eczema in the first year in high-risk infants. The immunological changes found require confirmation in a separate cohort. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impact of canine-assisted ambulation on hospitalized chronic heart failure patients' ambulation outcomes and satisfaction: a pilot study.

PubMed

Abate, Samantha V; Zucconi, Michele; Boxer, Bruce Alan

2011-01-01

Chronic heart failure (HF) is a prevalent and costly disease process. Early ambulation has been shown to have a positive impact on patient outcomes and length of stay. Animal-assisted therapy is a novel modality that has shown to be a safe and effective adjunct to a number of traditional treatment plans. This study sought to synergistically combine ambulation and animal-assisted therapy by using canine-assisted ambulation (CAA) to improve the ambulation outcomes of HF patients. Sixty-nine hospitalized patients with a primary diagnosis of HF were approached to ambulate with a restorative aide. After recording their initial response, they were given the opportunity to participate in CAA (walking with a therapy dog). Initial ambulation refusal rate was compared with a historical population of 537 HF patients. Distance ambulated was recorded using a pedometer and compared with a randomly selected, 64-patient sample from the historical HF patient population, stratified by day of hospital stay. Patient satisfaction was assessed through a 5-item Likert scale survey. The 537-patient historical HF population had an ambulation refusal rate of 28%. When offered the chance to participate in CAA, only 7.2% of the study population refused ambulation (P = .0002). Of the 69-patient study sample, 13 initially refused ambulation then agreed when offered CAA (P = .0009). Distance ambulated increased from 120.2 steps in a randomly selected, stratified historical sample to 235.07 in the CAA study sample (P < .0001). Patients unanimously agreed that they enjoyed CAA and would like to participate in CAA again. Canine-assisted ambulation is a safe and effective adjunct to an early ambulation program for HF patients. Canine-assisted ambulation may decrease hospital length of stay and thereby decrease the costs of HF care. Additional research involving CAA's application to other disease processes in various settings is warranted.

Unusual hafnium-pyridylamido/ER(n) heterobimetallic adducts (ER(n) = ZnR2 or AlR3).

PubMed

Rocchigiani, Luca; Busico, Vincenzo; Pastore, Antonello; Talarico, Giovanni; Macchioni, Alceo

2014-02-17

NMR spectroscopy and DFT studies indicate that the Symyx/Dow Hf(IV)-pyridylamido catalytic system for olefin polymerization, [{N(-),N,CNph(-)}HfMe][B(C6F5)4] (1, Nph = naphthyl), interacts with ER(n) (E = Al or Zn, R = alkyl group) to afford unusual heterobimetallic adducts [{N(-),N}HfMe(μ-CNph)(μ-R)ER(n-1)][B(C6F5)4 in which the cyclometalated Nph acts as a bridge between Hf and E. (1)H VT (variable-temperature) EXSY NMR spectroscopy provides direct evidence of reversible alkyl exchanges in heterobimetallic adducts, with ZnR2 showing a higher tendency to participate in this exchange than AlR3. 1-Hexene/ERn competitive reactions with 1 at 240 K reveal that the formation of adducts is strongly favored over 1-hexene polymerization. Nevertheless, a slight increase in the temperature (to >265 K) initiates 1-hexene polymerization. Copyright © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The pathophysiology of heart failure: a tale of two old paradigms revisited.

PubMed

Ashrafian, Houman; Williams, Lynne; Frenneaux, Michael P

2008-04-01

Although our current appreciation of the detrimental role of neurohumoral activation in heart failure (HF) has been intellectually appealing and has led to neurohumoral antagonism that has reduced morbidity and mortality from HF, the persisting disability and death rates remain unacceptably high. In the search for novel strategies to improve on these outcomes, we must reacquaint ourselves with basic cardiac physiology at levels ranging from the molecular to the systemic in order to identify new targets for the treatment of HF. This approach has already begun to yield results; in this review, two such aspects will be focused on: diastolic ventricular interaction and cardiac energetics. These two examples will be used to illuminate how fundamental research has elucidated age-old, although mechanistically elusive, principles (for example, the Frank-Starling law), explained why existing and emerging therapeutic approaches (for example, biventricular pacing in HF) have proved successful, and successfully identified novel therapy modes (for example, perhexiline as an energy augmentation agent).

Factors influencing self-care behaviors of African Americans with heart failure: a photovoice project.

PubMed

Woda, Aimee; Belknap, Ruth Ann; Haglund, Kristin; Sebern, Margaret; Lawrence, Ashley

2015-01-01

The purpose of this study was to understand the influences of heart failure (HF) self-care among low income, African Americans. Compared to all other racial groups, African Americans have the highest risk of developing HF, coupled with high mortality and morbidity rates. Using the photovoice method, participants related important lifestyle factors through photography. The participants and researcher met for reflection and discussion 2 h per week for six weeks. Four themes emerged: family support gives me the push I need, social interaction lifts me up, improving my mind to lift depression can improve my heart, and it is important but challenging to follow the HF diet. The findings from this study may assist policy makers, health care professionals, patients, and support systems in understanding the complexity of engaging in HF self-care. This understanding may lead to the development of appropriate patient-centered assessments and interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ponomarenko, N. S.; Poluektov, O. G.; Bylina, E. J.

High-field electron paramagnetic resonance (HF EPR) has been employed to investigate the primary electron donor electronic structure of Blastochloris viridis heterodimer mutant reaction centers (RCs). In these mutants the amino acid substitution His(M200)Leu or His(L173)Leu eliminates a ligand to the primary electron donor, resulting in the loss of a magnesium in one of the constituent bacteriochlorophylls (BChl). Thus, the native BChl/BChl homodimer primary donor is converted into a BChl/bacteriopheophytin (BPhe) heterodimer. The heterodimer primary donor radical in chemically oxidized RCs exhibits a broadened EPR line indicating a highly asymmetric distribution of the unpaired electron over both dimer constituents. Observed tripletmore » state EPR signals confirm localization of the excitation on the BChl half of the heterodimer primary donor. Theoretical simulation of the triplet EPR lineshapes clearly shows that, in the case of mutants, triplet states are formed by an intersystem crossing mechanism in contrast to the radical pair mechanism in wild type RCs. Photooxidation of the mutant RCs results in formation of a BPhe anion radical within the heterodimer pair. The accumulation of an intradimer BPhe anion is caused by the substantial loss of interaction between constituents of the heterodimer primary donor along with an increase in the reduction potential of the heterodimer primary donor D/D{sup +} couple. This allows oxidation of the cytochrome even at cryogenic temperatures and reduction of each constituent of the heterodimer primary donor individually. Despite a low yield of primary donor radicals, the enhancement of the semiquinone-iron pair EPR signals in these mutants indicates the presence of kinetically viable electron donors.« less

Application of the Interacting Quantum Atoms Approach to the S66 and Ionic-Hydrogen-Bond Datasets for Noncovalent Interactions.

PubMed

Suárez, Dimas; Díaz, Natalia; Francisco, Evelio; Martín Pendás, Angel

2018-04-17

The interacting quantum atoms (IQA) method can assess, systematically and in great detail, the strength and physics of both covalent and noncovalent interactions. The lack of a pair density in density functional theory (DFT), which precludes the direct IQA decomposition of the characteristic exchange-correlation energy, has been recently overcome by means of a scaling technique, which can largely expand the applicability of the method. To better assess the utility of the augmented IQA methodology to derive quantum chemical decompositions at the atomic and molecular levels, we report the results of Hartree-Fock (HF) and DFT calculations on the complexes included in the S66 and the ionic H-bond databases of benchmark geometry and binding energies. For all structures, we perform single-point and geometry optimizations using HF and selected DFT methods with triple-ζ basis sets followed by full IQA calculations. Pairwise dispersion energies are accounted for by the D3 method. We analyze the goodness of the HF-D3 and DFT-D3 binding energies, the magnitude of numerical errors, the fragment and atomic distribution of formation energies, etc. It is shown that fragment-based IQA decomposes the formation energies in comparable terms to those of perturbative approaches and that the atomic IQA energies hold the promise of rigorously quantifying atomic and group energy contributions in larger biomolecular systems. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction: The SOCRATES-REDUCED Randomized Trial.

PubMed

Gheorghiade, Mihai; Greene, Stephen J; Butler, Javed; Filippatos, Gerasimos; Lam, Carolyn S P; Maggioni, Aldo P; Ponikowski, Piotr; Shah, Sanjiv J; Solomon, Scott D; Kraigher-Krainer, Elisabeth; Samano, Eliana T; Müller, Katharina; Roessig, Lothar; Pieske, Burkert

2015-12-01

Worsening chronic heart failure (HF) is a major public health problem. To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF). Dose-finding phase 2 study that randomized 456 patients across Europe, North America, and Asia between November 2013 and January 2015, with follow-up ending June 2015. Patients were clinically stable with LVEF less than 45% within 4 weeks of a worsening chronic HF event, defined as worsening signs and symptoms of congestion and elevated natriuretic peptide level requiring hospitalization or outpatient intravenous diuretic. Placebo (n = 92) or 1 of 4 daily target doses of oral vericiguat (1.25 mg [n = 91], 2.5 mg [n = 91], 5 mg [n = 91], 10 mg [n = 91]) for 12 weeks. The primary end point was change from baseline to week 12 in log-transformed level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary analysis specified pooled comparison of the 3 highest-dose vericiguat groups with placebo, and secondary analysis evaluated a dose-response relationship with vericiguat and the primary end point. Overall, 351 patients (77.0%) completed treatment with the study drug with valid 12-week NT-proBNP levels and no major protocol deviation and were eligible for primary end point evaluation. In primary analysis, change in log-transformed NT-proBNP levels from baseline to week 12 was not significantly different between the pooled vericiguat group (log-transformed: baseline, 7.969; 12 weeks, 7.567; difference, -0.402; geometric means: baseline, 2890 pg/mL; 12 weeks, 1932 pg/mL) and placebo (log-transformed: baseline, 8.283; 12 weeks, 8.002; difference, -0.280; geometric means: baseline, 3955 pg/mL; 12 weeks, 2988 pg/mL) (difference of means, -0.122; 90% CI, -0.32 to 0.07; ratio of geometric means, 0.885, 90% CI, 0.73-1.08; P = .15). The exploratory secondary analysis suggested a dose-response relationship whereby higher vericiguat doses were associated with greater reductions in NT-proBNP level (P < .02). Rates of any adverse event were 77.2% and 71.4% among the placebo and 10-mg vericiguat groups, respectively. Among patients with worsening chronic HF and reduced LVEF, compared with placebo, vericiguat did not have a statistically significant effect on change in NT-proBNP level at 12 weeks but was well-tolerated. Further clinical trials of vericiguat based on the dose-response relationship in this study are needed to determine the potential role of this drug for patients with worsening chronic HF. clinicaltrials.gov Identifier: NCT01951625.

Heart failure and kidney dysfunction: epidemiology, mechanisms and management.

PubMed

Schefold, Joerg C; Filippatos, Gerasimos; Hasenfuss, Gerd; Anker, Stefan D; von Haehling, Stephan

2016-10-01

Heart failure (HF) is a major health-care problem and the prognosis of affected patients is poor. HF often coexists with a number of comorbidities of which declining renal function is of particular importance. A loss of glomerular filtration rate, as in acute kidney injury (AKI) or chronic kidney disease (CKD), independently predicts mortality and accelerates the overall progression of cardiovascular disease and HF. Importantly, cardiac and renal diseases interact in a complex bidirectional and interdependent manner in both acute and chronic settings. From a pathophysiological perspective, cardiac and renal diseases share a number of common pathways, including inflammatory and direct, cellular immune-mediated mechanisms; stress-mediated and (neuro)hormonal responses; metabolic and nutritional changes including bone and mineral disorder, altered haemodynamic and acid-base or fluid status; and the development of anaemia. In an effort to better understand the important crosstalk between the two organs, classifications such as the cardio-renal syndromes were developed. This classification might lead to a more precise understanding of the complex interdependent pathophysiology of cardiac and renal diseases. In light of exceptionally high mortality associated with coexisting HF and kidney disease, this Review describes important crosstalk between the heart and kidney, with a focus on HF and kidney disease in the acute and chronic settings. Underlying molecular and cellular pathomechanisms in HF, AKI and CKD are discussed in addition to current and future therapeutic approaches.

A general transformation to canonical form for potentials in pairwise interatomic interactions.

PubMed

Walton, Jay R; Rivera-Rivera, Luis A; Lucchese, Robert R; Bevan, John W

2015-06-14

A generalized formulation of explicit force-based transformations is introduced to investigate the concept of a canonical potential in both fundamental chemical and intermolecular bonding. Different classes of representative ground electronic state pairwise interatomic interactions are referenced to a chosen canonical potential illustrating application of such transformations. Specifically, accurately determined potentials of the diatomic molecules H2, H2(+), HF, LiH, argon dimer, and one-dimensional dissociative coordinates in Ar-HBr, OC-HF, and OC-Cl2 are investigated throughout their bound potentials. Advantages of the current formulation for accurately evaluating equilibrium dissociation energies and a fundamentally different unified perspective on nature of intermolecular interactions will be emphasized. In particular, this canonical approach has significance to previous assertions that there is no very fundamental distinction between van der Waals bonding and covalent bonding or for that matter hydrogen and halogen bonds.

1300 K Creep Behavior of [001] Oriented Ni-49Al-1Hf (at.%) Single Crystals

NASA Technical Reports Server (NTRS)

Whittenberger, J. Daniel; Locci, I. E.; Darolia, Ram; Bowman, R.

1999-01-01

A study of the 1300 K compressive and tensile creep properties of [001]-oriented NiAl-1Hf (D209) single crystals has been undertaken. Neither post homogenization cooling treatment, minor chemical variations within an ingot or from ingot-to-ingot, nor testing procedure had a significant effect on mechanical behavior; however a heat treatment which dissolved the initial G-phase precipitates and promoted formation of Heusler particles led to a strength reduction. Little primary creep was found utilizing direct measurement of strain, and a misorientation of 18 deg from the [001] did not reduce the creep strength. The effects of heat treatments on properties and a comparison of the flow stress-strain rate data to those predicted by the Jaswon-Cottrell solid solution hardening model indicate that the 1300 K strength in NiAl-1Hf single crystals is mainly due to precipitation hardening mechanisms.

Intensity modulation of HF heater-induced plasma lines

NASA Technical Reports Server (NTRS)

Kuo, S. P.; Lee, M. C.

1990-01-01

The Arecibo HF heater is normally composed of two separate sets of antenna array, transmitting waves vertically at the same frequency and polarization. However, when these two sets of antenna array radiate at slightly different frequencies, the intensities of HF heater-induced plasma lines (HFPLs) can be drastically modulated. In recent Duncan et al.'s (1989) experiments the 100 percent intensity modulation of HFPLs was seen to persist even when the secondary set of antenna array radiated at a few percent of the power transmitted by the primary set of antenna array. An explanation is offered, and it is shown that there exists a minimum power, Pmin, and if the secondary set of antenna array radiates at a power lower than Pmin, the 100-percent intensity modulation of HFPLs will not be observed. The functional dependence of Pmin on the difference frequency of the two sets of antenna array is also predicted for future experiments to corroborate.

Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial.

PubMed

Jaarsma, Tiny; Klompstra, Leonie; Ben Gal, Tuvia; Boyne, Josiane; Vellone, Ercole; Bäck, Maria; Dickstein, Kenneth; Fridlund, Bengt; Hoes, Arno; Piepoli, Massimo F; Chialà, Oronzo; Mårtensson, Jan; Strömberg, Anna

2015-07-01

Exercise is known to be beneficial for patients with heart failure (HF), and these patients should therefore be routinely advised to exercise and to be or to become physically active. Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes, the level of daily physical activity in most patients with HF is low. Exergaming may be a promising new approach to increase the physical activity of patients with HF at home. The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity, to decrease healthcare resource use, and to improve self-care and health-related quality of life. A multicentre randomized controlled study with two treatment groups will include 600 patients with HF. In each centre, patients will be randomized to either motivational support only (control) or structured access to a Wii game computer (Wii). Patients in the control group will receive advice on physical activity and will be contacted by four telephone calls. Patients in the Wii group also will receive advice on physical activity along with a Wii game computer, with instructions and training. The primary endpoint will be exercise capacity at 3 months as measured by the 6 min walk test. Secondary endpoints include exercise capacity at 6 and 12 months, level of daily physical activity, muscle function, health-related quality of life, and hospitalization or death during the 12 months follow-up. The HF-Wii study is a randomized study that will evaluate the effect of exergaming in patients with HF. The findings can be useful to healthcare professionals and improve our understanding of the potential role of exergaming in the treatment and management of patients with HF. NCT01785121. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics)

PubMed Central

2011-01-01

Background Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity. Methods/Design Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up. Discussion The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct evidence on the effect of a DMP in elderly patients with HF and high comorbidty, and will reduce the need to extrapolate the results of clinical trials in adults to elderly patients. Trial registration (ClinicalTrials.gov number, NCT01076465). PMID:21819564

Rearrangement of the Protein Phosphatase 1 Interactome During Heart Failure Progression.

PubMed

Chiang, David Y; Alsina, Katherina M; Corradini, Eleonora; Fitzpatrick, Martin; Ni, Li; Lahiri, Satadru K; Reynolds, Julia; Pan, Xiaolu; Scott, Larry; Heck, Albert J R; Wehrens, Xander H

2018-04-18

Background -Heart failure (HF) is a complex disease with a rising prevalence despite advances in treatment. Protein phosphatase 1 (PP1) has long been implicated in HF pathogenesis but its exact role is both unclear and controversial. Most previous studies measured only the PP1 catalytic subunit (PP1c) without investigating its diverse set of interactors, which confer localization and substrate specificity to the holoenzyme. In this study we define the PP1 interactome in cardiac tissue and test the hypothesis that this interactome becomes rearranged during HF progression at the level of specific PP1c interactors. Methods -Mice were subjected to transverse aortic constriction and grouped based on ejection fraction (EF) into sham, hypertrophy, moderate HF (EF 30-40%), and severe HF (EF<30%). Cardiac lysates were subjected to affinity-purification using anti-PP1c antibodies followed by high-resolution mass spectrometry. Ppp1r7 was knocked down in mouse cardiomyocytes and HeLa cells using adeno-associated virus serotype 9 (AAV9) and siRNA, respectively. Calcium imaging was performed on isolated ventricular myocytes. Results -Seventy-one and 98 PP1c interactors were quantified from mouse cardiac and HeLa lysates, respectively, including many novel interactors and protein complexes. This represents the largest reproducible PP1 interactome dataset ever captured from any tissue, including both primary and secondary/tertiary interactors. Nine PP1c interactors with changes in their binding to PP1c were strongly associated with HF progression including two known (Ppp1r7, Ppp1r18) and 7 novel interactors. Within the entire cardiac PP1 interactome, Ppp1r7 had the highest binding to PP1c. Cardiac-specific knockdown in mice led to cardiac dysfunction and disruption of calcium release from the sarcoplasmic reticulum. Conclusions -PP1 is best studied at the level of its interactome, which undergoes significant rearrangement during HF progression. The nine key interactors that are associated with HF progression may represent potential targets in HF therapy. In particular, Ppp1r7 may play a central role in regulating the PP1 interactome by acting as a competitive molecular "sponge" of PP1c.

Isoenergetic Feeding of Low Carbohydrate-High Fat Diets Does Not Increase Brown Adipose Tissue Thermogenic Capacity in Rats

PubMed Central

Mauracher, Brigitte; Abplanalp, William; Müller, Hans-Helge; Pieper, Korbinian; Ramisch, Juliane; Tschöp, Matthias H.; Beuschlein, Felix; Bidlingmaier, Martin; Slawik, Marc

2012-01-01

Low-carbohydrate, high-fat (LC-HF) diets are popular for inducing weight loss in overweighed adults. Adaptive thermogenesis increased by specific effects of macronutrients on energy expenditure has been postulated to induce this weight loss. We studied brown adipose tissue (BAT) morphology and function following exposure to different LC-HF diets. Methods Male Wistar rats were fed a standard control diet ad libitum or pair-fed isoenergetic amounts of three experimental diets for 4 weeks. The diets had the following macronutrient composition (% metabolizable energy: carbohydrates, fat, protein): control (64.3/16.7/19), LC-HF-low protein (LC-HF-LP, 1.7/92.8/5.5), LC-HF-normal-protein (LC-HF-NP, 2.2/78.7/19.1), and a high fat diet with carbohydrates (“high fat”, 19.4/61.9/18.7). Results Body weight gain was reduced in all pair-fed experimental groups as compared to rats fed the control diet, with more pronounced effect in rats on LC-HF diets than on the high fat diet with carbohydrates. High fat diets increased expression of PGC1α and ADRB3 in BAT indicating higher SNS outflow. However, UCP1 mRNA expression and expression of UCP1 assessed by immunohistochemistry was not different between diet groups. In accordance, analysis of mitochondrial function in-vitro by extracellular flux analyser (Seahorse Bioscience) and measurement of inducible thermogenesis in vivo (primary endpoint), explored by indirect calorimetry following norepinephrine injection, did not show significant differences between groups. Histology of BAT revealed increased lipid droplet size in rats fed the high-fat diet and both LC-HF diets. Conclusion All experimental diets upregulated expression of genes which are indicative for increased BAT activity. However, the functional measurements in vivo revealed no increase of inducible BAT thermogenesis. This indicates that lower body weight gain with LC-HF diets and a high fat diet in a pair-feeding setting is not caused by increased adaptive thermogenesis in BAT. PMID:22720011

Extending lactation in pasture-based dairy cows. II: Effect of genetic strain and diet on plasma hormone and metabolite concentrations.

PubMed

Kay, J K; Phyn, C V C; Roche, J R; Kolver, E S

2009-08-01

Fifty-six genetically divergent New Zealand and North American Holstein-Friesian (HF) cows grazed pasture, and were offered 0, 3, or 6 kg of concentrate DM/cow per day for an extended lactation (605 +/- 8.3 d in milk; mean +/- standard error of the mean). Weekly blood samples collected from individual cows from wk 1 to 10 postpartum (early lactation), and from wk 47 to 63 postpartum (extended lactation) were analyzed for nonesterified fatty acids (NEFA), glucose, insulin, leptin, growth hormone (GH), insulin-like growth factor-I (IGF-I), calcium, and urea. During early lactation, NEFA and GH concentrations were greater and IGF-I concentrations were less, and increased at a slower rate in North American HF. During this 10-wk period, there were no strain effects on plasma glucose, leptin, insulin, or calcium. During the extended lactation period, North American HF had greater NEFA and GH concentrations; there were strain x diet interactions for insulin and leptin, and a tendency for a strain x diet interaction for glucose. These interactions were primarily due to greater plasma insulin, leptin, and glucose concentrations in the New Zealand HF fed 6 kg of concentrate DM/cow per day, a result of excessive body condition in this treatment. In this period, there was no strain effect on plasma IGF-I, calcium, or urea concentration. During early lactation, there was a linear increase in glucose and IGF-I, and a linear decrease in GH and urea with increasing concentrate in the diet. However, plasma calcium, NEFA, insulin, and leptin remained unchanged. During the extended lactation period, there was an effect of feed supplementation on GH and urea, which decreased linearly with increasing concentrate in the diet. There was, however, no supplementation effect on NEFA, calcium, or IGF-I. These data indicate potential strain differences in recoupling of the somatotropic axis, insulin resistance, and energy partitioning, and may help explain the physiology behind the previously reported greater milk production and body condition score loss in North American HF. The results have implications for breeding and diet management during an extended lactation.

Macronutrient-specific effect of FTO rs9939609 in response to a 10-week randomized hypo-energetic diet among obese Europeans.

PubMed

Grau, K; Hansen, T; Holst, C; Astrup, A; Saris, W H M; Arner, P; Rössner, S; Macdonald, I; Polak, J; Oppert, J-M; Langin, D; Martinez, J A; Pedersen, O; Sørensen, T I A

2009-11-01

The A risk allele of rs9939609 of the fat mass- and obesity-associated gene (FTO) increases body fat mass. To examine whether FTO rs9939609 affects obese individuals' response to a high-fat, low-carbohydrate (CHO) (HF) or low-fat, high-CHO (LF), hypo-energetic diet and whether the effect of the FTO variant depends on dietary fat and CHO content. In a 10-week, European, multi-centre dietary intervention study 771 obese women and men were randomized to either LF (20-25% of energy (%E) from fat, 60-65%E from CHO) or HF (40-45%E from fat, 40-45%E from CHO), hypo-energetic diet (measured resting metabolic rate multiplied by 1.3-600 kcal day(-1)). Body weight, fat mass (FM), fat-free mass (FFM), waist circumference (WC), resting energy expenditure (REE), fasting fat oxidation as % of REE (FatOx), insulin release (HOMA-beta) and a surrogate measure of insulin resistance (HOMA-IR) were measured at baseline and after the intervention. In all, 764 individuals were genotyped for FTO rs9939609. For A-allele carriers the drop-out rate was higher on HF than LF diet (in AT, P=0.002; in AT/AA combined, P=0.003). Among those individuals completing the intervention, we found no effect of FTO rs9939609 genotype on Deltaweight, DeltaFM, DeltaFFM, DeltaWC or DeltaFatOx. However, participants with TT had a smaller reduction in REE on LF than on HF diet (75 kcal/24 h; interaction: P=0.0055). These individuals also showed the greatest reduction in HOMA-beta and HOMA-IR (interaction: P=0.0083 and P=0.047). The FTO rs9939609 may interact with the macronutrient composition in weight loss diets in various ways; carriers of the A allele on LF diet appear to have a lower risk for drop out, and TT individuals have a smaller decrease in REE and greater decrease in HOMA-beta and HOMA-IR on LF than on HF diet.

Heart failure risk among patients with rheumatoid arthritis starting a TNF antagonist.

PubMed

Solomon, Daniel H; Rassen, Jeremy A; Kuriya, Bindee; Chen, Lang; Harrold, Leslie R; Graham, David J; Lewis, James D; Lii, Joyce; Liu, Liyan; Griffin, Marie R; Curtis, J R

2013-11-01

While heart failure (HF) is associated with elevations in tumor necrosis factor (TNF)α, several trials of TNF antagonists showed no benefit and possibly worsening of disease in those with known severe HF. We studied the risk of new or recurrent HF among a group of patients receiving these agents to treat rheumatoid arthritis (RA). We used data from four different US healthcare programmes. Subjects with RA receiving methotrexate were eligible to enter the study cohort if they added or switched to a TNF antagonist or another non-biological disease modifying antirheumatic drug (nbDMARD). These groups were compared in Cox regression models stratified by propensity score decile and adjusted for oral glucocorticoid dosage, prior HF hospitalisations, and the use of loop diuretics. We compared 8656 new users of a nbDMARD with 11 587 new users of a TNF antagonist with similar baseline covariates. The HR for the TNF antagonists compared with nbDMARD was 0.85 (95% CI 0.63 to 1.14). The HR was also not elevated in subjects with a history of HF. But, it was elevated prior to 2002 (HR 2.17, 95% CI 0.45 to 10.50, test for interaction p=0.036). Oral glucocorticoids were associated with a dose-related gradient of HF risk: compared with no use, 1≤5 mg HR 1.30 (95% CI 0.91 to 1.85), ≥5 mg HR 1.54 (95% CI 1.09 to 2.19). TNF antagonists were not associated with a risk of HF hospital admissions compared with nbDMARDs in this RA population.

Potential energy and dipole moment surfaces for HF@C60: Prediction of spectral and electric response properties

NASA Astrophysics Data System (ADS)

Kalugina, Yulia N.; Roy, Pierre-Nicholas

2017-12-01

We present a five-dimensional potential energy surface (PES) for the HF@C60 system computed at the DF-LMP2/cc-pVTZ level of theory. We also calculated a five-dimensional dipole moment surface (DMS) based on DFT(PBE0)/cc-pVTZ calculations. The HF and C60 molecules are considered rigid with bond length rHF = 0.9255 Å (gas phase ground rovibrational state geometry). The C60 geometry is of Ih symmetry. The ab initio points were fitted to obtain a PES in terms of bipolar spherical harmonics. The minimum of the PES corresponds to a geometry where the center of mass of HF is located 0.11 Å away from the center of the cage with an interaction energy of -6.929 kcal/mol. The DMS was also represented in terms of bipolar spherical harmonics. The PES was used to calculate the rotation-translation bound states of HF@C60, and good agreement was found relative to the available experimental data [A. Krachmalnicoff et al., Nat. Chem. 8, 953 (2016)] except for the splitting of the first rotational excitation levels. We propose an empirical adjustment to the PES in order to account for the experimentally observed symmetry breaking. The form of that effective PES is additive. We also propose an effective Hamiltonian with an adjusted rotational constant in order to quantitatively reproduce the experimental results including the splitting of the first rotational state. We use our models to compute the molecular volume polarizability of HF confined by C60 and obtain good agreement with experiment.

Potential energy and dipole moment surfaces for HF@C60: Prediction of spectral and electric response properties.

PubMed

Kalugina, Yulia N; Roy, Pierre-Nicholas

2017-12-28

We present a five-dimensional potential energy surface (PES) for the HF@C 60 system computed at the DF-LMP2/cc-pVTZ level of theory. We also calculated a five-dimensional dipole moment surface (DMS) based on DFT(PBE0)/cc-pVTZ calculations. The HF and C 60 molecules are considered rigid with bond length r HF = 0.9255 Å (gas phase ground rovibrational state geometry). The C 60 geometry is of I h symmetry. The ab initio points were fitted to obtain a PES in terms of bipolar spherical harmonics. The minimum of the PES corresponds to a geometry where the center of mass of HF is located 0.11 Å away from the center of the cage with an interaction energy of -6.929 kcal/mol. The DMS was also represented in terms of bipolar spherical harmonics. The PES was used to calculate the rotation-translation bound states of HF@C 60 , and good agreement was found relative to the available experimental data [A. Krachmalnicoff et al., Nat. Chem. 8, 953 (2016)] except for the splitting of the first rotational excitation levels. We propose an empirical adjustment to the PES in order to account for the experimentally observed symmetry breaking. The form of that effective PES is additive. We also propose an effective Hamiltonian with an adjusted rotational constant in order to quantitatively reproduce the experimental results including the splitting of the first rotational state. We use our models to compute the molecular volume polarizability of HF confined by C 60 and obtain good agreement with experiment.

Sleep apnoea in heart failure: To treat or not to treat?

PubMed

Naughton, Matthew T; Kee, Kirk

2017-02-01

Heart failure (HF) and sleep apnoea are common disorders which frequently coexist. Two main types of apnoea occur: one is obstructive which, through recurring episodes of snoring, hypoxaemia, large negative intra-thoracic pressures and arousals from sleep leading to downstream inflammatory and autonomic nervous system changes, is thought to be a causative factor to the development of systemic hypertension and HF. The other type of apnoea, Cheyne-Stokes respiration with central sleep apnoea (CSR-CSA), is characterized by an oscillatory pattern of ventilation with a prevailing hyperventilation-induced hypocapnia, often in the absence of significant hypoxaemia and snoring, and is thought to be a consequence of advanced HF-related low cardiac output, high sympathetic nervous system activation and pulmonary congestion. CSR-CSA may be a compensatory response to advanced HF. Rostral fluid shift during sleep may play an important role in the pathogenesis of both obstructive sleep apnoea (OSA) and CSA. Studies of positive airway pressure (PAP) treatment of OSA and CSA in HF have shown short-term improvements in cardiac and autonomic function; however, there is no evidence of improved survival. Loop gain may provide useful marker of continuous PAP (CPAP) responsiveness in patients with central apnoea. A greater understanding of the pathophysiology of the interaction between obstructive and central apnoea and the various types of HF, and the mechanisms of therapies, such as PAP, is required to develop new strategies to overcome the disabling symptoms, and perhaps improve the mortality, that accompany HF with sleep apnoea. © 2016 Asian Pacific Society of Respirology.

The Metal Oxide Space Clouds (MOSC) Experiment: High Frequency (HF) Signatures and Interactions with the Ambient Ionosphere

NASA Astrophysics Data System (ADS)

Groves, K. M.; Caton, R. G.; Pedersen, T. R.; Parris, R. T.; Su, Y.; Cannon, P. S.; Jackson-booth, N. K.; Angling, M. J.; Retterer, J. M.

2013-12-01

With support from the NASA sounding rocket team, AFRL performed two separate 5 kg releases of samarium metal vapor in the lower F-region near Kwajalein Atoll in May 2013. A fraction of the samarium subsequently ionized forming a plasma cloud that persisted for tens of minutes to hours in the post-sunset period. Numerous sensors were used to characterize the clouds including the ALTAIR incoherent scatter radar, multiple GPS and optical instruments, satellite radio beacons, and a dedicated network of high frequency (HF) radio links. The primary objectives of the experiments were to understand the dynamics, evolution and chemistry of Sm atoms in the earth's upper atmosphere. Sm is predicted to both photo-ionize and chemi-ionize through charge exchange with neutral oxygen (O). Ionization rates and loss reactions are not well known. A secondary objective was to understand the interaction of an artificial plasma cloud with the low latitude ionosphere during the pre-reversal enhancement period leading up to the post-sunset development of large-scale Rayleigh-Taylor instability. It was initially hoped that the introduction of the artificial plasma might be sufficient to quench the development of the instability by maintaining high conductivity within the affected flux tubes. Modeling results showed that this result was unlikely due to the relatively small amount of material being released. However, it appeared possible that the presence of SmO+ near the bottomside of the F-region might be capable of reducing the formation of short-scale irregularities within the larger Rayleigh-Taylor 'bubbles'. Indeed, preliminary results indicate that the artificial layers, positioned at 170 and 180 km respectively, did interact with the overlying F region and in at least one case, cause a decrease in the short-scale component of the natural irregularity spectrum. The results suggest that it may be possible to mitigate the formation of low-latitude irregularities responsible for radio wave scintillation with a MOSC-based approach.

Functional anatomy of the hair follicle: The Secondary Hair Germ.

PubMed

Panteleyev, Andrey A

2018-07-01

The secondary hair germ (SHG)-a transitory structure in the lower portion of the mouse telogen hair follicle (HF)-is directly involved in anagen induction and eventual HF regrowth. Some crucial aspects of SHG functioning and ontogenetic relations with other HF parts, however, remain undefined. According to recent evidence (in contrast to previous bulge-centric views), the SHG is the primary target of anagen-inducing signalling and a source of both the outer root sheath (ORS) and ascending HF layers during the initial (morphogenetic) anagen subphase. The SHG is comprised of two functionally distinct cell populations. Its lower portion (originating from lower HF cells that survived catagen) forms all ascending HF layers, while the upper SHG (formed by bulge-derived cells) builds up the ORS. The predetermination of SHG cells to a specific morphogenetic fate contradicts their attribution to the "stem cell" category and supports SHG designation as a "germinative" or a "founder" cell population. The mechanisms of this predetermination driving transition of the SHG from "refractory" to the "competent" state during the telogen remain unknown. Functionally, the SHG serves as a barrier, protecting the quiescent bulge stem cell niche from the extensive follicular papilla/SHG signalling milieu. The formation of the SHG is a prerequisite for efficient "precommitment" of these cells and provides for easier sensing and a faster response to anagen-inducing signals. In general, the formation of the SHG is an evolutionary adaptation, which allowed the ancestors of modern Muridae to acquire a specific, highly synchronized pattern of hair cycling. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A minireview of E4BP4/NFIL3 in heart failure.

PubMed

Velmurugan, Bharath Kumar; Chang, Ruey-Lin; Marthandam Asokan, Shibu; Chang, Chih-Fen; Day, Cecilia-Hsuan; Lin, Yueh-Min; Lin, Yuan-Chuan; Kuo, Wei-Wen; Huang, Chih-Yang

2018-06-01

Heart failure (HF) remains a major cause of morbidity and mortality worldwide. The primary cause identified for HF is impaired left ventricular myocardial function, and clinical manifestations may lead to severe conditions like pulmonary congestion, splanchnic congestion, and peripheral edema. Development of new therapeutic strategies remains the need of the hour for controlling the problem of HF worldwide. Deeper insights into the molecular mechanisms involved in etiopathology of HF indicate the significant role of calcium signaling, autocrine signaling pathways, and insulin-like growth factor-1 signaling that regulates the physiologic functions of heart growth and development such as contraction, metabolism, hypertrophy, cytokine signaling, and apoptosis. In view of these facts, a transcription factor (TF) regulating the myriad of these signaling pathways may prove as a lead candidate for development of therapeutics. Adenovirus E4 promoter-binding protein (E4BP4), also known as nuclear-factor, interleukin 3 regulated (NFIL3), a type of basic leucine zipper TF, is known to regulate the signaling processes involved in the functioning of heart. The current review discusses about the expression, structure, and functional role of E4BP4 in signaling processes with emphasis on calcium signaling mechanisms, autocrine signaling, and insulin-like growth factor II receptor-mediated processes regulated by E4BP4 that may regulate the pathogenesis of HF. We propose that E4BP4, being the critical component for the regulation of the above signaling processes, may serve as a novel therapeutic target for HF, and scientific investigations are merited in this direction. © 2018 Wiley Periodicals, Inc.

Self-Care Motivation Among Patients With Heart Failure: A Qualitative Study Based on Orem's Theory.

PubMed

Abotalebidariasari, Ghasem; Memarian, Robabe; Vanaki, Zohreh; Kazemnejad, Anoshirvan; Naderi, Nasim

2016-11-01

Initiating and adhering to self-care activities necessitate self-care motivation. This study was undertaken in Iran to explore self-care motivation among patients with heart failure (HF). This qualitative study was done in 2014 and 2015. Study participants were patients with HF and their family members who were purposively selected from Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. The study data were collected from December 2014 to May 2015 by doing in-depth semistructured face-to-face interviews and were analyzed via the directed content analysis approach. Eleven primary codes were generated which reflected motivations for self-care among patients with HF in the Iranian sociocultural context. To enhance the clarity of the findings, these primarily codes were summarized and grouped into 7 subcategories including fear of death and love of life, returning to previous physical health status and preventing or alleviating symptoms, understanding the value of self-care behaviors and trusting them, having the desire for remaining independent, relying on God, reassuring and supporting family members, and preventing family members from feeling irritation. The findings of this study indicate that patients with HF have different motivations for doing self-care activities. Fear of death, love of life, wish to return to previous health status, and prevention or alleviation of HF symptoms were the participants' strongest motivations for self-care. Understanding the motivations for self-care among patients with HF, based a holistic approach and evidence-based practice, can help nurses and physicians develop motivational programs for promoting self-care behaviors.

Microsolvation of Cl anion by water clusters: Pertubative Monte Carlo simulations using a hybrid HF/MM potential

NASA Astrophysics Data System (ADS)

Truong, Thanh N.; Stefanovich, Eugene V.

1997-05-01

We present a study of micro-solvation of Cl anion by water clusters of the size up to seven molecules using a perturbative Monte Carlo approach with a hybrid HF/MM potential. In this approach, a perturbation theory was used to avoid performing full SCF calculations at every Monte Carlo step. In this study, the anion is treated quantum mechanically at the HF/6-31G ∗ level of theory while interactions between solvent waters are presented by the TIP3P potential force field. Analysis on the solvent induced dipole moment of the ion indicates that the Cl anion resides most of the time on the surface of the clusters. Accuracy of the perturbative MC approach is also discussed.

Efficacy and safety of sacubitril/valsartan (LCZ696) in Japanese patients with chronic heart failure and reduced ejection fraction: Rationale for and design of the randomized, double-blind PARALLEL-HF study.

PubMed

Tsutsui, Hiroyuki; Momomura, Shinichi; Saito, Yoshihiko; Ito, Hiroshi; Yamamoto, Kazuhiro; Ohishi, Tomomi; Okino, Naoko; Guo, Weinong

2017-09-01

The prognosis of heart failure patients with reduced ejection fraction (HFrEF) in Japan remains poor, although there is growing evidence for increasing use of evidence-based pharmacotherapies in Japanese real-world HF registries. Sacubitril/valsartan (LCZ696) is a first-in-class angiotensin receptor neprilysin inhibitor shown to reduce mortality and morbidity in the recently completed largest outcome trial in patients with HFrEF (PARADIGM-HF trial). The prospectively designed phase III PARALLEL-HF (Prospective comparison of ARNI with ACE inhibitor to determine the noveL beneficiaL trEatment vaLue in Japanese Heart Failure patients) study aims to assess the clinical efficacy and safety of LCZ696 in Japanese HFrEF patients, and show similar improvements in clinical outcomes as the PARADIGM-HF study enabling the registration of LCZ696 in Japan. This is a multicenter, randomized, double-blind, parallel-group, active controlled study of 220 Japanese HFrEF patients. Eligibility criteria include a diagnosis of chronic HF (New York Heart Association Class II-IV) and reduced ejection fraction (left ventricular ejection fraction ≤35%) and increased plasma concentrations of natriuretic peptides [N-terminal pro B-type natriuretic peptide (NT-proBNP) ≥600pg/mL, or NT-proBNP ≥400pg/mL for those who had a hospitalization for HF within the last 12 months] at the screening visit. The study consists of three phases: (i) screening, (ii) single-blind active LCZ696 run-in, and (iii) double-blind randomized treatment. Patients tolerating LCZ696 50mg bid during the treatment run-in are randomized (1:1) to receive LCZ696 100mg bid or enalapril 5mg bid for 4 weeks followed by up-titration to target doses of LCZ696 200mg bid or enalapril 10mg bid in a double-blind manner. The primary outcome is the composite of cardiovascular death or HF hospitalization and the study is an event-driven trial. The design of the PARALLEL-HF study is aligned with the PARADIGM-HF study and aims to assess the efficacy and safety of LCZ696 in Japanese HFrEF patients. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Comparison of Predictors of Heart Failure-related Hospitalization or Death in Patients with versus without Preserved Left Ventricular Ejection Fraction

PubMed Central

Mangla, Ashvarya; Kane, John; Beaty, Elijah; Richardson, DeJuran; Powell, Lynda H.; Calvin, James E.

2013-01-01

Heart failure with preserved ejection fraction (HFpEF) is recognized as a major cause of cardiovascular morbidity and mortality. An ability to identify patients with HFpEF who are at increased risk for adverse outcome can facilitate their more careful management. We studied the patients having heart failure (HF) using data from the Heart Failure Adherence and Retention Trial (HART). HART enrolled 902 NYHA Class II or III patients who had been recently hospitalized for HF to study the impact of self-management counseling on the primary outcome of death or HF hospitalization. In HART 208 patients had HFpEF and 692 had HFrEF (heart failure with reduced ejection fraction), and were followed for median of 1080 days. Two final multivariate models were developed. In patients having HFpEF, predictors of primary outcome were: male sex (OR 3.45, p=0.004), NYHA class III (OR 3.05, p=0.008), distance covered on 6-minute walk test (6-MWT) of< 620 feet (OR 2.81, p=0.013), and <80% adherence to prescribed medications (OR 2.61, p=0.018). In patients having HFrEF, the predictors were: being on diuretics (OR 3.06, p=0.001), having ≥ 3 comorbidities (OR 2.11, p=0.0001), distance covered on 6-MWT of < 620 feet (OR 1.94, p=0.001), NYHA class III (OR 1.90, p=0.001) and age > 65 years (OR 1.63, p=0.01). In conclusion, indicators of functional status(6-MWT and NYHA class) were common to both HFpEF and HFrEF patients while gender and adherence to prescribed therapy were unique to patients having HFpEF in predicting death or HF hospitalization. PMID:24063842

Educational attainment has a limited impact on disease management outcomes in heart failure.

PubMed

Smith, Brad; Forkner, Emma; Krasuski, Richard A; Galbreath, Autumn Dawn; Freeman, Gregory L

2006-06-01

The objective of this study was to assess whether educational attainment moderates outcomes in the intervention group in a trial of disease management in heart failure (HF). Data were collected from a sample of 654 patients enrolled in the disease management arm of a community- based study of HF patients. The full sample was used to analyze two primary outcomes- all-cause mortality and cardiac event-free survival. Two other primary outcomes- rates of HF-related emergency department (ED) visits and inpatient admissions-and secondary outcomes (patient self-confidence in managing HF symptoms and daily dietary sodium intake in milligrams) were analyzed in a smaller sample of 602 patients who completed at least 6 months of disease management. One-way analysis of variance and chi (2) tests were used to assess differences in baseline demographic and clinical characteristics. Survival analyses were conducted with proportional hazards regression, while negative binomial regression was used to assess educational differences in ED usage and inpatient admissions. Repeated measures analysis of variance models were used to assess whether secondary outcomes differed across educational strata and/or over time. All outcome analyses were adjusted for confounders. Patients with the least education fared the poorest for all-cause mortality, but education- related differences failed to achieve statistical significance. No education-related differences were observed for cardiac event-free survival, or for the rates of inpatient admission and ED usage. For secondary outcomes, sodium intake differed significantly by education (p = 0.04), with the largest drop (-838 mg/day) observed in the least well-educated group. Confidence increased an approximately equal amount (2.1-3.0 points on a 100-point scale) across all educational strata (p = ns). Low educational attainment may not be a barrier to effective disease management.

Prognostic value of plasma neutrophil gelatinase-associated lipocalin in patients with heart failure.

PubMed

Villacorta, Humberto; Santos, Rochele Alberto Martins; Marroig, Marcelle Alves Baco; Pereira, Guilherme Pinella Guedes; Xavier, Analucia Rampazzo; Kanaan, Salim

2015-01-01

Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of kidney injury. We sought to assess the prognostic value of this biomarker in patients with stable chronic heart failure (HF). We studied 61 patients with chronic systolic HF who had been receiving optimal medical treatment for at least six months. Biomarkers were measured at baseline and included plasma NGAL, microalbuminuria, serum creatinine, and B-type natriuretic peptide (BNP). Estimated glomerular filtration rate (eGFR) was also calculated. Mean follow-up was 10.6±6.6 months. The primary endpoint was time to first cardiovascular event, defined as a combination of cardiovascular death, HF hospitalization or emergency department visit due to HF. Variables independently related to events were determined using a Cox proportional hazards model. Fifteen (24.6%) patients reached the primary endpoint. Patients with events were more likely to have worse renal function at baseline and also higher NGAL levels (median 316 [interquartile range 122-705] vs. 107 [78-170]; p=0.006). NGAL correlated significantly with creatinine (r=0.50; p<0.0001), albuminuria (r=0.33; p=0.008), and eGFR (r=-0.47; p=0.0001) but not with BNP (r=0.003; p=0.97). The best NGAL cutoff as determined by ROC curve analysis was 179 ng/ml. Event-free survival was lower in patients with NGAL above this cutoff. Variables independently related to events were NGAL (HR 1.0035, 95% CI 1.0019-1.0052; p<0.0001) and male gender (HR 5.9, 95% CI 1.22-28.6; p=0.028). NGAL correlated with other biomarkers of renal function but not with BNP and was independently associated with outcomes. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews.

PubMed

Kitsiou, Spyros; Paré, Guy; Jaana, Mirou

2015-03-12

Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies.

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

PubMed Central

Paré, Guy; Jaana, Mirou

2015-01-01

Background Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. PMID:25768664

Distribution of p-process 174Hf in early solar system materials and the origin of nucleosynthetic Hf and W isotope anomalies in Ca-Al rich inclusions

NASA Astrophysics Data System (ADS)

Peters, Stefan T. M.; Münker, Carsten; Pfeifer, Markus; Elfers, Bo-Magnus; Sprung, Peter

2017-02-01

Some nuclides that were produced in supernovae are heterogeneously distributed between different meteoritic materials. In some cases these heterogeneities have been interpreted as the result of interaction between ejecta from a nearby supernova and the nascent solar system. Particularly in the case of the oldest objects that formed in the solar system - Ca-Al rich inclusions (CAIs) - this view is confirm the hypothesis that a nearby supernova event facilitated or even triggered solar system formation. We present Hf isotope data for bulk meteorites, terrestrial materials and CAIs, for the first time including the low-abundance isotope 174Hf (∼0.16%). This rare isotope was likely produced during explosive O/Ne shell burning in massive stars (i.e., the classical "p-process"), and therefore its abundance potentially provides a sensitive tracer for putative heterogeneities within the solar system that were introduced by supernova ejecta. For CAIs and one LL chondrite, also complementary W isotope data are reported for the same sample cuts. Once corrected for small neutron capture effects, different chondrite groups, eucrites, a silicate inclusion of a IAB iron meteorite, and terrestrial materials display homogeneous Hf isotope compositions including 174Hf. Hafnium-174 was thus uniformly distributed in the inner solar system when planetesimals formed at the <50 ppm level. This finding is in good agreement with the evidently homogeneous distributions of p-process isotopes 180W, 184Os and possibly 190Pt between different iron meteorite groups. In contrast to bulk meteorite samples, CAIs show variable depletions in p-process 174Hf with respect to the inner solar system composition, and also variable r-process (or s-process) Hf and W contributions. Based on combined Hf and W isotope compositions, we show that CAIs sampled at least one component in which the proportion of r- and s-process derived Hf and W deviates from that of supernova ejecta. The Hf and W isotope anomalies in CAIs are therefore best explained by selective processing of presolar carrier phases prior to CAI formation, and not by a late injection of supernova materials. Likewise, other isotope anomalies in additional elements in CAIs relative to the bulk solar system may reflect the same process. The isotopic heterogeneities between the first refractory condensates may have been eradicated partially during CAI formation, because W isotope anomalies in CAIs appear to decrease with increasing W concentrations as inferred from time-integrated 182W/184W. Importantly, the 176Lu-176Hf and 182Hf-182W chronometers are not significantly affected by nucleosynthetic heterogeneity of Hf isotopes in bulk meteorites, but may be affected in CAIs.

The Sr, Nd, and Hf isotopic geochemistry of rocks of the gabbro-diorite-tonalite association from the Eastern Segment of the Middle Urals as an indicator of the age of the continental crust in this area

NASA Astrophysics Data System (ADS)

Smirnov, V. N.; Ivanov, K. S.; Ronkin, Yu. L.; Koroteev, V. A.; Serov, P. A.; Gerdes, A.

2017-05-01

According to isotopic analysis of rocks of the Reft gabbro-diorite-tonalite complex (Middle Urals), gabbro and related diorite and dikes and vein-shaped bodies of plagiogranitoids, crosscutting gabbro, are similar to the depleted mantle substance in ɛNd( T) = 8.6-9.7 and ɛHf( T) = 15.9-17.9. Their model Hf ages are correlated with the time of crystallization. Here, the tonalites and quartz diorites constituting most of the Reft massif are characterized by lower values: ɛNd( T) = 3.7-6.0, ɛHf( T) = 11.1-12.7, and T DM values significantly exceeding the age datings. This is evidence that Neoproterozoic crustal rocks were a source of parental magma for these rocks. The primary 87Sr/86Sr ratio in rocks of both groups is highly variable (0.70348-0.70495). The data obtained allow us to reach the conclusion that the Reft gabbro-diorite-tonalite complex was formed as a result of nearly synchronous processes occurring in the crust and the mantle within a limited area.

Integrated in situ U-Pb Age and Hf-O Analyses of Zircon from the Northern Yangtze Block: New Insights into the Neoproterozoic Low-δ18O Magmas in the South China Block

NASA Astrophysics Data System (ADS)

Yang, Y. N.; Wang, X. C.; Li, Q. L.; Li, X. H.

2015-12-01

The oxygen isotopic composition of Neoproterozoic magmas from the northern Yangtze Block holds a key for the origin of large-scale 18O depletion in the HP and UHP metamorphic rocks in the Dabie-Sulu orogenic belt, northern margin of the South China Block. We report here the integrated in situ U-Pb dating and O-Hf isotope analyses of zircon grains from sedimentary and volcanic rocks of the late Neoproterozoic Suixian Group (SG) from the northern Yangtze Block. Detrital zircon grains display age peaks of 0.73-0.74 Ga, 0.79 Ga, and 2.0 Ga. Zircon U-Pb ages together with Hf-O isotopic composition indicate provenance of SG dominantly from proximal Neoproterozoic igneous rock and likely hidden Paleoproterozoic basement along the northern margin of the Yangtze Block. The zircon δ18O values from SG range from 10.5‰ to 1.3‰. Zircon grains with negative δ18O value, typical result of magma-ice interaction, were not identified in this study. The major phase of low-δ18O (< 4‰) magmas initiated at ca. 780 Ma, long before the first glaciation event (< 715 Ma) in the South China Block. Thus caution should be taken when using low-δ18O zircon grains to infer cold climate. Low-δ18O zircon grains have large ranges of ɛHf(t) values, varying from -15.5 to 10.7, concentrating on negative ɛHf(t). This strongly argues against the possibility that the low-δ18O magma was produced by partial melting of high-temperature hydrothermally altered oceanic crust because this model predicted MORB-like Hf isotopes for the resultant low-δ18O magmas. This study emphasizes that high-T water-rock interaction and continental rifting tectonic setting are essential to generate abundant low-δ18O magmas. The important application of our study is to confirm that most of negative-δ18O zircons identified in HP and UHP metamorphic rocks may not have been inherited from their Neoproterozoic protoliths.

Glass-water interaction: Effect of high-valence cations on glass structure and chemical durability

NASA Astrophysics Data System (ADS)

Hopf, J.; Kerisit, S. N.; Angeli, F.; Charpentier, T.; Icenhower, J. P.; McGrail, B. P.; Windisch, C. F.; Burton, S. D.; Pierce, E. M.

2016-05-01

Borosilicate glass is a durable solid, but it dissolves when in contact with aqueous fluids. The dissolution mechanism, which involves a variety of sequential reactions that occur at the solid-fluid interface, has important implications for the corrosion resistance of industrial and nuclear waste glasses. In this study, spectroscopic measurements, dissolution experiments, and Monte Carlo simulations were performed to investigate the effect of high-valence cations (HVC) on the mechanisms of glass dissolution under dilute and near-saturated conditions. Raman and NMR spectroscopy were used to determine the structural changes that occur in glass, specifically network formers (e.g., Al, Si, and B), with the addition of the HVC element hafnium in the Na2O-Al2O3-B2O3-HfO2-SiO2 system (e.g., Na/[Al + B] = 1.0 and HfO2/SiO2 from 0.0 to 0.42). Spectroscopic measurements revealed that increasing hafnium content decreases N4 (tetrahedral boron/total boron) and increases the amount of Si-O-Hf moieties in the glass. Results from flow-through experiments conducted under dilute and near-saturated conditions show a decrease of approximately 100× or more in the dissolution rate over the series from 0 to 20 mol% HfO2. Comparing the average steady-state rates obtained under dilute conditions to the rates obtained for near-saturated conditions reveals a divergence in the magnitude between the average steady state rates measured in these different conditions. The reason for this divergence was investigated more thoroughly using Monte Carlo simulations. Simulations indicate that the divergence in glass dissolution behavior under dilute and near-saturated conditions result from the stronger binding of Si sites that deposit on the surface from the influent when Hf is present in the glass. As a result, the residence time at the glass surface of these newly-formed Si sites is longer in the presence of Hf, which increases the density of anchor sites from which altered layers with higher Si densities can form. These results illustrate the importance of understanding solid-water/solid-fluid interactions by linking macroscopic reaction kinetics to nanometer scale interfacial processes.

Predator-prey modeling of the coupling of co-propagating CAE to kink modes

NASA Astrophysics Data System (ADS)

Fredrickson, Eric

2012-10-01

Co-propagating Compressional Alfven eigenmodes (CAE) with shorter wavelength and higher frequency than the counter-propagating CAE and Global Alfven eigenmodes (GAE) often accompany a low frequency n=1 kink. The lower frequency CAE and GAE are excited through a Doppler-shifted cyclotron resonance; the high frequency CAE (hfCAE) through a simple parallel resonance. We present measurements of the mode structure and spectrum of the hfCAE, and compare those measurements to predictions of a simple model for CAE. The modes are bursting with a typical burst frequency on the order of a few kHz. The n=1 kink frequency is usually higher than this, but when the kink frequency does drop towards the hfCAE burst frequency, the hfCAE burst frequency can become locked with the kink frequency. A simple predator-prey model to simulate the hfCAE bursting demonstrates that a modulation of the growth or damping rate by a few percent, at a frequency near the natural burst frequency, can lock the burst frequency to the modulation frequency. The modulation of the damping rate is postulated to be through a coupling of the kink with a symmetry-breaking error field. The deeper question is how the kink interaction with a locked mode can affect the damping/growth rates of the CAE.

Anemia: the point of convergence or divergence for kidney disease and heart failure?

PubMed

Kazory, Amir; Ross, Edward A

2009-02-24

Cardiorenal anemia syndrome refers to the simultaneous presence of anemia, heart failure (HF), and chronic kidney disease (CKD) that forms a pathologic triangle with an adverse impact on morbidity and mortality. The reciprocal relationships among these 3 components have been the subject of a number of trials with inconsistent and sometimes paradoxic results. In this paper, the pathophysiologic concepts underlying interactions among these 3 conditions are discussed. Then, the similarities and dissimilarities of the relationships between anemia and either HF or CKD are considered; explanations are provided for differences in the results of the currently available studies. Erythropoietin-stimulating agent protocols are usually based on the results of studies designed for the CKD population, and upper hemoglobin target levels are chosen to avoid cardiovascular complications. It is not yet clear whether those renal guidelines are optimal for patients with HF, especially because those patients may have reversible components of kidney dysfunction, both HF and renal parameters improving with anemia correction. We review these issues and suggest a pragmatic approach to the care of patients with HF until such time that controlled trials establish definitive anemia treatment goals that are dynamic and disease specific, rather than those that adopt a more simplistic hemoglobin-specific approach.

Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics.

PubMed

Eriksson, B; Wändell, P; Dahlström, U; Näsman, P; Lund, L H; Edner, M

2018-06-01

The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. The prospective Swedish Heart Failure Registry. Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. Comorbidities, risk factors and mortality. Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF ≥50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other independent risk factors than those in hospital care. All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care. In matched HF-patients RAS-antagonists, beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care.

Unexpected Competition between Antiferromagnetic and Ferromagnetic States in Hf2MnRu5B2: Predicted and Realized.

PubMed

Shankhari, Pritam; Zhang, Yuemei; Stekovic, Dejan; Itkis, Mikhail E; Fokwa, Boniface P T

2017-11-06

Materials "design" is increasingly gaining importance in the solid-state materials community in general and in the field of magnetic materials in particular. Density functional theory (DFT) predicted the competition between ferromagnetic (FM) and antiferromagnetic (AFM) ground states in a ruthenium-rich Ti 3 Co 5 B 2 -type boride (Hf 2 MnRu 5 B 2 ) for the first time. Vienna ab initio simulation package (VASP) total energy calculations indicated that the FM model was marginally more stable than one of the AFM models (AFM1), indicating very weak interactions between magnetic 1D Mn chains that can be easily perturbated by external means (magnetic field or composition). The predicted phase was then synthesized by arc-melting and characterized as Hf 2 Mn 1-x Ru 5+x B 2 (x = 0.27). Vibrating-scanning magnetometry shows an AFM ground state with T N ≈ 20 K under low magnetic field (0.005 T). At moderate-to-higher fields, AFM ordering vanishes while FM ordering emerges with a Curie temperature of 115 K. These experimental outcomes confirm the weak nature of the interchain interactions, as predicted by DFT calculations.

Chocolate consumption and risk of heart failure in the Physicians’ Health Study

PubMed Central

Petrone, Andrew B; Gaziano, J. Michael; Djoussé, Luc

2015-01-01

Aims To test the hypothesis that chocolate consumption is associated with a lower risk of heart failure (HF). Methods and Results We prospectively studied 20,278 men from the Physicians’ Health Study. Chocolate consumption was assessed between 1999 and 2002 via a self-administered food frequency questionnaire and HF was ascertained through annual follow-up questionnaires with validation in a subsample. We used Cox regression to estimate multivariable adjusted relative risk of HF. During a mean follow-up of 9.3 years, there were 876 new cases of HF. The mean age at baseline was 66.4 ± 9.2 years. Hazard ratios (95% CI) for HF were 1.0 (ref), 0.86 (0.72–1.03), 0.80 (0.66–0.98), 0.92 (0.74–1.13), and 0.82 (0.63–1.07), for chocolate consumption of less than 1/month, 1–3/week, 2–4/week, and 5+/week, respectively, after adjusting for age, body mass index (BMI), smoking, alcohol, exercise, energy intake, and history of atrial fibrillation (p for quadratic trend = 0.62). In a secondary analysis, chocolate consumption was inversely associated with risk of HF in men whose BMI was <25 kg/m2 (HR (95% CI) = 0.59 (0.37–0.94) for consumption of 5+ servings/week, p for linear trend = 0.03) but not in those with BMI of 25+ kg/m2 (HR (95% CI) = 1.01 (0.73–1.39), p for linear trend = 0.42, p for interaction=0.17). Conclusions Our data suggest that moderate consumption of chocolate might be associated with a lower risk of HF in male physicians.. PMID:25311633

High-fat diet-induced hepatic steatosis reduces glucagon receptor content in rat hepatocytes: potential interaction with acute exercise

PubMed Central

Charbonneau, Alexandre; Unson, Cecilia G; Lavoie, Jean-Marc

2007-01-01

Studies have revealed that high-fat (HF) diets promote hyperglycaemia, whole-body insulin resistance and non-alcoholic fatty liver disease (NAFLD). Recently, hepatic glucagon resistance has been shown to occur in rats fed a HF diet. More precisely, diet-induced obesity (DIO) reduces the number of hepatic plasma membrane glucagon receptors (GR), which results in a diminished response to glucagon during a hyperglucagonaemic clamp. The present study was undertaken to test the hypothesis that a HF-DIO is associated with a desensitization and destruction of the hepatic GR. We also hypothesized that a single bout of endurance exercise would modify the GR cellular distribution under our DIO model. Male rats were either fed a standard (sd) or a HF diet for two weeks. Each group was subdivided into a non-exercised (Rest) and an acute exercised (EX) group. The HF diet resulted in a reduction of total hepatic GR (55%) and hepatic plasma membrane GR protein content (20%). These changes were accompanied by a significant increase in endosomal and lysosomal GR content with the feeding of a HF diet. The reduction of GR plasma membrane as well as the increase in endosomal GR was strongly correlated with an increase of PKC-α, suggesting a role of PKC-α in GR desensitization. EX increased significantly PKC-α protein content in both diets, suggesting a role of PKC-α in EX-induced GR desensitization. The present results suggest that liver lipid infiltration plays a role in reducing glucagon action in the liver through a reduction in total cellular and plasma membrane GR content. Furthermore, the GR desensitization observed in our in vivo model of HF diet-induced hepatic steatosis and in EX individuals may be regulated by PKC-α. PMID:17053032

Is the human mirror neuron system plastic? Evidence from a transcranial magnetic stimulation study.

PubMed

Mehta, Urvakhsh Meherwan; Waghmare, Avinash V; Thirthalli, Jagadisha; Venkatasubramanian, Ganesan; Gangadhar, Bangalore N

2015-10-01

Virtual lesions in the mirror neuron network using inhibitory low-frequency (1Hz) transcranial magnetic stimulation (TMS) have been employed to understand its spatio-functional properties. However, no studies have examined the influence of neuro-enhancement by using excitatory high-frequency (20Hz) repetitive transcranial magnetic stimulation (HF-rTMS) on these networks. We used three forms of TMS stimulation (HF-rTMS, single and paired pulse) to investigate whether the mirror neuron system facilitates the motor system during goal-directed action observation relative to inanimate motion (motor resonance), a marker of putative mirror neuron activity. 31 healthy individuals were randomized to receive single-sessions of true or sham HF-rTMS delivered to the left inferior frontal gyrus - a component of the human mirror system. Motor resonance was assessed before and after HF-rTMS using three TMS cortical reactivity paradigms: (a) 120% of resting motor threshold (RMT), (b) stimulus intensity set to evoke motor evoked potential of 1-millivolt amplitude (SI1mV) and (c) a short latency paired pulse paradigm. Two-way RMANOVA showed a significant group (true versus sham) X occasion (pre- and post-HF-rTMS motor resonance) interaction effect for SI1mV [F(df)=6.26 (1, 29), p=0.018] and 120% RMT stimuli [F(df)=7.01 (1, 29), p=0.013] indicating greater enhancement of motor resonance in the true HF-rTMS group than the sham-group. This suggests that HF-rTMS could adaptively modulate properties of the mirror neuron system. This neuro-enhancement effect is a preliminary step that can open translational avenues for novel brain stimulation therapeutics targeting social-cognition deficits in schizophrenia and autism. Copyright © 2015 Elsevier B.V. All rights reserved.

Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial.

PubMed

Bekelman, David B; Plomondon, Mary E; Carey, Evan P; Sullivan, Mark D; Nelson, Karin M; Hattler, Brack; McBryde, Connor F; Lehmann, Kenneth G; Gianola, Katherine; Heidenreich, Paul A; Rumsfeld, John S

2015-05-01

Heart failure (HF) has a major effect on patients' health status, including their symptom burden, functional status, and health-related quality of life. To determine the effectiveness of a collaborative care patient-centered disease management (PCDM) intervention to improve the health status of patients with HF. The Patient-Centered Disease Management (PCDM) trial was a multisite randomized clinical trial comparing a collaborative care PCDM intervention with usual care in patients with HF. A population-based sample of 392 patients with an HF diagnosis from 4 Veterans Affairs centers who had a Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score of less than 60 (heavy symptom burden and impaired functional status and quality of life) were enrolled between May 2009 and June 2011. The PCDM intervention included collaborative care by a multidisciplinary care team consisting of a nurse coordinator, cardiologist, psychiatrist, and primary care physician; home telemonitoring and patient self-management support; and screening and treatment for comorbid depression. The primary outcome was change in the KCCQ overall summary score at 1 year (a 5-point change is clinically significant). Mortality, hospitalization, and depressive symptoms (Patient Health Questionnaire 9) were secondary outcomes. There were no significant differences in baseline characteristics between patients randomized to the PCDM intervention (n=187) vs usual care (n=197); baseline mean KCCQ overall summary scores were 37.9 vs 36.9 (P=.48). There was significant improvement in the KCCQ overall summary scores in both groups after 1 year (mean change, 13.5 points in each group), with no significant difference between groups (P=.97). The intervention was not associated with greater improvement in the KCCQ overall summary scores when the effect over time was estimated using 3-month, 6-month, and 12-month data (P=.74). Among secondary outcomes, there were significantly fewer deaths at 1 year in the intervention arm (8 of 187 [4.3%]) than in the usual care arm (19 of 197 [9.6%]) (P = .04). Among those who screened positive for depression, there was a greater improvement in the Patient Health Questionnaire 9 scores after 1 year in the intervention arm than in the usual care arm (2.1 points lower, P=.01). There was no significant difference in 1-year hospitalization rates between the intervention arm and the usual care arm (29.4% vs 29.9%, P=.87). This multisite randomized trial of a multifaceted HF PCDM intervention did not demonstrate improved patient health status compared with usual care. clinicaltrials.gov Identifier: NCT00461513.

Attenuated or absent HRV response to postural change in subjects with primary insomnia.

PubMed

Jiang, Xiao-ling; Zhang, Zheng-gang; Ye, Cui-ping; Lei, Ying; Wu, Lei; Zhang, Ying; Chen, Yuan-yuan; Xiao, Zhong-ju

2015-03-01

Previous studies have compared rest heart rate variability (HRV) between insomniacs and good sleepers, but the results have not been consistent. The altered HRV behavior in response to postural change was considered useful as another sensitive measure for evaluating the autonomic nervous function, however, to our knowledge, no study was found using HRV response to postural change in primary insomnia. Our study aimed to examine HRV response to postural change maneuver (PCM) in both primary insomniacs and controls between 22 and 39 years of age to gain insights into the characteristics of the autonomic nervous system (ANS) function in primary insomnia subjects. HRV was recorded for 5 min at seated rest, and then, the subjects quickly stood up from a seated position in up to 3s and remained standing for 15 min. HRV was recorded at the following times: seated rest and 0-5 min, 5-10 min and 10-15 min in the standing position. In primary insomnia subjects, attenuated or absent HRV response to postural change was identified, the increase in LF/HF ratio and the decrease in HF and SD1 from seated to standing were much slower than in the normal controls. In conclusion, this study provided evidence of the possible bi-directional relationship between insomnia and autonomic nervous system (ANS) function, which will move us closer to developing a new sensitive method for measuring autonomic impairment and early sympathetic damage in primary insomnia subjects. Copyright © 2015 Elsevier Inc. All rights reserved.

A new potential energy surface for vibration-vibration coupling in HF-HF collisions. Formulation and quantal scattering calculations

NASA Astrophysics Data System (ADS)

Schwenke, David W.; Truhlar, Donald G.

1988-04-01

We present new ab initio calculations of the HF-HF interaction potential for the case where both molecules are simultaneously displaced from their equilibrium internuclear distance. These and previous ab initio calculations are then fit to a new analytic representation which is designed to be efficient to evaluate and to provide an especially faithful account of the forces along the vibrational coordinates. We use the new potential for two sets of quantal scattering calculations for collisions in three dimensions with total angular momentum zero. First we test that the angular harmonic representation of the anisotropy is adequate by comparing quantal rigid rotator calculations to those carried out for potentials involving higher angular harmonics and for which the expansion in angular harmonics is systematically increased to convergence. Then we carry out large-scale quantal calculations of vibration-vibration energy transfer including the coupling of both sets of vibrational and rotational coordinates. These calculations indicate that significant rotational energy transfer accompanies the vibration-to-vibration energy transfer process.

Interaction of N-hydroxyurea with strong proton donors: HCl and HF

NASA Astrophysics Data System (ADS)

Sałdyka, Magdalena

2014-11-01

An infrared spectroscopic and MP2/6-311++G(2d,2p) study of strong hydrogen bonded complexes of N-hydroxyurea (NH2CONHOH) with hydrogen halides (HCl and HF) trapped in solid argon matrices is reported. 1:1 and 1:2 complexes between N-hydroxyurea and hydrogen chloride, hydrogen fluoride have been identified in the NH2CONHOH/HCl/Ar, NH2CONHOH/HF/Ar matrices, respectively; their structures were determined by comparison of the spectra with the results of calculations. In the 1:1 complexes, identified for both hydrogen halide molecules, the cyclic structure stabilized by the X-H⋯O and N-H⋯X bonds is present; for the NH2CONHOH⋯HF system another isomeric 1:1 complex is also observed. Two 1:2 complexes were identified for the N-hydroxyurea-hydrogen chloride system characterised by the Cl-H⋯O and N-H⋯Cl bonds. The results of the study evidence that N-hydroxyurea is an oxygen base in the gas-phase with the carbonyl group as the strongest proton acceptor centre in the molecule.

Characterization, shaping, and joining of SiC/superalloy sheet for exhaust system components

NASA Technical Reports Server (NTRS)

Cornie, J. A.

1977-01-01

Hafnium carbide was shown to be virtually inert when in contact with silicon carbide and Waspaloy for at least 200 hr at 1093 C (2000 F). Extensive interaction was noted with other superalloys such as HA-188. A continuous CVD HfC deposition process was developed for deposition of up to 8 microns on .14 mm (.0056 in.) SiC tungsten core filament at rates as high as .6 m/min. The rate can be increased by increasing the length of the reactor and the output of the power supply used in resistive heating of the filament substrate. The strength of HfC coated filament varies with thickness in a Griffith-like manner. This strength reduction was greater for HfC coatings than for tungsten coatings, presumably because of the greater ductility of tungsten.

Ceramic plasma-sprayed coating of melting crucibles for casting metal fuel slugs

DOE Office of Scientific and Technical Information (OSTI.GOV)

K.H. Kim; C.T. Lee; C.B. Lee

2013-10-01

Thermal cycling and melt reaction studies of ceramic coatings plasma-sprayed on Nb substrates were carried out to evaluate the performance of barrier coatings for metallic fuel casting applications. Thermal cycling tests of the ceramic plasma-sprayed coatings to 1450 degrees C showed that HfN, TiC, ZrC, and Y2O3 coating had good cycling characteristics with few interconnected cracks even after 20 cycles. Interaction studies by 1550 degrees C melt dipping tests of the plasma-sprayed coatings also indicated that HfN and Y2O3 do not form significant reaction layer between U–20 wt.% Zr melt and the coating layer. Plasma-sprayed Y2O3 coating exhibited the mostmore » promising characteristics among HfN, TiC, ZrC, and Y2O3 coating.« less

Artificial ionospheric layers during pump frequency stepping near the 4th gyroharmonic at HAARP.

PubMed

Sergeev, E; Grach, S; Shindin, A; Mishin, E; Bernhardt, P; Briczinski, S; Isham, B; Broughton, M; LaBelle, J; Watkins, B

2013-02-08

We report on artificial descending plasma layers created in the ionosphere F region by high-power high-frequency (HF) radio waves from High-frequency Active Auroral Research Program at frequencies f(0) near the fourth electron gyroharmonic 4f(ce). The data come from concurrent measurements of the secondary escaping radiation from the HF-pumped ionosphere, also known as stimulated electromagnetic emission, reflected probing signals at f(0), and plasma line radar echoes. The artificial layers appeared only for injections along the magnetic field and f(0)>4f(ce) at the nominal HF interaction altitude in the background ionosphere. Their average downward speed ~0.5 km/s holds until the terminal altitude where the local fourth gyroharmonic matches f(0). The total descent increases with the nominal offset f(0)-4f(ce).

Extending lactation in pasture-based dairy cows: I. Genotype and diet effect on milk and reproduction.

PubMed

Kolver, E S; Roche, J R; Burke, C R; Kay, J K; Aspin, P W

2007-12-01

The aim of this study was to test the feasibility of extended lactations in pastoral systems by using divergent dairy cow genotypes [New Zealand (NZ) or North American (NA) Holstein-Friesian (HF)] and levels of nutrition (0, 3, or 6 kg/d of concentrate dry matter). Mean calving date was July 28, 2003, and all cows were dried off by May 6, 2005. Of the 56 cows studied, 52 (93%) were milking at 500 d in milk (DIM) and 10 (18%) were milking at 650 DIM. Dietary treatments did not affect DIM (605 +/- 8.3; mean +/- SEM). Genotype by diet interactions were found for total yield of milk, protein, and milk solids (fat + protein), expressed per cow and as a percentage of body weight. Differences between genotypes were greatest at the highest level of supplementation. Compared with NZ HF, NA HF produced 35% more milk, 24% more milk fat, 25% more milk protein, and at drying off had 1.9 units less body condition score (1 to 10 scale). Annualized milk solids production, defined as production achieved during the 24-mo calving interval divided by 2 yr, was 79% of that produced in a normal 12-mo calving interval by NZ HF, compared with 94% for NA HF. Compared with NZ HF, NA HF had a similar 21-d submission rate (85%) to artificial insemination, a lower 42-d pregnancy rate (56 vs. 79%), and a higher final nonpregnancy rate (30 vs. 3%) when mated at 451 d after calving. These results show that productive lactations of up to 650 d are possible on a range of pasture-based diets, with the highest milk yields produced by NA HF supplemented with concentrates. Based on the genetics represented, milking cows for 2 yr consecutively, with calving and mating occurring every second year, may exploit the superior lactation persistency of high-yielding cows while improving reproductive performance.

Temporal trends and factors associated with diabetes mellitus among patients hospitalized with heart failure: Findings from Get With The Guidelines-Heart Failure registry.

PubMed

Echouffo-Tcheugui, Justin B; Xu, Haolin; DeVore, Adam D; Schulte, Phillip J; Butler, Javed; Yancy, Clyde W; Bhatt, Deepak L; Hernandez, Adrian F; Heidenreich, Paul A; Fonarow, Gregg C

2016-12-01

The contribution of diabetes to the burden of heart failure (HF) remains largely undescribed. Assessing diabetes temporal trends among US patients hospitalized with HF and their relation with quality measures in real-world practice can help to define this burden. Using data from the Get With the Guidelines-Heart Failure registry, we assessed temporal trends in diabetes prevalence among patients with HF and in subgroups with reduced ejection fraction (HFrEF; EF < 40%), borderline EF (HFbEF; 40%≤EF <50%), or preserved EF (HFpEF; EF ≥ 50%), hospitalized between 2005 and 2015. Logistic regression was used to assess whether in-hospital outcomes and HF quality of care were related to trends. Among 364,480 HF hospitalizations, 160,171 had diabetes (44.0% overall, 41.8% in HFrEF, 46.7% in HFbEF, 45.5% in HFpEF). There was a temporal increase in diabetes frequency in HF patients (43.2%-45.8%; P trend <.0001), including among those with HFrEF (42.0%-43.6%; P trend <.0001), HFbEF (46.0%-49.2%; P trend <.0001), or HFpEF (43.6%-46.8%, P trend <.0001). Diabetic patients had a longer hospital stay (adjusted odds ratio 1.14, 95% CI 1.12-1.16), but lower in-hospital mortality (adjusted odds ratio 0.93 [0.89-0.97]) compared with those without diabetes, with limited differences in quality measures. Temporal trends in diabetes were not associated with in-hospital mortality or length of stay. There were no temporal interactions of most HF quality measures with diabetes status. Approximately 44% of hospitalized HF patients have diabetes, and this proportion has been increasing over the past 10years, particularly among those patients with new-onset HFpEF. Copyright © 2016 Elsevier Inc. All rights reserved.

Brief exposure to obesogenic diet disrupts brain dopamine networks

PubMed Central

Williams, Jason M.; Siuta, Michael A.; Tantawy, Mohammed N.; Speed, Nicole K.; Saunders, Christine; Galli, Aurelio; Niswender, Kevin D.; Avison, Malcolm J.

2018-01-01

Objective We have previously demonstrated that insulin signaling, through the downstream signaling kinase Akt, is a potent modulator of dopamine transporter (DAT) activity, which fine-tunes dopamine (DA) signaling at the synapse. This suggests a mechanism by which impaired neuronal insulin receptor signaling, a hallmark of diet-induced obesity, may contribute to impaired DA transmission. We tested whether a short-term (two-week) obesogenic high-fat (HF) diet could reduce striatal Akt activity, a marker of central insulin, receptor signaling and blunt striatal and dopaminergic network responsiveness to amphetamine (AMPH). Methods We examined the effects of a two-week HF diet on striatal DAT activity in rats, using AMPH as a probe in a functional magnetic resonance imaging (fMRI) assay, and mapped the disruption in AMPH-evoked functional connectivity between key dopaminergic targets and their projection areas using correlation and permutation analyses. We used phosphorylation of the Akt substrate GSK3α in striatal extracts as a measure of insulin receptor signaling. Finally, we confirmed the impact of HF diet on striatal DA D2 receptor (D2R) availability using [18F]fallypride positron emission tomography (PET). Results We found that rats fed a HF diet for only two weeks have reductions in striatal Akt activity, a marker of decreased striatal insulin receptor signaling and blunted striatal responsiveness to AMPH. HF feeding also reduced interactions between elements of the mesolimbic (nucleus accumbens–anterior cingulate) and sensorimotor circuits (caudate/putamen–thalamus–sensorimotor cortex) implicated in hedonic feeding. D2R availability was reduced in HF-fed animals. Conclusion These studies support the hypothesis that central insulin signaling and dopaminergic neurotransmission are already altered after short-term HF feeding. Because AMPH induces DA efflux and brain activation, in large part via DAT, these findings suggest that blunted central nervous system insulin receptor signaling through a HF diet can impair DA homeostasis, thereby disrupting cognitive and reward circuitry involved in the regulation of hedonic feeding. PMID:29698491

HF Accelerated Electron Fluxes, Spectra, and Ionization

NASA Astrophysics Data System (ADS)

Carlson, Herbert C.; Jensen, Joseph B.

2015-10-01

Wave particle interactions, an essential aspect of laboratory, terrestrial, and astrophysical plasmas, have been studied for decades by transmitting high power HF radio waves into Earth's weakly ionized space plasma, to use it as a laboratory without walls. Application to HF electron acceleration remains an active area of research (Gurevich in Usp Fizicheskikh Nauk 177(11):1145-1177, 2007) today. HF electron acceleration studies began when plasma line observations proved (Carlson et al. in J Atmos Terr Phys 44:1089-1100, 1982) that high power HF radio wave-excited processes accelerated electrons not to ~eV, but instead to -100 times thermal energy (10 s of eV), as a consequence of inelastic collision effects on electron transport. Gurevich et al (J Atmos Terr Phys 47:1057-1070, 1985) quantified the theory of this transport effect. Merging experiment with theory in plasma physics and aeronomy, enabled prediction (Carlson in Adv Space Res 13:1015-1024, 1993) of creating artificial ionospheres once ~GW HF effective radiated power could be achieved. Eventual confirmation of this prediction (Pedersen et al. in Geophys Res Lett 36:L18107, 2009; Pedersen et al. in Geophys Res Lett 37:L02106, 2010; Blagoveshchenskaya et al. in Ann Geophys 27:131-145, 2009) sparked renewed interest in optical inversion to estimate electron spectra in terrestrial (Hysell et al. in J Geophys Res Space Phys 119:2038-2045, 2014) and planetary (Simon et al. in Ann Geophys 29:187-195, 2011) atmospheres. Here we present our unpublished optical data, which combined with our modeling, lead to conclusions that should meaningfully improve future estimates of the spectrum of HF accelerated electron fluxes. Photometric imaging data can significantly improve detection of emissions near ionization threshold, and confirm depth of penetration of accelerated electrons many km below the excitation altitude. Comparing observed to modeled emission altitude shows future experiments need electron density profiles to derive more accurate HF electron flux spectra.

Patient and clinical characteristics that heighten risk for heart failure readmission.

PubMed

Bradford, Chad; Shah, Bijal M; Shane, Patricia; Wachi, Nicole; Sahota, Kamalpreet

2017-11-01

Within 30 days of hospital discharge, heart failure (HF) readmission rates nationally accumulate to more than 20%. Due to this high rate of unplanned re-hospitalization, predictive models are needed to identify patients who pose the highest readmission risk. To evaluate the diagnosis and timing and to identify patient and clinical characteristics associated with 30 day readmissions among HF patients. A retrospective analysis of electronic health records was conducted to study HF admissions during the period October 2008 to November 2014. Patients with a primary discharge diagnosis consistent with HF were included. Descriptive statistics were used to compare the readmitted and non-readmitted cohorts. Logistic regression was used to develop a predictive model to determine patient and clinical variables associated with 30 day readmission. Characteristics of the study cohort (n = 2420) are: a mean age of 72, predominantly male (55%), white (55%), currently not employed (91%), and utilizing Medicare as a payer (68%). Overall, 42% were married. Over the study time period there were 394 (16.3%) 30 day readmissions after 2420 hospitalizations. The 3 most common reasons for readmission were HF (36.0%), renal disorders (8.4%), and other cardiac diseases (6.9%). Analysis showed that 11.9% of patients readmitted during days 0-3, 15.2% during days 4-7, 31.5% during days 8-15, and 41.4% during days 16-30. The final multivariate predictive model included 5 variables that were associated with an increased risk for 30-day readmission: employment status as retired or disabled, > 1 emergency department visit in the past 90 days, length of stay >5 days during index visit, and a BUN value > 45 mg/dL. This study provides a deeper understanding of patient and clinical characteristics that are associated with readmission in HF. Evaluation of these characteristics will provide additional information to guide strategies meant to reduce HF readmission rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Prognostic effects of rosuvastatin in patients with co-existing chronic obstructive pulmonary disease and chronic heart failure: A sub-analysis of GISSI-HF trial.

PubMed

Rossi, Andrea; Inciardi, Riccardo M; Rossi, Andrea; Temporelli, Pier Luigi; Lucci, Donata; Gonzini, Lucio; Marchioli, Roberto; Nicolosi, Gian Luigi; Tavazzi, Luigi

2017-06-01

Rising evidences showed a possible protective role of statins in chronic obstructive pulmonary disease (COPD). We aimed to evaluate in a post-hoc analysis of the GISSI-HF trial the prognostic effect of the use of rosuvastatin in patients with co-existing COPD and HF, assuming that the anti-inflammatory properties of these drugs may imply a potential beneficial effect in these associated chronic inflammatory conditions. We analyzed patients with chronic HF and history of COPD deriving from the GISSI-HF study. Of all 4574 patients eligible to statin, 1060 ambulatory patients with HF and concomitant COPD were enrolled and randomly assigned to rosuvastatin 10 mg daily (538 patients) or placebo (522 patients). The primary end-point was to compare all cause death rate in patients randomized to rosuvastatin or placebo. Further, we assessed the effects of rosuvastatin (10 mg daily) on cardiovascular (CV) death, non-CV death and hospital admissions. Median follow-up was 3.9 years with an interquartile range (IQR) of 3.0-4.4. During the follow-up 438 (41.3%) patients died, 304 (28.6%) for CV death and 687 (64.8%) had at least one hospitalization. The two patient groups had similar outcome, irrespective of randomization, in terms of all-cause mortality (log-rank test p = 0.30) CV, non CV-death (p = 0.88 and 0.09 respectively) and all-cause hospitalization (p = 0.82). Cox regression analysis did not show a favorable association between the use of statin and the examined end-points both on unadjusted and adjusted models. Statin use is not associated with a beneficial effects on all cause, CV, non CV mortality and hospitalization in patients with coexistent chronic HF and history of COPD. ClinicalTrials.gov Identifier: NCT00336336. Copyright © 2017. Published by Elsevier Ltd.

Effects of Spinal Cord Stimulation on Cardiac Sympathetic Nerve Activity in Patients with Heart Failure.

PubMed

Naar, Jan; Jaye, Deborah; Linde, Cecilia; Neužil, Petr; Doškář, Petr; Málek, Filip; Braunschweig, Frieder; Lund, Lars H; Mortensen, Lars; Linderoth, Bengt; Lind, Göran; Bone, Dianna; Scholte, Arthur J; Kueffer, Fred; Koehler, Jodi; Shahgaldi, Kambiz; Lang, Otto; Ståhlberg, Marcus

2017-05-01

Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF. HF patients with a SCS device previously participating in the DEFEAT-HF trial were included in this crossover study with 6-week intervention periods (SCS-ON and SCS-OFF). SCS (50 Hz, 210-μs pulse duration, aiming at T2-T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart-to-mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed. We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS-ON (1.37 ± 0.16) and SCS-OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS-ON (41.5 ± 5.3) and SCS-OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS-ON and SCS-OFF. In patients with HF, SCS (12 hours daily, targeting the T2-T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy. © 2017 Wiley Periodicals, Inc.

Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction.

PubMed

Brainin, Philip; Haahr-Pedersen, Sune; Sengeløv, Morten; Olsen, Flemming Javier; Fritz-Hansen, Thomas; Jensen, Jan Skov; Biering-Sørensen, Tor

2018-05-01

Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1-3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.

A multicenter randomized controlled evaluation of automated home monitoring and telephonic disease management in patients recently hospitalized for congestive heart failure: the SPAN-CHF II trial.

PubMed

Weintraub, Andrew; Gregory, Douglas; Patel, Ayan R; Levine, Daniel; Venesy, David; Perry, Kathleen; Delano, Christine; Konstam, Marvin A

2010-04-01

We performed a prospective, randomized investigation assessing the incremental effect of automated health monitoring (AHM) technology over and above that of a previously described nurse directed heart failure (HF) disease management program. The AHM system measured and transmitted body weight, blood pressure, and heart rate data as well as subjective patient self-assessments via a standard telephone line to a central server. A total of 188 consented and eligible patients were randomized between intervention and control groups in 1:1 ratio. Subjects randomized to the control arm received the Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) heart failure disease management program. Subjects randomized to the intervention arm received the SPAN-CHF disease management program in conjunction with the AHM system. The primary end point was prespecified as the relative event rate of HF hospitalization between intervention and control groups at 90 days. The relative event rate of HF hospitalization for the intervention group compared with controls was 0.50 (95%CI [0.25-0.99], P = .05). Short-term reductions in the heart failure hospitalization rate were associated with the use of automated home monitoring equipment. Long-term benefits in this model remain to be studied. (c) 2010 Elsevier Inc. All rights reserved.

Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study.

PubMed

Koehler, Friedrich; Winkler, Sebastian; Schieber, Michael; Sechtem, Udo; Stangl, Karl; Böhm, Michael; Boll, Herbert; Baumann, Gert; Honold, Marcus; Koehler, Kerstin; Gelbrich, Goetz; Kirwan, Bridget-Anne; Anker, Stefan D

2011-05-03

This study was designed to determine whether physician-led remote telemedical management (RTM) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure (HF). We enrolled 710 stable chronic HF patients in New York Heart Association functional class II or III with a left ventricular ejection fraction ≤35% and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction ≤25%. Patients were randomly assigned (1:1) to RTM or usual care. Remote telemedical management used portable devices for ECG, blood pressure, and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers. The primary end point was death from any cause. The first secondary end point was a composite of cardiovascular death and hospitalization for HF. Baseline characteristics were similar between the RTM (n=354) and control (n=356) groups. Of the patients assigned to RTM, 287 (81%) were at least 70% compliant with daily data transfers and no break for >30 days (except during hospitalizations). The median follow-up was 26 months (minimum 12), and was 99.9% complete. Compared with usual care, RTM had no significant effect on all-cause mortality (hazard ratio, 0.97; 95% confidence interval, 0.67 to 1.41; P=0.87) or on cardiovascular death or HF hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.67 to 1.19; P=0.44). In ambulatory patients with chronic HF, RTM compared with usual care was not associated with a reduction in all-cause mortality. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00543881.

A high-fat diet temporarily accelerates gastrointestinal transit and reduces satiety in men.

PubMed

Clegg, Miriam E; Shafat, Amir

2011-12-01

High-fat (HF) diets of 2 weeks have been shown to accelerate gastrointestinal (GI) transit and decrease satiety. However, the effects of HF diets on GI transit over longer periods than 2 weeks are unknown. We hypothesize that over 4 weeks, GI transit of a HF test meal will accelerate. The study was a repeated measures design with 10 male volunteers completing a 1-week HF diet intervention and 7 completing a 4-week HF diet intervention with testing once a week on the same day throughout the 4 weeks. Gastric emptying (GE) was measured using the (13)C-octanoic acid breath test and mouth-to-caecum transit time (MCTT) using the inulin H(2) breath test. Satiety was analysed using visual analogue scales and an ad libitum buffet meal. Body mass increased by 1.3 kg over the 4 weeks (p = 0.036). GE latency time decreased from 45 ± 8 to 41 ± 10 min (p = 0.047) over 1 week but there were no changes in any GE parameters over the 4 weeks. MCTT was accelerated over 1 week (p = 0.036) from 308 ± 43 to 248 ± 83 min. However, over the 4-week period, there was no change. Volunteers became more hungry and desire to eat became greater after 1 week (p = 0.01). Changes in satiety were also evident over the 4 weeks. Satiety was reduced in the primary weeks and then returned to baseline towards the end of the intervention. GI adaptation to a HF diet occurred over a 1-week period and returned to pre-diet levels at the end of 4 weeks.

TSOC-HFrEF Registry: A Registry of Hospitalized Patients with Decompensated Systolic Heart Failure: Description of Population and Management

PubMed Central

Wang, Chun-Chieh; Chang, Hung-Yu; Yin, Wei-Hsian; Wu, Yen-Wen; Chu, Pao-Hsien; Wu, Chih-Cheng; Hsu, Chih-Hsin; Wen, Ming-Shien; Voon, Wen-Chol; Lin, Wei-Shiang; Huang, Jin-Long; Chen, Shyh-Ming; Yang, Ning-I; Chang, Heng-Chia; Chang, Kuan-Cheng; Sung, Shih-Hsien; Shyu, Kou-Gi; Lin, Jiunn-Lee; Mar, Guang-Yuan; Chan, Kuei-Chuan; Kuo, Jen-Yuan; Wang, Ji-Hung; Chen, Zhih-Cherng; Tseng, Wei-Kung; Cherng, Wen-Jin

2016-01-01

Introduction Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. Methods The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. Results A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean age of 64 years (72% were male). Ischemic cardiomyopathy and dilated cardiomyopathy were diagnosed in 44% and 33% of patients, respectively. Coronary artery disease, hypertension, diabetes, and chronic renal insufficiency were the common comorbid conditions. Acute coronary syndrome, non-compliant to treatment, and concurrent infection were the major precipitating factors for acute decompensation. The median length of hospital stay was 8 days, and the in-hospital mortality rate was 2.4%. At discharge, 62% of patients were prescribed either angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, 60% were prescribed beta-blockers, and 49% were prescribed mineralocorticoid receptor antagonists. Conclusions The TSOC-HFrEF registry provided important insights into the current clinical characteristics and management of hospitalized decompensated systolic HF patients in Taiwan. One important observation was that adherence to guideline-directed medical therapy was suboptimal. PMID:27471353

Risk stratification for death and all-cause hospitalization in heart failure clinic outpatients.

PubMed

Hummel, Scott L; Ghalib, Hussam H; Ratz, David; Koelling, Todd M

2013-11-01

Most heart failure (HF) risk stratification models were developed for inpatient use, and available outpatient models use a complex set of variables. We hypothesized that routinely collected clinical data could predict the 6-month risk of death and all-cause medical hospitalization in HF clinic outpatients. Using a quality improvement database and multivariable Cox modeling, we derived the Heart Failure Patient Severity Index (HFPSI) in the University of Michigan HF clinic (UM cohort, n = 1,536; 314 reached primary outcome). We externally validated the HFPSI in the Ann Arbor Veterans' Affairs HF clinic (VA cohort, n = 445; 106 outcomes) and explored "real-time" HFPSI use (VA-RT cohort, n = 486; 141 outcomes) by tracking VA patients for 6 months from their most recently calculated HFPSI, rather than using an arbitrary start date for the cohort. The HFPSI model included blood urea nitrogen, B-type natriuretic peptide, New York Heart Association class, diabetes status, history of atrial fibrillation/flutter, and all-cause hospitalization within the prior 1 and 2 to 6 months. The concordance c statistics in the UM/VA/VA-RT cohorts were 0.71/0.68/0.74. Kaplan-Meier curves and log-rank testing demonstrated excellent risk stratification, particularly between a large, low-risk group (40% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 8%/12%/12%) and a small, high-risk group (10% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 57%/58%/79%). The HFPSI uses readily available data to predict the 6-month risk of death and/or all-cause medical hospitalization in HF clinic outpatients and could potentially help allocate specialized HF resources within health systems. © 2013.

Susceptibility of Nrf2-Null Mice to Steatohepatitis and Cirrhosis upon Consumption of a High-Fat Diet Is Associated with Oxidative Stress, Perturbation of the Unfolded Protein Response, and Disturbance in the Expression of Metabolic Enzymes but Not with Insulin Resistance

PubMed Central

Meakin, Paul J.; Chowdhry, Sudhir; Sharma, Ritu S.; Ashford, Fiona B.; Walsh, Shaun V.; McCrimmon, Rory J.; Dinkova-Kostova, Albena T.; Dillon, John F.

2014-01-01

Mice lacking the transcription factor NF-E2 p45-related factor 2 (Nrf2) develop more severe nonalcoholic steatohepatitis (NASH), with cirrhosis, than wild-type (Nrf2+/+) mice when fed a high-fat (HF) diet for 24 weeks. Although NASH is usually associated with insulin resistance, HF-fed Nrf2−/− mice exhibited better insulin sensitivity than HF-fed Nrf2+/+ mice. In livers of HF-fed mice, loss of Nrf2 resulted in greater induction of lipogenic genes, lower expression of β-oxidation genes, greater reduction in AMP-activated protein kinase (AMPK) levels, and diminished acetyl coenzyme A (CoA) carboxylase phosphorylation than in the wild-type livers, which is consistent with greater fatty acid (FA) synthesis in Nrf2−/− livers. Moreover, primary Nrf2−/− hepatocytes displayed lower glucose and FA oxidation than Nrf2+/+ hepatocytes, with FA oxidation partially rescued by treatment with AMPK activators. The unfolded protein response (UPR) was perturbed in control regular-chow (RC)-fed Nrf2−/− mouse livers, and this was associated with constitutive activation of NF-κB and JNK, along with upregulation of inflammatory genes. The HF diet elicited an antioxidant response in Nrf2+/+ livers, and as this was compromised in Nrf2−/− livers, they suffered oxidative stress. Therefore, Nrf2 protects against NASH by suppressing lipogenesis, supporting mitochondrial function, increasing the threshold for the UPR and inflammation, and enabling adaptation to HF-diet-induced oxidative stress. PMID:24958099

Susceptibility of Nrf2-null mice to steatohepatitis and cirrhosis upon consumption of a high-fat diet is associated with oxidative stress, perturbation of the unfolded protein response, and disturbance in the expression of metabolic enzymes but not with insulin resistance.

PubMed

Meakin, Paul J; Chowdhry, Sudhir; Sharma, Ritu S; Ashford, Fiona B; Walsh, Shaun V; McCrimmon, Rory J; Dinkova-Kostova, Albena T; Dillon, John F; Hayes, John D; Ashford, Michael L J

2014-09-01

Mice lacking the transcription factor NF-E2 p45-related factor 2 (Nrf2) develop more severe nonalcoholic steatohepatitis (NASH), with cirrhosis, than wild-type (Nrf2(+/+)) mice when fed a high-fat (HF) diet for 24 weeks. Although NASH is usually associated with insulin resistance, HF-fed Nrf2(-/-) mice exhibited better insulin sensitivity than HF-fed Nrf2(+/+) mice. In livers of HF-fed mice, loss of Nrf2 resulted in greater induction of lipogenic genes, lower expression of β-oxidation genes, greater reduction in AMP-activated protein kinase (AMPK) levels, and diminished acetyl coenzyme A (CoA) carboxylase phosphorylation than in the wild-type livers, which is consistent with greater fatty acid (FA) synthesis in Nrf2(-/-) livers. Moreover, primary Nrf2(-/-) hepatocytes displayed lower glucose and FA oxidation than Nrf2(+/+) hepatocytes, with FA oxidation partially rescued by treatment with AMPK activators. The unfolded protein response (UPR) was perturbed in control regular-chow (RC)-fed Nrf2(-/-) mouse livers, and this was associated with constitutive activation of NF-κB and JNK, along with upregulation of inflammatory genes. The HF diet elicited an antioxidant response in Nrf2(+/+) livers, and as this was compromised in Nrf2(-/-) livers, they suffered oxidative stress. Therefore, Nrf2 protects against NASH by suppressing lipogenesis, supporting mitochondrial function, increasing the threshold for the UPR and inflammation, and enabling adaptation to HF-diet-induced oxidative stress. Copyright © 2014 Meakin et al.

Sacubitril/valsartan: An important piece in the therapeutic puzzle of heart failure.

PubMed

Marques da Silva, Pedro; Aguiar, Carlos

2017-09-01

Sacubitril/valsartan (LCZ696), a supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, was recently approved in the EU and the USA for the treatment of chronic heart failure (HF) with reduced ejection fraction (HFrEF) (NYHA class II-IV). Inhibition of chronically activated neurohormonal pathways (the renin-angiotensin-aldosterone system [RAAS] and sympathetic nervous system [SNS]) is central to the treatment of chronic HFrEF. Furthermore, enhancement of the natriuretic peptide (NP) system, with favorable cardiovascular (CV) and renal effects in HF, is a desirable therapeutic goal to complement RAAS and SNS blockade. Sacubitril/valsartan represents a novel pharmacological approach that acts by enhancing the NP system via inhibition of neprilysin (an enzyme that degrades NPs) and by suppressing the RAAS via AT1 receptor blockade, thereby producing more effective neurohormonal modulation than can be achieved with RAAS inhibition alone. In the large, randomized, double-blind PARADIGM-HF trial, replacement of an angiotensin-converting enzyme inhibitor (ACEI) (enalapril) with sacubitril/valsartan resulted in a significant improvement in morbidity and mortality in patients with HFrEF. Sacubitril/valsartan was superior to enalapril in reducing the risk of CV death or HF hospitalization (composite primary endpoint) and all-cause death, and in limiting progression of HF. Sacubitril/valsartan was generally well tolerated, with a comparable safety profile to enalapril; symptomatic hypotension was more common with sacubitril/valsartan, whereas renal dysfunction, hyperkalemia and cough were less common compared with enalapril. In summary, sacubitril/valsartan is a superior alternative to ACEIs/ARBs in the treatment of HFrEF, a recommendation that is reflected in many HF guidelines. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Impact of prior permanent pacemaker on long-term clinical outcomes of patients undergoing percutaneous coronary intervention.

PubMed

Li, Yan-Jie; Zhang, Wei-Wei; Yang, Xiao-Xiao; Li, Ning; Qiu, Xing-Biao; Qu, Xin-Kai; Fang, Wei-Yi; Yang, Yi-Qing; Li, Ruo-Gu

2017-04-01

The impact of permanent pacemaker (PPM) on long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) has not been studied. PPM may increase heart failure (HF) burden on patients undergoing PCI. We recruited consecutive patients undergoing PCI and carried out a nested case-control study. Patients with confirmed PPM undergoing first PCI were identified and matched by age and sex in 1:1 fashion to patients without PPM undergoing first PCI. Clinical data were collected and analyzed. The primary endpoint outcomes were all-cause mortality and hospitalization for HF. The final analysis included 156 patients. The mean follow-up period was 4.6 ± 2.9 years. The overall all-cause mortality was 21.15%, without significant difference between the 2 groups (21.79% vs 20.51%; P = 0.85). However, the rate of HF-related hospitalization was significantly higher in patients with PPM than in controls (26.92% vs 10.26%; P = 0.008). After adjustment for hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, left ventricular ejection fraction, brain natriuretic peptide, and acute coronary syndrome (ACS), PCI patients with PPM were still associated with a greater hospitalization rate for HF (odds ratio: 4.31, 95% confidence interval: 0.94-19.80, P = 0.061). Further analysis in the ACS subgroup showed VVI-mode pacing enhanced the risk for HF-associated hospitalization (adjusted odds ratio: 8.27, 95% confidence interval: 1.37-49.75, P = 0.02). PPM has no effect on all-cause mortality in patients undergoing first PCI but significantly increases the HF-associated hospitalization rate, especially in ACS patients. © 2016 Wiley Periodicals, Inc.

Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial.

PubMed

Payvar, Saeed; Spertus, John A; Miller, Alan B; Casscells, S Ward; Pang, Peter S; Zannad, Faiez; Swedberg, Karl; Maggioni, Aldo P; Reid, Kimberly J; Gheorghiade, Mihai

2013-12-01

Risk stratification in patients admitted with worsening heart failure (HF) is essential for tailoring therapy and counselling. Risk models are available but rarely used, in part because many require laboratory and imaging results that are not routinely available. Body temperature is associated with prognosis in other illnesses, and we hypothesized that low body temperature would be associated with worse outcomes in patients admitted with worsening HF. The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial was an event-driven, randomized, double-blind, placebo-controlled study of tolvaptan in 4133 patients hospitalized for worsening HF with an EF <40%. Co-primary endpoints were all-cause mortality and cardiovascular (CV) death or HF rehospitalization. Body temperature was measured orally at randomization and entered in analyses both as a continuous variable and categorized into three groups (<36 °C, 36-36.5 °C, and >36.5 °C) using Cox regression models. The composite of CV death or HF rehospitalization occurred in 1544 patients within 1 year. For every 1 °C decrease in body temperature, the risk of adverse outcomes increased by 16% [hazard raio (HR) 1.16, 95% confidence interval (CI) 1.04-1.28], after adjustment for age, gender, race, systolic blood pressure, EF, blood urea nitrogen, and serum sodium. In fully adjusted analysis, the risk of adverse outcomes in the lowest body temperature group (<36 °C) was 51% higher than that of the index group (>36.5 °C) (HR 1.35, 95% CI 1.15-1.58). Low body temperature is an independent marker of poor cardiovascular outcomes in patients admitted with worsening HF and reduced EF.

Early insights into the characteristics and evolution of clinical parameters in a cohort of patients prescribed sacubitril/valsartan in Germany.

PubMed

Wachter, Rolf; Viriato, Daniel; Klebs, Sven; Grunow, Stefanie S; Schindler, Matthias; Engelhard, Johanna; Proenca, Catia C; Calado, Frederico; Schlienger, Raymond; Dworak, Markus; Balas, Bogdan; Bruce Wirta, Sara

2018-04-01

This study aimed to provide early insights into sacubitril/valsartan (sac/val) prescription patterns and the demographic and clinical characteristics of patients prescribed sac/val in primary care and cardiology settings in Germany. The study used electronic medical records from the German IMS® Disease Analyzer database. Patients with ≥1 prescription for sac/val during 1 January-31 December 2016 (n = 1643) were identified and followed up for ≤12 months from first prescription. Patients with ≥1 heart failure (HF) diagnosis during the study period, ≥1 additional HF diagnosis in the full history of the database, and ≥1 prescription for an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and a β-blocker during the study period, without a prescription for sac/val (n = 25,264), were included as a reference cohort. Changes in clinical parameters in the 12 months before and after sac/val initiation were investigated and compared with those from the PARADIGM-HF study. The characteristics of patients prescribed sac/val more closely resembled those of patients enrolled in PARADIGM-HF (e.g. younger age, higher proportion of men than women, lower systolic blood pressure) than patients in the reference cohort. Most patients were initiated on the lowest dose of sac/val irrespective of clinical setting. Significant decreases (p < 0.001) in NT-proBNP and glycated haemoglobin levels were observed following sac/val initiation. Patients prescribed sac/val had similar baseline demographics and clinical characteristics to those from PARADIGM-HF, and most patients were initiated on the lowest dose. Changes in clinical parameters before and after initiation mirrored findings from the PARADIGM-HF study.

Prognosis of Adults with Borderline Left Ventricular Ejection Fraction

PubMed Central

Tsao, Connie W.; Lyass, Asya; Larson, Martin G.; Cheng, Susan; Lam, Carolyn S.P.; Aragam, Jayashri R.; Benjamin, Emelia J.; Vasan, Ramachandran S.

2016-01-01

Objectives To examine the association of borderline LVEF of 50-55% with cardiovascular morbidity and mortality in a community-based cohort. Background Guidelines stipulate left ventricular ejection fraction (LVEF) >55% as normal, but the optimal threshold, if any, remains uncertain. The prognosis of a “borderline” LVEF, 50-55%, is unknown. Methods We evaluated Framingham Heart Study participants who underwent echocardiography between 1979 and 2008 (n=10,270 person-observations, mean age 60 years, 57% women). Using pooled data with up to 12 years of follow-up and multivariable Cox regression, we evaluated the associations of borderline LVEF, and continuous LVEF to the risk of developing a composite outcome (heart failure [HF] or death; primary outcome) and incident HF (secondary outcome). Results During follow-up (median 7.9 years), 355 participants developed HF and 1070 died. Among participants with LVEF 50-55% (prevalence 3.5%), rates of the composite outcome and HF were 0.24 and 0.13 per 10 years follow-up, respectively, versus 0.16 and 0.05 in those having normal LVEF. In multivariable-adjusted analyses, LVEF 50-55% was associated with increased risk of the composite outcome (Hazards ratio [HR] 1.37, 95% CI 1.05-1.80) and HF (HR 2.15, 95% CI 1.41-3.28). There was a linear inverse relationship of continuous LVEF with the composite outcome (HR per 5 LVEF% decrement: 1.12, 95% CI 1.07-1.16) and HF (HR 1.23 per 5 LVEF% decrement, 95% CI 1.15-1.32). Conclusions Individuals with LVEF of 50-55% in the community have greater risk for morbidity and mortality relative to those with LVEF >55%. Additional studies are warranted to elucidate their optimal management. PMID:27256754

EFFECTS OF HUMIC ACID PURIFICATION ON INTERACTION WITH HYDROPHOBIC ORGANIC MATTER: EVIDENCE FROM FLUORESCENCE BEHAVIOR. (R822832)

EPA Science Inventory

Conventional isolation of humic materials from natural
matrixes includes demineralization by treatment with HF/HCl. The possible effect of this on the structural integrity of
humic acid (HA) was investigated by comparing the
interactions of two aqueous HAs, one produc...

Determining the Sensitivity of the Hf-Nd Proxy to Glacial Weathering

NASA Astrophysics Data System (ADS)

Namsinh, A.; Scher, H.; Piotrowski, A. M.

2017-12-01

The history of polar ice sheets through the Cenozoic is incompletely known. Estimates of the onset of northern hemisphere glaciation range from the Pliocene to mid-Eocene and precursor Antarctic glaciations are believed to have commenced in the middle Eocene. Uncertainty surrounding the history of ice sheets has resulted in debates about the sensitivity of ice sheets to changes in atmospheric CO2 through the Cenozoic. Geochemical proxies for continental weathering — particularly those that are sensitive to mechanical breakdown of the upper continental crust by ice sheets — could improve the fidelity of paleoclimate reconstructions of ice sheet history. Coupled hafnium (Hf) and neodymium (Nd) isotopes in seawater and authigenic sediment phases show a strong correlation with mechanical weathering rates, however the proxy has not been systematically tested on Pleistocene time scales. We measured the Hf and Nd isotope ratios of authigenic and detrital phases of sediment cores from 1150 m to 4045 m depth on the Rockall Plateau in the NE Atlantic Ocean. Our study is limited to the LGM, deglaciation and Holocene intervals. The authigenic fraction was extracted from bulk sediments by leaching with dilute hydroxylamine hydrochloride and EDTA to prevent readsorption of Hf. A stronger leach solution was then used to isolate the terrigenous detrital fraction. The fidelity of the seawater signal obtained by leaching is assessed by comparison of leachate eNd values to previously published eNd values from uncleaned forams from the same depth intervals. Initial tests with Holocene and deglacial samples verify that leachate eNd values are statistically indistinguishable from uncleaned forams. Shale-normalized REE patterns for leachates reveal negative Ce anomalies and a MREE enrichment typical of Fe-Mn oxydydroxide phases. Coupled Hf-Nd isotopes from authigenic leachates from our initial tests fall along the Seawater Array when plotted on a Hf-Nd isotope diagram, confirming that a primary seawater Hf isotope signal can also be extracted from authigenic leachates. Further isotopic analysis of these cores, including the LGM intervals, will reveal if changes in weathering style through the deglaciation resulted in decoupling of Hf and Nd isotopes, which may be expressed as a deviation from the Seawater Array.

Rationale and design of the comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode (PIONEER-HF) trial.

PubMed

Velazquez, Eric J; Morrow, David A; DeVore, Adam D; Ambrosy, Andrew P; Duffy, Carol I; McCague, Kevin; Hernandez, Adrian F; Rocha, Ricardo A; Braunwald, Eugene

2018-04-01

The objective is to assess the safety, tolerability, and efficacy of sacubitril/valsartan compared with enalapril in patients with heart failure (HF) with a reduced ejection fraction (EF) stabilized during hospitalization for acute decompensated HF. Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitor, improves survival among ambulatory HF patients with a reduced EF. However, there is very limited experience with the in-hospital initiation of sacubitril/valsartan in patients who have been stabilized following hospitalization for acute decompensated HF. PIONEER-HF is a 12-week, prospective, multicenter, double-blind, randomized controlled trial enrolling a planned 882 patients at more than 100 participating sites in the United States. Medically stable patients >18 years of age with an EF <40% and an amino terminal-pro b-type natriuretic peptide >1600 pg/mL or b-type natriuretic peptide >400 pg/mL are eligible for participation no earlier than 24 hours and up to 10 days from initial presentation while still hospitalized. Patients are randomly assigned 1:1 to in-hospital initiation of sacubitril/valsartan titrated to 97/103 mg by mouth twice daily versus enalapril titrated to 10 mg by mouth twice daily for 8 weeks. All patients receive open-label treatment with sacubitril/valsartan for the remaining 4 weeks of the study. The primary efficacy end point is the time-averaged proportional change in amino terminal-pro b-type natriuretic peptide from baseline through weeks 4 and 8. Secondary and exploratory end points include serum and urinary biomarkers as well as clinical outcomes. Safety end points include the incidence of angioedema, hypotension, renal insufficiency, and hyperkalemia. The PIONEER-HF trial will inform clinical practice by providing evidence on the safety, tolerability, and efficacy of in-hospital initiation of sacubitril/valsartan among patients who have been stabilized following an admission for acute decompensated HF with a reduced EF. Copyright © 2018 Elsevier Inc. All rights reserved.

Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death.

PubMed

DeMazumder, Deeptankar; Limpitikul, Worawan B; Dorante, Miguel; Dey, Swati; Mukhopadhyay, Bhasha; Zhang, Yiyi; Moorman, J Randall; Cheng, Alan; Berger, Ronald D; Guallar, Eliseo; Jones, Steven R; Tomaselli, Gordon F

2016-12-01

The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyX QT , a novel non-linear measure of cardiac repolarization dynamics. In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyX QT . The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60 ± 13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29 ± 16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45 ± 24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyX QT ) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyX QT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. EntropyX QT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyX QT complements conventional risk predictors and has the potential for broad clinical application. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review protocol.

PubMed

Slyer, Jason T; Ferrara, Lucille R

The objective of this review is to identify the effectiveness of group visits for patients with heart failure (HF) on knowledge, quality of life, self-care behaviors, and hospital readmissions. BACKGROUND: Heart failure (HF) continues to be a major health burden throughout the world. There are currently over 5.7 million Americans, 15 million Europeans, and 277,800 Australians living with HF. These numbers are expected to double by 2040. Patients and caregivers perform the majority of HF care in the home. Patients with HF need to learn to be successful in self-managing their condition to lessen the burden of symptoms such as fatigue, dyspnea, and edema.Patient education is the primary process used to increase knowledge of self-care practices for patients with HF. Patients with HF need to follow a complex medical regimen while adhering to a low sodium diet and prescribed fluid restrictions. In addition patients monitor their physical condition daily for exacerbation of symptoms or signs of fluid overload. Education, behavior modification, and skill development are necessary for a patient with HF to be successful in self-managing their condition.Most HF education occurs during one-on-one visits between the patient and the health care provider in an examination room during a regular clinic visit. However, there is usually limited time to address all of the needed education topics in an in-depth, meaningful manner with information the patient can take home and utilize in their daily routines.Group visits provide an alternative venue to provide care for this complex patient population. A group visit is an interactive process between a health care provider and a small group of patients and their caregivers who usually share a common medical concern. The participants of group visits can benefit from the knowledge and experiences of the other participants while providing support and encouragement to each other as they learn to cope with living with a chronic condition.The process of the group visit was first developed in 1991 by Dr. John C. Scott at the Kaiser Permanente system in Colorado, United States. Dr. Scott and a nurse held monthly group visits lasting 60 minutes with a group of 15 to 20 patients to manage their complex medical conditions. The group visit model can vary across settings, including from 6-20 patients over a 1-2 hour period with varying times devoted to education and discussion of health concerns. The group visit typically incorporates a one-on-one physical examination with a physician or nurse practitioner in conjunction with a group discussion and medical management. Group visits have shown to be beneficial in improving patient outcomes for conditions such as diabetes, hypertension, and other chronic illness.The goal of group visits for patients with HF is to increase patient knowledge and self-care abilities, while improving self-efficacy. Self-care incorporates the decision making process a patient undergoes when deciding on a course of action to maintain stability as a result of a change in symptoms. Improved self-care can improve symptoms, which will likely result in an increase in quality of life and a reduction in hospitalizations related to decompensation. Quality of life (QOL) refers to a patient's perception of the impact of a health condition and treatment on the patient's health status and can be measured with valid and reliable tools such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or the Kansas City Cardiomyopathy Questionnaire (KCCQ). Self-care abilities can be measured using an instrument such as the Self-Care Heart Failure Index (SCHFI). HF knowledge can be measured using an instrument such as the Atlanta Heart Failure Knowledge Test. Group visits can be used to continue to optimize medication therapy while providing a forum for knowledge acquisition and fostering support.A search of the Cochrane Library of Systematic Reviews, the Joanna Briggs Library of Systematic Reviews, MEDLINE, and CINAHL did not identify any previously conducted systematic reviews on the effectiveness of group visits on outcomes for patients with heart failure. Therefore, this review seeks to identify studies evaluating the effectiveness of group visits for patients with heart failure on patient knowledge, quality of life, self-care behaviors, and hospital readmissions.

Application of DRIFTS, 13 C NMR, and py-MBMS to Characterize the Effects of Soil Science Oxidation Assays on Soil Organic Matter Composition in a Mollic Xerofluvent

DOE Office of Scientific and Technical Information (OSTI.GOV)

Margenot, Andrew J.; Calderón, Francisco J.; Magrini, Kimberly A.

Chemical oxidations are routinely employed in soil science to study soil organic matter (SOM), and their interpretation could be improved by characterizing oxidation effects on SOM composition with spectroscopy. We investigated the effects of routinely employed oxidants on SOM composition in a Mollic Xerofluvent representative of intensively managed agricultural soils in the California Central Valley. Soil samples were subjected to oxidation by potassium permanganate (KMnO4), sodium hypochlorite (NaOCl), and hydrogen peroxide (H2O2). Additionally, non-oxidized and oxidized soils were treated with hydrofluoric acid (HF) to evaluate reduction of the mineral component to improve spectroscopy of oxidation effects. Oxidized non-HF and HF-treatedmore » soils were characterized by diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS), 13C cross polarization magic angle spinning (CP-MAS) nuclear magnetic resonance (NMR) spectroscopy, and pyrolysis molecular beam mass spectrometry (py-MBMS), and for particle size distribution (PSD) using laser diffractometry (LD). Across the range of soil organic carbon (OC) removed by oxidations (14-72%), aliphatic C-H stretch at 3000-2800 cm-1 (DRIFTS) decreased with OC removal, and this trend was enhanced by HF treatment due to significant demineralization in this soil (70%). Analysis by NMR spectroscopy was feasible only after HF treatment, and did not reveal trends between OC removal and C functional groups. Pyrolysis-MBMS did not detect differences among oxidations, even after HF treatment of soils. Hydrofluoric acid entailed OC loss (13-39%), and for H2O2 oxidized soils increased C:N and substantially decreased mean particle size. This study demonstrates the feasibility of using HF to improve characterizations of SOM composition following oxidations as practiced in soil science, in particular for DRIFTS. Since OC removal by oxidants, mineral removal by HF, and the interaction of oxidants and HF observed for this soil may differ for soils with different mineralogies, future work should examine additional soil and land use types to optimize characterizations of oxidation effects on SOM composition.« less

Association of ambient particulate matter with heart failure incidence and all-cause readmissions in Tasmania: an observational study.

PubMed

Huynh, Quan L; Blizzard, Christopher Leigh; Marwick, Thomas H; Negishi, Kazuaki

2018-05-10

We sought to investigate the relationship between air quality and heart failure (HF) incidence and rehospitalisation to elucidate whether there is a threshold in this relationship and whether this relationship differs for HF incidence and rehospitalisation. This retrospective observational study was performed in an Australian state-wide setting, where air pollution is mainly associated with wood-burning for winter heating. Data included all 1246 patients with a first-ever HF hospitalisation and their 3011 subsequent all-cause readmissions during 2009-2012. Daily particulate matter <2.5 µm (PM 2.5 ), temperature, relative humidity and influenza infection were recorded. Poisson regression was used, with adjustment for time trend, public and school holiday and day of week. Tasmania has excellent air quality (median PM 2.5 =2.9 µg/m 3 (IQR: 1.8-6.0)). Greater HF incidences and readmissions occurred in winter than in other seasons (p<0.001). PM 2.5 was detrimentally associated with HF incidence (risk ratio (RR)=1.29 (1.15-1.42)) and weakly so with readmission (RR=1.07 (1.02-1.17)), with 1 day time lag. In multivariable analyses, PM 2.5 significantly predicted HF incidence (RR=1.12 (1.01-1.24)) but not readmission (RR=0.96 (0.89-1.04)). HF incidence was similarly low when PM <4 µg/m 3 and only started to rise when PM 2.5 ≥4 µg/m 3 . Stratified analyses showed that PM 2.5 was associated with readmissions among patients not taking beta-blockers but not among those taking beta-blockers (p interaction =0.011). PM 2.5 predicted HF incidence, independent of other environmental factors. A possible threshold of PM 2.5 =4 µg/m 3 is far below the daily Australian national standard of 25 µg/m 3 . Our data suggest that beta-blockers might play a role in preventing adverse association between air pollution and patients with HF. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Interaction between AT1 receptor and NF-κB in hypothalamic paraventricular nucleus contributes to oxidative stress and sympathoexcitation by modulating neurotransmitters in heart failure.

PubMed

Yu, Xiao-Jing; Suo, Yu-Ping; Qi, Jie; Yang, Qing; Li, Hui-Hua; Zhang, Dong-Mei; Yi, Qiu-Yue; Zhang, Jian; Zhu, Guo-Qing; Zhu, Zhiming; Kang, Yu-Ming

2013-12-01

Angiotensin II type 1 receptor (AT1-R) and nuclear factor-kappaB (NF-κB) in the paraventricular nucleus (PVN) play important roles in heart failure (HF); however, the central mechanisms by which AT1-R and NF-κB contribute to sympathoexcitation in HF are yet unclear. In this study, we determined whether interaction between AT1-R and NF-κB in the PVN modulates neurotransmitters and contributes to NAD(P)H oxidase-dependent oxidative stress and sympathoexcitation in HF. Rats were implanted with bilateral PVN cannulae and subjected to coronary artery ligation or sham surgery (SHAM). Subsequently, animals were treated for 4 weeks through bilateral PVN infusion with either vehicle or losartan (LOS, 10 μg/h), an AT1-R antagonist; or pyrrolidine dithiocarbamate (PDTC, 5 μg/h), a NF-κB inhibitor via osmotic minipump. Myocardial infarction (MI) rats had higher levels of glutamate (Glu), norepinephrine (NE) and NF-κB p65 activity, lower levels of gamma-aminobutyric acid (GABA), and more positive neurons for phosphorylated IKKβ and gp91(phox) (a subunit of NAD(P)H oxidase) in the PVN when compared to SHAM rats. MI rats also had higher levels of renal sympathetic nerve activity (RSNA) and plasma proinflammatory cytokines (PICs), NE and epinephrine. PVN infusions of LOS or PDTC attenuated the decreases in GABA and the increases in gp91(phox), NF-κB activity, Glu and NE, in the PVN of HF rats. PVN infusions of LOS or PDTC also attenuated the increases in RSNA and plasma PICs, NE and epinephrine in MI rats. These findings suggest that interaction between AT1 receptor and NF-κB in the PVN contributes to oxidative stress and sympathoexcitation by modulating neurotransmitters in heart failure.

Spin texture induced by oxygen vacancies in strontium perovskite (001) surfaces: A theoretical comparison between SrTiO3 and SrHfO3

NASA Astrophysics Data System (ADS)

Garcia-Castro, A. C.; Vergniory, M. G.; Bousquet, E.; Romero, A. H.

2016-01-01

The electronic structure of SrTiO3 and SrHfO3 (001) surfaces with oxygen vacancies is studied by means of first-principles calculations. We reveal how oxygen vacancies within the first atomic layer of the SrTiO3 surface (i) induce a large antiferrodistortive motion of the oxygen octahedra at the surface, (ii) drive localized magnetic moments on the Ti 3 d orbitals close to the vacancies, and (iii) form a two-dimensional electron gas localized within the first layers. The analysis of the spin texture of this system exhibits a splitting of the energy bands according to the Zeeman interaction, lowering of the Ti 3 dx y level in comparison with dx z and dy z, and also an in-plane precession of the spins. No Rashba-like splitting for the ground state or for the ab initio molecular dynamics trajectory at 400 K is recognized as suggested recently by A. F. Santander-Syro et al. [Nat. Mater. 13, 1085 (2014), 10.1038/nmat4107]. Instead, a sizable Rashba-like splitting is observed when the Ti atom is replaced by a heavier Hf atom with a much larger spin-orbit interaction. However, we observe the disappearance of the magnetism and the surface two-dimensional electron gas when full structural optimization of the SrHfO3 surface is performed. Our results uncover the sensitive interplay of spin-orbit coupling, atomic relaxations, and magnetism when tuning these Sr-based perovskites.

Arecibo - HF experiments in the E_region

NASA Astrophysics Data System (ADS)

Nossa, E.; Jain, K.; Sulzer, M. P.; Perillat, P.

2017-12-01

The new Arecibo Observatory - HF facility started operations in 2015. The HF facility is fully operational, acquiring consecutive days of data without unwanted interruptions. It has a maximum transmitted power of 600kW, with center frequencies at 5.125 MHz and 8.175 MHz. The 8.175 (5.125) MHz band frequency has a gain of 25.5 (22) dB and HPBW of 8.5 (13) degrees. The effects of the HF experiments in the ionosphere are being observed with the Arecibo incoherent scatter radar (ISR). The ISR has two beams that simultaneously could sense the modified region and the region outside of the affected volume. The ISR has height resolution of 300 m. and allows to observe from altitudes 95 km to the topside ionosphere. Observation of the E-region - HF experiments are sparse but possible at Arecibo. High ionization at a height 100 km are needed to modify the region artificially. This paper presents examples of E-region enhanced plasma lines (See Figure). Diagnostic of the layers is made using the ISR to estimate electron density, temperatures, ion drifts, among others. The data shows exceptional modifications of the ionosphere that range from creating artificial cavities and layers, induced irregularities, substantial variations in temperature profiles to enhanced ion and plasma densities.Previously, the HF experiments were performed to study specific effects in a narrow region. However, the extent of the data collected with the ISR during 2017 is revealing new features and different kind of forces that artificially modify extended regions of the ionosphere. This paper exhibits examples where the interaction between the E and F-region when HF experiments are evident. A theory of a correlation between the two layers due to different conductivities is explored to illustrate how the enhancement of irregularities is produced and maintained over time. Examples of strong artificially induced irregularities formed at F-region heights when Sporadic E-layer is present are shown to support the theory.The Figure shows an enhanced plasma line for the diurnal E-region. For this HF experiment, the plasma density increased from 3.6 MHz to 5.1MHz (which corresponds to the HF frequency). The vertical lines observed in the Figure are artifacts from the data, as well as the fake enhanced plasma lines at frequencies different than the HF frequency.

Phonon response of some heavy Fermion systems in dynamic limit

NASA Astrophysics Data System (ADS)

Sahoo, Jitendra; Shadangi, Namita; Nayak, Pratibindhya

2017-05-01

The phonon excitation spectrum of some Heavy Fermion (HF) systems in the presence of electron-phonon interaction is studied in the dynamic limit (ω≠0). The renormalized excitation phonon frequencies (ω˜ = ω/ω0) are evaluated through Periodic Anderson Model (PAM) in the presence of electron-phonon interaction using Zubarev-type double time temperature-dependent Green function. The calculated renormalized phonon energy is analyzed through the plots of (ω˜ = ω/ω0) against temperature for different system parameters like effective coupling strength ‘g’ and the position of f-level ‘d’. The observed behavior is analyzed and found to agree with the general features of HF systems found in experiments. Further, it is observed that in finite but small q-values the propagating phonons harden and change to localized peaks.

Modeling and characterization of as-welded microstructure of solid solution strengthened Ni-Cr-Fe alloys resistant to ductility-dip cracking Part II: Microstructure characterization

NASA Astrophysics Data System (ADS)

Unfried-Silgado, Jimy; Ramirez, Antonio J.

2014-03-01

In part II of this work is evaluated the as-welded microstructure of Ni-Cr-Fe alloys, which were selected and modeled in part I. Detailed characterization of primary and secondary precipitates, subgrain and grain structures, partitioning, and grain boundary morphology were developed. Microstructural characterization was carried out using optical microscopy, SEM, TEM, EBSD, and XEDS techniques. These results were analyzed and compared to modeling results displaying a good agreement. The Hf additions produced the highest waviness of grain boundaries, which were related to distribution of Hf-rich carbonitrides. Experimental evidences about Mo distribution into crystal lattice have provided information about its possible role in ductility-dip cracking (DDC). Characterization results of studied alloys were analyzed and linked to their DDC resistance data aiming to establish relationships between as-welded microstructure and hot deformation performance. Wavy grain boundaries, primary carbides distribution, and strengthened crystal lattice are metallurgical characteristics related to high DDC resistance.

Consumption of a High-Fat Diet Induces Central Insulin Resistance Independent of Adiposity

PubMed Central

Clegg, Deborah J.; Gotoh, Koro; Kemp, Christopher; Wortman, Matthew D.; Benoit, Stephen C.; Brown, Lynda M.; D’Alessio, David; Tso, Patrick; Seeley, Randy J.; Woods, Stephen C.

2011-01-01

Plasma insulin enters the CNS where it interacts with insulin receptors in areas that are related to energy homeostasis and elicits a decrease of food intake and body weight. Here, we demonstrate that consumption of a high-fat (HF) diet impairs the central actions of insulin. Male Long-Evans rats were given chronic (70-day) or acute (3-day) ad libitum access to HF, low-fat (LF), or chow diets. Insulin administered into the 3rd-cerebral ventricle (i3vt) decreased food intake and body weight of LF and chow rats but had no effect on HF rats in either the chronic or the acute experiment. Rats chronically pair-fed the HF diet to match the caloric intake of LF rats, and with body weights and adiposity levels comparable to those of LF rats, were also unresponsive to i3vt insulin when returned to ad lib food whereas rats pair-fed the LF diet had reduced food intake and body weight when administered i3vt insulin. Insulin’s inability to reduce food intake in the presence of the high-fat diet was associated with a reduced ability of insulin to activate its signaling cascade, as measured by pAKT. Finally, i3vt administration of insulin increased hypothalamic expression of POMC mRNA in the LF-but not the HF-fed rats. We conclude that consumption of a HF diet leads to central insulin resistance following short exposure to the diet, and as demonstrated by reductions in insulin signaling and insulin-induced hypothalamic expression of POMC mRNA. PMID:21241723

Effects of Sacubitril/Valsartan in the PARADIGM-HF Trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) According to Background Therapy.

PubMed

Okumura, Naoki; Jhund, Pardeep S; Gong, Jianjian; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Swedberg, Karl; Zile, Michael R; Solomon, Scott D; Packer, Milton; McMurray, John J V

2016-09-01

In the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan was more effective than the angiotensin-converting enzyme inhibitorenalapril in patients with heart failure and reduced ejection fraction. We examined whether this benefit was consistent irrespective of background therapy. We examined the effect of study treatment in the following subgroups: diuretics (yes/no), digitalis glycoside (yes/no), mineralocorticoid receptor antagonist (yes/no),and defibrillating device (implanted defibrillating device, yes/no). We also examined the effect of study drug according to β-blocker dose (≥50% and <50% of target dose) and according to whether patients had undergone previous coronary revascularization. We analyzed the primary composite end point of cardiovascular death or heart failure hospitalization, as well as cardiovascular death. Most randomized patients (n=8399)were treated with a diuretic (80%) and β-blocker (93%); 47% of those taking a β-blocker were treated with ≥50% of the recommended dose. In addition, 4671 (56%) were treated with a mineralocorticoid receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a defibrillating device; 2640 (31%) had undergone coronary revascularization. Overall, the sacubitril/valsartan versus enalapril hazard ratio for the primary composite end point was 0.80 (95% confidence interval,0.73-0.87;P<0.001) and for cardiovascular death was0.80 (0.71-0.89;P<0.001). The effect of sacubitril/valsartan was consistent across all subgroups examined. The hazard ratio for primary end point ranged from 0.74 to 0.85 and for cardiovascular death rangedfrom 0.75 to 0.89, with no treatment-by-subgroup interaction. The benefit of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor, was consistent regardless of background therapy and irrespective of previouscoronary revascularization or β-blocker dose. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255. © 2016 American Heart Association, Inc.

Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study).

PubMed

Fu, M; Ahrenmark, U; Berglund, S; Lindholm, C J; Lehto, A; Broberg, A Månsson; Tasevska-Dinevska, G; Wikstrom, G; Ågard, A; Andersson, B

2017-12-01

Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (<70 bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR <70 bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather than to the use of BBs. Therefore, our results underline the need for greater attention to HR control in patients with HFrEF and sinus rhythm and thus a potential for improved HF care.

Visceral Congestion in Heart Failure: Right Ventricular Dysfunction, Splanchnic Hemodynamics, and the Intestinal Microenvironment.

PubMed

Polsinelli, Vincenzo B; Sinha, Arjun; Shah, Sanjiv J

2017-12-01

Visceral venous congestion of the gut may play a key role in the pathogenesis of right-sided heart failure (HF) and cardiorenal syndromes. Here, we review the role of right ventricular (RV) dysfunction, visceral congestion, splanchnic hemodynamics, and the intestinal microenvironment in the setting of right-sided HF. We review recent literature on this topic, outline possible mechanisms of disease pathogenesis, and discuss potential therapeutics. There are several mechanisms linking RV-gut interactions via visceral venous congestion which could result in (1) hypoxia and acidosis in enterocytes, which may lead to enhanced sodium-hydrogen exchanger 3 (NHE3) expression with increased sodium and fluid retention; (2) decreased luminal pH in the intestines, which could lead to alteration of the gut microbiome which could increase gut permeability and inflammation; (3) alteration of renal hemodynamics with triggering of the cardiorenal syndrome; and (4) altered phosphate metabolism resulting in increased pulmonary artery stiffening, thereby increasing RV afterload. A wide variety of therapeutic interventions that act on the RV, pulmonary vasculature, intestinal microenvironment, and the kidney could alter these pathways and should be tested in patients with right-sided HF. The RV-gut axis is an important aspect of HF pathogenesis that deserves more attention. Modulation of the pathways interconnecting the right heart, visceral congestion, and the intestinal microenvironment could be a novel avenue of intervention for right-sided HF.

Material science and solid state physics studies with positive muon spin precession. [fe(a1) alloys

NASA Technical Reports Server (NTRS)

Stronach, C. E.

1979-01-01

The hyperfine field on the muon, B sub hf, at interstitial sites in dilute Fe(Al) alloys was measured for four different concentrations of Al and as a function of temperature by the muon spin rotation method. The magnitude of B sub hf, which is negative, decreases at rates ranging from 0.09 + or - 0.03% per at.% Al at 200 K to an asymptotic limit of 0.35 + or - far above 440 K. This behavior shows that sites near the Al impurity are weakly repulsive to the muon, with an interaction potential of 13 + or - 3 meV. In order to fit the temperature dependence of the hyperfine field, it is necessary to hypothesize the existence of a small concentration of unidentified defects, possibly dislocations, which are attractive to the muon. Although the Al impurity acts as a non-magnetic hole in the Fe lattice, the observed decrease in B sub hf is only 35% of the decrease in the bulk magnetization. It is concluded that B sub hf is determined mainly by the enhanced screening of conduction electrons in Fe and Fe(Al). Since the influence of the Al impurity on the neighboring Fe monents is very small, most of the change in B sub hf is therefore attributed to the increase in conduction electron polarization of the Al impurity.

Health Literacy and Outcomes among Patients with Heart Failure

PubMed Central

Peterson, Pamela N; Shetterly, Susan M; Clarke, Christina L; Bekelman, David B; Chan, Paul S; Allen, Larry A; Matlock, Daniel D; Magid, David J; Masoudi, Frederick A

2015-01-01

Context Little is known about the impact of low health literacy among patients with heart failure (HF), a condition that requires self-management and frequent interactions with the healthcare system. Objective Evaluate the association between low health literacy and all-cause rehospitalization and mortality among outpatients with HF. Design and Setting Retrospective cohort study performed at Kaiser Permanente Colorado, an integrated managed care organization. Patients with HF were identified between Jan, 2001 and May, 2008 and followed for a mean of 1.2 years. Patients were surveyed. Health literacy was assessed using three established screening questions and categorized as adequate or low. Patients Outpatients with HF. Main Outcomes All-cause mortality and hospitalization. Results The survey response rate was 72%. Of 1494 patients, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted 17.6% vs. 6.3%; adjusted hazard ratio [HR]: 1.61; 95% CI 1.06–2.43; p=0.026), but not hospitalization (30.5% vs. 23.2%; HR:1.04; 95% CI 0.79–1.37; p=0.760). Conclusions Among patients with HF in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality. PMID:21521851

Mode-specific multi-channel dynamics of the F- + CHD2Cl reaction on a global ab initio potential energy surface

NASA Astrophysics Data System (ADS)

Szabó, István; Czakó, Gábor

2016-10-01

We report a detailed quasiclassical trajectory study for the dynamics of the ground-state and CH/CD stretching-excited F- + CHD2Cl(vCH/CD = 0, 1) → Cl- + CHD2F, HF + CD2Cl-, and DF + CHDCl- SN2, proton-, and deuteron-abstraction reactions using a full-dimensional global ab initio analytical potential energy surface. The simulations show that (a) CHD2Cl(vCH/CD = 1), especially for vCH = 1, maintains its mode-specific excited character prior to interaction, (b) the SN2 reaction is vibrationally mode-specific, (c) double inversion can occur and is enhanced upon CH/CD stretching excitations, (d) in the abstraction reactions the HF channel is preferred and the vCH/CD = 1 excitations significantly promote the HF/DF channels, (e) back-side rebound, back-side stripping, and front-side stripping are the dominant direct abstraction mechanisms based on correlated scattering- and attack-angle distributions, (f) the exact classical vibrational energy-based Gaussian binning (1GB) provides realistic mode-specific polyatomic product state distributions, (g) in the abstraction reactions CH and CD stretchings are not pure spectator modes and mainly ground-state products are produced, thus most of the initial energy transfers into product translation, and (h) the HF and DF product molecules are rotationally cold without any significant dependence on the reactant's and HF/DF vibrational states.

Heart failure therapy at a crossroad: are there limits to the neurohormonal model?

PubMed

Mehra, Mandeep R; Uber, Patricia A; Francis, Gary S

2003-05-07

The advent of neurohormonal blockade in heart failure (HF) has been an overwhelming success, but current evidence points to a ceiling effect as newer neurohormonal targets are exploited in an incremental manner. This has lead us to question whether the neurohormonal model of HF can be sustained by simply stacking multiple neurohormonal or cytokine blockers together as treatment. A unifying theme in some of these disparate trials relates to either a lack of efficacy or, more importantly, adversity resulting in regression of already achieved benefits. It is our contention that the available evidence has uncovered the remarkable complexity of interaction within the context of the neurohormonal construct. As we stand at a crossroad in HF and begin to fervently pursue non-neurohormonal therapeutic targets, we must also direct attention at navigating the multifaceted labyrinth of the neurohormonal model that has led to the current imbroglio.

Contribution of slab melting to magmatism at the active rifts zone in the middle of the Izu-Bonin arc

NASA Astrophysics Data System (ADS)

Hirai, Y.; Okamura, S.; Sakamoto, I.; Shinjo, R.; Wada, K.; Yoshida, T.

2016-12-01

The active rifts zone lies just behind the Quaternary volcanic front in the middle of the Izu-Bonin arc. Volcanism at the active rifts zone has been active since ca. 2 Ma, and late Quaternary basaltic lavas (< 0.1 Ma) and hydrothermal activity occur along the central axis of the rifts (Taylor, 1992; Ishizuka et al., 2003). In this paper we present new Sr, Nd, and Hf isotope and trace element data for the basalts erupted in the active rifts zone, including the Aogashima, Myojin and Sumisu rifts. Two geochemical groups can be identified within the active rift basalts: High-Zr basalts (HZB) and Low-Zr basalts (LZB). In the case of the Sumisu rift, the HZB exhibits higher in K2O, Na2O, Y, Zr and Ni, and also has higher Ce/Yb and Zr/Y, lower Ba/Th than the LZB. Depletion of Zr-Hf in the N-MORB spidergram characterizes the LZB from the Aogashima, Myojin and Sumisu rifts. The 176Hf/177Hf ratios are slightly lower in the HZB than in the LZB, decoupling of 176Hf/177Hf ratios and 143Nd/144Nd ratios. Estimated primary magma compositions suggest that primary magma segregation for the HZB occurred at depths less than 70 km ( 2 GPa), whereas the LZB more than 70 km (2 3 GPa). ODP Leg126 site 788, 790, and 791 reached the basaltic basement of the Sumisu rift (Gill et al., 1992). The geochemical data and stratigraphic relations of the basement indicate that the HZB is younger than the LZB. Geochemical modelling demonstrates that slab-derived melt mixed with mantle wedge produces the observed isotopic and trace elemental characteristics. The LZB volcanism at the early stage of the back-arc rifting is best explained by a partial melting of subducted slab saturated with trace quantities of zircon under low-temperature conditions in the mantle wedge. On the other hand, the HZB requires a partial melt of subducted slab accompanied by full dissolution of zircon under high-temperature conditions in the mantle wedge, which could have been caused by hot asthenospheric injection during the syn stage of the back-arc rifting. referencesGill et al. (1992) Proc. ODP, Sci. Result, 126, 383-403. Ishizuka et al. (2003) Geol. Soc. Spec. Publ., 219, 187-205. Taylor (1992) Proc. ODP, Sci. Result, 126, 627-651.

Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial

PubMed Central

Leppänen, Juha; Kaijanranta, Hannu; Kulju, Minna; Heliö, Tiina; van Gils, Mark; Lähteenmäki, Jaakko

2014-01-01

Background Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients’ compliance with self-care, although the results are still contradictory. Objective A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. Methods HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients’ clinical status, use of health care resources, adherence, and user experience from the patients’ and the health care professionals’ perspective were studied. Results Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients’ clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. Conclusions Home telemonitoring did not reduce the number of patients’ HF-related hospital days and did not improve the patients’ clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. Trial Registration Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z). PMID:25498992

The effects of temperature gradient and growth rate on the morphology and fatigue properties of MAR-M246(Hf)

NASA Technical Reports Server (NTRS)

Schmidt, D. D.; Alter, W. S.; Hamilton, W. D.; Parr, R. A.

1989-01-01

MAR-M246(Hf) is a nickel based superalloy used in the turbopump blades of the Space Shuttle main engines. The effects are considered of temperature gradient (G) and growth rate (R) on the microstructure and fatigue properties of this superalloy. The primary dendrite arm spacings were found to be inversely proportional to both temperature gradient and growth rate. Carbide and gamma - gamma prime morphology trends were related to G/R ratios. Weibull analysis of fatigue results shows the characteristic life to be larger by a factor of 10 for the low gradient/fast rate pairing of G and R, while the reliability (beta) was lower.

Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes

PubMed Central

Lavie, Carl J.; Arena, Ross; Swift, Damon L.; Johannsen, Neil M.; Sui, Xuemei; Lee, Duck-chul; Earnest, Conrad P.; Church, Timothy S.; O’Keefe, James H.; Milani, Richard V.; Blair, Steven N.

2015-01-01

Substantial evidence has established the value of high levels of physical activity (PA), exercise training (ET), and overall cardiorespiratory fitness (CRF) in the prevention and treatment of cardiovascular diseases (CVD). This paper reviews some basics of exercise physiology and the acute and chronic responses of ET, as well as the impact of PA and CRF on CVD. This review also surveys data from epidemiologic and ET studies in the primary and secondary prevention of CVD, particularly coronary heart disease (CHD) and heart failure (HF). These data strongly support the routine prescription of ET to all patients and referrals for patients with CVD, especially CHD and HF, to specific cardiac rehabilitation and ET programs. PMID:26139859

Hydrides of intermetallic compounds with a H/M ratio greater than unity obtained at high hydrogen pressures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Semenenko, K.N.; Klyamkin, S.N.

1993-11-01

Novel hydride phases with H/M > 1 based on Zr{sub 2}Pd, Hf{sub 2}Pd, and Hf{sub 2}Cu (structures of the MoSi{sub 2} type) have been synthesized at high H{sub 2} pressures. The X-ray diffraction investigations of the resulting hydrides have been carried out. Some factors determining the maximum hydrogen content in the hydrides of intermetallic compounds are discussed. A model structure of the hydrides obtained is proposed, which assumes the possibility of direct H-H interactions when the interatomic distances are less than 1 {angstrom}.

The role of Upper Hybrid Turbulence on HF Artificial Ionization

NASA Astrophysics Data System (ADS)

Papadopoulos, Konstantinos Dennis; Najmi, Amir; Eliasson, Bengt; Milikh, Gennady

2016-07-01

One of the most fascinating and scientifically interesting phenomena of active space experiments is the discovery of artificial ionization by Todd Pedersen when the HAARP ERP reached the GW level. The phenomenon has been well documented experimentally. A theoretical model based on ionization by energetic electrons accelerated by 50-100 V/m localized electric fields due to Strong Langmuir Turbulence (SLT) near the reflection surface of the HF pump wave, reproduced the observed dynamics of the descending plasma layer quite accurately. A major defect of the model was that the electron temperature in the SLT region was a free parameter. When taken as the 2000 K representing the ambient electron temperature the SLT driven electron flux was insufficient to produce ionization. An equivalent electron temperature of 5000 K or higher was necessary to reproduce the observations. The needed electron heating was attributed to the interaction of the HF at the Upper Hybrid (UH) resonant layer, approximately 5 Km below the reflection region where the HF electric field is perpendicular to the ambient magnetic field. The heated electrons expanded upwards along the magnetic field line and interacted with SLT fields near the resonance region. A consequence of this defect was that the theory could not explain the puzzling double resonance effect. Namely the observation that the ionization level was much stronger when the HF frequency and the UH resonance were a multiple of the electron cyclotron frequency. To remedy this we used a series of Vlasov simulations to explore the HF-plasma interaction in the vicinity of the UH resonance. The simulations followed the evolution of the spectral density of the electric field over a 7.5 MHz frequency band and cm scale lengths and of the electron distribution function over one millisecond for both double resonant and non-resonant cases. Many new features were revealed by the analysis of the simulations such as: 1. Broadening of the wave-number spectral region at the at the UH frequency 2. Excitation of all Bernstein modes associated with cyclotron frequency harmonics both below and above the UH frequency for both the resonant and non0resonant cases. 3. Moderate electron heating, in the form of bulk heating caused by first Bernstein mode, although its wave intensity is more than 20 dB lower than the intensity of the UH branch for all non-resonant cases. 4. Strong generation of non-thermal tails for the resonant cases, by the UH waves downshifted by the lower hybrid frequency when the downshifted frequency was equal to an harmonic of the electron gyro-frequency. The new UH turbulence resolves several f the mysteries associated with artificial ionization and suggests several new observations. Acknowledgment:Work supported by AFOSR MURI grant FA95501410019.

[Heart failure in primary care: Attitudes, knowledge and self-care].

PubMed

Salvadó-Hernández, Cristina; Cosculluela-Torres, Pilar; Blanes-Monllor, Carmen; Parellada-Esquius, Neus; Méndez-Galeano, Carmen; Maroto-Villanova, Neus; García-Cerdán, Rosa Maria; Núñez-Manrique, M Pilar; Barrio-Ruiz, Carmen; Salvador-González, Betlem

2018-04-01

To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. Cross-sectional and multicentre study. Primary Care. Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R 2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Glass–water interaction: Effect of high-valence cations on glass structure and chemical durability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hopf, J.; Kerisit, Sebastien N.; Angeli, F.

2016-05-15

Borosilicate glass is a durable solid, but it dissolves when in contact with aqueous fluids. The dissolution mechanism, which involves a variety of sequential reactions that occur at the solid-fluid interface, has important implications for the corrosion resistance of industrial and nuclear waste glasses. In this study, spectroscopic measurements, dissolution experiments, and Monte Carlo simulations were performed to investigate the effect of high–valence cations (HVC) on the mechanisms of glass dissolution under dilute and near-saturated conditions. Raman and NMR spectroscopy were used to determine the structural changes that occur in glass, specifically network formers (e.g., Al, Si, and B), withmore » the addition of the HVC element hafnium in the Na2O–Al2O3–B2O3–HfO2–SiO2 system (e.g., Na/[Al+B] = 1.0 and HfO2/SiO2 from 0.0 to 0.42). Spectroscopic measurements revealed that increasing hafnium content decreases N4 (tetrahedral boron/total boron) and increases the amount of Si—O—Hf moieties in the glass. Results from flow–through experiments conducted under dilute and near–saturated conditions show a decrease of approximately 100× or more in the dissolution rate over the series from 0 to 20 mol% HfO2. Comparing the average steady-state rates obtained under dilute conditions to the rates obtained for near-saturated conditions reveals a divergence in the magnitude between the average steady state rates measured in these different conditions. The reason for this divergence was investigated more thoroughly using Monte Carlo simulations. Simulations indicate that the divergence in glass dissolution behavior under dilute and near-saturated conditions result from the stronger binding of Si sites that deposit on the surface from the influent when Hf is present in the glass. As a result, the residence time at the glass surface of these newly-formed Si sites is longer in the presence of Hf, which increases the density of anchor sites from which altered layers with higher Si densities can form. These results illustrate the importance of understanding solid–water/solid-fluid interactions by linking macroscopic reaction kinetics to nanometer scale interfacial processes.« less

Autonomic functioning in mothers with interpersonal violence-related posttraumatic stress disorder in response to separation-reunion.

PubMed

Schechter, Daniel S; Moser, Dominik A; McCaw, Jaime E; Myers, Michael M

2014-05-01

This study characterizes autonomic nervous system activity reactive to separation-reunion among mothers with Interpersonal Violence-Related Posttraumatic Stress Disorder (IPV-PTSD). Heart-rate (HR) and high frequency heart-rate-variability (HF-HRV) were measured in 17 IPV-PTSD-mothers, 22 sub-threshold-mothers, and 15 non-PTSD mother-controls while interacting with their toddlers (12-48 months). Analyses showed IPV-PTSD-mothers having generally lower HR than other groups. All groups showed negative correlations between changes in HR and HF-HRV from sitting- to standing-baseline. During initial separation, controls no longer showed a negative relationship between HR and HF-HRV. But by the second reunion, the negative relationship reappeared. IPV-PTSD- and sub-threshold-mothers retained negative HR/HF-HRV correlations during the initial separation, but stopped showing them by the second reunion. Results support that mother-controls showed a pattern of autonomic regulation suggestive of hypervigilance during initial separation that resolved by the time of re-exposure. PTSD-mothers showed delayed onset of this pattern only upon re-exposure, and were perhaps exhibiting defensive avoidance or numbing during the initial separation/reunion. © 2013 Wiley Periodicals, Inc.

Behavioral in-effectiveness of high frequency electromagnetic field in mice.

PubMed

Salunke, Balwant P; Umathe, Sudhir N; Chavan, Jagatpalsingh G

2015-03-01

The present investigation was carried out with an objective to study the influence of high frequency electromagnetic field (HF-EMF) on anxiety, obsessive compulsive disorder (OCD) and depression-like behavior. For exposure to HF-EMF, non-magnetic material was used to fabricate the housing. Mice were exposed to HF-EMF (2.45GHz), 60min/day for 7 or 30 or 60 or 90 or 120days. The exposure was carried out by switching-on inbuilt class-I BLUETOOTH device that operates on 2.45GHz frequency in file transfer mode at a peak density of 100mW. Mice were subjected to the assessment of anxiety, OCD and depression-like behavior for 7 or 30 or 60 or 90 or 120days of exposure. The anxiety-like behavior was assessed by elevated plus maze, open field test and social interaction test. OCD-like behavior was assessed by marble burying behavior, whereas depression-like behavior was assessed by forced swim test and tail suspension test. The present experiment demonstrates that up to 120days of exposure to HF-EMF does not produce anxiety, OCD and depression-like behavior in mice. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of push/pull perfusion and ultrasonication on the extraction efficiencies of phthalate esters in sports drink samples using on-line hollow-fiber liquid-phase microextraction.

PubMed

Chao, Yu-Ying; Lee, Chien-Hung; Chien, Tzu-Yang; Shih, Yu-Hsuan; Lu, Yin-An; Kuo, Ting-Hsuan; Huang, Yeou-Lih

2013-08-28

In previous studies, we developed a process, on-line ultrasound-assisted push/pull perfusion hollow-fiber liquid-phase microextraction (UA-PPP-HF-LPME), combining the techniques of push/pull perfusion (PPP) and ultrasonication with hollow-fiber liquid-phase microextraction (HF-LPME), to achieve rapid extraction of acidic phenols from water samples. In this present study, we further evaluated three more-advanced and novel effects of PPP and ultrasonication on the extraction efficiencies of neutral high-molecular-weight phthalate esters (HPAEs) in sports drinks. First, we found that inner-fiber fluid leakage occurs only in push-only perfusion-based and pull-only perfusion-based HF-LPME, but not in the PPP mode. Second, we identified a significant negative interaction between ultrasonication and temperature. Third, we found that the extraction time of the newly proposed system could be shortened by more than 93%. From an investigation of the factors affecting UA-PPP-HF-LPME, we established optimal extraction conditions and achieved acceptable on-line enrichment factors of 92-146 for HPAEs with a sampling time of just 2 min.

Deeply learnt hashing forests for content based image retrieval in prostate MR images

NASA Astrophysics Data System (ADS)

Shah, Amit; Conjeti, Sailesh; Navab, Nassir; Katouzian, Amin

2016-03-01

Deluge in the size and heterogeneity of medical image databases necessitates the need for content based retrieval systems for their efficient organization. In this paper, we propose such a system to retrieve prostate MR images which share similarities in appearance and content with a query image. We introduce deeply learnt hashing forests (DL-HF) for this image retrieval task. DL-HF effectively leverages the semantic descriptiveness of deep learnt Convolutional Neural Networks. This is used in conjunction with hashing forests which are unsupervised random forests. DL-HF hierarchically parses the deep-learnt feature space to encode subspaces with compact binary code words. We propose a similarity preserving feature descriptor called Parts Histogram which is derived from DL-HF. Correlation defined on this descriptor is used as a similarity metric for retrieval from the database. Validations on publicly available multi-center prostate MR image database established the validity of the proposed approach. The proposed method is fully-automated without any user-interaction and is not dependent on any external image standardization like image normalization and registration. This image retrieval method is generalizable and is well-suited for retrieval in heterogeneous databases other imaging modalities and anatomies.

Experience and management of chronic pain among patients with other complex chronic conditions.

PubMed

Butchart, Amy; Kerr, Eve A; Heisler, Michele; Piette, John D; Krein, Sarah L

2009-05-01

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF). We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups. More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain. Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Recent Advances in Narrowband Stimulated Electromagnetic Emission NSEE Investigations at HAARP and EISCAT

NASA Astrophysics Data System (ADS)

Scales, Wayne

2016-07-01

Investigation of stimulated radiation, commonly known as Stimulated Electromagnetic Emissions (SEE), produced by the interaction of high-power, High Frequency HF radiowaves with the ionospheric plasma has been a vibrant area of research since the early 1980's. Substantial diagnostic information about ionospheric plasma characteristics, dynamics, and turbulence can be obtained from the frequency spectrum of the stimulated radiation. During the past several decades, so-called wideband SEE (WSEE) which exists in a frequency band of ±100 KHz or so of the transmit wave frequency (which is several MHz) has been investigated relatively thoroughly. Upgrades both in transmitter power and diagnostic receiver frequency sensitivity at major ionosphere interaction facilities (i.e. HAARP and EISCAT) have allowed new breakthroughs in the ability to study a plethora of processes associated with the ionospheric plasma during these active experiments. A primary advance is in observations of so-called narrowband SEE (NSEE) which exists roughly within ±1 kHz of the transmit wave frequency. NSEE investigation has opened the door for a potentially powerful tool for aeronomy investigations as well. An overview of several important new results associated with NSEE are discussed in this presentation, including observations, theory, computational modeling, as well as implications to new diagnostics of space plasma physics occurring during ionospheric interaction experiments.

Empagliflozin in women with type 2 diabetes and cardiovascular disease - an analysis of EMPA-REG OUTCOME®.

PubMed

Zinman, Bernard; Inzucchi, Silvio E; Wanner, Christoph; Hehnke, Uwe; George, Jyothis T; Johansen, Odd Erik; Fitchett, David

2018-04-30

The global epidemic of type 2 diabetes affects women and men equally; however, the relative impact on the cardiovascular (CV) system appears greater for women than men when compared with peers without diabetes. Furthermore, women are often under-represented in CV outcome trials, resulting in less certainty about the impact of CV prevention therapies across the sexes. The EMPA-REG OUTCOME® trial, which included 28.5% women, found that empagliflozin, given in addition to standard of care, reduced the risk of CV death by 38%, heart failure (HF) hospitalisation by 35% and a composite endpoint for incident or worsening nephropathy by 39%. Here we report a secondary analysis of the trial to determine the relative effects of empagliflozin in women vs men. The population studied were individuals with type 2 diabetes (HbA 1c 53-86 mmol/mol [7-10%] and eGFR >30 ml min -1 [1.73 m] -2 ), with established atherosclerotic CV disease. Individuals were randomised to receive empagliflozin 10 mg or 25 mg, or placebo once daily in addition to standard of care, and followed. The trial continued until ≥691 individuals had experienced an adjudicated event included in the primary outcome. All CV outcome events, including HF hospitalisations and deaths were prospectively adjudicated by blinded clinical events committees. At baseline, the demographic profile of the 2004 women (age ± standard deviation 63.6 ± 8.8 years) compared with the 5016 men (age 63.0 ± 8.6 years) in the trial was largely similar, with the exception that LDL-cholesterol was numerically higher in women (2.5 ± 1.0 vs 2.1 ± 0.9 mmol/l), consistent with lower rates of lipid-lowering therapies (75.4% vs 83.2%). Women were also less likely to have smoked (31.5% vs 69.9%). The annualised incidence rate for women in the placebo group was numerically lower than in men for CV death (1.58% vs 2.19%), numerically higher for HF hospitalisation (1.75% vs 1.33%) and similar for renal events (7.22% vs 7.75%). We did not detect any effect modification by sex within the statistical power restrictions of the analysis for CV death, HF hospitalisation and incident or worsening nephropathy (interaction p values 0.32, 0.20 and 0.85, respectively). Compared with placebo, empagliflozin increased the rates of genital infections in both women (2.5% vs 10.0%) and men (1.5% vs 2.6%). CV death, HF hospitalisation and incident or worsening nephropathy rate reductions induced by empagliflozin were not different between women and men.

Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM-HF trial.

PubMed

Vardeny, Orly; Claggett, Brian; Packer, Milton; Zile, Michael R; Rouleau, Jean; Swedberg, Karl; Teerlink, John R; Desai, Akshay S; Lefkowitz, Martin; Shi, Victor; McMurray, John J V; Solomon, Scott D

2016-10-01

In this analysis, we utilized data from PARADIGM-HF to test the hypothesis that participants who exhibited any dose reduction during the trial would have similar benefits from lower doses of sacubitril/valsartan relative to lower doses of enalapril. In a post-hoc analysis from PARADIGM-HF, we characterized patients by whether they received the maximal dose (200 mg sacubitril/valsartan or 10 mg enalapril twice daily) throughout the trial or had any dose reduction to lower doses (100/50/0 mg sacubitril/valsartan or 5/2.5/0 mg enalapril twice daily). The treatment effect for the primary outcome was estimated, stratified by dose level using time-updated Cox regression models. In the two treatment arms, participants with a dose reduction (43% of those randomized to enalapril and 42% of those randomized to sacubitril/valsartan) had similar baseline characteristics and similar baseline predictors of the need for dose reduction. In a time-updated analysis, any dose reduction was associated with a higher subsequent risk of the primary event [hazard ratio (HR) 2.5, 95% confidence interval (CI) 2.2-2.7]. However, the treatment benefit of sacubitril/valsartan over enalapril following a dose reduction was similar (HR 0.80, 95% CI 0.70-0.93, P < 0.001) to that observed in patients who had not experienced any dose reduction (HR 0.79, 95% CI 0.71-0.88, P < 0.001). In PARADIGM-HF, study medication dose reduction identified patients at higher risk of a major cardiovascular event. The magnitude of benefit for patients on lower doses of sacubitril/valsartan relative to those on lower doses of enalapril was similar to that of patients who remained on target doses of both drugs. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

High serum erythropoietin levels are related to heart failure development in subjects from the general population with albuminuria: data from PREVEND.

PubMed

Grote Beverborg, Niels; van der Wal, Haye H; Klip, IJsbrand T; Voors, Adriaan A; de Boer, Rudolf A; van Gilst, Wiek H; van Veldhuisen, Dirk J; Gansevoort, Ron T; Hillege, Hans L; van der Harst, Pim; Bakker, Stephan J L; van der Meer, Peter

2016-07-01

In patients with heart failure (HF), serum erythropoietin (EPO) levels are elevated and associated with disease severity and outcome. Whether endogenous EPO levels are prospectively associated with the development of HF or cardiovascular events in the general population is unknown. Serum EPO levels were measured at baseline in 6686 subjects enrolled in the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) study. Mean age (±SD) was 53 ± 12 years, 49.8% were male, and the median (interquartile range) EPO level was 7.7 (5.9-10.2) IU/L. During a median follow-up of 8.3 (7.7-8.8) years, 209 (3.1%) subjects were newly diagnosed with HF, 97 (1.5%) died of a cardiovascular cause, and 386 (6.0%) subjects had a non-fatal cardiovascular event (277 cardiac events and 93 strokes). Each doubling of EPO level was multivariably associated with new-onset HF [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.03-1.69, P = 0.031]. EPO levels showed interaction with urinary albumin excretion (P = 0.006) and were only associated with HF in subjects with albuminuria (HR 1.51, 95% CI 1.13-2.03, P = 0.005). There was an independent association of EPO levels with stroke in women (HR 1.82, 95% CI 1.24-2.65, P = 0.002), but not in men. No association was observed for EPO levels with other cardiovascular events or cardiovascular mortality. High serum EPO levels are independently associated with an increased risk of new-onset HF in subjects with albuminuria. More research into the pathophysiological mechanisms linking EPO levels to HF is needed to understand this association. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Validation of HF Radar ocean surface currents in the Ibiza Channel using lagrangian drifters, moored current meter and underwater gliders

NASA Astrophysics Data System (ADS)

Lana, Arancha; Fernández, Vicente; Orfila, Alejandro; Troupin, Charles; Tintoré, Joaquín

2015-04-01

SOCIB High Frequency (HF) radar is one component of a multi-platform system located in the Balearic Islands and made up of Lagrangian platforms (profilers and drifting buoys), fixed stations (sea-level, weather, mooring and coastal), beach monitoring (camera), gliders, a research vessel as well as an ocean forecast system (waves and hydrodynamics). The HF radar system overlooks the Ibiza Channel, known as a 'choke point" where Atlantic and Mediterranean water masses interact and where meridional exchanges of water mass properties between the Balearic and the Algerian sub-basins take place. In order to determine the reliability of surface velocity measurements in this area, a quality assessment of the HF Radar is essential. We present the results of several validation experiments performed in the Ibiza Channel in 2013 and 2014. Of particular interest is an experiment started in September 2014 when a set of 13 surface drifters with different shapes and drogue lengths were released in the area covered by the HF radar. The drifter trajectories can be examined following the SOCIB Deployment Application (DAPP): http://apps.socib.es/dapp. Additionally, a 1-year long time series of surface currents obtained from a moored surface current-meter located in the Ibiza Channel, inside the area covered by the HF radar, was also used as a useful complementary validation exercise. Direct comparison between both radial surface currents from each radar station and total derived velocities against drifters and moored current meter velocities provides an assessment of the HF radar data quality at different temporal periods and geographical areas. Statistics from these comparisons give good correlation and low root-mean-square deviation. The results will be discussed for different months, geographical areas and types of surface drifters and wind exposure. Moreover, autonomous underwater glider constitutes an additional source of information for the validation of the observed velocity structures and some statistics will be presented.

Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure

PubMed Central

Gijsberts, Crystel M; Benson, Lina; Dahlström, Ulf; Sim, David; Yeo, Daniel P S; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Lund, Lars H; Lam, Carolyn S P

2016-01-01

Background QRS duration (QRSd) criteria for device therapy in heart failure (HF) were derived from predominantly white populations and ethnic differences are poorly understood. Methods We compared the association of QRSd with ejection fraction (EF) and outcomes between 839 Singaporean Asian and 11 221 Swedish white patients with HF having preserved EF (HFPEF)and HF having reduced EF (HFREF) were followed in prospective population-based HF studies. Results Compared with whites, Asian patients with HF were younger (62 vs 74 years, p<0.001), had smaller body size (height 163 vs 171 cm, weight 70 vs 80 kg, both p<0.001) and had more severely impaired EF (EF was <30% in 47% of Asians vs 28% of whites). Overall, unadjusted QRSd was shorter in Asians than whites (101 vs 104 ms, p<0.001). Lower EF was associated with longer QRSd (p<0.001), with a steeper association among Asians than whites (pinteraction<0.001), independent of age, sex and clinical covariates (including body size). Excluding patients with left bundle branch block (LBBB) and adjusting for clinical covariates, QRSd was similar in Asians and whites with HFPEF, but longer in Asians compared with whites with HFREF (p=0.001). Longer QRSd was associated with increased risk of HF hospitalisation or death (absolute 2-year event rate for ≤120 ms was 40% and for >120 ms it was 52%; HR for 10 ms increase of QRSd was 1.04 (1.03 to 1.06), p<0.001), with no interaction by ethnicity. Conclusion We found ethnic differences in the association between EF and QRSd among patients with HF. QRS prolongation was similarly associated with increased risk, but the implications for ethnicity-specific QRSd cut-offs in clinical decision-making require further study. PMID:27402805

Disrupted physiological reactivity among children with a history of suicidal ideation: Moderation by parental expressed emotion-criticism.

PubMed

James, Kiera M; Woody, Mary L; Feurer, Cope; Kudinova, Anastacia Y; Gibb, Brandon E

2017-12-01

The goal of this study was to examine physiological reactivity during parent-child interactions in children with and without a history of suicidal ideation (SI), a group known to be at increased risk for suicidal thoughts and behaviors in the future. We also examined the potential moderating role of parental expressed emotion-criticism (EE-Crit) to determine whether the presence of parental criticism may help to identify a subgroup of children with a history of SI most at risk for physiological dysregulation. Participants were 396 children (age 7-11; 54% male, 71.7% Caucasian) and their biological parent. Children's levels of high frequency heart rate variability (HF-HRV) were assessed during a resting baseline period followed by a positive and negative discussion with their parent. Additionally, parents completed the Five-Minute Speech Sample to determine levels of EE-Crit toward their child, and children completed an interview assessing their history of SI. Consistent with our hypothesis, we found that exposure to parental criticism moderated the relation between a child's history of SI and their HF-HRV reactivity to the discussions. Specifically, while most children exhibited the typical pattern of HF-HRV suppression from baseline to both interactions, the highest risk children (i.e., children with a history of SI who also had highly critical parents) did not display any change in HF-HRV across the tasks, suggesting a failure to engage a typical psychophysiological response during emotional contexts. These results suggest a specific physiological mechanism that may place these children at risk for suicidal thoughts and behaviors in the future. Copyright © 2017 Elsevier B.V. All rights reserved.

Influence of Fat/Carbohydrate Ratio on Progression of Fatty Liver Disease and on Development of Osteopenia in Male Rats Fed Alcohol via Total Enteral Nutrition (TEN)

PubMed Central

Ronis, Martin J. J.; Mercer, Kelly; Suva, Larry J.; Vantrease, Jamie; Ferguson, Matthew; Hogue, William R.; Sharma, Neha; Cleves, Mario A.; Blackburn, Michael L.; Badger, Thomas M.

2014-01-01

Alcohol abuse is associated with the development of fatty liver disease and also with significant osteopenia in both genders. In this study, we examined ethanol-induced pathology in response to diets with differing fat/carbohydrate ratios. Male Sprague-Dawley rats were fed intragastrically with isocaloric liquid diets. Dietary fat content was either 5% (high carbohydrate, HC) or 45% (high fat, HF), with or without ethanol (12–13 g/kg/day). After 14, 28, or 65 days, livers were harvested and analyzed. In addition, bone morphology was analyzed after 65 days. HC rats gained more weight and had larger fat pads than HF rats with or without ethanol. Steatosis developed in HC + ethanol (HC+EtOH) compared to HF + ethanol (HF+EtOH) rats, accompanied by increased fatty acid (FA) synthesis and increased nuclear carbohydrate response element binding protein (ChREBP) (p < 0.05), but in the absence of effects on hepatic silent mating type information regulation 2 homolog (SIRT-1) or nuclear sterol regulatory binding element protein (SREBP-1c). Ethanol reduced serum leptin (p < 0.05) but not adiponectin. Over time, HC rats developed fatty liver independent of ethanol. FA degradation was significantly elevated by ethanol in both HC and HF groups (p < 0.05). HF+EtOH rats had increased oxidative stress from 28 days, increased necrosis compared to HF controls and higher expression of cytochromes P450, CYP2E1, and CYP4A1 compared to HC+EtOH rats (p < 0.05). In contrast, HC+EtOH rats had no significant increase in oxidative stress until day 65 with no observed increase in necrosis. Unlike liver pathology, no dietary differences were observed on ethanol-induced osteopenia in HC compared to HF groups. These data demonstrate that interactions between diet composition and alcohol are complex, dependent on the length of exposure, and are an important influence in development of fatty liver injury. Importantly, it appears that diet composition does not affect alcohol-associated skeletal toxicity. PMID:24581955

Spectroscopic evidence of 3-hydroxyflavone sorption within MFI type zeolites: ESIPT and metal complexation.

PubMed

Moissette, A; Hureau, M; Kokaislova, A; Le Person, A; Cornard, J P; De Waele, I; Batonneau-Gener, I

2015-10-21

Due to its chemical and photochemical properties and potential applications in numerous domains as a molecular probe, 3-hydroxyflavone (3HF) is a molecule of high interest. In particular, the processes of intramolecular proton transfer in the excited state and metallic complexation are known to be dependent on the chemical environment. In this context, the particular properties of zeolites make these microporous materials an environment adapted to study the reactivity of isolated molecules adsorbed in their porous void space. Thus, this report investigates the incorporation without any solvent of 3HF into the internal volume of various channel-type MFI zeolites. Using complementary techniques (diffuse reflectance UV-vis absorption, Raman scattering, FTIR, fluorescence emission and molecular modelling), very different spectral behaviours are observed in totally dealuminated silicalite-1 and in Al rich MZSM-5 (M = H(+), Na(+), Zn(2+)). In silicalite-1, the non-polar and non-protic internal micro-environment does not induce any valuable interaction between 3HF and the channel walls. Therefore, the molecule shows easy tautomer formation upon excitation. Within HZSM-5, 3HF is adsorbed in close proximity of the acid proton of the zeolite which inhibits the intramolecular proton transfer and then, only the normal form is observed at the excited state. For NaZSM-5, the spectral data show an intermediary behaviour due to the aprotic but polar environment, in agreement with 3HF sorption in close proximity of the Na(+) extra framework cation. After mixing 3HF and ZnZSM-5, the spectral features clearly indicate metallic complexation of the guest molecule. The zeolite dependent reactivity reported here demonstrates the adsorption of the guest within the internal volume because the charge balancing cations which clearly control the reaction are principally located in the zeolite channels. The 3HF incorporation into the internal volume is proved by the decrease of the microporous volume observed by nitrogen adsorption-desorption isotherm measurements. The experimental data are confirmed by Monte Carlo molecular modelling which also predicts 3HF sorption in the zeolite channels in the proximity of charge compensating cations. Consequently, as the molecule dimensions are assumed to be slightly larger than the channel size, the flexibility of the molecule and the lattice deformation have to be considered to allow 3HF penetration into the zeolite void space.

FRAIL-HF, a study to evaluate the clinical complexity of heart failure in nondependent older patients: rationale, methods and baseline characteristics.

PubMed

Vidán, María T; Sánchez, Elísabet; Fernández-Avilés, Francisco; Serra-Rexach, José A; Ortiz, Javier; Bueno, Héctor

2014-12-01

The clinical scenario of heart failure (HF) in older hospitalized patients is complex and influenced by acute and chronic comorbidities, coexistent geriatric syndromes, the patient's ability for self-care after discharge, and degree of social support. The impact of all these factors on clinical outcomes or disability evolution is not sufficiently known. FRAIL-HF is a prospective observational cohort study designed to evaluate clinical outcomes (mortality and readmission), functional evolution, quality of life, and use of social resources at 1, 3, 6, and 12 months after admission in nondependent elderly patients hospitalized for HF. Clinical features, medical treatment, self-care ability, and health literacy were prospectively evaluated and a comprehensive geriatric assessment with special focus on frailty was systematically performed in hospital to assess interactions and relationships with postdischarge outcomes. Between May 2009 and May 2011, 450 consecutive patients with a mean age of 80 ± 6 years were enrolled. Comorbidity was high (mean Charlson index, 3.4 ± 2.9). Despite being nondependent, 118 (26%) had minor disability for basic activities of daily living, only 76 (16.2%) had no difficulty in walking 400 meters, and 340 (75.5%) were living alone or with another elderly person. In addition, 316 patients (70.2%) fulfilled frailty criteria. Even nondependent older patients hospitalized for HF show a high prevalence of clinical and nonclinical factors that may influence prognosis and are usually not considered in routine clinical practice. The results of FRAIL-HF will provide important information about the relationship between these factors and different postdischarge clinical, functional, and quality-of-life outcomes. © 2014 Wiley Periodicals, Inc.

Alteration of sweet taste in high-fat diet induced obese rats after 4 weeks treatment with exenatide.

PubMed

Zhang, Xiao-juan; Wang, Yu-qing; Long, Yang; Wang, Lei; Li, Yun; Gao, Fa-bao; Tian, Hao-ming

2013-09-01

Exenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is effective in inducing weight loss. The exact mechanisms are not fully understood. Reduced appetite and food intake may play important roles. Sweet taste contributes to food palatability, which promotes appetite. Interestingly, GLP-1 and its receptor are expressed in the taste buds of rodents and their interaction has an effect on mediating sweet taste sensitivity. Our aim was to investigate whether sweet taste will be changed after long term treatment with exenatide. The results showed that high-fat diet induced obese rats (HF-C) presented metabolic disorders in food intake, body weight, blood glucose and lipid metabolism compared with long term exenatide treated obese rats (EX) and normal chow fed control rats (NC). Meanwhile, greater preference for sweet taste was observed in HF-C rats but not in EX rats. Compared with NC rats, brain activities induced by sweet taste stimulation were stronger in HF-C rats, however these stronger activities were not found in EX rats. We further found reduced sweet taste receptor T1R3 in circumvallte taste buds of HF-C rats, while GLP-1 was increased. Besides, serum leptin was evaluated in HF-C rats with decreased leptin receptor expressed in taste buds. These changes were not observed in EX rats, which suggest them to be the underlying hormone and molecular mechanisms responsible for alterations in sweet taste of HF-C rats and EX rats. In summary, our results suggest that long term treatment with exenatide could benefit dietary obese rats partially by reversing sweet taste changes. Copyright © 2013 Elsevier Inc. All rights reserved.

Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure

PubMed Central

Jaenisch, Rodrigo B.; Hentschke, Vítor S.; Quagliotto, Edson; Cavinato, Paulo R.; Schmeing, Letiane A.; Xavier, Léder L.

2011-01-01

Respiratory muscle training (RMT) improves functional capacity in chronic heart-failure (HF) patients, but the basis for this improvement remains unclear. We evaluate the effects of RMT on the hemodynamic and autonomic function, arterial baroreflex sensitivity (BRS), and respiratory mechanics in rats with HF. Rats were assigned to one of four groups: sedentary sham (n = 8), trained sham (n = 8), sedentary HF (n = 8), or trained HF (n = 8). Trained animals underwent a RMT protocol (30 min/day, 5 day/wk, 6 wk of breathing through a resistor), whereas sedentary animals did not. In HF rats, RMT had significant effects on several parameters. It reduced left ventricular (LV) end-diastolic pressure (P < 0.01), increased LV systolic pressure (P < 0.01), and reduced right ventricular hypertrophy (P < 0.01) and pulmonary (P < 0.001) and hepatic (P < 0.001) congestion. It also decreased resting heart rate (HR; P < 0.05), indicating a decrease in the sympathetic and an increase in the vagal modulation of HR. There was also an increase in baroreflex gain (P < 0.05). The respiratory system resistance was reduced (P < 0.001), which was associated with the reduction in tissue resistance after RMT (P < 0.01). The respiratory system and tissue elastance (Est) were also reduced by RMT (P < 0.01 and P < 0.05, respectively). Additionally, the quasistatic Est was reduced after RMT (P < 0.01). These findings show that a 6-wk RMT protocol in HF rats promotes an improvement in hemodynamic function, sympathetic and vagal heart modulation, arterial BRS, and respiratory mechanics, all of which are benefits associated with improvements in cardiopulmonary interaction. PMID:21903877

Toward a muon-specific electronic structure theory: effective electronic Hartree-Fock equations for muonic molecules.

PubMed

Rayka, Milad; Goli, Mohammad; Shahbazian, Shant

2018-02-07

An effective set of Hartree-Fock (HF) equations are derived for electrons of muonic systems, i.e., molecules containing a positively charged muon, conceiving the muon as a quantum oscillator, which are completely equivalent to the usual two-component HF equations used to derive stationary states of the muonic molecules. In these effective equations, a non-Coulombic potential is added to the orthodox coulomb and exchange potential energy terms, which describes the interaction of the muon and the electrons effectively and is optimized during the self-consistent field cycles. While in the two-component HF equations a muon is treated as a quantum particle, in the effective HF equations it is absorbed into the effective potential and practically transformed into an effective potential field experienced by electrons. The explicit form of the effective potential depends on the nature of muon's vibrations and is derivable from the basis set used to expand the muonic spatial orbital. The resulting effective Hartree-Fock equations are implemented computationally and used successfully, as a proof of concept, in a series of muonic molecules containing all atoms from the second and third rows of the Periodic Table. To solve the algebraic version of the equations muon-specific Gaussian basis sets are designed for both muon and surrounding electrons and it is demonstrated that the optimized exponents are quite distinct from those derived for the hydrogen isotopes. The developed effective HF theory is quite general and in principle can be used for any muonic system while it is the starting point for a general effective electronic structure theory that incorporates various types of quantum correlations into the muonic systems beyond the HF equations.

Accurate prediction of polarised high order electrostatic interactions for hydrogen bonded complexes using the machine learning method kriging.

PubMed

Hughes, Timothy J; Kandathil, Shaun M; Popelier, Paul L A

2015-02-05

As intermolecular interactions such as the hydrogen bond are electrostatic in origin, rigorous treatment of this term within force field methodologies should be mandatory. We present a method able of accurately reproducing such interactions for seven van der Waals complexes. It uses atomic multipole moments up to hexadecupole moment mapped to the positions of the nuclear coordinates by the machine learning method kriging. Models were built at three levels of theory: HF/6-31G(**), B3LYP/aug-cc-pVDZ and M06-2X/aug-cc-pVDZ. The quality of the kriging models was measured by their ability to predict the electrostatic interaction energy between atoms in external test examples for which the true energies are known. At all levels of theory, >90% of test cases for small van der Waals complexes were predicted within 1 kJ mol(-1), decreasing to 60-70% of test cases for larger base pair complexes. Models built on moments obtained at B3LYP and M06-2X level generally outperformed those at HF level. For all systems the individual interactions were predicted with a mean unsigned error of less than 1 kJ mol(-1). Copyright © 2013 Elsevier B.V. All rights reserved.

Hydrogen bonding interactions and supramolecular assemblies in 2-amino guanidinium 4-methyl benzene sulphonate crystal structure: Hirshfeld surfaces and computational calculations

NASA Astrophysics Data System (ADS)

Muthuraja, P.; Joselin Beaula, T.; Balachandar, S.; Bena Jothy, V.; Dhandapani, M.

2017-10-01

2-aminoguanidinium 4-methyl benzene sulphonate (AGMS), an organic compound with big assembly of hydrogen bonding interactions was crystallized at room temperature. The structure of the compound was confirmed by FT-IR, NMR and single crystal X-ray diffraction analysis. Numerous hydrogen bonded interactions were found to form supramolecular assemblies in the molecular structure. Fingerprint plots of Hirshfeld surface analysis spells out the interactions in various directions. The molecular structure of AGMS was optimised by HF, MP2 and DFT (B3LYP and CAM-B3LYP) methods at 6-311G (d,p) basis set and the geometrical parameters were compared. Electrostatic potential calculations of the reactants and product confirm the transfer of proton. Optical properties of AGMS were ascertained by UV-Vis absorbance and reflectance spectra. The band gap of AGMS is found to be 2.689 eV. Due to numerous hydrogen bonds, the crystal is thermally stable up to 200 °C. Hyperconjugative interactions which are responsible for the second hyperpolarizabilities were accounted by NBO analysis. Static and frequency dependent optical properties were calculated at HF and DFT methods. The hyperpolarizabilities of AGMS increase rapidly at frequencies 0.0428 and 0.08 a.u. compared to static one. The compound exhibits violet and blue emission.

Comparison of a one-time educational intervention to a teach-to-goal educational intervention for self-management of heart failure: design of a randomized controlled trial.

PubMed

DeWalt, Darren A; Broucksou, Kimberly A; Hawk, Victoria; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kirsten; Holmes, Mark; Weinberger, Morris; Macabasco-O'Connell, Aurelia; Pignone, Michael

2009-06-11

Heart failure (HF) is common, costly and associated with significant morbidity and poor quality of life, particularly for patients with low socioeconomic status. Self-management training has been shown to reduce HF related morbidity and hospitalization rates, but there is uncertainty about how best to deliver such training and what patients benefit. This study compares a single session self-management HF training program against a multiple session training intervention and examines whether their effects differ by literacy level. In this randomized controlled multi-site trial, English and Spanish-speaking patients are recruited from university-affiliated General Internal Medicine and Cardiology clinics at 4 sites across the United States. Eligible patients have HF with New York Heart Association class II-IV symptoms and are prescribed a loop diuretic. Baseline data, including literacy level, are collected at enrollment and follow-up surveys are conducted at 1, 6 and 12 months. Upon enrollment, both the control and intervention groups receive the same 40 minute, literacy-sensitive, in-person, HF education session covering the 4 key self-management components of daily self assessment and having a plan, salt avoidance, exercise, and medication adherence. All participants also receive a literacy-sensitive workbook and a digital bathroom scale. After the baseline education was completed, patients are randomly allocated to return to usual care or to receive ongoing education and training. The intervention group receives an additional 20 minutes of education on weight and symptom-based diuretic self-adjustment, as well as periodic follow-up phone calls from the educator over the course of 1 year. These phone calls are designed to reinforce the education, assess participant knowledge of the education and address barriers to success.The primary outcome is the combined incidence of all cause hospitalization and death. Secondary outcomes include HF-related quality of life, HF-related hospitalizations, knowledge regarding HF, self-care behavior, and self-efficacy. The effects of each intervention will be stratified by patient literacy, in order to identify any differential effects. Enrollment of the proposed 660 subjects will continue through the end of 2009. Outcome assessments are projected to be completed by early 2011. ClinicalTrials.gov (http://www.clinicaltrials.gov/) NCT00378950.

Comparison of a one-time educational intervention to a teach-to-goal educational intervention for self-management of heart failure: design of a randomized controlled trial

PubMed Central

DeWalt, Darren A; Broucksou, Kimberly A; Hawk, Victoria; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kirsten; Holmes, Mark; Weinberger, Morris; Macabasco-O'Connell, Aurelia; Pignone, Michael

2009-01-01

Background Heart failure (HF) is common, costly and associated with significant morbidity and poor quality of life, particularly for patients with low socioeconomic status. Self-management training has been shown to reduce HF related morbidity and hospitalization rates, but there is uncertainty about how best to deliver such training and what patients benefit. This study compares a single session self-management HF training program against a multiple session training intervention and examines whether their effects differ by literacy level. Methods/Design In this randomized controlled multi-site trial, English and Spanish-speaking patients are recruited from university-affiliated General Internal Medicine and Cardiology clinics at 4 sites across the United States. Eligible patients have HF with New York Heart Association class II-IV symptoms and are prescribed a loop diuretic. Baseline data, including literacy level, are collected at enrollment and follow-up surveys are conducted at 1, 6 and 12 months Upon enrollment, both the control and intervention groups receive the same 40 minute, literacy-sensitive, in-person, HF education session covering the 4 key self-management components of daily self assessment and having a plan, salt avoidance, exercise, and medication adherence. All participants also receive a literacy-sensitive workbook and a digital bathroom scale. After the baseline education was completed, patients are randomly allocated to return to usual care or to receive ongoing education and training. The intervention group receives an additional 20 minutes of education on weight and symptom-based diuretic self-adjustment, as well as periodic follow-up phone calls from the educator over the course of 1 year. These phone calls are designed to reinforce the education, assess participant knowledge of the education and address barriers to success. The primary outcome is the combined incidence of all cause hospitalization and death. Secondary outcomes include HF-related quality of life, HF-related hospitalizations, knowledge regarding HF, self-care behavior, and self-efficacy. The effects of each intervention will be stratified by patient literacy, in order to identify any differential effects. Discussion Enrollment of the proposed 660 subjects will continue through the end of 2009. Outcome assessments are projected to be completed by early 2011. Trial Registration ClinicalTrials.gov NCT00378950 PMID:19519904

Hafnium-doped hydroxyapatite nanoparticles with ionizing radiation for lung cancer treatment.

PubMed

Chen, Min-Hua; Hanagata, Nobutaka; Ikoma, Toshiyuki; Huang, Jian-Yuan; Li, Keng-Yuan; Lin, Chun-Pin; Lin, Feng-Huei

2016-06-01

Recently, photodynamic therapy (PDT) is one of the new clinical options by generating cytotoxic reactive oxygen species (ROS) to kill cancer cells. However, the optical approach of PDT is limited by tissue penetration depth of visible light. In this study, we propose that a ROS-enhanced nanoparticle, hafnium-doped hydroxyapatite (Hf:HAp), which is a material to yield large quantities of ROS inside the cells when the nanoparticles are bombarded with high penetrating power of ionizing radiation. Hf:HAp nanoparticles are generated by wet chemical precipitation with total doping concentration of 15mol% Hf(4+) relative to Ca(2+) in HAp host material. The results show that the HAp particles could be successfully doped with Hf ions, resulted in the formation of nano-sized rod-like shape and with pH-dependent solubility. The impact of ionizing radiation on Hf:HAp nanoparticles is assessed by using in-vitro and in-vivo model using A549 cell line. The 2',7'-dichlorofluorescein diacetate (DCFH-DA) results reveal that after being exposed to gamma rays, Hf:HAp could significantly lead to the formation of ROS in cells. Both cell viability (WST-1) and cytotoxicity (LDH) assay show the consistent results that A549 lung cancer cell lines are damaged with changes in the cells' ROS level. The in-vivo studies further demonstrate that the tumor growth is inhibited owing to the cells apoptosis when Hf:HAp nanoparticles are bombarded with ionizing radiation. This finding offer a new therapeutic method of interacting with ionizing radiation and demonstrate the potential of Hf:HAp nanoparticles in tumor treatment, such as being used in a palliative treatment after lung surgical procedure. Photodynamic therapy (PDT) is one of the new clinical options by generating cytotoxic reactive oxygen species (ROS) to kill cancer cells. Unfortunately, the approach of PDT is usually limited to the treatment of systemic disease and deeper tumor, due to the limited tissue penetration depth of visible light (620-690nm). Here we report a ROS-enhanced nanoparticle, hafnium-doped hydroxyapatite (Hf:HAp), which can trigger ROS when particles are irradiated with high penetrating power of ionizing radiation. The present study provides quantitative data relating ROS generation and the therapeutic effect of Hf:HAp nanoparticles in lung cancer cells. As such, this material has opened an innovative window for deeper tumor and systemic disease treatment. Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Rationale and design of the GUIDE-IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure.

PubMed

Felker, G Michael; Ahmad, Tariq; Anstrom, Kevin J; Adams, Kirkwood F; Cooper, Lawton S; Ezekowitz, Justin A; Fiuzat, Mona; Houston-Miller, Nancy; Januzzi, James L; Leifer, Eric S; Mark, Daniel B; Desvigne-Nickens, Patrice; Paynter, Gayle; Piña, Ileana L; Whellan, David J; O'Connor, Christopher M

2014-10-01

The GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) study is designed to determine the safety, efficacy, and cost-effectiveness of a strategy of adjusting therapy with the goal of achieving and maintaining a target N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of <1,000 pg/ml compared with usual care in high-risk patients with systolic heart failure (HF). Elevations in natriuretic peptide (NP) levels provide key prognostic information in patients with HF. Therapies proven to improve outcomes in patients with HF are generally associated with decreasing levels of NPs, and observational data show that decreases in NP levels over time are associated with favorable outcomes. Results from smaller prospective, randomized studies of this strategy thus far have been mixed, and current guidelines do not recommend serial measurement of NP levels to guide therapy in patients with HF. GUIDE-IT is a prospective, randomized, controlled, unblinded, multicenter clinical trial designed to randomize approximately 1,100 high-risk subjects with systolic HF (left ventricular ejection fraction ≤40%) to either usual care (optimized guideline-recommended therapy) or a strategy of adjusting therapy with the goal of achieving and maintaining a target NT-proBNP level of <1,000 pg/ml. Patients in either arm of the study are followed up at regular intervals and after treatment adjustments for a minimum of 12 months. The primary endpoint of the study is time to cardiovascular death or first hospitalization for HF. Secondary endpoints include time to cardiovascular death and all-cause mortality, cumulative mortality, health-related quality of life, resource use, cost-effectiveness, and safety. The GUIDE-IT study is designed to definitively assess the effects of an NP-guided strategy in high-risk patients with systolic HF on clinically relevant endpoints of mortality, hospitalization, quality of life, and medical resource use. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT]; NCT01685840). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial.

PubMed

Ong, Michael K; Romano, Patrick S; Edgington, Sarah; Aronow, Harriet U; Auerbach, Andrew D; Black, Jeanne T; De Marco, Teresa; Escarce, Jose J; Evangelista, Lorraine S; Hanna, Barbara; Ganiats, Theodore G; Greenberg, Barry H; Greenfield, Sheldon; Kaplan, Sherrie H; Kimchi, Asher; Liu, Honghu; Lombardo, Dawn; Mangione, Carol M; Sadeghi, Bahman; Sadeghi, Banafsheh; Sarrafzadeh, Majid; Tong, Kathleen; Fonarow, Gregg C

2016-03-01

It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30, 2014, to October 1, 2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P = .74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions. clinicaltrials.gov Identifier: NCT01360203.

Prognostic Value of Right Ventricular Dysfunction in Heart Failure With Reduced Ejection Fraction: Superiority of Longitudinal Strain Over Tricuspid Annular Plane Systolic Excursion.

PubMed

Carluccio, Erberto; Biagioli, Paolo; Alunni, Gianfranco; Murrone, Adriano; Zuchi, Cinzia; Coiro, Stefano; Riccini, Clara; Mengoni, Anna; D'Antonio, Antonella; Ambrosio, Giuseppe

2018-01-01

In heart failure (HF) with reduced ejection fraction, right ventricular (RV) impairment, as defined by reduced tricuspid annular plane systolic excursion, is a predictor of poor outcome. However, peak longitudinal strain of RV free wall (RVFWS) has been recently proposed as a more accurate and sensitive tool to evaluate RV function. Accordingly, we investigated whether RVFWS could help refine prognosis of patients with HF with reduced ejection fraction in whom tricuspid annular plane systolic excursion is still preserved. A total of 200 patients with HF with reduced ejection fraction (age, 66±11 years; ejection fraction, 30±7%) with preserved tricuspid annular plane systolic excursion (>16 mm) underwent RV function assessment using speckle-tracking echocardiography to measure peak RVFWS. After a median follow-up period of 28 months, 62 (31%) patients reached the primary composite end point of all-cause death/HF rehospitalization. Median RVFWS was -19.3% (interquartile range, -23.3% to -15.0%). By lasso-penalized Cox-hazard model, RVFWS was an independent predictor of outcome, along with Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure-HF score, Echo-HF score, and severe mitral regurgitation. The best cutoff value of RVFWS for prediction of outcome was -15.3% (area under the curve, 0.68; P <0.001; sensitivity, 50%; specificity, 80%). In 50 patients (25%), RVFWS was impaired (ie, ≥-15.3%); event rate (per 100 patients per year) was greater in them than in patients with RVFWS <-15.3% (29.5% [95% confidence interval, 20.4-42.7] versus 9.4% [95% confidence interval, 6.7-13.1]; P <0.001). RVFWS yielded a significant net reclassification improvement (0.584 at 3 years; P <0.001), with 68% of nonevents correctly reclassified. In patients with HF with reduced ejection fraction with preserved tricuspid annular plane systolic excursion, RV free-wall strain provides incremental prognostic information and improved risk stratification. © 2018 American Heart Association, Inc.

Plume-stagnant slab-lithosphere interactions: Origin of the late Cenozoic intra-plate basalts on the East Eurasia margin

NASA Astrophysics Data System (ADS)

Kimura, Jun-Ichi; Sakuyama, Tetsuya; Miyazaki, Takashi; Vaglarov, Bogdan S.; Fukao, Yoshio; Stern, Robert J.

2018-02-01

Intra-plate basalts of 35-0 Ma in East Eurasia formed in a broad backarc region above the stagnant Pacific Plate slab in the mantle transition zone. These basalts show regional-scale variations in Nd-Hf isotopes. The basalts with the most radiogenic Nd-Hf center on the Shandong Peninsula with intermediate Nd-Hf at Hainan and Datong. The least radiogenic basalts occur in the perimeters underlain by the thick continental lithosphere. Shandong basalts possess isotopic signatures of the young igneous oceanic crust of the subducted Pacific Plate. Hainan and Datong basalts have isotopic signatures of recycled subduction materials with billions of years of storage in the mantle. The perimeter basalts have isotopic signatures similar to pyroxenite xenoliths from the subcontinental lithospheric mantle beneath East Eurasia. Hainan basalts exhibit the highest mantle potential temperature (Tp), while the Shandong basalts have the lowest Tp. We infer that a deep high-Tp plume interacted with the subducted Pacific Plate slab in the mantle transition zone to form a local low-Tp plume by entraining colder igneous oceanic lithosphere. We infer that the subducted Izanagi Plate slab, once a part of the Pacific Plate mosaic, broke off from the Pacific Plate slab at 35 Ma to sink into the lower mantle. The sinking Izanagi slab triggered the plume that interacted with the stagnant Pacific slab and caused subcontinental lithospheric melting. This coincided with formation of the western Pacific backarc marginal basins due to Pacific Plate slab rollback and stagnation.

Six-Year Change in High-Sensitivity Cardiac Troponin T and Risk of Subsequent Coronary Heart Disease, Heart Failure, and Death.

PubMed

McEvoy, John W; Chen, Yuan; Ndumele, Chiadi E; Solomon, Scott D; Nambi, Vijay; Ballantyne, Christie M; Blumenthal, Roger S; Coresh, Josef; Selvin, Elizabeth

2016-08-01

High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker of cardiovascular risk and could be approved in the United States for clinical use soon. However, data linking long-term temporal change in hs-cTnT to outcomes are limited, particularly in primary prevention settings. To examine the association of 6-year change in hs-cTnT with incident coronary heart disease (CHD), heart failure (HF), and all-cause mortality. This prospective observational cohort study, performed from January 1, 1990, to December 31, 2011, included 8838 participants with biracial representation from the Atherosclerosis Risk in Communities Study who were initially free of CHD and HF and who had hs-cTnT measured twice, 6 years apart. Data analysis was performed from October 28, 2014, to March 9, 2016. Risk factor and temporal hs-cTnT data were collected. Using Cox proportional hazards regression, we examined the association of hs-cTnT change with subsequent CHD, HF, and death during a maximum of 16 years. Improvement in discrimination was determined by the Harrell C statistic. Of the 8838 participants (mean age, 56 years; 5215 female [59.0%]; 1891 black [21.4%]) there were 1157 CHD events, 965 HF events, and 1813 deaths overall. Incident detectable hs-cTnT (baseline, <0.005 ng/mL; follow-up, ≥0.005 ng/mL) was independently associated with subsequent CHD (hazard ratio [HR], 1.4; 95% CI, 1.2-1.6), HF (HR, 2.0; 95% CI, 1.6-2.4), and death (HR, 1.5; 95% CI, 1.3-1.7), relative to an hs-cTnT level less than 0.005 ng/mL at both visits. In addition, HRs as high as 4 for CHD and death and 8 for HF were recorded among individuals with the most marked hs-cTnT increases (eg, baseline, < 0.005 ng/mL; follow-up, ≥0.014 ng/mL). Risk for subsequent outcomes was lower among those with relative hs-cTnT reductions greater than 50% from baseline. Furthermore, information on hs-cTnT change improved discrimination for HF and death when added to a model that included traditional risk factors, N-terminal pro-brain natriuretic peptide, and baseline hs-cTnT level. Among individuals with adjudicated HF hospitalizations, hs-cTnT change appeared to be similarly associated with HF with reduced and preserved ejection fraction. Temporal increases in hs-cTnT, suggestive of progressive myocardial damage, are independently associated with incident CHD, death, and, above all, HF. Serial determination of hs-cTnT trajectory adds clinically relevant information to baseline testing and may be useful in prognostic assessments and the targeting of prevention strategies to high-risk individuals, especially among persons with stage A or B HF.

The success and complementarity of Sm-Nd and Lu-Hf garnet geochronology

NASA Astrophysics Data System (ADS)

Baxter, E. F.; Scherer, E. E.

2013-12-01

Garnet's potential as a direct chronometer of tectonometamorphic processes and conditions was first realized over 30 years ago. Since then, the Sm-Nd and Lu-Hf systems have emerged as the most effective, with both permitting age precision < ×1 Myr. Both have proven successful not merely in dating garnet growth itself, but rather in constraining the ages, durations, and rates of particular earth processes or conditions that can be directly linked to garnet growth via chemical, thermodynamic, or petrographic, means. Appreciating important differences between Sm-Nd and Lu-Hf in terms of contaminant phases, partitioning, daughter element diffusivity, and isotopic analysis makes these two systems powerfully complementary when used and interpreted in concert. Well established, robust analytical methods mitigate the effects of ubiquitous mineral inclusions (monazite is most significant for Sm-Nd; zircon is most significant for Lu-Hf), improving the precision and accuracy of garnet dates from both systems. Parent-daughter ratios tend to be higher for Lu-Hf leading to the potential for better age precision in general. The Lu-176 decay rate is faster than Sm-147, meaning that Lu-Hf provides better age precision potential for young (Cenozoic) samples. However, Sm-Nd provides better precision potential for older (Precambrian) samples primarily because of the higher precisions on the parent-daughter ratios (i.e., 147Sm/144Nd) that can be achieved by ID-TIMS analysis. For dating microsampled zones or growth rings in single garnet crystals, Sm-Nd has proven most successful owing to more uniform distribution of Sm, and established methods to measure <10 ng quantities of Nd at high precision via TIMS. However, new MC-ICP-MS sample introduction technologies are closing this gap for small samples. For analyses of bulk garnet that grew over a protracted interval, Lu-Hf dates are expected to be older than Sm-Nd dates owing to differences in Lu and Sm zonation (i.e. Lu tends to be strongly sequestered by garnet cores, whereas Sm is more evenly distributed). Thus, Lu-Hf is often useful for targeting nucleation times (and earliest growth zones), whereas Sm-Nd is preferable when targeting the mid- to later stages (and outermost growth zones) of garnet. Depending on grain size and heating duration, most garnets can retain their primary growth chronology up to about 700 C, and thus they are one of the few metamorphic minerals that faithfully record prograde metamorphic processes and conditions. For granulite facies rocks (e.g., > about 700 C), higher retentivity (i.e., slower diffusivity) for Hf than for Nd can lead to older Lu-Hf (growth) ages compared to Sm-Nd (partially reset) dates for the same sample. Finally, as with all geochronometers, decay constant uncertainties and sources of systematic error in methods (e.g., spike calibrations) should be considered when comparing absolute Lu-Hf and Sm-Nd dates to each other or to other chronometers.

Adherence to the recommended prevention strategies before and after a hip fragility fracture: what makes us go blind?

PubMed

Daniel, Alexandra; Marques, Mary Lucy; Brites, Luísa; Torres, Carolina; Marques, Andréa; Pereira da Silva, José António

2018-05-24

Our main objective was to evaluate the percentage of patients under anti-osteoporotic treatment (OT) at the time of hip fracture (HF) and one and four years after the HF event. We compared these results with the percentage of patients who should be under treatment at all three stages, according to the recently published Portuguese cost-effectiveness recommendations (PCER) for OT. Data regarding occurrence of new fragility fractures and mortality were also determined, one and four years after the HF event. Our secondary objective was to evaluate characteristics of patients associated with OT at the time of hip fracture.. Patients hospitalized due to HF between May 1st and October 31st of 2013 in a single tertiary hospital, were selected for this study. Data regarding demographic, clinical features (including the clinical risk factors for fracture considered by FRAX®), level of independence in daily activities (Katz index), comorbidity (Charlson index) and OT were recorded at the time of the HF. The subsequent risk of fracture was estimated for each patient with FRAX® (without mineral bone density). Mortality and the percentage of patients receiving an OT prescription and suffering a new osteoporotic fracture, at one and four years after the HF event, were established. One hundred and thirty patients were included, with a mean age of 81.6±8.6 years. At the time of the HF only 28(21.5%) of the patients were receiving some form of OT. According to PCER, 115(88.5%) of these patients should be undergoing treatment according to FRAX® estimated risk, 30(23.1%) based on previous fractures and 119(91.5%) based on either criteria. The score of comorbidities was negatively associated with the prescription of OT at baseline (OR=0.17 [0.05-0.53], p=0.011) while the level of independence in daily activities was associated with higher probability of being treated (OR=3.20 [1.30-7.89], p=0.003). At one year after the HF, 39/130(30%) of patients had died. Although, according to PCER, all the remaining patients should be under OT based on the history of HF, only 11/91(12.1%) had received an OT prescription and 5/91(5.5%) suffered a new osteoporotic fracture during this period. At four years after the HF, 65/130 (50%) of patients had died. Only 6 of the remaining 65 (9.2%) were receiving an OT prescription and 9/65(13.8%) had suffered an additional fractured. Similar to other countries, the percentage of patients receiving OT at the time and especially after a HF is extremely low. Risk estimations with FRAX® and application of current PCER should allow clinicians to introduce appropriate primary and secondary preventive measures. Comorbidities and dependence seem to be important reasons for this undertreatment.

The in Silico Insight into Carbon Nanotube and Nucleic Acid Bases Interaction.

PubMed

Karimi, Ali Asghar; Ghalandari, Behafarid; Tabatabaie, Seyed Saleh; Farhadi, Mohammad

2016-05-01

To explore practical applications of carbon nanotubes (CNTs) in biomedical fields the properties of their interaction with biomolecules must be revealed. Recent years, the interaction of CNTs with biomolecules is a subject of research interest for practical applications so that previous research explored that CNTs have complementary structure properties with single strand DNA (ssDNA). Hence, the quantum mechanics (QM) method based on ab initio was used for this purpose. Therefore values of binding energy, charge distribution, electronic energy and other physical properties of interaction were studied for interaction of nucleic acid bases and SCNT. In this study, the interaction between nucleic acid bases and a (4, 4) single-walled carbon nanotube (SCNT) were investigated through calculations within quantum mechanics (QM) method at theoretical level of Hartree-Fock (HF) method using 6-31G basis set. Hence, the physical properties such as electronic energy, total dipole moment, charge distributions and binding energy of nucleic acid bases interaction with SCNT were investigated based on HF method. It has been found that the guanine base adsorption is bound stronger to the outer surface of nanotube in comparison to the other bases, consistent with the recent theoretical studies. In the other words, the results explored that guanine interaction with SCNT has optimum level of electronic energy so that their interaction is stable. Also, the calculations illustrated that SCNT interact to nucleic acid bases by noncovalent interaction because of charge distribution an electrostatic area is created in place of interaction. Consequently, small diameter SCNT interaction with nucleic acid bases is noncovalent. Also, the results revealed that small diameter SCNT interaction especially SCNT (4, 4) with nucleic acid bases can be useful in practical application area of biomedical fields such detection and drug delivery.

Li interactions with the B40 fullerene and its application in Li-ion batteries: DFT studies

NASA Astrophysics Data System (ADS)

Moradi, Morteza; Bagheri, Zargham; Bodaghi, Ali

2017-05-01

The interaction of Li and Li+ with a B40 all-boron fullerene was theoretically investigated at the B3LYP, and Minnesota 2006 levels of theory. It was found that, unexpectedly, the interaction Li+ cation with the electron deficient B40 fullerene is stronger than the Li atom. It indicates that the B40 fullerene does not act as a conventional Lewis acid because of its highly correlated structure. Frontier molecular orbitals, partial density of states, and natural bond orbital analyses were used to discuss this unusual behavior. Our calculations indicate that this behavior makes the B40 fullerene more appropriate for application in the Li-ion batteries as anode material. The calculated cell voltage is about 530 mV. Also, it was found that Hartree Fock (HF) exchange percentage of density functionals has a reverse effect on the adsorption energies of Li and Li+. This energy is increased and decreased, respectively, for Li+ and Li adsorptions by increasing %HF exchange. Finally, a potential energy surface for Li and Li+ penetration into B40 fullerene was predicted.

Modeling the Interaction Between Hydraulic and Natural Fractures Using Dual-Lattice Discrete Element Method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Jing; Huang, Hai; Deo, Milind

The interaction between hydraulic fractures (HF) and natural fractures (NF) will lead to complex fracture networks due to the branching and merging of natural and hydraulic fractures in unconventional reservoirs. In this paper, a newly developed hydraulic fracturing simulator based on discrete element method is used to predict the generation of complex fracture network in the presence of pre-existing natural fractures. By coupling geomechanics and reservoir flow within a dual lattice system, this simulator can effectively capture the poro-elastic effects and fluid leakoff into the formation. When HFs are intercepting single or multiple NFs, complex mechanisms such as direct crossing,more » arresting, dilating and branching can be simulated. Based on the model, the effects of injected fluid rate and viscosity, the orientation and permeability of NFs and stress anisotropy on the HF-NF interaction process are investigated. Combined impacts from multiple parameters are also examined in the paper. The numerical results show that large values of stress anisotropy, intercepting angle, injection rate and viscosity will impede the opening of NFs.« less

Assessment of Quantum Mechanical Methods for Copper and Iron Complexes by Photoelectron Spectroscopy.

PubMed

Niu, Shuqiang; Huang, Dao-Ling; Dau, Phuong D; Liu, Hong-Tao; Wang, Lai-Sheng; Ichiye, Toshiko

2014-03-11

Broken-symmetry density functional theory (BS-DFT) calculations are assessed for redox energetics [Cu(SCH 3 ) 2 ] 1-/0 , [Cu(NCS) 2 ] 1-/0 , [FeCl 4 ] 1-/0 , and [Fe(SCH 3 ) 4 ] 1-/0 against vertical detachment energies (VDE) from valence photoelectron spectroscopy (PES), as a prelude to studies of metalloprotein analogs. The M06 and B3LYP hybrid functionals give VDE that agree with the PES VDE for the Fe complexes, but both underestimate it by ∼400 meV for the Cu complexes; other hybrid functionals give VDEs that are an increasing function of the amount of Hartree-Fock (HF) exchange and so cannot show good agreement for both Cu and Fe complexes. Range-separated (RS) functionals appear to give a better distribution of HF exchange since the negative HOMO energy is approximately equal to the VDEs but also give VDEs dependent on the amount of HF exchange, sometimes leading to ground states with incorrect electron configurations; the LRC- ω PBEh functional reduced to 10% HF exchange at short-range give somewhat better values for both, although still ∼150 meV too low for the Cu complexes and ∼50 meV too high for the Fe complexes. Overall, the results indicate that while HF exchange compensates for self-interaction error in DFT calculations of both Cu and Fe complexes, too much may lead to more sensitivity to nondynamical correlation in the spin-polarized Fe complexes.

Assessment of Quantum Mechanical Methods for Copper and Iron Complexes by Photoelectron Spectroscopy

PubMed Central

2015-01-01

Broken-symmetry density functional theory (BS-DFT) calculations are assessed for redox energetics [Cu(SCH3)2]1–/0, [Cu(NCS)2]1–/0, [FeCl4]1–/0, and [Fe(SCH3)4]1–/0 against vertical detachment energies (VDE) from valence photoelectron spectroscopy (PES), as a prelude to studies of metalloprotein analogs. The M06 and B3LYP hybrid functionals give VDE that agree with the PES VDE for the Fe complexes, but both underestimate it by ∼400 meV for the Cu complexes; other hybrid functionals give VDEs that are an increasing function of the amount of Hartree–Fock (HF) exchange and so cannot show good agreement for both Cu and Fe complexes. Range-separated (RS) functionals appear to give a better distribution of HF exchange since the negative HOMO energy is approximately equal to the VDEs but also give VDEs dependent on the amount of HF exchange, sometimes leading to ground states with incorrect electron configurations; the LRC-ωPBEh functional reduced to 10% HF exchange at short-range give somewhat better values for both, although still ∼150 meV too low for the Cu complexes and ∼50 meV too high for the Fe complexes. Overall, the results indicate that while HF exchange compensates for self-interaction error in DFT calculations of both Cu and Fe complexes, too much may lead to more sensitivity to nondynamical correlation in the spin-polarized Fe complexes. PMID:24803858

A high carbohydrate, but not fat or protein meal attenuates postprandial ghrelin, PYY and GLP-1 responses in Chinese men

PubMed Central

Parvaresh Rizi, Ehsan; Loh, Tze Ping; Baig, Sonia; Chhay, Vanna; Huang, Shiqi; Caleb Quek, Jonathan; Tai, E. Shyong; Toh, Sue-Anne

2018-01-01

It is known that the macronutrient content of a meal has different impacts on the postprandial satiety and appetite hormonal responses. Whether obesity interacts with such nutrient-dependent responses is not well characterized. We examined the postprandial appetite and satiety hormonal responses after a high-protein (HP), high-carbohydrate (HC), or high-fat (HF) mixed meal. This was a randomized cross-over study of 9 lean insulin-sensitive (mean±SEM HOMA-IR 0.83±0.10) and 9 obese insulin-resistant (HOMA-IR 4.34±0.41) young (age 21–40 years), normoglycaemic Chinese men. We measured fasting and postprandial plasma concentration of glucose, insulin, active glucagon-like peptide-1 (GLP-1), total peptide-YY (PYY), and acyl-ghrelin in response to HP, HF, or HC meals. Overall postprandial plasma insulin response was more robust in the lean compared to obese subjects. The postprandial GLP-1 response after HF or HP meal was higher than HC meal in both lean and obese subjects. In obese subjects, HF meal induced higher response in postprandial PYY compared to HC meal. HP and HF meals also suppressed ghrelin greater compared to HC meal in the obese than lean subjects. In conclusion, a high-protein or high-fat meal induces a more favorable postprandial satiety and appetite hormonal response than a high-carbohydrate meal in obese insulin-resistant subjects. PMID:29385178

Radiation from an electron beam in magnetized plasma: excitation of a whistler mode wave packet by interacting, higher-frequency, electrostatic-wave eigenmodes

NASA Astrophysics Data System (ADS)

Brenning, N.; Axnäs, I.; Koepke, M.; Raadu, M. A.; Tennfors, E.

2017-12-01

Infrequent, bursty, electromagnetic, whistler-mode wave packets, excited spontaneously in the laboratory by an electron beam from a hot cathode, appear transiently, each with a time duration τ around ∼1 μs. The wave packets have a center frequency f W that is broadly distributed in the range 7 MHz < f W < 40 MHz. They are excited in a region with separate electrostatic (es) plasma oscillations at values of f hf, 200 MHz < f hf < 500 MHz, that are hypothesized to match eigenmode frequencies of an axially localized hf es field in a well-defined region attached to the cathode. Features of these es-eigenmodes that are studied include: the mode competition at times of transitions from one dominating es-eigenmode to another, the amplitude and spectral distribution of simultaneously occurring es-eigenmodes that do not lead to a transition, and the correlation of these features with the excitation of whistler mode waves. It is concluded that transient coupling of es-eigenmode pairs at f hf such that | {{{f}}}1,{{h}{{f}}}-{{{f}}}2,{{h}{{f}}}| = {f}{{W}}< {f}{{g}{{e}}} can explain both the transient lifetime and the frequency spectra of the whistler-mode wave packets (f W) as observed in lab. The generalization of the results to bursty whistler-mode excitation in space from electron beams, created on the high potential side of double layers, is discussed.

The Chronology of Asteroid Accretion, Differentiation, and Secondary Mineralization

NASA Technical Reports Server (NTRS)

Nyquist, L. E.; Kleine, T.; Shih, C.-Y.; Reese, Y. D.

2008-01-01

We evaluate initial (Al-26/Al-27)(sub I), (Mn-53/Mn-55)(sub I), (Hf-182/Hf-180)(sub I), and Pb-207/Pb-206 ages for igneous differentiated meteorites and chondrules from ordinary chondrites for consistency with radioactive decay of the parent nuclides within a common, closed isotopic system, i.e., the early solar nebula. We find that the relative abundances of Al-26, Mn-53, and Hf-182, here denoted by I(Al)(sub CAI, I(Mn)(sub CAI) and I(Hf)(sub CAI), are consistent with decay from common initial values for the bulk solar system. I(Mn)(sub CAI) and I(Hf)(sub CAI) = 9.1+/-1.7 x 10(exp -6) and 1.06+/-0.09 x 10(exp -6) respectively, correspond to the canonical value of I(Al)(sub CAI) = 5.1 x 10(exp -5). I(Hf)(sub CAI) thus determined is consistent with I(Hf)(sub CAI) = 1.003+/-0.045 x 10(exp -6) directly determined in separate work. I(Mn)(sub CAI) is within error of the lowest value directly determined for CAI. We suggest that erratically higher values directly determined for CAI in carbonaceous chondrites reflect proton irradiation of unaccreted CAIs by the early Sun after other asteroids destined for melting by Al-26 decay had already accreted. The Mn-53 incorporated within such asteroids would have been shielded from further "local" spallogenic contributions. The relative abundances of the short-lived nuclides are less consistent with the Pb-207/Pb-206 ages of the corresponding materials with the best consistency being obtained between (Hf-182/Hf-180)(sub I) and Pb-207/Pb-206 ages of angrites. (Hf-182/Hf-180)(sub I) decreases with decreasing Pb-207/Pb-206 ages at the rate expected from the 8.90+/-0.09 Ma half-life of Hf-182. However, the model "CAI age" thus determined, T(sub CAI,Mn-W) = 4568.6+/-0.7 Ma, is older than the commonly accepted directly measured value T(sub CAI) = 4567.l+/-0.2 Ma. I(Al)(sub I), and (Mn-53/Mn-55)(sub I) are less consistent with Pb-207/Pb-206 ages, but determine T(sub CAI, Mn-Cr) = 4568.3+/-0.5 Ma relative to I(AI)(sub CAI)= 5.1 x 10(exp -5) and a Pb-207/Pb-206 age of 4558.6 Ma for the LEW86010 angrite. However. the (Mn-53/Mn-55)(sub I) and Pb-207/Pb-206 ages of "intermediate" age D'Orbigny-clan angrites and Asuka 881394 are inconsistent with radioactive decay from CAI values with a Mn-55 half-life of 3.7+/-0.4 Ma. in spite of consistency between (Mn-53/Mn-55)(sub I) and (Al-26/Al-27)(sub I). Nevertheless, it appears that the Mn-Cr method with I(Mn)(sub CAI) = 9.1+/-1.7 x 10(exp -6) can be used to date primary igneous events and also secondary mineralization on asteroid parent bodies. We summarize ages thus determined for igneous events on differentiated asteroids and for carbonate and fayalite formation on carbonaceous asteroids.

Geochronology and geochemistry of early Paleozoic igneous rocks of the Lesser Xing'an Range, NE China: Implications for the tectonic evolution of the eastern Central Asian Orogenic Belt

NASA Astrophysics Data System (ADS)

Wang, Zhi-wei; Xu, Wen-liang; Pei, Fu-ping; Wang, Feng; Guo, Peng

2016-09-01

This paper presents new zircon U-Pb, Hf isotope, and whole-rock major and trace element data for early Paleozoic igneous rocks of the Lesser Xing'an Range, NE China, in order to constrain the early Paleozoic tectonic evolution of the eastern Central Asian Orogenic Belt (CAOB). Zircon U-Pb dating indicates that early Paleozoic magmatic events within the northern Songnen-Zhangguangcai Range Massif (SZM) can be subdivided into four stages: Middle Cambrian ( 505 Ma), Late Cambrian ( 490 Ma), Early-Middle Ordovician ( 470 Ma), and Late Ordovician (460-450 Ma). The Middle Cambrian monzogranites are K-rich, weakly to strongly peraluminous, and characterized by pronounced heavy rare earth element (HREE) depletions, high Sr/Y ratios, low Y concentrations, low primary zircon εHf(t) values (- 6.79 to - 1.09), and ancient two-stage model (TDM2) ages (1901-1534 Ma). These results indicate derivation from partial melting of thickened ancient crustal materials that formed during the amalgamation of the northern SZM and the northern Jiamusi Massif (JM). The Late Cambrian monzonite, quartz monzonite, and monzogranite units are chemically similar to A-type granites, and contain zircons with εHf(t) values of - 2.59 to + 1.78 and TDM2 ages of 1625-1348 Ma. We infer that these rocks formed from primary magmas generated by partial melting of Mesoproterozoic accreted lower crustal materials in a post-collisional extensional environment. The Early-Middle Ordovician quartz monzodiorite, quartz monzonite, monzogranite, and rhyolite units are calc-alkaline, relatively enriched in light REEs (LREEs) and large ion lithophile elements (LILEs; e.g., Rb, Th, and U), depleted in HREEs and high field strength elements (HFSEs; e.g., Nb, Ta, and Ti), and contain zircons with εHf(t) values of - 7.33 to + 4.98, indicative of formation in an active continental margin setting. The Late Ordovician alkali-feldspar granite and rhyolite units have A-type granite affinities that suggest they formed in an extensional environment. A comparison of early Paleozoic magmatic events and Hf isotopic model ages between the northern SZM and the JM indicates that these two massifs have similar histories of Mesoproterozoic and early Paleozoic crustal accretion and reworking, although the SZM contains much older crustal materials than the JM.

LC-MS/MS Based Quantitation of ABC and SLC Transporter Proteins in Plasma Membranes of Cultured Primary Human Retinal Pigment Epithelium Cells and Immortalized ARPE19 Cell Line.

PubMed

Pelkonen, Laura; Sato, Kazuki; Reinisalo, Mika; Kidron, Heidi; Tachikawa, Masanori; Watanabe, Michitoshi; Uchida, Yasuo; Urtti, Arto; Terasaki, Tetsuya

2017-03-06

The retinal pigment epithelium (RPE) forms the outer blood-retinal barrier between neural retina and choroid. The RPE has several important vision supporting functions, such as transport mechanisms that may also modify pharmacokinetics in the posterior eye segment. Expression of plasma membrane transporters in the RPE cells has not been quantitated. The aim of this study was to characterize and compare transporter protein expression in the ARPE19 cell line and hfRPE (human fetal RPE) cells by using quantitative targeted absolute proteomics (QTAP). Among 41 studied transporters, 16 proteins were expressed in hfRPE and 13 in ARPE19 cells. MRP1, MRP5, GLUT1, 4F2hc, TAUT, CAT1, LAT1, and MATE1 proteins were detected in both cell lines within 4-fold differences. MPR7, OAT2 and RFC1 were detected in the hfRPE cells, but their expression levels were below the limit of quantification in ARPE19 cells. PCFT was detected in both studied cell lines, but the expression was over 4-fold higher in hfRPE cells. MCT1, MCT4, MRP4, and Na + /K + ATPase were upregulated in the ARPE19 cell line showing over 4-fold differences in the quantitative expression values. Expression levels of 25 transporters were below the limit of quantification in both cell models. In conclusion, we present the first systematic and quantitative study on transporter protein expression in the plasma membranes of ARPE19 and hfRPE cells. Overall, transporter expression in the ARPE19 and hfRPE cells correlated well and the absolute expression levels were similar, but not identical. The presented quantitative expression levels could be a useful basis for further studies on drug permeation in the outer blood-retinal barrier.

Efficacy and Cost-effectiveness of the Children’s Oncology Group Long-Term Follow-Up Screening Guidelines for Childhood Cancer Survivors at Risk of Treatment-related Heart Failure

PubMed Central

Wong, F. Lennie; Bhatia, Smita; Landier, Wendy; Francisco, Liton; Leisenring, Wendy; Hudson, Melissa M.; Armstrong, Gregory T.; Mertens, Ann; Stovall, Marilyn; Robison, Leslie L.; Lyman, Gary H.; Lipshultz, Steven E.; Armenian, Saro H.

2014-01-01

Background Childhood cancer survivors treated with anthracyclines are at high risk for asymptomatic left ventricular dysfunction (ALVD), subsequent heart failure (HF), and death. The consensus-based Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines recommend lifetime echocardiographic screening for ALVD. Objective To evaluate the efficacy and cost-effectiveness of the COG Guidelines and to identify more cost-effective screening strategies. Design Simulation of life-histories using Markov health states. Data Sources Childhood Cancer Survivor Study; published literature. Target Population Childhood cancer survivors. Time Horizon Lifetime. Perspective Societal. Intervention Echocardiographic screening, followed by angiotensin-converting enzyme (ACE) inhibitor and beta-blocker therapies after ALVD diagnosis. Measurements Quality-adjusted life years (QALYs), costs, incremental cost-effectiveness ratios (ICERs) in dollars per QALY, and the cumulative incidence of HF. Results of Base-Case Analysis The COG Guidelines versus no screening have an ICER of $61,500, extend life expectancy by 6 months and QALYs by 1.6 months, and reduce the cumulative incidence of HF by 18% at 30 years after cancer diagnosis. However, less-frequent screenings are more cost-effective than the Guidelines, and maintain 80% of the health benefits. Results of Sensitivity Analysis The ICER was most sensitive to the magnitude of ALVD treatment efficacy; higher treatment efficacy resulted in lower ICER. Limitation Lifetime non-HF mortality and the cumulative incidence of HF more than 20 years after diagnosis were extrapolated; the efficacy of ACE inhibitor and beta-blocker therapy in childhood cancer survivors with ALVD is undetermined (or unknown). Conclusion The COG Guidelines could reduce the risk of HF in survivors at less than $100,000/QALY. Less-frequent screening achieves most of the benefits and would be more cost-effective than the COG Guidelines. Primary Funding Source Lance Armstrong Foundation, National Cancer Institute. PMID:24842414

Single‐dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo‐controlled study (PRACTICE‐ASIA‐HF)

PubMed Central

Yeo, Poh Shuan Daniel; Hadi, Farid Abdul; Cushway, Timothy; Lee, Kim Yee; Yin, Fang Fang; Ching, Anne; Li, Ruili; Loh, Seet Yoong; Lim, Shir Lynn; Wong, Raymond Ching‐Chiew; Tai, Bee Choo; Richards, Arthur Mark; Lam, Carolyn S.P.

2018-01-01

Abstract Aims Iron deficiency is highly prevalent in Southeast Asians with heart failure (HF) and associated with worse outcomes. This trial aimed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF. Methods and results Fifty patients hospitalized for acute decompensated HF, regardless of ejection fraction, with iron deficiency (defined as serum ferritin <300 ng/mL if transferrin saturation is <20%) were randomized to receive either one dose of intravenous ferric carboxymaltose (FCM) 1000 mg or placebo (0.9% saline) following HF stabilization and before discharge in two Singapore tertiary centres. The primary endpoint was difference in 6‐min walk test (6MWT) distance over 12 weeks, while secondary endpoints were quality of life assessed using validated Kansas City Cardiomyopathy Questionnaire (KCCQ) and Visual Analogue Scale (VAS). Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups (from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m, respectively). Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo, but adjustment for baseline covariates and time attenuated this effect {adjusted mean difference between groups: 0.88 m [95% confidence interval (CI) −30.2 to 32.0, P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [adjusted mean difference: KCCQ −1.48 (95% CI −8.27 to 5.31, P = 0.670) and VAS 0.26 (95% CI −0.33 to 0.86, P = 0.386)]. FCM was well tolerated with no serious treatment‐related adverse events. Conclusions Intravenous FCM administered pre‐discharge in Southeast Asians hospitalized with decompensated HF is clinically feasible. Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects. PMID:29345426

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure.

PubMed

León-González, Rocío; García-Esquinas, Esther; Paredes-Galán, Emilio; Ferrero-Martínez, Ana Isabel; González-Guerrero, José Luis; Hornillos-Calvo, Mercedes; Menéndez-Colino, Rocío; Torres-Torres, Ivett; Galán, María Concepción; Torrente-Carballido, Marta; Olcoz-Chiva, Mayte; Rodríguez-Pascual, Carlos; Rodríguez-Artalejo, Fernando

2018-03-01

Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. This prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. Disease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. No association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure.

PubMed

Park, Jin Joo; Park, Jun-Bean; Park, Jae-Hyeong; Cho, Goo-Yeong

2018-05-08

Heart failure (HF) is currently classified according to left ventricular ejection fraction (LVEF); however, the prognostic value of LVEF is controversial. Myocardial strain is a prognostic factor independently of LVEF. The authors sought to evaluate the prognostic value of global longitudinal strain (GLS) in patients with HF. GLS was measured in 4,172 consecutive patients with acute HF. Patients were categorized as either HF with reduced (LVEF <40%), midrange (LVEF 40% to 49%), or preserved ejection fraction (LVEF ≥50%) and were also classified as having mildly (GLS >12.6%), moderately (8.1% < GLS <12.5%), or severely (GLS ≤8.0%) reduced strain. The primary endpoint was 5-year all-cause mortality. Mean GLS was 10.8%, and mean LVEF was 40%. Overall, 1,740 (40.4%) patients had died at 5 years. Patients with reduced ejection fraction had slightly higher mortality than those with midrange or preserved ejection fraction (41%, 38%, and 39%, respectively; log-rank p = 0.031), whereas patients with reduced strain had significantly higher mortality (severely reduced GLS, 49%; moderately reduced GLS, 38%; mildly reduced GLS, 34%; log-rank p < 0.001). In multivariable analysis, each 1% increase in GLS was associated with a 5% decreased risk for mortality (p < 0.001). Patients with moderate (hazard ratio: 1.31; 95% confidence interval: 1.13 to 1.53) and severe GLS reductions (hazard ratio: 1.61; 95% confidence interval: 1.36 to 1.91) had higher mortality, but LVEF was not associated with mortality. In patients with acute HF, GLS has greater prognostic value than LVEF. Therefore, the authors suggest that GLS should be considered as the standard measurement in all patients with HF. This new concept needs validation in further studies. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction.

PubMed

Liang, Lin; Bin-Chia Wu, David; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong Quek; Tan, Doreen; Ng, Kwong

2018-02-01

Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care. To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective. A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I-IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively. At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.

Planning for coordinated space and ground-based ionospheric modification experiments

NASA Technical Reports Server (NTRS)

Lee, M. C.; Burke, William J.; Carlson, Herbert C.; Heckscher, John L.; Kossey, Paul A.; Weber, E. J.; Kuo, S. P.

1990-01-01

The planning and conduction of coordinated space and ground-based ionospheric modification experiments are discussed. The purpose of these experiments is to discuss: (1) the nonlinear VLF wave interaction with the ionospheric plasmas; and (2) the nonlinear propagation of VLF waves in the HF-modified ionosphere. It is expected that the HF-induced ionospheric density striations can render the nonlinear mode conversion of VLF waved into lower hybrid waves. Lower hybrid waves can also be excited parametrically by the VLF waves in the absence of the density striations if the VLF waves are intense enough. Laboratory experiments are planned for crosschecking the results obtained from the field experiments.

Health Care Human Factors/Ergonomics Fieldwork in Home and Community Settings

PubMed Central

Valdez, Rupa S.; Holden, Richard J.

2017-01-01

Feature at a glance Designing innovations aligned with patients’ needs and workflow requires human factors and ergonomics (HF/E) fieldwork in home and community settings. Fieldwork in these extra-institutional settings is challenged by a need to balance the occasionally competing priorities of patient and informal caregiver participants, study team members, and the overall project. We offer several strategies that HF/E professionals can use before, during, and after home and community site visits to optimize fieldwork and mitigate challenges in these settings. Strategies include interacting respectfully with participants, documenting the visit, managing the study team-participant relationship, and engaging in dialogue with institutional review boards. PMID:28781512

Synthesis and characterisation of ionic liquids based on 1-butyl-3-methylimidazolium chloride and MCl(4), M = Hf and Zr.

PubMed

Campbell, Paul S; Santini, Catherine C; Bouchu, Denis; Fenet, Bernard; Rycerz, Leszek; Chauvin, Yves; Gaune-Escard, Marcelle; Bessada, Catherine; Rollet, Anne-Laure

2010-02-07

Dialkylimidazolium chlorometallate molten salts resulting from the combination of zirconium or hafnium tetrachloride and 1-butyl-3-methylimidazolium chloride, [C(1)C(4)Im][Cl], have been prepared with a molar fraction of MCl(4), R = n(MCl4)/n(MCl4) + n([C1C4IM][Cl]) equal to 0, 0.1, 0.2, 0.33, 0.5, 0.67. The structure and composition were studied by Differential Scanning Calorimetry (DSC), (35)Cl (263 to 333 K), (1)H and (13)C solid state and solution NMR spectroscopy, and electrospray ionisation (ESI) mass spectrometry. The primary anions of the MCl(4)-based ILs were [MCl(5)], [MCl(6)] and [M(2)Cl(9)], whose relative abundances varied with R. For R = 0.33, pure solid [C(1)C(4)Im](2)[MCl(6)], for both M = Zr and Hf are formed (m.p. = 366 and 385 K, respectively). For R = 0.67 pure ionic liquids [C(1)C(4)Im][M(2)Cl(9)] for both M = Zr and Hf are formed (T(g) = 224 and 220 K, respectively). The thermal dissociation has been attempted of [C(1)C(4)Im](2)[HfCl(6)], and [C(1)C(4)Im](2)[ZrCl(6)] monitored by (35)Cl and (91)Zr solid NMR (high temperature up to 551 K).

Closed-cycle 1-kHz-pulse-repetition-frequency HF(DF) laser

NASA Astrophysics Data System (ADS)

Harris, Michael R.; Morris, A. V.; Gorton, Eric K.

1998-05-01

We describe the design and performance of a closed cycle, high pulse repetition frequency HF(DF) laser. A short duration, glow discharge is formed in a 10 SF6:1 H2(D2) gas mixture at a total pressure of approximately 110 torr. A pair of profiled electrodes define a 15 X 0.5 X 0.5 cm3 discharge volume through which gas flow is forced in the direction transverse to the optical axis. A centrifugal fan provides adequate gas flow to enable operation up to 3 kHz repetition frequency. The fan also passes the gas through a scrubber cell in which ground state HF(DF) is eliminated from the gas stream. An automated gas make-up system replenishes the spent fuel gases removed by the scrubber. Total gas admission is regulated by monitoring the system pressure, whilst the correct fuel balance is maintained through measurement of the discharge voltage. The HF(DF) generation rate is determined to be close to 5 X 1019 molecules per second per watt of laser output. Typical mean laser output powers of up to 3 watts can be delivered for extended periods of time. The primary limitation to life is found to be the discharge pre- ionization system. A distributed resistance corona pre- ionizer is shown to be advantageous when compared with an alternative arc array scheme.

Maturity of nearby faults influences seismic hazard from hydraulic fracturing.

PubMed

Kozłowska, Maria; Brudzinski, Michael R; Friberg, Paul; Skoumal, Robert J; Baxter, Nicholas D; Currie, Brian S

2018-02-20

Understanding the causes of human-induced earthquakes is paramount to reducing societal risk. We investigated five cases of seismicity associated with hydraulic fracturing (HF) in Ohio since 2013 that, because of their isolation from other injection activities, provide an ideal setting for studying the relations between high-pressure injection and earthquakes. Our analysis revealed two distinct groups: ( i ) deeper earthquakes in the Precambrian basement, with larger magnitudes (M > 2), b-values < 1, and many post-shut-in earthquakes, versus ( ii ) shallower earthquakes in Paleozoic rocks ∼400 m below HF, with smaller magnitudes (M < 1), b-values > 1.5, and few post-shut-in earthquakes. Based on geologic history, laboratory experiments, and fault modeling, we interpret the deep seismicity as slip on more mature faults in older crystalline rocks and the shallow seismicity as slip on immature faults in younger sedimentary rocks. This suggests that HF inducing deeper seismicity may pose higher seismic hazards. Wells inducing deeper seismicity produced more water than wells with shallow seismicity, indicating more extensive hydrologic connections outside the target formation, consistent with pore pressure diffusion influencing seismicity. However, for both groups, the 2 to 3 h between onset of HF and seismicity is too short for typical fluid pressure diffusion rates across distances of ∼1 km and argues for poroelastic stress transfer also having a primary influence on seismicity.

Maturity of nearby faults influences seismic hazard from hydraulic fracturing

NASA Astrophysics Data System (ADS)

Kozłowska, Maria; Brudzinski, Michael R.; Friberg, Paul; Skoumal, Robert J.; Baxter, Nicholas D.; Currie, Brian S.

2018-02-01

Understanding the causes of human-induced earthquakes is paramount to reducing societal risk. We investigated five cases of seismicity associated with hydraulic fracturing (HF) in Ohio since 2013 that, because of their isolation from other injection activities, provide an ideal setting for studying the relations between high-pressure injection and earthquakes. Our analysis revealed two distinct groups: (i) deeper earthquakes in the Precambrian basement, with larger magnitudes (M > 2), b-values < 1, and many post–shut-in earthquakes, versus (ii) shallower earthquakes in Paleozoic rocks ˜400 m below HF, with smaller magnitudes (M < 1), b-values > 1.5, and few post–shut-in earthquakes. Based on geologic history, laboratory experiments, and fault modeling, we interpret the deep seismicity as slip on more mature faults in older crystalline rocks and the shallow seismicity as slip on immature faults in younger sedimentary rocks. This suggests that HF inducing deeper seismicity may pose higher seismic hazards. Wells inducing deeper seismicity produced more water than wells with shallow seismicity, indicating more extensive hydrologic connections outside the target formation, consistent with pore pressure diffusion influencing seismicity. However, for both groups, the 2 to 3 h between onset of HF and seismicity is too short for typical fluid pressure diffusion rates across distances of ˜1 km and argues for poroelastic stress transfer also having a primary influence on seismicity.

Waon Therapy for Managing Chronic Heart Failure　- Results From a Multicenter Prospective Randomized WAON-CHF Study.

PubMed

Tei, Chuwa; Imamura, Teruhiko; Kinugawa, Koichiro; Inoue, Teruo; Masuyama, Tohru; Inoue, Hiroshi; Noike, Hirofumi; Muramatsu, Toshihiro; Takeishi, Yasuchika; Saku, Keijiro; Harada, Kazumasa; Daida, Hiroyuki; Kobayashi, Youichi; Hagiwara, Nobuhisa; Nagayama, Masatoshi; Momomura, Shinichi; Yonezawa, Kazuya; Ito, Hiroshi; Gojo, Satoshi; Akaishi, Makoto; Miyata, Masaaki; Ohishi, Mitsuru

2016-01-01

Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain. In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60℃ for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group. Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF.

Applying the Seattle Heart Failure Model in the Office Setting in the Era of Electronic Medical Records.

PubMed

Williams, Brent A; Agarwal, Shikhar

2018-02-23

Prediction models such as the Seattle Heart Failure Model (SHFM) can help guide management of heart failure (HF) patients, but the SHFM has not been validated in the office environment. This retrospective cohort study assessed the predictive performance of the SHFM among patients with new or pre-existing HF in the context of an office visit.Methods and Results:SHFM elements were ascertained through electronic medical records at an office visit. The primary outcome was all-cause mortality. A "warranty period" for the baseline SHFM risk estimate was sought by examining predictive performance over time through a series of landmark analyses. Discrimination and calibration were estimated according to the proposed warranty period. Low- and high-risk thresholds were proposed based on the distribution of SHFM estimates. Among 26,851 HF patients, 14,380 (54%) died over a mean 4.7-year follow-up period. The SHFM lost predictive performance over time, with C=0.69 and C<0.65 within 3 and beyond 12 months from baseline respectively. The diminishing predictive value was attributed to modifiable SHFM elements. Discrimination (C=0.66) and calibration for 12-month mortality were acceptable. A low-risk threshold of ∼5% mortality risk within 12 months reflects the 10% of HF patients in the office setting with the lowest risk. The SHFM has utility in the office environment.

Evolution of E 2 transition strength in deformed hafnium isotopes from new measurements on 172Hf,174Hf, and 176Hf

NASA Astrophysics Data System (ADS)

Rudigier, M.; Nomura, K.; Dannhoff, M.; Gerst, R.-B.; Jolie, J.; Saed-Samii, N.; Stegemann, S.; Régis, J.-M.; Robledo, L. M.; Rodríguez-Guzmán, R.; Blazhev, A.; Fransen, Ch.; Warr, N.; Zell, K. O.

2015-04-01

Background: The available data for E 2 transition strengths in the region between neutron-deficient hafnium and platinum isotopes are far from complete. More and precise data are needed to enhance the picture of structure evolution in this region and to test state-of-the-art nuclear models. In a simple model, the maximum collectivity is expected at the middle of the major shell. However, for actual nuclei, particularly in heavy-mass regions, which should be highly complex, this picture may no longer be the case, and one should use a more realistic nuclear-structure model. We address this point by studying the spectroscopy of Hf as a representative case. Purpose: We remeasure the 21+ half-lives of 172,174,176Hf, for which there is some disagreement in the literature. The main goal is to measure, for the first time, the half-lives of higher-lying states of the rotational band. The new results are compared to a theoretical calculation for absolute transition strengths. Method: The half-lives were measured using γ -γ and conversion-electron-γ delayed coincidences with the fast timing method. For the determination of half-lives in the picosecond region, the generalized centroid difference method was applied. For the theoretical calculation of the spectroscopic properties, the interacting boson model is employed, whose Hamiltonian is determined based on microscopic energy-density functional calculations. Results: The measured 21+ half-lives disagree with results from earlier γ -γ fast timing measurements, but are in agreement with data from Coulomb excitation experiments and other methods. Half-lives of the 41+ and 61+ states were measured, as well as a lower limit for the 81+ states. Conclusions: This work shows the importance of a mass-dependent effective boson charge in the interacting boson model for the description of E 2 transition rates in chains of nuclei. It encourages further studies of the microscopic origin of this mass dependence. New experimental values on transition rates in nuclei from neighboring isotopic chains could support these studies.

Investigation of Ionospheric Turbulence and Whistler Wave Interactions with Space Plasmas

DTIC Science & Technology

2012-11-21

an oscillating LOS velocity with the same periodicity as the heating modulation pattern. A set of Fourier periodogram from the MUIR LOS velocity...scale ionospheric turbulence are discussed separately, viz., (a) anomalous heat source-induced acoustic gravity waves (AGW), and (b) HF radio wave...ionospheric ducts, acoustic gravity waves (AGWs), anomalous heat sources, inner and outer radiation belts, L parameter, whistler wave interactions

Nanoscopic studies of domain structure dynamics in ferroelectric La:HfO2 capacitors

NASA Astrophysics Data System (ADS)

Buragohain, P.; Richter, C.; Schenk, T.; Lu, H.; Mikolajick, T.; Schroeder, U.; Gruverman, A.

2018-05-01

Visualization of domain structure evolution under an electrical bias has been carried out in ferroelectric La:HfO2 capacitors by a combination of Piezoresponse Force Microscopy (PFM) and pulse switching techniques to study the nanoscopic mechanism of polarization reversal and the wake-up process. It has been directly shown that the main mechanism behind the transformation of the polarization hysteretic behavior and an increase in the remanent polarization value upon the alternating current cycling is electrically induced domain de-pinning. PFM imaging and local spectroscopy revealed asymmetric switching in the La:HfO2 capacitors due to a significant imprint likely caused by the different boundary conditions at the top and bottom interfaces. Domain switching kinetics can be well-described by the nucleation limited switching model characterized by a broad distribution of the local switching times. It has been found that the domain velocity varies significantly throughout the switching process indicating strong interaction with structural defects.

First results from the energetic particle instrument on the OEDIPUS-C sounding rocket

NASA Astrophysics Data System (ADS)

Gough, M. P.; Hardy, D. A.; James, H. G.

The Canadian / US OEDIPUS-C rocket was flown from the Poker Flat Rocket Range November 6th 1995 as a mother-son sounding rocket. It was designed to study auroral ionospheric plasma physics using active wave sounding and prove tether technology. The payload separated into two sections reaching a separation of 1200m along the Earth's magnetic field. One section included a frequency stepped HF transmitter and the other included a synchronised HF receiver. Both sections included Energetic Particle Instruments, EPI, stepped in energy synchronously with the transmitter steps. On-board EPI particle processing in both payloads provided direct measurements of electron heating, wave-particle interactions via particle correlators, and a high resolution measurement of wave induced particle heating via transmitter synchronised fast sampling. Strong electron heating was observed at times when the HF transmitter frequency was equal to a harmonic of the electron gyrofrequency, f_ce, or equal to the upper hybrid frequency, f_uh.

High-Intensity Intermittent Exercise and Autonomic Modulation: Effects of Different Volume Sessions.

PubMed

Castrillón, Carlos Iván Mesa; Miranda, Rodolfo Augusto Travagin; Cabral-Santos, Carolina; Vanzella, Lais Manata; Rodrigues, Bruno; Vanderlei, Luiz Carlos Marques; Lira, Fábio Santos; Campos, Eduardo Zapaterra

2017-06-01

The aim of this study was to compare heart rate variability (HRV) recovery after 2 sessions of high-intensity intermittent exercise at different volumes (1.25 km [HIIE 1.25 ] and 2.5 km [HIIE 2.5 ]). 13 participants determined their maximal aerobic speed (MAS) and completed 2 HIIE (1:1 at 100% MAS) trials. The heart rate was recorded before and after each session. HRV indicators were calculated according to time (RMSSD and SDNN) and frequency (LF, HF and LF/HF ratio) domains. SDNN and RMSSD presented effect of test (F=20.97; p<0.01 and F=21.00; p<0.01, respectively) and moment (F=6.76; p<0.01 and F=12.30; p<0.01, respectively), without interaction. Even though we did not find an interaction effect for any HRV variables, the HIIE 2.5 presented a delay of only 5 min in HRV recovery, when compared to HIIE 1.25 . However, the effects of the test (SDNN, RMSSD, LF-log, and HF-log) indicate higher autonomic stress during the entire recovery period. These findings may indicate that exercise volume interferes with HRV recovery. If so, physically active subjects may choose a lower volume exercise (i. e., HIIE 1.25 ) in order to promote similar physical fitness adaptations with lower loading on autonomic modulation. © Georg Thieme Verlag KG Stuttgart · New York.

Heart failure education in the emergency department markedly reduces readmissions in un- and under-insured patients.

PubMed

Asthana, Vishwaratn; Sundararajan, Miel; Ackah, Ruth Linda; Karun, Vivek; Misra, Arunima; Pritchett, Allison; Bugga, Pallavi; Siler-Fisher, Angela; Peacock, William Frank

2018-03-21

Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients. HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group. Eligible patients provided informed consent, had an established HF diagnosis, and were hemodynamically stable. Intervention patients received a standardized educational intervention in the ED waiting room before seeing the emergency physician, and a 30-day telephone follow-up. Primary and secondary endpoints were 30- and 90-day ED and hospital readmission rates, as well as days alive and out of hospital (DAOH) respectively. Of the 94 patients enrolled, median age was 58.4 years; 40.4% were female, and 54.3% were African American. Intervention patients (n = 45) experienced a 47.8% and 45.3% decrease in ED revisits (P = 0.02 &P < 0.001), and 60.0% and 47.4% decrease in hospital readmissions (P = 0.049 &P = 0.007) in the 30 and 90 days pre- versus post-intervention respectively. Control patients (n = 49) had no change in hospital readmissions or 30-day ED revisits, but experienced a 36.6% increase in 90-day ED revisits (P = 0.03). Intervention patients also saw a 59.2% improvement in DAOH versus control patients (P = 0.03). An ED educational intervention markedly decreases ED and hospital readmissions in un- and under-insured HF patients. Copyright © 2018 Elsevier Inc. All rights reserved.

A Randomized Controlled Trial of High Dose Vitamin D3 in Patients with Heart Failure

PubMed Central

Boxer, Rebecca S.; Kenny, Anne M.; Schmotzer, Brian J.; Vest, Marianne; Fiutem, Justin J.; Piña, Ileana L.

2013-01-01

Objective To investigate the effect of Vitamin D3 on physical performance in patients with HF. Background HF is associated with functional decline and frailty. Vitamin D deficiency is associated with loss of muscle strength and poor outcomes in patients with HF. Methods: Sixty-four patients participated in a 6-month parallel design double blind RCT to test the hypothesis that oral vitamin D3 would improve physical performance. Vitamin D3 50,000 IU or placebo was given weekly; all received daily calcium. Patients were included regardless of EF and 25OHD ≤ 37.5 ng/ml. The primary outcome was peak VO2, and secondary outcomes were the 6MW, TGUG and knee isokinetic muscle strength. Between group comparisons were made using ANCOVA models that adjust for baseline measures. Results Patients were age 65.9 ± 10.4 years old, 48% women, 64% African American, EF 37.6±13.9, 36% NYHA III, the remainder NYHA II. At baseline the vitamin D group 25OHD was 19.1 ± 9.3 ng/ml and increased to 61.7 ± 20.3 ng/ml; in the placebo group baseline 25OHD was 17.8 ± 9.0 ng/ml and decreased to 17.4 ± 9.8 ng/ml at 6 months (between groups p<0.001). There was no significant change from baseline to 6 months in peak VO2, 6MW, TGUG or isokinetic muscle strength. Conclusions Vitamin D3 did not improve physical performance for patients with HF despite a robust increase in serum 25OHD. Vitamin D repletion in patients with HF should conform to standard adult guidelines for vitamin D supplementation. PMID:24614995

Adherence to 2016 European Society of Cardiology guidelines predicts outcome in a large real-world population of heart failure patients requiring cardiac resynchronization therapy.

PubMed

Stabile, Giuseppe; Pepi, Patrizia; Palmisano, Pietro; D'Onofrio, Antonio; De Simone, Antonio; Caico, Salvatore Ivan; Pecora, Domenico; Rapacciuolo, Antonio; Arena, Giuseppe; Marini, Massimiliano; Pieragnoli, Paolo; Badolati, Sandra; Savarese, Gianluca; Maglia, Gianpiero; Iuliano, Assunta; Botto, Giovanni Luca; Malacrida, Maurizio; Bertaglia, Emanuele

2018-04-14

Professional guidelines are based on the best available evidence. However, patients treated in clinical practice may differ from those included in reference trials. The aim of this study was to evaluate the effects of cardiac resynchronization therapy (CRT) in a large population of patients implanted with a CRT device stratified in accordance with the 2016 European heart failure (HF) guidelines. We collected data on 930 consecutive patients from the Cardiac Resynchronization Therapy MOdular REgistry. The primary end point was a composite of death and HF hospitalization. Five hundred sixty-three (60.5%) patients met class I indications, 145 (15.6%) class IIa, 108 (11.6%) class IIb, and 114 (12.3%) class III. After a median follow-up of 1001 days, 120 patients who had an indication for CRT implantation had died and 71 had been hospitalized for HF. The time to the end point was longer in patients with a class I indication (hazard ratio 0.55; 95% confidence interval 0.39-0.76; P = .0001). After 12 months, left ventricular (LV) end-systolic volume had decreased by ≥15% in 61.5% of patients whereas in 57.5% of patients the absolute LV ejection fraction improvement was ≥5%. Adherence to class I was also associated with an absolute LV ejection fraction increase of >5% (P = .0142) and an LV end-systolic volume decrease of ≥15% (P = .0055). In our population, ∼60% of patients underwent implantation according to the 2016 European HF guidelines class I indication. Adherence to class I was associated with a lower death and HF hospitalization rate and better LV reverse remodeling. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

International differences in clinical characteristics, management, and outcomes in acute heart failure patients: better short-term outcomes in patients enrolled in Eastern Europe and Russia in the PROTECT trial

PubMed Central

Mentz, Robert J.; Cotter, Gad; Cleland, John G.F.; Stevens, Susanna R.; Chiswell, Karen; Davison, Beth A.; Teerlink, John R.; Metra, Marco; Voors, Adriaan A.; Grinfeld, Liliana; Ruda, Mikhail; Mareev, Viacheslav; Lotan, Chaim; Bloomfield, Daniel M.; Fiuzat, Mona; Givertz, Michael M.; Ponikowski, Piotr; Massie, Barry M.; O’Connor, Christopher M.

2017-01-01

Aims The implications of geographical variation are unknown following adjustment for hospital length of stay (LOS) in heart failure (HF) trials that included patients whether or not they had systolic dysfunction. We investigated regional differences in an international acute HF trial. Methods and results The PROTECT trial investigated 2033 patients with acute HF and renal dysfunction hospitalized at 173 sites in 17 countries with randomization to rolofylline or placebo. We grouped enrolling countries into six regions. Baseline characteristics, in-hospital management, and outcomes were explored by region. The primary study outcome was 60-day mortality or cardiovascular/renal hospitalization. Secondary outcomes included 180-day mortality. Of 2033 patients, 33% were from Eastern Europe, 19% from Western Europe, 16% from Israel, 15% from North America, 14% from Russia, and 3% from Argentina. Marked differences in baseline characteristics, HF phenotype, in-hospital diuretic and vasodilator strategies, and LOS were observed by region. LOS was shortest in North America and Israel (median 5 days) and longest in Russia (median 15 days). Regional event rates varied significantly. Following multivariable adjustment, region was an independent predictor of the risk of mortality/hospitalization at 60 days, with the lowest risk in Russia (hazard ratio 0.39, 95% confidence interval 0.23–0.64 vs. Western Europe) due to lower rehospitalization; mortality differences were attenuated by 180 days. Conclusions In an international HF trial, there were differences in baseline characteristics, treatments, LOS, and rehospitalization amongst regions, but little difference in longer term mortality. Rehospitalization differences exist independent of LOS. This analysis may help inform future trial design and should be externally validated. PMID:24771609

Heart rate at first postdischarge visit and outcomes in patients with heart failure.

PubMed

Kim, Tae-Hun; Kim, Hyungseop; Kim, In-Cheol; Yoon, Hyuck-Jun; Park, Hyoung-Seob; Cho, Yun-Kyeong; Nam, Chang-Wook; Han, Seongwook; Hur, Seung-Ho; Kim, Yoon-Nyun

2018-07-01

Heart rate control is important to prevent adverse outcomes in patients with heart failure (HF). However, postdischarge activity may worsen heart rate control, resulting in readmission. This study aimed to explore the implications of the heart rate differences between discharge and the first outpatient visit (D-O diff). We retrospectively identified 458 patients (male: 46%; mean age: 72 years) discharged after HF. The heart rates at admission, discharge and first outpatient visit were analysed. The primary outcome was a composite of cardiovascular (CV) death and readmission of non-fatal myocardial infarction (MI), non-fatal stroke or non-fatal HF over a mean follow-up of 16 months. During follow-up, the clinical outcomes were noted in 223 patients (49%): HF, 199; stroke, 9; MI, 6; CV death, 9. The heart rate at the first outpatient visit (r=-0.311, P<0.001) and D-O diff (r=0.416, P<0.001) showed a better correlation with the time-to-clinical event than the heart rate at admission or discharge. The events group displayed a pronounced heart rate increase (13 beats/min) from discharge to the first outpatient visit compared with the event-free group (a decrease of 2 beats/min). A decrease less than -15 in the D-O diff showed a 4.5-fold risk of clinical outcomes during follow-up (P<0.001). A decreased D-O diff was related to the adverse outcomes of HF. The failure of heart rate control within more than 15 beats/min at the first outpatient visit was an independent factor for CV events. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lack of long-term benefits of a 6-month heart failure disease management program.

PubMed

Nguyen, Viviane; Ducharme, Anique; White, Michel; Racine, Normand; O'Meara, Eileen; Zhang, Bin; Rouleau, Jean L; Brophy, James

2007-05-01

Heart failure (HF) represents a major burden on the health care system, causing repeated hospitalizations and numerous emergency department (ED) visits. In a 6-month randomized study of a multidisciplinary HF clinic, we have previously shown decreased hospital readmissions and improved quality of life. Despite these encouraging results, it is unknown if these beneficial effects are sustained. To assess long-term recurrent ED visits, readmissions, and mortality among HF patients who were discharged after a 6-month intensive HF management program (HFMP). Of the 230 subjects (New York Heart Association Class II-IV) who were initially randomized to standard follow-up care or to a HFMP for 6 months, 190 were studied retrospectively for long-term evaluation. Long-term data was obtained from the Quebec administrative health databases. We compared the intervention and control groups for the number of recurrent ED visits, hospital readmissions, and all-cause deaths. After a mean follow-up of 2.8 +/- 1.7 years, there was no difference in the composite end point of all-cause death, hospital admissions, and ED visits between those patients initially in the HFMP group and the controls. After multivariable adjustment, there was no difference in the composite primary endpoint (HR 1.01, 95% CI: 0.75-1.37) or in the secondary end point of all-cause death alone (HR 1.09, 95%CI:0.69-1.72) between those initially assigned to the HF clinic and those receiving usual care. For severely ill patients, the clinical and resource benefits of a 6-month HFMP are not sustained upon program cessation. Further research into the benefits of long-term HFMP is required.