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.

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

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.

Large ionospheric disturbances produced by the HAARP HF facility

NASA Astrophysics Data System (ADS)

Bernhardt, Paul A.; Siefring, Carl L.; Briczinski, Stanley J.; McCarrick, Mike; Michell, Robert G.

2016-07-01

The enormous transmitter power, fully programmable antenna array, and agile frequency generation of the High Frequency Active Auroral Research Program (HAARP) facility in Alaska have allowed the production of unprecedented disturbances in the ionosphere. Using both pencil beams and conical (or twisted) beam transmissions, artificial ionization clouds have been generated near the second, third, fourth, and sixth harmonics of the electron gyrofrequency. The conical beam has been used to sustain these clouds for up to 5 h as opposed to less than 30 min durations produced using pencil beams. The largest density plasma clouds have been produced at the highest harmonic transmissions. Satellite radio transmissions at 253 MHz from the National Research Laboratory TACSat4 communications experiment have been severely disturbed by propagating through artificial plasma regions. The scintillation levels for UHF waves passing through artificial ionization clouds from HAARP are typically 16 dB. This is much larger than previously reported scintillations at other HF facilities which have been limited to 3 dB or less. The goals of future HAARP experiments should be to build on these discoveries to sustain plasma densities larger than that of the background ionosphere for use as ionospheric reflectors of radio signals.

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.

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.

Applications of a time-dependent polar ionosphere model for radio modification experiments

NASA Astrophysics Data System (ADS)

Fallen, Christopher Thomas

A time-dependent self-consistent ionosphere model (SLIM) has been developed to study the response of the polar ionosphere to radio modification experiments, similar to those conducted at the High-Frequency Active Auroral Research Program (HAARP) facility in Gakona, Alaska. SCIM solves the ion continuity and momentum equations, coupled with average electron and ion gas energy equations; it is validated by reproducing the diurnal variation of the daytime ionosphere critical frequency, as measured with an ionosonde. Powerful high-frequency (HF) electromagnetic waves can drive naturally occurring electrostatic plasma waves, enhancing the ionospheric reflectivity to ultra-high frequency (UHF) radar near the HF-interaction region as well as heating the electron gas. Measurements made during active experiments are compared with model calculations to clarify fundamental altitude-dependent physical processes governing the vertical composition and temperature of the polar ionosphere. The modular UHF ionosphere radar (MUIR), co-located with HAARP, measured HF-enhanced ion-line (HFIL) reflection height and observed that it ascended above its original altitude after the ionosphere had been HF-heated for several minutes. The HFIL ascent is found to follow from HF-induced depletion of plasma surrounding the F-region peak density layer, due to temperature-enhanced transport of atomic oxygen ions along the geomagnetic field line. The lower F-region and topside ionosphere also respond to HF heating. Model results show that electron temperature increases will lead to suppression of molecular ion recombination rates in the lower F region and enhancements of ambipolar diffusion in the topside ionosphere, resulting in a net enhancement of slant total electron content (TEC); these results have been confirmed by experiment. Additional evidence for the model-predicted topside ionosphere density enhancements via ambipolar diffusion is provided by in-situ measurements of ion density and vertical velocity over HAARP made by a Defense Meteorological Satellite Program (DMSP) satellite.

Methods for Creation and Detection of Ultra-Strong Artificial Ionization in the Upper Atmosphere (Invited)

NASA Astrophysics Data System (ADS)

Bernhardt, P. A.; Siefring, C. L.; Briczinski, S. J.; Kendall, E. A.; Watkins, B. J.; Bristow, W. A.; Michell, R.

2013-12-01

The High Frequency Active Auroral Research Program (HAARP) transmitter in Alaska has been used to produce localized regions of artificial ionization at altitudes between 150 and 250 km. High power radio waves tuned near harmonics of the electron gyro frequency were discovered by Todd Pederson of the Air Force Research Laboratory to produce ionosonde traces that looked like artificial ionization layers below the natural F-region. The initial regions of artificial ionization (AI) were not stable but had moved down in altitude over a period of 15 minutes. Recently, artificial ionization has been produced by the 2nd, 3rd, 4th and 6th harmonics transmissions by the HAARP. In march 2013, the artificial ionization clouds were sustained for more the 5 hours using HAARP tuned to the 4 fce at the full power of 3.6 Mega-Watts with a twisted-beam antenna pattern. Frequency selection with narrow-band sweeps and antenna pattern shaping has been employed for optimal generation of AI. Recent research at HAARP has produced the longest lived and denser artificial ionization clouds using HF transmissions at the harmonics of the electron cyclotron frequency and ring-shaped radio beams tailored to prevent the descent of the clouds. Detection of artificial ionization employs (1) ionosonde echoes, (2) coherent backscatter from the Kodiak SuperDARN radar, (3) enhanced ion and plasma line echoes from the HAARP MUIR radar at 400 MHz, (4) high resolution optical image from ground sites, and (5) unique stimulated electromagnetic emissions, and (6) strong UHF and L-Band scintillation induced into trans-ionospheric signals from satellite radio beacons. Future HAARP experiments will determine the uses of long-sustained AI for enhanced HF communications.

Studies of the ionospheric turbulence excited by the fourth gyroharmonic at HAARP

NASA Astrophysics Data System (ADS)

Najmi, A.; Milikh, G.; Yampolski, Y. M.; Koloskov, A. V.; Sopin, A. A.; Zalizovski, A.; Bernhardt, P.; Briczinski, S.; Siefring, C.; Chiang, K.; Morton, Y.; Taylor, S.; Mahmoudian, A.; Bristow, W.; Ruohoniemi, M.; Papadopoulos, K.

2015-08-01

A study is presented of artificial ionospheric turbulence (AIT) induced by HF heating at High Frequency Active Auroral Research Program (HAARP) using frequencies close to the fourth electron gyroharmonic, in a broad range of radiated powers and using a number of different diagnostics. The diagnostics include GPS scintillations, ground-based stimulated electromagnetic emission (SEE), the HAARP ionosonde, Kodiak radar, and signals received at the Ukrainian Antarctic Station (UAS). The latter allowed analysis of waves scattered by the AIT into the ionospheric waveguide along Earth's terminator, 15.6 mm from the HAARP facility. For the first time, the amplitudes of two prominent SEE features, the downshifted maximum and broad upshifted maximum, were observed to saturate at ~50% of the maximum HAARP effective radiated power. Nonlinear effects in slant total electron content, SEE, and signals received at UAS at different transmitted frequencies and intensities of the pump wave were observed. The correlations between the data from different detectors demonstrate that the scattered waves reach UAS by the waveguide along the Earth's terminator, and that they were injected into the waveguide by scattering off of artificial striations produced by AIT above HAARP, rather than via direct injection from sidelobe radiation.

ELF/VLF Waves Generated by an Artificially-Modulated Auroral Electrojet Above the HAARP HF Transmitter

NASA Astrophysics Data System (ADS)

Moore, R. C.; Inan, U. S.; Bell, T. F.

2004-12-01

Naturally-forming, global-scale currents, such as the polar electrojet current and the mid-latitude dynamo, have been used as current sources to generate electromagnetic waves in the Extremely Low Frequency (ELF) and Very Low Frequency (VLF) bands since the 1970's. While many short-duration experiments have been performed, no continuous multi-week campaign data sets have been published providing reliable statistics for ELF/VLF wave generation. In this paper, we summarize the experimental data resulting from multiple ELF/VLF wave generation campaigns conducted at the High-frequency Active Auroral Research Project (HAARP) HF transmitter in Gakona, Alaska. For one 14-day period in March, 2002, and one 24-day period in November, 2002, the HAARP HF transmitter broadcast ELF/VLF wave generation sequences for 10 hours per day, between 0400 and 1400 UT. Five different modulation frequencies broadcast separately using two HF carrier frequencies are examined at receivers located 36, 44, 147, and 155 km from the HAARP facility. Additionally, a continuous 24-hour transmission period is analyzed to compare day-time wave generation to night-time wave generation. Lastly, a power-ramping scheme was employed to investigate possible thresholding effects at the wave-generating altitude. Wave generation statistics are presented along with source-region property calculations performed using a simple model.

Observations of HF backscatter decay rates from HAARP generated FAI

NASA Astrophysics Data System (ADS)

Bristow, William; Hysell, David

2016-07-01

Suitable experiments at the High-frequency Active Auroral Research Program (HAARP) facilities in Gakona, Alaska, create a region of ionospheric Field-Aligned Irregularities (FAI) that produces strong radar backscatter observed by the SuperDARN radar on Kodiak Island, Alaska. Creation of FAI in HF ionospheric modification experiments has been studied by a number of authors who have developed a rich theoretical background. The decay of the irregularities, however, has not been so widely studied yet it has the potential for providing estimates of the parameters of natural irregularity diffusion, which are difficult measure by other means. Hysell, et al. [1996] demonstrated using the decay of radar scatter above the Sura heating facility to estimate irregularity diffusion. A large database of radar backscatter from HAARP generated FAI has been collected over the years. Experiments often cycled the heater power on and off in a way that allowed estimates of the FAI decay rate. The database has been examined to extract decay time estimates and diffusion rates over a range of ionospheric conditions. This presentation will summarize the database and the estimated diffusion rates, and will discuss the potential for targeted experiments for aeronomy measurements. Hysell, D. L., M. C. Kelley, Y. M. Yampolski, V. S. Beley, A. V. Koloskov, P. V. Ponomarenko, and O. F. Tyrnov, HF radar observations of decaying artificial field aligned irregularities, J. Geophys. Res. , 101, 26,981, 1996.

Observations of HF backscatter decay rates from HAARP generated FAI

NASA Astrophysics Data System (ADS)

Bristow, W. A.; Hysell, D. L.

2016-12-01

Suitable experiments at the High-frequency Active Auroral Research Program (HAARP) facilities in Gakona, Alaska, create a region of ionospheric Field-Aligned Irregularities (FAI) that produces strong radar backscatter observed by the SuperDARN radar on Kodiak Island, Alaska. Creation of FAI in HF ionospheric modification experiments has been studied by a number of authors who have developed a rich theoretical background. The decay of the irregularities, however, has not been so widely studied yet it has the potential for providing estimates of the parameters of natural irregularity diffusion, which are difficult measure by other means. Hysell, et al. [1996] demonstrated using the decay of radar scatter above the Sura heating facility to estimate irregularity diffusion. A large database of radar backscatter from HAARP generated FAI has been collected over the years. Experiments often cycled the heater power on and off in a way that allowed estimates of the FAI decay rate. The database has been examined to extract decay time estimates and diffusion rates over a range of ionospheric conditions. This presentation will summarize the database and the estimated diffusion rates, and will discuss the potential for targeted experiments for aeronomy measurements. Hysell, D. L., M. C. Kelley, Y. M. Yampolski, V. S. Beley, A. V. Koloskov, P. V. Ponomarenko, and O. F. Tyrnov, HF radar observations of decaying artificial field aligned irregularities, J. Geophys. Res. , 101, 26,981, 1996.

Interharmonic modulation products as a means to quantify nonlinear D-region interactions

NASA Astrophysics Data System (ADS)

Moore, Robert

Experimental observations performed during dual beam ionospheric HF heating experiments at the High frequency Active Auroral Research Program (HAARP) HF transmitter in Gakona, Alaska are used to quantify the relative importance of specific nonlinear interactions that occur within the D region ionosphere. During these experiments, HAARP broadcast two amplitude modulated HF beams whose center frequencies were separated by less than 20 kHz. One beam was sinusoidally modulated at 500 Hz while the second beam was sinusoidally modulated using a 1-7 kHz linear frequency-time chirp. ELF/VLF observations performed at two different locations (3 and 98 km from HAARP) provide clear evidence of strong interactions between all field components of the two HF beams in the form of low and high order interharmonic modulation products. From a theoretical standpoint, the observed interharmonic modulation products could be produced by several different nonlinearities. The two primary nonlinearities take the form of wave-medium interactions (i.e., cross modulation), wherein the ionospheric conductivity modulation produced by one signal crosses onto the other signal via collision frequency modification, and wave-wave interactions, wherein the conduction current associated with one wave mixes with the electric field of the other wave to produce electron temperature oscillations. We are able to separate and quantify these two different nonlinearities, and we conclude that the wave-wave interactions dominate the wave-medium interactions by a factor of two. These results are of great importance for the modeling of transioinospheric radio wave propagation, in that both the wave-wave and the wave-medium interactions could be responsible for a significant amount of anomalous absorption.

Stimulated Brillouin scattering during electron gyro-harmonic heating at EISCAT

NASA Astrophysics Data System (ADS)

Fu, H. Y.; Scales, W. A.; Bernhardt, P. A.; Briczinski, S. J.; Kosch, M. J.; Senior, A.; Rietveld, M. T.; Yeoman, T. K.; Ruohoniemi, J. M.

2015-08-01

Observations of secondary radiation, stimulated electromagnetic emission (SEE), produced during ionospheric modification experiments using ground-based, high-power, high-frequency (HF) radio waves are considered. The High Frequency Active Auroral Research Program (HAARP) facility is capable of generating narrowband SEE in the form of stimulated Brillouin scatter (SBS) and stimulated ion Bernstein scatter (SIBS) in the SEE spectrum. Such narrowband SEE spectral lines have not been reported using the European Incoherent Scatter (EISCAT) heater facility before. This work reports the first EISCAT results of narrowband SEE spectra and compares them to SEE previously observed at HAARP during electron gyro-harmonic heating. An analysis of experimental SEE data shows observations of emission lines within 100 Hz of the pump frequency, interpreted as SBS, during the 2012 July EISCAT campaign. Experimental results indicate that SBS strengthens as the pump frequency approaches the third electron gyro-harmonic. Also, for different heater antenna beam angles, the CUTLASS radar backscatter induced by HF radio pumping is suppressed near electron gyro-harmonics, whereas electron temperature enhancement weakens as measured by EISCAT/UHF radar. The main features of these new narrowband EISCAT observations are generally consistent with previous SBS measurements at HAARP.

Artificial Aurora and Ionospheric Heating by HAARP

NASA Astrophysics Data System (ADS)

Hadavandkhani, S.; Nikouravan, Bijan; Ghazimaghrebi, F.

2016-08-01

A recent experiment was achieved at HAARP to study the scaling of the ionospherically generated ELF signal with power transmitted from the high frequency (HF) array. The results were in excellent agreement with computer simulations. The outcomes approving that the ELF power increases with the square of the incident HF power. This paper present a review on the situation of the ionized particles in Ionospheric layer when stimulated by artificial an ELF and VLF external high energy radio waves.

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.

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.

Studies of Plasma Instabilities Excited by Ground-Based High Power HF (Heating) Facilities and of X and Gamma Ray Emission in Runaway Breakdown Processes

DTIC Science & Technology

2006-08-01

latitude ( HAARP , TROMSO) and mid latitude (SURA) facilities [1]. The very strong and fully reproducible plasma perturbations in ionosphere are observed...beam propagating along magnetic field (θ = 0), in this case factor κs ≈ 1. As an a example we will consider now the HAARP facility. The ERP for HAARP ...as a function of fre- quency f0 is presented in the Table 1. ISTC 2236p 12 Table 1 ERP as function of wave frequency for HAARP (2001) f0 (MHz

Excitation of Ionospheric Alfvén Resonator with HAARP

NASA Astrophysics Data System (ADS)

Streltsov, A. V.; Chang, C.; Labenski, J.; Milikh, G. M.; Vartanyan, A.; Snyder, A. L.

2011-12-01

We report results from numerical and experimental studies of the excitation of ULF waves inside the ionospheric Alfvén resonator (IAR) by heating the ionosphere with powerful HF waves launched from the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. Numerical simulations of the two-fluid MHD model describing IAR in a dipole magnetic field geometry with plasma parameters taken from the observations at HAARP during October-November 2010 experimental campaign reveal that the IAR quality is higher during night-time conditions, when the ionospheric conductivity is very low. Simulations also reveal that the resonance wave cannot be identified from the magnetic measurements on the ground or at an altitude above 600 km because the magnetic field in this wave has nodes on both ends of the resonator, and the best way to detect IAR modes is by measuring the electric field on low-Earth-orbit satellites. These theoretical predictions are in good, quantitative agreement with results from observations: In particular, 1) observations from the ground-based magnetometer at the HAARP site demonstrate no any significant difference in the amplitudes of the magnetic field generated by HAARP in the frequency range from 0 to 5 Hz, and 2) the DEMETER satellite detected the electric field of the IAR first harmonic at an altitude of 670 km above HAARP during the heating experiment.

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.

Studies of Plasma Instability Processes Excited by Ground Based High Power HF (Heating) Facilities

DTIC Science & Technology

2001-04-01

and Megill, 1974; Carlson, 1974; Bernhardt et al., 1989). During the last years new interesting results have been obtained at HAARP facility (Peterson...Haslett and Megill, 1974; Carlson, 1974; Bernhardt et al., 1989). During the last years new interesting results have been obtained at HAARP facility

HAARP-Induced Ionospheric Ducts

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

Milikh, Gennady; Vartanyan, Aram

2011-01-04

It is well known that strong electron heating by a powerful HF-facility can lead to the formation of electron and ion density perturbations that stretch along the magnetic field line. Those density perturbations can serve as ducts for ELF waves, both of natural and artificial origin. This paper presents observations of the plasma density perturbations caused by the HF-heating of the ionosphere by the HAARP facility. The low orbit satellite DEMETER was used as a diagnostic tool to measure the electron and ion temperature and density along the satellite orbit overflying close to the magnetic zenith of the HF-heater. Thosemore » observations will be then checked against the theoretical model of duct formation due to HF-heating of the ionosphere. The model is based on the modified SAMI2 code, and is validated by comparison with well documented experiments.« less

In-Band and Out-of-Band VLF Scattering by Modulated D-region Heating at the Arecibo Observatory

NASA Astrophysics Data System (ADS)

Burch, H.; Moore, R. C.

2017-12-01

The HF heating facility at the Arecibo Observatory is able to create an artificial disturbance in the D-region ionosphere through HF heating, a phenomenon which has been well documented at HAARP. Very Low Frequency (VLF, 3-30 kHz) waves radiated by Navy transmitters propagate around the globe in the Earth-Ionosphere waveguide and scatter from this artificially disturbed region. We investigated this effect at the Arecibo Observatory during the July 2017 HF heating campaign using an amplitude-modulated HF signal at modulation frequencies from below 1 Hz to approximately 5 kHz. VLF receivers stationed in Puerto Rico measured the amplitude and phase of propagating VLF transmitter signals under HF-heated and ambient ionospheric conditions. We interpret the scattered VLF signals in the context of an ionospheric HF heating model that has been successfully used to interpret the results of HAARP experiments for a number of years. We present initial results regarding the generation and detection of nonlinear mixing components at the VLF transmitter frequency +/- the HF modulation frequency.

"Twisted Beam" SEE Observations of Ionospheric Heating from HAARP

NASA Astrophysics Data System (ADS)

Briczinski, S. J.; Bernhardt, P. A.; Siefring, C. L.; Han, S.-M.; Pedersen, T. R.; Scales, W. A.

2015-10-01

Nonlinear interactions of high power HF radio waves in the ionosphere provide aeronomers with a unique space-based laboratory capability. The High-Frequency Active Auroral Research Program (HAARP) in Gakona, Alaska is the world's largest heating facility, yielding effective radiated powers in the gigawatt range. New results are present from HAARP experiments using a "twisted beam" excitation mode. Analysis of twisted beam heating shows that the SEE results obtained are identical to more traditional patterns. One difference in the twisted beam mode is the heating region produced is in the shape of a ring as opposed to the more traditional "solid spot" region from a pencil beam. The ring heating pattern may be more conducive to the creation of stable artificial airglow layers because of the horizontal structure of the ring. The results of these runs include artificial layer creation and evolution as pertaining to the twisted beam pattern. The SEE measurements aid the interpretation of the twisted beam interactions in the ionosphere.

Excitation of the ionospheric Alfvén resonator from the ground: Theory and experiments

NASA Astrophysics Data System (ADS)

Streltsov, A. V.; Chang, C.-L.; Labenski, J.; Milikh, G.; Vartanyan, A.; Snyder, A. L.

2011-10-01

We report results from numerical and experimental studies of the excitation of ULF shear Alfvén waves inside the ionospheric Alfvén resonator (IAR) by heating the ionosphere with powerful HF waves launched from the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. Numerical simulations of the two-fluid MHD model describing IAR in a dipole magnetic field geometry with plasma parameters taken from the observations at HAARP during the October-November 2010 experimental campaign reveal that the IAR quality is higher during nighttime conditions, when the ionospheric conductivity is very low. Simulations also reveal that the resonance wave cannot be identified from the magnetic measurements on the ground or at an altitude above 600 km because the magnetic field in this wave has nodes on both ends of the resonator, and the best way to detect IAR modes is by measuring the electric field on low Earth orbit satellites. These theoretical predictions are in good, quantitative agreement with results from observations: In particular, (1) observations from the ground-based magnetometer at the HAARP site demonstrate no significant difference in the amplitudes of the magnetic field generated by HAARP in the frequency range from 0 to 5 Hz, and (2) the DEMETER satellite detected the electric field of the IAR first harmonic at an altitude of 670 km above HAARP during the heating experiment.

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.

SEE Observations of Ionospheric Heating from HAARP Using Orbital Angular Momentum

NASA Astrophysics Data System (ADS)

Briczinski, S. J.; Bernhardt, P. A.; Siefring, C. L.

2013-12-01

High power HF radio waves exciting the ionosphere provide aeronomers with a unique space-based laboratory capability. The High-Frequency Active Auroral Research Program (HAARP) in Gakona, Alaksa is the world's largest heating facility, providing effective radiated powers in the gigawatt range. Experiments performed at HAARP have allowed researchers to study many non-linear effects of wave-plasma interactions. Stimulated Electromagnetic Emission (SEE) is of interest to the ionospheric community for its diagnostic purposes. Typical SEE experiments at HAARP have focused on characterizing the parametric decay of the electromagnetic pump wave into several different wave modes such as upper and lower hybrid, ion acoustic, ion-Bernstein and electron-Bernstein. These production modes have been extensively studied at HAARP using traditional beam heating patterns and SEE detection. New results are present from HAARP experiments using an excitation mode that attempts to impart orbital angular momentum (OAM) into the heating region. This OAM mode is also referred to as a 'twisted beam.' Previous analysis of twisted beam heating shows that the SEE results obtained are nearly identical to the modes without OAM. Recent twisted beam heating experiments have produced SEE modes not previously characterized. These new modes are presented and discussed. One difference in the twisted beam mode is the heating region produced is in the shape of a ring as opposed to the more traditional 'solid spot' region. The ring heating pattern may be more conducive to the creation of artificial ionization clouds. The results of these runs include artificial ionization creation and evolution as pertaining to the twisted beam pattern.

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

100 Days of ELF/VLF Generation via HF Heating with HAARP (Invited)

NASA Astrophysics Data System (ADS)

Cohen, M.; Golkowski, M.

2013-12-01

ELF/VLF radio waves are difficult to generate with conventional antennas. Ionospheric HF heating facilities generate ELF/VLF waves via modulated heating of the lower ionosphere. HF heating of the ionosphere changes the lower ionospheric conductivity, which in the presence of natural currents such as the auroral electrojet, creates an antenna in the sky when heating is modulated at ELF/VLF frequencies. We present a summary of nearly 100 days of ELF/VLF wave generation experiments at the 3.6 MW HAARP facility near Gakona, Alaska, and provide a baseline reference of ELF/VLF generation capabilities with HF heating. Between February 2007 and August 2008, HAARP was operated on close to 100 days for ELF/VLF wave generation experiments, at a variety of ELF/VLF frequencies, seasons and times of day. We present comprehensive statistics of generated ELF/VLF magnetic fields observed at a nearby site, in the 500-3500 Hz band. Transmissions with a specific HF beam configuration (3.25 MHz, vertical beam, amplitude modulation) are isolated so the data comparison is self-consistent, across nearly 5 million individual measurements of either a tone or a piece of a frequency-time ramp. There is a minimum in the average generation close to local midnight. It is found that generation during local nighttime is on average weaker, but more highly variable, with a small number of very strong generation periods. Signal amplitudes from day to day may vary by as much as 20-30 dB. Generation strengthens by ~5 dB during the first ~30 minutes of transmission, which may be a signature of slow electron density changes from sustained HF heating. Theoretical calculations are made to relate the amplitude observed to the power injected into the waveguide and reaching 250 km. The median power generated by HAARP and injected into the waveguide is ~0.05-0.1 W in this base-line configuration (vertical beam, 3.25 MHz, amplitude modulation), but may have generated hundreds of Watts for brief durations. Several efficiency improvements have improved the ELF/VLF wave generation efficiency further.

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.

Lunar Radar Cross Section at Low Frequency

NASA Technical Reports Server (NTRS)

Rodriguez, P.; Kennedy, E. J.; Kossey, P.; McCarrick, M.; Kaiser, M. L.; Bougeret, J.-L.; Tokarev, Y. V.

2002-01-01

Recent bistatic measurements of the lunar radar cross-section have extended the spectrum to long radio wavelength. We have utilized the HF Active Auroral Research Program (HAARP) radar facility near Gakona, Alaska to transmit high power pulses at 8.075 MHz to the Moon; the echo pulses were received onboard the NASA/WIND spacecraft by the WAVES HF receiver. This lunar radar experiment follows our previous use of earth-based HF radar with satellites to conduct space experiments. The spacecraft was approaching the Moon for a scheduled orbit perturbation when our experiment of 13 September 2001 was conducted. During the two-hour experiment, the radial distance of the satellite from the Moon varied from 28 to 24 Rm, where Rm is in lunar radii.

Future Operations of HAARP with the UAF's Geophysical Institute

NASA Astrophysics Data System (ADS)

McCoy, R. P.

2015-12-01

The High frequency Active Aurora Research Program (HAARP) in Gakona Alaska is the world's premier facility for active experimentation in the ionosphere and upper atmosphere. The ionosphere affects communication, navigation, radar and a variety of other systems depending on, or affected by, radio propagation through this region. The primary component of HAARP, the Ionospheric Research Instrument (IRI), is a phased array of 180 HF antennas spread across 33 acres and capable of radiating 3.6 MW into the upper atmosphere and ionosphere. The array is fed by five 2500 kW generators, each driven by a 3600 hp diesel engine (4 + 1 spare). Transmit frequencies are selectable in the range 2.8 to 10 MHz and complex configurations of rapidly slewed single or multiple beams are possible. HAARP was owned by the Air Force Research Laboratory (AFRL/RV) in Albuquerque, NM but recently was transferred to the Geophysical Institute of the University of Alaska Fairbanks (UAF/GI). The transfer of ownership of the facility is being implemented in stages involving a Cooperative Research and Development Agreement (CRADA) and an Educational Partnership Agreement (EPA) which are complete, and future agreements to transfer ownership of the facility land. The UAF/GI plans to operate the facility for continued ionospheric and upper atmospheric experimentation in a pay-per-use model. In their 2013 "Decadal Survey in Solar and Space Physics" the National Research Council (NRC) made the recommendation to "Fully realize the potential of ionospheric modification…" and in their 2013 Workshop Report: "Opportunities for High-Power, High-Frequency Transmitters to Advance Ionospheric/Thermospheric Research" the NRC outlined the broad range of future ionospheric, thermospheric and magnetospheric experiments that could be performed with HAARP. HAARP is contains a variety of RF and optical ionospheric diagnostic instruments to measure the effects of the heater in real time. The UAF/GI encourages the scientific community to plan experiments at HAARP and bring their remote sensing instruments to HAARP for extended or permanent operation. The power and flexibility of HAARP and its unique location in the subarctic will help secure the future of this facility as the foremost laboratory for active experimentation in the ionosphere and upper atmosphere.

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.

HF-enhanced 4278-Å airglow: evidence of accelerated ionosphere electrons?

NASA Astrophysics Data System (ADS)

Fallen, C. T.; Watkins, B. J.

2013-12-01

We report calculations from a one-dimensional physics-based self-consistent ionosphere model (SCIM) demonstrating that HF-heating of F-region electrons can produce 4278-Å airglow enhancements comparable in magnitude to those reported during ionosphere HF modification experiments at the High-frequency Active Auroral Research Program (HAARP) observatory in Alaska. These artificial 'blue-line' emissions, also observed at the EISCAT ionosphere heating facility in Norway, have been attributed to arise solely from additional production of N2+ ions through impact ionization of N2 molecules by HF-accelerated electrons. Each N2+ ion produced by impact ionization or photoionization has a probability of being created in the N2+(1N) excited state, resulting in a blue-line emission from the allowed transition to its ground state. The ionization potential of N2 exceeds 18 eV, so enhanced impact ionization of N2 implies that significant electron acceleration processes occur in the HF-modified ionosphere. Further, because of the fast N2+ emission time, measurements of 4278-Å intensity during ionosphere HF modification experiments at HAARP have also been used to estimate artificial ionization rates. To the best of our knowledge, all observations of HF-enhanced blue-line emissions have been made during twilight conditions when resonant scattering of sunlight by N2+ ions is a significant source of 4278-Å airglow. Our model calculations show that F-region electron heating by powerful O-mode HF waves transmitted from HAARP is sufficient to increase N2+ ion densities above the shadow height through temperature-enhanced ambipolar diffusion and temperature-suppressed ion recombination. Resonant scattering from the modified sunlit region can cause a 10-20 R increase in 4278-Å airglow intensity, comparable in magnitude to artificial emissions measured during ionosphere HF-modification experiments. This thermally-induced artificial 4278-Å aurora occurs independently of any artificial aurora maintained by HF-accelerated (non-thermal) electrons. The numerical results presented here do not necessarily rule out the presence of HF-accelerated electrons with energies exceeding 18 eV. However, vertical or field-aligned airglow intensity measurements made during twilight conditions do not provide definitive evidence of energetic HF-accelerated electrons. Consequently, artificial blue-line airglow measurements should not be used to estimate N2+ ionization rates without also accounting for temperature-dependent chemistry and diffusion. Future experiments that make simultaneous measurements of N2+ ion airglow emissions from both the first negative bands and the Meinel bands can potentially resolve the relative contributions of accelerated electron and resonant scattering mechanisms. Airglow emission rates from these bands are expected to be in strict proportion when the emissions result from electron impact ionization of N2 molecules. Side-view altitude-resolved 4278-Å airglow measurements may also indicate the presence of energetic HF-accelerated electrons if the blue-line emissions are determined to occur below the shadow height.

SATSIN System Manual

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

Livingston, R.C.

1995-01-01

This report outlines the design, functions and operation of the HAARP Diagnostic Satellite Scintillation (SATSIN) system that will be used to characterize the structure and dynamics of F region ionospheric irregularities created during HF heating. When in routine operation, the SATSIN system will be located so that the propagation path from satellite radio beacons passes through the heated volume created by HAARP. The signal, altered in phase and amplitude by the irregularities, is received by the SATSIN array of eight antennas and is processed to extract the spatial and temporal characteristics of the scintillation. From this information, the strength, shapemore » and motion of the in situ irregularities generated by HAARP can be implied. The hardware and software components of the system are reviewed, and the installation and operation in conjunction with the HAARP network are outlined.« less

Artificial Excitation of Schumann Resonance with HAARP

NASA Astrophysics Data System (ADS)

Streltsov, A. V.; Chang, C. L.

2014-12-01

We report results from the experiment aimed at the artificial excitation of extremely-low-frequency (ELF) electromagnetic waves with frequencies corresponding to the frequency of Schumann resonance (typically, 7.5 - 8.0 Hz frequency range). Electromagnetic waves with these frequencies can form a standing pattern inside the spherical cavity formed by the surface of the earth and the ionosphere. In the experiment the ELF waves were excited by heating the ionosphere with X-mode HF electromagnetic waves generated by the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. The experiment demonstrates that heating of the ionosphere can excite relatively large-amplitude electromagnetic waves with frequencies in the range of the Schumann resonance, when the ionosphere has a strong F-layer and an electric field greater than 5 mV/m is present in the E-region.

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.

Optimizing an ELF/VLF Phased Array at HAARP

NASA Astrophysics Data System (ADS)

Fujimaru, S.; Moore, R. C.

2013-12-01

The goal of this study is to maximize the amplitude of 1-5 kHz ELF/VLF waves generated by ionospheric HF heating and measured at a ground-based ELF/VLF receiver. The optimization makes use of experimental observations performed during ELF/VLF wave generation experiments at the High-frequency Active Auroral Research Program (HAARP) Observatory in Gakona, Alaska. During these experiments, the amplitude, phase, and propagation delay of the ELF/VLF waves were carefully measured. The HF beam was aimed at 15 degrees zenith angle in 8 different azimuthal directions, equally spaced in a circle, while broadcasting a 3.25 MHz (X-mode) signal that was amplitude modulated (square wave) with a linear frequency-time chirp between 1 and 5 kHz. The experimental observations are used to provide reference amplitudes, phases, and propagation delays for ELF/VLF waves generated at these specific locations. The presented optimization accounts for the trade-off between duty cycle, heated area, and the distributed nature of the source region in order to construct a "most efficient" phased array. The amplitudes and phases generated by modulated heating at each location are combined in post-processing to find an optimal combination of duty cycle, heating location, and heating order.

Investigation of third gyro-harmonic heating at HAARP using stimulated radio emissions and the MUIR and Kodiak radars

NASA Astrophysics Data System (ADS)

Mahmoudian, A.; Scales, W. A.; Watkins, B. J.; Bernhardt, P. A.; Isham, B.; Vega-Cancel, O.; Ruohoniemi, J. M.

2017-01-01

This paper presents data from two campaigns at the High Frequency Active Auroral Research Program facility (HAARP) in 2011 and 2012. The measurements of stimulated radio emissions (often called stimulated electromagnetic emissions or SEE) were conducted 15 km from the HAARP site. The potential of Narrowband SEE (NSEE) as a new diagnostic tool to monitor artificial irregularities excited during HF-pump heating of the ionosphere is the main goal of this paper. This has been investigated using well established diagnostics including the Modular UHF Ionospheric Radar (MUIR) and Kodiak SuperDARN radars as well as Wideband SEE (WSEE). The measured data using these three diagnostics were compared to characterize the ionospheric parameters and study the plasma irregularities generated in the interaction region. Variation of the wideband/narrowband SEE features, SuperDARN echoes, and HF-enhanced ion lines (EHIL) were studied with pump power variation, pump frequency stepping near the third electron gyro-frequency (3fce) as well as changing beam angle relative to the magnetic zenith. In particular, electrostatic plasma waves and associated irregularities excited near the reflection resonance layer as well as the upper-hybrid resonance layer are investigated. The time evolution and growth rate of these irregularities are studied using the experimental observations. Close alignment of narrowband SEE (NSEE) with wideband SEE (WSEE) and EHIL was observed. SuperDARN radar echoes and WSEE also showed alignment as in previous investigations. Correlations between these three measurements underscore potential diagnostics by utilizing the NSEE spectrum to estimate ionospheric parameters such as electron temperature.

Large-Scale Ionospheric Effects Related to Electron-Gyro Harmonics: What We Have Learned from HAARP.

NASA Astrophysics Data System (ADS)

Watkins, B. J.; Fallen, C. T.; Secan, J. A.

2014-12-01

The HAARP ionospheric modification facility has unique capabilities that enable a wide range of HF frequencies with transmit powers ranging from very low to very high values. We will review a range of experiment results that illustrate large-scale ionospheric effects when the HF frequencies used are close to electron gyro-harmoncs and we focus mainly on the 3rd and 4th harmonics. The data are primarily from the UHF diagnosticc radar and total electron content (TEC) observations through the heated topside ionosphere. Radar data for HF frequencies just above and just below gyro harmoncs show significant differences in radar scatter cross-section that suggest differing plasma processes, and this effect is HF power dependent with some effects only observable with full HF power. For the production of artificial ionization in the E-region when the HF frequency is near gyro-harmoncs the results differ significantly for relatively small (50 kHz) variations in the HF frequency. We show how slow FM scans in conjunction with gyro-harmonic effects are effective in producing artificial ionization in the lower ionosphere.In the topside ionosphere enhanced density and upward fluxes have been observed and these may act as effective ducts for the propagation of VLF waves upward into the magneosphere. Experimental techniques have been developed that may be used to continuously maintain these effects in the topside ionossphere.

Prompt Ion Outflows and Artificial Ducts during High-Power HF Heating at HAARP: Effect of Suprathermal Electrons?

NASA Astrophysics Data System (ADS)

Mishin, E. V.; Milikh, G. M.

2014-12-01

In situ observations from the DMSP and Demeter satellites established that high-power HF heating of the ionosphere F-region results in significant ion outflows associated with 10-30% density enhancements in the topside ionosphere magnetically-conjugate to the heated region. As follows from the SAMI2 two-fluid model calculations, their formation time should exceed 5-7 minutes. However, specially designed DMSP-HAARP experiments have shown that artificial ducts and ion outflows appear on the topside within 2 minutes. We describe the results of these observations and present a semi-quantitative explanation of the fast timescale due to suprathermal electrons accelerated by HF-induced plasma turbulence. There are two possible effects of suprathermal electrons: (1) the increase of the ambipolar electric field over the usual thermal ambipolar diffusion and (2) excitation of heat flux-driven plasma instability resulting in an anomalous electron-ion momentum exchange. Both effects result in faster upward ion flows.

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).

First demonstration of HF-driven ionospheric currents

NASA Astrophysics Data System (ADS)

Papadopoulos, K.; Chang, C.-L.; Labenski, J.; Wallace, T.

2011-10-01

The first experimental demonstration of HF driven currents in the ionosphere at low ELF/ULF frequencies without relying in the presence of electrojets is presented. The effect was predicted by theoretical/computational means in a recent letter and given the name Ionospheric Current Drive (ICD). The effect relies on modulated F-region HF heating to generate Magneto-Sonic (MS) waves that drive Hall currents when they reach the E-region. The Hall currents inject ELF waves into the Earth-Ionosphere waveguide and helicon and Shear Alfven (SA) waves in the magnetosphere. The proof-of-concept experiments were conducted using the HAARP heater in Alaska under the BRIOCHE program. Waves between 0.1-70 Hz were measured at both near and far sites. The letter discusses the differences between ICD generated waves and those relying on modulation of electrojets.

Ground and Satellite Observations of ULF Waves Artificially Produced by HAARP

NASA Astrophysics Data System (ADS)

Chang, C.; Labenski, J.; Shroff, H.; Doxas, I.; Papadopoulos, D.; Milikh, G.; Parrot, M.

2008-12-01

Modulated ionospheric heating at ULF frequencies using the HAARP heater was performed from April 28 to May 3, 2008 (http://www.haarp.alaska.edu). Simultaneous ground-based ULF measurements were made locally at Gakona, AK and at Lake Ozette, WA that is 2000 km away. The ground-based results showed that ULF amplitudes measured at Gakona are mostly proportional to the electrojet strength above HAARP, indicating electrojet modulation to be the source of the local ULF waves. However, the timing of ULF events recorded at Lake Ozette did not correlated with the electrojet strength at Gakona, indicating that modulation of F region pressure is the more likely source for distant ULF waves. These observations are consistent with the theoretical understanding that ULF waves generated by current modulation are shear Alfven waves propagating along the magnetic field line, thus at high latitude their observations are limited to the vicinity of the heated spot. On the other hand, propagation of ULF waves at significant lateral distances requires generation of magnetosonic waves since they are the only mode that propagates isotropically and can thus couple efficiently in the Alfvenic duct. In addition to ground-based observations, the DEMETER satellite also provided space measurements of the heating effects during its passes over HAARP. The DEMETER results showed direct detection of HAARP ULF waves at 0.1 Hz. Moreover, density dips were observed every time HAARP was operated at CW mode, which provides clear evidence of duct formation by direct HF heating at F peak. Details of these results will be presented at the meeting. We would like to acknowledge the support provided by the HAARP facility during our ULF experiments.

Electron Acceleration and Ionization Production in High-Power Heating Experiments at HAARP

NASA Astrophysics Data System (ADS)

Mishin, E. V.; Pedersen, T.

2012-12-01

Recent ionospheric modification experiments with the 3.6 MW transmitter at the High Frequency Active Auroral Research Program (HAARP) facility in Alaska led to discovery of artificial ionization descending from the nominal interaction altitude in the background F-region ionosphere by ~60-80 km. Artificial ionization production is indicated by significant 427.8 nm emissions from the 1st negative band of N2+ and the appearance of transmitter-induced bottomside traces in ionosonde data during the periods of most intense optical emissions. However, the exact mechanisms producing the artificial plasmas remain to be determined. Yet the only existing theoretical models explain the development of artificial plasma as an ionizing wavefront moving downward due to ionization by electrons accelerated by HF-excited strong Langmuir turbulence (SLT) generated near the plasma resonance, where the pump frequency matches the plasma frequency. However, the observations suggest also the significance of interactions with upper hybrid and electron Bernstein waves near multiples of the electron gyrofrequency. We describe recent observations and discuss suitable acceleration mechanisms.

ELF/VLF Wave Generation via HF Modulation of the Equatorial Electrojet at Arecibo Observatory

NASA Astrophysics Data System (ADS)

Flint, Q. A.; Moore, R. C.; Burch, H.; Erdman, A.; Wilkes, R.

2017-12-01

In this work we generate ELF/VLF waves by modulating the conductivity of the lower ionosphere using the HF heater at Arecibo. For many years, researchers have generated ELF/VLF waves using the powerful HF transmitters at HAARP, but few have attempted to do the same in the mid- to low- latitude region. While HAARP users have benefitted from the auroral electrojet, we attempt to exploit the equatorial electrojet to generate radio waves. On 31 July 2017, we transmitted at an HF frequency of 5.1 MHz (X-Mode) applying sinusoidal amplitude modulation in a step-like fashion from 0-5 kHz in 200 Hz steps over 10 seconds at 100% peak power to approximate a linear frequency ramp. We also transmitted 10-second-long fixed frequency tones spaced from 1 to 5 kHz. The frequency sweep is a helpful visual tool to identify generated waves, but is also used to determine optimal modulation frequencies for future campaigns. The tones allow us to perform higher SNR analysis. Ground-based B-field VLF receivers recorded the amplitude and phase of the generated radio waves. We employ time-of-arrival techniques to determine the altitude of the ELF/VLF signal source. In this paper, we present the initial analysis of these experimental results.

Geophysical Remote Sensing Using the HF Pumped Stimulated Brillouin Scatter (SBS) Emission Lines Produced by HAARP

NASA Astrophysics Data System (ADS)

Bernhardt, P. A.; Selcher, C. A.

2009-12-01

An ordinary or extraordinary mode electromagnetic wave can decay into a low frequency electrostatic wave and a scattered electromagnetic wave by a process called stimulated Brillouin scatter (SBS). The low frequency wave can be either an ion acoustic wave (IA) or an electrostatic ion cyclotron (EIC) wave. The first detection ion acoustic waves by this process during ionospheric modification with high power radio waves was reported by Norin et al. (2009) using the HAARP transmitter in Alaska. The first detection of the electrostatic ion cyclotron waves is reported here using HAARP during the March 2009 campaign. Subsequent experiments have provided additional verification of the SBS process and quantitative interpretation of the scattered wave frequency offsets to yield measurements of the electron temperatures in the heated ionosphere by Bernhardt et al. (2009). Using the SBS technique to generate ion acoustic waves, electron temperatures between 3000 and 4000 K were measured over the HAARP facility. The matching conditions for decay of the high frequency pump wave show that in addition to the production of an ion-acoustic wave, an electrostatic ion cyclotron wave can produced by the generalized SBS processes only if the pump waves makes a large angle with the magnetic field. When the EIC mode is produced, it is seen as a narrow of stimulated electromagnetic emissions at the ion cyclotron frequency. Occasionally, multiple lines are seen and analyzed to yield the relative abundance of oxygen, and molecular ions in the lower ionosphere. This ion mass spectrometer interpretation of the SBS data is new to the field of ionosphere remote sensing. In addition, based on the matching condition theory, the first profiles of the scattered wave amplitude are produced using the stimulated Brillouin scatter (SBS) matching conditions. These profiles are consistent with maximum ionospheric interactions at the upper-hybrid resonance height and at a region just below the plasma resonance altitude where the pump wave electric fields reach their maximum values. All of these measurements of the HF modified ionosphere are made possible at HAARP because of (1) the recently increased transmitter power to 3.6 MW into the large antenna array and (2) the new digital receiver diagnostics that allow up to 100 dB dynamic range in the stimulated electromagnetic emission measurements. Paul A. Bernhardt, Craig A. Selcher, Robert H. Lehmberg, Serafin Rodriguez, Joe Thomason, Mike McCarrick, Gordon Frazer, Determination of the Electron Temperature in the Modified Ionosphere over HAARP Using the HF Pumped Stimulated Brillouin Scatter (SBS) Emission Lines, Annales Geophysicae, in press, 2009. Norin, L., Leyser, T. B., Nordblad, E., Thidé, B., and McCarrick, M., Unprecedentedly strong and narrow electromagnetic emissions stimulated by high-frequency radio waves in the ionosphere, Phys. Rev. Lett., 102, 065003, 2009.

Further Investigations of Ionospheric Total Electron Content and Scintillation Effects on Transionospheric Radiowave Propagation

DTIC Science & Technology

1998-02-12

HAARP ). 14. SUBJECT TERMS Global Positioning System (GPS), High Frequency Active Auroral Research Program ( HAARP ), ionosphere, radiowave...Scintillation Simulation 23 4.10 Automated Calibrations 23 5. HAARP Activities 24 5.1 Development of HAARP Diagnostics 24 5.2 Facilitation of... HAARP Operations and Broader Scientific Collaborations 27 5.3 Public Relations 28 6. Publications 30 References 30 Acronyms and Initials 30 Appendix

Shear Alfven Wave Injection in the Magnetosphere by Ionospheric Modifications in the Absence of Electrojet Currents

NASA Astrophysics Data System (ADS)

Papadopoulos, K.; Eliasson, B.; Shao, X.; Labenski, J.; Chang, C.

2011-12-01

A new concept of generating ionospheric currents in the ULF/ELF range with modulated HF heating using ground-based transmitters even in the absence of electrojet currents is presented. The new concept relies on using HF heating of the F-region to modulate the electron temperature and has been given the name Ionospheric Current Drive (ICD). In ICD, the pressure gradient associated with anomalous or collisional F-region electron heating drives a local diamagnetic current that acts as an antenna to inject mainly Magneto-Sonic (MS) waves in the ionospheric plasma. The electric field associated with the MS wave drives Hall currents when it reaches the E region of the ionosphere. The Hall currents act as a secondary antenna that inject waves in the Earth-Ionosphere Waveguide (EIW) below and shear Alfven waves or EMIC waves upwards towards the conjugate regions. The paper presents: (i) Theoretical results using a cold Hall MHD model to study ICD and the generation of ULF/ELF waves by the modulation of the electron pressure at the F2-region with an intense HF electromagnetic wave. The model solves equations governing the dynamics of the shear Alfven and magnetosonic modes, of the damped modes in the diffusive Pedersen layer, and of the weakly damped helicon wave mode in the Hall-dominated E-region. The model incorporates realistic profile of the ionospheric conductivities and magnetic field configuration. We use the model to simulate propagation and dynamics of the low-frequency waves and their injection into the magnetosphere from the HAARP and Arecibo ionospheric heaters. (ii) Proof of principle experiments using the HAARP ionospheric heater in conjunction with measurements by the DEMETER satellite This work is supported by ONR MURI grant and DARPA BRIOCHE Program

Detection of Heater Generated Super Small Scale Striations Using GPS Signal Diagnostics

NASA Astrophysics Data System (ADS)

Najmi, A. C.; Milikh, G. M.; Chiang, K.; Psiaki, M.; Secan, J. A.; Bernhardt, P. A.; Briczinski, S. J.; Siefring, C. L.; Papadopoulos, K.

2013-12-01

Recent theoretical models predict that super small striations (SSS) of the electron density, on the order of ten centimeters, can be excited by HF waves with frequency close to multiples of the electron gyro frequency [Gurevich et al., 2006]. The first experimental verification of SSS was made at HAARP [Milikh et al., 2008]. We present results of HAARP experiments that include simultaneous observations of GPS carrier phase and SEE observations of ionospheric turbulence. These observations show that SSS excited by HF frequencies near the fourth harmonic of the gyro frequency scatter GPS signals, and in three out of six experiments indicate the presence of strong turbulence, similar to that observed in descending artificial ionized layer experiments [Pedersen et al., 2010]. This turbulence is capable of generating suprathermal electrons, and in one of the experiments, the presence of fast electrons was confirmed by the HAARP incoherent scattering radar. Estimates on the SSS shows that they correspond to 3-10% electron density depletions. Such irregularities affect UHF signals including GPS, and thus can be important in applications. Gurevich, A.V. and K.P. Zybin (2006), Phys. Lett. A, 358, 159. Milikh, G., et al. (2008), Geophys. Res. Let., 35, L22102, doi:10.1029/2008GL035527. Pedersen, T. et al. (2010), Geophys. Res. Let., 37, L02106, doi:10.1029/2009GL041895.

On the altitude-variation of electron acceleration by HF radio-waves in the F-region

NASA Astrophysics Data System (ADS)

Gustavsson, Bjorn

2016-07-01

I will talk about artificial aurora, the descending layers we have observed at HAARP and the altitude-variations we have observed in enhanced ion and plasma-lines with the EISCAT UHF-radar, and present an empirical model describing these phenomena.

First artificial periodic inhomogeneity experiments at HAARP

NASA Astrophysics Data System (ADS)

Hysell, D. L.; McCarrick, M. J.; Fallen, C. T.; Vierinen, J.

2015-03-01

Experiments involving the generation and detection of artificial periodic inhomogeneities have been performed at the High Frequency Active Auroral Research Program (HAARP) facility. Irregularities were created using powerful X-mode HF emissions and then probed using short (10 μs) X- and O-mode pulses. Reception was performed using a portable software-defined receiver together with the crossed rhombic antenna from the local ionosonde. Echoes were observed reliably between about 85 and 140 km altitude with signal-to-noise ratios as high as about 30 dB. The Doppler shift of the echoes can be associated with the vertical neutral wind in this altitude range. Small but persistent Doppler shifts were observed. The decay time constant of the echoes is meanwhile indicative of the ambipolar diffusion coefficient which depends on the plasma temperature, composition, and neutral gas density. The measured time constants appear to be consistent with theoretical expectations and imply a methodology for measuring neutral density profiles. The significance of thermospheric vertical neutral wind and density measurements which are difficult to obtain using ground-based instruments by other means is discussed.

Solar Radiation Alert System

DTIC Science & Technology

2009-03-01

18 December 2007). 19. HAARP , The Hgh Frequency Actve Auroral Research Program. Glossary of Solar and Geophysical Terms. Avalable at...www.haarp.alaska.edu/ haarp /glos.html (accessed: 4 September 2007). 13 20. IZMIRAN. Pushkov Insttute of Terrestral Mag- netsm, Ionosphere and Radowave

Artificial excitation of ELF waves with frequency of Schumann resonance

NASA Astrophysics Data System (ADS)

Streltsov, A. V.; Guido, T.; Tulegenov, B.; Labenski, J.; Chang, C.-L.

2014-11-01

We report results from the experiment aimed at the artificial excitation of extremely low-frequency (ELF) electromagnetic waves with frequencies corresponding to the frequency of Schumann resonance. Electromagnetic waves with these frequencies can form a standing pattern inside the spherical cavity formed by the surface of the Earth and the ionosphere. In the experiment the ELF waves were excited by heating the ionosphere with X-mode HF electromagnetic waves generated at the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. The experiment demonstrates that heating of the ionosphere can excite relatively large-amplitude electromagnetic waves with frequencies in the range 7.8-8.0 Hz when the ionosphere has a strong F layer, the frequency of the HF radiation is in the range 3.20-4.57 MHz, and the electric field greater than 5 mV/m is present in the ionosphere.

A Comparison of Science and Technology Funding for DoD’s Space and Nonspace Programs

DTIC Science & Technology

2008-01-15

Artificial intelligence for HAARP Multispectral signature libraries Environmental conditions that Ionospheric prediction HAARP Weather software for...Hardware and software for solar HAARP Electromagnetic interference for Plasma theory in the space Subproject details were not available Subproject

An Artificial Particle Precipitation Technique Using HAARP-Generated VLF Waves

DTIC Science & Technology

2006-11-02

AFRL-VS-HA-TR-2007-1021 An Artificial Particle Precipitation Technique Using HAARP -Generated VLF Waves O o o r- Q M. J. Kosch T. Pedersen J...Artificial Particle Precipitation Technique Using HAARP Generated VLF Waves. 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 62101F...model. The frequency-time modulated VLF wave patterns have been successfully implemented at the HAARP ionospheric modification facility in Alaska

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.

Recent Observations and Modeling of Narrowband Stimulated Electromagnetic Emissions SEEs at HAARP and EISCAT

NASA Astrophysics Data System (ADS)

Scales, W.; Mahmoudian, A.; Fu, H.; Bordikar, M. R.; Samimi, A.; Bernhardt, P. A.; Briczinski, S. J., Jr.; Kosch, M. J.; Senior, A.; Isham, B.

2014-12-01

There has been significant interest in so-called narrowband Stimulated Electromagnetic Emission SEE over the past several years due to recent discoveries at the High Frequency Active Auroral Research Program HAARP facility near Gakone, Alaska. Narrowband SEE (NSEE) has been defined as spectral features in the SEE spectrum typically within 1 kHz of the transmitter (or pump) frequency. SEE is due to nonlinear processes leading to re-radiation at frequencies other than the pump wave frequency during heating the ionospheric plasma with high power HF radio waves. Although NSEE exhibits a richly complex structure, it has now been shown after a substantial number of observations at HAARP, that NSEE can be grouped into two basic classes. The first are those spectral features, associated with Stimulated Brillouin Scatter SBS, which typically occur when the pump frequency is not close to electron gyro-harmonic frequencies. Typically, these spectral features are within roughly 50 Hz of the pump wave frequency where it is to be noted that the O+ ion gyro-frequency is roughly 50 Hz. The second class of spectral features corresponds to the case when the pump wave frequency is typically within roughly 10 kHz of electron gyro-harmonic frequencies. In this case, spectral features ordered by harmonics of ion gyro-frequencies are typically observed, and termed Stimulated Ion Bernstein Scatter SIBS. This presentation will first provide an overview of the recent NSEE experimental observations at HAARP. Both Stimulated Brillouin Scatter SBS and Stimulated Ion Bernstein Scatter SIBS observations will be discussed as well as their relationship to each other. Possible theoretical formulation in terms of parametric decay instabilities and computational modeling will be provided. Possible applications of NSEE will be pointed out including triggering diagnostics for artificial ionization layer formation, proton precipitation event diagnostics, electron temperature measurements in the heated volume and detection of heavy ion species. Finally potential for observing such SEE at the European Incoherent Scatter EISCAT facility will be discussed.

Investigation of ionospheric disturbances and associated diagnostic techniques. Final report, 1 January 1992-31 December 1994

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

Duncan, L.M.

1995-12-12

The objectives of this research and development program were to conduct simulation modeling of the generation and propagation of atmospheric acoustic signals associated with surface and subsurface ground disturbances; to construct an experimental measurement system for exploratory research studies of acoustic generated ionospheric disturbances; to model high power radio wave propagation through the ionosphere, including nonlinear wave plasma interaction effects; and to assist in the assessment of diagnostic systems for observation of ionospheric modification experiments using existing and planned high latitude high power RF transmitting facilities. A computer simulation of ionospheric response to ground launched acoustic pulses was constructed andmore » results compared to observational data associated with HF and incoherent scatter radar measurements of ionospheric effects produced by earthquakes and ground level explosions. These results were then utilized to help define the design, construct and test for an HF Doppler radar system. In addition, an assessment was conducted of ionospheric diagnostic instruments proposed for the Air Force/Navy High Frequency Active Auroral Research Program (HAARP).« less

High Frequency Resolution TOA Analysis for ELF/VLFWave Generation Experiments at HAARP

NASA Astrophysics Data System (ADS)

Ruddle, J. D.; Moore, R. C.

2014-12-01

Modulated HF heating of the ionosphere in the presence of natural ionospheric current sources has been used as a method to generate electromagnetic ELF/VLF waves since the 1970's. In the ~1-5 kHz band, the amplitude and phase of the received ELF/VLF signal depends on the amplitude and phase of the conductivity modulation generated throughout the HF-heated ionospheric body, as well as on the signal propagation parameters (i.e., the attenuation and phase constants) between each of the current sources and the receiver. Recent signal processing advances have produced an accurate ELF/VLF time-of-arrival (TOA) analysis technique that differentiates line-of-sight and ionospherically-reflected signal components, determining the amplitude and phase of each component observed at the receiver. This TOA method requires a wide bandwidth (> 2.5 kHz) and therefore is relatively insensitive to the frequency-dependent nature of ELF/VLF wave propagation. In this paper, we present an improved ELF/VLF TOA method that is capable of providing high frequency resolution. The new analysis technique is applied to experimental observations of ELF/VLF signals generated by modulated heating at HAARP. We present measurements of the amplitude and phase of the received ELF/VLF signal as a function of frequency and compare the results with the predictions of an HF heating model.

Investigations of the Nature and Behavior of Plasma-Density Disturbances That May Impact GPS and Other Transionospheric Systems

DTIC Science & Technology

2002-10-31

association with the High-frequency Active Auroral Research Program ( HAARP ). In addition to a classic riometer and a GPS Total Electron Content (TEC...sensor previously operating at the HAARP site, NWRA also operates a set of Transit receivers for measurements of TEC and scintillation at VHF and UHF...supplementing the receiver at HAARP with a receiver north of the site and an additional receiver installed south of the HAARP site.

Multi-hop Whistler-Mode ELF/VLF Signals and Triggered Emissions Excited by the HAARP HF Heater

DTIC Science & Technology

2004-12-28

distribution along the field line [ Angerami and Thomas, 1964] to infer the equatorial electron density Neq. This analysis revealed values of L ’ 4.9 and...the ELF/VLF receiver used on RV Tangaroa. References Angerami , J. J., and J. O. Thomas (1964), Studies of planetary atmospheres: 1. The distribution of

HF-induced airglow structure as a proxy for ionospheric irregularity detection

NASA Astrophysics Data System (ADS)

Kendall, E. A.

2013-12-01

The High Frequency Active Auroral Research Program (HAARP) heating facility allows scientists to test current theories of plasma physics to gain a better understanding of the underlying mechanisms at work in the lower ionosphere. One powerful technique for diagnosing radio frequency interactions in the ionosphere is to use ground-based optical instrumentation. High-frequency (HF), heater-induced artificial airglow observations can be used to diagnose electron energies and distributions in the heated region, illuminate natural and/or artificially induced ionospheric irregularities, determine ExB plasma drifts, and measure quenching rates by neutral species. Artificial airglow is caused by HF-accelerated electrons colliding with various atmospheric constituents, which in turn emit a photon. The most common emissions are 630.0 nm O(1D), 557.7 nm O(1S), and 427.8 nm N2+(1NG). Because more photons will be emitted in regions of higher electron energization, it may be possible to use airglow imaging to map artificial field-aligned irregularities at a particular altitude range in the ionosphere. Since fairly wide field-of-view imagers are typically deployed in airglow campaigns, it is not well-known what meter-scale features exist in the artificial airglow emissions. Rocket data show that heater-induced electron density variations, or irregularities, consist of bundles of ~10-m-wide magnetic field-aligned filaments with a mean depletion depth of 6% [Kelley et al., 1995]. These bundles themselves constitute small-scale structures with widths of 1.5 to 6 km. Telescopic imaging provides high resolution spatial coverage of ionospheric irregularities and goes hand in hand with other observing techniques such as GPS scintillation, radar, and ionosonde. Since airglow observations can presumably image ionospheric irregularities (electron density variations), they can be used to determine the spatial scale variation, the fill factor, and the lifetime characteristics of irregularities. Telescopic imaging of airglow is a technique capable of simultaneously determining the properties of ionospheric irregularities at decameter resolution over a range of several kilometers. The HAARP telescopic imager consists of two cameras, a set of optics for each camera, and a robotic mount that supports and orients the system. The camera and optics systems are identical except for the camera lenses: one has a wide-angle lens (~19 degrees) and the other has a telescopic lens (~3 degrees). The telescopic imager has a resolution of ~20 m in the F layer and ~10 m in the E layer, which allows the observation of decameter- and kilometer-scale features. Analysis of telescopic data from HAARP campaigns over the last five years will be presented.

Low-Frequency Waves in HF Heating of the Ionosphere

NASA Astrophysics Data System (ADS)

Sharma, A. S.; Eliasson, B.; Milikh, G. M.; Najmi, A.; Papadopoulos, K.; Shao, X.; Vartanyan, A.

2016-02-01

Ionospheric heating experiments have enabled an exploration of the ionosphere as a large-scale natural laboratory for the study of many plasma processes. These experiments inject high-frequency (HF) radio waves using high-power transmitters and an array of ground- and space-based diagnostics. This chapter discusses the excitation and propagation of low-frequency waves in HF heating of the ionosphere. The theoretical aspects and the associated models and simulations, and the results from experiments, mostly from the HAARP facility, are presented together to provide a comprehensive interpretation of the relevant plasma processes. The chapter presents the plasma model of the ionosphere for describing the physical processes during HF heating, the numerical code, and the simulations of the excitation of low-frequency waves by HF heating. It then gives the simulations of the high-latitude ionosphere and mid-latitude ionosphere. The chapter also briefly discusses the role of kinetic processes associated with wave generation.

New Generation of ELF/VLF Wave Injection Experiments for HAARP

NASA Astrophysics Data System (ADS)

Sonwalkar, V. S.; Reddy, A.; Watkins, B. J.

2016-12-01

We present a ray tracing study to investigate the feasibility of a new generation of wave injection experiments from HAARP transmitter (L 4.9). Highly successful whistler mode wave injection experiments from SIPLE station, Antarctica, have established the importance of such experiments to study magnetospheric wave-particle interactions, and for cold and hot plasma diagnostics [Helliwell and Katsufrakis, 1974; Carpenter and Miller, 1976; Sonwalkar et al., 1997]. Modulated heating experiments from HAARP have shown that it is possible to launch ELF/VLF waves into the magnetosphere that can be observed on the ground after one-, two-, and multi-hop ducted propagation [Inan et al., 2004]. Recent research has also shown that ionospheric heating experiments using HAARP can lead to the formation of magnetospheric ducts [e.g. Milikh et al., 2010; Fallen et al., 2011]. Collectively, these results indicate that the HAARP (or similar) transmitter can be used first to form ducts on nearby L shells, and then to inject and trap transmitter generated ELF/VLF waves in those ducts. Ray tracing studies using a model magnetosphere shows that ELF/VLF waves in a few kilohertz range can be trapped in ducts with L shells near the HAARP transmitter. For example, 1.5 kHz waves injected from L shell = 4.9 and altitude = 200 km can be trapped in ducts located within 0.3 L of the transmitter L-shell. The duct parameters needed for ray-trapping are typically duct width dL 0.1-0.3 and duct enhancement factor dNe/Ne 10-20% or more. The location of plasmapause with respect to transmitter plays a role in the nature of trapping. The duct locations and parameters required for trapping ELF/VLF waves inside the ducts are consistent with past observations of ducts generated by the HAARP transmitter. Ray tracing calculations provide trapped wave normal angles, time delays, resonant energetic electron energy, estimates of wave intensity inside the duct, on the ground, and on satellites such DEMETER, Van Allen probe, and planned DSX. We discuss the potential of a new generation of wave injection experiments from HAARP transmitter to investigate: duct and ELF/VLF generation by high power HF transmitters, whistler mode wave propagation and wave particle interactions, and cold and hot plasma diagnostics.

Detection and Analysis of Partial Reflections of HF Waves from the Lower Ionosphere

NASA Astrophysics Data System (ADS)

Erdman, A.; Moore, R. C.

2016-12-01

On the afternoon of August 27, 2011, the western half of the High Frequency Active Auroral Research Program's (HAARP's) HF transmitter repeatedly broadcast a low-power (1 kW/Tx), 4.5-MHz, X-mode polarized, 10 microsecond pulse. The HF beam was directed vertically, and the inter-pulse period was 20 milliseconds. HF observations were performed at Oasis (62° 23' 30" N, 145° 9' 03" W) using two crossed 90-foot folded dipoles. Observations clearly indicate the detection of a ground wave and multiple reflections from different sources at F-region altitudes, which is consistent with digisonde measurements at 4.5 MHz. Additional reflections were detected at a virtual altitude of 90-110 km, and we interpret these reflections as partial reflections from the rapid conductivity change at the base of the ionosphere. We compare these observations with the predictions of a new finite-difference time-domain (FDTD) plasma model. The model is a one-dimensional, second-order accurate, cold plasma FDTD model of the ionosphere extending from ground through the lower F-region. The model accounts for a spatially varying plasma frequency, cyclotron frequency, and electron-neutral collision frequency. We discuss the possibility to analyze partial reflections from the base of the ionosphere as a function of frequency to characterize the reflecting plasma.

IMPROVING SCIENCE EDUCATION AND CAREER OPPORTUNITIES IN RURAL ALASKA:The Synergistic Connection between Educational Outreach Efforts in the Copper Valley, Alaska.

NASA Astrophysics Data System (ADS)

Solie, D. J.; McCarthy, S.

2004-12-01

The objective of the High frequency Active Auroral Research Program (HAARP) Education Outreach is to enhance the science education opportunities in the Copper Valley region in Alaska. In the process, we also educate local residents about HAARP and its research. Funded jointly by US Air Force and Navy, HAARP is located at Gakona Alaska, a very rural region of central Alaska with a predominantly Native population. The main instrument at HAARP is a vertically directed, phased array RF transmitter which is primarily an ionospheric research tool, however, its geophysical research applications range from terrestrial to near-space. Research is conducted at HAARP in collaboration with scientists and institutions world-wide. The HAARP Education Outreach Program, run through the University of Alaska Geophysical Institute has been active for over six years and in that time has become an integral part of science education in the Copper Valley for residents of all ages. HAARP education outreach efforts are through direct involvement in local schools in the Copper River School District (CRSD) and the Prince William Sound Community College (PWSCC), as well as public lectures and workshops, and intern and student research programs. These outreach efforts require cooperation and coordination between the CRSD, PWSCC, the University of Alaska Fairbanks Physics Department and the NSF sponsored Alaska Native Science & Engineering Program (ANSEP) and HAARP researchers. The HAARP Outreach program also works with other organizations promoting science education in the region, such as the National Park Service (Wrangell- St. Elias National Park) and the Wrangell Institute for Science and Environment (WISE) a newly formed regional non-profit organization. We work closely with teachers in the schools, adapting to their needs and the particular scientific topic they are covering at the time. Because of time and logistic constraints, outreach visits to schools are episodic, occurring roughly four times a year. Even though the in-class time per year is not large, our experience suggests that a long term, multi-year connection enhances learning by the students. We coordinate with HAARP research campaigns so as to utilize the availability of top scientists for public lectures. We do not limit our scope to only ionospheric physics, but try to meet the demands and needs of the region as they arise. Less than two weeks after the November, 2002 Denali Fault Earthquake, we traveled to the villages most strongly effected by the quake and presented basic preliminary information about the quake (Sources: Alaska Earthquake Information Center, Alaska State Geological Survey & USGS). As a teachable moment it was unparalleled, but it was also an example of where even preliminary information on an event can truly help to calm people.

Ionospheric Sensor Developments for the Year-2000 Solar Maximum

DTIC Science & Technology

2000-10-23

locations, work during the year enhanced and exploited several diagnostic instruments deployed for the High frequency Active Aurora Research Program ( HAARP ...Under HAARP , measurements employing both GPS and coherent VHF-UHF signals transmitted from satellites in low-earth polar orbit resulted in time...histories and latitudinal scans of absolute TEC over Maska, and enhanced operation of the HAARP classic riometer resulted in essentially continuous

Optimization of VLf/ELF Wave Generation using Beam Painting

NASA Astrophysics Data System (ADS)

Robinson, A.; Moore, R. C.

2017-12-01

A novel optimized beam painting algorithm (OBP) is used to generate high amplitude very low frequency (VLF) and extremely low frequency (ELF) waves in the D-region of the ionosphere above the High-frequency Active Auroral Research Program (HAARP) observatory. The OBP method creates a phased array of sources in the ionosphere by varying the azimuth and zenith angles of the high frequency (HF) transmitter to capitalize on the constructive interference of propagating VLF/ELF waves. OBP generates higher amplitude VLF/ELF signals than any other previously proposed method. From April through June during 2014, OBP was performed at HAARP over 1200 times. We compare the BP generated signals against vertical amplitude modulated transmissions at 50 % duty cycle (V), oblique amplitude modulated transmissions at 15 degrees zenith and 81 degrees azimuth at 50 % duty cycle (O), and geometric (circle-sweep) modulation at 15 degrees off-zenith angle at 1562.5 Hz, 3125 Hz, and 5000 Hz. We present an analysis of the directional dependence of each signal, its polarization, and its dependence on the properties of the different source region elements. We find that BP increases the received signal amplitudes of VLF and ELF waves when compared to V, O, and GM methods over a statistically significant number of trials.

Artificial Ionospheric Turbulence and Radio Wave Propagation (Sura - HAARP)

DTIC Science & Technology

2006-11-01

investigations of AIT features, which have allowed to establish dependences of low-frequency AIT properties on PW power, frequency, and polarization , on...that a powerful HF heater wave of ordinary polarization , injected vertically from the ground into the ionosphere F-region, gives rise to secondary...or in direct proportion to the value of striation k- vector ). Basing on experimental data considered above we can conclude that for both narrow

Determining Energy Distributions of HF-Accelerated Electrons at HAARP

DTIC Science & Technology

2015-11-18

altitude satellites , altitude- resolved side-view optical measurements of artificial airglow emissions combined with full ISR measurements of electron...for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data...3. DATES COVERED. Indicate the time during which the work was performed and the report was written, e.g., Jun 1997 - Jun 1998; 1-10 Jun 1996; May

Experiments and theory on parametric instabilities excited in HF heating experiments at HAARP

NASA Astrophysics Data System (ADS)

Kuo, Spencer; Snyder, Arnold; Lee, M. C.

2014-06-01

Parametric instabilities excited by O-mode HF heater and the induced ionospheric modification were explored via HAARP digisonde operated in a fast mode. The impact of excited Langmuir waves and upper hybrid waves on the ionosphere are manifested by bumps in the virtual spread, which expand the ionogram echoes upward as much as 140 km and the downward range spread of the sounding echoes, which exceeds 50 km over a significant frequency range. The theory of parametric instabilities is presented. The theory identifies the ionogram bump located between the 3.2 MHz heater frequency and the upper hybrid resonance frequency and the bump below the upper hybrid resonance frequency to be associated with the Langmuir and upper hybrid instabilities, respectively. The Langmuir bump is located close to the upper hybrid resonance frequency, rather than to the heater frequency, consistent with the theory. Each bump in the virtual height spread of the ionogram is similar to the cusp occurring in daytime ionograms at the E-F2 layer transition, indicating that there is a small ledge in the density profile similar to E-F2 layer transitions. The experimental results also show that the strong impact of the upper hybrid instability on the ionosphere can suppress the Langmuir instability.

Experiments and theory on parametric instabilities excited in HF heating experiments at HAARP

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

Kuo, Spencer; Snyder, Arnold; Lee, M. C.

2014-06-15

Parametric instabilities excited by O-mode HF heater and the induced ionospheric modification were explored via HAARP digisonde operated in a fast mode. The impact of excited Langmuir waves and upper hybrid waves on the ionosphere are manifested by bumps in the virtual spread, which expand the ionogram echoes upward as much as 140 km and the downward range spread of the sounding echoes, which exceeds 50 km over a significant frequency range. The theory of parametric instabilities is presented. The theory identifies the ionogram bump located between the 3.2 MHz heater frequency and the upper hybrid resonance frequency and the bump below themore » upper hybrid resonance frequency to be associated with the Langmuir and upper hybrid instabilities, respectively. The Langmuir bump is located close to the upper hybrid resonance frequency, rather than to the heater frequency, consistent with the theory. Each bump in the virtual height spread of the ionogram is similar to the cusp occurring in daytime ionograms at the E-F2 layer transition, indicating that there is a small ledge in the density profile similar to E-F2 layer transitions. The experimental results also show that the strong impact of the upper hybrid instability on the ionosphere can suppress the Langmuir instability.« less

Excitation of Earth-ionosphere waveguide in the ELF and lower VLF bands by modulated ionospheric current

NASA Astrophysics Data System (ADS)

Field, E. C.; Bloom, R. M.

1993-05-01

In this report, the principal of reciprocity is used in conjunction with a full-wave propagation code to calculate ground-level fields excited by ionospheric currents modulated at frequencies between 50 and 100 Hz with HF heaters. Results show the dependence on source orientation, altitude, and dimension and therefore pertain to experiments using the HIPAS or HAARP ionospheric heaters. In the end-fire mode, the waveguide excitation efficiency of an ELF HED in the ionosphere is up to 20 dB greater than for a ground-based antenna, provided its altitude does not exceed 80 to 90 km. The highest efficiency occurs for a source altitude of around 70 km; if that altitude is raised to 100 km, the efficiency drops by about 20 dB in the day and 10 dB at night. That efficiency does not account for the greater conductivity modulation that might be achieved at altitudes greater than 70 km, however. The trade-off between the altitude dependencies of the excitation efficiency and maximum achievable modulation depends on the ERP of the HF heater, the optimum altitude increasing with increasing ERP. For HIPAS the best modulation altitude is around 70 km, whereas for HAARP there might be marginal value in modulating at attitudes as high as 100 km.

HAARP-based Investigations of Lightning-induced Nonlinearities within the D-Region Ionosphere

NASA Astrophysics Data System (ADS)

Moore, R. C.

2015-12-01

It is well-documented that energetic lightning can produce fantastical events with the lower ionosphere. Although the High-frequency Active Auroral Research Program (HAARP) transmitter is not as powerful as lightning, it can be used to investigate the nonlinear interactions that occur within the lower ionosphere, many of which also occur during lightning-induced ionospheric events. This paper presents the best experimental results obtained during D-region modification experiments performed by the University of Florida at the HAARP observatory between 2007 and 2014, including ELF/VLF wave generation experiments, wave-wave mixing experiments, and cross-modulation experiments. We emphasize the physical processes important for lightning-ionosphere interactions that can be directly investigated using HAARP.

Development of a Space Flight Prototype Doppler Asymmetric Spatial Heterodyne (DASH) Spectrometer for the Measurement of Upper Atmospheric Winds

DTIC Science & Technology

2011-10-31

required for space flight. Dr. John Hughes and Dr. Abas Sivjee of Embry-Riddle Aeronautical University in Daytona FL and all the staff at the HAARP ...Laboratory, was conducted at the High Frequency Active Auroral Research Program ( HAARP ) facility in Alaska. ARROW was shipped to Anchorage AK from...the Naval Research Laboratory in Washington DC and was delivered, installed, and run at the HAARP facility by ARTEP Inc. personnel. The field

Final Technical Report for ELF/VLF Electromagnetic Detection and Characterization of Deeply Buried Targets

DTIC Science & Technology

1998-06-22

remote (e.g. HAARP /HIPAS), and natural sources (e.g. external noise); b) model the perturbed fields due to the specified underground structures...examined in this study are of three types • Remote man-made sources, e.g. HAARP /HIPAS • Local sources, e.g. metal-detector loop • Natural sources, e.g...The High Power Auroral Stimulation Observatory (HIPAS) and the High Frequency Active Auroral Research Program ( HAARP ) are capable of exciting plasma

Mid-latitude Narrowband Stimulated Electromagnetic Emissions (NSEE): New Observations and Modeling

NASA Astrophysics Data System (ADS)

Nossa, E.; Mahmoudian, A.; Isham, B.; Bernhardt, P. A.; Briczinski, S. J., Jr.

2017-12-01

High power electromagnetic waves (EM) transmitted from the ground interact with the local plasma in the ionosphere and can produce Stimulated Electromagnetic Emissions (SEE) through the parametric decay instability (PDI). The classical SEE features known as wideband SEE (WSEE) with frequency offset of 1 kHz up to 100 kHz have been observed and studied in detail in the 1980s and 1990s. A new era of ionospheric remote sensing techniques was begun after the recent update of the HF transmitter at the HAARP. Sideband emissions of unprecedented strength have been reported during recent campaigns at HAARP, reaching up to 10 dB relative to the reflected pump wave which are by far the strongest spectral features of secondary radiation that have been reported. These emissions known as narrowband SEE (NSEE) are shifted by only up to a few tens of Hertz from radio-waves transmitted at several megahertz. One of these new NSEE features are emission lines within 100 Hz of the pump frequency and are produced through magnetized stimulated Brillouin scatter (MSBS) process. Stimulated Brillouin Scatter (SBS) is a strong SEE mode involving a direct parametric decay of the pump wave into an electrostatic wave (ES) and a secondary EM wave that sometimes could be stronger than the HF pump. SBS has been studied in laboratory plasma experiments by the interaction of high power lasers with plasmas. The SBS instability in magnetized ionospheric plasma was observed for the first time at HAARP in 2010. Our recent work at HAARP has shown that MSBS emission lines can be used to asses electron temperature in the heated region, ion mass spectrometry, determine minor ion species and their densities in the ionosphere, study the physics associated with electron acceleration and artificial airglow. Here, we present new observations of narrowband SEE (NSEE) features at the new mid-latitude heating facility at Arecibo. This includes the direct mode conversion of pump wave through MSBS process. Collected data using ground-based SEE receiver, incoherent scatter radar (ISR), ionospgram, as well as satellite observations will be discussed. The different characteristics of parametric decay instabilities in the high and mid-latitude will be compared. Preliminary theoretical and computational modeling of mid-latitude NSEE will be presented.

Investigation of Third Gyro-harmonic Heating at HAARP Using Stimulated Radio Emissions, the MUIR and SuperDARN Radars

NASA Astrophysics Data System (ADS)

Mahmoudian, Alireza; Bernhardt, Paul; Ruohoniemi, J. Michael; Isham, Brett; Watkins, Brenton; Scales, Wayne

2016-07-01

Use of high frequency (HF) heating experiments has been extended in recent years as a useful methodology for plasma physicists wishing to remotely study the properties and behavior of the ionosphere as well as nonlinear plasma processes. Our recent work using high latitude heating experiments has lead to several important discoveries that have enabled assessment of active geomagnetic conditions, determination of minor ion species and their densities, ion mass spectrometry, electron temperature measurements in the heating ionosphere, as well a deeper understanding of physical processes associated with electron acceleration and formation of field aligned irregularities. The data recorded during two campaigns at HAARP in 2011 and 2012 will be presented. Several diagnostic instruments have been used to detect HAARP heater-generated ionospheric irregularities and plasma waves. These diagnostics include an ionosonde, MUIR (Modular UHF Ionospheric Radar at 446 MHz), SuperDARN HF backscatter radar and ground-based SEE receivers. Variation of the wideband/ narrowband SEE features, SuperDARN echoes, and enhanced ion lines were studied with pump power variation, pump frequency stepping near 3fce as well as changing beam angle relative to the magnetic zenith. In particular, formation of field-aligned irregularities (FAIs) and upper hybrid (UH) waves through oscillating two-stream instability (OSTI) and resonance instability is studied. During heating, Narrowband SEE (NSEE) showed enhancements that correlated with the enhanced MUIR radar ion lines. IA MSBS (Magnetized Stimulated Brillouin Scatter) lines are much narrower than Wideband SEE (WSEE) lines and as a result electron temperature calculated using NSEE line offset has potential to be more accurate. This technique may therefore complement the electron temperature calculation using ISR spectra. Strength of IA MSBS lines correlate with EHIL in the MUIR spectrum during HF pump frequency variation near 3fce. Therefore, NSEE could be used for similar diagnostic information, particularly temperature assessment during heating. More detailed physics-based modeling of such SEE is expected to provide further diagnostic information/capabilities. This work has demonstrated the tremendous future potential of Narrowband SEE (NSEE) as a powerful untapped ionospheric diagnostic which could provide complementary measurements for locations that ISR facilities are not available or as a complementary measurement for the waves and irregularities that cannot be observed by ISR.

Technology Transition and Adoption: A Study in Search of Metrics for Evaluating Transition

DTIC Science & Technology

2010-12-01

Coalitions and Agents Project (Fast C2AP) 3 Direct Thermal to Electric Conversion (DTEC) 3 High-Frequency Active Auroral Project ( HAARP ) Instrument...which the technology is disruptive: 40 RAID TEAM SDS M&DC2 LCCMD DTEC AT3 WASP DOTS LASER Boomerang Virtual Autopsy  Program HAARP PCES Ultralog Sticky...RAID SDS Fast C2AP DTEC AT3 WASP Radar Scope DOTS SPEYES LASER Boomerang MAV ACTD HAARP TEAM PCES Ultralog Sticky Flare Active Templates LCCMD VIVID

Multisite Optical Imaging of Artificial Ionospheric Plasmas (Postprint)

DTIC Science & Technology

2011-11-09

Frequency Active Auroral Research Program ( HAARP ) facility in Gakona, Alaska (62.4◦ N 145◦ W) after the trans- mitter reached full 3.6-MW power, these...The experiment was carried out on November 19, 2009, between 02:26 UT and 02:43:50 UT. Optical images were acquired at the HAARP site at 557.7 nm (O 1S...noise and integrated for 5 s at a temperature of −40 ◦C. A second system located 160 km north of the HAARP near Delta Junction used an Apogee Alta

Excitation of earth-ionosphere waveguide in the ELF and lower VLF bands by modulated ionospheric current. Technical report

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

Field, E.C.; Bloom, R.M.

1993-05-21

In this report the authors use the principal of reciprocity in conjunction with a full-wave propagation code to calculate ground-level fields excited by ionospheric currents modulated at frequencies between 50 and 100 Hz with HF heaters. Their results show the dependence on source orientation, altitude, and dimension and therefore pertain to experiments using the HIPAS or HAARP ionospheric heaters. In the end-fire mode, the waveguide excitation efficiency of an ELF HED in the ionosphere is up to 20 dB greater than for a ground-based antenna, provided its altitude does not exceed 80-to-90 km. The highest efficiency occurs for a sourcemore » altitude of around 70 km; if that altitude is raised to 100 km, the efficiency drops by about 20 dB in the day and 10 dB at night. That efficiency does not account for the greater conductivity modulation that might be achieved at altitudes greater than 70 km, however. The trade-off between the altitude dependencies of the excitation efficiency and maximum achievable modulation depends on the ERP of the HF heater, the optimum altitude increasing with increasing ERP. For HIPAS the best modulation altitude is around 70 km, whereas for HAARP there might be marginal value in modulating at attitudes as high as 100 Km. Ionospheric modification, Ionospheric currents, Ionospheric heating.« less

Study of HF-induced plasma turbulence by SEE and ISR technique during 2011 HAARP experimental campaign

NASA Astrophysics Data System (ADS)

Grach, Savely; Bernhardt, Paul; Sergeev, Evgeny; Shindin, Alexey; Broughton, Matt; Labelle, James; Bricinsky, Stanley; Mishin, Evgeny; Isham, Brett; Watkins, Brenton

A concise review of the results of the 20 March - 4 April 2011 experimental campaign at the HAARP heating facility, Gakona, Alaska is presented. The campaign goals were to study the physical processes that determine the interaction of high-power HF radio waves with the F-region ionosphere. The stimulated electromagnetic emission (SEE) observational sites A/B/C were located along the magnetic meridian to the south of the HAARP facility at about 11/83/113 km distant. Site A (B) was nearly under the region during injections at vertical (Magnetic Zenith, MZ). Enhanced plasma line (PL) radar echoes were measured by the modular UHF incoherent scatter radar (MUIR) located at HAARP. Specially designed 'diagnostic' regimes of the pump wave radiation were used to account for the characteristic times of the excitation and fading of the plasma waves (Delta t_w ˜ 1-10 ms) and small-scale field-aligned irregularities (FAI, Delta t_{fai} ˜ 1-10 s). They include mainly (I) alternation low-duty cycles consisting of short (a few Delta t_w) pulses with long (Delta t_{fai}) pauses between them and high duty cycles, i.e. long injection pulses (≫ t_w) with a short pauses of 20-30 ms. The low-duty regime is aimed to study the excited Langmuir turbulence and at to specify the evolution of FAI and their scale-lengths related to different SEE spectral features. The main objective of the high-duty regime is to explore the excitation and fading of upper-hybrid and electron Bernstein plasma waves, with FAI fixed. (II) Concurrent injection of the pump wave f_0 in the regime I, and another wave at a frequency f_1≠q f_0 in the low duty cycle. Since these waves reflect/refract at different altitudes, the altitudinal distribution of FAI can be obtained. (III) Fast (within some seconds) sweeping the pump frequency about electron gyroharmonics s f_c (s=2,3,4) in order to determine the contribution of various nonlinear interaction processes to the excitation of the HF part of the pump-excited turbulence as a function of f_0-sf_c at the fixed FAI and background ionosphere parameters. The main results describe (1) the rise and fall of Langmuir turbulence after the start of pumping, which reveal the notable difference in the SEE spectra and reflected PW signals at different receiving cites and the energy transfer of the Langmuir waves over the spectrum; (2) the development of descending layers of artificial ionization during high-duty cycle injections at MZ; (3) the PL generation during the fast sweeping at MZ near the altitude where the PW frequency is close to local multiple electron gyro-frequency; (4) the discovery of a new SEE spectral feature at frequencies below the PW frequency by 50-150 kHz, coined the Broad Downshifted Emission; (5) the specification of the SEE spectra near the second electron gyroharmonic.

Recent Observations and Modeling of Narrowband Stimulated Electromagnetic Emissions SEEs at the HAARP Facility

NASA Astrophysics Data System (ADS)

Scales, Wayne; Bernhardt, Paul; McCarrick, Michael; Briczinski, Stanley; Mahmoudian, Alireza; Fu, Haiyang; Ranade Bordikar, Maitrayee; Samimi, Alireza

There has been significant interest in so-called narrowband Stimulated Electromagnetic Emission SEE over the past several years due to recent discoveries at the High Frequency Active Auroral Research Program HAARP facility near Gakone, Alaska. Narrowband SEE (NSEE) has been defined as spectral features in the SEE spectrum typically within 1 kHz of the transmitter (or pump) frequency. SEE is due to nonlinear processes leading to re-radiation at frequencies other than the pump wave frequency during heating the ionospheric plasma with high power HF radio waves. Although NSEE exhibits a richly complex structure, it has now been shown after a substantial number of observations at HAARP, that NSEE can be grouped into two basic classes. The first are those spectral features, associated with Stimulated Brillouin Scatter SBS, which typically occur when the pump frequency is not close to electron gyro-harmonic frequencies. Typically, these spectral features are within roughly 50 Hz of the pump wave frequency where it is to be noted that the O+ ion gyro-frequency is roughly 50 Hz. The second class of spectral features corresponds to the case when the pump wave frequency is typically within roughly 10 kHz of electron gyro-harmonic frequencies. In this case, spectral features ordered by harmonics of ion gyro-frequencies are typically observed, and termed Stimulated Ion Bernstein Scatter SIBS. There is also important parametric behavior on both classes of NSEE depending on the pump wave parameters including the field strength, antenna beam angle, and electron gyro-harmonic number. This presentation will first provide an overview of the recent NSEE experimental observations at HAARP. Both Stimulated Brillouin Scatter SBS and Stimulated Ion Bernstein Scatter SIBS observations will be discussed as well as their relationship to each other. Possible theoretical formulation in terms of parametric decay instabilities will be provided. Computer simulation model results will be presented to provide insight into associated higher order nonlinear effects including particle acceleration and wave-wave processes. Both theory and model results will be put into the context of the experimental observations. Finally, possible applications of NSEE will be pointed out including triggering diagnostics for artificial ionization layer formation, proton precipitation event diagnostics, and electron temperature measurements in the heated volume.

Artificial periodic irregularities in the high-latitude ionosphere excited by the HAARP facility

NASA Astrophysics Data System (ADS)

Bakhmetieva, N. V.; Grach, S. M.; Sergeev, E. N.; Shindin, A. V.; Milikh, G. M.; Siefring, C. L.; Bernhardt, P. A.; McCarrick, M.

2016-07-01

We present results of the new observations of artificial periodic irregularities (APIs) in the ionosphere using the High Frequency Active Auroral Research Program (HAARP) heating facility carried out in late May and early June 2014.The objective of this work is to detect API using high-latitude facility and analyze possible differences of the temporal and spatial variations of the API echoes in the high (HAARP) and middle (Sura) latitudes. Irregularities were created by the powerful wave of X mode and were sounded using the short probing pulses signals of X mode. API echoes were observed in the D, E, and F regions of the ionosphere. Amplitudes and characteristic times of the API echoes were measured. The API growth and decay times at HAARP (high latitudes) observed were similar to those at the Sura heating facility (midlatitudes).

Multi Station Frequency Response and Polarization of ELF/VLF Signals Generated via Ionospheric Modification

NASA Astrophysics Data System (ADS)

Maxworth, Ashanthi; Golkowski, Mark; University of Colorado Denver Team

2013-10-01

ELF/VLF wave generation via HF modulated ionospheric heating has been practiced for many years as a unique way to generate waves in the ELF/VLF band (3 Hz - 30 kHz). This paper presents experimental results and associated theoretical modeling from work performed at the High Frequency Active Auroral Research Program (HAARP) facility in Alaska, USA. An experiment was designed to investigate the modulation frequency dependence of the generated ELF/VLF signal amplitudes and polarization at multiple sites at distances of 37 km, 50 km and 99 km from the facility. While no difference is observed for X mode versus O mode modulation of the heating wave, it is found that ELF/VLF amplitude and polarization as a function of modulated ELF/VLF frequency is different for each site. An ionospheric heating code is used to determine the primary current sources leading to the observations.

High Power HF Excitation of Low Frequency Stimulated Electrostatic Waves in the Ionospheric Plasma over HAARP

NASA Astrophysics Data System (ADS)

Bernhardt, Paul; Selcher, Craig A.

High Power electromagnetic (EM) waves transmitted from the HAARP facility in Alaska can excite low frequency electrostatic waves by several processes including (1) direct magnetized stimulated Brillouin scatter (MSBS) and (2) parametric decay of high frequency electrostatic waves into electron and ion Bernstein waves. Either an ion acoustic (IA) wave with a frequency less than the ion cyclotron frequency (fCI) or an electrostatic ion cyclotron (EIC) wave just above fCI can be produced by MSBS. The coupled equations describing the MSBS instabil-ity show that the production of both IA and EIC waves is strongly influenced by the wave propagation direction relative to the background magnetic field. Experimental observations of stimulated electromagnetic emissions (SEE) using the HAARP transmitter in Alaska have confirmed the theoretical predictions that only IA waves are excited for propagation along the magnetic zenith and that EIC waves can only be detected with oblique propagation angles. The electron temperature in the heated plasma is obtained from the IA spectrum offsets from the pump frequency. The ion composition can be determined from the measured EIC frequency. Near the second harmonic of the electron cyclotron frequency, the EM pump wave is converted into an electron Bernstein (EB) wave that decays into another EB wave and an ion Bernstein (IB) wave. Strong cyclotron resonance with the EB wave leads to acceleration of the electrons. Ground based SEE observations are related to the theory of low-frequency electrostatic wave generation.

Characterization of Ionosphere Waveguide Propagation by Monitoring HAARP HF Transmissions in Antarctica

DTIC Science & Technology

2015-04-17

hhh hhhh hh (7а)  .)cos(cos)sincoscos( cos)coscossin( cos 1sin 0 2)(22 0 2)( 00 )( 00 )()( 00 )( 00)(22 0 2 0 )( 2,1         s x i...z i xz si z i xxs xz s hhhh hhh hh   7b) Here the top sign stands for )(1 s , while the lower sign stands for )(2 s . It is also taken into

Upper Hybrid Effects in Artificial Ionization

NASA Astrophysics Data System (ADS)

Papadopoulos, K.; Eliasson, B. E.

2014-12-01

A most fascinating result of recent ionospheric experiments has been the discovery of artificial ionization by Pedersen et al. (GRL, 37, L02106, 2010). The Artificial Ionospheric Layers (AIL) were the result of F-region O-mode HF irradiation using the HAARP ionospheric heater operating at 3.6 MW power. As demonstrated by Eliasson et al. (JGR, 117, A10321, 2012) the physics controlling the observed phenomenon and its threshold can be summarized as: " Collisional ionization due to high energy (~ 20 eV) electron tails generated by the interaction of strong Langmuir turbulence with plasma heated at the upper hybrid resonance and transported at the reflection height". The objective of the current presentation is to explore the role of the upper hybrid heating in the formation of AIL and its implications to future experiments involving HF heaters operating in middle and equatorial latitudes.

Artificial plasma cusp generated by upper hybrid instabilities in HF heating experiments at HAARP

NASA Astrophysics Data System (ADS)

Kuo, Spencer; Snyder, Arnold

2013-05-01

High Frequency Active Auroral Research Program digisonde was operated in a fast mode to record ionospheric modifications by the HF heating wave. With the O mode heater of 3.2 MHz turned on for 2 min, significant virtual height spread was observed in the heater off ionograms, acquired beginning the moment the heater turned off. Moreover, there is a noticeable bump in the virtual height spread of the ionogram trace that appears next to the plasma frequency (~ 2.88 MHz) of the upper hybrid resonance layer of the HF heating wave. The enhanced spread and the bump disappear in the subsequent heater off ionograms recorded 1 min later. The height distribution of the ionosphere in the spread situation indicates that both electron density and temperature increases exceed 10% over a large altitude region (> 30 km) from below to above the upper hybrid resonance layer. This "mini cusp" (bump) is similar to the cusp occurring in daytime ionograms at the F1-F2 layer transition, indicating that there is a small ledge in the density profile reminiscent of F1-F2 layer transitions. Two parametric processes exciting upper hybrid waves as the sidebands by the HF heating waves are studied. Field-aligned purely growing mode and lower hybrid wave are the respective decay modes. The excited upper hybrid and lower hybrid waves introduce the anomalous electron heating which results in the ionization enhancement and localized density ledge. The large-scale density irregularities formed in the heat flow, together with the density irregularities formed through the parametric instability, give rise to the enhanced virtual height spread. The results of upper hybrid instability analysis are also applied to explain the descending feature in the development of the artificial ionization layers observed in electron cyclotron harmonic resonance heating experiments.

The Precision Expandable Radar Calibration Sphere (PERCS) With Applications for Laser Imaging and Ranging

NASA Astrophysics Data System (ADS)

Bernhardt, P.; Nicholas, A.; Thomas, L.; Davis, M.; Hoberman, C.; Davis, M.

The Naval Research Laboratory will provide an orbiting calibration sphere to be used with ground-based laser imaging telescopes and HF radio systems. The Precision Expandable Radar Calibration Sphere (PERCS) is a practical, reliable, high-performance HF calibration sphere and laser imaging target to orbit at about 600 km altitude. The sphere will be made of a spherical wire frame with aspect independent radar cross section in the 3 to 35 MHz frequency range. The necessary launch vehicle to place the PERCS in orbit will be provided by the Department of Defense Space Test Program. The expandable calibration target has a stowed diameter of 1 meter and a fully deployed diameter of 10.2 meters. A separate deployment mechanism is provided for the sphere. After deployment, the Precision Expandable Radar Calibration Sphere (PERCS) with 180 vertices will be in a high inclination orbit to scatter radio pulses from a number of ground systems, including (1) over-the-horizon (OTH) radars operated by the United States and Australia; (2) high power HF facilities such as HAARP in Alaska, EISCAT in Norway, and Arecibo in Puerto Rico; (3) the chain of high latitude SuperDARN radars used for auroral region mapping; and (4) HF direction finding for Navy ships. With the PERCS satellite, the accuracy of HF radars can be periodically checked for range, elevation, and azimuth errors. In addition, each of the 360 vertices on the PERCS sphere will support an optical retro-reflector for operations with ground laser facilities used to track satellites. The ground laser systems will be used to measure the precise location of the sphere within one cm accuracy and will provide the spatial orientation of the sphere as well as the rotation rate. The Department of Defense facilities that can use the corner-cube reflectors on the PERCS include (1) the Air Force Maui Optical Site (AMOS), (2) the Starfire Optical Range (SOR), and (3) the NRL Optical Test Facility (OTF).

Generation of whistler waves by continuous HF heating of the upper ionosphere

NASA Astrophysics Data System (ADS)

Vartanyan, A.; Milikh, G. M.; Eliasson, B. E.; Sharma, A.; Chang, C.; Parrot, M.; Papadopoulos, K.

2013-12-01

We report observations of VLF waves by the DEMETER satellite overflying the HAARP facility during ionospheric heating experiments. The detected VLF waves were in the range 8-17 kHz and coincided with times of continuous heating. The experiments indicate whistler generation due to conversion of artificial lower hybrid waves to whistlers on small scale field-aligned plasma density striations. The observations are compared with theoretical models, taking into account both linear and nonlinear processes. Implications of the mode conversion technique on VLF generation with subsequent injection into the radiation belts to trigger particle precipitation are discussed.

Artificial ionosphere layers for pumping-wave frequencies near the fourth electron gyroharmonic in experiments at the HAARP facility

NASA Astrophysics Data System (ADS)

Grach, S. M.; Sergeev, E. N.; Shindin, A. V.; Mishin, E. V.; Watkins, B.

2014-02-01

In this paper we consider the action (in the magnetic-zenith direction) of powerful high frequency (HF) radiation of ordinary polarization on the ionosphere F region. We deal with frequencies f 0 > 4 f ce ( f ce is the electron cyclotron frequency) of 1.7 GW equivalent radiated power. This action results in the appearance in the ionosphere of an artificial ionization layer. The layer descends with respect to the basic (unperturbed) layer at a rate of ˜500 m s-1 down to the altitude, where f 0 ≈ 4 f ce .

ELF/VLF Wave Generation and Scattering from Modulated Heating of the Ionosphere at Arecibo Observatory

NASA Astrophysics Data System (ADS)

Maxworth, A. S.; Golkowski, M.; McCormick, J.; Cohen, M.; Hosseini, P.; Bittle, J.

2017-12-01

The recently completed ionospheric heater at Arecibo Observatory is used for modulated HF (5 or 8 MHz) heating of the ionosphere, to generate ELF/VLF (3 Hz - 30 kHz) waves. Observation of ramp and tone signals at frequencies from hundreds of Hz to several kHz at multiple receivers confirms the ability of the heater to modulate D region currents and create an ELF/VLF antenna in the ionosphere. Observed ELF/VLF signal amplitudes are lower than for similar experiments performed at high latitudes at the HAARP and Tromso facilities, for a variety of reasons including the reduced natural currents at mid latitudes, and the lower HF power of the Arecibo heater. The heating of the overhead ionosphere is also observed to change the Earth-ionosphere waveguide propagation characteristics as is evident from simultaneous observations of lightning induced sferics and VLF transmitter signals that propagate under the heated region. The active heating of the ionosphere modifies the reflection of incident VLF (3-30 kHz) waves. We present initial observations of HF heating of the D-region and resulting ELF/VLF wave generation.

Partnering with law enforcement to deliver good public health: the experience of the HIV/AIDS Asia regional program.

PubMed

Sharma, Mukta; Chatterjee, Anindya

2012-07-09

In the South-East Asia region, the drug control and supply reduction agenda is of high political importance. A multitude of law enforcement agencies are engaged in this work. Nationwide campaigns such as the "Strike- Hard" campaign in China or the "war on drugs" in Thailand dominate the landscape. Viet Nam's response to drug use has historically focused on deterrence through punishment and supply-side measures. This policy environment is further complicated by lack of evidence-based drug dependence treatment in several settings. The public health consequences of this approach have been extremely serious, with some of the highest documented prevalence of preventable blood-borne viral infections, including HIV, and hepatitis B and C. The wider socioeconomic consequences of this have been borne by families, communities and the governments themselves.The HIV/AIDS Asia Regional Program (HAARP) aims to stop the spread of HIV associated with drug use in South-East Asia and parts of southern China. HAARP works across five countries (Cambodia, China Burma, Laos, Viet Nam) chiefly through the Ministries of Health and Social Affairs, National Drug Control Agencies, and Public Security sectors, including prisons. HAARP has also engaged with UN agencies and a wide range of civil society organisations, including organisations of people who use drugs, to ensure their meaningful involvement in matters that directly affect them. We describe the experience of HAARP in implementing a large-scale harm reduction programme in the Sub-Mekong Region. HAARP chose to direct its efforts in three main areas: supporting an enabling environment for effective harm reduction policies, building core capacity among national health and law enforcement agencies, and supporting "universal access" goals by making effective, high-coverage services available to injecting drug users and their partners.The activities supported by HAARP are humble yet important steps. However, a much higher political-level dialogue is needed. The current huge gap of human rights standards in drug control practices also needs to be bridged immediately. Public health that embraces a rights-based approach must be given its fair share of policy space, budget and influence.

Partnering with law enforcement to deliver good public health: the experience of the HIV/AIDS Asia regional program

PubMed Central

2012-01-01

In the South-East Asia region, the drug control and supply reduction agenda is of high political importance. A multitude of law enforcement agencies are engaged in this work. Nationwide campaigns such as the “Strike- Hard” campaign in China or the “war on drugs” in Thailand dominate the landscape. Viet Nam’s response to drug use has historically focused on deterrence through punishment and supply-side measures. This policy environment is further complicated by lack of evidence-based drug dependence treatment in several settings. The public health consequences of this approach have been extremely serious, with some of the highest documented prevalence of preventable blood-borne viral infections, including HIV, and hepatitis B and C. The wider socioeconomic consequences of this have been borne by families, communities and the governments themselves. The HIV/AIDS Asia Regional Program (HAARP) aims to stop the spread of HIV associated with drug use in South-East Asia and parts of southern China. HAARP works across five countries (Cambodia, China Burma, Laos, Viet Nam) chiefly through the Ministries of Health and Social Affairs, National Drug Control Agencies, and Public Security sectors, including prisons. HAARP has also engaged with UN agencies and a wide range of civil society organisations, including organisations of people who use drugs, to ensure their meaningful involvement in matters that directly affect them. We describe the experience of HAARP in implementing a large-scale harm reduction programme in the Sub-Mekong Region. HAARP chose to direct its efforts in three main areas: supporting an enabling environment for effective harm reduction policies, building core capacity among national health and law enforcement agencies, and supporting “universal access” goals by making effective, high-coverage services available to injecting drug users and their partners. The activities supported by HAARP are humble yet important steps. However, a much higher political-level dialogue is needed. The current huge gap of human rights standards in drug control practices also needs to be bridged immediately. Public health that embraces a rights-based approach must be given its fair share of policy space, budget and influence. PMID:22769065

VLF wave generation by beating of two HF waves in the ionosphere

NASA Astrophysics Data System (ADS)

Kuo, Spencer; Snyder, Arnold; Kossey, Paul; Chang, Chia-Lie; Labenski, John

2011-05-01

Theory of a beat-wave mechanism for very low frequency (VLF) wave generation in the ionosphere is presented. The VLF current is produced by beating two high power HF waves of slightly different frequencies through the nonlinearity and inhomogeneity of the ionospheric plasma. Theory also shows that the density irregularities can enhance the beat-wave generation. An experiment was conducted by transmitting two high power HF waves of 3.2 MHz and 3.2 MHz + f, where f = 5, 8, 13, and 2.02 kHz, from the HAARP transmitter. In the experiment, the ionosphere was underdense to the O-mode heater, i.e., the heater frequency f0 > foF2, and overdense or slightly underdense to the X-mode heater, i.e., f0 < fxF2 or f0 ≥ fxF2. The radiation intensity increased with the VLF wave frequency, was much stronger with the X-mode heaters, and was not sensitive to the electrojet. The strongest VLF radiation of 13 kHz was generated when the reflection layer of the X-mode heater was just slightly below the foF2 layer and the spread of the O-mode sounding echoes had the largest enhancement, suggesting an optimal setting for beat-wave generation of VLF waves by the HF heaters.

Telescopic Imaging of Heater-Induced Airglow at HAARP

DTIC Science & Technology

2007-01-01

03-01-2007 Final1 10-09-2003 - 10-09-2006 4. TITLE AND SUBTITLE Ba. CONTRACT NUMBER Telescopic Imaging of Heater-Induced Airglow at HAARP N00014-03-1... HAARP to optically measure fine structure in the ionosphere and to study airglow sources. In the presence of aurora and a strong blanketing E layer... HAARP was modulated at intervals of several seconds. For several cycles, small bright airglow spots were observed whenever HAARP was on. These spots

Multiple-Station Observation of Frequency Dependence and Polarization Characteristics of ELF/VLF waves generated via Ionospheric Modification

NASA Astrophysics Data System (ADS)

Maxworth, A. S.; Golkowski, M.; Cohen, M.; Moore, R. C.

2014-12-01

Generation of Extremely Low Frequency (ELF) and Very Low Frequency (VLF) signals through ionospheric modification has been practiced for many years. Heating the lower ionosphere with high power HF waves allows for modulation of natural current systems. Our experiments were carried out at the High Frequency Active Auroral Research Program (HAARP) facility in Alaska, USA. In this experiment, the ionosphere was heated with a vertical amplitude modulating signal and the modulation frequency was changed sequentially within an array of 40 frequencies followed by a frequency ramp. The observed magnetic field amplitude and polarization of the generated ELF/VLF signals were analyzed for multiple sites and as a function of modulation frequency. Our three observation sites: Chistochina, Paxson and Paradise are located within 36km (azimuth 47.7°), 50.2km (azimuth -20°) and 99km (azimuth 80.3°) respectively. We show that the peak amplitudes observed as a function of frequency result from vertical resonance in the Earth-ionosphere waveguide and can be used to diagnose the D-region profile. Polarization analysis showed that out of the three sites Paxson shows the highest circularity in the magnetic field polarization, compared to Chistochina and Paradise which show highly linear polarizations. The experimental results were compared with a theoretical simulation model results and it was clear that in both cases, the modulated Hall current dominates the observed signals at Chistochina and Paradise sites and at Paxson there is an equal contribution from Hall and Pedersen currents. The Chistochina site shows the highest magnetic field amplitudes in both experimental and simulation environments. Depending upon the experimental and simulation observations at the three sites, a radiation pattern for the HAARP ionospheric heater can be mapped

On the Additional Absorption of Radio Emission from Discrete Cosmic Sources Under HF Modification of the Lower Ionosphere

NASA Astrophysics Data System (ADS)

Bezrodny, V. G.; Charkina, O. V.; Yampolski, Yu. M.

2015-12-01

The possibilities of modification of a weakly ionized plasma are investigated theoretically and experimentally within different electron density behavior models. The dependence of the additional absorption of radiation of discreet cosmic sources Cassiopeia A and Cygnus A in the artificially disturbed ionospheric D-region on the amplitude of heating signal during the special measuring campaigns of February and October 2008 has been analyzed. The ionosphere has been modified with using the world most powerful HAARP heater, Alaska, USA. The 64 beam riometer located in the immediate vicinity of the heater was used as the recording system.

Electromagnetic interference impact of the proposed emitters for the High Frequency Active Auroral Research Program (HAARP). Interim report

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

Robertshaw, G.A.; Snyder, A.L.; Weiner, M.M.

1993-05-14

The proposed HAARP emitters at the Gakona (Alaska) preferred site and at the Clear AFS (Alaska) alternative site are the Ionospheric Research Instrument (IRI), the Incoherent Scatter Radar (ISR), and the Vertical Incidence Sounder(VIS). The electromagnetic interference (EMI) impact of those emitters on receiving systems in the vicinity of the sites is estimated in this study. The results are intended for use as an input to the Air Force Environmental Impact Statement as part of the Environmental Impact Analysis Process.

Optimizing ELF/VLF generation via HF heating utilizing beam motion

NASA Astrophysics Data System (ADS)

Cohen, M. B.; Inan, U. S.; Lehtinen, N. G.; Golkowski, M. A.

2008-12-01

ELF/VLF (300 Hz - 30 kHz) waves are difficult to generate with conventional antennae due to their extraordinary long wavelengths, and the good conductance of the Earth at these frequencies. Recently, ELF and VLF waves have been generated using HF (3-10 MHz) heating of the lower ionosphere, in the presence of natural currents such as the auroral electrojet, which modulates the ionospheric conductivity and therefore turns the lower ionosphere into a large radiating element. The recently upgraded HAARP facility, near Gakona Alaska, utilizes 3.6 MW of HF power, along with an unprecedented ability to steer the HF heating beam over a large area extremely rapidly. Since the completion of the upgrade in 2007, the first successful implementation of techniques such as geometric modulation [Cohen et al. 2008, Borisov et al. 1998], and beam painting [Papadopoulos et al. 1989] have occurred. These results have shown as much as 7-11 dB improvement in the signal strengths, as well as the first ability to direct ELF/VLF signals via an unprecedented ELF/VLF phased array. Here, we use a combination of experimental and theoretical investigations to discuss the optimization of ELF/VLF generation via HF heating, including the effect of HF and ELF frequency on the amplitude and the directional pattern for various generation techniques. The experimental observations occur over an array of receivers across Alaska. The theoretical formulation utilizes a 3D model of the HF heating and subsequent electron cooling processes, leading to spatial structure of modulated ionospheric conductivities, the results of which are input into a model of ELF/VLF propagation in the Earth-ionosphere waveguide.

Vlasov Simulations of Ionospheric Heating Near Upper Hybrid Resonance

NASA Astrophysics Data System (ADS)

Najmi, A. C.; Eliasson, B. E.; Shao, X.; Milikh, G. M.; Papadopoulos, K.

2014-12-01

It is well-known that high-frequency (HF) heating of the ionosphere can excite field- aligned density striations (FAS) in the ionospheric plasma. Furthermore, in the neighborhood of various resonances, the pump wave can undergo parametric instabilities to produce a variety of electrostatic and electromagnetic waves. We have used a Vlasov simulation with 1-spatial dimension, 2-velocity dimensions, and 2-components of fields, to study the effects of ionospheric heating when the pump frequency is in the vicinity of the upper hybrid resonance, employing parameters currently available at ionospheric heaters such as HAARP. We have found that by seeding theplasma with a FAS of width ~20% of the simulation domain, ~10% depletion, and by applying a spatially uniform HF dipole pump electric field, the pump wave gives rise to a broad spectrum of density fluctuations as well as to upper hybrid and lower hybrid oscillating electric fields. We also observe collisionless bulk-heating of the electrons that varies non-linearly with the amplitude of the pump field.

Geometric Aspects of Artificial Ionospheric Layers Driven by High-Power HF-Heating

NASA Astrophysics Data System (ADS)

Milikh, G. M.; Eliasson, B.; Shao, X.; Djordjevic, B.; Mishin, E. V.; Zawdie, K.; Papadopoulos, K.

2013-12-01

We have generalized earlier developed multi-scale dynamic model for the creation and propagation of artificial plasma layers in the ionosphere [Eliasson et al, 2012] by including two dimensional effects in the horizontal direction. Such layers were observed during high-power high frequency HF heating experiments at HAARP [Pedersen et al., 2010]. We have numerically investigated the importance of different angles of incidence of ordinary mode waves on the Langmuir turbulence and the resulting electron acceleration that leads to the formation of artificial ionospheric layers. It was shown that the most efficient electron acceleration and subsequent ionization is obtained at angles between magnetic zenith and the vertical, where strong Langmuir turbulence dominates over weak turbulence. A role played by the heating wave propagation near caustics was also investigated. Eliasson, B. et al. (2012), J. Geophys. Res. 117, A10321, doi:10.1029/2012JA018105. Pedersen, T., et al. (2010), Geophys. Res. Lett., 37, L02106, doi:10.1029/2009GL041895.

The WIND-HAARP-HIPAS Interferometer Experiment

DTIC Science & Technology

1999-04-22

Naval Research Laboratory Washington, DC 20375-5320 NRL/MR/6750--99-8349 The WIND- HAARP -HIPAS Interferometer Experiment P. RODRIGUEZ AND M. J...1999 3. REPORT TYPE AND DATES COVERED Interim Report 4. TITLE AND SUBTITLE The WIND- HAARP -HIPAS Interferometer Experiment 5. FUNDING NUMBERS JO...frequency transmitting facilities in a bistatic, interferometer mode. The HAARP and HIPAS facilities in Alaska radiated at 4525 kHz with total combined

Full-Wave Radio Characterization of Ionospheric Modification at HAARP

DTIC Science & Technology

2015-07-26

Full-Wave Radio Characterization of Ionospheric Modification at HAARP We have studied electrostatic and electromagnetic turbulence stimulated by...radio receivers at HAARP in Alaska, and ground-based radio receivers, incoherent scatter radars, and in-situ measurements from Canadian, ESA, and Polish...363255 San Juan, PR 00936 -3255 31-May-2015 ABSTRACT Final Report: Full-Wave Radio Characterization of Ionospheric Modification at HAARP Report Title We

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.

Characterization of the Auroral Electrojet and the Ambient and Modified D Region for HAARP Using Long-Path VLF Diagnostics

DTIC Science & Technology

2001-03-15

order to characterize the auroral electrojet and the ambient and modified D-region directly above and near the HAARP (High Frequency Active Auroral...near the HAARP facility and along the west coast of Alaska. In addition in order to characterize the auroral electrojet on a continental scale and to...United States and Canada. Data from the complete array of D-region diagnostic systems was acquired during a number of Fall and Spring HAARP campaigns

Equator and High-Latitude Ionosphere-to-Magnetosphere Research

DTIC Science & Technology

2010-12-04

characterizing plasma velocity profile in the heated region above HAARP has been clearly established. Specification of D region absorption from Digisonde...Electron density profile, Ground truth, Cal/Val, Doppler skymap, HAARP , Plasma velocity profile, Ionogram autoscaling, D region absorption...2  3  HAARP INVESTIGATIONS ............................................................................ 5  3.1

Handling Nonlinearities in ELF/VLF Generation Using Modulated Heating at HAARP

NASA Astrophysics Data System (ADS)

Jin, G.; Spasojevic, M.; Cohen, M.; Inan, U. S.

2011-12-01

George Jin Maria Spasojevic Morris Cohen Umran Inan Stanford University Modulated HF heating of the D-region ionosphere near the auroral electrojet can generate extremely low frequency (ELF) waves in the kilohertz range. This process is nonlinear and generates harmonics at integer multiples of the ELF modulation frequency. The nonlinear distortion has implications for any communications applications since the harmonics contain a substantial fraction of the signal power and use up bandwidth. We examine two techniques for handling the nonlinearity. First we modulate the HF heating with a non-sinusoidal envelope designed to create a sinusoidal change in the Hall conductivity at a particular altitude in the ionosphere to minimize any generated harmonics. The modulation waveform is generated by inverting a numerical HF heating model, starting from the desired conductivity time series, and obtaining the HF power envelope that will result in that conductivity. The second technique attempts to use the energy in the harmonics to improve bit error rates when digital modulation is applied to the ELF carrier. In conventional quadrature phase-shift keying (QPSK), where a ELF carrier is phase-shifted by 0°, 90°, 180°, and 270° in order to transmit a pair of bits, the even harmonics cannot distinguish between the four possible shifts. By using different phase values, all the energy in the harmonics can contribute to determining the phase of the carrier and thus improve the bit error rate.

Defense Science and Technology Success Stories

DTIC Science & Technology

2007-01-01

Active Auroral Research Project ( HAARP ) ........................................................................136 Weapons Strategic Illuminator Laser...drawing 136 Service/Agency Background: The High Frequency Active Auroral Research Project ( HAARP ) developed new experimental research capabilities and...Appropriation Act provided funds for the creation of HAARP , jointly managed by the Air Force Research Laboratory and the Office of Naval Research to exploit

Unique concurrent observations of whistler mode hiss, chorus, and triggered emissions

NASA Astrophysics Data System (ADS)

Hosseini, Poorya; Gołkowski, Mark; Turner, Drew L.

2017-06-01

We present a unique 2 h ground-based observation of concurrent magnetospheric hiss, chorus, VLF triggered emissions as well as ELF/VLF signals generated locally by the High Frequency Active Auroral Research Program (HAARP) facility. Eccentricity of observed wave polarization is used as a criteria to identify magnetospheric emissions and estimate their ionospheric exit points. The observations of hiss and chorus in the unique background of coherent HAARP ELF/VLF waves and triggered emissions allow for more accurate characterization of hiss and chorus properties than in typical ground-based observations. Eccentricity and azimuth results suggest a moving ionospheric exit point associated with a single ducted path at L 5. The emissions exhibit dynamics in time suggesting an evolution of a magnetospheric source from hiss generation to chorus generation or a moving plasmapause location. We introduce a frequency band-limited autocorrelation method to quantify the relative coherency of the emissions. A range of coherency was observed from high order of coherency in local HAARP transmissions and their echoes to lower coherency in natural chorus and hiss emissions.

Artificial Aurora Generated by HAARP (Invited)

NASA Astrophysics Data System (ADS)

Streltsov, A. V.; Kendall, E. A.

2013-12-01

We present results from the ionospheric heating experiment conducted on March 12, 2013 at the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. During the experiment HAARP transmitted X-mode 4.57 MHz waves modulated with the frequency 0.9 mHz and pointed in the direction of the magnetic zenith. The beam was focused to ~20 km spot at the altitude 100 km. The heating produces two effects: First, it generates magnetic field-aligned currents producing D and H components of the magnetic field with frequency 0.9 mHz detected by fluxgate magnetometer in Gakona. Second, the heating produced bright luminous structures in the heated region detected with the SRI telescope in 427.8 nm, 557.7 nm, 630.0 nm wavelengths. We emphasize, that for the best of our knowledge, this is the first experiment where the heating of the ionosphere with X-mode produces luminous structures in the ionosphere. We classify this luminosity as an 'artificial aurora', because it correlate with the intensity of the magnetic field-aligned currents, and such correlation is constantly seen in the natural aurora.

HAARP diesel engine-generator(s) noise study

DOT National Transportation Integrated Search

2005-01-07

This document presents the results and corresponding analysis of an outdoor noise measurement program conducted by the John A. Volpe National Transportation Systems Centers Acoustic Facility (Volpe Center) at the United States Air Forces High F...

SATSIN System Manual.

DTIC Science & Technology

1995-01-01

This report outlines the design, functions and operation of the HAARP Diagnostic Satellite Scintillation (SATSIN) system that will be used to...be located so that the propagation path from satellite radio beacons passes through the heated volume created by HAARP . The signal, altered in phase...characteristics of the scintillation. From this information, the strength, shape and motion of the in situ irregularities generated by HAARP can be implied. The

The Energy Spectrum of Accelerated Electrons from Wave-Plasma Interactions in the Ionosphere

DTIC Science & Technology

2012-06-29

STATEMENT Distribution A: Approved for public release; distribution is unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT A HAARP ...data was obtained. It was therefore necessary to find the resources to repeat the campaign effort (see budget below). A HAARP campaign was...were highly structured in space and time. This fact, and the lack of electron temperature data at HAARP , made data analysis difficult. It became

Imaging and Forecasting of Ionospheric Structures and Their System Impacts

DTIC Science & Technology

2003-12-05

Trapped electrons, Wave/particle interaction, Plasmasphere, Magnetic field, HAARP , Cal/Val 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a...support to the HAARP digisonde (DPS) over the past year, UMLCAR cooperated with AFRL on a campaign during the last week of August 2003. This campaign was...held to develop new diagnostic techniques using the HAARP transmitter, the digisonde, and the all-sky imager as part of a coordinated measurement

Detection of Transionospheric SuperDARN HF Waves by the Radio Receiver Instrument on the enhanced Polar Outflow Probe Satellite

NASA Astrophysics Data System (ADS)

Gillies, R. G.; Yau, A. W.; James, H. G.; Hussey, G. C.; McWilliams, K. A.

2014-12-01

The enhanced Polar Outflow Probe (ePOP) Canadian small-satellite was launched in September 2013. Included in this suite of eight scientific instruments is the Radio Receiver Instrument (RRI). The RRI has been used to measure VLF and HF radio waves from various ground and spontaneous ionospheric sources. The first dedicated ground transmission that was detected by RRI was from the Saskatoon Super Dual Auroral Radar Network (SuperDARN) radar on Nov. 7, 2013 at 14 MHz. Several other passes over the Saskatoon SuperDARN radar have been recorded since then. Ground transmissions have also been observed from other radars, such as the SPEAR, HAARP, and SURA ionospheric heaters. However, the focus of this study will be on the results obtained from the SuperDARN passes. An analysis of the signal recorded by the RRI provides estimates of signal power, Doppler shift, polarization, absolute time delay, differential mode delay, and angle of arrival. By comparing these parameters to similar parameters derived from ray tracing simulations, ionospheric electron density structures may be detected and measured. Further analysis of the results from the other ground transmitters and future SuperDARN passes will be used to refine these results.

Imaging and Forecasting of Ionospheric Structures and Their System Impacts

DTIC Science & Technology

2005-01-27

Radiation Belt Remediation (RBR) studies were done and many of them remain active. The results of two HAARP heating experiments with the digisonde at...LORERS, Plasmasphere, HAARP , Cal/Val, Drift Software, ARTIST 4.5 16. SECURITY CLASSIFICATION OF: 17. UMITATION OF 1. NUMBER 19a. NAME OF RESPONSIBLE...STATION OBSERVATIONS 1 1.3 VLF INDUCED ELECTRON PITCH ANGLE SCATTERING (IEPAS) 2 1.4 HAARP CAMPAIGN 2 1.5 DRIFT SOFTWARE DEVELOPMENT 2 1.6 DISS SUPPORT

Geophysical Electromagnetic Sounding Using HAARP

DTIC Science & Technology

2002-03-01

apparent resistivity vs. frequency can be converted into true resistivity vs. depth, This grant involved an investigation into the HAARP virtual antenna pattern out to 200 km, and its use as a CSAMT transmitter.

Characteristics of VLF wave propagation in the Earth's magnetosphere in the presence of an artificial density duct

NASA Astrophysics Data System (ADS)

Pasmanik, Dmitry; Demekhov, Andrei

We study the propagation of VLF waves in the Earth's ionosphere and magnetosphere in the presence of large-scale artificial plasma inhomogeneities which can be created by HF heating facilities like HAARP and ``Sura''. A region with enhanced cold plasma density can be formed due to the action of HF heating. This region is extended along geomagnetic field (up to altitudes of several thousand km) and has rather small size across magnetic field (about 1 degree). The geometric-optical approximation is used to study wave propagation. The plasma density and ion composition are calculated with the use of SAMI2 model, which was modified to take the effect of HF heating into account. We calculate ray trajectories of waves with different initial frequency and wave-normal angles and originating at altitudes of about 100 km in the region near the heating area. The source of such waves could be the lightning discharges, modulated HF heating of the ionosphere, or VLF transmitters. Variation of the wave amplitude along the ray trajectories due to refraction is considered and spatial distribution of wave intensity in the magnetosphere is analyzed. We show that the presence of such a density disturbances can lead to significant changes of wave propagation trajectories, in particular, to efficient guiding of VLF waves in this region. This can result in a drastic increase of the VLF-wave intensity in the density duct. The dependence of wave propagation properties on parameters of heating facility operation regime is considered. We study the variation of the spatial distribution of VLF wave intensity related to the slow evolution of the artificial inhomogeneity during the heating.

What Can We Learn About the Ionosphere Using the EISCAT Heating Facility?

DTIC Science & Technology

2006-06-01

1970s to do both plasma physics and geophysical research. At present there are five operating facilities: HIPAS [1] and HAARP [2] in Alaska, Heating...1995: HAARP (Alaska) •2003: SPEAR (Svalbard) World overview 32 (8) 22 (16) 0.19 4-6 (2-3) 78.9 N 78.15 W SPEAR Spitsbergen Norway 150-280180-340...19.2 E 62.39 N 145.15W 65.0 N 147.0 W 18.3 N 66.8 W 40.18 N 104.73 E Geographic Coordinates SURA Russia Tromsø Norway HAARP Alaska USA HIPAS Alaska

Studies of Ionospheric Processes in the Atmosphere and the Laboratory

DTIC Science & Technology

2006-06-01

relevance to HAARP observations, and on vibrationally-excited levels of the O2 ground state [2] and the b1Σ +g excited state [3]. Synergy with the...UT [20] 29.4 (33) 260 0.94 .077 3/24/95 1737 UT 43.4 (44) 278 0.54 0.53 HAARP 62N, 145W 3/20/04 0617 UT [21] 54 (44) 290 0.33 0.54... HAARP 0.62 5.0E8 1.09E8 4.6 Studies of Ionospheric Processes in the Atmosphere and the Laboratory RTO-MP-IST-056 1 - 9 UNCLASSIFIED/UNLIMITED

Attenuation of Scintillation of Discrete Cosmic Sources during Nonresonant HF Heating of the Upper Ionosphere

NASA Astrophysics Data System (ADS)

Bezrodny, V. G.; Watkins, B.; Charkina, O. V.; Yampolski, Y. M.

2014-03-01

The aim of the work is to experimentally investigate the response of scintillation spectra and indices of discrete cosmic sources (DCS) to modification of the ionospheric F-region by powerful electromagnetic fields with frequencies exceeding the Langmuir and upper hybrid ones. The results of a special experiment on the scintillations of radiation from DCS Cygnus A observed with using the 64-beam imaging riometer located near the Gakona village (Alaska, USA) are here presented. The ionosphere was artificially disturbed by powerful HAARP heater. Under the studied conditions of nonresonant heating of the ionospheric plasma, an earlier unknown effect of reducing the level of DCS scintillation was discovered. The theoretical interpretation has been given for the discovered effect, which using allowed the proposed technique of solving the inverse problem (recovery deviations of average electron density and temperature in the modified region from their unperturbed values).

Influence of heating experiments on parameters of Schumann resonances

NASA Astrophysics Data System (ADS)

Agranat, Irina; Sivokon, Vladimir

2017-10-01

Recently the significant increase in intensity of researches in the field of the fissile impact on geophysical processes in various environments is noted. Special attention is paid to a research of impact on an ionosphere of a potent short-wave radio emission of heating stands. Today experiments on change of an ionosphere are made generally at stands HAARP, EISCAT in Tromse (Norway). Within the Russian campaign (Tomsk) EISCAT/heating (AARI_HFOX) made from October 19 to October 30, 2016 experiments on impact on an ionosphere F-layer by the radiation potent HF. For assessment of impact of these experiments on geophysical processes mathematical methods carried out the analysis of change of the parameters of the Schumann resonances received on the basis of data from the station of constant observation of the Schumann resonances in the city of Tomsk, the Tomsk State University (Russia).

Solar Radar Experiments

DTIC Science & Technology

1998-01-01

communications satellites and electric power grids. RELATED PROJECTS Studies with the HAARP radar facility being constructed in Alaska are conducted with...on wave-plasma interactions and also are assessing the possible use of HAARP as a solar radar. REFERENCES James, J. C., Radar studies of the sun, in

Initial results of stimulated radiation measurements during the HAARP campaign of September 2017

NASA Astrophysics Data System (ADS)

Yellu, A. D.; Scales, W. A.; Mahmoudian, A.; Siefring, C.; Bernhardt, P.

2018-02-01

Initial results of stimulated electromagnetic radiation observed during an ionosphere heating experiment conducted at the High-Frequency Active Auroral Program (HAARP) facility are reported. The frequency of the pump wave used in the heating is in the neighborhood of the third harmonic of the electron cyclotron frequency, and of interest are simulated electromagnetic emissions (SEEs) within ? kHz of the heating frequency known as narrowband SEE (NSEE) and the commonly known wideband SEE (WSEE) which occur within ? kHz of the pump wave frequency. With the transmit power maintained at maximum, and all other conditions of the experiment invariable, the characteristics of NSEE and WSEE as time progresses from the time the transmitter is switched on are detailed in the results. The dependence of the characteristics of the NSEE and WSEE with temporal evolution into the heating cycle are observed to be fundamentally different.

Resonant scattering of energetic electrons in the outer radiation belt by HAARP-induced ELF/VLF waves

NASA Astrophysics Data System (ADS)

Chang, Shanshan; Zhu, Zhengping; Ni, Binbin; Cao, Xing; Luo, Weihua

2016-10-01

Several extremely low-frequency (ELF)/very low-frequency (VLF) wave generation experiments have been performed successfully at High-Frequency Active Auroral Research Program (HAARP) heating facility and the artificial ELF/VLF signals can leak into the outer radiation belt and contribute to resonant interactions with energetic electrons. Based on the artificial wave properties revealed by many of in situ observations, we implement test particle simulations to evaluate the effects of energetic electron resonant scattering driven by the HAARP-induced ELF/VLF waves. The results indicate that for both single-frequency/monotonic wave and multi-frequency/broadband waves, the behavior of each electron is stochastic while the averaged diffusion effect exhibits temporal linearity in the wave-particle interaction process. The computed local diffusion coefficients show that, the local pitch-angle scattering due to HARRP-induced single-frequency ELF/VLF whistlers with an amplitude of ∼10 pT can be intense near the loss cone with a rate of ∼10-2 rad2 s-1, suggesting the feasibility of HAARP-induced ELF/VLF waves for removal of outer radiation belt energetic electrons. In contrast, the energy diffusion of energetic electrons is relatively weak, which confirms that pitch-angle scattering by artificial ELF/VLF waves can dominantly lead to the precipitation of energetic electrons. Moreover, diffusion rates of the discrete, broadband waves, with the same amplitude of each discrete frequency as the monotonic waves, can be much larger, which suggests that it is feasible to trigger a reasonable broadband wave instead of the monotonic wave to achieve better performance of controlled precipitation of energetic electrons. Moreover, our test particle scattering simulation show good agreement with the predictions of the quasi-linear theory, confirming that both methods are applied to evaluate the effects of resonant interactions between radiation belt electrons and artificially generated discrete ELF/VLF waves.

SuperDARN elevation angle calibration using HAARP-induced backscatter

NASA Astrophysics Data System (ADS)

Shepherd, S. G.; Thomas, E. G.; Palinski, T. J.; Bristow, W.

2017-12-01

SuperDARN radars rely on refraction in the ionosphere to make Doppler measurements of backscatter from ionospheric irregularities or the ground/sea, often to ranges of 4000 km or more. Elevation angle measurements of backscattered signals can be important for proper geolocation, mode identification and Doppler velocity corrections to the data. SuperDARN radars are equipped with a secondary array to make elevation angle measurements, however, calibration is often difficult. One method of calibration is presented here, whereby backscatter from HAARP-induced irregularities, at a known location, is used to independently determine the elevation angle of signals. Comparisons are made for several radars with HAARP in their field-of-view in addition to the results obtained fromray-tracing in a model ionosphere.

Numerical study of the generation and propagation of ultralow-frequency waves by artificial ionospheric F region modulation at different latitudes

NASA Astrophysics Data System (ADS)

Xu, Xiang; Zhou, Chen; Shi, Run; Ni, Binbin; Zhao, Zhengyu; Zhang, Yuannong

2016-09-01

Powerful high-frequency (HF) radio waves can be used to efficiently modify the upper-ionospheric plasmas of the F region. The pressure gradient induced by modulated electron heating at ultralow-frequency (ULF) drives a local oscillating diamagnetic ring current source perpendicular to the ambient magnetic field, which can act as an antenna radiating ULF waves. In this paper, utilizing the HF heating model and the model of ULF wave generation and propagation, we investigate the effects of both the background ionospheric profiles at different latitudes in the daytime and nighttime ionosphere and the modulation frequency on the process of the HF modulated heating and the subsequent generation and propagation of artificial ULF waves. Firstly, based on a relation among the radiation efficiency of the ring current source, the size of the spatial distribution of the modulated electron temperature and the wavelength of ULF waves, we discuss the possibility of the effects of the background ionospheric parameters and the modulation frequency. Then the numerical simulations with both models are performed to demonstrate the prediction. Six different background parameters are used in the simulation, and they are from the International Reference Ionosphere (IRI-2012) model and the neutral atmosphere model (NRLMSISE-00), including the High Frequency Active Auroral Research Program (HAARP; 62.39° N, 145.15° W), Wuhan (30.52° N, 114.32° E) and Jicamarca (11.95° S, 76.87° W) at 02:00 and 14:00 LT. A modulation frequency sweep is also used in the simulation. Finally, by analyzing the numerical results, we come to the following conclusions: in the nighttime ionosphere, the size of the spatial distribution of the modulated electron temperature and the ground magnitude of the magnetic field of ULF wave are larger, while the propagation loss due to Joule heating is smaller compared to the daytime ionosphere; the amplitude of the electron temperature oscillation decreases with latitude in the daytime ionosphere, while it increases with latitude in the nighttime ionosphere; both the electron temperature oscillation amplitude and the ground ULF wave magnitude decreases as the modulation frequency increases; when the electron temperature oscillation is fixed as input, the radiation efficiency of the ring current source is higher in the nighttime ionosphere than in the daytime ionosphere.

Contrasting O/X-mode Heater Effects on O-Mode Sounding echo and the Generation of Magnetic Pulsations

DTIC Science & Technology

2010-01-06

Micropulsation [10] The induced magnetic field variation was monitored by the fluxgate magnetometer located at Gakona, AK. The 1 sec resolution data...minutes on and 1 minute off, were explored. The experiments were monitored using the digisonde and magnetometer located at the HAARP facility. The...were explored. The experiments were monitored using the digisonde and magnetometer located at the HAARP facility. The results show that the

A Heart Failure Management Program Using Shared Medical Appointments.

PubMed

Carroll, Allison J; Howrey, Hillary L; Payvar, Susan; Deshida-Such, Kristen; Kansal, Mayank; Brar, Charanjit K

2017-04-01

Disease management programs for heart failure (HF) effectively reduce HF-related hospitalization rates and mortality. Shared medical appointments (SMAs) offer a cost-effective delivery method for HF disease management programs. However, few studies have evaluated this cost-effective delivery method of HF disease management among Veterans with acute HF. We hypothesized that Veterans who attended a multidisciplinary HF-SMA clinic promoting HF self-management, compared those who only received individual treatment through the HF specialty clinic, would have better 12-month hospitalization outcomes. We completed a retrospective review of the VA electronic health record for HF-SMA clinic appointments (1/1/2012 to 12/31/2013). The multidisciplinary HF-SMA program comprised 4 weekly sessions covering topics including HF disease, HF medications, diet adherence, physical activity, psychological well-being, and stress management. Patients who attended the HF-SMA clinic ( n =54) were compared to patients who were scheduled for an HF-SMA appointment but never attended and were followed only in the HF clinic ( n =37). Outcomes were 12-month HF-related and all-cause hospitalization rates, days in the hospital, and time to first hospitalization. Of 141 patients scheduled for an HF-SMA clinic appointment, 54 met criteria for the HF-SMA clinic group and 37 were included in the HF clinic group. The groups did not significantly differ on any sociodemographic variables. Furthermore, no significant differences were observed between the HF-SMA group and the HF clinic group on demographics or hospitalization outcomes, p >.05 for all comparisons. Our results did not support our hypothesis that offering multidisciplinary, HF-SMAs promoting HF self-management skills, above and beyond the individual disease management care provided in an HF specialty clinic, would improve hospitalization outcomes among Veterans with acute HF. Limitations of the present study and recommendations for HF self-management programs for Veterans are discussed.

Environmental Impact Statement. Volume 1. Proposed High Frequency Active Auroral Research Program

DTIC Science & Technology

1993-07-01

Proposed HAARP Facility and Potential Borrow Areas P-1 & P-2 Cultural Resources Survey Areas, 1988 - 1990 ....... 3-97 3.9-3 Potential Borrow Area A -1...Cultural Resou Survey Areas 1988 ..... 3-99 3.9-4 Potential Borrow Area A -4 Cultural Resource Survey Areas 1988 ...... 3-101 3.9-5 Potential Borrow Area A -5...1987 (5 holes) and 1988 (2 holes) (USACOE, 1987a; 1988 ), and a series of additional borings conducted in 1989 (Moolin and Associates, 1989). These

Environmental Impact Analysis Process. Final Environmental Impact Statement. Part 2. Proposed High Frequency Active Auroral Research Program.

DTIC Science & Technology

1993-07-01

there are any. The recent set of articles in gcience (1) on the effects of Electromagnetic Fields (EDF) states quite clearly and accurately that we...gone into the explanation of how the HAARP will impact the areas most closely related to the study subject, associated electromagnetic fields and...during break-up each year. page 4-90. Exposure to Humans . This first paragraph is terrible. Concerned citizens will be looking here first to learn if

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.

High fat programming of beta cell compensation, exhaustion, death and dysfunction.

PubMed

Cerf, Marlon E

2015-03-01

Programming refers to events during critical developmental windows that shape progeny health outcomes. Fetal programming refers to the effects of intrauterine (in utero) events. Lactational programming refers to the effects of events during suckling (weaning). Developmental programming refers to the effects of events during both fetal and lactational life. Postnatal programming refers to the effects of events either from birth (lactational life) to adolescence or from weaning (end of lactation) to adolescence. Islets are most plastic during the early life course; hence programming during fetal and lactational life is most potent. High fat (HF) programming is the maintenance on a HF diet (HFD) during critical developmental life stages that alters progeny metabolism and physiology. HF programming induces variable diabetogenic phenotypes dependent on the timing and duration of the dietary insult. Maternal obesity reinforces HF programming effects in progeny. HF programming, through acute hyperglycemia, initiates beta cell compensation. However, HF programming eventually leads to chronic hyperglycemia that triggers beta cell exhaustion, death and dysfunction. In HF programming, beta cell dysfunction often co-presents with insulin resistance. Balanced, healthy nutrition during developmental windows is critical for preserving beta cell structure and function. Thus early positive nutritional interventions that coincide with the development of beta cells may reduce the overwhelming burden of diabetes and metabolic disease. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impact of the implementation of telemanagement on a disease management program in an elderly heart failure cohort.

PubMed

Gambetta, Miguel; Dunn, Patrick; Nelson, Dawn; Herron, Bobbi; Arena, Ross

2007-01-01

The purpose of the present investigation is to examine the impact of a telemanagement component on an outpatient disease management program in patients with heart failure (HF). A total of 282 patients in whom HF was diagnosed and who were enrolled in an outpatient HF program were included in this analysis. One hundred fifty-eight patients additionally participated in a self-directed telemanagement component. The remaining 124 patients received care at an HF clinic but declined telemanagement. During the 7-month tracking period, 19 patients in the HF clinic plus telemanagement group and 53 patients in the HF clinic only group were hospitalized for cardiac reasons (log rank, 36.0; P<.001). The HF clinic only group had a significantly higher risk for hospitalization (hazard ratio, 4.0; 95% confidence interval, 2.4-6.7; P<.001). The results of the present study indicate that telemanagement is an important component of a disease management program in patients with HF.

Active experiments in the ionosphere and geomagnetic field variations

NASA Astrophysics Data System (ADS)

Sivokon, V. P.; Cherneva, N. V.; Khomutov, S. Y.; Serovetnikov, A. S.

2014-11-01

Variations of ionospheric-magnetospheric relation energy, as one of the possible outer climatology factors, may be traced on the basis of analysis of natural geophysical phenomena such as ionosphere artificial radio radiation and magnetic storms. Experiments on active impact on the ionosphere have been carried out for quite a long time in Russia as well. The most modern heating stand is located in Alaska; it has been used within the HAARP Program. The possibility of this stand to affect geophysical fields, in particular, the geomagnetic field is of interest.

Radio Pumping of Ionospheric Plasma with Orbital Angular Momentum

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

Leyser, T. B.; Norin, L.; McCarrick, M.

2009-02-13

Experimental results are presented of pumping ionospheric plasma with a radio wave carrying orbital angular momentum (OAM), using the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. Optical emissions from the pumped plasma turbulence exhibit the characteristic ring-shaped morphology when the pump beam carries OAM. Features of stimulated electromagnetic emissions (SEE) that are attributed to cascading Langmuir turbulence are well developed for a regular beam but are significantly weaker for a ring-shaped OAM beam in which case upper hybrid turbulence dominates the SEE.

Radio pumping of ionospheric plasma with orbital angular momentum.

PubMed

Leyser, T B; Norin, L; McCarrick, M; Pedersen, T R; Gustavsson, B

2009-02-13

Experimental results are presented of pumping ionospheric plasma with a radio wave carrying orbital angular momentum (OAM), using the High Frequency Active Auroral Research Program (HAARP) facility in Alaska. Optical emissions from the pumped plasma turbulence exhibit the characteristic ring-shaped morphology when the pump beam carries OAM. Features of stimulated electromagnetic emissions (SEE) that are attributed to cascading Langmuir turbulence are well developed for a regular beam but are significantly weaker for a ring-shaped OAM beam in which case upper hybrid turbulence dominates the SEE.

Maternal obesity and high-fat diet program offspring metabolic syndrome.

PubMed

Desai, Mina; Jellyman, Juanita K; Han, Guang; Beall, Marie; Lane, Robert H; Ross, Michael G

2014-09-01

We determined the potential programming effects of maternal obesity and high-fat (HF) diet during pregnancy and/or lactation on offspring metabolic syndrome. A rat model of maternal obesity was created using an HF diet prior to and throughout pregnancy and lactation. At birth, pups were cross-fostered, thereby generating 4 paradigms of maternal diets during pregnancy/lactation: (1) control (Con) diet during pregnancy and lactation (Con/Con), (2) HF during pregnancy and lactation (HF/HF), (3) HF during pregnancy alone (HF/Con), and (4) HF during lactation alone (Con/HF). Maternal phenotype during pregnancy and the end of lactation evidenced markedly elevated body fat and plasma corticosterone levels in HF dams. In the offspring, the maternal HF diet during pregnancy alone programmed increased offspring adiposity, although with normal body weight, whereas the maternal HF diet during lactation increased both body weight and adiposity. Metabolic disturbances, particularly that of hyperglycemia, were apparent in all groups exposed to the maternal HF diet (during pregnancy and/or lactation), although differences were apparent in the manifestation of insulin resistant vs insulin-deficient phenotypes. Elevated systolic blood pressure was manifest in all groups, implying that exposure to an obese/HF environment is disadvantageous for offspring health, regardless of pregnancy or lactation periods. Nonetheless, the underlying mechanism may differ because offspring that experienced in utero HF exposure had increased corticosterone levels. Maternal obesity/HF diet has a marked impact on offspring body composition and the risk of metabolic syndrome was dependent on the period of exposure during pregnancy and/or lactation. Copyright © 2014 Mosby, Inc. All rights reserved.

Unprecedentedly Strong and Narrow Electromagnetic Emissions Stimulated by High-Frequency Radio Waves in the Ionosphere

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

Norin, L.; Leyser, T. B.; Nordblad, E.

2009-02-13

Experimental results of secondary electromagnetic radiation, stimulated by high-frequency radio waves irradiating the ionosphere, are reported. We have observed emission peaks, shifted in frequency up to a few tens of Hertz from radio waves transmitted at several megahertz. These emission peaks are by far the strongest spectral features of secondary radiation that have been reported. The emissions are attributed to stimulated Brillouin scattering, long predicted but hitherto never unambiguously identified in high-frequency ionospheric interaction experiments. The experiments were performed at the High-Frequency Active Auroral Research Program (HAARP), Alaska, USA.

Unprecedentedly strong and narrow electromagnetic emissions stimulated by high-frequency radio waves in the ionosphere.

PubMed

Norin, L; Leyser, T B; Nordblad, E; Thidé, B; McCarrick, M

2009-02-13

Experimental results of secondary electromagnetic radiation, stimulated by high-frequency radio waves irradiating the ionosphere, are reported. We have observed emission peaks, shifted in frequency up to a few tens of Hertz from radio waves transmitted at several megahertz. These emission peaks are by far the strongest spectral features of secondary radiation that have been reported. The emissions are attributed to stimulated Brillouin scattering, long predicted but hitherto never unambiguously identified in high-frequency ionospheric interaction experiments. The experiments were performed at the High-Frequency Active Auroral Research Program (HAARP), Alaska, USA.

Developing an instrument to measure heart failure disease management program intensity and complexity.

PubMed

Riegel, Barbara; Lee, Christopher S; Sochalski, Julie

2010-05-01

Comparing disease management programs and their effects is difficult because of wide variability in program intensity and complexity. The purpose of this effort was to develop an instrument that can be used to describe the intensity and complexity of heart failure (HF) disease management programs. Specific composition criteria were taken from the American Heart Association (AHA) taxonomy of disease management and hierarchically scored to allow users to describe the intensity and complexity of the domains and subdomains of HF disease management programs. The HF Disease Management Scoring Instrument (HF-DMSI) incorporates 6 of the 8 domains from the taxonomy: recipient, intervention content, delivery personnel, method of communication, intensity/complexity, and environment. The 3 intervention content subdomains (education/counseling, medication management, and peer support) are described separately. In this first test of the HF-DMSI, overall intensity (measured as duration) and complexity were rated using an ordinal scoring system. Possible scores reflect a clinical rationale and differ by category, with zero given only if the element could potentially be missing (eg, surveillance by remote monitoring). Content validity was evident as the instrument matches the existing AHA taxonomy. After revision and refinement, 2 authors obtained an inter-rater reliability intraclass correlation coefficient score of 0.918 (confidence interval, 0.880 to 0.944, P<0.001) in their rating of 12 studies. The areas with most variability among programs were delivery personnel and method of communication. The HF-DMSI is useful for describing the intensity and complexity of HF disease management programs.

Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center.

PubMed

Riley, William T; Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A Susana; Carroll, Mark

2015-03-01

Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. "Care Beyond Walls and Wires," a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems.

What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness.

PubMed

Nelson, Geoffrey; Caplan, Rachel; MacLeod, Timothy; Macnaughton, Eric; Cherner, Rebecca; Aubry, Tim; Méthot, Christian; Latimer, Eric; Piat, Myra; Plenert, Erin; McCullough, Scott; Zell, Sarah; Patterson, Michelle; Stergiopoulos, Vicky; Goering, Paula

2017-03-01

This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five-site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self-report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross-site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4-point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieved. Factors that promoted or impeded sustainability were observed at multiple ecological levels: broad contextual (i.e., dissemination of research evidence, the policy context), community (i.e., partnerships, the presence of HF champions), organizational (i.e., leadership, ongoing training, and technical assistance), and individual (i.e., staff turnover, changes, and capacity). The findings are discussed in terms of the implementation science literature and their implications for how evidence-based programs like HF can be sustained. © Society for Community Research and Action 2017.

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

Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature

PubMed Central

Ly, Angela; Latimer, Eric

2015-01-01

Objective: Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs. Method: A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted. Results: Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre–post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF. Conclusions: While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services. PMID:26720505

ELF/VLF Perturbations Above the Haarp Transmitter Recorded by the Demeter Satellite in the Upper Ionosphere

NASA Astrophysics Data System (ADS)

Titova, E. E.; Demekhov, A. G.; Mochalov, A. A.; Gvozdevsky, B. B.; Mogilevsky, M. M.; Parrot, M.

2015-08-01

In the studies of the data received from DEMETER (orbit altitude above the Earth is about 700 km), we detected for the first time electromagnetic perturbations, which are due to the ionospheric modification by HAARP, a high-power high-frequency transmitter, simultaneously in the extremely low-frequency (ELF, below 1200 Hz) and very low-frequency (VLF, below 20 kHz) ranges. Of the thirteen analyzed flybys of the satellite above the heated area, the ELF/VLF signals were detected in three cases in the daytime (LT = 11-12 h), when the minimum distance between the geomagnetic projections of the satellite and the heated area center on the Earth's surface did not exceed 31 km. During the nighttime flybys, the ELF/VLF perturbations were not detected. The size of the perturbed region was about 100 km. The amplitude, spectrum, and polarization of the ELF perturbations were analyzed, and their comparison with the characteristics of natural ELF noise above the HAARP transmitter was performed. In particular, it was shown that in the daytime the ELF perturbation amplitude above the heated area can exceed by a factor of 3 to 8 the amplitude of natural ELF noise. The absence of the nighttime records of artificial ELF/VLF perturbations above the heated area can be due to both the lower frequency of the heating signal, at which the heating occurs in the lower ionosphere, and the higher level of natural noise. The spectrum of the VLF signals related to the HAARP transmitter operation had two peaks at frequencies of 8 to 10 kHz and 15 to 18 kHz, which are close to the first and second harmonics of the lower-hybrid resonance in the heated area. The effect of the whistler wave propagation near the lower-hybrid resonance region on the perturbation spectrum recorded in the upper ionosphere for these signals has been demonstrated. In particular, some of the spectrum features can be explained by assuming that the VLF signals propagate in quasiresonance, rather than quasilongitudinal, regime. It is noted that the profile and dynamics of the ELF perturbation frequency spectrum conform to the assumption of their connection with quasistatic small-scale electron-density inhomogeneities occurring in the heated region and having lifetimes of a few seconds or more. The possible mechanisms of the ELF/VLF perturbation formation in the ionospheric plasma above the high-latitude HAARP facility at the DEMETER flyby altitudes are discussed.

Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study

PubMed Central

Lee, Heesun; Choi, Sae Won; Yoon, Yeonyee E; Park, Hyo Eun; Lee, Sang Eun; Lee, Seung-Pyo; Kim, Hyung-Kwan; Cho, Hyun-Jai; Choi, Su-Yeon; Lee, Hae-Young; Choi, Jonghyuk; Lee, Young-Joon; Kim, Yong-Jin; Cho, Goo-Yeong; Choi, Jinwook; Sohn, Dae-Won

2017-01-01

Background Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. Objective The objective of this study was to evaluate whether a new information communication technology (ICT)–based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. Methods In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Results Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Conclusions Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program. PMID:28970189

Do heart failure disease management programs make financial sense under a bundled payment system?

PubMed

Eapen, Zubin J; Reed, Shelby D; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D

2011-05-01

Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown. Our study determined the cost-neutral point for the typical DM program and examined whether published HF DM programs can be cost saving under bundled payment programs. We used a decision analytic model using data from retrospective cohort studies, meta-analyses, 5 randomized trials evaluating DM programs, and inpatient claims for all Medicare beneficiaries discharged with an HF diagnosis from 2001 to 2004. We determined the costs of DM programs and inpatient care over 30 and 180 days. With a baseline readmission rate of 22.9%, the average cost for readmissions over 30 days was $2,272 per patient. Under base-case assumptions, a DM program that reduced readmissions by 21% would need to cost $477 per patient to be cost neutral. Among evaluated published DM programs, 2 of the 5 would increase provider costs (+$15 to $283 per patient), whereas 3 programs would be cost saving (-$241 to $347 per patient). If bundled payments were broadened to include care over 180 days, then program saving estimates would increase, ranging from $419 to $1,706 per patient. Proposed bundled payments for HF admissions provide hospitals with a potential financial incentive to implement DM programs that efficiently reduce readmissions. Copyright © 2011 Mosby, Inc. All rights reserved.

A randomized trial of heart failure disease management in skilled nursing facilities: design and rationale.

PubMed

Boxer, Rebecca S; Dolansky, Mary A; Bodnar, Christine A; Singer, Mendel E; Albert, Jeffery M; Gravenstein, Stefan

2013-09-01

Heart failure (HF) disease management can improve health outcomes for older community dwelling patients with heart failure. HF disease management has not been studied in skilled nursing facilities, a major site of transitional care for older adults. The objective of this trial is to investigate if a HF- disease management program (HF-DMP) in skilled nursing facilities (SNF)s will decrease all-cause rehospitalizations for the first 60 days post-SNF admission. The trial is a randomized cluster trial to be conducted in 12 for-profit SNF in the greater Cleveland area. The study population is inclusive of patients with HF regardless of ejection fraction but excludes those patients on dialysis and with a life expectancy of 6 months or less. The HF-DMP includes 7 elements considered standard of care for patients with HF documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7-day follow-up appointment post-SNF discharge, and patient education. The HF-DMP is conducted by a research nurse tasked with adhering to each element of the program and regularly audited to maintain fidelity of the program. Additional outcomes include health status, self-care management, and discharge destination. The SNF-Connect Trial is the first trial of its kind to assess if a HF-DMP will improve outcomes for patients in SNFs. This trial will provide evidence on the effectiveness of HF-DMP to improve outcomes for older frail HF patients undergoing postacute rehabilitation. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups.

PubMed

Stergiopoulos, Vicky; O'Campo, Patricia; Gozdzik, Agnes; Jeyaratnam, Jeyagobi; Corneau, Simon; Sarang, Aseefa; Hwang, Stephen W

2012-10-02

The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory. Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology. The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components. Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services.

Resveratrol Prevents the Development of Hypertension Programmed by Maternal Plus Post-Weaning High-Fructose Consumption Through Modulation of Oxidative Stress, Nutrient-Sensing Signals, and Gut Microbiota.

PubMed

Tain, You-Lin; Lee, Wei-Chia; Wu, Kay L H; Leu, Steve; Chan, Julie Y H

2018-04-30

High-fructose (HF) intake, oxidative stress, nutrient-sensing signals, and gut microbiota dysbiosis are closely related to the development of hypertension. We investigated whether resveratrol can prevent hypertension induced by maternal plus post-weaning HF diets in adult offspring via the above-mentioned mechanisms. Female Sprague-Dawley rats received either a normal (ND) or 60% high-fructose (HF) diet during gestation and lactation. Male offspring were assigned to five groups (maternal diet/post-weaning diet; n = 8/group): ND/ND, ND/HF, HF/ND, HF/HF, and HF/HF+ Resveratrol. Resveratrol (50 mg/L) was administered in drinking water from weaning to three months of age. We found that HF/HF induced hypertension in adult offspring. Maternal HF diet altered gut microbiota composition in adult offspring, including decreasing the abundance of genera Bacteroides, Dysgonomonas, and Turicibacter, while increasing phylum Verrucomicrobia and Akkermansia muciniphila. Additionally, HF/HF diets increased oxidative stress and decreased renal mRNA expression of Prkaa2, Prkag2, Ppara, Pparb, Ppargc1a, and Sirt4. Resveratrol reduced renal oxidative stress, activated nutrient-sensing signals, modulated gut microbiota, and prevented associated HF/HF-induced programmed hypertension. Targeting oxidative stress, nutrient-sensing signals, and gut microbiota by resveratrol might be a useful therapeutic strategy for treatment of hypertension induced by excessive consumption of fructose in the adult rat offspring. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Heart failure patient adherence: epidemiology, cause, and treatment.

PubMed

Corotto, Paul S; McCarey, Melissa M; Adams, Suzanne; Khazanie, Prateeti; Whellan, David J

2013-01-01

Poor adherence to therapeutic regimens is a significant impediment to improving clinical outcomes in the HF population. Typical rates of adherence to prescribed medications, low-sodium diets, and aerobic exercise programs remain lower than that needed to decrease morbidity and mortality associated with HF. Factors contributing to poor adherence include multiple comorbidities, clinical depression, and decreased cognitive functioning. HF education and programs to enhance self-management skills have improved patient quality of life but have yet to decrease mortality or rehospitalization rates significantly. Telemonitoring to improve adherence behaviors and self-management interventions within broader HF management programs have demonstrated significant clinical improvements in this population. Copyright © 2013 Elsevier Inc. All rights reserved.

The feasibility of a telephone coaching program on heart failure home management for family caregivers

PubMed Central

Piamjariyakul, Ubolrat; Smith, Carol E.; Russell, Christy; Werkowitch, Marilyn; Elyachar, Andrea

2012-01-01

Objectives To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers. Background The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation. Method This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness. Results Caregiver (n=10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program. Conclusion The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy. PMID:23116654

Effectiveness of a multidimensional home nurse led heart failure disease management program--a French nationwide time-series comparison.

PubMed

Agrinier, Nelly; Altieri, Christelle; Alla, François; Jay, Nicolas; Dobre, Daniela; Thilly, Nathalie; Zannad, Faiez

2013-10-09

The purpose of this study was to assess the effectiveness of a disease management program (DMP) in heart failure (HF) on the incidence of HF hospitalizations and related costs in a real-world population-based setting. Insuffisance CArdiaque en LORraine (ICALOR), a DMP for HF was established in 2006 in the French region of Lorraine. Patients were enrolled after an index HF hospitalization. They received educational and home-visit monitoring programs by HF-trained nurses. General physicians received automatic alerts about patients' significant clinical or biological changes. We used the ICALOR and the national diagnostic related group databases to conduct a comparison of time-series trends in HF hospitalizations in France. The economic impact was obtained using the national scale of costs in France. The median age of the 1222 patients recruited before 2010 was 76 years, and 65% were male. Upon enrollment, patients essentially presented with NYHA class II (n=537, 48%) or class III (n=359, 32%) symptoms. One-year mortality rate was 20.3%. The implementation of the ICALOR program was associated with a reduction in HF hospitalizations in Lorraine estimated by an absolute difference between the number of hospitalizations observed in the Lorraine region and that expected had it been similar to that observed in the whole country of -7.19% in 2010. The estimated annual hospital cost saved by ICALOR was €1,927,648 in 2010. Coordinated DMP of HF might improve outcome cost-effectively when implemented in a real-world population setting, and was associated in Lorraine with a substantial modification of the trend of HF hospitalizations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Stimulated Brillouin scatter in a magnetized ionospheric plasma.

PubMed

Bernhardt, P A; Selcher, C A; Lehmberg, R H; Rodriguez, S P; Thomason, J F; Groves, K M; McCarrick, M J; Frazer, G J

2010-04-23

High power electromagnetic waves transmitted from the HAARP facility in Alaska can excite low-frequency electrostatic waves by magnetized stimulated Brillouin scatter. Either an ion-acoustic wave with a frequency less than the ion cyclotron frequency (f(CI)) or an electrostatic ion cyclotron (EIC) wave just above f(CI) can be produced. The coupled equations describing the magnetized stimulated Brillouin scatter instability show that the production of both ion-acoustic and EIC waves is strongly influenced by the wave propagation relative to the background magnetic field. Experimental observations of stimulated electromagnetic emissions using the HAARP transmitter have confirmed that only ion-acoustic waves are excited for propagation along the magnetic zenith and that EIC waves can only be detected with oblique propagation angles. The ion composition can be obtained from the measured EIC frequency.

Social Relationships of Dually Diagnosed Homeless Adults Following Enrollment in Housing First or Traditional Treatment Services

PubMed Central

Henwood, Benjamin F.; Stefancic, Ana; Petering, Robin; Schreiber, Sarah; Abrams, Courtney; Padgett, Deborah K.

2015-01-01

Objective Strong and effective social support is a critical element of mental health recovery, yet social support is often lacking for adults experiencing homelessness. This study examines differences in the social networks of participants newly enrolled in programs that use either a Housing First (HF) approach (i.e., provides immediate access to permanent housing with ongoing consumer-driven support services) or a treatment first (TF) approach (i.e., traditional clinician-driven staircse model that requires temporary or transitional housing and treatment placements before accessing permanent housing). Method We use a mixed-methods social network analysis approach to assess group differences of 75 individuals based on program type (HF or TF) and program retention. Results Quantitative results show that compared with TF, HF participants have a greater proportion of staff members in their network. TF participants are more likely than HF participants to maintain mixed-quality relationships (i.e., relationships with elements of support and conflict). As compared with participants who remain in a program, those who disengage from programs have a greater proportion of mixed relationships and relationships that grow distant. Qualitative analyses suggest that HF participants regard housing as providing a stable foundation from which to reconnect or restore broken relationships. However, HF participants are guarded about close relationships for fear of being exploited due to their newly acquired apartments. TF participants report that they are less inclined to develop new relationships with peers or staff members due to the time-limited nature of the TF programs. Conclusions These findings suggest that HF participants are not more socially isolated than those in traditional care. Implications for practice, policy and future research are discussed. PMID:26635919

Postnatal dietary omega-3 fatty acid supplementation rescues glucocorticoid-programmed adiposity, hypertension, and hyperlipidemia in male rat offspring raised on a high-fat diet.

PubMed

Zulkafli, Intan S; Waddell, Brendan J; Mark, Peter J

2013-09-01

Fetal glucocorticoid excess programs several adverse outcomes in adult offspring, many of which can be prevented by postnatal, dietary omega-3 (n-3) fatty acids. Here we tested 2 separate hypotheses: 1) a postnatal high-fat diet exacerbates the glucocorticoid-programmed phenotype; and 2) postnatal, dietary n-3 fatty acids rescue programmed outcomes, even in the presence of a high-fat diet challenge. Pregnant Wistar rat dams were either untreated or administered dexamethasone acetate (Dex; 0.5 μg/mL drinking water) from day 13 of pregnancy. Offspring were cross-fostered to untreated mothers and males were weaned onto a standard (Std), high-fat, low n-3 (HF), or high-fat, high n-3 (HFHn-3) diet. Prenatal Dex reduced birth weight (26%) and delayed puberty onset by 1.2 days, irrespective of postnatal diet. Prenatal Dex programmed increased blood pressure in adult offspring, an effect worsened by the postnatal HF diet. Supplementation with high n-3 fatty acids, however, prevented both the Dex and HF-induced increases in blood pressure. Prenatal Dex also programmed increased adiposity, plasma cholesterol, and plasma triglyceride levels at 6 months of age, particularly in those offspring raised on the HF diet. But again, each of these adverse outcomes was rescued by supplementation of the HF diet with n-3 fatty acids. In conclusion, the capacity of n-3 fatty acids to overcome adverse programming outcomes remains evident, even in the presence of a HF diet challenge.

Real-time Specification and Forecasting for HF Links During Disturbed Conditions

NASA Astrophysics Data System (ADS)

Rice, D.; Hunsuker, R. D.; Eccles, J.; Sojka, J. J.

2004-05-01

The HF communications community has long been dependent on climatological ionosphere descriptions to support HF propagation programs. Additionally, these programs include solar zenith angle and frequency-squared variation of HF absorption but do not include space weather effects due to solar x-ray events and sporadic E layers. The usefulness of real-time specification and forecasting of HF links is desired in programs such as Operational Space Environment Network Display (OpSend). The creation of HF illumination maps requires proper specifications of D, E and F regions of the ionosphere. We present results and validation efforts of the Data-Driven D region (DDDR) model of HF absorption for mid-latitude HF paths. The DDDR programs assimilate real-time data such as the NOAA/GOES 12 x-ray measurements to produce space weather related absorption predictions. The data-driven model is being validated with observations from the HF Investigation of D-Region Ionospheric Variation Experiment (HIDIVE). Monitoring of standard time-frequency HF stations has been employed for the past three decades. The passive monitoring technique used in HIDIVE was mainly applied for studies of the high-latitude and equatorial ionosphere, thus long-term, quantitative data on the mid-latitude ionosphere are difficult to find in archival literature. HIDIVE is a careful examination of long-term observations HF absorption to study seasonal variation and space weather events. Simultaneous continuous measurements of NOAA/GOES 12 solar x-ray flux and calibrated HF signal strength were initiated in December 2002 to provide validation data for the DDDR model. Continuous recording of transmissions of standard time-frequency stations (WWV and WWVH) over the range of 2.5 to 20.0 MHz and 5-minute averages of 1.0 to 8.0 nm solar x-ray flux have been studied for 35 solar flares ranging from Class C to Class X from March through August 2003 during the descending phase of solar cycle 23. The monitoring stations are located at Providence, Utah and at Klamath Falls, Oregon and continuous recordings are planned through August 2005. In particular, we will examine the extreme solar events of October-November 2003 as an example of the Societal Impact of Space Weather. This is timely because of renewed interest in the use of HF circuits by the Military and by commercial airlines.

Remote sensing of mesospheric dust layers using active modulation of PMWE by high-power radio-waves

NASA Astrophysics Data System (ADS)

Cohen, M.; Zhang, X.; Cohen, M.; Mahmoudian, A.; Scales, W.; Kosch, M. J.; M Farahani, M.; Mohebalhojeh, A.

2016-12-01

So-called polar mesospheric winter echoes (PMWE) are radar echoes observed during winter at altitudes around 50-80 km and are much weaker than their PMSE (Polar Mesospheric Summer Echoes) counterpart. Unlike PMSE, PMWE are less studied and understood. Breaking of gravity waves and the associated turbulence are proposed as the major source for PMWE echoes. The action of neutral turbulence alone does not appear to give a good explanation for PMWE. PMWE is also attributed to Bragg scatter from electron irregularities which result from charging of free electrons onto sub-visible particles. The temporal behavior of PMWE response to HF pump heating can be employed to diagnose the charged dust layer. Specifically, the rise and fall time of radar echo strength as well as relaxation and recovery time after heater turn-on and off are distinct parameters that are a function of radar frequency. This work presents the first study of the modulation of PMWE by artificial radiowave heating using computational modeling and experimental observation in different radar frequency bands. Variation of dust plasma parameters associated with PMWE such as dust radius, dust density, recombination rate, electron- and dust-neutral collision frequencies, photo-detachment current and electron temperature enhancement ratio are included. Computational results derived from different sets of parameters are considered and compared with recent observations at EISCAT using 224 MHz and 56 MHz radars. The agreement between the model results and the observations show the high potential of remote sensing of dust and plasma parameters associated with PMWE. Measurement of Te/Ti using ISR and simultaneous observations in two frequency bands may lead to a more accurate estimation of dust density and radius. The enhancement of backscattered signal in the HF band during PMWE heating is predicted for the first time. The required background dust-plasma parameters as well as heater power (Te/Ti) for the observation of turn-on overshoot are investigated. It has been shown that the similarity of the temporal evolution of radar echoes in HF band and average charge on the dust particles can be used to study the fundamental physics associated with the dust charging in the PMWE source region. The possibilities of perusing PMWE heating experiments at HAARP will be discussed.

Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study.

PubMed

Lee, Heesun; Park, Jun-Bean; Choi, Sae Won; Yoon, Yeonyee E; Park, Hyo Eun; Lee, Sang Eun; Lee, Seung-Pyo; Kim, Hyung-Kwan; Cho, Hyun-Jai; Choi, Su-Yeon; Lee, Hae-Young; Choi, Jonghyuk; Lee, Young-Joon; Kim, Yong-Jin; Cho, Goo-Yeong; Choi, Jinwook; Sohn, Dae-Won

2017-10-02

Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. The objective of this study was to evaluate whether a new information communication technology (ICT)-based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program. ©Heesun Lee, Jun-Bean Park, Sae Won Choi, Yeonyee E Yoon, Hyo Eun Park, Sang Eun Lee, Seung-Pyo Lee, Hyung-Kwan Kim, Hyun-Jai Cho, Su-Yeon Choi, Hae-Young Lee, Jonghyuk Choi, Young-Joon Lee, Yong-Jin Kim, Goo-Yeong Cho, Jinwook Choi, Dae-Won Sohn. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 02.10.2017.

The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.

PubMed

Chung, Eugene S; Bartone, Cheryl; Daly, Kathleen; Menon, Santosh; McDonald, Mark

2015-01-01

Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually. HF hospitalizations have been incorporated into a national measure of hospital and provider quality, with associated financial penalties based on the 30-day readmission rate after an index hospitalization for HF. However, it is not clear whether the number of HF-related hospitalizations or 30-day readmissions is consistently related to quality of care. The relationships between various measures of HF care quality and hospitalization rates were evaluated by performing a cohort study of an HF disease management program in a clinical practice setting. Following the statistical analyses assessing outcomes and survival, the conclusion was that an HF disease management program in clinical practice associated with improved utilization of evidence-based medical and device therapies tends to improve ejection fraction and survival, and reduce sex and race disparities, but not with an associated reduction in hospitalizations or total hospital days.

Maternal perinatal diet induces developmental programming of bone architecture.

PubMed

Devlin, M J; Grasemann, C; Cloutier, A M; Louis, L; Alm, C; Palmert, M R; Bouxsein, M L

2013-04-01

Maternal high-fat (HF) diet can alter offspring metabolism via perinatal developmental programming. This study tests the hypothesis that maternal HF diet also induces perinatal programming of offspring bone mass and strength. We compared skeletal acquisition in pups from C57Bl/6J mice fed HF or normal diet from preconception through lactation. Three-week-old male and female pups from HF (HF-N) and normal mothers (N-N) were weaned onto normal diet. Outcomes at 14 and 26 weeks of age included body mass, body composition, whole-body bone mineral content (WBBMC) via peripheral dual-energy X-ray absorptiometry, femoral cortical and trabecular architecture via microcomputed tomography, and glucose tolerance. Female HF-N had normal body mass and glucose tolerance, with lower body fat (%) but higher serum leptin at 14 weeks vs. N-N (P<0.05 for both). WBBMC was 12% lower at 14 weeks and 5% lower at 26 weeks, but trabecular bone volume fraction was 20% higher at 14 weeks in female HF-N vs. N-N (P<0.05 for all). Male HF-N had normal body mass and mildly impaired glucose tolerance, with lower body fat (%) at 14 weeks and lower serum leptin at 26 weeks vs. N-N (P<0.05 for both). Serum insulin was higher at 14 weeks and lower at 26 weeks in HF-N vs. N-N (P<0.05). Trabecular BV/TV was 34% higher and cortical bone area was 6% higher at 14 weeks vs. N-N (P<0.05 for both). These data suggest that maternal HF diet has complex effects on offspring bone, supporting the hypothesis that maternal diet alters postnatal skeletal homeostasis.

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups

PubMed Central

2012-01-01

Background The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory. Methods Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology. Results The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components. Conclusions Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services. Trial registration Current Controlled Trials ISRCTN42520374 PMID:23031406

"We are all there for the same purpose": Support for an integrated community exercise program for older adults with HF and COPD.

PubMed

Desveaux, Laura; Harrison, Samantha; Lee, Annemarie; Mathur, Sunita; Goldstein, Roger; Brooks, Dina

Despite well-established improvements following rehabilitation, functional gains often diminish following discharge. To explore the attitudes of older adults with HF and COPD, who have completed rehabilitation, toward community-based exercise maintenance. Semi-structured interviews were conducted with 11 individuals with HF or COPD. Deductive thematic analysis uncovered three themes: 1) transitioning to community exercise is challenging, highlighting participants' struggle with unstructured maintenance and a lack of appropriate programs; 2) a structured, group-based program tailored to functional ability facilitates adherence, describing participants views on the importance of routine, and accountability; and 3) "We are all there for the same purpose" - participant support for integrated exercise, including the benefit of multiple perspectives and sustainability. A motivating program leader and access to appropriate facilities are key features to support adherence to prescribed activity. Tailored programs can be delivered consecutively to older adults with HF and COPD. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Stimulated Brillouin Scatter in a Magnetized Ionospheric Plasma

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

Bernhardt, P. A.; Selcher, C. A.; Lehmberg, R. H.

2010-04-23

High power electromagnetic waves transmitted from the HAARP facility in Alaska can excite low-frequency electrostatic waves by magnetized stimulated Brillouin scatter. Either an ion-acoustic wave with a frequency less than the ion cyclotron frequency (f{sub CI}) or an electrostatic ion cyclotron (EIC) wave just above f{sub CI} can be produced. The coupled equations describing the magnetized stimulated Brillouin scatter instability show that the production of both ion-acoustic and EIC waves is strongly influenced by the wave propagation relative to the background magnetic field. Experimental observations of stimulated electromagnetic emissions using the HAARP transmitter have confirmed that only ion-acoustic waves aremore » excited for propagation along the magnetic zenith and that EIC waves can only be detected with oblique propagation angles. The ion composition can be obtained from the measured EIC frequency.« less

Maternal fructose-intake-induced renal programming in adult male offspring.

PubMed

Tain, You-Lin; Wu, Kay L H; Lee, Wei-Chia; Leu, Steve; Chan, Julie Y H

2015-06-01

Nutrition in pregnancy can elicit long-term effects on the health of offspring. Although fructose consumption has increased globally and is linked to metabolic syndrome, little is known about the long-term effects of maternal high-fructose (HF) exposure during gestation and lactation, especially on renal programming. We examined potential key genes and pathways that are associated with HF-induced renal programming using whole-genome RNA next-generation sequencing (NGS) to quantify the abundance of RNA transcripts in kidneys from 1-day-, 3-week-, and 3-month-old male offspring. Pregnant Sprague-Dawley rats received regular chow or chow supplemented with HF (60% diet by weight) during the entire period of pregnancy and lactation. Male offspring exhibited programmed hypertension at 3 months of age. Maternal HF intake modified over 200 renal transcripts from nephrogenesis stage to adulthood. We observed that 20 differentially expressed genes identified in 1-day-old kidney are related to regulation of blood pressure. Among them, Hmox1, Bdkrb2, Adra2b, Ptgs2, Col1a2 and Tbxa2r are associated with endothelium-derived hyperpolarizing factor (EDHF). NGS also identified genes in arachidonic acid metabolism (Cyp2c23, Hpgds, Ptgds and Ptges) that may be potential key genes/pathways contributing to renal programming and hypertension. Collectively, our NGS data suggest that maternal HF intake elicits a defective adaptation of interrelated EDHFs during nephrogenesis which may lead to renal programming and hypertension in later life. Moreover, our results highlight genes and pathways involved in renal programming as potential targets for therapeutic approaches to prevent metabolic-syndrome-related comorbidities in children with HF exposure in early life. Copyright © 2015 Elsevier Inc. All rights reserved.

The role and meaning of interim housing in housing first programs for people experiencing homelessness and mental illness.

PubMed

Zerger, Suzanne; Francombe Pridham, Katherine; Jeyaratnam, Jeyagobi; Connelly, Jolynn; Hwang, Stephen; O'Campo, Patricia; Stergiopoulos, Vicky

2014-07-01

The housing first (HF) model for individuals experiencing homelessness and mental illness differs by design from traditional models that require consumers to achieve "housing readiness" by meeting program or treatment prerequisites in transitional housing settings prior to permanent housing placement. Given a growing body of evidence for its favorable outcomes and cost effectiveness, HF is increasingly seen as an alternative to and argument against these traditional programs. As such, it is important that the elements and implementation challenges of the HF model be clearly understood and articulated. This qualitative study explored a largely unexamined aspect of the HF model-the need for and meaning of temporary residential settings (interim housing), a place to stay while waiting to secure permanent housing-using interviews and focus groups with service providers and consumers who experienced interim housing during implementation of HF in a large urban center. Although interim housing may not be necessary for all programs implementing the model, our study revealed numerous reasons and demands for safe, flexible interim housing options, and illustrated how they influence the effectiveness of consumer recovery, continuous service engagement, and housing stability.

Housing first on a large scale: Fidelity strengths and challenges in the VA's HUD-VASH program.

PubMed

Kertesz, Stefan G; Austin, Erika L; Holmes, Sally K; DeRussy, Aerin J; Van Deusen Lukas, Carol; Pollio, David E

2017-05-01

Housing First (HF) combines permanent supportive housing and supportive services for homeless individuals and removes traditional treatment-related preconditions for housing entry. There has been little research describing strengths and shortfalls of HF implementation outside of research demonstration projects. The U.S. Department of Veterans Affairs (VA) has transitioned to an HF approach in a supportive housing program serving over 85,000 persons. This offers a naturalistic window to study fidelity when HF is adopted on a large scale. We operationalized HF into 20 criteria grouped into 5 domains. We assessed 8 VA medical centers twice (1 year apart), scoring each criterion using a scale ranging from 1 ( low fidelity ) to 4 ( high fidelity ). There were 2 HF domains (no preconditions and rapidly offering permanent housing) for which high fidelity was readily attained. There was uneven progress in prioritizing the most vulnerable clients for housing support. Two HF domains (sufficient supportive services and a modern recovery philosophy) had considerably lower fidelity. Interviews suggested that operational issues such as shortfalls in staffing and training likely hindered performance in these 2 domains. In this ambitious national HF program, the largest to date, we found substantial fidelity in focusing on permanent housing and removal of preconditions to housing entry. Areas of concern included the adequacy of supportive services and adequacy in deployment of a modern recovery philosophy. Under real-world conditions, large-scale implementation of HF is likely to require significant additional investment in client service supports to assure that results are concordant with those found in research studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The programming effects of nutrition-induced catch-up growth on gut microbiota and metabolic diseases in adult mice.

PubMed

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

2016-04-01

Substantial evidence indicated that catch-up growth could increase the susceptibility to obesity, insulin resistance, and type 2 diabetes mellitus in adulthood. However, investigations into the "programming" effects of catch-up growth on gut microbiota in the offspring are limited. C57/BL6 mice were fed on either low protein (LP) or normal chow (NC) diet throughout gestation and lactation. Then, the offspring were randomly weaned to either NC or high fat (HF) diet until 32 weeks of age, generating four experimental groups: NC-NC, NC-HF, LP-NC, and LP-HF. Metabolic parameters and gut microbiota were examined in the offspring. It showed that the NC-HF and LP-HF offspring displayed higher body weight (P < 0.05), impaired glucose tolerance (P < 0.001), and elevated serum lipids (P < 0.05) at 32 weeks of age. Both the operational taxonomic units (OTUs) and the Shannon indexes (P < 0.05) showed significantly lower microbial diversity in NC-HF and LP-HF offspring. There were significant variations in the compositions of gut microbiota in the NC-HF and LP-HF offspring, compared with NC-NC offspring (P < 0.05). Furthermore, it indicated Lactobacillus percentage was negatively associated with blood glucose concentrations of intraperitoneal glucose tolerance test (r = -0.886, P = 0.019). In conclusion, catch-up growth predisposes the offspring to gut microbiota perturbation, obesity, impaired glucose tolerance, insulin resistance, and dyslipidemia. Our study is novel in showing the "programming" effects of nutrition-induced catch-up growth on gut microbiota and metabolic diseases in later life. © 2016 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.

Heart failure and diabetes: collateral benefit of chronic disease management.

PubMed

Ware, Molly G; Flavell, Carol M; Lewis, Eldrin F; Nohria, Anju; Warner-Stevenson, Lynne; Givertz, Michael M

2006-01-01

To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64+/-11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8+/-1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF.

ULF Generation by Modulated Ionospheric Heating

NASA Astrophysics Data System (ADS)

Chang, C.; Labenski, J.; Wallace, T.; Papadopoulos, K.

2013-12-01

Modulated ionospheric heating experiments designed to generate ULF waves using the HAARP heater have been conducted since 2007. Artificial ULF waves in the Pc1 frequency range were observed from space and by ground induction magnetometers located in the vicinity of the heater as well as at long distances. Two distinct generation mechanisms of artificial ULF waves were identified. The first was electroject modulation under geomagnetically disturbed conditions. The second was pressure modulation in the E and F regions of the ionosphere under quiet conditions. Ground detections of ULF waves near the heater included both Shear Alfven waves and Magnetosonic waves generated by electrojet and/or pressure modulations. Distant ULF detections involved Magnetosonic wave propagation in the Alfvenic duct with pressure modulation as the most likely source. Summary of our observations and theoretical interpretations will be presented at the meeting. We would like to acknowledge the support provided by the staff at the HAARP facility during our ULF experiments.

PROspective MEmory Training to improve HEart failUre Self-care (PROMETHEUS): study protocol for a randomised controlled trial.

PubMed

Cameron, Jan; Rendell, Peter G; Ski, Chantal F; Kure, Christina E; McLennan, Skye N; Rose, Nathan S; Prior, David L; Thompson, David R

2015-04-29

Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients' health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients' engagement in HF self-care and health outcomes, carer strain and quality of life. The proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients' baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients' HF symptoms, and ratings of the patients' level of engagement in HF self-care behaviours. If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs. Australian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False .

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

PubMed Central

Howlett, Jonathan G; McKelvie, Robert S; Costigan, Jeannine; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Kouz, Simon; Leblanc, Kori; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; O’Meara, Eileen; Rajda, Miroslav; Siu, Samuel; Stolee, Paul; Swiggum, Elizabeth; Zeiroth, Shelley

2010-01-01

Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world – HF in ethnic minorities – and in an uncommon but important setting – the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics – disease management programs in HF and quality assurance – have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada. PMID:20386768

ACCF/AHA/HFSA 2011 survey results: current staffing profile of heart failure programs, including programs that perform heart transplant and mechanical circulatory support device implantation.

PubMed

Jessup, Mariell; Albert, Nancy M; Lanfear, David E; Lindenfeld, JoAnn; Massie, Barry M; Walsh, Mary Norine; Zucker, Mark J

2011-05-01

There have been no published recommendations about staffing needs for a heart failure (HF) clinic or an office setting focused on heart transplant. The goal of this survey was to understand the current staffing environment of HF, transplant, and mechanical circulatory support device (MCSD) programs in the United States and abroad. This report identifies current staffing patterns but does not endorse a particular staffing model. An online survey, jointly sponsored by the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and the Heart Failure Society of America (HFSA), was sent to the members of all 3 organizations who had identified themselves as interested in HF, heart transplant, or both, between March 12, 2009, and May 12, 2009. The overall response rate to the 1,823 e-mail surveys was 23%. There were 257 unique practices in the United States (81% of total sites) and 58 international sites (19%); approximately 30% of centers were in a cardiovascular group practice and 30% in a medical school hospital setting. The large majority of practices delivered HF care in both an inpatient and outpatient environment, and slightly more centers were implanting MCSDs (47%) than performing cardiac transplantation (39%). Most practices (43%) were small, with <4 staff members, or small- to medium-sized (34%), with 4 to 10 staff members, with only 23% being medium (11-20 staff) or large programs (>20 staff). On average, a U.S. HF practice cared for 1,641 outpatients annually. An average HF program with transplant performed 10 transplants. Although larger programs were able to perform more transplants and see more outpatient HF visits, their clinician staffing volume tended to double for approximately every 500 to 700 additional HF visits annually. The average staffing utilization was 2.65 physician full-time equivalents (FTEs), 2.21 nonphysician practitioner (nurse practitioner or physician assistant) FTEs, and 2.61 nurse coordinator FTEs annually. The HF patient population is growing in number in the United States and internationally, and the clinicians who provide the highly skilled and time-consuming care to this population are under intense scrutiny as a result of focused quality improvement initiatives and reduced financial resources. Staffing guidelines should be developed to ensure that an adequate number of qualified professionals are hired for a given practice volume. These survey results are an initial step in developing such standards. Copyright © 2011. Published by Elsevier Inc.

Exploration of patients' readiness for an eHealth management program for chronic heart failure: a preliminary study.

PubMed

Nahm, Eun-Shim; Blum, Kay; Scharf, Barbara; Friedmann, Erika; Thomas, Sue; Jones, Deborah; Gottlieb, Stephen S

2008-01-01

Heart failure (HF) is a major public health problem in the United States. Approximately 5 million Americans are living with HF, and each year, 550,000 more are newly diagnosed. With recent, rapidly advancing technologies, many studies have examined the effects of technology-based HF management programs. Most of these studies focused on telemonitoring devices, lacking an aspect to motivate individuals to manage their own illnesses. This exploratory study was conducted to (1) examine the readiness of patients with HF in using an eHealth program that includes both telemonitoring and motivational components (ie, Web learning modules, eCommunication) and (2) assess the specific needs of patients with HF that can be addressed by a future eHealth program. This was a single group descriptive study using a convenience sample. A total of 44 patients with HF (mean age, 72.8 years; range, 55-85 years) were recruited from the pool of enrollees of the Medicare Coordinated Care Demonstration project for HF management that used only a telemonitoring component. Although only 10 participants were users, among 34 nonusers, 17 reported availability of Web access, and 15 reported that they would use the Internet if access and training were available. Overall, confidence for using telemonitoring devices and Web-based health modules was high, with means of 27 (range, 3-30) and 7.6 (range, 1-10), respectively. Confidence for learning health information using Web modules, however, was lower with a mean of 41.5 (range, 8-80). The 2 most highly rated health information needs were research findings (n = 41, 93.2%) and medication (n = 39, 88.6%). Most participants would like to have e-mail communication with healthcare providers. The findings showed the participants' high readiness to use the proposed eHealth program if access and training were provided. This study used a small convenience sample. Further studies are needed with larger, diverse samples.

Neuromuscular electrical stimulation and inspiratory muscle training as potential adjunctive rehabilitation options for patients with heart failure.

PubMed

Arena, Ross; Pinkstaff, Sherry; Wheeler, Emma; Peberdy, Mary Ann; Guazzi, Marco; Myers, Jonathan

2010-01-01

Aerobic and resistance exercise training programs produce an abundance of physiologic and clinical benefits in patients with heart failure (HF). Improved maximal aerobic capacity, submaximal aerobic endurance, muscle force production, perceived quality of life, and skeletal muscle characteristics are among the more established outcomes resulting from these rehabilitation techniques. Moreover, both aerobic and resistance exercise training appear to portend a low risk to patients with HF when appropriate exercise prescription methods are followed. While the aforementioned training techniques will undoubtedly continue to be at the center of a well-formulated rehabilitation program, other adjunctive interventions, which are presently underutilized in clinical practice, may prove beneficial in patients with HF. Specifically, both neuromuscular electrical stimulation (NMES) and inspiratory muscle training (IMT) appear to significantly improve several physiologic, exercise, symptomatologic, and quality-of-life parameters. NMES targets skeletal muscle abnormalities, whereas IMT primarily targets the weakened respiratory musculature, both often encountered in patients with HF. A PubMed search using relevant key words identified 19 original investigations examining the impact of NMES (13 studies) and IMT (6 studies) training programs in patients with HF. The resultant review (1) provides a summary of the original research outcomes of both NMES and IMT in patients with HF; (2) addresses current research gaps, providing a direction for future investigations; and (3) provides clinical scenarios where NMES and IMT may prove to be beneficial during the rehabilitation of patients with HF.

High Frequency Active Auroral Research Program (HAARP) Imager

DTIC Science & Technology

1993-09-30

T-3 HCTL!; *WR-EN HCTL@ F- 3 HC7L! ; * HACK H(TL-@ F-4 HCTL!; ]NIiT-HOST 00 HB! F8 HCrL!; DSP-RESET INIT-HOST HCTL@ DUP F-6 HCTh! T-6 HCTU! DSP-IRQB...CONSTANTPS2 PI_HI P2-11 OR 3_-1O OR TG..LO OR CONSTANT PS3 P1I.,O P2_.i OR P3..LO OR TG_.LO OR CONSTANT PS4 PlLO P21-1I OR P3_H1 OR TGIIl OR CONSTANTPS5 P1_LO...CONSTANT PSTATEI PS2 SER-IDLE OR CONSTANT PSTATE2 PS3 SERIDLE OR CONSTANT PSTATE3 PS4 SERIDLE OR CONSTANT PSTATE4 PS5 SERIDLE OR CONSTANT PSTATES PS6

High Frequency Active Auroral Research Program (HAARP) imager. Final report, 29 August 1991-29 August 1993

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

Lance, C.; Eather, R.

1993-09-30

A low-light-level monochromatic imaging system was designed and fabricated which was optimized to detect and record optical emissions associated with high-power rf heating of the ionosphere. The instrument is capable of detecting very low intensities, of the order of 1 Rayleigh, from typical ionospheric atomic and molecular emissions. This is achieved through co-adding of ON images during heater pulses and subtraction of OFF (background) images between pulses. Images can be displayed and analyzed in real time and stored in optical disc for later analysis. Full image processing software is provided which was customized for this application and uses menu ormore » mouse user interaction.« less

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

Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

PubMed

Qian, Feng; Fonarow, Gregg C; Krim, Selim R; Vivo, Rey P; Cox, Margueritte; Hannan, Edward L; Shaw, Benjamin A; Hernandez, Adrian F; Eapen, Zubin J; Yancy, Clyde W; Bhatt, Deepak L

2015-01-01

Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Home care nurses' knowledge of evidence-based education topics for management of heart failure.

PubMed

Delaney, Colleen; Apostolidis, Beka; Lachapelle, Leeanne; Fortinsky, Richard

2011-01-01

We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. Copyright © 2011 Elsevier Inc. All rights reserved.

Examining mortality among formerly homeless adults enrolled in Housing First: An observational study.

PubMed

Henwood, Benjamin F; Byrne, Thomas; Scriber, Brynn

2015-12-04

Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older. This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process. The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72% died from natural causes, compared to 49% from the homeless group. This included 21% of HF participants and 7% from the homeless group who died from cancer. Among homeless adults, 40% died from an accident, which was significantly more than the 14% of HF participants who died from an accident. HIV or other infectious diseases contributed to 13% of homeless deaths compared to only 2% of HF participants. Hypothermia contributed to 6% of homeless deaths, which was not a cause of death for HF participants. Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.

Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program.

PubMed

Carroll, Robert; Mudge, Alison; Suna, Jessica; Denaro, Charles; Atherton, John

2016-08-01

Heart failure (HF) medications improve clinical outcomes, with optimal doses defined in clinical trials. Patient, provider and system barriers may limit achievement of optimal doses in real life settings, although disease management programs (HF-DMPs) can facilitate up-titration. Secondary analysis of a prospective cohort of 216 participants recently hospitalized with systolic HF, attending 5 HF-DMPs in Queensland, Australia. Medication history at baseline (6weeks after discharge) and 6months provided data to describe prescription rates, dosage and optimal titration of HF medications, and associations with patient and system factors were explored. At baseline, 94% were on an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB), 94% on a beta-blocker (BB) and 42% on a mineralocorticoid receptor antagonist (MRA). The proportion of participants on optimal doses of ACEI/ARB increased from 38% (baseline) to 52% (6months, p=0.001) and on optimal BB dose from 23% to 49% (p<0.001). Significant barriers to ACEI/ARB up-titration were body mass index (BMI)<25, female gender, polypharmacy, previously diagnosed HF, and tertiary hospital. Significant barriers for BB up-titration were BMI<25, previously diagnosed HF and non-cardiologist care. Effective up-titration in HF DMPs is influenced by patient, disease and service factors. Better understanding of barriers to effective up-titration in women, normal weight, and established HF patients may help provide targeted strategies for improving outcomes in these groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

Get With The Guidelines program participation, process of care, and outcome for Medicare patients hospitalized with heart failure.

PubMed

Heidenreich, Paul A; Hernandez, Adrian F; Yancy, Clyde W; Liang, Li; Peterson, Eric D; Fonarow, Gregg C

2012-01-01

Hospitals enrolled in the American Heart Association's Get With The Guidelines Program for heart failure (GWTG-HF) have improved their process of care. However, it is unclear if process of care and outcomes are better in the GWTG-HF hospitals compared with hospitals not enrolled. We compared hospitals enrolled in GWTG-HF from 2006 to 2007 with other hospitals using data on 4 process of heart failure care measures, 5 noncardiac process measures, risk-adjusted 30-day mortality, and 30-day all-cause readmission after a heart failure hospitalization, as reported by the Center for Medicare and Medicaid Services (CMS). Among the 4460 hospitals reporting data to CMS, 215 (5%) were enrolled in GWTG-HF. Of the 4 CMS heart failure performance measures, GWTG-HF hospitals had significantly higher documentation of the left ventricular ejection fraction (93.4% versus 88.8%), use of angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist (88.3% versus 86.6%), and discharge instructions (74.9% versus 70.5%) (P<0.005 for all). Smoking cessation counseling rates were similar (94.1% versus 94.0%; P=0.51). There was no significant difference in compliance with noncardiac process of care. After heart failure discharge, all-cause readmission at 30 days was 24.5% and mortality at 30 days after admission was 11.1%. After adjustment for hospital characteristics, 30-day mortality rates were no different (P=0.45). However, 30-day readmission was lower for GWTG hospitals (-0.33%; 95% CI, -0.53% to -0.12%; P=0.002). Although there was evidence that hospitals enrolled in the GTWG-HF program demonstrated better processes of care than other hospitals, there were few clinically important differences in outcomes. Further identification of opportunities to improve outcomes, and inclusion of these metrics in GTWG-HF, may further support the value of GTWG-HF in improving care for patients with HF.

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.

Racial and sex differences in prevalence of hypothyroidism in patients with cardiomyopathies enrolled into a heart failure disease management program.

PubMed

Marzouka, George; Cortazar, Frank; Alvarez, Jorge Alex; Dias, Andre; Hebert, Kathy

2011-01-01

The authors evaluated the prevalence of hypothyroidism in patients with heart failure (HF) to determine whether there are racial and sex differences and to determine the number of new cases of hypothyroidism. The study included 194 patients in an HF disease management program (HFDMP) in South Florida. Patients were interviewed for a history of hypothyroidism and referred for measurement of thyrotropin. The prevalence of hypothyroidism was calculated by race and sex. The prevalence of hypothyroidism was 18% for all patients with HF and 23% among Hispanics; however, this trend was not statistically significant (P = .06). More men than women had hypothyroidism (P = .04). Patients with hypothyroidism had higher mean lipid profiles (P < .01) and lower mean heart rates (P = .03) than healthy patients. Hypothyroidism is prevalent among HF patients, especially men. Hispanics with HF may have a higher prevalence of hypothyroidism. The standardized protocol of the HFDMP helped identify new cases of hypothyroidism. © 2011 Wiley Periodicals, Inc.

Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Tung, Tao-Hsin; Lee, Chii-Ming; Yang, Ning-I; Wang, Jong-Shyan; Kuo, Li-Tang; Cherng, Wen-Jin

2012-01-01

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.

Incorporating development of a patient-reported outcome instrument in a clinical drug development program: examples from a heart failure program.

PubMed

Wiklund, Ingela; Anatchkova, Milena; Oko-Osi, Hafiz; von Maltzahn, Robyn; Chau, Dina; Malik, Fady I; Patrick, Donald L; Spertus, John; Teerlink, John R

2016-09-15

Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process. Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items. During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders. Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.

Open access to an outpatient intravenous diuresis program in a systolic heart failure disease management program.

PubMed

Hebert, Kathy; Dias, Andre; Franco, Emiliana; Tamariz, Leonardo; Steen, Dylan; Arcement, Lee M

2011-01-01

In order to provide efficient utilization of resources in an outpatient setting for acute exacerbation of heart failure (HF), the authors piloted an open-access outpatient intravenous (IV) diuretic program (IVDP) to evaluate utilization in an HF disease management program (HFDMP), patient characteristics for users of the program, and safety. An outpatient HFDMP at Jackson Memorial Hospital in Miami, Florida, enrolling 577 patients 18 years and older with an ejection fraction ≤40% was implemented. For symptoms or weight gain ≥5 pounds, patients were eligible to use an open-access IVDP during clinic hours. A total of 130 HFDM patients (22.5%) used the IVDP. IVDP users were more likely to be diabetic, with lower body mass indices than non-IVDP users. New York Heart Association class IV patients and previously hospitalized patients were more likely to use the IVDP. There were no documented adverse reactions for patients receiving treatment and no difference in mortality between groups. This open-access outpatient IVDP model for patients with HF was readily utilized by the HFDMP participants and appears safe for use in this population. This unique model may provide alternative access for acute HF treatment. Congest Heart Fail. © 2011 Wiley Periodicals, Inc.

Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach.

PubMed

Hwang, Rita; Mandrusiak, Allison; Morris, Norman R; Peters, Robyn; Korczyk, Dariusz; Bruning, Jared; Russell, Trevor

To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing. Limited information currently exists on patient experiences of telerehabilitation for HF. Patient feedback and end-user perspectives provide important information regarding the acceptability of this new delivery model which may have a substantial impact on future uptake. We used mixed-methods design with purposive sampling of patients with HF. We used self-report surveys and semi-structured interviews to measure patient experiences and perspectives following a 12-week telerehabilitation program. The telerehabilitation program encompassed group-based exercise and education, and were delivered in real-time via videoconferencing. Interviews were transcribed and coded, with thematic analysis undertaken. Seventeen participants with HF (mean age [SD] of 69 [12] years and 88% males) were recruited. Participants reported high visual clarity and ease of use for the monitoring equipment. Major themes included motivating and inhibiting influences related to telerehabilitation and improvement suggestions. Participants liked the health benefits, access to care and social support. Participants highlighted a need for improved audio clarity and connectivity as well computer training for those with limited computer experience. The majority of participants preferred a combined face-to-face and online delivery model. Participants in this study reported high visual clarity and ease-of-use, but provided suggestions for further improvements in group-based video telerehabilitation for HF. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

High-intensity Interval Training Dosage for Heart Failure and Coronary Artery Disease Cardiac Rehabilitation. A Systematic Review and Meta-analysis.

PubMed

Ballesta García, Ismael; Rubio Arias, Jacobo Ángel; Ramos Campo, Domingo Jesús; Martínez González-Moro, Ignacio; Carrasco Poyatos, María

2018-04-09

High-interval intensity training (HIT) has been suggested to improve peak VO 2 in cardiac rehabilitation programs. However, the optimal HIT protocol is unknown. The objective of this study was to identify the most effective doses of HIT to optimize peak VO 2 in coronary artery disease (CAD) and heart failure (HF) patients. A search was conducted in 6 databases (MEDLINE, Web of Science, LILACS, CINAHL, Academic Search Complete, and SportDiscus). Studies using a HIT protocol in CAD or HF patients and measuring peak VO 2 were included. The PEDro Scale and Cochrane Collaboration tools were used. Analyses reported significant improvements in peak VO 2 after HIT in both diseases (P = .000001), with a higher increase in HF patients (P = .03). Nevertheless, in HF patients, there were no improvements when the intensity recovery was ≤ 40% of peak VO 2 (P = .19) and the frequency of training was ≤ 2 d/wk (P = .07). There were significant differences regarding duration in CAD patients, with greater improvements in peak VO 2 when the duration was < 12 weeks (P = .05). In HF, programs lasting < 12 weeks did not significantly improve peak VO 2 (P = .1). The HIT is an effective method for improving peak VO 2 in HF and CAD, with a significantly greater increase in HF patients. The recovery intervals should be active and be between 40% and 60% of peak VO 2 in HF patients. Training frequency should be ≥ 2 d/wk for CAD patients and ≥ 3 d/wk for HF patients. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Multidisciplinary management of heart failure just beginning in Japan.

PubMed

Sato, Yukihito

2015-09-01

The mortality associated with end-stage heart failure (HF) is high despite the development of new and increasingly effective drugs and non-pharmacological therapies. Repetitive hospitalizations predict fatal outcomes and each hospitalization should prompt individual conversations with the patient, the family, and the caregivers. A multidisciplinary disease management program promotes the education of patients and their families and modifies their behavior, with a view to ultimately improve the prognosis and quality of life. From the early to the late stages of HF, a multidisciplinary disease management program should be implemented. In Western societies this multidisciplinary management has long been debated and endorsed, in contrast to Japan, where it has just begun. In 2012, the Japanese Nursing Association launched a certification in chronic HF nursing. A Japanese version of HF disease management should soon be developed in its own social environment. Copyright © 2015. Published by Elsevier Ltd.

Model for heart failure education.

PubMed

Baldonado, Analiza; Dutra, Danette; Abriam-Yago, Katherine

2014-01-01

Heart failure (HF) is the heart's inability to meet the body's need for blood and oxygen. According to the American Heart Association 2013 update, approximately 5.1 million people are diagnosed with HF in the United States in 2006. Heart failure is the most common diagnosis for hospitalization. In the United States, the HF direct and indirect costs are estimated to be US $39.2 billion in 2010. To address this issue, nursing educators designed innovative teaching frameworks on HF management both in academia and in clinical settings. The model was based on 2 resources: the American Association of Heart Failure Nurses (2012) national nursing certification and the award-winning Pierce County Responsive Care Coordination Program. The HF educational program is divided into 4 modules. The initial modules offer foundational levels of Bloom's Taxonomy then progress to incorporate higher-levels of learning when modules 3 and 4 are reached. The applicability of the key components within each module allows formatting to enhance learning in all areas of nursing, from the emergency department to intensive care units to the medical-surgical step-down units. Also applicable would be to provide specific aspects of the modules to nurses who care for HF patients in skilled nursing facility, rehabilitation centers, and in the home-health care setting.

Real-Time 12-Lead High-Frequency QRS Electrocardiography for Enhanced Detection of Myocardial Ischemia and Coronary Artery Disease

NASA Technical Reports Server (NTRS)

Schlegel, Todd T.; Kulecz, Walter B.; DePalma, Jude L.; Feiveson, Alan H.; Wilson, John S.; Rahman, M. Atiar; Bungo, Michael W.

2004-01-01

Several studies have shown that diminution of the high-frequency (HF; 150-250 Hz) components present within the central portion of the QRS complex of an electrocardiogram (ECG) is a more sensitive indicator for the presence of myocardial ischemia than are changes in the ST segments of the conventional low-frequency ECG. However, until now, no device has been capable of displaying, in real time on a beat-to-beat basis, changes in these HF QRS ECG components in a continuously monitored patient. Although several software programs have been designed to acquire the HF components over the entire QRS interval, such programs have involved laborious off-line calculations and postprocessing, limiting their clinical utility. We describe a personal computer-based ECG software program developed recently at the National Aeronautics and Space Administration (NASA) that acquires, analyzes, and displays HF QRS components in each of the 12 conventional ECG leads in real time. The system also updates these signals and their related derived parameters in real time on a beat-to-beat basis for any chosen monitoring period and simultaneously displays the diagnostic information from the conventional (low-frequency) 12-lead ECG. The real-time NASA HF QRS ECG software is being evaluated currently in multiple clinical settings in North America. We describe its potential usefulness in the diagnosis of myocardial ischemia and coronary artery disease.

HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria.

PubMed

Von der Heidt, Andreas; Ammenwerth, Elske; Bauer, Karl; Fetz, Bettina; Fluckinger, Thomas; Gassner, Andrea; Grander, Willhelm; Gritsch, Walter; Haffner, Immaculata; Henle-Talirz, Gudrun; Hoschek, Stefan; Huter, Stephan; Kastner, Peter; Krestan, Susanne; Kufner, Peter; Modre-Osprian, Robert; Noebl, Josef; Radi, Momen; Raffeiner, Clemens; Welte, Stefan; Wiseman, Andreas; Poelzl, Gerhard

2014-11-01

Heart failure (HF) is approaching epidemic proportions worldwide and is the leading cause of hospitalization in the elderly population. High rates of readmission contribute substantially to excessive health care costs and highlight the fragmented nature of care available to HF patients. Disease management programs (DMPs) have been implemented to improve health outcomes, patient satisfaction, and quality of life, and to reduce health care costs. Telemonitoring systems appear to be effective in the vulnerable phase after discharge from hospital to prevent early readmissions. DMPs that emphasize comprehensive patient education and guideline-adjusted therapy have shown great promise to result in beneficial long-term effects. It can be speculated that combining core elements of the aforementioned programs may substantially improve long-term cost-effectiveness of patient management.We introduce a collaborative post-discharge HF disease management program (HerzMobil Tirol network) that incorporates physician-controlled telemonitoring and nurse-led care in a multidisciplinary network approach.

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.

Hemodynamic-guided heart-failure management using a wireless implantable sensor: Infrastructure, methods, and results in a community heart failure disease-management program.

PubMed

Jermyn, Rita; Alam, Amit; Kvasic, Jessica; Saeed, Omar; Jorde, Ulrich

2017-03-01

The real-world impact of remote pulmonary artery pressure (PAP) monitoring on New York Heart Association (NYHA) class improvement and heart failure (HF) hospitalization rate is presented here from a single center. METHODS: Seventy-seven previously hospitalized outpatients with NYHA class III HF were offered PAP monitoring via device implantation in a multidisciplinary HF-management program. Prospective effectiveness analyses compared outcomes in 34 hemodynamically monitored patients to a group of similar patients (n = 32) who did not undergo device implantation but received usual care. NYHA class and 6-minute walk testing were assessed at baseline and 90 days. All hospitalizations were collected after 6 months of the implantation date (average follow-up, 15 months) and compared with the number of hospitalizations experienced prior to hemodynamic monitoring. Patients in both groups had similar distributions of age, sex, and ejection fraction. After 90 days, 61.8% of the monitored patients had NYHA class improvement of ≥1, compared with 12.5% in the controls (P < 0.001). Distance walked in 6 minutes increased by 54.5 meters in the monitored group (253.0 ± 25.6 meters to 307.4 ± 26.3 meters; P < 0.005), whereas no change was seen in the usual-care group. After implantation, 19.4% of the monitored group had ≥1 HF hospitalization, compared with 100% who had been hospitalized in the year prior to implantation. The monitored group had a significantly lower HF hospitalization rate (0.16; 95% confidence interval: 0.06-0.35 hospitalizations/patient-year) compared with the year prior (1.0 hospitalizations/patient-year; P < 0.001). Hemodynamic-guided HF management leads to significant improvements in NYHA class and HF hospitalization rate in a real-world setting compared with usual care delivered in a comprehensive disease-management program. © 2016 Wiley Periodicals, Inc.

Depot- and sex-specific effects of maternal obesity in offspring's adipose tissue.

PubMed

Lecoutre, Simon; Deracinois, Barbara; Laborie, Christine; Eberlé, Delphine; Guinez, Céline; Panchenko, Polina E; Lesage, Jean; Vieau, Didier; Junien, Claudine; Gabory, Anne; Breton, Christophe

2016-07-01

According to the Developmental Origin of Health and Disease (DOHaD) concept, alterations of nutrient supply in the fetus or neonate result in long-term programming of individual body weight (BW) setpoint. In particular, maternal obesity, excessive nutrition, and accelerated growth in neonates have been shown to sensitize offspring to obesity. The white adipose tissue may represent a prime target of metabolic programming induced by maternal obesity. In order to unravel the underlying mechanisms, we have developed a rat model of maternal obesity using a high-fat (HF) diet (containing 60% lipids) before and during gestation and lactation. At birth, newborns from obese dams (called HF) were normotrophs. However, HF neonates exhibited a rapid weight gain during lactation, a key period of adipose tissue development in rodents. In males, increased BW at weaning (+30%) persists until 3months of age. Nine-month-old HF male offspring was normoglycemic but showed mild glucose intolerance, hyperinsulinemia, and hypercorticosteronemia. Despite no difference in BW and energy intake, HF adult male offspring was predisposed to fat accumulation showing increased visceral (gonadal and perirenal) depots weights and hyperleptinemia. However, only perirenal adipose tissue depot exhibited marked adipocyte hypertrophy and hyperplasia with elevated lipogenic (i.e. sterol-regulated element binding protein 1 (Srebp1), fatty acid synthase (Fas), and leptin) and diminished adipogenic (i.e. peroxisome proliferator-activated receptor gamma (Pparγ), 11β-hydroxysteroid dehydrogenase type 1 (11β-Hds1)) mRNA levels. By contrast, very few metabolic variations were observed in HF female offspring. Thus, maternal obesity and accelerated growth during lactation program offspring for higher adiposity via transcriptional alterations of visceral adipose tissue in a depot- and sex-specific manner. © 2016 Society for Endocrinology.

Educational needs for improving self-care in heart failure patients with diabetes.

PubMed

Cha, EunSeok; Clark, Patricia C; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L; Dunbar, Sandra B

2012-01-01

To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF- DM patients) by describing cognitive and affective factors to provide guidance in developing effective self-management education. A cross-sectional correlation design was employed using baseline patient data from a study testing a 12-week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and comorbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t tests, or Mann-Whitney tests were performed to compare HF patients with and without DM. HF-DM patients were older and heavier, had more comorbidities, and took more daily medications than HF patients. High self-efficacy on medication and low-sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication-taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients but clinically higher levels of sodium. Diabetes educators need to be aware of potential conflicts of treatment regimens to manage 2 chronic diseases. Special and integrated diabetes self-management education programs that incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients.

[Disease management for chronic heart failure patient].

PubMed

Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

2011-02-01

Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

Protein-restriction diet during the suckling phase programs rat metabolism against obesity and insulin resistance exacerbation induced by a high-fat diet in adulthood.

PubMed

Martins, Isabela Peixoto; de Oliveira, Júlio Cezar; Pavanello, Audrei; Matiusso, Camila Cristina Ianoni; Previate, Carina; Tófolo, Laize Peron; Ribeiro, Tatiane Aparecida; da Silva Franco, Claudinéia Conationi; Miranda, Rosiane Aparecida; Prates, Kelly Valério; Alves, Vander Silva; Francisco, Flávio Andrade; de Moraes, Ana Maria Praxedes; de Freitas Mathias, Paulo Cezar; Malta, Ananda

2018-04-03

Protein restriction during the suckling phase can malprogram rat offspring to a lean phenotype associated with metabolic dysfunctions later in life. We tested whether protein-caloric restriction during lactation can exacerbate the effect of a high-fat (HF) diet at adulthood. To test this hypothesis, we fed lactating Wistar dams with a low-protein (LP; 4% protein) diet during the first 2 weeks of lactation or a normal-protein (NP; 23% protein) diet throughout lactation. Rat offspring from NP and LP mothers received a normal-protein diet until 60 days old. At this time, a batch of animals from both groups was fed an HF (35% fat) diet, while another received an NF (7% fat) diet. Maternal protein-caloric restriction provoked lower body weight and fat pad stores, hypoinsulinemia, glucose intolerance, higher insulin sensitivity, reduced insulin secretion and altered autonomic nervous system (ANS) function in adult rat offspring. At 90 days old, NP rats fed an HF diet in adulthood displayed obesity, impaired glucose homeostasis and altered insulin secretion and ANS activity. Interestingly, the LP/HF group also presented fat pad and body weight gain, altered glucose homeostasis, hyperleptinemia and impaired insulin secretion but at a smaller magnitude than the NP-HF group. In addition, LP/HF rats displayed elevated insulin sensitivity. We concluded that protein-caloric restriction during the first 14 days of life programs the rat metabolism against obesity and insulin resistance exacerbation induced by an obesogenic HF diet. Copyright © 2017 Elsevier Inc. All rights reserved.

Designing a high-frequency nutrient and biogeochemical monitoring network for the Sacramento–San Joaquin Delta, northern California

USGS Publications Warehouse

Bergamaschi, Brian A.; Downing, Bryan D.; Kraus, Tamara E.C.; Pellerin, Brian A.

2017-07-11

Executive SummaryThis report is the third in a series of three reports that provide information about how high-frequency (HF) nutrient monitoring may be used to assess nutrient inputs and dynamics in the Sacramento–San Joaquin Delta, California (Delta). The purpose of this report is to provide the background, principles, and considerations for designing an HF nutrient-monitoring network for the Delta to address high-priority, nutrient-management questions. The report starts with discussion of the high-priority management questions to be addressed, continues through discussion of the questions and considerations that place demands and constraints on network design, discusses the principles applicable to network design, and concludes with the presentation of three example nutrient-monitoring network designs for the Delta. For three example network designs, we assess how they would address high-priority questions that have been identified by the Delta Regional Monitoring Program (Delta Regional Monitoring Program Technical Advisory Committee, 2015).This report, along with the other two reports of this series (Kraus and others, 2017; Downing and others, 2017), was drafted in cooperation with the Delta Regional Monitoring Program to help scientists, managers, and planners understand how HF data improve our understanding of nutrient sources and sinks, drivers, and effects in the Delta. The first report in the series (Kraus and others, 2017) provides an introduction to the reasons for and fundamental concepts behind using HF monitoring measurements, including a brief summary of nutrient status and trends in the Delta and an extensive literature review showing how and where other research and monitoring programs have used HF monitoring to improve our understanding of nutrient cycling. The report covers the various technologies available for HF nutrient monitoring and presents the different ways HF monitoring instrumentation may be used for both fixed station and spatial assessments. Finally, it presents numerous examples of how HF measurements are currently (2017) being used in the Delta to examine how nutrients and nutrient cycling are related to aquatic habitat conditions.The second report in the series (Downing and others, 2017) summarizes information about HF nutrient and associated biogeochemical monitoring in the north Delta. The report synthesizes data available from the nutrient and water quality monitoring network currently (2017) operated by the U.S. Geological Survey in this ecologically important region of the Delta. In the report, we present and discuss the available data at various timescales—first at the monthly, seasonal, and inter-annual timescales; and, second, for comparison, at the tidal and event timescales. As expected, we determined that there is substantial variability in nitrate concentrations at short timescales, such as within a few hours, but also significant variability at longer timescales such as months or years. This high variability affects calculation of fluxes and loads, indicating that HF monitoring is necessary for understanding and assessing flux-based processes and outcomes in Delta tidal environments.

Synthesis of data from high-frequency nutrient and associated biogeochemical monitoring for the Sacramento–San Joaquin Delta, northern California

USGS Publications Warehouse

Downing, Bryan D.; Bergamaschi, Brian A.; Kraus, Tamara E.C.

2017-07-11

Executive SummaryThis report is the second in a series of three reports that provide information about high-frequency (HF) nutrient and biogeochemical monitoring in the Sacramento–San Joaquin Delta of northern California (Delta). The purpose of this report is to synthesize the data available from a nutrient and water-quality HF (about every 15 minutes) monitoring network operated by the U.S. Geological Survey in the northern Delta. In this report, we describe the network and focus on the purpose of each station. We then present and discuss the available data, at various timescales—first at the monthly, seasonal, and inter-annual timescales, and second, for comparison, at the tidal and event timescales. As expected, we determined that there is substantial variability in nitrate-N concentrations at short timescales within hours, but also significant variability at longer timescales such as months or years. Resolving this variability is made possible by the HF data, with the largest variability caused by storms, tides, and diel biological processes. Given this large temporal variability, calculations of cumulative nutrient fluxes (for example, daily, monthly, or annual loads) is difficult without HF data. For example, in the Cache Slough, calculation of the annual load without the tidal variability resulted in a 30 percent underestimation of the true annual load value. We conclude that HF measurements are important for accurate determination of fluxes and loads in tidal environments, but, more importantly, provide important insights into processes and rates of nutrient cycling.This report, along with the other two reports of this series (Bergamaschi and others, 2017; Kraus, Bergamaschi, and others, 2017), was drafted in cooperation with the Delta Regional Monitoring Program to help scientists, managers, and planners understand how HF data improve our understanding of nutrient sources and sinks, drivers, and effects in the Delta. The first report in the series (Kraus, Bergamaschi, and others, 2017) provides an introduction to the reasons for and fundamental concepts behind using HF monitoring measurements, including a brief summary of nutrient status and trends in the Delta and an extensive literature review showing how and where other research and monitoring programs have used HF monitoring to improve our understanding of nutrient cycling. The report covers the various technologies available for HF nutrient monitoring and presents the different ways HF monitoring instrumentation may be used for fixed station and spatial assessments. Finally, it presents numerous examples of how HF measurements are currently (2017) being used in the Delta to examine how nutrients and nutrient cycling are related to aquatic habitat conditions.The third report in the series (Bergamaschi and others, 2017) provides the background, principles, and considerations for designing an HF nutrient-monitoring network for the Delta to address high-priority, nutrient-management questions. The report starts with discussion of the high‑priority management questions to be addressed, continues through discussion of the questions and considerations that place demands and constraints on network design, discusses the principles applicable to network design, and concludes with the presentation of three example nutrient-monitoring network designs for the Delta, proposed to address high-priority questions identified by the Delta Regional Monitoring Program (Delta Regional Monitoring Program Technical Advisory Committee, 2015).

Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure.

PubMed

Huynh, Quan; Negishi, Kazuaki; De Pasquale, Carmine; Hare, James; Leung, Dominic; Stanton, Tony; Marwick, Thomas H

2018-06-18

To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes. Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF. All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission. 58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings. Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

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).

Educational Needs for Improving Self-care in Heart Failure Patients with Diabetes

PubMed Central

Cha, Eun Seok; Clark, Patricia C.; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L.; Dunbar, Sandra B.

2013-01-01

Purpose To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF-DM patients) by describing cognitive and affective factors to provide guidance in developing effective self- management education. Method A cross-sectional correlation design was employed using baseline patient data from a study testing a 12 week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and co-morbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t-tests or Mann Whitney tests were performed to compare HF patients with and without DM. Results HF-DM patients were older, heavier, had more co- morbidities, and took more daily medications than HF patients. High self-efficacy on medication and low sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients, but clinically higher levels of sodium. Conclusions Diabetes educators need to be aware of potential conflicts of treatment regimens to manage two chronic diseases. Special and integrated diabetes self-management education programs which incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients. PMID:22722611

Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

PubMed

George, Susan; Leasure, A Renee

2016-01-01

Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

Prenatal Dexamethasone and Postnatal High-Fat Diet Decrease Interferon Gamma Production through an Age-Dependent Histone Modification in Male Sprague-Dawley Rats

PubMed Central

Yu, Hong-Ren; Tain, You-Lin; Sheen, Jiunn-Ming; Tiao, Mao-Meng; Chen, Chih-Cheng; Kuo, Ho-Chang; Hung, Pi-Lien; Hsieh, Kai-Sheng; Huang, Li-Tung

2016-01-01

Overexposure to prenatal glucocorticoid (GC) disturbs hypothalamic-pituitary-adrenocortical axis-associated neuroendocrine metabolism and susceptibility to metabolic syndrome. A high-fat (HF) diet is a major environmental factor that can cause metabolic syndrome. We aimed to investigate whether prenatal GC plus a postnatal HF diet could alter immune programming in rat offspring. Pregnant Sprague-Dawley rats were given intraperitoneal injections of dexamethasone or saline at 14–21 days of gestation. Male offspring were then divided into four groups: vehicle, prenatal dexamethasone exposure, postnatal HF diet (VHF), and prenatal dexamethasone exposure plus a postnatal HF diet (DHF). The rats were sacrificed and adaptive immune function was evaluated. Compared to the vehicle, the DHF group had lower interferon gamma (IFN-γ) production by splenocytes at postnatal day 120. Decreases in H3K9 acetylation and H3K36me3 levels at the IFN-γ promoter correlated with decreased IFN-γ production. The impaired IFN-γ production and aberrant site-specific histone modification at the IFN-γ promoter by prenatal dexamethasone treatment plus a postnatal HF diet resulted in resilience at postnatal day 180. Prenatal dexamethasone and a postnatal HF diet decreased IFN-γ production through a site-specific and an age-dependent histone modification. These findings suggest a mechanism by which prenatal exposure to GC and a postnatal environment exert effects on fetal immunity programming. PMID:27669212

Ferroelectric transistors with monolayer molybdenum disulfide and ultra-thin aluminum-doped hafnium oxide

NASA Astrophysics Data System (ADS)

Yap, Wui Chung; Jiang, Hao; Liu, Jialun; Xia, Qiangfei; Zhu, Wenjuan

2017-07-01

In this letter, we demonstrate ferroelectric memory devices with monolayer molybdenum disulfide (MoS2) as the channel material and aluminum (Al)-doped hafnium oxide (HfO2) as the ferroelectric gate dielectric. Metal-ferroelectric-metal capacitors with 16 nm thick Al-doped HfO2 are fabricated, and a remnant polarization of 3 μC/cm2 under a program/erase voltage of 5 V is observed. The capability of potential 10 years data retention was estimated using extrapolation of the experimental data. Ferroelectric transistors based on embedded ferroelectric HfO2 and MoS2 grown by chemical vapor deposition are fabricated. Clockwise hysteresis is observed at low program/erase voltages due to slow bulk traps located near the 2D/dielectric interface, while counterclockwise hysteresis is observed at high program/erase voltages due to ferroelectric polarization. In addition, the endurances of the devices are tested, and the effects associated with ferroelectric materials, such as the wake-up effect and polarization fatigue, are observed. Reliable writing/reading in MoS2/Al-doped HfO2 ferroelectric transistors over 2 × 104 cycles is achieved. This research can potentially lead to advances of two-dimensional (2D) materials in low-power logic and memory applications.

Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy.

PubMed

Brasca, Francesco Ma; Franzetti, Jessica; Rella, Valeria; Malfatto, Gabriella; Brambilla, Roberto; Facchini, Mario; Parati, Gianfranco; Perego, Giovanni B

2017-05-01

Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728-0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90-7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

A High Fat Diet during Adolescence in Male Rats Negatively Programs Reproductive and Metabolic Function Which Is Partially Ameliorated by Exercise

PubMed Central

Ibáñez, Carlos A.; Erthal, Rafaela P.; Ogo, Fernanda M.; Peres, Maria N. C.; Vieira, Henrique R.; Conejo, Camila; Tófolo, Laize P.; Francisco, Flávio A.; da Silva Silveira, Sandra; Malta, Ananda; Pavanello, Audrei; Martins, Isabela P.; da Silva, Paulo H. O.; Jacinto Saavedra, Lucas Paulo; Gonçalves, Gessica D.; Moreira, Veridiana M.; Alves, Vander S.; da Silva Franco, Claudinéia C.; Previate, Carina; Gomes, Rodrigo M.; de Oliveira Venci, Renan; Dias, Francielle R. S.; Armitage, James A.; Zambrano, Elena; Mathias, Paulo C. F.; Fernandes, Glaura S. A.; Palma-Rigo, Kesia

2017-01-01

An interaction between obesity, impaired glucose metabolism and sperm function in adults has been observed but it is not known whether exposure to a diet high in fat during the peri-pubertal period can have longstanding programmed effects on reproductive function and gonadal structure. This study examined metabolic and reproductive function in obese rats programmed by exposure to a high fat (HF) diet during adolescence. The effect of physical training (Ex) in ameliorating this phenotype was also assessed. Thirty-day-old male Wistar rats were fed a HF diet (35% lard w/w) for 30 days then subsequently fed a normal fat diet (NF) for a 40-day recovery period. Control animals were fed a NF diet throughout life. At 70 days of life, animals started a low frequency moderate exercise training that lasted 30 days. Control animals remained sedentary (Se). At 100 days of life, biometric, metabolic and reproductive parameters were evaluated. Animals exposed to HF diet showed greater body weight, glucose intolerance, increased fat tissue deposition, reduced VO2max and reduced energy expenditure. Consumption of the HF diet led to an increase in the number of abnormal seminiferous tubule and a reduction in seminiferous epithelium height and seminiferous tubular diameter, which was reversed by moderate exercise. Compared with the NF-Se group, a high fat diet decreased the number of seminiferous tubules in stages VII-VIII and the NF-Ex group showed an increase in stages XI-XIII. HF-Se and NF-Ex animals showed a decreased number of spermatozoa in the cauda epididymis compared with animals from the NF-Se group. Animals exposed to both treatments (HF and Ex) were similar to all the other groups, thus these alterations induced by HF or Ex alone were partially prevented. Physical training reduced fat pad deposition and restored altered reproductive parameters. HF diet consumption during the peri-pubertal period induces long-term changes on metabolism and the reproductive system, but moderate and low frequency physical training is able to recover adipose tissue deposition and reproductive system alterations induced by high fat diet. This study highlights the importance of a balanced diet and continued physical activity during adolescence, with regard to metabolic and reproductive health. PMID:29163186

A High Fat Diet during Adolescence in Male Rats Negatively Programs Reproductive and Metabolic Function Which Is Partially Ameliorated by Exercise.

PubMed

Ibáñez, Carlos A; Erthal, Rafaela P; Ogo, Fernanda M; Peres, Maria N C; Vieira, Henrique R; Conejo, Camila; Tófolo, Laize P; Francisco, Flávio A; da Silva Silveira, Sandra; Malta, Ananda; Pavanello, Audrei; Martins, Isabela P; da Silva, Paulo H O; Jacinto Saavedra, Lucas Paulo; Gonçalves, Gessica D; Moreira, Veridiana M; Alves, Vander S; da Silva Franco, Claudinéia C; Previate, Carina; Gomes, Rodrigo M; de Oliveira Venci, Renan; Dias, Francielle R S; Armitage, James A; Zambrano, Elena; Mathias, Paulo C F; Fernandes, Glaura S A; Palma-Rigo, Kesia

2017-01-01

An interaction between obesity, impaired glucose metabolism and sperm function in adults has been observed but it is not known whether exposure to a diet high in fat during the peri-pubertal period can have longstanding programmed effects on reproductive function and gonadal structure. This study examined metabolic and reproductive function in obese rats programmed by exposure to a high fat (HF) diet during adolescence. The effect of physical training (Ex) in ameliorating this phenotype was also assessed. Thirty-day-old male Wistar rats were fed a HF diet (35% lard w/w) for 30 days then subsequently fed a normal fat diet (NF) for a 40-day recovery period. Control animals were fed a NF diet throughout life. At 70 days of life, animals started a low frequency moderate exercise training that lasted 30 days. Control animals remained sedentary (Se). At 100 days of life, biometric, metabolic and reproductive parameters were evaluated. Animals exposed to HF diet showed greater body weight, glucose intolerance, increased fat tissue deposition, reduced VO 2max and reduced energy expenditure. Consumption of the HF diet led to an increase in the number of abnormal seminiferous tubule and a reduction in seminiferous epithelium height and seminiferous tubular diameter, which was reversed by moderate exercise. Compared with the NF-Se group, a high fat diet decreased the number of seminiferous tubules in stages VII-VIII and the NF-Ex group showed an increase in stages XI-XIII. HF-Se and NF-Ex animals showed a decreased number of spermatozoa in the cauda epididymis compared with animals from the NF-Se group. Animals exposed to both treatments (HF and Ex) were similar to all the other groups, thus these alterations induced by HF or Ex alone were partially prevented. Physical training reduced fat pad deposition and restored altered reproductive parameters. HF diet consumption during the peri-pubertal period induces long-term changes on metabolism and the reproductive system, but moderate and low frequency physical training is able to recover adipose tissue deposition and reproductive system alterations induced by high fat diet. This study highlights the importance of a balanced diet and continued physical activity during adolescence, with regard to metabolic and reproductive health.

A Randomized Trial of Heart Failure Disease Management in Skilled Nursing Facilities: Design and Rationale

PubMed Central

Boxer, Rebecca S.; Dolansky, Mary A.; Bodnar, Christine A.; Singer, Mendel E.; Albert, Jeffery M.; Gravenstein, Stefan

2013-01-01

Background Heart failure disease management can improve health outcomes for older community dwelling patients with heart failure. Heart failure disease management has not been studied in skilled nursing facilities, a major site of transitional care for older adults. Methods and Anticipated Results The objective of this trial is to investigate if a heart failure disease management program (HF-DMP) in skilled nursing facilities (SNF) will decrease all-cause rehospitalizations for the first 60 days post SNF admission. The trial is a randomized cluster trial to be conducted in 12 for-profit SNF in the greater Cleveland area. The study population is inclusive of patients with heart failure regardless of ejection fraction but excludes those patients on dialysis and with a life expectancy of 6 months or less. The HF-DMP includes 7 elements considered standard of care for patients with heart failure: documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7 day follow up appointment post SNF discharge, patient education. The HF-DMP is conducted by a research nurse tasked with adhering to each element of the program and regularly audited to maintain fidelity of the program. Additional outcomes include health status, self-care management, and discharge destination. Conclusion The SNF-Connect Trial is the first trial of its kind to assess if a HF-DMP will improve outcomes for patients in SNFs. This trial will provide evidence on the effectiveness of HF-DMP to improve outcomes for older frail heart failure patients undergoing post-acute rehabilitation. PMID:23871475

A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure.

PubMed

Postmus, Douwe; Pari, Anees A Abdul; Jaarsma, Tiny; Luttik, Marie Louise; van Veldhuisen, Dirk J; Hillege, Hans L; Buskens, Erik

2011-12-01

Although previously conducted meta-analyses suggest that nurse-led disease management programs in heart failure (HF) can improve patient outcomes, uncertainty regarding the cost-effectiveness of such programs remains. To compare the relative merits of 2 variants of a nurse-led disease management program (basic or intensive support by a nurse specialized in the management of patients with HF) against care as usual (routine follow-up by a cardiologist), a trial-based economic evaluation was conducted alongside the COACH study. In terms of costs per life-year, basic support was found to dominate care as usual, whereas the incremental cost-effectiveness ratio between intensive support and basic support was found to be equal to €532,762 per life-year; in terms of costs per quality-adjusted life-year (QALY), basic support was found to dominate both care as usual and intensive support. An assessment of the uncertainty surrounding these findings showed that, at a threshold value of €20,000 per life-year/€20,000 per QALY, basic support was found to have a probability of 69/62% of being optimal against 17/30% and 14/8% for care as usual and intensive support, respectively. The results of our subgroup analysis suggest that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF would be optimal if the willingness-to-pay threshold exceeds €45,345 per life-year/€59,289 per QALY. Although the differences in costs and effects among the 3 study groups were not statistically significant, from a decision-making perspective, basic support still had a relatively large probability of generating the highest health outcomes at the lowest costs. Our results also substantiated that a stratified approach based on offering basic support to patients with mild to moderate HF and intensive support to patients with severe HF could further improve health outcomes at slightly higher costs. Copyright © 2011 Mosby, Inc. All rights reserved.

Effect of weekly physical activity frequency on weight loss in healthy overweight and obese women attending a weight loss program: a randomized controlled trial.

PubMed

Madjd, Ameneh; Taylor, Moira A; Shafiei Neek, Leila; Delavari, Alireza; Malekzadeh, Reza; Macdonald, Ian A; Farshchi, Hamid R

2016-11-01

The effect of intensity and duration of physical activity (PA) on weight loss has been well described. However, the effect of the frequency of weekly PA on weight loss is still unknown. The purpose of this study was to evaluate the effect of the frequency of weekly PA sessions while maintaining the same total activity time on weight loss during a 24-wk weight loss program. Overweight and obese women [n = 75; body mass index (BMI; in kg/m 2 ): 27-37; age: 18-40 y] who had a normally sedentary lifestyle were randomly allocated to 1 of 2 intervention groups: a high-frequency physical activity (HF) or a low-frequency physical activity (LF) group. The HF group included 50 min/d PA, 6 d/wk (300 min/wk). The LF group included 100 min/d PA, 3 d/wk (300 min/wk). Both groups were advised to follow the same dietary weight loss program. Both groups showed a significant decrease in anthropometric measurements and significant improvements in cardiometabolic disease risk characteristics over the 24 wk of the study. Compared with the HF group, the LF group had a greater decrease in weight (mean ± SD; LF: 9.58 ± 3.77 kg; HF: 7.78 ± 2.68 kg; P = 0.028), BMI (LF: 3.62 ± 1.56; HF: 2.97 ± 1.02; P = 0.029) and waist circumference (LF: 9.36 ± 4.02 cm; HF: 7.86 ± 2.41 cm; P = 0.031). However, there were no significant differences in carbohydrate metabolism characteristics or lipid profile after the 24 wk of intervention. Weekly PA undertaken over fewer sessions of longer duration during the week could be more effective for weight loss than when undertaken as more frequent shorter sessions in overweight and obese women on a weight loss program. This may be helpful for those who are neither willing nor able to schedule time for PA almost every day to achieve weight loss. This trial was registered at www.irct.ir as IRCT201402157754N4. © 2016 American Society for Nutrition.

Development of a practice tool for community-based nurses: the Heart Failure Palliative Approach to Care (HeFPAC).

PubMed

Strachan, Patricia H; Joy, Cathy; Costigan, Jeannine; Carter, Nancy

2014-04-01

Patients living with advanced heart failure (HF) require a palliative approach to reduce suffering. Nurses have described significant knowledge gaps about the disease-specific palliative care (PC) needs of these patients. An intervention is required to facilitate appropriate end-of-life care for HF patients. The purpose of this study was to develop a user-friendly, evidence-informed HF-specific practice tool for community-based nurses to facilitate care and communication regarding a palliative approach to HF care. Guided by the Knowledge to Action framework, we identified key HF-specific issues related to advanced HF care provision within the context of a palliative approach to care. Informed by current evidence and subsequent iterative consultation with community-based and specialist PC and HF nurses, a pocket guide tool for community-based nurses was created. We developed the Heart Failure Palliative Approach to Care (HeFPAC) pocket guide to promote communication and a palliative approach to care for HF patients. The HeFPAC has potential to improve the quality of care and experiences for patients with advanced HF. It will be piloted in community-based practice and in a continuing education program for nurses. The HeFPAC pocket guide offers PC nurses a concise, evidence-informed and practical point-of care tool to communicate with other clinicians and patients about key HF issues that are associated with improving disease-specific HF palliative care and the quality of life of patients and their families. Pilot testing will offer insight as to its utility and potential for modification for national and international use.

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.

Undergraduates Learn about Industrial-Organizational Psychology and Human Factors from an Informational Brochure

ERIC Educational Resources Information Center

Kottke, Janet L.; Shoenfelt, Elizabeth L.; Stone, Nancy J.

2017-01-01

An informational brochure was created to assist students and faculty unfamiliar with the industrial-organizational (IO) and human factors (HF) disciplines. The brochure highlights the content of these two professions, presents advice for undergraduates to prepare for admission to IO and HF graduate programs, provides sources of IO and HF…

Cross-education after high-frequency versus low-frequency volume-matched handgrip training.

PubMed

Boyes, Natasha G; Yee, Peter; Lanovaz, Joel L; Farthing, Jonathan P

2017-10-01

Cross-education training programs cause interlimb asymmetry of strength and hypertrophy. We examined the cross-education effects from a high-frequency (HF) versus a low-frequency (LF) volume-matched handgrip training program on interlimb asymmetry. Right-handed participants completed either HF (n = 10; 2 × 6 repetitions 10 times per week) or LF (n = 9; 5 × 8 repetitions 3 times per week) training. Testing occurred twice before and once after 4 weeks of right-handed isometric handgrip training totaling 120 weekly repetitions. Measures were maximal isometric handgrip and wrist flexion torque, muscle thickness, and muscle activation (electromyography; EMG). Grip strength was greater in both limbs posttraining, pooled across groups (P < 0.001). Trained limb muscle thickness increased in both groups (P < 0.05; untrained, P = 0.897). EMG and wrist flexion torque did not change (all P > 0.103). Both LF and HF induced cross-education of grip strength to the untrained limb, but HF did not reduce asymmetry. These findings have implications for injury rehabilitation. Muscle Nerve 56: 689-695, 2017. © 2017 Wiley Periodicals, Inc.

Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study.

PubMed

Chen, Yiyin; Funk, Marjorie; Wen, Jia; Tang, Xianghua; He, Guixiang; Liu, Hong

Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited. To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China. This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31). Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up. A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. Copyright © 2017 Elsevier Inc. All rights reserved.

Performance Evaluations of Prototype Houses: Minimum 40% Residential Building Energy Savings Level Habitat for Humanity of Greater Newburgh Liberty Street Project: April 2003--September 2004

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

Guilbert, R.; Magee, A.

Habitat for Humanity International (HfHI) is a nonprofit organization that engages volunteers and would-be homebuyers in programs that emphasize sweat-equity and self-help. Habitat is among the top-ten housing producers in the United States. In collaboration with the HfHI Department of Construction & Environmental Resources, Steven Winter Associates, Inc., (SWA) began working with the Habitat for Humanity of Greater Newburgh (HfHGN) affiliate in Newburgh, New York, in April 2003. Since October 1999, HfHGN has acquired and renovated abandoned houses for an average cost of $45,000 per home. The affiliate serves area families living in overcrowded, substandard housing and spending 50% tomore » 80% of their income on housing. In August 2003, HfHGN began their first new construction project, six row houses located on Liberty Street in Newburgh.« less

First Light from Triple-Etalon Fabry-Perot Interferometer for Atmospheric OI Airglow (6300 A)

NASA Astrophysics Data System (ADS)

Watchorn, S.; Noto, J.; Pedersen, T.; Betremieux, Y.; Migliozzi, M.; Kerr, R. B.

2006-05-01

Scientific Solutions, Inc. (SSI) has developed a triple-etalon Fabry-Perot interferometer (FPI) to observe neutral winds in the ionosphere by measuring neutral oxygen (O I) emission at 630.0 nm during the day. This instrument is to be deployed in the SSI airglow building at the Cerro Tololo observatory (30.17S 70.81W) in Chile, in support of the Comm/Nav Outage Forecast System (C/NOFS) project. Post-deployment observation will be made in conjunction with two other Clemson University Fabry-Perots in Peru, creating a longitudinal chain of interferometers for thermospheric observations. These instruments will make autonomous day and night observations of thermospheric dynamics. Instruments of this type can be constructed for a global chain of autonomous airglow observatories. The FPI presented in this talk consists of three independently pressure-controlled etalons, fed collimated light by a front optical train headed by an all-sky lens with a 160-degree field of view. It can be controlled remotely via a web-based service which allows any internet-connected computer to mimic the control computer at the instrument site. In fall 2005, the SSI system was first assembled at the Millstone Hill Observatory in Westford, Massachusetts, and made day and evening observations. It was then moved to the High-frequency Active Auroral Research Project (HAARP) site in Gakona, Alaska, to participate in joint optical/ionospheric heating campaigns. Additionally, natural airglow observations were made, both locally and remotely via the internet from Massachusetts. The Millstone and HAARP observations with two etalons yielded strong 630-nm atmospheric Fraunhofer absorption lines, with some suggestion of the Ring effect. By modeling the atmospheric absorption line as the constant times the corresponding solar absorption -- itself modeled as a Gaussian plus a polynomial -- the absorption feature is subtracted, leaving only the emission feature. Software ring-summing tools developed at the University of Wisconsin are employed to increase the signal-to-noise of the resulting data. Results to date will be presented and discussed, as well as prospects and plans for the instrument. This research is supported by the Air Force Research Laboratory through the Small Business Innovative Research program, and by the National Science Foundation's CEDAR program.

Insights from internet-based remote intrathoracic impedance monitoring as part of a heart failure disease management program.

PubMed

Mullens, Wilfried; Oliveira, Leonardo P J; Verga, Tanya; Wilkoff, Bruce L; Tang, Wai Hong Wilson

2010-01-01

Changes in intrathoracic impedance (Z) leading to crossing of a derived fluid index (FI) threshold has been associated with heart failure (HF) hospitalization. The authors developed a remote monitoring program as part of HF disease management and prospectively examined the feasibility and resource utilization of monitoring individuals with an implanted device capable of measuring Z. An HF nurse analyzed all transmitted data daily, as they were routinely uploaded as part of quarterly remote device monitoring, and called the patient if the FI crossed the threshold (arbitrarily defined at 60 Omega) to identify clinically relevant events (CREs) that occurred during this period (eg, worsening dyspnea or increase in edema or weight). A total of 400 uploads were completed during the 4-month study period. During this period, 34 patients (18%) had an FI threshold crossing, averaging 0.52 FI threshold crossings per patient-year. Thirty-two of 34 patients contacted by telephone (94%) with FI threshold crossing had evidence of CREs during this period. However, only 6 (18%) had HF hospitalizations, 19 (56%) had reported changes in HF therapy, and 13 (38%) reported drug and/or dietary plan nonadherence. The average data analysis time required was 30 min daily when focusing on those with FI threshold crossing, averaging 8 uploads for review per working day and 5 telephone follow-ups per week. Our pilot observations suggested that Internet-based remote monitoring of Z trends from existing device interrogation uploads is feasible as part of a daily routine of HF disease management. 2010 Wiley Periodicals, Inc.

[Screening for asymptomatic left ventricular systolic dysfunction in high-risk patients. Preliminary experience with a program based on the use of ECG and natriuretic peptide].

PubMed

Tarantini, Luigi; Cioffi, Giovanni; Di Lenarda, Andrea; Valle, Roberto; Pulignano, Giovanni; Del Sindaco, Donatella; Frigo, Gianfranco; Soravia, Giorgio; Tessier, Renato; Catania, Giuseppe

2008-12-01

Patients with asymptomatic left ventricular systolic dysfunction (ALVSD) have an increased risk of heart failure (HF) and a worse life expectancy. Since valuable therapies may prevent such dismal evolution, screening programs for ALVSD have recently been advocated to detect as early as possible such ominous condition. Echocardiography represents the gold standard for the assessment of ALVSD but its indiscriminate use in screening programs is impractical. Clinical multivariate risk assessment associated with ECG and serum brain natriuretic peptide (BNP) may be a feasible strategy to screen ALVSD. We prospectively sought to investigate the feasibility and effectiveness of a screening program for ALVSD based on ECG and BNP used in a hierarchical sequence in patients at high risk for HF. Patients > or =55 years old with > or =2 risk factors for HF or > or =70 years old with > or =1 risk factor for HF entered the study performing sequentially ECG, BNP and echocardiographic evaluation. ALVSD was defined as a left ventricular ejection fraction < or =50%. Thirty-three of 122 enrolled patients (27%) had ALVSD. They were older, presented more frequently a history of chemotherapy exposure, had often bundle branch block and higher BNP levels. No patient without any major abnormalities (atrial fibrillation, left ventricular hypertrophy, STT alterations of ischemic/strain origin, pathologic Q wave, bundle branch block) on ECG (n=31, 24.4%) had ALVSD. Among the 91 patients with abnormal ECG, ALVSD was observed in 33 (36%). The area under the receiver operating characteristic curve to detect ALVSD by BNP was 0.86 (confidence interval 0.79-0.94, p<0.0001) and BNP values of > or =43 pg/ml showed a sensitivity and a specificity of 94% and 57%, respectively. The proposed screening program was able to identify 95% (31/33) of patients with ALVSD saving 53% of echocardiographic examinations with a substantial reduction of the costs to diagnose ALVSD. Our prospective investigation confirms that ECG and BNP may be useful in detecting ALVSD in high-risk patients. A cost-effective screening program based on such simple and low-cost diagnostic tests might be employed for the prevention of HF in primary and secondary prevention programs in high-risk patients.

The Prevalence of Stages of Heart Failure in Primary Care: A Population-Based Study.

PubMed

Jorge, Antonio Lagoeiro; Rosa, Maria Luiza G; Martins, Wolney A; Correia, Dayse Mary S; Fernandes, Luiz Claudio M; Costa, Jean A; Moscavitch, Samuel D; Jorge, Bruno Afonso L; Mesquita, Evandro T

2016-02-01

Planning strategies to prevent heart failure (HF) in developing countries require epidemiologic data in primary care. The purpose of this study was to estimate the prevalence of HF stages and their phenotypes, HF with preserved ejection fraction (HFPEF), and HF with reduced EF (HFREF) and to determine B-type natriuretic peptide (BNP) levels to identify HF in the adult population. This is a cross-sectional study including 633 individuals, aged ≥45 years, who were randomly selected and registered in a primary care program of a medium-sized city in Brazil. All participants were underwent clinical evaluations, BNP measurements, electrocardiograms, and tissue Doppler echocardiography in a single day. The participants were classified as stage 0 (healthy, 11.7%), stage A (risk factors, 36.6%), stage B (structural abnormalities, 42.7%), or stage C (symptomatic HF, 9.3%). Among patients with HF, 59% presented with HFPEF and 41% presented with HFREF. The mean BNP levels were 20 pg/mL(-1) in stage 0, 20 pg/mL(-1) in stage A, 24 pg/mL(-1) in stage B, 93 pg/mL(-1) in HFPEF, and 266 pg/mL(-1) in HFREF. The cutoff BNP level with optimal sensitivity (92%) and specificity (91%) to identify HF was 42 pg/mL(-1). The present study demonstrated a high prevalence of individuals at risk for HF and the predominance of HFPEF in a primary care setting. The clinical examination, along with BNP and tissue Doppler echocardiography, may facilitate early detection of stages A and B HF and allow implementation of interventions aimed at preventing progression to symptomatic HF. Copyright © 2015 Elsevier Inc. All rights reserved.

Mitochondrial ROS Drive Sudden Cardiac Death and Chronic Proteome Remodeling in Heart Failure.

PubMed

Dey, Swati; DeMazumder, Deeptankar; Sidor, Agnieszka; Foster, D B; O'Rourke, Brian

2018-06-13

Rationale: Despite increasing prevalence and incidence of heart failure (HF), therapeutic options remain limited. In early stages of HF, sudden cardiac death (SCD) from ventricular arrhythmias claims many lives. Reactive oxygen species (ROS) have been implicated in both arrhythmias and contractile dysfunction. However, little is known about how ROS in specific subcellular compartments contribute to HF or SCD pathophysiology. The role of ROS in chronic proteome remodeling has not been explored. Objective: We will test the hypothesis that elevated mitochondrial ROS (mROS) is a principal source of oxidative stress in HF and in vivo reduction of mROS mitigates SCD. Methods and Results: Using a unique guinea pig model of non-ischemic HF that recapitulates important features of human HF, including prolonged QT interval and high incidence of spontaneous arrhythmic SCD. Compartment-specific ROS sensors revealed increased mROS in resting and contracting left ventricular (LV) myocytes in failing hearts. Importantly, mitochondrially-targeted antioxidant (MitoTEMPO) normalized global cellular ROS. Further, in vivo MitoTEMPO treatment of HF animals prevented and reversed HF; eliminated SCD by decreasing dispersion of repolarization and ventricular arrhythmias; suppressed chronic HF-induced remodeling of the expression proteome; and prevented specific phosphoproteome alterations. Pathway analysis of mROS-sensitive networks indicated that increased mROS in HF disrupts the normal coupling between cytosolic signals and nuclear gene programs driving mitochondrial function, antioxidant enzymes, Ca2+ handling and action potential repolarization, suggesting new targets for therapeutic intervention. Conclusions: mROS drive both acute emergent events, such as electrical instability responsibly for SCD, and those that mediate chronic HF remodeling, characterized by suppression or altered phosphorylation of metabolic, antioxidant and ion transport protein networks. In vivo reduction of mROS prevents and reverses electrical instability, SCD and HF. Our findings support the feasibility of targeting the mitochondria as a potential new therapy for HF and SCD while identifying new mROS-sensitive protein modifications.

Transforming the culture of surgical education: promoting teacher identity through human factors training.

PubMed

Cahan, Mitchell A; Starr, Susan; Larkin, Anne C; Litwin, Demetrius E M; Sullivan, Kate M; Quirk, Mark E

2011-07-01

Promoting a culture of teaching may encourage students to choose a surgical career. Teaching in a human factors (HF) curriculum, the nontechnical skills of surgery, is associated with surgeons' stronger identity as teachers and with clinical students' improved perception of surgery and satisfaction with the clerkship experience. To describe the effects of an HF curriculum on teaching culture in surgery. Surgeons and educators developed an HF curriculum including communication, teamwork, and work-life balance. Teacher identity, student interest in a surgical career, student perception of the HF curriculum, and teaching awards. Ninety-two of 123 faculty and residents in a single program (75% of total) completed a survey on teacher identity. Fifteen of the participants were teachers of HF. Teachers of HF scored higher than control participants on the total score for teacher identity (P < .001) and for subcategories of global teacher identity (P = .001), intrinsic satisfaction (P = .001), skills and knowledge (P = .006), belonging to a group of teachers (P < .001), feeling a responsibility to teach (P = .008), receiving rewards (P =.01), and HF (P = .02). Third-year clerks indicated that they were more likely to select surgery as their career after the clerkship and rated the curriculum higher when it was taught by surgeons than when taught by educators. Of the teaching awards presented to surgeons during HF years, 100% of those awarded to attending physicians and 80% of those awarded to residents went to teachers of HF. Curricular focus on HF can strengthen teacher identity, improve teacher evaluations, and promote surgery as a career choice.

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.

Maternal Perinatal Diet Induces Developmental Programming of Bone Architecture

PubMed Central

Devlin, MJ; Grasemann, C; Cloutier, AM; Louis, L; Alm, C; Palmert, MR; Bouxsein, ML

2013-01-01

Maternal high fat diet can alter offspring metabolism via perinatal developmental programming. This study tests the hypothesis that maternal high fat diet also induces perinatal programming of offspring bone mass and strength. We compared skeletal acquisition in pups from C57Bl/6J mice fed high fat or normal diet from preconception through lactation. Three-week-old male and female pups from high fat (HF-N) and normal mothers (N-N) were weaned onto normal diet. Outcomes at 14 and 26 wks of age included body mass, body composition, whole body bone mineral content via pDXA, femoral cortical and trabecular architecture via μCT, and glucose tolerance. Female HF-N had normal body mass and glucose tolerance, with lower %body fat but higher serum leptin at 14 wks vs. N-N (p<0.05 for both). Whole body bone mineral content was 12% lower at 14 wks and 5% lower at 26 wks, but trabecular bone volume fraction was 20% higher at 14 wks in female HF-N vs. N-N (p<0.05 for all). Male HF-N had normal body mass and mildly impaired glucose tolerance, with lower %body fat at 14 wks and lower serum leptin at 26 wks vs. N-N (p<0.05 for both). Serum insulin was higher at 14 wks and lower at 26 wks in HF-N vs. N-N (p<0.05). Trabecular BV/TV was 34% higher and cortical bone area was 6% higher at 14 wks vs. N-N (p<0.05 for both). These data suggest maternal high fat diet has complex effects on offspring bone, supporting the hypothesis that maternal diet alters postnatal skeletal homeostasis. PMID:23503967

Paresthesia-Independence: An Assessment of Technical Factors Related to 10 kHz Paresthesia-Free Spinal Cord Stimulation.

PubMed

De Carolis, Giuliano; Paroli, Mery; Tollapi, Lara; Doust, Matthew W; Burgher, Abram H; Yu, Cong; Yang, Thomas; Morgan, Donna M; Amirdelfan, Kasra; Kapural, Leonardo; Sitzman, B Todd; Bundschu, Richard; Vallejo, Ricardo; Benyamin, Ramsin M; Yearwood, Thomas L; Gliner, Bradford E; Powell, Ashley A; Bradley, Kerry

2017-05-01

Spinal cord stimulation (SCS) has been successfully used to treat chronic intractable pain for over 40 years. Successful clinical application of SCS is presumed to be generally dependent on maximizing paresthesia-pain overlap; critical to achieving this is positioning of the stimulation field at the physiologic midline. Recently, the necessity of paresthesia for achieving effective relief in SCS has been challenged by the introduction of 10 kHz paresthesia-free stimulation. In a large, prospective, randomized controlled pivotal trial, HF10 therapy was demonstrated to be statistically and clinically superior to paresthesia-based SCS in the treatment of severe chronic low back and leg pain. HF10 therapy, unlike traditional paresthesia-based SCS, requires no paresthesia to be experienced by the patient, nor does it require paresthesia mapping at any point during lead implant or post-operative programming. To determine if pain relief was related to technical factors of paresthesia, we measured and analyzed the paresthesia responses of patients successfully using HF10 therapy. Prospective, multicenter, non-randomized, non-controlled interventional study. Outpatient pain clinic at 10 centers across the US and Italy. Patients with both back and leg pain already implanted with an HF10 therapy device for up to 24 months were included in this multicenter study. Patients provided pain scores prior to and after using HF10 therapy. Each patient's most efficacious HF10 therapy stimulation program was temporarily modified to a low frequency (LF; 60 Hz), wide pulse width (~470 mus), paresthesia-generating program. On a human body diagram, patients drew the locations of their chronic intractable pain and, with the modified program activated, all regions where they experienced LF paresthesia. Paresthesia and pain drawings were then analyzed to estimate the correlation of pain relief outcomes to overlap of pain by paresthesia, and the mediolateral distribution of paresthesia (as a surrogate of physiologic midline lead positioning). A total of 61 patients participated across 11 centers. Twenty-eight men and 33 women with a mean age of 56 ± 12 years of age participated in the study. The average duration of implantable pulse generator (IPG) implant was 19 ± 9 months. The average predominant pain score, as measured on a 0 - 10 visual analog scale (VAS), prior to HF10 therapy was 7.8 ± 1.3 and at time of testing was 2.5 ± 2.1, yielding an average pain relief of 70 ± 24%. For all patients, the mean paresthesia coverage of pain was 21 ± 28%, with 43% of patients having zero paresthesia coverage of pain. Analysis revealed no correlation between percentage of LF paresthesia overlap of predominant pain and HF10 therapy efficacy (P = 0.56). Exact mediolateral positioning of the stimulation electrodes was not found to be a statistically significant predictor of pain relief outcomes. Non-randomized/non-controlled study design; short-term evaluation; certain technical factors not investigated. Both paresthesia concordance with pain and precise midline positioning of the stimulation contacts appear to be inconsequential technical factors for successful HF10 therapy application. These results suggest that HF10 therapy is not only paresthesia-free, but may be paresthesia-independent.

HAARP 2011 Summer Student Research Campaign

DTIC Science & Technology

2012-10-16

in order to take advantage of a wide variety of background ionospheric conditions and to provide ample time for each student to investigate...The SSRC expands on the PARS Summer School by providing a significant increase in facility operational time. This has advantages in several areas...in several advantages for scheduling and conducting experiments: (1) Higher ionospheric density yields higher F-region critical frequency (foF2

High Latitude Scintillation Monitoring at UHF with the COMMX Experiment on TACSat4

NASA Astrophysics Data System (ADS)

Bernhardt, P. A.; Siefring, C. L.; Akins, K.; Nurnberger, M.

2013-12-01

UHF Beacon Transmissions at 253 MHz have provided high latitude scintillation monitoring from Gakona Alaska using the COMMX instrument on TACSat4. TACSat4 was constructed by the Naval Research Laboratory and was launched in September 2011 as an experimental communications satellite. Ground UHF transmissions are uplinked to TACSat4 using the 4 meter diameter antenna deployed to view the earth. These signals are coherently translated to other UHF frequency to be rebroadcast to the ground. Scintillation monitoring is achieved by taking the 401.25 MHz signals from ground DORIS beacons located in Cold Bay, Alaska; Yellowknife, Canada; Kauai, Hawaii; and Soccoro Island, Mexico. These signals are translated to 253 MHz and broadcast with the 4 meter antenna pointed to the UHF receiver located at Gakona, Alaska. The satellite antenna gain is 18 dB in this UHF band and the transmitter power is 2 Watts. The satellite is in an elliptical orbit with an inclination of 63 degrees and a perigee of 12,000 km. Doppler frequency shifts allow separation of each uplink from the ground DORIS beacons. This new scintillation monitoring system has been used to detect natural and artificial field aligned irregularity effects on the amplitude and phase of UHF carriers where typical scintillation amplitudes are 2dB or less. Using the HAARP transmitter in Alaska, TACSat4 was used to discover the artificial ionization clouds produce scintillation with as much as 16 dB and amplitude indices S4 greater than unity. This is the first demonstration of significant effects on radio scintillations using high power HF radio waves to disturb the ionosphere.

Nonlinear interactions of electromagnetic waves with the auroral ionosphere

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

Wong, Alfred Y.

1999-09-20

The ionosphere provides us with an opportunity to perform plasma experiments in an environment with long confinement times, very large-scale lengths, and no confining walls. The auroral ionosphere with its nearly vertical magnetic field geometry is uniquely endowed with large amount of free energy from electron and ion precipitation along the magnetic field and mega-ampere current across the magnetic field. To take advantage of this giant outdoor laboratory, two facilities HAARP and HIPAS, with frequencies ranging from the radio to optical bands, are now available for active probing of and interaction with this interesting region. The ponderomotive pressures from themore » self-consistent wave fields have produced significant local perturbations of density and particle distributions at heights where the incident EM frequency matches a plasma resonance. This paper will review theory and experiments covering the nonlinear phenomena of parametric decay instability to wave collapse processes. At HF frequencies plasma lenses can be created by preconditioning pulses to focus what is a normally divergent beam into a high-intensity spot to further enhance nonlinear phenomena. At optical wavelengths a large rotating liquid metal mirror is used to focus laser pulses up to a given height. Such laser pulses are tuned to the same wavelengths of selected atomic and molecular resonances, with resulting large scattering cross sections. Ongoing experiments on dual-site experiments and excitation of ELF waves will be presented. The connection of such basic studies to environmental applications will be discussed. Such applications include the global communication using ELF waves, the ozone depletion and remediation and the control of atmospheric CO{sub 2} through the use of ion cyclotron resonant heating.« less

Nonlinear interactions of electromagnetic waves with the auroral ionosphere

NASA Astrophysics Data System (ADS)

Wong, Alfred Y.

1999-09-01

The ionosphere provides us with an opportunity to perform plasma experiments in an environment with long confinement times, very large-scale lengths, and no confining walls. The auroral ionosphere with its nearly vertical magnetic field geometry is uniquely endowed with large amount of free energy from electron and ion precipitation along the magnetic field and mega-ampere current across the magnetic field. To take advantage of this giant outdoor laboratory, two facilities HAARP and HIPAS, with frequencies ranging from the radio to optical bands, are now available for active probing of and interaction with this interesting region. The ponderomotive pressures from the self-consistent wave fields have produced significant local perturbations of density and particle distributions at heights where the incident EM frequency matches a plasma resonance. This paper will review theory and experiments covering the nonlinear phenomena of parametric decay instability to wave collapse processes. At HF frequencies plasma lenses can be created by preconditioning pulses to focus what is a normally divergent beam into a high-intensity spot to further enhance nonlinear phenomena. At optical wavelengths a large rotating liquid metal mirror is used to focus laser pulses up to a given height. Such laser pulses are tuned to the same wavelengths of selected atomic and molecular resonances, with resulting large scattering cross sections. Ongoing experiments on dual-site experiments and excitation of ELF waves will be presented. The connection of such basic studies to environmental applications will be discussed. Such applications include the global communication using ELF waves, the ozone depletion and remediation and the control of atmospheric CO2 through the use of ion cyclotron resonant heating.

HF propagation results from the Metal Oxide Space Cloud (MOSC) experiment

NASA Astrophysics Data System (ADS)

Joshi, Dev; Groves, Keith M.; McNeil, William; Carrano, Charles; Caton, Ronald G.; Parris, Richard T.; Pederson, Todd R.; Cannon, Paul S.; Angling, Matthew; Jackson-Booth, Natasha

2017-06-01

With support from the NASA sounding rocket program, the Air Force Research Laboratory launched two sounding rockets in the Kwajalein Atoll, Marshall Islands in May 2013 known as the Metal Oxide Space Cloud experiment. The rockets released samarium metal vapor at preselected altitudes in the lower F region that ionized forming a plasma cloud. Data from Advanced Research Project Agency Long-range Tracking and Identification Radar incoherent scatter radar and high-frequency (HF) radio links have been analyzed to understand the impacts of the artificial ionization on radio wave propagation. The HF radio wave ray-tracing toolbox PHaRLAP along with ionospheric models constrained by electron density profiles measured with the ALTAIR radar have been used to successfully model the effects of the cloud on HF propagation. Up to three new propagation paths were created by the artificial plasma injections. Observations and modeling confirm that the small amounts of ionized material injected in the lower F region resulted in significant changes to the natural HF propagation environment.

Effects of high-fat diet on somatic growth, metabolic parameters and function of peritoneal macrophages of young rats submitted to a maternal low-protein diet.

PubMed

Alheiros-Lira, Maria Cláudia; Jurema-Santos, Gabriela Carvalho; da-Silva, Helyson Tomaz; da-Silva, Amanda Cabral; Moreno Senna, Sueli; Ferreira E Silva, Wylla Tatiana; Ferraz, José Candido; Leandro, Carol Góis

2017-03-01

This study evaluated the effects of a post-weaning high-fat (HF) diet on somatic growth, food consumption, metabolic parameters, phagocytic rate and nitric oxide (NO) production of peritoneal macrophages in young rats submitted to a maternal low-protein (LP) diet. Male Wistar rats (aged 60 d) were divided in two groups (n 22/each) according to their maternal diet during gestation and lactation: control (C, dams fed 17 % casein) and LP (dams fed 8 % casein). At weaning, half of the groups were fed HF diet and two more groups were formed (HF and low protein-high fat (LP-HF)). Somatic growth, food and energy intake, fat depots, serum glucose, cholesterol and leptin concentrations were evaluated. Phagocytic rate and NO production were analysed in peritoneal macrophages under stimulation of zymosan and lipopolysaccharide (LPS)+interferon γ (IFN-γ), respectively. The maternal LP diet altered the somatic parameters of growth and development of pups. LP and LP-HF pups showed a higher body weight gain and food intake than C pups. HF and LP-HF pups showed increased retroperitoneal and epididymal fat depots, serum level of TAG and total cholesterol compared with C and LP pups. After LPS+IFN-γ stimulation, LP and LP-HF pups showed reduced NO production when compared with their pairs. Increased phagocytic activity and NO production were seen in LP but not LP-HF peritoneal macrophages. However, peritoneal macrophages of LP pups were hyporesponsive to LPS+IFN-γ induced NO release, even after a post-weaning HF diet. Our data demonstrated that there was an immunomodulation related to dietary fatty acids after the maternal LP diet-induced metabolic programming.

Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy.

PubMed

Luttik, M L A; Brons, M; Jaarsma, T; Hillege, H L; Hoes, A; de Jong, R; Linssen, G; Lok, D J; Berger, M; van Veldhuisen, D J

2012-08-01

Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking. To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance. The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes. The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.

Programmed hyperphagia in offspring of obese dams: Altered expression of hypothalamic nutrient sensors, neurogenic factors and epigenetic modulators.

PubMed

Desai, Mina; Han, Guang; Ross, Michael G

2016-04-01

Maternal overnutrition results in programmed offspring obesity, mediated in part, by hyperphagia. This is remarkably similar to the effects of maternal undernutrition on offspring hyperphagia and obesity. In view of the marked differences in the energy environment of the over and under-nutrition exposures, we studied the expression of select epigenetic modifiers associated with energy imbalance including neurogenic factors and appetite/satiety neuropeptides which are indicative of neurogenic differentiation. HF offspring were exposed to maternal overnutrition (high fat diet; HF) during pregnancy and lactation. We determined the protein expression of energy sensors (mTOR, pAMPK), epigenetic factors (DNA methylase, DNMT1; histone deacetylase, SIRT1/HDAC1), neurogenic factors (Hes1, Mash1, Ngn3) and appetite/satiety neuropeptides (AgRP/POMC) in newborn hypothalamus and adult arcuate nucleus (ARC). Despite maternal obesity, male offspring born to obese dams had similar body weight at birth as Controls. However, when nursed by the same dams, male offspring of obese dams exhibited marked adiposity. At 1 day of age, HF newborn males had significantly decreased energy sensors, DNMT1 including Hes1 and Mash1, which may impact neuroprogenitor cell proliferation and differentiation. This is consistent with increased AgRP in HF newborns. At 6 months of age, HF adult males had significantly increased energy sensors and decreased histone deactylases. In addition, the persistent decreased Hes1, Mash1 as well as Ngn3 are consistent with increased AgRP and decreased POMC. Thus, altered energy sensors and epigenetic responses which modulate gene expression and adult neuronal differentiation may contribute to hyperphagia and obesity in HF male offspring. Copyright © 2016 Elsevier Ltd. All rights reserved.

Programmed Hyperphagia in Offspring of Obese Dams: Altered Expression of Hypothalamic Nutrient Sensors, Neurogenic Factors and Epigenetic Modulators

PubMed Central

Desai, Mina; Han, Guang; Ross, Michael G.

2016-01-01

Maternal overnutrition results in programmed offspring obesity, mediated in part, by hyperphagia. This is remarkably similar to the effects of maternal undernutrition on offspring hyperphagia and obesity. In view of the marked differences in the energy environment of the over and under-nutrition exposures, we studied the expression of select epigenetic modifiers associated with energy imbalance including neurogenic factors and appetite/satiety neuropeptides which are indicative of neurogenic differentiation. HF offspring were exposed to maternal overnutrition (high fat diet; HF) during pregnancy and lactation. We determined the protein expression of energy sensors (mTOR, pAMPK), epigenetic factors (DNA methylase, DNMT1; histone deacetylase, SIRT1/HDAC1), neurogenic factors (Hes1, Mash1, Ngn3) and appetite/satiety neuropeptides (AgRP/POMC) in newborn hypothalamus and adult arcuate nucleus (ARC). Despite maternal obesity, male offspring born to obese dams had similar body weight at birth as Controls. However, when nursed by the same dams, male offspring of obese dams exhibited marked adiposity. At 1 day of age, HF newborn males had significantly decreased energy sensors, DNMT1 including Hes1 and Mash1, which may impact neuroprogenitor cell proliferation and differentiation. This is consistent with increased AgRP in HF newborns. At 6 months of age, HF adult males had significantly increased energy sensors and decreased histone deactylases. In addition, the persistent decreased Hes1, Mash1 as well as Ngn3 are consistent with increased AgRP and decreased POMC. Thus, altered energy sensors and epigenetic responses which modulate gene expression and adult neuronal differentiation may contribute to hyperphagia and obesity in HF male offspring. PMID:26785315

Polar azimuth diversity HF propagation experiment

NASA Astrophysics Data System (ADS)

Baker, Kurt A.; Haines, D. M.; Weijers, Bertus

1986-03-01

Presented are the results of an HF Azimuth Diversity Propagation Experiment conducted by RADC over several paths, transauroral and polar, separated in azimuth by 30, 70, and 100 degrees, as part of the RADC Adaptive HF Propagation Program. The data presented give the occurrence of several ionospheric characteristics important to the operation of HF networks in a disturbed environment. The analysis was performed on data collected during the four seasonal periods to obtain statistical samples representative of each season under slightly disturbed as well as quiet conditions. The system used to collect the data was a network of three chirpsounder transmitters and one receiver, each sweeping over a frequency range of 2 to 30 MHz, once every five minutes. The transmitters were located at Ava, N.Y., Grand Forks, N. Dak., and Barter Island, Alaska. The receiving system was located at Thule Air Base, Greenland.

Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

PubMed Central

Asrar Ul Haq, Muhammad; Goh, Cheng Yee; Levinger, Itamar; Wong, Chiew; Hare, David L

2015-01-01

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed. PMID:25698883

Synaptic Plasticity and Learning Behaviors Mimicked in Single Inorganic Synapses of Pt/HfOx/ZnOx/TiN Memristive System

NASA Astrophysics Data System (ADS)

Wang, Lai-Guo; Zhang, Wei; Chen, Yan; Cao, Yan-Qiang; Li, Ai-Dong; Wu, Di

2017-01-01

In this work, a kind of new memristor with the simple structure of Pt/HfOx/ZnOx/TiN was fabricated completely via combination of thermal-atomic layer deposition (TALD) and plasma-enhanced ALD (PEALD). The synaptic plasticity and learning behaviors of Pt/HfOx/ZnOx/TiN memristive system have been investigated deeply. Multilevel resistance states are obtained by varying the programming voltage amplitudes during the pulse cycling. The device conductance can be continuously increased or decreased from cycle to cycle with better endurance characteristics up to about 3 × 103 cycles. Several essential synaptic functions are simultaneously achieved in such a single double-layer of HfOx/ZnOx device, including nonlinear transmission properties, such as long-term plasticity (LTP), short-term plasticity (STP), and spike-timing-dependent plasticity. The transformation from STP to LTP induced by repetitive pulse stimulation is confirmed in Pt/HfOx/ZnOx/TiN memristive device. Above all, simple structure of Pt/HfOx/ZnOx/TiN by ALD technique is a kind of promising memristor device for applications in artificial neural network.

Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home–Chez soi Demonstration Project

PubMed Central

Aubry, Tim; Nelson, Geoffrey; Tsemberis, Sam

2015-01-01

Objective: To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)–Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing. Method: The AH–CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care. Results: Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH–CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual. Conclusions: Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH–CS project and to scale up the HF approach across Canada. PMID:26720504

Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home-Chez soi Demonstration Project.

PubMed

Aubry, Tim; Nelson, Geoffrey; Tsemberis, Sam

2015-11-01

To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)-Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing. The AH-CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care. Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH-CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual. Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH-CS project and to scale up the HF approach across Canada.

Creating Space Plasma from the Ground

DTIC Science & Technology

2016-05-12

estimated a GW ERP of rf energy would produce an ionosphere half that from an overhead sun, assuming ~15% efficiency conversion of rf energy to...rf energy would produce an ionosphere half that from an overhead sun, assuming ~15% efficiency conversion of rf energy to accelerated electron energy...altitudes along the HAARP field line indicated); images of artificial optical emissions as viewed looking upwards along the magnetic field line from

Health-related quality of life in a multicenter randomized controlled comparison of telephonic disease management and automated home monitoring in patients recently hospitalized with heart failure: SPAN-CHF II trial.

PubMed

Konstam, Varda; Gregory, Douglas; Chen, Jie; Weintraub, Andrew; Patel, Ayan; Levine, Daniel; Venesy, David; Perry, Kathleen; Delano, Christine; Konstam, Marvin A

2011-02-01

Although disease management programs have been shown to provide a number of clinical benefits to patients with heart failure (HF), the incremental impact of an automated home monitoring (AHM) system on health-related quality of life (HRQL) is unknown. We performed a prospective randomized investigation, examining the additive value of AHM to a previously described nurse-directed HF disease management program (SPAN-CHF), with attention to HRQL, in patients with a recent history of decompensated HF. A total of 188 patients were randomized to receive the SPAN-CHF intervention for 90 days, either with (AHM group) or without (NAHM, standard-care group) AHM, with a 1:1 randomization ratio after HF-related hospitalization. HRQL, measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ) (Physical, Emotional, and Total scores on MLHFQ) was assessed at 3 time points: baseline, 45 days, and 90 days. Although both treatments (AHM and NAHM) improved HRQL at 45 and 90 days compared with baseline with respect to Physical, Emotional, and Total domain scales, no significant difference emerged between AHM and NAHM groups. AHM and NAHM treatments demonstrated improved HRQL scores at 45 and 90 days after baseline assessment. When comparing 2 state-of the-art disease management programs regarding HRQL outcomes, our results did not support the added value of AHM. Copyright © 2011. Published by Elsevier Inc.

What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis.

PubMed

Jonkman, Nini H; Westland, Heleen; Groenwold, Rolf H H; Ågren, Susanna; Anguita, Manuel; 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; Trappenburg, Jaap C A; Schuurmans, Marieke J; Hoes, Arno W

2016-11-01

To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97-0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96-0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92-0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Hydrotherapy in advanced heart failure: the cardio-HKT pilot study.

PubMed

Municinó, Annamaria; Nicolino, Annamaria; Milanese, Manlio; Gronda, Edoardo; Andreuzzi, Bruno; Oliva, Fabrizio; Chiarella, Francesco

2006-12-01

In-water exercise, hydrotherapy, may offer an attractive alternative to conventional training in markedly compromised patients with advanced HF. This Pilot Study evaluates the safety and efficacy of Cardio-Hydrokinesitherapy (Cardio-HKT) in patients with advanced HF on optimal medical therapy. Cardio-HKT is a novel rehabilitation program that includes training sessions in warm water (31 degrees C), integrated by educational and psycho-behavioural sessions to promote healthy life style modifications. We studied 18 adult patients with advanced HF, LVEF < 35%, NYHA functional class > II and peak oxygen uptake (peak VO2) < 18 ml/kg/min. Cardio-HKT consisted of a 3 weeks daily in-water training, combined to educational and psycho-behavioural sessions. Patients underwent a six-minute-walking-test (6mWT), a cardiopulmonary exercise test at baseline and after 3 weeks of Cardio-HKT. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire (MLHF). All patients completed the Cardio-HKT rehabilitation program without complications. The 6mWT improved from 453 +/- 172 m to 571 +/- 120 m (p < 0.01), peak VO2 from 13.0 +/- 3.1 to 14.5 +/- 2.9 ml/kg/min (p = 0.03), whereas VE/ CO2 slope declined from 37 +/- 10 to 33 +/- 9 (p = 0.01). MLHF markedly improved from 56 (68-27) to 18 (40-7) (p < 0.01). Our results support the safety and efficacy of the innovative Cardio-HKT rehabilitation program in patients with advanced HF.

Self-reported recall and daily diary-recorded measures of weight monitoring adherence: associations with heart failure-related hospitalization.

PubMed

Jones, Christine D; Holmes, George M; DeWalt, Darren A; Erman, Brian; Wu, Jia-Rong; Cene, Crystal W; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kirsten; Macabasco-O'Connell, Aurelia; Hawk, Victoria; Broucksou, Kimberly; Pignone, Michael

2014-01-31

Weight monitoring is an important element of HF self-care, yet the most clinically meaningful way to evaluate weight monitoring adherence is uncertain. We conducted this study to evaluate the association of (1) self-reported recall and (2) daily diary-recorded weight monitoring adherence with heart failure-related (HF-related) hospitalization. We conducted a prospective cohort study among 216 patients within a randomized trial of HF self-care training. All patients had an initial self-care training session followed by 15 calls (median) to reinforce educational material; patients were also given digital scales, instructed to weigh daily, record weights in a diary, and mail diaries back monthly. Weight monitoring adherence was assessed with a self-reported recall question administered at 12 months and dichotomized into at least daily versus less frequent weighing. Diary-recorded weight monitoring was evaluated over 12 months and dichotomized into ≥80% and <80% adherence. HF-related hospitalizations were ascertained through patient report and confirmed through record review. Over 12 months in 216 patients, we identified 50 HF-related hospitalizations. Patients self-reporting daily or more frequent weight monitoring had an incidence rate ratio of 1.34 (95% CI 0.24-7.32) for HF-related hospitalizations compared to those reporting less frequent weight monitoring. Patients who completed ≥80% of weight diaries had an IRR of 0.37 (95% CI 0.18-0.75) for HF-related hospitalizations compared to patients who completed <80% of weight diaries. Self-reported recall of weight monitoring adherence was not associated with fewer HF hospitalizations. In contrast, diary-recorded adherence ≥80% of days was associated with fewer HF-related hospitalizations. Incorporating diary-based measures of weight monitoring adherence into HF self-care training programs may help to identify patients at risk for HF-related hospitalizations.

β2 adrenergic receptor activation governs cardiac repolarization and arrhythmogenesis in a guinea pig model of heart failure.

PubMed

Wang, Yao; Yuan, Jiamin; Qian, Zhiyong; Zhang, Xiwen; Chen, Yanhong; Hou, Xiaofeng; Zou, Jiangang

2015-01-08

β2-AR activation increases the risk of sudden cardiac death (SCD) in heart failure (HF) patients. Non-selective β-AR blockers have greater benefits on survival than selective β1-AR blockers in chronic HF patients, indicating that β2-AR activation contributes to SCD in HF. This study investigated the role of β2-AR activation on repolarization and ventricular arrhythmia (VA) in the experimental HF model. The guinea pig HF was induced by descending aortic banding. The effective refractoriness period (ERP), corrected QT (QTc) and the incidence of VA were examined using Langendorff and programmed electrical stimulation. Ikr and APD were recorded by the whole cell patch clamp. Selective β2-AR agonist salbutamol significantly increased the incidence of VA, prolonged QTc and shortened ERP. These effects could be prevented by the selective β2-AR antagonist, ICI118551. Salbutamol prolonged APD90 and reduced Ikr in guinea pig HF myocytes. The antagonists of cAMP (Rp-cAMP) and PKA (KT5720) attenuated Ikr inhibition and APD prolongation induced by salbutamol. However, the antagonists of Gi protein (PTX) and PDE III (amrinone) showed opposite effects. This study indicates that β2-AR activation increases the incidence of VA in the experimental HF model via activation of Gs/cAMP/PKA and/or inhibition of Gi/PDE pathways.

β2 adrenergic receptor activation governs cardiac repolarization and arrhythmogenesis in a guinea pig model of heart failure

PubMed Central

Wang, Yao; Yuan, Jiamin; Qian, Zhiyong; Zhang, Xiwen; Chen, Yanhong; Hou, Xiaofeng; Zou, Jiangang

2015-01-01

β2-AR activation increases the risk of sudden cardiac death (SCD) in heart failure (HF) patients. Non-selective β-AR blockers have greater benefits on survival than selective β1-AR blockers in chronic HF patients, indicating that β2-AR activation contributes to SCD in HF. This study investigated the role of β2-AR activation on repolarization and ventricular arrhythmia (VA) in the experimental HF model. The guinea pig HF was induced by descending aortic banding. The effective refractoriness period (ERP), corrected QT (QTc) and the incidence of VA were examined using Langendorff and programmed electrical stimulation. Ikr and APD were recorded by the whole cell patch clamp. Selective β2-AR agonist salbutamol significantly increased the incidence of VA, prolonged QTc and shortened ERP. These effects could be prevented by the selective β2-AR antagonist, ICI118551. Salbutamol prolonged APD90 and reduced Ikr in guinea pig HF myocytes. The antagonists of cAMP (Rp-cAMP) and PKA (KT5720) attenuated Ikr inhibition and APD prolongation induced by salbutamol. However, the antagonists of Gi protein (PTX) and PDE III (amrinone) showed opposite effects. This study indicates that β2-AR activation increases the incidence of VA in the experimental HF model via activation of Gs/cAMP/PKA and/or inhibition of Gi/PDE pathways. PMID:25567365

Stimulated Brillouin scatter and stimulated ion Bernstein scatter during electron gyroharmonic heating experiments

NASA Astrophysics Data System (ADS)

Fu, H.; Scales, W. A.; Bernhardt, P. A.; Samimi, A.; Mahmoudian, A.; Briczinski, S. J.; McCarrick, M. J.

2013-09-01

Results of secondary radiation, Stimulated Electromagnetic Emission (SEE), produced during ionospheric modification experiments using ground-based high-power radio waves are reported. These results obtained at the High Frequency Active Auroral Research Program (HAARP) facility specifically considered the generation of Magnetized Stimulated Brillouin Scatter (MSBS) and Stimulated Ion Bernstein Scatter (SIBS) lines in the SEE spectrum when the transmitter frequency is near harmonics of the electron gyrofrequency. The heater antenna beam angle effect was investigated on MSBS in detail and shows a new spectral line postulated to be generated near the upper hybrid resonance region due to ion acoustic wave interaction. Frequency sweeping experiments near the electron gyroharmonics show for the first time the transition from MSBS to SIBS lines as the heater pump frequency approaches the gyroharmonic. Significantly far from the gyroharmonic, MSBS lines dominate, while close to the gyroharmonic, SIBS lines strengthen while MSBS lines weaken. New possibilities for diagnostic information are discussed in light of these new observations.

The economic effect of a tertiary hospital-based heart failure program.

PubMed

Gregory, Douglas; DeNofrio, David; Konstam, Marvin A

2005-08-16

This study was designed to determine the economic effect of a tertiary heart failure (HF) program at an academic medical center. Most hospitals use cross-sectional financial models to analyze the economic contribution of clinical programs for a budget period. We estimated the incremental value of a tertiary hospital HF program on the basis of the longitudinal utilization of a sample of HF patients. The primary data source was a sample of 82 HF patients referred for cardiac transplant evaluation at an academic medical center during calendar years 2000 to 2001. Cumulative recurrent rates of utilization, cost, and reimbursement for hospital services were computed as functions of time using reliability models. The economic contribution of patients transplanted was contrasted with those not transplanted. Mean hospitalizations and outpatient encounters per patient at the end of the first year of follow-up for those transplanted were 2.1 (95% confidence interval [CI] 1.6 to 2.7) and 11.9 (95% CI 9.2 to 15.4), compared with 1.1 (95% CI 0.8 to 1.6) and 6.0 (95% CI 4.8 to 7.6), respectively, for those not transplanted. Mean revenue and direct cost per patient were 194,470 dollars (95% CI 136,683 dollars to 276,689 dollars) and 146,623 dollars (95% CI 96,377 dollars to 233,065 dollars), respectively, for transplanted patients and 43,587 dollars (95% CI 28,149 dollars to 67,503 dollars) and 33,424 dollars (95% CI 21,584 dollars to 51,760 dollars), respectively, for non-transplanted patients. The point estimates of first-year contribution margins per patient for transplanted and non-transplanted patients were 47,847 dollars and 10,163 dollars, respectively. Newly evaluated patients for cardiac transplantation at an academic medical center generated substantial incident demands for inpatient and outpatient services over a two-year follow-up period. The estimated contribution margin associated with these services was positive. Hospitals without cardiac transplantation that serve high-acuity HF patients may generate favorable long-term contribution margins, on the basis of the results for the non-transplant group.

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.

TEAM-HF Cost-Effectiveness Model: A Web-Based Program Designed to Evaluate the Cost-Effectiveness of Disease Management Programs in Heart Failure

PubMed Central

Reed, Shelby D.; Neilson, Matthew P.; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H.; Polsky, Daniel E.; Graham, Felicia L.; Bowers, Margaret T.; Paul, Sara C.; Granger, Bradi B.; Schulman, Kevin A.; Whellan, David J.; Riegel, Barbara; Levy, Wayne C.

2015-01-01

Background Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. Methods We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics, use of evidence-based medications, and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model (SHFM). Projections of resource use and quality of life are modeled using relationships with time-varying SHFM scores. The model can be used to evaluate parallel-group and single-cohort designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. Results The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. Conclusion The TEAM-HF Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. PMID:26542504

Heart Failure Update: Chronic Disease Management Programs.

PubMed

Fountain, Lorna B

2016-03-01

With high mortality and readmission rates among patients with heart failure (HF), multiple disease management models have been and continue to be tested, with mixed results. Early postdischarge care improves outcomes for patients. Telemonitoring also can assist in reducing mortality and HF-related hospitalizations. Office-based team care improves patient outcomes, with important components including rapid access to physicians, partnerships with clinical pharmacists, education, monitoring, and support. Pay-for-performance measures developed for HF, primarily use of angiotensin-converting enzyme inhibitors and beta blockers, also improve patient outcomes, but the influence of adherence to other measures has been minimal. Evaluating comorbid conditions, including diabetes and hypertension, and making drug adjustments for patients with HF to include blood pressure control and use of metformin, when possible, can reduce mortality and morbidity. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

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.

Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming

PubMed Central

Golembiewski, Elizabeth; Watson, Dennis P.; Robison, Lisa; Coberg, John W.

2017-01-01

The positive relationship between social support and mental health has been well documented, but individuals experiencing chronic homelessness face serious disruptions to their social networks. Housing First (HF) programming has been shown to improve health and stability of formerly chronically homeless individuals. However, researchers are only just starting to understand the impact HF has on residents’ individual social integration. The purpose of the current study was to describe and understand changes in social networks of residents living in a HF program. Researchers employed a longitudinal, convergent parallel mixed method design, collecting quantitative social network data through structured interviews (n = 13) and qualitative data through semi-structured interviews (n = 20). Quantitative results demonstrated a reduction in network size over the course of one year. However, increases in both network density and frequency of contact with network members increased. Qualitative interviews demonstrated a strengthening in the quality of relationships with family and housing providers and a shedding of burdensome and abusive relationships. These results suggest network decay is a possible indicator of participants’ recovery process as they discontinued negative relationships and strengthened positive ones. PMID:28890807

Unrecognized heart failure and chronic obstructive pulmonary disease (COPD) in frail elderly detected through a near-home targeted screening strategy.

PubMed

van Mourik, Yvonne; Bertens, Loes C M; Cramer, Maarten J M; Lammers, Jan-Willem J; Reitsma, Johannes B; Moons, Karel G M; Hoes, Arno W; Rutten, Frans H

2014-01-01

Reduced exercise tolerance and dyspnea are common in older people, and heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the main causes. We want to determine the prevalence of previously unrecognized HF, COPD, and other chronic diseases in frail older people using a near-home targeted screening strategy. Community-dwelling frail persons aged ≥65 years underwent a 2-step screening strategy. First, they received a questionnaire inquiring about dyspnea and exercise tolerance. Those with exercise intolerance and/or dyspnea were invited to visit their primary care physician's office for a screening program, including medical history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. The final diagnosis of every patient was determined by a panel consisting of 3 physicians. Of the 570 elderly who filled out the questionnaire, 395 (69%) had reduced exercise tolerance or dyspnea. Of these, 389 underwent the screening program: 127 (33.5%, 95% confidence interval, 28.9-38.4%) were newly diagnosed with HF (mainly HF with a preserved ejection fraction [23.5%]), and previously unrecognized COPD was detected in 16.8% (95% confidence interval, 13.4-20.9%). In total, 165 patients (43.9%) received a new diagnosis of either HF, COPD, or both. Other new diagnoses (in 32.7% of the screening program patients) included atrial fibrillation (1.8%), valvular disease (21.4%), (persisting) asthma (3.1%), anemia (12.7%), and thyroid disease (0.6%). No clear explanation for the complaints of 47 patients (12.2%) was found using our strategy. Unrecognized chronic diseases might be detected in community-dwelling frail elderly using a near-home screening strategy that is simple to implement. It remains to be proven, however, whether optimizing treatment of the newly detected diagnoses in this fragile population with multimorbidities and polypharmacy improves quality of life and reduces morbidity and mortality. © Copyright 2014 by the American Board of Family Medicine.

Report on the HAARP 2008 Winter Campaign Focusing on Artificial Ionospheric Irregularities

DTIC Science & Technology

2008-07-31

Figure Bl. Magnetic field variations recorded by the fluxgate magnetometer 30 Figure B2. Composite ionogram showing the variation of the reflection...variation was monitored by the Fluxgate Magnetometer . The density irregularities were monitored by the Ionosonde. 20:00 Preliminary Results The...magnetic field variations in three directions (H, D, and Z) recorded by the fluxgate magnetometer from UTC 20:00 to 04:00 are shown in the plots of

Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies.

PubMed

Ghosh, Raktim K; Ball, Somedeb; Prasad, Vinita; Gupta, Anjan

2016-12-01

Heart failure (HF) is a burgeoning chronic health condition affecting more than 20million people worldwide. Patients with HF have a significant (17.1%) 30-day readmission rate, which invites substantial penalty in payment to hospitals from Centers for Medicare and Medicaid Services, as per the newly introduced Hospital Readmissions Reduction Program. Depression is one of the important risk factors for readmission in HF patients. It has a significant prevalence in patients with HF and contributes to the overall poor quality of life in them. Several behavioral (smoking, obesity, lack of exercise and medication noncompliance) and pathophysiological factors (hypercortisolism, elevated inflammatory biomarkers, fibrinogen, and atherosclerosis) have been found responsible for the adverse outcome in patients with HF and concomitant depression. Hippocampal volume loss noted in patients with acute HF exacerbations may contribute to the development of depressive symptoms in them. Screening for depression in HF patients continues to be challenging due to a considerable overlap in symptoms. Published trials on the use of antidepressants and cognitive behavioral therapy (CBT) have shown variable outcomes. Newer modalities like internet-based CBT have been tried in small studies, with promising results. A recent meta-analysis observed the beneficial role of aerobic exercise training in patients with HFrEF. Future long-term prospective studies may contribute to the formulation of a detailed screening and management guideline for patients with HF and depression. Our review is aimed to summarize the intricate relationship between depression and heart failure, with respect to their epidemiology, pathophysiological aspects, and optimal management approach. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Maternal High-Fat and High-Salt Diets Have Differential Programming Effects on Metabolism in Adult Male Rat Offspring.

PubMed

Segovia, Stephanie A; Vickers, Mark H; Harrison, Claudia J; Patel, Rachna; Gray, Clint; Reynolds, Clare M

2018-01-01

Maternal high-fat or high-salt diets can independently program adverse cardiometabolic outcomes in offspring. However, there is a paucity of evidence examining their effects in combination on metabolic function in adult offspring. Female Sprague Dawley rats were randomly assigned to either: control (CD; 10% kcal from fat, 1% NaCl), high-salt (SD; 10% kcal from fat, 4% NaCl), high-fat (HF; 45% kcal from fat, 1% NaCl) or high-fat and salt (HFSD; 45% kcal from fat, 4% NaCl) diets 21 days prior to mating and throughout pregnancy and lactation. Male offspring were weaned onto a standard chow diet and were culled on postnatal day 130 for plasma and tissue collection. Adipocyte histology and adipose tissue, liver, and gut gene expression were examined in adult male offspring. HF offspring had significantly greater body weight, impaired insulin sensitivity and hyperleptinemia compared to CD offspring, but these increases were blunted in HFSD offspring. HF offspring had moderate adipocyte hypertrophy and increased expression of the pre-adipocyte marker Dlk1 . There was a significant effect of maternal salt with increased hepatic expression of Dgat1 and Igfb2 . Gut expression of inflammatory ( Il1r1, Tnfα, Il6 , and Il6r ) and renin-angiotensin system ( Agtr1a, Agtr1b ) markers was significantly reduced in HFSD offspring compared to HF offspring. Therefore, salt mitigates some adverse offspring outcomes associated with a maternal HF diet, which may be mediated by altered adipose tissue morphology and gut inflammatory and renin-angiotensin regulation.

Undertreatment of hyperlipidemia in patients with coronary artery disease and heart failure.

PubMed

Sueta, Carla A; Massing, Mark W; Chowdhury, Mridul; Biggs, David P; Simpson, Ross J

2003-02-01

Coronary artery disease patients with heart failure (CAD+HF) are at high risk for cardiovascular events. We examined the frequency of lipid assessment and prescription of lipid-lowering agents in outpatients with combined CAD+HF compared with patients with CAD alone. We analyzed an administrative data set from the Quality Assurance Program II, a Merck & Co., Inc., sponsored national retrospective chart audit of 41,487 CAD patients seen at 296 ambulatory medical practices. About 34% of these patients had CAD+HF. Documentation of low-density lipoprotein (LDL) cholesterol was significantly lower in patients with CAD+HF (53%) compared with those with CAD alone (69%). Lipid-lowering drugs were prescribed in only 36% of patients with CAD+HF, compared with 52% of patients with CAD alone. Lipid levels alone did not justify this disparity. Patients with documented LDL cholesterol values were 4 times more likely to receive a prescription for a lipid-lowering medication than those without recorded values. Other predictors of lipid-lowering prescription included: younger age, history of myocardial infarction, revascularization, care by a cardiologist, and geographic region. Patients with CAD, HF, and advanced age simultaneously experience among the highest risk and the lowest lipid-lowering treatment rates. Strategies to increase LDL testing and aggressively treat patients with heart failure and CAD are warranted.

Flaxseed oil during lactation changes milk and body composition in male and female suckling pups rats.

PubMed

Guarda, Deysla Sabino; Lisboa, Patricia Cristina; de Oliveira, Elaine; Nogueira-Neto, José Firmino; de Moura, Egberto Gaspar; Figueiredo, Mariana Sarto

2014-07-01

We have reported several changes in neonate or adult offspring after the maternal use of whole flaxseed or its components. However, it is unknown the use of higher oil intake in the neonatal period. Here we evaluated the effects of high maternal intake of flaxseed oil during lactation upon milk and body composition in male and female offspring. Lactating rats were divided into: (1) control (C, n=10), 7% soybean oil; (2) hyper 19% soybean oil (HS, n=10); and (3) hyper 17% flaxseed oil+2% soybean oil (HF, n=10). Dams and offspring were killed at weaning. HS and HF dams, male and female offspring presented lower body weight during lactation. HF mothers presented lower body and visceral fat masses. HF male offspring presented lower body and subcutaneous fat masses. HS and HF milk presented lower triglycerides (TG) and cholesterol. HF male and female offspring showed lower triglyceridemia and insulinemia, but no changes in glycemia and leptinemia. The higher intake of flaxseed oil during lactation reduced the body weight of mothers and offspring, decreases milk lipids and apparently increases insulin sensitivity in this critical period of life. Those changes may explain the previously reported programming effect of maternal flaxseed intake during lactation. Copyright © 2014 Elsevier Ltd. All rights reserved.

An introduction to high-frequency nutrient and biogeochemical monitoring for the Sacramento–San Joaquin Delta, northern California

USGS Publications Warehouse

Kraus, Tamara E.C.; Bergamaschi, Brian A.; Downing, Bryan D.

2017-07-11

Executive SummaryThis report is the first in a series of three reports that provide information about high-frequency (HF) nutrient and biogeochemical monitoring in the Sacramento–San Joaquin Delta of northern California (Delta). This first report provides an introduction to the reasons for and fundamental concepts behind collecting HF measurements, and describes the benefits associated with a real-time, continuous, HF, multi-parameter water quality monitoring station network that is co-located with flow stations. It then provides examples of how HF nutrient measurements have improved our understating of nutrient sources and cycling in aquatic systems worldwide, followed by specific examples from the Delta. These examples describe the ways in which HF instrumentation may be used for both fixed-station and spatial assessments. The overall intent of this document is to describe how HF measurements currently (2017) are being used in the Delta to examine the relationship between nutrient concentrations, nutrient cycling, and aquatic habitat conditions.The second report in the series (Downing and others, 2017) summarizes information about HF nutrient and associated biogeochemical monitoring in the northern Delta. The report synthesizes data available from the nutrient and water quality monitoring network currently operated by the U.S. Geological Survey in this ecologically important region of the Delta. In the report, we present and discuss the available data at various timescales—first, at the monthly, seasonal, and inter-annual timescales; and, second, for comparison, at the tidal and event (for example, storms, reservoir releases, phytoplankton blooms) timescales. As expected, we determined that there is substantial variability in nitrate concentrations at short timescales within hours, but also significant variability at longer timescales such as months or years. This multi-scale, high variability affects calculation of fluxes and loads, indicating that HF monitoring is necessary for understanding and assessing flux-based processes and outcomes in tidal environments, such as the Delta.The third report in the series (Bergamaschi and others, 2017) provides information about how to design HF nutrient and biogeochemical monitoring for assessment of nutrient inputs and dynamics in the Delta. The report provides background, principles, and considerations for designing an HF nutrient-monitoring network for the Sacramento–San Joaquin Delta to address high-priority, nutrient-management questions. The report starts with high-priority management questions to be addressed, continues with questions and considerations that place demands and constraints on network design, discusses the principles applicable to network design, and concludes with the presentation of three example nutrient‑monitoring network designs for the Delta. For the three example networks, we assess how they would address high-priority questions identified by the Delta Regional Monitoring Program (Delta Regional Monitoring Program Technical Advisory Committee, 2015).

Conceptual model for heart failure disease management.

PubMed

Andrikopoulou, Efstathia; Abbate, Kariann; Whellan, David J

2014-03-01

The objective of this review is to propose a conceptual model for heart failure (HF) disease management (HFDM) and to define the components of an efficient HFDM plan in reference to this model. Articles that evaluated 1 or more of the following aspects of HFDM were reviewed: (1) outpatient clinic follow-up; (2) self-care interventions to enhance patient skills; and (3) remote evaluation of worsening HF either using structured telephone support (STS) or by monitoring device data (telemonitoring). The success of programs in reducing readmissions and mortality were mixed. Outpatient follow-up programs generally resulted in improved outcomes, including decreased readmissions. Based on 1 meta-analysis, specialty clinics improved outcomes and nonspecialty clinics did not. Results from self-care programs were inconsistent and might have been affected by patient cognitive status and educational level, and intervention intensity. Telemonitoring, despite initially promising meta-analyses demonstrating a decrease in the number and duration of HF-related readmissions and all-cause mortality rates at follow-up, has not been shown in randomized trials to consistently reduce readmissions or mortality. However, evidence from device monitoring trials in particular might have been influenced by technology and design issues that might be rectified in future trials. Results from the literature suggest that the ideal HFDM plan would include outpatient follow-up at an HF specialty clinic and continuous education to improve patient self-care. The end result of this plan would lead to better understanding on the part of the patient and improved patient ability to recognize and respond to signs of decompensation. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Confidence Region for the Evaluation of HF DF Single Site Location Systems.

DTIC Science & Technology

1983-09-02

CONTRACT ORt GRANT NUMBER(@) M.H. Reilly and J. Coran S. PERFORMING ORGANIZATION NAME AND ADDRESS WD PROGRAM ELEMENT. PROJECTAS Naval Research...1 DETERMINATION OF THE CONFIDENCE REGION....................2 COMPUTER PROGRAM FOR THE CONFIDENCE ELLIPSE..............5 EXAMPLES OF COMPUTER... PROGRAM OUTPUT......................6 DISCUSSION ................................................... 7 ACKNOWLEDGMENTS

Stimulating safety culture change in four field demonstration pilots

DOT National Transportation Integrated Search

2010-01-01

Approximately 10 years ago, FRA began investigating organizational culture. Subsequent reorganization of the Volpe Center and HF Program to include Org. Culture & Safety Performance program. This is a summary of FRA field evaluations on the impact of...

Novel Stimulated Electromagnetic Emission Observations with Artificial Airglow Using RF Excitation with HAARP

NASA Astrophysics Data System (ADS)

Briczinski, S. J., Jr.; Bernhardt, P. A.; Siefring, C. L.; Michell, R.; Hampton, D. L.; Watkins, B. J.; Bristow, W. A.

2014-12-01

Neutral hydrogen plays an important role in determining the state of the plasmasphere and its response to forcing from geomagnetic storms. Hydrogen's solar cycle variation is counterintuitive: there is more hydrogen at solar minimum at 300 km that there is at solar maximum. Similarly there is more hydrogen in winter than in summer and hydrogen density maximizes in the morning. In this presentation we describe these variations and consider some possible causes for them.

Visual analysis as a method of interpretation of the results of satellite ionospheric measurements for exploratory problems

NASA Astrophysics Data System (ADS)

Korneva, N. N.; Mogilevskii, M. M.; Nazarov, V. N.

2016-05-01

Traditional methods of time series analysis of satellite ionospheric measurements have some limitations and disadvantages that are mainly associated with the complex nonstationary signal structure. In this paper, the possibility of identifying and studying the temporal characteristics of signals via visual analysis is considered. The proposed approach is illustrated by the example of the visual analysis of wave measurements on the DEMETER microsatellite during its passage over the HAARP facility.

Developing New Treatments for Heart Failure: Focus on the Heart.

PubMed

Gheorghiade, Mihai; Larson, Christopher J; Shah, Sanjiv J; Greene, Stephen J; Cleland, John G F; Colucci, Wilson S; Dunnmon, Preston; Epstein, Stephen E; Kim, Raymond J; Parsey, Ramin V; Stockbridge, Norman; Carr, James; Dinh, Wilfried; Krahn, Thomas; Kramer, Frank; Wahlander, Karin; Deckelbaum, Lawrence I; Crandall, David; Okada, Shunichiro; Senni, Michele; Sikora, Sergey; Sabbah, Hani N; Butler, Javed

2016-05-01

Compared with heart failure (HF) care 20 to 30 years ago, there has been tremendous advancement in therapy for ambulatory HF with reduced ejection fraction with the use of agents that block maladaptive neurohormonal pathways. However, during the past decade, with few notable exceptions, the frequency of successful drug development programs has fallen as most novel therapies have failed to offer incremental benefit or raised safety concerns (ie, hypotension). Moreover, no therapy has been approved specifically for HF with preserved ejection fraction or for worsening chronic HF (including acutely decompensated HF). Across the spectrum of HF, preliminary results from many phase II trials have been promising but are frequently followed by unsuccessful phase III studies, highlighting a disconnect in the translational process between basic science discovery, early drug development, and definitive clinical testing in pivotal trials. A major unmet need in HF drug development is the ability to identify homogeneous subsets of patients whose underlying disease is driven by a specific mechanism that can be targeted using a new therapeutic agent. Drug development strategies should increasingly consider therapies that facilitate reverse remodeling by directly targeting the heart itself rather than strictly focusing on agents that unload the heart or target systemic neurohormones. Advancements in cardiac imaging may allow for more focused and direct assessment of drug effects on the heart early in the drug development process. To better understand and address the array of challenges facing current HF drug development, so that future efforts may have a better chance for success, the Food and Drug Administration facilitated a meeting on February 17, 2015, which was attended by clinicians, researchers, regulators, and industry representatives. The following discussion summarizes the key takeaway dialogue from this meeting. © 2016 American Heart Association, Inc.

Moderate caloric restriction in lactating rats programs their offspring for a better response to HF diet feeding in a sex-dependent manner.

PubMed

Palou, Mariona; Torrens, Juana María; Priego, Teresa; Sánchez, Juana; Palou, Andreu; Picó, Catalina

2011-06-01

We aimed to assess the lasting effects of moderate caloric restriction in lactating rats on the expression of key genes involved in energy balance of their adult offspring (CR) and their adaptations under high-fat (HF) diet. Dams were fed with either ad libitum normal-fat (NF) diet or a 30% caloric restricted diet throughout lactation. After weaning, the offspring were fed with NF diet until the age of 15 weeks and then with an NF or a HF diet until the age of 28 weeks, when they were sacrificed. Body weight and food intake were followed. Blood parameters and the expression of selected genes in hypothalamus and white adipose tissue (WAT) were analysed. CR ate fewer calories and showed lower body weight gain under HF diet than their controls. CR males were also resistant to the increase of insulin and leptin occurring in their controls under HF diet, and HF diet exposed CR females showed lower circulating fasting triglyceride levels than controls. In the hypothalamus, CR males had higher ObRb mRNA levels than controls, and CR females displayed greater InsR mRNA levels than controls and decreased neuropeptide Y mRNA levels when exposed to HF diet. CR males maintained WAT capacity of fat uptake and storage and of fatty-acid oxidation under HF diet, whereas these capacities were impaired in controls; female CR showed higher WAT ObRb mRNA levels than controls. These results suggest that 30% caloric restriction in lactating dams ameliorates diet-induced obesity in their offspring by enhancing their sensitivity to insulin and leptin signaling, but in a gender-dependent manner. Copyright © 2011 Elsevier Inc. All rights reserved.

Numerical simulation of hydrogen fluorine overtone chemical lasers

NASA Astrophysics Data System (ADS)

Chen, Jinbao; Jiang, Zhongfu; Hua, Weihong; Liu, Zejin; Shu, Baihong

1998-08-01

A two-dimensional program was applied to simulate the chemical dynamic process, gas dynamic process and lasing process of a combustion-driven CW HF overtone chemical lasers. Some important parameters in the cavity were obtained. The calculated results included HF molecule concentration on each vibration energy level while lasing, averaged pressure and temperature, zero power gain coefficient of each spectral line, laser spectrum, the averaged laser intensity, output power, chemical efficiency and the length of lasing zone.

Rationale and design of the Japanese heart failure outpatients disease management and cardiac evaluation (J-HOMECARE).

PubMed

Tsuchihashi-Makaya, Miyuki; Matsuo, Hisashi; Kakinoki, Shigeo; Takechi, Shigeru; Tsutsui, Hiroyuki

2011-09-01

Although many studies have demonstrated the efficacy of disease management programs on mortality, morbidity, quality of life (QOL), and medical cost in patients with heart failure (HF), no study has focused on psychological status as an outcome of disease management. In addition, very little information is available on the effectiveness of disease management programs in other areas than the USA and Europe. The Japanese Heart Failure Outpatients Disease Management and Cardiac Evaluation (J-HOMECARE) is a randomized controlled trial in which 156 patients hospitalized with HF will be randomized into usual care or a home-based disease management arm receiving comprehensive advice and counseling by visiting nurses during the initial 2 months and telephone follow-up for the following 4 months after discharge. This study evaluates depression and anxiety (Hospital Anxiety and Depression Scale), mortality, readmission due to HF, and QOL (Short Form-8). Data are collected during index hospitalization and then 2, 6, and 12 months after discharge. This study started in December 2007, and the final results are expected in 2011. The J-HOMECARE will provide important information on the efficacy of disease management for psychological status as well as the effective components of disease management for patients with HF. (ClinicalTrials.gov number, NCT01284400). Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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

Rodgers, A. J.

This is the final report for United States Geological Survey (USGS) National Earthquake Hazard Reduction Program (NEHRP) Project 08HQGR0022, entitled “Quantifying Uncertainties in Ground Motion Simulations for Scenario Earthquakes on the HaywardRodgers Creek Fault System Using the USGS 3D Seismic Velocity Model and Realistic Pseudodynamics Ruptures”. Work for this project involved three-dimensional (3D) simulations of ground motions for Hayward Fault (HF) earthquakes. We modeled moderate events on the HF and used them to evaluate the USGS 3D model of the San Francisco Bay Area. We also contributed to ground motions modeling effort for a large suite of scenario earthquakes onmore » the HF. Results were presented at conferences (see appendix) and in one peer-reviewed publication (Aagaard et al., 2010).« less

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.

Gender and racial differences in surgical outcomes among adult patients with acute heart failure.

PubMed

Arslanian-Engoren, Cynthia; Sferra, Joseph J; Engoren, Milo

Approximately three million U.S. adult women have heart failure (HF), increasing their risk of adverse perioperative outcomes. While gender and racial differences are reported in surgical outcomes, less is known about 30-day perioperative outcomes in HF patients. To characterize and compare gender and racial differences in 30-day perioperative outcomes in adults with new or acute/worsening HF. The 2012-2013 American College of Surgeons National Surgical Quality Improvement Program database of surgical patients (n = 9458) with HF was analyzed. Logistic regression was used to adjust for gender and racial differences in baseline covariates. No gender difference in mortality (odds ratio = 0.922, 95% confidence interval = 0.0792-1.073, p = 0.294) was noted. Whites were more likely than Blacks to die 30 days after surgery (14% vs 9%, p < 0.001); after adjustment, Blacks were more likely to experience complications and be readmitted compared to Whites. There was no gender difference in mortality. White patients with HF were more likely to die after surgery than Black patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Delivering heart failure disease management in 3 tertiary care centers: key clinical components and venues of care.

PubMed

Shah, Monica R; Whellan, David J; Peterson, Eric D; Nohria, Anju; Hasselblad, Vic; Xue, Zhenyi; Bowers, Margaret T; O'Connor, Christopher M; Califf, Robert M; Stevenson, Lynne W

2008-04-01

Little data exist to assist to help those organizing and managing heart failure (HF) disease management (DM) programs. We aimed to describe the intensity of outpatient HF care (clinic visits and telephone calls) and medical and nonpharmacological interventions in the outpatient setting. This was a prospective substudy of 130 patients enrolled in STARBRITE in HFDM programs at 3 centers. Follow-up occurred 10, 30, 60, 90, and 120 days after discharge. The number of clinic visits and calls made by HF cardiologists, nurse practitioners, and nurses were prospectively tracked. The results were reported as medians and interquartile ranges. There were a total of 581 calls with 4 (2, 6) per patient and 467 clinic visits with 3 (2, 5) per patient. Time spent per patient was 8.9 (6, 10.6) minutes per call and 23.8 (20, 28.3) minutes per clinic visit. Nurses and nurse practitioners spent 113 hours delivering care on the phone, and physicians and nurse practitioners spent 187.6 hours in clinic. Issues addressed during calls included HF education (341 times [52.6%]) and fluid overload (87 times [41.8%]). Medical interventions included adjustments to loop diuretics (calls 101 times, clinic 156 times); beta-blockers (calls 18 times, clinic 126 times); vasodilators (calls 8 times, clinic 55 times). More than a third of clinician time was spent on calls, during which >50% of patient contacts and HF education and >39% of diuretic adjustments occurred. Administrators and public and private insurers need to recognize the amount of medical care delivered over the telephone and should consider reimbursement for these activities.

Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure.

PubMed

Kao, David P; Lindenfeld, JoAnn; Macaulay, Dendy; Birnbaum, Howard G; Jarvis, John L; Desai, Urvi S; Page, Robert L

2016-01-01

Telehealth has the potential to improve chronic disease management and outcomes, but data regarding direct benefit of telehealth in patients with heart failure (HF) have been mixed. The objective of this study was to determine whether the Health Buddy Program (HBP) (Bosch Healthcare, Palo Alto, CA), a content-driven telehealth system coupled with care management, is associated with improved outcomes in Medicare beneficiaries with HF. This was a retrospective cohort study of 623 Medicare beneficiaries with HF offered HBP enrollment compared with a propensity score-matched control group of Medicare beneficiaries with HF from the Medicare 5% sample. Associations between availability of the HBP and all-cause mortality, hospitalization, hospital days, and emergency department visits were evaluated. Beneficiaries offered enrollment in the HBP had 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up (hazard ratio [HR] = 0.75; 95% confidence interval [CI], 0.63-0.89; p = 0.001). Patients who used the HBP at least once (36.9%) had 57.2% lower mortality compared with matched controls (HR = 0.43; 95% CI, 0.31-0.60; p < 0.001), whereas patients who did not use the HBP had no significant difference in survival (HR = 0.96; 95% CI, 0.78-1.19; p = 0.69). Patients offered the HBP also had fewer hospital admissions following enrollment (Δ = -0.05 admissions/quarter; p = 0.011), which was primarily observed in patients who used the HBP at least once (Δ = -0.10 admissions/quarter; p < 0.001). The HBP, a content-driven telehealth system coupled with care management, was associated with significantly better survival and reduced hospitalization in Medicare beneficiaries with HF. Prospective study is warranted to determine the mechanism of this association and opportunities for optimization.

The Effectiveness of a Nurse-Led Cognitive-Behavioral Therapy on the Quality of Life, Self-Esteem and Mood Among Filipino Patients Living With Heart Failure: a Randomized Controlled Trial.

PubMed

Cajanding, Ruff Joseph Macale

2016-08-01

The diagnosis and complications associated with heart failure (HF) have been very well established to adversely impact an individual's physical and psychosocial well-being, and interventions such as cognitive-behavioral techniques have demonstrated potential positive benefits among patients with HF. However, the effects of such interventions among Filipino HF patients have not been studied. This study aimed to determine the effectiveness of a nurse-led cognitive-behavioral intervention program on the quality of life, self-esteem and mood among Filipino patients with HF. A randomized control two-group design with repeated measures and collected data before and after the intervention was used in this study. Participants were assigned to either the control (n=48) or the intervention group (n=52). Control group participants received traditional care. Intervention participants underwent a 12-week nurse-led cognitive-behavioral intervention program focusing on patient education, self-monitoring, skills training, cognitive restructuring and spiritual development. Measures of quality of life, self-esteem and mood were obtained at baseline and after the intervention. At baseline, participants in both groups have poor quality of life, low self-esteem, and moderate depressive symptom scores. After the 12-week intervention period, participants in the intervention group had significant improvement in their quality of life, self-esteem and mood scores compared with those who received only standard care. Nurse-led cognitive-behavioral intervention is an effective strategy in improving the quality of life, self-esteem and mood among Filipino patients living with HF. It is recommended that this intervention be incorporated in the optimal care of patients with this cardiac condition. Copyright © 2015 Elsevier Inc. All rights reserved.

Predictors of physical activity in patients with heart failure: a questionnaire study.

PubMed

Chien, Hui-Chin; Chen, Hsing-Mei; Garet, Martin; Wang, Ruey-Hsia

2014-07-01

Adequate physical activity is believed to help decrease readmission and improve quality of life for patients with heart failure (HF). The aim of this study was to explore the predictors of physical activity level 1 month after discharge from hospital in Taiwanese patients with HF. A prospective research design was used. Overall, 111 patients with HF from a medical center in Southern Taiwan were recruited. Symptomatic distress, self-efficacy for physical activity, physical activity knowledge, and demographic and disease characteristics of patients with HF were collected at their discharge. One month later, patients' total daily energy expenditure (DEE), DEE for low-intensity physical activities (PA(low) DEE; strictly <3 metabolic equivalents [METs]), DEE for high-intensity physical activities (PA(high) DEE; 3-5 METs), and DEE for intensive-intensity physical activities (PA(intensive) DEE; strictly >5 METs) were collected. The mean total DEE was 8175.85 ± 2595.12 kJ 24 h, of which 19.12% was for PAlow DEE, 7.20% was for PA(high) DEE, and only 1.42% was for PA(intensive) DEE. Body mass index (BMI), age, self-efficacy for instrumental activities of daily living, and educational level were predictors of total DEE of patients with HF 1 month after discharge. Self-efficacy for instrumental activities of daily living, gender, and BMI were predictors of PA(high) DEE. Age, BMI, and symptom distress were predictors of PA(intensive) DEE. Taiwanese patients with HF practiced lower intensity physical activities. Factors related to physical activity of patients with HF in Taiwan were similar to those of Western countries. Nurses should emphasize the importance of physical activity to patients with HF who are male, of older age, with lower educational level, or with lower BMI. Improving self-efficacy for instrumental activities and decreasing symptom distress should be incorporated into discharge planning programs for patients with HF.

Calving traits, milk production, body condition, fertility, and survival of Holstein-Friesian and Norwegian Red dairy cattle on commercial dairy farms over 5 lactations.

PubMed

Ferris, C P; Patterson, D C; Gordon, F J; Watson, S; Kilpatrick, D J

2014-01-01

The objective of this study was to compare calving traits, BCS, milk production, fertility, and survival of Holstein-Friesian (HF) and Norwegian Red (NR) dairy cattle in moderate-concentrate input systems. The experiment was conducted on 19 commercial Northern Ireland dairy farms, and involved 221 HF cows and 221 NR cows. Cows completed 5 lactations during the experiment, unless they died or were culled or sold. Norwegian Red cows had a lower calving difficulty score than HF cows when calving for the first and second time, but not for the third and fourth time. At first calving, the incidence of stillbirths for NR cows was 4%, compared with 13% for HF cows, whereas no difference existed between breeds in the proportion of calves born alive when calving for the second time. When calving for the first time, NR cows had a poorer milking temperament than HF cows, whereas milking temperament was unaffected by breed following the second calving. Holstein-Friesian cows had a higher full-lactation milk yield than NR cows, whereas NR cows produced milk with a higher milk fat and protein content. Full-lactation fat + protein yield was unaffected by genotype. Norwegian Red cows had a lower somatic cell score than HF cows during all lactations. Although NR cattle had a higher BCS than the HF cows during lactations 1 and 2, no evidence existed that the 2 genotypes either lost or gained body condition at different rates. Conception rates to first artificial insemination were higher with the NR cows during lactations 1 to 4 (57.8 vs. 40.9%, respectively), with 28.5% of HF cows and 11.8% of NR cows culled as infertile before lactation 6. A greater percentage of NR cows calved for a sixth time compared with HF cows (27.2 vs. 16.3%, respectively). In general, NR cows outperformed HF cows in traits that have been historically included in the NR breeding program. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The DoD Environmental Restoration Program: An Air Force Perspective and Status Update

DTIC Science & Technology

2011-11-01

PFCs of interest Perfluorooctane sulfonate ( PFOS ) Perfluorooctanoic acid ( PFOA ) C8HF17O3S C8HF15O2 I n t e g r i t y - S...Mixtures Change in science/methods Evaluation in progress Perchlorate Lower regulatory standards Continue to monitor PFCs ( PFOS / PFOA ) Regulatory interest...e 25 DoD Activities: PFCs PFOA / PFOS on the DoD Emerging Contaminant Watch List for continued surveillance of regulatory actions SERDP

Introduction of the TEAM-HF Costing Tool: A User-Friendly Spreadsheet Program to Estimate Costs of Providing Patient-Centered Interventions

PubMed Central

Reed, Shelby D.; Li, Yanhong; Kamble, Shital; Polsky, Daniel; Graham, Felicia L.; Bowers, Margaret T.; Samsa, Gregory P.; Paul, Sara; Schulman, Kevin A.; Whellan, David J.; Riegel, Barbara J.

2011-01-01

Background Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Methods and Results Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers or health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. Conclusions The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions. PMID:22147884

Ionospheric modification at twice the electron cyclotron frequency.

PubMed

Djuth, F T; Pedersen, T R; Gerken, E A; Bernhardt, P A; Selcher, C A; Bristow, W A; Kosch, M J

2005-04-01

In 2004, a new transmission band was added to the HAARP high-frequency ionospheric modification facility that encompasses the second electron cyclotron harmonic at altitudes between approximately 220 and 330 km. Initial observations indicate that greatly enhanced airglow occurs whenever the transmission frequency approximately matches the second electron cyclotron harmonic at the height of the upper hybrid resonance. This is the reverse of what happens at higher electron cyclotron harmonics. The measured optical emissions confirm the presence of accelerated electrons in the plasma.

Investigation of Plasma Phenomena in the Ionosphere Under Natural Conditions and Under Conditions Artificially Perturbed by HAARP

DTIC Science & Technology

2008-08-31

fabricated, the concept was tested , and a number of design defects were discovered, a usual occurrence. The test board was modified with cuts and...jumper wires to correct the defects and continue testing until the design was verified. Based on the testing , new artwork was prepared. Note that...mobile data was roughly similar to the fixed station data. It also revealed a circuit design defect that required further testing at the Bellevue

Effects of simulation-based educational program in improving the nurses' self-efficacy in caring for patients' with COPD and CHF in a post-acute care (PACU) setting.

PubMed

Genuino, Mary Jane

2018-02-01

The 2014 national percentage for 30-day readmissions among Medicare recipients from Post-Acute Care Unit (PACU) showed: Heart Failure (HF) with major complications and co-morbidities, an average of 24.09%, and Chronic Obstructive Pulmonary Disease (COPD) with complications and co-morbidities 23.12%. The percentage of readmissions for New Jersey among PACU showed: HF with major complications and co-morbidities, an average of 24.40% and COPD 26.35% (Avalere Health, 2014). For this study site, the hospital readmission rate was not specifically broken down according to condition/diagnosis. Overall, the hospital readmission rate was approximately 20%. A few percent lower than the national and state average, but still a considerable number. This study is significant in finding out whether a simulation based educational program will increase the nurses' self-efficacy in caring for these patients. The positive outcome of this study can provide a template for training PACU nurses to aid in decreasing hospital readmissions in this vulnerable population. The simulation-based educational program was approximately 5h in length, and it was divided into two parts, a presentation on HF and COPD, and the actual simulation scenario, using a low-fidelity manikin (LFM). There were approximately 20 Registered nurses as participants but 4 did not complete the post-simulation self-efficacy scale, and the 16 were included in the actual study. This study was able to define the effects of simulation-based educational program on the RNs self-efficacy in caring for COPD and HF patients. The participants' demographic information, i.e. age, educational attainment, years of experience, and previous work experience, did not show any differences in how much the nurses' self-efficacy improved. The post-simulation self-efficacy score of the participants showed approximately 5% increase compared to the pre-simulation score. The outcome of the study concluded the simulation-based educational program as having a significant effect on the participants' self-efficacy post-simulation. Copyright © 2017 Elsevier Inc. All rights reserved.

Heart failure severity, inappropriate ICD therapy, and novel ICD programming: a MADIT-RIT substudy.

PubMed

Daimee, Usama A; Vermilye, Katherine; Rosero, Spencer; Schuger, Claudio D; Daubert, James P; Zareba, Wojciech; McNitt, Scott; Polonsky, Bronislava; Moss, Arthur J; Kutyifa, Valentina

2017-12-01

The effects of heart failure (HF) severity on risk of inappropriate implantable cardioverter-defibrillator (ICD) therapy have not been thoroughly investigated. We aimed to study the association between HF severity and inappropriate ICD therapy in MADIT-RIT. MADIT-RIT randomized 1,500 patients to three ICD programming arms: conventional (Arm A), high-rate cut-off (Arm B: ≥200 beats/min), and delayed therapy (Arm C: 60-second delay for ≥170 beats/min). We evaluated the association between New York Heart Association (NYHA) class III (n = 256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A patients with ICD-only and cardiac resynchronization therapy with defibrillator (CRT-D). We additionally assessed benefit of novel ICD programming in Arms B and C versus Arm A by NYHA classification. In Arm A, the risk of inappropriate therapy was significantly higher in those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] = 2.55, confidence interval [CI]: 1.51-4.30, P < 0.001) and CRT-D patients (HR = 3.73, CI: 1.14-12.23, P = 0.030). This was consistent for inappropriate ATP and inappropriate ICD therapy < 200 beats/min, but not for inappropriate shocks. Novel ICD programming significantly reduced inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR = 0.08, P < 0.001; Arm C vs Arm A: HR = 0.17, P < 0.001) and NYHA I-II (Arm B vs Arm A: HR = 0.25, P < 0.001; Arm C vs Arm A: HR = 0.28, P < 0.001). Patients with more severe HF are at increased risk for inappropriate ICD therapy, particularly ATP due to arrhythmias < 200 beats/min. Novel programming with high-rate cut-off or delayed detection reduces inappropriate ICD therapies in both mild and moderate HF. © 2017 Wiley Periodicals, Inc.

Effects of Interfacial Fluorination on Performance Enhancement of High-k-Based Charge Trap Flash Memory

NASA Astrophysics Data System (ADS)

Wang, Chenjie; Huo, Zongliang; Liu, Ziyu; Liu, Yu; Cui, Yanxiang; Wang, Yumei; Li, Fanghua; Liu, Ming

2013-07-01

The effects of interfacial fluorination on the metal/Al2O3/HfO2/SiO2/Si (MAHOS) memory structure have been investigated. By comparing MAHOS memories with and without interfacial fluorination, it was identified that the deterioration of the performance and reliability of MAHOS memories is mainly due to the formation of an interfacial layer that generates excess oxygen vacancies at the interface. Interfacial fluorination suppresses the growth of the interfacial layer, which is confirmed by X-ray photoelectron spectroscopy depth profile analysis, increases enhanced program/erase efficiency, and improves data retention characteristics. Moreover, it was observed that fluorination at the SiO-HfO interface achieves a more effective performance enhancement than that at the HfO-AlO interface.

Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology.

PubMed

Thomson, Nick; Moore, Tim; Crofts, Nick

2012-07-09

For over 15 years the Australian Agency for International Development (AusAID) has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP), from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP), from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers.In July 2008, the Australian Development Research Awards (ADRA) funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project). The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness.While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR.

Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology

PubMed Central

2012-01-01

For over 15 years the Australian Agency for International Development (AusAID) has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP), from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP), from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers. In July 2008, the Australian Development Research Awards (ADRA) funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project). The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness. While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR. PMID:22769050

Outcomes of a Mobile Phone Intervention for Heart Failure in a Minority County Hospital Population.

PubMed

Dang, Stuti; Karanam, Chandana; Gómez-Marín, Orlando

2017-06-01

Chronic heart failure (HF) causes significant morbidity, mortality, and cost. Managing HF requires considerable self-management skills and self-efficacy. Little information exists about feasibility and potential impact of a mobile monitoring intervention to improve self-efficacy and quality of life (QoL) among minority patients with HF. We developed a mobile phone-assisted case management program and tested its impact on outcomes in minority patients with HF in a 2:1 randomized controlled trial. We evaluated self-care efficacy, knowledge, behavior, and QoL at baseline and 3 months. We enrolled 61 participants: intervention 42, usual care 19; mean age ± SD: 55 ± 10 years; 64% male; 75% white Hispanic, 25% African American; and 56% high school education or less. Comparison of the two groups with respect to changes from baseline to 3 months showed significant differences for Self-Efficacy for Managing Chronic Disease (2.09 ± 2.32, p-value = 0.005); health distress scale (-1.1 ± 1.5, p-value = 0.017); and QoL (Role Physical, 23.6 ± 44.5, p-value = 0.042, and General Health, 11.1 ± 14.2, p-value = 0.012). A mobile phone-based disease management program may help improve self-care efficacy and QoL in a minority population and offers a modality to help reduce ethnic disparity.

Community-based care for the specialized management of heart failure: an evidence-based analysis.

PubMed

2009-01-01

In August 2008, the Medical Advisory Secretariat (MAS) presented a vignette to the Ontario Health Technology Advisory Committee (OHTAC) on a proposed targeted health care delivery model for chronic care. The proposed model was defined as multidisciplinary, ambulatory, community-based care that bridged the gap between primary and tertiary care, and was intended for individuals with a chronic disease who were at risk of a hospital admission or emergency department visit. The goals of this care model were thought to include: the prevention of emergency department visits, a reduction in hospital admissions and re-admissions, facilitation of earlier hospital discharge, a reduction or delay in long-term care admissions, and an improvement in mortality and other disease-specific patient outcomes.OHTAC approved the development of an evidence-based assessment to determine the effectiveness of specialized community based care for the management of heart failure, Type 2 diabetes and chronic wounds.PLEASE VISIT THE MEDICAL ADVISORY SECRETARIAT WEB SITE AT: www.health.gov.on.ca/ohtas to review the following reports associated with the Specialized Multidisciplinary Community-Based care series.Specialized multidisciplinary community-based care series: a summary of evidence-based analysesCommunity-based care for the specialized management of heart failure: an evidence-based analysisCommunity-based care for chronic wound management: an evidence-based analysisPlease note that the evidence-based analysis of specialized community-based care for the management of diabetes titled: "Community-based care for the management of type 2 diabetes: an evidence-based analysis" has been published as part of the Diabetes Strategy Evidence Platform at this URL: http://www.health.gov.on.ca/english/providers/program/mas/tech/ohtas/tech_diabetes_20091020.htmlPLEASE VISIT THE TORONTO HEALTH ECONOMICS AND TECHNOLOGY ASSESSMENT COLLABORATIVE WEB SITE AT: http://theta.utoronto.ca/papers/MAS_CHF_Clinics_Report.pdf to review the following economic project associated with this series:Community-based Care for the specialized management of heart failure: a cost-effectiveness and budget impact analysis. The objective of this evidence-based analysis was to determine the effectiveness of specialized multidisciplinary care in the management of heart failure (HF). TARGET POPULATION AND CONDITION HF is a progressive, chronic condition in which the heart becomes unable to sufficiently pump blood throughout the body. There are several risk factors for developing the condition including hypertension, diabetes, obesity, previous myocardial infarction, and valvular heart disease.(1) Based on data from a 2005 study of the Canadian Community Health Survey (CCHS), the prevalence of congestive heart failure in Canada is approximately 1% of the population over the age of 12.(2) This figure rises sharply after the age of 45, with prevalence reports ranging from 2.2% to 12%.(3) Extrapolating this to the Ontario population, an estimated 98,000 residents in Ontario are believed to have HF. Disease management programs are multidisciplinary approaches to care for chronic disease that coordinate comprehensive care strategies along the disease continuum and across healthcare delivery systems.(4) Evidence for the effectiveness of disease management programs for HF has been provided by seven systematic reviews completed between 2004 and 2007 (Table 1) with consistency of effect demonstrated across four main outcomes measures: all cause mortality and hospitalization, and heart-failure specific mortality and hospitalization. (4-10) However, while disease management programs are multidisciplinary by definition, the published evidence lacks consistency and clarity as to the exact nature of each program and usual care comparators are generally ill defined. Consequently, the effectiveness of multidisciplinary care for the management of persons with HF is still uncertain. Therefore, MAS has completed a systematic review of specialized, multidisciplinary, community-based care disease management programs compared to a well-defined usual care group for persons with HF. What is the effectiveness of specialized, multidisciplinary, community-based care (SMCCC) compared with usual care for persons with HF? LITERATURE SEARCH STRATEGY: A comprehensive literature search was completed of electronic databases including MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Library and Cumulative Index to Nursing & Allied Health Literature. Bibliographic references of selected studies were also searched. After a review of the title and abstracts, relevant studies were obtained and the full reports evaluated. All studies meeting explicit inclusion and exclusion criteria were retained. Where appropriate, a meta-analysis was undertaken to determine the pooled estimate of effect of specialized multidisciplinary community-based care for explicit outcomes. The quality of the body of evidence, defined as one or more relevant studies was determined using GRADE Working Group criteria. (11) INCLUSION CRITERIA: Randomized controlled trialSystematic review with meta analysisPopulation includes persons with New York Heart Association (NYHA) classification 1-IV HFThe intervention includes a team consisting of a nurse and physician one of which is a specialist in HF management.The control group receives care by a single practitioner (e.g. primary care physician (PCP) or cardiologist)The intervention begins after discharge from the hospitalThe study reports 1-year outcomes The intervention is delivered predominately through home-visitsStudies with mixed populations where discrete data for HF is not reported All cause mortalityAll cause hospitalizationHF specific mortalityHF specific hospitalizationAll cause duration of hospital stayHF specific duration of hospital stayEmergency room visitsQuality of Life One large and seven small randomized controlled trials were obtained from the literature search. A meta-analysis was completed for four of the seven outcomes including: All cause mortalityHF-specific mortalityAll cause hospitalizationHF-specific hospitalization.Where the pooled analysis was associated with significant heterogeneity, subgroup analyses were completed using two primary categories: direct and indirect model of care; andtype of control group (PCP or cardiologist).The direct model of care was a clinic-based multidisciplinary HF program and the indirect model of care was a physician supervised, nurse-led telephonic HF program. All studies, except one, were completed in jurisdictions outside North America. (12-19) Similarly, all but one study had a sample size of less than 250. The mean age in the studies ranged from 65 to 77 years. Six of the studies(12;14-18) included populations with a NYHA classification of II-III. In two studies, the control treatment was a cardiologist (12;15) and two studies reported the inclusion of a dietitian, physiotherapist and psychologist as members of the multidisciplinary team (12;19). ALL CAUSE MORTALITY: Eight studies reported all cause mortality (number of persons) at 1 year follow-up. (12-19) When the results of all eight studies were pooled, there was a statistically significant RRR of 29% with moderate heterogeneity (I(2) of 38%). The results of the subgroup analyses indicated a significant RRR of 40% in all cause mortality when SMCCC is delivered through a direct team model (clinic) and a 35% RRR when SMCCC was compared with a primary care practitioner. HF-SPECIFIC MORTALITY: Three studies reported HF-specific mortality (number of persons) at 1 year follow-up. (15;18;19) When the results of these were pooled, there was an insignificant RRR of 42% with high statistical heterogeneity (I(2) of 60%). The GRADE quality of evidence is moderate for the pooled analysis of all studies. ALL CAUSE HOSPITALIZATION: Seven studies reported all cause hospitalization at 1-year follow-up (13-15;17-19). When pooled, their results showed a statistically insignificant 12% increase in hospitalizations in the SMCCC group with high statistical heterogeneity (I(2) of 81%). A significant RRR of 12% in all cause hospitalization in favour of the SMCCC care group was achieved when SMCCC was delivered using an indirect model (telephonic) with an associated (I(2) of 0%). The Grade quality of evidence was found to be low for the pooled analysis of all studies and moderate for the subgroup analysis of the indirect team care model. HF-SPECIFIC HOSPITALIZATION: Six studies reported HF-specific hospitalization at 1-year follow-up. (13-15;17;19) When pooled, the results of these studies showed an insignificant RRR of 14% with high statistical heterogeneity (I(2) of 60%); however, the quality of evidence for the pooled analysis of was low. DURATION OF HOSPITAL STAY: Seven studies reported duration of hospital stay, four in terms of mean duration of stay in days (14;16;17;19) and three in terms of total hospital bed days (12;13;18). Most studies reported all cause duration of hospital stay while two also reported HF-specific duration of hospital stay. These data were not amenable to meta-analyses as standard deviations were not provided in the reports. However, in general (and in all but one study) it appears that persons receiving SMCCC had shorter hospital stays, whether measured as mean days in hospital or total hospital bed days. EMERGENCY ROOM VISITS: Only one study reported emergency room visits. (14) This was presented as a composite of readmissions and ER visits, where the authors reported that 77% (59/76) of the SMCCC group and 84% (63/75) of the usual care group were either readmitted or had an ER visit within the 1 year of follow-up (P=0.029). (ABSTRACT TRUNCATED)

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

PubMed

Zhang, James X; Rathouz, Paul J; Chin, Marshall H

2003-04-01

To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

Diet-induced obesity prolongs neuroinflammation and recruits CCR2+ monocytes to the brain following herpes simplex virus (HSV)-1 latency in mice

PubMed Central

White, Katherine A.; Hutton, Scott R.; Weimer, Jill M.

2016-01-01

Herpes simplex virus (HSV)-1 is a ubiquitous human infection, with increased prevalence in obese populations. Obesity has been linked to increased inflammation, susceptibility to infection, and higher rates of anxiety disorder and cognitive impairment. To determine how obesity alters neuroinflammation and behavior following infection, we infected weanling C57BL/6 or CCR2RFP/+/CX3CR1GFP/+ mice with a very low dose of HSV-1. Following viral latency (14 days post infection (d p.i.)), mice were randomly assigned to remain on the low fat (LF) diet or switched to a 45% high fat (HF) diet. Eight weeks post diet shift, latently infected mice on the HF diet (HSV-HF) had greater microglial activation and infiltration of inflammatory CCR2+ monocytes in the hypothalamus and dentate gyrus, in comparison to both HSV-LF mice and uninfected mice on LF and HF diets. VCAM staining was present in hypothalamus and hippocampus of the HSV-HF mice in the areas of monocyte infiltration. Infiltrating monocytes also produced proinflammatory cytokines demonstrating that, along with activated microglia, monocytes contribute to sustained neuroinflammation in latently infected obese mice. Utilizing a light-dark preference test, we found that HSV-HF mice had increased anxiety-like behavior. In the marble-burying test, HF diet and HSV infection resulted in increased numbers of buried marbles. Together, these mice provide a useful, testable model to study the biobehavioral effects of obesity and latent HSV-1 infection in regards to anxiety and may provide a tool for studying diet intervention programs in the future. PMID:27311830

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.

Heart failure disease management programs: a cost-effectiveness analysis.

PubMed

Chan, David C; Heidenreich, Paul A; Weinstein, Milton C; Fonarow, Gregg C

2008-02-01

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

One-year mortality outcomes and hospital readmissions of patients admitted with acute heart failure: Data from the Trivandrum Heart Failure Registry in Kerala, India.

PubMed

Harikrishnan, Sivadasanpillai; Sanjay, Ganapathi; Agarwal, Anubha; Kumar, N Pratap; Kumar, K Krishna; Bahuleyan, Charantharayil Gopalan; Vijayaraghavan, Govindan; Viswanathan, Sunitha; Sreedharan, Madhu; Biju, R; Rajalekshmi, N; Nair, Tiny; Suresh, Krishnan; Jeemon, Panniyammakal

2017-07-01

There are sparse data on outcomes of patients with heart failure (HF) from India. The objective was to evaluate hospital readmissions and 1-year mortality outcomes of patients with HF in Kerala, India. We followed 1,205 patients enrolled in the Trivandrum Heart Failure Registry for 1 year. A trained research nurse contacted each participant every 3 months using a structured questionnaire which included hospital readmission and mortality information. The mean (SD) age was 61.2 (13.7) years, and 31% were women. One out of 4 (26%) participants had HF with preserved ejection fraction. Only 25% of patients with HF with reduced ejection fraction received guideline-directed medical therapy at discharge. Cumulative all-cause mortality at 1 year was 30.8% (n = 371), but the greatest risk of mortality was in the first 3 months (18.1%). Most deaths (61%) occurred in patients younger than 70 years. One out of every 3 (30.2%) patients was readmitted at least once over 1 year. The hospital readmission rates were similar between HF with preserved ejection fraction and HF with reduced ejection fraction patients. New York Heart Association functional class IV status and lack of guideline-directed medical treatment after index hospitalization were associated with increased likelihood of readmission. Similarly, older age, lower education status, nonischemic etiology, history of stroke, higher serum creatinine, lack of adherence to guideline-directed medical therapy, and hospital readmissions were associated with increased 1-year mortality. In the Trivandrum Heart Failure Registry, 1 of 3 HF patients died within 1 year of follow-up during their productive life years. Suboptimal adherence to guideline-directed treatment is associated with increased propensity of readmission and death. Quality improvement programs aiming to improve adherence to guideline-based therapy and reducing readmission may result in significant survival benefits in the relatively younger cohort of HF patients in India. Copyright © 2017 Elsevier Inc. All rights reserved.

Reciprocal transcriptional regulation of metabolic and signaling pathways correlates with disease severity in heart failure.

PubMed

Barth, Andreas S; Kumordzie, Ami; Frangakis, Constantine; Margulies, Kenneth B; Cappola, Thomas P; Tomaselli, Gordon F

2011-10-01

Systolic heart failure (HF) is a complex systemic syndrome that can result from a wide variety of clinical conditions and gene mutations. Despite phenotypic similarities, characterized by ventricular dilatation and reduced contractility, the extent of common and divergent gene expression between different forms of HF remains a matter of intense debate. Using a meta-analysis of 28 experimental (mouse, rat, dog) and human HF microarray studies, we demonstrate that gene expression changes are characterized by a coordinated and reciprocal regulation of major metabolic and signaling pathways. In response to a wide variety of stressors in animal models of HF, including ischemia, pressure overload, tachypacing, chronic isoproterenol infusion, Chagas disease, and transgenic mouse models, major metabolic pathways are invariably downregulated, whereas cell signaling pathways are upregulated. In contrast to this uniform transcriptional pattern that recapitulates a fetal gene expression program in experimental animal models of HF, human HF microarray studies displayed a greater heterogeneity, with some studies even showing upregulation of metabolic and downregulation of signaling pathways in end-stage human hearts. These discrepant results between animal and human studies are due to a number of factors, prominently cardiac disease and variable exposure to cold cardioplegic solution in nonfailing human samples, which can downregulate transcripts involved in oxidative phosphorylation (OXPHOS), thus mimicking gene expression patterns observed in failing samples. Additionally, β-blockers and ACE inhibitor use in end-stage human HF was associated with higher levels of myocardial OXPHOS transcripts, thus partially reversing the fetal gene expression pattern. In human failing samples, downregulation of metabolism was associated with hemodynamic markers of disease severity. Irrespective of the etiology, gene expression in failing myocardium is characterized by downregulation of metabolic transcripts and concomitant upregulation of cell signaling pathways. Gene expression changes along this metabolic-signaling axis in mammalian myocardium are a consistent feature in the heterogeneous transcriptional response observed in phenotypically similar models of HF.

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.

A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study.

PubMed

Hale, Timothy M; Jethwani, Kamal; Kandola, Manjinder Singh; Saldana, Fidencio; Kvedar, Joseph C

2016-04-17

Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high-25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno).

ROSCOE Manual, Volume 14A-1 - Ambient Atmosphere (Major and Minor Neutral Species and Ionosphere).

DTIC Science & Technology

1979-06-30

height EDDSCH 100 - 300 Parabola, determined by data-point values EBOTD and EF2MXD at altitudes HEBOTD and HF2MXD and vertical slope at altitude HF2MXD...Ionosphere) c Science Applications, Inc. P.O. Box 2351 La Jolla, California 92038 30 June 1979 Final Report for Period 1 January 1976-30 June 1979...ORGANIZATION NAME AND ADDRESS 10 PROGRAM ELEMENT. PROJECT. TASK Science Applications, Inc. V/ AREA 6 WORK U NIT NUMBERS P.O. Box 2351 Subtask S99QAXHCO62-37 La

GSDO Program Hexavalent Chrome Alternatives: Final Pretreatments Test Report

NASA Technical Reports Server (NTRS)

Kessel, Kurt

2013-01-01

Hexavalent chrome free pretreatments should be considered for use on Ground Support Equipment (OSE) and Electrical Ground Support Equipment (EOSE). Both of the hexavalent chrome free pretreatments (Metalast TCP HF and SurTec 650C) evaluated by this project met, and in some instances exceeded, the requirements ofMIL-DTL-5541 "Chemical Conversion Coatings on Aluminum and Aluminum Alloys". For DC resistance measurements, both Metalast TCP HF and SurTec (!50C met initial requirements following assembly and in many cases continued to maintain passing readings for the duration of testing.

A Formative Program Evaluation of a Postsecondary Support Program for Students with High Functioning Autism Spectrum Disorder

ERIC Educational Resources Information Center

Wise, Kelly L.

2015-01-01

Adults with a diagnosis of High Functioning Autism Spectrum Disorder (HF ASD) are becoming a significant presence on college campuses across the United States. A number of colleges have created programs to provide services to support accommodations for these students under the Americans with Disabilities Act (ADA); the first was created in 2002.…

Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria.

PubMed

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J

2012-01-01

In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug. This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.

Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria

PubMed Central

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J.

2012-01-01

Background In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. Methods NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. Findings LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child’s vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children’s illness, and only 19.9% could accurately describe how to administer the prescribed drug. Conclusion This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services. PMID:23028519

Denver Spirited Heart: Mixed-Methods Pilot Study of a Psychospiritual Intervention for Heart Failure Patients.

PubMed

Hooker, Stephanie A; Ross, Kaile; Masters, Kevin S; Park, Crystal L; Hale, Amy E; Allen, Larry A; Bekelman, David B

Increased spiritual well-being is related to quality of life (QOL) in patients with heart failure (HF). However, consistent and deliberate integration of spirituality into HF patient care has received limited attention. The aim of this study was to evaluate the feasibility, acceptability, and preliminary evidence regarding the efficacy of a resource-sparing psychospiritual intervention to improve QOL in HF patients. A 12-week mail-based intervention addressing spirituality, stress, coping, and adjusting to illness was developed and tested using a mixed-methods, 1-group pretest-posttest pilot study design. A convenience sample of patients with HF completed prestudy and poststudy questionnaires, including the Kansas City Cardiomyopathy Questionnaire, Patient Health Questionnaire, Meaning in Life Questionnaire, and Functional Assessment of Chronic Illness Therapy-Spiritual. Research staff conducted semistructured interviews with program completers. Interviews were coded and analyzed using conventional content analysis. Participants (N = 33; 82% male; mean age, 61 years) completed 87% of baseline data collection, an average of 9 intervention modules, and 55% of poststudy questionnaires. Participants rated all the modules as at least moderately helpful, and qualitative themes suggested that patients found the intervention acceptable and beneficial. Most participants believed spirituality should continue to be included, although they disagreed on the extent to which religion should remain. Participants who completed the intervention reported evidence suggesting increased QOL (Kansas City Cardiomyopathy Questionnaire; effect size [ES], 0.53), decreased depressive symptoms (Patient Health Questionnaire-9; ES, 0.62), and less searching for meaning (Meaning in Life Questionnaire; ES, 0.52). Results indicate that a module-based program integrating spirituality and psychosocial coping strategies was feasible and acceptable and may improve QOL. This preliminary study suggests that clinicians be open to issues of spirituality as they may relate to QOL in patients with HF. Future research will test a revised intervention.

21 CFR 56.106 - Registration.

Code of Federal Regulations, 2012 CFR

2012-04-01

....cit.nih.gov/efile. If an IRB lacks the ability to register electronically, it must send its registration information, in writing, to the Good Clinical Practice Program (HF-34), Office of Science and...

Combined aerobic and resistance exercise program improves task performance in patients with heart failure.

PubMed

Gary, Rebecca A; Cress, M Elaine; Higgins, Melinda K; Smith, Andrew L; Dunbar, Sandra B

2011-09-01

To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF). Randomized controlled trial. Home based. Stable patients (N=24; mean age, 60 ± 10 y; left ventricular ejection fraction, 25% ± 9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF). A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises. A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels. After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively. Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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.

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.

Heater-induced ionization inferred from spectrometric airglow measurements

NASA Astrophysics Data System (ADS)

Hysell, D. L.; Miceli, R. J.; Varney, R. H.; Schlatter, N.; Huba, J. D.

2013-12-01

Spectrographic airglow measurements were made during an ionospheric modification experiment at HAARP on March 12, 2013. Artificial airglow enhancements at 427.8, 557.7, 630.0, 777.4, and 844.6 nm were observed. On the basis of these emissions and using a methodology based on the method of Backus and Gilbert [1968, 1970], we estimate the suprathermal electron population and the subsequent equilibrium electron density profile, including contributions from electron impact ionization. We find that the airglow is consistent with significant induced ionization in view of the spatial intermittency of the airglow.

Stimulated electromagnetic emission and plasma line during pump wave frequency stepping near 4th electron gyroharmonic at HAARP

NASA Astrophysics Data System (ADS)

Grach, Savely; Sergeev, Evgeny; Shindin, Alexey; Mishin, Evgeny; Watkins, Brenton

Concurrent observations of stimulated (secondary) electromagnetic emissions (SEE) and incoherent plasma line (PL) backscatter from the MUIR radar during HF pumping of the ionosphere by the HAARP heating facility (62.4(°) °N, 145.15(°) W, magnetic inclination α = 75.8^circ) with the pump wave (PW) frequency sweeps about the fourth electron gyroharmonic (4f_c) are presented. The PW frequency f0 was changed every 0.2 s in a 1-kHz step, i.e. with the rate of r_{f_0}=5 kHz/s. PW was transmitted at the magnetic zenith (MZ). Prior to sweeping, PW was transmitted continuously (CW) during 2 min at f_0 = 5730 kHz <4f_c to create the “preconditioned” ionosphere with small-scale magnetic field-aligned irregularities. During CW pumping, a typical SEE spectrum for f_0<4f_c, containing the prominent downshifted maxiμm (DM) shifted by Delta f_{DM} = f_{DM}-f_0approx-9 kHz, developed in 5-10 s after PW turn on. The PL echoes were observed during 2-3 s from the range dsim 220 km corresponding to the altitude slightly above PW reflection height. After sim5 s the PL echoes descended to dsim 210-212 km corresponding to the height h = d / (sinalpha) by sim 7 km below the height where f_0 = 4f_c. During frequency sweeps, two upshifted features appeared in the SEE spectrum for f_0> 4f_c, namely BUM_S and BUM_D. The former (stationary broad upshifted maxiμm) peaks at Delta f_{BUMs} approx f0 - nfc (d) + 15-20 kHz and is a typical SEE spectral feature. The latter, the dynamic BUM_D at smaller Delta f, is observed only at high pump powers (ERP=1.7 GW) and corresponds to artificial descending plasma layers created in the F-region ionosphere [1]. In the experiment in question, the BUM_D was present for f_0> f^*, where f^* was 5805-5815 kHz during stepping up and sim 10 kHz less for stepping down, and located 8-10 km below the background F-layer. The miniμm DM which indicated that f_0=4f_c=f_{uh} in the background ionospheric plasma, was sim 5760 kHz. The PL was observed only for f_0< f^* and mainly from altitudes h where f_0 <4f_c. The height h decreased with increasing f_0 in accordance with the altitude dependence 4f_c(h), the difference Delta f_g = f_0 - 4f_c was kept constant during either sweeping up [-(4-8 kHz)] or sweeping down [-(18-22 kHz)]. This corresponds to the difference between the altitude where f_0=4f_c and the PL generation altitude by Delta h sim 1.5-3 km and 7-8 km, respectively. During stepping up, the PL was observed also from the ranges where f_0 > 4f_c. In this case we obtained Delta f_g sim 8-13 kHz corresponding to Delta h sim - 4 km. The PL has never been observed for f_0>f^*$. \\ 1. Sergeev E., Grach S., et al. //Phys. Rev. Lett., 110 (2013), 065002.

Factors Associated With Inadequate Effectiveness of a Multidisciplinary Disease Management Program in Heart Failure Patients Stratified by Galectin 3 Level.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Chiou, Ai-Fu; Yang, Ning-I; Kuo, Li-Tang

2016-07-21

This study investigated whether multidisciplinary disease management programs (MDPs) exert the same effects in heart failure (HF) patients across risk levels stratified by galectin-3 (Gal-3) level and what factors are associated with inadequate effectiveness of MDP. We used a longitudinal follow-up design based on a previous randomized trial. A total of 355 stabilized hospitalized HF patients were enrolled. The effects of MDP on death and HF-related rehospitalization were analyzed according to Gal-3 levels. During the 4-year follow-up, Gal-3 levels predicted mortality and composite events (p < .001). Multivariable analysis demonstrated the event-lowering effect of MDP (hazard ratio [HR] = 0.49, p = .001 for death and HR = 0.50, p < .001 for composite events). However, the effect of MDP was inadequate for those with high Gal-3 levels (≥17.9 ng/ml), whose 4-year composite event rate was 43% in the MDP arm. Further analysis showed that, in patients with Gal-3 ≥ 17.9 ng/ml, the independent factors associated with a high composite event rate were no MDP, older age, worse New York Heart Association functional class, no angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, higher predischarge natriuretic peptide levels, and wider QRS complexes. The effectiveness of MDP for HF patients at high risk was inadequate. Our findings identified the characteristics of these MDP nonresponders. Better integration of advanced care plans based on strategies guided by Gal-3 level is needed to improve care quality. © The Author(s) 2016.

HF Propagation sensitivity study and system performance analysis with the Air Force Coverage Analysis Program (AFCAP)

NASA Astrophysics Data System (ADS)

Caton, R. G.; Colman, J. J.; Parris, R. T.; Nickish, L.; Bullock, G.

2017-12-01

The Air Force Research Laboratory, in collaboration with NorthWest Research Associates, is developing advanced software capabilities for high fidelity simulations of high frequency (HF) sky wave propagation and performance analysis of HF systems. Based on the HiCIRF (High-frequency Channel Impulse Response Function) platform [Nickisch et. al, doi:10.1029/2011RS004928], the new Air Force Coverage Analysis Program (AFCAP) provides the modular capabilities necessary for a comprehensive sensitivity study of the large number of variables which define simulations of HF propagation modes. In this paper, we report on an initial exercise of AFCAP to analyze the sensitivities of the tool to various environmental and geophysical parameters. Through examination of the channel scattering function and amplitude-range-Doppler output on two-way propagation paths with injected target signals, we will compare simulated returns over a range of geophysical conditions as well as varying definitions for environmental noise, meteor clutter, and sea state models for Bragg backscatter. We also investigate the impacts of including clutter effects due to field-aligned backscatter from small scale ionization structures at varied levels of severity as defined by the climatologically WideBand Model (WBMOD). In the absence of additional user provided information, AFCAP relies on International Reference Ionosphere (IRI) model to define the ionospheric state for use in 2D ray tracing algorithms. Because the AFCAP architecture includes the option for insertion of a user defined gridded ionospheric representation, we compare output from the tool using the IRI and ionospheric definitions from assimilative models such as GPSII (GPS Ionospheric Inversion).

Atomic-layer-deposited Al2O3 and HfO2 on InAlAs: A comparative study of interfacial and electrical characteristics

NASA Astrophysics Data System (ADS)

Wu, Li-Fan; Zhang, Yu-Ming; Lv, Hong-Liang; Zhang, Yi-Men

2016-10-01

Al2O3 and HfO2 thin films are separately deposited on n-type InAlAs epitaxial layers by using atomic layer deposition (ALD). The interfacial properties are revealed by angle-resolved x-ray photoelectron spectroscopy (AR-XPS). It is demonstrated that the Al2O3 layer can reduce interfacial oxidation and trap charge formation. The gate leakage current densities are 1.37 × 10-6 A/cm2 and 3.22 × 10-6 A/cm2 at +1 V for the Al2O3/InAlAs and HfO2/InAlAs MOS capacitors respectively. Compared with the HfO2/InAlAs metal-oxide-semiconductor (MOS) capacitor, the Al2O3/InAlAs MOS capacitor exhibits good electrical properties in reducing gate leakage current, narrowing down the hysteresis loop, shrinking stretch-out of the C-V characteristics, and significantly reducing the oxide trapped charge (Q ot) value and the interface state density (D it). Project supported by the National Basic Research Program of China (Grant No. 2010CB327505), the Advanced Research Foundation of China (Grant No. 914xxx803-051xxx111), the National Defense Advance Research Project, China (Grant No. 513xxxxx306), the National Natural Science Foundation of China (Grant No. 51302215), the Scientific Research Program Funded by Shaanxi Provincial Education Department, China (Grant No. 14JK1656), and the Science and Technology Project of Shaanxi Province, China (Grant No. 2016KRM029).

[Efficacy of a multidisciplinary care management program for patients admitted at hospital because of heart failure (ProMIC)].

PubMed

Domingo, Cristina; Aros, Fernando; Otxandategi, Agurtzane; Beistegui, Idoia; Besga, Ariadna; Latorre, Pedro María

2018-02-26

To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate. Quasi-experimental research with control group. Twelve primary health care centres and 3 hospitals from the Basque Country. Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV. Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care. The rate of readmission for HF and health-related quality of life RESULTS: One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio=0.59, CI 95%: 0.36-0.98; P=.049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up. ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables. Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Nemaline myopathy and heart failure: role of ivabradine; a case report.

PubMed

Sarullo, Filippo M; Vitale, Giuseppe; Di Franco, Antonino; Sarullo, Silvia; Salerno, Ylenia; Vassallo, Laura; Baviera, Emanuela Petrona; Marazia, Stefania; Mandalà, Giorgio; Lanza, Gaetano A

2015-01-19

Nemaline myopathy (NM) is a rare congenital myopathy characterized by muscle weakness, hypotonia and the presence in muscle fibers of inclusions known as nemaline bodies and a wide spectrum of clinical phenotypes, ranging from severe forms with neonatal onset to asymptomatic forms. The adult-onset form is heterogeneous in terms of clinical presentation and disease progression. Cardiac involvement occurs in the minority of cases and little is known about medical management in this subgroup of NM patients. We report a rare case of heart failure (HF) in a patient with adult-onset NM in whom ivabradine proved to be able to dramatically improve the clinical picture. We report a case of a 37-year-old man with adult-onset NM, presenting with weakness and hypotonia of the proximal limb muscles and shoulder girdle, severely limiting daily activities. He developed progressive HF over a period of 6 months while attending a rehabilitation program, with reduced left ventricular ejection fraction (LVEF = 20%), manifested by dyspnea and signs of systemic congestion. The patient was started HF therapy with enalapril, carvedilol, spironolactone and loop diuretics. Target HF doses of these drugs (including carvedilol) were not reached because of symptomatic hypotension causing a high resting heart rate (HR) ≥70 beats per minute (bpm). Further deterioration of the clinical picture occurred with several life-threatening arrhythmic episodes requiring external defibrillation. An implantable cardioverter defibrillator (ICD) was then implanted. Persistent high resting HR was successfully treated with ivabradine with HR lowering from 90 bpm to 55 bpm at 1 month follow up, LVEF rising to 50% at 3 month follow up and to 54% at 2,5 year follow up. To date no more hospitalizations for heart failure occurred. A single hospitalization due to aspiration pneumonia required insertion of a tracheostomy tube to protect airways from further aspiration. At present, the patient is attending a regular rehabilitation program with net improvement in neuromotor control and less limitations in daily activities. HF is a rare feature of NM, but it can negatively influence prognosis. Conventional HF therapy and/or heart transplant are the only reasonable strategy in these patients. Ivabradine is a useful, effective and safe drug for therapy in NM patients with HF and should be considered when resting HR remains high despite beta-blockers' full titration or beta-blockers' underdosing due to intolerance or side effects.

Cyanotoxin occurrence associated with cyanoHAB events on ...

EPA Pesticide Factsheets

A monitoring approach combining wet chemistry and high frequency (HF) water quality sensors was employed to improve our understanding of the ecology of an inland reservoir with a history of cyanoHAB events. The study was conducted with samples collected from Lake Harsha, is a multi-use reservoir in southwest OH that has experienced an increase in cyanoHAB frequency and intensity. Nutrient, algal taxa, chlorophyll-a, and physico-chemical data have been collected on the lake since 2010 at three week intervals. Beginning in 2014 in cooperation with Clermont County Drinking Water Division, a high frequency (HF) monitoring program was implemented to complement the tri-weekly data and provide DWTP operators time-relevant information regarding source water quality. HF data included in-vivo fluorescence and physico-chemical parameters and were collected at two locations. These data, coupled with microcystin (MC) analyses demonstrated the utility of HF data for tracking the cyanoHAB status of the reservoir. It was also apparent that MC concentrations were potentially underestimated as MC sampling did not coincide with bloom peaks indicated by the HF data. To better characterize the cyanobacterial population and both intracellular and extracellular MC production, an intensive sampling regime was implemented in 2015 and 2016 including LC-MSMS analysis of select MC congeners and a total MC surrogate, cylindrospermopsin, and anatoxin-a, MC ELISA quantification, molecular (i.

Satellite voice broadcast system study, volume 2

NASA Technical Reports Server (NTRS)

Horstein, M.

1985-01-01

This study investigates the feasibility of providing Voice of America (VOA) broadcasts by satellite relay, rather than via terrestrial relay stations. Satellite voice broadcast systems are described for three different frequency bands: HF (26 MHz), VHF (68 MHz), and L-band (1.5 GHz). The geographical areas of interest at HF and L-band include all major land masses worldwide with the exception of the U.S., Canada, and Australia. Geostationary satellite configurations are considered for both frequency bands. In addition, a system of subsynchronous, circular satellites with an orbit period of 8 hours is developed for the HF band. VHF broadcasts, which are confined to the Soviet Union, are provied by a system of Molniya satellites. Satellites intended for HF or VHF broadcastinbg are extremely large and heavy. Satellite designs presented here are limited in size and weight to the capability of the STS/Centaur launch vehicle combination. Even so, at HF it would take 47 geostationary satellites or 20 satellites in 8-hour orbits to fully satisfy the voice-channel requirements of the broadcast schedule provided by VOA. On the other hand, three Molniya satellites suffice for the geographically restricted schedule at VHF. At L-band, only four geostationary satellites are needed to meet the requirements of the complete broadcast schedule. Moreover, these satellites are comparable in size and weight to current satellites designed for direct broadcast of video program material.

Remote health monitoring of heart failure with data mining via CART method on HRV features.

PubMed

Pecchia, Leandro; Melillo, Paolo; Bracale, Marcello

2011-03-01

Disease management programs, which use no advanced information and computer technology, are as effective as telemedicine but more efficient because less costly. We proposed a platform to enhance effectiveness and efficiency of home monitoring using data mining for early detection of any worsening in patient's condition. These worsenings could require more complex and expensive care if not recognized. In this letter, we briefly describe the remote health monitoring platform we designed and realized, which supports heart failure (HF) severity assessment offering functions of data mining based on the classification and regression tree method. The system developed achieved accuracy and a precision of 96.39% and 100.00% in detecting HF and of 79.31% and 82.35% in distinguishing severe versus mild HF, respectively. These preliminary results were achieved on public databases of signals to improve their reproducibility. Clinical trials involving local patients are still running and will require longer experimentation.

Generation of Artificial Acoustic-Gravity Waves and Traveling Ionospheric Disturbances in HF Heating Experiments

NASA Astrophysics Data System (ADS)

Pradipta, R.; Lee, M. C.; Cohen, J. A.; Watkins, B. J.

2015-10-01

We report the results of our ionospheric HF heating experiments to generate artificial acoustic-gravity waves (AGW) and traveling ionospheric disturbances (TID), which were conducted at the High-frequency Active Auroral Research Program facility in Gakona, Alaska. Based on the data from UHF radar, GPS total electron content, and ionosonde measurements, we found that artificial AGW/TID can be generated in ionospheric modification experiments by sinusoidally modulating the power envelope of the transmitted O-mode HF heater waves. In this case, the modulation frequency needs to be set below the characteristic Brunt-Vaisala frequency at the relevant altitudes. We avoided potential contamination from naturally-occurring AGW/TID of auroral origin by conducting the experiments during geomagnetically quiet time period. We determine that these artificial AGW/TID propagate away from the edge of the heated region with a horizontal speed of approximately 160 m/s.

Housing First/HUD-VASH: Importance, Flaws, and Potential for Transformation: Response to Commentary.

PubMed

Westermeyer, Joseph; Lee, Kathryn; Y Carr, Tegan Batres

2015-07-01

This paper consists of responses to issues raised in the accompanying Commentary. Our response is organized under three topics: (1) reasons regarding the importance of issues, (2) the need for a comprehensive framework in housing placement, and (3) conceptualization and scientific design (with details on contemporary methods for investigating unanticipated consequences when randomization is no longer feasible). Recurrences to substance use disorder in the American Society of Addiction Medicine (ASAM) housing placement condition are noted within hours or days, with rapid implementation of planned contingencies, and avoidance of enabling. Recurrences in the Housing First/HUD-VASH (HF/H-V) condition escape notice for weeks to months, and continued use is accepted as a core principle of the program. HF/H-V contingencies occur later for major disruptions, leading to discharge. For patients recruited from our clinic, HF/H-V performed poorly when compared to a long-accepted standard of care, the ASAM placement criteria.

Evaluation of synergistic effects of resynchronization therapy and a β-blocker up-titration strategy based on a predefined patient-management program: the RESTORE study.

PubMed

Palmisano, Pietro; Ammendola, Ernesto; D'Onofrio, Antonio; Accogli, Michele; Calò, Leonardo; Ruocco, Antonio; Rapacciuolo, Antonio; Del Giorno, Giuseppe; Bianchi, Valter; Malacrida, Maurizio; Valsecchi, Sergio; Gronda, Edoardo

2015-01-01

Prior studies have suggested that a substantial number of eligible heart failure (HF) patients fail to receive β-blocker therapy, or receive it at a suboptimal dose. The aim of this study is to assess the benefit of a predefined management program designed for β-blocker up-titration, evaluating the synergistic effect of cardiac resynchronization therapy (CRT) and β-blockers in a HF population. The Resynchronization Therapy and β-Blocker Titration (RESTORE) study is a prospective, case-control, multicenter cohort study designed to test the hypothesis that a β-blocker up-titration strategy based on a predefined management program maximizes the beneficial effect of CRT, increasing the number of patients reaching the target dose of β-blockers and improving their clinical outcome. All study patients receive an implantable defibrillator for CRT delivery in accordance with current guidelines. Enrollments started in December 2011 and are scheduled to end in December 2014. Approximately 250 consecutive patients will be prospectively enrolled in 6 Italian centers and followed up for 24 months after implantation. The primary endpoint is to demonstrate that CRT may allow titration of β-blockers until the optimal dose, or at least to the effective dose, in patients with HF. This study might provide important information about the benefit of a predefined management program for β-blocker up-titration in patients receiving CRT. Moreover, assessment of health-care utilization and the consumption of resources will allow estimating the potential utility of remote monitoring by means of an automated telemedicine system in facilitating the titration of β-blockers in comparison with a standard in-hospital approach. © 2015 Wiley Periodicals, Inc.

BMP signaling in dermal papilla cells is required for their hair follicle-inductive properties

PubMed Central

Rendl, Michael; Polak, Lisa; Fuchs, Elaine

2008-01-01

Hair follicle (HF) formation is initiated when epithelial stem cells receive cues from specialized mesenchymal dermal papilla (DP) cells. In culture, DP cells lose their HF-inducing properties, but during hair growth in vivo, they reside within the HF bulb and instruct surrounding epithelial progenitors to orchestrate the complex hair differentiation program. To gain insights into the molecular program that maintains DP cell fate, we previously purified DP cells and four neighboring populations and defined their cell-type-specific molecular signatures. Here, we exploit this information to show that the bulb microenvironment is rich in bone morphogenetic proteins (BMPs) that act on DP cells to maintain key signature features in vitro and hair-inducing activity in vivo. By employing a novel in vitro/in vivo hybrid knockout assay, we ablate BMP receptor 1a in purified DP cells. When DPs cannot receive BMP signals, they lose signature characteristics in vitro and fail to generate HFs when engrafted with epithelial stem cells in vivo. These results reveal that BMP signaling, in addition to its key role in epithelial stem cell maintenance and progenitor cell differentiation, is essential for DP cell function, and suggest that it is a critical feature of the complex epithelial–mesenchymal cross-talk necessary to make hair. PMID:18281466

Exercise Training in Group 2 Pulmonary Hypertension: Which Intensity and What Modality.

PubMed

Arena, Ross; Lavie, Carl J; Borghi-Silva, Audrey; Daugherty, John; Bond, Samantha; Phillips, Shane A; Guazzi, Marco

2016-01-01

Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure. A wealth of literature demonstrates the value of exercise training (ET) in patients with LSHD, which is particularly robust in patients with HFrEF and growing in patients with HFpEF. While the effects of ET have not been specifically explored in the LSHD-PH phenotype (i.e., composite pathophysiologic characteristics of patients in this advanced disease state), the overall body of evidence supports clinical application in this subgroup. Moderate intensity aerobic ET significantly improves peak oxygen consumption, quality of life and prognosis in patients with HF. Resistance ET significantly improves muscle strength and endurance in patients with HF, which further enhance functional capacity. When warranted, inspiratory muscle training and neuromuscular electrical stimulation are becoming recognized as important components of a comprehensive rehabilitation program. This review will provide a detailed account of ET programing considerations in patients with LSHD with a particular focus on those concomitantly diagnosed with PH. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Bacterially activated B-cells drive T cell differentiation towards Tr1 through PD-1/PD-L1 expression.

PubMed

Said, Sawsan Sudqi; Barut, Guliz Tuba; Mansur, Nesteren; Korkmaz, Asli; Sayi-Yazgan, Ayca

2018-04-01

Regulatory B cells (Bregs) play a crucial role in immunological tolerance primarily through the production of IL-10 in many diseases including autoimmune disorders, allergy, infectious diseases, and cancer. To date, various Breg subsets with overlapping phenotypes have been identified. However, the roles of Bregs in Helicobacter infection are largely unknown. In the present study, we investigate the phenotype and function of Helicobacter -stimulated B cells. Our results demonstrate that Helicobacter felis -stimulated IL-10- producing B cells (Hf stim - IL-10 + B) are composed of B10 and Transitional 2 Marginal Zone Precursor (T2-MZP) cells with expression of CD9, Tim-1, and programmed death 1 (PD-1). On the other hand, Helicobacter felis -stimulated IL-10- nonproducing B (Hf stim - IL-10 - B) cells are mainly marginal zone (MZ) B cells that express PD-L1 and secrete TGF-β, IL-6, and TNF-α, and IgM and IgG2b. Furthermore, we show that both Hf stim - IL-10 + B cells and Hf stim - IL-10 - B cells induce CD49b + LAG-3 + Tr1 cells. Here, we describe a novel mechanism for PD-1/PD-L1- driven B cell-dependent Tr1 cell differentiation. Finally, we explore the capability of Hf stim - IL-10 - B cells to induce Th17 cell differentiation, which we find to be dependent on TGF-β. Taken together, the current study demonstrates that Hf stim - B cells induce Tr1 cells through the PD-1/PD-L1 axis and Th17 cells by secreting TGF-β. Copyright © 2018 Elsevier Ltd. All rights reserved.

Parenting in 2 Worlds: Effects of a Culturally Adapted Intervention for Urban American Indians on Parenting Skills and Family Functioning.

PubMed

Kulis, Stephen S; Ayers, Stephanie L; Harthun, Mary L; Jager, Justin

2016-08-01

Parenting in 2 Worlds (P2W) is a culturally grounded parenting intervention that addresses the distinctive social and cultural worlds of urban American Indian (AI) families. P2W was culturally adapted through community-based participatory research in three urban AI communities with diverse tribal backgrounds. This paper reports the immediate outcomes of P2W in a randomized controlled trial, utilizing data from 575 parents of AI children (ages 10-17). Parents were assigned to P2W or to the comparison group, an informational family health curriculum, Healthy Families in 2 Worlds (HF2W). Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. Pretests were administered at the first workshop and a post-test at the last workshop. Tests of the efficacy of P2W versus HF2W on parenting skills and family functioning were analyzed with pairwise t tests, within intervention type, and by baseline adjusted path models using FIML estimation in Mplus. Intervention effect sizes were estimated with Cohen's d. Participants in P2W reported significant improvements in parental agency, parenting practices, supervision and family cohesion, and decreases in discipline problems and parent-child conflict. Compared to HF2W, P2W participants reported significantly larger increases in parental self-agency and positive parenting practices, and fewer child discipline problems. Most of these desired program effects for P2W approached medium size. Culturally adapted parenting interventions like P2W can effectively strengthen parenting practices and family functioning among urban AI families and help address their widespread need for targeted, culturally grounded programs.

Parenting in 2 Worlds: Effects of a Culturally Adapted Intervention for Urban American Indians on Parenting Skills and Family Functioning

PubMed Central

Kulis, Stephen S.; Ayers, Stephanie L.; Harthun, Mary L.; Jager, Justin

2016-01-01

Parenting in 2 Worlds (P2W) is a culturally grounded parenting intervention that addresses the distinctive social and cultural worlds of urban American Indian (AI) families. P2W was culturally adapted through community-based participatory research in three urban AI communities with diverse tribal backgrounds. This paper reports the immediate outcomes of P2W in a randomized controlled trial, utilizing data from 575 parents of AI children (ages 10–17). Parents were assigned to P2W or to the comparison group, an informational family health curriculum, Healthy Families in 2 Worlds (HF2W). Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. Pretests were administered at the first workshop and a post-test at the last workshop. Tests of the efficacy of P2W versus HF2W on parenting skills and family functioning were analyzed with pairwise t-tests, within intervention type, and by baseline adjusted path models using FIML estimation in Mplus. Intervention effect sizes were estimated with Cohen’s d. Participants in P2W reported significant improvements in parental agency, parenting practices, supervision and family cohesion, and decreases in discipline problems and parent-child conflict. Compared to HF2W, P2W participants reported significantly larger increases in parental self-agency and positive parenting practices, and fewer child discipline problems. Most of these desired program effects for P2W approached medium size. Culturally adapted parenting interventions like P2W can effectively strengthen parenting practices and family functioning among urban AI families and help address their widespread need for targeted, culturally grounded programs. PMID:27129476

Modulation of whistlers

NASA Astrophysics Data System (ADS)

Sivokon', V. P.; Bogdanov, V. V.; Druzhin, G. I.; Cherneva, N. V.; Kubyshkin, A. V.; Sannikov, D. V.; Agranat, I. V.

2014-11-01

Analysis of the experimental data obtained at Paratunka observatory (53.02° N, 158.65° E; L = 2.3) has revealed a nonstandard form of whistlers involving spectral lines that are symmetric with respect to the whistler. We have shown that this form is most likely due to the amplitude modulation of whistlers by electromagnetic pulses with a length of around 1 s and carrier frequency of around 1.1 kHz. We have suggested that these pulses could be emitted by the auroral electrojet modified by heating radiation from the HAARP facility (62.30° N, 145.30° W; L > 4.2).

Measurement fidelity of heart rate variability signal processing: The devil is in the details

PubMed Central

Jarrin, Denise C.; McGrath, Jennifer J.; Giovanniello, Sabrina; Poirier, Paul; Lambert, Marie

2017-01-01

Heart rate variability (HRV) is a particularly valuable quantitative marker of the flexibility and balance of the autonomic nervous system. Significant advances in software programs to automatically derive HRV have led to its extensive use in psychophysiological research. However, there is a lack of systematic comparisons across software programs used to derive HRV indices. Further, researchers report meager details on important signal processing decisions making synthesis across studies challenging. The aim of the present study was to evaluate the measurement fidelity of time- and frequency-domain HRV indices derived from three predominant signal processing software programs commonly used in clinical and research settings. Triplicate ECG recordings were derived from 20 participants using identical data acquisition hardware. Among the time-domain indices, there was strong to excellent correspondence (ICCavg =0.93) for SDNN, SDANN, SDNNi, rMSSD, and pNN50. The frequency-domain indices yielded excellent correspondence (ICCavg =0.91) for LF, HF, and LF/HF ratio, except for VLF which exhibited poor correspondence (ICCavg =0.19). Stringent user-decisions and technical specifications for nuanced HRV processing details are essential to ensure measurement fidelity across signal processing software programs. PMID:22820268

Heterogeneity of heart failure management programs in Australia.

PubMed

Driscoll, Andrea; Worrall-Carter, Linda; McLennan, Skye; Dawson, Anna; O'Reilly, Jan; Stewart, Simon

2006-03-01

Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes. To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure. Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003. All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs. Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Collision-Induced Dissociation Study of Strong Hydrogen-Bonded Cluster Ions Y-(HF) n (Y=F, O2) Using Atmospheric Pressure Corona Discharge Ionization Mass Spectrometry Combined with a HF Generator.

PubMed

Sakamoto, Kenya; Sekimoto, Kanako; Takayama, Mitsuo

2017-01-01

Hydrogen fluoride (HF) was produced by a homemade HF generator in order to investigate the properties of strong hydrogen-bonded clusters such as (HF) n . The HF molecules were ionized in the form of complex ions associated with the negative core ions Y - produced by atmospheric pressure corona discharge ionization (APCDI). The use of APCDI in combination with the homemade HF generator led to the formation of negative-ion HF clusters Y - (HF) n (Y=F, O 2 ), where larger clusters with n ≥4 were not detected. The mechanisms for the formation of the HF, F - (HF) n , and O 2 - (HF) n species were discussed from the standpoints of the HF generator and APCDI MS. By performing energy-resolved collision-induced dissociation (CID) experiments on the cluster ions F - (HF) n ( n =1-3), the energies for the loss of HF from F - (HF) 3 , F - (HF) 2 , and F - (HF) were evaluated to be 1 eV or lower, 1 eV or higher, and 2 eV, respectively, on the basis of their center-of-mass energy ( E CM ). These E CM values were consistent with the values of 0.995, 1.308, and 2.048 eV, respectively, obtained by ab initio calculations. The stability of [O 2 (HF) n ] - ( n =1-4) was discussed on the basis of the bond lengths of O 2 H-F - (HF) n and O 2 - H-F(HF) n obtained by ab initio calculations. The calculations indicated that [O 2 (HF) 4 ] - separated into O 2 H and F - (HF) 3 .

Strategies to balance fidelity to Housing First principles with local realities: lessons from a large urban centre.

PubMed

O'Campo, Patricia; Zerger, Suzanne; Gozdzik, Agnes; Jeyaratnam, Jeyagobi; Stergiopoulos, Vicky

2015-05-01

The importance of program implementation in achieving desired outcomes is well-documented, but there remains a need for concrete guidance on how to achieve fidelity to evidence-based models within dynamic local contexts. Housing First (HF), an evidence-based model for people experiencing homelessness and mental illness, provides an important test-case for such guidance; it targets a uniquely underserved subpopulation with complex needs, and is delivered by practitioners with varying knowledge and skill levels. Scientific evidence affirms HF's effectiveness, but its rapid dissemination has outpaced the ability to monitor not only whether it is being implemented with fidelity, but also how this can be achieved within variable local contexts and challenges. This qualitative study contributes to this need by capturing insights from practitioners on implementation challenges and specific strategies developed to overcome them. Findings reinforce the importance of developing HF-specific implementation guidelines, and of engaging relevant stakeholders throughout all phases of that development.

DCDS: A Real-time Data Capture and Personalized Decision Support System for Heart Failure Patients in Skilled Nursing Facilities.

PubMed

Zhu, Wei; Luo, Lingyun; Jain, Tarun; Boxer, Rebecca S; Cui, Licong; Zhang, Guo-Qiang

2016-01-01

Heart disease is the leading cause of death in the United States. Heart failure disease management can improve health outcomes for elderly community dwelling patients with heart failure. This paper describes DCDS, a real-time data capture and personalized decision support system for a Randomized Controlled Trial Investigating the Effect of a Heart Failure Disease Management Program (HF-DMP) in Skilled Nursing Facilities (SNF). SNF is a study funded by the NIH National Heart, Lung, and Blood Institute (NHLBI). The HF-DMP involves proactive weekly monitoring, evaluation, and management, following National HF Guidelines. DCDS collects a wide variety of data including 7 elements considered standard of care for patients with heart failure: documentation of left ventricular function, tracking of weight and symptoms, medication titration, discharge instructions, 7 day follow up appointment post SNF discharge and patient education. We present the design and implementation of DCDS and describe our preliminary testing results.

Induction of hair follicle dermal papilla cell properties in human induced pluripotent stem cell-derived multipotent LNGFR(+)THY-1(+) mesenchymal cells

PubMed Central

Veraitch, Ophelia; Mabuchi, Yo; Matsuzaki, Yumi; Sasaki, Takashi; Okuno, Hironobu; Tsukashima, Aki; Amagai, Masayuki; Okano, Hideyuki; Ohyama, Manabu

2017-01-01

The dermal papilla (DP) is a specialised mesenchymal component of the hair follicle (HF) that plays key roles in HF morphogenesis and regeneration. Current technical difficulties in preparing trichogenic human DP cells could be overcome by the use of highly proliferative and plastic human induced pluripotent stem cells (hiPSCs). In this study, hiPSCs were differentiated into induced mesenchymal cells (iMCs) with a bone marrow stromal cell phenotype. A highly proliferative and plastic LNGFR(+)THY-1(+) subset of iMCs was subsequently programmed using retinoic acid and DP cell activating culture medium to acquire DP properties. The resultant cells (induced DP-substituting cells [iDPSCs]) exhibited up-regulated DP markers, interacted with human keratinocytes to up-regulate HF related genes, and when co-grafted with human keratinocytes in vivo gave rise to fibre structures with a hair cuticle-like coat resembling the hair shaft, as confirmed by scanning electron microscope analysis. Furthermore, iDPSCs responded to the clinically used hair growth reagent, minoxidil sulfate, to up-regulate DP genes, further supporting that they were capable of, at least in part, reproducing DP properties. Thus, LNGFR(+)THY-1(+) iMCs may provide material for HF bioengineering and drug screening for hair diseases. PMID:28220862

What is the strength of evidence for heart failure disease-management programs?

PubMed

Clark, Alexander M; Savard, Lori A; Thompson, David R

2009-07-28

Heart failure (HF) disease-management programs are increasingly common. However, some large and recent trials of programs have not reported positive findings. There have also been parallel recent advances in reporting standards and theory around complex nonpharmacological interventions. These developments compel reconsideration in this Viewpoint of how research into HF-management programs should be evaluated, the quality, specificity, and usefulness of this evidence, and the recommendations for future research. Addressing the main determinants of intervention effectiveness by using the PICO (Patient, Intervention, Comparison, and Outcome) approach and the recent CONSORT (Consolidated Standards of Reporting Trials) statement on nonpharmacological trials, we will argue that in both current trials and meta-analyses, interventions and comparisons are not sufficiently well described; that complex programs have been excessively oversimplified; and that potentially salient differences in programs, populations, and settings are not incorporated into analyses. In preference to more general meta-analyses of programs, adequate descriptions are first needed of populations, interventions, comparisons, and outcomes in past and future trials. This could be achieved via a systematic survey of study authors based on the CONSORT statement. These more detailed data on studies should be incorporated into future meta-analyses of comparable trials and used with other techniques such as patient-based outcomes data and meta-regression. Although trials and meta-analyses continue to have potential to generate useful evidence, a more specific evidence base is needed to support the development of effective programs for different populations and settings.

Collision-Induced Dissociation Study of Strong Hydrogen-Bonded Cluster Ions Y−(HF)n (Y=F, O2) Using Atmospheric Pressure Corona Discharge Ionization Mass Spectrometry Combined with a HF Generator

PubMed Central

Sakamoto, Kenya; Sekimoto, Kanako; Takayama, Mitsuo

2017-01-01

Hydrogen fluoride (HF) was produced by a homemade HF generator in order to investigate the properties of strong hydrogen-bonded clusters such as (HF)n. The HF molecules were ionized in the form of complex ions associated with the negative core ions Y− produced by atmospheric pressure corona discharge ionization (APCDI). The use of APCDI in combination with the homemade HF generator led to the formation of negative-ion HF clusters Y−(HF)n (Y=F, O2), where larger clusters with n≥4 were not detected. The mechanisms for the formation of the HF, F−(HF)n, and O2−(HF)n species were discussed from the standpoints of the HF generator and APCDI MS. By performing energy-resolved collision-induced dissociation (CID) experiments on the cluster ions F−(HF)n (n=1–3), the energies for the loss of HF from F−(HF)3, F−(HF)2, and F−(HF) were evaluated to be 1 eV or lower, 1 eV or higher, and 2 eV, respectively, on the basis of their center-of-mass energy (ECM). These ECM values were consistent with the values of 0.995, 1.308, and 2.048 eV, respectively, obtained by ab initio calculations. The stability of [O2(HF)n]− (n=1–4) was discussed on the basis of the bond lengths of O2H–F−(HF)n and O2−H–F(HF)n obtained by ab initio calculations. The calculations indicated that [O2(HF)4]− separated into O2H and F−(HF)3. PMID:28966900

The effect of progressive, reinforcing telephone education and counseling versus brief educational intervention on knowledge, self-care behaviors and heart failure symptoms.

PubMed

Baker, David W; Dewalt, Darren A; Schillinger, Dean; Hawk, Victoria; Ruo, Bernice; Bibbins-Domingo, Kirsten; Weinberger, Morris; Macabasco-O'Connell, Aurelia; Grady, Kathy L; Holmes, George M; Erman, Brian; Broucksou, Kimberly A; Pignone, Michael

2011-10-01

The optimal strategy for promoting self-care for heart failure (HF) is unclear. We conducted a randomized trial to determine whether a "teach to goal" (TTG) educational and behavioral support program provided incremental benefits to a brief (1 hour) educational intervention (BEI) for knowledge, self-care behaviors, and HF-related quality of life (HFQOL). The TTG program taught use of adjusted-dose diuretics and then reinforced learning goals and behaviors with 5 to 8 telephone counseling sessions over 1 month. Participants' (n = 605) mean age was 61 years; 37% had marginal or inadequate literacy; 69% had ejection fraction <0.45; and 31% had Class III or IV symptoms. The TTG group had greater improvements in general and salt knowledge (P < .001) and greater increases in self-care behaviors (from mean 4.8 to 7.6 for TTG vs. 5.2 to 6.7 for BEI; P < .001). HFQOL improved from 58.5 to 64.6 for the TTG group but did not change for the BEI group (64.7 to 63.9; P < .001 for the difference in change scores). Improvements were similar regardless of participants' literacy level. Telephone reinforcement of learning goals and self-care behaviors improved knowledge, health behaviors, and HF-related QOL compared to a single education session. Copyright © 2011 Elsevier Inc. All rights reserved.

Aquatic Exercise Training is Effective in Maintaining Exercise Performance in Trained Heart Failure Patients: A Randomised Crossover Pilot Trial.

PubMed

Adsett, Julie; Morris, Norman; Kuys, Suzanne; Hwang, Rita; Mullins, Robert; Khatun, Mohsina; Paratz, Jennifer; Mudge, Alison

2017-06-01

Providing flexible models and a variety of exercise options are fundamental to supporting long-term exercise participation for patients with heart failure (HF). The aim of this pilot study was to determine the feasibility and efficacy of aquatic exercise training during a maintenance phase for a clinical heart failure population. In this 2 x 2 crossover design trial, individuals who had previously completed HF rehabilitation were randomised into either a land-based or aquatic training program once per week for six weeks, after which time they changed to the alternate exercise training protocol for an additional six weeks. Six-minute walk test (6MWT), grip strength, walk speed, and measures of balance were compared for the two training protocols. Fifty-one participants (43 males, mean age 69.2 yrs) contributed data for the analysis. Both groups maintained function during the follow-up period, however improvements in 6MWT were greater in the land-based training group (95% CI: 0.7, 22.5; p=0.038), by a mean difference of 10.8 metres. No significant difference was observed for other parameters when the two training protocols were compared. Attending an aquatic exercise program once per week is feasible for patients with stable HF and may provide a suitable option to maintain functional performance in select patients. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

47 CFR Appendix to Part 216 - NCS Directives

Code of Federal Regulations, 2011 CFR

2011-10-01

...—Telecommunications Operations—Shared Resources (SHARES) High Frequency (HF) Radio Program Note: NCS Directives and... Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL NATIONAL COMMUNICATIONS..., Membership and Administration—National Communications System (NCS) Issuance System NCS Directive 1-2...

47 CFR Appendix to Part 216 - NCS Directives

Code of Federal Regulations, 2013 CFR

2013-10-01

...—Telecommunications Operations—Shared Resources (SHARES) High Frequency (HF) Radio Program Note: NCS Directives and... Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL NATIONAL COMMUNICATIONS..., Membership and Administration—National Communications System (NCS) Issuance System NCS Directive 1-2...

47 CFR Appendix to Part 216 - NCS Directives

Code of Federal Regulations, 2010 CFR

2010-10-01

...—Telecommunications Operations—Shared Resources (SHARES) High Frequency (HF) Radio Program Note: NCS Directives and... Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL NATIONAL COMMUNICATIONS..., Membership and Administration—National Communications System (NCS) Issuance System NCS Directive 1-2...

47 CFR Appendix to Part 216 - NCS Directives

Code of Federal Regulations, 2012 CFR

2012-10-01

...—Telecommunications Operations—Shared Resources (SHARES) High Frequency (HF) Radio Program Note: NCS Directives and... Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL NATIONAL COMMUNICATIONS..., Membership and Administration—National Communications System (NCS) Issuance System NCS Directive 1-2...

47 CFR Appendix to Part 216 - NCS Directives

Code of Federal Regulations, 2014 CFR

2014-10-01

...—Telecommunications Operations—Shared Resources (SHARES) High Frequency (HF) Radio Program Note: NCS Directives and... Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL NATIONAL COMMUNICATIONS..., Membership and Administration—National Communications System (NCS) Issuance System NCS Directive 1-2...

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.

Hf-Nd Isotopes in West Philippine Basin Basalts: Results from International Ocean Discovery Program (IODP) Site U1438 and Implications for the Early History of the Izu-Bonin-Mariana (IBM) Subduction System

NASA Astrophysics Data System (ADS)

Yogodzinski, G. M.; Hocking, B.; Bizimis, M.; Hickey-Vargas, R.; Ishizuka, O.; Bogus, K.; Arculus, R. J.

2015-12-01

Drilling at IODP Site U1438, located immediately west of Kyushu-Palau Ridge (KPR), the site of IBM subduction initiation, penetrated 1460 m of volcaniclastic sedimentary rock and 150 m of underlying basement. Biostratigraphic controls indicate a probable age for the oldest sedimentary rocks at around 55 Ma (51-64 Ma - Arculus et al., Nat Geosci in-press). This is close to the 48-52 Ma time period of IBM subduction initiation, based on studies in the forearc. There, the first products of volcanism are tholeiitic basalts termed FAB (forearc basalt), which are more depleted than average MORB and show subtle indicators of subduction geochemical enrichment (Reagan et al., 2010 - Geochem Geophy Geosy). Shipboard data indicate that Site U1438 basement basalts share many characteristics with FABs, including primitive major elements (high MgO/FeO*) and strongly depleted incompatible element patterns (Ti, Zr, Ti/V and Zr/Y below those of average MORB). Initial results thus indicate that FAB geochemistry may have been produced not only in the forearc, but also in backarc locations (west of the KPR) at the time of subduction initiation. Hf-Nd isotopes for Site 1438 basement basalts show a significant range of compositions from ɛNd of 7.0 to 9.5 and ɛHf of 14.5 to 19.8 (present-day values). The data define a well-correlated and steep array in Hf-Nd isotope space. Relatively radiogenic Hf compared to Nd indicates an Indian Ocean-type MORB source, but the dominant signature, with ɛHf >16.5, is more radiogenic than most Indian MORB. The pattern through time is from more-to-less radiogenic and more variable Hf-Nd isotopes within the basement section. This pattern culminates in basaltic andesite sills, which intrude the lower parts of the sedimentary section. The sills have the least radiogenic compositions measured so far (ɛNd ~6.6, ɛHf ~13.8), and are similar to those of boninites of the IBM forearc and modern IBM arc and reararc rocks. The pattern within the basement suggests modest enrichment of a depleted Indian MORB source over time.

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

Impact of active geomagnetic conditions on stimulated radiation during ionospheric second electron gyroharmonic heating

NASA Astrophysics Data System (ADS)

Bordikar, M. R.; Scales, W. A.; Mahmoudian, A.; Kim, H.; Bernhardt, P. A.; Redmon, R.; Samimi, A. R.; Brizcinski, S.; McCarrick, M. J.

2014-01-01

Recently, narrowband emissions ordered near the H+ (proton) gyrofrequency (fcH) were reported in the stimulated electromagnetic emission (SEE) spectrum during active geomagnetic conditions. This work presents new observations and theoretical analysis of these recently discovered emissions. These emission lines are observed in the stimulated electromagnetic emission (SEE) spectrum when the transmitter is tuned near the second electron gyroharmonic frequency (2fce) during recent ionospheric modification experiments at the High Frequency Active Auroral Research (HAARP) facility near Gakona, Alaska. The spectral lines are typically shifted below and above the pump wave frequency by harmonics of a frequency roughly 10% less than fcH (≈ 800 Hz) with a narrow emission bandwidth less than the O+ gyrofrequency (≈ 50 Hz). However, new observations and analysis of emission lines ordered by a frequency approximately 10% greater than fcH are presented here for the first time as well. The interaction altitude for the heating for all the observations is in the range of 160 km up to 200 km. As described previously, proton precipitation due to active geomagnetic conditions is considered as the reason for the presence of H+ ions known to be a minor background constituent in this altitude region. DMSP satellite observations over HAARP during the heating experiments and ground-based magnetometer and riometer data validate active geomagnetic conditions. The theory of parametric decay instability in multi-ion component plasma including H+ ions as a minority species described in previous work is expanded in light of simultaneously observed preexisting SEE features to interpret the newly reported observations. Impact of active geomagnetic conditions on the SEE spectrum as a diagnostic tool for proton precipitation event characterization is discussed.

VHF Scintillation in an Artificially Heated Ionosphere

NASA Astrophysics Data System (ADS)

Suszcynsky, D. M.; Layne, J.; Light, M. E.; Pigue, M. J.; Rivera, L.

2017-12-01

As part of an ongoing project to characterize very-high-frequency (VHF) radio wave propagation through structured ionospheres, Los Alamos National Laboratory has been conducting a set of experiments to measure the scintillation effects of VHF transmissions under a variety of ionospheric conditions. Previous work (see 2015 Fall AGU poster by D. Suszcynsky et al.) measured the S4 index and ionospheric coherence bandwidth in the 32 - 44 MHz frequency range under naturally scintillated conditions in the equatorial region at Kwajalein Atoll during three separate campaigns centered on the 2014 and 2015 equinoxes. In this paper, we will present preliminary results from the February and September, 2017 High Altitude Auroral Research Project (HAARP) Experimental Campaigns where we are attempting to make these measurements under more controlled conditions using the HAARP ionospheric heater in a twisted-beam mode. Two types of measurements are made by transmitting VHF signals through the heated ionospheric volume to the Radio Frequency Propagation (RFProp) satellite experiment. The S4 scintillation index is determined by measuring the power fluctuations of a 135-MHz continuous wave signal and the ionospheric coherence bandwidth is simultaneously determined by measuring the delay spread of a frequency-modulated continuous wave (FMCW) signal in the 130 - 140 MHz frequency range. Additionally, a spatial Fourier transform of the CW time series is used to calculate the irregularity spectral density function. Finally, the temporal evolution of the time series is used to characterize spread-Doppler clutter effects arising from preferential ray paths to the satellite due to refraction off of isolated density irregularities. All results are compared to theory and scaled for comparison to the 32 - 44 MHz Kwajalein measurements.

L-Band Ionosphere Scintillations Observed by A GNSS Receiver Array at HAARP

NASA Astrophysics Data System (ADS)

Morton, Y.; Pelgrum, W.; van Graas, F.

2011-12-01

As we enter a new solar maximum period, GNSS receivers, especially the ones operating in high latitude and equatorial regions, are facing an increasing threat from ionosphere scintillations. The increased solar activities, however, also offer a great opportunity to collect scintillation data to gain better understandings of scintillation effects on GNSS signals. During the past decade, many GPS receivers have been deployed around the globe to monitor ionosphere scintillations. Most of these GPS receivers are commercial receivers whose tracking mechanisms are not designed to operate under ionosphere scintillation. When strong scintillations occur, these receivers will either generate erroneous outputs or completely lose lock. Even when the scintillation is mild, the tracking loop outputs are not true representation of the signal parameters due the tracking loop transfer function. High quality, unprocessed GNSS receiver front end raw IF samples collected during ionosphere scintillations are necessary to produce realistic scintillation signal parameter estimations. In this presentation, we will update our effort in establishing a unique GNSS receiver array at HAARP, Alaska to collect GPS and GLONASS satellite signals at various stages of the GNSS receiver processing. Signal strength, carrier phase, and relative TEC measurements generated by the receiver array as well as additional on-site diagnostic instrumentation measurements obtained from two active heating experiment campaigns conducted in 2011 will be presented. Additionally, we will also highlight and contrast the artificial heating experiment results with observations of natural scintillation events captured by our receivers using an automatic event trigger mechanism during the past year. These interesting results demonstrate the feasibility and effectiveness of our experimental data collection system in providing insightful details of ionosphere responses to active perturbations and natural disturbances.

High-intensity interval training beneficial effects on body mass, blood pressure, and oxidative stress in diet-induced obesity in ovariectomized mice.

PubMed

Pimenta, Marcel; Bringhenti, Isabele; Souza-Mello, Vanessa; Dos Santos Mendes, Iara Karise; Aguila, Marcia B; Mandarim-de-Lacerda, Carlos A

2015-10-15

To investigate the possible beneficial effect of high-intensity interval training (HIIT) on skeletal muscle oxidative stress, body mass (BM) and systolic blood pressure (SBP) in ovariectomized mice fed or not fed a high-fat diet. Three-month-old female C57BL/6 mice were bilaterally ovariectomized (OVX group) or submitted to surgical stress without ovariectomy (SHAM group) and separated into standard chow (SHAM-SC; OVX-SC) and high-fat diet (SHAM-HF; OVX-HF) groups. After 13 weeks, an HIIT program (swimming) was carried out for 8 weeks in non-trained (NT) and trained (T) groups. The significant reduction of uterine mass and the cytological examination of vaginal smears in the OVX group confirmed that ovariectomy was successful. Before the HIIT protocol, the ovariectomized groups showed a greater BM than the SHAM group, irrespective of the diet they received. The HIIT minimized BM gain in animals fed an HF diet and/or ovariectomized. SBP and total cholesterol were increased in the OVX and HF animals compared to their counterparts, and the HIIT efficiently reduced these factors. In the HF and OVX mice, the muscular superoxide dismutase and catalase levels were low while their glutathione peroxidase and glutathione reductase levels were high and the HIIT normalized these parameters. Diet-induced obesity maximizes the deleterious effects of an ovariectomy. The HIIT protocol significantly reduced BM, SBP and oxidative stress in the skeletal muscle indicating that HIIT diminishes the cardiovascular and metabolic risk that is inherent to obesity and menopause. Copyright © 2015 Elsevier Inc. All rights reserved.

A Hartree-Fock Application Using UPC++ and the New DArray Library

DOE PAGES

Ozog, David; Kamil, Amir; Zheng, Yili; ...

2016-07-21

The Hartree-Fock (HF) method is the fundamental first step for incorporating quantum mechanics into many-electron simulations of atoms and molecules, and it is an important component of computational chemistry toolkits like NWChem. The GTFock code is an HF implementation that, while it does not have all the features in NWChem, represents crucial algorithmic advances that reduce communication and improve load balance by doing an up-front static partitioning of tasks, followed by work stealing whenever necessary. To enable innovations in algorithms and exploit next generation exascale systems, it is crucial to support quantum chemistry codes using expressive and convenient programming modelsmore » and runtime systems that are also efficient and scalable. Here, this paper presents an HF implementation similar to GTFock using UPC++, a partitioned global address space model that includes flexible communication, asynchronous remote computation, and a powerful multidimensional array library. UPC++ offers runtime features that are useful for HF such as active messages, a rich calculus for array operations, hardware-supported fetch-and-add, and functions for ensuring asynchronous runtime progress. We present a new distributed array abstraction, DArray, that is convenient for the kinds of random-access array updates and linear algebra operations on block-distributed arrays with irregular data ownership. Finally, we analyze the performance of atomic fetch-and-add operations (relevant for load balancing) and runtime attentiveness, then compare various techniques and optimizations for each. Our optimized implementation of HF using UPC++ and the DArrays library shows up to 20% improvement over GTFock with Global Arrays at scales up to 24,000 cores.« less

A Hartree-Fock Application Using UPC++ and the New DArray Library

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

Ozog, David; Kamil, Amir; Zheng, Yili

The Hartree-Fock (HF) method is the fundamental first step for incorporating quantum mechanics into many-electron simulations of atoms and molecules, and it is an important component of computational chemistry toolkits like NWChem. The GTFock code is an HF implementation that, while it does not have all the features in NWChem, represents crucial algorithmic advances that reduce communication and improve load balance by doing an up-front static partitioning of tasks, followed by work stealing whenever necessary. To enable innovations in algorithms and exploit next generation exascale systems, it is crucial to support quantum chemistry codes using expressive and convenient programming modelsmore » and runtime systems that are also efficient and scalable. Here, this paper presents an HF implementation similar to GTFock using UPC++, a partitioned global address space model that includes flexible communication, asynchronous remote computation, and a powerful multidimensional array library. UPC++ offers runtime features that are useful for HF such as active messages, a rich calculus for array operations, hardware-supported fetch-and-add, and functions for ensuring asynchronous runtime progress. We present a new distributed array abstraction, DArray, that is convenient for the kinds of random-access array updates and linear algebra operations on block-distributed arrays with irregular data ownership. Finally, we analyze the performance of atomic fetch-and-add operations (relevant for load balancing) and runtime attentiveness, then compare various techniques and optimizations for each. Our optimized implementation of HF using UPC++ and the DArrays library shows up to 20% improvement over GTFock with Global Arrays at scales up to 24,000 cores.« less

Clinical presentation at first heart failure hospitalization does not predict recurrent heart failure admission.

PubMed

Kosztin, Annamaria; Costa, Jason; Moss, Arthur J; Biton, Yitschak; Nagy, Vivien Klaudia; Solomon, Scott D; Geller, Laszlo; McNitt, Scott; Polonsky, Bronislava; Merkely, Bela; Kutyifa, Valentina

2017-11-01

There are limited data on whether clinical presentation at first heart failure (HF) hospitalization predicts recurrent HF events. We aimed to assess predictors of recurrent HF hospitalizations in mild HF patients with an implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Data on HF hospitalizations were prospectively collected for patients enrolled in MADIT-CRT. Predictors of recurrent HF hospitalization (HF2) after the first HF hospitalization were assessed using Cox proportional hazards regression models including baseline covariates and clinical presentation or management at first HF hospitalization. There were 193 patients with first HF hospitalization, and 156 patients with recurrent HF events. Recurrent HF rate after the first HF hospitalization was 43% at 1 year, 52% at 2 years, and 55% at 2.5 years. Clinical signs and symptoms, medical treatment, or clinical management of HF at first HF admission was not predictive for HF2. Baseline covariates predicting recurrent HF hospitalization included prior HF hospitalization (HR = 1.59, 95% CI: 1.15-2.20, P = 0.005), digitalis therapy (HR = 1.58, 95% CI: 1.13-2.20, P = 0.008), and left ventricular end-diastolic volume >240 mL (HR = 1.62, 95% CI: 1.17-2.25, P = 0.004). Recurrent HF events are frequent following the first HF hospitalization in patients with implanted implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Neither clinical presentation nor clinical management during first HF admission was predictive of recurrent HF. Prior HF hospitalization, digitalis therapy, and left ventricular end-diastolic volume at enrolment predicted recurrent HF hospitalization, and these covariates could be used as surrogate markers for identifying a high-risk cohort. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Lipidomic fatty acid profile and global gene expression pattern in mammary gland of rats that were exposed to lard-based high fat diet during fetal and lactation periods associated to breast cancer risk in adulthood.

PubMed

Andrade, Fábia de Oliveira; de Assis, Sonia; Jin, Lu; Fontelles, Camile Castilho; Barbisan, Luís Fernando; Purgatto, Eduardo; Hilakivi-Clarke, Leena; Ong, Thomas Prates

2015-09-05

The persistent effects of animal fat consumption during pregnancy and nursing on the programming of breast cancer risk among female offspring were studied here. We have previously found that female offspring of rat dams that consumed a lard-based high-fat (HF) diet (60% fat-derived energy) during pregnancy, or during pregnancy and lactation, were at a reduced risk of developing mammary cancer. To better understand the unexpected protective effects of early life lard exposure, we have applied lipidomics and nutrigenomics approaches to investigate the fatty acid profile and global gene expression patterns in the mammary tissue of the female offspring. Consumption of this HF diet during gestation had few effects on the mammary tissue fatty acids profile of young adult offspring, while exposure from gestation throughout nursing promoted significant alterations in the fatty acids profile. Major differences were related to decreases in saturated fatty acids (SFA) and increases in omega-6 polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs) and conjugated linolenic acid (CLA) concentrations. In addition several differences in gene expression patterns by microarray analysis between the control and in utero or in utero and during lactation HF exposed offspring were identified. Differential dependency network (DDN) analysis indicated that many of the genes exhibited unique connections to other genes only in the HF offspring. These unique connections included Hrh1-Ythdf1 and Repin1-Elavl2 in the in utero HF offspring, and Rnf213-Htr3b and Klf5-Chrna4 in the in utero and lactation HF offspring, compared with the control offspring. We conclude that an exposure to a lard-based HF diet during early life changes the fatty acid profile and transcriptional network in mammary gland in young adult rats, and these changes appear to be consistent with reduced mammary cancer risk observed in our previous study. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Importance of the Lu-Hf isotopic system in studies of planetary chronology and chemical evolution

USGS Publications Warehouse

Patchett, P.J.

1983-01-01

The 176Lu-176Hf isotope method and its applications in earth sciences are discussed. Greater fractionation of Lu/Hf than Sm/Nd in planetary magmatic processes makes 176Hf 177Hf a powerful geochemical tracer. In general, proportional variations of 176Hf 177Hf exceed those of 143Nd l44Nd by factors of 1.5-3 in terrestrial and lunar materials. Lu-Hf studies therefore have a major contribution to make in understanding of terrestrial and other planetary evolution through time, and this is the principal importance of Lu-Hf. New data on basalts from oceanic islands show unequivocally that whereas considerable divergences occur in 176Hf 177Hf- 87Sr 86Sr and 143Nd l44Nd- 87Sr 86Sr diagrams, 176Hf 177Hf and 143Nd 144Nd display a single, linear isotopic variation in the suboceanic mantle. These discordant 87Sr 86Sr relationships may allow, with the acquisition of further Hf-Nd-Sr isotopic data, a distinction between processes such as mantle metasomatism, influence of seawater-altered material in the magma source, or recycling of sediments into the mantle. In order to evaluate the Hf-Nd isotopic correlation in terms of mantle fractionation history, there is a need for measurements of Hf distribution coefficients between silicate minerals and liquids, and specifically for a knowledge of Hf behavior in relation to rareearth elements. For studying ancient terrestrial Hf isotopic variations, the best quality Hf isotope data are obtained from granitoid rocks or zircons. New data show that very U-Pb discordant zircons may have upwardly-biased 176Hf 177Hf, but that at least concordant to slightly discordant zircons appear to be reliable carriers of initial 176Hf 177Hf. Until the controls on addition of radiogenic Hf to zircon are understood, combined zircon-whole rock studies are recommended. Lu-Hf has been demonstrated as a viable tool for dating of ancient terrestrial and extraterrestrial samples, but because it offers little advantage over existing methods, is unlikely to find wide application in pure chronological studies. ?? 1983.

ASC Methylation and Interleukin-1β Are Associated with Aerobic Capacity in Heart Failure.

PubMed

Butts, Brittany; Butler, Javed; Dunbar, Sandra B; Corwin, Elizabeth J; Gary, Rebecca A

2017-06-01

Aerobic capacity, as measured by peak oxygen uptake (V˙O2), is one of the most powerful predictors of prognosis in heart failure (HF). Inflammation is a key factor contributing to alterations in aerobic capacity, and interleukin (IL)-1 cytokines are implicated in this process. The adaptor protein ASC is necessary for inflammasome activation of IL-1β and IL-18. ASC expression is controlled through epigenetic modification; lower ASC methylation is associated with worse outcomes in HF. The purpose of this study is to examine the relationships between ASC methylation, IL-1β, and IL-18 with V˙O2peak in persons with HF. This study examined the relationship between ASC methylation, IL-1β, and IL-18 with V˙O2peak in 54 stable outpatients with HF. All participants were NYHA class II or III, not engaged in an exercise program, and physically able to complete an exercise treadmill test. Mean V˙O2peak was 16.68 ± 4.7 mL·kg·min. V˙O2peak was positively associated with mean percent ASC methylation (r = 0.47, P = 0.001) and negatively associated with IL-1β (r = -0.38, P = 0.007). Multiple linear regression models demonstrated that V˙O2peak increased by 2.30 mL·kg·min for every 1% increase in ASC methylation and decreased by 1.91 mL·kg·min for every 1 pg·mL increase in plasma IL-1β. Mean percent ASC methylation and plasma IL-1β levels are associated with clinically meaningful differences in V˙O2peak in persons with HF. Inflammasome activation may play a mechanistic role in determining aerobic capacity. ASC methylation is a potentially modifiable mechanism for reducing the inflammatory response, thereby improving aerobic capacity in HF.

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

Reduced SIRT1 expression correlates with enhanced oxidative stress in compensated and decompensated heart failure

PubMed Central

Akkafa, Feridun; Halil Altiparmak, Ibrahim; Erkus, Musluhittin Emre; Aksoy, Nurten; Kaya, Caner; Ozer, Ahmet; Sezen, Hatice; Oztuzcu, Serdar; Koyuncu, Ismail; Umurhan, Berrin

2015-01-01

Sirtuin-1 (SIRT1) is a longevity factor in mammals initiating the cell survival mechanisms, and preventing ischemic injury in heart. In the etiopathogenesis of heart failure (HF), impairment in cardiomyocyte survival is a notable factor. Oxidative stress comprises a critical impact on cardiomyocyte lifespan in HF. The aim of the present study was to investigate SIRT1 expression in patients with compensated (cHF) and decompensated HF (dHF), and its correlation with oxidative stress. SIRT1 expression in peripheral leukocytes was examined using quantitative RT-PCR in 163 HF patients and 84 controls. Serum total oxidant status (TOS) and total antioxidant status (TAS) were measured via colorimetric assays, and oxidative stress index (OSI) was calculated. Lipid parameters were also determined by routine laboratory methods. SIRT1 mRNA expression was significantly downregulated in HF with more robust decrease in dHF (p=0.002, control vs cHF; p<0.001, control vs dHF). Markedly increased oxidative stress defined as elevated TOS, OSI and low TAS levels were detected in HF patients comparing with the controls (TAS; p=0.010, control vs cHF, p=0.045 control vs dHF, TOS; p=0.004 control vs cHF; p<0.001 control vs dHF, OSI; p<0.001 for both comparisons, respectively). With SIRT1 expression levels, TAS, TOS, OSI, and high density lipoprotein levels in cHF and dHF were determined correlated. SIRT1 expression were significantly reduced in both HF subtypes, particularly in dHF. SIRT1 expression was correlated with the oxidant levels and antioxidant capacity. Data suggest that SIRT1 may have a significant contribution in regulation of oxidant/antioxidant balance in HF etiology and compensation status. PMID:26233702

Meteorite zircon constraints on the bulk Lu-Hf isotope composition and early differentiation of the Earth.

PubMed

Iizuka, Tsuyoshi; Yamaguchi, Takao; Hibiya, Yuki; Amelin, Yuri

2015-04-28

Knowledge of planetary differentiation is crucial for understanding the chemical and thermal evolution of terrestrial planets. The (176)Lu-(176)Hf radioactive decay system has been widely used to constrain the timescales and mechanisms of silicate differentiation on Earth, but the data interpretation requires accurate estimation of Hf isotope evolution of the bulk Earth. Because both Lu and Hf are refractory lithophile elements, the isotope evolution can be potentially extrapolated from the present-day (176)Hf/(177)Hf and (176)Lu/(177)Hf in undifferentiated chondrite meteorites. However, these ratios in chondrites are highly variable due to the metamorphic redistribution of Lu and Hf, making it difficult to ascertain the correct reference values for the bulk Earth. In addition, it has been proposed that chondrites contain excess (176)Hf due to the accelerated decay of (176)Lu resulting from photoexcitation to a short-lived isomer. If so, the paradigm of a chondritic Earth would be invalid for the Lu-Hf system. Herein we report the first, to our knowledge, high-precision Lu-Hf isotope analysis of meteorite crystalline zircon, a mineral that is resistant to metamorphism and has low Lu/Hf. We use the meteorite zircon data to define the Solar System initial (176)Hf/(177)Hf (0.279781 ± 0.000018) and further to identify pristine chondrites that contain no excess (176)Hf and accurately represent the Lu-Hf system of the bulk Earth ((176)Hf/(177)Hf = 0.282793 ± 0.000011; (176)Lu/(177)Hf = 0.0338 ± 0.0001). Our results provide firm evidence that the most primitive Hf in terrestrial zircon reflects the development of a chemically enriched silicate reservoir on Earth as far back as 4.5 billion years ago.

Meteorite zircon constraints on the bulk Lu−Hf isotope composition and early differentiation of the Earth

PubMed Central

Iizuka, Tsuyoshi; Yamaguchi, Takao; Hibiya, Yuki; Amelin, Yuri

2015-01-01

Knowledge of planetary differentiation is crucial for understanding the chemical and thermal evolution of terrestrial planets. The 176Lu−176Hf radioactive decay system has been widely used to constrain the timescales and mechanisms of silicate differentiation on Earth, but the data interpretation requires accurate estimation of Hf isotope evolution of the bulk Earth. Because both Lu and Hf are refractory lithophile elements, the isotope evolution can be potentially extrapolated from the present-day 176Hf/177Hf and 176Lu/177Hf in undifferentiated chondrite meteorites. However, these ratios in chondrites are highly variable due to the metamorphic redistribution of Lu and Hf, making it difficult to ascertain the correct reference values for the bulk Earth. In addition, it has been proposed that chondrites contain excess 176Hf due to the accelerated decay of 176Lu resulting from photoexcitation to a short-lived isomer. If so, the paradigm of a chondritic Earth would be invalid for the Lu−Hf system. Herein we report the first, to our knowledge, high-precision Lu−Hf isotope analysis of meteorite crystalline zircon, a mineral that is resistant to metamorphism and has low Lu/Hf. We use the meteorite zircon data to define the Solar System initial 176Hf/177Hf (0.279781 ± 0.000018) and further to identify pristine chondrites that contain no excess 176Hf and accurately represent the Lu−Hf system of the bulk Earth (176Hf/177Hf = 0.282793 ± 0.000011; 176Lu/177Hf = 0.0338 ± 0.0001). Our results provide firm evidence that the most primitive Hf in terrestrial zircon reflects the development of a chemically enriched silicate reservoir on Earth as far back as 4.5 billion years ago. PMID:25870298

Reconciliation of the excess 176Hf conundrum in meteorites: Recent disturbances of the Lu-Hf and Sm-Nd isotope systematics

NASA Astrophysics Data System (ADS)

Bast, Rebecca; Scherer, Erik E.; Sprung, Peter; Mezger, Klaus; Fischer-Gödde, Mario; Taetz, Stephan; Böhnke, Mischa; Schmid-Beurmann, Hinrich; Münker, Carsten; Kleine, Thorsten; Srinivasan, Gopalan

2017-09-01

The long-lived 176Lu-176Hf and 147Sm-143Nd radioisotope systems are commonly used chronometers, but when applied to meteorites, they can reveal disturbances. Specifically, Lu-Hf isochrons commonly yield dates up to ∼300 Myr older than the solar system and varying initial 176Hf/177Hf values. We investigated this problem by attempting to construct mineral and whole rock isochrons for eucrites and angrites. Meteorites from different parent bodies exhibit similar disturbance features suggesting that a common process is responsible. Minerals scatter away from isochron regressions for both meteorite classes, with low-Hf phases such as plagioclase and olivine typically being most displaced above (or left of) reference isochrons. Relatively Hf-rich pyroxene is less disturbed but still to the point of steepening Lu-Hf errorchrons. Using our Lu-Hf and Sm-Nd data, we tested various Hf and Lu redistribution scenarios and found that decoupling of Lu/Hf from 176Hf/177Hf must postdate the accumulation of significant radiogenic 176Hf. Therefore early irradiation or diffusion cannot explain the excess 176Hf. Instead, disturbed meteorite isochrons are more likely caused by terrestrial weathering, contamination, or common laboratory procedures. The partial dissolution of phosphate minerals may predominantly remove rare earth elements including Lu, leaving relatively immobile and radiogenic Hf behind. Robust Lu-Hf (and improved Sm-Nd) meteorite geochronology will require the development of chemical or physical methods for removing unsupported radiogenic Hf and silicate-hosted terrestrial contaminants without disturbing parent-daughter ratios.

Cinnamon improves insulin sensitivity and alters the body composition in an animal model of the metabolic syndrome.

PubMed

Couturier, K; Batandier, C; Awada, M; Hininger-Favier, I; Canini, F; Anderson, R A; Leverve, X; Roussel, A M

2010-09-01

Polyphenols from cinnamon (CN) have been described recently as insulin sensitizers and antioxidants but their effects on the glucose/insulin system in vivo have not been totally investigated. The aim of this study was to determine the effects of CN on insulin resistance and body composition, using an animal model of the metabolic syndrome, the high fat/high fructose (HF/HF) fed rat. Four groups of 22 male Wistar rats were fed for 12 weeks with: (i) (HF/HF) diet to induce insulin resistance, (ii) HF/HF diet containing 20 g cinnamon/kg of diet (HF/HF + CN), (iii) Control diet (C) and (iv) Control diet containing 20 g cinnamon/kg of diet (C + CN). Data from hyperinsulinemic euglycemic clamps showed a significant decrease of the glucose infusion rates in rats fed the HF/HF diet. Addition of cinnamon to the HF/HF diet increased the glucose infusion rates to those of the control rats. The HF/HF diet induced a reduction in pancreas weight which was prevented in HF/HF+CN group (p<0.01). Mesenteric white fat accumulation was observed in HF/HF rats vs. control rats (p<0.01). This deleterious effect was alleviated when cinnamon was added to the diet. In summary, these results suggest that in animals fed a high fat/high fructose diet to induce insulin resistance, CN alters body composition in association with improved insulin sensitivity. 2010 Elsevier Inc. All rights reserved.

An Optimized Combined Wave and Current Bottom Boundary Layer Model for Arbitrary Bed Roughness

DTIC Science & Technology

2017-06-30

Engineer Research and Development Center (ERDC), Coastal and Hydraulics Laboratory (CHL), Flood and Storm Protection Division (HF), Coastal ...ER D C/ CH L TR -1 7- 11 Coastal Inlets Research Program An Optimized Combined Wave and Current Bottom Boundary Layer Model for...client/default. Coastal Inlets Research Program ERDC/CHL TR-17-11 June 2017 An Optimized Combined Wave and Current Bottom Boundary Layer Model

Transformation toughened ceramics for the heavy duty diesel engine technology program

NASA Technical Reports Server (NTRS)

Musikant, S.; Feingold, E.; Rauch, H.; Samanta, S.

1984-01-01

The objective of this program is to develop an advanced high temperature oxide structural ceramic for application to the heavy duty diesel engine. The approach is to employ transformation toughening by additions of ZrO.5HfO.5O2 solid solution to the oxide ceramics, mullite (2Al2O3S2SiO2) and alumina (Al2O3). The study is planned for three phases, each 12 months in duration. This report covers Phase 1. During this period, processing techniques were developed to incorporate the ZrO.5HfO.5O2 solid solution in the matrices while retaining the necessary metastable tetragonal phase. Modulus of rupture and of elasticity, coefficient of thermal expansion, fracture toughness by indent technique and thermal diffusivity of representative specimens were measured. In Phase 2, the process will be improved to provide higher mechanical strength and to define the techniques for scale up to component size. In Phase 3, full scale component prototypes will be fabri-]cated.

Tools and Techniques for Evaluating the Effects of Maintenance Resource Management (MRM) in Air Safety

NASA Technical Reports Server (NTRS)

Taylor, James C.

2002-01-01

This research project was designed as part of a larger effort to help Human Factors (HF) implementers, and others in the aviation maintenance community, understand, evaluate, and validate the impact of Maintenance Resource Management (MRM) training programs, and other MRM interventions; on participant attitudes, opinions, behaviors, and ultimately on enhanced safety performance. It includes research and development of evaluation methodology as well as examination of psychological constructs and correlates of maintainer performance. In particular, during 2001, three issues were addressed. First a prototype process for measuring performance was developed and used. Second an automated calculator was developed to aid the HF implementer user in analyzing and evaluating local survey data. These results include being automatically compared with the experience from all MRM programs studied since 1991. Third the core survey (the Maintenance Resource Management Technical Operations Questionnaire, or 'MRM/TOQ') was further developed and tested to include topics of added relevance to the industry.

Thrust chamber material technology program

NASA Technical Reports Server (NTRS)

Andrus, J. S.; Bordeau, R. G.

1989-01-01

This report covers work performed at Pratt & Whitney on development of copper-based materials for long-life, reusable, regeneratively cooled rocket engine thrust chambers. The program approached the goal of enhanced cyclic life through the application of rapid solidification to alloy development, to introduce fine dispersions to strengthen and stabilize the alloys at elevated temperatures. After screening of alloy systems, copper-based alloys containing Cr, Co, Hf, Ag, Ti, and Zr were processed by rapid-solidification atomization in bulk quantities. Those bulk alloys showing the most promise were characterized by tensile testing, thermal conductivity testing, and elevated-temperature, low-cycle fatigue (LFC) testing. Characterization indicated that Cu- 1.1 percent Hf exhibited the greatest potential as an improved-life thrust chamber material, exhibiting LCF life about four times that of NASA-Z. Other alloys (Cu- 0.6 percent Zr, and Cu- 0.6 percent Zr- 1.0 percent Cr) exhibited promise for use in this application, but needed more development work to balance properties.

Neogene volcanism associated with back-arc basin tectonics at the northern Fossa Magna, NE Japan

NASA Astrophysics Data System (ADS)

Okamura, S.; Inaba, M.; Shinjo, R.; Adachi, Y.

2016-12-01

New isotopic and trace element data presented here imply a temporal change in magma sources and thermal conditions beneath the northern Fossa Magna of NE Japan from the Miocene to the Pliocene. Rocks from more sediment melt-rich Early Miocene volcanoes have less radiogenic 176Hf/177Hf and 143Nd/144Nd, high Zr/Hf, and little or no Hf anomaly (Hf/Hf*; ˜1.0). The mantle wedge in the Early Miocene consisted of enriched mantle source. We propose that during the onset of subduction, influx of hot asthenospheric mantle provided sufficient heat to partially melt newly subducting sediment. Geochemical modeling results suggest breakdown of zircon in the slab surface sediments for the Early Miocene lavas in the northern Fossa Magna region. In the Middle Miocene, the injection of hot and depleted asthenospheric material replaced the mantle beneath the northern Fossa Magna region of NE Japan. This caused the isotopic signature of the rocks to change from enriched to depleted. The Middle Miocene lavas characterized by most radiogenic Hf and Nd isotope ratios, have high Zr/Hf, low Lu/Hf, and little or no Hf anomaly. An appropriate working petrogenetic model is that the Middle Miocene lavas were derived from asthenospheric depleted mantle, slightly ( < 1%) contaminated by slab melt accompanied by full dissolution of zircon. All the Late Miocene and Pliocene samples are characterized by distinctly more radiogenic 176Hf/177Hf and 143Nd/144Nd, and more negative Hf anomalies (greater Hf/Hf* variability; ˜0.3). The Pliocene samples are displaced toward lower Hf/Hf* and Zr/Hf, and higher Lu/Hf relative to the Middle Miocene samples, which requires mixing between depleted mantle and a partial melt of subducted metasediment saturated with trace quantity of zircon.

A Polyphenol-Rich Fraction Obtained from Table Grapes Decreases Adiposity, Insulin Resistance, and Markers of Inflammation and Impacts Gut Microbiota in High-Fat Fed Mice

PubMed Central

Collins, Brian; Hoffman, Jessie; Martinez, Kristina; Grace, Mary; Lila, Mary Ann; Cockrell, Chase; Nadimpalli, Anuradha; Chang, Eugene; Chuang, Chia-Chi; Zhong, Wei; Mackert, Jessica; Shen, Wan; Cooney, Paula; Hopkins, Robin; McIntosh, Michael

2016-01-01

The objective of this study was to determine if consuming an extractable or non-extractable fraction of table grapes reduced the metabolic consequences of consuming a high-fat, American-type diet. Male C57BL/6J mice were fed a low fat (LF) diet, a high fat (HF) diet, or a HF diet containing whole table grape powder (5% w/w), an extractable, polyphenol-rich (HF-EP) fraction, a non-extractable, polyphenol-poor (HF-NEP) fraction, or equal combinations of both fractions (HF-EP+NEP) from grape powder for 16 weeks. Mice fed the HF-EP and HF-EP+NEP diets had lower percentages of body fat and amounts of white adipose tissue (WAT) and improved glucose tolerance compared to the HF-fed controls. Mice fed the HF-EP+NEP diet had lower liver weights and triglyceride (TG) levels compared to the HF-fed controls. Mice fed the HF-EP+NEP diets had higher hepatic mRNA levels of hormone sensitive lipase and adipose TG lipase, and decreased expression of c-reactive protein compared to the HF-fed controls. In epididymal (visceral) WAT, the expression levels of several inflammatory genes were lower in mice fed the HF-EP and HF-EP+NEP diets compared to the HF-fed controls. Mice fed the HF diets had increased myeloperoxidase activity and impaired localization of the tight junction protein zonula occludens-1 in ileal mucosa compared to the HF-EP and HF-NEP diets. Several of these treatment effects were associated with alterations in gut bacterial community structure. Collectively, these data demonstrate that the polyphenol-rich, EP fraction from table grapes attenuated many of the adverse health consequences associated with consuming a HF diet. PMID:27133434

Future Perspectives for Management of Stage A Heart Failure.

PubMed

Tanaka, Hidekazu

2018-05-07

Patients with Stage A heart failure (HF) show no HF symptoms but have related comorbid diseases with a high risk of progressing to HF. Screening for comorbid diseases warrants closer attention because of the growing interest in addressing Stage A HF as the best means of preventing eventual progression to overt HF such as Stages C and D. The identification of individuals of Stage A HF is potentially useful for the implementation of HF-prevention strategies; however, not all Stage A HF patients develop left ventricular (LV) structural heart disease or symptomatic HF, which lead to advanced HF stages. Therefore, Stage A HF requires management with the long-term goal of avoiding HF development; likewise, Stage B HF patients are ideal targets for HF prevention. Although the early detection of subclinical LV dysfunction is, thus, essential for delaying the progression to HF, the assessment of subclinical LV dysfunction can be challenging. Global longitudinal strain (GLS) as assessed by speckle-tracking echocardiography has recently been reported to be a sensitive marker of early subtle LV myocardial abnormalities, helpful for the prediction of the outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS reflects LV longitudinal myocardial systolic function, and can be assessed usually by means of two-dimensional speckle-tracking. This article reviews the importance of the assessment of subclinical LV dysfunction in Stage A HF patients by means of GLS, and its current potential to prevent progression to later stage HF.

SEMICONDUCTOR TECHNOLOGY: Wet etching characteristics of a HfSiON high-k dielectric in HF-based solutions

NASA Astrophysics Data System (ADS)

Yongliang, Li; Qiuxia, Xu

2010-03-01

The wet etching properties of a HfSiON high-k dielectric in HF-based solutions are investigated. HF-based solutions are the most promising wet chemistries for the removal of HfSiON, and etch selectivity of HF-based solutions can be improved by the addition of an acid and/or an alcohol to the HF solution. Due to densification during annealing, the etch rate of HfSiON annealed at 900 °C for 30 s is significantly reduced compared with as-deposited HfSiON in HF-based solutions. After the HfSiON film has been completely removed by HF-based solutions, it is not possible to etch the interfacial layer and the etched surface does not have a hydrophobic nature, since N diffuses to the interface layer or Si substrate formation of Si-N bonds that dissolves very slowly in HF-based solutions. Existing Si-N bonds at the interface between the new high-k dielectric deposit and the Si substrate may degrade the carrier mobility due to Coulomb scattering. In addition, we show that N2 plasma treatment before wet etching is not very effective in increasing the wet etch rate for a thin HfSiON film in our case.

The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors.

PubMed

Fleming, Richard M

2002-01-01

Over 60% of Americans are overweight and a number of popular diets have been advocated, often without evidence, to alleviate this public health hazard. This study was designed to investigate the effects of several diets on weight loss, serum lipids, and other cardiovascular disease risk factors. One hundred men and women followed one of four dietary programs for 1 year: a moderate-fat (MF) program without calorie restriction (28 patients); a low-fat (LF) diet (phase I) (16) ; a MF, calorie-controlled (phase II) diet (38 patients); and a high-fat (HF) diet (18 subjects) [corrected]. Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), homocysteine (Ho), and lipoprotein(a) [Lp(a)], were measured every 4th month. The TC/HDL-C ratio was calculated and fibrinogen levels were measured at baseline and after one year. The MF diet resulted in a 2.6% (NS) decrease in weight compared with 18.4% (p=0.045) decrease in patients on phase I, 12.6% (p=0.0085) decrease in patients on phase II, and 13.7% (p=0.025) decrease in those on the HF diet. TC was reduced by 5% (NS) in the MF group, 39.1% (p=0.0005) in the phase I group, and 30.4% (p=0.0001) in the phase II group. HF group had a 4.3% (NS) increase in TC. LDL-C was reduced by 6.1% (NS) on MF, 52.0% (p=0.0001) on phase I, and 38.8% (p=0.0001) on phase II. Patients on HF had a 6.0% (NS) increase in LDL-C. There were nonsignificant reductions in HDL-C in those on MF (-1.5%) and HF (-5.8%). Patients on phase I showed an increase in HDL-C of 9.0% (NS), while those on phase II diet had a 3.6% increase (NS) in HDL-C. TC/HDL-C increased (9.8%) only in patients following the high-fat diets (NS). Patients on MF had a 5.3% (NS) reduction in TC/HDL-C, while those on LF had significant reductions on the phase I ( -45.8%; p=0.0001) diet and phase II diet (-34.7%; p=0.0001). TG levels increased on both the MF (1.0%) and HF (5.5%) diets, although neither was statistically significant. People following the phase I and II diets showed reductions of 37.3% and 36.9%, respectively. Ho levels increased by 9.7% when people followed the MF diet and by 12.4% when they followed the HF diet. Patients following the phase I and phase II diets showed reductions of 13.6% and 14.6%, respectively. Only those following phase II diets showed a tendency toward significant improvement (p=0.061). Lp(a) levels increased by 4.7% following the MF (NS) diet and by 31.0% (NS) on the HF diet. Patients following phase I showed a 7.4% (NS) reduction and a 10.8% reduction (NS) following phase II. Fibrinogen levels increased only in individuals following HF diets (11.9%), while patients following MF (-0.6%), phase I (-11.0%), and phase II (-6.3%) diets showed nonsignificant reductions in fibrinogen. Patients on MF demonstrated nonsignificant reductions in weight, LDL-C, TC, HDL-C, TC/HDL-C ratios, and fibrinogen and nonsignificant increases in TGs, Lp(a), and homocysteine. There was significant weight loss in patients on phase I and II and HF diets after 1 year. Reductions in TC, LDL-C, TGs, and TC/HDL ratios were significant only in patients either following a LF diet or a MF, calorically reduced diet. Only patients following HF diets showed a worsening of each cardiovascular disease risk factor (LDL-C, TG, TC, HDL-C, TC/HDL ratio, Ho, Lp(a), and fibrinogen), despite achieving statistically significant weight loss. Copyright 2002 CHF, Inc.

Effects of High-Intensity Interval Exercise Training on Skeletal Myopathy of Chronic Heart Failure.

PubMed

Tzanis, Georgios; Philippou, Anastassios; Karatzanos, Eleftherios; Dimopoulos, Stavros; Kaldara, Elisavet; Nana, Emmeleia; Pitsolis, Theodoros; Rontogianni, Dimitra; Koutsilieris, Michael; Nanas, Serafim

2017-01-01

It remains controversial which type of exercise elicits optimum adaptations on skeletal myopathy of heart failure (HF). Our aim was to evaluate the effect of high-intensity interval training (HIIT), with or without the addition of strength training, on skeletal muscle of HF patients. Thirteen male HF patients (age 51 ± 13 years, body mass index 27 ± 4 kg/m 2 ) participated in either an HIIT (AER) or an HIIT combined with strength training (COM) 3-month program. Biopsy samples were obtained from the vastus lateralis. Analyses were performed on muscle fiber type, cross-section area (CSA), capillary density, and mRNA expression of insulin-like growth factor (IGF) 1 isoforms (ie, IGF-1Ea, IGF-1Eb, IGF-1Ec), type-1 receptor (IGF-1R), and binding protein 3 (IGFBP-3). Increased expression of IGF-1Ea, IGF-1Eb, IGF-1Ec, and IGFBP-3 transcripts was found (1.7 ± 0.8, 1.5 ± 0.8, 2.0 ± 1.32.4 ± 1.4 fold changes, respectively; P < .05). Type I fibers increased by 21% (42 ± 10% to 51 ± 7%; P < .001) and capillary/fiber ratio increased by 24% (1.27 ± 0.22 to 1.57 ± 0.41; P = .005) in both groups as a whole. Fibers' mean CSA increased by 10% in total, but the increase in type I fibers' CSA was greater after AER than COM (15% vs 6%; P < .05). The increased CSA correlated with the increased expression of IGF-1Ea and IGF-1Εb. HIIT reverses skeletal myopathy of HF patients, with the adaptive responses of the IGF-1 bioregulation system possibly contributing to these effects. AER program seemed to be superior to COM to induce muscle hypertrophy. Copyright © 2016 Elsevier Inc. All rights reserved.

Validation of High Frequency (HF) Propagation Prediction Models in the Arctic region

NASA Astrophysics Data System (ADS)

Athieno, R.; Jayachandran, P. T.

2014-12-01

Despite the emergence of modern techniques for long distance communication, Ionospheric communication in the high frequency (HF) band (3-30 MHz) remains significant to both civilian and military users. However, the efficient use of the ever-varying ionosphere as a propagation medium is dependent on the reliability of ionospheric and HF propagation prediction models. Most available models are empirical implying that data collection has to be sufficiently large to provide good intended results. The models we present were developed with little data from the high latitudes which necessitates their validation. This paper presents the validation of three long term High Frequency (HF) propagation prediction models over a path within the Arctic region. Measurements of the Maximum Usable Frequency for a 3000 km range (MUF (3000) F2) for Resolute, Canada (74.75° N, 265.00° E), are obtained from hand-scaled ionograms generated by the Canadian Advanced Digital Ionosonde (CADI). The observations have been compared with predictions obtained from the Ionospheric Communication Enhanced Profile Analysis Program (ICEPAC), Voice of America Coverage Analysis Program (VOACAP) and International Telecommunication Union Recommendation 533 (ITU-REC533) for 2009, 2011, 2012 and 2013. A statistical analysis shows that the monthly predictions seem to reproduce the general features of the observations throughout the year though it is more evident in the winter and equinox months. Both predictions and observations show a diurnal and seasonal variation. The analysed models did not show large differences in their performances. However, there are noticeable differences across seasons for the entire period analysed: REC533 gives a better performance in winter months while VOACAP has a better performance for both equinox and summer months. VOACAP gives a better performance in the daily predictions compared to ICEPAC though, in general, the monthly predictions seem to agree more with the observations compared to the daily predictions.

A routine high-precision method for Lu-Hf isotope geochemistry and chronology

USGS Publications Warehouse

Patchett, P.J.; Tatsumoto, M.

1981-01-01

A method for chemical separation of Lu and Hf from rock, meteorite and mineral samples is described, together with a much improved mass spectrometric running technique for Hf. This allows (i) geo- and cosmochronology using the176Lu???176Hf+??- decay scheme, and (ii) geochemical studies of planetary processes in the earth and moon. Chemical yields for the three-stage ion-exchange column procedure average 90% for Hf. Chemical blanks are <0.2 ng for Lu and Hf. From 1 ??g of Hf, a total ion current of 0.5??10-11 Ampere can be maintained for 3-5 h, yielding 0.01-0.03% precision on the ratio176Hf/177Hf. Normalisation to179Hf/177Hf=0.7325 is used. Extensive results for the Johnson Matthey Hf standard JMC 475 are presented, and this sample is urged as an international mass spectrometric standard; suitable aliquots, prepared from a single batch of JMC 475, are available from Denver. Lu-Hf analyses of the standard rocks BCR-1 and JB-1 are given. The potential of the Lu-Hf method in isotope geochemistry is assessed. ?? 1980 Springer-Verlag.

Maternal supplementation with conjugated linoleic acid in the setting of diet-induced obesity normalises the inflammatory phenotype in mothers and reverses metabolic dysfunction and impaired insulin sensitivity in offspring.

PubMed

Segovia, Stephanie A; Vickers, Mark H; Zhang, Xiaoyuan D; Gray, Clint; Reynolds, Clare M

2015-12-01

Maternal consumption of a high-fat diet significantly impacts the fetal environment and predisposes offspring to obesity and metabolic dysfunction during adulthood. We examined the effects of a high-fat diet during pregnancy and lactation on metabolic and inflammatory profiles and whether maternal supplementation with the anti-inflammatory lipid conjugated linoleic acid (CLA) could have beneficial effects on mothers and offspring. Sprague-Dawley rats were fed a control (CD; 10% kcal from fat), CLA (CLA; 10% kcal from fat, 1% total fat as CLA), high-fat (HF; 45% kcal from fat) or high fat with CLA (HFCLA; 45% kcal from fat, 1% total fat as CLA) diet ad libitum 10days prior to and throughout gestation and lactation. Dams and offspring were culled at either late gestation (fetal day 20, F20) or early postweaning (postnatal day 24, P24). CLA, HF and HFCLA dams were heavier than CD throughout gestation. Plasma concentrations of proinflammatory cytokines interleukin-1β and tumour necrosis factor-α were elevated in HF dams, with restoration in HFCLA dams. Male and female fetuses from HF dams were smaller at F20 but displayed catch-up growth and impaired insulin sensitivity at P24, which was reversed in HFCLA offspring. HFCLA dams at P24 were protected from impaired insulin sensitivity as compared to HF dams. Maternal CLA supplementation normalised inflammation associated with consumption of a high-fat diet and reversed associated programming of metabolic dysfunction in offspring. This demonstrates that there are critical windows of developmental plasticity in which the effects of an adverse early-life environment can be reversed by maternal dietary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Increase in endogenous estradiol in the progeny of obese rats is associated with precocious puberty and altered follicular development in adulthood.

PubMed

Ambrosetti, Valery; Guerra, Marcelo; Ramírez, Luisa A; Reyes, Aldo; Álvarez, Daniela; Olguín, Sofía; González-Mañan, Daniel; Fernandois, Daniela; Sotomayor-Zárate, Ramón; Cruz, Gonzalo

2016-07-01

Maternal obesity during pregnancy has been related with several pathological states in offspring. However, the impact of maternal obesity on reproductive system on the progeny is beginning to be elucidated. In this work, we characterize the effect of maternal obesity on puberty onset and follicular development in adult offspring in rats. We also propose that alterations in ovarian physiology observed in offspring of obese mothers are due to increased levels of estradiol during early development. Offspring of control dams and offspring of dams exposed to a high-fat diet (HF) were studied at postnatal days (PND) 1, 7, 14, 30, 60, and 120. Body weight and onset of puberty were measured. Counting of ovarian follicles was performed at PND 60 and 120. Serum estradiol, estriol, androstenedione, FSH, LH, and insulin levels were measured by ELISA. Hepatic CYP3A2 expression was determined by Western blot. HF rats had a higher weight than controls at all ages and they also had a precocious puberty. Estradiol levels were increased while CYP3A2 expression was reduced from PND 1 until PND 60 in HF rats compared to controls. Estriol was decreased at PND60 in HF rats. Ovaries from HF rats had a decrease in antral follicles at PND60 and PND120 and an increase in follicular cysts at PND60 and PND120. In this work, we demonstrated that maternal obesity in rats alters follicular development and induces follicular cysts generation in the adult offspring. We observed that maternal obesity produces an endocrine disruption through increasing endogenous estradiol in early life. A programmed failure in hepatic metabolism of estradiol is probably the cause of its increase.

Life expectancy for community-based patients with heart failure from time of diagnosis.

PubMed

James, Stephanie; Barton, David; O'Connell, Eoin; Voon, Victor; Murtagh, Gillian; Watson, Chris; Murphy, Theodore; Prendiville, Brian; Brennan, David; Hensey, Mark; O'Neill, Louisa; O'Hanlon, Rory; Waterhouse, Deirdre; Ledwidge, Mark; Gallagher, Joseph; McDonald, Kenneth

2015-01-15

Heart failure has been demonstrated in previous studies to have a dismal prognosis. However, the modern-day prognosis of patients with new onset heart failure diagnosed in the community managed within a disease management programme is not known. The purpose of this study is to report on prognosis of patients presenting with new onset heart failure in the community who are subsequently followed in a disease management program. A review of patients referred to a rapid access heart failure diagnostic clinic between 2002 and 2012 was undertaken. Details of diagnosis, demographics, medical history, medications, investigations and mortality data were analysed. A total of 733 patients were seen in Rapid Access Clinic for potential new diagnosis of incident of heart failure. 38.9% (n=285) were diagnosed with heart failure, 40.7% (n=116) with HF-REF and 59.3% (n=169) with HF-PEF. There were 84 (29.5%) deaths in the group of patients diagnosed with heart failure; 41 deaths (35.3%) occurred in patients with HF-REF and 43 deaths (25.4%) occurred in patients with HF-PEF. In patients with heart failure, 52.4% (n=44) died from cardiovascular causes. 63.8% of HF patients were alive after 5 years resulting on average in a month per year loss of life expectancy over that period compared with aged matched simulated population. In this community-based cohort, the prognosis of heart failure was better than reported in previous studies. This is likely due to the impact of prompt diagnosis, the improvement in therapies and care within a disease management structure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States.

PubMed

Khera, Rohan; Pandey, Ambarish; Kumar, Nilay; Singh, Rajeev; Bano, Shah; Golwala, Harsh; Kumbhani, Dharam J; Girotra, Saket; Fonarow, Gregg C

2016-11-01

There has been an increase in the use of pulmonary artery (PA) catheters in heart failure (HF) in the United States in recent years. However, patterns of hospital use and trends in patient outcomes are not known. In the National Inpatient Sample 2001 to 2012, using International Classification of Diseases-Ninth Revision codes, we identified 11 888 525 adult (≥18 years) HF hospitalizations nationally, of which an estimated 75 209 (SE 0.6%) received a PA catheter. In 2001, the number of hospitals with ≥1 PA catheterization was 1753, decreasing to 1183 in 2011. The mean PA catheter use per hospital trended from 4.9 per year in 2001 (limits 1-133) to 3.8 per year in 2007 (limits 1-46), but increased to 5.5 per year in 2011 (limits 1-70). During 2001 to 2006, PA catheterization declined across hospitals; however, in 2007 to 2012, there was a disproportionate increase at hospitals with large bedsize, teaching programs, and advanced HF capabilities. The overall in-hospital mortality with PA catheter use was higher than without PA catheter use (13.1% versus 3.4%; P<0.0001); however, in propensity-matched analysis, differences in mortality between these groups have attenuated over time-risk-adjusted odds ratio for mortality for PA catheterization, 1.66 (95% confidence interval, 1.60-1.74) in 2001 to 2003 down to 1.04 (95% confidence interval, 0.97-1.12) in 2010 to 2012. There is substantial hospital-level variability in PA catheterization in HF along with increasing volume at fewer hospitals over-represented by large, academic hospitals with advanced HF capabilities. This is accompanied by a decline in excess mortality associated with PA catheterization. © 2016 American Heart Association, Inc.

Glacial reduction of AMOC strength and long-term transition in weathering inputs into the Southern Ocean since the mid-Miocene: Evidence from radiogenic Nd and Hf isotopes

NASA Astrophysics Data System (ADS)

Dausmann, Veit; Frank, Martin; Gutjahr, Marcus; Rickli, Jörg

2017-03-01

Combined seawater radiogenic hafnium (Hf) and neodymium (Nd) isotope compositions were extracted from bulk sediment leachates and foraminifera of Site 1088, Ocean Drilling Program Leg 177, 2082 m water depth on the Agulhas Ridge. The new data provide a continuous reconstruction of long- and short-term changes in ocean circulation and continental weathering inputs since the mid-Miocene. Due to its intermediate water depth, the sediments of this core sensitively recorded changes in admixture of North Atlantic Deep Water to the Antarctic Circumpolar Current as a function of the strength of the Atlantic Meridional Overturning Circulation (AMOC). Nd isotope compositions (ɛNd) range from -7 to -11 with glacial values generally 1 to 3 units more radiogenic than during the interglacials of the Quaternary. The data reveal episodes of significantly increased AMOC strength during late Miocene and Pliocene warm periods, whereas peak radiogenic ɛNd values mark a strongly diminished AMOC during the major intensification of Northern Hemisphere Glaciation near 2.8 Ma and in the Pleistocene after 1.5 Ma. In contrast, the Hf isotope compositions (ɛHf) show an essentially continuous evolution from highly radiogenic values of up to +11 during the Miocene to less radiogenic present-day values (+2 to +4) during the late Quaternary. The data document a long-term transition in dominant weathering inputs, where inputs from South America are replaced by those from Southern Africa. Moreover, radiogenic peaks provide evidence for the supply of radiogenic Hf originating from Patagonian rocks to the Atlantic sector of the Southern Ocean via dust inputs.

Depression Effects on Hospital Cost of Heart Failure Patients in California: An Analysis by Ethnicity and Gender.

PubMed

Husaini, Baqar A; Taira, Deborah; Norris, Keith; Adhish, S Vivek; Moonis, Majaz; Levine, Robert

2018-01-01

Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost. Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender. Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF +D ) versus HF without depression (HF ND ). HF cases ( n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher ( P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher ( P < 0.001) compared to other groups. The cost for HF +D was 22% higher compared to HF ND , across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization. Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF +D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted.

Association Between Rheumatoid Arthritis and Risk of Ischemic and Nonischemic Heart Failure.

PubMed

Mantel, Ängla; Holmqvist, Marie; Andersson, Daniel C; Lund, Lars H; Askling, Johan

2017-03-14

It is unknown whether the increased risk of heart failure (HF) in rheumatoid arthritis (RA) is independent of ischemic heart disease (IHD). This study sought to investigate the relative risk of HF overall and by subtype (ischemic and nonischemic HF) in patients with RA and to assess the impact of RA disease factors. Two contemporary cohorts of RA subjects were identified from Swedish patient and rheumatology registries and matched 1:10 to general population comparator subjects. A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs). By the time of RA onset, a history of HF was not more common in RA. In the new-onset RA cohort, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27. The risk of nonischemic HF increased rapidly after RA onset, in contrast to the risk of ischemic HF. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. In the cohort of patients with RA of any duration, the HRs were between 1.71 and 1.88 for the different HF subtypes. Patients with RA are at increased risk of HF that cannot be explained by their increased risk of IHD. The increased risk of nonischemic HF occurred early and was associated with RA severity. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

THERMODYNAMIC PROPERTIES OF Zr AND Hf HALIDES (in Rumanian)

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

Lungu, S.N.

1962-01-01

The following standard heats of formation were found: ZrCl/sub 3/, 178.6 plus or minus 3.2; ZrCl/sub 2/, 124.3 plus or minus 3; ZrBr/sub 3/, 151 plus or minus 7; Zr Br/sbu 2/, 100 plus or minus 6; ZrI/sub 3/, 103 plus or minus 6; ZrI/sub 2/, 68 plus or minus 4; and HfCl/sub 4/, 239.4 plus or minus 5.5; HfCl/sub 3/, 186.6; HfCl/sub 2/, 130; HfBr/sub 4/, 200; HfBr/sub 3/, 157; HfBr / sub 2/, 108; HfI/sub 4/, 140; HfI/sub 3/, 113; and HfI/sub 2/, 72 kcal/mole. (R.V.J.)

Investigation and Development of Data-Driven D-Region Model for HF Systems Impacts

NASA Technical Reports Server (NTRS)

Eccles, J. V.; Rice, D.; Sojka, J. J.; Hunsucker, R. D.

2002-01-01

Space Environment Corporation (SEC) and RP Consultants (RPC) are to develop and validate a weather-capable D region model for making High Frequency (HF) absorption predictions in support of the HF communications and radar communities. The weather-capable model will assimilate solar and earth space observations from NASA satellites. The model will account for solar-induced impacts on HF absorption, including X-rays, Solar Proton Events (SPE's), and auroral precipitation. The work plan includes: I . Optimize D-region model to quickly obtain ion and electron densities for proper HF absorption calculations. 2. Develop indices-driven modules for D-region ionization sources for low, mid, & high latitudes including X-rays, cosmic rays, auroral precipitation, & solar protons. (Note: solar spectrum & auroral modules already exist). 3. Setup low-cost monitors of existing HF beacons and add one single-frequency beacon. 4. Use PENEX HF-link database with HF monitor data to validate D-region/HF absorption model using climatological ionization drivers. 5. Develop algorithms to assimilate NASA satellite data of solar, interplanetary, and auroral observations into ionization source modules. 6. Use PENEX HF-link & HF-beacon data for skill score comparison of assimilation versus climatological D-region/HF absorption model. Only some satellites are available for the PENEX time period, thus, HF-beacon data is necessary. 7. Use HF beacon monitors to develop HF-link data assimilation algorithms for regional improvement to the D-region/HF absorption model.

Ion/Ioff ratio enhancement and scalability of gate-all-around nanowire negative-capacitance FET with ferroelectric HfO2

NASA Astrophysics Data System (ADS)

Jang, Kyungmin; Saraya, Takuya; Kobayashi, Masaharu; Hiramoto, Toshiro

2017-10-01

We have investigated the energy efficiency and scalability of ferroelectric HfO2 (FE:HfO2)-based negative-capacitance field-effect-transistor (NCFET) with gate-all-around (GAA) nanowire (NW) channel structure. Analytic simulation is conducted to characterize NW-NCFET by varying NW diameter and/or thickness of gate insulator as device structural parameters. Due to the negative-capacitance effect and GAA NW channel structure, NW-NCFET is found to have 5× higher Ion/Ioff ratio than classical NW-MOSFET and 2× higher than double-gate (DG) NCFET, which results in wider design window for high Ion/Ioff ratio. To analyze these obtained results from the viewpoint of the device scalability, we have considered constraints regarding very limited device structural spaces to fit by the gate insulator and NW channel for aggresively scaled gate length (Lg) and/or very tight NW pitch. NW-NCFET still has design point with very thinned gate insulator and/or narrowed NW. Therefore, FE:HfO2-based NW-NCFET is applicable to the aggressively scaled technology node of sub-10 nm Lg and to the very tight NW integration of sub-30 nm NW pitch for beyond 7 nm technology. From 2011 to 2014, he engaged in developing high-speed optical transceiver module as an alternative military service in Republic of Korea. His research interest includes the development of steep slope MOSFETs for high energy-efficient operation and ferroelectric HfO2-based semiconductor devices, and fabrication of nanostructured devices. He joined the IBM T.J. Watson Research Center, Yorktown Heights, NY, in 2010, where he worked on advanced CMOS technologies such as FinFET, nanowire FET, SiGe channel and III-V channel. He was also engaged in launching 14 nm SOI FinFET and RMG technology development. Since 2014, he has been an Associate Professor in Institute of Industrial Science, University of Tokyo, Tokyo, Japan, where he has been working on ultralow power transistor and memory technology. Dr. Kobayashi is a member of IEEE and the Japan Society of Applied Physics. Dr. Hiramoto is a fellow of Japan Society of Applied Physics and a member of IEEE and IEICE. He served as the General Chair of Silicon Nanoelectronics Workshop in 2003 and the Program Chair in 1997, 1999, and 2001. He was on Committee of IEDM from 2003 to 2009. He was the Program Chair of Symposium on VLSI Technology in 2013 and was the General Chair in 2015. He is the Program Chair of International Conference on Solid-State Devices and Materials (SSDM) in 2016.

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

Zircon U-Pb geochronology, Sr-Nd-Hf isotopic composition and geological significance of the Late Triassic Baijiazhuang and Lvjing granitic plutons in West Qinling Orogen

NASA Astrophysics Data System (ADS)

Duan, Meng; Niu, Yaoling; Kong, Juanjuan; Sun, Pu; Hu, Yan; Zhang, Yu; Chen, Shuo; Li, Jiyong

2016-09-01

The Qinling Orogen was a consequence of continental collision of the South China Craton with the North China Craton in the Triassic and caused widespread granitoid magmatism. However, the petrogenesis of these granitoids remains controversial. In this paper, we choose the Baijiazhuang (BJZ) and Lvjing (LJ) plutons in the West Qinling Orogen for a combined study of the zircon U-Pb geochronology, whole-rock major and trace element compositions and Sr-Nd-Hf isotopic characteristics. We obtained zircon crystallization ages of 216 Ma and 212 Ma for the BJZ and the LJ plutons, respectively. The granitoid samples from both plutons have high K2O metaluminous to peraluminous compositions. They are enriched in large ion lithophile elements (LILEs), light rare earth elements (LREEs) and depleted in high field-strength elements (HFSEs) with significant negative Eu anomalies. The BJZ samples have initial Sr isotopic ratios of 0.7032 to 0.7078, εNd(t) of - 10.99 to - 8.54 and εHf (t) of - 10.22 to - 6.41. The LJ granitoids have initial Sr isotopic ratios of 0.7070 to 0.7080, εNd(t) of - 5.37 to - 4.58 and εHf(t) of - 3.64 to - 1.78. The enriched isotopic characteristics of the two plutons are consistent with their source being dominated by ancient continental crust. However, two BJZ samples show depleted Sr isotope compositions, which may infer possible involvement of mantle materials. Mantle-derived melt, which formed from partial melting of mantle wedge peridotite facilitated by dehydration of the subducted/subducting Mianlue ocean crust, provide the required heat for the crustal melting while also contributing to the compositions of these granitoids. That is, the two granitic plutons are magmatic responses to the closure of the Mianlue ocean basin and the continental collision between the Yangtze and South Qinling crustal terranes. (143Nd/144Nd)i = (143Nd/144Nd) - (147Sm/144Nd) × (eλt - 1), εNd(t) = [(143Nd/144Nd) / (143Nd/144Nd)CHUR(t) - 1] × 104, (143Nd/144Nd)CHUR(t) = 0.512638-0.1967 × (eλt - 1), TDM = 1/λ × ln{1 + [((143Nd/144Nd) - 0.51315) / ((147Sm/144Nd) - 0.21317)]}, λ Sm-Nd = 6.54 × 10- 12a- 1. (176Hf/177Hf)i = [(176Hf/177Hf) - (176Lu/177Hf) × (eλt - 1), εHf(t) = [(176Hf/177Hf) / (176Hf/177Hf)CHUR(t) - 1] × 104, TDM1 = 1/λ × ln[1 + ((176Hf/177Hf)Sample - (176Hf/177Hf)DM)/((176Lu/177Hf)Sample - (176Lu/177Hf)DM)], TDM2 = TDM1 - (TDM1 - t)((fCC - fSample) / (fCC - fDM)), fLu-Hf = (176Lu/177Hf)Sample / (176Lu/177Hf)CHUR-1, (176Lu/177Hf)CHUR = 0.0332, (176Hf/177Hf)CHUR, 0 = 0.282785, (176Lu/177Hf)DM = 0.0384, (176Hf/177Hf)DM = 0.28325, fCC, fSample, fDM are their own fLu-Hf, λ = 1.867 × 10- 11a- 1.

Effects of renal sympathetic denervation on the atrial electrophysiology in dogs with pacing-induced heart failure.

PubMed

Wang, Xiaozhan; Zhao, Qingyan; Deng, Hongping; Wang, Xule; Guo, Zongwen; Dai, Zixuan; Xiao, Jinping; Wan, Peixing; Huang, Congxin

2014-10-01

Heart failure (HF) and atrial fibrillation (AF) are associated with sympathetic activation. Renal sympathetic denervation (RSD) can suppress AF vulnerability. The impact of RSD on atrial electrophysiology in experimental HF is unclear. Twenty-two beagles were randomized into control, HF, and HF + RSD groups. Control dogs were implanted cardiac pacemakers without pacing. Dogs in the HF group underwent right ventricular pacing for 3 weeks at 240 beats/min to induce HF. The dogs in the HF + RSD group received RSD and underwent the same HF-inducing procedure. The P-wave dispersion was higher in HF dogs than in the control and HF + RSD dogs (19 ± 3.1 ms vs 13 ± 2.3 ms, 15 ± 2.9 ms, P = 0.04). Conduction time within the interatrium was significantly longer in the HF dogs than that in the control and HF + RSD dogs (39 ± 4 ms vs 31 ± 3 ms, 33 ± 4 ms; P = 0.03). Window of vulnerability (WOV) of AF was widened in the HF dogs than in the HF + RSD dogs (37 ± 5 ms vs 14 ± 3 ms; P < 0.01), while AF could not be induced (WOV = 0) in the control dogs during S1 S2 stimulation. The voltage in the threshold for AF inducibility was lower during ganglionated plexi stimulation in the HF dogs than in the control and HF + RSD dogs (1.8 ± 0.6 V vs 2.5 ± 0.6 V, 2.4 ± 0.4 V; P = 0.04). RSD could reverse the atrial electrical remodeling and decrease AF inducibility in dogs with pacing-induced HF. ©2014 Wiley Periodicals, Inc.

Hf layer thickness dependence of resistive switching characteristics of Ti/Hf/HfO2/Au resistive random access memory device

NASA Astrophysics Data System (ADS)

Nakajima, Ryo; Azuma, Atsushi; Yoshida, Hayato; Shimizu, Tomohiro; Ito, Takeshi; Shingubara, Shoso

2018-06-01

Resistive random access memory (ReRAM) devices with a HfO2 dielectric layer have been studied extensively owing to the good reproducibility of their SET/RESET switching properties. Furthermore, it was reported that a thin Hf layer next to a HfO2 layer stabilized switching properties because of the oxygen scavenging effect. In this work, we studied the Hf thickness dependence of the resistance switching characteristics of a Ti/Hf/HfO2/Au ReRAM device. It is found that the optimum Hf thickness is approximately 10 nm to obtain good reproducibility of SET/RESET voltages with a small RESET current. However, when the Hf thickness was very small (∼2 nm), the device failed after the first RESET process owing to the very large RESET current. In the case of a very thick Hf layer (∼20 nm), RESET did not occur owing to the formation of a leaky dielectric layer. We observed the occurrence of multiple resistance states in the RESET process of the device with a Hf thickness of 10 nm by increasing the RESET voltage stepwise.

A review of treatment strategies for hydrofluoric acid burns: current status and future prospects.

PubMed

Wang, Xingang; Zhang, Yuanhai; Ni, Liangfang; You, Chuangang; Ye, Chunjiang; Jiang, Ruiming; Liu, Liping; Liu, Jia; Han, Chunmao

2014-12-01

Hydrofluoric acid (HF), a dangerous inorganic acid, can cause severe corrosive effects and systemic toxicity. HF enters the human body via where it contacts, such as skin and mucosa, alimentary and respiratory tracts, and ocular surfaces. In the recent years, the incidence of HF burn has tended to increase over time. The injury mechanism of HF is associated primarily with the massive absorption of HF and the release of hydrogen ions. Correct diagnosis and timely treatment are especially important for HF burns. The critical procedure to treat HF burn is to prevent on-going HF absorption, and block the progressive destruction caused by fluoride ions. Due to the distinct characteristics of HF burns, the topical treatment, as well as systemic support, has been emphasised. Whereas, management of patients with HF burns remains a great challenge in some situations. To date, there has been no widely accepted protocol for the rescue of HF burns, partly due to the diversity of HF burns. This paper overviews the current status and problems of treatment strategies for HF burns, for the purpose of promoting the future researches and improvement. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Satellite voice broadcase system study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Horstein, M.

1985-01-01

The feasibility of providing Voice of America (VOA) broadcasts by satellite relay was investigated. Satellite voice broadcast systems are described for three different frequency bands: HF, FHV, and L-band. Geostationary satellite configurations are considered for both frequency bands. A system of subsynchronous, circular satellites with an orbit period of 8 hours was developed for the HF band. The VHF broadcasts are provided by a system of Molniya satellites. The satellite designs are limited in size and weight to the capability of the STS/Centaur launch vehicle combination. At L-band, only four geostationary satellites are needed to meet the requirements of the complete broadcast schedule. These satellites are comparable in size and weight to current satellites designed for the direct broadcast of video program material.

Relationship between ankle range of motion and Biodex Balance System in females and males.

PubMed

Sung, Eun-Sook; Kim, Jung-Hyun

2018-02-01

This study examined whether there are differences between range of motion (ROM) and balance in lower extremities according to gender. A total of 31 male and 28 female students measured plantar flexion (PF), dorsiflexion, inversion (IV), eversion (EV), hip flexion (HF), hip internal rotation (HIR), and hip external rotation (HER) and tested on the Biodex Balance System. ROM of PF and HF were significantly high the female group and ROMs of IV, EV, HIR, and HER were significantly higher the male group than in the female group. Low ROM of PF may be more negative related to overall balance, especially, back balance in males; therefore, it is necessary to assess and plan the training program for PF ROM in male students.

Synthesis of Hf 8O 7, a new binary hafnium oxide, at high pressures and high temperatures

DOE PAGES

Bayarjargal, L.; Morgenroth, W.; Schrodt, N.; ...

2017-01-23

In this paper, two binary phases in the system Hf-O have been synthesized at pressures between 12 and 34 GPa and at temperatures up to 3000 K by reacting Hf with HfO 2 using a laser-heated diamond anvil cell. In situ X-ray diffraction in conjunction with density functional theory calculations has been employed to characterize a previously unreported tetragonal Hf 8O 7 phase. This phase has a structure which is based on an fcc Hf packing with oxygen atoms occupying octahedral interstitial positions. Its predicted bulk modulus is 223(1) GPa. The second phase has a composition close to Hf 6O,more » where oxygen atoms occupy octahedral interstitial sites in an hcp Hf packing. Its experimentally determined bulk modulus is 128(30) GPa. Finally, the phase diagram of Hf metal was further constrained at high pressures and temperatures, where we show that α-Hf transforms to β-Hf around 2160(150) K and 18.2 GPa and β-Hf remains stable up to at least 2800 K at this pressure.« less

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.

Heart failure in a cohort of patients with chronic kidney disease: the GCKD study.

PubMed

Beck, Hanna; Titze, Stephanie I; Hübner, Silvia; Busch, Martin; Schlieper, Georg; Schultheiss, Ulla T; Wanner, Christoph; Kronenberg, Florian; Krane, Vera; Eckardt, Kai-Uwe; Köttgen, Anna

2015-01-01

Chronic kidney disease (CKD) is a risk factor for development and progression of heart failure (HF). CKD and HF share common risk factors, but few data exist on the prevalence, signs and symptoms as well as correlates of HF in populations with CKD of moderate severity. We therefore aimed to examine the prevalence and correlates of HF in the German Chronic Kidney Disease (GCKD) study, a large observational prospective study. We analyzed data from 5,015 GCKD patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73m² or with an eGFR ≥60 and overt proteinuria (>500 mg/d). We evaluated a definition of HF based on the Gothenburg score, a clinical HF score used in epidemiological studies (Gothenburg HF), and self-reported HF. Factors associated with HF were identified using multivariable adjusted logistic regression. The prevalence of Gothenburg HF was 43% (ranging from 24% in those with eGFR >90 to 59% in those with eGFR<30 ml/min/1.73m2). The corresponding estimate for self-reported HF was 18% (range 5%-24%). Lower eGFR was significantly and independently associated with the Gothenburg definition of HF (p-trend <0.001). Additional significantly associated correlates included older age, female gender, higher BMI, hypertension, diabetes mellitus, valvular heart disease, anemia, sleep apnea, and lower educational status. The burden of self-reported and Gothenburg HF among patients with CKD is high. The proportion of patients who meet the criteria for Gothenburg HF in a European cohort of patients with moderate CKD is more than twice as high as the prevalence of self-reported HF. However, because of the shared signs, symptoms and medications of HF and CKD, the Gothenburg score cannot be used to reliably define HF in CKD patients. Our results emphasize the need for early screening for HF in patients with CKD.

Biological Therapies: Effects of Proinflammatory Pathways and their Inhibition on the Myocardium of Rheumatoid Athritis Patients.

PubMed

Obermair, Florian; Pieringer, Herwig

2015-01-01

The elevated risk of heart failure (HF) in rheumatoid arthritis (RA) is considered to be partly caused by the chronic low-grade systemic inflammation. As potent suppressors of inflammation, biologics were expected to influence HF development in RA. Unfortunately, case reports of HF in RA patients and non-RA HF studies have suggested that these drugs may even increase HF rates in RA. With this review we want to provide insight into the molecular mechanisms by which elevated cytokines, immune cell alterations and biologics influence myocardial function in RA patients. Beside preclinical data, clinical studies that assess the influence of biologics on HF development are reviewed. Preclinical studies suggest a bidirectional role of the investigated cytokines (TNF-alpha, IL- 1, IL-6) on myocardial function. Common mechanisms of immune cell alterations in HF and RA have been observed in preclinical studies. High doses of infliximab in non-RA patients with HF were found to be harmful. The vast majority of retrospective studies suggest that TNF-alpha inhibitors do not increase the risk of HF development in RA patients. Nevertheless randomized controlled trials are missing and TNF-alpha inhibitors are contraindicated in RA patients with HF NYHA III/IV and should be used with caution in RA patients with HF NYHA I/II based on non-RA HF studies. Due to rare adverse events of HF, rituximab is contraindicated in RA patients with HF NYHA IV. Cytokines seem to have a bidirectional influence on HF development in RA. According to the published evidence it is unlikely that TNFalpha inhibitors substantially increase the risk of HF development in an RA population. Nevertheless they are contraindicated in RA patients with HF NYHA III/IV and should be used with caution in RA patients with HF NYHA I/II. The influence of anakinra, tocilizumab, rituximab and abatacept needs to be investigated in future studies.

Baseline differences in the HF-ACTION trial by sex.

PubMed

Piña, Ileana L; Kokkinos, Peter; Kao, Andrew; Bittner, Vera; Saval, Matt; Clare, Bob; Goldberg, Lee; Johnson, Maryl; Swank, Ann; Ventura, Hector; Moe, Gordon; Fitz-Gerald, Meredith; Ellis, Stephen J; Vest, Marianne; Cooper, Lawton; Whellan, David

2009-10-01

In patients with heart failure (HF), assessment of functional capacity plays an important prognostic role. Both 6-minute walk and cardiopulmonary exercise testing have been used to determine physical function and to determine prognosis and even listing for transplantation. However, as in HF trials, the number of women reported has been small, and the cutoffs for transplantation have been representative of male populations and extrapolated to women. It is also well known that peak VO(2) as a determinant of fitness is inherently lower in women than in men and potentially much lower in the presence of HF. Values for a female population from which to draw for this important determination are lacking. The HF-ACTION trial randomized 2,331 patients (28% women) with New York Heart Association class II-IV HF due to systolic dysfunction to either a formal exercise program in addition to optimal medical therapy or to optimal medical therapy alone without any formal exercise training. To characterize differences between men and women in the interpretation of final cardiopulmonary exercise testing models, the interaction of individual covariates with sex was investigated in the models of (1) VE/VCO(2), (2) VO(2) at ventilatory threshold (VT), (3) distance on the 6-minute walk, and (4) peak VO(2). The women were younger than the men and more likely to have a nonischemic etiology and a higher ejection fraction. Dose of angiotensin converting enzyme inhibitor (ACEI) was lower in the women, on average. The lower ACEI dose may reflect the higher use of angiotensin II receptor blocker (ARB) in women. Both the peak VO(2) and the 6-minute walk distance were significantly lower in the women than in the men. Perhaps the most significant finding in this dataset of baseline characteristics is that the peak VO(2) for women was significantly lower than that for men with similar ventricular function and health status. Therefore, in a well-medicated, stable, class II-IV HF cohort of patients who are able to exercise, women have statistically significantly lower peak VO(2) and 6-minute walk distance than men with similar health status and ventricular function. These data should prompt careful thought when considering prognostic markers for women and listing for cardiac transplant.

Effectiveness of the Civil Aviation Security Program.

DTIC Science & Technology

1978-03-31

Passenger Screening Results 12. Scope of Civil Aviation Security Program 13. Basic Policies 14. Explosives Detection Dog Teams 15. Explosives Detection... policies guiding the program recognize airline responsibilities for the safety of passengers, baggage and cargo in their care as well as for the...U *i * (U U Los -7 .cn cf) 1-4 ~~LL _m e- Hf LMU 0- u,-C -oL -ccJLL LII -~ LLIOL 0 _ CL. LLJ cr-L LCnIJ C ~ ~ CnCD C. ) &j 2ic- nc r JL AJ -L JC C.- L

Characteristics of high-k gate dielectric formed by the oxidation of sputtered Hf/Zr/Hf thin films on the Si substrate

NASA Astrophysics Data System (ADS)

Kim, H. D.; Roh, Y.; Lee, J. E.; Kang, H.-B.; Yang, C.-W.; Lee, N.-E.

2004-07-01

We have investigated the effects of high temperature annealing on the physical and electrical properties of multilayered high-k gate oxide [HfSixOy/HfO2/intermixed-layer(IL)/ZrO2/intermixed-layer(IL)/HfO2] in metal-oxide-semiconductor device. The multilayered high-k films were formed after oxidizing the Hf/Zr/Hf films deposited directly on the Si substrate. The subsequent N2 annealing at high temperature (>= 700 °C) not only results in the polycrystallization of the multilayered high-k films, but also causes the diffusion of Zr. The latter transforms the HfSixOy/HfO2/IL/ZrO2/IL/HfO2 film into the Zr-doped HfO2 film, and improves electrical properties in general. However, the thin SiOx interfacial layer starts to form if annealing temperature increases over 700 °C, deteriorating the equivalent oxide thickness. .

Design for human factors (DfHF): a grounded theory for integrating human factors into production design processes.

PubMed

Village, Judy; Searcy, Cory; Salustri, Filipo; Patrick Neumann, W

2015-01-01

The 'design for human factors' grounded theory explains 'how' human factors (HF) went from a reactive, after-injury programme in safety, to being proactively integrated into each step of the production design process. In this longitudinal case study collaboration with engineers and HF Specialists in a large electronics manufacturer, qualitative data (e.g. meetings, interviews, observations and reflections) were analysed using a grounded theory methodology. The central tenet in the theory is that when HF Specialists acclimated to the engineering process, language and tools, and strategically aligned HF to the design and business goals of the organisation, HF became a means to improve business performance. This led to engineers 'pulling' HF Specialists onto their team. HF targets were adopted into engineering tools to communicate HF concerns quantitatively, drive continuous improvement, visibly demonstrate change and lead to benchmarking. Senior management held engineers accountable for HF as a key performance indicator, thus integrating HF into the production design process. Practitioner Summary: Research and practice lack explanations about how HF can be integrated early in design of production systems. This three-year case study and the theory derived demonstrate how ergonomists changed their focus to align with design and business goals to integrate HF into the design process.

A thermodynamic model for the solubility of HfO2(am) in the aqueous K +– HCO 3 -– CO 3 2-–O -–H 2O system

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

Rai, Dhanpat; Kitamura, Akira; Rosso, Kevin M.

Solubility of HfO2(am) was determined as a function of KHCO3 concentrations ranging from 0.001 mol·kg-1 to 0.1 mol·kg-1. The solubility of HfO2(am) increased dramatically with the increase in KHCO3 concentrations, indicating that Hf(IV) makes strong complexes with carbonate. Thermodynamic equilibrium constants for the formation of Hf-carbonate complexes were determined using both the Pitzer and SIT models. The dramatic increase in Hf concentrations with the increase in KHCO3 concentrations can best be described by the formation of Hf(OH-)2(CO3)22- and Hf(CO3)56-. The log10 K0 values for the reactions [Hf4++2CO32-+2OH-⇌Hf(OH)2(CO3)22-] and [Hf4++5CO32-⇌Hf(CO3)56-], based on the SIT model, were determined to be 44.53±0.46 andmore » 41.53±0.46, respectively, and based on the Pitzer model they were 44.56±0.48 and 40.20±0.48, respectively.« less

Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception.

PubMed

Jurgens, Corrine Y; Lee, Christopher S; Riegel, Barbara

Symptoms are known to predict survival among patients with heart failure (HF), but discrepancies exist between patients' and health providers' perceptions of HF symptom burden. The purpose of this study is to quantify the internal consistency, validity, and prognostic value of patient perception of a broad range of HF symptoms using an HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v. 3. Factor analysis of the HF Somatic Perception Scale was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire. Divergent validity was examined using the Self-care of HF Index self-care management score. One-year survival based on HF Somatic Perception Scale scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics, and lab values. The sample was 63% male, 85% white, 67% functionally compromised (New York Heart Association class III-IV) with a mean (SD) age of 63 (12.8) years. Internal consistency of the HF Somatic Perception Scale was α = .90. Convergent (r = -0.54, P < .0001) and divergent (r = 0.18, P > .05) validities were supported. Controlling for Seattle HF scores, HF Somatic Perception Scale was a significant predictor of 1-year survival, with those most symptomatic having worse survival (hazard ratio, 1.012; 95% confidence interval, 1.001-1.024; P = .038). Perception of HF symptom burden as measured by the HF Somatic Perception Scale is a significant predictor of survival, contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms, may be useful in evaluating therapeutic outcomes and predicting event-free survival.

Impact of sacubitril/valsartan on heart failure admissions: insights from real-world patient prescriptions.

PubMed

Martens, Pieter; Lambeets, Seppe; Lau, Chirikwah; Dupont, Matthias; Mullens, Wilfried

2018-06-17

Sacubitril/valsartan reduced heart failure (HF)-admissions and cardiovascular mortality in the PARADIGM-HF-trial. However, real-world patients are often frailer and less able to tolerate high doses of sacubitril/valsartan. We performed a retrospective analysis of consecutive patients prescribed sacubitril/valsartan in a single tertiary HF-clinic between December 2016 and January 2018. HF-admissions were assessed in a paired fashion, comparing the amount of antecedent HF-episodes with incident HF-episodes after the initiation. Baseline risk for adverse events was assessed by the EMPHASIS-HF-risk-score Results: A total of 201-HF-patients were retrospectively identified (age = 68 ± 11 years, ejection fraction = 29 ± 8%). Real world patients were older, had higher serum creatinine and a higher New-York Heart-Association (NYHA)-class (p < .05 for all) than in the PARADIGM-HF trial. Over a mean duration of 221 ± 114 days after initiation of sacubitril/valsartan a total of 23-individual patients experienced at least one HF-episodes. Over the same time period preceding initiation of sacubitril/valsartan, 51 individual patients experienced a HF-episodes (p < .001). Sacubitril/valsartan significantly reduced the rate of incident vs. antecedent HF-admissions, in patients with low or high baseline NYHA-class (II vs. III and IV; p value = 0.019 respectively p = .004) or patients with an EMPHASIS-HF risk score below or above the mean (p = .002 respectively p = .016). Patients older than 75-years exhibited a trend towards HF-reduction. Higher doses of sacubitril/valsartan were associated with more reduction in incident versus antecedent HF-episodes. Despite being frailer and older, real-world patients exhibit a significant and early reduction in incident HF-hospitalisations following initiation of sacubitril/valsartan. Higher doses might be associated with more reduction in HF-admissions, underscoring the importance of dose uptitration.

Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diuretics.

PubMed

Arcand, JoAnne; Floras, John S; Azevedo, Eduardo; Mak, Susanna; Newton, Gary E; Allard, Johane P

2011-03-01

Twenty-four-hour urine collections are considered the optimal method for sodium intake assessment. Whether a diagnosis of heart failure (HF) or the use of loop diuretic (LD) therapy for HF compromises the validity of 24-h urine collections as a surrogate marker for sodium intake is unknown. The objective was to determine the strength of association between 24-h urine collections and food records for sodium intake assessment in non-HF cardiac patients and in HF patients stratified by LD usage. Food records and 24-h urine collections were simultaneously completed for 2 consecutive days. Correlation coefficients and the Bland-Altman method of agreement described the relation between the techniques. Non-HF cardiac patients (n = 96; mean ± SD age: 65 ± 11 y), HF patients who were not taking an LD (n = 47; 62 ± 11 y), and HF patients who were taking an LD (n = 62; age: 60 ± 12 y) were included. Correlation coefficients for sodium intake between food records and urine collections were r = 0.624 (P < 0.001) for non-HF cardiac patients and r = 0.678 (P < 0.001) for HF patients who were not taking an LD. However, no significant association (r = 0.132, P = 0.312) was observed for HF patients who were taking LDs. The 95% limits of agreement between the non-HF cardiac patients and the HF patients who were not taking LDs were similar but were ≈50% wider for HF patients who were taking LDs. For the assessment of sodium intake, food records agree well with 24-h urine collections in non-HF patients with cardiovascular disease and in HF patients who are not receiving LD but not for HF patients who are taking LDs. Therefore, food records may provide a better estimate of sodium intake in HF patients who are receiving LD therapy.

Composition effects on mechanical properties of tungsten-rhenium-hafnium-carbon alloys

NASA Technical Reports Server (NTRS)

Witzke, W. R.

1973-01-01

The mechanical properties of rod and sheet fabricated from arc melted W-4Re-Hf-C alloys containing up to about 0.8 mol percent hafnium carbide (HfC) were evaluated in the as-worked condition. The DBTT's of electropolished bend and tensile specimens were independent of HfC content in this range but dependent on excess Hf or C above that required for stoichiometric HfC. Low temperature ductility was a maximum at Hf contents slightly in excess of stoichiometric. Variations in high temperature strength were also dependent on excess Hf and C. Maximum creep strengthening also occurred at Hf contents in excess of stoichiometric. Analysis of extracted second phase particles indicated that creep strength was reduced by increasing WC content in the HfC particles.

Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.

PubMed

Heidenreich, Paul A; Albert, Nancy M; Allen, Larry A; Bluemke, David A; Butler, Javed; Fonarow, Gregg C; Ikonomidis, John S; Khavjou, Olga; Konstam, Marvin A; Maddox, Thomas M; Nichol, Graham; Pham, Michael; Piña, Ileana L; Trogdon, Justin G

2013-05-01

Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed.

Dysbiosis and compositional alterations with aging in the gut microbiota of patients with heart failure

PubMed Central

Kamo, Takehiro; Suda, Wataru; Saga-Kamo, Akiko; Shimizu, Yu; Yagi, Hiroki; Liu, Qing; Nomura, Seitaro; Naito, Atsuhiko T.; Takeda, Norifumi; Harada, Mutsuo; Toko, Haruhiro; Kumagai, Hidetoshi; Ikeda, Yuichi; Takimoto, Eiki; Suzuki, Jun-ichi; Honda, Kenya; Morita, Hidetoshi; Hattori, Masahira; Komuro, Issei

2017-01-01

Emerging evidence has suggested a potential impact of gut microbiota on the pathophysiology of heart failure (HF). However, it is still unknown whether HF is associated with dysbiosis in gut microbiota. We investigated the composition of gut microbiota in patients with HF to elucidate whether gut microbial dysbiosis is associated with HF. We performed 16S ribosomal RNA gene sequencing of fecal samples obtained from 12 HF patients and 12 age-matched healthy control (HC) subjects, and analyzed the differences in gut microbiota. We further compared the composition of gut microbiota of 12 HF patients younger than 60 years of age with that of 10 HF patients 60 years of age or older. The composition of gut microbial communities of HF patients was distinct from that of HC subjects in both unweighted and weighted UniFrac analyses. Eubacterium rectale and Dorea longicatena were less abundant in the gut microbiota of HF patients than in that of HC subjects. Compared to younger HF patients, older HF patients had diminished proportions of Bacteroidetes and larger quantities of Proteobacteria. The genus Faecalibacterium was depleted, while Lactobacillus was enriched in the gut microbiota of older HF patients. These results suggest that patients with HF harbor significantly altered gut microbiota, which varies further according to age. New concept of heart-gut axis has a great potential for breakthroughs in the development of novel diagnostic and therapeutic approach for HF. PMID:28328981

Forecasting the Impact of Heart Failure in the United States

PubMed Central

Heidenreich, Paul A.; Albert, Nancy M.; Allen, Larry A.; Bluemke, David A.; Butler, Javed; Fonarow, Gregg C.; Ikonomidis, John S.; Khavjou, Olga; Konstam, Marvin A.; Maddox, Thomas M.; Nichol, Graham; Pham, Michael; Piña, Ileana L.; Trogdon, Justin G.

2013-01-01

Background Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. Methods and Results We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). Conclusions The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed. PMID:23616602

Butter naturally enriched in cis-9, trans-11 CLA prevents hyperinsulinemia and increases both serum HDL cholesterol and triacylglycerol levels in rats.

PubMed

de Almeida, Mariana Macedo; Luquetti, Sheila Cristina Potente Dutra; Sabarense, Céphora Maria; do Amaral Corrêa, José Otávio; dos Reis, Larissa Gomes; Santos da Conceição, Ellen Paula; Lisboa, Patrícia Cristina; de Moura, Egberto Gaspar; Gameiro, Jacy; da Gama, Marco Antônio Sundfeld; Lopes, Fernando César Ferraz; Garcia, Raúl Marcel González

2014-12-22

Evidence from in vitro and animal studies indicates that conjugated linoleic acid (CLA) possesses anti-diabetic properties, which appear to be attributed to cis-9, trans-11 CLA, the major CLA isomer in ruminant fat. However, there is a shortage of studies addressing CLA from natural source. The present study aimed to evaluate the effects of butter naturally enriched in cis-9, trans-11 CLA on parameters related to glucose tolerance, insulin sensitivity and dyslipidemia in rats. Forty male Wistar rats were randomly assigned to the following dietary treatments (n=10/group), for 60 days: 1) Normal fat-Soybean oil (NF-So): diet containing 4.0% soybean oil (SO); 2) High Fat-Control Butter (HF-Cb): diet containing 21.7% control butter and 2.3% SO; 3) High Fat-CLA enriched Butter (HF-CLAb): diet containing 21.7% cis-9, trans-11 CLA-enriched butter and 2.3% SO; and 4) High fat-Soybean oil (HF-So): diet containing 24.0% SO. HF-Cb and HF-CLAb diets contained 0.075% and 0.235% of cis-9, trans-11 CLA, respectively. HF-CLAb-fed rats had lower serum insulin levels at fasting than those fed with the HF-Cb diet, while the PPARγ protein levels in adipose tissue was increased in HF-CLAb-fed rats compared to HF-Cb-fed rats. Furthermore, R-QUICK was lower in HF-Cb than in NF-So group, while no differences in R-QUICK were observed among NF-So, HF-CLAb and HF-So groups. Serum HDL cholesterol levels were higher in HF-CLAb-fed rats than in those fed NF-So, HF-Cb and HF-So diets, as well as higher in NF-So-fed rats than in HF-Cb and HF-So-fed rats. HF-CLAb, HF-Cb and HF-So diets reduced serum LDL cholesterol levels when compared to NF-So, whereas serum triacylglycerol levels were increased in HF-CLAb. Feeding rats on a high-fat diet containing butter naturally enriched in cis-9, trans-11 CLA prevented hyperinsulinemia and increased HDL cholesterol, which could be associated with higher levels of cis-9, trans-11 CLA, vaccenic acid, oleic acid and lower levels of short and medium-chain saturated fatty acids from butter naturally modified compared to control butter. On the other hand CLA-enriched butter also increased serum triacylglycerol levels, which could be associated with concomitant increases in the content of trans-9 and trans-10 C18:1 isomers in the CLA-enriched butter.

Oscillating two-stream instability in a magnetized electron-positron-ion plasma

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

Tinakiche, Nouara; Faculty of Physics, U.S.T.H.B, Algiers 16111; Annou, R.

2015-04-15

Oscillating two-stream instability (OTSI) in a magnetized electron-ion plasma has been thoroughly studied, e.g., in ionospheric heating experiments [C. S. Liu and V. K. Tripathi, Interaction of Electromagnetic Waves With Electron Beams and Plasmas (World Scientific, 1994); V. K. Tripathi and P. V. Siva Rama Prasad, J. Plasma Phys. 41, 13 (1989); K. Ramachandran and V. K. Tripathi, IEEE Trans. Plasma Sci. 25, 423 (1997)]. In this paper, OTSI is investigated in a magnetized electron-positron-ion plasma. The dispersion relation of the process is established. The pump field threshold, along with the maximum growth rate of the instability is assessed usingmore » the Arecibo and HAARP parameters.« less

Oscillating two-stream instability in a magnetized electron-positron-ion plasma

NASA Astrophysics Data System (ADS)

Tinakiche, Nouara; Annou, R.

2015-04-01

Oscillating two-stream instability (OTSI) in a magnetized electron-ion plasma has been thoroughly studied, e.g., in ionospheric heating experiments [C. S. Liu and V. K. Tripathi, Interaction of Electromagnetic Waves With Electron Beams and Plasmas (World Scientific, 1994); V. K. Tripathi and P. V. Siva Rama Prasad, J. Plasma Phys. 41, 13 (1989); K. Ramachandran and V. K. Tripathi, IEEE Trans. Plasma Sci. 25, 423 (1997)]. In this paper, OTSI is investigated in a magnetized electron-positron-ion plasma. The dispersion relation of the process is established. The pump field threshold, along with the maximum growth rate of the instability is assessed using the Arecibo and HAARP parameters.

The Development and Acceptability of a Mobile Application for Tracking Symptoms of Heart Failure Among Older Adults.

PubMed

Portz, Jennifer Dickman; Vehovec, Anton; Dolansky, Mary A; Levin, Jennifer B; Bull, Sheana; Boxer, Rebecca

2018-02-01

Heart failure (HF) is common in older adults. With increases in technology use among older adults, mobile applications may provide a solution for older adults to self-manage symptoms of HF. This article discusses the development and acceptability of a HF symptom-tracking mobile application (HF app). The HF app was developed to allow patients to track their symptoms of HF. Thirty (N = 30) older adults completed an acceptability survey after using the mobile app. The survey used Likert items and open-ended feedback questions. Overall, the acceptability feedback from users was positive with participants indicating that the HF app was both easy to use and understand. Participants identified recommendations for improvement including additional symptoms to track and the inclusion of instructions and reminders. HF is common in older adults, and acceptability of mobile apps is of key importance. The HF app is an acceptable tool for older patients with HF to self-manage their symptoms, identify patterns, and changes in symptoms, and ultimately prevent HF readmission.

Proposed truncated Cu-Hf tight-binding potential to study the crystal-to-amorphous phase transition

NASA Astrophysics Data System (ADS)

Cui, Yuanyuan; Li, Jiahao; Dai, Ye; Liu, Baixin

2010-09-01

Proposed truncated Cu-Hf tight-binding potential was constructed by fitting the physical properties of Cu, Hf, and their stable compounds, i.e., Cu5Hf, Cu8Hf3, Cu10Hf7, and CuHf2. Based on the constructed potentials, molecular dynamics simulations were carried out to compare the relative stability of the crystalline solid solution and the disordered state. Simulation results not only reveal that the physical origin of crystal-to-amorphous transition is the crystalline lattice collapsing when the solute atoms exceeding the critical concentration, but also predict that the glass forming range (GFR) of the Cu-Hf system is 21-77 at. % Cu, which covers the GFRs determined by various metallic glass-producing techniques. Ion beam mixing experiments of the Cu-Hf system were conducted using 200 keV xenon ions and the results show that a uniform amorphous phase can be obtained in the Cu23Hf77 sample, matching well with the GFR determined by the interatomic potential, which, in turn, provides additional evidence to the relevance of the constructed Cu-Hf potential.

ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care

PubMed Central

Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

2017-01-01

Abstract Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment. In conclusion, This guidance document details roles and interactions of cardiology specialists, so as to best exploit the added value of their input in the care of HF patients and is intended to promote a more efficient and effective organization of HF services. PMID:28751837

Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from Studies Investigating Co-morbidities Aggravating Heart Failure.

PubMed

Saitoh, Masakazu; Dos Santos, Marcelo Rodrigues; Ebner, Nicole; Emami, Amir; Konishi, Masaaki; Ishida, Junichi; Valentova, Miroslava; Sandek, Anja; Doehner, Wolfram; Anker, Stefan D; von Haehling, Stephan

2016-12-01

Inadequate nutritional status has been linked to poor outcomes in patients with heart failure (HF). Skeletal muscle wasting affects about 20% of ambulatory patients with HF. The impact of nutritional intake and appetite on skeletal muscle wasting has not been investigated so far. We sought to investigate the impact of nutritional status on muscle wasting and mortality in ambulatory patients with HF. We studied 130 ambulatory patients with HF who were recruited as a part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) program. Muscle wasting was defined according to criteria of sarcopenia, i.e., appendicular skeletal muscle mass two standard deviations below the mean of a healthy reference group aged 18-40 years. Nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Functional capacity was assessed as peak oxygen consumption (peak VO 2 ) by cardiopulmonary exercise testing, 6‑minute walk testing, and the Short Physical Performance Battery (SPPB). At baseline, 19 patients (15%) presented with muscle wasting. Patients with muscle wasting had significantly lower values of peak VO 2 , 6‑minute walk distance, SPPB, and MNA-SF score than patients without (all p < 0.05). In multivariate analysis, MNA-SF remained an independent predictor of muscle wasting after adjustment for age and New York Heart Association class (odds ratio [OR] 0.66; confidence interval [CI] 0.50-0.88; p < 0.01). A total of 16 (12%) patients died during a mean follow-up of 21 months. In Cox regression analysis, MNA-SF (OR 0.80, CI 0.64-0.99, p = 0.04), left ventricular ejection fraction (OR 0.93, CI 0.86-0.99, p = 0.05), and peak VO 2 (OR 0.78, CI 0.65-0.94, p = 0.008) were predictors of death. MNA-SF is an independent predictor of muscle wasting and mortality in ambulatory patients with HF. Nutritional screening should be included as a fundamental part of the overall assessment of these patients.

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

PubMed Central

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Purpose Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. Methods The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. Results A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Conclusion Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination. PMID:25653510

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review.

PubMed

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen's Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary hospital-based quality initiatives, disease management, and care transition programs are a priority for health care systems to achieve better coordination.

The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial.

PubMed

Stergiopoulos, Vicky; Gozdzik, Agnes; Misir, Vachan; Skosireva, Anna; Sarang, Aseefa; Connelly, Jo; Whisler, Adam; McKenzie, Kwame

2016-10-21

Little is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds. This unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care. During the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72). Housing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness. International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009.

The distribution of zirconium and hafnium in terrestrial rocks, meteorites and the moon

NASA Technical Reports Server (NTRS)

Ehmann, W. D.; Chyi, L. L.; Garg, A. N.; Ali, M. Z.

1979-01-01

It is shown that Zr and Hf are not always fractionated in terrestrial igneous differentiation or regional metamorphism. Data do support a Zr-Hf fractionation in the differentiation of the alkali olivine magma at St. Helena Island. A strong Zr-Hf fractionation exists among lunar rocks and minerals. Ilmenite is an excellent concentrator of Zr and Hf and always exhibits high Zr/Hf ratios. Chondritic meteorites exhibit rather uniform Zr abundances and Zr/Hf ratios but a distinct Zr-Hf fractionation is observed among the eucrite and diogenite achondrites.

A novel ventricular restraint device (ASD) repetitively deliver Salvia miltiorrhiza to epicardium have good curative effects in heart failure management.

PubMed

Naveed, Muhammad; Wenhua, Li; Gang, Wang; Mohammad, Imran Shair; Abbas, Muhammad; Liao, Xiaoqian; Yang, Mengqi; Zhang, Li; Liu, Xiaolin; Qi, Xiaoming; Chen, Yineng; Jiadi, Lv; Ye, Linlan; Zhijie, Wang; Ding, Chen Ding; Feng, Yu; Xiaohui, Zhou

2017-11-01

A novel ventricular restraint is the non-transplant surgical option for the management of an end-stage dilated heart failure (HF). To expand the therapeutic techniques we design a novel ventricular restraint device (ASD) which has the ability to deliver a therapeutic drug directly to the heart. We deliver a Traditional Chinese Medicine (TCM) Salvia miltiorrhiza (Danshen Zhusheye) through active hydraulic ventricular support drug delivery system (ASD) and we hypothesize that it will show better results in HF management than the restraint device and drug alone. SD rats were selected and divided into five groups (n=6), Normal, HF, HF+SM (IV), HF+ASD, HF+ASD+SM groups respectively. Post myocardial infarction (MI), electrocardiography (ECG) showed abnormal heart function in all groups and HF+ASD+SM group showed a significant therapeutic improvement with respect to other treatment HF, HF+ASD, and HF+SM (IV) groups on day 30. The mechanical functions of the heart such as heart rate, LVEDP, and LVSP were brought to normal when treated with ASD+SM and show significant (P value<0.01) compared to other groups. BNP significantly declines in HF+ASD+SM group animals compared with other treatment groups. Masson's Trichrome staining was used to study histopathology of cardiac myocytes and quantification of fibrosis was assessed. The large blue fibrotic area was observed in HF, HF+ASD, and HF+SM (IV) groups while HF+ASD+SM showed negligible fibrotic myocyte at the end of study period (30days). This study proves that novel ASD device augments the therapeutic effect of the drug and delivers Salvia miltiorrhiza to the cardiomyocytes significantly as well as provides additional support to the dilated ventricle by the heart failure. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Heart failure in nursing home residents; a cross-sectional study to determine the prevalence and clinical characteristics.

PubMed

Daamen, Mariëlle A M J; Hamers, Jan P H; Gorgels, Anton P M; Brunner-La Rocca, Hans-Peter; Tan, Frans E S; van Dieijen-Visser, Marja P; Schols, Jos M G A

2015-12-16

Heart failure (HF) is expected to be highly prevalent in nursing home residents, but precise figures are scarce. The aim of this study was to determine the prevalence of HF in nursing home residents and to get insight in the clinical characteristics of residents with HF. The study followed a multi-centre cross-sectional design. Nursing home residents (n = 501) in the southern part of the Netherlands aged over 65 years and receiving long-term somatic or psychogeriatric care were included in the study. The diagnosis of HF and related characteristics were based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. A panel of two cardiologists and a geriatrician ultimately judged the data to diagnose HF. The overall prevalence of HF in nursing home residents was 33 %, of which 52 % had HF with preserved ejection fraction. The symptoms dyspnoea and oedema and a cardiac history were more common in residents with HF. Diabetes mellitus, chronic obstructive pulmonary disease (COPD) were also more prevalent in those with HF. Residents with HF had a higher score on the Mini Mental State Examination. 54 % of those with HF where not known before, and in 31 % with a history of HF, this diagnosis was not confirmed by the expert panel. This study shows that HF is highly prevalent in nursing home residents with many unknown or falsely diagnosed with HF. Equal number of HF patients had reduced and preserved left-ventricular ejection fraction. The Netherlands National Trial Register NTR2663 (27-12-2010).

Characteristics and outcomes of heart failure-related hospitalization in adults with congenital heart disease.

PubMed

Moussa, Nidhal Ben; Karsenty, Clement; Pontnau, Florence; Malekzadeh-Milani, Sophie; Boudjemline, Younes; Legendre, Antoine; Bonnet, Damien; Iserin, Laurence; Ladouceur, Magalie

2017-05-01

Heart failure (HF) is the main cause of death in adult congenital heart disease (ACHD). We aimed to characterize HF-related hospitalization of patients with ACHD, and to determine HF risk factors and prognosis in this population. We prospectively included 471 patients with ACHD admitted to our unit over 24 months. Clinical and biological data and HF management were recorded. Major cardiovascular events were recorded for ACHD with HF. HF was the main reason for hospitalization in 13% of cases (76/583 hospitalizations). Patients with HF were significantly older (median age 44±14 years vs. 37±15 years; P<0.01), with more complex congenital heart disease (P=0.04). In the multivariable analysis, pulmonary arterial hypertension (odds ratio [OR] 6.2, 95% confidence interval [CI] 3.5-10.7), history of HF (OR 9.8, 95% CI 5.7-16.8) and history of atrial arrhythmia (OR 3.6, 95% CI 2.2-5.9) were significant risk factors for HF-related admissions (P<0.001). The mean hospital stay of patients with HF was longer (12.2 vs. 6.9 days; P<0.01), and 25% of patients required intensive care. Overall, 11/55 (20%) patients with HF died, 10/55 (18%) were readmitted for HF, and 6/55 (11%) had heart transplantation during the median follow-up of 18 months (95% CI 14-20 months). The risk of cardiovascular events was 19-fold higher after HF-related hospitalization. HF is emerging as a leading cause of morbidity and mortality in the ACHD population. Earlier diagnosis and more active management are required to improve outcomes of HF in ACHD. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Early postweaning exercise improves central leptin sensitivity in offspring of rat dams fed high-fat diet during pregnancy and lactation.

PubMed

Sun, Bo; Liang, Nu-Chu; Ewald, Erin R; Purcell, Ryan H; Boersma, Gretha J; Yan, Jianqun; Moran, Timothy H; Tamashiro, Kellie L K

2013-11-01

Maternal high-fat (HF) diet has long-term consequences on the metabolic phenotype of the offspring. Here, we determined the effects of postweaning exercise in offspring of rat dams fed HF diet during gestation and lactation. Pregnant Sprague-Dawley rats were maintained on chow or HF diet throughout gestation and lactation. All pups were weaned onto chow diet on postnatal day (PND) 21. At 4 wk of age, male pups were given free access to running wheels (RW) or remained sedentary (SED) for 3 wk, after which all rats remained sedentary, resulting in four groups: CHOW-SED, CHOW-RW, HF-SED, and HF-RW. Male HF offspring gained more body weight by PND7 compared with CHOW pups and maintained this weight difference through the entire experiment. Three weeks of postweaning exercise did not affect body weight gain in either CHOW or HF offspring, but reduced adiposity in HF offspring. Plasma leptin was decreased at the end of the 3-wk running period in HF-RW rats but was not different from HF-SED 9 wk after the exercise period ended. At 14 wk of age, intracerebroventricular injection of leptin suppressed food intake in CHOW-SED, CHOW-RW, and HF-RW, while it did not affect food intake in HF-SED group. At death, HF-RW rats also had higher leptin-induced phospho-STAT3 level in the arcuate nucleus than HF-SED rats. Both maternal HF diet and postweaning exercise had effects on hypothalamic neuropeptide and receptor mRNA expression in adult offspring. Our data suggest that postweaning exercise improves central leptin sensitivity and signaling in this model.

Validation of an automated electronic algorithm and "dashboard" to identify and characterize decompensated heart failure admissions across a medical center.

PubMed

Cox, Zachary L; Lewis, Connie M; Lai, Pikki; Lenihan, Daniel J

2017-01-01

We aim to validate the diagnostic performance of the first fully automatic, electronic heart failure (HF) identification algorithm and evaluate the implementation of an HF Dashboard system with 2 components: real-time identification of decompensated HF admissions and accurate characterization of disease characteristics and medical therapy. We constructed an HF identification algorithm requiring 3 of 4 identifiers: B-type natriuretic peptide >400 pg/mL; admitting HF diagnosis; history of HF International Classification of Disease, Ninth Revision, diagnosis codes; and intravenous diuretic administration. We validated the diagnostic accuracy of the components individually (n = 366) and combined in the HF algorithm (n = 150) compared with a blinded provider panel in 2 separate cohorts. We built an HF Dashboard within the electronic medical record characterizing the disease and medical therapies of HF admissions identified by the HF algorithm. We evaluated the HF Dashboard's performance over 26 months of clinical use. Individually, the algorithm components displayed variable sensitivity and specificity, respectively: B-type natriuretic peptide >400 pg/mL (89% and 87%); diuretic (80% and 92%); and International Classification of Disease, Ninth Revision, code (56% and 95%). The HF algorithm achieved a high specificity (95%), positive predictive value (82%), and negative predictive value (85%) but achieved limited sensitivity (56%) secondary to missing provider-generated identification data. The HF Dashboard identified and characterized 3147 HF admissions over 26 months. Automated identification and characterization systems can be developed and used with a substantial degree of specificity for the diagnosis of decompensated HF, although sensitivity is limited by clinical data input. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Hafnium isotope results from mid-ocean ridges and Kerguelen.

USGS Publications Warehouse

Patchett, P.J.

1983-01-01

176Hf/177Hf ratios are presented for oceanic volcanic rocks representing both extremes of the range of mantle Hf-Nd-Sr isotopic variation. Hf from critical mid-ocean ridge basalts shows that 176Hf/177Hf does indeed have a greater variability than 143Nd/144Nd and 87Sr/86Sr in the depleted mantle. This extra variation is essentially of a random nature, and can perhaps be understood in terms of known Rb/Sr-Sm/Nd-Lu/Hf fractionation relationships. At the other extreme of mantle isotopic compositions, 176Hf/177Hf ratios for igneous rocks from the Indian Ocean island of Kerguelen show a closely similar variation to published 143Nd/144Nd ratios for the same samples. Comparison of Hf-Nd-Sr isotopic relatonships for Tristan da Cunha, Kerguelen and Samoa reveals divergences in the mantle array for ocean-island magma sources, and perhaps suggests that these irregularities are largely the result of an extra component of 87Sr/86Sr variation.-G.R.

Hafnium isotope results from mid-ocean ridges and Kerguelen

USGS Publications Warehouse

Jonathan, Patchett P.

1983-01-01

176Hf/177Hf ratios are presented for oceanic volcanics representing both extremes of the range of mantle HfNdSr isotopic variation. Hf from critical mid-ocean ridgebasalts shows that 176Hf/177Hf does indeed have a greater variability than 143Nd/144Nd and 87Sr/86Sr in the depleted mantle. This extra variation is essentially of a random nature, and can perhaps be understood in terms of known Rb/SrSm/NdLu/Hf fractionation relationships. At the other extreme of mantle isotopic composition, 176Hf/177Hf ratios for igneous rocks from the Indian Ocean island of Kerguelen show a closely similar variation to published 143Nd/144Nd ratios for the same samples. Comparison of HfNdSr c relationships for Tristan da Cunha, Kerguelen and Samoa reveals divergences in the mantle array for ocean island magma sources, and perhaps suggests that these irregularities are largely the result of an extra component of 87Sr/86Sr variation. ?? 1983.

Electron Microprobe Analysis of Hf in Zircon: Suggestions for Improved Accuracy of a Difficult Measurement

NASA Astrophysics Data System (ADS)

Fournelle, J.; Hanchar, J. M.

2013-12-01

It is not commonly recognized as such, but the accurate measurement of Hf in zircon is not a trivial analytical issue. This is important to assess because Hf is often used as an internal standard for trace element analyses of zircon by LA-ICPMS. The issues pertaining to accuracy revolve around: (1) whether the Hf Ma or the La line is used; (2) what accelerating voltage is applied if Zr La is also measured, and (3) what standard for Hf is used. Weidenbach, et al.'s (2004) study of the 91500 zircon demonstrated the spread (in accuracy) of possible EPMA values for six EPMA labs, 2 of which used Hf Ma, 3 used Hf La, and one used Hf Lb, and standards ranged from HfO2, a ZrO2-HfO2 compound, Hf metal, and hafnon. Weidenbach, et al., used the ID-TIMS values as the correct value (0.695 wt.% Hf.), for which not one of the EPMA labs came close to that value (3 were low and 3 were high). Those data suggest: (1) that there is a systematic underestimation error of the 0.695 wt% Hf (ID-TIMS Hf) value if Hf Ma is used; most likely an issue with the matrix correction, as the analytical lines and absorption edges of Zr La, Si Ka and Hf Ma are rather tightly packed in the electromagnetic spectrum. Mass absorption coefficients are easily in error (e.g., Donovan's determination of the MAC of Hf by Si Ka of 5061 differs from the typically used Henke value of 5449 (Donovan et al, 2002); and (2) For utilization of the Hf La line, however, the second order Zr Ka line interferes with Hf La if the accelerating voltage is greater than 17.99 keV. If this higher keV is used and differential mode PHA is applied, only a portion of the interference is removed (e.g., removal of escape peaks), causing an overestimation of Hf content. Unfortunately, it is virtually impossible to apply an interference correction in this case, as it is impossible to locate Hf-free Zr probe standard. We have examined many of the combinations used by those six EPMA labs and concluded that the optimal EPMA is done with Hf La with the accelerating voltage under 18 keV (e.g. 17 keV is optimal), and also with synthetic stoichiometric hafnon as the standard. We have developed useful standards that are to be distributed to the community for those researchers working on this problem and can be obtained from the second author at jhanchar@mun.ca. The standards include synthetic stoichiometric undoped zircon and hafnon, and synthetic zircon doped with 2 wt. % Hf. Donovan et al. (2002) Probe for Windows: User's Guide and Reference Wiedenbeck, M., et al. (2004) Further characterisation of the 91500 zircon crystal. Geostandards and Geoanatytical Research, 28: 9-39.

The association between atrial fibrillation and cognitive function in patients with heart failure.

PubMed

Yang, Huifeng; Niu, Weihua; Zang, Xiaoying; Lin, Mei; Zhao, Yue

2017-02-01

Atrial fibrillation (AF) is associated with cognitive impairment in heart failure (HF). The purpose of this study was to examine whether AF independently predicted cognitive function in HF patients after controlling for more demographic, medical and psychological characteristics, and whether the timing of AF onset in relation to HF diagnosis independently contributed to cognitive function in HF patients with AF. A total of 188 hospitalized HF patients (62.8% male, age 66.3±10.6 years) completed cognitive function assessment with the Montreal Cognitive Assessment (MoCA). A history of AF, along with other medical characteristics, was ascertained through a review of participants' medical charts. The timing of AF onset in relation to HF diagnosis was categorized into AF occurring prior to HF diagnosis (i.e. prior AF) and AF developing after HF diagnosis (i.e. incident AF). Altogether 72 participants had a positive diagnostic history of AF. Specifically, 41 had prior AF, and 31 developed AF subsequently. In HF patients, AF was associated with poorer performance on cognitive function after controlling for more confounders (β=-0.112, ΔR 2 =0.010, p=0.046). Among HF patients with AF, incident AF independently predicted poorer cognitive function (β=-0.238, ΔR 2 =0.027, p=0.047). AF independently contributes to cognitive function in HF patients after adjusting for more confounding variables. The timing of AF onset in relation to HF diagnosis independently predicts cognitive function in HF patients with AF. Prospective studies are needed to elucidate possible mechanisms for the association between AF and cognitive function in HF populations.

Nocturnal Hot Flashes: Relationship to Objective Awakenings and Sleep Stage Transitions

PubMed Central

Bianchi, Matt T.; Kim, Semmie; Galvan, Thania; White, David P.; Joffe, Hadine

2016-01-01

Study Objectives: While women report sleep interruption secondary to nighttime hot flashes, the sleep disrupting impact of nocturnal hot flashes (HF) is not well characterized. We utilized a model of induced HF to investigate the relationship of nighttime HF to sleep architecture and sleep-stage transitions. Methods: Twenty-eight healthy, premenopausal volunteers received the depot gonadotropin-releasing hormone agonist (GnRHa) leuprolide to rapidly induce menopause, manifesting with HF. Sleep disruption was measured on 2 polysomnograms conducted before and after 4–5 weeks on leuprolide, when HF had developed. Results: 165 HF episodes were recorded objectively during 48 sleep studies (mean 3.4 HF/night). After standardizing to sleep-stage time distribution, the majority of HF were recorded during wake (51.0%) and stage N1 (18.8%). Sixty-six percent of HF occurred within 5 minutes of an awakening, with 80% occurring just before or during the awakening. Objective HF were not associated with sleep disruption as measured by increased transitions to wake or N1, but self-reported nocturnal HF correlated with an increase from pre- to post-leuprolide in the rate of transitions to wake (p = 0.01), and to N1 (p = 0.008). Conclusions: By isolating the effect of HF on sleep in women without the confound of age-related sleep changes associated with natural menopause, this experimental model shows that HF arise most commonly during N1 and wake, typically preceding or occurring simultaneously with wake episodes. Perception of HF, but not objective HF, is linked to increased sleep-stage transitions, suggesting that sleep disruption increases awareness of and memory for nighttime HF events. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01116401. Citation: Bianchi MT, Kim S, Galvan T, White DP, Joffe H. Nocturnal hot flashes: relationship to objective awakenings and sleep stage transitions. J Clin Sleep Med 2016;12(7):1003–1009. PMID:26951410

Evolution of continental crust and mantle heterogeneity: Evidence from Hf isotopes

USGS Publications Warehouse

Jonathan, Patchett P.; Kouvo, O.; Hedge, C.E.; Tatsumoto, M.

1982-01-01

We present initial 176Hf/177 Hf ratios for many samples of continental crust 3.7-0.3 Gy old. Results are based chiefly on zircons (1% Hf) and whole rocks: zircons are shown to be reliable carriers of essentially the initial Hf itself when properly chosen on the basis of U-Pb studies. Pre-3.0 Gy gneisses were apparently derived from an unfractionated mantle, but both depleted and undepleted mantle are evident as magma sources from 2.9 Gy to present. This mantle was sampled mainly from major crustal growth episodes 2.8, 1.8 and 0.7 Gy ago, all of which show gross heterogeneity of 176Hf/177Hf in magma sources from ??Hf=0 to +14, or about 60% of the variability of the present mantle. The approximate ??Hf=2??Nd relationship in ancient and modern igneous rocks shows that 176Lu/177Hf fractionates in general twice as much as 147Sm/144Nd in mantle melting processes. This allows an estimation of the relative value of the unknown bulk solid/liquid distribution coefficient for Hf. DLu/DHf=??? 2.3 holds for most mantle source regions. For garnet to be an important residual mantle phase, it must hold Hf strongly in order to preserve Hf-Nd isotopic relationships. The ancient Hf initials are consistent with only a small proportion of recycled older cratons in new continental crust, and with quasi-continuous, episodic growth of the continental crust with time. However, recycling of crust less than 150 My old cannot realistically be detected using Hf initials. The mantle shows clearly the general positive ??Hf resulting from a residual geochemical state at least back to 2.9 Gy ago, and seems to have repeatedly possessed a similar degree of heterogeneity, rather than a continuously-developing depletion. This is consistent with a complex dynamic disequilibrium model for the creation, maintenance and destruction of heterogeneity in the mantle. ?? 1981 Springer-Verlag.

Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing.

PubMed

Atalla, Angela; Carlisle, Thomas W; Simonds, Anita K; Cowie, Martin R; Morrell, Mary J

2017-06-01

Patients with heart failure (HF) and sleep disordered breathing (SDB) are typically not sleepy, unlike patients without heart failure. Previous work in HF patients with obstructive SDB suggested that sleepiness was associated with a reduction in daytime activity. The consequences of predominately central SDB on sleepiness in HF are less well understood. The aim of this study was to test the hypothesis that subjective sleepiness is associated with reduced daytime activity in HF patients with central SDB, compared to those without SDB. The Epworth Sleepiness Scale (ESS), nocturnal polysomnography, and 14 days of wrist watch actigraphy were used to assess subjective daytime sleepiness, nocturnal sleep and breathing, and 24-h activity levels, respectively. A total of 54 patients with HF were studied, nine had obstructive SDB and were removed from further analysis. Of the patients, 23 had HF with predominantly central SDB (HF-CSA; apnea-hypopnea index (AHI) median 20.6 (IQR 12.9-40.2)/h), and 22 had noSDB (HF-noSDB; AHI 3.7 (2.5-5.9)/h). The median patient age was 68 years (range 59-73 years). There were no significant differences either in ESS score (HF-CSA; 8 [4-10] vs. HF-noSDB; 8 (6-12); p = 0.49) or in duration of daytime activity (HF-CSA 14.5 (14.1-15.2) and HF-noSDB 15.1 (14.4-15.3) hours; p = 0.10) between the groups. HF patients with predominately central SDB are not subjectively sleepy compared to those without SDB, despite reduced sleep quality. We speculate that the lack of sleepiness (based on ESS score) may be due to increased sympathetic nerve activity, although further studies are needed due to the small number (n = 5) of sleepy HF-CSA patients. Daytime activity was not different between HF-noSDB and HF-CSA patients. Copyright © 2017. Published by Elsevier B.V.

Cost-effectiveness of telephonic disease management in heart failure.

PubMed

Smith, Brad; Hughes-Cromwick, Paul F; Forkner, Emma; Galbreath, Autumn Dawn

2008-02-01

To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. Bootstrap-resampled incremental cost-effectiveness ratios (ICERs) were computed and compared across groups. Direct medical costs were obtained from a medical record review that collected records from 92% of patients; 66% of records requested were obtained. Disease management produced statistically significant survival advantages among all patients (17.4 days, P = .04), among patients with New York Heart Association (NYHA) class III/IV symptoms (47.7 days, P = .02), and among patients with SHF (24.2 days, P = .01). Analyses of direct medical and intervention costs showed no cost savings associated with the intervention. For all patients and considering all-cause medical care, the ICER was $146 870 per quality-adjusted life-year (QALY) gained, while for patients with NYHA class III/IV symptoms and patients with SHF, the ICERs were $67 784 and $95 721 per QALY gained, respectively. Costs per QALY gained were $101 120 for all patients, $72 501 for patients with SHF, and $41 348 for patients with NYHA class III/IV symptoms. The intervention was effective but costly to implement and did not reduce utilization. It may not be cost-effective in other broadly representative samples of patients. However, with program cost reductions and proper targeting, this program may produce life-span increases at costs that are less than $100 000 per QALY gained.

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…

Electrical Characteristics of WSi2 Nanocrystal Capacitors with Barrier-Engineered High-k Tunnel Layers

NASA Astrophysics Data System (ADS)

Lee, Hyo Jun; Lee, Dong Uk; Kim, Eun Kyu; You, Hee-Wook; Cho, Won-Ju

2011-06-01

Nanocrystal-floating gate capacitors with WSi2 nanocrystals and high-k tunnel layers were fabricated to improve the electrical properties such as retention, programming/erasing speed, and endurance. The WSi2 nanocrystals were distributed uniformly between the tunnel and control gate oxide layers. The electrical performance of the tunnel barrier with the SiO2/HfO2/Al2O3 (2/1/3 nm) (OHA) tunnel layer appeared to be better than that with the Al2O3/HfO2/Al2O3 (2/1/3 nm) (AHA) tunnel layer. When ΔVFB is about 1 V after applying voltage at ±8 V, the programming/erasing speeds of AHA and OHA tunnel layers are 300 ms and 500 µs, respectively. In particular, the device with WSi2 nanocrystals and the OHA tunnel barrier showed a large memory window of about 7.76 V when the voltage swept from 10 to -10 V, and it was maintained at about 2.77 V after 104 cycles.

Comparison of Body Weight Trend Algorithms for Prediction of Heart Failure Related Events in Home Care Setting.

PubMed

Eggerth, Alphons; Modre-Osprian, Robert; Hayn, Dieter; Kastner, Peter; Pölzl, Gerhard; Schreier, Günter

2017-01-01

Automatic event detection is used in telemedicine based heart failure disease management programs supporting physicians and nurses in monitoring of patients' health data. Analysis of the performance of automatic event detection algorithms for prediction of HF related hospitalisations or diuretic dose increases. Rule-Of-Thumb and Moving Average Convergence Divergence (MACD) algorithm were applied to body weight data from 106 heart failure patients of the HerzMobil-Tirol disease management program. The evaluation criteria were based on Youden index and ROC curves. Analysis of data from 1460 monitoring weeks with 54 events showed a maximum Youden index of 0.19 for MACD and RoT with a specificity > 0.90. Comparison of the two algorithms for real-world monitoring data showed similar results regarding total and limited AUC. An improvement of the sensitivity might be possible by including additional health data (e.g. vital signs and self-reported well-being) because body weight variations obviously are not the only cause of HF related hospitalisations or diuretic dose increases.

Effects of C and Hf concentration on phase relations and microstructure of a wrought powder-metallurgy superalloy

NASA Technical Reports Server (NTRS)

Miner, R. V., Jr.

1977-01-01

NASA IIB-11, a candidate alloy for advanced temperature turbine engine disks, and four modifications with varying C and Hf concentrations were produced from prealloyed powders. Several notable effects of C and Hf concentration in the alloys were observed. Both the amount of the gamma-prime phase and its solvus temperature increased with decreasing C, but only the gamma-prime solvus was affected by Hf, increasing with increasing Hf. Hf also promoted a cellular gamma-prime precipitation. Hf was, however, about equally distributed between gamma-prime and gamma. Hf and C both affected the carbides formed. Increasing both promoted formation of an MC relative to that of an M6C.

Hardness and Second Phase Percentage of Ni-Ti-Hf Compounds After Heat Treatment at 700C

NASA Technical Reports Server (NTRS)

Stanford, Malcolm K.

2017-01-01

The Vickers hardness and second phase precipitation of three ternary intermetallic Ni-Ti-Hf compounds containing either 1, 3 or 5 at.% Hf were compared to 60-Nitinol (55 at.% Ni - 45 at.% Ti). Heat treatment either at 700 C or with a subsequent aging step, hardened the 3 and 5 at.% Hf-containing ternaries to approximately 620 HV (56 HRC). Heat treatment increased the hardness of the 1 at.% Hf compound by more than 25 percent. Average hardness of the 3 and 5 at.% Hf ternaries, though higher than that of the binary Ni-Ti or the Ni-Ti-Hf compound containing 1 at.% Hf, appeared to be fairly insensitive to the different heat treatments. There was a drastic reduction of fatigue-enhancing second phase precipitates for the 5 at.% Hf ternaries compared to the other compounds. These results should guide materials selection for development of aerospace componentry.

Clinical trials update from the Heart Failure Society of America Meeting 2009: FAST, IMPROVE-HF, COACH galectin-3 substudy, HF-ACTION nuclear substudy, DAD-HF, and MARVEL-1.

PubMed

Lainscak, Mitja; Coletta, Alison P; Sherwi, Nasser; Cleland, John G F

2010-02-01

This article presents findings and a commentary on late-breaking trials presented during the meeting of the Heart Failure Society of America in September 2009. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The FAST trial showed somewhat better performance of intrathoracic impedance for prediction of deterioration in patients with heart failure (HF) when compared with daily weighing. The IMPROVE-HF study reported the benefits of education on the management of patients with systolic HF. Galectin-3 appeared a useful method for improving risk stratification of patients with chronic HF in a substudy of the COACH trial. A nuclear substudy of the HF-ACTION trial failed to demonstrate that resting myocardial perfusion imaging, a measure of myocardial scar and viability, was clinically useful. A small randomized controlled trial (DAD-HF) suggested that the use of low-dose dopamine in patients with acutely decompensated HF was associated with less deterioration in renal function and less hypokalaemia. The MARVEL-1 trial raises further concerns about the safety of myoblast transplantation in ischaemic HF.

The rotational excitation of HF by H

NASA Astrophysics Data System (ADS)

Desrousseaux, Benjamin; Lique, François

2018-06-01

The HF molecule is a key tracer of molecular hydrogen in diffuse interstellar medium (ISM). Accurate modelling of the HF abundance in such media requires one to model its excitation by both radiation and collisions. In diffuse ISM, the dominant collisional partners are atomic and molecular hydrogen. We report quantum time-independent calculations of collisional cross-sections and rate coefficients for the rotational excitation of HF by H. The reactive hydrogen exchange channels are taken into account in the scattering calculations. For the first time, HF-H rate coefficients are provided for temperature ranging from 10 to 500 K. The strongest collision-induced rotational HF transitions are those with Δj = 1, and the order of magnitude of the new HF-H rate coefficients is similar to that of the HF-H2 ones previously computed. As a first application, we simulate the excitation of HF by both H and H2 in typical diffuse ISM. We show that, depending on the rotational transition, hydrogen atoms increase or decrease the simulated excitation temperatures compared to collisional excitation only due to H2 molecules. Such results suggest that the new HF-H collisional data have to be used for properly modelling the abundance of HF in diffuse ISM.

Predictors of memory performance among Taiwanese postmenopausal women with heart failure.

PubMed

Chou, Cheng-Chen; Pressler, Susan J; Giordani, Bruno

2014-09-01

There are no studies describing the nature of memory deficits among women with heart failure (HF). The aims of this study were to examine memory performance among Taiwanese women with HF compared with age- and education-matched healthy women, and to evaluate factors that explain memory performance in women with HF. Seventy-six women with HF and 64 healthy women were recruited in Taiwan. Women completed working, verbal, and visual memory tests; HF severity was collected from the medical records. Women with HF performed significantly worse than healthy women on tests of working memory and verbal memory. Among women with HF, older age explained poorer working memory, and older age, higher HF severity, more comorbidities, and systolic HF explained poorer verbal memory. Menopausal symptoms were not associated with memory performance. Results of the study validate findings of memory loss in HF patients from the United States and Europe in a culturally different sample of women. Working memory and verbal memory were worse in Taiwanese women with HF compared with healthy participants. Studies are needed to determine mechanisms of memory deficits in these women and develop interventions to improve memory. Copyright © 2014 Elsevier Inc. All rights reserved.

Influence of oxygen vacancies in ALD HfO2-x thin films on non-volatile resistive switching phenomena with a Ti/HfO2-x/Pt structure

NASA Astrophysics Data System (ADS)

Sokolov, Andrey Sergeevich; Jeon, Yu-Rim; Kim, Sohyeon; Ku, Boncheol; Lim, Donghwan; Han, Hoonhee; Chae, Myeong Gyoon; Lee, Jaeho; Ha, Beom Gil; Choi, Changhwan

2018-03-01

We report a modulation of oxygen vacancies profile in atomic layer deposition (ALD) HfO2-x thin films by reducing oxidant pulse time (0.7 s-0.1 s) and study its effect on resistive switching behavior with a Ti/HfO2-x/Pt structure. Hf 4f spectra of x-ray photoelectron microscopy (XPS) and depth profile confirm varied oxygen vacancies profiles by shifts of binding energies of Hf 4f5/2 and Hf 4f7/2 main peaks and its according HfO2-x sub-oxides for each device. The ultraviolet photoelectron spectroscopy (UPS) confirms different electron affinity (χ) of HfO2 and HfO2-x thin films, implying that barrier height at Ti/oxide interface is reduced. Current transport mechanism is dictated by Ohmic conduction in fully oxidized HfO2 thin films - Device A (0.7 s) and by Trap Filled Space Charge Limited Conduction (TF-SCLC) in less oxidized HfO2-x thin films - Device B (0.3 s) and Device C (0.1 s). A switching mechanism related to the oxygen vacancies modulation in Ti/HfO2-x/Pt based resistive random access memory (RRAM) devices is used to explain carefully notified current transport mechanism variations from device-to-device. A proper endurance and long-time retention characteristics of the devices are also obtained.

Small Volume Isotopic Analysis of Zircon Using LA-MC-ICP-MS U-Pb and Lu-Hf and Sub-ng Amounts of Hf in Solution

NASA Astrophysics Data System (ADS)

Bauer, A.; Horstwood, M. S.

2016-12-01

Crust-mantle evolution studies are greatly informed by zircon U-Pb and Lu-Hf isotopic datasets and the ease with which these data can now be acquired has seen their application become commonplace. In order to deconvolute geochemical change and interpret geologic variation in complexly zoned zircons, this information is most ideally obtained on the smallest volume of zircon by successive SIMS U-Pb and LA-MC-ICP-MS Lu-Hf isotopic analyses. However, due to variations in zircon growth zone geometry at depth, the Lu-Hf analysis may not relate to the lower volume U-Pb analysis, potentially causing inaccuracy of the resultant age-corrected Hf isotope signature. Laser ablation split-stream methods are applied to be certain that U-Pb and Lu-Hf data represent the same volume of zircon, however, the sampling volume remains relatively large at 40x30µm1. Coupled ID-TIMS U-Pb and solution MC-ICP-MS Lu-Hf work traditionally utilize whole-zircon dissolution ( 10-50ng Hf), which has the potential to homogenize different zones of geologic significance within an analysis. Conversely, modern ID-TIMS U-Pb methods utilize microsampling of zircon grains, often providing < 5ng Hf, thereby challenging conventional Lu-Hf acquisition protocols to achieve the required precision. In order to obtain usable precision on minimal zircon volumes, we developed laser ablation methods using successive 25um spot U-Pb and Lu-Hf ablation pits with a combined depth of 18um, and low-volume solution introduction methods without Hf-REE separation utilizing Hf amounts as low as 0.4ng, while retaining an uncertainty level of ca. 1 ɛHf for both methods. We investigated methods of Yb interference correction and the potential for matrix effects, with a particular focus on the accurate quantification of 176Lu/177Hf. These improvements reduce the minimum amount of material required for U-Pb and Hf isotopic analysis of zircon by about an order of magnitude. 1Ibanez-Mejia et al (2015). PreRes, 267, 285-310.

The initial Hf isotopic composition of the Earth

NASA Astrophysics Data System (ADS)

Bouvier, A.; Boyet, M. M.; Vervoort, J. D.; Patchett, P. J.

2011-12-01

One area of considerable activity in trying to understand the formation and evolution of Earth's crust is the isotopic analysis of Hf in parallel with Sm-Nd and U-Pb zircon studies, either to constrain early crustal growth and evolution [1], or as a complement to detrital zircon studies [2]. The 176Lu decay constant deduced from early planetary and Earth materials have different values. It has been suggested that a period of irradiation in the early Solar System affected the 176Hf production rate in meteoritic and planetary materials [3,4]. In this scenario, the initial Hf isotopic composition of the Solar System and the Earth would be ~4 ∈Hf units lower, affecting tremendously the interpretation of the differentiation history of the early Earth. We investigated Lu-Hf compositions of calcium-aluminum-rich inclusions, the oldest known objects of the Solar System dated at 4568 Ma [5], to assess the possibility of neutrino irradiation in the solar nebula. Here we report high-precision 176Lu-176Hf systematics of leached and unleached, and spiked and unspiked, bulk fractions and mineral separates of 6 individual CAIs from 2 CV3 chondrites. Isotopic analyses were carried out by Neptune MC-ICPMS at ASU. Analytical details are in [6,7]. The unspiked Hf fractions reveal stable isotope anomalies of μ178Hf= 20 ± 6 and μ180Hf= 31 ± 9 (2SD) for the CAI B4 fractions (n=3) and μ178Hf= -4 ± 10 and μ180Hf= 2 ± 10 (n=2) for BCR-2 relative to the JMC 475 Hf standard. Further high-precision analysis of unspiked Sm and Nd fractions of the samples will be made to correct from nucleosynthetic or neutron capture anomalies [8]. Such Hf stable isotopic anomalies predict no more than 50ppm correction on 176Hf/177Hf. At this stage, we have thus regressed together the spiked and unspiked Hf compositions of CAI fractions (n=13) for isochron calculations. The slope of the Lu-Hf isochron is 0.0882 ± 0.0026 (2SD) which corresponds to a 176Lu decay constant value of 1.852 (± 0.052) ×10-11×y-1 consistent with the "terrestrial" determination [9,10]. We do not find evidence of 176Hf excesses in the CAI Lu-Hf systematics which excludes the possibility of neutrino irradiation to explain the anomalous Lu-Hf isochron ages of eucrite and angrite meteorites [3]. The initial 176Hf/177Hf of the CAIs and thus of the Solar System is 0.28286 ± 0.00011 which is consistent with the estimates of 0.28279 ± 0.00002 obtained using the modern CHUR composition [6] and the terrestrial decay constant [9,10]. This last composition remains the best estimate for the initial 176Hf/177Hf of the Earth. [1] Harrison. AREP Sci. 2009 37, 479. [2] Sun et al. Prec. Res. 2009 172, 99. [3] Albarède et al. GCA 2006 70, 1261. [4] Thrane et al. Astrophys. J. 2010 717, 861-867. [5] Bouvier & Wadhwa. Nat. Geosci. 2010 3, 637. [6] Bouvier et al. EPSL 2008 273, 48. [7] Münker et al. G3 2001 2. [8] Sprung et al. EPSL 2010 295, 1. [9] Scherer et al. Science 2001 293, 683. [10] Söderlund et al. EPSL 2004 219, 311.

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

Health facility-based data on women receiving sulphadoxine-pyrimethamine during pregnancy in Tanzania: lessons to learn from a cross-sectional survey in Mkuranga and Mufindi districts and other national survey reports

PubMed Central

2014-01-01

Background A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care clinics in Mkuranga and Mufindi districts. Methods A review of health management information system (HMIS) registers, interviews with health-care workers (HWs) and district and national level malaria control program managers corroborated by inter-temporal assessment through observations at HF levels. Statistical data were analyzed in Excel and interpreted in triangulation with qualitative data from interviews and observations. Results Data indicated that IPTp doses administered to women were inadequate and partly inconsistent. HMIS registers lacked space for IPT records, forcing HWs to manipulate their record-keeping. The proportion/number of IPTp recipients in related to the supply of SP for free delivery, to women’s attendance behaviours, showed variation by quarter and year of reporting. Conclusion It is impossible to achieve rational health service planning when the HMIS is weak. Whilst it is acknowledged that the HMIS is already overloaded, concerted measures are urgently needed to accommodate data on new interventions and other vertical programs if malaria programs are to achieve their goals. PMID:24433529

Chronic Aerobic Exercise Associated to Dietary Modification Improve Endothelial Function and eNOS Expression in High Fat Fed Hamsters

PubMed Central

Boa, Beatriz C. S.; Souza, Maria das Graças C.; Leite, Richard D.; da Silva, Simone V.; Barja-Fidalgo, Thereza Christina; Kraemer-Aguiar, Luiz Guilherme; Bouskela, Eliete

2014-01-01

Obesity is epidemic in the western world and central adipose tissue deposition points to increased cardiovascular morbidity and mortality, independently of any association between obesity and other cardiovascular risk factors. Physical exercise has been used as non-pharmacological treatment to significantly reverse/attenuate obesity comorbidities. In this study we have investigated effects of exercise and/or dietary modification on microcirculatory function, body composition, serum glucose, iNOS and eNOS expression on 120 male hamsters treated for 12 weeks with high fat chow (HF, n = 30) starting on the 21st day of birth. From week 12 to 20, animals were randomly separated in HF (no treatment change), return to standard chow (HFSC, n = 30), high fat chow associated to an aerobic exercise training program (AET) (HFEX, n = 30) and return to standard chow+AET (HFSCEX, n = 30). Microvascular reactivity in response to acetylcholine and sodium nitroprusside and macromolecular permeability increase induced by 30 minutes ischemia followed by reperfusion were assessed on the cheek pouch preparation. Total body fat and aorta eNOS and iNOS expression by immunoblotting assay were evaluated on the experimental day. Compared to HFSC and HFSCEX groups, HF and HFEX ones presented increased visceral fat [(mean±SEM) (HF)4.9±1.5 g and (HFEX)4.7±0.9 g vs. (HFSC)*3.0±0.7 g and (HFSCEX)*1.9±0.4 g/100 g BW]; impaired endothelial-dependent vasodilatation [Ach 10−8 M (HF)87.9±2.7%; (HFSC)*116.7±5.9%; (HFEX)*109.1±4.6%; (HFSCEX)*105±2.8%; Ach10−6 M (HF)95.3±3.1%; (HFSC)*126±6.2%; (HFEX)*122.5±2.8%; (HFSCEX)*118.1±4.3% and Ach10−4 M (HF)109.5±4.8%; (HFSC)*149.6±6.6%; (HFEX)*143.5±5.4% and (HFSCEX)*139.4±5.2%], macromolecular permeability increase after ischemia/reperfusion [(HF)40.5±4.2; (HFSC)*19.0±1.6; (HFEX)*18.6±2.1 and (HFSCEX)* 21.5±3.7 leaks/cm2), decreased eNOS expression, increased leptin and glycaemic levels. Endothelial-independent microvascular reactivity was similar between groups, suggesting that only endothelial damage had occurred. Our results indicate that an aerobic routine and/or dietary modification may cause significant improvements to high fat fed animals, diminishing visceral depots, increasing eNOS expression and reducing microcirculatory dysfunction. PMID:25036223

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.

Mango Supplementation Modulates Gut Microbial Dysbiosis and Short-Chain Fatty Acid Production Independent of Body Weight Reduction in C57BL/6 Mice Fed a High-Fat Diet.

PubMed

Ojo, Babajide; El-Rassi, Guadalupe Davila; Payton, Mark E; Perkins-Veazie, Penelope; Clarke, Stephen; Smith, Brenda J; Lucas, Edralin A

2016-08-01

High-fat (HF) diet-induced obesity is associated with changes in the gut microbiota. Fiber and other bioactive compounds in plant-based foods are suggested to prevent gut dysbiosis brought on by HF feeding. Mango is high in fiber and has been reported to have anti-obesogenic, hypoglycemic, and immunomodulatory properties. We investigated the effects of freeze-dried mango pulp combined with an HF diet on the cecal microbial population and its relation to body composition, lipids, glucose parameters, short-chain fatty acid (SCFA) production, and gut inflammatory markers in a mouse model of diet-induced obesity. Six-wk-old male C57BL/6 mice were randomly assigned to 1 of 4 dietary treatment groups: control (AIN-93M, 10% fat kcal), HF (60% fat kcal), and HF + 1% or 10% mango (HF+1%M or HF+10%M, wt:wt) for 12 wk. The cecal microbial population was assessed by use of 16S rDNA sequencing. Body composition, plasma glucose and lipids, cecal and fecal SCFAs, and mRNA abundance of inflammatory markers in the ileum and colonic lamina propria were assessed. Compared with the control group, HF feeding significantly reduced (P < 0.05) 1 operational taxonomic unit (OTU) of the genus Bifidobacteria (64-fold) and 5 OTUs of the genus Akkermansia (≥16-fold). This reduction was prevented in the HF+10%M group, members of which had 10% higher final body weight compared with the HF group (P = 0.01) and similar fasting blood glucose concentrations (P = 0.24). The HF+10%M group had 135% (P = 0.004) and 133% (P < 0.0001) greater fecal acetic and n-butyric acids concentrations than the HF group, suggesting greater microbial fermentation. Furthermore, a 59% greater colonic interleukin 10 (Il10) gene expression was observed in the HF+10%M group than in the HF group (P = 0.048), indicating modulation of gut inflammation. The HF+1%M group generally did not differ from the HF group. The addition of mango to an HF diet modulated the gut microbiota and production of SCFAs in C57BL/6 mice; these changes may improve gut tolerance to the insult of an HF diet. © 2016 American Society for Nutrition.

Integration of lead-free ferroelectric on HfO2/Si (100) for high performance non-volatile memory applications

PubMed Central

Kundu, Souvik; Maurya, Deepam; Clavel, Michael; Zhou, Yuan; Halder, Nripendra N.; Hudait, Mantu K.; Banerji, Pallab; Priya, Shashank

2015-01-01

We introduce a novel lead-free ferroelectric thin film (1-x)BaTiO3-xBa(Cu1/3Nb2/3)O3 (x = 0.025) (BT-BCN) integrated on to HfO2 buffered Si for non-volatile memory (NVM) applications. Piezoelectric force microscopy (PFM), x-ray diffraction, and high resolution transmission electron microscopy were employed to establish the ferroelectricity in BT-BCN thin films. PFM study reveals that the domains reversal occurs with 180° phase change by applying external voltage, demonstrating its effectiveness for NVM device applications. X-ray photoelectron microscopy was used to investigate the band alignments between atomic layer deposited HfO2 and pulsed laser deposited BT-BCN films. Programming and erasing operations were explained on the basis of band-alignments. The structure offers large memory window, low leakage current, and high and low capacitance values that were easily distinguishable even after ~106 s, indicating strong charge storage potential. This study explains a new approach towards the realization of ferroelectric based memory devices integrated on Si platform and also opens up a new possibility to embed the system within current complementary metal-oxide-semiconductor processing technology. PMID:25683062

Sub-10 nm Ta Channel Responsible for Superior Performance of a HfO 2 Memristor

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

Jiang, Hao; Han, Lili; Lin, Peng

Memristive devices are promising candidates for the next generation non-volatile memory and neuromorphic computing. It has been widely accepted that the motion of oxygen anions leads to the resistance changes for valence-change-memory (VCM) type of materials. Only very recently it was speculated that metal cations could also play an important role, but no direct physical characterizations have been reported yet. We report a Ta/HfO 2/Pt memristor with fast switching speed, record high endurance (120 billion cycles) and reliable retention. We also programmed the device to 24 discrete resistance levels, and also demonstrated over a million (220) epochs of potentiation andmore » depression, suggesting that our devices can be used for both multi-level non-volatile memory and neuromorphic computing applications. More importantly, we directly observed a sub-10 nm Ta-rich and O-deficient conduction channel within the HfO 2 layer that is responsible for the switching. Our work deepens our understanding of the resistance switching mechanism behind oxide-based memristive devices and paves the way for further device performance optimization for a broad spectrum of applications.« less

Ferroelectric memory based on molybdenum disulfide and ferroelectric hafnium oxide

NASA Astrophysics Data System (ADS)

Yap, Wui Chung; Jiang, Hao; Xia, Qiangfei; Zhu, Wenjuan

Recently, ferroelectric hafnium oxide (HfO2) was discovered as a new type of ferroelectric material with the advantages of high coercive field, excellent scalability (down to 2.5 nm), and good compatibility with CMOS processing. In this work, we demonstrate, for the first time, 2D ferroelectric memories with molybdenum disulfide (MoS2) as the channel material and aluminum doped HfO2 as the ferroelectric gate dielectric. A 16 nm thick layer of HfO2, doped with 5.26% aluminum, was deposited via atomic layer deposition (ALD), then subjected to rapid thermal annealing (RTA) at 1000 °C, and the polarization-voltage characteristics of the resulting metal-ferroelectric-metal (MFM) capacitors were measured, showing a remnant polarization of 0.6 μC/cm2. Ferroelectric memories with embedded ferroelectric hafnium oxide stacks and monolayer MoS2 were fabricated. The transfer characteristics after program and erase pulses revealed a clear ferroelectric memory window. In addition, endurance (up to 10,000 cycles) of the devices were tested and effects associated with ferroelectric materials, such as the wake-up effect and polarization fatigue, were observed. This research can potentially lead to advances of 2D materials in low-power logic and memory applications.

Applications of high-frequency radar

NASA Astrophysics Data System (ADS)

Headrick, J. M.; Thomason, J. F.

1998-07-01

Efforts to extend radar range by an order of magnitude with use of the ionosphere as a virtual mirror started after the end of World War II. A number of HF radar programs were pursued, with long-range nuclear burst and missile launch detection demonstrated by 1956. Successful east coast radar aircraft detect and track tests extending across the Atlantic were conducted by 1961. The major obstacles to success, the large target-to-clutter ratio and low signal-to-noise ratio, were overcome with matched filter Doppler processing. To search the areas that a 2000 nautical mile (3700 km) radar can reach, very complex and high dynamic range processing is required. The spectacular advances in digital processing technology have made truly wide-area surveillance possible. Use of the surface attached wave over the oceans can enable HF radar to obtain modest extension of range beyond the horizon. The decameter wavelengths used by both skywave and surface wave radars require large physical antenna apertures, but they have unique capabilities for air and surface targets, many of which are of resonant scattering dimensions. Resonant scattering from the ocean permits sea state and direction estimation. Military and commercial applications of HF radar are in their infancy.

Sub-10 nm Ta Channel Responsible for Superior Performance of a HfO 2 Memristor

DOE PAGES

Jiang, Hao; Han, Lili; Lin, Peng; ...

2016-06-23

Memristive devices are promising candidates for the next generation non-volatile memory and neuromorphic computing. It has been widely accepted that the motion of oxygen anions leads to the resistance changes for valence-change-memory (VCM) type of materials. Only very recently it was speculated that metal cations could also play an important role, but no direct physical characterizations have been reported yet. We report a Ta/HfO 2/Pt memristor with fast switching speed, record high endurance (120 billion cycles) and reliable retention. We also programmed the device to 24 discrete resistance levels, and also demonstrated over a million (220) epochs of potentiation andmore » depression, suggesting that our devices can be used for both multi-level non-volatile memory and neuromorphic computing applications. More importantly, we directly observed a sub-10 nm Ta-rich and O-deficient conduction channel within the HfO 2 layer that is responsible for the switching. Our work deepens our understanding of the resistance switching mechanism behind oxide-based memristive devices and paves the way for further device performance optimization for a broad spectrum of applications.« less

Organization of heart failure management in European Society of Cardiology member countries: survey of the Heart Failure Association of the European Society of Cardiology in collaboration with the Heart Failure National Societies/Working Groups.

PubMed

Seferovic, Petar M; Stoerk, Stefan; Filippatos, Gerasimos; Mareev, Viacheslav; Kavoliuniene, Ausra; Ristic, Arsen D; Ponikowski, Piotr; McMurray, John; Maggioni, Aldo; Ruschitzka, Frank; van Veldhuisen, Dirk J; Coats, Andrew; Piepoli, Massimo; McDonagh, Theresa; Riley, Jillian; Hoes, Arno; Pieske, Burkert; Dobric, Milan; Papp, Zoltan; Mebazaa, Alexandre; Parissis, John; Ben Gal, Tuvia; Vinereanu, Dragos; Brito, Dulce; Altenberger, Johann; Gatzov, Plamen; Milinkovic, Ivan; Hradec, Jaromír; Trochu, Jean-Noel; Amir, Offer; Moura, Brenda; Lainscak, Mitja; Comin, Josep; Wikström, Gerhard; Anker, Stefan

2013-09-01

The aim of this document was to obtain a real-life contemporary analysis of the demographics and heart failure (HF) statistics, as well as the organization and major activities of the Heart Failure National Societies (HFNS) in European Society of Cardiology (ESC) member countries. Data from 33 countries were collected from HFNS presidents/representatives during the first Heart Failure Association HFNS Summit (Belgrade, Serbia, 29 October 2011). Data on incidence and/or prevalence of HF were available for 22 countries, and the prevalence of HF ranged between 1% and 3%. In five European and one non-European ESC country, heart transplantation was reported as not available. Natriuretic peptides and echocardiography are routinely applied in the management of acute HF in the median of 80% and 90% of centres, respectively. Eastern European and Mediterranean countries have lower availability of natriuretic peptide testing for acute HF patients, compared with other European countries. Almost all countries have organizations dealing specifically with HF. HFNS societies for HF patients exist in only 12, while in 16 countries HF patient education programmes are active. Most HFNS reported that no national HF registry exists in their country. Fifteen HFNS produced national HF guidelines, while 19 have translated the ESC HF guidelines. Most HFNS (n = 23) participated in the organization of the European HF Awareness Day. This document demonstrated significant heterogeneity in the organization of HF management, and activities of the national HF working groups/associations. High availability of natriuretic peptide and echocardiographic measurements was revealed, with differences between developed countries and countries in transition.

NT-proBNP and Heart Failure Risk Among Individuals With and Without Obesity: The ARIC Study

PubMed Central

Ndumele, Chiadi E.; Matsushita, Kunihiro; Sang, Yingying; Lazo, Mariana; Agarwal, Sunil K.; Nambi, Vijay; Deswal, Anita; Blumenthal, Roger S.; Ballantyne, Christie M.; Coresh, Josef; Selvin, Elizabeth

2016-01-01

Background Obesity is a risk factor for heart failure (HF), but is associated with lower N-terminal of pro-Brain Natriuretic Peptide (NT-proBNP) levels. It is unclear whether the prognostic value and implications of NT-proBNP levels for HF risk differ across body mass index (BMI) categories. Methods and Results We followed 12,230 ARIC participants free of prior HF at baseline (visit 2, 1990–1992) with BMI ≥18.5 kg/m2. We quantified and compared the relative and absolute risk associations of NT-proBNP with incident HF across BMI categories. There were 1,861 HF events during a median 20.6 years of follow-up. Despite increased HF risk in obesity, a weak inverse association was seen between baseline BMI and NT-proBNP levels (r = −0.10). Nevertheless, higher baseline NT-proBNP was associated with increased HF risk in all BMI categories. NT-proBNP improved HF risk prediction overall and even among those with severe obesity (BMI ≥35 kg/m2; improvement in c-statistic +0.032 [95% CI 0.011–0.053]). However, given higher HF rates among those with obesity, at each NT-proBNP level, higher BMI was associated with greater absolute HF risk. Indeed, among those with NT-proBNP 100 to < 200 pg/ml, the average 10-year HF risk was <5% among normal weight individuals but >10% if severely obese. Conclusions Despite its inverse relationship with BMI, NT-proBNP provides significant prognostic information regarding the risk of developing HF even among individuals with obesity. Given the higher baseline HF risk among persons with obesity, even slight elevations in NT-proBNP may have implications for increased absolute HF risk in this population. PMID:26746175

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.

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

[Type B natriuretic peptide in the diagnosis of heart failure with preserved systolic function].

PubMed

Castro, A; Dias, P; Pereira, M; Pimenta, J; Friões, F; Rodrigues, R; Ferreira, A; Bettencourt, P

2001-11-01

Heart failure (HF) with preserved left ventricular systolic function (LVSF) is observed in up to 50% patients with HF. There is no consensus on non-invasive diagnosis of this entity. Evaluation of B-type natriuretic peptide (BNP) in the diagnosis of HF with preserved left ventricular systolic function. Prospective study. One hundred and seventy-six consecutive patients with suspected HF were evaluated. Patients were classified as having HF with preserved LVSF, if they had symptoms and signs of HF, an ejection fraction greater than 40% and an abnormal Doppler pattern of the mitral inflow or atrial fibrilation and no other causes for the symptoms. All patients had a 12-lead EKG, chest roentgenogram, simple spirometry, M-mode and 2D echocardiogram with pulsed Doppler study of transmitral inflow and determination of plasma BNP levels. Of the 176 patients, 65 had ejection fraction greater than 40%. Of these patients 46 were classified as having HF with preserved LVSF and 19 as not having HF. Patients with HF and preserved LVSF were older, had a higher systolic blood pressure (SBP), less pathologic Q waves on ECG and higher left ventricular ejection fraction and plasma BNP than patients without HF. Multivariate analysis revealed that BNP and SBP were independently associated with the diagnosis of HF. The accuracy of BNP in the diagnosis of HF with preserved LVSF evaluated by the area under the receiver operating characteristic curve was 0.94. These results suggest that the measurement of BNP levels can help clinicians in the diagnosis of HF with preserved LVSF. Whether BNP levels might be used in clinical practice as a test for the diagnosis of HF with preserved LVSF is a question that merits further studies.

Heart failure in pregnant women with cardiac disease: data from the ROPAC.

PubMed

Ruys, Titia P E; Roos-Hesselink, Jolien W; Hall, Roger; Subirana-Domènech, Maria T; Grando-Ting, Jennifer; Estensen, Mette; Crepaz, Roberto; Fesslova, Vlasta; Gurvitz, Michelle; De Backer, Julie; Johnson, Mark R; Pieper, Petronella G

2014-02-01

Heart failure (HF) is one of the most important complications in pregnant women with heart disease, causing maternal and fetal mortality and morbidity. This is an international observational registry of patients with structural heart disease during pregnancy. Sixty hospitals in 28 countries enrolled 1321 women between 2007 and 2011. Pregnant women with valvular heart disease, congenital heart disease, ischaemic heart disease, or cardiomyopathy could be included. Main outcome measures were onset and predictors of HF and maternal and fetal death. In total, 173 (13.1%) of the 1321 patients developed HF, making HF the most common major cardiovascular complication during pregnancy. Baseline parameters associated with HF were New York Heart Association class ≥ 3, signs of HF, WHO category ≥ 3, cardiomyopathy or pulmonary hypertension. HF occurred at a median time of 31 weeks gestation (IQR 23-40) with the highest incidence at the end of the second trimester (34%) or peripartum (31%). Maternal mortality was higher in patients with HF (4.8% in patients with HF and 0.5% in those without HF p<0.001). Pre-eclampsia was strongly related to HF (OR 7.1, 95% CI 3.9 to 13.2, p<0.001). Fetal death and the incidence of preterm birth were higher in women with HF compared to women without HF (4.6% vs 1.2%, p=0.001; and 30% vs 13%, p=0.001). HF was the most common complication during pregnancy, and occurred typically at the end of the second trimester, or after birth. It was most common in women with cardiomyopathy or pulmonary hypertension and was strongly associated with pre-eclampsia and an adverse maternal and perinatal outcome.

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.

Heart failure in patients admitted for acute coronary syndromes: A report from a large national registry.

PubMed

Jeger, Raban V; Pfister, Otmar; Radovanovic, Dragana; Eberli, Franz R; Rickli, Hans; Urban, Philip; Pedrazzini, Giovanni; Stauffer, Jean-Christophe; Nossen, Jörg; Erne, Paul

2017-10-01

Data on temporal trends of heart failure (HF) in acute coronary syndrome (ACS) are scarce. Improved treatment options may have led to lower case-fatality rates (CFRs) during the last years in ACS complicated by HF. Patients of the nationwide Acute Myocardial Infarction in Switzerland (AMIS)-Plus ACS registry were analyzed from 2000 to 2014. Of 36 366 ACS patients, 3376 (9.3%) had acute or chronic HF, 2111 (5.8%) de novo acute HF (AHF), 964 (2.7%) chronic HF (CHF), and 301 (0.8%) acute decompensated CHF (ADCHF). In-hospital CFRs were highest in patients with ADCHF (32.6%) and de novo AHF (29.7%), followed by patients with CHF (12.9%) and without HF (3.2%, P < 0.001). Although in-hospital CFRs gradually decreased in CHF patients (14.3% to 4.5%, P = 0.003) and patients without HF (3.5% to 2.2%, P < 0.001), they remained high in patients with ADCHF (36.4% to 40.0%, P = 0.45) and de novo AHF (50.0% to 29.4%, P = 0.37). Although there was an increase in specific ACS therapies in the cohort over time, ACS patients with HF received significantly less pharmacological and interventional ACS therapies than patients without HF. There was no significant change in HF medication rates except less frequent use of β-blockers and diuretics in de novo AHF patients in recent years. HF is present in 1 out of 10 patients presenting with ACS and is associated with high in-hospital CFRs, particularly in acute HF. Although advances in ACS therapy improved in-hospital CFRs in patients with no HF or CHF, CFRs remained unchanged and high in patients with acute HF and ACS over the last decade. © 2017 Wiley Periodicals, Inc.

Seepage and Piping through Levees and Dikes using 2D and 3D Modeling Codes

DTIC Science & Technology

2016-06-01

by the Hydrologic Systems Branch of the Flood and Storm Protection Division (CEERD-HF), U.S. Army Engineer Research and Development Center, Coastal ...ER D C/ CH L TR -1 6- 6 Flood & Coastal Storm Damage Reduction Program Seepage and Piping through Levees and Dikes Using 2D and 3D...Flood & Coastal Storm Damage Reduction Program ERDC/CHL TR-16-6 June 2016 Seepage and Piping through Levees and Dikes Using 2D and 3D Modeling Codes

The pecan nut (Carya illinoinensis) and its oil and polyphenolic fractions differentially modulate lipid metabolism and the antioxidant enzyme activities in rats fed high-fat diets.

PubMed

Domínguez-Avila, Jesús A; Alvarez-Parrilla, Emilio; López-Díaz, José A; Maldonado-Mendoza, Ignacio E; Gómez-García, María Del Consuelo; de la Rosa, Laura A

2015-02-01

Tree nuts such as pecans (Carya illinoinensis) contain mostly oil but are also a source of polyphenols. Nut consumption has been linked to a reduction in serum lipid levels and oxidative stress. These effects have been attributed to the oil while overlooking the potential contribution of the polyphenols. Because the evidence regarding each fraction's bioactivity is scarce, we administered high-fat (HF) diets to male Wistar rats, supplementing them with pecan oil (HF+PO), pecan polyphenols (HF+PP) or whole pecans (HF+WP), and analysed the effects of each fraction. The HF diet increased the serum leptin and total cholesterol (TC) with respect to the control levels. The HF+WP diet prevented hyperleptinemia and decreased the TC compared with the control. The HF+WP diet upregulated the hepatic expression of apolipoprotein B and LDL receptor mRNAs with respect to the HF levels. The HF+PO diet reduced the level of triacylglycerols compared with the control. The HF+PP diet stimulated the hepatic expression of liver X receptor alpha mRNA. The HF+WP diet increased the activities of hepatic catalase, glutathione peroxidase and glutathione S transferase compared with the control, and decreased the degree of lipid peroxidation compared with the HF diet. The most bioactive diet was the WP diet. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lu-Hf total-rock age for the Amîtsoq gneisses, West Greenland

USGS Publications Warehouse

Pettingill, H.S.; Patchett, P.J.

1981-01-01

Lu-Hf total-rock data for the Amîtsoq gneisses of West Greenland yield an age of 3.55±0.22Gy(2σ), based on the decay constant λ176Lu=1.96×10−11y−1, and an initial176Hf/177Hf ratio of 0.280482±33. The result is in good agreement with Rb-Sr total-rock and U-Pb zircon ages. In spite of severe metamorphism of the area at 2.9 Gy, zircons from two of the samples have remained on the total-rock line, and define points close to the initial Hf ratio. The initial176Hf/177Hf lies close to a chondritic Hf isotopic evolution curve from 4.55 Gy to present. This is consistent with the igneous precursors to the Amîtsoq gneisses having been derived from the mantle at or shortly before 3.6 Gy. Anomalous relationships between Hf concentration and the176Lu/177Hf ratio may suggest that trace element abundances in the Amîtsoq gneisses are partly controlled by processes related to metamorphism.

Lu-Hf total-rock age for the Amitsoq gneisses, West Greenland

NASA Technical Reports Server (NTRS)

Pettingill, H. S.; Patchett, P. J.

1981-01-01

Lu-Hf total-rock data for the Amitsoq gneisses of West Greenland yield an age of 3.55 + or - 0.22 billion years, based on the decay constant for Lu-176 of 1.96 x 10 to the -11th/year, and an initial Hf-176/Hf-177 ratio of 0.280482 + or - 33. The result is in good agreement with Rb-Sr total-rock and U-Pb zircon ages. In spite of severe metamorphism of the area at 2.9 billion years, zircons from two of the samples have remained on the total-rock line, and define points close to the initial Hf ratio. The initial Hf-176/Hf-177 lies close to a chondritic Hf isotopic evolution curve from 4.55 billion years to present. This is consistent with the igneous precursors to the Amitsoq gneisses having been derived from the mantle at or shortly before 3.6 billion years. Anomalous relationships between Hf concentration and the Lu-176/Hf-177 ratio may suggest that trace element abundances in the Amitsoq gneisses are partly controlled by processes related to metamorphism.

Anticoagulant therapy and outcomes in patients with prior or acute heart failure and acute coronary syndromes: Insights from the APixaban for PRevention of Acute ISchemic Events 2 trial.

PubMed

Cornel, Jan H; Lopes, Renato D; James, Stefan; Stevens, Susanna R; Neely, Megan L; Liaw, Danny; Miller, Julie; Mohan, Puneet; Amerena, John; Raev, Dimitar; Huo, Yong; Urina-Triana, Miguel; Gallegos Cazorla, Alex; Vinereanu, Dragos; Fridrich, Viliam; Harrington, Robert A; Wallentin, Lars; Alexander, John H

2015-04-01

Clinical outcomes and the effects of oral anticoagulants among patients with acute coronary syndrome (ACS) and either a history of or acute heart failure (HF) are largely unknown. We aimed to assess the relationship between prior HF or acute HF complicating an index ACS event and subsequent clinical outcomes and the efficacy and safety of apixaban compared with placebo in these populations. High-risk patients were randomly assigned post-ACS to apixaban 5.0 mg or placebo twice daily. Median follow-up was 8 (4-12) months. The primary outcome was cardiovascular death, myocardial infarction, or stroke. The main safety outcome was thrombolysis in myocardial infarction major bleeding. Heart failure was reported in 2,995 patients (41%), either as prior HF (2,076 [28%]) or acute HF (2,028 [27%]). Patients with HF had a very high baseline risk and were more often managed medically. Heart failure was associated with a higher rate of the primary outcome (prior HF: adjusted hazard ratio [HR] 1.73, 95% CI 1.42-2.10, P < .0001, acute HF: adjusted HR 1.65, 95% CI 1.35-2.01, P < .0001) and cardiovascular death (prior HF: HR 2.54, 95% CI 1.82-3.54, acute HF: adjusted HR 2.52, 95% CI 1.82-3.50). Patients with acute HF also had significantly higher rates of thrombolysis in myocardial infarction major bleeding (prior HF: adjusted HR 1.22, 95% CI 0.65-2.27, P = .54, acute HF: adjusted HR 1.78, 95% CI 1.03-3.08, P = .04). There was no statistical evidence of a differential effect of apixaban on clinical events or bleeding in patients with or without prior HF; however, among patients with acute HF, there were numerically fewer events with apixaban than placebo (14.8 vs 19.3, HR 0.76, 95% CI 0.57-1.01, interaction P = .13), a trend that was not seen in patients with prior HF or no HF. In high-risk patients post-ACS, both prior and acute HFs are associated with an increased risk of subsequent clinical events. Apixaban did not significantly reduce clinical events and increased bleeding in patients with and without HF; however, there was a tendency toward fewer clinical events with apixaban in patients with acute HF. Copyright © 2015 Elsevier Inc. All rights reserved.

Physical exercise counteracts the increase in velocity of propagation of cortical spreading depression imposed by early over-nutrition in rats.

PubMed

Monteiro, Heloísa Mirelle Costa; de Mendonça, Débora Carneiro; Sousa, Mariana Séfora Bezerra; Amancio-Dos-Santos, Angela

2018-06-01

This investigation studied whether physical exercise could modulate cortical spreading depression (CSD) propagation velocity in adult rat offspring from dams that had received a high-fat (HF) diet during lactation. Wistar male rats suckled by dams fed either control (C) or HF diet ad libitum. After weaning, pups received standard laboratory chow. From 40 to 60 days of life, half of the animals exercised on a treadmill (group E); the other half remained sedentary (group S). Two additional HF groups (E and S) received fluoxetine (F; 10 mg/kg/day, orogastrically) from 40 to 60 days of life (groups HF/EF and HF/F). At 40 days of life, rats from the maternal HF diet presented higher weight, thoracic circumference, and Lee Index than C animals and remained heavier at 60 days of life. Physical exercise decreased abdominal circumference. HF diet increased CSD propagation velocity (mean ± SD; mm/min) in sedentaries (HF/S 3.47 ± 0.31 versus C/S 3.24 ± 0.26). Treadmill exercise decelerated CSD propagation in both groups C/E (2.94 ± 0.28) and HF/E (2.97 ± 0.40). Fluoxetine alone decreased CSD propagation (HF/F 2.88 ± 0.45) compared with HF/S group. The combination of fluoxetine + exercise under HF condition (2.98 ± 0.27) was similar to HF/E group. Physical exercise is able to reduce CSD propagation velocity in rat adult brains even when they have suffered over-nourishing during lactation. The effects of exercise alone or fluoxetine alone on CSD were similar to the effects of fluoxetine + exercise, under the HF condition. Data reinforce malnutrition during lactation modifies cortical electrophysiology even when the HF condition no longer exists.

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

Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients With Normal Kidney Function.

PubMed

George, Lekha K; Koshy, Santhosh K G; Molnar, Miklos Z; Thomas, Fridtjof; Lu, Jun L; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

2017-08-01

Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes. Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) ≥60 mL min -1 1.73 m -2 during October 1, 2004 to September 30, 2006, we identified 156 743 with an International Classification of Diseases , Ninth Revision , diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min -1 1.73 m -2 y -1 ) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean±standard deviation baseline age and eGFR of HF patients were 68±11 years and 78±14 mL min -1 1.73 m -2 and in patients without HF were 59±14 years and 84±16 mL min -1 1.73 m -2 , respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively. HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications. © 2017 American Heart Association, Inc.

Influence of LVAD function on mechanical unloading and electromechanical delay: a simulation study.

PubMed

Heikhmakhtiar, Aulia Khamas; Ryu, Ah Jin; Shim, Eun Bo; Song, Kwang-Soup; Trayanova, Natalia A; Lim, Ki Moo

2018-05-01

This study hypothesized that a left ventricular assist device (LVAD) shortens the electromechanical delay (EMD) by mechanical unloading. The goal of this study is to examine, by computational modeling, the influence of LVAD on EMD for four heart failure (HF) cases ranging from mild HF to severe HF. We constructed an integrated model of an LVAD-implanted cardiovascular system, then we altered the Ca 2+ transient magnitude, with scaling factors 1, 0.9, 0.8, and 0.7 representing HF1, HF2, HF3, and HF4, respectively, in order of increasing HF severity. The four HF conditions are classified into two groups. Group one is the four HF conditions without LVAD, and group two is the conditions treated with continuous LVAD pump. The single-cell mechanical responses showed that EMD was prolonged with the higher load. The findings indicated that in group one, the HF-induced Ca2 + transient remodeling prolonged the mechanical activation time (MAT) and decreased the contractile tension, which reduced the left ventricle (LV) pressure, and increased the end-diastolic strain. In group two, LVAD shortened MAT of the ventricles. Furthermore, LVAD reduced the contractile tension, and end-diastolic strain, but increased the aortic pressure. The computational study demonstrated that LVAD shortens EMD by mechanical unloading of the ventricle.

LU-HF Age and Isotope Systematics of ALH84001

NASA Technical Reports Server (NTRS)

Righter, M.; Lapen, T. J.; Brandon, A. D.; Beard, B. L.; Shafer, J. T.; Peslier, A. H.

2009-01-01

Allan Hills (ALH) 84001 is an orthopyroxenite that is unique among the Martian meteorites in having the oldest inferred crystallization age (approx..4.5 to 4.0 Gyr) [e.g., 1-6 and references therein 7]. Its ancient origin makes this stone a critical constraint on early history of Mars, in particular the evolution of different planetary crust and mantle reservoirs. However, because there is significant variability in reported crystallization ages, determination of initial isotope compositions is imprecise making assessment of planetary reservoirs difficult. Here we report a new Lu-Hf mineral isochron age, initial Hf-176/Hf-177 isotope composition, and inferred Martian mantle source compositions for ALH84001 that place constraints on longlived source reservoirs for the enriched shergottite suite of Martian meteorites including Shergotty, Zagami, NWA4468, NWA856, RBT04262, LAR06319, and Los Angeles. Sm-Nd isotope analyses are under way for the same mineral aliquots analyzed for Lu-Hf. The Lu-Hf system was utilized because Lu and Hf are both lithophile and refractory and are not easily redistributed during short-lived thermal pulses associated with shock metamorphism. Moreover, chromite has relatively modest Hf concentrations with very low Lu/Hf ratios [9] yielding tight constraints on initial Hf-176/Hf-177 isotope compositions

Evolution of the mechanical and tribological properties of DLC thin films doped with low-concentration hafnium on 316L steel

NASA Astrophysics Data System (ADS)

Qi, Meng; Xiao, Jianrong; Gong, Chenyang; Jiang, Aihua; Chen, Yong

2018-01-01

Low concentrations (<1 at%) of hafnium doped into diamond-like thin films (Hf-DLC) were deposited on 316L stainless steel and silicon (1 0 0) substrates by magnetron sputtering to attain superior mechanical and tribological properties. Ar and CH4 were used as source gases. The microstructure, chemical composition, and morphology of the Hf-DLC thin films in various concentrations were analyzed using x-ray diffraction, Raman spectroscopy, x-ray photoelectron spectroscopy, scanning electron microscopy and atomic force microscopy. Results showed that Hf species transferred from the particulate microstructure to Hf carbide phases, and the surface roughness increased monotonically with increasing Hf concentration. Moreover, the hardness and elastic modulus exhibited high values when the doped Hf concentration was 0.42 at%. Similarly, the tribological behaviors and wear life of Hf-DLC thin films had a low friction coefficient and excellent wear resistance at 0.42 at% Hf concentration. Therefore, 0.42 at% Hf is an optimal doping concentration to improve the mechanical and tribological properties of DLC thin films. Generally, the use of low-concentration Hf doping into DLC thin films is novel, and the present results provide guidance for the selection of suitable and effective concentration to optimize Hf-DLC thin films with superior performance.

Meditation-induced changes in high-frequency heart rate variability predict smoking outcomes

PubMed Central

Libby, Daniel J.; Worhunsky, Patrick D.; Pilver, Corey E.; Brewer, Judson A.

2012-01-01

Background: High-frequency heart rate variability (HF-HRV) is a measure of parasympathetic nervous system (PNS) output that has been associated with enhanced self-regulation. Low resting levels of HF-HRV are associated with nicotine dependence and blunted stress-related changes in HF-HRV are associated with decreased ability to resist smoking. Meditation has been shown to increase HF-HRV. However, it is unknown whether tonic levels of HF-HRV or acute changes in HF-HRV during meditation predict treatment responses in addictive behaviors such as smoking cessation. Purpose: To investigate the relationship between HF-HRV and subsequent smoking outcomes. Methods: HF-HRV during resting baseline and during mindfulness meditation was measured within two weeks of completing a 4-week smoking cessation intervention in a sample of 31 community participants. Self-report measures of smoking were obtained at a follow up 17-weeks after the initiation of treatment. Results: Regression analyses indicated that individuals exhibiting acute increases in HF-HRV from resting baseline to meditation smoked fewer cigarettes at follow-up than those who exhibited acute decreases in HF-HRV (b = −4.89, p = 0.008). Conclusion: Acute changes in HF-HRV in response to meditation may be a useful tool to predict smoking cessation treatment response. PMID:22457646