Search

BACKGROUNDThe use of traditional models to predict heart failure (HF) has limitations in preventing HF hospitalizations. Artificial intelligence (AI) and machine learning (ML) in cardiovascular medicine only have limited data published regarding HF populations, with none assessing the favorability of decongestive therapy aquapheresis (AQ). AI and ML can be leveraged to design non-traditional models to identify those who are at high risk of HF readmissions.OBJECTIVESThis study aimed to develop a model for pretreatment identification of risk for 90-day HF events among HF patients who have undergone AQ.METHODSUsing data from the AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial, we designed a ML-based predictive model that can be used before initiating AQ to anticipate who will respond well to AQ and who will be at high risk of future HF events.RESULTSUsing ML we identified the top ten predictors for 90-day HF events. Interestingly, the variable for ‘intimate relationships with loved ones’ strongly predicted response to therapy. This ML-model was more successful in predicting the outcome in HF patients who were treated with AQ. In the original AVOID-HF trial, the overall 90-day HF event rate in the AQ arm was 32%. Our proposed predictive model was accurate in anticipating 90-day HF events with better statistical accuracy (area under curve 0.88, sensitivity 80%, specificity 75%, negative predictive value 90%, and positive predictive value 57%).CONCLUSIONSML can help identify HF patients who will respond to AQ therapy. Our model can identify super-respondents to AQ therapy and predict 90-day HF events better than currently existing traditional models.CONDENSED ABSTRACTUtilizing data from the AVOID-HF trial, we designed a ML-predictive model that can be used before initiating AQ to anticipate who will respond well to AQ and who will be at high risk of future HF events. Using ML, we identified the top 10 predictors for 90-day HF events. Our model can identify super-respondents to ultrafiltration therapy and predict 90-day HF events better than currently existing traditional models.

How do political communities stick together as polities in times of crisis? What is needed to motivate their citizens work together to deter threats, maintain state monopolies of violence, and sustain different forms of military alliances and cooperation? The answer, in large part, is patriotism. Patriotic thinking—both as a sentiment and as an element of political ideology—is a central tenet in building states and conducting state affairs. From the perspective of political philosophy, patriotism is often characterized as love for one’s country and as an affective relationship imbued with such emotions as pride, honor, and appreciation for the collective that it represents. Scholars from the tradition of republican patriotism argue that such love may be directed toward political institutions and that it helps form a way of life that sustains the liberty of a state’s population. This stands in contrast to nationalism, which regards thesame object of veneration, the homeland, with less tolerance of heterogeneity and political disunion. Both patriotism and nationalism are conceptualized in a variety of ways and can take on meanings as varied as benign civic unity and exclusionary chauvinism. Patriotism is often conceptualized as a form of civic virtue, stressing the way it prioritizes the community ahead of the individual.

The sodium glucose co-transporter 2 inhibitors have demonstrated favorable effects on cardiovascular and renal disease; however, they may also increase low-density lipoprotein cholesterol (LDL-C). There are limited data directly comparing the effects of sodium glucose co-transporter 2inhibitors on serum lipids to other antihyperglycemic therapies. In this post-hoc analysis of the CANA-HF trial, we sought to compare the effects of canagliflozin to sitagliptin in patients with type 2 diabetes mellitus (T2DM) and heart failure and reduced ejection fraction (HFrEF). The CANA-HF trial was a prospective, randomized controlled study that compared the effects of canagliflozin 100 mg daily to sitagliptin 100 mg daily on cardiorespiratory fitness in patients with HFrEF and T2DM. Of the 36 patients enrolled in CANA-HF, 35 patients had both baseline and 12-weeks serum lipids obtained via venipuncture. The change in LDL-C from baseline to 12 weeks was 5 (-12.5 to 19.5) mg/dL versus -8 (-19 to -1) mg/dL (P = 0.82) and triglyceride levels was -4 (-26 to 9) mg/dL and -10.5 (-50 to 29.3) mg/dL (P = 0.52) for canagliflozin and sitagliptin, respectively. No significant differences were found between canagliflozin and sitagliptin for total cholesterol, high-density lipoprotein cholesterol or non-HDL-C (P > 0.5 for all). These data suggest that compared with sitagliptin, canagliflozin may not increase LDL-C in patients with T2DM and HFrEF.

The legal recognition of different forms of family relations has expanded a great deal in Europe in recent years. Most political and legal change has taken place with the legal sex of an individual becoming less important than before in the formal recognition of family relations. In this chapter, it is argued with empirical examples from the case law of the European Court of Human Rights that what law has joined, is seldom undone even with the force of law itself. However, the malleability of legal family relations is conditional. Unions between adults such as marriage are easier to modify in terms of legal sex and gender identity than parental relations, which rarely escape the irreducible differences between female and male bodies underpinning human reproduction.

Background Canagliflozin reduces hospitalizations for heart failure (HF) in type 2 diabetes mellitus (T2DM). Its effect on cardiorespiratory fitness and cardiac function in patients with established HF with reduced ejection fraction (HFrEF) is unknown. Methods We conducted a double-blind randomized controlled trial of canagliflozin 100 mg or sitagliptin 100 mg daily for 12 weeks in 88 patients, and measured peak oxygen consumption (VO2 ) and minute ventilation/carbon dioxide production (VE/VCO2 ) slope (co-primary endpoints for repeated measure ANOVA time_x_group interaction), lean peak VO2 , ventilatory anaerobic threshold (VAT), cardiac function and quality of life (ie, Minnesota Living with Heart Failure Questionnaire [MLHFQ]), at baseline and 12-week follow-up. Results The study was terminated early due to the new guidelines recommending canagliflozin over sitagliptin in HF: 17 patients were assigned to canagliflozin and 19 to sitagliptin, total of 36 patients. There were no significant changes in peak VO2 and VE/VCO2 slope between the two groups (P = .083 and P = .98, respectively). Canagliflozin improved lean peak VO2 (+2.4 mL kgLM -1 min-1 , P = .036), VAT (+1.5 mL kg-1 min-1 , P = .012) and VO2 matched for respiratory exchange ratio (+2.4 mL Kg-1 min-1 , P = .002) compared to sitagliptin. Canagliflozin also reduced MLHFQ score (-12.1, P = .018). Conclusions In this small and short-term study of patients with T2DM and HFrEF, interrupted early after only 36 patients, canagliflozin did not improve the primary endpoints of peak VO2 or VE/VCO2 slope compared to sitagliptin, while showing favourable trends observed on several additional surrogate endpoints such as lean peak VO2 , VAT and quality of life.

This article develops new analytical tools for considering the dynamics of power in gender equality. This is done by focusing on a closely related concept, legitimacy , and utilizing it to shed light on the relations between gender equality and power. We develop a new concept to describe the "undecided" conceptual zone between what is considered "legitimate" and what is "illegitimate," that we have named "a-legitimate". The starting point is the idea that legitimacy is construed in a binary opposition with illegitimacy. Instead of being static, the struggles over definition of "legitimate" and "illegitimate" are an outcome of dynamic processes and fundamentally shaped by the "a-legitimate" that falls in-between.

This article analyses two judgments by the ECHR on granting authorization to adopt to non-heterosexual people. E.B. v. France overturned Frette v. France, establishing that refusing to grant adoption licences to gay, lesbian, and bisexual applicants is against the provisions of Article 14 (in conjunction with Article 8) of the European Convention. In Frette, an adoption licence was not granted to a single gay man due to, notably, ‘lack of scientific consensus’ on the advisability of child rearing by non-heterosexuals. In E.B., it was established that prejudice against sexual minorities had ‘contaminated’ the reasoning of the French administrative courts. The cases are considered from a sociological viewpoint, stressing that it is of vital importance to look at the non-legal expertise, knowledge, and theories referred to. Because of the politicized nature of the issue, scientific consensus or lack of it cannot be considered the final yardstick, and judges and decision-makers are faced with an inevitable political choice.

In the language of medical liability, no concept has received as much misinterpretation as "informed consent." In the last five years, most medical liability carriers have experienced a significant increase in claims that allege failure to obtain a proper informed consent prior to treatment. The authors discuss forensic testing of the medical record and offer recommendations for record-keeping. These suggestions, if followed, will help establish the reliability of the record as an accurate reflection of the treatment of the patient in any given case.

core mission of health professions schools is to educate and train a workforce that will be optimally prepared to provide health care and public health services for the diverse communities that they serve. It is important to create and develop a health care workforce who can understand and assist in the battle against health care disparities. For health care workers and health profession schools, cultural competence education and training has been identified as one solution to the problem. However to educate and properly train a culturally competent health care workforce is not an easy task. The literature on cultural competency is growing, with numerous studies that have focused on specific traits of cultural competency but unfortunately, a consensus on the best approach to achieve the desired outcomes has not been reached. A review of the literature on cultural competency reveals some common concerns regarding cultural competency, especially about how cultural competence education is incorporated in the classroom/clinical setting. What training and preparation does the instructor possess to qualify him or her to teach cultural competency? Was the instructor chosen because of gender or because he/she is from a racial or ethnic minority group which somehow makes him/her an expert? How much time should be devoted to cultural competency training in health professions? How do we accurately assess student learning of cultural competency? And finally, how do we as faculty committed to cultural competency get our colleagues to also participate in cultural training/education? These are key ques- tions, concerns, and problems that many who teach cultural competency training have encountered. Therefore, a variety of approaches to cultural competency education and training have been developed within our schools. Earlier this year, a joint expert panel convened by the Association of American Medical Colleges and the Association of Schools of Public Health released a report with recommendations for Schools of medicine and public health defining a set of

This paper describes our experiences as facilitators in adventure-based ropes course training. It summarizes experiences with different groups that raise rich and complex issues about the use of adventure-based learning for personal growth and professional development. These groups include women executives, women living in public housing who have formed a women's resource group, adolescent women in treatment, adolescents from currently diverse backgrounds, graduate students, and women who have been sexually abused. These groups reflect the diversity of female participants who have engaged in ropes course training. Although participants are diverse, deep commonalities exist in the kinds of issues they are addressing in ropes course programs. Positive changes in women's abilities to take risks, practice assertive leadership, solve problems effectively, and feel more competent in general, can result from participation in a ropes course experience. In this article, the reader will see how one fixed ropes cour...

The lattice relaxation of strained Si 1− x Ge x layers on Si (001) substrates has been examined. Three specimens consisting of a single Si 1− x Ge x layer were grown by molecular beam epitaxy. All layers were grown with a nominal composition of x = 0.14 to thicknesses of 0.5, 1.0 or 1.5 μm. Double-crystal and white-radiation topographic methods were used to reveal the misfit dislocation structure and distribution. The misfit dislocations were shown to extend from heterogeneous nucleation sites along the directions in the plane of the interface. A symmetric distribution of dislocations between the orthogonal directions was observed. The Burgers vectors of the misfit dislocation array were evenly distributed amongst the available 60°-type candidates. Double-crystal X-ray diffractometry showed the 0.5 and 1.0 μm layers to be fully strained to within the experimental uncertainty. Secondary branching of misfit dislocations was observed in the 1.0μm layer which indicated cross-slip of the threading dislocation segments.

Infection control practice is a cornerstone of modern health care. However, there is minimal research into health professionals' perception of infection control practices and how those perceptions influence staff compliance with recommended protocols. The objective of this study was to explore health care professionals' perceptions of infection control practices in relation to the management of infectious diseases. A grounded theory approach was used as the research framework. Semi-structured interviews were completed with a sample of 16 nurses and doctors working at hospitals in Western Australia. Four major categories emerged from the data. These were: knowledge, culture, conflict, and risk assessment. The findings indicate the importance of both individual and organisational factors in determining clinicians' levels of compliance with recommended infection control practices. Identification of the factors that influence health professionals' level of compliance can be used to develop strategies to support long-term compliance with infection control practices.

Edward Dutton. The Finnuit: Finnish Culture and the Religion of Uniqueness. Budapest: Akadémiai Kiadó, 2009. Pp. 288. ISBN: 978-963-05-8731-0.

Objective. Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmission in the United States, obstacles to perinatal HIV prevention that include lack of prenatal care; failure to test pregnant women for HIV before delivery; and lack of prenatal, intrapartum, or neonatal antiretroviral (ARV) use remain. The objective of this study was to describe trends in perinatal HIV prevention methods, perinatal transmission rates, and the contribution of missed opportunities for perinatal HIV prevention to perinatal HIV infection. Methods. We analyzed data obtained from infant medical records on 4755 HIV-exposed singleton deliveries in 1996–2000, from 6 US sites that participate in the Centers for Disease Control and Prevention’s Pediatric Spectrum of HIV Disease Project. HIV-exposed deliveries refer to deliveries in which the mother was known to have HIV infection during the pregnancy. Results. Of the 4287 women with data on prenatal care, 92% had prenatal care. From 1996 to 2000, among the 3925 women with prenatal care, 92% had an HIV test before delivery; the use of prenatal zidovudine (ZDV) alone decreased from 71% to 9%, and the use of prenatal ZDV with other ARVs increased from 6% to 70%. Complete data on maternal and neonatal ARVs were available for 3284 deliveries. Perinatal HIV transmission was 3% in 1651 deliveries with prenatal ZDV in combination with other ARVs, intrapartum ZDV, and neonatal ZDV; 6% in 1111 deliveries with prenatal, intrapartum, and neonatal ZDV alone; 8% in 152 deliveries with intrapartum and neonatal ZDV alone; 14% of 73 deliveries with neonatal ZDV only started within 24 hours of birth; and 20% in 297 deliveries with no prenatal, intrapartum, and neonatal ARVs. Complete data on prenatal events were available in 328 HIV-infected and 3258 HIV-uninfected infants. A total of 56% of mothers of HIV-infected infants had missed opportunities for perinatal HIV prevention versus 16% of mothers of HIV-uninfected infants. Forty-four percent of the infected infants were born to mothers who had prenatal care, a prenatal HIV diagnosis, and documented prenatal ARV therapy. Seventeen percent of women with reported illicit drug use had no prenatal care versus 3% of women with no reported drug use. In a multivariate analysis, maternal illicit drug use was significantly associated with lack of prenatal care. In a multivariate analysis, year of infant birth and the combination of lack of maternal HIV testing before delivery and lack of prenatal antiretroviral therapies were significantly associated with perinatal HIV transmission. Conclusions. Missed opportunities for perinatal HIV prevention contributed to more than half of the cases of HIV-infected infants. Prenatal care and HIV testing before delivery are major opportunities for perinatal HIV prevention. Illicit drug use was highly associated with lack of prenatal care, and lack of HIV testing before delivery was highly associated with perinatal HIV transmission.

Previous research has examined the effectiveness of a single session of aerobic exercise in lowering blood pressure responsivity to the subsequent presentation of a nonexercise stressor in the laboratory. This case study was designed to explore the possibility that a single session of aerobic exercise might lower blood pressure for up to 4 hours postexercise as the subject engaged in his usual activities at home and at work. The subject was an untrained, unmedicated, borderline hypertensive who underwent ambulatory blood pressure monitoring as he maintained a normal schedule of activities over a 5-day period. On 2 of the 5 days, the subject exercised at 8:30 AM for 30 minutes at 70% VO2max. Blood pressure readings on days when the subject read for 30 minutes were compared with readings on days when he exercised. He showed an average reduction in systolic blood pressure of 26.4 mm Hg at 2 hours after exercise, 24.2 mm Hg at 4 hours afterward, and 12.2 mm Hg at 9 hours after the exercise. Changes in diastolic blood pressure and heart rate were smaller and less consistent. The authors concluded that the modifying influence of a single session of aerobic exercise on blood pressure responsivity to subsequent laboratory-based stressors may also extend to the natural environment. The discussion addresses theoretical, methodological, and clinical considerations in the use of aerobic exercise to modify excessive blood pressure reactivity.

The lattice relaxation of strained Si 1-x Ge x layers on Si (001) substrates has been examined. Single layers having a nominal composition of x = 0.14 were grown by Molecular Beam Epitaxy to thicknesses of 0.5, 1.0 and 1.5 μm, all of which are greater than the critical thickness where misfit-dislocation generation commences. Double-crystal and white-radiation topographic methods were used to reveal the misfit dislocation structure and distribution. The misfit dislocations were shown to extend from heterogeneous nucleation sites along the four available directions in the plane of the interface. A symmetric distribution of dislocations between the orthogonal directions was observed. Secondary branching of the misfit dislocations was also observed which accelerates the relaxation process.

X-ray reflectance measurements at grazing incidence provide non-destructively a measure of the thickness of thin layers, the electron density as a function of depth, and interface and surface roughness. We show that the effect of roughness at a buried interface is only to reduce the visibility of the interference fringes, whereas roughness at the top surface leads also to an overall increase in the rate of fall of intensity with angle (or energy). These two contributions can then be readily distinguished.Most work has been performed in monochromatic angular dispersive mode. We present here a preliminary study of the application of the high-energy, fixed-angle, energy dispersive mode for the study of thin epitaxial layers, Langmuir-Blodgett films, surface damage on silicon chemi-sol polished wafers and ion implanted silicon and aluminium. Data has been analysed using the theory of Parratt, which we have adapted for use in the energy dispersive method.

Detailed x-ray double-axis rocking-curve analysis has been made of a series of silicon wafers, polished using various colloidal silicas with a number of different conditions. Significant differences, attributable to the polishing conditions, were observed in the tails of the rocking curves, using a four-reflection, non-dispersive beam conditioner. These have been compared with theoretical simulations in order to deduce the strain profile near the surface.