Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure

BACKGROUND: Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN: All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS: Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS: Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION: Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.

Health-related quality of life and survival in liver transplant candidates.

Health-related quality of life (HRQOL) is an important measure of the effects of chronic liver disease in affected patients that helps guide interventions to improve well-being. However, the relationship between HRQOL and survival in liver transplant candidates remains unclear. We examined whether the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the Short Form 36 (SF-36) Health Survey were associated with survival in liver transplant candidates. We administered the SF-36 questionnaire (version 2.0) to patients in the Pulmonary Vascular Complications of Liver Disease study, a multicenter prospective cohort of patients evaluated for liver transplantation in 7 academic centers in the United States between 2003 and 2006. Cox proportional hazards models were used with death as the primary outcome and adjustment for liver transplantation as a time-varying covariate. The mean age of the 252 participants was 54 +/- 10 years, 64% were male, and 94% were white. During the 422 person years of follow-up, 147 patients (58%) were listed, 75 patients (30%) underwent transplantation, 49 patients (19%) died, and 3 patients were lost to follow-up. Lower baseline PCS scores were associated with an increased mortality rate despite adjustments for age, gender, Model for End-Stage Liver Disease score, and liver transplantation (P for the trend = 0.0001). The MCS score was not associated with mortality (P for the trend = 0.53). In conclusion, PCS significantly predicts survival in liver transplant candidates, and interventions directed toward improving the physical status may be helpful in improving outcomes in liver transplant candidates.

Weather and War – Economic and social vulnerability in Switzerland at the end of the First World War

Neutral Switzerland – not embedded in the fighting forces – yet was involved in the Great War mainly in economical terms. Since Switzerland is a landlocked country especially agriculture became an important topic of war economy in regard to food security. Until 1916 national food supply was limited but could be maintained through barter trade. In 1916 a crisis on both supply and production level occurred and led to a decline in food availability and to immense price risings causing social turmoil. This paper aims to outline the factors of vulnerability in respect of food in Switzerland during the First World War and further it will show different coping strategies that were undertaken during that time. The paper takes the work of Mario Aeby and Christian Pfister (University of Bern) into consideration that pointed out to weather anomalies during the years 1916 and 1917 aggravating the already tense food situation. Arguing for an overlap of supply and production crisis the paper focuses on agricultural and economic history including environmental impacts. Further the paper addresses the question of what makes a food system resilient to such unforeseen impacts.

Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

BACKGROUND A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. METHODS Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. RESULTS Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. CONCLUSIONS Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

Acute Toxicity and Quality of Life After Dose-Intensified Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer After Prostatectomy: First Results of the Randomized Trial SAKK 09/10

PURPOSE Patients with biochemical failure (BF) after radical prostatectomy may benefit from dose-intensified salvage radiation therapy (SRT) of the prostate bed. We performed a randomized phase III trial assessing dose intensification. PATIENTS AND METHODS Patients with BF but without evidence of macroscopic disease were randomly assigned to either 64 or 70 Gy. Three-dimensional conformal radiation therapy or intensity-modulated radiation therapy/rotational techniques were used. The primary end point was freedom from BF. Secondary end points were acute toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) and quality of life (QoL) according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and PR25. RESULTS Three hundred fifty patients were enrolled between February 2011 and April 2014. Three patients withdrew informed consent, and three patients were not eligible, resulting in 344 patients age 48 to 75 years in the safety population. Thirty patients (8.7%) had grade 2 and two patients (0.6%) had grade 3 genitourinary (GU) baseline symptoms. Acute grade 2 and 3 GU toxicity was observed in 22 patients (13.0%) and one patient (0.6%), respectively, with 64 Gy and in 29 patients (16.6%) and three patients (1.7%), respectively, with 70 Gy (P = .2). Baseline grade 2 GI toxicity was observed in one patient (0.6%). Acute grade 2 and 3 GI toxicity was observed in 27 patients (16.0%) and one patient (0.6%), respectively, with 64 Gy, and in 27 patients (15.4%) and four patients (2.3%), respectively, with 70 Gy (P = .8). Changes in early QoL were minor. Patients receiving 70 Gy reported a more pronounced and clinically relevant worsening in urinary symptoms (mean difference in change score between arms, 3.6; P = .02). CONCLUSION Dose-intensified SRT was associated with low rates of acute grade 2 and 3 GU and GI toxicity. The impact of dose-intensified SRT on QoL was minor, except for a significantly greater worsening in urinary symptoms.

Development of an Elevated Temperature Loop Heat Pipe for Space Applications and Investigation of Non Condensable Gas Impact on its Performance

Un caloducto en bucle cerrado o Loop Heat Pipe (LHP) es un dispositivo de transferencia de calor cuyo principio de operación se basa en la evaporación/condensación de un fluido de trabajo, que es bombeado a través de un circuito cerrado gracias a fuerzas de capilaridad. Gracias a su flexibilidad, su baja masa y su mínimo (incluso nulo) consumo de potencia, su principal aplicación ha sido identificada como parte del subsistema de control térmico de vehículos espaciales. En el presente trabajo se ha desarrollado un LHP capaz de funcionar eficientemente a temperaturas de hasta 125 oC, siguiendo la actual tendencia de los equipos a bordo de satélites de incrementar su temperatura de operación. En la selección del diseño optimo para dicho LHP, la compatibilidad entre materiales y fluido de trabajo se identificó como uno de los puntos clave. Para seleccionar la mejor combinación, se llevó a cabo una exhaustiva revisión del estado del arte, además de un estudio especifico que incluía el desarrollo de un banco de ensayos de compatibilidad. Como conclusión, la combinación seleccionada como la candidata idónea para ser integrada en el LHP capaz de operar hasta 125 oC fue un evaporador de acero inoxidable, líneas de titanio y amoniaco como fluido de trabajo. En esa línea se diseñó y fabricó un prototipo para ensayos y se desarrolló un modelo de simulación con EcosimPro para evaluar sus prestaciones. Se concluyó que el diseño era adecuado para el rango de operación definido. La incompatibilidad entre el fluido de trabajo y los materiales del LHP está ligada a la generación de gases no condensables. Para un estudio más detallado de los efectos de dichos gases en el funcionamiento del LHP se analizó su comportamiento con diferentes cantidades de nitrógeno inyectadas en su cámara de compensación, simulando un gas no condensable formado en el interior del dispositivo. El estudio se basó en el análisis de las temperaturas medidas experimentalmente a distintos niveles de potencia y temperatura de sumidero o fuente fría. Adicionalmente, dichos resultados se compararon con las predicciones obtenidas por medio del modelo en EcosimPro. Las principales conclusiones obtenidas fueron dos. La primera indica que una cantidad de gas no condensable más de dos veces mayor que la cantidad generada al final de la vida de un satélite típico de telecomunicaciones (15 años) tiene efectos casi despreciables en el funcionamiento del LHP. La segunda es que el principal efecto del gas no condensable es una disminución de la conductancia térmica, especialmente a bajas potencias y temperaturas de sumidero. El efecto es más significativo cuanto mayor es la cantidad de gas añadida. Asimismo, durante la campaña de ensayos se observó un fenómeno no esperado para grandes cantidades de gas no condensable. Dicho fenómeno consiste en un comportamiento oscilatorio, detectado tanto en los ensayos como en la simulación. Este efecto es susceptible de una investigación más profunda y los resultados obtenidos pueden constituir la base para dicha tarea. ABSTRACT Loop Heat Pipes (LHPs) are heat transfer devices whose operating principle is based on the evaporation/condensation of a working fluid, and which use capillary pumping forces to ensure the fluid circulation. Thanks to their flexibility, low mass and minimum (even null) power consumption, their main application has been identified as part of the thermal control subsystem in spacecraft. In the present work, an LHP able to operate efficiently up to 125 oC has been developed, which is in line with the current tendency of satellite on-board equipment to increase their operating temperatures. In selecting the optimal LHP design for the elevated temperature application, the compatibility between the materials and working fluid has been identified as one of the main drivers. An extensive literature review and a dedicated trade-off were performed, in order to select the optimal combination of fluids and materials for the LHP. The trade-off included the development of a dedicated compatibility test stand. In conclusion, the combination of stainless steel evaporator, titanium piping and ammonia as working fluid was selected as the best candidate to operate up to 125 oC. An LHP prototype was designed and manufactured and a simulation model in EcosimPro was developed to evaluate its performance. The first conclusion was that the defined LHP was suitable for the defined operational range. Incompatibility between the working fluid and LHP materials is linked to Non Condensable Gas (NCG) generation. Therefore, the behaviour of the LHP developed with different amounts of nitrogen injected in its compensation chamber to simulate NCG generation, was analyzed. The LHP performance was studied by analysis of the test results at different temperatures and power levels. The test results were also compared to simulations in EcosimPro. Two additional conclusions can be drawn: (i) the effects of an amount of more than two times the expected NCG at the end of life of a typical telecommunications satellite (15 years) is almost negligible on the LHP operation, and (ii) the main effect of the NCG is a decrease in the LHP thermal conductance, especially at low temperatures and low power levels. This decrease is more significant with the progressive addition of NCG. An unexpected phenomenon was observed in the LHP operation with large NCG amounts. Namely, an oscillatory behaviour, which was observed both in the tests and the simulation. This effect provides the basis for further studies concerning oscillations in LHPs.

Length of life; a study of the life table,

Bibliography: p. 379-385; "References" at end of chapter 9.

Light vehicle antilock brake research program. Report 1 - evaluation of an electronic four sensor, three circuit integrated system. Final report.

Mode of access: Internet.

Reliability stress and failure rate data for electronic equipment.

Cover title.

Workmen's compensation act Chapter 751, acts of 1911, and amendments to end of the legislative year of 1915 with introductory statement, rules, forms, annotations and index. Industrial accident board...

At head of title : The Commonwealth of Massachusetts.

The history of the Church of Scotland, : beginning the year of our Lord 203, and continued to the end of the reign of King James VI. ... /

Head-pieces; initials.

A report on electronic equipment disposal and recycling : reporting to Governor Rod R. Blagojevich, the 94th General Assembly, and IEPA director, Doug Scott.

"May 12, 2006."

The conduct of life /

Fate -- Power -- Wealth -- Culture -- Behavior -- Worship -- Considerations by the way -- Beauty -- Illusions.

Porcupine's works : containing various writings and selections, exhibiting a faithful picture of the United States of America; of their governments, laws, politics and resources; of the characters of their presidents, governors, legislators, magistrates, and military men; and of the customs, manners, morals, religion, virtues and vices of the people : comprising also a complete series of historical documents and remarks, from the end of the war, in 1783, to the election of the President, in March, 1801 /

continued: ... XII. Historical documents and remarks (from December, 1799 to March, 1801) ; Trial of Cooper ; Emigration Society ; Washington's death ; Proceedings in Congress during the session which began December, 1799 ; Board of Commissioners ; Defence of the Quakers of Pennsylvania ; Farewell advertisement ; Prison eclogue ; Republican morality ; Jefferson's election ; Adam's public conduct ; Jefferson's character ; Convention concluded between America and France, in 1800 ; Proceedings in Congress during the session which ended in March, 1801 ; Index.

Direct support and general support maintenance repair parts and special tools lists (including depot maintenance repair parts and special tools) for maintenance kit, electronic equipment, MK-733/ARC-54 (NSN 5821-00-901-4327).

"November 1978."