Cognitive impairment in heart failure

The clinical syndrome of heart failure is one of the leading causes of hospitalisation and mortality in older adults. Due to ageing of the general population and improved survival from cardiac disease the prevalence of heart failure is rising. Despite the fact that the majority of patients with heart failure are aged over 65 years old, many with multiple co-morbidities, the association between cognitive impairment and heart failure has received relatively little research interest compared to other aspects of cardiac disease. The presence of concomitant cognitive impairment has implications for the management of patients with heart failure in the community. There are many evidence based pharmacological therapies used in heart failure management which obviously rely on patient education regarding compliance. Also central to the treatment of heart failure is patient self-monitoring for signs indicative of clinical deterioration which may prompt them to seek medical assistance or initiate a therapeutic intervention e.g. taking additional diuretic. Adherence and self-management may be jeopardised by cognitive impairment. Formal diagnosis of cognitive impairment requires evidence of abnormalities on neuropsychological testing (typically a result ≥1.5 standard deviation below the age-standardised mean) in at least one cognitive domain. Cognitive impairment is associated with an increased risk of dementia and people with mild cognitive impairment develop dementia at a rate of 10-15% per year, compared with a rate of 1-2% per year in healthy controls.1 Cognitive impairment has been reported in a variety of cardiovascular disorders. It is well documented among patients with hypertension, atrial fibrillation and coronary artery disease, especially after coronary artery bypass grafting. This background is relevant to the study of patients with heart failure as many, if not most, have a history of one or more of these co-morbidities. A systematic review of the literature to date has shown a wide variation in the reported prevalence of cognitive impairment in heart failure. This range in variation probably reflects small study sample sizes, differences in the heart failure populations studied (inpatients versus outpatients), neuropsychological tests employed and threshold values used to define cognitive impairment. The main aim of this study was to identify the prevalence of cognitive impairment in a representative sample of heart failure patients and to examine whether this association was due to heart failure per se rather than the common cardiovascular co-morbidities that often accompany it such as atherosclerosis and atrial fibrillation. Of the 817 potential participants screened, 344 were included in this study. The study cohort included 196 patients with HF, 61 patients with ischaemic heart disease and no HF and 87 healthy control participants. The HF cohort consisted of 70 patients with HF and coronary artery disease in sinus rhythm, 51 patients with no coronary artery disease in sinus rhythm and 75 patients with HF and atrial fibrillation. All patients with HF had evidence of HF-REF with a LVEF <45% on transthoracic echocardiography. The majority of the cohort was male and elderly. HF patients with AF were more likely to have multiple co-morbidities. Patients recruited from cardiac rehabilitation clinics had proven coronary artery disease, no clinical HF and a LVEF >55%. The ischaemic heart disease group were relatively well matched to healthy controls who had no previous diagnosis of any chronic illness, prescribed no regular medication and also had a LVEF >55%. All participants underwent the same baseline investigations and there were no obvious differences in baseline demographics between each of the cohorts. All 344 participants attended for 2 study visits. Baseline investigations including physiological measurements, electrocardiography, echocardiography and laboratory testing were all completed at the initial screening visit. Participants were then invited to attend their second study visit within 10 days of the screening visit. 342 participants completed all neuropsychological assessments (2 participants failed to complete 1 questionnaire). A full comprehensive battery of neuropsychological assessment tools were administered in the 90 minute study visit. These included three global cognitive screening assessment tools (mini mental state examination, Montreal cognitive assessment tool and the repeatable battery for the assessment of neuropsychological status) and additional measures of executive function (an area we believe has been understudied to date). In total there were 9 cognitive tests performed. These were generally well tolerated. Data were also collected using quality of life questionnaires and health status measures. In addition to this, carers of the study participant were asked to complete a measure of caregiver strain and an informant questionnaire on cognitive decline. The prevalence of cognitive impairment varied significantly depending on the neuropsychological assessment tool used and cut-off value used to define cognitive impairment. Despite this, all assessment tools showed the same pattern of results with those patients with heart failure and atrial fibrillation having poorer cognitive performance than those with heart failure in sinus rhythm. Cognitive impairment was also more common in patients with cardiac disease (either coronary artery disease or heart failure) than age-, sex- and education-matched healthy controls, even after adjustment for common vascular risk factors.

Spatial scale effects of sampling on the interpolation of species distribution models in the southwestern Amazon.

Knowledge of the geographical distribution of timber tree species in the Amazon is still scarce. This is especially true at the local level, thereby limiting natural resource management actions. Forest inventories are key sources of information on the occurrence of such species. However, areas with approved forest management plans are mostly located near access roads and the main industrial centers. The present study aimed to assess the spatial scale effects of forest inventories used as sources of occurrence data in the interpolation of potential species distribution models. The occurrence data of a group of six forest tree species were divided into four geographical areas during the modeling process. Several sampling schemes were then tested applying the maximum entropy algorithm, using the following predictor variables: elevation, slope, exposure, normalized difference vegetation index (NDVI) and height above the nearest drainage (HAND). The results revealed that using occurrence data from only one geographical area with unique environmental characteristics increased both model overfitting to input data and omission error rates. The use of a diagonal systematic sampling scheme and lower threshold values led to improved model performance. Forest inventories may be used to predict areas with a high probability of species occurrence, provided they are located in forest management plan regions representative of the environmental range of the model projection area.

Expected values for pedometer-determined physical activity in older populations

The purpose of this review is to update expected values for pedometer-determined physical activity in free-living healthy older populations. A search of the literature published since 2001 began with a keyword (pedometer, "step counter," "step activity monitor" or "accelerometer AND steps/day") search of PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), SportDiscus, and PsychInfo. An iterative process was then undertaken to abstract and verify studies of pedometer-determined physical activity (captured in terms of steps taken; distance only was not accepted) in free-living adult populations described as ≥ 50 years of age (studies that included samples which spanned this threshold were not included unless they provided at least some appropriately age-stratified data) and not specifically recruited based on any chronic disease or disability. We identified 28 studies representing at least 1,343 males and 3,098 females ranging in age from 50–94 years. Eighteen (or 64%) of the studies clearly identified using a Yamax pedometer model. Monitoring frames ranged from 3 days to 1 year; the modal length of time was 7 days (17 studies, or 61%). Mean pedometer-determined physical activity ranged from 2,015 steps/day to 8,938 steps/day. In those studies reporting such data, consistent patterns emerged: males generally took more steps/day than similarly aged females, steps/day decreased across study-specific age groupings, and BMI-defined normal weight individuals took more steps/day than overweight/obese older adults. The range of 2,000–9,000 steps/day likely reflects the true variability of physical activity behaviors in older populations. More explicit patterns, for example sex- and age-specific relationships, remain to be informed by future research endeavors.

Threshold concepts in property education : a case study

First year Property Economics students enrolled in the Bachelor of Urban Development at QUT are required to undertake a number of compulsory subjects, alongside students undertaking studies in other disciplines. One such common unit is ‘Stewardship of Land’, an interdisciplinary unit that introduces students to the characteristics of land and land tenure with a focus on land use and property rights. It covers a range of issues including: native title, land contamination, heritage values, alternative uses, the property development process, impact of environmental and social factors, and the management of land, both urban and regional. Teaching such a diverse content to a diverse audience has in previous years proved difficult, from the perspectives of relevance, engagement and content overload. In 2011 a project was undertake to redevelop this unit to reflect ‘threshold concepts’, concepts that are “transformative, probably irreversible, integrative, often troublesome and probably bounded” (Meyer & Land, 2003) . This project involved the development of a new set of underlying concepts students should draw from the unit, application of these to the unit curriculum, and a survey of the student response to these changes. This paper reports on the threshold concepts developed for this unit, the changes this made to the unit curriculum, and a preliminary report on survey responses. Recommendations for other educators seeking to incorporate threshold concepts into their curricula are provided.

Biological monitoring and Biological Limit Values (BLV): the strategy of the European Union

Occupational standards concerning allowable concentrations of chemical compounds in the ambient air of workplaces have been established in several countries worldwide. With the integration of the European Union (EU), there has been a need of establishing harmonised Occupational Exposure Limits (OEL). The European Commission Directive 95/320/EC of 12 July 1995 has given the tasks to a Scientific Committee for Occupational Exposure Limits (SCOEL) to propose, based on scientific data and where appropriate, occupational limit values which may include the 8-h time-weighted average (TWA), short-term limits/excursion limits (STEL) and Biological Limit Values (BLVs). In 2000, the European Union issued a list of 62 chemical substances with Occupational Exposure Limits. Of these, 25 substances received a "skin" notation, indicating that toxicologically significant amounts may be taken up via the skin. For such substances, monitoring of concentrations in ambient air may not be sufficient, and biological monitoring strategies appear of potential importance in the medical surveillance of exposed workers. Recent progress has been made with respect to formulation of a strategy related to health-based BLVs.

The Threshold Learning Outcome on self-management for the Bachelor of Laws degree : a proposed focus for teaching strategies in the first year law curriculum

The Australian Learning and Teaching Council (ALTC) Discipline Scholars for Law, Professors Sally Kift and Mark Israel, articulated six Threshold Learning Outcomes (TLOs) for the Bachelor of Laws degree as part of the ALTC’s 2010 project on Learning and Teaching Academic Standards. One of these TLOs promotes the learning, teaching and assessment of self-management skills in Australian law schools. This paper explores the concept of self-management and how it can be relevantly applied in the first year of legal education. Recent literature from the United States (US) and Australia provides insights into the types of issues facing law students, as well as potential antidotes to these problems. Based on these findings, I argue that designing a pedagogical framework for the first year law curriculum that promotes students’ connection with their intrinsic interests, values, motivations and purposes will facilitate student success in terms of their personal well-being, ethical dispositions and academic engagement.

Stochastic Simulations Suggest that HIV-1 Survives Close to Its Error Threshold

The use of mutagenic drugs to drive HIV-1 past its error threshold presents a novel intervention strategy, as suggested by the quasispecies theory, that may be less susceptible to failure via viral mutation-induced emergence of drug resistance than current strategies. The error threshold of HIV-1, mu(c), however, is not known. Application of the quasispecies theory to determine mu(c) poses significant challenges: Whereas the quasispecies theory considers the asexual reproduction of an infinitely large population of haploid individuals, HIV-1 is diploid, undergoes recombination, and is estimated to have a small effective population size in vivo. We performed population genetics-based stochastic simulations of the within-host evolution of HIV-1 and estimated the structure of the HIV-1 quasispecies and mu(c). We found that with small mutation rates, the quasispecies was dominated by genomes with few mutations. Upon increasing the mutation rate, a sharp error catastrophe occurred where the quasispecies became delocalized in sequence space. Using parameter values that quantitatively captured data of viral diversification in HIV-1 patients, we estimated mu(c) to be 7 x 10(-5) -1 x 10(-4) substitutions/site/replication, similar to 2-6 fold higher than the natural mutation rate of HIV-1, suggesting that HIV-1 survives close to its error threshold and may be readily susceptible to mutagenic drugs. The latter estimate was weakly dependent on the within-host effective population size of HIV-1. With large population sizes and in the absence of recombination, our simulations converged to the quasispecies theory, bridging the gap between quasispecies theory and population genetics-based approaches to describing HIV-1 evolution. Further, mu(c) increased with the recombination rate, rendering HIV-1 less susceptible to error catastrophe, thus elucidating an added benefit of recombination to HIV-1. Our estimate of mu(c) may serve as a quantitative guideline for the use of mutagenic drugs against HIV-1.

Model independent bounds on the modulus of the pion form factor on the unitarity cut below the omega pi threshold

We calculate upper and lower bounds on the modulus of the pion electromagnetic form factor on the unitarity cut below the omega pi inelastic threshold, using as input the phase in the elastic region known via the Fermi-Watson theorem from the pi pi P-wave phase shift, and a suitably weighted integral of the modulus squared above the inelastic threshold. The normalization at t = 0, the pion charge radius and experimental values at spacelike momenta are used as additional input information. The bounds are model independent, in the sense that they do not rely on specific parametrizations and do not require assumptions on the phase of the form factor above the inelastic threshold. The results provide nontrivial consistency checks on the recent experimental data on the modulus available below the omega pi threshold from e(+)e(-) annihilation and tau-decay experiments. In particular, at low energies the calculated bounds offer a more precise description of the modulus than the experimental data.

Threshold voltage model for accumulation mode polycrystalline SOI MOSFETs and comparisons with experimental results

In this paper, a simple but accurate semi analytical charge sheet model is presented for threshold voltage of accumulation mode polycrystalline silicon on insulator (PSOI) MOSFETs. In this model, we define the threshold voltage (V-T) of the polysilicon accumulation mode MOSFET as the gate voltage required to raise the surface potential (phi(s)) to a value phi(sT) necessary to overcome the charge trapping in the grain boundary and to create channel accumulation charge that is equal to the channel accumulation charge available in the case of single crystal silicon accumulation mode MOSFET at that phi(sT). The correctness of the model is demonstrated by comparing the theoretically estimated values of threshold voltage with the experimentally measured threshold voltages on the accumulation mode PSOI MOSFETs fabricated in the laboratory using LPCVD polysilicon layers doped with boron to achieve dopant densities in the range 3.3 x 10(-15)-5 x 10(17)/cm(3). Further, it is shown that the threshold voltage values of accumulation mode PSOI MOSFETs predicted by the present model match very closely with the experimental results, better than those obtained with the models previously reported in the literature. (C) 2012 Elsevier B.V. All rights reserved.

Investigations on growth, structure, optical properties and laser damage threshold of organic nonlinear optical crystals of Guanidinium L-Ascorbate

Single crystals of Guanidinium L-Ascorbate (GuLA) were grown and crystal structure was determined by direct methods. GuLA crystallizes in orthorhombic, non-centrosymmetric space group P2(1)2(1)2(1). The UV-cutoff was determined as 325 nm. The morphology was generated and the interplanar angles estimated and compared with experimental values. Second harmonic generation conversion efficiency was measured and compared with other salts of L-Ascorbic acid. Surface laser damage threshold was calculated as 11.3GW/cm(2) for a single shot of laser of 1064 nm wavelength.

Mixed-mode fracture mechanisms near the fatigue threshold of aisi-316 stainless-steel

Near threshold, mixed mode (I and II), fatigue crack growth occurs mainly by two mechanisms, coplanar (or shear) mode and branch (or tensile) mode. For a constant ratio of ΔK_I/ΔK_II the shear mode growth shows a self-arrest character and it would only start again when ΔK_I and ΔK_II are increased. Both shear crack growth and the early stages of tensile crack growth, are of a crystallographic nature; the fatigue crack proceeds along slip planes or grain boundaries. The appearance of the fracture surfaces suggest that the mechanism of crack extension is by developing slip band microcracks which join up to form a macrocrack. This process is thought to be assisted by the nature of the plastic deformation within the reversed plastic zone where high back stresses are set up by dislocation pile-ups against grain boundaries. The interaction of the crack tip stress field with that of the dislocation pile-ups leads to the formation of slip band microcracks and subsequent crack extension. The change from shear mode to tensile mode growth probably occurs when the maximum tensile stress and the microcrack density in the maximum tensile plane direction attain critical values.

Contour Generator Points for Threshold Selection and a Novel Photo-Consistency Measure for Space Carving

Space carving has emerged as a powerful method for multiview scene reconstruction. Although a wide variety of methods have been proposed, the quality of the reconstruction remains highly-dependent on the photometric consistency measure, and the threshold used to carve away voxels. In this paper, we present a novel photo-consistency measure that is motivated by a multiset variant of the chamfer distance. The new measure is robust to high amounts of within-view color variance and also takes into account the projection angles of back-projected pixels. Another critical issue in space carving is the selection of the photo-consistency threshold used to determine what surface voxels are kept or carved away. In this paper, a reliable threshold selection technique is proposed that examines the photo-consistency values at contour generator points. Contour generators are points that lie on both the surface of the object and the visual hull. To determine the threshold, a percentile ranking of the photo-consistency values of these generator points is used. This improved technique is applicable to a wide variety of photo-consistency measures, including the new measure presented in this paper. Also presented in this paper is a method to choose between photo-consistency measures, and voxel array resolutions prior to carving using receiver operating characteristic (ROC) curves.

Bayesian Analysis of Latent Threshold Dynamic Models

We discuss a general approach to dynamic sparsity modeling in multivariate time series analysis. Time-varying parameters are linked to latent processes that are thresholded to induce zero values adaptively, providing natural mechanisms for dynamic variable inclusion/selection. We discuss Bayesian model specification, analysis and prediction in dynamic regressions, time-varying vector autoregressions, and multivariate volatility models using latent thresholding. Application to a topical macroeconomic time series problem illustrates some of the benefits of the approach in terms of statistical and economic interpretations as well as improved predictions. Supplementary materials for this article are available online. © 2013 Copyright Taylor and Francis Group, LLC.

Semiclassical-quantal approach to the near-threshold ionization of hydrogen

A recent improved version of the semiclassical-quantal approach has been applied to the e(-)-H near-threshold ionization for theta (12) = 180 degrees geometry. It is found, that unlike other sophisticated theoretical methods such as distorted wave theory or convergent close-coupling calculation, the present relatively simpler approach produces correct behavior and numerical values for the triple-differential cross sections. We compare our results with recent absolute measurements and accurate numerical calculations at 2 eV and 4 eV above the threshold at constant theta (12) geometry.