Association of Obstructive Airway Disease and Lung Function with Incident Heart Failure, and Optimal Prediction of Heart Failure in Community Settings: The Atherosclerosis Risk in Communities Study

Background: This epidemiologic investigation of heart failure (HF) has two components, one focused on airway disease as a putative antecedent factor to HF and the other centered on the prediction of HF as a means toward reducing the growing burden of HF in the population. Methods: Forced Expiratory volume-1 second (FEV1) and covariates were measured for the ARIC cohort in 1987-89. Incident HF was ascertained annually from hospital records and death certificates. Cox proportional hazards models were used to derive a risk score to predict 10 years risk of HF. Area under curve (AUC) and Net Reclassification Improvement (NRI) were estimated as measures of discrimination. Results: Over an average follow-up of 14.9 years, 1369 (10%) ARIC participants free of HF at baseline had incident HF. The hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV1. The associations were seen in each of cigarette smoking strata, inclusive of never-smokers. After multivariable adjustment for traditional cardiovascular risk factors at baseline, the HRs of HF and their 95% confidence intervals (CI) comparing the lowest with the highest quartile of FEV1 were 3.91(2.40, 6.35) for white women, 3.03(2.12, 4.33) for white men, 2.11(1.33, 3.34) for black women and 2.23(1.37, 3.59) for black men. The multivariable adjusted hazards of HF were higher in those with FEV1/FVC < 70% vs. [greater than or equal to] 70%: HR 1.42 (95% CI 1.22, 1.68). The ARIC HF risk score included information easily available to the primary care physician including COPD. The estimated AUC of the ARIC HF risk score was 0.810(optimism-corrected = 0.808), 95% CI = 0.807, 0.813. It was higher than AUC estimated using variables from the Framingham risk score(0.762) and the ABC risk score(0.784). Overall classification using the ARIC HF risk score improved for 23.5% individuals relative to the Framingham, and 12.8% relative to the Health-ABC classification. Conclusions: In this population-based cohort, low FEV1, and obstructive respiratory illness were strongly and independently associated with incident HF. The underlying mechanisms may include diastolic-dysfunction, cor-pulmonale, silent-CHD, and require exploration. The ARIC HF risk score performs better than extant scores and may improve risk prediction of HF in the community

Predictors of Mortality Amongst Recipients of Implantable Cardioverter Defibrillators for Secondary Prevention of Cardiac Arrest

BACKGROUND: Implantable Cardioverter-defibrillators (ICD) reduce mortality in survivors of cardiac arrest (CA). We investigated the predictors of mortality after ICD implantation in survivors of CA. METHODS: Retrospective review of clinical records and social security death index of all patients who received an ICD in a preexisting database of survivors of CA at the University of Pittsburgh Medical Center was performed. Multivariate analyses using the Cox proportional hazard model were performed with backward elimination to identify independent predictors of the time to death, and Kaplan-Meier curves were plotted. RESULTS: Eighty patients (64 men) with a mean age of 64.4+/-12.5 years were followed for 4.7+/-2.3 years after ICD implantation. Survival rates were 93.8%, 65% and 50% at 1, 5, and 10 years, respectively. Independent predictors of time to death were determined to include age (hazard ratio (HR) = 1.91 per 10-year increase, p = 0.003), serum creatinine > or = 1.3 mg/dL (HR = 2.56, p = 0.004), and QRS width >120 ms (HR = 5.14, p = 0.012). CONCLUSIONS: In this sample of ICD recipients secondary to CA, older age, elevated serum creatinine, and wider QRS duration were independent predictors of mortality. The presence of more than one risk factor in the same patient was associated with higher mortality rates. Whether interventions such as biventricular pacing can offset this increase risk of death warrants further investigation

Scrub typhus: as it stands today

Scrub typhus is one of the three most common causes of prolonged fever in Southeast Asia and Pacific affecting almost 1 million people annually worldwide out of 1 billion exposed. Scrub typhus is a rickettsial infection caused by Orientia Tsutsugamushi transmitted through bite of Chiggers (larval stage of trombiculid mite). It is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure and death. Deaths are attributable to late presentation, delayed diagnosis, and drug resistance. Scrub typhus, though endemic in India; yet is under reported. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, and B/L chest opacities. Relapse is not uncommon. Presumptive treatment with Doxycycline can be a suitable option in febrile patients from Typhus pockets. Alert physician should keep an eye on deviation from usual presentation to changing spectrum of the disease. Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality

Service Augmentation and Customer Satisfaction: An Analysis of Cell Phone Services in Base-of-the-Pyramid Markets

In this study, we investigate how IT-enabled service augmentation influences customer satisfaction for cell phone services in Base-of-the-Pyramid (BOP) markets. We conceptualize value added service and customer care as two components of service augmentation. In spite of the acknowledged competitive significance of digital services, the impact of service augmentation on customer satisfaction remains an unexplored area of research. Arguing for price- and relational- evaluations, we develop hypotheses for a substitution effect of value added services, and a complementary effect of customer care, on the relationship between core service and customer satisfaction. Specific to the BOP market context, we argue for a differentiated influence of service augmentation for different categories of providers. We empirically examine and find support for the hypothesized relationships using an archival data set from surveys of cell phone customers in seven South Asian BOP markets. We discuss the managerial implications and contributions of the findings

Use of Technology in Segregating Occupational risks of Migrant and linking them with Services: Experiences from National AIDS Control Program for Migrants

Background: The migrant intervention in India was initiated during the National AIDS Control Program (NACP) Phase-2 (2002-2007). Even by the end of NACP Phase-3 (2010-11); the service uptake among migrants remained very low (14% referred for HIV testing, of which only 37% were tested). USAID PHFI-PIPPSE project in collaboration with the National AIDS Control Organization (NACO) developed a unique system called Migrant Service Delivery System (MSDS) to capture migrants profile with respect to their risk profile and to provide tailor made services to them.Description: MSDS is a web-based system, designed and implemented to increase service uptake among migrants through evidence based planning. 110 destination migrants Targeted Intervention (TI) from 11 states were selected for study with varied target populations in terms of occupations; to understand occupation related risk behaviors amongst the migrants. Occupation wise registration data of high risk vulnerable migrants were analyzed through MSDS for the period April 2014-June 2016. Analysis was made on specific indicators amongst these occupational groups to understand the risk behavior and their vulnerability to HIV and STI.Lessons Learned: Out of total migrants workers enrolled in MSDS HIV rate is found to be highest amongst Auto-Rickshaw (18.66%) followed by daily wage laborers (14.46%), loom workers (10.73%), industrial workers (10.04%) and construction workers (7.93%). With 45.14% positivity, industrial workers are found to be most vulnerable to Sexually Transmitted Infections (STIs) amongst all occupational categories followed by loom workers (16.28%), skilled worker (Furniture, Jeweler)(7.14%), daily wage laborers (5.45%) .Conclusion/Next Steps: MSDS is an effective tool to assess migrants’ risk and their vulnerability to HIV for designing evidence informed program. This system calls for a replication across all destination TIs by NACO for differential strategies for different occupation groups to ensure better yield through scientific planning of intervention among high risk and high vulnerable migrants.

Smoking Behaviors and Arterial Stiffness Measured by Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Though smoking is strongly associated with peripheral vascular disease and arteriosclerosis, smoking’s association with arterial stiffness has been inconsistent and mostly limited to a single arterial segment. We examined the relationship between smoking behaviors with arterial stiffness in multiple arterial segments among community dwelling older adults

Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study

The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation

Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998–2011

Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005–2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998–2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005–2011, numbers of ADHF hospitalizations were stable (−0.5%/year; 95% CI: −1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by −1.5%/year (95% CI: −2.2, −0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005

Probing ultrafast carrier dynamics and nonlinear absorption and refraction in core-shell silicon nanowires

We investigate the relaxation dynamics of photogenerated carriers in silicon nanowires consisting of a crystalline core and a surrounding amorphous shell, using femtosecond time-resolved differential reflectivity and transmission spectroscopy at photon energies of 3.15 eV and 1.57 eV. The complex behavior of the differential transmission and reflectivity transients is the mixed contributions from the crystalline core and the amorphous silicon on the nanowire surface and the substrate where competing effects of state filling and photoinduced absorption govern the carrier dynamics. Faster relaxation rates are observed on increasing the photo-generated carrier density. Independent experimental results on crystalline silicon-on-sapphire help us in separating the contributions from the carrier dynamics in crystalline core and the amorphous regions in the nanowire samples. Further, single beam z-scan nonlinear transmission experiments at 1.57 eV in both open and close aperture configurations yield two-photon absorption coefficient \$beta$ (~3 cm/GW) and nonlinear refraction coefficient \$gamma$ (-2.5x10^-4 cm2/GW).Comment: 6 pages, 6 figure

Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation

Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear