Prevalence of prediabetes and undiagnosed diabetes in patients with HFpEF and HFrEF and associated clinical outcomes

Purpose: The prevalence and consequences of prediabetic dysglycemia and undiagnosed diabetes is unknown in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and has not been compared to heart failure and reduced ejection fraction (HFrEF). Methods: We examined the prevalence and outcomes associated with normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM). We studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and estimated hazard ratios (HR) by use of multivariable Cox regression models. Results: HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF. 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively. Finally among patients with HFpEF 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%. The rates of both clinical outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared to normoglycemic patients, irrespective of HF subtype, and in general higher among HFrEF patients. For the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63–1.65) for prediabetes, HR 1.18 (0.75–1.86) for undiagnosed diabetes and 2.75 (1.83–4.11) for known diabetes, respectively, p value for trend across groups < 0.001. Dysglycemia was also associated with worse outcomes in HFrEF. Conclusions: These findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF

Dysphagia Management and Research in an Acute-Care Military Treatment Facility: The Role of Applied Informatics

Purpose: This report describes the development and preliminary analysis of a database for traumatically injured military service members with dysphagia. Methods: A multidimensional database was developed to capture clinical variables related to swallowing. Data were derived from clinical records and instrumental swallow studies, and ranged from demographics, injury characteristics, swallowing biomechanics, medications, and standardized tools (e.g.. Glasgow Coma Scale, Penetration-Aspiration Scale). Bayesian Belief Network modeling was used to analyze the data at intermediate points, guide data collection, and predict outcomes. Predictive models were validated with independent data via receiver operating characteristic curves. Results: The first iteration of the model (n = 48) revealed variables that could be collapsed for the second model (n = 96). The ability to predict recovery from dysphagia improved from the second to third models (area under the curve = 0.68 to 0.86). The third model, based on 161 cases, revealed “initial diet restrictions” as first-degree, and “Glasgow Coma Scale, intubation history, and diet change” as second-degree associates for diet restrictions at discharge. Conclusion: This project demonstrates the potential for bioinformatics to advance understanding of dysphagia. This database in concert with Bayesian Belief Network modeling makes it possible to explore predictive relationships between injuries and swallowing function, individual variability in recovery, and appropriate treatment options

The Experiences of Counselors-in-Training in a School-based Counseling Practicum

Counselor education programs often must choose between providing in vivo faculty supervision or a community-based setting. Programs that combine both elements have shown positive preliminary findings related to counselor development; however, the in-depth experiences of students in such programs have not been explored. This phenomenological study examined the lived experiences of counselors-in-training who participated in a school-based counseling practicum with in vivo faculty supervision. Researchers identified six themes, including continuum of support within relationships, operational challenges and concerns, needs and challenges of the community, working with children, expectations and realities, and counselor identity development. Implications for counselor education and research are provided

The Experiences of Counselors-in-Training in a School-based Counseling Practicum

Counselor education programs often must choose between providing in vivo faculty supervision or a community-based setting. Programs that combine both elements have shown positive preliminary findings related to counselor development; however, the in-depth experiences of students in such programs have not been explored. This phenomenological study examined the lived experiences of counselors-in-training who participated in a school-based counseling practicum with in vivo faculty supervision. Researchers identified six themes, including continuum of support within relationships, operational challenges and concerns, needs and challenges of the community, working with children, expectations and realities, and counselor identity development. Implications for counselor education and research are provided

Genetic Mutations Associated with Hormone-Positive Breast Cancer in a Small Cohort of Ethiopian Women

In Ethiopia, a breast cancer diagnosis is associated with a prognosis significantly worse than that of Europe and the US. Further, patients presenting with breast cancer in Ethiopia are far younger, on average, and patients are typically diagnosed at very late stages, relative to breast cancer patients of European descent. Emerging data suggest that a large proportion of Ethiopian patients have hormone-positive (ER+) breast cancer. This is surprising given 1) that patients have late-stage breast cancer at the time of diagnosis, 2) that African Americans with breast cancer frequently have triple negative breast cancer (TNBC), and 3) these patients typically receive chemotherapy, not hormone-targeting drugs.To further examine the similarity of Ethiopian breast tumors to those of African Americans or of those of European descent, we sequenced matched tumor and normal adjacent tissue from Ethiopian patients from a small pilot collection. We identified mutations in 615 genes across all three patients, unique to the tumor tissue. Across this analysis, we found far more mutations shared between Ethiopian patient tissue and White patients (103) than we did comparing to African Americans (3). Several mutations were found in extracellular matrix encoding genes with known roles in tumor cell growth and metastasis. We suggest future mechanistic studies on this disease focus on these genes first, toward finding new treatment strategies for breast cancer patients in Ethiopia

Generation of Facial Composites

A system for generating facial composites, comprises a processor for processing facial composite data and a display for displaying images constructed from facial composite data. The processor is adapted to implement an interface in which a plurality of facial images are presented to a user, and in response to a user input, including the selection of one best match facial image of the plurality of faces, a further plurality of facial images is presented to the user. A mutation algorithm is used for generating the further plurality of facial images, and which generates facial images corresponding to facial composites which vary from the facial composite of the best match facial image in dependence on a random control parameter. The facial composite comprises a vector having a plurality of terms, and each term is assigned a probability of mutating. The random control parameter determines which vector terms are altered. This provides an efficient representation of multiple choice facial images

Forage seed systems in eastern Africa: Challenges and opportunities

Despite the profound livestock importance in eastern Africa, livestock productivity remains low attributable to a number of challenges. One of the major drawbacks is lack of quality feeds and forages. This results in poor animal performance and suboptimal use of resources. Intertwined with this lack of quality forages is the dearth of forage planting materials - including seed and vegetative propagation – to offer producers improved forages adapted to different ecologies and agricultural context. To alter the landscape, developed forage technologies coupled with awareness creation is needed along the forage value chain to support commercially functioning forage seed systems. With the projected doubling of demand for animal products (meat and milk) in sub-Saharan Africa, the pressure will be exerted on livestock feed resources. This is likely to result in a knock-on demand for forage cultivation and hence forage seed demand. To be successful, the forage seed systems need to be supported by an enabling policy across the region, which include: functional procedures for certification and quality control, publicprivate partnerships for the production and dissemination of planting materials, and technical advice in the management of forages. Availability of proven forage technologies, coupled with awareness creation and facilitative movement of forage seeds across countries would boost forage seed system development in eastern Africa, for increased livestock productivity

The linewidth-size relationship in the dense ISM of the Central Molecular Zone

The linewidth (sigma) - size (R) relationship has been extensively measured and analysed, in both the local ISM and in nearby normal galaxies. Generally, a power-law describes the relationship well with an index ranging from 0.2-0.6, now referred to as one of "Larson's Relationships." The nature of turbulence and star formation is considered to be intimately related to these relationships, so evaluating the sigma-R correlations in various environments is important for developing a comprehensive understanding of the ISM. We measure the sigma-R relationship in the Central Molecular Zone (CMZ) of the Galactic Centre using spectral line observations of the high density tracers N2H+, HCN, H13CN, and HCO+. We use dendrograms, which map the hierarchical nature of the position-position-velocity (PPV) data, to compute sigma and R of contiguous structures. The dispersions range from ~2-30 km/s in structures spanning sizes 2-40 pc, respectively. By performing Bayesian inference, we show that a power-law with exponent 0.3-1.1 can reasonably describe the sigma-R trend. We demonstrate that the derived sigma-R relationship is independent of the locations in the PPV dataset where sigma and R are measured. The uniformity in the sigma-R relationship suggests turbulence in the CMZ is driven on the large scales beyond >30 pc. We compare the CMZ sigma-R relationship to that measured in the Galactic molecular cloud Perseus. The exponents between the two systems are similar, suggestive of a connection between the turbulent properties within a cloud to its ambient medium. Yet, the velocity dispersion in the CMZ is systematically higher, resulting in a coefficient that is nearly five times larger. The systematic enhancement of turbulent velocities may be due to the combined effects of increased star formation activity, larger densities, and higher pressures relative to the local ISM.Comment: 11 pages, 8 figures, Accepted for publication in MNRA

Robust averaging protects decisions from noise in neural computations

An ideal observer will give equivalent weight to sources of information that are equally reliable. However, when averaging visual information, human observers tend to downweight or discount features that are relatively outlying or deviant (‘robust averaging’). Why humans adopt an integration policy that discards important decision information remains unknown. Here, observers were asked to judge the average tilt in a circular array of high-contrast gratings, relative to an orientation boundary defined by a central reference grating. Observers showed robust averaging of orientation, but the extent to which they did so was a positive predictor of their overall performance. Using computational simulations, we show that although robust averaging is suboptimal for a perfect integrator, it paradoxically enhances performance in the presence of “late” noise, i.e. which corrupts decisions during integration. In other words, robust decision strategies increase the brain’s resilience to noise arising in neural computations during decision-making