International children's accelerometry database (ICAD): design and methods.

BACKGROUND: Over the past decade, accelerometers have increased in popularity as an objective measure of physical activity in free-living individuals. Evidence suggests that objective measures, rather than subjective tools such as questionnaires, are more likely to detect associations between physical activity and health in children. To date, a number of studies of children and adolescents across diverse cultures around the globe have collected accelerometer measures of physical activity accompanied by a broad range of predictor variables and associated health outcomes. The International Children's Accelerometry Database (ICAD) project pooled and reduced raw accelerometer data using standardized methods to create comparable outcome variables across studies. Such data pooling has the potential to improve our knowledge regarding the strength of relationships between physical activity and health. This manuscript describes the contributing studies, outlines the standardized methods used to process the accelerometer data and provides the initial questions which will be addressed using this novel data repository. METHODS: Between September 2008 and May 2010 46,131 raw Actigraph data files and accompanying anthropometric, demographic and health data collected on children (aged 3-18 years) were obtained from 20 studies worldwide and data was reduced using standardized analytical methods. RESULTS: When using ≥ 8, ≥ 10 and ≥ 12 hrs of wear per day as a criterion, 96%, 93.5% and 86.2% of the males, respectively, and 96.3%, 93.7% and 86% of the females, respectively, had at least one valid day of data. CONCLUSIONS: Pooling raw accelerometer data and accompanying phenotypic data from a number of studies has the potential to: a) increase statistical power due to a large sample size, b) create a more heterogeneous and potentially more representative sample, c) standardize and optimize the analytical methods used in the generation of outcome variables, and d) provide a means to study the causes of inter-study variability in physical activity. Methodological challenges include inflated variability in accelerometry measurements and the wide variation in tools and methods used to collect non-accelerometer data.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Thermochemical evolution of the sub-arc mantle due to back-arc spreading

We present the results of a series of numerical geodynamic experiments designed to characterize the thermal and compositional evolution of the sub-arc mantle in response to spreading in the back-arc. We find large changes in both the temperature and composition of the sub-arc mantle with time as the BASC migrates away from the arc. In particular, the sub-arc mantle becomes increasingly more depleted with time following the onset of spreading, as mantle that has experienced decompression melting and melt extraction beneath the BASC is gradually drawn beneath the arc plate by slab-induced corner flow. The rate at which this depletion increases during the ~2 Myr immediately following the onset of spreading is controlled by the spreading rate at the BASC, with faster spreading leading to a more rapid increase in depletion. Following this initial period, depletion within the sub-arc mantle continues to increase at a somewhat slower pace. During this phase, the rate at which depletion increases is chiefly dictated by the subduction rate, with faster subduction leading to a more rapid increase in depletion beneath the arc. Depletion within the sub-arc mantle is also found to increase with increasing mantle potential temperature, decreasing age of the overriding plate, and decreasing distance between the initial location of the BASC and the arc. Predicted changes in the depletion of the sub-arc mantle with time are shown to be consistent with observations of systematic along-strike geochemical variations within a portion of the Tonga Arc adjacent to the Eastern Lau Spreading Center

A Tribute to Patrick Baude

The Board of Editors dedicates Volume 86 of the Indiana Law Journal to the memory of Patrick Baude, who taught at the School of Law from August 1968 until his death in January 2011, and who served for many years as the faculty advisor for the Indiana Law Journal. As evidenced below, Professor Baude’s influence spread far beyond the bounds of his classroom walls, and his presence in the Law School’s community will be sorely missed

A Tribute to Patrick Baude

The Board of Editors dedicates Volume 86 of the Indiana Law Journal to the memory of Patrick Baude, who taught at the School of Law from August 1968 until his death in January 2011, and who served for many years as the faculty advisor for the Indiana Law Journal. As evidenced below, Professor Baude’s influence spread far beyond the bounds of his classroom walls, and his presence in the Law School’s community will be sorely missed

Global variations in H_2O/Ce: 2. Relationships to arc magma geochemistry and volatile fluxes

We compiled a data set of 100 primitive arc magma compositions from melt inclusion and whole rock analyses to compare volatile contents, slab tracers, and calculated subduction component compositions between 18 subduction zone segments spanning the global range in slab thermal structure. The average primitive magma H_2O content in our data set is 3.3 ± 1.2 wt.% (1 s.d.) for melts erupted within 50 km of the volcanic front. While there is a wide range of volatile contents in magmas within individual arcs, the highest values occur in magmas erupted from vents along the volcanic front, where the subducting slab is located 104 ± 29 km (avg ± 1 s.d.) beneath the surface. This observation, coupled with positive correlations between H_2O, Cl, S, and B contents and predictions from geodynamic models, provides strong evidence for the active supply of volatile-rich slab-derived components from the subducting oceanic plate beneath volcanic arcs. We also show that temperature-sensitive ratios (e.g., H_2O/Ce) for both primitive arc magmas and calculated subduction components are similar and display monotonic behavior with slab thermal parameter. Furthermore, calculated subduction component compositions have higher trace element to H_2O ratios in arcs with hotter slabs (lower thermal parameter), suggesting that hydrous melts of differing compositions are added beneath different arcs. Finally, we present new volatile outflux estimates for Central Cascades magmatism and then compare these to estimates for the Central American and Kamchatka-Kurile arcs to create a combined data set spanning a large range in slab thermal parameter

Patients hospitalized with acute heart failure, worsening renal function, and persistent congestion are at high risk for adverse outcomes despite current medical therapy

INTRODUCTION: Approximately 1/3 of patients with acute decompensated heart failure (ADHF) are discharged with persistent congestion. Worsening renal function (WRF) occurs in approximately 50% of patients hospitalized for ADHF and the combination of WRF and persistent congestion are associated with higher risk of mortality and HF readmissions. METHODS: We designed a multicenter, prospective registry to describe current treatments and outcomes for patients hospitalized with ADHF complicated by WRF (defined as a creatinine increase ≥0.3 mg/dL) and persistent congestion at 96 h. Study participants were followed during the hospitalization and through 90-day post-discharge. Hospitalization costs were analyzed in an economic substudy. RESULTS: We enrolled 237 patients hospitalized with ADHF, who also had WRF and persistent congestion. Among these, the average age was 66 ± 13 years and 61% had a left ventricular ejection fraction (LVEF) ≤ 40%. Mean baseline creatinine was 1.7 ± 0.7 mg/dL. Patients with persistent congestion had a high burden of clinical events during the index hospitalization (7.6% intensive care unit transfer, 2.1% intubation, 1.7% left ventricular assist device implantation, and 0.8% dialysis). At 90-day follow-up, 33% of patients were readmitted for ADHF or died. Outcomes and costs were similar between patients with reduced and preserved LVEF. CONCLUSIONS: Many patients admitted with ADHF have WRF and persistent congestion despite diuresis and are at high risk for adverse events during hospitalization and early follow-up. Novel treatment strategies are urgently needed for this high-risk population

Hemodynamic Predictors of Heart Failure Morbidity and Mortality: Fluid or Flow?

BACKGROUND: Patients with advanced heart failure may persist for prolonged times with persistent hemodynamic abnormalities; intermediate and long-term outcomes of these patients are unknown. METHODS AND RESULTS: We used ESCAPE trial data to examine characteristics and outcomes of patients with invasive hemodynamic monitoring during an acute heart failure hospitalization. Patients were stratified by final measurement of cardiac index (CI; L/min/m2) and pulmonary capillary wedge pressure (PCWP; mmHg) before catheter removal. The study groups were CI ≥ 2/PCWP <20 (n = 74), CI ≥ 2/PCWP ≥ 20 (n = 37), CI < 2/PCWP < 20 (n = 23), and CI < 2/PCWP ≥ 20 (n = 17). Final CI was not associated with the combined risk of death, cardiovascular hospitalization, and transplantation (HR:1.03, 95% CI:0.96–1.11 per 0.2 L/min/m(2) decrease, p=0.39), but final PCWP ≥ 20mmHg was associated with increased risk of these events (HR:2.03, 95% CI:1.31–3.15, p<0.01), as was higher final right atrial pressure (RAP; HR:1.09, 95% CI:1.06–1.12 per mmHg increase, p<0.01). CONCLUSION: Final PCWP and final RAP were stronger predictors of post-discharge outcomes than CI in patients with advanced heart failure. The ability to lower filling pressures appears to be more prognostically important than improving CI in the management of patients with advanced heart failure. CLINICALTRIALS.GOV IDENTIFIER: NCT0000061

Differences in health care use and outcomes by the timing of in-hospital worsening heart failure

BACKGROUND: Patients hospitalized with acute heart failure may experience worsening symptoms requiring escalation of therapy. In-hospital worsening heart failure is associated with worse in-hospital and postdischarge outcomes, but associations between the timing of worsening heart failure and outcomes are unknown. METHODS: Using data from a large clinical registry linked to Medicare claims, we examined characteristics, outcomes, and costs of patients hospitalized for acute heart failure. We defined in-hospital worsening heart failure by the use of inotropes or intravenous vasodilators or initiation of mechanical circulatory support, hemodialysis, or ventilation. The study groups were early worsening heart failure (n = 1,990), late worsening heart failure (n = 4,223), complicated presentation (n = 15,361), and uncomplicated hospital course (n = 41,334). RESULTS: Among 62,908 patients, those with late in-hospital worsening heart failure had higher in-hospital and postdischarge mortality than patients with early worsening heart failure or complicated presentation. Those with early or late worsening heart failure had more frequent all-cause and heart failure readmissions at 30 days and 1 year, with resultant higher costs, compared with patients with an uncomplicated hospital course. CONCLUSION: Although late worsening heart failure was associated with the highest mortality, both early and late worsening heart failures were associated with more frequent readmissions and higher health care costs compared to uncomplicated hospital course. Prevention of worsening heart failure may be an important focus in the care of hospitalized patients with acute heart failure