Randomised controlled trial of specialist nurse intervention in heart failure

<p>Objectives. To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.</p> <p>Design. Randomised controlled trial.</p> <p>Setting. Acute medical admissions unit in a teaching hospital.</p> <p>Participants. 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.</p> <p>Main outcome measures. Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.</p> <p>Results. 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).</p> <p>Conclusions. Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.</p&gt

Myocardial power output of an isolated eel (Anguilla dieffenbachii) heart preparation in response to adrenaline

1. Myocardial power output was continuously monitored in an isolated perfused eel heart. Maximum cardiac power output and the conditions (e.g. filling and output pressures, cardiac outputs) under which maximum power occurred were determined at 1, 10, 100 and 1000 nmol 1-1 adrenaline. 2. Maximum cardiac power output occurred when the heart pumped high flows against moderate afterload pressures. 3. Adrenaline increased the myocardial power output of the eel heart at lower concentrations by elevating cardiac output via increases in stroke volume, and then at greater adrenaline concentrations by allowing the heart to pump against higher output pressures and by elevating cardiac output via increases in heart rate

Myocardial oxygen consumption and mechanical efficiency of a perfused dogfish heart preparation

Oxygen consumption of an in-pericardium heart preparation from the spiny dogfish (Squalus acanthias) was linearly related to cardiac power output. Basal oxygen consumption, predicted from the regression, was 0.127 μl · s-1 · g ventricle mass-1 and increased by 0.189 μl · s-1 · g ventricle mass-1 per milliwatt of power generated. From the relationship between cardiac power output and mechanical efficiency, mechanical efficiency was predicted to increase with cardiac power output to a maximum of 21 %. Mechanical efficiency was measured during volume loading and pressure loading at two power outputs (50% and 72% of maximum power output). At 50% of maximum power output, mechanical efficiency increased significantly by 2.87%, from 11.9±0.3% to 14.8±0.5% (n=7), when flow was halved and output pressure doubled to achieve the same power output. Similarly, at 72% of maximum power output, mechanical efficiency increased from 14.74±0.92% to 17.61±0.84% (n=6) when flow was halved and output pressure doubled to generate the same higher level of power output. The increased mechanical efficiency at higher output pressures is believed to result from cardiac myocytes working within a length range where they are able to generate the most tension during contraction and are most efficient. We speculate that the loss of mechanical efficiency associated with large changes in sarcomere length, when stroke volume is large, is a driving force behind the use of frequency as the principal means of increasing cardiac output as observed in more active fishes, birds and mammals

Towards a global paradigm for research in early childhood education

Early years education is now a global activity, as school systems expand and diverse programmes become established in countries throughout the world. We inherit a rich legacy of theories, methodologies and evidence, from the vision of early childhood pioneers to the latest empirical research. I want to step back from particular initiatives and research evaluations to consider the underlying images of the child that inform early childhood research and practice. What would be an appropriate child development paradigm for promoting quality early years education in a global context? I question the adequacy of much theory and research to encompass global childhoods, especially the dangers inherent in current knowledge-imbalances. I ask about the way child development is conceptualised within early childhood work, and the potential of a sociocultural perspective. Finally, I ask about the status of young children themselves within early education research and practice; whether they are viewed as subjects in a child development project, as participants in a process or as consumers of a service. For each theme, I will argue that we are witnessing a paradigm shift which takes us beyond idealisations about normal development, children's nature and their needs. An alternative paradigm emphasises the plurality of pathways through childhood, the respects in which early development and education is a sociocultural process, and the status of children as active participants, with their own perspective on issues in their lives