Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study

OBJECTIVES: To characterise the clinical features of patients with suspected heart failure but preserved left ventricular systolic function to determine if they have other potential causes for their symptoms rather than being diagnosed with 'diastolic heart failure.' DESIGN: Prospective descriptive study. SETTING: Outpatient based direct access echocardiography service. PARTICIPANTS: 159 consecutive patients with suspected heart failure referred by general practitioners. MAIN OUTCOME MEASURES: Symptoms (including shortness of breath, ankle oedema, and paroxysmal nocturnal dyspnoea) and history of coronary heart disease and chronic pulmonary disease. Transthoracic echocardiography, body mass index, pulmonary function tests, and electrocardiography. RESULTS: 109 of 159 participants had suspected heart failure in the absence of left ventricular systolic dysfunction, valvular heart disease, or atrial fibrillation. Of these 109, 40 were either obese or very obese, 54 had a reduction in forced expiratory volume in 1 second to </=70%, and 97 had a peak expiratory flow rate </=70% of normal. Thirty one patients had a history of angina, 12 had had a myocardial infarction, and seven had undergone a coronary artery bypass graft. Only seven patients lacked a recognised explanation for their symptoms. CONCLUSIONS: For most patients with a diagnosis of heart failure but preserved left ventricular systolic function there is an alternative explanation for their symptoms-for example, obesity, lung disease, and myocardial ischaemia-and the diagnosis of diastolic heart failure is rarely needed. These alternative diagnoses should be rigorously sought and managed accordingly

It\u27s okay, I\u27m a...teacher. Is professional status important to teachers?

Teacher accountability and the debate around teacher quality are issues of international importance. As society places increasing demands on the teaching profession, and regulatory bodies around the globe raise the ‘standards’ for teachers to adhere to, the professional status of teachers is drawn into focus. This paper reports research findings of an investigation into the perspectives of professional status of teachers, held by pre-service teachers about to embark on their teaching career. This was a comparative study whereby data were collected from an Australian university and an American university to explore professional status as an international issue. This quantitative study utilised a Likert scale to gather responses from participants. Data were analysed and findings from both universities indicated that professional status was a significant concern for pre-service teachers. Pre-service teachers felt that whilst they may have entered their teaching degree as a vocation, they hoped to receive status, as a professional, within society

Differential Settlement of Nuclear Power Plant Foundations

A rational approach is presented for evaluating differential settlement of structures at nuclear power plants where settlement monitoring and the associated documentation are important. In nuclear plants, allowable differential settlement is governed by the necessity to prevent architectural and structural damage, equipment malfunction, touching of adjacent buildings during an earthquake, and damage to buried utilities. Measurements of actual settlement of the plant should be taken on a regular basis from start of construction and compared with the allowable values. A description is given of methods for calculating allowable values for differential settlements, and a comprehensive program for obtaining actual settlement data at a nuclear site is outlined. The ratio of measured to allowable differential settlement at which remedial action may be required is discussed. A case history of differential settlements at a nuclear plant is presented. The settlement patterns exhibited by the major structures can be correlated with foundation conditions at the plant site. Measured differential settlements are small, generally less than 0.25 inch, compared with values of allowable differential settlement which are mainly greater than 0.75 inch

Uplift Load Tests on Driven Piles

Details and results of uplift load tests on 25 piles at 15 sites are presented. The allowable uplift load on each pile determined from the BOCA code criterion is compared with an allowable capacity based on small movements at design load. In the majority of cases, the BOCA capacities are significantly lower

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

Accelerated Consolidation of Soft Clays Using Wick Drains

Construction of the New Istana for the Sultan of Brunei required that fill slopes up to 85 feet high be placed on very soft compressible floodplain soils. Wick drains installed in the soft sediments accelerated their consolidation and reduced long-term settlements. The consolidation also produced a strength increase in the soft soils that allowed the fill to be constructed without danger of a major base slip failure. Instrumentation installed in the floodplain soils provided data on excess porepressures built up during the fill placement, and on the resulting settlements. The measured porepressures and settlements were in good agreement with the predicted values

Micropiles for Support of Heavy Crane Ring Foundation

The replacement of a steam generator at a nuclear power plant was accomplished with the use of a massive crane, believed to be one of the largest available cranes in the world market. Four steam generators were replaced, with each generator weighing 3.2 MN. The crane used for the job had a circular support that required a ring foundation. The crane support imposed huge loads on the ring foundation. Because of the presence of soft to medium stiff clayey fill on one side of the ring foundation, the load-sensitive nature of existing underground safetyrelated duct banks, and the nature of the loads applied to the foundation, it was necessary to support the ring foundation on piles. In order to minimize vibrations next to the containment building (the plant was operational while the piles were being installed), micropiles were selected. A total of 80 micropiles were installed, most of them at a batter of 10o from vertical, to provide the required vertical and lateral load resistance. Despite significant challenges imposed by space constraints, subsurface conditions, buried utilities, and design changes, the micropiles were installed within schedule, and performed as designed

Vision screening in children:a retrospective study of social and demographic factors with regard to visual outcomes

BACKGROUND: Amblyopia and its risk factors have been demonstrated to be more common among children from low socioeconomic backgrounds. We sought to investigate this association in a region with orthoptic-delivered screening and whole population coverage, and to also examine the association of the Health Plan Indicator (HPI) with screening outcome. METHODS: Screening examination outcomes, postcodes and HPIs were extracted from the community child health database for every child who underwent preschool vision screening between March 2010 and February 2011 Tayside. We obtained the Scottish Index of Multiple Deprivation score for every child as a measure of area-based deprivation. We assessed the vulnerability/needs of the individual family through the HPI—‘Core’ (children and families receiving universal health visiting service), ‘Additional’ (receiving additional health/social support) and ‘Intensive’ (receiving high levels of support). The outcomes from follow-up examinations for those who failed screening were extracted from the orthoptic department database. RESULTS: 4365 children were screened during the year 2010–2011 of whom 523 (11.9%) failed. The odds of children from the least deprived socioeconomic group passing the visual screening test was 1.4 times higher than those from the most deprived socioeconomic group (OR 1.4, 95% CI 1.07 to 1.89, p=0.01). The odds of a child from a family assigned as ‘Intensive’ failing the preschool visual screening test was three times greater than the odds of a child from a family assigned as ‘Core’ (OR 3.59, 95% CI 1.6 to 7.8, p=0.001). CONCLUSIONS: We found that children from the most deprived backgrounds and those from unstable homes were more likely to fail preschool vision screening