High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis

Aims: High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome. Methods and results: Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 ± 0.4 cm2) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity. Conclusions: In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death

Calcific Aortic Stenosis A Disease of the Valve and the Myocardium

Although aortic stenosis is a common condition associated with major morbidity, mortality, and health economic costs, there are currently no medical interventions capable of delaying or halting its progression. Re-evaluation of the underlying pathophysiology is therefore required so that novel therapeutic strategies can be developed. Aortic stenosis is characterized by progressive aortic valve narrowing and secondary left ventricular hypertrophy. Both processes are important because in combination they drive the development of symptoms and adverse events that characterize the latter stages of the disease. In this review, the authors examine the pathophysiology of aortic stenosis with respect to both the valve and the myocardium. In particular, the authors focus on the role of inflammation, fibrosis, and calcification in progressive valve narrowing and then examine the development of left ventricular hypertrophy, its subsequent decompensation, and the transition to heart failure. Finally the authors discuss potential therapeutic strategies on the basis of similarities aortic stenosis shares with other pathological conditions

Impactos Do Novo Regime Fiscal Na Saúde E Educação

321

Academic achievement : the role of praise in motivating students

The motivation of students is an important issue in higher education, particularly in the context of the increasing diversity of student populations. A social-cognitive perspective assumes motivation to be dynamic, context-sensitive and changeable, thereby rendering it to be a much more differentiated construct than previously understood. This complexity may be perplexing to tutors who are keen to develop applications to improve academic achievement. One application that is within the control of the tutor, at least to some extent, is the use of praise. Using psychological literature the article argues that in motivating students, the tutor is not well served by relying on simplistic and common sense understandings of the construct of praise and that effective applications of praise are mediated by students' goal orientations, which of themselves may be either additive or interactive composites of different objectives and different contexts

Trinity University\u27s Summer Bridge Program: Navigating the Changing Demographics in Higher Education

Our article is divided into five sections. First, our study explores the demographic, economic, and cultural changes influencing higher education. We also explain the tangible and intangible benefits of a college education for first-generation, underrepresented students (FGUS). Second, we provide a brief discussion of the history of Trinity University and our Summer Bridge program. Third, our study describes our Summer Bridge program. Fourth, the data we collected examines how our Summer Bridge students’ grades and retention rates compare to our other first-year students. And, fifth, our article concludes with a discussion of future directions for our Summer Bridge program and how it may apply to other higher educational institutions. In particular, we offer recommendations for other student affairs professionals who also will be experiencing an increase in first-generation, underrepresented students

The pivotal role of effort beliefs in mediating implicit theories of intelligence and achievement goals & academic motivations

Empirical studies into meaning systems surrounding implicit theories of intelligence typically entail two stringent assumptions: that different implicit theories and different effort beliefs represent opposite poles on a single scale, and that implicit theories directly impact the constructs as achievement goals and academic motivations. Through an empirical study based on a large sample of university students, we aim to demonstrate that relaxing these stringent assumptions, and thereby using the meaning system framework to its full potential, will provide strong benefits: effort beliefs are crucial mediators of relationships between implicit theories and achievement goals and academic motivations, and the different poles of implicit theories and effort beliefs do expose different relationships with goal setting behaviour and academic motivations. A structural equation model, cross-validated by demonstrating gender-invariance of path coefficients, demonstrates that incremental and entity theory views have less predictive power than positive and negative effort beliefs in explaining achievement goals and motivations