Incremental Shuttle Walking Test Distance Is Reduced in Patients With Pulmonary Hypertension in World Health Organisation Functional Class I

Background: There is increasing interest in screening for and diagnosing pulmonary hypertension earlier in the course of disease. However, there is limited data on cardiopulmonary abnormalities in patients with pulmonary hypertension newly diagnosed in World Health Organization Function Class (WHO FC) I. Methods: Data were retrieved from the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral center) for consecutive treatment naïve patients diagnosed with pulmonary hypertension by cardiac catheterization between 2001 and 2010 who underwent incremental shuttle walk exercise testing. Results: Eight hundred and ninety-five patients were diagnosed with Group 1-5 pulmonary hypertension. Despite the absence of symptoms, patients in WHO FC I (n = 9) had a significant reduction in exercise capacity (Incremental shuttle walk distance percent predicted (ISWD%pred) 65 ± 13%, Z score -1.77 ± 1.05), and modest pulmonary hypertension with a median (interquartile range) pulmonary artery pressure 31(20) mmHg and pulmonary vascular resistance 2.1(8.2) Wood Units, despite a normal diffusion of carbon monoxide adjusted for age and sex (DLco)%pred 99 ± 40%. Compared to patients in WHO FC I, patients in WHO FC II (n = 162) had a lower ISWD%pred 43 ± 22 and lower DLco%pred 65 ± 21%. Conclusion: Our results demonstrate that patients with newly diagnosed pulmonary hypertension with no or minimal symptomatic limitation have a significant reduction of exercise capacity

Is the Health and Wellbeing of University Students Associated with their Academic Performance? Cross Sectional Findings from the United Kingdom

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one University in the UK during 2008−2009. The first survey was a general health survey; the second survey measured students’ satisfaction with different aspects of their learning and teaching experience. Students’ registration numbers linked the responses of both questionnaires together, and subsequently linked the questionnaires to the university database to import the grades that students actually achieved in their studies. Generally, on average, students (N = 380) exhibited medium to high satisfaction with their educational experiences. In the multivariate regression analyses, students’ satisfaction with their educational experiences was not associated with any of the three indicators of educational achievement (actual module mark; perceived own performance; importance of achieving good grades). The associations of educational satisfaction, health, health behaviours, heath complaints and financial parameters with the three outcomes of educational achievement did not differ between male and female students. Each of the health, health behaviours, health complaints and financial parameters were selectively associated with only some but not all three indicators of student educational achievement. We conclude that the findings support a conceptual framework suggesting reciprocal relationships between health, health behaviour and educational achievement. Comprehensive health promotion programmes may have the potential to influence relevant predictors of educational achievement in university students

The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students

<p>Abstract</p> <p>Background</p> <p>Despite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners^®in Arthritis (PP^®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP^®IA taught students.</p> <p>Methods</p> <p>Pre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP^®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK.</p> <p>Results</p> <p>83 students completed the OSCE (42 PP^®IA, 41 physician taught) and 82 completed the questionnaire (42 PP^®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP^®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions.</p> <p>Conclusions</p> <p>PP^®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.</p

Eruptive history of the Karoo lava flows and their impact on early Jurassic environmental change:

This paper reports new paleomagnetic and geochronologic data from a ~1500 m thick composite section belonging to the Drakensberg group, the thickest remnant of the Karoo lavas in Northern Lesotho. Flow‐by‐flow analysis of paleomagnetic directions reveals 21 magnetic directional groups, corresponding to single eruptive events, and 16 individual lava flows. The new age determinations of lava flows range from 180.1 ± 1.4 to 182.8 ± 2.6 Ma. These data, combined with previous results, allow us to propose that the main part of the Drakensberg group and the Karoo intrusive complex dated around 181–183 Ma may have been erupted over a period as short as 250 kyr and may have coincided with the two main phases of extinction in the Early Toarcian. This scenario agrees well with the discontinuous rhythm of environmental and biotic perturbations in the Late Pliensbachian‐Toarcian interval

Strengthening the Resilience of Urban Retailers towards Flood Risks - A Case Study in the Riverbank Region of Kaohsiung City

[[abstract]]The urban environment is a complex system composed of the human-environment interactions within the physical-environmental system. It is constantly at the risk of the recurrent and prevalent flooding events in densely populated low land neighborhoods. Resilience is crucial to mitigating climate risks; this study ascertained the retail sector as the basic industry in Meinung with the Location Quotient (LQ) analysis; the interactive visualization tools supported and affirmed the retailers' concentration in the area most prone to flood risk. By conducting the semi-structured interviews for 15 key retailers, the study focused on the driver, pressure, state, impact, and response (DPSIR) framework to assess the knowledge, skills, and network capacity attained from climate change scenarios and flooding. The measurement of the level of resilience showed that retailers’ focus on strategic identification of potential weather-related risks and implementation of adaptation plans for each business's provision of services conformed to place-specificity criteria. The results indicated that (1) mal-adaptation of mitigation measures focus only on short-term objectives and overlook long-term and the overall resilience potential; (2) the appropriate tools for resilience strengthening assessment ascertained the perceived vulnerability; the mitigation relies on knowledge, skill and network capacity attained from previous experiences; (3) interactive visual tools provided an accurate mean, evaluation, and implementation of an integrative interface to guide and enhance the process of resilience strengthening; (4) resilience adaptability from local retailers built an effective way to mitigate flood risks. Finally, further research issues are identified with an effective resilience strengthening method against climate change.[[notice]]補正完

The high-resolution map of Oxia Planum, Mars; the landing site of the ExoMars Rosalind Franklin rover mission

This 1:30,000 scale geological map describes Oxia Planum, Mars, the landing site for the ExoMars Rosalind Franklin rover mission. The map represents our current understanding of bedrock units and their relationships prior to Rosalind Franklin’s exploration of this location. The map details 15 bedrock units organised into 6 groups and 7 textural and surficial units. The bedrock units were identified using visible and near-infrared remote sensing datasets. The objectives of this map are (i) to identify where the most astrobiologically relevant rocks are likely to be found, (ii) to show where hypotheses about their geological context (within Oxia Planum and in the wider geological history of Mars) can be tested, (iii) to inform both the long-term (hundreds of metres to ∼1 km) and the short-term (tens of metres) activity planning for rover exploration, and (iv) to allow the samples analysed by the rover to be interpreted within their regional geological context

Biological heterogeneity in idiopathic pulmonary arterial hypertension identified through unsupervised transcriptomic profiling of whole blood

Idiopathic pulmonary arterial hypertension (IPAH) is a rare but fatal disease diagnosed by right heart catheterisation and the exclusion of other forms of pulmonary arterial hypertension, producing a heterogeneous population with varied treatment response. Here we show unsupervised machine learning identification of three major patient subgroups that account for 92% of the cohort, each with unique whole blood transcriptomic and clinical feature signatures. These subgroups are associated with poor, moderate, and good prognosis. The poor prognosis subgroup is associated with upregulation of the ALAS2 and downregulation of several immunoglobulin genes, while the good prognosis subgroup is defined by upregulation of the bone morphogenetic protein signalling regulator NOG, and the C/C variant of HLA-DPA1/DPB1 (independently associated with survival). These findings independently validated provide evidence for the existence of 3 major subgroups (endophenotypes) within the IPAH classification, could improve risk stratification and provide molecular insights into the pathogenesis of IPAH

Biological heterogeneity in idiopathic pulmonary arterial hypertension identified through unsupervised transcriptomic profiling of whole blood

Idiopathic pulmonary arterial hypertension (IPAH) is a rare but fatal disease diagnosed by right heart catheterisation and the exclusion of other forms of pulmonary arterial hypertension, producing a heterogeneous population with varied treatment response. Here we show unsupervised machine learning identification of three major patient subgroups that account for 92% of the cohort, each with unique whole blood transcriptomic and clinical feature signatures. These subgroups are associated with poor, moderate, and good prognosis. The poor prognosis subgroup is associated with upregulation of the ALAS2 and downregulation of several immunoglobulin genes, while the good prognosis subgroup is defined by upregulation of the bone morphogenetic protein signalling regulator NOG, and the C/C variant of HLA-DPA1/DPB1 (independently associated with survival). These findings independently validated provide evidence for the existence of 3 major subgroups (endophenotypes) within the IPAH classification, could improve risk stratification and provide molecular insights into the pathogenesis of IPAH

Pilot Study on the Impact of Green Roofs on Ozone Levels Near Building Ventilation Air Supply

Outdoor air is often introduced into commercial buildings from ventilation intakes sited on rooftops where vegetation (a green roof) is increasingly present. Little is known about the impact of green roofs on the quality of building outdoor ventilation air supply. In this study, we investigated the potential for green roofs to impact ozone (O3) levels in ventilation air by parameterizing O3 dry deposition to vegetation and substrate typical of extensive green roofs in field and laboratory studies. Values obtained constrain a 2-D advection-diffusion model of O3 transport and reaction at the rooftop scale. The 10th, 50th, and 90th percentiles for O3 surface resistances measured using flux-gradient methods in field studies were 46 s/m, 155 s/m, and 1700 s/m. Surface resistances measured in laboratory chambers for substrate and green roof samples ranged from 360 s/m to 435 s/m, in the 60th-70th percentile of field measurements. The modeled impact of a green roof on O3 levels in building outdoor ventilation air intake was a reduction ranging from 0.25 to 1.8 μg/m3 for short fetch lengths (1 m) and low vertical mixing to larger fetch lengths (5 m) and stronger vertical mixing, respectively, from ambient O3 levels of 144 μg/m3. Vegetation fetch and vegetation height had the largest impact on modeled O3 reductions, suggesting large, continuous, intensive green roof designs may enhance O3 reductions in building ventilation air

Effect of Fiber Material on Ozone Removal and Carbonyl Production from Carpets

Indoor air quality is affected by indoor materials such as carpets that may act as sources and/or sinks of gas-phase air pollutants. Heterogeneous reactions of ozone with carpets may result in potentially harmful products. In this study, indoor residential carpets of varying fiber types were tested to evaluate their ability to remove ozone, and to assess their role in the production of carbonyls when exposed to elevated levels of ozone. Tests were conducted with six types of new unused carpets. Two sets of experiments were conducted, the first measured ozone removal and ozone deposition velocities, and the second measured primary carbonyl production and secondary production as a result of exposure to ozone. The tests were conducted using glass chambers with volume of 52 L each. Air exchange rates for all tests were 3 h−1. The ozone removal tests show that, for the conditions tested, the polyester carpet sample had the lowest ozone removal (40%), while wool carpet had the greatest ozone removal (65%). Most carpet samples showed higher secondary than primary carbonyl emissions, with carpets containing polypropylene fibers being a notable exception. Carpets with polyester fibers had both the highest primary and secondary emissions of formaldehyde among all samples tested. While it is difficult to make blanket conclusions about the relative air quality merits of various carpet fiber options, it is clear that ozone removal percentages and emissions of volatile organic compounds can vary drastically as a function of fiber type