Changes in heart failure management and long-term mortality over ten years: observational study

Objectives: To estimate the long-term survival of two cohorts of people diagnosed with heart failure 10 years apart and to assess differences in patient characteristics, clinical guideline compliance and survival by diagnosis setting. Methods Data: for patients aged 18 and over with a new diagnosis of heart failure in the Clinical Practice Research Datalink in 2001–2002 (5966 patients in 156 practices) and 2011–2012 (12 827 patients in 331 practices). Survival rates since diagnosis were described using Kaplan-Meier plots. Compliance with national guidelines was summarised. Results: 2011/2012 patients were older than those diagnosed a decade before, with lower blood pressure and cholesterol but more comorbidity and healthcare contacts. For those diagnosed in 2001/2002, the 5-year survival was 40.0% (40.2% in the 2011/2012 cohort), 10-year survival was 20.8%, and 15-year survival 11.1%. Improvement in survival between the two time periods was seen only in those diagnosed in primary care (5-year survival 46.0% vs 57.4%, compared with 33.9% and 32.6% for hospital-diagnosed patients). Beta-blocker use rose from 24.3% to 39.1%; renin–angiotensin system blockers rose from 31.8% to 54.3% (both p<0.001). There was little change for loop diuretics and none for thiazide diuretics. For the 9963 patients with symptoms recorded by their general practitioner before diagnosis, brain natriuretic peptide (BNP) testing was low, but echocardiogram use rose from 8.3% to 19.3%, and specialist referral rose from 7.2% to 24.6% (all p<0.001)

Climate change scenarios for the California region

To investigate possible future climate changes in California, a set of climate change model simulations was selected and evaluated. From the IPCC Fourth Assessment, simulations of twenty-first century climates under a B1 (low emissions) and an A2 (a medium-high emissions) emissions scenarios were evaluated, along with occasional comparisons to the A1fi (high emissions) scenario. The climate models whose simulations were the focus of the present study were from the Parallel Climate Model (PCM1) from NCAR and DOE, and the NOAA Geophysical Fluid Dynamics Laboratory CM2.1 model (GFDL). These emission scenarios and attendant climate simulations are not “predictions,” but rather are a purposely diverse set of examples from among the many plausible climate sequences that might affect California in the next century. Temperatures over California warm significantly during the twenty-first century in each simulation, with end-of-century temperature increases from approximately +1.5°C under the lower emissions B1 scenario in the less responsive PCM1 to +4.5°C in the higher emissions A2 scenario within the more responsive GFDL model. Three of the simulations (all except the B1 scenario in PCM1) exhibit more warming in summer than in winter. In all of the simulations, most precipitation continues to occur in winter. Relatively small (less than ~10%) changes in overall precipitation are projected. The California landscape is complex and requires that model information be parsed out onto finer scales than GCMs presently offer. When downscaled to its mountainous terrain, warming has a profound influence on California snow accumulations, with snow losses that increase with warming. Consequently, snow losses are most severe in projections by the more responsive model in response to the highest emissions

Reassessing China’s Higher Education Development: A Focus on Academic Culture

During the past three and a half decades, China has been progressing in higher education in a surprisingly dramatic manner, evidenced especially by scientific publications and sheer numbers of graduates. Such a fact has national, regional and global implications. China’s higher education development and its future directions are now placed highly on the research agendas of many from various parts of the world. Unlike the general acknowledgment of China’s achievements, assessment of the future development of China’s higher education is wide open to question. To some, Chinese universities are on a trajectory to become “world-class” and China’s high-fliers challenge Western supremacy. To others, China’s notion of “world-class” status has been largely imitative. Pumping resources into universities will only lead to diminishing returns as Chinese culture and practices will act as a brake to the pursuit of academic excellence. An increasing deal of attention has been paid to where China will be located in a global higher education landscape and in what shape. Based on the author’s long-standing professional observation and recent empirical studies, this article assesses China’s higher education development, with a particular focus on the challenges brought forward by academic culture. It interrogates China’s pride of the idea that Chinese universities are not willing to assume that Western models define excellence, and asks how far Chinese universities could move within their current development model.postprin

The programming of sequences of saccades

Saccadic eye movements move the high-resolution fovea to point at regions of interest. Saccades can only be generated serially (i.e., one at a time). However, what remains unclear is the extent to which saccades are programmed in parallel (i.e., a series of such moments can be planned together) and how far ahead such planning occurs. In the current experiment, we investigate this issue with a saccade contingent preview paradigm. Participants were asked to execute saccadic eye movements in response to seven small circles presented on a screen. The extent to which participants were given prior information about target locations was varied on a trial-by-trial basis: participants were aware of the location of the next target only, the next three, five, or all seven targets. The addition of new targets to the display was made during the saccade to the next target in the sequence. The overall time taken to complete the sequence was decreased as more targets were available up to all seven targets. This was a result of a reduction in the number of saccades being executed and a reduction in their saccade latencies. Surprisingly, these results suggest that, when faced with a demand to saccade to a large number of target locations, saccade preparation about all target locations is carried out in paralle

Climate change scenarios for the California region.

Abstract To investigate possible future climate changes in California, a set of climate change scenario in PCM1) exhibit more warming in summer than in winter. In all of the simulations, most precipitation continues to occur in winter, and relatively small (less than ~10%) change in overall precipitation is projected. The California landscape is complex and requires that model information be parsed out onto finer scales than GCMs presently offer. When downscaled to its mountainous terrain, warming has a profound influence on California snow accumulations, with snow losses that increase with warming. Consequently, snow losses are most severe in projections by the more responsive model in response to the highest emissions. i

Our Globally Changing Climate

Since the Third U.S. National Climate Assessment (NCA3) was published in May 2014, new observations along multiple lines of evidence have strengthened the conclusion that Earth's climate is changing at a pace and in a pattern not explainable by natural influences. While this report focuses especially on observed and projected future changes for the United States, it is important to understand those changes in the global context (this chapter). The world has warmed over the last 150 years, especially over the last six decades, and that warming has triggered many other changes to Earth's climate. Evidence for a changing climate abounds, from the top of the atmosphere to the depths of the oceans. Thousands of studies conducted by tens of thousands of scientists around the world have documented changes in surface, atmospheric, and oceanic temperatures; melting glaciers; disappearing snow cover; shrinking sea ice; rising sea level; and an increase in atmospheric water vapor. Rainfall patterns and storms are changing, and the occurrence of droughts is shifting

Functional Redundancy of Class I Phosphoinositide 3-Kinase (PI3K) Isoforms in Signaling Growth Factor-Mediated Human Neutrophil Survival

We have investigated the contribution of individual phosphoinositide 3-kinase (PI3K) Class I isoforms to the regulation of neutrophil survival using (i) a panel of commercially available small molecule isoform-selective PI3K Class I inhibitors, (ii) novel inhibitors, which target single or multiple Class I isoforms (PI3Kα, PI3Kβ, PI3Kδ, and PI3Kγ), and (iii) transgenic mice lacking functional PI3K isoforms (p110δKOγKO or p110γKO). Our data suggest that there is considerable functional redundancy amongst Class I PI3Ks (both Class IA and Class IB) with regard to GM-CSF-mediated suppression of neutrophil apoptosis. Hence pharmacological inhibition of any 3 or more PI3K isoforms was required to block the GM-CSF survival response in human neutrophils, with inhibition of individual or any two isoforms having little or no effect. Likewise, isolated blood neutrophils derived from double knockout PI3K p110δKOγKO mice underwent normal time-dependent constitutive apoptosis and displayed identical GM-CSF mediated survival to wild type cells, but were sensitized to pharmacological inhibition of the remaining PI3K isoforms. Surprisingly, the pro-survival neutrophil phenotype observed in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) was resilient to inactivation of the PI3K pathway

Global trends of habitat destruction and consequences for parrot conservation

Human advance on natural habitats is a major cause of biodiversity loss. This transformation process represents a profound change in wooded environments, disrupting original communities of flora and fauna. Many species are highly dependent on forests, especially parrots (Psittaciformes) with almost a third of their species threatened by extinction. Most parrot species occur in tropical and subtropical forests, and given the forest dependence of most species, this is the main reason why habitat loss has been highlighted as the main threat for the group. Such habitat loss acts in synergy with other important threats (e.g., logging and poaching), which become especially problematic in certain developing countries along tropical latitudes. In this study, we used available information on parrot distributions, species traits, IUCN assessment, habitat loss and timber extraction for different periods, and distribution of protected areas, to determine conservation hotspots for the group, and analyze potential changes in the conservation status of these species. We detected four conservation hotspots for parrots: two in the Neotropics and two in Oceania, all of them facing different degrees of threat in regard of current habitat loss and agricultural trends. Our results suggest that the future of the group is subject to policymaking in specific regions, especially in the northeastern Andes and the Atlantic Forest. In addition, we predicted that agricultural expansion will have a further negative effect on the conservation status of parrots, pushing many parrot species to the edge of extinction in the near future. Our results have conservation implications by recommending protected areas in specific parrot conservation hotspots. Our recommendations to mitigate conservation risks to this group of umbrella species would also benefit many other coexisting species as well.Fil: Vergara Tabares, David Lautaro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Zoología Aplicada; ArgentinaFil: Cordier, Javier Maximiliano. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Zoología Aplicada; ArgentinaFil: Landi, Marcos Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Zoología Aplicada; ArgentinaFil: Olah, George. Wildlife Messengers; Estados UnidosFil: Nori, Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Zoología Aplicada; Argentin