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

Never a \u27needless\u27 suicide: An empirical test of Shneidman\u27s theory of psychological needs, psychological pain, and suicidality (Edwin Shneidman).

The phenomenology of suicidal thoughts and behaviour has been an area of increased interest in recent years. One particular area of focus is psychological pain, or psychache. In this dissertation, Edwin Shneidman\u27s psychological theory of suicide was studied. Shneidman has theorized that psychological needs are associated with the development of psychological pain, which in turn leads to suicide as an escape from pain. Two hundred and fifty-seven undergraduate students completed the Personality Research Form, the Psychache Scale, the Orbach and Mikulincer Mental Pain Scale, two items from Shneidman\u27s Psychological Pain Assessment Scale, as well as demographic and suicide history items. Measures of psychological pain demonstrated convergent validity. Low need for affiliation and high impulsivity were significantly related to psychological pain. All measures of psychological pain were associated with suicidal ideation and history of suicide attempts. Possible gender differences emerged. This study provides some evidence for Shneidman\u27s theory, although not all identified needs were supported. The importance of understanding the role of psychological pain in the phenomenology of suicidal thinking and behaviour is emphasized.Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis2005 .D375. Source: Dissertation Abstracts International, Volume: 66-11, Section: B, page: 6267. Thesis (Ph.D.)--University of Windsor (Canada), 2005

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

Vibrations Due to Pile Driving

Vibrations due to pile installation have long been a concern to owners, contractors, and engineers. Specifically, what levels of vibrations can be assumed for a given pile, hammer, and subsurface conditions and how can these levels be predicted in advance of construction so an assessment of nearby structures can be made? This paper presents the results of vibration monitoring at several sites where various piles and pile hammers have been used, and recommends a conservative method of predicting peak particle velocity at the ground surface near pile installations. Where sensitive structures are involved, a response spectrum analysis is recommended

CLONAL NATURE OF THE IMMUNE RESPONSE TO PHOSPHORYLCHOLINE : IV. IDIOTYPIC UNIFORMITY OF BINDING SITE-ASSOCIATED ANTIGENIC DETERMINANTS AMONG MOUSE ANTIPHOSPHORYLCHOLINE ANTIBODIES

A new idiotypic determinant(s) on mouse anti-PC antibodies is described. Antibodies to the determinant(s) were raised in rabbits by immunization with HOPC 8, a PC-binding myeloma protein, and were isolated from HOPC 8 immunoadsorbent by elution with PC. These antibodies react with binding site determinants on anti-PC antibodies raised in all 15 inbred mouse strains tested regardless of histocompatibility or allotype, but fail to react with antibodies of other specificities or with anti-PC antibodies raised in other rodent species. These results correlate closely with other studies which show similar binding specificity of anti-PC antibodies raised in 17 different strains of mice. The site-associated idiotypic determinant(s) is clearly distinct from that detected by mouse anti-HOPC 8 antisera. This latter determinant(s) is present on anti-PC antibodies of only a few strains of mice and may not be in the binding site

Environmental Water Quality - a guide to sampling and measurement

The guide covers the problems associated with sampling water in the field and suggestions to overcome them. The main types of water pollution that potentially occur in the south west of Western Australia are discussed and for each contaminant, the origins and environmental effects are briefly described and where available, water quality guidelines are provided for major water uses. This is followed by specific requirements of the collection, storage and analysis of samples. The guide also includes further reading and details on suppliers, analytical costs and web resources

Variation in Capacities of Different Pile Types Under Similar Soil Conditions

The interaction between soil and various pile types is of interest because it depends not only on the shear strength characteristics of the soil, but also on the pile dimensions, shape, and installation method, and on time after pile installation. This paper presents load test results from three types of displacement piles installed at the same site. The results obtained from the tests are compared with theoretical estimates. The computed values of soil-pile adhesion, back-calculated from the load tests, are discussed and compared with values found in the literature. Estimated pile capacities during driving and retap are also compared and discussed

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