Care Coordination as Part of the Discharge Plan to Support Community Reintegration of Individuals with Stroke Living in Appalachian Rural Communities

Studies indicate a high incidence of readmission within the first 12 months post-discharge home following stroke. In addition, there is a limited awareness of healthcare services, community resources, and lack of access to information in rural communities. Previous work from our group has demonstrated the need for community-based navigational support during community reintegration for survivors of stroke. The purpose of this study was to determine the effectiveness of providing community health navigation to facilitate continued communications with healthcare providers and linkages to services and community resources for survivors of stroke in Appalachian rural communities

Operant Assessment of Visual Acuity in the Profoundly Retarded

72 leaves. Advisor: Dr. Kenneth E. LloydThe problem. Traditional subjective visual acuity tests are not effective in testing nonverbal, profoundly retarded individuals. The present paper investigated the use of operant conditioning procedures in determining threshold crossings and compared the effectiveness of the staircase and descending series stimulus presentation methods, using a two-response paradigm. Procedure. Three profoundly retarded and two mildly retarded individuals were trained to discriminate between a right-facing E and an upward-facing E, using stimulus fading and reinforcement procedures. The participants indicated the presence of a given stimulus by responding on one of two levers or drawing the E as displayed. Correct responses resulted in praise and an edible reinforcer. Incorrect responses were followed by a 10 second time-out and the reinforcer was withheld. Findings. Correct responses reached the established criterion during the right-facing E versus blank card condition only after the implementation of instructions and time-out procedures. The upward-facing E was faded onto the blank card and the distance from the participants was increased to ten feet without significant difficulties. The threshold crossings obtained with three participants were reliable within and across the type of stimulus presentation method used. The threshold crossings produced with the staircase method were similar to or lower than those produced with the descending-series method. The threshold estimations obtained with the present procedures were similar to or lower than those obtained by an ophthalmologist using the Snellen chart. Conclusions. The instructions and time-out procedures appeared to be significant variables in obtaining stimulus control over responding. The present procedures must be further refined before application to applied settings due to the extended time spent in training. Recommendations. Procedures for testing visual acuity in the profoundly retarded must include a means to promote attention to the stimuli. Future research should investigate the significance of simple instructions and time-out procedures and testing between sessions (Test B) in visual acuity assessments

Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise

AbstractOBJECTIVESThe aim of the study was to test the hypothesis that angiotensin II (Ang II) blockade would improve exercise tolerance in patients with diastolic dysfunction and a marked increase in systolic blood pressure (SBP) during exercise.BACKGROUNDDiastolic dysfunction may be exacerbated during exercise, especially if there is a marked increase in SBP. Angiotensin II may contribute to the hypertensive response to exercise and impair diastolic performance.METHODSWe performed a randomized, double-blind, placebo-controlled, crossover study of two weeks of losartan (50 mg q.d.) on exercise tolerance and quality of life. The subjects were 20 patients, mean age 64 ± 10 years with normal left ventricular systolic function (EF >50%), no ischemia on stress echocardiogram, mitral flow velocity E/A <1, normal resting SBP (<150 mm Hg), and a hypertensive response to exercise (SBP >200 mm Hg). Exercise echocardiograms (Modified Bruce Protocol) and the Minnesota Living With Heart Failure questionnaire were administered at baseline, and after each two-week treatment period, separated by a two-week washout period.RESULTSResting blood pressure (BP) was unaltered by placebo or losartan. During control, patients were able to exercise for 11.3 ± 2.5 (mean ± SD) min, with a peak exercise SBP of 226 ± 24 mm Hg. After two weeks of losartan, baseline BP was unaltered, but peak SBP during exercise decreased to 193 ± 27 mm Hg (p < 0.05 vs. baseline and placebo), and exercise time increased to 12.3 ± 2.6 min (p < 0.05 vs. baseline and placebo). With placebo, there was no improvement in exercise duration (11.0 ± 2.0 min) or peak exercise SBP (217 ± 26 mm Hg). Quality of life improved with losartan (18 ± 22, p < 0.05) compared to placebo (22 ± 26).CONCLUSIONSIn patients with Doppler evidence of diastolic dysfunction at rest and a hypertensive response to exercise, Ang II receptor blockade blunts the hypertensive response to exercise, increases exercise tolerance and improves quality of life

Statins and Exercise Training Response in Heart Failure Patients: Insights From HF-ACTION.

OBJECTIVES: The aim of this study was to assess for a treatment interaction between statin use and exercise training (ET) response. BACKGROUND: Recent data suggest that statins may attenuate ET response, but limited data exist in patients with heart failure (HF). METHODS: HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized trial of 2,331 patients with chronic HF with ejection fraction ≤35% who were randomized to usual care with or without ET. We evaluated whether there was a treatment interaction between statins and ET response for the change in quality of life and aerobic capacity (peak oxygen consumption and 6-min walk distance) from baseline to 3 months. We also assessed for a treatment interaction among atorvastatin, simvastatin, and pravastatin and change in these endpoints with ET. Multiple linear regression analyses were performed for each endpoint, adjusting for baseline covariates. RESULTS: Of 2,331 patients in the HF-ACTION trial, 1,353 (58%) were prescribed statins at baseline. Patients treated with statins were more likely to be older men with ischemic HF etiology but had similar use of renin angiotensin system blockers and beta-blockers. There was no evidence of a treatment interaction between statin use and ET on changes in quality of life or exercise capacity, nor was there evidence of differential association between statin type and ET response for these endpoints (all p values \u3e0.05). CONCLUSIONS: In a large chronic HF cohort, there was no evidence of a treatment interaction between statin use and short-term change in aerobic capacity and quality of life with ET. These findings contrast with recent reports of an attenuation in ET response with statins in a different population, highlighting the need for future prospective studies. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)

Quantum acoustic Fano interference of surface phonons

Quantum acoustic systems, which integrate surface or bulk phonons with superconducting qubits, offer a unique opportunity to investigate phononic $interference$ and $scattering$ processes in the quantum regime. In particular the interaction between a superconducting qubit and a phononic oscillator allows the qubit to sense the oscillator's excitation spectrum and underlying interference effects. Here we present measurements revealing Fano interference of a resonantly trapped piezoelectric surface acoustic wave (SAW) mode with a broad continuum of surface phonons in a system consisting of a SAW resonator coupled to a superconducting qubit. The experiments highlight the existence of additional weakly coupled mechanical modes and their influence on the qubit-phonon interaction and underscore the importance of phononic interference in quantum acoustic architectures that have been proposed for quantum information processing applications.Comment: 7 pages, 5 figures. Updated title and abstrac

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Free-space coupling and characterization of transverse bulk phonon modes in a quantum acoustic device

Transverse bulk phonons in a multimode integrated quantum acoustic device are excited and characterized via their free-space coupling to a three-dimensional (3D) microwave cavity. These bulk acoustic modes are defined by the geometry of the Y-cut lithium niobate substrate in which they reside and couple to the cavity electric field via a large dipole antenna, with an interaction strength on the order of the cavity line-width. Using finite element modeling (FEM) we determine that the bulk phonons excited by the cavity field have a transverse polarization with a shear velocity matching previously reported values. We demonstrate how the coupling between these transverse acoustic modes and the electric field of the 3D cavity depends on the relative orientation of the device dipole, with a coupling persisting to room temperature. Our study demonstrates the versatility of 3D microwave cavities for mediating contact-less coupling to quantum, and classical, piezoacoustic devices.Comment: 5 pages, 4 figure

Phononic bath engineering of a superconducting qubit

Phonons, the ubiquitous quanta of vibrational energy, play a vital role in the performance of many quantum technologies. Coupling to well-defined phonon modes allows for highly-connected multi-qubit gates in ion trap architectures as well as the generation of entangled states in systems of superconducting qubits. Even when the phonons take the form of a large dissipative bath, an irreversible flow of heat allows for state initialization critical to the function of laser systems and the operation of optically active spin qubits. Conversely, unintended coupling to phonons has been shown to degrade qubit performance by generating decohering quasiparticles and leading to correlated errors in superconducting qubit systems. Regardless of whether a phononic bath plays an enabling or deleterious role, it is typically intrinsic to the system and does not admit specific control over its spectral properties, nor the possibility of engineering aspects of its dissipation to be used as a resource. Here we show that by precisely designing and controlling the coupling of a superconducting qubit to phononic degrees of freedom allows a new type of quantum control over superconducting circuits. By shaping the loss spectrum of the qubit via its coupling to a bath of lossy piezoelectric surface acoustic wave phonons, we are able to prepare and stabilize arbitrary qubit states. Additionally, we find that the presence of the energy-dependent loss imparted onto the qubit by the phonons is well-described by a master equation treatment of the composite system, with excellent agreement in both the qubit dynamics as well as its steady state. Our results demonstrate the ability of engineered phononic dissipation to achieve highly efficient qubit control.Comment: 18 pages, 5 figures, 1 table, main text and S

Baseline characteristics and enrichment results from the SONAR trial

Aim: The SONAR trial uses an enrichment design based on the individual response to the selective endothelin receptor antagonist atrasentan on efficacy (the degree of the individual response in the urinary albumin‐to‐creatinine ratio [UACR]) and safety/tolerability (signs of sodium retention and acute increases in serum creatinine) to assess the effects of this agent on major renal outcomes. The patient population and enrichment results are described here. Methods: Patients with type 2 diabetes with an estimated glomerular filtration rate (eGFR) within 25 to 75 mL/min/1.73 m2 and UACR between 300 and 5000 mg/g were enrolled. After a run‐in period, eligible patients received 0.75 mg/d of atrasentan for 6 weeks. A total of 2648 responder patients in whom UACR decreased by ≥30% compared to baseline were enrolled, as were 1020 non‐responders with a UACR decrease of &lt;30%. Patients who experienced a weight gain of &gt;3 kg and in whom brain natriuretic peptide exceeded ≥300 pg/mL, or who experienced an increase in serum creatinine &gt;20% (0.5 mg/dL), were not randomized. Results: Baseline characteristics were similar for atrasentan responders and non‐responders. Upon entry to the study, median UACR was 802 mg/g in responders and 920 mg/g in non‐responders. After 6 weeks of treatment with atrasentan, the UACR change in responders was −48.8% (95% CI, −49.8% to −47.9%) and in non‐responders was −1.2% (95% CI, −6.4% to 3.9%). Changes in other renal risk markers were similar between responders and non‐responders except for a marginally greater reduction in systolic blood pressure and eGFR in responders. Conclusions: The enrichment period has successfully identified a population with a profound UACR reduction without clinical signs of sodium retention in whom a large atrasentan effect on clinically important renal outcomes is possible. The SONAR trial aims to establish whether atrasentan confers renal protection