Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

Natural clusters of tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND): new findings from the TOSCA TAND research project.

BACKGROUND: Tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) have unique, individual patterns that pose significant challenges for diagnosis, psycho-education, and intervention planning. A recent study suggested that it may be feasible to use TAND Checklist data and data-driven methods to generate natural TAND clusters. However, the study had a small sample size and data from only two countries. Here, we investigated the replicability of identifying natural TAND clusters from a larger and more diverse sample from the TOSCA study. METHODS: As part of the TOSCA international TSC registry study, this embedded research project collected TAND Checklist data from individuals with TSC. Correlation coefficients were calculated for TAND variables to generate a correlation matrix. Hierarchical cluster and factor analysis methods were used for data reduction and identification of natural TAND clusters. RESULTS: A total of 85 individuals with TSC (female:male, 40:45) from 7 countries were enrolled. Cluster analysis grouped the TAND variables into 6 clusters: a scholastic cluster (reading, writing, spelling, mathematics, visuo-spatial difficulties, disorientation), a hyperactive/impulsive cluster (hyperactivity, impulsivity, self-injurious behavior), a mood/anxiety cluster (anxiety, depressed mood, sleep difficulties, shyness), a neuropsychological cluster (attention/concentration difficulties, memory, attention, dual/multi-tasking, executive skills deficits), a dysregulated behavior cluster (mood swings, aggressive outbursts, temper tantrums), and an autism spectrum disorder (ASD)-like cluster (delayed language, poor eye contact, repetitive behaviors, unusual use of language, inflexibility, difficulties associated with eating). The natural clusters mapped reasonably well onto the six-factor solution generated. Comparison between cluster and factor solutions from this study and the earlier feasibility study showed significant similarity, particularly in cluster solutions. CONCLUSIONS: Results from this TOSCA research project in an independent international data set showed that the combination of cluster analysis and factor analysis may be able to identify clinically meaningful natural TAND clusters. Findings were remarkably similar to those identified in the earlier feasibility study, supporting the potential robustness of these natural TAND clusters. Further steps should include examination of larger samples, investigation of internal consistency, and evaluation of the robustness of the proposed natural clusters

GRAZING-ANGLE NEUTRON DIFFRACTION

Nous décrivons les principes de la diffraction en incidence rasante en y apportant notre propre contribution. En s'affranchissant des collimations non nécessaires, nous pouvons augmenter l'intensité limitée utilisable provenant des sources conventionnelles de neutrons, tout en préservant la sensibilité en profondeur de la méthode de diffusion en incidence rasante. Nous avons étudié un film de 3200 Å de Cr, déposé par épitaxie en jet moléculaire. Nous présentons et discutons les résultats obtenus.We describe the principles of grazing-angle neutron diffraction and our implementation of it. By relaxing non-essential collimations, we can make optimal use of the limited intensity available from conventional neutron sources, yet still preserve the depth-sensitivity of the grazing-angle method. We have studied a 3200 Å Cr film, grown by molecular beam epitaxy and discuss the results of this measurement in the context of current experimental conditions and future improvements

SURFACE PHASE TRANSITION AND KINETICS OF Cu3Au (111)

Nous avons analysé la transition ordre-désordre de Cu3Au au voisinage de la surface (111) en utilisant la technique de diffusion de rayons X en incidence rasante. Le film de 5000 Å de Cu3Au a été déposé par épitaxie sur du saphir (11[MATH]0) couvert par une couche tampon de Nb. Les expériences ont été conduites à la fois en fonction de la température et de l'angle d'incidence, ce dernier déterminant la profondeur de pénétration. Quand on approche de la température de désordre, les balayages radiaux de la réflexion (1[MATH]0) de surstructure présentent des profils non classiques qui consistent en la superposition de deux composantes gaussiennes. Ce profil indique qu'au voisinage de la surface de petits domaines désordonnés peuvent coexister avec des grands complètement ordonnés, ce qui est très différent du comportement du composé massif. De plus, des expériences de trempe faites à partir de températures supérieures à Tc montrent que le volume s'ordonne avant la surface et que le développement d'un profil à composante unique ou double dépend respectivement de la vitesse rapide, ou lente, de la trempe.Using glancing angle x-ray scattering techniques we have investigated the order-disorder transition of Cu3Au close to a (111) surface. The 5000Å thick Cu3Au film was grown epitaxially on a sapphire (11[MATH]0) substrate with a Nb buffer layer. The experiments were made as a function of both temperature and angle of incidence, the latter determining the penetration depth. Upon approaching the disordering temperature, radial scans of the (1[MATH]0) superstructure reflection exhibit non-classical line shapes consisting of a superposition of two Gaussian components. This profile indicates that close to the surface small disordered clusters may coexist with larger ordered domains, which is much different from the bulk behavior. In addition, quenching experiments from above to various temperatures below the ordering temperature showed that the bulk orders before the surface does and that the development of a single or double component line shape depends on whether the quench is deep or shallow

Correlation between Crystal Structure and Thermoelectric Properties of Sr1−xTi0.9Nb0.1O3−δ Ceramics

Polycrystalline Sr1−xTi0.9Nb0.1O3−δ (x = 0, 0.1, 0.2) ceramics have been prepared by the solid state method and their structural and thermoelectric properties have been studied by neutron powder diffraction (NPD), thermal, and transport measurements. The structural analysis of Sr1-xTi0.9Nb0.1O3−δ (x = 0.1, 0.2) confirms the presence of a significant amount of oxygen vacancies, associated with the Sr-deficiency of the materials. The analysis of the anisotropic displacement parameters (ADPs) indicates a strong softening of the overall phonon modes for these samples, which is confirmed by the extremely low thermal conductivity value (κ ≈ 1.6 W m-1 K−1 at 823 K) found for Sr1−xTi0.9Nb0.1O3−δ (x = 0.1, 0.2). This approach of introducing A-site cation vacancies for decreasing the thermal conductivity seems more effective than the classical substitution of strontium by rare-earth elements in SrTiO3 and opens a new optimization scheme for the thermoelectric properties of oxides

Fast psychomotor functioning in anorexia nervosa: Effect of weight restoration

Item does not contain fulltextIn a previous study young seriously underweight anorexia nervosa (AN) patients in the early phase of treatment were found to react faster in psychomotor tasks. To further understand this finding we studied the impact of weight restoration on the performance of AN patients in drawing and copying tasks. A group of 17 female AN patients, aged 14 to 25, was compared with 17 healthy controls, matched for sex, age and educational level. Patients were tested when severely underweight and after weight restoration. Control subjects were also tested twice. Using computerized recording and analysis of writing and drawing behavior, reaction times and drawing times were derived, while cognitive and motor demands were manipulated. Overall, AN patients showed shorter reaction times in copying tasks and shorter drawing time in the drawing task than normal controls, and this pattern persisted after weight restoration. No significant group (AN vs. controls) by session (test vs. retest) effect emerged. The finding of a consistent pattern of shorter reaction and drawing times in AN patients before and after weight restoration is compatible with a personality characteristic of perfectionism and overachievement in AN patients