Performance of prognostic risk scores in chronic heart failure patients enrolled in the European Society of Cardiology Heart Failure long-term registry

[Abstract] Objectives. This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Background. Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. Methods. This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients. Results. At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician. Conclusions. Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered

Chemical and spectroscopic characterization of humic acids extracted from the bottom sediments of a Brazilian subtropical microbasin

International audienceHumic substances (HS) perform a fundamental role in aquatic environments, exhibiting different levels of reactivity in retaining metal ions and organic pollutants. Also, they control the primary production of these ecosystems and act in the carbon sequestering process. In order to improve our understanding vis-à-vis the structural and functional features of HS from aquatic systems, this study aimed to chemically and spectroscopically characterize humic acids (HA) isolated from bottom sediment samples of a stream in a Brazilian subtropical microbasin by elemental analysis, and infrared (FT-IR), ultraviolet and visible (UV-Vis) and solid-state 13C nuclear magnetic resonance (CP-MAS 13C NMR) spectroscopies, thermogravimetry (TG), and scanning electron microscopy (SEM). Although all samples originated from the same environment, the data showed that the HA have distinct chemical and spectroscopic properties, and that the location and characteristics of the sampling points from which the sediments were collected played an important role in the differences observed. Furthermore, vascular plant matter is probably the main contributor to these samples

Stable vortex and dipole vector solitons in a saturable nonlinear medium

We study both analytically and numerically the existence, uniqueness, and stability of vortex and dipole vector solitons in a saturable nonlinear medium in (2+1) dimensions. We construct perturbation series expansions for the vortex and dipole vector solitons near the bifurcation point where the vortex and dipole components are small. We show that both solutions uniquely bifurcate from the same bifurcation point. We also prove that both vortex and dipole vector solitons are linearly stable in the neighborhood of the bifurcation point. Far from the bifurcation point, the family of vortex solitons becomes linearly unstable via oscillatory instabilities, while the family of dipole solitons remains stable in the entire domain of existence. In addition, we show that an unstable vortex soliton breaks up either into a rotating dipole soliton or into two rotating fundamental solitons.Comment: To appear in Phys. Rev.

Does the inclusion of protease inhibitors in the insemination extender affect rabbit reproductive performance?

[EN] The bioavailability of buserelin acetate when added to the seminal dose appears to be determined by the activity of the existing aminopeptidases. Thus, the addition of amino peptidase inhibitors to rabbit semen extenders could be a solution to decrease the hormone degradation. This study was conducted to evaluate the effect of the protease activity inhibition on rabbit semen quality parameters and reproductive performance after artificial insemination. Seminal quality was not affected by the incubation with protease inhibitors, being the values of motility, viability, and acrosome integrity not significantly different between the protease inhibitors and the control group. In addition, seminal plasma aminopeptidase activity was inhibited in a 55.1% by the protease inhibitors. On the other hand, regarding the effect of protease inhibitors on reproductive performance, our results showed that the presence of protease inhibitors affected the prolificacy rate (9.2 +/- 0.26 and 9.3 +/- 0.23 vs. 8.2 +/- 0.22 total born per litter for negative control, positive control, and aminopeptidase inhibitors group, respectively; P < 0.05), having this group one kit less per delivery. We conclude that the addition of a wide variety of protease inhibitors in the rabbit semen extender negatively affects prolificacy rate. Therefore, the development of new extenders with specific aminopeptidase inhibitors would be one of the strategies to increase the bioavailability of GnRH analogues without affecting the litter size. (C) 2016 Elsevier Inc. All rights reserved.This research was supported in part by the RTA2013-00058-00-00 from INIA, the European Social Fund and the European FEDER Funds. L Casares-Crespo is supported by a scholarship from Institute Valenciano de Investigaciones Agrarias (IVIA) and the European Social Fund.Casares-Crespo, L.; Vicente Antón, JS.; Talavan, A.; Viudes De Castro, MP. (2016). Does the inclusion of protease inhibitors in the insemination extender affect rabbit reproductive performance?. Theriogenology. 85(5):928-932. doi:10.1016/j.theriogenology.2015.10.044S92893285

Acceptance and Use of E-Learning Based on Cloud Computing: The Role of Consumer Innovativeness

Cloud computing and E-learning are the inevitable trend of computational science in general, and information systems and technologies in specific.However, there are not many studies on the adoption of cloud-based E-learning systems. Moreover, while there are many papers on information system adoption as well as customer innovativeness, the innovativeness and adoption in the same model seems to be rare in the literature. The study combines the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) and consumer innovativeness on the adoption of E-learning systems based on cloud computing. A survey was conducted among 282 cloud-based E-learning participants and analyzed by structural equation modeling (SEM). The findings indicate that the adoption of cloud-based E-learning is influenced by performance expectancy, social influence, hedonic motivation, and habit. Interestingly, although innovativeness is not significant to use intention, it has a positive effect on E-learning usage which is relatively new in Vietnam

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Novel genetic loci associated with hippocampal volume

The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness