Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction

<p><b>Background:</b> The purpose of this study was to examine the prevalence of abnormalities in cardiac structure and function present in patients with heart failure and a preserved ejection fraction (HFPEF) and to determine whether these alterations in structure and function were associated with cardiovascular morbidity and mortality.</p> <p><b>Methods and Results:</b> The Irbesartan in HFPEF trial (I-PRESERVE) enrolled 4128 patients; echocardiographic determination of left ventricular (LV) volume, mass, left atrial (LA) size, systolic function, and diastolic function were made at baseline in 745 patients. The primary end point was death or protocol-specific cardiovascular hospitalization. A secondary end point was the composite of heart failure death or heart failure hospitalization. Associations between baseline structure and function and patient outcomes were examined using univariate and multivariable Cox proportional hazard analyses. In this substudy, LV hypertrophy or concentric remodeling was present in 59%, LA enlargement was present in 66%, and diastolic dysfunction was present in 69% of the patients. Multivariable analyses controlling for 7 clinical variables (including log N-terminal pro-B–type natriuretic peptide) indicated that increased LV mass, mass/volume ratio, and LA size were independently associated with an increased risk of both primary and heart failure events (all P<0.05).</p> <p><b>Conclusions:</b> Left ventricular hypertrophy or concentric remodeling, LA enlargement, and diastolic dysfunction were present in the majority of patients with HFPEF. Left ventricular mass and LA size were independently associated with an increased risk of morbidity and mortality. The presence of structural remodeling and diastolic dysfunction may be useful additions to diagnostic criteria and provide important prognostic insights in patients with HFPEF.</p&gt

A nitrogen-based model of plankton dynamics in the oceanic mixed layer

As a first step toward the development of coupled, basin scale models of ocean circulation and biogeochemical cycling, we present a model of the annual cycles of plankton dynamics and nitrogen cycling in the oceanic mixed layer. The model is easily modified and runs in FORTRAN on a personal computer. In our initial development and exploration of the model\u27s behavior we have concentrated on modeling the annual cycle at Station S near Bermuda using seven compartments (Phytoplankton, Zooplankton, Bacteria, Nitrate, Ammonium, Dissolved organic nitrogen and Detritus). This choice of compartments and the attendant flows (fluxes or intercompartmental exchanges) permits a functional distinction between new and regenerated production. We have examined over 200 different runs and carried out sensitivity analyses. Results of model runs with detrital sinking rates of 1 and 10 meters per day are presented. In these runs, the phytoplankton biomass-specific mortality rate was varied to adjust the annual net primary production (NPP) for the mixed layer to a value equivalent to 45 gC m−2, which was calculated from the literature. Modelled cycles of zooplankton and bacterial stocks, and magnitudes of their annual production which cannot be validated due to sparse observations, are driven by the amplitude of the spring bloom and by changes in foodweb structure. Most, but not all model runs exhibit a spring bloom triggered by the winter depression of zooplankton stocks and the vernal increase in solar irradiance. The bloom is driven by nitrate entrained into the mixed layer during the wintertime deepening of the mixed layer. Following the shoaling of the pycnocline to ca 20 m, nitrate supply is limited to diffusional inputs, nitrate stocks are depleted, and regenerated production exceeds new production. The resulting cycles of new and regenerated production produce an annual cycle of the f-ratio with winter maxima approaching 0.8–0.9 and summer minima reaching ca 0.1–0.2, with annual values averaging 0.7. The model reproduces the Eppley Curve, a hyperbolic relationship of increasing f with increasing primary production. This curve is shown to be the trajectory of the production system in the f-NPP phase plane. These model runs reproduce the annual cycles of areal NPP, and average annual NPP, new production, and particulate N flux values reported in the literature. The model demonstrates that currently accepted values for these annual fluxes can be reconciled only if the f-ratio has a high annual average. At present, the annual average f-ratio is poorly quantified due to severe undersampling in fall and winter. Our model\u27s ecological structure has been successfully incorporated into the Princeton general circulation model for the North Atlantic Ocean

An unusual “venous circle” of the internal mammary vein encountered during microvascular anastomosis and implications for practice

The internal mammary vessels are commonly used for anastomosis in breast reconstruction. The anatomy when using the 2nd ICS has been shown to be predictable and hence preferentially used by the senior author. We present an unusual case of internal mammary vein bifurcation and immediate confluence forming a ‘venous circle’

The Emerging Church Movement: An Exploratory Case Study of Its Environmental and Political Attitudes

To date, no investigation of the Emerging Church Movement has made an effort to examine the environmental and political views of its members. Despite the vast research on the politics and environmental opinions of American evangelicals, little is known about where the majority of members of the Emerging Church Movement are on the political spectrum or how they view environmental protection and climate change issues. As an exploratory case study, this thesis advances our understanding of the Emerging Church Movement by considering these issues and how the movement influences its members. Using interviews and participant-observation, this thesis utilized qualitative methods to analyze and compare the environmental and political views of emerging church members against those of traditional evangelicals. There were three main findings from this research: (1) members of the Emerging Church Movement are more politically moderate than their evangelical counterparts; (2) social action calls were heard in church services rather than political action calls; and (3) environmental protection, though seen as important, did not appear to be a prominent issue in the Emerging Church Movement. The findings from the research suggest that there were both differences and similarities among the views of emerging church members and traditional evangelicals. The methods and practices employed in this study present a usable framework for future research, while the findings prompt new and interesting questions for future research on the nascent study of the Emerging Church Movement

Is Strategy Different for Very Small and New Firms?

In this paper, we argue that much of the small business strategic management literature has drawn too heavily from work done on large, established firms. We build upon the notions of the liabilities of smallness and newness to discuss how microenterprises and very new firms are different in regards to their strategic analysis, strategic content, strategic resources, and strategic processes. We note that there are a number of important and non-obvious questions that need to be asked that have implications for the most common firms in the world, those that are very small

HI galaxies with little star formation: an abundance of LIERs

We present a sample of 91 HI galaxies with little or no star formation and discuss the analysis of the integral field unit (IFU) spectra of 28 of these galaxies. We identified HI galaxies from the HI Parkes All-Sky Survey Catalog (HICAT) with Wide-field Infrared Survey Explorer (WISE) colours consistent with low specific star formation (< 10$^{-10.4}$ yr$^{-1}$), and obtained optical IFU spectra with the Wide-Field Spectrograph (WiFeS). Visual inspection of the PanSTARRS, Dark Energy Survey, and Carnegie-Irvine imaging of 62 galaxies reveals that at least 32 galaxies in the sample have low levels of star formation, primarily in arms/rings. New IFU spectra of 28 of these galaxies reveal 3 galaxies with central star formation, 1 galaxy with low-ionisation nuclear emission-line regions (LINERs), 20 with extended low-ionisation emission-line regions (LIERs) and 4 with high excitation Seyfert (Sy) emission. From the spectroscopic analysis of HI-selected galaxies with little star formation, we conclude that 75% of this population are LINERs/LIERs

Wave propagation in stereo-lithographical (STL) bone replicas at oblique incidence

Comparisons between predictions of a Biot-Allard model allowing for angle-dependent elasticity and angle-and-porosity dependent tortuosity and transmission data obtained at normal incidence on water-saturated replica bones are extended to oblique incidence. The model includes two parameters which are adjusted for best fit at normal incidence. Using the same parameter values, it is found that predictions of the variation of transmitted waveforms with angle through two types of bone replica are in reasonable agreement with data despite the fact that scattering is not included in the theory

The Tully–Fisher relation from SDSS-MaNGA: physical causes of scatter and variation at different radii

The stellar mass Tully–Fisher relation (STFR) and its scatter encode valuable information about the processes shaping galaxy evolution across cosmic time. However, we are still missing a proper quantification of the STFR slope and scatter dependence on the baryonic tracer used to quantify rotational velocity, on the velocity measurement radius and on galaxy integrated properties. We present a catalogue of stellar and ionized gas (traced by H emission) kinematic measurements for a sample of galaxies drawn from the MaNGA Galaxy Survey, providing an ideal tool for galaxy formation model calibration and for comparison with high-redshift studies. We compute the STFRs for stellar and gas rotation at 1, 1.3 and 2 effective radii (Re). The relations for both baryonic components become shallower at 2Re compared to 1Re and 1.3Re. We report a steeper STFR for the stars in the inner parts (≤1.3Re) compared to the gas. At 2Re, the relations for the two components are consistent. When accounting for covariances with integrated v/σ, scatter in the stellar and gas STFRs shows no strong correlation with: optical morphology, star formation rate surface density, tidal interaction strength or gas accretion signatures. Our results suggest that the STFR scatter is driven by an increase in stellar/gas dispersional support, from either external (mergers) or internal (feedback) processes. No correlation between STFR scatter and environment is found. Nearby Universe galaxies have their stars and gas in statistically different states of dynamical equilibrium in the inner parts (≤1.3Re), while at 2Re the two components are dynamically coupled

GECKOS: Turning galaxy evolution on its side with deep observations of edge-on galaxies

We present GECKOS (Generalising Edge-on galaxies and their Chemical bimodalities, Kinematics, and Outflows out to Solar environments), a new ESO VLT/MUSE large program. The main aim of GECKOS is to reveal the variation in key physical processes of disk formation by connecting Galactic Archaeology with integral field spectroscopic observations of nearby galaxies. Edge-on galaxies are ideal for this task: they allow us to disentangle the assembly history imprinted in thick disks and provide the greatest insights into outflows. The GECKOS sample of 35 nearby edge-on disk galaxies is designed to trace the assembly histories and properties of galaxies across a large range of star formation rates, bulge-to-total ratios, and boxy and non-boxy bulges. GECKOS will deliver spatially resolved measurements of stellar abundances, ages, and kinematics, as well as ionised gas metallicities, ionisation parameters, pressure, and inflow and outflow kinematics; all key parameters for building a complete chemodynamical picture of disk galaxies. With these data, we aim to extend Galactic analysis methods to the wider galaxy population, reaping the benefits of detailed Milky Way studies, while probing the diverse mechanisms of galaxy evolution.Comment: 6 pages, 2 figures, Proceedings of IAUS 377, eds. F. Tabatabaei, B. Barbuy, and Y. Tin

Clinical and echocardiographic characteristics and cardiovascular outcomes according to diabetes status in patients with heart failure and preserved ejection fraction. A report from the Irbesartan in Heart Failure with Preserved Ejection Fraction Trial (I-Preserve)

Background—In patients with HF and preserved ejection fraction (HFpEF), little is known about the characteristics of and outcomes in those with and without diabetes. Methods—We examined clinical and echocardiographic characteristics and outcomes in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial (I-Preserve), according to history of diabetes. Cox regression models were used to estimate hazard ratios (HR) for cardiovascular outcomes adjusted for known predictors, including age, sex, natriuretic peptides, and comorbidity. Echocardiographic data were available in 745 patients and were additionally adjusted for in supplementary analyses. Results—Overall, 1134 of 4128 patients (27%) had diabetes. Compared to those without diabetes, they were more likely to have a history of myocardial infarction (28% vs. 22%), higher BMI (31kg/m2 vs. 29kg/m2), worse Minnesota living with HF score (48 vs. 40), higher median NT-proBNP concentration (403 vs 320 pg/ml; all p&lt;0.01), more signs of congestion but no significant difference in LVEF. Patients with diabetes had a greater left ventricular (LV) mass and left atrial area than patients without diabetes. Doppler E wave velocity (86 vs 76 cm/sec, p&lt;0.0001) and the ratio of E/e' (11.7 vs 10.4, p=0.010) were higher in patients with diabetes. Over a median follow-up of 4.1 years, cardiovascular death or HF hospitalization occurred in 34% of patients with diabetes vs. 22% of those without diabetes; adjusted HR 1.75 (95% CI 1.49-2.05) and 28% vs. 19% of patients with and without diabetes died; adjusted HR 1.59 (1.33-1.91). Conclusions—In HFpEF, patients with diabetes have more signs of congestion, worse quality of life, higher NT-proBNP levels, and a poorer prognosis. They also display greater structural and functional echocardiographic abnormalities. Further investigation is needed to determine the mediators of the adverse impact of diabetes on outcomes in HFPEF, and whether they are modifiable