Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure

AbstractObjectivesThis study aimed to investigate the impact of hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) therapy in patients with advanced heart failure (HF).BackgroundAlthough statins are known to reduce mortality in coronary artery disease (CAD), the impact of statin therapy in patients with HF has not been well studied. Both the potential risks and benefits of statins in HF have been described.MethodsWe studied a cohort of 551 patients with systolic HF (left ventricular ejection fraction [EF] ≤40%) referred to a single university center for clinical management and/or transplant evaluation. Survival without the necessity of urgent heart transplantation was determined.ResultsThe patients' mean age was 52 ± 13 years; mean EF was 25 ± 7%. Forty-five percent of the cohort had CAD, and 45% were receiving statin therapy, including 73% and 22% of CAD and non-CAD patients with HF, respectively. Patients receiving statins were significantly older and more likely to be male, with higher rates of hypertension, diabetes, and smoking. The EF and cholesterol levels were similar between treated and non-treated patients. Statin use was associated with improved survival without the necessity of urgent transplantation in both non-ischemic and ischemic HF patients (91% vs. 72%, p < 0.001 and 81% vs. 63%, p < 0.001 at one-year follow-up, respectively). After risk adjustment for age, gender, CAD, cholesterol, diabetes, medications, hemoglobin, creatinine, and New York Heart Association functional class, statin therapy remained an independent predictor of improved survival (hazard ratio 0.41 95% confidence interval 0.18 to 0.94).ConclusionsStatin therapy is associated with improved survival in patients with ischemic and non-ischemic HF. Randomized trials are needed for confirmation of a therapeutic benefit

Di[2,6-bis(5-phenylpyrazol-3-yl)pyridine]Co(II): an old coordination mode fora novel supramolecular assembly

CoCl2 was treated with 1, 2, and 6 eq. of 2,6-bis(5-phenylpyrazol-3-yl)pyridine (H2L) yielding respectively the monosubstituted [Co(H2L)Cl2], the disubstituted [Co(H2L)2][PF6]2, and a supramolecular assembly formed by a central disubstituted octahedral complex and four more hydrogen bonded peripheral ligands, [{Co(H2L)2}(H2L)4][PF6]2, as illustrated by X-ray crystal structure analysis

Experienced tutors' deployment of thinking skills and what might be entailed in enhancing such skills

In the context of research that reports weaknesses in adults' critical thinking skills, the primary aim was to examine adults' use of critical thinking skills that are described in taxonomies and to identify areas for development. Position papers written by an opportunity sample of 32 experienced adult educators formed the data for a descriptive sample survey design intended to reveal participants' use of critical thinking skills. Each 6000-word paper was written during a development programme that supported such skills. A content analysis of the papers revealed that when participants drew on personal and published ideas about learning to derive their proposals for change, they accepted the ideas uncritically, thereby implying that they might find it difficult to help learners to examine ideas critically. The evidence supports research that implies that critical thinking skills are unlikely to develop unless overall course design privileges the development of epistemological understanding (King and Kitchener 1994, Kuhn 1999). A fundamental assumption underlying the study is that this understanding influences effective citizenship and personal development, as well as employability. A proposition that merits attention in future research is that the development of epistemological understanding is largely neglected in current curricula in formal post-16 education

Helping education undergraduates to use appropriate criteria for evaluating accounts of motivation

The aim of the study was to compare students in a control group with those in a treatment group with respect to evaluative comments on psychological accounts of motivation. The treatment group systematically scrutinized the nature and interpretation of evidence that supported different accounts, and the assumptions, logic, coherence and clarity of accounts. Content analysis of 74 scripts (using three categories) showed that the control group students made more assertions than either evidential or evaluative points, whereas the treatment group used evaluative statements as often as they used assertion. The findings provide support for privileging activities that develop understanding of how knowledge might be contested, and suggest a need for further research on pedagogies to serve this end. The idea is considered that such understanding has a pivotal role in the development of critical thinking

Divergent Mitochondrial Biogenesis Responses in Human Cardiomyopathy

Background—Mitochondria are key players in the development and progression of heart failure (HF). Mitochondrial (mt) dysfunction leads to diminished energy production and increased cell death contributing to the progression of left ventricular failure. The fundamental mechanisms that underlie mt dysfunction in HF have not been fully elucidated. Methods and Results—To characterize mt morphology, biogenesis, and genomic integrity in human HF, we investigated left ventricular tissue from nonfailing hearts and end-stage ischemic (ICM) or dilated (DCM) cardiomyopathic hearts. Although mt dysfunction was present in both types of cardiomyopathy, mt were smaller and increased in number in DCM compared with ICM or nonfailing hearts. mt volume density and mtDNA copy number was increased by ≈2-fold (P<0.001) in DCM hearts in comparison with ICM hearts. These changes were accompanied by an increase in the expression of mtDNA-encoded genes in DCM versus no change in ICM. mtDNA repair and antioxidant genes were reduced in failing hearts, suggestive of a defective repair and protection system, which may account for the 4.1-fold increase in mtDNA deletion mutations in DCM (P<0.05 versus nonfailing hearts, P<0.05 versus ICM). Conclusions—In DCM, mt dysfunction is associated with mtDNA damage and deletions, which could be a consequence of mutating stress coupled with a peroxisome proliferator-activated receptor γ coactivator 1α–dependent stimulus for mt biogenesis. However, this maladaptive compensatory response contributes to additional oxidative damage. Thus, our findings support further investigations into novel mechanisms and therapeutic strategies for mt dysfunction in DCM

Induced Photon Correlations Through the Overlap of Two Four-Wave Mixing Processes in Integrated Cavities

Induced photon correlations are directly demonstrated by exploring two coupled nonlinear processes in an integrated device. Using orthogonally polarized modes within an integrated microring cavity, phase matching of two different nonlinear four-wave mixing processes is achieved simultaneously, wherein both processes share one target frequency mode, while their other frequency modes differ. The overlap of these modes leads to the coupling of both nonlinear processes, producing photon correlations. The nature of this process is confirmed by means of time- and power-dependent photon correlation measurements. These findings are relevant to the fundamental understanding of spontaneous parametric effects as well as single-photon-induced processes, and their effect on optical quantum state generation and control

Academic achievement : the role of praise in motivating students

The motivation of students is an important issue in higher education, particularly in the context of the increasing diversity of student populations. A social-cognitive perspective assumes motivation to be dynamic, context-sensitive and changeable, thereby rendering it to be a much more differentiated construct than previously understood. This complexity may be perplexing to tutors who are keen to develop applications to improve academic achievement. One application that is within the control of the tutor, at least to some extent, is the use of praise. Using psychological literature the article argues that in motivating students, the tutor is not well served by relying on simplistic and common sense understandings of the construct of praise and that effective applications of praise are mediated by students' goal orientations, which of themselves may be either additive or interactive composites of different objectives and different contexts

Representing addition and subtraction : learning the formal conventions

The study was designed to test the effects of a structured intervention in teaching children to represent addition and subtraction. In a post-test only control group design, 90 five-year-olds experienced the intervention entitled Bi-directional Translation whilst 90 control subjects experienced typical teaching. Post-intervention testing showed some significant differences between the two groups both in terms of being able to effect the addition and subtraction operations and in being able to determine which operation was appropriate. The results suggest that, contrary to historical practices, children's exploration of real world situations should precede practice in arithmetical symbol manipulation