The Impact of Frailty on Health Related Quality of Life in Heart Failure

Background/Aims: Most heart failure (HF) hospital discharges involve people \u3e 65 years, many frail. The purpose of this study was to determine if frailty explains variability in health related quality of life (HRQOL) in older adults with HF over and above known correlates. Methods: A frailty index score was developed by weighting age, number of comorbid conditions, and symptom severity. A multivariate hierarchical regression analysis of known predictors of HRQOLgender, income, ethnicity, health perception, NYHA class — were entered first and then the frailty index was entered and regressed on HRQOL in 2 unique samples. Results: When known predictors were tested on a sample they explained 11% (p 0.14) of the variance in HRQOL; when the frailty index score was added 24% (p 0.001) was explained. When the index was validated in a second sample, known predictors explained 15% (p 0.04) of the variance; with the frailty index score 40% (p 0.000) was explained. Conclusion: Frailty explains significant amounts of variance in HRQOL in HF. Treating comorbid conditions and controlling symptoms may improve HRQOL in HF patients. These findings support the need for further research into the impact of frailty on HRQOL in HF patients

A Systematic Review and Integration of Concept Analyses of Self-Care and Related Concepts

Purpose This systematic review identified, synthesized, and integrated concept analyses on self‐care and related concepts. Design The guidelines for systematic literature reviews of the Joanna Briggs Institute were followed. Methods The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and EMBASE databases were searched for concept analyses published in the past 20 years. Findings A total of 26 concept analyses were identified that had been published on self‐care, self‐care agency, self‐monitoring, self‐management, self‐management support, symptom management, and self‐efficacy. Differences and commonalities in the examined literature were identified, and a model was delineated, explaining the relations among the various concepts from the nursing perspective. Conclusions The healthcare literature has broadly described self‐care and related concepts; however, consensus on the definitions remains beyond our reach and should not be expected, due to the different perspectives and paradigms from which the concepts are interpreted. From a nursing perspective, self‐care can be considered a broad concept encompassing the other concepts, which describe more specific individual levels of activities and processes. Clinical Relevance Nurses are actively involved in disease management and self‐management support as well as in promoting self‐care in healthy and sick people. Referring to a model on self‐care and related concepts could avoid misinterpretations in nursing practice, research, and policy

Origin of the giant magnetic moments of Fe impurities on and in Cs films

To explore the origin of the observed giant magnetic moments ($\sim 7 \mu_B$) of Fe impurities on the surface and in the bulk of Cs films, we have performed the relativistic LSDA + U calculations using the linearized muffin-tin orbital (LMTO) band method. We have found that Fe impurities in Cs behave differently from those in noble metals or in Pd. Whereas the induced spin polarization of Cs atoms is negligible, the Fe ion itself is found to be the source of the giant magnetic moment. The 3d electrons of Fe in Cs are localized as the 4f electrons in rare-earth ions so that the orbital magnetic moment becomes as large as the spin magnetic moment. The calculated total magnetic moment of $M = 6.43 \mu_B$, which comes mainly from Fe ion, is close to the experimentally observed value.Comment: 4 pages including 3 figures and 1 table. Submitted to PR

Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial

Aims Intense health-care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE-HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health-care service use (e.g. emergency service use and hospitalizations) and all-cause mortality.Methods and results This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face-to-face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health-care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014-0.882, P = 0.04]; no difference was found at subsequent follow-ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104-1.414, P = 0.15).Conclusion This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow-up are needed to clarify the benefits of MI on health-care service use and mortality

Hydrogel-Based Flexible Energy Storage Using Electrodes Based on Polypyrrole and Carbon Threads

Developing new flexible and electroactive materials is a significant challenge to producing safe, reliable, and environmentally friendly energy storage devices. This study introduces a promising electrolyte system that fulfills these requirements. First, polypyrrole (PPy) nanotubes are electropolymerized in graphite-thread electrodes using methyl orange (MO) templates in an acidic medium. The modification increases the conductivity and does not compromise the flexibility of the electrodes. Next, flexible supercapacitors are built using hydrogel prepared from poly(vinyl alcohol) (PVA)/sodium alginate (SA) obtained by freeze–thawing and swollen with ionic solutions as an electrolyte. The material exhibits a homogenous and porous hydrogel matrix allowing a high conductivity of 3.6 mS cm−1 as-prepared while displaying great versatility, changing its electrochemical and mechanical properties depending on the swollen electrolyte. Therefore, it allows its combination with modified graphite-thread electrodes into a quasi-solid electrochemical energy storage device, achieving a specific capacitance (Cs) value of 66 F g−1 at 0.5 A g−1. Finally, the flexible device exhibits specific energy and power values of 19.9 W kg−1 and 3.0 Wh kg−1, relying on the liquid phase in the hydrogel matrix produced from biodegradable polymers. This study shows an environment friendly, flexible, and tunable quasi-solid electrolyte, depending on a simple swell experiment to shape its properties according to its application

Clinical and Socio-Demographic Determinants of Self-Care Behaviours in Patients with Heart Failure and Diabetes Mellitus: A Multicentre Cross-Sectional Study

Background Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. Objectives (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. Design Secondary analysis of data from a multicentre cross-sectional study. Setting Outpatient clinics from 29 Italian provinces. Participants 1192 adults with confirmed diagnosis of heart failure. Methods Socio-demographic and clinical data were abstracted from patients’ medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score \u3c70 indicates inadequate self-care. Multiple linear regression analyses were performed. Results Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p = 0.12), self-care management (p = 0.21) or self-care confidence (p = 0.51). Age (p = 0.04), number of medications (p = 0.01), presence of a caregiver (p = 0.04), family income (p = 0.009) and self-care confidence (p \u3c 0.001) were determinants of self-care maintenance. Gender (p = 0.01), number of medications (p = 0.004) and self-care confidence (p \u3c 0.001) were significant determinants of self-care management. Number of medications (p = 0.002) and cognitive function (p \u3c 0.001) were determinants of self-care confidence. Conclusions Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care

An Automated Method for the Detection and Extraction of HI Self-Absorption in High-Resolution 21cm Line Surveys

We describe algorithms that detect 21cm line HI self-absorption (HISA) in large data sets and extract it for analysis. Our search method identifies HISA as spatially and spectrally confined dark HI features that appear as negative residuals after removing larger-scale emission components with a modified CLEAN algorithm. Adjacent HISA volume-pixels (voxels) are grouped into features in (l,b,v) space, and the HI brightness of voxels outside the 3-D feature boundaries is smoothly interpolated to estimate the absorption amplitude and the unabsorbed HI emission brightness. The reliability and completeness of our HISA detection scheme have been tested extensively with model data. We detect most features over a wide range of sizes, linewidths, amplitudes, and background levels, with poor detection only where the absorption brightness temperature amplitude is weak, the absorption scale approaches that of the correlated noise, or the background level is too faint for HISA to be distinguished reliably from emission gaps. False detection rates are very low in all parts of the parameter space except at sizes and amplitudes approaching those of noise fluctuations. Absorption measurement biases introduced by the method are generally small and appear to arise from cases of incomplete HISA detection. This paper is the third in a series examining HISA at high angular resolution. A companion paper (Paper II) uses our HISA search and extraction method to investigate the cold atomic gas distribution in the Canadian Galactic Plane Survey.Comment: 39 pages, including 14 figure pages; to appear in June 10 ApJ, volume 626; figure quality significantly reduced for astro-ph; for full resolution, please see http://www.ras.ucalgary.ca/~gibson/hisa/cgps1_survey

The VLA Galactic Plane Survey

The VLA Galactic Plane Survey (VGPS) is a survey of HI and 21-cm continuum emission in the Galactic plane between longitude 18 degrees 67 degr. with latitude coverage from |b| < 1.3 degr. to |b| < 2.3 degr. The survey area was observed with the Very Large Array (VLA) in 990 pointings. Short-spacing information for the HI line emission was obtained by additional observations with the Green Bank Telescope (GBT). HI spectral line images are presented with a resolution of 1 arcmin x 1 arcmin x 1.56 km/s (FWHM) and rms noise of 2 K per 0.824 km/s channel. Continuum images made from channels without HI line emission have 1 arcmin (FWHM) resolution. VGPS images are compared with images from the Canadian Galactic Plane Survey (CGPS) and the Southern Galactic Plane Survey (SGPS). In general, the agreement between these surveys is impressive, considering the differences in instrumentation and image processing techniques used for each survey. The differences between VGPS and CGPS images are small, < 6 K (rms) in channels where the mean HI brightness temperature in the field exceeds 80 K. A similar degree of consistency is found between the VGPS and SGPS. The agreement we find between arcminute resolution surveys of the Galactic plane is a crucial step towards combining these surveys into a single uniform dataset which covers 90% of the Galactic disk: the International Galactic Plane Survey (IGPS). The VGPS data will be made available on the World Wide Web through the Canadian Astronomy Data Centre (CADC).Comment: Accepted for publication in The Astronomical Journal. 41 pages, 13 figures. For information on data release, colour images etc. see http://www.ras.ucalgary.ca/VGP

HI Narrow Line Absorption in Dark Clouds

We have used the Arecibo telescope to carry out an survey of 31 dark clouds in the Taurus/Perseus region for narrow absorption features in HI ($\lambda$ 21cm) and OH (1667 and 1665 MHz) emission. We detected HI narrow self--absorption (HINSA) in 77% of the clouds that we observed. HINSA and OH emission, observed simultaneously are remarkably well correlated. Spectrally, they have the same nonthermal line width and the same line centroid velocity. Spatially, they both peak at the optically--selected central position of each cloud, and both fall off toward the cloud edges. Sources with clear HINSA feature have also been observed in transitions of CO, \13co, \c18o, and CI. HINSA exhibits better correlation with molecular tracers than with CI. The line width of the absorption feature, together with analyses of the relevant radiative transfer provide upper limits to the kinetic temperature of the gas producing the HINSA. Some sources must have a temperature close to or lower than 10 K. The correlation of column densities and line widths of HINSA with those characteristics of molecular tracers suggest that a significant fraction of the atomic hydrogen is located in the cold, well--shielded portions of molecular clouds, and is mixed with the molecular gas. The average number density ratio [HI]/[\h2] is $1.5\times10^{-3}$. The inferred HI density appears consistent with but is slightly higher than the value expected in steady state equilibrium between formation of HI via cosmic ray destruction of H$_2$ and destruction via formation of H$_2$ on grain surfaces. The distribution and abundance of atomic hydrogen in molecular clouds is a critical test of dark cloud chemistry and structure, including the issues of grain surface reaction rates, PDRs, circulation, and turbulent diffusion.Comment: 40 pages, 10 figures, accepted by Ap