Association is not causation: treatment effects cannot be estimated from observational data in heart failure

Aims: Treatment ‘effects’ are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). Methods and results: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the ‘effect’ of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. Conclusion: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients

The NASA Space Communications Data Networking Architecture

The NASA Space Communications Architecture Working Group (SCAWG) has recently been developing an integrated agency-wide space communications architecture in order to provide the necessary communication and navigation capabilities to support NASA's new Exploration and Science Programs. A critical element of the space communications architecture is the end-to-end Data Networking Architecture, which must provide a wide range of services required for missions ranging from planetary rovers to human spaceflight, and from sub-orbital space to deep space. Requirements for a higher degree of user autonomy and interoperability between a variety of elements must be accommodated within an architecture that necessarily features minimum operational complexity. The architecture must also be scalable and evolvable to meet mission needs for the next 25 years. This paper will describe the recommended NASA Data Networking Architecture, present some of the rationale for the recommendations, and will illustrate an application of the architecture to example NASA missions

Structure and Hydrogen Bonding in CaSiD\u3csub\u3e1+ \u3cem\u3ex\u3c/em\u3e\u3c/sub\u3e: Issues About Covalent Bonding

We report here our high-resolution neutron powder diffraction and neutron vibrational spectroscopy study of CaSiD1+x along with first-principles calculations, which reveal the deuterium structural arrangements and bonding in this novel alloy hydride. Both the structural and spectroscopic results show that, for x \u3e 0, D atoms start occupying a Ca3Si interstitial site. The corresponding Si-D bond length is determined to be 1.82 Å, fully 0.24 Å larger than predicted by theory. Thus, our neutron measurements are at odds with the strongly covalent Si-H bonding in CaSiH1+x that such calculations suggest, a result which may have implications for a number of ongoing studies of metal-hydrogen systems destabilized by Si alloying

Validation and preliminary data from a health-related quality of life questionnaire for owners of dogs with cardiac disease

BACKGROUND: Cardiac disease in dogs impacts the quality of life (QoL) of their owners, but owners\u27 QoL has not been comprehensively assessed in this population. OBJECTIVES: To develop, validate, and provide preliminary data from a health-related QoL (hrQoL) questionnaire for owners of dogs with cardiac disease. SUBJECTS: A total of 141 owners of dogs with cardiac disease were studied. METHODS: An owner hrQoL (O-hrQoL) questionnaire containing 20 items related to areas of a person\u27s life that could be impacted by caring for a dog with cardiac disease was developed and administered to owners of dogs with cardiac disease. The highest possible total score was 100, with higher scores indicating a worse hrQoL. Readability, internal consistency, face and construct validity, and item-total correlations were assessed. RESULTS: Median O-hrQoL score was 35 (range, 0-87). The questionnaire had good internal consistency (Cronbach\u27s alpha = 0.933), construct validity (Spearman\u27s r = 0.38-0.53; Kendall\u27s tau = 0.30-0.43; P \u3c .001), and item-total correlation (Spearman\u27s r = 0.44-0.79; Kendall\u27s tau = 0.34-0.66; all P \u3c .001). Fifty percent of owners indicated a negative effect of dogs\u27 cardiac disease on their own QoL, but all owners responded that caring for their dogs either had strengthened (n = 76; 53.9%) or had no effect on their relationship with their dog (n = 65; 46.1%). CONCLUSIONS AND CLINICAL IMPORTANCE: The O-hrQoL questionnaire had good validity, and results suggest that owners\u27 QoL is significantly impacted by caring for dogs with cardiac disease. Additional research on effective approaches to minimizing the negative effects of a dog\u27s cardiac disease on the owner is warranted

Neutron Vibrational Spectroscopy and First-Principles Calculations of the Ternary Hydrides Li\u3csub\u3e4\u3c/sub\u3eSi\u3csub\u3e2\u3c/sub\u3eH(D) and Li\u3csub\u3e4\u3c/sub\u3eGe\u3csub\u3e2\u3c/sub\u3eH(D): Electronic Structure and Lattice Dynamics

Using combined neutron spectroscopy and first-principles calculations, we investigated the electronic structure and vibrational dynamics of the recently discovered class of ternary hydrides Li4Tt2H (Tt=Si and Ge). In these compounds, all hydrogen atoms are located in a single type of Li6-defined octahedral site. The Tt atoms form long-range Tt-Tt chains sandwiched between each Li6-octahedra layer. The Li-H interactions are strongly ionic, with bond lengths comparable to those in LiH. Our density functional theory calculations indicate that Li atoms transfer their electrons to both H and Tt atoms. Tt atoms within the Tt-Tt chain are bonded covalently. The electronic density of states reveals that both hydrides exhibit metallic behavior. The observed vibrational spectra of these hydrides are in good overall agreement with the calculated phonon modes. There is evidence of dispersion induced splitting in the optical phonon peaks that can be ascribed to the coupling of H vibrations within the Li6-octahedra layers

The emerging burden of heart failure in adults with congenital heart disease

Ntiloudi et al. confirm the high burden of failure-related morbidity and mortality in adults with CHD. However, the pathways leading to heart failure in ACHD are heterogeneous and often poorly understood. Most importantly, there is a need for more randomized trials. Trials investigating effects on symptoms and surrogate measures of disease need not be large. However, much larger trials are required to investigate the effects of treatment on disease progression and prognosis, requiring collaborations at national and international levels, as is already the case for other forms of heart failure

Structure and Interstitial Deuterium site of ß-phase ZrNi Deuteride

ß-ZrNiD1-x (for x≈0.1, near the ß-γ phase boundary) was found to possess a triclinic P1(overline) structure as determined by high-resolution neutron power diffraction. This is very different from the widely accepted orthohombic and distorted orthorhombic Cmcm structures previously proposed. In contrast to the single type of D site associated with these latter structures, the true ß-ZrNiD1-x structure contains two crystallographically distinct interstitial D sites: Zr4Ni2 octahedral sites and Zr4 tetrahedral sites, alternately ordered along the a direction. From first-principles calculations, the total energy of the P1(overline) structure was found to be ≈0.24 eV per unit cell lower than Cmcm-symmetry ZrNiD and could be rationalized in terms of different D local-bonding configurations and metal-deuterium interactions. Resultant phonon calculations based on this structure were also consistnet with the measured neutron vibrational spectrum