Semiclosed-circuit atmosphere control in a portable recompression chamber

A small portable recompression chamber is described that can be used both to treat a diver for decompression sickness or to transport him to a larger chamber complex. The device can be operated in either open circuit or semiclosed circuit atmospheres, permits two way conversation between patient and attendant, and uses an air injector for circulation of the chamber atmosphere

Effect of humidity on transonic flow

An experimental investigation of the effects of humidity-induced condensation on shock/boundary-layer interaction has been conducted in a transonic wind-tunnel test. The test geometry considered was a wall-mounted bump model inserted in the test section of the wind tunnel. The formation of a λ-shape condensation shock wave was shown from schlieren visualization and resulted in a forward movement of the shock wave, reduced shock wave strength, and reduced separation. Empirical correlations of the shock wave strength and humidity/dew point temperature were established. For humidity levels below 0.15 or a dew point temperature of 268 K, the effect of humidity was negligible. The unsteady pressure measurements showed that if a condensation shock wave formed and interacted with a main shock wave, the flow becomes unsteady with periodic flow oscillations occurring at 720 Hz

Environmental effects of SPS: The middle atmosphere

The heavy lift launch vehicle associated with the solar power satellite (SPS) would deposit in the upper atmosphere exhaust and reentry products which could modify the composition of the stratosphere, mesosphere, and lower ionosphere. In order to assess such effects, atmospheric model simulations were performed, especially considering a geographic zone centered at the launch and reentry latitudes

The Influence of Heart Failure Self-Care on Health Outcomes: Hypothetical Cardioprotective Mechanisms

Lapses in self-care are commonly cited as a major cause of poor outcomes in persons with heart failure (HF). Not surprisingly, self-care is assumed to be central to improving health outcomes in this patient population. Empirically, however, this assumption is not well supported, and mechanistically, relationships between self-care and outcomes in HF have not yet been described. In this review, it is proposed that effective self-care maintenance (adherence) and self-care management (symptom evaluation and management) practices are complementary to optimal medical management in delaying HF progression and improving health outcomes in this population. Potential mechanisms through which effective HF self-care practices are complementary to pharmacological therapy in improving outcomes include (a) facilitating partial blockade and partial deactivation of deleterious neurohormones, (b) limiting inflammatory processes, (c) decreasing the need for administration of detrimental pharmacological agents, and (d) minimizing myocardial hibernation. Because these mechanisms are hypothetical, research findings are required to establish their validity. Several strategic research questions are proposed

Razvojni prospekti bankarstva u novim i budućim zemljama članicama EU

Bank consolidation has substantially decreased the number of banks in European banking, which has had important implications for the banking sectors structure in all EU member countries. The consolidation processes have had a tremendous impact on the developments in banking sectors of new EU member countries, where major structural changes have been initiated mostly by new entrant banks from the old EU member countries. The future banking development in new EU member countries will very likely follow some main patterns known from the old EU members. Rather speculative conjectures, which are based on a comparison with banking sectors in other EU member countries indicate, that the total-asset-to-GDP ratio in new member countries should further improve in the future. The banking sector growth will be based mostly on the growth of the credit to non-banking sector, while banks are not expected anymore to use non-bank deposits as a predominant way of funding. Instead potentials for alternative funding possibilities should be activated. Although the non-bank financial intermediaries in new EU members represent a serious competition to banks, their relative underdevelopment prevents them from impacting the developments in banking sectors as known from old EU member countries.Konsolidacija banaka znatno je smanjila broj banaka u europskom bankarstvu, što ima značajne implikacije na bankarski sektor u svim zemljama članicama EU. Konsolidacija banaka imala je veliki utjecaj na razvoj bankarskog sektora svih novih zemalja članica, gdje su najveće strukturalne promjene inicirane stvaranjem novih banaka uz sudioništvo starih članica EU. Budući bankarski razvoj u novim zemljama članicama EU vjerojatno će se temeljiti na onom starih članica. Više spekulativna nagađanja, koja se temelje na usporedbi s bankarskim sektorima u drugim zemljama članicama, pokazuju da će se odnos kapitala prema BDP u novim zemljama članicama povećavati u budućnosti. Rast bankarskog sektora temeljit će se većim dijelom na rastu zajmova nebankarskim sektorima, a od banaka se očekuje da više ne rabe nebankarske depozite kao glavni oblik financiranja. Umjesto toga, trebaju se aktivirati mogućnosti za alternativnim financiranjem. Nebankarski financijski posrednici u novim zemljama članicama EU bankama predstavljaju ozbiljnu konkurenciju, međutim, njihova relativna nerazvijenost sprečava ih da utječu na razvoj u bankarskom sektoru kao što je to bio slučaj u starim zemljama članicama EU

Psychometric Analysis of the Heart Failure Somatic Perception Scale as a Measure of Patient Symptom Perception.

BACKGROUND: Symptoms are known to predict survival among patients with heart failure (HF), but discrepancies exist between patients\u27 and health providers\u27 perceptions of HF symptom burden. OBJECTIVE: The purpose of this study is to quantify the internal consistency, validity, and prognostic value of patient perception of a broad range of HF symptoms using an HF-specific physical symptom measure, the 18-item HF Somatic Perception Scale v. 3. METHODS: Factor analysis of the HF Somatic Perception Scale was conducted in a convenience sample of 378 patients with chronic HF. Convergent validity was examined using the Physical Limitation subscale of the Kansas City Cardiomyopathy Questionnaire. Divergent validity was examined using the Self-care of HF Index self-care management score. One-year survival based on HF Somatic Perception Scale scores was quantified using Cox regression controlling for Seattle HF Model scores to account for clinical status, therapeutics, and lab values. RESULTS: The sample was 63% male, 85% white, 67% functionally compromised (New York Heart Association class III-IV) with a mean (SD) age of 63 (12.8) years. Internal consistency of the HF Somatic Perception Scale was α = .90. Convergent (r = -0.54, P \u3c .0001) and divergent (r = 0.18, P \u3e .05) validities were supported. Controlling for Seattle HF scores, HF Somatic Perception Scale was a significant predictor of 1-year survival, with those most symptomatic having worse survival (hazard ratio, 1.012; 95% confidence interval, 1.001-1.024; P = .038). CONCLUSIONS: Perception of HF symptom burden as measured by the HF Somatic Perception Scale is a significant predictor of survival, contributing additional prognostic value over and above objective Seattle HF Risk Model scores. This analysis suggests that assessment of a broad range of HF symptoms, or those related to dyspnea or early and subtle symptoms, may be useful in evaluating therapeutic outcomes and predicting event-free survival

A Model Predicting the Health Status of Patients with Heart Failure

Objective: To test the causal relationships among the components of sociodemographics,illnesscharacteristics, and selfmanagement ability, and health status in the model of health status of patients with heart failure (HSHF). Design: Descriptive cross-sectional study Materials and methods: Four hundred heart failure patients, either hospitalized or attending out-patient clinics at six hospitals in southern Thailand, were interviewed. Questionnaires covered sociodemographics, the duration of illness, severity of illness, comorbid diseases, measured by the New York Heart Association Functional Classification (NYHA-FC) using the Charlson Comorbidity Index, self-management ability, using the Self-Care of Heart Failure Index (SCHFI), and health status using the Short Form-36 Health Survey (SF-36). The relationships among the study variables were tested and modified under the structural equation modeling (SEM) technique by using LISREL. Results: The collected data were found not to fit with the initial hypothesized model but after modification the new derived model gave an adequate fit with the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status (β=-0.20, p \u3c 0.01) and had an indirect negative effect on health status through self-management ability, severity of illness and comorbid disease (β=-0.13, p \u3c 0.01). Education had a direct positive effect on health status (β=0.12, p \u3c 0.01). Gender and income had indirect negative effects on health status through severity of illness (β=-0.05; -0.05, p \u3c 0.05). Duration of illness had an indirect positive effect on health status through self-management ability (β=0.09, p \u3c 0.05). Severity of illness and comorbid disease had a direct negative effect on health status (β=-0.31; -0.16, p \u3c 0.01, respectively) and indirect negative effect on health status through self-management ability (β=-0.06; -0.05, p \u3c 0.05, respectively). Selfmanagement ability had a direct positive effect on health status (β=0.38, p \u3c 0.01). Conclusions: The final model provides a guideline for explaining and predicting the health status of patients with heart failure. To improve health status continuity care programs promoting self management ability should be developed and imple-mented both in hospital-based and home-based settings

The Problem with Cronbach\u27s Alpha: Comment on Sijtsma and Van der Ark (2015)

Knowledge of a scale\u27s dimensionality is an essential preliminary step to the application of any measure of reliability derived from classical test theory--an approach commonly used is nursing research. The focus of this article is on the applied aspects of reliability and dimensionality testing. Throughout the article, the Self-Care of Heart Failure Index is used to exemplify real-world data challenges of quantifying reliability and to provide insight into how to overcome such challenges

Measures of Self-Care in Heart Failure: Issues with Factorial Structure and Reliability

Dear Editor We read with great interest the recently published paper by Dr Lambrinou and colleagues1 entitled “The Greek version of the 9-item European heart failure self-care behaviour scale: A multidimensional or an uni-dimensional scale?” The paper is one of several papers published on the psychometric properties of the European Heart Failure Self-care Behaviour Scale (EHFScBS) and continues to raise the important questions: (1) Is self-care of heart failure (HF) a multidimensional or an uni-dimensional construct? (2) Is self-care of HF a generalizable construct across countries? (3) Is Cronbach\u27s alpha the best approach to estimate reliability of instruments

Identifying Biomarker Patterns and Predictors of Inflammation and Myocardial Stress

BACKGROUND: Regular exercise is recommended to improve outcomes in patients with heart failure. Exercise is known to decrease inflammation and thought to decrease myocardial stress; however, studies of exercise in heart failure have had mixed results on levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP). A multimarker analysis may help to identify distinct subgroups of patients who respond to exercise. Our primary study objective was to identify common and distinct patterns of change in hsCRP and NT-proBNP and to quantify the influence of exercise therapy on the observed patterns of change. METHODS AND RESULTS: NT-proBNP and hsCRP were assessed in a random sample of 320 participants from the biomarker substudy of HF-ACTION, a randomized clinical trial of exercise training versus usual care in patients with stable and chronic heart failure. Growth mixture modeling was used to identify unique biomarker patterns over 12 months. Three statistically independent and clinically meaningful biomarker patterns of NT-proBNP and hsCRP were identified. Two patterns were combined and compared with the low/stable\u22 pattern, which was characterized by the lowest levels of NT-proBNP and hsCRP over time. Participants who were taking a loop diuretic and had hypertension or ischemic etiology were ∼2 times as likely to be in the elevated/worsening biomarker pattern. Participants randomized to the exercise intervention were less likely to be in the elevated/worsening pattern of NT-proBNP and hsCRP (relative risk ratio 0.56, 95% confidence interval 0.32-0.98; P = .04). CONCLUSIONS: Exercise therapy was protective for reducing the frequency of membership in the elevated/worsening biomarker pattern, indicating that exercise may be helpful in delaying the progression of heart failure