Heart rate and blood pressure monitoring in heart failure.

It has been long known that incessant tachycardia and severe hypertension can cause heart failure (HF). In recent years, it has also been recognized that more modest elevations in either heart rate (HR) or blood pressure (BP), if sustained, can be a risk factor both for the development of HF and for mortality in patients with established HF. Heart rate and BP are thus both modifiable risk factors in the setting of HF. What is less clear is the question whether routine systematic monitoring of these simple physiological parameters to a target value can offer clinical benefits. Measuring these parameters clinically during patient review is recommended in HF management in most HF guidelines, both in the acute and chronic phases of the disease. More sophisticated systems now allow long-term automatic or remote monitoring of HR and BP and whether this more detailed patient information can improve clinical outcomes will require prospective RCTs to evaluate. In addition, analysis of patterns of both HR and BP variability can give insights into autonomic function, which is also frequently abnormal in HF. This window into autonomic dysfunction in our HF patients can also provide further independent prognostic information and may in itself be target for future interventional therapies. This article, developed during a consensus meeting of the Heart Failure Association of the ESC concerning the role of physiological monitoring in the complex multi-morbid HF patient, highlights the importance of repeated assessment of HR and BP in HF, and reviews gaps in our knowledge and potential future directions

Renal function, electrolytes, and congestion monitoring in heart failure.

Congestion, renal function, and electrolyte imbalance (particularly potassium) are common problems in the management of the complex multi-morbid patient with heart failure (HF). Poor control of these fundamental clinical features is associated with adverse outcomes. Close monitoring of serum potassium and renal function is recommended by most current guidelines during the management of an episode of acute decompensated HF, yet the recommendations remain poorly implemented. Physicians are advised to treat a state of euvolaemia after an admission with decompensated HF and residual congestion is a marker of worse outcome, yet control of congestion is poorly assessed and managed in real-world practice. This document reflects the key points discussed by a panel of experts during a Heart Failure Association meeting on physiological monitoring of the complex multi-morbid HF patient, and here, we present to aspects related to renal function, electrolyte, and congestion monitoring

Bounded variability of metric temporal logic

Deciding validity of Metric Temporal Logic (MTL) formulas is generally very complex and even undecidable over dense time domains; bounded variability is one of the several restrictions that have been proposed to bring decidability back. A temporal model has bounded variability if no more than v events occur over any time interval of length V, for constant parameters v and V. Previous work has shown that MTL validity over models with bounded variability is less complex—and often decidable—than MTL validity over unconstrained models. This paper studies the related problem of deciding whether an MTL formula has intrinsic bounded variability, that is whether it is satisfied only by models with bounded variability. The results of the paper are mainly negative: over dense time domains, the problem is mostly undecidable (even if with an undecidability degree that is typically lower than deciding validity); over discrete time domains, it is decidable with the same complexity as deciding validity. As a partial complement to these negative results, the paper also identifies MTL fragments where deciding bounded variability is simpler than validity, which may provide for a reduction in complexity in some practical cases

Learning from mistakes: An empirical study of elicitation interviews performed by novices

© 2018 IEEE. [Context] Interviews are the most widely used elicitation technique in requirements engineering. However, conducting effective requirements elicitation interviews is challenging, due to the combination of technical and soft skills that requirements analysts often acquire after a long period of professional practice. Empirical evidence about training the novices on conducting effective requirements elicitation interviews is scarce. [Objectives] We present a list of most common mistakes that novices make in requirements elicitation interviews. The objective is to assist the educators in teaching interviewing skills to student analysts. [Re-search Method] We conducted an empirical study involving role-playing and authentic assessment with 110 students, teamed up in 28 groups, to conduct interviews with a customer. One re-searcher made observation notes during the interview while two researchers reviewed the recordings. We qualitatively analyzed the data to identify the themes and classify the mistakes. [Results and conclusion] We identified 34 unique mistakes classified into 7 high level themes. We also give examples of the mistakes made by the novices in each theme, to assist the educationists and trainers. Our research design is a novel combination of well-known pedagogical approaches described in sufficient details to make it re-peatable for future requirements engineering education and training research

Cytomegalovirus-associated pulmonary exacerbation in patients with cystic fibrosis.

CMV is an unusual cause of pulmonary exacerbation in immunocompetent individuals with CF http://ow.ly/Rdds30hlnjV

Genetic polymorphisms of glutathione S-transferases GSTM1, GSTT1, GSTP1 and GSTA1 as risk factors for schizophrenia

Oxidative damage is thought to play a role in the predisposition to schizophrenia. We determined if the polymorphisms of the GSTP1, GSTM1, GSTT1 and GSTA1 genes, which affect the activity of these enzymes against oxidative stress, have a role as susceptibility genes for schizophrenia, analyzing 138 schizophrenic patients and 133 healthy controls. We found that the combination of the absence of GSTM1 gene with the of the GSTM1 gene with the polymorphism GSTA1*B/*B, and the presence of the GSTT1 gene, represents a risk factor for schizophrenia, indicating that the combination of different GST polymorphisms has a role in the predisposition to schizophrenia, probably affecting the capacity of the cell to detoxify the oxidized metabolites of catecholamines

Integrated Structure and Semantics for Reo Connectors and Petri Nets

In this paper, we present an integrated structural and behavioral model of Reo connectors and Petri nets, allowing a direct comparison of the two concurrency models. For this purpose, we introduce a notion of connectors which consist of a number of interconnected, user-defined primitives with fixed behavior. While the structure of connectors resembles hypergraphs, their semantics is given in terms of so-called port automata. We define both models in a categorical setting where composition operations can be elegantly defined and integrated. Specifically, we formalize structural gluings of connectors as pushouts, and joins of port automata as pullbacks. We then define a semantical functor from the connector to the port automata category which preserves this composition. We further show how to encode Reo connectors and Petri nets into this model and indicate applications to dynamic reconfigurations modeled using double pushout graph transformation

Coordination via Interaction Constraints I: Local Logic

Wegner describes coordination as constrained interaction. We take this approach literally and define a coordination model based on interaction constraints and partial, iterative and interactive constraint satisfaction. Our model captures behaviour described in terms of synchronisation and data flow constraints, plus various modes of interaction with the outside world provided by external constraint symbols, on-the-fly constraint generation, and coordination variables. Underlying our approach is an engine performing (partial) constraint satisfaction of the sets of constraints. Our model extends previous work on three counts: firstly, a more advanced notion of external interaction is offered; secondly, our approach enables local satisfaction of constraints with appropriate partial solutions, avoiding global synchronisation over the entire constraints set; and, as a consequence, constraint satisfaction can finally occur concurrently, and multiple parts of a set of constraints can be solved and interact with the outside world in an asynchronous manner, unless synchronisation is required by the constraints. This paper describes the underlying logic, which enables a notion of local solution, and relates this logic to the more global approach of our previous work based on classical logic

ZNF804A risk allele is associated with relatively intact gray matter volume in patients with schizophrenia

ZNF804A rs1344706 is the first genetic risk variant to achieve genome wide significance for psychosis. Following earlier evidence that patients carrying the ZNF804A risk allele had relatively spared memory function compared to patient non-carriers, we investigated whether ZNF804A was also associated with variation in brain volume. In a sample of 70 patients and 38 healthy participants we used voxel based morphometry to compare homozygous (AA) carriers of the ZNF804A risk allele to heterozygous and homozygous (AC/CC) non-carriers for both whole brain volume and specific regions implicated in earlier ZNF804A studies-the dorsolateral pre-frontal cortex, the hippocampus, and the amygdala. For patients, but not for controls, we found that homozygous 'AA' risk carriers had relatively larger gray matter volumes than heterozygous/homozygous non-carriers (AC/CC), particularly for hippocampal volumes. These data are consistent with our earlier behavioral data and suggest that ZNF804A is delineating a schizophrenia subtype characterized by relatively intact brain volume. Establishing if this represents a discrete molecular pathogenesis with consequences for nosology and treatment will be an important next step in understanding ZNF084A's role in illness risk