Epidemiology of pulmonary hypertension: new data from the Swiss registry

BACKGROUND: since 1999 data from pulmonary hypertension (PH) patients from all PH centres in Switzerland were prospectively collected. We analyse the epidemiological aspects of these data. METHODS: PH was defined as a mean pulmonary artery pressure of >25 mm Hg at rest or >30 mm Hg during exercise. Patients with pulmonary arterial hypertension (PAH), PH associated with lung diseases, PH due to chronic thrombotic and/or embolic disease (CTEPH), or PH due to miscellaneous disorders were registered. Data from adult patients included between January 1999 and December 2004 were analysed. RESULTS: 250 patients were registered (age 58 +/- 16 years, 104 (41%) males). 152 patients (61%) had PAH, 73 (29%) had CTEPH and 18 (7%) had PH associated with lung disease. Patients 50 years (76% vs. 53%, p <0.005). Twenty-four patients (10%) were lost to followup, 58 patients (26%) died and 150 (66%) survived without transplantation or thrombendarterectomy. Survivors differed from patients who died in the baseline six-minute walking distance (400 m [300-459] vs. 273 m [174-415]), the functional impairment (NYHA class III/IV 86% vs. 98%), mixed venous saturation (63% [57-68] vs. 56% [50-61]) and right atrial pressure (7 mm Hg [4-11] vs. 11 mm Hg [4-18]). DISCUSSION: PH is a disease affecting adults of all ages. The management of these patients in specialised centres guarantees a high quality of care. Analysis of the registry data could be an instrument for quality control and might help identify weak points in assessment and treatment of these patients

Pulse-pressure variation and hemodynamic response in patients with elevated pulmonary artery pressure: a clinical study

Pulse-pressure variation (PPV) due to increased right ventricular afterload and dysfunction may misleadingly suggest volume responsiveness. We aimed to assess prediction of volume responsiveness with PPV in patients with increased pulmonary artery pressure

The Burst Alert Telescope (BAT) on the Swift MIDEX Mission

The Burst Alert Telescope (BAT) is one of 3 instruments on the Swift MIDEX spacecraft to study gamma-ray bursts (GRBs). The BAT first detects the GRB and localizes the burst direction to an accuracy of 1-4 arcmin within 20 sec after the start of the event. The GRB trigger initiates an autonomous spacecraft slew to point the two narrow field-of-view (FOV) instruments at the burst location within 20-70 sec so to make follow-up x-ray and optical observations. The BAT is a wide-FOV, coded-aperture instrument with a CdZnTe detector plane. The detector plane is composed of 32,768 pieces of CdZnTe (4x4x2mm), and the coded-aperture mask is composed of approximately 52,000 pieces of lead (5x5x1mm) with a 1-m separation between mask and detector plane. The BAT operates over the 15-150 keV energy range with approximately 7 keV resolution, a sensitivity of approximately 10E-8 erg*cm^-2*s^-1, and a 1.4 sr (half-coded) FOV. We expect to detect >100 GRBs/yr for a 2-year mission. The BAT also performs an all-sky hard x-ray survey with a sensitivity of approximately 2 mCrab (systematic limit) and it serves as a hard x-ray transient monitor.Comment: 18 Pages, 12 Figures, To be published in Space Science Review

A Search for Correlation of Ultra-High Energy Cosmic Rays with IRAS-PSCz and 2MASS-6dF Galaxies

We study the arrival directions of 69 ultra-high energy cosmic rays (UHECRs) observed at the Pierre Auger Observatory (PAO) with energies exceeding 55 EeV. We investigate whether the UHECRs exhibit the anisotropy signal expected if the primary particles are protons that originate in galaxies in the local universe, or in sources correlated with these galaxies. We cross-correlate the UHECR arrival directions with the positions of IRAS-PSCz and 2MASS-6dF galaxies taking into account particle energy losses during propagation. This is the first time that the 6dF survey is used in a search for the sources of UHECRs and the first time that the PSCz survey is used with the full 69 PAO events. The observed cross-correlation signal is larger for the PAO UHECRs than for 94% (98%) of realisations from an isotropic distribution when cross-correlated with the PSCz (6dF). On the other hand the observed cross-correlation signal is lower than that expected from 85% of realisations, had the UHECRs originated in galaxies in either survey. The observed cross-correlation signal does exceed that expected by 50% of the realisations if the UHECRs are randomly deflected by intervening magnetic fields by 5 degrees or more. We propose a new method of analysing the expected anisotropy signal, by dividing the predicted UHECR source distribution into equal predicted flux radial shells, which can help localise and constrain the properties of UHECR sources. We find that the 69 PAO events are consistent with isotropy in the nearest of three shells we define, whereas there is weak evidence for correlation with the predicted source distribution in the two more distant shells in which the galaxy distribution is less anisotropic.Comment: 23 pages, version published in JCA

AGN dust tori: the X-ray-infrared connection

We have combined the CLASXS Chandra survey in Lockman with the Spitzer SWIRE survey data to study the X-ray-infrared connection for AGN. The sample consists of 401 X-ray-sources, of which 306 are detected by Spitzer, and a further 257 AGN candidates detected through their dust torus, but not by Chandra. For X-ray sources the X-ray hardness ratio has been modelled in terms of a power-law with absorption N(H). The optical and infrared data have been modelled in terms of our well-established optical galaxy and QSO templates, and infrared templates based on radiative transfer models. Our estimate of the N(H) distribution is consistent with other studies, but we do find a higher proportion of low absorption objects at z 0.5. While we find only one X-ray AGN with N(H) > 10^{24} cm^{-2}, we argue that 10 objects with torus luminosity apparently exceeding the bolometric X-ray to 3 \mu m luminosity are strong candidates for being heavily absorbed in X-rays. We also estimate that at least half of the infrared-detected AGN dust tori which are undetected in X-rays are likely to be Compton thick. Our estimate of the total number of Compton-thick objects corresponds to > 20%$ of the combined SWIRE-CLASXS sample (and with an upper limit of 39 %). The range of dust covering factors is 1-100 %, with a mean of 40 %, ie a Type 2 fraction of 40 %. Measured by the ratio of dust torus luminosity to X-ray or (for Type 1 objects) optical luminosity, the covering factor appears to decrease towards intermediate AGN luminosity, in contradiction to estimates based on ratios of narrow-line and broad-line spectra, but may increase again at low AGN luminosity.Comment: 15 pages, 18 figures, accepted for publication MNRA

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Left ventricular afterload reduction by transcatheter aortic valve implantation in severe aortic stenosis and its prompt effects on comprehensive coronary haemodynamics.

AIMS In this study we aimed to test the hypothesis that left ventricular (LV) afterload reduction in severe aortic valve stenosis (AS) by transcatheter aortic valve implantation (TAVI) acutely improves coronary haemodynamics. METHODS AND RESULTS This was a prospective, pathophysiologic study in 40 patients with severe AS undergoing TAVI. Endpoints were determined invasively immediately before and after TAVI without altering coronary stenotic lesions if present. Myocardial hyperaemia was induced by intravenous adenosine. The primary study endpoints were coronary flow reserve (thermodilution-derived CFR), and fractional flow reserve (FFR). The secondary study endpoint was coronary collateral flow index (CFI) as obtained during a one-minute coronary balloon occlusion. CFR was 1.9±0.9 before TAVI and 2.0±1.0 after TAVI (p=0.72). FFR was 0.90±0.08 before TAVI and 0.93±0.08 after TAVI (p=0.0021). The TAVI-induced increase in FFR was related to a significant decrease in hyperaemic mean aortic pressure from 71±16 mmHg before TAVI to 67±15 mmHg after TAVI (p=0.0099). Hyperaemic CFI increased from 0.127±0.083 before to 0.146±0.090 after TAVI (p=0.0508). CONCLUSIONS CFR appears not to be acutely affected by LV afterload reduction among patients with severe AS in response to TAVI. However, it acutely improves FFR; this occurs via lowering of mean aortic pressure. Hyperaemic coronary collateral flow index tends to augment in response to TAVI