320 research outputs found

    Biomarkers to Improve Prognostication in Heart Failure

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    Biomarkers to Improve Prognostication in Heart Failure

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    The relationship of undergraduate cognitive development and academic advising preference at two small, private, liberal arts colleges

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    Though developmental advising has been widely accepted for some time, some recent studies have questioned whether this approach to advising is universally appropriate. The primary purposes of this study were to determine what, if any, relationship exists between students\u27 preference for academic advising approach and either their level of cognitive development or their gender. One hundred seventy-three students at two small, private, liberal arts colleges completed the Academic Advising Inventory (AAI) to assess their advising preferences and the Measure of Epistemological Reflection (MER) to measure cognitive development levels. A correlation coefficient of scores on the AAI and the MER indicated there is no significant relationship. Similarly, there was no statistically significant difference in mean scores on advising preference between men and women. In response to additional research questions regarding other factors that might influence student preference for advising approach or affect students\u27 advising experiences, MER results and information from interviews of twelve participants revealed that relational skills of advisers, student lack of experience with advising, and adviser accessibility influence student advising experiences. Implications for practice in the field of academic advising and recommendations for further research are included

    Yes it is,… no it isn't: A reply to van Vark and Bilsborough

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    No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37669/1/1330950110_ftp.pd

    Under pressure: security and stability related challenges for liberal democracy in North-western Europe

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    Liberal democracy in the world is under pressure. This article will specifically look at security and stability related challenges for liberal democracy in a specific region, namely North-western Europe. As will be shown, three distinct security and stability related challenges put pressure on liberal democracy in this region. Firstly, the struggle by states to provide security for their citizens in an era where the blurring of internal and external security leads to “new” security threats. Secondly, the decline of social cohesion in society, causing unrest and instability. Thirdly, the undermining of liberal democracy by the state. As will be shown, these challenges have an impact on the organizations working in the security domain as well, in particular the armed forces and the police. Paradoxically, efforts by governments to counter the security and stability related challenges could eventually lead to a declining stability of liberal democracy.Centrum Regionale KennisontwikkelingEffective Protection of Fundamental Rights in a pluralist worl

    Individualized Angiotensin‐Converting Enzyme (ACE)‐Inhibitor Therapy in Stable Coronary Artery Disease Based on Clinical and Pharmacogenetic Determinants: The PERindopril GENEtic (PERGENE) Risk Model

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    Patients with stable coronary artery disease (CAD) constitute a heterogeneous group in which the treatment benefits by angiotensin-converting enzyme (ACE)-inhibitor therapy vary between individuals. Our objective was to integrate clinical and pharmacogenetic determinants in an ultimate combined risk prediction model.Clinical, genetic, and outcomes data were used from 8726 stable CAD patients participating in the EUROPA/PERGENE trial of perindopril versus placebo. Multivariable analysis of phenotype data resulted in a clinical risk score (range, 0-21 points). Three single-nucleotide polymorphisms (rs275651 and rs5182 in the angiotensin-II type I-receptor gene and rs12050217 in the bradykinin type I-receptor gene) were used to construct a pharmacogenetic risk score (PGXscore; range, 0-6 points). Seven hundred eighty-five patients (9.0%) experienced the primary endpoint of cardiovascular mortality, nonfatal myocardial infarction or resuscitated cardiac arrest, during 4.2 years of follow-up. Absolute risk reductions ranged from 1.2% to 7.5% in the 73.5% of patients with PGXscore of 0 to 2. As a consequence, estimated annual numbers needed to treat ranged from as low as 29 (clinical risk score ≥10 and PGXscore of 0) to 521 (clinical risk score ≤6 and PGXscore of 2). Furthermore, our data suggest that long-term perindopril prescription in patients with a PGXscore of 0 to 2 is cost-effective.Both baseline clinical phenotype, as well as genotype determine the efficacy of widely prescribed ACE inhibition in stable CAD. Integration of clinical and pharmacogenetic determinants in a combined risk prediction model demonstrated a very wide range of gradients of absolute treatment benefit

    Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of reninangiotensinaldosterone system inhibitors involving 158 998 patients

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    AimsRenin-Angiotensin-Aldosterone system (RAAS) inhibitors are well established for the reduction in cardiovascular morbidity, but their impact on all-cause mortality in hypertensive patients is uncertain. Our objective was to analyse the effects of RAAS inhibitors as a class of drugs, as well as of angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers (ARBs) separately, on all-cause mortality. Methods and resultsWe performed a pooled analysis of 20 cardiovascular morbiditymortality trials. In each trial at least two-thirds of the patients had to be diagnosed with hypertension, according to the trial-specific definition, and randomized to treatment with an RAAS inhibitor or control treatment. The cohort included 158 998 patients (71 401 RAAS inhibitor; 87 597 control). The incidence of all-cause death was 20.9 and 23.3 per 1000 patient-years in patients randomized to RAAS inhibition and controls, respectively. Overall, RAAS inhibition was associated with a 5 reduction in all-cause mortality (HR: 0.95, 95 CI: 0.911.00, P = 0.032), and a 7 reduction in cardiovascular mortality (HR: 0.93, 95 CI: 0.880.99, P = 0.018). The observed treatment effect resulted entirely from the class of ACE inhibitors, which were associated with a significant 10 reduction in all-cause mortality (HR: 0.90, 95 CI: 0.840.97, P = 0.004), whereas no mortality reduction could be demonstrated with ARB treatment (HR: 0.99, 95 CI: 0.941.04, P = 0.683). This difference in treatment effect between ACE inhibitors and ARBs on all-cause mortality was statistically significant (P-value for heterogeneity 0.036). ConclusionIn patients with hypertension, treatment with an ACE inhibitor results in a significant further reduction in all-cause mortality. Because of the high prevalence of hypertension, the widespread use of ACE inhibitors may result in an important gain in lives saved

    Appetite-regulating hormones in early life and relationships with type of feeding and body composition in healthy term infants

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    Introduction: Body composition in early life influences development of obesity during childhood and beyond. Appetite-regulating hormones (ARH) play a role in regulation of food intake and might thus influence body composition in later life. Studies on associations between ARH and body composition in early life are limited. Methods: In 197 healthy term infants, we measured serum fasting levels of ghrelin, leptin, insulin, glucose-dependent insulinotropic peptide (GIP), pancreatic polypeptide (PP) and peptide YY (PYY) at 3 months and in 41 infants also at 6 months and their associations with type of feeding and longitudinal fat mass percentage (FM%) measured by air displacement plethysmography at 1, 3 and 6 months and abdominal visceral and subcutaneous fat, measured by ultrasound, at 3 and 6 months. Results: Infants with formula feeding for 3 months had significantly higher serum levels of ghrelin, leptin, insulin, GIP and PP (p = 0.026, p = 0.018, p = 0.002, p < 0.001, resp.) and lower serum levels of PYY (p = 0.002) at 3 months than breastfed infants. Leptin and ghrelin correlated positively with FM% at 3 months and insulin with change in FM% between 1 and 3 months (r = 0.40, p < 0.001, r = 0.23, p < 0.05, r = 0.22, p < 0.01, resp.). Leptin at 3 months correlated with subcutaneous fat at 3 months (r = 0.23, p < 0.001), but not with visceral fat. Other ARH did not correlate with body composition. Conclusion: Formula-fed infants had a different profile of ARH than breastfed infants, suggesting that lower levels of ghrelin, leptin and insulin in breastfed infants contribute to the protective role of breastfeeding against obesity development. Leptin, ghrelin and insulin were associated with fat mass percentage or its changes
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