Detection of Sleep Disordered Breathing in Patients Hospitalized with Congestive Heart Failure

OBJECTIVES: The purpose of this study was to evaluate the plethysmographic signal-derived oxygen desaturation index (ODI) as an inpatient screening strategy to identify sleep-disordered breathing (SDB) in patients with congestive heart failure (CHF). BACKGROUND: SDB is highly prevalent among patients hospitalized with CHF but is widely underdiagnosed. We evaluated overnight photoplethysmography as a possible screening strategy for hospitalized patients with CHF. METHODS: Consecutively admitted heart failure patients with high clinical suspicion of SDB and ODI ≥5 were offered outpatient polysomnography (PSG), which was completed within 4 weeks of discharge. PSG was considered positive if the apnea hypoxia index (AHI) was ≥5. A Bland-Altman plot was used to assess agreement between ODI and AHI. Receiver-operator characteristics were determined for ODI ≥5 and AHI ≥5. RESULTS: A screening questionnaire identified 246 of 282 consecutive patients with positive symptoms for SDB. Of these patients, 105 patients were offered further evaluation and 86 had ODI ≥5 (mean ODI 17 ± 17). Among these 86 patients, 68 underwent outpatient PSG within 4 weeks of discharge. PSG showed that 64 (94%) had SDB, with a mean AHI of 28. Inpatient ODI correlated well with PSG-derived AHI. The area under the curve was 0.82 for AHI ≥5. The Bland-Altman plot revealed no major bias. Matthew\u27s correlation coefficient revealed that the optimal cut-off for ODI is 5. CONCLUSIONS: Screening hospitalized patients with heart failure using targeted inpatient ODI identifies a cohort of patients with a high prevalence of SDB. Our screening strategy provides a potentially cost-effective method for early detection and treatment of SDB

Scalable Storage for Digital Libraries

I propose a storage system optimised for digital libraries. Its key features are its heterogeneous scalability; its integration and exploitation of rich semantic metadata associated with digital objects; its use of a name space; and its aggressive performance optimisation in the digital library domain

The observation of Land Resources from Space

&nbsp

Managerial share ownership and discretionary accruals in Australia : do independent and executive directors have different incentives?

We examine the relation between managerial share ownership (MSO) and discretionary accruals in Australia. We find a positive relation between MSO and discretionary accruals up to a certain level of MSO followed by a negative relation (inverse U-shaped). We suggest that these unique results are a result of certain Australian institutional features that are markedly different to those in the US and the UK and imply that the ownership-discretionary accruals relation is context specific with the wider corporate governance systems influencing the theorised incentive effects. We also posit that executive directors and independent directors have different ownership-discretionary accruals incentives and report results consistent with this proposition.<br /

The value of executive director share ownership and discretionary accruals

Purpose &ndash; The purpose of this paper is to investigate the relation between the value of executive director share ownership and discretionary accruals.Design/methodology/approach &ndash; This study uses a dataset of 1,173 firm-year observations drawn from 188 Australian listed companies for the period 2000-2006. The analysis is based on multivariate regression analysis and ordinary least square models were used to investigate the relation between the value of managerial ownership and discretionary accruals. The issue of potential endogeneity is addressed by using a simultaneous equation system.Findings &ndash; A negative relation is found between value of managerial share ownership and discretionary accruals at lower levels of value of ownership, which is consistent with the theorised incentive alignment that as the managers commit more resources to their firms, stakeholders impose less contractual constraints specified in terms of accounting numbers and managers make lower accrual adjustments. After a certain level of value of ownership is attained, a positive relations seen, consistent with increased discretionary accrual adjustments associated with stakeholders anticipating managerial entrenchment. Also, it is found that these results are driven by firms with income increasing, as opposed to income decreasing, discretionary accruals.Practical implications &ndash; Shares and options are forming an increasing proportion of executive remuneration that continues to be the subject of much debate amongst regulators and in the media. Showing that the value of share ownership may be an effective internal governance mechanism to help align incentives adds to the debate and has policy implications.Originality/value &ndash; The paper\u27s primary contribution is finding that the value (as opposed to proportion) of share ownership, typically representing a sizeable proportion of managers\u27 undiversified wealth, is a potentially direct driver of theorised incentive alignment and entrenchment effects associated with share ownership

Invited Commentary on: Orthotopic Heart Transplantation in Patients With Metabolic Risk Factors

This is invited commentary to the following article: Kilic, A., Conte, J. V., Shah, A. S., & Yuh, D. D. (2012). Orthotopic heart transplantation in patients with metabolic risk factors. Annals of Thoracic Surgery, 93(3), 718-724

Current Management of Heart Failure: When to Refer to Heart Failure Specialist and When Hospice is the Best Option.

Heart failure is a common syndrome caused by different abnormalities of the cardiovascular system that result in impairment of the ventricles in filling or ejecting blood. It is one of the most common causes of hospitalization in the United States, with a very high cost to the health care system. This article focuses on the causes of left ventricle dysfunction and the presentation and management of heart failure, both acute and chronic

Shrimp Allocation Policies and Regional Development Under Conditions of Environmental Change: Insights for Nunatsiavutimmuit

This report is part of a larger research program examining the relationship between fisheries policy and regional development in Atlantic Canada’s northern shrimp fisheries. Since the extension of Canadian jurisdiction over its 200 mile Exclusive Economic Zone in 1977, federal policy makers have allocated shrimp licenses and quotas to cooperatives, community based organizations, inshore fish harvesters, large fishing companies as well as Indigenous groups. However, our knowledge of the relationship between fisheries policy and regional development outcomes in this fishery remains very limited, with the exception of case studies of a few organizations and regions in southeast Labrador and in Newfoundland. Despite the long history of substantial allocations of shrimp in northern Labrador/Nunatsiavut, we know little about how effective allocation policies have been in meeting regional development goals for Indigenous communities in the region. The objective of this research is to build on and extend our larger research project by identifying allocation policies that have enabled Nunatsiavut communities, and people to benefit from the shrimp fishery and to identify those development benefits in a systematic way. The research findings help us meet two further practical objectives: to provide research evidence to inform federal, provincial, and municipal policymaking and decision-making and to assist regional bodies and community groups in their decision-making and activities aimed at improving social, economic, cultural, and environmental conditions

Sepsis-induced cardiomyopathy: a review of pathophysiologic mechanisms.

Cardiac dysfunction is a well-recognized complication of severe sepsis and septic shock. Cardiac dysfunction in sepsis is characterized by ventricular dilatation, reduction in ejection fraction and reduced contractility. Initially, cardiac dysfunction was considered to occur only during the hypodynamic phase of shock. But we now know that it occurs very early in sepsis even during the hyperdynamic phase of septic shock. Circulating blood-borne factors were suspected to be involved in the evolution of sepsis induced cardiomyopathy, but it is not until recently that the cellular and molecular events are being targeted by researchers in a quest to understand this enigmatic process. Septic cardiomyopathy has been the subject of investigation for nearly half a century now and yet controversies exist in understanding it\u27s pathophysiology. Here, we discuss our understanding of the pathogenesis of septic cardiomyopathy and the complex roles played by nitric oxide, mitochondrial dysfunction, complements and cytokines

Education and remote sensing in Great Britain

Este artículo describe la enseñanza de la teledetección en la Educación Primaria, Secundaria y Universitaria en Gran Bretaña. Una breve explicación de la organización de los dos primeros niveles de la educación servirá para situar al lector. A continuación se describe el lugar que ocupa la teledetección en el nuevo Curriculum Nacional. Por último se comentan, en términos generales, los cursos impartidos en la enseñanza universitaria, tanto en licenciaturas como en masters.This paper describes the teaching of remote sensing at the school, college and university level in Great Britain. In order to set the scene, a preliminary explanation of the organisation of school-level education in Great Britain is provided, and the place of remote sensing in the new National Curriculum is discussed. Undergraduate and postgraduate (Masters) degree courses in UK universities are described in general terms