Objectives To evaluate the prevalence and prognostic impact of non-cardiac comorbidities in patients with heart failure (HF) with preserved ejection fraction (HFpEF) versus heart failure with reduced ejection fraction (HFrEF). Background There is paucity of information on the comparative prognostic significance of comorbidities between HFpEF and HFrEF patients. Methods In a national ambulatory cohort of Veterans with HF, we compared the comorbidity burden of 15 non-cardiac comorbidities and the impact of these comorbidities on hospitalization and mortality between HFpEF and HFrEF patients. Results The cohort consisted of 2,843 HFpEF and 6,599 HFrEF patients with 2 year follow-up. Compared to HFrEF, HFpEF patients were older and had higher prevalence of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, psychiatric disorders, anemia, obesity, peptic ulcer disease and cancer, but lower prevalence of chronic kidney disease. HFpEF patients had lower HF hospitalization, higher non-HF hospitalization and similar overall hospitalization, compared with HFrEF patients (p<0.001, p<0.001, p=0.19, respectively). Increasing number of non-cardiac comorbidities was associated with higher risk of all-cause admissions (p<0.001). Comorbidities had similar impact on mortality in HFpEF vs. HFrEF patients except for COPD, which was associated with a higher hazard (1.62 [95% CI 1.36-1.92] vs. 1.23 [95% CI 1.11, 1.37], respectively; p=0.01 for interaction) in HFpEF patients. Conclusions There is a higher non-cardiac comorbidity burden associated with higher non-HF hospitalizations in HFpEF compared to HFrEF patients. However, individually, most comorbidities have similar impact on mortality in both groups. Aggressive management of comorbidities may have an overall greater prognostic impact in HFpEF compared to HFrEF.

Obesity has reached epidemic proportions in the U.S. and more developed countries, particularly so among adolescents. A substantial impact on public health could be achieved if other factors causing obesity besides the conventional ones of diet and physical activity could be identified and acted upon. The present study investigates whether there is a link between low sleep quality and obesity in a tri-ethnic, cross-sectional sample (n = 383) of male and female adolescents ages 11-16 years old (Heartfelt Study). Sleep quality was expressed as two variables, total sleep time and sleep disturbance time obtained by 24-hour wrist actigraphy. Percent body fat and body mass index (BMI) were used together to define obesity. The potential influence of demographic and behavioral confounders were considered in models that described the relation of sleep to obesity occurrence. Obese adolescents experienced less sleep than nonobese adolescents (P < 0.01). For each hour of lost sleep, the odds of obesity increased by 80%. Sleep disturbance was not directly related to obesity in the sample, but influenced physical activity level (P < 0.01). Daytime physical activity diminished by 3% for every hour increase in sleep disturbance. The above observations were independent of potential confounding variables. Inadequate and poor sleep quality in adolescents may be important factors to consider in the prevention of childhood obesity.

Free‐radical polymerization of p‐cumyl phenyl methacrylate (CPMA) was performed in benzene using bezoyl peroxide as an initiator at 80°C. The effect of time on the molecular weight was studied. Functional copolymers of CPMA and glycidyl methacrylate (GMA) with different feed ratios were synthesized by free‐radical polymerization in methyl ethyl ketone at 70°C, and they were characterized by FTIR and 1H‐NMR spectroscopy. The molecular weights and polydispersity indexes of the polymers and copolymers were determined by gel permeation chromatography. The copolymer composition was determined by 1H‐NMR. The glass‐transition temperature of the polymer and the copolymers was determined by differential scanning calorimetry. The reactivity ratios of the monomers were determined by the Fineman–Ross and Kelen–Tudos methods. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 97: 336–347, 2005

Background: It was recently demonstrated that the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) score can be used to accurately stage severity of Alzheimer dementia and mild cognitive impairment (MCI). However, to our knowledge, the utility of those interpretive guidelines has not been cross-validated or applied to a heterogeneous sample of dementia cases.Objective: To cross-validate the staging guidelines proposed in a previous study using the National Alzheimer's Coordinating Center (NACC) database. Design:The previously published cut scores were applied to the NACC sample and diagnostic accuracy estimates obtained. Next, analyses were restricted to NACC participants with a CDR global score (CDR-GS) of 0.5 and receiver operating characteristic curves generated to determine optimal CDR-SB cut scores for distinguishing MCI from very early dementia. Setting:The 2008 NACC uniform data set.Participants: There were 12 462 participants (5115 controls; 2551 patients with MCI; 4796 patients with de-mentia, all etiologies) in the NACC data set used for the current analysis.Main Outcome Measure: Accurate prediction of diagnoses (MCI or dementia) using the CDR-SB score. Results:The previously proposed CDR-SB ranges successfully classified the vast majority of patients across all impairment ranges with a of 0.91 and 94% overall correct classification rate. Additionally, the CDR-SB score discriminated between patients diagnosed with MCI and dementia when CDR-GS was restricted to 0.5 (overall area under the curve=0.83).Conclusions: These findings cross-validate the previously published CDR-SB interpretative guidelines for staging dementia severity and extend those findings to a large heterogeneous sample of patients with dementia. Additionally, the CDR-SB scores distinguished MCI from dementia in patients with reasonable accuracy when CDR-GS was restricted to 0.5.

Background and Purpose-Only a small minority of acute stroke patients receive approved acute stroke therapy. We performed a community and professional behavioral intervention project to increase the proportion of stroke patients treated with approved acute stroke therapy. Methods-This study used a quasi-experimental design. Intervention and comparison communities were compared at baseline and during educational intervention. The communities were based in 5 nonurban East Texas counties. The multilevel intervention worked with hospitals and community physicians while changing the stroke identification skills, outcome expectations, and social norms of community residents. The primary goal was to increase the proportion of patients treated with intravenous recombinant tissue plasminogen activator (rTPA) from 1% to 6% of all cerebrovascular events in the intervention community.