Cardiac biomarkers for risk stratification of arrhythmic death in patients with heart failure and reduced ejection fraction.

Objectives. Patients with heart failure and reduced left ventricular ejection fraction (HFrEF) are prone to ventricular tachyarrhythmias. We tested whether biomarkers C-terminal Endothelin 1 (CT-ET1), midregional pro atrial natriuretic peptide (MR-proANP) and midregional pro adrenomedullin (MR-proADM) might improve risk stratification for arrhythmic death.Methods: This prospective observational study included 160 heart failure patients with ischaemic cardiomyopathy (ICM) or non-ischaemic, dilated cardiomyopathy (DCM) and 30 control patients without heart disease. Primary endpoint was arrhythmic death (ArD) or resuscitated cardiac arrest (resCA).Results: A total of 61 patients died during the median follow-up of 7.0 [5.2-8.4] years. An ArD or resCA was observed in 48 patients. Plasma levels of CT-ET1 (p = 0.002), MR-proANP (p < 0.001) and MR-proADM (p = 0.013) were significantly higher in ICM or DCM patients compared to controls. MR-proANP levels in ICM patients were associated with a significantly increased risk for ArD or resCA (hazard ratio (HR) = 1.42, [95%CI: 1.08-1.85], p = 0.011) in a multivariable Cox regression model. Plasma levels of CT-ET1 (HR = 1.07 [0.98-1.17], p = 0.113) and MR-proADM (HR = 1.80 [0.92-3.55], p = 0.087) were not associated with ArD or resCA in ICM patients. No significant association with ArD or resCA was found in DCM patients. Multivariable Cox regression showed that CT-ET1 (HR = 1.14 [1.07-1.22], p < 0.001), MR-proANP (HR = 1.64 [1.29-2.08], p < 0.001) and MR-pro ADM (HR = 2.06 [1.12-3.77], p = 0.020) were associated with a higher risk for overall mortality.Conclusion: Patients with HFrEF had elevated levels of CT-ET1, MR-proANP and MR-proADM. Plasma levels of MR-proANP are useful as predictor for arrhythmic death in patients with ICM.

Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome.

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.

Effects of hypothesis testing and variable format training on generalization of a verbal abstraction strategy by EMR learners.

The effectiveness of a training program, varying in presentation format (single vs. multiple task), in promoting the acquisition and generalization of a verbal abstraction strategy was evaluated for 38 female and 42 male EMR learners. Although the training program enhanced the acquisition and near generalization of the verbal abstraction strategy, no far generalization was observed. Presentation format had no effect on acquisition nor on near or far generalization. The results were interpreted in terms of prior findings, and an alternate definition of generalization was offered.

Generalization of verbal abstraction strategies by EMR children and adolescents.

The effectiveness of strategy-training programs that differed in the degree of subject self-management required on the verbal abstraction performance of 37 female and 43 male EMR children and adolescents was compared. In terms of acquisition, all three training conditions, irrespective of the degree of self-management required, were superior to the control condition. At maintenance, the two self-managing conditions (self-instruction and modeling) were superior both to more traditional instructor-controlled training (relevant attributes) and the control condition. All three training conditions were more effective in promoting generalization when compared to the control condition.

Retrieval speed, age-of-acquisition estimates, uncertainty, and semantic-dimension comparisons with mentally retarded persons.

Age-of-acquisition estimates and ratings on seven semantic dimensions by nonretarded adults were compared with the codability and retrieval speed of those items by retarded individuals. Correlational analyses indicated that age-of-acquisition estimates, codability, and retrieval speed were highly related to each other and significantly related to most of the semantic dimensions. Regression analyses revealed that codability, meaningfulness, and imagery each contributed significantly to the variance of retrieval speed. These results were compared with those of similar studies in which the lexical retrieval speed of nonretarded persons was investigated.

Maintenance and generalization of a sorting and retrieval strategy by EMR and nonretarded individuals.

The ability of 47 EMR and 51 nonretarded individuals to maintain and generalize a sorting and retrieval strategy designed to facilitate recall and clustering was examined. Each of these two groups of subjects was assigned to one of three conditions: experimental, practice, or control. Only subjects in the experimental condition received strategy training. The three conditions were each further divided into two subconditions: superordinate and associative. The experimental task consisted of two phases: word elicitation and recall. The data showed that after a 6-month interval, the strategy was still maintained. Neither the far-generalization data that was provided by the word-elicitation phase nor the near-generalization data, obtained through the recall phase, however, revealed any significant results.

Digit span estimation and the effects of explicit strategy training on recall of EMR individuals.

Accuracy of digit span estimation by EMR subjects at two different MA levels, 8 and 11, was assessed. The effects of explicit strategy training, generalized instruction, and no training on recall performance and apportionment of study time were compared. The older group was more realistic in their digit span estimation than was the younger group. Explicit strategy training facilitated digit recall and evoked longer study times than did the other conditions.

Use of active sorting and retrieval strategies as a facilitator of recall, clustering, and sorting by EMR and nonretarded children.

The ability of 60 EMR and 60 nonretarded children to acquire and retain a sorting and retrieval strategy designed to be facilitative of recall and clustering was examined. All subjects were given a baseline task and, based on their performance, were assigned to one of three groups: experimental, practice, and control. The experimental group received a multi-session training procedure that consisted of instructing the subjects to arrange the stimuli in conceptual arrays, to name individual stimuli and the superordinates to which the stimuli belong, and to count the number of stimuli in each superordinate. The practice group was presented with the same stimuli but received no training. The control group received only the baseline and criterion measures. Analyses of data showed superior performance by the experimental group on measures of short- and long-term recall, clustering, and sorting.

Imagery and verbal mediation in paired-associate learning of educable mentally retarded adolescents.

PA learning was investigated among sixty educable mentally retarded adolescents as a function of variations in image-evoking potential of the response members and of instructions to utilise a verbal mediation strategy. The data indicated that performance with verbal mediation instruction surpassed that under non-mediation instruction conditions regardless of imagery level. Results were discussed in terms of Paivio's conceptual peg hypothesis as well as the EMR's deficiency in input organisation.

Effects of preferred stimuli on the free recall of moderately and severely mentally retarded children.

The effects of two types of stimuli, preferred and nonpreferred, on the free recall and clustering of 16 moderately and severely retarded public-school children were investigated. An empirical determination was made as to whether to classify a particular conceptual category of stimuli as preferred or nonpreferred. All subjects were presented with 18 objects from 6 conceptual categories in blocked condition. Both the preferred and nonpreferred stimuli were given to each subject in a counterbalanced order using a repeated measures design. Our major finding was that the use of preferred stimuli had a significant facilitating effect on recall but not clustering.

Acquisition and retention of a mediational strategy for PA learning in EMR children.

The ability of EMR children to acquire and retain a mediational strategy for PA learning was demonstrated by a training procedure which consisted of the sequencing of consecutive lists under varying degrees of mediational facilitation. The components of the training procedure included training interval, overt verbalization, and verbal context combined with imagery instruction. Forty-five EMR children (mean CA = 11.26; mean IQ = 63.33) were randomly assigned to one of three groups: mediation, standard, and control. Analyses of data showed significantly superior performance of the mediation group in acquisition and retention of the mediational strategy. The pedagogical implications of the study were discussed.