scholarly journals Identification of Persons Who Are Responsive To Wood Smoke Particle-Induced Airway Inflammation With Assessment of The Effect of GSTM1, Asthma Status And Sex On This Response.

2021 ◽  
Author(s):  
David B. Peden ◽  
Laura Zhou ◽  
Allison J. Burbank ◽  
Martha Almond ◽  
Michelle L. Hernandez ◽  
...  
Keyword(s):  
Polymorphonuclear Neutrophil ◽  
Wood Smoke ◽  
Similar Response ◽  
Entire Cohort ◽  
Markers Of Inflammation ◽  
Human Volunteers ◽  
Asthma Status ◽  
Identification Of Persons ◽  
The Impact ◽  
Time Point

Abstract Background: We are currently screening human volunteers to determine their sputum polymorphonuclear neutrophil (PMN) response 6 and 24 hours following initiation of exposure to wood smoke particles (WSP). Inflammatory responders (>10% increase in %PMN) are identified for their subsequent participation in mitigation studies against WSP-induced airways inflammation. In this report we compared responder status (N=52) at both 6 and 24hr time points to refine/expand its classification, assessed the impact of the GSTM1 genotype, asthma status and sex on responder status, and explored whether sputum soluble phase markers of inflammation correlate with PMN responsiveness to WSP. Results: In the entire cohort, we found a significant, but very small, decrease in FVC and systolic blood pressure immediately following WSP exposure and sputum %PMNs were significantly increased at 24 hours post exposure, the latter finding was also significantly correlated with sputum IL-1b, IL-6, IL-8, and PMN/mg; a similar response was not found at the 6 hour %PMN response. Blood endpoints in the entire cohort showed a significant increase in %PMN and PMN/mg at 6 but not 24 hours. Six-hour responders tended to be 24-hour responders and vice versa, but 24-hour responders also had significantly increased IL-1b, IL-6, IL-8 at 24 hours post WSP exposure. The GSTM1 null genotype significantly (p<0.05) enhanced the %PMN response at 6 hours in the entire cohort, by 24% in the 24-hour responders and not at all in the 6 hours responders. Asthma status enhanced the 24 hour %PMN response in the entire cohort and in the 6- and 24-hour responders. Sex had no effect on %PMN response. Conclusions: The 24 hour time point was more informative than the 6 hour time point in optimally defining airway inflammatory responsiveness to WSP exposure. GSTM1 and asthma status are significant effect modifiers of this response. These study design and subject parameters should be considered before enrolling volunteers for proof-of-concept WSP mitigation studies.

The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

2020 ◽  
Author(s):  
Matthew Wade ◽  
Nicola Brown ◽  
James Steele ◽  
Steven Mann ◽  
Bernadette Dancy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Motivational Interviewing ◽  
Social Action ◽  
Multilevel Models ◽  
Physical Activity Intervention ◽  
Mental Wellbeing ◽  
Community Based ◽  
The Impact ◽  
Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

scholarly journals Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF

2021 ◽  
pp. 219256822098827
Author(s):  
Zachariah W. Pinter ◽  
Anthony Mikula ◽  
Matthew Shirley ◽  
Ashley Xiong ◽  
Scott Wagner ◽  
...  
Keyword(s):  
Global Alignment ◽  
Minimal Effect ◽  
Cervical Alignment ◽  
Entire Cohort ◽  
Patient Reported ◽  
Cage Subsidence ◽  
Student’S T ◽  
Segmental Lordosis ◽  
The Impact

Study Design: Retrospective cohort study. Objective: Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. The purpose of this study was to assess whether allograft subsidence assessed on CT is associated with worse cervical alignment. Methods: We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF. Cervical alignment was assessed on standing radiographs performed preoperatively, less than 2 months postoperatively, and greater than 6 months postoperatively. Allograft subsidence was assessed on CT scan performed at least 6 months postoperatively. Patients with at least 1 level demonstrating greater than 4mm of cage subsidence were classified as severe subsidence. Student’s t-test was used to compare all means between groups. Results: We identified 66 patients for inclusion, including 56 patients with non-severe subsidence and 10 patients with severe subsidence. For the entire cohort, there was a significant increase in C2-7 Lordosis (p = 0.005) and Segmental Lordosis (p < 0.00 001) from preoperative to early postoperative. On comparison of severely and non-severely subsided levels, severely subsided levels demonstrated a significantly greater loss of segmental lordosis from early to mid-term follow-up than non-severely subsided levels (-4.89 versus -2.59 degrees, p < 0.0001), manifesting as a significantly lower segmental lordosis at >6 months postoperative (0.54 versus 3.82 degrees, p < 0.00 001). There were no significant differences in global cervical alignment parameters between patients with severe and non-severe subsidence. Conclusions: Severe subsidence is associated with a significant increase in loss of segmental lordosis, but has minimal effect on global cervical alignment parameters.

Time Domain Models for Damping-Controlled Fluidelastic Instability Forces in Tubes With Loose Supports

2010 ◽  
Vol 132 (4) ◽  
Author(s):  
Marwan Hassan ◽  
Achraf Hossen
Keyword(s):  
Time Domain ◽  
Cross Flow ◽  
Work Rate ◽  
Interaction Parameters ◽  
Similar Response ◽  
Fluid Force ◽  
Support Interaction ◽  
Fluidelastic Instability ◽  
The Impact ◽  
Normal Work

This paper presents simulations of a loosely supported cantilever tube subjected to turbulence and fluidelastic instability forces. Several time domain fluid force models are presented to simulate the damping-controlled fluidelastic instability mechanism in tube arrays. These models include a negative damping model based on the Connors equation, fluid force coefficient-based models (Chen, 1983, “Instability Mechanisms and Stability Criteria of a Group of Cylinders Subjected to Cross-Flow. Part 1: Theory,” Trans. ASME, J. Vib., Acoust., Stress, Reliab. Des., 105, pp. 51–58; Tanaka and Takahara, 1981, “Fluid Elastic Vibration of Tube Array in Cross Flow,” J. Sound Vib., 77, pp. 19–37), and two semi-analytical models (Price and Païdoussis, 1984, “An Improved Mathematical Model for the Stability of Cylinder Rows Subjected to Cross-Flow,” J. Sound Vib., 97(4), pp. 615–640; Lever and Weaver, 1982, “A Theoretical Model for the Fluidelastic Instability in Heat Exchanger Tube Bundles,” ASME J. Pressure Vessel Technol., 104, pp. 104–147). Time domain modeling and implementation challenges for each of these theories were discussed. For each model, the flow velocity and the support clearance were varied. Special attention was paid to the tube/support interaction parameters that affect wear, such as impact forces and normal work rate. As the prediction of the linear threshold varies depending on the model utilized, the nonlinear response also differs. The investigated models exhibit similar response characteristics for the lift response. The greatest differences were seen in the prediction of the drag response, the impact force level, and the normal work rate. Simulation results show that the Connors-based model consistently underestimates the response and the tube/support interaction parameters for the loose support case.

scholarly journals Ultrastructural Adaptation of the Cardiomyocyte to Chronic Mitral Regurgitation

2021 ◽  
Vol 8 ◽  
Author(s):  
Daniella Corporan ◽  
Ana Segura ◽  
Muralidhar Padala
Keyword(s):  
Mitral Regurgitation ◽  
Structural Changes ◽  
Recovery Of Function ◽  
Wall Stress ◽  
Ultrastructural Changes ◽  
Sprague Dawley ◽  
Cross Sectional ◽  
Systolic Volume ◽  
The Impact ◽  
Time Point

Introduction: Mitral regurgitation (MR) imposes volume overload on the left ventricle (LV) and elevates wall stress, triggering its adverse remodeling. Pronounced LV dilation, minimal wall thinning, and a gradual decline in cardiac ejection fraction (EF) are observed. The structural changes in the myocardium that define these gross, organ level remodeling are not known. Cardiomyocyte elongation and slippage have both been hypothesized, but neither are confirmed, nor are the changes to the cardiomyocyte structure known. Using a rodent model of MR, we used immunohistochemistry and transmission electron microscopy (TEM) to describe the ultrastructural remodeling of the cardiomyocyte.Methods: Twenty-four male Sprague-Dawley rats (350–400 g) were assigned to two groups: group (1) rats induced with severe MR (n = 18) and group (2) control rats that were healthy and age and weight matched (n = 6). MR was induced in the beating heart using a 23-G ultrasound-guided, transapical needle to perforate the anterior mitral leaflet, and the rats were followed to 2, 10, and 20 weeks (n = 6/time-point). Echocardiography was performed to quantify MR severity and to measure LV volume and function at each time-point. Explanted myocardial tissue were examined with TEM and immunohistochemistry to investigate the ultrastructural changes.Results: MR induced rapid and significant increase in end-diastolic volume (EDV), with a 50% increase by 2 weeks, compared with control. Rise in end-systolic volume (ESV) was more gradual; however, by 20 weeks, both EDV and ESV in MR rats were increased by 126% compared with control. A significant decline in EF was measured at 10 weeks of MR. At the ultrastructural level, as early as 2 weeks after MR, cardiomyocyte elongation and increase in cross-sectional area were observed. TEM depicted sarcomere shortening, with loss of Z-line and I-band. Desmin, a cytoskeletal protein that is uniformly distributed along the length of the cardiomyocyte, was disorganized and localized to the intercalated disc, in the rats induced with MR and not in the controls. In the rats with MR, the linear registry of the mitochondrial arrangement along the sarcomeres was lost, with mitochondrial fragmentation, aggregation around the nucleus, and irregularities in the cristae.Discussion: In the setting of chronic mitral regurgitation, LV dilatation occured by cardiomyocyte elongation, which manifests at the subcellular level as distinct ultrastructural alterations of the sarcomere, cytoskeleton, and mitochondria. Since the cytoskeleton not only provides tensegrity but has functional consequences on myocyte function, further investigation into the impact of cytoskeletal remodeling on progressive heart failure or recovery of function upon correcting the valve lesion are needed.

scholarly journals Design and evaluation of probabilistic record linkage methods supporting the Brazilian 100-million cohort initiative.

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Robespierre Pita ◽  
Clicia Pinto ◽  
Marcos Barreto ◽  
Samila Sena ◽  
Rosemeire Fiaccone ◽  
...  
Keyword(s):  
Hybrid Approach ◽  
Conditional Cash Transfer ◽  
Probabilistic Methods ◽  
Cash Transfer ◽  
Bloom Filters ◽  
Santa Catarina ◽  
Entire Cohort ◽  
Unified Health System ◽  
Linkage Methods ◽  
The Impact

ABSTRACTBackground and aimsA cooperation Brazil-UK was set in mid-2013 aiming at to build a huge cohort comprised by individuals registered in CadastroÚnico (CADU), a socioeconomic database used in social programmes of the Brazilian government. Epidemiologists and statisticians wish to assess the impact of Bolsa Família (PBF), a conditional cash transfer programme, on the incidence of several diseases (tuberculosis, leprosy, HIV etc). The cohort must contain all individuals who received at least one payment from PBF between 2007 and 2012, which results in a 100-million records according to our preliminary analysis. These individuals must be probabilistically linked with databases from the Unified Health System (SUS), such as hospitalization (SIH), notifiable diseases (SINAN), mortality (SIM), live births (SINASC), to produce data marts (domain-specific data) to the proposed studies. Within this cooperation, our first goal was to design and evaluate probabilistic methods to routine link the cohort, PBF, and SUS outcomes. ApproachWe implemented two probabilistic linkage methods: a full probabilistic, based on the Dice similarity (Sorensen index) of Bloom filters; and an hybrid approach, based on rules to deterministic and probabilistic matching. We performed linkages involving CADU (2011 extraction) and SUS outcomes (SIH, SINAN, and SIM) with samples from 3 states (Sergipe, Santa Catarina and Bahia) with an increasing size (from 1,447,512 to 12,036,010). ResultsUsing a Dice between 0.90 and 0.92, our methods retrieved more than 95% of true positive pairs amongst the linked pairs. For Sergipe, we obtained as <linked pairs,true positives>: <23,22>, <315,300>, <32,32>, respectively for SIH, SINAN, and SIM. For Bahia: <771,593>, <2677,2626>, <208,207>. Another linkage between CADU (1,447,512 records) and SINAN (624 records), for tuberculosis in Sergipe, returned 397 (full probabilistic) and 311 (hybrid) linked pairs, being 306 and 300 true positives. Another execution considering CADU (1,988,599 records) and SINAN (2,094 records), for tuberculosis in Santa Catarina, returned 791 (full probabilistic) and 500 (hybrid) linked pairs, with 667 and 472 true positives. Linking CADU (1.685,697 records) and SIM, for mortality of children under-4, returned 18 linked pairs, all of them true positives, for a Dice between 0.90 and 0.92 and with 100% of sensitivity, specificity, and positive predictive value. ConclusionDue to the absence of gold standards, we use samples with increasing sizes and manual review when adequate. Our results are quite accurate, although obtained with an unique extraction of CADU. We are starting to run linkages with the entire cohort.

Simplified estimation of forage degradability in the rumen assuming zero-order degradation kinetics

2008 ◽  
Vol 147 (3) ◽  
pp. 225-240 ◽  
Author(s):  
M. S. DHANOA ◽  
S. LÓPEZ ◽  
R. SANDERSON ◽  
J. FRANCE
Keyword(s):  
Reference Values ◽  
Incubation Time ◽  
Lag Time ◽  
Zero Order ◽  
Regression Equations ◽  
Order Model ◽  
First Order ◽  
Simplified Procedure ◽  
The Impact ◽  
Time Point

SUMMARYIn the present paper, a simplified procedure using few in situ data points is derived and then evaluated (using a large database) against reference values estimated with the standard nylon bag first-order kinetics model. The procedure proposed involved a two-stage mathematical process, with a statistical prediction of some degradation parameters (such as lag time) and then a kinetic model derived by assuming degradation follows zero-order kinetics to determine effective degradability in the rumen (E). In addition to the estimation of washout fraction and discrete lag, which is common to both procedures, the simplified procedure requires measurement of dry matter losses at one incubation time point only. Thus, interference of the animal rumen will be much reduced, which will lead to increased capacity for feed evaluation. Calibration of the zero-order model against the first-order model showed that suitable estimates of E can be obtained with disappearance at 24, 48 or 72 h as the single incubation end time point. The strength of the calibration is such that an end incubation time point as low as 24 h may be sufficient, which may reduce substantially the total incubation time required and thus the impact on the experimental animal. Relevant regression equations to predict reference values of parameters such as lag time or E are also developed and validated.

A Standardized Approach to Cesarean Surgical Technique and Its Effect on Operative Time and Surgical Morbidity

2018 ◽  
Vol 36 (03) ◽  
pp. 277-284 ◽  
Author(s):  
M. Pallister ◽  
J. Ballas ◽  
J. Kohn ◽  
C. S. Eppes ◽  
M. Belfort ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Operative Time ◽  
Retrospective Chart Review ◽  
Surgical Morbidity ◽  
Entire Cohort ◽  
Cesarean Deliveries ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact ◽  
Academic Year

Objective To evaluate the impact of a standardized surgical technique for primary cesarean deliveries (CDs) on operative time and surgical morbidity. Materials and Methods Two-year retrospective chart review of primary CD performed around the implementation of a standardized CD surgical technique. The primary outcome was total operative time (TOT). Secondary outcomes included incision-to-delivery time (ITDT), surgical site infection, blood loss, and maternal and fetal injuries. Results When comparing pre- versus postimplementation surgical times, there was no significant difference in TOT (76.5 vs. 75.9 minutes, respectively; p = 0.42) or ITDT (9.8 vs. 8.8 minutes, respectively; p = 0.06) when the entire cohort was analyzed. Subgroup analysis of CD performed early versus late in an academic year among the pre- and postimplementation groups showed no significant difference in TOT (79.3 early vs. 73.8 minutes late; p = 0.10) or ITDT (10.8 early vs. 8.8 minutes late; p = 0.06) within the preimplementation group. In the postimplementation group, however, there was significant decrease in TOT (80.5 early vs. 71.3 minutes late; p = 0.02) and ITDT (10.6 early vs. 6.8 minutes late; p < 0.01). Secondary outcomes were similar for both groups. Conclusion A standardized surgical technique combined with surgical experience can decrease TOT and ITDT in primary CD without increasing maternal morbidity.

Abstract MP25: Obesity, Heart Failure Risk & Cardiorespiratory Fitness

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Peter F Kokkinos ◽  
Puneet Narayan ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiorespiratory Fitness ◽  
Reference Group ◽  
Normal Weight ◽  
Entire Cohort ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
The Impact

Introduction: Obesity, defined as body mass index (BMI) ≥30 kg/m 2 , is associated with increased incidence of heart failure (HF). Increased cardiorespiratory fitness (CRF), as indicated by increased exercise capacity, is associated with lower risk of cardiovascular disease and HF. However, the CRF-BMI-HF interaction has not been fully explored. Hypothesis: We assessed the hypothesis that the risk of HF associated with increased BMI is moderated by increased CRF. Methods: We identified 19,881 Veterans (mean age: 58.0±11.3 years) who completed an exercise tolerance test (ETT) to assess either CRF status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, CA). None had documented HF at baseline or evidence of ischemia during the ETT. We established four BMI categories: <25 kg/m 2 ; 25-29.9 kg/m 2 ; 30-34.9 kg/m 2 ; and ≥35 kg/m 2 . In addition, we established four CRF categories based on age-stratified quartiles of peak metabolic equivalents (METs) achieved (mean ± SD): Least-Fit (4.5±1.2 METs; n=4,743); Low-Fit (6.6±1.3; n=5,103); Moderate-Fit (8.0±1.3 METs; n=5,084); and High-Fit (11.1±2.4 METs; n=4,951). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of HF across BMI categories for the entire cohort, using BMI 25-29.9 kg/m 2 (lowest HF rate) as the reference group. We then stratified the cohort by the four BMI categories and assessed HF risk across CRF categories within each stratum, using the Least-fit category as the reference group. The models were adjusted for age, race, gender, cardiac risk factors, sleep apnea, alcohol dependence, medications. Results: During follow-up (median=11.8 years), 2,193 developed HF (10.5 per 1,000 person-years of follow-up). The HF risk for normal weight individuals (18.5-24.9 kg/m2) was 10% higher (p=0.93). For obese individuals, the HF risk was 22% higher in those with BMI 30-34.9 kg/m 2 (HR=1.22; 95% CI: 1.09-1.35) and 50% higher (HR=1.50, 95% CI: 1.32-1.72) for those with BMI ≥35 kg/m 2 . When CRF (peak METs achieved) was introduced in the model, the risk for those with BMI 30-34.9 was reduced from 22% to 16% (HR=1.16; 95% CI: 1.04-1.29) and from 50% to 29% (HR=1.29; 95% CI: 1.13-1.48) among those with ≥35 kg/m 2 . For every 1-MET increase in exercise capacity, HF risk was 15% lower (HR=0.85; 95% CI: 0.83-0.87). We then assessed the impact of CRF on the risk of HF within each of the four BMI categories. The HF risk declined progressively (range: 25% to 69%; p<0.01) with increasing fitness within all BMI categories. Conclusions: The obesity-associated increased risk of HF was attenuated by increased CRF. The HF risk was progressively decreased with increased CRF within all BMI categories.

Defining the Impact of Adjuvant Treatment on the Prognosis of Patients with Inoperable Glioblastoma Undergoing Biopsy-only: Does the Survival Benefit Outweigh the Treatment Effort?

2021 ◽  
Author(s):  
Ronja Löber-Handwerker ◽  
Katja Döring ◽  
Christoph Bock ◽  
Veit Rohde ◽  
Vesna Malinova
Keyword(s):  
Adjuvant Treatment ◽  
Survival Benefit ◽  
Rank Test ◽  
Tumor Biopsy ◽  
Entire Cohort ◽  
Good Clinical Condition ◽  
The Impact ◽  
Radio Chemotherapy ◽  
Worse Prognosis

Abstract Purpose: Patients with inoperable glioblastoma (GBM) usually experience worse prognosis compared to those in whom gross total resection (GTR) is achievable. Considering the treatment duration and its side effects identification of patients with survival benefit from treatment is essential to guarantee the best achievable quality of life. The aim of this study was to evaluate the survival benefit from radio-chemotherapy and to identify clinical, molecular, and imaging parameters associated with better outcome in patients with biopsied GBMs. Methods: Consecutive patients with inoperable GBM, who underwent tumor biopsy at our department from 2005 to 2019 were retrospectively analyzed. All patients had histologically confirmed GBM and were followed up until death. The overall survival (OS) was calculated from date of diagnosis to date of death. Clinical, radiological and molecular predictors of OS were evaluated. Results: A total of 95 patients with biopsied primary GBM were enrolled in the study. The mean age was 64.3±13.2 years, 56.8 % (54/95) were male and 43.2 % (41/95) female. Mean OS in the entire cohort was 9 months. After stratification for adjuvant treatment a higher median OS was found in the group with adjuvant treatment (7 months, range 2-88) compared to the group without treatment (1 month, range 1-5) Log-rank test, p<0.0001.Conclusion: Patients with inoperable GBM undergoing biopsy indeed experience a very limited OS. Adjuvant treatment is associated with significantly longer OS compared to patients not receiving treatment and should be considered, especially in younger patients with good clinical condition at presentation.

Abstract 3230: Elevated Glucose and Mortality in Patients Hospitalized with Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mikhail Kosiborod ◽  
Silvio Inzucchi ◽  
John A Spertus ◽  
Yongfei Wang ◽  
Frederick A Masoudi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Linear Trend ◽  
Adverse Outcomes ◽  
Entire Cohort ◽  
Hazard Ratios ◽  
Elevated Glucose ◽  
Nationally Representative ◽  
Support Resource ◽  
The Impact

Background: While some professional societies recommend target-driven blood glucose (BG) control for all hospitalized patients, the association between elevated BG and adverse outcomes has not been well established in patients hospitalized with heart failure (HF). Methods: We evaluated a nationally representative cohort of 50,532 patients hospitalized with HF between 04/1998 – 06/2001. Admission BG was analyzed as a categorical variable (≤110, >110 –140, >140 –170, >170 –200, >200 mg/dL), and in 10 mg/dL increments. The association between BG and all-cause mortality over 30 days and 1 year was analyzed using Cox regression, both in the entire cohort and in patients with and without diabetes (DM). Results: After multivariable adjustment, there was no significant relationship between BG and 30-day mortality (for BG >110 to 140, >140 to 170, >170 to 200, and >200, hazard ratios and 95% confidence intervals were: 1.09 (0.98 –1.22), 1.27 (1.11–1.45), 1.16 (0.98–1.37), 1.00 (0.87–1.15) respectively vs. BG ≤110, P for linear trend 0.53). Results were similar for 1-year mortality, and did not differ between patients with and without DM (P values for DM*BG interaction 0.11 and 0.55 for 30-day and 1-year mortality respectively). A lack of association between BG and mortality over 30-days and 1-year was also observed when BG was analyzed in 10mg/dL increments (Figure ). Conclusions: We found no significant association between BG and mortality in a large cohort of hospitalized HF patients. While the impact of BG lowering on outcomes cannot be determined based on this study, our findings do not support resource-intensive interventions for BG monitoring and management in this patient group.

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