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Recovery‐based design links building‐level engineering and broader community resilience objectives. However, the relationship between above‐code engineering improvements and recovery performance is highly nonlinear and varies on a building‐ and site‐specific basis, presenting a challenge to both individual owners and code developers. In addition, downtime simulations are computationally expensive and hinder exploration of the full design space. In this paper, we present an optimization framework to identify optimal above‐code design improvements to achieve building‐specific recovery objectives. We supplement the optimization with a workflow to develop surrogate models that (i) rapidly estimate recovery performance under a range of user‐defined improvements, and (ii) enable complex and informative optimization techniques that can be repeated for different stakeholder priorities. We explore the implementation of the framework using a case study office building, with a 50th percentile baseline functional recovery time of 155 days at the 475‐year ground‐motion return period. To optimally achieve a target recovery time of 21 days, we find that nonstructural component enhancements are required, and that increasing structural strength (through increase of the importance factor) can be detrimental. However, for less ambitious target recovery times, we find that the use of larger importance factors eliminates the need for nonstructural component improvements. Such results demonstrate that the relative efficacy of a given recovery‐based design strategy will depend strongly on the design criteria set by the user. [ABSTRACT FROM AUTHOR]

This study explored teachers' perceptions of English teaching method preferences and learning styles in selected secondary schools of Morogoro Municipality by finding their impacts on teaching and learning styles and the challenges of matching English teaching method preferences and learning styles in secondary schools. The study used an exploratory case study design under a qualitative approach where five teachers from five selected schools consisting of four males and one female were selected purposely and voluntarily to be interviewed using semi-structured questions. The results indicate that three teaching methods are mostly preferred by teachers: learnercentred, engagement style, and multiple styles methods. These methods assist learners to achieve good performance in their studies. Moreover, the aforementioned approaches affect the teaching process as they are more effective in facilitating teachers' tasks. However, shortage of teaching materials, English language communication barriers, shortage of classroom facilities, and students' readiness are the challenges in implementing teaching preferences and learning styles in English classes. It is therefore recommended that English teachers should work out to improve their utilization of teaching methods and learning styles to reduce the setbacks found in this study. Additionally, curriculum developers, the Ministry of Education, and other education stakeholders may consider the findings of this study for tackling the challenges faced by English teachers in secondary schools. [ABSTRACT FROM AUTHOR]

Purpose of review: Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes. This review aims to summarize the current evidence and treatment guidelines for the management of myocarditis in the active population. Recent findings: Physical exertion is likely a trigger for dangerous arrythmias and further propagates myocardial damage in athletes with myocarditis. For this reason, abstinence from sports is a critical facet of management in the initial inflammatory period. The use of cardiac magnetic resonance imaging, specifically late gadolinium enhancement, to guide return to play decisions is becoming more common in clinical practice. Summary: Establishing a stepwise approach for proper diagnosis and risk stratification, with an emphasis on contemporary cardiac magnetic resonance (CMR) imaging techniques, in myocarditis is critical. After a diagnosis of myocarditis is made, it is imperative for any athlete or highly active individual to refrain from physical exercise. Additionally, therapy for heart failure should be applied in cases of myocarditis with cardiac dysfunction. Undoubtedly, COVID 19, and its potential to cause myocarditis, is sure to change the landscape of management of this disease. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationship between fitness, heart failure (HF) risk factors (age, blood pressure, and obesity), and global/regional myocardial longitudinal strain in young adults undergoing stress testing. Methods: Individuals 25–55 years old without any significant medical history, not taking medications, and with a normal maximal stress echocardiogram were eligible. Global and regional longitudinal strain (LS) was evaluated by 2D speckle tracking echocardiography. Results: One hundred and seventy patients were included, of which 60% were males. The mean age was 43 years old, 49% had optimal blood pressure, and 30% were obese. On average, patients achieved 10.5 (3) METS, and the global LS was −19.9 (3.1) %. Reduced fitness was associated with decreased global longitudinal strain (GLS). Those in the top GLS quartile walked on average 1 minute and 21 seconds longer compared with the lowest quartile (P <.001). The effect of fitness on LS was preferential to the mid and apex, such that there was an apex‐to‐base gradient. Obesity was also independently associated with reduced GLS. However, the reduction in LS in obese individuals was more prominent at the base and mid‐walls with relative sparing of the apex. Similar to fitness, aging was also associated with an increase in the apex‐to‐base gradient of LS. Furthermore, diastolic filling parameters correlated distinctively with regional LS. Conclusions: In young adults without cardiovascular disease, low fitness and obesity are independently associated with reduced left ventricular longitudinal strain. There is a differential effect of HF risk factors on regional longitudinal function. [ABSTRACT FROM AUTHOR]

Importance: In a prespecified subgroup analysis of participants not on statin therapy at baseline in the TACT, a high-dose complex oral multivitamins and multimineral regimen was found to have a large unexpected benefit compared with placebo. The regimen tested was substantially different from any vitamin regimen tested in prior clinical trials.Objective: To explore these results, we performed detailed additional analyses of participants not on statins at enrollment in TACT.Design: TACT was a factorial trial testing chelation treatments and a 28-component high-dose oral multivitamins and multiminerals regimen versus placebo in post-myocardial infarction (MI) patients 50 years or older.Participants: There were 460 (27%) of 1,708 TACT participants not taking statins at baseline, 224 (49%) were in the active vitamin group and 236 (51%) were in the placebo group.Setting: Patients were enrolled at 134 sites around the United States and Canada.Intervention: Daily high-dose oral multivitamins and multiminerals (6 tablets, active or placebo).Main Outcome: The primary end point of TACT was time to the first occurrence of any component of the composite end point: all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for angina.Results: The primary end point occurred in 137 nonstatin participants (30%), of which 51 (23%) of 224 were in the active group and 86 (36%) of 236 were taking placebo (hazard ratio, 0.62; 95% confidence interval, 0.44-0.87; P=.006). Results in the key TACT secondary end point, a combination of cardiovascular mortality, stroke, or recurrent MI, was consistent in favoring the active vitamin group (hazard ratio, 0.46; 95% confidence interval, 0.28-0.75; P=.002). Multiple end point analyses were consistent with these results.Conclusion and Relevance: High-dose oral multivitamin and multimineral supplementation seem to decrease combined cardiac events in a stable, post-MI population not taking statin therapy at baseline. These unexpected findings are being retested in the ongoing TACT2. [ABSTRACT FROM AUTHOR]

Context: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with diastolic function abnormalities. It remains unclear which factors, if any, can predict the transition from asymptomatic diastolic dysfunction to an overt symptomatic phase. Materials and Methods: Patients hospitalized with suspected heart failure between January 2012 and November 2014 with a transthoracic echocardiogram demonstrating preserved systolic function were screened (n = 425). Patients meeting the American College of Cardiology Foundation/American Heart Association definition for HFpEF (n = 40) were matched in a 1:1 fashion to individuals admitted for hypertensive urgency with diastolic dysfunction and neither pulmonary edema nor history of heart failure (n = 40). The clinical records and echocardiograms of all eighty patients included in this retrospective study were reviewed. Results: Patients with HFpEF had higher body mass index (BMI), creatinine, beta‑blocker use, and Grade 2 diastolic dysfunction when compared to the hypertensive control population. Echocardiographic analysis demonstrated higher right ventricular systolic pressures, left ventricular mass index, E/A, and E/e’ in patients with HFpEF. Similarly, differences were observed in most left atrial (LA) parameters including larger LA maximum and minimum volume indices, as well as smaller LA‑emptying fractions in the heart failure group. Multivariate logistic regression analysis revealed LA minimum volume index (odds ratio [OR]: 1.23 [1.09–1.38], P = 0.001) to have the strongest association with heart failure hospitalization after adjustment for creatinine (OR: 7.09 [1.43–35.07], P = 0.016) and BMI (OR: 1.11 [0.99–1.25], P = 0.074). Conclusion: LA minimum volume index best correlated with HFpEF in this patient cohort with diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy of R2CHADS2, CHADS2, and CHA2DS2-VASc scores vs the Society of Thoracic Surgeons (STS) score as predictors of morbidity and mortality after cardiovascular surgery.Methods: All patients who underwent cardiothoracic surgery at our institution from January 2008 to July 2013 were analyzed. Only those patients who fulfilled the criteria for STS score calculation were included. The R2CHADS2 score was computed as follows: 2 points for GFR < 60 mL/min/1.73 m(2) (R2), prior stroke or TIA (S2); 1 point for history of congestive heart failure (C), hypertension (H), age ≥75 years (A), or diabetes (D). Area under the curve (AUC) analysis was used to estimate the accuracy of the different scores. The end point variables included operative mortality, permanent stroke, and renal failure as defined by the STS database system.Results: Of the 3,492 patients screened, 2,263 met the inclusion criteria. These included 1,160 (51%) isolated valve surgery, 859 (38%) coronary artery bypass graft surgery, and 245 (11%) combined procedures. There were 147 postoperative events: 75 (3%) patients had postoperative renal failure, 48 (2%) had operative mortality, and 24 (1%) had permanent stroke. AUC analysis revealed that STS, R2CHADS2, CHADS2, and CHA2DS2-VASc reliably estimated all postoperative outcomes. STS and R2CHADS2 scores had the best accuracy overall, with no significant difference in AUC values between them.Conclusion: The R2CHADS2 score estimates postoperative events with acceptable accuracy and if further validated may be used as a simple preoperative risk tool calculator. [ABSTRACT FROM AUTHOR]

An abundance of data, known for decades, is available linking metals, such as lead and cadmium, with cardiovascular disease. However, the idea that these toxic metals could be a modifiable risk factor for atherosclerosis did not become apparent clinically until the completion of the Trial to Assess Chelation Therapy in 2012. This pivotal study was the first double-blind, randomized, controlled trial of its kind to demonstrate a clear improvement in cardiovascular outcomes with edetate disodium therapy in a secondary prevention, post-myocardial infarction population. This effect size was most striking in diabetic patients, where the efficacy of edetate disodium was comparable, if not superior, to that of current guideline-based therapies. Given the economic burden of diabetes and cardiovascular disease, the potential impact of this therapy could be enormous if the results of this study are replicated. [ABSTRACT FROM AUTHOR]

Despite its association with cardioembolic stroke, atrial fibrillation (AF) appears to be inconsistent as a risk factor for postoperative strokes in patients who underwent cardiac surgery. Furthermore, the relation between AF and the CHA2DS2VASc score has not been definitively established with respect to postoperative stroke. We retrospectively analyzed the records of all cardiac surgery performed at our institution between January 2008 and July 2013. Baseline characteristics, operative data, and postoperative outcomes were compared in patients who developed stroke with those who did not. Previously recognized stroke risk factors, including AF, were analyzed along with the CHADS2 and CHA2DS2VASc scores. A total of 3,492 consecutive patients were identified, of which 2,077 (60%) underwent valve surgery, 915 (26%) had coronary artery bypass grafting, 399 (11%) underwent combined coronary artery bypass grafting and valve procedures, and 101 (3%) had other cardiac operations. Postoperative ischemic strokes occurred in 44 patients (1.2%). The development of a stroke was associated with older age (74 ± 12 vs 69 ± 12, p = 0.008), preoperative antiplatelet medication use (38.6% vs 24.5%, p = 0.043), congestive heart failure (37% vs 20%, p = 0.002), and greater CHADS2 (2.48 ± 1.3 vs 1.98 ± 1.1, p = 0.015) and CHA2DS2VASc scores (4.2 ± 1.8 vs 3.4 ± 1.6, p = 0.002). Multivariable analysis demonstrated that the CHA2DS2VASc score was the only independent predictor of postoperative strokes (odds ratio 1.25; 95% confidence interval 1.05 to 1.5, p = 0.014). In conclusion, the CHA2DS2VASc score appears to predict postoperative strokes independent of the presence of AF. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality and effective strategies for its prevention are greatly needed. The purpose of this retrospective, single-center study was to investigate whether nitrate use during percutaneous coronary artery intervention reduces the incidence of CIN. Chart review of all individuals who underwent percutaneous coronary intervention (PCI) from April 2010 to March 2011 was done. Included in the study were patients who were admitted to the hospital after percutaneous coronary artery intervention and had baseline and follow-up creatinine measured. Patients with end-stage renal disease requiring dialysis and those patients with insufficient information to calculate Mehran score were excluded. There were 199 patients who met the eligibility criteria for inclusion in this study. In the identified population, postprocedure renal function was compared between 112 patients who received nitrates prior to coronary intervention and 87 who did not. Baseline characteristics were similar between the 2 groups. Contrast-induced nephropathy was defined as either a 25% or a 0.5 mg/dL, or greater, increase in serum creatinine during the first 48 to 72 hours after contrast exposure. Overall, 43 (21.6%) patients developed CIN post-PCI. Of the patients who received nitrates, 15.2% developed renal impairment when compared to 29.9% in those who did not (odds ratio [OR] = 0.42, 95% confidence interval [CI] 0.21-0.84, P = .014). Multivariate logistic regression analysis demonstrated that nitrate use was independently correlated with a reduction in the development of contrast nephropathy (OR = 0.334, 95% CI 0.157-0.709, P = .004). Additionally, of the various methods of nitrate administration, intravenous infusion was shown to be the most efficacious route in preventing renal impairment (OR = 0.42, 95% CI 0.20-0.90, P = .03). In conclusion, the use of nitrates prior to PCI, particularly intravenous nitroglycerin infusion, may be associated with a decreased incidence of CIN. [ABSTRACT FROM AUTHOR]

To assess the developmental toxicity of trichloroacetate (TCA), zebrafish embryos were exposed to 8 to 48 mM of TCA and evaluated for developmental milestones from 8‐ to 144‐hour postfertilization (hpf). All developmental toxicities are reported in this paper. Embryos were found to have developed edema in response to 16 to 48 mM of TCA exposure at 32‐ to 80‐hpf, experienced delay in hatching success in response to 24 to 48 mM at 80‐hpf. Lordosis was observed in developing embryos exposed to 40 to 48 mM at 55‐ to 144‐hpf. The observed toxic effects of TCA exposure were found to be concentration and exposure period independent. Effects were found to be associated with increases in superoxide anion production, but these increases were also found to be concentration and time independent. TCA resulted in concentration‐dependent increases in embryonic lethality at 144‐hpf, with an LC50 determined to be 29.7 mM. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Normalisation of aortic root and cusp configuration is a prerequisite for successful aortic valve repair (AVR). Using transthoracic echocardiography, we studied aortic root dimensions relative to body size in normal subjects and AVR patients. Methods: Aortic roots of healthy volunteers (n =130, age 27.9±16.9 years) were examined for aortoventricular (AV), sinus (S), sinutubular-junction diameters (ST) and effective height (height difference between the AV plane and central coaptation point, eH) by transthoracic echocardiography. In 651 patients, after AVR residual aortic valve insufficiency (AI) and eH were determined. The relationships between eH versus root dimensions and eH versus residual AI were analysed by analysis of variance with Bonferroni post hoc testing. Results: Root dimensions correlated with each other and body size (r =0.74–0.91). In addition, a correlation between AV (r =0.73), sinus diameter (r =0.76), body height (r =0.77), body surface area (r =0.81) and eH was found. After AVR, eH was 9.8±0.9mm in 235 patients without postoperative AI, 9.4±1.1mm in 370 with mild AI, 7.9±1.4mm in 43 patients with moderate AI and 6±1mm in three patients with severe AI. The difference in means of effective height between the groups was significant (p <0.005). Of 497 AVR patients with an eH ≥9mm, 309 had no or trivial AI, 186 had mild AI and only two had moderate AI. Conclusions: Parameters of aortic root dimensions follow a seemingly constant pattern in humans of different sizes. Effective height has a constant relationship to root dimensions and body size. In AVR, normalisation of eH leads to a high probability of normal or near-normal aortic valve function. [ABSTRACT FROM AUTHOR]

Synthetic psychoactive cathinones (SPCs) are drugs with psychostimulant and entactogenic properties like methamphetamine (MA) and 3,4-methylenedioxymethamphetamine (MDMA). Despite clinical reports of human overdose, it remains to be determined if SPCs have greater propensity for adverse effects than MA or MDMA. To determine whether the SPCs cathinone (CAT), methcathinone (MCAT), mephedrone (MMC), and methylenedioxypyrovalerone (MDPV) have lower LD50 values than MA or MDMA. Male and female C57Bl/6J mice received single injections of one of 6 doses of a test drug (0–160 mg/kg IP). Temperature and behavioral observations were taken every 20 min for 2 h followed by euthanasia of surviving mice. Organs were weighed and evaluated for histopathological changes. LD50 values for MA and MDMA, 84.5 and 100.9 mg/kg respectively, were similar to previous observations. The LD50 for MMC was 118.8 mg/kg, but limited lethality was observed for other SPCs (CAT, MCAT, MDPV), so LD50 values could not be calculated. For all drugs, death was associated with seizure, when it was observed. Rather than hyperthermia, dose-dependent hypothermia was observed for MMC, MDPV, CAT, and MCAT. Contrary to initial expectations, none of the SPCs studied here had LD50 values lower than MA or MDMA. These data indicate that, under the conditions studied here: (1) SPCs exhibit less lethality than MA and MDMA; (2) SPCs impair thermoregulation; (3) effects of SPCs on temperature appear to be independent of effects on lethality. [ABSTRACT FROM AUTHOR]

Background: Current electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) have low sensitivity.Objectives: The goal of this study was to test a new method to improve the diagnostic performance of the electrocardiogram.Methods: The study was divided into 2 groups, a test and a validation cohort. In the test cohort, 94 patients were analyzed, including 47 with the diagnosis of hypertensive crisis and 47 with normal blood pressure at admission. Echocardiography was used to estimate the left ventricular mass index. Area under the curve (AUC) analysis was used for comparison of single and combined leads. The McNemar test was used to assess agreement among the ECG criteria against the left ventricular mass index. The proposed ECG criteria involved measuring the amplitude of the deepest S wave (SD) in any single lead and adding it to the S wave amplitude of lead V4 (SV4). Currently accepted LVH ECG criteria such as Cornell voltage and Sokolow-Lyon were used for comparison. The validation cohort consisted of 122 consecutive patients referred for an echocardiogram regardless of the admitting diagnosis.Results: The SD was the most accurate single lead measurement for the diagnosis of LVH (AUC: 0.80; p < 0.001). When both cohorts were analyzed, the SD + SV4 criteria outperformed Cornell voltage with a significantly higher sensitivity (62% [95% confidence interval [CI]: 50% to 72%] vs. 35% [95% CI: 24% to 46%]). The specificities of all the criteria were ≥90%, with no significant difference among them.Conclusions: The proposed criteria for the ECG diagnosis of LVH improved the sensitivity and overall accuracy of the test. [ABSTRACT FROM AUTHOR]