Vascular risk assessment in older adults without a history of cardiovascular disease.

Modern cardiovascular risk prediction tools, which have their genesis in the Framingham Heart Study, have allowed more accurate risk stratification and targeting of treatments worldwide over the last seven decades. Better cardiovascular risk factor control during this time has led to a reduction in cardiovascular mortality and, at least in part, to improved life expectancy. As a result, western societies as a whole have seen a steady increase in the proportion of older persons in their populations. Unfortunately, several studies have shown that the same tools which have contributed to this increase cannot be reliably extrapolated for use in older generations. Recent work has allowed recalibration of existing models for use in older populations but these modified tools still require external validation before they can be confidently applied in clinical practice. Another complication is emerging evidence that aggressive risk factor modification in older adults, particularly more frail individuals, may actually be harmful. This review looks at currently available cardiovascular risk prediction models and the specific challenges faced with their use in older adults, followed by analysis of recent attempts at recalibration for this cohort. We discuss the issue of frailty, looking at our evolving understanding of its constituent features and various tools for its assessment. We also review work to date on the impact of frailty on cardiovascular risk modification and outline its potentially central role in determining the most sensible approach in older patients. We summarise the most promising novel markers of cardiovascular risk which may be of use in improving risk prediction in older adults in the future. These include markers of vascular compliance (such as aortic pulse wave velocity and pulse wave analysis), of endothelial function (such as flow mediated dilation, carotid intima-media thickness and coronary artery calcium scores), and also biochemical and circulating cellular markers.

Performance assessment of NAPL remediation in heterogeneous alluvium.

Over the last few years, more than 40 partitioning interwell tracer tests (PITTs) have been conducted at many different sites to measure nonaqueous phase liquid (NAPL) saturations in the subsurface. While the main goal of these PITTs was to estimate the NAPL volume in the subsurface, some were specifically conducted to assess the performance of remedial actions involving NAPL removal. In this paper, we present a quantitative approach to assess the performance of remedial actions to recover NAPL that can be used to assess any NAPL removal technology. It combines the use of PITTs (to estimate the NAPL volume in the swept pore volume between injection and extraction wells of a test area) with the use of several cores to determine the vertical NAPL distribution in the subsurface. We illustrate the effectiveness of such an approach by assessing the performance of a surfactant/foam flood conducted at Hill Air Force Base, UT, to remove a TCE-rich NAPL from alluvium with permeability contrasts as high as one order of magnitude. In addition, we compare the NAPL volumes determined by the PITTs with volumes estimated through geostatistical interpolation of aquifer sediment core data collected with a vertical frequency of 5-10 cm and a lateral borehole spacing of 0.15 m. We demonstrate the use of several innovations including the explicit estimation of not only the errors associated with NAPL volumes and saturations derived from PITTs but also the heterogeneity of the aquifer sediments based upon permeability estimates. Most importantly, we demonstrate the reliability of the

Leisure motivation in relation to psychosocial adjustment and personality in young offender and high school samples.

The Jackson Personality Inventory (JPI), Holden Psychological Screening Inventory (HPSI), and the Leisure Motivation Scale (LMS) were administered to samples of 66 young offenders and 67 high school students. Significant between sample differences occurred for the HPSI Depression and Social Symptomatology scales, the JPI Responsibility and Risk Taking scales, but none of the 4 LMS scales. Statistically significant correlations were obtained for the LMS with 13 of the 15 JPI scales, with the HPSI Psychiatric, Social, and Depression Symptomatology scales, and with gender and sample. The canonical correlation redundancy index indicated that 40% of the variance in leisure motivation was accounted for by the HPSI and JPI measures. Sample and gender added 2% to the explained variance.

Improvement in psychosocial adjustment for psychiatric patients after a 16-week life skills education program.

The Holden Psychological Screening Inventory, a 36-item screening inventory for psychosocial adjustment, was administered pre- and posttreatment to 31 psychiatric patients enrolled in a 16-week life skills education program. Statistically significant improvements in the Depression Symptomatology, Social Symptomatology, and Total scores were obtained, but the Psychiatric Symptomatology scale did not improve significantly. Size of effect was larger for Depression Symptomatology (.52) and Social Symptomatology (.30) than for Psychiatric Symptomatology (.23). On a 6-point scale all patients rated their overall satisfaction with the program on the two most favorable categories, excellent and very good. The results provide support for life skills education programming for psychiatric patients as part of the treatment and recovery process.