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Background. Chronic and acute stress and emotion predict incidence/recurrence of CHD, but long-term effects on HF exacerbations are poorly understood. This study determined long-term chronic and episodic effects of stress, anxiety, and anger on hospitalizations or death, and worsened health status in HF. Methods and Results. 147 patients with heart failure and reduced ejection fraction (HFrEF) completed measures of perceived stress (Perceived Stress Scale; PSS), state anxiety (STAI), recent anger (RA), and HF-related health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) every 6 months for up to 39 months. Relationships of chronic (Mean) stress and emotion and episodic changes (Deviation) to subsequent hospitalizations or death and health status were determined utilizing Generalized Estimating Equation models. All-cause hospitalizations were predicted by chronic (Mean) PSS (OR=1.06, 95% CI 1.02-1.11, p=0.004), Mean STAI (OR=1.06, 95% CI=1.03, 1.10, p<0.001), and episodic (Deviation) PSS (OR=1.03, 95% CI 1.01-1.06, p=0.022). Mean PSS and Mean STAI also predicted cardiovascular hospitalizations. Each 1 standard deviation increase in Mean PSS and Mean STAI was associated, respectively, with a 61% and 79% increase in hospitalization or death. Anger was not associated with hospitalizations. Poorer KCCQ health status was related to higher Mean and Deviation PSS, STAI, and RA. Relationships to hospitalizations and health status were significant for Anxiety and Perceived Stress, independently of the other psychological measures. Conclusions. In HF patients, chronic perceived stress and anxiety and episodic stress increases are predictive of hospitalizations or death and worsened health status over a >3-year period. Mechanisms may involve sympathetic activation, and/or exacerbations of perceived symptoms or health behaviors.

SUMMARYA simple and reliable method for predicting the relationship between lateral displacement and earth pressure for rigidly framed earth retaining structures (RFERS) was developed. Closed-form equations were derived such that if one value of displacement or pressure is known (or assumed) the other can be computed for hydrostatic, seismic, uniform, and semi-elliptical earth pressure distributions. Additionally, the general form of the equations can be used to predict the magnitude of the lateral force even if the shape of the earth pressure is unknown, with a reasonable degree of accuracy. The expressions for deflection were derived by treating the structure as an equivalent cantilever beam and calibrating the resulting expression using the finite element method (FEM). A parametric FEM analysis, of 42 000 different RFERS configurations, was performed to calibrate the expressions, using multivariate non-linear regression between the derived expressions and FEM. A Weibull statistical analysis was performed for each equation and determined that the equations had better than 80% probability to yield deflections that are within 25% of the value computed using FEM. Furthermore, there is a 98% certainty that each equation will yield a deflection that is within 50% of that computed using FEM.

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