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Figure 2.

Kaplan-Meier curves of survival without hospital readmission for heart failure in trained patients (broken line) and untrained patients (solid line) during follow-up. + indicates censored cases.

Cardiac Deaths

Mortality was significantly lower in trained than in untrained patients (RR=0.37; 95% CI, 0.17 to 0.84; =0.01). All deaths (6 during the training phase and 23 during follow-up) were cardiac in nature (congestive heart failure, myocardial infarction, or arrhythmia), and death occurred more frequently in patients with than in those without ischemic heart disease (24 versus 5 deaths, respectively). Six deaths were sudden. Patients who died had higher resting heart rate, end-diastolic diameter, and wall thickening score index and lower systolic blood pressure and oxygen uptake at peak exercise than patients who survived.

On univariate analysis, the best predictors of improvement in functional capacity were the change in ventilatory threshold and ventilation after training ( r =0.67 and 0.62, respectively; P <0.001 for both). Stepwise forward logistic regression was performed to assess the independent predictors of posttraining changes in peak V̇ o 2 using the univariate variables with higher correlation coefficients. The most significant predictors of posttraining change in peak V̇ o 2 were 201 Tl uptake score index (β-coefficient −0.15; P =0.006) and peak V̇ o 2 at baseline (β-coefficient 1.05; P =0.001). Patients with a 201 Tl uptake score index >2.1 and a peak V̇ o 2 <11.3 mL · kg −1 · min −1 at baseline had the lowest probability of improving their functional capacity (log rank 6.47; P =0.01).

The survival model showed an overall effect of exercise training on predicting all cardiac events (log rank 14.29; P =0.002) (Figure 3 ). A lower event-free survival rate was observed in untrained patients with higher end-systolic diameter ( P =0.008) and ventilation at baseline ( P =0.01) and lower change in fractional shortening after exercise training ( P =0.02). Moreover, there was a significant difference between survival curves when separated by exercise training (log rank 6.24; P =0.01) (Figure 4 ). Patients with thallium uptake score <2 at baseline had a significantly lower mortality rate (log rank 15.08; P <0.001) and a lower incidence of overall cardiac events (log rank 9.56; P =0.002). However, the trend of survival curves was similar when patients were separated by age, cause of heart failure, number of diseased vessels, and number of prior myocardial infarctions. Analysis by Cox proportional hazards model with cardiac death as the dependent variable showed that ventilatory threshold at baseline and thallium uptake score index after training were the only independent predictors (β-coefficients 0.378 and −0.165, P =0.0004 and 0.008, respectively).

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Describes the category of expanded access under U.S. Food and Drug Administration (FDA) regulations. There are three types of expanded access:
Individual Patients Intermediate-size Population Treatment IND/Protocol
An arm type in which a group of participants receives the intervention/treatment that is the focus of the clinical trial.
In certain circumstances, a sponsor or investigator may request an extension to delay the standard results submission deadline (generally one year after the primary completion date ). The request for an extension must demonstrate good cause (for example, the need to preserve the scientific integrity of an ongoing masked trial). All requests must be reviewed and granted by the National Institutes of Health. This process for review and granting of extension requests is being developed. See Delay Results Type in the Results Data Element definitions for more information.
A type of intervention model describing a clinical trial in which groups of participants receive one of several combinations of interventions. For example, two-by-two factorial assignment involves four groups of participants. Each group receives one of the following pairs of interventions: (1) drug A and drug B, (2) drug A and a placebo, (3) a placebo and drug B, or (4) a placebo and a placebo. So during the trial, all possible combinations of the two drugs (A and B) and the placebos are given to different groups of participants.
The date on which the study record was first available on There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
The date on which the study sponsor or investigator first submitted a study record to There is typically a delay of a few days between the first submitted date and the record's availability on (the first posted date).
The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
U.S. Public Law 110-85, which was enacted on September 27, 2007. Section 801 of FDAAA amends Section 402 of the U.S. Public Health Service Act to expand and create a clinical study results database . For more information on FDAAA 801, see the Trask Audra Shearling wjM8zM
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Describes the organization that provides funding or support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting. Organizations listed as sponsors and collaborators for a study are considered the funders of the study. refers to four types of funders:
A type of eligibility criteria that indicates whether eligibility to participate in a clinical study is based a person's self-representation of gender identity or gender (yes, no). Gender is distinct from sex .
A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
A group of people who review, approve, and monitor the clinical study's protocol . Their role is to protect the rights and welfare of people participating in a study (referred to as human research subjects), such as reviewing the informed consent form . The group typically includes people with varying backgrounds, including a community member, to make sure that research activities conducted by an organization are completely and adequately reviewed. Also called an institutional review board, or IRB, or an ethics committee.

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A type of eligibility criteria . These are the reasons that a person is allowed to participate in a clinical study.
A process used by researchers to communicate to potential and enrolled participants the risks and potential benefits of participating in a clinical study.

For more information, see Participating in Studies on this site.

The document used in the informed consent or process.
The general design of the strategy for assigning interventions to participants in a clinical study. Types of intervention models include: single group assignment , parallel assignment , cross-over assignment , and factorial assignment .
A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
A type of clinical study in which participants are assigned to groups that receive one or more intervention/treatment (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. The assignments are determined by the study's protocol . Participants may receive diagnostic, therapeutic, or other types of interventions.
A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator .
The most recent date on which changes to a study record were made available on There may be a delay between when the changes were submitted to by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
The most recent date on which the study sponsor or investigator submitted changes to a study record to There is typically a delay of a few days between the last update submitted date and when the date changes are posted on (the last update posted date).
The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown .
Countries in which research facilities for a study are located. A country is listed only once, even if there is more than one facility in the country. The list includes all countries as of the last update submitted date; any country for which all facilities were removed from the study record are listed under removed location countries .
In the search feature, the Location terms field is used to narrow a search by location-related terms other than Country, State, and City or distance. For example, you may enter a specific facility name (such as National Institutes of Health Clinical Center) or a part of a facility name (such as Veteran for studies listing Veterans Hospital or Veteran Affairs in the facility name). Note: Not all study records include this level of detail about locations.
A clinical trial design strategy in which one or more parties involved in the trial, such as the investigator or participants, do not know which participants have been assigned which interventions. Types of masking include: open label, single blind masking, and double-blind masking.
A unique identification code given to each clinical study record registered on The format is "NCT" followed by an 8-digit number (for example, NCT00000419). Also called the identifier .
An arm type in which a group of participants does not receive any intervention/treatment during the clinical trial.
A type of clinical study in which participants are identified as belonging to study groups and are assessed for biomedical or health outcomes. Participants may receive diagnostic, therapeutic, or other types of interventions, but the investigator does not assign participants to a specific interventions/treatment .
The general design of the strategy for identifying and following up with participants during an observational study . Types of observational study models include cohort, case-control, case-only, case-cross-over, ecologic or community studies, family-based, and other.
An adverse event that is not a serious adverse event , meaning that it does not result in death, is not life-threatening, does not require inpatient hospitalization or extend a current hospital stay, does not result in an ongoing or significant incapacity or interfere substantially with normal life functions, and does not cause a congenital anomaly or birth defect; it also does not put the participant in danger and does not require medical or surgical intervention to prevent one of the results listed above.
Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
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For clinical trials , a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies , a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure .
A type of intervention model describing a clinical trial in which two or more groups of participants receive different interventions. For example, a two-arm parallel assignment involves two groups of participants. One group receives drug A, and the other group receives drug B. So during the trial, participants in one group receive drug A "in parallel" to participants in the other group, who receive drug B.
A summary of the progress of participants through each stage of a clinical study, by study arm or group/cohort . This includes the number of participants who started, completed, and dropped out of the study.
The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA) . The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0) , Phase 1 , Phase 2 , Phase 3 , and Phase 4 . Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
A phase of research to describe clinical trials that focus on the safety of a drug. They are usually conducted with healthy volunteers, and the goal is to determine the drug's most frequent and serious adverse events and, often, how the drug is broken down and excreted by the body. These trials usually involve a small number of participants.
A phase of research to describe clinical trials that gather preliminary data on whether a drug works in people who have a certain condition/disease (that is, the drug's effectiveness). For example, participants receiving the drug may be compared to similar participants receiving a different treatment, usually an inactive substance (called a placebo ) or a different drug. Safety continues to be evaluated, and short-term adverse events are studied.
A phase of research to describe clinical trials that gather more information about a drug's safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. These studies typically involve more participants.
A phase of research to describe clinical trials occurring after FDA has approved a drug for marketing. They include postmarket requirement and commitment studies that are required of or agreed to by the study sponsor. These trials gather additional information about a drug's safety, efficacy, or optimal use.
Describes trials without FDA-defined phases , including trials of devices or behavioral interventions.
An inactive substance or treatment that looks the same as, and is given in the same way as, an active drug or intervention/treatment being studied.
An arm type in which a group of participants receives a placebo during a clinical trial.
The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure . Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "estimated" primary completion date is the date that the researchers think will be the primary completion date for the study.
In a clinical study's protocol , the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment . Most clinical studies have one primary outcome measure, but some have more than one.
The main reason for the clinical trial . The types of primary purpose are: treatment, prevention, diagnostic, supportive care, screening, health services research, basic science, and other.
The person who is responsible for the scientific and technical direction of the entire clinical study.
The written description of a clinical study. It includes the study's objectives, design, and methods. It may also include relevant scientific background and statistical information.
National Library of Medicine (NLM) staff perform a limited review of submitted study records for apparent errors, deficiencies, or inconsistencies. NLM staff identify potential major and advisory issues and provide comments directly to the study sponsor or investigator. Major issues identified in QC review must be addressed or corrected (see First submitted that met QC criteria and Results first submitted that met QC criteria ). Advisory issues are suggestions to help improve the clarity of the record. NLM staff do not verify the scientific validity or relevance of the submitted information. The study sponsor or investigator is responsible for ensuring that the studies follow all applicable laws and regulations.
A type of allocation strategy in which participants are assigned to the arms of a clinical trial by chance.
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Citizens' Climate Lobby > CCL News > Honoring a friend by supporting CCL
Posted on June 29, 2018 in CCL News

Bill Betchart (second from left) lobbies Rep. Anna Eshoo in November 2017 with a team of fellow CCL volunteers.

By Tim Dec

As many of you know, CCL puts high value on relationship. By relationship, I mean with our members of Congress, with editorial boards, with other partner groups, and even with those who might not agree with us. But for me, the most important relationships have been with other CCLers. It’s these relationships where I draw inspiration and support in this often challenging work.

I joined CCL when the Silicon Valley North chapter was founded almost five years ago along with a group of others, one of which was Bill Betchart. Tasha Reddy, who went on to become a co-lead of the chapter and is now CCL’s California state coordinator, invited Bill and me to an upcoming group start training. I did not know Bill at the time, but from that point on, both Bill and I were hooked on CCL.

Remembering Bill Betchart

Professionally, Bill was a water resources engineer most recently working in the Sacramento delta area of California. Bill’s wife, Margaret, was the owner of Betchart Expeditions , which specializes in natural history expeditions where Bill was “one of Margaret’s right hands.” Between his professional work and his work and travels with Betchart Expeditions, he saw firsthand the challenges and impacts of a changing climate.

Without exception, Bill attended every chapter meeting, every CCL social event, and even helped with some major donor fundraising. So, Bill was always there and was a core member of our Silicon Valley North family. Though focused and diligent in his work with CCL, he was always up for some fun as shown in this photo at one of our early chapter socials.

Bill was a passionate supporter of CCL’s policy and approach, and he was a tireless liaison to our member of Congress, Adrianna Papell Agatha LdGVQO
. I was Bill’s roommate for all our June Lobby Day conferences, and Bill became a very dear friend. Bill so believed in the mission of CCL that he stayed involved and engaged even as he was fighting cancer—to the very end. He lost that fight in February of last year. Soon after his passing and as a result of his diligence and persistence, Rep. Anna Eshoo joined the bipartisan House CrocsOn The Clock Work SlipOn UjMuVq

Honoring Bill with donations in his name

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