Acute changes in kidney function and outcomes following an acute myocardial infarction:Insights from PARADISE-MI

Aims: Pharmacologic blockade of neurohormonal pathways in patients with acute myocardial infarction (MI) can result in acute changes in biomarkers of kidney function. We evaluated the effect of sacubitril/valsartan versus ramipril on initial changes in serum creatinine and the association of these changes with longer-term outcomes among participants in PARADISE-MI. Methods and results: In this randomized, double-blind, active-controlled, event-driven trial, 5661 patients with an acute MI were assigned to receive sacubitril/valsartan or ramipril, with no run-in. The frequency of an initial pre-specified increase in serum creatinine (≥26.5 or ≥44 μmol/L) from baseline to week 1 was compared between arms. Multivariable Cox regression models were fit to examine the association of acute changes in serum creatinine with the primary cardiovascular composite outcome (cardiovascular death, first heart failure hospitalization, or outpatient heart failure), all-cause mortality, and longer-term changes in estimated glomerular filtration rate (eGFR). An initial increase in serum creatinine ≥26.5 μmol/L occurred in 155 of 2604 (6.0%) patients assigned to sacubitril/valsartan and 120 of 2603 (4.6%) patients assigned to ramipril (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.03–1.68). The corresponding numbers for an increase ≥44 μmol/L were 57 (2.2%) and 42 (1.6%), respectively (OR 1.37; 95% CI 0.92–2.05). A higher odds of increased serum creatinine ≥26.5 and ≥44 μmol/L for sacubitril/valsartan versus ramipril appeared to be restricted to patients who had a greater decline in systolic blood pressure over the same period (p-interaction = 0.05 and 0.001, respectively). In multivariable analyses, neither an acute increase in serum creatinine ≥26.5 or ≥44 μmol/L was associated with a higher risk of cardiovascular outcomes, all-cause mortality, or differences in longer-term eGFR slope. Findings were similar across the randomized treatment arms (p-interaction &gt;0.6 for all). Conclusions: Following acute MI, patients assigned to sacubitril/valsartan had a higher frequency of initial increases in serum creatinine at 1 week, compared with ramipril. In adjusted models, initial increases in serum creatinine with either treatment were not associated with adverse cardiovascular outcomes or changes in longer-term kidney function.</p

De waternaam laak/leek in Groningerland

Om hun tekort aan broodgraan en turf aan te vullen beschikten Groninger kloosters over talrijke bezittingen en rechten in Drenthe. Rogge was het belangrijkste product dat vanaf de Drentse zandgronden werd aangevoerd. En turf uit de Drentse venen was voor de kloosters van groot belang voor hun industriële en ambachtelijke activiteiten, in het bijzonder de steen- en pannenbakkerij. De aanwezigheid dicht bij de stad Groningen van uitgestrekte hoogveengebieden in Oost-Drenthe alsook de door deze stad beheerste transportader van het riviertje de Hunze vormden daarbij belangrijke voordelen.De waternaam laak/leek kent vele varianten en een groot verspreidingsgebied, op het continent in Vlaanderen, Nederland en het aangrenzende Saksische taalgebied, terwijl daarbinnen ook regio’s zijn waar de naam ontbreekt. Het verwijst naar stilstaand of langzaam stromend water en ging ook over op belendende percelen. Minder bekend is de nevenbetekenis van grens, water als scheiding tussen territoria. Voor Groningerland wordt nagegaan welke laak-leek namen zich waar voordoen, hoe oud ze zijn en of ze oude territoriumgrenzen kunnen blootleggen

Charge dynamics in the 2D/3D semiconductor heterostructure WSe₂/GaAs

Understanding the relaxation and recombination processes of excited states in two-dimensional (2D)/three-dimensional (3D) semiconductor heterojunctions is essential for developing efficient optical and (opto)electronic devices, which integrate van der Waals 2D materials with more conventional 3D ones. In this work, we unveil the carrier dynamics and charge transfer in a monolayer of WSe2 on a GaAs substrate. We use time-resolved differential reflectivity to study the charge relaxation processes involved in the junction and how they change when compared to an electrically decoupled heterostructure, WSe2/hBN/GaAs. We observe that the monolayer in direct contact with the GaAs substrate presents longer optically excited carrier lifetimes (3.5 ns) when compared with the hBN-isolated region (1 ns), consistent with a strong reduction of radiative decay and a fast charge transfer of a single polarity. Through low-temperature measurements, we find evidence of a type-II band alignment for this heterostructure with an exciton dissociation that accumulates electrons in GaAs and holes in WSe2. The type-II band alignment and fast photoexcited carrier dissociation shown here indicate that WSe2/GaAs is a promising junction for advanced photovoltaic and other optoelectronic devices, making use of the best properties of van der Waals (2D) and conventional (3D) semiconductors.</p

Major reduction in occurrence of anti-c and anti-E in pregnancy after more than 10 years of preventive matched transfusion with most benefit for c-matching

Extension with cE-matching of the transfusion policy for women under 45 years to prevent alloimmunization and hemolytic disease of the foetus and newborn (HDFN) was evaluated. After implementation of cEK-matching, anti-c occurrence decreased from 46.8 to 30.4 per 100 000 pregnancies (RR 0.65, 95% CI 0.54–0.79), while anti-E occurrence decreased from 122.1 to 89.9 per 100 000 pregnancies (RR 0.74, 95% CI 0.66–0.84). The c-negative women showed a higher anti-E occurrence before cEK-matching and a more pronounced decline with the new policy. This indicates that cEK-matched transfusion effectively reduces alloimmunization, and that a cK-matched approach could prevent most transfusion-related alloimmunization and HDFN.</p

Contraction Analysis for Discrete-Time Singular Nonlinear Switched Systems Via Their Surrogate Systems under Fully Known Switching Signals

We study the contraction analysis-a notion that ensures the system's trajectories converge exponentially to a certain trajectory-of discrete-time singular nonlinear switched systems under a fully known switching signal. A necessary and sufficient condition for the system to be contracting is provided via a single Lyapunov function approach, which is rather conservative due to the requirement of the existence of a common Lyapunov function for all subsystems. For a less conservative condition, a sufficient condition is then provided via a switched Lyapunov function approach. This approach does not require a common Lyapunov function for all subsystems, nevertheless, it requires that all subsystems are contracting. Finally, the study is complemented with illustrative examples of contracting switched systems.</p

Opportunities for fundamental physics research with radioactive molecules

Molecules containing short-lived, radioactive nuclei are uniquely positioned to enable a wide range of scientific discoveries in the areas of fundamental symmetries, astrophysics, nuclear structure, and chemistry. Recent advances in the ability to create, cool, and control complex molecules down to the quantum level, along with recent and upcoming advances in radioactive species production at several facilities around the world, create a compelling opportunity to coordinate and combine these efforts to bring precision measurement and control to molecules containing extreme nuclei. In this manuscript, we review the scientific case for studying radioactive molecules, discuss recent atomic, molecular, nuclear, astrophysical, and chemical advances which provide the foundation for their study, describe the facilities where these species are and will be produced, and provide an outlook for the future of this nascent field.</p

Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals:Outcomes of a Functional Resonance Analysis Method (FRAM) Study

Objectives Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]). Methods Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30). Results Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses' perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints. Conclusions The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.</p

Step width modification to change rearfoot eversion and medial longitudinal arch angle during walking and running in individuals with pronated feet

BACKGROUND: Individuals with pronated feet often experience altered foot biomechanics, leading to increased risk of lower limb injuries. Step width modification has been proposed as a potential intervention to improve foot alignment during gait.RESEARCH QUESTION: Does modifying step width influence rearfoot eversion and medial longitudinal arch angle (MLAA) in individuals with pronated feet during walking and running?METHODS: Twenty individuals with pronated feet underwent analysis during walking and running on treadmill, maintaining increased or decreased step width using real-time visual feedback. Three-dimensional motion analysis measured rearfoot eversion and MLAA during the stance phase of gait.RESULTS: Wide step width significantly reduced peak rearfoot eversion during waking (mean difference - with normal step width - (MD) = 3.6°, p &lt; 0.001) and running (MD = 4.4°, p &lt; 0.001), time to peak rearfoot eversion during walking (MD = 16.6 p &lt; 0.001) and running (MD = 13.8°, p = 0.014), rearfoot eversion at touch down (TD) during walking (MD = 1.3°, p = 0.004), rearfoot eversion excursion during running (MD = 4.3°, p &lt; 0.001), and peak MLAA during walking (MD = 2.9°, p = 0.006) and MLAA excursion during running (MD = 4.8°, p = 0.004). By contrast, during running, narrow condition significantly increased peak rearfoot eversion (MD = 3.4°, p &lt; 0.001). During walking, time to peak rearfoot eversion (MD = 16.1, p &lt; 0.001), rearfoot eversion at TD (MD = 1.4°, p = 0.008), rearfoot eversion excursion (MD = 5.9°, p &lt; 0.001), and peak MLAA (MD = 3.4°, p &lt; 0.001) were significantly increased.SIGNIFICANCE: This study highlights the potential of step width modification as a simple yet effective intervention to improve foot biomechanics in pronated feet individuals during walking and running. Further research could lead to the development of personalized strategies for pronated feet individuals.</p