Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

Objective: To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Design: Systematic review and meta-analysis. Data sources: Medline and Embase. Eligibility criteria: Cohort studies examining the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with atrial fibrillation: specifically, all cause mortality, cardiovascular mortality, major cardiovascular events, any stroke, ischaemic stroke, haemorrhagic stroke, ischaemic heart disease, sudden cardiac death, congestive heart failure, chronic kidney disease, and peripheral arterial disease. Estimates were pooled with inverse variance weighted random effects meta-analysis. Results: 104 eligible cohort studies involving 9 686 513 participants (587 867 with atrial fibrillation) were identified. Atrial fibrillation was associated with an increased risk of all cause mortality (relative risk 1.46, 95% confidence interval 1.39 to 1.54), cardiovascular mortality (2.03, 1.79 to 2.30), major cardiovascular events (1.96, 1.53 to 2.51), stroke (2.42, 2.17 to 2.71), ischaemic stroke (2.33, 1.84 to 2.94), ischaemic heart disease (1.61, 1.38 to 1.87), sudden cardiac death (1.88, 1.36 to 2.60), heart failure (4.99, 3.04 to 8.22), chronic kidney disease (1.64, 1.41 to 1.91), and peripheral arterial disease (1.31, 1.19 to 1.45) but not haemorrhagic stroke (2.00, 0.67 to 5.96). Among the outcomes examined, the highest absolute risk increase was for heart failure. Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses. Conclusions: Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease. Interventions aimed at reducing outcomes beyond stroke are warranted in patients with atrial fibrillation

Tailoring Science Outreach through E-Matching Using a Community-Based Participatory Approach

In an effort to increase science exposure for pre-college (K-12) students and as part of the science education reform agenda, many biomedical research institutions have established university-community partnerships. Typically, these science outreach programs consist of pre-structured, generic exposure for students, with little community engagement. However, the use of a medium that is accessible to both teachers and scientists, electronic web-based matchmaking (E-matching) provides an opportunity for tailored outreach utilizing a community-based participatory approach (CBPA), which involves all stakeholders in the planning and implementation of the science outreach based on the interests of teachers/students and scientists. E-matching is a timely and urgent endeavor that provides a rapid connection for science engagement between teachers/students and experts in an effort to fill the science outreach gap. National Lab Network (formerly National Lab Day), an ongoing initiative to increase science equity and literacy, provides a model for engaging the public in science via an E-matching and hands-on learning approach. We argue that science outreach should be a dynamic endeavor that changes according to the needs of a target school. We will describe a case study of a tailored science outreach activity in which a public school that serves mostly under-represented minority students from disadvantaged backgrounds were E-matched with a university, and subsequently became equal partners in the development of the science outreach plan. In addition, we will show how global science outreach endeavors may utilize a CBPA, like E-matching, to support a pipeline to science among under-represented minority students and students from disadvantaged backgrounds. By merging the CBPA concept with a practical case example, we hope to inform science outreach practices via the lens of a tailored E-matching approach

N-Terminal Pro-B-Type Natriuretic Peptide and Clinical Outcomes

OBJECTIVES The purpose of this study was to examine the treatment effect of vericiguat in relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at randomization. BACKGROUND Vericiguat compared with placebo reduced the primary outcome of cardiovascular death (CVD) or heart failure hospitalization (HFH) in patients with HF with reduced ejection fraction (HFrEF) in the VICTORIA (A Study of Vericiguat in Participants With Heart Failure With Reduced Ejection Fraction) trial. Because an interaction existed between treatment and the primary outcome according to pre-specified quartiles of NT-proBNP at randomization, we examined this further. METHODS This study evaluated the NT-proBNP relationship with the primary outcome in 4,805 of 5,050 patients as a risk-adjusted, tog-transformed continuous variable. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. RESULTS Median NT-proBNP was 2,816 pg/ml (25th to 75th percentile: 1,556 to 5,314 pg/ml). The study treatment effect varied across the spectrum of NT-proBNP at randomization (with log(2) transformation, p for interaction = 0.002). A significant association between treatment effects existed in patients with levels 8,000 pg/ml (n = 672), the HR was 1.16 (95% CI: 0.94 to 1.41) for the primary outcome. CONCLUSIONS A reduction in the primary composite endpoint and its CVD and HFH components was observed in patients on vericiguat compared with subjects on placebo with NT-proBNP levels up to 8,000 pg/ml. This provided new insight into the benefit observed in high-risk patients with worsening HFrEF. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

The Youngest Victims: Children and Youth Affected by War

In 1989, the United Nation Convention on the Rights of the Child declared, “[state parties] shall take all feasible measures to ensure protection and care of children who are affected by an armed conflict.” In addition to attempting to secure the welfare of children in armed conflict, the Convention went on to ban the recruitment and deployment of children during armed conflict. Despite the vast majority of sovereign nations signing and ratifying this agreement, this treaty, unfortunately, has not prevented children and youth from witnessing, becoming victims of, or participating in political, ethnic, religious, and cultural violence across the past three decades. This chapter offers an “ecological perspective” on the psychosocial consequences of exposure to the trauma of war-related violence and social disruption

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Pursuing the Pedagogical Potential of the Pillars of Hip-hop through Urban Science Education

Despite the recent popularity of hip-hop based education, and the increasing diversity of academics who consume, critique, and create artifacts produced by hip-hop, there is a general superficiality in the relationship between hip-hop and education. I argue that this is the case because of the societal fascination with the most visible and commercially promoted aspects of the culture, and the misperception that these small strands of hip-hop are representative of the complexities of the culture. In response, this paper focuses on the often-forgotten four pillars of hip-hop, and explores the pedagogical potential of each of these pillars in the development of a hip-hop based approach to pedagogy.

Beyond Coteaching: Power Dynamics, Cosmopolitanism and the Psychoanalytic Dimension

Dieser Artikel bezieht sich auf die Ergebnisse der "Coteaching"-Arrangements, die GALLO-FOX et al. (2006) und LEHNER (2006) realisiert haben. Durch kritische Auseinandersetzung und den Vorschlag einer neuartigen theoretischen Sicht auf die Analyse von "Coteaching"-Erfahrungen und "Kogenerativen Dialogen" lassen sich vorhandene Machtdynamiken unter den Forschungsteilnehmer(inne)n aufdecken und es wird erklärbar, wie diese Dynamiken auf eine Forschungsarbeit einwirken.This article draws upon the results of coteaching arrangements implemented by GALLO-FOX et al. (2006) and LEHNER (2006) and provides responses to those studies. By employing criticality and providing a new theoretical lens for the analysis of coteaching experiences and cogenerative dialogues, this article serves to uncover existent power dynamics among research participants and explains how these dynamics impact a research study.Este artículo se refiere a los resultados de los arreglos de la coenseñanza implementados por GALLO-FOX et al. (2006) y LEHNER (2006) y propone respuestas a esos estudios. Usando la criticalidad y estableciendo una nueva perspectiva teórica para el análisis de las experiencias de la coenseñanza y de diálogos cogenerativos, este artículo sirve para descubrir dinámicas de poder existentes entre los participantes de las investigaciones y explica como estas dinámicas impactan al estudio

Mas allá de la coenseñanza: Dinámicas de poder, cosmopolitanismo y la dimensión psicoanalítica

Dieser Artikel bezieht sich auf die Ergebnisse der "Coteaching"-Arrangements, die GALLO-FOX et al. (2006) und LEHNER (2006) realisiert haben. Durch kritische Auseinandersetzung und den Vorschlag einer neuartigen theoretischen Sicht auf die Analyse von "Coteaching"-Erfahrungen und "Kogenerativen Dialogen" lassen sich vorhandene Machtdynamiken unter den Forschungsteilnehmer(inne)n aufdecken und es wird erklärbar, wie diese Dynamiken auf eine Forschungsarbeit einwirken. URN: urn:nbn:de:0114-fqs0604279This article draws upon the results of coteaching arrangements implemented by GALLO-FOX et al. (2006) and LEHNER (2006) and provides responses to those studies. By employing criticality and providing a new theoretical lens for the analysis of coteaching experiences and cogenerative dialogues, this article serves to uncover existent power dynamics among research participants and explains how these dynamics impact a research study. URN: urn:nbn:de:0114-fqs0604279Este artículo se refiere a los resultados de los arreglos de la coenseñanza implementados por GALLO-FOX et al. (2006) y LEHNER (2006) y propone respuestas a esos estudios. Usando la criticalidad y estableciendo una nueva perspectiva teórica para el análisis de las experiencias de la coenseñanza y de diálogos cogenerativos, este artículo sirve para descubrir dinámicas de poder existentes entre los participantes de las investigaciones y explica como estas dinámicas impactan al estudio. URN: urn:nbn:de:0114-fqs060427