Renal function, revascularization and risk

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The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery

B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of complications and mortality following major emergency non-cardiac surgery.Forty patients were studied with a primary end-point of a new post-operative cardiac event, and/or development of significant ECG changes, and/or cardiac death. The main secondary outcome was all cause mortality at 6 months. Preoperative BNP levels were higher in 11 patients who suffered a new postoperative cardiac event (p=0.001) and predicted this outcome with an area under the receiver operating characteristic curve of 0.85 (CI=0.72-0.98,p=0.001). A pre-operative BNP value >170pg.ml-1 has a sensitivity of 82% and a specificity of 79% for the primary end-point. In this small study, pre-operative BNP levels identify patients undergoing major emergency non-cardiac surgery who are at increased risk of early post-operative cardiac events. Larger studies are required to confirm these data.Peer reviewedPreprin

Utility of B-type natriuretic peptide in predicting medium-term mortality in patients undergoing major non-cardiac surgery

We assessed the ability of pre-operative B-type natriuretic peptide (BNP) levels to predict medium-term mortality in patients undergoing major noncardiac surgery. During a median 654 days follow-up 33 patients from a total cohort of 204 patients (16%) died. The optimal cut-off in this cohort, determined using a receiver operating characteristic curve, was >35pg.mL-1. This was associated with a 3.47-fold increase in the hazard of death (p=0.001) and had a sensitivity of 70% and a specificity of 68% for this outcome. These findings extend recent work demonstrating that BNP levels obtained before major noncardiac surgery can be used to predict peri-operative morbidity, and indicate that they also forecast medium-term mortality.This work was supported by a grant from TENOVUS Scotland. The Health Services Research Unit is core-funded by the Chief Scientists Office of the Scottish Executive Health Department.Peer reviewedAuthor versio

Annual Survey of Virginia Law: Insurance Law

This article reviews the changes in Virginia insurance law that have occurred in the past two years. Most of the developments have been in motor vehicle liability and uninsured/underinsured motorist ( VM/UIM ) coverage. But the article also surveys cases on bad faith, fire insurance, insurance regulation, life insurance, motor vehicle medical expense insurance, and waiver and estoppel

Central European foreign exchange markets: a cross-spectral analysis of the 2007 financial crisis

This paper investigates co-movements between currency markets of Czech Republic, Poland, Hungary, Slovakia and the Euro in the year following the drying up of money markets in August 2007. The paper shows that assessing the degree of foreign currency co-movement by correlation can lead to concluding, erroneously, that financial contagion has not occurred. Using cross-spectral methods, the paper shows that defining contagion as changes in the structure of co-movements of asset prices encompasses more of the complex nature of exchange rate dynamics. What is shown is that, following August 2007, there is increased in the intensity of co-movements, but non-linearly. Focusing on the activities of a mix of banks and currency managers, it is suggested that changes in the structure of currency interaction present an unfavourable view of the contagion experienced by at least three of these currencies

Expanding Effective Behavioral Health Literacy Programs to Address Farm Stress

Attention to stress and mental health among agricultural producers has increased over recent years, and Cooperative Extension has been active in offering educational workshops and resources to agricultural audiences. This article describes the process and effectiveness of expanding two (university) Extension farm stress management programs to Cooperative Extension in other states through a national Farm Stress Management Summit. The two-day training Summit provided deeper knowledge about farm stress issues and prepared Extension professionals to offer behavioral health programs in their own communities and respective states. Evaluation findings highlight effective aspects of the Summit and next steps

Community Engagement: Using Feedback Loops to Empower Residents and Influence Systemic Change in Culturally Diverse Communities

A multi-faceted approach to community engagement includes the need to involve the community members in the design, implementation and feedback of any program, services, or supports provided. Intentional participatory engagement of residents also requires shared responsibility for workload, shared recognition of achievement, thoughtful communication, engagement in robust discussions taking care not to internalize conversations as personal affronts and holding close the rules of effective decision making (Toms & Burgess, 2014). Implementing a feedback loop process can be used as a tool to foster intentional resident engagement. The findings presented in this article are from a case study of a neighborhood that implemented a feedback loop process. Analysis of data indicate that while transportation, housing, and places for people to safely be outside are real community concerns, acts of nature and choices made by city government also directly impact the quality of life of the residents in this community. The need for purposeful channels of communication to be established among residents, between neighborhood action groups, and city government is evident. Leveraging relationships with community partners to establish trust and organizational understanding of culture within community socio-economic context, along with the multiple layers of community engagement is discussed

Community Engagement: Using Feedback Loops to Empower Residents and Influence Systemic Change in Culturally Diverse Communities

A multi-faceted approach to community engagement includes the need to involve the community members in the design, implementation and feedback of any program, services, or supports provided. Intentional participatory engagement of residents also requires shared responsibility for workload, shared recognition of achievement, thoughtful communication, engagement in robust discussions taking care not to internalize conversations as personal affronts and holding close the rules of effective decision making (Toms & Burgess, 2014). Implementing a feedback loop process can be used as a tool to foster intentional resident engagement. The findings presented in this article are from a case study of a neighborhood that implemented a feedback loop process. Analysis of data indicate that while transportation, housing, and places for people to safely be outside are real community concerns, acts of nature and choices made by city government also directly impact the quality of life of the residents in this community. The need for purposeful channels of communication to be established among residents, between neighborhood action groups, and city government is evident. Leveraging relationships with community partners to establish trust and organizational understanding of culture within community socio-economic context, along with the multiple layers of community engagement is discussed

Evidence of immunometabolic dysregulation and airway dysbiosis in athletes susceptible to respiratory illness

Background Respiratory tract infection (RTI) is a leading cause of training and in-competition time-loss in athlete health. The immune factors associated with RTI susceptibility remain unclear. In this study, we prospectively characterise host immune factors in elite athletes exhibiting RTI susceptibility. Methods Peripheral blood lymphocyte flow cytometry phenotyping and 16S rRNA microbial sequencing of oropharyngeal swabs was performed in a prospective elite athlete cohort study (n = 121). Mass cytometry, peripheral blood mononuclear cell (PBMC) stimulation and plasma metabolic profiling was performed in age-matched highly-susceptible (HS) athletes (≥4RTI in last 18 months) (n = 22) compared to non-susceptible (NS) (≤1RTI in last 18 months) (n = 23) athletes. Findings were compared to non-athletic healthy controls (HC) (n = 19). Findings Athletes (n = 121) had a reduced peripheral blood memory T regulatory cell compartment compared to HC (p = 0.02 (95%CI:0.1,1.0)) and reduced upper airway bacterial biomass compared to HC (p = 0.032, effect size r = 0.19). HS athletes (n = 22) had lower circulating memory T regulatory cells compared to NS (n = 23) athletes (p = 0.005 (95%CI:-1.5,-0.15)) and HC (p = 0.002 (95%CI:-1.9,-0.3) with PBMC microbial stimulation assays revealing a T-helper 2 skewed immune response compared to HC. Plasma metabolomic profiling showed differences in sphingolipid pathway metabolites (a class of lipids important in infection and inflammation regulation) in HS compared to NS athletes and HC, with sphingomyelin predictive of RTI infection susceptibility (p = 0.005). Interpretation Athletes susceptible to RTI have reduced circulating memory T regulatory cells, metabolic dysregulation of the sphingolipid pathway and evidence of upper airway bacterial dysbiosis. Funding This study was funded by the English Institute of Sport (UK)