The Greek regional problem: Some analytic and policy perspectives

[Δε διατίθεται περίληψη][No abstract available

Epidemiology of Salmonellosis in Australia: surveillance of serovars and phage types from human and food animal sources

Data are presented on Salmonella in food animals in Australia, including pigs, cattle, sheep, broiler chickens and raw meats. These are compared with the most common types found in the human population. Questions are discussed regarding the importance of food animals versus other vehicles as sources of Salmonella in human infection

Soft tissue sarcomas of vulva

Fifteen cases of vulvar sarcomas were studied. The most common neoplasm was leiomyosarcoma, which also had the least favorable prognosis with a tendency to develop local recurrences and disseminated hematogenous metastases. The second most frequent sarcoma belonged to the fibrous histiocytoma group. Although they are unpredictable, they tended to be less aggressive than the leiomysarcomas. Other sarcomas encountered were fibrosarcoma, hemangiosarcoma, malignant hemangiopericytoma, epithelioid sarcoma, neurogenous sarcoma, malignant mesothelioma, and embryonal stromal sarcoma. Local recurrences were common in the series due in part to inadequate initial treatment. It was evident from the study that wide local excision or radical vulvectomy early in the disease with bilateral lymph node resection for those sarcomas that have a potential for lymphogenous metastases is the treatment of choice and gives the most favorable results. In the presence of local recurrences, aggressive surgical treatment is indicated and increases the survival rate significantly.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21810/1/0000210.pd

Exercise training for chronic heart failure (ExTraMATCH II): individual participant data meta-analysis of randomised controlled trials

This is the author accepted manuscript. The final version is available from NIHR Journals Library via the DOI in this record.Background: Current national and international guidelines on the management of heart failure (HF) recommend exercise-based cardiac rehabilitation (ExCR), but do not differentiate this recommendation according to patient subgroups. Objective(s): (1) to obtain definitive estimates of the impact of ExCR interventions versus control (no exercise intervention) on mortality, hospitalisation, exercise capacity, and health-related quality of life (HRQoL) in HF patients; (2) to determine the differential (subgroup) effects of ExCR in HF patients according to their age, gender, ejection fraction, aetiology, New York Heart Association (NYHA) class, and baseline exercise capacity; (3) to assess whether the change in exercise capacity mediates for the impact of the ExCR on final outcomes (mortality, hospitalisation, and HRQoL) and is an acceptable surrogate endpoint. Design: Individual participant data (IPD) meta-analysis Setting: An international literature review Participants: HF patients in randomised controlled trials (RCTs) of ExCR Interventions: ExCR for at least 3 weeks compared with no exercise control with 6 months follow-up Main outcome measures: mortality (all cause and HF-specific), hospitalisation (all-cause & HF-specific), exercise capacity, and HRQoL Data sources: Individual participant data from eligible RCTs 3 Review methods: RCTs from ExTraMATCH IPD meta-analysis and 2014 Cochrane systematic review of ExCR Results: Out of the 23 eligible RCTs (4,398 patients), 19 RCTs (3,990 patients) contributed data to this IPD meta-analysis. There was a wide variation in exercise programme prescriptions across included studies. Compared with control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals were wide: all-cause mortality: hazard ratio (HR) 0.83 (95% confidence interval (CI): 0.67 to 1.04), HF-related mortality: HR 0.84 (95% CI: 0.49 to 1.46), all-cause hospitalisation: HR 0.90 (95% CI: 0.76 to 1.06), and HF-related hospitalisation: HR 0.98 (95% CI: 0.72 to 1.35). There was a statistically significant difference in favour of ExCR for exercise capacity and HRQoL. Compared to control, at 12-months follow-up, improvements were seen in the six-minute walk test (6MWT) (mean: 21.0 metres, 95% CI: 1.57 to 40.4, and Minnesota Living with HF Questionnaire score (mean: -5.94, 95% CI: -1.0 to -10.9, lower scores indicate improved HRQoL). No strong evidence for differential intervention effects across patient characteristics was found for any outcomes. Moderate to good levels of correlation (R2 trial>50% & ρ>0.50) between peak oxygen uptake (VO2peak) or 6MWT with mortality and HRQoL were seen. Estimated surrogate threshold effect (STE) was an increase of 1.6 to 4.6 ml/kg/min for VO2peak. Limitations: Lack consistency in how included RCTs defined and collected the outcomes; we were unable to obtain IPD from all includable trials for all outcomes; and we did not seek patient level on exercise adherence. . Conclusions: In comparison to no exercise control, participation in ExCR improves the exercise and HRQoL in HF patients but appears to have no effect on their mortality or hospitalisation. No strong evidence was found of differential intervention effects of ExCR across patient characteristics. VO2peak and 6MWT may be suitable surrogate endpoints for the treatment effect of ExCR on mortality and HRQoL in HF.NIHR Health Technology Assessment programm

National baseline surveys to characterise processing hygiene and microbial hazards of Australian culled sow meat, retail pork sausages and retail pork mince

Pork products were sampled at retail to determine the impact of further processing on hazard levels to which consumers may be exposed, compared to carcases. Surveys of 116 fresh pork sausages and 148 fresh pork mince samples were purchased from supermarkets (n=87, n=105) and butcher shops (n=29, n=43), respectively. For sausages, concentrations of TVC averaged 4.6 log10 cfu/g

Validation of Exercise Capacity as a Surrogate Endpoint in Exercise-Based Rehabilitation for Heart Failure: A Meta-Analysis of Randomized Controlled Trials

This is the final version. Available on open access from Elsevier via the DOI in this recordObjectives: This study sought to validate exercise capacity (EC) as a surrogate for mortality, hospitalization, and health-related quality of life (HRQOL). Background: EC is often used as a primary outcome in exercise-based cardiac rehabilitation (CR) trials of heart failure (HF) via direct cardiorespiratory assessment of maximum oxygen uptake (VO2peak) or through submaximal tests, such as the 6-min walk test (6MWT). Methods: After a systematic review, 31 randomized trials of exercise-based CR compared with no exercise control (4,784 HF patients) were included. Outcomes were pooled using random effects meta-analyses, and inverse variance weighted linear regression equations were fitted to estimate the relationship between the CR on EC and all-cause mortality, hospitalization, and HRQOL. Spearman correlation coefficient (ρ), R2 at trial level, and surrogate threshold effect (STE) were calculated. STE represents the intercept of the prediction band of the regression line with null effect on the final outcome. Results: Exercise-based CR is associated with positive effects on EC measured through VO2peak (+3.10 ml/kg/min; 95% confidence interval [CI]: 2.01 to 4.20) or 6MWT (+41.15 m; 95% CI: 16.68 to 65.63) compared to control. The analyses showed a low level of association between improvements in EC (VO2peak or 6MWT) and mortality and hospitalization. Moderate levels of correlation between EC with HRQOL were seen (e.g., R2 <52%; |ρ| < 0.72). Estimated STE was an increase of 5 ml/kg/min for VO2peak and 80 m for 6MWT to predict a significant improvement in HRQOL. Conclusions: The study results indicate that EC is a poor surrogate endpoint for mortality and hospitalization but has moderate validity as a surrogate for HRQOL. Further research is needed to confirm these findings across other HF interventions.National Institute for Health Research (NIHR)University of Exete

Cardiovascular risk in high-hazard occupations: the role of occupational cardiology

Abstract Work is beneficial for health, but many individuals develop cardiovascular disease (CVD) during their working lives. Occupational cardiology is an emerging field that combines traditional cardiology sub-specialisms with prevention and risk management unique to specific employment characteristics and conditions. In some occupational settings incapacitation through CVD has the potential to be catastrophic due to the nature of work and/or the working environment. These are often termed 'hazardous' or 'high-hazard' occupations. Consequently, many organizations that employ individuals in high-hazard roles undertake pre-employment medicals and periodic medical examinations to screen for CVD. The identification of CVD that exceeds predefined employer (or regulatory body) risk thresholds can result in occupational restriction, or disqualification, which may be temporary or permanent. This article will review the evidence related to occupational cardiology for several high-hazard occupations related to aviation and space, diving, high altitude, emergency workers, commercial transportation, and the military. The article will focus on environmental risk, screening, surveillance, and risk management for the prevention of events precipitated by CVD. Occupational cardiology is a challenging field that requires a broad understanding of general cardiology, environmental, and occupational medicine principles. There is a current lack of consensus and contemporary evidence which requires further research. Provision of evidence-based, but individualized, risk stratification and treatment plans is required from specialists that understand the complex interaction between work and the cardiovascular system. There is a current lack of consensus and contemporary evidence in occupational cardiology and further research is required

Desmin mediates TNF-α–induced aggregate formation and intercalated disk reorganization in heart failure

We explored the involvement of the muscle-specific intermediate filament protein desmin in the model of tumor necrosis factor α (TNF-α)–induced cardiomyopathy. We demonstrate that in mice overexpressing TNF-α in the heart (α–myosin heavy chain promoter-driven secretable TNF-α [MHCsTNF]), desmin is modified, loses its intercalated disk (ID) localization, and forms aggregates that colocalize with heat shock protein 25 and ubiquitin. Additionally, other ID proteins such as desmoplakin and β-catenin show similar localization changes in a desmin-dependent fashion. To address underlying mechanisms, we examined whether desmin is a substrate for caspase-6 in vivo as well as the implications of desmin cleavage in MHCsTNF mice. We generated transgenic mice with cardiac-restricted expression of a desmin mutant (D263E) and proved that it is resistant to caspase cleavage in the MHCsTNF myocardium. The aggregates are diminished in these mice, and D263E desmin, desmoplakin, and β-catenin largely retain their proper ID localization. Importantly, D263E desmin expression attenuated cardiomyocyte apoptosis, prevented left ventricular wall thinning, and improved the function of MHCsTNF hearts

The integration of wildfire risk in the urbanism: a legal, analytical and practical approach for Catalonia

En un contexto donde el riesgo de incendio forestal (IF) es latente y la estructura urbanística presenta asentamientos expuestos a este riesgo, la situación derivada de los cambios en los usos del suelo y el cambio climático se traduce en un aumento de la potencial interacción entre los IF y los sistemas urbanos.El trabajo tiene como objetivo analizar la capacidad de integración del riesgo de IF en la planificación territorial y urbanística de Cataluña, especialmente desde la perspectiva de la vulnerabilidad de los asentamientos. De este modo, se ha llevado a cabo un análisis comparado entre la información del análisis del riesgo y los requerimientos legales y operativos del sistema de planeamiento, para así poder identificar aspectos presentes, o que sea necesario mejorar para hacer efectiva esta integración. Se han identificado unos procesos clave que hace falta definir e introducir en el sistema de planeamiento para que éste sea capaz de tener en cuenta el riesgo de IF para gestionar el territorio.In a context where wildfire risk is latent and the urban structure presents exposed settlements, the derivate situation from the land uses changes and the climate change, is translated as an increase of the potential interaction between wildfires and the urban systems.The objective of this research is to analyze the capacity to integrate the wildfire risk into the spatial and urban planning of Catalonia, specially from the perspective of settlement vulnerability. Thereby, it has carried out a comparative analysis between the risk analysis information and the legal and operational requirements of the planning system, in order to identify current aspects or what is necessary to improve, to make effective this integration. It has identified key processes that are necessary to define and introduce in the planning system so that it is able to take into account wildfire risk to manage the territory.Peer Reviewe