Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Lane Keeping Aid- a driver support system for cars

Many traffic incidents are due to the driver’s lack of attention, resulting in dangerous lane departures, either sliding off theroad or into the oppose lane. These kinds of incidents often have serious outcomes, which has led to much effort being concentrated on preventing or lessening the damages when the incident is already a fact, for example by installing safety belts and air bags. These measures may be considered to be acts of so-called passive safety. Active safety on the other hand, means that the safety systems intervene before the incidents have occurred. Lane Keeping Aid (LKA), which has been developed and implemented in this master thesis project, is a system designed to support the driver in the lateral axis in situations when unwanted lane departure is an evident risk. To be able to determine when the system should intervene and support the driver, information regarding how the driver handles the vehicle, along with the vehicle’s position and direction in the lane, is essential. The car’s position may be obtained by installing a camera in the vehicle. The information needed regarding other things, e.g. the car’s position in relation to the lane, is obtained by using a Kalmanfilter, which is based on a physically developed model, and which estimates the mentioned distances. Based on measurements and estimated values, it is possible for the LKA system to calculate an assistance torque, aimed at decreasing the lateral deviation from the centre of the lane. An electric power steering, instead of a conventional hydraulic steering servo is then used to produce the torque. The LKA system has been developed in a simulation environment using Simulink before being implemented, in order to monitor the function of the system before beginning actual testdrives. Furthermore, real measurement data given at driving with the test vehicle has been used to adjust and test the function. The results from the project’s first phase, in the simulation environment, show that the estimated values from the Kalmanfilter correlates well with real test data. Simulations with real measurement data show that the system functions as intended. Finally, it may also be mentioned, that the system has yet not been fully tested in a vehicle equipped with an electric power steering, which ought to be included in future development of the system

Vad är IT-kompetens : Ur åtta rektorers perspektiv

IT-utvecklingen i skolan har gått framåt mycket under det sena 90-talet. Detta har medfört att man på senare tid fört upp till diskussion att vi nu behöver föra in ytterligare en kompetens bland lärare och elever, nämligen IT-kompetens. Vi såg det därmed som intressant att undersöka vad rektorer på olika skolor anser att IT-kompetens är för något, för att jämföra detta med vad de nationella måldo-kument, övriga politiska dokument och olika IT-projekt menar att IT-kompetens är. Uppsatsen är av en kvalitativ karaktär och består dels av en litteraturstudie och dels en undersökning i form av åtta stycken intervjuer. Vår referensram bygger på politiska dokument och nationella måldokument som skriver något kring IT-kompetens i skolan. Vi har även tittat på två stora IT-projekt inom skolan, nämligen ITiS (IT i Skolan) och KK (Kunskaps- och Kompetensutveckling), för att se vad dessa skriver om IT-kompetens i skolan. IT-kompetens är ett begrepp som har diskuterats mycket på sistone. I intervjuerna framkom det att rektorerna, sinsemellan, inte alltid hade samma tolkningar gällandes vad begreppet innebar. Vad gäll-er jämförelsen mellan rektorernas tolkningar och vad de nationella måldokumenten, övriga politiska dokument och olika IT-projekt säger så finns det både överensstämmande tolkningar samt icke överensstämmande tolkningar. För att få en mer enhetlig uppfattning kring vad begreppet innebär krävs det mer förtydligande måldokument

Persistent vegetative state with high cerebral blood flow following profound hypoglycemia

A persistent vegetative state (severe dementia) developed in a 30-year-old man following hypoglycemic coma. Despite the poor clinical outcome, sensory evoked response recovered between 6 and 34 months after the insult. The cerebral blood flow level at rest after 34 months was slightly above the normal range. This finding contrasts with the low cerebral blood flow regularly reported in patients who are comatose or stuporous following severe brain hypoxia-ischemia

The role of dopamine and serotonin in suicidal behaviour and aggression

Serotonin and dopamine are two monoamines which are known to interact with each other. Their role for suicidal behaviour, aggression and mood are reviewed in this chapter. We found a substantial amount of evidence for the relevance of a serotonin and dopamine model of aggression, and for aggression as a major risk factor for suicide. Evidence was found that serotonin and dopamine also may be involved in depressed mood, and possibly the individual's ability to cope with imminent suicidality

The cerebral vascular response to a rapid decrease in blood glucose to values above normal in poorly controlled type 1 (insulin-dependent) diabetes mellitus

The effect of rapid lowering of blood glucose on cerebral blood flow (CBF) was studied in 10 Type 1 (insulin-dependent) diabetic patients (age 23.5 ± 3.8 years; mean ± S.D.) with longstanding, poor metabolic control (HbA1c 11.2 ± 1.0%; normal value 4.0–5.3%) using an intravenous xenon 133 single photon emission computed tomography technique. After a fall in blood glucose, during 81 ± 11 min (mean ± S.E.M.), from 18.2 ± 1.4 mmol/l to 9.2 ± 0.9 mmol/1 CBF was unchanged, but increased from its initial value of 48.8 ± 2.9 ml/100 g per min to 57.1 ± 2.4 ml/100 g per min (P < 0.001) when the blood glucose level was restored. The CBF was higher in the right compared to the left hemisphere at all measurements (1.8 ± 0.5 ml/100 g per min, P < 0.01; 1.9 ± 0.5 ml/100 g per min, P < 0.05; 2.1 ± 0.7 ml/100 g per min, P < 0.05, respectively). The change in CBF was inversely correlated with time for fall of blood glucose, but there was no correlation with absolute levels of blood glucose. The respiratory end-tidal Pco2 decreased during the low blood glucose level, but there was no correlation between the Pco2 and CBF. The cerebral volume was unchanged during the study. The results indicate that in patients with chronic hyperglycemia a rapid fall in blood glucose may cause a rise in CBF of the same magnitude as previously shown during absolute hypoglycemia in patients with well controlled diabetes mellitus and in normal subjects. However, the rise occurred when the blood glucose had been restored to its initial value, indicating an altered vascular response to lowering of blood glucose during chronic hyperglycemia