Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery : the VISION study

AIMS: The aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery. METHODS AND RESULTS: We conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73–0.95; P = 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40–0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23–0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73–0.98; P = 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke. CONCLUSION: Among patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial. CLINICAL TRIAL REGISTRATION: Clinical Trials.gov NCT0051210

Vulnerability of Amazon forests to storm-driven tree mortality

Tree mortality is a key driver of forest community composition and carbon dynamics. Strong winds associated with severe convective storms are dominant natural drivers of tree mortality in the Amazon. Why forests vary with respect to their vulnerability to wind events and how the predicted increase in storm events might affect forest ecosystems within the Amazon are not well understood. We found that windthrows are common in the Amazon region extending from northwest (Peru, Colombia, Venezuela, and west Brazil) to central Brazil, with the highest occurrence of windthrows in the northwest Amazon. More frequent winds, produced by more frequent severe convective systems, in combination with well-known processes that limit the anchoring of trees in the soil, help to explain the higher vulnerability of the northwest Amazon forests to winds. Projected increases in the frequency and intensity of convective storms in the Amazon have the potential to increase wind-related tree mortality. A forest demographic model calibrated for the northwestern and the central Amazon showed that northwestern forests are more resilient to increased wind-related tree mortality than forests in the central Amazon. Our study emphasizes the importance of including wind-related tree mortality in model simulations for reliable predictions of the future of tropical forests and their effects on the Earth' system

Practical guide for the use of biotechnological therapies in Rheumatoid Arthritis

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I do it for myself : A study on motivational differences between contracted and permanent employees in Sweden

Over the past decades outsourcing decades outsourcing has become an increasing trend.Firms decide to outsource in order to increase their profits or flexibility and many differentfunctions of the firm may be outsourced, one of them being the Human Resource (HR)function. When it comes to HR outsourcing, recruitment and selection are among the morecommon functions to be outsourced (Ordanini & Silvestri, 2008:373). The motivation foroutsourcing of HR is to reduce cost and increase efficiency (Elmuti, Grunewald and Abebe,2010:177). Outsourcing of HR functions like recruitment can also have negative aspect, forexample lack of loyalty and high turnover (Fisher et al, 2008:202). Previous research hasinvestigated how commitment and loyalty is affected by HR outsourcing (Connelly &Gallagher, 2004:963) and one aspect that has been touched upon but not dealt withexclusively is motivation and therefore this paper will explore it further. Using the following research question: How does motivation vary between individuals working at a company butare hired through a staffing firm versus hired directly by the company? This paper tries to both evaluate the existing literature and provide practicalimplications for managers. In order to explore this question and abductive research approachhas been used where the data and theory are intertwined and played of each other to achievethe purpose (Alvesson & Sköldberg, 2009:4). The data collection consists of eight semistructuredinterviews, four with people hired directly by the company and four that are orhave previously been hired through a staffing company. The study found that the theoretical framework does for the most part explain themotivational behavior of both groups studied, and that the two groups are not alwaysmotivated in the same way. Those hired directly by the company are more interested inreceiving praise, relationships at work, and receiving small tokens of appreciation. The grouphired by staffing companies was more often motivated by an internal drive to satisfythemselves and did not value work relationships to the same extent. The research also showedthat the individual rather than the form of employment plays a big role when it comes to howpeople are motivated. It was also made apparent that education and work situation wereimportant factors influencing the respondent’s motivation