Morbidity and mortality associated with atherosclerotic peripheral artery disease: A systematic review.

BACKGROUND AND AIMS It is unclear whether improvements in the detection/treatment of peripheral artery disease (PAD) affect overall survival and morbidity. We undertook a systematic review to describe survival and morbidity in contemporary PAD cohorts. METHODS Electronic databases were searched for randomised and observational studies reporting mortality/morbidity events between 1 May 2003 and 31 December, 2017 in patients with PAD, diagnosed by intermittent claudication (IC), critical limb ischaemia (CLI), or an ankle brachial index (ABI) < 0.9. Pooled event rates for all-cause and cardiovascular (CV) mortality, non-fatal myocardial infarction (MI), non-fatal stroke, major CV events (MACE; non-fatal MI/stroke, CV death), and major amputation were calculated per 1000 person-years. RESULTS 124 eligible studies were identified (570,856 patients; 855,894 person-years of follow-up). Statin use was reported in 67% of the overall cohort and antiplatelet use in 79%. Pooled event rates for all-cause and CV mortality, MI, stroke, MACE, and major amputation were 113, 39, 20, 12, 71, and 70 per 1000 person-years, respectively. Compared with patients with an ABI <0.9, the presence of CLI was associated with increased rates of all-cause and CV mortality, MI, MACE, and major amputation. Event rates for stroke were similar between patients with an ABI <0.9 and CLI. CONCLUSIONS Our data show PAD patients have a high risk of all-cause and CV mortality, and imply the risk of stroke or MI is at least equivalent to the risk in patients with coronary artery disease. Moreover, our data underline the need for improved treatments to attenuate CV risk in PAD patients

87Sr/86Sr and 14C evidence for peccary (Tayassuidae) introduction challenges accepted historical interpretation of the 1657 Ligon map of Barbados

Contemporary West Indian biodiversity has been shaped by two millennia of non-native species introductions. Understanding the dynamics of this process and its legacy across extended temporal and spatial scales requires accurate knowledge of introduction timing and the species involved. Richard Ligon’s 17th&nbsp;century account and celebrated map of early colonial Barbados records the translocation of several Old World species to the island in the post-contact era, including pigs (Sus scrofa) believed to have been released by passing sailors the century prior. Here we challenge this long-accepted historical narrative, presenting evidence that Ligon’s “pigs” were in fact peccaries, a New World continental mammal often confused with wild boars. We document the first recorded instance of non-native peccary (Tayassuidae) on Barbados based on a securely identified mandibular specimen from a historic archaeological context. Results of specimen&nbsp;87Sr/86Sr and AMS radiocarbon assays, along with newly reported data from Sr isotope environmental analyses, indicate a local origin dating to AD 1645–1670/1780–1800. These data support the presence of living peccary on Barbados some time during the first 175 years of English settlement, which, based on review of historical and archaeological data, most likely arises from 16th&nbsp;century peccary introduction from the Guianas/Trinidad by the Spanish or Portuguese. We argue dimorphic representations of “pigs” on Ligon’s map reflect the co-occurrence of peccary and European domestic swine on historic Barbados. Our findings overturn conventional history and provide greater taxonomic and chronological resolution for Caribbean bioinvasion studies, helping to refine our understanding of potential ecological impacts. In addition, the new bioavailable&nbsp;87Sr/86Sr data for Barbados reported here advance current efforts toward mapping the Caribbean Sr isoscape

Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study

BACKGROUND: It is widely considered that improved diagnostics in suspected acute coronary syndrome (ACS) are needed. To help clarify the current situation and the improvement potential, we analyzed characteristics, disposition and outcome among patients with suspected ACS at a university hospital emergency department (ED). METHODS: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). RESULTS: 4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit. CONCLUSIONS: Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large

Not a limitless resource: ethics and guidelines for destructive sampling of archaeofaunal remains

Publisher's version (útgefin grein)With the advent of ancient DNA, as well as other methods such as isotope analysis, destructive sampling of archaeofaunal remains has increased much faster than the effort to collect and curate them. While there has been considerable discussion regarding the ethics of destructive sampling and analysis of human remains, this dialogue has not extended to archaeofaunal material. Here we address this gap and discuss the ethical challenges surrounding destructive sampling of materials from archaeofaunal collections. We suggest ways of mitigating the negative aspects of destructive sampling and present step-by-step guidelines aimed at relevant stakeholders, including scientists, holding institutions and scientific journals. Our suggestions are in most cases easily implemented without significant increases in project costs, but with clear long-term benefits inthe preservation and use of zooarchaeologicalmaterial.his work was supported by the Icelandic Research Fund grant no. 162783-051, Finnish Academy grant no. SA286499, the European Union’s Horizon 2020 research and innovation programme under the Marie SkłodowskaCurie grant agreement no. 749226 and Estonian Research Council grant nos. PRG29 and IUT 20-7.Peer Reviewe

EU-wide cross-sectional observational study of lipid-modifying therapy use in secondary and primary care: the DA VINCI study

Aims To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement.Methods and results An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their risk-based 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination).Conclusion Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.Cardiolog

No Pig Atoll: Island Biogeography and the Extirpation of a Polynesian Domesticate

The significance of the domestic pig, Sus scrofa, to prehistoric Polynesians is hinted at by its inclusion among the species that they transported with them as they colonized Oceania. However, archaeological data reveal a pattern of pig distribution far more extensive in prehistory than at historic contact. Domestic mammal extirpation is a phenomenon apparently unique to prehistoric Polynesia. Although well recognized, the local extinction of domestic pigs in Polynesia prior to European contact has yet to be satisfactorily explained. Earlier accounts attributed the patchy distribution of pigs across the Island South Pacific to intentional extermination by their Polynesian keepers. More recent approaches seek to understand the disappearance of these animals within a biogeographic and ecological framework. Here, I test the hypothesis that the success of pig husbandry is correlated with ecological variables and demonstrate that the likelihood of pig extinction increases with decreasing island size. KEYWORDS: Polynesia, domestic animals, pigs, island biogeography, extinction