Mesophotic coral ecosystems research strategy: international workshop to prioritize research and management needs for mesophotic coral ecosystems, Jupiter, Florida, 12-15 July 2008

On July 12-15, 2008, researchers and resource managers met in Jupiter, Florida to discuss and review the state of knowledge regarding mesophotic coral ecosystems, develop a working definition for these ecosystems, identify critical resource management information needs, and develop a Mesophotic Coral Ecosystems Research Strategy to assist the U.S. National Oceanic and Atmospheric Administration (NOAA) and other agencies and institutions in their research prioritization and strategic planning for mesophotic coral ecosystems. Workshop participants included representatives from international, Federal, and state governments; academia; and nongovernmental organizations. The Mesophotic Coral Ecosystems Workshop was hosted by the Perry Institute for Marine Science (PIMS) and organized by NOAA and the U.S. Geological Survey (USGS). The workshop goals, objectives, schedule, and products were governed by a Steering Committee consisting of members from NOAA (National Centers for Coastal Ocean Science’s Center for Sponsored Coastal Ocean Research, the Office of Ocean Exploration and Research’s NOAA Undersea Research Program, and the National Marine Fisheries Service), USGS, PIMS, the Caribbean Coral Reef Institute, and the Bishop Museum

The first mm detection of a neutron star high-mass X-ray binary

Neutron stars accreting from OB supergiants are often divided between persistently and transiently accreting systems, called supergiant X-ray binaries (SgXBs) and supergiant fast X-ray transients (SFXTs). This dichotomy in accretion behaviour is typically attributed to systematic differences in the massive stellar wind, binary orbit, or magnetic field configuration, but direct observational evidence for these hypotheses remains sparse. To investigate their stellar winds, we present the results of pilot 100-GHz observations of one SFXT and one SgXB with the Northern Extended Millimetre Array. The SFXT, IGR J18410-0535, is detected as a point source at 63.4 ± 9.6 μJy, while the SgXB, IGR J18410-0535 remains undetected. Radio observations of IGR J18410-0535 imply a flat or inverted low-frequency spectrum, arguing for wind emission and against non-thermal flaring. Due to the uncertain SFXT distance, however, the observations do not necessarily imply a difference between the wind properties of the SFXT and SgXB. We compare the mm constraints with other HMXBs and isolated OB supergiants, before considering how future mm campaigns can constrain HMXB wind properties by including X-ray measurements. Specifically, we discuss caveats and future steps to successfully measure wind mass-loss rates and velocities in HMXBs with coordinated mm, radio, and X-ray campaigns

Phenotypic expansion of the BPTF-related neurodevelopmental disorder with dysmorphic facies and distal limb anomalies

Neurodevelopmental disorder with dysmorphic facies and distal limb anomalies (NEDDFL), defined primarily by developmental delay/intellectual disability, speech delay, postnatal microcephaly, and dysmorphic features, is a syndrome resulting from heterozygous variants in the dosage-sensitive bromodomain PHD finger chromatin remodeler transcription factor BPTF gene. To date, only 11 individuals with NEDDFL due to de novo BPTF variants have been described. To expand the NEDDFL phenotypic spectrum, we describe the clinical features in 25 novel individuals with 20 distinct, clinically relevant variants in BPTF, including four individuals with inherited changes in BPTF. In addition to the previously described features, individuals in this cohort exhibited mild brain abnormalities, seizures, scoliosis, and a variety of ophthalmologic complications. These results further support the broad and multi-faceted complications due to haploinsufficiency of BPTF.Genetics of disease, diagnosis and treatmen

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efeito da aplicação sucessiva de precipitações pluviais com diferentes perfis na taxa de infiltração de água no solo

O processo de infiltração é influenciado pelas condições da superfície do solo e pela precipitação pluvial. O objetivo deste trabalho foi avaliar a influência de aplicações sucessivas de precipitações pluviais com diferentes perfis na formação do encrostamento superficial e, consequentemente, na taxa de infiltração de água em solo sem cobertura e com cobertura. Foram aplicadas três precipitações pluviais sucessivas para cada perfil de precipitação pluvial, em intervalos de 24 h, sendo usados os perfis de precipitação pluvial constante, exponencial decrescente, duplo exponencial adiantado e atrasado, com uma lâmina média de 55 mm por aplicação. Buscou-se ajustar um fator de decaimento da taxa de infiltração (Ti) em função da energia cinética acumulada da chuva, denominado de fator f, dado pela razão entre a taxa de infiltração estável (Tie) com efeito da chuva e a Tie sem o efeito da chuva. Foram avaliadas duas condições de cobertura do solo, solo sem cobertura e solo coberto com palhada, sendo os ensaios de infiltração realizados com um simulador de chuvas, em parcelas experimentais de dimensões de 1,0 x 0,7 m. Os resultados foram avaliados por meio de análises gráficas, análise de variância e teste de média. Verificou-se que os diferentes perfis de precipitação pluvial não influenciaram a infiltração de água no solo, tanto para o solo sem cobertura como para o solo com cobertura, sendo esta influenciada somente pelas aplicações sucessivas, com menores valores da taxa de infiltração obtidos na segunda e terceira aplicações. O decréscimo na Ti em solo sem cobertura foi devido à formação de encrostamento superficial, o que ocorreu logo na primeira aplicação. A Tie em solo sem cobertura teve decréscimo de 75 % se comparada à Tie em solo com cobertura. A lâmina infiltrada não foi influenciado pelos quatro perfis de precipitação pluvial. O fator f foi descrito com uso de uma equação do tipo exponencial

Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe. A Report From the Euro Heart Survey on Atrial Fibrillation

Objectives: This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. Background: Gender-related differences may play a significant role in AF. Methods: We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. Results: Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019). Conclusions: Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar. © 2007 American College of Cardiology Foundation

Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation

Aims To describe guideline adherence and application of different stroke risk strati. cation schemes regarding antithrombotic therapy in real-life atrial. brillation (AF) patients and to assess which factors influence antithrombotic management decisions.Methods and results The Euro Heart Survey enrolled 5333 AF patients in 35 countries, in 2003 and 2004. Prescription of antithrombotic drugs, especially oral anticoagulation (OAC), was hardly tailored to the patient's stroke risk pro. le as indicated by the joint guidelines of the American College of Cardiology, American Heart Association, and the European Society of Cardiology, ACCP guidelines, or CHADS(2) and Framingham risk scores. In multivariable analysis, only a limited number of the well-known stroke risk factors triggered OAC prescription. In contrast, less relevant factors, of which clinical type of AF and availability of an OAC monitoring outpatient clinic were the most marked, played a significant role in OAC prescription. Electrical cardioversions and catheter ablations clearly triggered OAC prescription, whereas pharmacological cardioversions even in the presence of stroke risk factors did not.Conclusion Antithrombotic therapy in AF is hardly tailored to the patient's stroke risk pro. le. Factors other than well-known stroke risk factors were significantly involved in antithrombotic management decisions. To facilitate this tailored treatment, guideline writers and physician educators should focus on providing one uniform and easy to use stroke risk strati. cation scheme

Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)

BACKGROUND: Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure. METHODS: We recruited patients from October, 1997, to June, 2000. 13655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4.2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat. FINDINGS: Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% beta blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated. INTERPRETATION: Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3–58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5–56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32–6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20–5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin–kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron