Amlodipine+Benazepril is Superior to Hydrochlorothiazide+Benazepril Irrespective of Baseline Pulse Pressure: Subanalysis of the ACCOMPLISH Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110751/1/jch12460.pd

Circumpolar patterns of Arctic freshwater fish biodiversity: A baseline for monitoring

This is the peer reviewed version of the following article: "Circumpolar patterns of Arctic freshwater fish biodiversity: A baseline for monitoring", which has been published in final form at https://doi.org/10.1111/fwb.13405. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsClimate change, biological invasions, and anthropogenic disturbance pose a threat to the biodiversity and function of Arctic freshwater ecosystems. Understanding potential changes in fish species distribution and richness is necessary, given the great importance of fish to the function of freshwater ecosystems and as a resource to humans. However, information gaps limit large‐scale studies and our ability to determine patterns and trends in space and time. This study takes the first step in determining circumpolar patterns of fish species richness and composition, which provides a baseline to improve both monitoring and conservation of Arctic freshwater biodiversity. Information on species presence/absence was gathered from the Circumpolar Biodiversity Monitoring Program's Freshwater Database and used to examine patterns of freshwater fish γ‐, α‐, and β‐diversity across 234° of longitude in the Arctic. The metrics of diversity provided information on species richness and composition across hydrobasins, ecoregions, and Arctic zones. Circumpolar patterns of fish species biodiversity varied with latitude, isolation, and coarse ecoregion characteristics; patterns were consistent with historic and contemporary barriers to colonisation and environmental characteristics. Gamma‐diversity was lower in the high Arctic compared to lower latitude zones, but α‐diversity did not decrease with increasing latitude below 71°N, reflecting glacial history. Alpha‐diversity was reduced to a single species, Arctic charr Salvelinus alpinus, in ecoregions above 71°N, where γ‐diversity was the lowest. Beta‐diversity indicated little variation in the composition and richness of species across the High Arctic; at lower latitudes, ecoregions contained more species, although species composition turned over across large spatial extents. In an analysis of five ecoregions in the circumpolar Arctic, physical isolation, and ecoregion area and topography were identified as strong drivers of γ‐, α‐, and β‐diversity. Physical isolation reduced the γ‐ and α‐diversity, and changes in β‐diversity between adjacent locations were due mainly to losses in species richness, rather than due to differences in species composition. Heterogeneity of habitats, environmental gradients, and geographic distance probably contributed to patterns of fish dissimilarity within and across ecoregions. This study presents the first analysis of large‐scale patterns of freshwater fish biodiversity in the circumpolar Arctic. However, information gaps in space, time, and among taxonomic groups remain. Future inclusion of extensive archive and new data will allow future studies to test for changes and drivers of the observed patterns of biodiversity. This is important given the potential impacts of ongoing and accelerating climate change, land use, and biotic exchange on Arctic fish biodiversity

Evaluation of a web-based ECG-interpretation programme for undergraduate medical students

<p>Abstract</p> <p>Background</p> <p>Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institutet have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity.</p> <p>Methods</p> <p>A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group.</p> <p>Results</p> <p>20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 – very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03).</p> <p>Conclusion</p> <p>Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.</p

Clinical Evidence for the Cardiovascular Benefits of Angiotensin Receptor Blockers

Targeting the renin-angiotensin-aldosterone system (RAAS), specifically the effector peptide angiotensin II (Ang II), represents a major opportunity for slowing the progression of cardiovascular disease (CVD) and, in turn, reducing the risk of morbidity and mortality. Inhibition of angiotensin-converting enzyme (ACE) and selective blockade of Ang II AT1 receptors are two approaches through which the pathophysiological effects of Ang II can be targeted. Numerous clinical studies have established the benefits of ACE inhibitors P, (ACE-Is) in lessening the morbidity and mortality burden of CVD. There are, however, tolerability concerns associated with ACE-Is, such as angioedema and dry cough. By blocking Ang II at the AT1 receptor level, Ang II receptor blockers (ARBs) provide a more specific and complete blockade of the deleterious effects of Ang II and tend to have more favourable tolerability. A number of clinical trials have shown that ARBs are not only associated with positive outcomes across the CVD continuum but may also have a role in the prevention or delay of diabetes (a major cardiovascular risk factor). Ongoing trials are aiming to define the place of such agents in lessening morbidity and mortality from CVD

Järv, lodjur och varg i renskötselområdet: inventeringsresultat 2001

För sjätte året i rad har länsstyrelserna i Norrbottens-, Västerbottens-, Jämtlands- och Dalarnas län i samarbete med samebyarna i Sverige inventerat renskötselområdet påförekomst och föryngring av järv, lodjur och varg. Inventeringsmetoderna har under tiden sedan 1996 reviderats och förfinats och samma metodik används i alla län i renskötselområdet(och även i Norge).Resultatet av arbetet skall användas i följande hänseenden:1. Underlag för Sametingets beslut om fördelning av ersättningar för rovdjur till samebyarna.2. Underlag för Naturvårdsverkets beslut om var och hur stor omfattningen ska vara av eventuell skyddsjakt.3. Uppföljning av effekterna av beviljad skyddsjakt.4. Möjliggöra ansvarsfull förvaltning genom ökad kunskap om de stora rovdjuren i renskötselområdet.5. Uppföljning av de nationella målen om rovdjursförekomst och beståndsstorlek.År 2001 dokumenterades 50 föryngringar av järv i renskötselområdet i Sverige. Dessutomdokumenterades sex järvföryngringar inom 5 km in på norsk sida och ytterligare fem i konventionsbetesområden i Norge. Alla dessa är ersättningsberättigande i det svenskaersättningssystemet. Antalet järvföryngringar har ökat något sedan år 2000 efter att fram till dess ha uppvisat en starkt minskande trend. Uppgången har skett i Norrbotten. Trots detta är det ändå tydligt att antalet järvföryngringar har minskat sedan 1996. Det finns nu drygthälften av de 90 järvföryngringar som utgör det nationella etappmålet. Det totala antalet järvar i renskötselområdet år 2001 uppskattas grovt till drygt 300 individer(exklusive årsungar).Antalet familjegrupper av lodjur som dokumenterades i renskötselområdet i Sverige var 131 stycken. Dessutom dokumenterades ytterligare sex i konventionsbetesområden i Norge. Antalet familjegrupper av lodjur har ökat i Norrbotten och i Västerbotten jämfört med ifjol. IJämtland har dock lodjuren fortsatt att minska vilket gjort att det totala antalet familjegrupperi princip är detsamma år 2001 som år 2000. Sedan 1996 har dock lodjursbeståndet i renskötselområdet minskat. Det har bedrivits en omfattande skyddsjakt på lodjur vilketbedöms vara en orsak till minskningen. Det totala antalet lodjur i renskötselområdet år 2001uppskattas grovt till ca 800 individer (inklusive årsungar).Tillfällig vargförekomst har dokumenterats i totalt nio samebyar fördelat på samtliga län.Förekomst av björn och kungsörn rapporteras i samtliga samebyar.Den minskade medelstilldelningen till länsstyrelserna under de senaste åren har medfört attdet varit svårt att bibehålla kvaliteten på inventeringarna. Främst gäller detta lodjursinventeringen. År 2001 anvisades 3 miljoner kronor till länsstyrelserna i fjällänen för inventeringsverksamheten. Samebyarna tilldelades år 2001 via Sametinget 3 miljoner förinventeringsarbetet kopplat till ersättningssystemet.Regionala inventeringsrapporter import från MDP 2015-05</p

Järv, lodjur och varg i renskötselområdet: inventeringsresultat 2001

För sjätte året i rad har länsstyrelserna i Norrbottens-, Västerbottens-, Jämtlands- och Dalarnas län i samarbete med samebyarna i Sverige inventerat renskötselområdet påförekomst och föryngring av järv, lodjur och varg. Inventeringsmetoderna har under tiden sedan 1996 reviderats och förfinats och samma metodik används i alla län i renskötselområdet(och även i Norge).Resultatet av arbetet skall användas i följande hänseenden:1. Underlag för Sametingets beslut om fördelning av ersättningar för rovdjur till samebyarna.2. Underlag för Naturvårdsverkets beslut om var och hur stor omfattningen ska vara av eventuell skyddsjakt.3. Uppföljning av effekterna av beviljad skyddsjakt.4. Möjliggöra ansvarsfull förvaltning genom ökad kunskap om de stora rovdjuren i renskötselområdet.5. Uppföljning av de nationella målen om rovdjursförekomst och beståndsstorlek.År 2001 dokumenterades 50 föryngringar av järv i renskötselområdet i Sverige. Dessutomdokumenterades sex järvföryngringar inom 5 km in på norsk sida och ytterligare fem i konventionsbetesområden i Norge. Alla dessa är ersättningsberättigande i det svenskaersättningssystemet. Antalet järvföryngringar har ökat något sedan år 2000 efter att fram till dess ha uppvisat en starkt minskande trend. Uppgången har skett i Norrbotten. Trots detta är det ändå tydligt att antalet järvföryngringar har minskat sedan 1996. Det finns nu drygthälften av de 90 järvföryngringar som utgör det nationella etappmålet. Det totala antalet järvar i renskötselområdet år 2001 uppskattas grovt till drygt 300 individer(exklusive årsungar).Antalet familjegrupper av lodjur som dokumenterades i renskötselområdet i Sverige var 131 stycken. Dessutom dokumenterades ytterligare sex i konventionsbetesområden i Norge. Antalet familjegrupper av lodjur har ökat i Norrbotten och i Västerbotten jämfört med ifjol. IJämtland har dock lodjuren fortsatt att minska vilket gjort att det totala antalet familjegrupperi princip är detsamma år 2001 som år 2000. Sedan 1996 har dock lodjursbeståndet i renskötselområdet minskat. Det har bedrivits en omfattande skyddsjakt på lodjur vilketbedöms vara en orsak till minskningen. Det totala antalet lodjur i renskötselområdet år 2001uppskattas grovt till ca 800 individer (inklusive årsungar).Tillfällig vargförekomst har dokumenterats i totalt nio samebyar fördelat på samtliga län.Förekomst av björn och kungsörn rapporteras i samtliga samebyar.Den minskade medelstilldelningen till länsstyrelserna under de senaste åren har medfört attdet varit svårt att bibehålla kvaliteten på inventeringarna. Främst gäller detta lodjursinventeringen. År 2001 anvisades 3 miljoner kronor till länsstyrelserna i fjällänen för inventeringsverksamheten. Samebyarna tilldelades år 2001 via Sametinget 3 miljoner förinventeringsarbetet kopplat till ersättningssystemet.Regionala inventeringsrapporter import från MDP 2015-05</p

Social mobility, marital status, and mortality risk in an adult life course perspective: The Malmo preventive project

Aims: Adverse social factors predict increased mortality. This study aimed to assess the influence of social class and marital status on mortality, adding an adult life course perspective. Methods: In total, 32,907 males and 20,204 females were evaluated based on census data in Malmo, Sweden. Of these subjects, 22,444 males and 10,902 females also took part in health screening. The main outcomes were all-cause and cause-specific mortality rates in subgroups based on social class and marital status, either measured once or repeatedly in adult life. Results were based on a total of 522,807 years of follow-up in men ( 5,761 deaths) and 239,815 in women ( 1,354 deaths). Results: Total and cardiovascular mortality were significantly higher in manual male employees with age-adjusted risk ratios (RR) of 1.7 (95% CI 1.5-1.9) and 1.6 (1.3-2.0) in skilled manual workers, and 2.0 (1.7-2.2) and 1.9 (1.6-2.3) in unskilled manual workers, compared with high-level non-manual employees. The differences remained after adjustment for baseline risk factors and prevalent cardiovascular disease, and were similar for women. Increased mortality risk was also documented for subjects who were divorced or unmarried ( adjusted for social class), as well as being downward socially mobile or in a permanent low social class ( manual) position. Conclusions: Social class based on occupation, either measured once or repeatedly in adult life, is associated with marked differences in mortality risk in middle-aged subjects. People who remain married/cohabiting or remarry are at lower risk of early death than people who remain unmarried or divorced

High beat-to-beat blood pressure variability in atrial fibrillation compared to sinus rhythm

Purpose: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm. Materials and methods: We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site. Results: We observed a significant difference (p < .001) in systolic and diastolic blood pressure variability between the atrial fibrillation and sinus rhythm groups at all locations. Systolic blood pressure variability roughly doubled in the atrial fibrillation group compared to the sinus rhythm group (4.9 and 2.4 mmHg respectively). Diastolic beat-to-beat blood pressure variability was approximately 6 times as high in the atrial fibrillation group compared to the sinus rhythm group (7.5 and 1.2 mmHg respectively). No significant difference in blood pressure variability was seen between measurement locations. Conclusions: Beat-to-beat blood pressure variability in patients with atrial fibrillation was substantially higher than in patients with sinus rhythm. Hemodynamic effects of this beat-to-beat variation in blood pressure may negatively affect vascular structure and function, which may contribute to the increased cardiovascular morbidity and mortality seen in patients with atrial fibrillation