Co-Management of COVID-19 and heart failure during the COVID-19 pandemic. lessons learned

The COVID pandemic has brought many new challenges worldwide, which has impacted on patients with chronic conditions. There is an increasing evidence base suggesting an interaction between chronic heart failure (HF) and COVID-19, and in turn the prognostic impact of co-existence of the two conditions. Patients with existing HF appear more prone to develop severe complications on contracting COVID-19, but the exact prevalence in patients with mild symptoms of COVID-19 not requiring hospital admission is poorly investigated. In addition, hospitalization rates for acute HF over the pandemic period appear reduced compared to previous periods. Several key issues remain rather unaddressed and, importantly, a specific algorithm focused on diagnostic differentiation between HF and acute respiratory distress syndrome, a severe complication of COVID-19, is still lacking. Furthermore, recent data suggests potential interaction existing between HF treatment and some anti-viral anti-inflammatory drugs prescribed during the infection, raising some doubts about a universal treatment strategy for all patients with COVID-19. With this manuscript, we aim to review the current literature in this field in light of growing understanding of COVID-19 in the setting of the HF population, its associated morbidity and mortality burden, and the impact on healthcare systems. We hope that this may stimulate a discussion to guarantee a better, more tailored delivery of care for patients with HF in the setting of concomitant COVID-19 infection

A spectral survey of an ultra-hot Jupiter: Detection of metals in the transmission spectrum of KELT-9 b

Context: KELT-9 b exemplifies a newly emerging class of short-period gaseous exoplanets that tend to orbit hot, early type stars - termed ultra-hot Jupiters. The severe stellar irradiation heats their atmospheres to temperatures of $\sim 4,000$ K, similar to the photospheres of dwarf stars. Due to the absence of aerosols and complex molecular chemistry at such temperatures, these planets offer the potential of detailed chemical characterisation through transit and day-side spectroscopy. Studies of their chemical inventories may provide crucial constraints on their formation process and evolution history. Aims: To search the optical transmission spectrum of KELT-9 b for absorption lines by metals using the cross-correlation technique. Methods: We analyse 2 transits observed with the HARPS-N spectrograph. We use an isothermal equilibrium chemistry model to predict the transmission spectrum for each of the neutral and singly-ionized atoms with atomic numbers between 3 and 78. Of these, we identify the elements that are expected to have spectral lines in the visible wavelength range and use those as cross-correlation templates. Results: We detect absorption of Na I, Cr II, Sc II and Y II, and confirm previous detections of Mg I, Fe I, Fe II and Ti II. In addition, we find evidence of Ca I, Cr I, Co I, and Sr II that will require further observations to verify. The detected absorption lines are significantly deeper than model predictions, suggesting that material is transported to higher altitudes where the density is enhanced compared to a hydrostatic profile. There appears to be no significant blue-shift of the absorption spectrum due to a net day-to-night side wind. In particular, the strong Fe II feature is shifted by $0.18 \pm 0.27$ km~s$^{-1}$, consistent with zero. Using the orbital velocity of the planet we revise the steller and planetary masses and radii.Comment: Submitted to Astronomy and Astrophysics on January 18, 2019. Accepted on May 3, 2019. 26 pages, 11 figure

Wind of Change: retrieving exoplanet atmospheric winds from high-resolution spectroscopy

Context. The atmosphere of exoplanets has been studied extensively in recent years, using numerical models to retrieve chemical composition, dynamical circulation or temperature from data. One of the best observational probes in transmission is the sodium doublet, due to its large cross section. However, modelling the shape of the planetary sodium lines has proven to be challenging. Models with different assumptions regarding the atmosphere have been employed to fit the lines in the literature, yet statistically sound direct comparisons of different models are needed to paint a clear picture. Aims. We will compare different wind and temperature patterns and provide a tool to distinguish them driven by their best fit for the sodium transmission spectrum of the hot Jupiter HD 189733b. We parametrise different possible wind patterns already tested in literature and introduce the new option of an upwards driven vertical wind. Methods. We construct a forward model where the wind speed, wind geometry and temperature are injected into the calculation of the transmission spectrum. We embed this forward model in a nested sampling retrieval code to rank the models via their Bayesian evidence. Results. We retrieve a best-fit to the HD 189733b data for vertical upward winds $|\vec{v}_{\mathrm{ver}}(\mathrm{mean})|=40\pm4$ km/s at altitudes above $10^{-6}$ bar. With the current data from HARPS, we cannot distinguish wind patterns for higher pressure atmospheric layers. Conclusions. We show that vertical upwards winds in the upper atmosphere are a possible explanation for the broad sodium signature in hot Jupiters. We highlight other influences on the width of the doublet and explore strong magnetic fields acting on the lower atmosphere as one possible origin of the retrieved wind speed.Comment: 17 pages, 30 figures, accepted for publication in Astronomy & Astrophysics (04.12.2019

Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients

Background: Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients. Purpose: We examined (1) variability in Type D caseness following CR, (2) Type D as a determinant of health status, and (3) the clinical relevance of Type D as a determinant of health status compared to cardiac history. Methods: CAD patients (n = 368) participating in CR completed the Type D Scale, the Short-Form Health Survey 36 pre- and post-CR, and the Hospital Anxiety and Depression Scale pre-CR, to assess health status and depressive and anxious symptomatology, respectively. Results: The prevalence of Type D decreased from 26.6% to 20.7% (p = 0.012) following CR, but Type D caseness remained stable in 81% of patients. Health status significantly improved following CR [F(1,359) = 17.48, p < 0.001], adjusting for demographic and clinical factors and anxious and depressive symptoms. Type D patients reported poorer health status [F(1,359) = 10.40, p = 0.001], with the effect of Type D being stable over time [F(1,359) = 0.49, p = 0.48]. Patients with a cardiac history benefited less from CR [F(1,359) = 5.76, p = 0.02]. The influence of Type D on health status was larger compared to that for cardiac history, as indicated by Cohen's effect size index. Conclusions: Type D patients reported poorer health status compared to non-Type D patients pre- and post-CR. In the majority of patients, CR did not change Type D caseness, with Type D being associated with a stable and clinically relevant effect on outcome. These high-risk patients should

The response to the COVID-19 pandemic: With hindsight what lessons can we learn?

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1) peer review; 2) historical perspectives; 3) investing in resilience and protection; 4) unintended consequences; 5) protecting physical activity; 6) school closures; 7) mental health; and 8) obesity. As in all probability there will be another Pandemic, it is important that the lessons learned over the last three years in relation to HLB are acted upon. Whilst there will not always be a consensus on what to emphasise, it is important that many evidence-based positions are presented. The authors of this paper recognise that this work is a starting point and that the lessons presented here will need to be revisited as new evidence becomes available