Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study.

Funder: Wellcome TrustObjectiveTo describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results42 290 patients (49% female), aged 65-74 (n=11 722), 75-84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65-74 years, from 54% to 86% in people aged 75-84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65-74, 75-84 and 85+ years, respectively.ConclusionsRates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years

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Pasienter som legges inn i sykehus opplever endringer fra sitt vante sovemiljø. Disse endringene vil i seg selv kunne være søvnforstyrrende. Eldre pasienter er i større grad utsatt for søvnproblemer da de er spesielt sårbare for endringer i døgnrytme og har normale aldersforandringer med reduksjon i dyp søvn. Mange lider i tillegg av aldersrelaterte sykdommer. Eldre våkner lettere av ytre stimuli fra sykehusmiljøet, til tross for dette er det ikke automatikk i å utføre søvnkartlegging ved innleggelse i sykehus. Etter som ivaretakelse av pasientens individuelle- og grunnleggende behov er en sykepleieroppgave, mener vi at sykepleieren har en viktig rolle i å tilrettelegge for en så god søvnopplevelse som mulig hos inneliggende pasienter. God søvn er en forutsetning for rask rekonvalesens under sykdom, så vel som å fremme kognitiv funksjon, skape overskudd og mestringsevne under et sykehusopphold. Tilrettelegging for en god søvnopplevelse hos eldre pasienter handler om at sykepleieren via god kartlegging fanger opp de individuelle behovene pasienten har rundt søvn. Sykepleieren må sammen med pasienten velge ut realistiske tiltak som vil fremme og optimalisere en god nattesøvn og påse at tiltakene blir fulgt opp under tiden pasienten er innlagt. En god søvnopplevelse gjennom natten vil kunne gi raskere rekonvalesens og forebygge uheldige komplikasjoner som vil kunne kreve flere liggedøgn en nødvendig

Becoming academics : embracing and resisting changing writing practice

Purpose The purpose of this paper is to analyze how global and local changes in higher education impact upon writing practices through which doctoral students become academics. The study explores how norms and values of academic writing practice are learned, negotiated and resisted and elucidates how competences related to writing come to determine the academic selves. Design/methodology/approach The study uses memory work, which is a group method that puts attention to written individual memories and their collective analysis and theorizing. The authors offer a comparison of experiences in becoming academics by two generational cohorts (1990s and 2010s) in the same management studies department in a business school. Findings The study indicates that the contextual and temporal enactment of academic writing practice in the department created a situation where implicit and ambiguous criteria for writing competence gradually changed into explicit and narrow ones. The change was relatively slow for two reasons. First, new performance management indicators were introduced over a period of two decades. Second, when the new indicators were gradually introduced, they were locally resisted. The study highlights how the focus, forms and main actors of resistance changed over time. Originality/value The paper offers a detailed account of how exogenous changes in higher education impact upon, over time and cultural space, academic writing practices through which doctoral students become academics.Purpose The purpose of this paper is to analyze how global and local changes in higher education impact upon writing practices through which doctoral students become academics. The study explores how norms and values of academic writing practice are learned, negotiated and resisted and elucidates how competences related to writing come to determine the academic selves. Design/methodology/approach The study uses memory work, which is a group method that puts attention to written individual memories and their collective analysis and theorizing. The authors offer a comparison of experiences in becoming academics by two generational cohorts (1990s and 2010s) in the same management studies department in a business school. Findings The study indicates that the contextual and temporal enactment of academic writing practice in the department created a situation where implicit and ambiguous criteria for writing competence gradually changed into explicit and narrow ones. The change was relatively slow for two reasons. First, new performance management indicators were introduced over a period of two decades. Second, when the new indicators were gradually introduced, they were locally resisted. The study highlights how the focus, forms and main actors of resistance changed over time. Originality/value The paper offers a detailed account of how exogenous changes in higher education impact upon, over time and cultural space, academic writing practices through which doctoral students become academics.Peer reviewe

Impaired metabolic flexibility in the osteoarthritis process: a study on transmitochondrial cybrids

[Abstract] Osteoarthritis (OA) is the most frequent joint disease; however, the etiopathogenesis is still unclear. Chondrocytes rely primarily on glycolysis to meet cellular energy demand, but studies implicate impaired mitochondrial function in OA pathogenesis. The relationship between mitochondrial dysfunction and OA has been established. The aim of the study was to examine the differences in glucose and Fatty Acids (FA) metabolism, especially with regards to metabolic flexibility, in cybrids from healthy (N) or OA donors. Glucose and FA metabolism were studied using D-[14C(U)]glucose and [1-14C]oleic acid, respectively. There were no differences in glucose metabolism among the cybrids. Osteoarthritis cybrids had lower acid-soluble metabolites, reflecting incomplete FA β-oxidation but higher incorporation of oleic acid into triacylglycerol. Co-incubation with glucose and oleic acid showed that N but not OA cybrids increased their glucose metabolism. When treating with the mitochondrial inhibitor etomoxir, N cybrids still maintained higher glucose oxidation. Furthermore, OA cybrids had higher oxidative stress response. Combined, this indicated that N cybrids had higher metabolic flexibility than OA cybrids. Healthy donors maintained the glycolytic phenotype, whereas OA donors showed a preference towards oleic acid metabolism. Interestingly, the results indicated that cybrids from OA patients had mitochondrial impairments and reduced metabolic flexibility compared to N cybrids.Instituto de Salud Carlos III; CB06/01/0040Instituto de Salud Carlos III; RETIC-RIER-RD16/0012/0002Instituto de Salud Carlos III; PI12/00329Instituto de Salud Carlos III; PI14/01254Instituto de Salud Carlos III; PI16/02124Instituto de Salud Carlos III; PRB3-ISCIII-PT17/0019Instituto de Salud Carlos III; PI17/0021

Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

Objectives: Atrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018. Design: Longitudinal cohort study. Setting: English primary care electronic health records linked to Index of Multiple Deprivation data. Participants: Cohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018. Primary and secondary outcome measures: Incident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation. Results: Incidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation. Conclusions: Changes in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018

Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

Objectives: Atrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018. Design: Longitudinal cohort study. Setting: English primary care electronic health records linked to Index of Multiple Deprivation data. Participants: Cohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018. Primary and secondary outcome measures: Incident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation. Results: Incidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation. Conclusions: Changes in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018

Nordic Crop Wild Relative conservation : A report from two cooperation projects 2015-2019

The report summarizes results from a cooperation among all the Nordic countries during the period 2015 – 2019 (two projects). The work has focused on the conservation of Crop Wild Relatives (CWR), i.e. wild plant species closely related to crops. They are of special importance to humanity since traits of potential value for food security and climate change adaptation can be transferred from CWR into crops. The projects represent the first joint action on the Nordic level regarding in situ conservation of CWR. Substantial progress has been made regarding CWR conservation planning, including development of a Nordic CWR checklist and identification of suitable sites for CWR conservation. A set of recommended future actions was developed, with the most important one being initiation of active in situ conservation of CWR in all Nordic countries

Exploring the Potential Impact of Artificial Intelligence (AI) on International Students in Higher Education: Generative AI, Chatbots, Analytics, and International Student Success

Article asserts that international students face unique challenges in pursuing higher education in a foreign country. To address these challenges and enhance their academic experience, higher education institutions are increasingly exploring the use of artificial intelligence (AI) applications. The research paper explores various AI applications, such as personalized learning experiences, adaptive testing, predictive analytics, and chatbots for learning and research

Is the risk of infection higher during treatment with secukinumab than with TNF inhibitors? An observational study from the Nordic countries

Objectives The positioning of secukinumab in the treatment of axial SpA (axSpA) and PsA is debated, partly due to a limited understanding of the comparative safety of the available treatments. We aimed to assess the risk of the key safety outcome infections during treatment with secukinumab and TNF inhibitors (TNFi). Methods Patients with SpA and PsA starting secukinumab or TNFi year 2015 through 2018 were identified in four Nordic rheumatology registers. The first hospitalized infection during the first year of treatment was identified through linkage to national registers. Incidence rates (IRs) with 95% CIs per 100 patient-years were calculated. Adjusted hazard ratios were estimated through Cox regression, with secukinumab as the reference. Several sensitivity analyses were performed to investigate confounding by indication. Results Among 7708 patients with SpA and 5760 patients with PsA, we identified 16 229 treatment courses of TNFi (53% bionaive) and 1948 with secukinumab (11% bionaive). For secukinumab, the first-year risk of hospitalized infection was 3.5% (IR 5.0; 3.9-6.3), compared with 1.7% (IR 2.3; 1.7-3.0) during 3201 courses with adalimumab, with the IRs for other TNFi lying in between these values. The adjusted HR for adalimumab, compared with secukinumab, was 0.58 (0.39-0.85). In sensitivity analyses, the difference from secukinumab was somewhat attenuated and in some analyses no longer statistically significant. Conclusion When used according to clinical practice in the Nordic countries, the observed first-year absolute risk of hospitalized infection was doubled for secukinumab compared with adalimumab. This excess risk seemed largely explained by confounding by indication.Peer reviewe