Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy.

International audienceBACKGROUND: For patients with symptomatic New York Heart Association class III or IV, ejection fraction ≤ 35%, and QRS ≥ 130 ms, cardiac resynchronization therapy (CRT) has become an established treatment option. However, use of these implant criteria fails to result in clinical or echocardiographic improvement in 30% to 45% of CRT patients. METHODS AND RESULTS: The Predictors of Response to CRT (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. ECGs collected before, during, and after CRT implantation were analyzed. Primary outcomes were improvement in clinical composite score (CCS) and reduction of left ventricular end systolic volume (LVESV) of >15% after 6 months. Age, sex, cause of cardiomyopathy, myocardial infarction location, right ventricular function, mitral regurgitation, preimplantation QRS width, preimplantation PR interval, preimplantation right ventricular-paced QRS width, preimplantation axis categories, LV-paced QRS width, postimplantation axis categories, difference between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle branch morphological features were analyzed univariably in logistic regression models to predict outcomes. All significant predictors (α=0.1), age, and sex were used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses were also performed. In multivariable analyses, only QRS left bundle branch morphological features predicted both CCS (odds ratio [OR]=2.46, P=0.02) and LVESV (OR=2.89, P=0.048) response. The difference between Bi-V and preimplantation QRS width predicted CCS improvement (OR=0.89, P=0.04). LV-paced QRS width predicted LVESV reduction (OR=0.86, P=0.01). Specifically, an LV-paced QRS width of ≤ 200 ms was predictive of nonischemic LVESV reduction (OR=5.12, P=0.01). CONCLUSIONS: Baseline left bundle branch QRS morphological features, LV-paced QRS width, and the difference between Bi-V and preimplantation QRS width can predict positive outcomes after CRT and may represent a novel intraprocedural method to optimize coronary sinus lead placement. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00253357

The Living Planet Index (LPI) for migratory freshwater fish:Technical Report

Migratory freshwater fish (i.e. fish that use freshwater systems, either partly or exclusively) occur around the world and travel between critical habitats to complete their life cycle. They are disproportionately threatened compared to other fish groups but global trends in abun-dance, regional differences and drivers of patterns have not yet been comprehensively described. Using abundance information from the Living Planet Database, we found widespread declines between 1970 and 2016 in tropical and temperate areas and across all regions, all migration categories and all populations. Globally, migratory freshwater fish have declined by an average of 76%. Average declines have been more pronounced in Europe (-93%) and Latin America & Caribbean (-84%), and least in North America (-28%). The percentage of species represented was highest in the two temperate regions of Europe and North America (almost 50%). For the continents of Africa, Asia, Oceania, and South America, data was highly deficient, and we advise against making conclusions on the status of migratory freshwater SUMMARYfish in these areas. Potamodromous fish, have declined more than fish migrating between fresh and salt water on average (-83% vs -73%). Populations that are known to be affected by threats anywhere along their migration routes show an average decline of 94% while those not threatened at the population level have increased on av-erage. Habitat degradation, alteration, and loss accounted for around a half of threats to migratory fish, while over-exploitation accounted for around one-third. Protected, regulated and exploited populations decreased less than unmanaged ones, with the most often recorded actions being related to fisheries regulations, including fishing restrictions, no-take zones, fisheries closures, bycatch reductions and stocking (these were most com-mon in North America and Europe). Recorded reasons for observed increases tended to be mostly unknown or un-described, especially in tropical regions. This information is needed to assemble a more complete picture to assess how declines in migratory freshwater fishes could be reduced or reversed. Our findings confirm that migratory freshwater fish may be more threatened throughout their range than previously documented

Representations of sport in the revolutionary socialist press in Britain, 1988–2012

This paper considers how sport presents a dualism to those on the far left of the political spectrum. A long-standing, passionate debate has existed on the contradictory role played by sport, polarised between those who reject it as a bourgeois capitalist plague and those who argue for its reclamation and reformation. A case study is offered of a political party that has consistently used revolutionary Marxism as the basis for its activity and how this party, the largest in Britain, addresses sport in its publications. The study draws on empirical data to illustrate this debate by reporting findings from three socialist publications. When sport did feature it was often in relation to high profile sporting events with a critical tone adopted and typically focused on issues of commodification, exploitation and alienation of athletes and supporters. However, readers’ letters, printed in the same publications, revealed how this interpretation was not universally accepted, thus illustrating the contradictory nature of sport for those on the far left

Diversification of T Cell Responses to Carboxy-terminal Determinants within the 65-kD Heat-shock Protein Is Involved in Regulation of Autoimmune Arthritis

The T cell response to the 65-kD mycobacterial heat-shock protein (Bhsp65) has been implicated in the pathogenesis of autoimmune arthritis. Adjuvant arthritis (AA) induced in the Lewis rat (RT-1l) by injection of Mycobacterium tuberculosis serves as an experimental model for human rheumatoid arthritis (RA). However, the immunological basis of regulation of acute AA, or of susceptibility/resistance to AA is not known. We have defined the specificity of the proliferative T cell responses to Bhsp65 during the course of AA in the Lewis rat. During the early phase of the disease (6–9 d after onset of AA), Lewis rats raised T cell responses to many determinants within Bhsp65, spread throughout the molecule. Importantly, in the late phase of the disease (8–10 wk after onset of AA), there was evidence for diversification of the T cell responses toward Bhsp65 carboxy-terminal determinants (BCTD) (namely, 417–431, 441–455, 465–479, 513–527, and 521–535). Moreover, arthritic rats in the late phase of AA also raised vigorous T cell responses to those carboxy-terminal determinants within self(rat) hsp65 (Rhsp65) that correspond in position to the above BCTD. These results suggest that the observed diversification is possibly triggered in vivo by induction of self(Rhsp65)-reactive T cells. Interestingly, another strain of rat, the Wistar Kyoto (WKY/NHsd) rat (RT-1l), with the same major histocompatibility complex class II molecules as the Lewis rat, was found to be resistant to AA. In WKY rats, vigorous responses to the BCTD, to which the Lewis rat responded only in the late phase of AA, were observed very early, 10 d after injection of M. tuberculosis. Strikingly, pretreatment with the peptides comprising the set of BCTD, but not its amino-terminal determinants, provided significant protection to naive Lewis rats from subsequent induction of AA. Thus, T cell responses to the BCTD are involved in regulating inflammatory arthritis in the Lewis rat and in conferring resistance to AA in the WKY rat. These results have important implications in understanding the pathogenesis of RA and in devising new immunotherapeutic strategies for this disease

Tracking family medicine graduates. Where do they go, what services do they provide and whom do they see?

<p>Abstract</p> <p>Background</p> <p>There are continued concerns over an adequate supply of family physicians (FPs) practicing in Canada. While most resource planning has focused on intake into postgraduate education, less information is available on what postgraduate medical training yields. We therefore undertook a study of Family Medicine (FM) graduates from the University of Toronto (U of T) to determine the type of information for physician resource planning that may come from tracking FM graduates using health administrative data. This study compared three cohorts of FM graduates over a 10 year period of time and it also compared FM graduates to all Ontario practicing FPs in 2005/06. The objectives for tracking the three cohorts of FM graduates were to: 1) describe where FM graduates practice in the province 2) examine the impact of a policy introduced to influence the distribution of new FM graduates in the province 3) describe the services provided by FM graduates and 4) compare workload measures. The objectives for the comparison of FM graduates to all practicing FPs in 2005/06 were to: 1) describe the patient population served by FM graduates, 2) compare workload of FM graduates to all practicing FPs.</p> <p>Methods</p> <p>The study cohort consisted of all U of T FM postgraduate trainees who started and completed their training between 1993 and 2003. This study was a descriptive record linkage study whereby postgraduate information for FM graduates was linked to provincial health administrative data. Comprehensiveness of care indicators and workload measures based on administrative data where determined for the study cohort.</p> <p>Results</p> <p>From 1993 to 2003 there were 857 University of Toronto FM graduates. While the majority of U of T FM graduates practice in Toronto or the surrounding Greater Toronto Area, there are FM graduates from U of T practicing in every region in Ontario, Canada. The proportion of FM graduates undertaking further emergency training had doubled from 3.6% to 7.8%. From 1993 to 2003, a higher proportion of the most recent FM graduates did hospital visits, emergency room care and a lower proportion undertook home visits. Male FM graduates appear to have had higher workloads compared with female FM graduates, though the difference between them was decreasing over time. A 1997 policy initiative to discount fees paid to new FPs practicing in areas deemed over supplied did result in a decrease in the proportion of FM graduates practicing in metropolitan areas.</p> <p>Conclusions</p> <p>We were able to profile the practices of FM graduates using existing and routinely collected population-based health administrative data. Further work tracking FM graduates could be helpful for physician resource forecasting and in examining the impact of policies on family medicine practice.</p

Correlations, Causes and the Logic of Obscuration: Donor Shaping of Dominant Narratives in Indonesia's Irrigation Development

This article analyses policy trends in Indonesian irrigation, particularly during the last five decades, from the perspective of dominant narratives, as authored, suggested and pushed by international donors. It argues that international donors' adherence to ‘deferred maintenance’ as the core element of irrigation policy problem framing does not match with farmers' and the irrigation agency staff perceptions and practices. The logic of obscuration and the discursive manoeuvers that maintain it are analysed. The article concludes that there is space for more profound conceptual contestation and for alternative actions pathways even within the ‘dominant paradigm’ to address management problems more effectively