Introducing the Journal of Deliberative Democracy

This editorial introduction provides a statement of our vision for the Journal of Deliberative Democracy and an overview of the Special Issue on the Frontiers of Deliberative Democracy

Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide

Objective: To examine the prognostic value of perioperative N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in hip fracture patients.Design: Blinded prospective cohort study.Setting: Single centre trial at Turku University Hospital in Finland.Participants: Inclusion criterion was admittance to the study hospital due to hip fracture during the trial period of October 2009-May 2010. Exclusion criteria were the patient's refusal and inadequate laboratory tests. The final study population consisted of 182 patients.Primary and secondary outcome measures: NT-proBNP was assessed once during the perioperative period and later if clinically indicated, and troponin T (TnT) and ECG recordings were evaluated repeatedly. The short-term (30-day) and long-term (1000 days) mortalities were studied.Results: Median (IQR) follow-up time was 3.1 (0.3) years. The median (IQR) NT-proBNP level was 1260 (2298) ng/L in preoperative and 1600 (3971) ng/L in postoperative samples (p=0.001). TnT was elevated in 66 (36%) patients, and was significantly more common in patients with higher NT-proBNP. Patients with high (>2370 ng/L) and intermediate (806-2370 ng/L) NT-proBNP level had significantly higher short-term mortality compared with patients having a low (<806 ng/L) NT-proBNP level (15 vs 11 vs 2%, p=0.04), and the long-term mortality remained higher in these patients (69% vs 49% vs 27%, p<0.001). Intermediate or high NT-proBNP level (HR 7.8, 95% CI 1.03 to 59.14, p<0.05) was the only independent predictor of short-term mortality, while intermediate or high NT-proBNP level (HR 2.27, 95% CI 1.30 to 3.96, p=0.004), the presence of dementia (HR 1.74, 95% CI 1.13 to 2.66, p=0.01) and higher preoperative American Society of Anesthesiologists' (ASA) classification (HR 1.59, 95% CI 1.06 to 2.38, p=0.02) were independent predictors of long-term mortality.Conclusion: An elevated perioperative NT-proBNP level is common in hip fracture patients, and it is an independent predictor of short-term and long-term mortality superior to the commonly used clinical risk scores

Muistisairaiden liikunnallisen kuntoutuksen vaikuttavuus : Satunnaistettu vertailutukimus

Tutkimuksen tavoitteena oli selvittää satunnaistetulla,kontrolloidulla asetelmalla liikunnallisen harjoittelun vaikuttavuutta kotona asuvien, Alzheimerin tautia sairastavien toimintakyvyn eri ulottuvuuksiin, heidän omaishoitajiensa elämänlaatuun sekä molempien palveluiden käyttöön ja niiden kustannuksiin vuosina 2008–2011. Tutkimukseen osallistui 210 pariskuntaa, joista toinen puoliso oli muistisairaan omaishoitaja. Pariskunnat randomoitiin kolmeen yhtä suureen ryhmään: 1) ryhmäkuntoutusryhmään (liikuntaharjoittelua neljä tuntia kaksi kertaa viikossa päiväkeskuksessa vuoden ajan), 2) kotikuntoutusryhmään (tunti kaksi kertaa viikossa kotona vuoden ajan fysioterapeutin ohjauksessa) ja 3) vertailuryhmään (tavallinen kunnallinen hoito). Tutkimushoitajan haastattelut tehtiin lähtötilanteessa sekä 3:n, 6:n, 12:n ja 24 kuukauden kohdalla. Päätulosmuuttujat olivat muistisairaan ihmisen toimintakyky (mitattiin FIM-toimintakykymittarilla) sekä liikuntakyky (mitattiin Guralnikin liikuntakyky- ja tasapainotesteillä = SPPB). Kotona annetulla räätälöidyllä kuntoutuksella voidaan hidastaa muistisairaiden fyysisen toimintakyvyn (mitattu FIM-mittarilla) heikkenemistä merkitsevästi. Liikuntatesteissä (SPPB) ei ollut eroja ryhmien välillä. Myös kognitiossa näkyi myönteinen muutos toiminnanohjauksen osalta kellotestillä mitattuna kotikuntoutusryhmässä. Ryhmäkuntoutuksessa palveluiden kokonaiskustannusten säästöt olivat merkittävät, joskaan muutokset toimintakyvyssä eivät saavuttaneet tilastollista merkitsevyyttä. Omaisten elämänlaadussa tai muissa mittareissa ei ollut merkitseviä eroja interventioryhmien ja vertailuryhmien välillä. Kaatumiset vähenivät molemmissa interventioryhmissä. Kuolemanvaara näytti pienentyneen kotikuntoutusryhmässä. Tutkimuksessa luotiin kuntoutusmalli, joka parantaa Alzheimerin tautia sairastavien toimintakykyä lisäämättä sosiaali- ja terveyspalveluiden kokonaiskustannuksia.15,00 euro

Measurements of proton induced reaction cross sections on 120Te for the astrophysical p-process

The total cross sections for the 120Te(p,gamma)121I and 120Te(p,n)120I reactions have been measured by the activation method in the effective center-of-mass energies between 2.47 MeV and 7.93 MeV. The targets were prepared by evaporation of 99.4 % isotopically enriched 120Te on Aluminum and Carbon backing foils, and bombarded with proton beams provided by the FN tandem accelerator at the University of Notre Dame. The cross sections and $S$ factors were deduced from the observed gamma ray activity, which was detected off-line by two Clover HPGe detectors mounted in close geometry. The results are presented and compared with the predictions of statistical model calculations using the codes NON-SMOKER and TALYS.Comment: 17 pages, 5 figures, 5 tables, regular articl

Overlapping properties of the short membrane-active peptide BP100 with (i) Polycationic TAT and (ii) α-helical Magainin Family Peptides

Copyright © 2021 Mink, Strandberg, Wadhwani, Melo, Reichert, Wacker, Castanho and Ulrich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.BP100 is a short, designer-made membrane-active peptide with multiple functionalities: antimicrobial, cell-penetrating, and fusogenic. Consisting of five lysines and 6 hydrophobic residues, BP100 was shown to bind to lipid bilayers as an amphipathic a-helix, but its mechanism of action remains unclear. With these features, BP100 embodies the characteristics of two distinctly different classes of membrane-active peptides, which have been studied in detail and where the mechanism of action is better understood. On the one hand, its amphiphilic helical structure is similar to the pore forming magainin family of antimicrobial peptides, though BP100 is much too short to span the membrane. On the other hand, its length and high charge density are reminiscent of the HIV-TAT family of cell penetrating peptides, for which inverted micelles have been postulated as translocation intermediates, amongst other mechanisms. Assays were performed to test the antimicrobial and hemolytic activity, the induced leakage and fusion of lipid vesicles, and cell uptake. From these results the functional profiles of BP100, HIV-TAT, and the magainin-like peptides magainin 2, PGLa, MSI-103, and MAP were determined and compared. It is observed that the activity of BP100 resembles most closely the much longer amphipathic a-helical magainin-like peptides, with high antimicrobial activity along with considerable fusogenic and hemolytic effects. In contrast, HIV-TAT shows almost no antimicrobial, fusogenic, or hemolytic effects. We conclude that the amphipathic helix of BP100 has a similar membranebased activity as magainin-like peptides and may have a similar mechanism of action.This work was supported financially by the BIF-TM program of the Helmholtz-Gemeinschaft; by the DFG grant INST 121384/58-1 FUGG; and by the DAAD “Portugal - Acções Integradas Luso-Alemãs/DAAD-GRIC” grant D/07/13644.info:eu-repo/semantics/publishedVersio

Body-mass index and risk of obesity-related complex multimorbidity : an observational multicohort study

Background The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). Methods We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (Peer reviewe

Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study

BACKGROUND: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). METHODS: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m2), overweight (25·0-29·9 kg/m2), healthy weight (18·5-24·9 kg/m2), and underweight (<18·5 kg/m2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated. FINDINGS: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74-2·93; PAF 19·9% [95% CI 19·3-20·5]) for developing at least one obesity-related disease, 5·17 (4·84-5·53; 34·4% [33·2-35·5]) for two diseases, and 12·39 (9·26-16·58; 55·2% [50·9-57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose-response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94-3·68; PAF 13·3% [95% CI 9·6-16·3]). The same pattern of results was observed in the UK Biobank cohort. INTERPRETATION: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens. FUNDING: Wellcome Trust, Medical Research Council, National Institute on Aging