Coronary angiography in heart failure: when and why? Uncertainty reigns

No abstract available

Face Value

There is growing evidence of systematic heterogeneity in behavior by observable characteristics, such as what one would see in a face. We ask, is there informational value in knowing these characteristics in a strategic interaction? Subjects are given the opportunity to purchase a photograph of their partner in the play of a trust game. Not everyone purchases the photo, even at prices as low as $0.20. Senders (first movers in the game) have a more inelastic demand for pictures than responders (second movers). White senders have a substantially higher demand than nonwhite senders or responders. For responders, there is no difference in demand for pictures across ethnicity or sex. White senders who pay to see the picture of their partner use the information to discriminate, sending significantly less to black responders than to white responders. Overall, responders return a higher percentage of the amount received as offers go up, but they do differentiate that percentage when they see the picture of the sender, returning more to a member of the same ethnicity. A face, it appears, has strategic value, especially for those who will use the information to differentiate their decisions.

Incidence and outcome of encapsulating peritoneal sclerosis

Background: Studies report variation in the incidence and outcomes of encapsulating peritoneal sclerosis (EPS). This study reports the incidence and outcome of EPS cases in a national cohort of peritoneal dialysis (PD) patients. Methods: The incident cohort of adult patients who started PD between 1 January 2000 and 31 December 2007 in Scotland (n = 1238) was identified from the Scottish Renal Registry. All renal units in Scotland identified potential EPS cases diagnosed from 1 January 2000 to 31 December 2014, by which point all patients had a minimum of 7 years follow-up from start of PD. Results: By 31 December 2014, 35 EPS cases were diagnosed in the 1238 patient cohort: an overall incidence of 2.8%. The incidence for subgroups with longer PD duration rises exponentially: 1.1% by 1 year, 3.4% by 3 years, 8.8% at 4 years, 9.4% at 5 years and 22.2% by 7 years. Outcomes are poor with mortality of 57.1% by 1 year after diagnosis. Survival analysis demonstrates an initial above-average survival in patients who later develop EPS, which plummets to well below average after EPS diagnosis. Conclusions: The incidence of EPS is reassuringly low provided PD exposure is not prolonged and this supports ongoing use of PD. However, continuing PD beyond 3 years results in an exponential rise in the risk of developing EPS and deciding whether this risk is acceptable should be made on an individual patient basis

Novel diabetes drugs and the cardiovascular specialist

Recently, treatment with 2 newer classes of type 2 diabetes drugs were found to reduce events in patients with diabetes and cardiovascular (CV) disease, a group common in cardiology clinics. The sodium-glucose cotransporter 2 inhibitor, empagliflozin, markedly and rapidly reduced CV death and heart failure hospitalization, likely with hemodynamic/metabolic-driven mechanisms of action. More recently, the glucagon-like peptide–1 receptor agonists liraglutide and semaglutide also reduced CV death and/or major adverse CV events, but did so more slowly and did not influence heart failure risks, suggesting alternative mechanisms of benefit. We will discuss drug therapy for diabetes relative to CV risk, briefly summarize key findings of CV benefit from recent trials, discuss potential mechanisms for benefits of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide–1 agonists, and suggest how such drugs might be embraced by CV specialists to reduce CV events and mortality in their patients

Toxicity of cancer therapy: what the cardiologist needs to know about angiogenesis inhibitors

Clinical outcomes for patients with a wide range of malignancies have improved substantially over the last two decades. Tyrosine kinase inhibitors (TKIs) are potent signalling cascade inhibitors and have been responsible for significant advances in cancer therapy. By inhibiting vascular endothelial growth factor receptor (VEGFR)-mediated tumour blood vessel growth, VEGFR-TKIs have become a mainstay of treatment for a number of solid malignancies. However, the incidence of VEGFR-TKI-associated cardiovascular toxicity is substantial and previously under-recognised. Almost all patients have an acute rise in blood pressure, and the majority develop hypertension. They are associated with the development of left ventricular systolic dysfunction (LVSD), heart failure and myocardial ischaemia and can have effects on myocardial repolarisation. Attention should be given to rigorous baseline assessment of patients prior to commencing VEGFR-TKIs, with careful consideration of baseline cardiovascular risk factors. Baseline blood pressure measurement, ECG and cardiac imaging should be performed routinely. Hypertension management currently follows national guidelines, but there may be a future role forendothelin-1 antagonism in the prevention or treatment of VEGFR-TKI-associated hypertension. VEGFR-TKI-associated LVSD appears to be independent of dose and is reversible. Patients who develop LVSD and heart failure should be managed with conventional heart failure therapies, but the role of prophylactic therapy is yet to be defined. Serial monitoring of left ventricular function and QT interval require better standardisation and coordinated care. Management of these complex patients requires collaborative, cardio-oncology care to allow the true therapeutic potential from cancer treatment while minimising competing cardiovascular effects

A solar active region loop compared with a 2D MHD model

We analyzed a coronal loop observed with the Normal Incidence Spectrometer (NIS), which is part of the Coronal Diagnostic Spectrometer (CDS) on board the Solar and Heliospheric Observatory (SOHO). The measured Doppler shifts and proper motions along the selected loop strongly indicate unidirectional flows. Analysing the Emission Measure Curves of the observed spectral lines, we estimated that the temperature along the loop was about 380000 K. We adapted a solution of the ideal MHD steady equations to our set of measurements. The derived energy balance along the loop, as well as the advantages/disadvantages of this MHD model for understanding the characteristics of solar coronal loops are discussed.Comment: A&A in press, 10 pages, 6 figure

Association is not causation: treatment effects cannot be estimated from observational data in heart failure

Aims: Treatment ‘effects’ are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). Methods and results: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the ‘effect’ of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. Conclusion: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients

Evidence for polar jets as precursors of polar plume formation

Observations from the Hinode/XRT telescope and STEREO/SECCHI/EUVI are utilized to study polar coronal jets and plumes. The study focuses on the temporal evolution of both structures and their relationship. The data sample, spanning April 7-8 2007, shows that over 90% of the 28 observed jet events are associated with polar plumes. EUV images (STEREO/SECCHI) show plume haze rising from the location of approximately 70% of the polar X-ray (Hinode/XRT) and EUV jets, with the plume haze appearing minutes to hours after the jet was observed. The remaining jets occurred in areas where plume material previously existed causing a brightness enhancement of the latter after the jet event. Short-lived, jet-like events and small transient bright points are seen (one at a time) at different locations within the base of pre-existing long-lived plumes. X-ray images also show instances (at least two events) of collimated-thin jets rapidly evolving into significantly wider plume-like structures that are followed by the delayed appearance of plume haze in the EUV. These observations provide evidence that X-ray jets are precursors of polar plumes, and in some cases cause brightenings of plumes. Possible mechanisms to explain the observed jet and plume relationship are discussed.Comment: 10 pages, 4 figures, accepted as APJ Lette

Towards a social pedagogic approach for social care

The term ‘social care’ has come to be applied in England to a variety of policies and services for children and adults deemed, for a variety of reasons, in need of support and assistance. The field to which it is applied is widely recognised to be in crisis, as demand grows, funding lags and a poorly qualified, low-paid workforce shows increasing signs of strain. The article argues that a further dimension to the crisis is the very term ‘social care’. It has little substance and is of limited value in addressing the practice involved in working with children, young people and adults, while its continued use has encouraged a simplified and commodified understanding of what this work entails. The article introduces an alternative concept – social pedagogy – long established and well developed in continental Europe, which, it is argued, could provide a more substantial basis for everyday practice, and a strong foundation for future policy, including reforming the workforce. The conclusion questions whether ‘social care’ can play any useful role in the evolution of policy and practice, discussing some issues that a turn to a social pedagogic approach might raise