Rationale and design of the multicenter catheter ablation of ventricular tachycardia before transcatheter pulmonary valve replacement in repaired tetralogy of Fallot study

Patients with repaired tetralogy of Fallot are at elevated risk for ventricular arrhythmia and sudden cardiac death. Over the past decade, the pathogenesis and natural history of ventricular tachycardia has become increasingly understood, and catheter ablation has emerged as an effective treatment modality. Concurrently, there has been great progress in the development of a versatile array of transcatheter valves that can be placed in the native right ventricular outflow tract for the treatment of long-standing pulmonary regurgitation. Although such valve platforms may eliminate the need for repeat cardiac operations, they may also impede catheter access to the myocardial substrates responsible for sustained macro-reentrant ventricular tachycardia. This manuscript provides the rationale and design of a recently devised multicenter study that will examine the clinical outcomes of a uniform, preemptive strategy to eliminate ventricular tachycardia substrates before transcatheter pulmonary valve implantation in patients with tetralogy of Fallot.Cardiolog

Viral hepatitis C therapy: pharmacokinetic and pharmacodynamic considerations

Item does not contain fulltextChronic hepatitis C is a global health problem. To prevent or reduce complications, the hepatitis C virus (HCV) infection needs to be eradicated. There have been several developments in treating these patients since the discovery of the virus. As of 1 January 2014, the drugs that are approved for treatment of chronic HCV infection are peginterferon-alpha, ribavirin, boceprevir, telaprevir, simeprevir and sofosbuvir. In this review we provide an overview of the clinical pharmacokinetic characteristics of these agents by describing their absorption, distribution, metabolism and excretion. In the pharmacodynamic part we summarize what is known about the relationships between the pharmacokinetics of each drug and efficacy or toxicity. We briefly discuss the pharmacokinetics and pharmacodynamics of chronic hepatitis C treatment in special patient populations, such as patients with liver cirrhosis, renal insufficiency or HCV/HIV coinfection, and children. With this knowledge, physicians, pharmacists, nurse practitioners, etc. should be educated to safely and effectively treat HCV-infected patients

Evaluating agricultural trade-offs in the age of sustainable development

A vibrant, resilient and productive agricultural sector is fundamental to achieving the Sustainable Development Goals. Bringing about such a transformation requires optimizing a range of agronomic, environmental and socioeconomic outcomes from agricultural systems – from crop yields, to biodiversity, to human nutrition. However, these outcomes are not independent of each other – they interact in both positive and negative ways, creating the potential for synergies and trade-offs. Consequently, transforming the agricultural sector for the age of sustainable development requires tracking these interactions, assessing if objectives are being achieved and allowing for adaptive management within the diverse agricultural systems that make up global agriculture. This paper reviews the field of agricultural trade-off analysis, which has emerged to better understand these interactions – from field to farm, region to continent. Taking a “cradle-to-grave” approach, we distill agricultural trade-off analysis into four steps: 1) characterizing the decision setting and identifying the context-specific indicators needed to assess agricultural sustainability, 2) selecting the methods for generating indicator values across different scales, 3) deciding on the means of evaluating and communicating the trade-off options with stakeholders and decision-makers, and 4) improving uptake of trade-off analysis outputs by decision-makers. Given the breadth of the Sustainable Development Goals and the importance of agriculture to many of them, we assess notions of human well-being beyond income or direct health concerns (e.g. related to gender, equality, nutrition), as well as diverse environmental indicators ranging from soil health to biodiversity to climate forcing. Looking forward, areas of future work include integrating the four steps into a single modeling platform and connecting tools across scales and disciplines to facilitate trade-off analysis. Likewise, enhancing the policy relevance of agricultural trade-off analysis requires improving scientist-stakeholder engagement in the research process. Only then can this field proactively address trade-off issues that are integral to sustainably intensifying local and global agriculture – a critical step toward successfully implementing the Sustainable Development Goals

Leader values for constructive controversy and team effectiveness in India

Leading teams effectively is a challenge for organizations in many countries. This study proposes that leaders who value people, productivity, and participation help teams work effectively and productively by encouraging team members to discuss their diverse views open-mindedly. Working in diverse organizations in India, team leaders indicated their participation, people, and productivity values and team members rated their constructive controversy and their effectiveness and performance. Structural equation analysis suggested that productivity values affect constructive controversy and team effectiveness and productivity. However, contrary to expectations based on the idea that India is a collectivist society, people values were not predictive. The study\u27s findings and previous research were interpreted as suggesting that leader productivity values coupled with constructive controversy provide a foundation for effective teamwork in India