Poor sleep quality in patients after coronary artery bypass graft surgery: An intervention study using the PRECEDE-PROCEED model

Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. Results: The mean age of the patients in the intervention (24 women) and control (24 women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients. © 2015 Tehran Heart Center. All rights reserved

Financialisation reinforced: the dual legacy of the covid pandemic

This paper examines the impact of the covid pandemic on the financialisation process, here viewed as the growing domination of the world’s bond and equity markets over the world’s product markets. Two major arguments are advanced. The first is that the pandemic has reinforced the functionality of financial market scale, which is that its continuing growth signifies nothing other than that government and corporate organisations are colonising the future to cope with the rising financial pressures of the present. The second argument is that the pandemic has also accentuated one of the more notable dysfunctional aspects of the continuing growth of financial market scale, which is its enforcement of a core-periphery divide between the advanced and emerging market economies that occupy the global financial system. The paper concludes with some policy implications of the analysis that includes the call for a global wealth tax

Determinants of medication adherence among Iranian patients with type 2 diabetes: An application of health action process approach

Diabetes; Diet; Health profession; Health sciences; Health promotion; Insulin; Determinants, Medication adherence, Type 2 diabetes, Health action process approach, Iran © 2020 To identify determinants of medication adherence among patients with type 2 diabetes based on the health action process approach. This cross-sectional study was conducted among 734 patients with type 2 diabetes attending to south Tehran health centers during June to December 2018. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8-Item) and the health action process approach questionnaire. We used Mann-Whitney, Pearson Chi-Squared, Fisher's Exact and Independent Samples Tests for comparison of adherence medication by demographic characteristics; and linear regression analysis to predict factors related to medication adherence based on HAPA. P-value less than 0.05 considered statistically significant. A total of 232 men and 502 women participated in the study, Mean age was 61.61 ± 9.74. Most participants (82.3) reported low medication adherence (females: 68.4). Medication adherence was significantly associated with gender (p = 0.03). Medication adherence was significantly predicted by intention (β = 0.172, p = 0.0001), task self-efficacy (β = 0.172, p = 0.01), copping planning (β = 0.6, p = 0.0001) and copping self-efficacy (β = -0.244, p = 0.001). The level of adherence to medications among type 2 diabetes patients was low. The behavior intention, task self-efficacy, copping planning and copping self-efficacy were significant determinants contributed to the medication adherence. HAPA inventory includes various factors, especially types of self-efficacy. Thus, utilization of this comprehensive model in interventional studies is suggested. These determinants should be considered in developing interventional programs to improve adherence. © 202

Lymphocyte Subpopulations in Lymph Nodes and Peripheral Blood: A Comparison between Patients with Stable Angina and Acute Coronary Syndrome

Objective: Atherosclerosis is characterized by a chronic inflammatory response involving activated T cells and impairment of natural killer (NK) cells. An increased T cell activity has been associated with plaque instability and risk of acute cardiac events. Lymphocyte analyses in blood are widely used to evaluate the immune status. However, peripheral blood contains only a minor proportion of lymphocytes. In this study, we hypothesized that thoracic lymph nodes from patients with stable angina (SA) and acute coronary syndrome (ACS) might add information to peripheral blood analyses. less thanbrgreater than less thanbrgreater thanMethods: Peripheral blood and lymph nodes were collected during coronary by-pass surgery in 13 patients with SA and 13 patients with ACS. Lymphocyte subpopulations were assessed by flow cytometry using antibodies against CD3, CD4, CD8, CD19, CD16/56, CD25, Foxp3, CD69, HLA-DR, IL-18 receptor (R) and CCR4. less thanbrgreater than less thanbrgreater thanResults: Lymph nodes revealed a lymphocyte subpopulation profile substantially differing from that in blood including a higher proportion of B cells, lower proportions of CD8(+) T cells and NK cells and a 2-fold higher CD4/CD8 ratio. CD4(+)CD69(+) cells as well as Foxp3(+) regulatory T cells were markedly enriched in lymph nodes (p andlt; 0.001) while T helper 1-like (CD4(+)IL-18R(+)) cells were more frequent in blood (p andlt; 0.001). The only significant differences between ACS and SA patients involved NK cells that were reduced in the ACS group. However, despite being reduced, the NK cell fraction in ACS patients contained a significantly higher proportion of IL-18R(+) cells compared with SA patients (p andlt; 0.05). less thanbrgreater than less thanbrgreater thanConclusion: There were several differences in lymphocyte subpopulations between blood and lymph nodes. However, the lymphocyte perturbations in peripheral blood of ACS patients compared with SA patients were not mirrored in lymph nodes. The findings indicate that lymph node analyses in multivessel coronary artery disease may not reveal any major changes in the immune response that are not detectable in blood.Funding Agencies|Swedish Heart-Lung Foundation|20090489|Swedish Research Council|2008-2282

Is the inflammasome a potential therapeutic target in renal disease?

The inflammasome is a large, multiprotein complex that drives proinflammatory cytokine production in response to infection and tissue injury. Pattern recognition receptors that are either membrane bound or cytoplasmic trigger inflammasome assembly. These receptors sense danger signals including damage-associated molecular patterns and pathogen-associated molecular patterns (DAMPS and PAMPS respectively). The best-characterized inflammasome is the NLRP3 inflammasome. On assembly of the NLRP3 inflammasome, post-translational processing and secretion of pro-inflammatory cytokines IL-1β and IL-18 occurs; in addition, cell death may be mediated via caspase-1. Intrinsic renal cells express components of the inflammasome pathway. This is most prominent in tubular epithelial cells and, to a lesser degree, in glomeruli. Several primary renal diseases and systemic diseases affecting the kidney are associated with NLRP3 inflammasome/IL-1β/IL-18 axis activation. Most of the disorders studied have been acute inflammatory diseases. The disease spectrum includes ureteric obstruction, ischaemia reperfusion injury, glomerulonephritis, sepsis, hypoxia, glycerol-induced renal failure, and crystal nephropathy. In addition to mediating renal disease, the IL-1/ IL-18 axis may also be responsible for development of CKD itself and its related complications, including vascular calcification and sepsis. Experimental models using genetic deletions and/or receptor antagonists/antiserum against the NLRP3 inflammasome pathway have shown decreased severity of disease. As such, the inflammasome is an attractive potential therapeutic target in a variety of renal diseases

Design of hybrid composites from scrap aluminum reinforced with (SiC+TiO \u3c inf\u3e 2 +Gr+Ti+B)

© The Society for Experimental Mechanics, Inc. 2017. Hybrid Metal Matrix Composites (HMMCs) have very light weight, high strength, and show better resistance to corrosion, oxidation, and wear. Impact resistance is an especially important property of these HMMCs which is essential for automotive applications. In this study, hybrid aluminum matrix composites were designed through the powder metallurgy route. As matrix, fresh scrap aluminium chips (AA2014), byproduct of machining, were used. Silicon carbide (SiC), boron, titanium, titanium oxide (TiO2) and graphite (Gr) particles were used as reinforcement elements for the present work. The hybrid MMCs were prepared with SiC (5, 10 and 15 % by weight) as a main reinforcement and also certain amounts of Ti, B, TiO2 and graphite powders were added in the matrix. Within the framework of the present study, an original idea of producing a hybrid composite has been developed by using scrap aluminum (AA2014) chips. This consist of the mixing, blending and compacting of aluminum chips through press moulding and sintering. The influence of the reinforcement particles on the mechanical behavior of these composites was evaluated. Microstructure of each composite was analyzed by Scanning Electron Microscope (SEM)