A Comparison of SGLT2 Inhibitors to Current Guideline Directed Medical Therapy for the Treatment of Heart Failure in Non-diabetic Patients

Heart failure remains a complex disease that affects a continually increasing number of patients annually. For heart failure, most of the research has focused on the hemodynamic changes of the heart chambers and the medication interventions that slow the progression of heart failure. Recent studies have investigated treatment options that may disrupt the neuro-hormonal and pathophysiologic cell changes that lead to further progression of heart failure. Although the mechanisms by which the sodium-glucose cotransporter 2 (SGLT2) inhibitors are not entirely understood, they are believed to directly affect the cardiac electrolyte imbalances that trigger the cellular changes which contribute to the altered contractility, adrenergic receptor changes, and resulting hemodynamic changes seen with heart failure. To evaluate SGLT2 inhibitors in the treatment of heart failure in diabetic and non-diabetic patients, placebo studies for SGLT2 inhibitors and current guideline-directed therapies including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), mineralocorticoid receptor agonists (MRA), and angiotensin receptor-neprilysin inhibitors (ARNIs) were compared for each class of medications using the hazard ratios and confidences intervals of the all-cause mortality rates. The results showed that treatment with SGLT2 inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) may be comparable to other guideline-directed therapies. Because of the lack of data specific to patients with heart failure with preserved ejection fraction (HFpEF), further research is needed to assess these medications’ efficacy in this population. When assessing the available pooled data for HFrEF and HFpEF patients, SGLT2 inhibitors appear to be a promising area of research compared to the recommended therapies for those with HFpEF

A Place For Plants: Ethnobotany, Bioregionalism And Folkways In Appalachia

This thesis examines the ways in which ethnobotany continues to serve Appalachia by bringing the literature on Appalachian ethnobotany into conversation with literatures on bioregionalism and folkways to examine mutually-reinforcing strategies for the preservation for local economies, ecosystems, and cultures in southern Appalachia. This thesis reviews the merits of ethnobotanical approaches to environmental and socio-economic sustainability. As well as Appalachian ethnobotany and bioregionalism, including comparisons to other biogeographic regions which provide inspiration for similar ethnobotanical initiatives and programs which have diverse functions from cultural preservation to interdisciplinary learning opportunities. Next, it examines the folkways revival in Appalachia and the ways in which it has been and can still be used for bioregional sustainability and economic opportunity. Synthesizing these insights, this thesis provides a short inventory of key plant,shrub and tree species and their ethnobotanical uses in Appalachia. The thesis concludes by discussing untapped ethnobotanical opportunities in Appalachia from entrepreneurial craft to sustainable botanical product creation utilizing common southern Appalachian flora

CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure

Aims: The main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is associated with many cardiovascular (CV) risk factors, especially since HFpEF is linked to a high risk for both mortality and recurrent heart failure (HF) hospitalizations. Therefore, there is a need for new tools to identify patients with a high risk profile early. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score is a promising tool to identify cardiac changes early. Methods and results: Heart failure patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis the asymptomatic control group (n = 19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n = 12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnormalities (n = 7) as well as patients with HFpEF (n = 19). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG). Assessing the MyoHealth score at rest revealed preserved regional strain in 85 +/- 9% of LV segments in controls, 73 +/- 11% in at Risk subjects and 73 +/- 8% in HFpEF patients. During stress the MyoHealth score was 84 +/- 7% in controls, 83 +/- 7 in at risk subjects and 74 +/- 11 in HFpEF patients. Conclusion: In summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future

Open science practices need substantial improvement in prognostic model studies in oncology using machine learning

Objective: To describe the frequency of open science practices in a contemporary sample of studies developing prognostic models using machine learning methods in the field of oncology. Study design and setting: We conducted a systematic review, searching the MEDLINE database between December 1, 2022, and December 31, 2022, for studies developing a multivariable prognostic model using machine learning methods (as defined by the authors) in oncology. Two authors independently screened records and extracted open science practices. Results: We identified 46 publications describing the development of a multivariable prognostic model. The adoption of open science principles was poor. Only one study reported availability of a study protocol, and only one study was registered. Funding statements and conflicts of interest statements were common. Thirty-five studies (76%) provided data sharing statements, with 21 (46%) indicating data were available on request to the authors and seven declaring data sharing was not applicable. Two studies (4%) shared data. Only 12 studies (26%) provided code sharing statements, including 2 (4%) that indicated the code was available on request to the authors. Only 11 studies (24%) provided sufficient information to allow their model to be used in practice. The use of reporting guidelines was rare: eight studies (18%) mentioning using a reporting guideline, with 4 (10%) using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis statement, 1 (2%) using Minimum Information About Clinical Artificial Intelligence Modeling and Consolidated Standards Of Reporting Trials-Artificial Intelligence, 1 (2%) using Strengthening The Reporting Of Observational Studies In Epidemiology, 1 (2%) using Standards for Reporting Diagnostic Accuracy Studies, and 1 (2%) using Transparent Reporting of Evaluations with Nonrandomized Designs. Conclusion: The adoption of open science principles in oncology studies developing prognostic models using machine learning methods is poor. Guidance and an increased awareness of benefits and best practices of open science are needed for prediction research in oncology

Reduced functional capacity is associated with the proportion of impaired myocardial deformation assessed in heart failure patients by CMR

Aims: Heart failure (HF) does not only reduce the life expectancy in patients, but their life is also often limited by HF symptoms leading to a reduced quality of life (QoL) and a diminished exercise capacity. Novel parameters in cardiac imaging, including both global and regional myocardial strain imaging, promise to contribute to better patient characterization and ultimately to better patient management. However, many of these methods are not part of clinical routine yet, their associations with clinical parameters have been poorly studied. An imaging parameters that also indicate the clinical symptom burden of HF patients would make cardiac imaging more robust toward incomplete clinical information and support the clinical decision process. Methods and results: This prospective study conducted at two centers in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 19). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS), and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics including the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 6-minute walk test (6MWT). If less than 80% of the LV segments are preserved in their deformation capacity the functional capacity by 6MWT (6 minutes walking distance: MyoHealth >= 80%: 579.8 +/- 177.6 m; MyoHealth 60-= 80%: 0.6 +/- 1.1 m; MyoHealth 60-p-value = 80%: 8.2 +/- 2.3 m; MyoHealth 60-p-value: 0.20) as well as quality of life measures (MLHFQ; MyoHealth >= 80%: 7.5 +/- 12.4 m; MyoHealth 60-p-value: 0.15)-while these differences were not significant. Conclusion: The share of LV segments with preserved myocardial contraction promises to discriminate between symptomatic and asymptomatic subjects based on the imaging findings, even when the LV ejection fraction is preserved. This finding is promising to make imaging studies more robust toward incomplete clinical information

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe