Exercise-based cardiac rehabilitation in heart transplant recipients

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effectiveness and safety of exercise‐based rehabilitation on the mortality, hospital admissions, morbidity, exercise capacity, health‐related quality of life, and return to work of people after heart transplantation

Cardiac Troponin Assessment Following Atrial Fibrillation Ablation: Implications for Chest Pain Evaluation

Background: The range of elevation of troponin I (tI) that is within expected limits from left atrial radiofrequency ablation for atrial fibrillation (AF) is not well described, though such information may be of clinical value. Objectives: Identify the expected range of tI values post-atrial fibrillation (AF) ablation. Methods: 31 patients undergoing AF ablation had a single tI level drawn the day following the procedure. Clinical variables were also collected, such as ablation type and radiofrequency (RF) time. Results: Paroxysmal AF was present in 23 patients, and 8 had chronic AF. The average RF time was 2627.8 ± 737.5 seconds. The mean RF power was 61.7 ± 4.3W (range 55-70W). The mean RF temperature limit was 53.6 ± 2.0°C (range 50-55°C). There was no clinical or electrocardiographic evidence of coronary ischemia in this population. The mean tI the following day was 3.21 ± 1.5 (range 1.48-8.41). There was no correlation between RF time, ablation type, ablation catheter size, and ablation temperature or ablation power and tI levels. Conclusions: Troponin I elevation post-ablation was ubiquitous. Knowledge of expected post-ablation tI levels may be helpful in the evaluation of post-procedure chest pain

Hvordan kan kommunerne bedst implementere kliniske retningslinjer? En evaluering af implementeringsprocessen i ni pilotkommuner

I denne rapport præsenteres resultaterne af Center for Interventionsforsknings evaluering af ni kommuners implementering af fire nyudviklede kliniske retningslinjer. De kliniske retningslinjer er blevet udviklet i forbindelse med et treårigt overenskomstprojekt igangsat af KL (Kommunernes Landsforening) og Sundhedskartellet (SHK). Formålet med evalueringen har været at undersøge og dokumentere, hvordan ni pilotkommuner har gennemført implementeringen af fire nyudviklede KR og de afledte instrukser. Evalueringen belyser, hvordan kommunerne har forberedt og gennemført implementeringen, hvordan ledelse og medarbejdere oplever anvendeligheden og brugen af KR samt betydningen af implementeringen for kommunernes indsats. Evalueringen bygger på individuelle interview, fokusgruppeinterview, observationer samt dokumenter, som vi har indsamlet fra de ni kommuner, KL og Sundhedskartellet

Expression of Intermediate Filaments in the Developing Testis and Testicular Germ Cell Cancer

Cytokeratin and desmin expression have been associated with Sertoli cell maturity and the development of testicular germ cell cancer (TGCC). Thus, the present study aimed to characterize the expression of these intermediate filaments in normal testis development and TGCC. Cytokeratin and desmin were determined by immunohistochemistry and immunofluorescence in human fetal, and adult testis and tissue from patients with pre-invasive germ cell neoplasia in-situ (GCNIS) or invasive TGCC. Desmin was expressed in Sertoli cells of the human fetal testis, and the proportion of desmin expressing Sertoli cells was significantly reduced in the second trimester, compared with the first trimester (31.14% vs. 6.74%, p = 0.0016). Additionally, Desmin was expressed in the majority of Sertoli cells in the adult testis and TGCC samples. Cytokeratin was detected in Sertoli cells of human fetal testis but was not expressed in Sertoli cells of human adult testis. In patients with TGCC, cytokeratin was not expressed in Sertoli cells in tubules with active spermatogenesis but was detected in Sertoli cells in tubules containing GCNIS cells in patients with both pre-invasive and invasive TGCC. In conclusion, desmin was not associated with Sertoli cell maturation or progression to TGCC. However, cytokeratin appeared to be an indicator of impaired Sertoli cell maturation

Workplace psychosocial resources and risk of cardiovascular disease among employees: a multi-cohort study of 135 669 participants

Objective In terms of prevention, it is important to determine effects on cardiovascular disease (CVD) when some workplace psychosocial resources are high while others are low. The aim of the study was to assess the prospective relationship between clustering of workplace psychosocial resources and risk of CVD among employees. Methods We pooled data from three cohort studies of 135 669 employees (65% women, age 18–65 years and free of CVD) from Denmark, Finland and Sweden. Baseline horizontal resources (culture of collaboration and support from colleagues) and vertical resources (leadership quality and procedural justice) were measured using standard questionnaire items. Incident CVD, including coronary heart and cerebrovascular disease, was ascertained using linked electronic health records. We used latent class analysis to assess clustering (latent classes) of workplace psychosocial resources. Cox proportional hazard models were used to examine the association between these clusters and risk of CVD, adjusting for demographic and employment-related factors and pre-existing physical and mental disorders. Results We identified five clusters of workplace psychosocial resources from low on both vertical and horizontal resources (13%) to generally high resources (28%). High horizontal resources were combined with either inter-mediate [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.95] or high (HR 0.88, 95% CI 0.78–1.00) vertical resources were associated with lower risks of CVD compared to those with generally low resources. The association was most prominent for cerebrovascular disease (eg, general high resources: HR 0.80, 95% CI 0.67–0.96). Conclusions Individuals with high levels of workplace psychosocial resources across horizontal and vertical dimensions have a lower risk of CVD, particularly cerebrovascular disease

Antidepressant treatment among social workers, human service professionals, and non-human service professionals : A multi-cohort study in Finland, Sweden and Denmark

Background: Social workers have an elevated risk for mental disorders, but little is known about their antidepressant treatment. Aims: To examine any and long-term antidepressant treatment among social workers in Finland, Sweden and Denmark. Methods: We linked records from drug prescription registers to three prospective cohorts: the Finnish Public Sector study, years 2006-2011, and nation-wide cohorts in Sweden and Denmark, years 2006-2014, including a total of 1.5 million employees in (1) social work, (2) other social and health care professions, (3) education and (4) office work. We used Cox proportional hazards models to estimate hazard ratios for any and long-term (>6 months) antidepressant treatment among social workers compared to the three reference occupational groups and carried out meta-analyses. Results: During follow-up, 25% of social workers had any prescriptions for antidepressants (19-24% reference occupations) and 20% for long-term treatment (14-19% reference occupations). The pooled effects for any and long-term treatment showed that probabilities were 10% higher in social workers compared to other health and social care professionals and 30% higher compared to education and non-human service professionals. Probabilities for any treatment in the three countries were relatively similar, but for long-term treatment social workers in Finland had a greater risk compared with other human service professions. Limitations: There were differences between the cohorts in the availability of data. Specific diagnoses for the antidepressant treatment were not known neither adherence to treatment. Conclusion: Social workers have a higher risk for any and long-term antidepressant treatment than other human and non-human service professionals.Peer reviewe

Onset of Workplace Bullying and Risk of Weight Gain: A Multicohort Longitudinal Study

OBJECTIVE: This study aimed to examine the onset of workplace bullying as a risk factor for BMI increase. METHODS: Repeated biennial survey data from three Nordic cohort studies were used, totaling 46,148 participants (67,337 participant observations) aged between 18 and 65 who did not have obesity and who were not bullied at the baseline. Multinomial logistic regression was applied for the analysis under the framework of generalized estimating equations. RESULTS: Five percent reported onset of workplace bullying within 2 years from the baseline. In confounder-adjusted models, onset of workplace bullying was associated with a higher risk of weight gain of ≥ 1 BMI unit (odds ratio = 1.09; 95% CI: 1.01-1.19) and of ≥ 2.5 BMI units (odds ratio = 1.24; 95% CI: 1.06-1.45). A dose-response pattern was observed, and those exposed to workplace bullying more frequently showed a higher risk (Ptrend  = 0.04). The association was robust to adjustments, restrictions, stratifications, and use of relative/absolute scales for BMI change. CONCLUSIONS: Participants with exposure to the onset of workplace bullying were more likely to gain weight, a possible pathway linking workplace bullying to increased long-term risk of type 2 diabetes

The mortality rates and the space-time patterns of John Snow’s cholera epidemic map

Background Snow’s work on the Broad Street map is widely known as a pioneering example of spatial epidemiology. It lacks, however, two significant attributes required in contemporary analyses of disease incidence: population at risk and the progression of the epidemic over time. Despite this has been repeatedly suggested in the literature, no systematic investigation of these two aspects was previously carried out. Using a series of historical documents, this study constructs own data to revisit Snow’s study to examine the mortality rate at each street location and the space-time pattern of the cholera outbreak. Methods This study brings together records from a series of historical documents, and prepares own data on the estimated number of residents at each house location as well as the space-time data of the victims, and these are processed in GIS to facilitate the spatial-temporal analysis. Mortality rates and the space-time pattern in the victims’ records are explored using Kernel Density Estimation and network-based Scan Statistic, a recently developed method that detects significant concentrations of records such as the date and place of victims with respect to their distance from others along the street network. The results are visualised in a map form using a GIS platform. Results Data on mortality rates and space-time distribution of the victims were collected from various sources and were successfully merged and digitised, thus allowing the production of new map outputs and new interpretation of the 1854 cholera outbreak in London, covering more cases than Snow’s original report and also adding new insights into their space-time distribution. They confirmed that areas in the immediate vicinity of the Broad Street pump indeed suffered from excessively high mortality rates, which has been suspected for the past 160 years but remained unconfirmed. No distinctive pattern was found in the space-time distribution of victims’ locations. Conclusions The high mortality rates identified around the Broad Street pump are consistent with Snow’s theory about cholera being transmitted through contaminated water. The absence of a clear space-time pattern also indicates the water-bourne, rather than the then popular belief of air bourne, nature of cholera. The GIS data constructed in this study has an academic value and would cater for further research on Snow’s map

Biogeochemical research priorities for sustainable biofuel and bioenergy feedstock production in the Americas.

Rapid expansion in biomass production for biofuels and bioenergy in the Americas is increasing demand on the ecosystem resources required to sustain soil and site productivity. We review the current state of knowledge and highlight gaps in research on biogeochemical processes and ecosystem sustainability related to biomass production. Biomass production systems incrementally remove greater quantities of organic matter, which in turn affects soil organic matter and associated carbon and nutrient storage (and hence long-term soil productivity) and off-site impacts. While these consequences have been extensively studied for some crops and sites, the ongoing and impending impacts of biomass removal require management strategies for ensuring that soil properties and functions are sustained for all combinations of crops, soils, sites, climates, and management systems, and that impacts of biomass management (including off-site impacts) are environmentally acceptable. In a changing global environment, knowledge of cumulative impacts will also become increasingly important. Long-term experiments are essential for key crops, soils, and management systems because short-term results do not necessarily reflect long-term impacts, although improved modeling capability may help to predict these impacts. Identification and validation of soil sustainability indicators for both site prescriptions and spatial applications would better inform commercial and policy decisions. In an increasingly interrelated but constrained global context, researchers should engage across inter-disciplinary, inter-agency, and international lines to better ensure the long-term soil productivity across a range of scales, from site to landscape.Fil: Gollany, Hero T. USDA. Agricultural Research Service. Columbia Plateau Conservation Research Center; Estados UnidosFil: Titus, Brian D. Pacific Forestry Centre. Canadian Forest Service. Natural Resources Canada; CanadáFil: Scott, Andrew USDA Forest Service. Agricultural Research Center. Southern Research Station; Estados UnicosFil: Asbjornsen, Heidi. University of New Hampshire. Institute for Earth, Oceans and Space. Department of Natural Resources and the Environment and the Earth Systems Research Center; Estados UnidosFil: Resh, Sigrid C. Michigan Technological University. School of Forest Resources and Environmental Science; Estados UnidosFil: Chimner, Rodney Allen. Michigan Technological University. School of Forest Resources and Environmental Science; Estados UnidosFil: Kaczmarek, Donald J. Oregon Department of Forestry; Estados UnidosFil: Leite, Luiz F. Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA); BrasilFil: Ferreira, Ana C. Climate Change Adaptation Consultant; BrasilFil: Rod, Kenton A. Washington State University. School of the Environment; Estados UnidosFil: Hilbert, Jorge Antonio. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Ingeniería Rural; ArgentinaFil: Galdos, Marcelo. Brazilian Center for Research in Energy and Materials (CNPEM). Brazilian Bioethanol Science and Technology Laboratory (CTBE); BrasilFil: Cisz, Michelle E. Michigan Technological University. School of Forest Resources and Environmental Science; Estados Unido

High platelet reactivity in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Randomised controlled trial comparing prasugrel and clopidogrel

Background: Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. Objectives: To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome (ACS). Patients: Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer, i.e. “poor responders” were randomised to prasugrel (60 mg loading and 10 mg maintenance dose) or clopidogrel (600 mg reloading and 150 mg maintenance dose). The primary outcome measure was proportion of patients with platelet reactivity <40 AUC 4 hours after loading with study medication, and also at one hour (secondary outcome). 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors. Results: At 4 hours after study medication 100% of patients treated with prasugrel compared to 91% of those treated with clopidogrel had platelet reactivity <40 AUC (p = 0.49), while at 1 hour the proportions were 95% and 64% respectively (p = 0.02). Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 (p = 0.005) and 19 versus 34 (p = 0.01) respectively. Conclusions: Routine platelet function testing identifies patients with high residual platelet reactivity (“poor responders”) on clopidogrel. A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity. Future trials need to identify if this translates into clinical benefit