Fibrin D-dimer, markers of coagulation activation and the risk of major ischaemic heart disease in the Caerphilly Study

We have previously reported that plasma fibrin D-dimer (a marker of turnover of cross-linked Fibrin) showed a strong and independent association with incident ischaemic heart disease (IHD) in the Caerphilly Study cohort of 1,998 men a-ed 49-65. To establish the specificity of this finding, we assayed plasma samples from this cohort with a more specific assay for fibrin D-dimer: this showed an association with incident IHD which was at least as strong and independent as that for the original assay (odds ratio, OR for top fifth compared to bottom fifth 3.79; 95% CI 1.77-8.10; p lt 0.0001). To establish potential causes of the increased fibrin turnover. we also assayed several potential markers of coagulation activation or thrombotic tendency (prothrombin fragment F1+2, thrombin- antithrombin complexes, factor VIIc, activated partial thromboplastin time [APTT] and activated protein C resistance): none of these variables were associated with incident IHD in this cohort. We suggest that further studies are required to establish the causes of increased cross-linked fibrin turnover, which is associated with incident IHD in the general population when measured by a specific assay

Prolonged elevations in haemostatic and rheological responses following psychological stress in low socioeconomic status men and women

Low socioeconomic status (SES) and psychological stress are associated with increased risk of coronary heart disease, and both may influence haemostatic responses. Von Willebrand factor (vWF), Factor VIII, plasma viscosity, haematocrit, blood viscosity, tissue plasminogen activator (t-PA) and fibrin D- dimer were measured at rest and following stressful tasks in 238 middle-aged British civil servants. SES was defined by grade of employment. Lower SES was associated with higher resting vWF, Factor VIII and plasma viscosity. Psychological stress stimulated increases in haemostatic and rheological factors. Initial stress responses did not vary with SES, but Factor VIII, plasma viscosity and blood viscosity remained more elevated 45 minutes post-stress in lower SES participants. High blood pressure stress reactivity was also associated with greater haemostatic responses. We conclude that lower SES is characterised by more prolonged elevations in procoagulant responses following psychological stress, and that these processes might contribute to increased cardiac risk

Inactivation and transmission studies of the carnation viruses mosaic and streak

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Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression

<p><b>Background and Purpose:</b> Early clinical progression of ischemic stroke is common and is associated with increased risk of death and dependency. We hypothesized that activation of the coagulation system is an important contributor in some cases of deterioration. We aimed to characterize alterations in circulating hemostatic markers in patients with progressing stroke.</p> <p><b>Methods:</b> Consecutive acute ischemic stroke admissions were recruited. Progressing stroke was defined by deterioration in components of the Scandinavian Stroke Scale. Hemostatic markers (coagulation factors VIIc, VIIIc, and IXc, prothrombin fragments 1+2 [F1+2], thrombin-antithrombin complexes [TAT], D- dimer, fibrinogen, von Willebrand factor [vWF] and tissue plasminogen activator) were measured within 24 hours of symptom recognition.</p> <p><b>Results:</b> Fifty-four (25%) of the 219 patients met criteria for progressing stroke. F1+2 (median 1.28 versus 1.06 nmol/L, P=0.01), TAT (5.28 versus 4.07 mug/L, P lt 0.01), D-dimer ( 443 versus 194 ng/mL, P lt 0.001) and vWF (216 versus 198 IU/dL, P lt 0.05) levels were higher in these patients than in stable/improving patients. In logistic regression analysis, with all important clinical and laboratory variables included, only natural log D-dimer (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.38 to 2.54; P=0.0001) and mean arterial blood pressure (OR: 1.26 per 10 mm Hg change; 95% CI: 1.05 to 1.51; P=0.01) remained independent predictors of progressing stroke.</p> <p><b>Conclusions:</b> There is evidence of excess thrombin generation and fibrin turnover in patients with progressing ischemic stroke. Measurement of D-dimer levels can identify patients at high risk for stroke progression. Further research is required to determine whether such patients benefit from acute interventions aimed at modifying hemostatic function.</p&gt

Sideways Leadership: Perceptions of the Senior Pastor’s Transformational Leadership Style and Its Relationship to Church Effectiveness

What if research could demonstrate how a more collaborative or transformational approach to church leadership had a positive impact on the overall effectiveness of the church? Would pastors adjust their leadership style, and would seminaries expand their pastoral training curriculum? Research continues to affirm the importance of leadership in the health and effectiveness of organizations from multiple contexts. Everything from schools to politics shows the need for leadership. Yet, little quantitative research has been done to see the impact of leadership within the church arena. Is it possible that leadership style correlates to the effectiveness of corporate America but has little correlation within the church? Should seminaries continue to focus on training pastors for exegetically-correct sermons and leave void the need to nurture and guide people to meaningful relationships within the community? Should pastors continue to lead parishioners from an authoritative position that their seminary-trained expertise might dictate, or should pastors collaborate with lay leaders to jointly develop a church atmosphere that reflects shared values developed through a collaborative approach

Perceptions of the Senior Pastors\u27 Transformational Leadership Style and Its Relationship to the Eight Markers of Natural Church Development [Dissertation Notice]

What if research could demonstrate how a more collaborative approach to church leadership had a positive impact on the overall effectiveness of the church? Would pastors adjust their leadership style and would seminaries expand their pastoral training curriculum? Research continues to affirm the importance of leadership in the health and effectiveness of organizations from multiple contexts. Everything from schools to politics indicates the need for leadership. Yet, little quantitative research has been done to see the impact of leadership within the church arena. Is it possible that leadership style correlates to the effectiveness of corporate America, but has little correlation within the church? Should seminaries continue to focus on training pastors for exegetically-correct sermons and leave void the need to nurture and guide real-life people to meaningful relationships within the community? Should pastors continue to lead parishioners from an authoritative position or should pastors collaborate with lay leaders to jointly develop a church atmosphere that reflects shared values developed through a collaborative approach? Does strong leadership indicate more empowerment and less control within collaborative efforts? This research sought a statistically relevant linear correlation between the leadership style of the senior pastor, as defined by the Multifactor Leadership Questionnaire, and the effectiveness of the church, as defined by Natural Church Development. The Natural Church Development scores were averaged for fifteen churches that participated in the research. Each senior pastor participated in the Multifactor Leadership Questionnaire giving each a rating on transactional, transformational, and laissez-faire leadership traits. Regression analysis was used to determine correlation between the variables. These two variables (NCD average score and MLQ averages for transformational, transactional, and laissez-faire) were examined with linear regression testing. The result was a statistically strong linear relationship with transformational (Adjusted R2 = .24) and transactional leadership (Adjusted R2 = .25), but no statistically significant correlation with laissez-faire. The leadership of the senior pastor does relate to the effectiveness of the church as defined by the eight markers of Natural Church Development

Effects of moderate weight loss on anginal symptoms and indices of coagulation and fibrinolysis in overweight patients with angina pectoris

Objective: To evaluate the effects of moderate weight loss, in overweight patients with angina, on plasma coagulation, fibrinolytic indicies and pain frequency. Design: Single- stranded 12-week dietary intervention, an individualised eating plan with quantitative advice delivered by a dietitian. Target weight loss of 0.5 kg per week. Setting: Outpatient research clinic. Subjects: Fifty-four volunteers with angina pectoris were recruited. Five subjects withdrew, so 27 males, 22 females, mean body mass index (BMI) 29.3 (s.d. 4.3) kg/m(2) and age 60.3 (s.d. 6.5) y completed the intervention. Measurements: Body weight and frequency of anginal pain. Plasma fibrinogen, red cell aggregation (RCA), viscosity, factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator antigen (t-PA), plasma cholesterol, triglyceride and insulin. Results: After the 12-week dietary intervention period, mean body weight fell by 3.5 (s.d. 2.6) kg or 4.3% (P = 0.0001), range -11.7 to +1.7 kg. Mean angina frequency fell by 1.8 (s.d. 3.6) from 3.2 to 1.4 episodes/week (P = 0.009) and plasma cholesterol by 0.4 (s.d. 0.7) from 6.3 to 5.9 mmol/1 (P = 0.0001). HDL cholesterol and triglyceride were unchanged. Of the coagulation and fibrinolytic factors, factor VII activity and RCA were significantly reduced by 5 (s.d. 20), IU/dl (P = 0.04) and 1.3 (s.d. 1.3) arbitrary units (P = 0.014), respectively. Conclusions: A conventional dietetic intervention, resulting in 4% weight loss, offers the potential to reduce atherosclerotic and thrombotic risk, and to reduce pain frequency, in angina patients. Given the importance of this result in a public health context, these results indicate that this may be a fruitful area for future nutrition research