Postsystolic Shortening by Speckle Tracking Echocardiography Is an Independent Predictor of Cardiovascular Events and Mortality in the General Population

Background Postsystolic shortening ( PSS ) has been proposed as a novel marker of contractile dysfunction in the myocardium. Our objective was to assess the prognostic potential of PSS on cardiovascular events and death in the general population. Methods and Results The study design consisted of a prospective cohort study of 1296 low‐risk participants from the general population, who were examined by speckle tracking echocardiography. The primary end point was the composite of heart failure, myocardial infarction, and cardiovascular death, defined as major adverse cardiovascular events ( MACEs ). The secondary end point was all‐cause death. The postsystolic index ( PSI ) was defined as follows: [(maximum strain in cardiac cycle−peak systolic strain)/(maximum strain in cardiac cycle)]×100. PSS was regarded as present if PSI &gt;20%. During a median follow‐up of 11 years, 149 participants (12%) were diagnosed as having MACE s and 236 participants (18%) died. Increasing number of walls with PSS predicted both end points, an association that persisted after adjustment for age, sex, estimated glomerular filtration rate, global longitudinal strain, hypertension, heart rate, left ventricular ejection fraction, LV mass index, pro‐B‐type natriuretic peptide, previous ischemic heart disease, systolic blood pressure, average peak early diastolic longitudinal mitral annular velocity (e′), ratio between peak transmitral early and late diastolic inflow velocity (E/A), and left atrial volume index: MACEs (hazard ratio, 1.35; 95% confidence interval, 1.09–1.67; P =0.006 per 1 increase in walls displaying PSS ) and death (hazard ratio, 1.30; 95% confidence interval, 1.08–1.57; P =0.006 per 1 increase in walls displaying PSS ). The strongest predictor of end points was ≥2 walls exhibiting PSS. The PSI also predicted increased risk of the end points, and the associations remained significant in multivariable models: MACEs (per 1% increase in PSI : hazard ratio, 1.18; 95% confidence interval, 1.02–1.36; P =0.024) and death (per 1% increase in PSI : hazard ratio, 1.18; 95% confidence interval, 1.05–1.33; P =0.005). Conclusions Presence of PSS in the general population provides independent and long‐term prognostic information on the occurrence of MACEs and death. </jats:sec

The effect of neonatal vitamin A supplementation on growth in the first year of life among low-birth-weight infants in Guinea-Bissau:two by two factorial randomised controlled trial

BACKGROUND: Vitamin A supplementation (VAS) may amplify the effect of vaccines. We therefore investigated if neonatal VAS given with and without Bacille Calmette-Guérin (BCG) vaccine to low-birth-weight (LBW) neonates had an effect on growth in the first year of life. We hypothesised that VAS would be particularly beneficial when provided with BCG. METHODS: We conducted a randomised two-by-two factorial trial in Guinea-Bissau; 1,717 LBW neonates were randomly allocated to VAS or placebo at birth as well as early or the usual postponed BCG vaccination. Anthropometric measurements were obtained at 2, 6, and 12 months after inclusion. RESULTS: Overall there was no effect of neonatal VAS on growth in the first year of life. By 2 months, VAS tended to have a beneficial effect on weight and head circumference when given with BCG but not when given without BCG (interaction: weight-for-age p = 0.07 and head circumference-for-age: p = 0.06). By 6 months, there was a beneficial effect of VAS on head circumference and weight among children who had not received DTP vaccine 2 months after inclusion (weight: 0.18 (0.00; 0.36) and head circumference 0.27 (0.06; 0.48)), but no beneficial effect among those who had received DTP. CONCLUSION: The results support other trials indicating that neonatal VAS does not have consistent effects on childhood growth and if anything the effects seem to be temporary. They also show that the effect may differ by vaccination status, being beneficial when given with BCG at birth and when DTP is delayed. TRIAL REGISTRATION: http://www.ClinicalTrials.gov (NCT00168610) (nct00168610

Danish Foundations, CSR Legislation, and how Tradition Facilitates Compettive Advantage

In stark contrast to other national settings, the commercial foundation is a rather common form of ownership of enterprises in Denmark. Today, there are around 1,300 Danish commercial foundations. Familiar foundations include AP Møller Mærsk, Carlsberg, Egmont, and Novo Nordisk. Our paper aims to facilitate an understanding of this unique Danish tradition and explore its profound contemporary relevance.The significance of Danish commercial foundations, their societal and compassionate role, has manifested itself through philanthropic projects for centuries. We explore the dual identities that inhere in contemporary Danish commercial foundations, and how these impact contemporary society. There are also challenges and opportunities for such foundations in light of recent Danish corporate social responsibility (CSR) legislation. We explore these through a contextual analysis of legal structures that govern Danish commercial foundations. Extended Foundational Corporate Citizenship (EFCC) is presented in the paper as a communications model or tool to help resolve the inherent tension between a commercial foundation’s contemporary business and philanthropic units, offering an aid to strategic advantage identification. The EFCC model and associated modes of communication proposed may further serve to manage legislative pressures presented to commercial foundations. Moreover, the traditional commercial foundation structure, coupled with EFCC model deployment, appears theoretically and strategically anticipatory of emerging Danish legislative obligations. Isomorphic processes within commercial foundations shed light on the links between the internal communicative challenge and CSR legislation. Such isomorphism appears between the business - philanthropic configuration and the company - CSR configuration. These processes aid recognition of the potential benefit of the inherent structure of a commercial foundation in relation to the emerging focus on CSR legislation. An additional purpose of illustrating the isomorphic processes was to facilitate clarification of a potential strategic advantage of commercial foundations, indicating how such traditional foundations may not only exist in society but operate “ahead of” emerging CSR legislative reporting obligations. The contemporary proliferation of CSR, as a legal matter, is a potent source of consumer interest. It is also a research field that provides commercial foundations with a number of opportunities to explore. Legislative obligations may appear to be little more than a reporting obligation for commercial foundations’ business units. Yet, our research suggests the structure of a commercial foundation already contains a latent communicative advantage for the good, not only of commercial foundations, but also contemporary society. We believe that our research findings in the Danish case of foundation organization and management theory may be of interest to an international audience. Within the structure of a commercial foundation one may find inherent notions of compassion coupled with authentic commercial and profit-making intentions. Indeed, we hope the results offer a path to successfully anticipate current, as well as future, stakeholder and public expectations for an organizational form of historical interest and future merit

Gerinnungsveränderungen unter In-vitro-Fertilisationstherapie

Unterschiedliche Hormonpräparate, wie beispielsweise orale Kontrazeptiva oder Substitutionspräparate in der Menopause sind in den letzten Jahren vermehrt in die Schlagzeilen geraten. Es wurden viele Studien veröffentlicht, die zeigten, daß es unter bestimmten Hormongaben zu Veränderungen der Blutgerinnung kommt im Sinne von Steigerung des pro- bzw. Reduktion des antikoagulatorischen Potentials. Somit besteht ein erhöhtes Thromboserisiko unter Verwendung bestimmter Hormonpräparate, insbesondere, wenn weitere Risikofaktoren für thromboembolische Ereignisse (Rauchen, Adipositas, Immobilisation usw.) hinzu kommen. Da die In-vitro-Fertilisation in den letzten 20 Jahren immer mehr an Bedeutung gewonnen hat und während eines IVF-Zyklus Hormone in hoher Dosierung verabreicht werden, stellte sich die Frage, ob und inwieweit es auch hier zu Gerinnungsveränderungen kommt. In der vorliegenden Arbeit konnten wir anhand unterschiedlicher Gerinnungs-parameter und Hormonwertbestimmungen bei zwei unterschiedlichen IVF-Stimu-lations-Protokollen zeigen, daß es unter In-vitro-Fertilisations-Therapie zu Veränderungen der Blutgerinnung der Patientinnen kommt. In beiden von uns untersuchten Patientengruppen (LONG- versus SHORT-Protokoll Programm) wiesen sowohl die Globaltests der plasmatischen Gerinnung (Quick-Wert, aPTT und Fibrinogen) als auch die Gerinnungsaktivierungsparameter Prothrombinfragment F1+2 und D-Dimer auf eine Erhöhung des prokoagulatorischen Potentials bzw. eine Gerinnungsaktivierung hin. Die in den letzten Jahren auf dem Gebiet der Gerinnungsaktivierung bzw. -inhibierung erst genauer erforschten Faktoren Tissue factor und Tissue factor pathway inhibitor verhielten sich unterschiedlich in den beiden von uns untersuchten Gruppen und zeigten keine eindeutig signifikanten Veränderungen. In bezug auf die Hormonwertveränderungen unter IVF-Therapie konnten wir zeigen, daß die Gerinnungswerte, insbesondere Prothrombinfragment F1+2 und D-Dimer, der Patientinnen beider Protokolle signifikant mit den Progesteron-Werten korrelierten. Estrogen-Spiegel scheinen dagegen bei der In-vitro-Fertilisations-Hormontherapie eine untergeordnete Rolle zu spielen in bezug auf die Gerinnungsaktivierung. Zwischen den beiden Patientengruppen bestanden kaum Unterschiede hinsichtlich Ansteigen bzw. Abfallen der einzelnen Parameter. Lediglich in bezug auf die Höhe des jeweiligen Anstiegs bzw. Abfalls konnte gezeigt werden, daß, außer bei den F 1+2-Werten, jeweils die Endwerte der Patientinnen der LONG-Protokoll Gruppe deutlich über bzw. unter denen der SHORT-Protokoll Gruppe lagen, was auf ein stärkeres Ansteigen des prokoagulatorischen Potentials in diesem Protokoll weist, insbesondere im Zusammenhang mit dem auch in dieser Gruppe stärkeren Ansteigen des Progesterons