Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome.

Background The prognostic significance of obstructive sleep apnea ( OSA ) in patients with acute coronary syndrome ( ACS ) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index ≥15 events·h-1. The primary end point was major adverse cardiovascular and cerebrovascular event ( MACCE ), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. OSA was present in 403 of 804 (50.1%) patients. During median follow-up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non- OSA group (log-rank, P=0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE (adjusted hazard ratio, 1.55; 95% CI, 0.94-2.57; P=0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20-12.46; P=0.023), but no increased risk was found within 1-year follow-up (adjusted hazard ratio, 1.18; 95% CI, 0.67-2.09; P=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non- OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09-4.05; P=0.027). Conclusions There was no independent correlation between OSA and 1-year MACCE after ACS . The increased risk associated with OSA was only observed after 1-year follow-up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation

Beyond the Illustration of Research Data: Using professionally facilitated image making techniques to enable participants to describe, enhance and extend data originally captured using traditional text-based methods of research

Using professionally facilitatedimage making techniques to enable participants to describe, enhance and extend data originally captured using traditional text-based methods of research. The Growing Up with Cancer project design • Young people’s experiences of dealing with cancer, its treatment and long terms consequences at the same time as they are growing up • 19 young people aged 16‐29 years who were diagnosed with cancer between the ages of 11‐22 years • Interviewed about their experiences of growing up with cancer • Created self‐portraits about their experiences of growing up with cancer • Interviewed after completed self‐portrait The benefits of a creative process for a research project • Different to a ‘hit and run’ single interview • Process provided an extended opportunity –and for some, multiple opportunities –to reflect on their experiences • Created different way to think about self and experience • Young people decided what they wanted to represent and how –not all the portraits are simply about cancer • Creative process more than a catalyst for a subsequent interview • Self‐portraits engage research audiences in different way to traditional research output

Phenolic assessment of white musts: Varietal differences in free-run juices and pressings

Direct spectrophotometry over the range 250-400 nm enables rapid assessment of juice fractions from commercial juice preparation systems. Attention is focused on spectral estimates of the total flavonoids which increase during skin contact, with increasing must temperature, and particularly during recovery of heavy pressings.Spectral data from many sets of commercial juice fractions, concerning eight grape varieties in several districts, were collated over three seasons, 1987-88-89. Such observations have indicated the prime importance of grape variety in relation to phenolic extract in the juice fractions. The data have suggested the notion of 'spectral recognition profiles' arising from intrinsic varietal differences in the distribution of phenolic constituents within wine grapes.Thus the flavonoid concentration appears to be a significant variable of varietal dry white wine style. Qualitative differences in phenolic composition have also been demonstrated by differential spectrophotometry of model skin extracts at 250-300 nm.Fining treatments with various commercial fining agents had only minor effect on flavonoid levels in juice pressings and in press wines

Evolution of red wines III. Promotion of the maturation phase

Die Entwicklung von RotweinenIII. Beschleunigung der ReifungsphaseAusgehend von der Tatsache, daß die chemischen Reaktionen zu Beginn des Weinausbaus im wesentlichen anaerob sind und durch erhöhte Temperaturen beschleunigt werden können, wurde der Einfluß der anaeroben Lagerung bei 42-45 ° C über einen Zeitraum von 25-40 d verfolgt; als Kontrolle dienten bei normaler Kellertemperatur gelagerte Weine. Die Versuche wurden mit Gebinden junger Rotweine (Shiraz, Cabernet Sauvignon, Malbec) in isolierten Edelstahltanks (250, 1200, 5000 l) durchgeführt. Es wurden stetige Veränderungen bei Komponenten festgestellt, die für Farbe, Geruch und Geschmack wesentlich sind; sie entsprachen den Veränderungen, die sich bei normaler Kühllagerung während eines viel längeren Zeitraumes einstellten. Die spektralen Veränderungen der Farbintensität und -tönung waren von einer raschen logarithmischen Abnahme der Anthocyankonzentration bei Wärmebehandlung begleitet, während sich die Kontrollweine nur geringfügig veränderten. In den behandelten Weinen stabilisierte sich die Färbung, bedingt durch die Zunahme oligomerer Farbstoffe.Es gab keine analytischen oder sonstigen Hinweise auf den nachteiligen Einfluß einer derartigen, zeitlich begrenzten Weinlagerung. Bei Shiraz-Weinen wurde die Entwicklung eines zarten Beerenaromas und -geschmackes festgestellt; gleichzeitig wurde zu Beginn der Wärmebehandlung die vermehrte Bildung von Damascenon beobachtet

'Nowhere to be found’: disabled refugees and asylum seekers within the Australian resettlement landscape

Australia has long placed restrictions on the immigration of people with disabilities. While recent civil society mobilisation has forced some shift in policy, it is far from clear whether this will result in people with disabilities being accepted as immigrants. The issue is complicated further for people defined as ‘refugees’ and ‘asylum seekers’ who have encountered the migration restrictions on disability. As a result of this policy landscape, there is limited rigorous research that seeks to understand the social inclusion and participation of disabled refugees and asylum seekers within the resettlement process. An extensive review reveals that refugees and asylum seekers with disabilities remain largely absent from both resettlement literature and disability research. This paper summarises the limited available research in the area around the following themes: processes of offshore migration and the way that disability is assessed under Australia’s refugee legislation; the uncertainty of the prevalence of disability within refugee and asylum seeker communities; the provision of resettlement services, both mainstream and disability-specific, through the transitional period and beyond; and the invisibility of asylum seekers with disabilities in Australia’s immigration detention centres, community-based arrangements and offshore processing centres. To conclude, the paper outlines implications for further research, policy and practice in the Australian context

Finding Earnesto: Temporary Labour Migration and Disbled Children's Health

We seek to expose the implications of Australia’s exclusionary and discriminatory disability migration provisions on the health and wellbeing of disabled children who have arrived in Australia through alternative migratory routes. By undertaking an in- depth analysis of a single case study, Ernesto, we bring to the fore the key issues facing disabled immigrant children. These children, like our case study Ernesto, are only granted visas on the proviso that their parents/primary caregivers agree to cover the full costs associated with their disability, including medical care and additional expenses such as educational inclusion. The story of Ernesto reveals the extreme impact of these discriminatory policies on this population’s health and wellbeing. Further, we discuss how the state’s “right to exclude” people with disabilities from the migratory process negatively affects the health and wellbeing of their siblings and parents

A systematic review of the individual determinants of research evidence use in allied health

Background: The use of evidence-based practice (EBP) is often not reflected in allied health (AH) practitioners’ day-to-day practice (the research-practice gap). Research suggests that considerable differences between and within AH disciplines exist, which require different approaches in order to influence practice behavior. It is therefore important to develop a better understanding of what influences individual AH practitioners’ adoption of evidence into daily practice. Objective: This systematic review aims to examine the individual characteristics of AH practitioners which determine their uptake of evidence into practice. Methods: Studies which examined individual factors or variables that influence research evidence use by any AH practitioner were included in the review. The methodological quality of the included papers was assessed using the Quality Assessment and Validity Tool for Cross-sectional Studies. A narrative summary of the findings was presented. Results: Six studies were included and the methodological quality scores indicated that two were weak and the remainder had moderate–weak quality. The review demonstrated that factors such as educational degree or academic qualification, involvement in research or EBP-related activities, and practitioners’ perceptions, attitudes and beliefs about research and EBP are significant predictors of self-reported research evidence use in AH. The effect of other factors such as professional characteristics, clinical setting/work environment, information-seeking behavior and sociodemographic variables are less clear. Whether there is an interaction effect between evidence-uptake factors has not been tested. Conclusion: Improving the research knowledge of clinicians and overcoming negative attitudes toward EBP have the potential to move AH practitioners towards regularly utilizing evidence in practice. Allied health practitioners may benefit from participation in regular educational opportunities such as case studies or journal clubs which can put them at the same level of thinking and awareness of research evidence. Future research should aim to review organizational and contextual factors and explore their interaction with individual determinants of research evidence use.L Lizarondo, K Grimmer-Somers, S Kuma

Development, initial content validation and reliability of Nigerian Composite Lifestyle CVD risk factors questionnaire for adolescents

Background: Cardiovascular disease risk (CVD) factors affect every age category including adolescents in developing nations. Prevention strategies are effective only when there are epidemiological data for the targeted populations. The collection of such data is only made easy with composite lifestyle CVD risk factors measures that are culturally sensitive and acceptable among the target populations.Objective: The objective of the study was to develop a culturally sensitive and friendly composite lifestyle CVD risk factors questionnaire for adolescents in NigeriaMethods: A systematic review was conducted to identify existing, published questionnaires from which items could be selected. Content and face validation were conducted using an expert panel and a sub-sample of the target population. Data was analyzed qualitatively and reliability was assessed using intra-class correlation and Kappa statistic.Results: Based on the comments received from experts, the questions were restructured, simplified, clarified, formatted, some questions were added and expert reached a consensus. Kappa showed fair to moderate agreement in 65% of the questions and perfect agreement in one question.Conclusion: The CVD risk factors questionnaire has acceptable content validity and reliability and should be used to assess CVD risk factors among adolescents in NigeriaKey words: Cardiovascular disease, risk factors, questionnaire, adolescent