Achieving the SDGs: building on interlinkages among goals

In September 2015, 193 countries of the UN General Assembly adopted a new development agenda Transforming Our World: the 2030 Agenda for Sustainable Development. With 17 Sustainable Development Goals (SDGs) and 169 underlying targets that are "integrated and indivisible", the agenda provides both an extraordinary chance and extraordinary challenge to society at the global, national and local level. If these goals are met, the pay-off is likely to be a higher level of well-being throughout the world, and a more sustainable planet. Innumerable connections exist among the goals and targets: some are dependent on one another; others have potential trade-offs between them. To effectively implement sustainable social, economic and environmental development and move forward on the SDGs it is necessary to understand and act on these interactions. This Wilton Park event considered the extent to which science and policy can connect and cooperate to achieve the SDGs, in particular how they can work together to help identify the most important interactions among SDGs to improve economic and social development. Discussion focused on the SDGs which will be considered at the UN High-level Political Forum in New York in July 2018, namely the goals pertaining to water (Goal 6), energy (Goal 7), cities (Goal 11), consumption and production (Goal 12), and land (Goal 15). Key points from the discussion will be fed into the High-level Political Forum to help inform the debate and encourage consideration of the interlinkages among goals

Contested landscapes: the global political economy of climate smart agriculture

Analysing key initiatives in the area of climate-smart agriculture and the politics which surround them, this paper identifies the dominant discourses shaping the debate through a discussion of discursive sites of power and by mapping the emerging ‘regime complex’ of institutional power that operates at the interface of the climate and agrifood system. This is connected to forms of material power that derive from control over production, finance and technology in the neoliberal food regime by transnational capital. Such an analysis has important implications for which solutions are promoted as part of climate-smart agriculture and which actors are likely to benefit from the flows of technology, finance and institutional support that are mobilised in the struggle to define a viable global agrifood system in a warming world

One size does not fit all— application of accelerometer thresholds in chronic disease

No abstract available

Cardiac rehabilitation and physical activity : systematic review and meta-analysis

OBJECTIVE: To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. METHODS: Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. RESULTS: Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. CONCLUSION: Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA

Factors associated with objectively assessed physical activity levels of heart failure patients

Aim: To determine the level of objectively measured moderate-to-vigorous physical activity (MVPA) in patients with heart failure (HF), and to assess the association between MVPA and patient sociodemographic, exercise capacity, and health status factors. Methods: Baseline MVPA data was available in 247 HF patients with 7-day wrist-worn accelerometry from two randomized controlled trials. Associations between MVPA and patient sociodemographic, exercise capacity, and health status factors were assessed using univariate and multivariable linear regression models. Results: 247 patients (28% female, mean age 71 ± 10 years) with HF with reduced ejection fraction (n=198) and preserved ejection fraction (n=49) were included in the analysis. Average MVPA was 283. 3 min/week and ranged widely from a minimum of 0 mins/week to maximum of 2626. 7 mins/week (standard deviation: 404. 1 mins/week). 111 (45%) of patients had a level of PA that met current guidelines of at least 150 minutes/week of MVPA. Multivariable regression showed patient’s age, body mass index, employment status, smoking status, New York Heart Association class, NT-proBNP and exercise capacity to be strongly associated (p&lt;0. 001) with the level of MVPA (p&lt;0. 001). Conclusion: Whilst 45% of HF patients had objectively measured levels of MVPA that met current PA recommendations, we observed a wide range in the level of MVPA across this patient sample. As a number of factors were found to be associated with MVPA our findings provide important information for future interventions aiming to increase MVPA in HF patients

Continuous positive airway pressure therapy effects on lipid and hepatic function test values

Introduction : Continuous positive airway pressure (CPAP) therapy is an established therapy for patients diagnosed with obstructive sleep apnea (OSA). The following study aims to measure the impact of CPAP therapy on lipid and liver profiles of patients diagnosed with OSA. We hypothesize that CPAP therapy will improve patient serum lipid and liver measures in this patient population compared to patient baseline prior to CPAP therapy. Furthermore, we also will examine differences in hepatic ultrasound results for OSA patients on CPAP therapy. Methods: The target patient population has moderate-severe OSA, defined as an Apnea-Hypopnea Index greater than 15. The intervention is defined as a minimum of four hours of CPAP therapy use nightly on average. For lipid panel outcomes, we recorded high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), total cholesterol (TC), and triglycerides (TG). For liver panel outcomes, we measured aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values. All values were compared to each patients’ averaged baseline values six months prior to initiation of CPAP therapy. Furthermore, we also examined hepatic ultrasound results prior to and after beginning CPAP therapy. Results: Data collection is currently ongoing. We expect preliminary data of ten chart reviews of eligible subjects show lower HDL, LDL, TC, TG, AST, and ALT on lipid and liver function tests after consistent CPAP use compared to baseline. Unfortunately, due to this initial small pilot sample size, no significant findings with regard to hepatic ultrasound results have been observed. Discussion: Our results demonstrate that consistent CPAP therapy use helps to lower liver function and lipid tests. This provides support that CPAP therapy, in conjunction with treating OSA, may help to improve outcome values for patients with hypertriglyceridemia and poor liver function. We will continue to collect data on a much larger sample of patients to adequately test our study hypothesis regarding the effects of CPAP therapy effects on hepatic outcomes, such as liver failure, which would provide further support of the beneficial effects of CPAP therapy on vulnerable populations

The effect of CPAP treatment on T2DM in moderate to severe OSA subjects

Introduction: Obstructive sleep apnea (OSA) is a significant risk factor for type 2 diabetes mellitus (T2DM). CPAP treatment can potentially improve glycemic control in such subjects. However, the exact effects of CPAP treatment on diabetes are uncertain. The objective of this study is to examine the effect of CPAP treatment on HbA1c levels in subjects with moderate to severe OSA and T2DM. Methods: This is a combined retrospective and prospective study collecting data through EPIC medical record reviews. We are collecting HbA1c levels (primary outcome variable) before and after CPAP treatment in subjects with moderate to severe OSA and T2DM. The analysis will be controlled for via CPAP compliance, which will be assessed as both a categorical (adherent/non-adherent) and continuous predictor variable (number of hours of nightly usage). Results: Reproducibility of collected data has been verified as \u3e95% between chart reviewers on this project. We have collected data on 10 subjects so far and analysis results are pending. We hypothesize that higher levels of CPAP compliance will correlate with significant reductions in HbA1c levels in patients with both moderate to severe OSA and T2DM. Discussion: Some studies report a decrease in HbA1c levels after CPAP treatment, while others report no significant change. All studies report that their limiting factor was variable CPAP adherence rates and small sample size. This project will add to the existing literature with a goal sample size of n=5000 and CPAP adherence rates above 70%, much higher than the national average (30%)

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant