An IT approach to cardiovascular care based on primary care

We describe a unique telemedicine approach to cardiovascular care, based in primary care, which combines store and forward with real time video. Patients presenting to the family practitioner (GP) with chest pain or symptoms indicative of cardiac disease are assessed within the health centre by exercise test ECG. The report, together with other clinical information is forwarded as an electronic referral to the cardiologist. Suitable candidates for angiography have an initial teleconsultation by video-conferencing, in which not only may the patient, GP and cardiologist discuss the diagnosis and forthcoming procedures in hospital, but also can undertake management of the patient, such as review of medication and life style. Follow-up consultations may be conducted by further tele-clinics. We also show how re-engineering the process has the potential to eliminate 75 of outpatient appointment

Four new species of deep water agglutinated foraminifera from the Oligocene-Miocene of the Congo Fan (offshore Angola)

Four new species of deep-water agglutinated benthic foraminifera are described from the Oligocene and Miocene of the Congo Fan, offshore Angola. Scherochorella congoensis n.sp., Paratrochamminoides goroyskiformis n.sp., Haplophragmoides nauticus n.sp. and Portatrochammina profunda n.sp. all occur in deep-sea turbiditic shales and sands from the distal section of the Congo Fan

How can we best assess the quality of life of people with dementia? The Bath Assessment of Subjective Quality of Life in Dementia (BASQID)

Purpose of the Study - The study aim was to develop a measure of self-reported QoL for people with mild to moderate dementia based on their views - the Bath Assessment of Subjective Quality of Life in Dementia (BASQID). Design and Methods - The measure was developed through multiple stages. Two field tests of the measure (n=60 & n=150) enrolled people with dementia from a memory clinic and the data were used to analyse the psychometric properties of the scale. Nested within this was a longitudinal investigation of 36 Alzheimer’s disease patients prescribed with acetylcholinesterase inhibitors. Results - The BASQID contains 14 items assessing a range of QoL issues. Results show that the BASQID satisfies the criteria of a valid, reliable, and acceptable assessment of subjective QoL. Scores were responsive to changes in QoL, over 3-months. Low association between the BASQID and Mini Mental State Examination indicates that cognitive function may influence QoL, but is an indirect measure of the QoL experienced during dementia. Implications – The BASQID provides a means of better understanding the experiences, perceptions, and beliefs of people with dementia. It does this through acknowledgement of the many influences on QoL, over and above health status. The BASQID can be used alongside objective assessments of dementia to provide a complete appraisal of a person’s QoL

Adiposity is associated with blunted cardiovascular, neuroendocrine and cognitive responses to acute mental stress

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited - Copyright @ 2012 Jones et al.Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N=43) and women (N=45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2*-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β=−0.50 bpm.unit−1, P=0.009; SV:β=−0.33 mL.unit−1, P=0.01; CO:β=−61 mL.min−1.unit−1, P=0.002; systolic BP:β=−0.41 mmHg.unit−1, P=0.01; TPR:β=0.11 WU.unit−1, P=0.02), cognitive (correct answers: r=−0.28, P=0.01; time to answer: r=0.26, P=0.02) and endocrine responses (cortisol: r=−0.25, P=0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence.This work is funded by the UK National Institute of Health Research (NIHR), Siemens Medical Systems, British Heart Foundation (BHF), NIHR Senior Research Fellowship & The Fondation Leducq, BHF Intermediate Fellowship

Oligocene Deep-Water Agglutinated Foraminifera from the Congo Fan, Offshore Angola: Palaeoenvironments and Assemblage Distributions

Seventh International Workshop on Agglutinated Foraminifera, Urbino, Italy, October 2-8, 2005Agglutinated foraminiferal assemblages from the Oligocene section of an exploration well drilled in the distal part of the Congo Fan are fully documented and interpreted for palaeoenvironment. A total of 65 ditch cutting samples were analysed at 10 m intervals, from 3630 to 4270 m below rotary table. An average of 170 specimens were extracted per sample, with over 100 species being documented and described using SEM and light photography. The results reveal the most taxonomically diverse deepsea Oligocene fauna yet described. Six assemblages have been defined and analysed with Correspondence and 'Morphogroup' Analysis. These are 1. Nothia robusta / Reticulophragmium Assemblage (4110-4270 m), 2. Nothia robusta / Scherochorella congoensis / Discamminoides sp. 1 Assemblage (4000-4100 m), 3. High diversity Reticulophragmium Assemblage (3870-3990 m), 4. Portatrochammina profunda Assemblage (3790-3860 m), 5. Nothia latissima Assemblage (3730-3780 m) and 6. Low abundance Assemblage (3630-3720 m). Palaeobathymetric estimates range from middle - lower bathyal based on comparison with living taxa and morphogroup distributions. These results extend the known stratigraphic range (last occurrences) of Reticulophragmium amplectens into the Oligocene in the Atlantic, and possibly also Paratrochamminoides gorayskii, Paratrochamminoides olszewskii, Trochamminoides aff. proteus, Trochamminoides subcoronatus, Haplophragmoides horridus and Haplophragmoides walteri, although reworking is documented with these species. Results also extend the known first occurrences of Recurvoides azuaensis, Spiropsammina primula, Cyclammina aff. orbicularis, Discamminoides sp. and Glaphyrammina americana into the Oligocene. Large scale variations within faunas are largely assigned to documented variations in sand content, where higher proportions of sand generally coincide with reduced diversity and abundance along with a dominance of opportunistic species such as Nothia robusta, Nothia latissima and Ammodiscus latus. A major excursion in the infaunal morphogroup, suspension-feeding morphogroup and diversity and abundance within Assemblage 2 is termed the 'Scherochorella Event', and does not correlate with an increase in sand. This fauna is thought to be the result of lower oxygen conditions allowing the dominance of the low oxygen morphotype Scherochorella congoensis and the opportunistic species Nothia robusta. Deep-water circulation in the Atlantic at this time is generally thought to have been strong, and this event suggests that there may have been a temporary expansion of the oxygen minimum zone during the Late Oligocene, coinciding with increased benthic δ18O values, global cooling, and increased upwelling associated with a stronger polar front. The otherwise high diversity of the fauna in the well supports the interpretation of well-oxygenated conditions.We would like to thank BP Exploration for their support in fully funding this project

Progress in treatment of ANCA-associated vasculitis.

Autoantibodies to neutrophil cytoplasmic antigen-associated vasculitis (AAV) is characterised by inflammation of blood vessels. The introduction of immunosuppressive therapy with glucocorticoids and cyclophosphamide transformed AAV from a fatal condition to a largely treatable condition. Over the past 30 years, considerable progress has been made refining immunosuppressive regimens with a focus on minimising toxicity. There is, however, a high unmet need in the treatment of AAV. A proportion of patients are refractory to current therapies; 50% experience a relapse within 5 years and treatment toxicity contributes to mortality and chronic disability. As knowledge of the pathogenesis of vasculitis grows, it is mirrored by the availability of biological agents, which herald a revolution in the treatment of vasculitis. Lymphocyte-targeted and cytokine-targeted agents have been evaluated for the treatment of AAV and are entering the routine therapeutic arena with the potential to improve patient outcomes. As rare diseases, treatment advances in vasculitis depend on international collaborative research networks both to establish an evidence base for newer agents and to develop recommendations for patient management

IgA vasculitis (Henoch-Schönlein purpura): refractory and relapsing disease course in the adult population.

BACKGROUND: The disease course of adult immunoglobulin A (IgA) vasculitis (IgAV; Henoch-Schönlein purpura) has not been well defined. METHODS: In a retrospective survey, we studied 85 adult IgAV patients with extended follow-up (median 43 months) for 67 patients. RESULTS: Only 33 of 67 (49%) achieved complete remission. Ongoing renal disease was the most common persistent organ manifestation, but extra-renal disease activity was also present in >50% of patients not achieving complete remission. Twenty-nine of 67 (43%) had relapsing disease, with 18/67 (27%) experiencing several relapses. Skin disease was the most common feature in relapsing patients, followed by nephritis. At 4 years of follow-up, 6 of 29 (21%) experienced progressive disease and 10/29 (34%) relapsing disease. Five of 67 (7%) developed nephritis after diagnosis, within the first 6 months of follow-up. At final follow-up, 10 of 67 (15%) had chronic kidney disease Stage ≥G3a, 18 (27%) haematuria and 13 (19%) proteinuria. No therapy appeared particularly effective and only 6/17 patients treated with mycophenolate mofetil experienced a good response. CONCLUSIONS: The disease course of adult IgAV is different from that seen in children, with higher frequency of persisting and relapsing disease. Renal disease is the main determinant of ongoing disease activity, but extra-renal features were seen in >50% of patients with chronic disease activity. No clear conclusions on use or choice of immunosuppressive agent could be made based on our experience