Treatment of Secondary Mitral Regurgitation in Heart Failure: A Shifting Paradigm in the Wake of the COAPT Trial

Secondary mitral regurgitation (MR) is common in patients with left heart dysfunction and it is associated with poor outcomes. Findings from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, published in 2018, suggest that in a subset of people with heart failure with secondary MR that persists despite optimization of guideline-directed medical therapies, there is now a role for percutaneous mitral valve repair using the MitraClip device. Defining which patients are most likely to benefit from MitraClip, and when, requires both a multidisciplinary approach centered on heart failure, as well as a recognition of the need for further research in this area

Use, Practices and Attitudes of Sports Nutrition and Strength and Conditioning Practitioners towards Tart Cherry Supplementation

This is the final version. Available from MDPI via the DOI in this record. No new data were created or analyzed in this study. Data sharing is not applicable to this article.Tart cherry (TC) supplementation has been shown to accelerate post-exercise recovery, enhance endurance performance and improve sleep duration and quality. This study aimed to identify the use, practices and attitudes of sports nutrition and strength and conditioning practitioners towards tart cherry supplementation. Thirty-five practitioners anonymously completed an online survey investigating their use, practices and attitudes towards tart cherry supplements. Forty-six percent of the responders were currently recommending TC supplements, 11% had previously recommended TC supplements and 26% have not previously recommended TC supplements but were planning on doing so in the future. Of those recommending TC, 50% recommended or were planning on recommending TC supplements to enhance exercise recovery and 26% to improve sleep duration and quality. Acute supplementation and daily use during multi-day competition or demanding training blocks with a 2–3-day pre-load were the most reported supplementation recommendations (28% and 18%, respectively). Fifty-two percent of responders indicated uncertainty about the daily polyphenol dose to recommend as part of a TC supplementation protocol. Despite the high use and interest from sports nutrition and strength and conditioning practitioners in TC supplements, their practices did not align with the protocols found to be effective within the literature

Reducing dose for digital cranial radiography : The increased source to the image-receptor distance approach

This investigation proposes that an increased source to the image-receptor distance (SID) technique can be used to optimize occipital frontal and lateral cranial radiographs acquired with direct digital radiography. Although cranial radiography is not performed on a routine basis, it should nonetheless be optimized to keep the dose to the patient as low as reasonably achievable, particularly because it can form part of the facial bone and sinus series. Dose measurements were acquired at various SIDs, and image quality was assessed using visual grading analysis. Statistically significant reductions in the effective dose between 19.2% and 23.9% were obtained when the SID was increased from the standard 100 to 150 cm (P ≤.05), and visual grading analysis scores indicate that image quality remained diagnostically acceptable for both projections. This investigation concludes that increasing the SID effectively optimizes occipital frontal and lateral skull radiographs. Radiology departments must be advised of the benefits of this technique with the goal of introducing an updated reference SID of 150 cm into clinical practice.Peer reviewe

Weekend effect: analysing temporal trends in solid organ donation

Background: Research suggests patients treated over weekends experience poorer outcomes. Only one US-based study explored this weekend effect in organ donation, specifically the kidney discard rate. In Australia potential donors are referred to a donation service, and donation proceeds if family consent is granted and the donor is deemed medically suitable to donate. Organ procurement occurs when utilization is almost certain hence discard rates are much lower than in the USA. We aimed to characterize the effect of weekend referral on organ donation in Australia. Methods: We retrospectively reviewed all New South Wales Organ and Tissue Donation Service logs from 2010 to 2016. Our primary outcome was progression to organ procurement, and secondary outcomes were family consent and meeting medical suitability thresholds. We used logistic regression with random effects adjusting for clustering of referral hospitals. Results: Of 3496 potential donors referred for consideration, 694 (20%) progressed to organ procurement. There were fewer referrals on weekends (average 415 versus 588 for weekdays). However, donation rates were no lower for weekend compared to weekday referrals (adjusted OR 1.17; 95% CI 0.95, 1.44). Family consent (adjusted OR 1.20; 95% CI 1.00, 1.44) and medical suitability (adjusted OR 1.15; 95% CI 0.96, 1.38) were not lower for weekend compared to weekday referrals. Similar results were found for all sensitivity analyses conducted. Conclusions: In Australia, the donation pathway operates consistently throughout the week, with donation no less likely to proceed on weekends and holidays. This finding contrasts with findings in the USA

Passive sorting of asteroid material using solar radiation pressure

Understanding dust dynamics in asteroid environments is key for future science missions to asteroids and, in the long-term, also for asteroid exploitation. This paper proposes a novel way of manipulating asteroid material by means of solar radiation pressure (SRP). We envisage a method for passively sorting material as a function of its grain size where SRP is used as a passive in-situ ‘mass spec-trometer’. The analysis shows that this novel method allows an effective sorting of regolith material. This has immediate applications for sample return, and in-situ resource utilisation to separate different regolith particle sizes

Hepatitis transmission risk IN kidney Transplantation (the HINT study); a cross-sectional survey of transplant clinicians in Australian and New Zealand

Background Interpreting hepatitis serology and virus transmission risk in transplantation can be challenging. Decisions must balance opportunity to transplant against potential infection transmission. We aimed to survey understanding among the Australian and New Zealand medical transplant workforce of hepatitis risk in kidney donors and recipients. Methods An anonymous, self-completed, cross-sectional survey was distributed via electronic mailing lists to Australian and New Zealand clinicians involved in kidney transplantation (2014-2015). We compared interpretation of clinical scenarios with paired donor and recipient hepatitis B virus and hepatitis C virus serology to recommendations in clinical practice guidelines. We used logistic regression modeling to investigate characteristics associated with decisions on transplant suitability in scenarios with poor (<50%) guideline concordance (odds ratios [OR]). Results One hundred ten respondents had representative workforce demographics: most were male (63%) nephrologists (74%) aged 40 to 49 years. Although donor and recipient hepatitis status was largely well understood, transplant suitability responses varied among respondents. For a hepatitis B virus surface antigen-positive donor and vaccinated recipient, 44% suggested this was unsuitable for transplant (guideline concordant) but 35% suggested this was suitable with prophylaxis (guideline divergent). In 4 scenarios with transplant suitability guideline concordance less than 50%, acute transplant care involvement predicted guideline concordant responses (OR, 1.69; P = 0.04). Guideline concordant responses were chosen less by hepatologists, intensive care doctors (OR, 0.23, 0.35, respectively; P = 0.01), and New Zealanders (guideline concordant responses OR, 0.17; P < 0.01; alternative responses OR, 4.31; P < 0.01). Conclusions Despite broadly consistent interpretations of hepatitis serology, transplant suitability decisions varied and often diverged from guidelines. Improved decision support may reduce clinician variability

Drawing the Line: How African, Caribbean and White British Women Live Out Psychologically Abusive Experiences

The final, definitive version of this paper has been published in Violence Against Women, 19 (9):1104-32, Sept 2013 by SAGE Publications Ltd, All rights reserved. © The Author(s) 2013. The online version of this article can be found at: http://vaw.sagepub.com/content/19/9/110

‘Trust me I am a Football Agent’. The discursive practices of the players’ agents in (un)professional football

While the public and media attention is largely focused on the corruption scandals of high-ranking officials in international football, FIFA’s decision in April 2015 to deregulate football agents raises further concerns about its ability for self-regulation and governance. FIFA’s introduction (2006) and subsequent updating (2008, 2015) of its regulations and legal frameworks governing the activity of agents in professional football has important implications on the inner workings of international football. In this regard, FIFA’s decision to deregulate the industry is perhaps a reflection of the neoliberal influences surrounding the organisation to let the agents govern themselves and deal with the wrongdoings of the alleged bribery, exploitation and trafficking of young players. However, the deregulation of agents by FIFA can also be seen as the organisation’s inefficiency to maintain the primacy of self-regulation and self-governance in serious matters of the industry, such as agents’ global leadership and regulation of practices. This paper, using qualitative data collected from players, agents and managers from professional football leagues in the UK and Ireland, aims to uncover the unethical, extremely complex and deceptive sides of the agents’ industry. By doing so, it aims to emphasise the need for gold standards of practice and leadership in the regulation of international football, which desperately needs to restore its integrity. Two key issues are unpacked: (i) the alleged (un)ethical behaviour of football agents that provokes so much hostility in the football world; (ii) the power shift(s) from clubs and managers to agents and players and the implications these may have on the ethics of the business practices in football