En utvärdering av tillförlitligheten i Ekbom- Baks test vid uppskattning av brandmäns VO2max

Bakgrund:Hälsa är starkt sammankopplad med nivå av kondition. Ett sätt att mäta konditionsnivå är att mäta en individs maximala syreupptagningsförmåga (VO2max). Att genomföra ett VO2max-test är både omständligt och dyrt. Inom vården är det istället vanligt att submaximala tester används för att uppskatta VO2max. Åstrands cykeltest är ett sådant test. Resultatet från Åstrandstestet räknas fram genom att ett uppskattat maxvärde räknas ut baserat på uppmätt puls vid ett givet motstånd i förhållande till beräknad maxpuls (220-ålder). Nyligen utvecklades ett nytt svenskt submaximalt test, Ekblom-Baks cykeltest (EB-testet). I detta test tas inte testpersonens maxpuls med i beräkningarna utan VO2max räknas ut genom att se hur stor pulsökning en person har mellan två olika belastningar. Det nya testet har i tidigare studier visat sig ha en större reliabilitet än Åstrands cykeltest. Syfte och frågeställning: Syftet med denna studie var att undersöka hur väl EB-testet uppskattar VO2max i relation till ett faktiskt uppmätt VO2max då det tillämpas på en grupp vältränade individer i form av brandmän. Följande frågeställningar användes: Vilket värde på variationskoefficienten uppvisar EB-testet då det jämförs med ett maxtest? Hur väl korrelerar de uppskattade VO2max värdena från EB-testet med faktiskt uppmätta VO2max värden? Uppvisar EB-testet någon systematisk över eller underskattning av VO2max jämfört med ett maxtest? Material och metod: 10 brandmän i åldern 20-55 år deltog i studien (7 män och 3 kvinnor). Samtliga deltagare genomförde ett EB-test och ett maximalt test på löpband. Resultaten från de båda testerna plottades mot varandra i en scatterplot och korrelationskoefficienten räknades ut. Vidare konstruerades ett Bland-Altman-diagram med 95 % Limit of agreement för att grafiskt se hur resultaten från de båda testerna skiljer sig åt. Variationskoefficienten räknades också ut för att utvärdera spridningen av resultaten från EB-testet i förhållande till maxtestet. Resultat: I sex utav fallen uppnådde testdeltagarna en VO2max (L/min) som låg utanför valideringsintervallet för EB-testet. Resultatredovisningen delades därför upp i två grupper där den ena gruppen innehåller samtliga resultat och den andra enbart valida resultat. Korrelationskoefficienten för gruppen samtliga räknades ut till r = 0,89 och r = 0,93 för den valida gruppen. Variationskoefficienten för gruppen samtliga räknades fram 7,6% och för den valida gruppen till 4,1%. Resultaten från Bland-Altman-diagrammen pekar i riktning mot att EB-testet tenderar att underskatta testdeltarnas VO2max jämfört med deras faktiskt uppmätta VO2max. Slutsats: Resultaten av studien är jämförbara med de resultat som Ekblom-Bak presenterar i sin studie både beträffande korrelationskoefficient (r = 0,89) och variationskoefficient (7,6%). Vidare pekar resultaten på att EB-testet tenderar att underskatta VO2max hos testpersonerna i studien. Slutsatsen vi drar är att i den undersökta populationen fungerar EB-testet väl för att uppskatta brandmäns VO2max. Resultaten från den här studien tillsammans med resultaten från Ekblom-Baks ger oss inga indikationer om att förhållandet skulle vara annorlunda vid tillämpningen av testet på en större grupp vältränade individer i form av brandmän

Radiofrequency Electromagnetic Fields Cause Non-Temperature-Induced Physical and Biological Effects in Cancer Cells

Non-temperature-induced effects of radiofrequency electromagnetic fields (RF) have been controversial for decades. Here, we established measurement techniques to prove their existence by investigating energy deposition in tumor cells under RF exposure and upon adding amplitude modulation (AM) (AMRF). Using a preclinical device LabEHY-200 with a novel in vitro applicator, we analyzed the power deposition and system parameters for five human colorectal cancer cell lines and measured the apoptosis rates in vitro and tumor growth inhibition in vivo in comparison to water bath heating. We showed enhanced anticancer effects of RF and AMRF in vitro and in vivo and verified the non-temperature-induced origin of the effects. Furthermore, apoptotic enhancement by AM was correlated with cell membrane stiffness. Our findings not only provide a strategy to significantly enhance non-temperature-induced anticancer cell effects in vitro and in vivo but also provide a perspective for a potentially more effective tumor therapy

Radiofrequency Electromagnetic Fields Cause Non-Temperature-Induced Physical and Biological Effects in Cancer Cells

Non-temperature-induced effects of radiofrequency electromagnetic fields (RF) have been controversial for decades. Here, we established measurement techniques to prove their existence by investigating energy deposition in tumor cells under RF exposure and upon adding amplitude modulation (AM) (AMRF). Using a preclinical device LabEHY-200 with a novel in vitro applicator, we analyzed the power deposition and system parameters for five human colorectal cancer cell lines and measured the apoptosis rates in vitro and tumor growth inhibition in vivo in comparison to water bath heating. We showed enhanced anticancer effects of RF and AMRF in vitro and in vivo and verified the non-temperature-induced origin of the effects. Furthermore, apoptotic enhancement by AM was correlated with cell membrane stiffness. Our findings not only provide a strategy to significantly enhance non-temperature-induced anticancer cell effects in vitro and in vivo but also provide a perspective for a potentially more effective tumor therapy

The Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial: baseline characteristics

The aims of this study were to: (i) report the baseline characteristics of patients enrolled in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial, (ii) compare DAPA-HF patients to participants in contemporary heart failure (HF) registries and in other recent HF trials, and (iii) compare individuals with diabetes, pre-diabetes and a normal glycated haemoglobin (HbA1c) in DAPA-HF. Adults with HF in New York Heart Association functional class ≥ II, a left ventricular ejection fraction ≤ 40%, an elevated N-terminal pro-B-type natriuretic peptide concentration and receiving standard treatment were eligible for DAPA-HF, which is comparing dapagliflozin 10 mg once daily to matching placebo. In patients without a history of diabetes, previously undiagnosed diabetes was defined as a confirmed HbA1c ≥ 6.5%. Among patients without known or undiagnosed diabetes, pre-diabetes was defined as a HbA1c ≥ 5.7% The remainder of patients, with a HbA1c < 5.7%, were defined as normoglycaemic. Of the 4774 patients (mean age 66 years; 23% women) randomized, 42% had known diabetes and 3% undiagnosed diabetes. Of the remainder, 67% had pre-diabetes and 33% normal HbA1c. Overall, DAPA-HF patients were generally similar to those in recent registries and in relevant trials and had high levels of background therapy: 94% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, 96% beta-blocker, and 71% mineralocorticoid receptor antagonist; 26% had a defibrillator. Patients with diabetes had worse HF status, more co-morbidity, and greater renal impairment but received similar HF therapy. Patients with diabetes received non-insulin hypoglycaemic therapy alone in 49%, insulin alone in 11%, both in 14%, and none in 26%. Patients randomized in DAPA-HF were similar to those in other contemporary HF with reduced ejection fraction (HFrEF) registries and trials. These patients were receiving recommended HFrEF therapy and those with diabetes were also treated with conventional glucose-lowering therapy. Consequently, DAPA-HF will test the incremental efficacy and safety of dapagliflozin in HFrEF patients with and without diabetes

Effect of dapagliflozin in DAPA-HF according to background glucose-lowering therapy

Objective: To determine whether the benefits of dapagliflozin in patients with heart failure and reduced ejection fraction (HFrEF) and type 2 diabetes in the Dapagliflozin And Prevention of Adverse-Outcomes in Heart Failure trial (DAPA-HF) varied by background glucose-lowering therapy (GLT). Research Design and Methods: We examined the effect of study treatment by the use or not of GLT and by GLT classes and combinations. The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Results: In the 2,139 type 2 diabetes patients, the effect of dapagliflozin on the primary outcome was consistent by GLT use or no use (hazard ratio 0.72 [95% CI 0.58–0.88] versus 0.86 [0.60–1.23]; interaction P = 0.39) and across GLT classes. Conclusions: In DAPA-HF, dapagliflozin improved outcomes irrespective of use or no use of GLT or by GLT type used in patients with type 2 diabetes and HFrEF

Self-assembly of mechanoplasmonic bacterial cellulose-metal nanoparticle composites

Nanocomposites of metal nanoparticles (NPs) and bacterial nanocellulose (BC) enable fabrication of soft and biocompatible materials for optical, catalytic, electronic, and biomedical applications. Current BC-NP nanocomposites are typically prepared by in situ synthesis of the NPs or electrostatic adsorption of surface functionalized NPs, which limits possibilities to control and tune NP size, shape, concentration, and surface chemistry and influences the properties and performance of the materials. Here a self-assembly strategy is described for fabrication of complex and well-defined BC-NP composites using colloidal gold and silver NPs of different sizes, shapes, and concentrations. The self-assembly process results in nanocomposites with distinct biophysical and optical properties. In addition to antibacterial materials and materials with excellent senor performance, materials with unique mechanoplasmonic properties are developed. The homogenous incorporation of plasmonic gold NPs in the BC enables extensive modulation of the optical properties by mechanical stimuli. Compression gives rise to near-field coupling between adsorbed NPs, resulting in tunable spectral variations and enhanced broadband absorption that amplify both nonlinear optical and thermoplasmonic effects and enables novel biosensing strategies

Water, Forests, People: The Swedish Experience in Building Resilient Landscapes

A growing world population and rapid expansion of cities increase the pressure on basic resources such as water, food and energy. To safeguard the provision of these resources, restoration and sustainable management of landscapes is pivotal, including sustainable forest and water management. Sustainable forest management includes forest conservation, restoration, forestry and agroforestry practices. Interlinkages between forests and water are fundamental to moderate water budgets, stabilize runoff, reduce erosion and improve biodiversity and water quality. Sweden has gained substantial experience in sustainable forest management in the past century. Through significant restoration efforts, a largely depleted Swedish forest has transformed into a well-managed production forest within a century, leading to sustainable economic growth through the provision of forest products. More recently, ecosystem services are also included in management decisions. Such a transformation depends on broad stakeholder dialog, combined with an enabling institutional and policy environment. Based on seminars and workshops with a wide range of key stakeholders managing Sweden’s forests and waters, this article draws lessons from the history of forest management in Sweden. These lessons are particularly relevant for countries in the Global South that currently experience similar challenges in forest and landscape management. The authors argue that an integrated landscape approach involving a broad array of sectors and stakeholders is needed to achieve sustainable forest and water management. Sustainable landscape management—integrating water, agriculture and forests—is imperative to achieving resilient socio-economic systems and landscapes

Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF

Background: The DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) showed that dapagliflozin added to other guideline-recommended therapies reduced the risk of mortality and heart failure hospitalization and improved symptoms in patients with heart failure and reduced ejection fraction. We examined the effects of dapagliflozin according to age, given potential concerns about the efficacy and safety of therapies in the elderly. Methods: Patients in New York Heart Association functional class II or greater with a left ventricular ejection fraction ≤40% and a modest elevation of NT-proBNP (N-terminal pro-B-type natriuretic peptide) were eligible. Key exclusion criteria included systolic blood pressure <95 mm Hg and estimated glomerular filtration rate <30 mL·min−1·1.73 m−2. The primary outcome was the composite of an episode of worsening heart failure (heart failure hospitalization or urgent heart failure visit) or cardiovascular death, whichever occurred first. Results: A total of 4744 patients 22 to 94 years of age (mean age, 66.3 [SD 10.9] years) were randomized: 636 patients (13.4%) were <55 years of age, 1242 (26.2%) were 55 to 64 years of age, 1717 (36.2%) were 65 to 74 years of age, and 1149 (24.2%) were ≥75 years of age. The rate of the primary outcome (per 100 person-years, placebo arm) in each age group was 13.6 (95% CI, 10.4–17.9), 15.7 (95% CI, 13.2–18.7), 15.1 (95% CI, 13.1–17.5), and 18.0 (95% CI, 15.2–21.4) with corresponding dapagliflozin/placebo hazard ratios of 0.87 (95% CI, 0.60–1.28), 0.71 (95% CI, 0.55–0.93), 0.76 (95% CI, 0.61–0.95), and 0.68 (95% CI, 0.53–0.88; P for interaction=0.76). Consistent benefits were observed for the components of the primary outcome, all-cause mortality, and symptoms. Although adverse events and study drug discontinuation increased with age, neither was significantly more common with dapagliflozin in any age group. Conclusions: Dapagliflozin reduced the risk of death and worsening heart failure and improved symptoms across the broad spectrum of age studied in DAPA-HF. There was no significant imbalance in tolerability or safety events between dapagliflozin and placebo, even in elderly individuals