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BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death in Belgium. Current strategies for the prevention and management of CVD focus on reducing low-density lipoprotein cholesterol (LDL-C) levels. This analysis assessed whether LDL-C goals, recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines, were being achieved in a Belgian study population. METHODS: The cross-sectional, observational, DA VINCI study enrolled patients prescribed lipid-lowering therapy (LLT) between 21 June 2017 and 20 November 2018. Data for patients from Belgium were extracted for this country-specific analysis. Primary endpoint was the proportion of patients who achieved 2016 ESC/EAS risk-based LDL-C goals; attainment of 2019 risk-based LDL-C goals was evaluated post hoc. RESULTS: Of 497 enrolled patients, 41% were female and mean age was 68 years. Among subjects with an LDL-C measurement on stabilised LLT, moderate-intensity statin monotherapy was the most prescribed LLT regimen (59%). Overall, 63% of patients achieved their risk-based LDL-C goals according to the 2016 ESC/EAS guidelines. Among patients with established ASCVD, risk-based LDL-C goal attainment was higher in patients with peripheral arterial disease (53%) than patients with coronary (37%) and cerebrovascular disease (42%). According to the updated 2019 ESC/EAS guidelines, less than half (41%) of patients achieved their risk-based LDL-C goal. The proportion of primary and secondary prevention patients who achieved 2019 risk-based LDL-C goals was 59% and 18%, respectively. CONCLUSION: These findings reveal a large gap between the LDL-C goals advocated by the ESC/EAS and the levels achieved in routine clinical practice in Belgium. ispartof: ACTA CARDIOLOGICA ispartof: location:England status: published

Purpose: Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. Methods: DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. Results: Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81–115) mg/dl and 32% (25–43%), respectively. Median LDL-C reductions of 24 (12–46) and 39 (27–91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7–25%) and 22% (15–32%), respectively, and ARRs of 4% (2–7%) and 6% (4–9%), respectively. Conclusion: In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach. Graphical abstract: [Figure not available: see fulltext.] © 2022, The Author(s).

Darren L Clark,1–4 Nithya Konduru,1 Anne Kemp,5 Signe Bray,6–8 Elliot C Brown,1–4 Bradley Goodyear,1,2,4,6 Rajamannar Ramasubbu1–4 1Department of Psychiatry, 2Department of Clinical Neuroscience, 3Mathison Centre for Mental Health Research and Education, 4Hotchkiss Brain Institute, University of Calgary, Calgary, 5School of Medicine, University of Alberta, Edmonton, 6Department of Radiology, 7Department of Pediatrics, University of Calgary, 8Child and Adolescent Imaging Research Program, Alberta Children’s Hospital, Calgary, AB, Canada Background: Early-onset major depressive disorder (EO-MDD), beginning during childhood and adolescence, is associated with more illness burden and a worse prognosis than adult-onset MDD (AO-MDD), but little is known about the neural features distinguishing these subgroup phenotypes. Functional abnormalities of the amygdala are central to major depressive disorder (MDD) neurobiology; therefore, we examined whether amygdala intrinsic connectivity (IC) can differentiate EO-MDD from AO-MDD in a cohort of adult MDD patients.Subjects and methods: Twenty-one EO-MDD (age of onset ≤18 years), 31 AO-MDD patients (age of onset ≥19 years), and 19 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (7 minutes). Amygdala seed-based resting-state functional connectivity was compared between groups.Results: AO-MDD patients showed loss of inverse left amygdala–left dorsolateral prefrontal cortex IC and increased inverse left amygdala–left inferior parietal IC, compared to both HCs and EO-MDD. EO-MDD showed a switch from inverse to positive IC with right dorsomedial prefrontal cortex, compared to HCs and AO-MDD. This effect was removed when we controlled for illness burden.Conclusion: Alterations in amygdala IC with the default-mode network were specifically related to EO-MDD, whereas amygdala IC with executive cognitive control regions was preferentially disrupted in AO-MDD. Increased illness burden, an important clinical marker of EO-MDD, accounted for its specific effects on amygdala IC. Brain imaging has the potential for validation of clinical subtypes and can provide markers of prognostic value in MDD patients. Keywords: major depressive disorder, onset age, resting-state functional connectivity, functional magnetic resonance imaging, biomarker, amygdala

The Southern Ocean plays a pivotal role in the control of atmospheric CO2 levels, via both physical and biological sequestration processes. The biological carbon transfer to the ocean interior is tightly coupled to the availability of other elements, especially iron as a trace-limiting nutrient and dissolved silicon as the mineral substrate that allows diatoms to dominate primary production. Importantly, variations in the silicon cycling are large but not well understood. Here we use Si-30 measurements to track seasonal flows of silica to the deep sea, as captured by sediment trap time series, for the three major zones (Antarctic, AZ; Polar Frontal, PFZ; and Sub-Antarctic, SAZ) of the open Southern Ocean. Variations in the exported flux of biogenic silica (BSi) and its Si-30 composition reveal a range of insights, including that (i) the sinking rate of BSi exceeds 200md(-1) in summer in the AZ yet decreases to very low values in winter that allow particles to remain in the water column through to the following spring, (ii) occasional vertical mixing events affect the Si-30 composition of exported BSi in both the SAZ and AZ, and (iii) the Si-30 signature of diatoms is well conserved through the water column despite strong BSi and particulate organic carbon (POC) attenuation at depth and is closely linked to the Si consumption in surface waters. With the strong coupling observed between BSi and POC fluxes in PFZ and AZ, these data provide new constraints for application to biogeochemical models of seasonal controls on production and export.

Background: Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a curative treatment option for many patients with Acute Myeloid Leukemia (AML); however, it can lead to complications of Graft-Versus-Host-Disease (GVHD) which can affect the quality of life and overall survival. The aim of this study was to assess the effects of both acute and chronic GVHD on survival rate in patients with AML who received HSCT. Subjects and Methods: In a longitudinal study, 587 patients with AML who underwent bone marrow transplantation in Tehran-Iran between1991 and 2011 were recruited. All patient records were analyzed for the occurrence of adverse events including acute and chronic GVHD and leukemia relapse. Data were analyzed using Log-rank, Kaplan-Meier, Univariate and Multivariate Cox Regression models. Results: The five-year overall survival (OS) was found to be 71.9% (95% CI: 67.40-76.41). Also there was a significant relationship between cGVHD and OS (P=0.001, HR = 0.476, 95%). Hazard of death in these patients was less than those who did not experience an occurrence of cGVHD and aGVHD (HR= 0.629, P= 0.078). A significant relationship between cGVHD and relapse was observed (P< 0.001) indicating that patients who developed cGVHD experienced a better survival rate. A significant relationship was also found between overall survival and aGVHD grade (P< 0.001). Hazard of death (HD) for cGVHD and relapse variables were estimated to be 0.554 and 3.869. Discussion: This study is one of the largest studies (regarding the number of participants) done to date in the Middle East with quite a long duration (20 years). cGVHD appears to have a positive influence on survival rate in patients with AML who received HSCT. It is recommended that further studies investigate the underlying reason or mechanisms behind this.

Many patients with advanced type 2 diabetes do not meet their glycated haemoglobin targets and randomised controlled studies comparing the efficacy of pump treatment and multiple daily injections for lowering glucose in insulin-treated patients have yielded inconclusive results. We aimed to resolve this uncertainty with a randomised controlled trial (OpT2mise).We did this multicentre, controlled trial at 36 hospitals, tertiary care centres, and referal centres in Canada, Europe, Israel, South Africa, and the USA. Patients with type 2 diabetes who had poor glycaemic control despite multiple daily injections with insulin analogues were enrolled into a 2-month dose-optimisation run-in period. After the run-in period, patients with glycated haemoglobin of 8·0-12·0% (64-108 mmol/mol) were randomly assigned (1:1) by a computer-generated randomisation sequence (block size 2 with probability 0·75 and size 4 with probability 0·25) to pump treatment or to continue with multiple daily injections. Neither patients nor investigators were masked to treatment allocation. The primary endpoint was change in mean glycated haemoglobin between baseline and end of the randomised phase for the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01182493.495 of 590 screened patients entered the run-in phase and 331 were randomised (168 to pump treatment, 163 to multiple daily injections). Mean glycated haemoglobin at baseline was 9% (75 mmol/mol) in both groups. At 6 months, mean glycated haemoglobin had decreased by 1·1% (SD 1·2; 12 mmol/mol, SD 13) in the pump treatment group and 0·4% (SD 1·1; 4 mmol/mol, SD 12) in the multiple daily injection group, resulting in a between-group treatment difference of -0·7% (95% CI -0·9 to -0·4; -8 mmol/mol, 95% CI -10 to -4, p0·0001). At the end of the study, the mean total daily insulin dose was 97 units (SD 56) with pump treatment versus 122 units (SD 68) for multiple daily injections (p0·0001), with no significant difference in bodyweight change between the two groups (1·5 kg [SD 3·5] vs 1·1 kg [3·6], p=0·322). Two diabetes-related serious adverse events (hyperglycaemia or ketosis without acidosis) resulting in hospital admission occurred in the pump treatment group compared with one in the multiple daily injection group. No ketoacidosis occurred in either group and one episode of severe hypoglycaemia occurred in the multiple daily injection group.In patients with poorly controlled type 2 diabetes despite using multiple daily injections of insulin, pump treatment can be considered as a safe and valuable treatment option.Medtronic.

This paper presents a mechanism-based approach for modelling the thermomechanical behaviour of a Cr-Mo-V steel. A set of unified viscoplastic constitutive equations were employed to model dislocation density, recrystallisation and grain size during deformation. The evolution of dislocation density accounts for the build-up of dislocations due to plastic strain, the static and dynamic recovery and the effect of recrystallisation. Recrystallisation occurs when a critical dislocation density is reached after an incubation time, and grain size becomes smaller after such event. Gleeble compression tests were used to obtain Stress-strain curves and evaluate the microstructural evolution at different temperature and strain rate, and the material constants for the model were determined from the experimental data. Copyright © 2010 MS&T10®.

Notch is the receptor in a signalling pathway that operates in a diverse spectrum of developmental processes. Its ligands (e.g. Serrate) are transmembrane proteins whose signalling competence is regulated by the endocytosis-promoting E3 ubiquitin ligases, Mindbomb1 and Neuralized. The ligands also inhibit Notch present in the same cell (cis-inhibition). Here, we identify two conserved motifs in the intracellular domain of Serrate that are required for efficient endocytosis. The first, a dileucine motif, is dispensable for trans-activation and cis-inhibition despite the endocytic defect, demonstrating that signalling can be separated from bulk endocytosis. The second, a novel motif, is necessary for interactions with Mindbomb1/Neuralized and is strictly required for Serrate to trans-activate and internalise efficiently but not for it to inhibit Notch signalling. Cis-inhibition is compromised when an ER retention signal is added to Serrate, or when the levels of Neuralized are increased, and together these data indicate that cis-inhibitory interactions occur at the cell surface. The balance of ubiquitinated/unubiquitinated ligand will thus affect the signalling capacity of the cell at several levels. © 2006 European Molecular Biology Organization | All Rights Reserved. 25 4697 4706 Cited By :79

The present paper outlines the development of a sport-specific measure of precompetitive emotion to assess anger, anxiety, dejection, excitement, and happiness. Face, content, factorial, and concurrent validity were examined\ud over four stages. Stage 1 had 264 athletes complete an open-ended questionnaire to identify emotions experienced in sport. The item pool was extended through the inclusion of additional items taken from the literature. In Stage 2\ud a total of 148 athletes verified the item pool while a separate sample of 49 athletes indicated the extent to which items were representative of the emotions\ud anger, anxiety, dejection, excitement, and happiness. Stage 3 had 518 athletes complete a provisional Sport Emotion Questionnaire (SEQ) before competition. Confirmatory factor analysis indicated that a 22-item and 5-factor structure provided acceptable model fit. Results from Stage 4 supported the criterion validity of the SEQ. The SEQ is proposed as a valid measure of precompetitive emotion for use in sport settings.

Metadata only record 1. The main impacts on marine ecosystems are summarised and the potential for their restoration is discussed in relation to their key features. Rocky shores, seagrass beds and disused docks are focused on.

A common consequence of Notch signalling in Drosophila is the transcriptional activation of seven Enhancer of split [E(spl)] genes, which encode a family of closely related basic-helix-loop-helix transcriptional repressors. Different E(spl) proteins can functionally substitute for each other, hampering loss-of-function genetic analysis and raising the question of whether any specialization exists within the family. We expressed each individual E(spl) gene using the GAL4-UAS system in order to analyse their effect in a number of cell fate decisions taking place in the wing imaginal disk. We focussed on sensory organ precursor determination, wing rein determination and wing pattern formation. All of the E(spl) proteins affect the first two processes in the same way namely they antagonize neural precursor and vein fates. Yet, the efficacy of this antagonism is quite distinct: E(spl)mβ has the strongest vein suppression effect, whereas E(spl)m8 and E(spl)m7 are the most active bristle suppressors. During wing patterning, Notch activity orchestrates a complex sequence of events that define the dorsoventral boundary of the wing. We have discerned two phases within this process based on the sensitivity of N loss-of-function phenotypes to concomitant expression of E(spl) genes, E(spl) proteins are initially involved in repression of the vg quadrant enhancer, whereas later they appear to relay the Notch signal that triggers activation of cut expression. Of the seven proteins, most active in both of these processes. In E(spl) proteins have partially redundant functions, yet they have evolved distinct preferences in implementing different cell fate decisions, which closely match their individual normal expression patterns. 126 2205 2214 Cited By :38

Made available in DSpace on 2022-04-29T08:42:02Z (GMT). No. of bitstreams: 0 Previous issue date: 1980-01-01 Cultivation began in the 1930's but in the 1940's with the market drop, due to the Second World War, the paulista citrus production declined, aggravated by 'tristeza' disease. After 1945 the export market increased and in the 1950's production increased in Bebedouro on many estates due to the emergence of packing-houses. In the 1960's citrus industries (concentrated juice) for export began. Limeira and Bebedouro are the principal producing and exporting centres of citrus products in Brazil. -after English summary Departamento de Geografia e Planejamento do Instrluto de Geocienaas e Cievicias Exatas da UNESP - Campus de Rio Claro.

The mortality/morbidity and quality of life benefits of exercise-based cardiac rehabilitation (CR) are well established, yet adherence to exercise is generally poor post-discharge. Recent trials have attempted to enhance adherence to aerobic activities during transition from CR to home-based exercise. However, these trials have not addressed resistance training, which is also an integral part of many participants' CR exercise routines. Because accessibility to familiar training equipment (e.g., weight machines) and instruction may be limited for many patients upon completion of CR, poor adherence to this beneficial form of exercise can be resultant. The purpose of this study was to examine the effects of a brief intervention involving the provision of a motivation-enhancing instructional manual and elastic Thera-Bands® on self-efficacy for, outcome expectancies for, and adherence to, upper body resistance exercise. It was hypothesized that participants receiving the intervention would report higher self-efficacy, outcome expectancies and greater adherence than those in a standard care control condition. The study was a randomized controlled trial involving informed and consenting CR participants recruited from an established outpatient CR programme at a major urban hospital (N = 40; n_males = 32; M_age= 61.20 ± 11.10). Participants in the intervention group (n=20) received an orientation to home-based upper body resistance training, a theory-based instructional manual designed to enhance self-efficacy and outcome expectations, and Thera-Bands®. The standard care control group received an orientation to home-based upper body resistance training and standard care CR follow-up (n=20). Participants completed baseline measures of self-efficacy for performing resistance training and activities of daily living as well as outcome expectancy measures one week prior to discharge from CR. The same measures were completed again one week later (i.e., at the end of the CR program), and at 4-weeks post-discharge. Participants logged their sets of upper-body resistance exercises continuously throughout the 4-week period following completion of the CR program. There were no differences between groups on any of the study variables at baseline. Participants in the intervention condition reported higher self-efficacy and outcome expectations for resistance training than controls at the 4-week follow-up assessment. Adherence to resistance training was significantly greater with the intervention group completing over twice as many (105%) sets over the four weeks than the control group. Maintaining or increasing upper body strength is an important outcome of CR as it relates to the performance of many activities of daily living. However, adherence to resistance exercises may be difficult upon completion of supervised, facility-based CR. This study illustrates that the provision of a motivation-enhancing instructional manual and low cost materials has a positive impact on self-efficacy, outcome expectations and adherence to resistance training, and may help participants make a successful transition to home-based resistance exercise. Thesis Master of Science (MS)

After looking in the vault copies, the Digitization Centre has determined that page vi is a missing page and may be a printing error. -Digitization Centre This study aimed to improve understanding of walking exercise among individuals with intermittent claudication. Using a prospective design, Ajzen's (1985, 1991) theory of planned behaviour was applied to examine psychosocial determinants of walking exercise. In addition, measures of barrier self-efficacy were explored as determinants of behaviour and perceived pain intensity was examined as a moderator of the intention-behaviour relationship. Ninety-four participants (n = 33 female) completed baseline measures of attitudes, subjective norms, perceived behavioural control, and intentions to engage in walking exercise. Additional measures of pain-related barrier self-efficacy and barrier self-efficacy regarding walking exercise were obtained and the Borg CR1 0 Pain Scale (Borg, 1998) was used to assess perceived pain intensity during walking. Participants were contacted weekly by telephone over four consecutive weeks and asked to recall their walking exercise and associated perceived pain intensity for the preceding seven-day period. Attitudes, subjective norms and perceived behavioural control contributed significantly to a multiple regression model predicting 67% of the variance in walking intentions. Intentions and perceived behavioural control explained 34% of the variance in walking exercise; however, pain-related barrier self-efficacy and barrier self-efficacy did not explain additional variance in behaviour and perceived pain intensity failed to moderate the intention-behaviour relationship. Findings support the theory of planned behaviour for predicting walking intentions and exercise among individuals with intermittent claudication, and suggest that pain cognitions as measured in this study do not play a role in determining walking. Thesis Master of Science (MS)