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Background\ud \ud Several studies have suggested that proton pump inhibitors (PPIs) may reduce the antiplatelet effects of clopidogrel and/or aspirin, possibly leading to cardiovascular events.\ud \ud \ud \ud Aims\ud \ud We aimed to investigate the association between PPI and clinical outcomes in patients treated with ticagrelor monotherapy or conventional antiplatelet therapy after percutaneous coronary intervention (PCI).\ud \ud \ud \ud Methods\ud \ud This is a subanalysis of the randomized GLOBAL LEADERS trial, comparing the experimental antiplatelet arm (23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy [DAPT]) with the reference arm (12-month aspirin monotherapy following 12-month DAPT) after PCI. Patient-oriented composite endpoints (POCEs: all-cause mortality, myocardial infarction, stroke, or repeat revascularization) and its components were assessed stratified by PPI use as a time-dependent covariate in patients with the experiment or reference antiplatelet arm.\ud \ud \ud \ud Results\ud \ud Among 15,839 patients, 2115 patients (13.5%) experienced POCE at 2 years. In the reference arm, the use of PPIs was independently associated with POCE (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12–1.44) and its individual components, whereas it was not in the experimental arm (HR: 1.04; 95% CI: 0.92–1.19; pinteraction = 0.035). During the second-year follow-up, patients taking aspirin with PPIs had a significantly higher risk of POCE compared to those on aspirin without PPIs (HR: 1.57; 95% CI: 1.27–1.94), whereas the risk did not differ significantly irrespective of PPI in ticagrelor monotherapy group (HR: 1.03; 95% CI: 0.83–1.28; pinteraction = 0.008).\ud \ud \ud \ud Conclusions\ud \ud In contrast to conventional antiplatelet strategy, there were no evidence suggesting the interaction between ticagrelor monotherapy and PPIs on increased cardiovascular events, which should be confirmed in further studies.\ud \ud \ud \ud Clinical Trial Registration\ud \ud URL: https://clinicaltrials.gov

Aims The purpose of the Multivessel TALENT trial is to compare clinical outcomes of the novel Supraflex Cruz stent with those of the SYNERGY stent in patients with three-vessel disease (3VD) undergoing state-of-the-art percutaneous coronary intervention (PCI). Methods and results In this prospective, randomised, 1:1 balanced, multicentre, open-label trial, 1,550 patients with de novo 3VD without left main disease will be assigned to the Supraflex Cruz or SYNERGY arm. The following treatment principles of "best practice" PCI will be applied: Heart Team consensus based on SYNTAX score II treatment recommendation, functional lesion evaluation by quantitative flow ratio (QFR), stent optimisation by intravascular imaging, optimal pharmacological treatment and prasugrel monotherapy. The primary endpoint is a non-inferiority comparison of the patient-oriented composite endpoint (POCE) of all-cause death, any stroke, any myocardial infarction, or any revascularisation, at 12 months post procedure. The powered secondary endpoint is a superiority comparison of the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular death, vessel-related myocardial infarction, or clinically and physiologically indicated target vessel revascularisation, at 24 months. Conclusions The Multivessel TALENT trial will be evaluating a novel treatment strategy for complex coronary artery disease with state-of-the-art PCI based on angiography-derived QFR with novel ultra-thin Supraflex Cruz stents, compared with SYNERGY stents. Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672. Unique Identifier: NCT04390672 Visual summary. Flow chart of the Multivessel TALENT trial. 3VD: three-vessel disease; QFR: quantitative flow ratio; IVUS: intravascular ultrasound; OCT: optical coherence tomography; CTO: chronic total occlusion; OMT: optimal medical therapy; POCE: patient-oriented composite endpoint; VOCE: vessel-oriented composite endpoint.

The way in which farm managers' attitudes, personality, behavior, values, and sociodemographic characteristics influence farm business performance is, at best, only partially understood. The study reported here expands on this understanding by analyzing the attitudes and personal attributes of 80 dairy farmers in Great Britain in relation to the profitability over 3 yr of their farm businesses. Business goals, temperament, purchasing behavior, and having a growth mindset toward the business were found to be associated with profitability. A linear regression model consisting of 5 variables related to the above was presented that predicts 34% of the observed variation in profitability. Each of these variables were questions related to the participants' personal attitudes or beliefs. Other assessed variables, such as specific husbandry behaviors or practices, or management practices and sociodemographic characteristics, did not warrant inclusion in the final model. These results uniquely contribute to understanding how the attitudes, personality, behaviors, and attributes of dairy farmers are associated with, and thus likely to influence, the profitability of their farm businesses.

Precision technologies and data have had relatively modest impacts in grass-based livestock ruminant production systems compared to other agricultural sectors such as arable. Precision technologies promise increased efficiency, reduced environmental impact, improved animal health, welfare and product quality. The benefits of precision technologies have, however, been relatively slow to be realised on pasture based farms. Though there is significant overlap with indoor systems, implementing technology in grass based dairying bring unique opportunities and challenges. The large areas animals roam and graze in pasture based systems and the associated connectivity challenges may, in part at least, explain the comparatively reduced use of such technologies in such systems. There are thus few technologies designed specifically to increase pasture utilisation with the exception of sensor and Bluetooth enabled plate meters. Terrestrial and satellite-based spectral analysis of pasture biomass and quality is still in the development phase. One of the key drivers of efficiency in pasture based systems has thus only been marginally impacted by Precision technologies. In contrast, technological development in the area of fertility and heat detection has been significant and offers significant potential value to dairy farmers, including those in pasture based systems. A past review of sensors in health management for dairy farms concluded that while the collection of accurate data was generally achieved, the processing, integration and presentation of the resulting information and decision-support applications were inadequate. The technologies value to farming systems is thus unclear. As a result, it is unclear if farm management is being sufficiently improved to justify widespread adoption of precision technologies. We argue for a user need-driven development of technologies and for a focus on how outputs arising from Precision technologies and resulting in decision support applications are delivered to users to maximise their value. Further cost/benefit analysis is required to determine the efficacy of investing in specific PTs, likely taking account of as yet to ascertained farm specific variables.

Precision technologies and data have had relatively modest impacts in grass-based livestock ruminant production systems compared with other agricultural sectors such as arable. Precision technologies promise increased efficiency, reduced environmental impact, improved animal health, welfare and product quality. The benefits of precision technologies have, however, been relatively slow to be realised on pasture based farms. Though there is significant overlap with indoor systems, implementing technology in grass-based dairying brings unique opportunities and challenges. The large areas animals roam and graze in pasture based systems and the associated connectivity challenges may, in part at least, explain the comparatively lower adoption of such technologies in pasture based systems. With the exception of sensor and Bluetooth-enabled plate metres, there are thus few technologies designed specifically to increase pasture utilisation. Terrestrial and satellite-based spectral analysis of pasture biomass and quality is still in the development phase. One of the key drivers of efficiency in pasture based systems has thus only been marginally impacted by precision technologies. In contrast, technological development in the area of fertility and heat detection has been significant and offers significant potential value to dairy farmers, including those in pasture based systems. A past review of sensors in health management for dairy farms concluded that although the collection of accurate data was generally achieved, the processing, integration and presentation of the resulting information and decision-support applications were inadequate. These technologies' value to farming systems is thus unclear. As a result, it is not certain that farm management is being sufficiently improved to justify widespread adoption of precision technologies currently. We argue for a user need-driven development of technologies and for a focus on how outputs arising from precision technologies and associated decision support applications are delivered to users to maximise their value. Further cost/benefit analysis is required to determine the efficacy of investing in specific precision technologies, potentially taking account of several yet to ascertained farm specific variables.

Purpose : The PrOVIDe study aimed to investigate the prevalence of a range of vision problems among people with dementias, aged 60-89 years and to examine the extent to which these conditions are undetected or inappropriately managed.\ud \ud Methods : The study had two stages, a cross-sectional prevalence study followed by qualitative research. In Stage 1, 708 people with dementia (389 living at home and 319 in care homes) had a domiciliary eye examination. The inclusion criteria were people with dementia (any type), aged 60-89 years; individuals lacking mental capacity to provide informed consent to participate required a consultee who could give approval on their behalf.\ud \ud Results : 22 percent reported not having had a test in the last two years: this included 19 participants who had not been tested in the last 10 years. Prevalence of visual impairment (VI) was 32.4% (95% Confidence Intervals (CI) 28.7 to 36.5) and 16.3% (CI 13.5 to 19.6) for the commonly-used criteria for VI of visual acuity (VA) worse than 6/12 and 6/18 respectively. Of those with VI, 44% (VA

Background Height is regarded as a marker of early-life illness, adversity, nutrition and psychosocial stress, but the extent to which differences in height are determined by early-life socioeconomic circumstances, particularly in contemporary populations, is unclear. This study examined socioeconomic differences in children’s height trajectories from birth through to 21 years of age in four European countries. Methods Data were from six prospective cohort studies Generation XXI, Growing Up in Ireland (infant and child cohorts), Millennium Cohort Study, EPITeen and Cardiovascular Risk in Young Finns Study—comprising a total of 49 492 children with growth measured repeatedly from 1980 to 2014. We modelled differences in children’s growth trajectories over time by maternal educational level using hierarchical models with fixed and random components for each cohort study. Results Across most cohorts at practically all ages, children from lower educated mothers were shorter on average. The gradient in height was consistently observed at 3 years of age with the difference in expected height between maternal education groups ranging between −0.55 and −1.53 cm for boys and −0.42 to −1.50 cm for girls across the different studies and widening across childhood. The height deficit persists into adolescence and early adulthood. By age 21, boys from primary educated maternal backgrounds lag the tertiary educated by −0.67 cm (Portugal) and −2.15 cm (Finland). The comparable figures for girls were −2.49 cm (Portugal) and −2.93 cm (Finland). Conclusions Significant differences in children’s height by maternal education persist in modern child populations in Europe.

Purpose: To estimate the specificity of the Guided Progression Analysis (GPA) (Carl Zeiss Meditec, Dublin, CA) in individual patients with glaucoma.\ud \ud Design: Observational cohort study.\ud \ud Participants: Thirty patients with open-angle glaucoma.\ud \ud Methods: In 30 patients with open-angle glaucoma, 1 eye (median mean deviation [MD], −2.5 decibels [dB]; interquartile range, −4.4 to −1.3 dB) was tested 12 times over 3 months (Humphrey Field Analyzer, Carl Zeiss Meditec; SITA Standard, 24-2). “Possible progression” and “likely progression” were determined with the GPA. These analyses were repeated after the order of the tests had been randomly rearranged (1000 unique permutations).\ud \ud Main Outcome Measures: Rate of false-positive alerts of “possible progression” and “likely progression” with the GPA.\ud \ud Results: On average, the specificity of the GPA “likely progression” alert was high—for the entire sample, the mean rate of false-positive alerts after 10 follow-up tests was 2.6%. With “possible progression,” the specificity was considerably lower (false-positive rate, 18.5%). Most important, the cumulative rate of false-positive alerts varied substantially among patients, from 0.31, P≤0.10).\ud \ud Conclusions: On average, progression criteria currently used in the GPA have high specificity, but some patients are more likely to show false-positive alerts than others. This is a natural consequence of population-based change criteria and may not matter in clinical trials and studies in which large groups of patients are compared. However, it must be considered when the GPA is used in clinical practice where specificity needs to be controlled for individual patients.

• Premise of the study: A new infrafamilial circumscription of the Verbenaceae with eight tribes: Casselieae, Citharexyleae, Duranteae, Lantaneae, Neospartoneae, Petreeae, Priveae, and Verbeneae, has been recently proposed, on the basis of molecular phylogenetic studies. Two genera, Dipyrena and Rhaphithamnus, remain unplaced. The aim of this work is to reconstruct the evolutionary history of morphological characters traditionally employed in the classification of the Verbenaceae, with special attention to tribes Verbeneae and Lantaneae. • Methods: Twenty-one characters, related to habit and vegetative morphology, inflorescence and floral morphology, ovary and fruit morphology, as well as chromosome number, were optimized over a molecular phylogeny of Verbenaceae. • Key Results: All tribes are supported by at least one morphological trait except tribes Duranteae and Citharexyleae. Suffrutescent habit, sessile flowers, and four cluses are synapomorphies for tribe Verbeneae. Gynoecium with short style and entire stigma are synapomorphic traits for tribe Lantaneae. Sessile flowers and unicarpellate ovaries are morphological synapomorphies for the new tribe Neospartoneae. Suffrutescent habit is a synapomorphic trait for tribe Priveae. Homothetic pleiobotrya and absence of the adaxial staminode are synapomorphic traits for tribe Casselieae. Undivided fleshy fruits are probably a synapomorphic trait for tribe Petreeae. Putative plesiomorphies for the ancestor of the Verbenaceae are discussed as well as synapomorphic traits within other Verbenaceae clades. • Conclusions: Many of the characters traditionally employed in classification have proven to be very homoplastic, or have been shown not to support relationships within the family. Moreover, traditional assumptions concerning character polarity have in some cases been shown to be incorrect. © 2012 Botanical Society of America. Fil:O'Leary, N. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Fil:Calviño, C.I. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Fil:Martínez, S. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.

To evaluate the relationship between serum CA125 tumour marker level before and after surgery of epithelial ovarian carcinoma and assess its potential role as a prognostic factor. A retrospective review of 87 patients with epithelial ovarian carcinoma at a single centre between January 2001 and December 2005 was performed. Serum CA125 levels were assessed for their relationship to pathological stage, tumour grade, tumour volume and age as well as overall survival. A total of 75 patients, mean age 58.94 years and median follow-up of 24 months were included in the analysis. While the preoperative CA125 level did not correlate significantly with stage, tumour grade or survival, the postoperative CA125 correlated to FIGO stage (p0.0001), tumour grade (p0.0001) and overall survival (p=0.01). Reduced survival was noted with increasing age at the time of surgery (p=0.009) and bulk of the residual disease postoperatively (p=0.011).

Objectives This study aimed to assess the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in contemporary acute coronary syndrome (ACS) patients, and its relation to antiplatelet strategies.Background The predictive value of the GRACE risk score in the contemporary ACS cohort and the appropriate antiplatelet regimen according to the risk remain unclear.Methods This is a subgroup analysis of the all-comers, randomized GLOBAL LEADERS trial, comparing ticagrelor monotherapy versus conventional dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The GRACE risk score 2.0 with 1-year mortality prediction was implemented. The randomized antiplatelet effect was assessed in predefined three GRACE risk-groups; low-risk (GRACE 140).Results The GRACE risk score was available in 6,594 out of 7,487 ACS patients among whom 1,743, 2,823, and 2,028 patients were classified as low-risk, moderate-risk, and high-risk, respectively. At 1 year, all-cause mortality occurred in 120 patients (1.8%). The discrimination ability of the GRACE model was moderate (C-statistic = 0.742), whereas 1-year mortality risk was overestimated (mean predicted mortality rate: 3.9%; the Hosmer-Lemeshow chi-square: 21.47; p = 0.006). There were no significant interactions between the GRACE risk strata and effects of the ticagrelor monotherapy on ischemic or bleeding outcomes at 1 year compared to the reference strategy.Conclusion The GRACE risk score 2.0 is valuable in discriminating high risk ACS patients, however, the recalibration of the score is recommended for better risk stratification. There is no significant differences in efficacy and safety of ticagrelor monotherapy across the three GRACE risk strata. WOA Institution: National University of Ireland Galway Blended DEAL: IReL