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Background: Endostatin, cleaved from collagen XVIII in the extracellular matrix, is a promising circulating biomarker for cardiovascular damage. It possesses anti-angiogenic and anti-fibrotic functions and has even been suggested to be involved in blood pressure regulation. Less is known if endostatin levels relate to circadian blood pressure patterns. In the present paper we studied the association between circulating levels of endostatin and nocturnal dipping in blood pressure.Methods: We used the CARDIPP-study, a cohort of middle aged, type 2 diabetics (n=593, 32% women), with data on both 24-hour and office blood pressure, serum-endostatin, cardiovascular risk factors, and incident major cardiovascular events. Nocturnal dipping was defined as a amp;gt;10% difference between day- and night-time blood pressures.Results: Two-hundred four participants (34%) were classified as non-dippers. The mean endostatin levels were significantly higher in non-dippers compared to dippers (meanstandard deviation: 62.6 +/- 1.8 mu g/l vs. 58.7 +/- 1.6 mu g/l, respectively, p=.007). Higher serum levels of endostatin were associated with a diminished decline in nocturnal blood pressure adjusted for age, sex, HbA1c, mean systolic day blood pressure, hypertension treatment, glomerular filtration rate, and prevalent cardiovascular disease (regression coefficient per SD increase of endostatin -0.01, 95% CI, -0.02-(-0.001), p=.03). Structural equation modelling analyses suggest that endostatin mediates 7% of the association between non-dipping and major cardiovascular events.Conclusion: We found an independent association between higher circulating levels of endostatin and a reduced difference between day- and night-time systolic blood pressure in patients with type 2 diabetes. Yet endostatin mediated only a small portion of the association between non-dipping and cardiovascular events arguing against a clinical utility of our findings., Funding Agencies|European Union [634869]; Swedish Research Council [2012-2215, 2015-03477]; Marianne and Marcus Wallenberg foundation [2012.0082]; Thureus Foundation; Landstinget Dalarna; Dalarna University; Swedish Heart-Lung Foundation [20150429, 20120169]; Lasarettslakare F. Olaisons foundation

Human fatigue continues to threaten safe transport. There are claims that employers of operators should do more to mitigate the risks, and several regulators are promoting fatigue-risk management in the context of safety management systems (SMS). The current paper reviews fatigue-related risk and exposure factors and control measures for operators of land-and sea-based transport forms. Our review identifies 13 types of measures for the monitoring or control of fatigue risks: optimal staffing; optimal schedule design; optimisation of breaks/naps; monitoring of actual hours worked; optimisation of work content; monitoring and feedback of actual sleep; health screening and treatment; promotion of recovery from work; fitness-for-duty testing; monitoring of fatigue symptoms while operating; control of fatigue while operating; performance monitoring and assistance; and fatigue-proofing. We also identify two systemic measures needed to anchor risk mitigation in SMS: organisational learning and training/other. By structuring monitoring and control measures along Dawson and McCullochs [Managing fatigue: Its about sleep. Sleep Medicine Reviews, 9(5), 365-380] fatigue-risk trajectory, a framework is obtained that acts as a guide for fatigue-risk management by transport employers. To inform transport managers further, evaluations are needed of the effectiveness of individual control measures as well as whole fatigue-risk management interventions., Funding Agencies|Norges Forskningsrad

Occupational therapists need to be cognizant of evidence-based role balance advice and strategies that women with multigenerational caring responsibilities can implement independently or with minimal assistance, as role balance may not be the primary goal during many encounters with this population. Hence, this study aimed to identify the viewpoints on the most helpful role balance strategies for working sandwich generation women, both from their own perspectives and from the perspective of occupational therapists. This was achieved through a Q methodology study, where 54 statements were based on findings from interviews, sandwich generation literature and occupational therapy literature. In total, 31 working sandwich generation women and 42 occupational therapists completed the Q sort through either online or paper administration. The data were analysed using factor analysis with varimax rotation and were interpreted through collaboration with experts in the field. The findings revealed similarities between working sandwich generation women and occupational therapists, particularly in terms of advocating strategies related to sleep, rest and seeking practical assistance from support networks. Differences were also present, with working sandwich generation women viewpoints tending to emphasize strategies related to coping with a busy lifestyle attending to multiple responsibilities. In contrast, occupational therapy viewpoints prioritized strategies related to the occupational therapy process, such as goal setting, activity focused interventions, monitoring progress and facilitating sustainable outcomes., Funding Agencies|Edith Cowan University, [ECU Postgraduate Research Scholarship] [10.13039/501100001798]