Progression of left atrial volume index in a population at risk for heart failure:a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial

AIMS: Limited data are available concerning the evolution of the left atrial volume index (LAVI) in pre-heart failure (HF) patients. The aim of this study was to investigate clinical characteristics and serological biomarkers in a cohort with risk factors for HF and evidence of serial atrial dilatation.

METHODS AND RESULTS: This was a prospective substudy within the framework of the STOP-HF cohort (NCT00921960) involving 518 patients with risk factors for HF electively undergoing serial clinical, echocardiographic, and natriuretic peptide assessment. Mean follow-up time between assessments was 15 ± 6 months. 'Progressors' (n = 39) were defined as those with serial LAVI change ≥3.5 mL/m(2) (and baseline LAVI between 20 and 34 mL/m(2)). This cut-off was derived from a calculated reference change value above the biological, analytical, and observer variability of serial LAVI measurement. Multivariate analysis identified significant baseline clinical associates of LAVI progression as increased age, beta-blocker usage, and left ventricular mass index (all P < 0.05). Serological biomarkers were measured in a randomly selected subcohort of 30 'Progressors' matched to 30 'Non-progressors'. For 'Progressors', relative changes in matrix metalloproteinase 9 (MMP9), tissue inhibitor of metalloproteinase 1 (TIMP1), and the TIMP1/MMP9 ratio, markers of interstitial remodelling, tracked with changes in LAVI over time (all P < 0.05).

CONCLUSION: Accelerated LAVI increase was found to occur in up to 14% of all pre-HF patients undergoing serial echocardiograms over a relatively short follow-up period. In a randomly selected subcohort of 'Progressors', changes in LAVI were closely linked with alterations in MMP9, TIMP1, and the ratio of these enzymes, a potential aid in highlighting this at-risk group.

Oppositional Political Identity in the Song Culture of the Vormärz and the 1848 Revolution in Germany

Historically political song has often been perceived negatively, as a disturbance of the peace, summed up by the legendary line from Goethe’s Faust: “Politisches Lied – ein garstiges Lied”. In the period in Germany of the Vormärz (from 1815 up to the revolution of March 1848), however, we see how this perception may be changing as it increasingly becomes a means of self-expression in public life. This was the era of restauration, in which broader sections of German society are striving for political emancipation from the princes and kings. A whole host of political themes emerge in the songs (Freiheitslieder) of that period in which a new oppositional political consciousness is reflected. The themes range from freedom of speech, freedom from censorship, and the need for democratic and national self-determination to critiques of injustice and hunger, and parodies of political convention and opportunism. Sources of reception give indications about the social and political milieus in which these songs circulated. Such sources include broadsheets, handwritten manuscripts, song collections, commemoration events, advertisements in political press, memoires, police reports and general literature of the time. In many cases we see how these songs reflect the emerging social and political identities of those who sing them. One also sees the use of well known melodies in the popular dissemination of these songs. An intertextual function of music often becomes apparent in the practice of contrefacture whereby melodies with particular semantic associations are used to either underline the message or parody the subject of the song.

'Dare the boist'rous main': the role of the Belfast Newsletter in the process of emigration from Ulster to North America 1760-1800

Before the mass migrations from Ireland in the nineteenth century, earlier waves of migration in the eighteenth century saw significant numbers of people leave Ireland, predominantly from Ulster, to settle in North America. This article, using as its principal data source the Belfast News Letter ( BNL), its letters, advertisements and reports, focuses firstly on reconstructing the late eighteenth-century migration process and voyage, highlighting the barriers represented by the Atlantic Ocean. In addition to the challenges of the sea, there were problems with the ships, the ever-present danger of disease and also threats from other vessels, from privateers to press gangs. The voyage was recognized as a ‘universal dread’, and the risks taken to ‘dare the boist’rous main’ were perhaps not minimized in the pages of the BNL, whose editorial stance was antipathetic to the migration for the potential harm it caused to Ulster by removing so many of its industrious young. The second part of this article goes on to consider the newspaper’s and others’ vested interests in the emigration process, demonstrates how these were manifested in the press and sets the coverage of this very significant early emigration flow within the context of contemporary religious and colonial discourses at a period of very lively transatlantic interactions.

The Battle of the Somme in Ulster memory and identity

One of the enduring illusions about Northern Ireland is that its society can be conceptualized through a binary distinction between protestant and catholic. unionist and nationalist. It is increasingly apparent that these broad domains are themselves fractured and diverse and that otherness is often conceived from within rather than without. Northern Ireland can also be viewed as a laboratory for identity formation as unionists and loyalists strive to reconcile themselves with the fundamental political changes that have followed in the wake of the Peace Process. This paper considers one aspect of the contestation of belonging that increasingly characterizes unionism. It examines the competition for the ownership of the mythology of the Battle of the Somme ( 1916), long a key event in the unionist narrative. In particular, the paper addresses the ways in which paramilitary organizations are using the Somme to legitimate their own activities but also to distance the loyalist working classes from the former hegemonic Britishness of official unionism and the sectarianism of the Orange Order. The analysis concludes that loyalist identity is being conceptualized thorough a narrative of betrayal from within and at an intensely localized scale.

Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study

Background In Europe skin melanoma (SM) survival has increased over time. The aims were to evaluate recent trends and differences between countries and regions of Europe.

Methods Relative survival (RS) estimates and geographical comparisons were based on 241,485 patients aged 15 years and over with a diagnosis of invasive SM in Europe (2000-2007). Survival time trends during 1999-2007 were estimated using the period approach, for 213,101 patients. Age, gender, sub-sites and morphology subgroups were considered. 

Results In European patients, estimated 5-year RS was 83% (95% confidence interval, CI 83-84%). The highest values were found for patients resident in Northern (88%; 87-88%) and Central (88%; 87-88%) Europe, followed by Ireland and United Kingdom (UK) (86%; 85-86%) and Southern Europe (83%; 82-83%). The lowest survival was in Eastern Europe (74%; 74-75%). Within regions the intercountry absolute difference in percentage points of RS varied from 4% (North) to 34% (East). RS decreased markedly with patients' age and was higher in women than men. Differences according to SM morphology and skin sub-sites also emerged. Survival has slightly increased from 1999 to 2007, with a small improvement in Northern and the most pronounced improvement in Eastern Europe. 

Discussion SM survival is high and still increasing in European patients. The gap between Northern and Southern and especially Eastern European countries, although still present, diminished over time. Differences in stage distribution at diagnosis may explain most of the geographical differences. However, part of the improvement in survival may be attributed to overdiagnosis from early diagnosis practices.