Predicting 3-year mortality after percutaneous coronary intervention: updated logistic clinical SYNTAX score based on patient-level data from 7 contemporary stent trials

OBJECTIVES This study aimed to update the Logistic Clinical SYNTAX score to predict 3-year survival after percutaneous coronary intervention (PCI) and compare the performance with the SYNTAX score alone. BACKGROUND The SYNTAX score is a well-established angiographic tool to predict long-term outcomes after PCI. The Logistic Clinical SYNTAX score, developed by combining clinical variables with the anatomic SYNTAX score, has been shown to perform better than the SYNTAX score alone in predicting 1-year outcomes after PCI. However, the ability of this score to predict long-term survival is unknown. METHODS Patient-level data (N = 6,304, 399 deaths within 3 years) from 7 contemporary PCI trials were analyzed. We revised the overall risk and the predictor effects in the core model (SYNTAX score, age, creatinine clearance, and left ventricular ejection fraction) using Cox regression analysis to predict mortality at 3 years. We also updated the extended model by combining the core model with additional independent predictors of 3-year mortality (i.e., diabetes mellitus, peripheral vascular disease, and body mass index). RESULTS The revised Logistic Clinical SYNTAX models showed better discriminative ability than the anatomic SYNTAX score for the prediction of 3-year mortality after PCI (c-index: SYNTAX score, 0.61; core model, 0.71; and extended model, 0.73 in a cross-validation procedure). The extended model in particular performed better in differentiating low- and intermediate-risk groups. CONCLUSIONS Risk scores combining clinical characteristics with the anatomic SYNTAX score substantially better predict 3-year mortality than the SYNTAX score alone and should be used for long-term risk stratification of patients undergoing PCI.

How Do Gastroenterologists Assess Overall Activity of Eosinophilic Esophagitis in Adult Patients?

OBJECTIVES:There is no "gold standard" for assessing disease activity in patients with eosinophilic esophagitis (EoE). We aimed to compare physicians' judgment of EoE activity with patients' judgment of symptom severity. We also aimed to examine the relative contribution of symptoms as well as endoscopic and histologic findings in shaping physicians' judgment of EoE activity.METHODS:Six gastroenterologists (all EoE experts) assessed EoE-associated symptoms in adult patients. Patients completed a symptom instrument and provided global assessment of EoE symptom severity (PatGA) (Likert scale: 0 (inactive) to 10 (most active)). Following esophagogastroduodenoscopy with biopsy sampling, gastroenterologists provided a global assessment of EoE activity (PhysGA) (Likert scale from 0 to 10) based on patient history and endoscopic and histologic findings. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms and endoscopic and histologic findings explain variations in PhysGA.RESULTS:A total of 149 EoE patients were prospectively included (71.8% male, median age at inclusion 38 years, 71.8% with concomitant allergies). A moderate positive correlation between PhysGA and PatGA (rho=0.442, P<0.001) was observed and the mean difference in the Bland-Altman plot was 1.77. Variations in severity of endoscopic findings, symptoms, and histologic findings alone explained 53%, 49%, and 30%, of the variability in PhysGA, respectively. Together, these findings explained 75% of variability in PhysGA.CONCLUSIONS:Gastroenterologists rate EoE activity mainly on the basis of endoscopic findings and symptoms and, to a lesser extent, on histologic findings.Am J Gastroenterol advance online publication, 3 March 2015; doi:10.1038/ajg.2015.32.

De novo loss- or gain-of-function mutations in KCNA2 cause epileptic encephalopathy.

Epileptic encephalopathies are a phenotypically and genetically heterogeneous group of severe epilepsies accompanied by intellectual disability and other neurodevelopmental features. Using next-generation sequencing, we identified four different de novo mutations in KCNA2, encoding the potassium channel KV1.2, in six isolated patients with epileptic encephalopathy (one mutation recurred three times independently). Four individuals presented with febrile and multiple afebrile, often focal seizure types, multifocal epileptiform discharges strongly activated by sleep, mild to moderate intellectual disability, delayed speech development and sometimes ataxia. Functional studies of the two mutations associated with this phenotype showed almost complete loss of function with a dominant-negative effect. Two further individuals presented with a different and more severe epileptic encephalopathy phenotype. They carried mutations inducing a drastic gain-of-function effect leading to permanently open channels. These results establish KCNA2 as a new gene involved in human neurodevelopmental disorders through two different mechanisms, predicting either hyperexcitability or electrical silencing of KV1.2-expressing neurons.

Shaping gender inequalities: critical moments and critical places

Purpose – There is much scientific interest in the connection between the emergence of gender-based inequalities and key biographical transition points of couples in long-term relationships. Little empirical research is available comparing the evolution of a couple’s respective professional careers over space and time. The purpose of this paper is to contribute to filling this gap by addressing the following questions: what are the critical biographical moments when gender (in)equalities within a relationship begin to arise and consolidate? Which biographical decisions precede and follow such critical moments? How does decision making at critical moments impact the opportunities of both relationship partners in gaining equal access to paid employment? Design/methodology/approach – These questions are addressed from the perspectives of intersectionality and economic citizenship. Biographical interviewing is used to collect the personal and professional narratives of Swiss-, bi-national and migrant couples. The case study of a Swiss-Norwegian couple illustrates typical processes by which many skilled migrant women end up absently or precariously employed. Findings – Analysis reveals that the Scandinavian woman’s migration to Switzerland is a primary and critical moment for emerging inequality, which is then reinforced by relocation (to a small town characterized by conservative gender values) and the subsequent births of their children. It is concluded that factors of traditional gender roles, ethnicity and age intersect to create a hierarchical situation which affords the male Swiss partner more weight in terms of decision making and career advancement. Practical implications – The paper’s findings are highly relevant to the formulation of policies regarding gender inequalities and the implementation of preventive programmes within this context. Originality/value – Little empirical research is available comparing the evolution of a couple’s respective professional careers over space and time. The originality of this paper is to fill this research gap; to include migration as a critical moment for gender inequalities; to use an intersectional and geographical perspective that have been given scant attention in the literature; to use the original concept of economic citizenship; and to examine the case of a bi-national couple, which has so far not been examined by the literature on couple relationships.

Land use intensification alters ecosystem multifunctionality via loss of biodiversity and changes to functional composition

Global change, especially land-use intensification, affects human well-being by impacting the deliv-ery of multiple ecosystem services (multifunctionality). However, whether biodiversity loss is amajor component of global change effects on multifunctionality in real-world ecosystems, as inexperimental ones, remains unclear. Therefore, we assessed biodiversity, functional compositionand 14 ecosystem services on 150 agricultural grasslands differing in land-use intensity. We alsointroduce five multifunctionality measures in which ecosystem services were weighted according torealistic land-use objectives. We found that indirect land-use effects, i.e. those mediated by biodi-versity loss and by changes to functional composition, were as strong as direct effects on average.Their strength varied with land-use objectives and regional context. Biodiversity loss explainedindirect effects in a region of intermediate productivity and was most damaging when land-useobjectives favoured supporting and cultural services. In contrast, functional composition shifts,towards fast-growing plant species, strongly increased provisioning services in more inherentlyunproductive grasslands.

Temperature and precipitation effects on δ13C depth profiles in SOM under temperate beech forests

Enrichment of 13C in SOM with soil depth is related to interacting processes influenced by temperature and precipitation. Our objectives were to derive climate effects on patterns of vertical δ13C values of soil organic matter (SOM) while minimizing the effect of confounding variables. We investigated vertical changes in δ13C values of SOM in 1-cm depth intervals in silvicultural mature beech (Fagus sylvatica L.) forest ecosystems in northern Rhineland-Palatinate across gradients of MAT (7.9 to 9.7 °C mean annual temperature) and MAP (607 to 1085 mm mean annual precipitation) in winter 2011. Forest stands (n = 10) were chosen based on data sets provided by the Rhineland-Palatinate Forest Administration so that variations in these gradients occurred while other environmental factors like physico-chemical soil properties, tree species, stand age, exposition and precipitation (for the temperature gradient) or temperature (for the precipitation gradient) did not differ among study sites. From litter down to the mineral soil at 10 cm depth, soil organic carbon (SOC) content decreased (47.5 ± SE 0.1% to 2.5 ± 0.1%) while the δ13C values increased (− 29.4 ± 0.1‰ to − 26.1 ± 0.1‰). Litter of sites under higher MAP/lower MAT had lower δ13C values which was in line with literature data on climate driven plant physiological process. To compare the dimension of the vertical 13C enrichment, δ13C values were regressed linearly against log-transformed carbon contents yielding absolute values of these slopes (beta). Beta values ranged between 0.6 and 4.5 (range of r from − 0.7 to − 1.0; p < 0.01). Due to an assumed decay continuum and similar variations of δ13C values in litter and in 10 cm depth, we conclude that effects on isotope composition in the Oi layer continue vertically and therefore, δ13C values in litter do not solely control beta values. Beta values decreased with increasing MAT (r = − 0.83; p < 0.05). Reduced soil moisture and therefore both, reduced microbial activity and reduced downward transport of microbial cycled DOM (=13C enriched) might be responsible for less pronounced δ13C depth profiles in case of high temperatures. Greater C:N ratios (lower degradability) of the litter under higher temperatures likely contributed to these depth trends. Beta values increased with increasing MAP (r = 0.73; p < 0.05). We found decreasing C:N ratios in the mineral soil that possibly indicates higher decomposition under higher precipitation. Exclusion of the organic layers from linear regressions indicated a stronger impact of MAP on the development of δ13C depth profiles. Our results confirm temperature and precipitation effects on δ13C depth profiles and indicate stronger 13C enrichment under lower MAT/higher MAP. Therefore, time series of vertical δ13C depth profiles might provide insights into climate change effects.

The potential of female immigrants' integration into sport by intercultural clubs in Switzerland

Sport participation means a privileged access to participate in the sport system and the opportunities of actual integration into sport (Seiberth et al., 2013). The access to sport activities is often restricted for female immigrants. The function of sport participation concerning exercise offers of social associations is not a common theme in research on migration or on sports-related integration. Research on boundaries (Lamont & Molnár, 2002) suggest that gender-related and ethnic boundaries are stable behavioural and cognitive patterns leading to unequal social opportunities. The present study examined the potential of a Swiss intercultural club regarding female immigrants’ integration into sport by focussing on gender-related and ethnic boundaries. Ten interviews with female immigrants and conductress of an intercultural club plus a group discussion were held. Using qualitative content analysis and documentary method, findings reveal multifaceted, interwoven boundaries, e.g. maternal devotion, exclusive exercise offers for women, language learning devotion, religious need of headscarf. Otherwise resources to overcome boundaries are provided: Deploying competent employees; offering childcare, exercise offers suited to mothers‘ time schedule and language lessons; equitable, on integration focussed club-life. Thus, intercultural clubs might help to overcome boundaries and facilitate access to exercise for female immigrants and integrate them more successfully into sport than many sport clubs. A boundary focus and present data may open new perspectives for sport organisation and integration research. Further investigations of social associations offering exercise are advised.

Migrantinnen in interkulturellen Vereinen: Perspektiven zur Integration in den Sport

Im deutschsprachigen Raum wird ein hoher Anteil an Migrantinnen, die sportlich inaktiv und in Sportvereinen unterrepräsentiert sind, konstatiert (Burrmann et al., 2015; Lamprecht et al., 2014). Migrantinnen ist der Zugang zu Sportaktivitäten häufig erschwert aufgrund von Diskriminierung, Konflikten und Grenzziehungsprozessen, denen Aspekte betreffend des Geschlechts und der Ethnizität inhärent sind. Vor diesem Hintergrund wurde bislang häufig das Potenzial der Integration in den Sport bzw. Sozialisation zum Sport von Migrantinnen in (ethnischen) Sportvereinen und im Schulsport untersucht. Wie jedoch die Integration in den Sport in interkulturellen Vereinen, welche Sportangebote offerieren, funktioniert, ist weder in der Migrations- noch in der sportbezogenen Integrationsforschung ein gängiges Thema. Basierend auf dem theoretischen Ansatz Boundary Work (Lamont & Molnár, 2002) untersucht die vorliegende Studie geschlechtsbezogene und ethnische Grenzziehungsprozesse hinsichtlich der Sportpartizipation von Migrantinnen in einem interkulturellen Verein sowie vereinsbezogene Möglichkeiten, welche die Integration in den Sport fördern. Es wurden halbstrukturierte Interviews mit acht Migrantinnen verschiedener Herkunft und zwei Leiterinnen eines interkulturellen Vereins in der deutschsprachigen Schweiz durchgeführt. Zusätzlich erfolgte eine Gruppendiskussion mit sechs Migrantinnen. Mittels qualitativer Inhaltsanalyse und dokumentarischer Methode wurden geschlechtsbezogene und ethnische Grenzen sowie Möglichkeiten für eine Sportpartizipation durch den Verein abgeleitet. Hinsichtlich der erschwerten Sportpartizipation indizieren die Resultate vielfältige, miteinander verschränkte, sich überlagernde und durchlässige Grenzen, die das Geschlecht und die Ethnizität allgemein betreffen. Im Speziellen wirken migrationsbedingt und lebensphasenspezifisch geprägte Haltungen gegenüber „mütterlichen“ Verpflichtungen, sprachlichen- und beruflichen Aus- bzw. Weiterbildungspflichten sowie Praktiken der Körperverhüllung. Die jeweilige Struktur der Grenzverschränkungen wirkt z.T. mehrfach restriktiv und prägt zugleich die verfügbare Zeit und finanzielle Mittel der Migrantinnen, was eine Dilemma artige Situation hervorruft. Zur Überwindung der Grenzen bietet der interkulturelle Verein insbesondere professionelle Mitarbeiterinnen; Kinderbetreuung; niederschwellige, kosten- und zeitgünstige Sportangebote exklusiv für Frauen; und eine wohlwollende Atmosphäre mit gleichberechtigtem Zusammensein. Interkulturelle Vereine können somit den Zugang zu Sportangeboten für Migrantinnen erleichtern und die Integration in den Sport bzw. die Sozialisation zum Sport fördern. Dies geschieht z.B. infolge bedarfsgerechter Vereinsangebote, unverbindlicher Teilnahmebedingungen und einer integrationsorientierten Vereinskultur. Der auf Grenzziehung fokussierte theoretische Ansatz und die vorliegenden Resultate eröffnen neue Forschungsperspektiven im Bereich Sport und Sozialisation sowie Integration.