Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia.

METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE).

RESULTS: -Vital status at 24 months was known for 2960 (88.5%) patients. Two thirds were female. Although patients were young (median age 28 years, interquartile range 18 to 40), the two year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.80-3.11), CHF (HR 2.16, 95% CI 1.70-2.72), New York Heart Association functional class III/IV (HR 1.67, 95% CI 1.32-2.10), atrial fibrillation (AF) (HR 1.40, 95% CI 1.10-1.78) and older age (HR 1.02, 95% CI 1.01-1.02 per year increase) at enrolment. Post-primary education (HR 0.67, 95% CI 0.54-0.85) and female sex (HR 0.65, 95%CI 0.52-0.80) were associated with lower risk of death. 204 (6.9%) had new CHF (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or TIA (8.45/1000 patient-years), 19 (0.6%) had ARF (3.49/1000 patient-years), and 20 (0.7%) had IE (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/TIA or systemic embolism. Patients from low and lower-middle income countries had significantly higher age- and sex-adjusted mortality compared to patients from upper-middle income countries. Valve surgery was significantly more common in upper-middle income than in lower-middle- or low-income countries.

CONCLUSIONS: -Patients with clinical RHD have high mortality and morbidity despite being young; those from low and lower-middle income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and treatment of clinical RHD are required to improve outcomes.

Continuation of Benchmark Project - Phase IV, 1999 Calendar Year, 2000

This is the final Report to the Iowa DOT Offices of Construction and the Highway Division for the calendar year 1999 research project entitled - Continuation of Benchmarking Project: Phase IV. This project continues efforts started in 1995 with the development of a performance measurement system. The performance measurements were used to identify areas that required improvement and process improvement teams (PITs) were launched to make recommendations for improvement. This report provides a brief historical background, documents Benchmark Steering Team Activities, describes measurement activities including the employee survey and collection of non-survey data. Then a retrospective of past PIT activities is given, which sets the stage for the substantial increase in PIT activity that occurred during the winter of 1998/9. Finally, the report closes with suggestions for future directions in Benchmarking Activity.

Yellow Perch Population Assessment in Southwestern Lake Michigan, Including Evaluation of Sampling Techniques and the Identification Factors that Determine Yellow Perch Year-Class Strength April 1, 1996 - March 31, 1997

F-123-R; issued June 1, 1997; two different reports were issued from the Center for Aquatic Ecology with report number 1997 (9)

Yellow Perch Population Assessment in Southwestern Lake Michigan, Including Identification of Factors that Determine Yellow Perch Year-Class Strength April 1, 2002 - March 31, 2003

INHS Technical Report prepared for unspecified recipient

Yellow Perch population assessment in Southwestern Lake Michigan, including evaluation of sampling techniques and identification of the factors that determine Yellow Perch year-class strength April 1, 2004 - March 31, 2005

ID: 8528; Annual Report to Division of Fisheries, Illinois Department of Natural Resources; F-123-R-11

Annual Report of the Game Department for the year ended 31st December, 1948

Fisheries section of the annual report covers the following A. ADMINISTRATION (1) General, (2) Legislation, (3) Nets (4) Imports and Exports of Dried Fish, (B) ECONOMIC :( 1) Lake Victoria, (2) Lake Albert (including the Albert Nile), (3) Lake Edward and Associated Fisheries, (4) Report by Fish Culturist, (5) Lake Kyoga, (6) Minor Lakes and the Victoria Nile, (7) Dams,(8) Introductions,(9) Fish Transfers (10) Crocodiles:(i) Control,(ii) Industry, (iii) General (ll) General Notes, (C) ANGLING:Trout, Nile Perch Barbei, Tilapia variabilis.

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

AIMS: The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. METHODS: LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). CONCLUSIONS: LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT.

Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.

Determination of a Mean Solar Radiation Year and of a Typical Meteorological Year for the region of Funchal in the Madeira Island

This paper presents the determination of a mean solar radiation year and of a typical meteorological year for the region of Funchal in the Madeira Island, Portugal. The data set includes hourly mean and extreme values for air temperature, relative humidity and wind speed and hourly mean values for solar global and diffuse radiation for the period 2004-2014, with maximum data coverage of 99.7%. The determination of the mean solar radiation year consisted, in a first step, in the average of all values for each pair hour/day and, in a second step, in the application of a five days centred moving average of hourly values. The determination of the typical meteorological year was based on Finkelstein-Schafer statistics, which allows to obtain a complete year of real measurements through the selection and combination of typical months, preserving the long term averages while still allowing the analysis of short term events. The typical meteorological year validation was carried out through the comparison of the monthly averages for the typical year with the long term monthly averages. The values obtained were very close, so that the typical meteorological year can accurately represent the long term data series. The typical meteorological year can be used in the simulation of renewable energy systems, namely solar energy systems, and for predicting the energy performance of buildings.

JERICO Next. Rules and procedures for TNA. D8.9

The JERICO-NEXT Trans National Access (TNA) activity is built on the successful experience of the previous FP7 JERICO project, G.A. 262584 (Sparnocchia et al., 2014, 2016). However, it will involve a greater number of observatories distributed, as before, in coastal and shelf seas all around Europe, including some dedicated to biological observation (see D7.1 for a detailed description). A limited number of supporting facilities (calibration and research laboratories) and one item of special equipment are also included in the TNA service catalogue. This document relates to WP8 - Outreach, communication and engagement, and in particular to Task 8.8: Implementing Transnational Access to coastal observatories. It describes the procedures adopted for providing TNA during the three planned Calls for proposals, one per year from May 2016 until 2018. These procedures are a review and update of those already used by JERICO. Updates of this report prior to the next Call are possible and will depend on new needs that may emerge while conducting the first Call.

One-year follow-up of the nutritional status of patients undergoing liver transplantation

Background: Choosing the method of nutritional assessment is essential for proper follow-up of the nutritional status of patients undergoing liver transplantation. Objectives: Evaluate and compare the nutritional status of cirrhotic patients before and after liver transplantation over a year by different methods of nutritional assessment. Methods: Patients undergoing liver transplantation were assessed in five phases: pre-transplant, 1, 3, 6 and 12 months after transplantation at the hospital Santa Casa de Misericordia de Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, grip strength of the non-dominant hand (HGS) by dynamometry, thickness of the adductor pollicis muscle (APM) and phase angle (PA) by bioelectrical impedance analysis (BIA). In all evaluations, the same measurements were taken. Results: Evaluations were performed in 22 patients. Methods that showed a higher prevalence of malnourished patients before transplantation were PA by BIA (25%), arm muscle circumference (AMC) (21.9%) and arm circumference (AC) (18.8%). When comparing the nutritional status of patients during follow-up, there was a significant difference only in the evaluation methods AC, triceps skinfold thickness and PA by BIA. At the end, the methods of nutritional assessment were compared again. They showed a significant statistical difference, with HGS being the best method for detecting malnutrition. Conclusions: In conclusion, it is suggested that the method PA by BIA could be widely used with this population since the results are consistent with other findings in the literature and they are significant, reliable, and reproducible.

Hábito lector en niños de edad escolar de 9 a 10 años

La presente investigación que lleva como título: “Hábito lector en niños de edad escolar de 9 a 10 años”, fue realizada en la Unidad Educativa Tres de Noviembre de la ciudad de Cuenca- Ecuador en febrero del 2016, tuvo como principal objetivo el de determinar el hábito lector que poseen los niños y niñas de esta edad, además de constatar los factores asociados que repercuten en la actividad lectora. Para cumplir con este propósito, se enmarcó la realización de este estudio dentro de la investigación cuantitativa de carácter transversal, donde se procedió a trabajar con una muestra de 117 niños y niñas, a quienes se les aplicó la encuesta sobre hábitos lectores de Yubero y Larrañaga (2010). Los principales datos obtenidos en esta investigación, demostraron que la mayoría de niños y niñas participantes en este trabajo mantienen un adecuado desarrollo del hábito lector, además los encuestados manifestaron que la actividad lectora les gustaba mucho; por otra parte en lo que concierne a los factores asociados al hábito lector se llegó a establecer la influencia que tiene la familia y el contexto escolar en promover la lectura en la población estudiada.

Comparison of 1-year outcome in patients with severe aorta stenosis treated conservatively or by aortic valve replacement or by percutaneous transcatheter aortic valve implantation (data from a multicenter Spanish registry)

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.

Prevalencia y factores asociados al consumo de bebidas azucaradas en escolares de 9 a 17 años de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: Determinar la prevalencia y los factores asociados al consumo de bebidas azucaradas en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, realizado en 8136 niños y adolescentes en edad escolar entre 9 y 17 años de Bogotá, Colombia. El peso, la estatura, el índice de masa corporal (IMC), la circunferencia de cintura y el porcentaje de grasa, se recogieron como marcadores antropométricos y de composición corporal. El consumo de bebidas azucaradas (bebidas carbonatadas, jugos ultra-procesados y/o Té), y los factores asociados (sexo, edad, obesidad abdominal, clasificación del IMC, grado de estudios de la madre/padre, y nivel nutricional por cuestionario “Krece plus”), se recogieron por encuesta estructurada. Se establecieron asociaciones mediante la construcción de modelos de regresión logística simple. Resultados: De la población general, el 58,4% eran mujeres. En función al sexo, los varones acusaron la mayor ingesta de “bebidas carbonatadas” con una frecuencia semanal y diaria de 70,9% y 21,0%, respectivamente, seguido de “jugos ultra- procesados” (64,4% semanal vs. 11,3% diario). En ambos sexos, la prevalencia de obesidad abdominal fue mayor en los escolares que respondieron consumir diariamente “bebidas carbonatadas” (23,3%), “jugos ultra-procesados” (13,2%) y “bebidas Té” (9,7%). La edad, el grado de educación de los padres y el nivel nutricional, se asociaron como factores predisponentes al consumo diario de “bebidas carbonatadas”. Conclusión: El consumo de bebidas azucaradas cambia por los factores analizados. Se recomiendan intervenciones integrales en las que estén involucrados los componentes nutricional y educativo entre los niños y adolescentes de Bogotá, Colombia.

Normative reference of standing long jump for Colombian schoolchildren aged 9-17.9 years: The FUPRECOL study

El propósito del presente estudio era generar los valores normativos de salto largo para niños de 9-17.9 años, e investigar las diferencias de sexo y grupo de edad