Clinical profiles and outcomes in patients with chronic heart failure and chronic obstructive pulmonary disease: an efficacy and safety analysis of SHIFT study

BACKGROUND

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist, with undefined prognostic and therapeutic implications. We investigated clinical profile and outcomes of patients with chronic HF and COPD, notably the efficacy and safety of ivabradine, a heart rate-reducing agent.

METHODS

6505 ambulatory patients, in sinus rhythm, heart rate ≥ 70 bpm and stable systolic HF were randomised to placebo or ivabradine (2.5 to 7.5mg bid). Multivariate Cox model analyses were performed to compare the COPD (n=730) and non-COPD subgroups, and the ivabradine and placebo treatment effects.

RESULTS

COPD patients were older and had a poorer risk profile. Beta-blockers were prescribed to 69% of COPD patients and 92% of non-COPD patients. The primary endpoint (PEP) and its component, hospitalisation for worsening HF, were more frequent in COPD patients (HRs f, 1.22 [p=0.006]; and 1.34 [p<0.001]) respectively, but relative risk was reduced similarly by ivabradine in both COPD (14%, and 17%) and non-COPD (18% and 27%) patients (p interaction=0.82, and 0.53, respectively). Similar effect was noted also for cardiovascular death. Adverse events were more common in COPD patients, but similar in treatment subgroups. Bradycardia occurred more frequently in ivabradine subgroups, with similar incidence in patients with or without COPD.

CONCLUSIONS

The association of COPD and HF results in a worse prognosis, and COPD represents a barrier to optimisation of beta-blocker therapy. Ivabradine is similarly effective and safe in chronic HF patients with or without COPD, and can be safely combined with beta-blockers in COPD.

The mobilisation of sediment and benthic infauna by scallop dredges

We present the results of experiments to assess the immediate impact of scallop dredging on the seabed sediment and on the inhabiting infauna. The passage of the scallop dredge is shown to homogenise the seabed, flattening sand ripples. The turbulent wake entrains up to the equivalent of a 1 mm layer of sediment per unit of swept width, although an analysis of the finer particles material implies that the suspended silt material must originate from depths of at least 10 mm. The species most abundant in the sediment plume either swim actively in the water column or are found in, or on, the upper layers of the substrate, whereas those most abundant in core samples taken from the sediment, but not present in the net samples, are almost all tube-building or deep burrowing. The vertical stratification of sediment concentration and of animal numbers in the water column suggests that even if some of these species respond actively to the presence of the dredge, once entrained, they are transported more or less passively in the same way as the larger sediment particles. There was no difference between the core samples taken before or after towing suggesting that animals mobilised by the dredge resettle in the tow path. Our analysis does not provide any information regarding the fate of these animals.

The Tayside insulin management course: an effective education programme in type 1 diabetes

AIMS

The Tayside insulin management (TIM) course is an intensive insulin management programme for adults with type 1 diabetes. The aim was to assess its effectiveness.

METHODS

Haemoglobin A1c (HbA1c) and body mass index (BMI) from individuals with type 1 diabetes were collected 3 months before, and 6 and 24 months after the programme. The programme involved a full day of education per week for 4 weeks in a row. Quality of life was assessed using the standardised Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire completed both before and 3 months after the course. Subjects were also asked to complete a pre- and postcourse questionnaire gathering information about aspects of their diabetes management. In addition, individual satisfaction with course content and delivery was recorded.

RESULTS

Participants had a median reduction in haemoglobin A1c (HbA1c) of 4 mmol/mol (0.4%) after 6 months and 5 mmol/mol (0.5%) 2 years after the course (p < 0.001). Mean daily dose of short-acting insulin decreased from 31.5 (1.9) units to 27.3 (1.9, p < 0.001). There was no significant change in BMI. There was an improvement in all 18 domains of the ADDQoL questionnaire. There was a decrease in hypoglycaemia unawareness from 34.3 ± 47.8% of patients to 8.6 ± 28% (p < 0.001), and a decrease in self-reported lipohypertrophy from 27.8% to 11.1% (p = 0.001). There was a significant reduction in the mean number of diabetic ketoacidosis and severe hypoglycaemic episodes. The number of blood glucose checks changed from 2.8 ± 2.1 to 3.2 ± 1.1 (p = 0.058) per day. Participant satisfaction with all aspects of course content and delivery was high.

CONCLUSIONS

TIM is an effective intensive education programme for patients with type 1 diabetes.

Rapidly swept, ultra-widely-tunable 1060 nm MEMS-VCSELs

Demonstrated are 1060 nm microelectromechanical-systems-based tunable vertical-cavity surface-emitting lasers (MEMS-VCSELs) with a 100 nm continuous tuning range under repetitively scanned operation at rates beyond 500 kHz and a 90 nm continuous tuning range under static operation. These devices employ a thin strained InGaAs multiple quantum well active region integrated with a fully oxidised GaAs/Al_xO_y bottom mirror and a suspended dielectric top mirror. The devices are optically pumped via 850 nm light. These ultra-widely tunable lasers represent the first MEMS-VCSELs reported in this wavelength range, and are ideally suited for application in ophthalmic swept-source optical coherence tomography.

High-sweep-rate 1310 nm MEMS-VCSEL with 150 nm continuous tuning range

Microelectromechanical-systems-based vertical-cavity surface-emitting lasers (MEMS-VCSELs) capable of a 150 nm continuous tuning range near 1310 nm are demonstrated. These devices employ a thin optically pumped active region structure with large free-spectral range, which promotes wide and continuous tuning. To achieve VCSEL emission at 1310 nm, a wide-gain-bandwidth indium phosphide-based multiple quantum well active region is combined with a wide-bandwidth fully oxidised GaAs-based mirror through wafer bonding, with tuning enabled by a suspended dielectric top mirror. These devices are capable of being scanned over the entire tuning range at frequencies up to 500 kHz, making them ideal for applications such as swept source optical coherence tomography and high-speed transient spectroscopy.

Crash and burn? Vehicle, collision, and driver factors that influence motor vehicle collision fires

A retrospective population-based case-control study was performed to determine the association between vehicle fires, and vehicle, collision, and driver factors on highways with a posted speed limit of at least 55mph. Data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000-2009 from the Kentucky State Police Records Sections. The results from the final multiple logistic regression show that large trucks were at a higher risk for a collision involving a fire than passenger vehicles and pickup trucks. When controlling for all other variables in the model, vehicles 6 years old and older, driving straight down the highway, and single vehicle collisions were also identified as factors that increase the risk of motor vehicle collision fires on roadways with a posted speed limit of ≥55mph. Of the 2096 vehicles that caught fire, there were 632 (30%) non-fatally injured drivers and 224 (11%) fatally injured drivers. The results of this study have the potential to inform public health messages directed to the transportation industry, particularly semi truck drivers, in regard to fire risk.

High performance multilayered nano-crystalline silicon/silicon-oxide light-emitting diodes on glass substrates

A low-temperature hydrogenation-assisted sequential deposition and crystallization technique is reported for the preparation of nano-scale silicon quantum dots suitable for light-emitting applications. Radio-frequency plasma-enhanced deposition was used to realize multiple layers of nano-crystalline silicon while reactive ion etching was employed to create nano-scale features. The physical characteristics of the films prepared using different plasma conditions were investigated using scanning electron microscopy, transmission electron microscopy, room temperature photoluminescence and infrared spectroscopy. The formation of multilayered structures improved the photon-emission properties as observed by photoluminescence and a thin layer of silicon oxy-nitride was then used for electrical isolation between adjacent silicon layers. The preparation of light-emitting diodes directly on glass substrates has been demonstrated and the electroluminescence spectrum has been measured.

What's in a referral letter: does the detail matter?

Background: The referral letter is an often-overlooked yet essential element that contributes to the quality of patient care when specialist services are accessed. In the field of maternal-fetal medicine, incomplete referral letters that fail to comprehensively identify pregnancy risk factors can have significant implications for pregnancy management and delivery planning. Objectives: To evaluate the quality and completeness of referral letters from general practitioners and obstetricians to the Fetal Medicine Unit (FMU) at The Canberra Hospital and to improve practice through validation of a patient questionnaire with sensitivity for identifying pregnancy risk factors. Methods: Self reported information from a questionnaire completed by pregnant women presenting for initial consultation to the FMU was compared with information contained in the written referral letter for that particular patient. Information compared was categorised as mandatory referral information, significant past obstetric or gynaecological history, or other relevant medical history. Results: The patient questionnaire was successful in providing clinicians with relevant medical information in addition to that which was contained in professional referrals in 57% (95% confidence interval (CI) 48-67%) of cases. Significantly more risk factors for the current pregnancy were highlighted in the questionnaires than in the referral letters (P = 0.008). Conclusions: A significant proportion of referral letters received by the FMU during the study period lacked completeness in many key areas. Recommendations to improve this situation include the routine use of patient questionnaires or referral letter templates, the development of local referral guidelines, and regular clinician education.

An Ad5-vectored HIV-1 vaccine elicits cell-mediated immunity but does not affect disease progression in HIV-1-infected male subjects: results from a randomized placebo-controlled trial (the Step study)

BACKGROUND

The Step study was a randomized trial to determine whether an adenovirus type 5 (Ad5) vector vaccine, which elicits T cell immunity, can lead to control of human immunodeficiency virus (HIV) replication in participants who became HIV-infected after vaccination.

METHODS

We evaluated the effect of the vaccine on trends in HIV viral load, CD4+ T cell counts, time to initiation of antiretroviral therapy (ART), and AIDS-free survival in 87 male participants who became infected with HIV during the Step study and who had a median of 24 months of post-infection follow-up.

RESULTS

There was no overall effect of vaccine on mean log(10) viral load (estimated difference between groups, -0.11; P = .47). In a subset of subjects with protective HLA types (B27, B57, B58), mean HIV-1 RNA level over time was lower among vaccine recipients. There was no significant difference in CD4+ T cell counts, time to ART initiation, or in AIDS-free survival between HIV-1-infected subjects who received vaccine versus those who received placebo.

CONCLUSIONS

HIV RNA levels, CD4+ T cell counts, time to initiation of ART, and AIDS-free survival were similar in vaccine and placebo recipients. There may have been a favorable effect of vaccine on HIV-1 RNA levels in participants with HLA types associated with better control of HIV-1.