bluuebunny/crossref_metadata_2025 huggingface dataset:
Race matters: cardiovascular disease risk in male US prisoners
Authors: Miller J , Williams L , Alhurani A , Saleh Z , Bailey A , Connell A , Hammash M , Chung M , Moser D
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH/National Institute of Nursing Research, 1RC2NR011948

Introduction

Approximately 10% of the 2.2 million prisoners in the US have a diagnosis of cardiovascular disease (CVD) and in 2016, 28% of all deaths in custody were attributable to CVD. Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk, which are prevalent in prisoners. However, little is known about the relationships among race, health literacy, and perceived control in CVD risk for male prisoners.

Objective

The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for well-known risk factors (education, partner status, and body mass index) in male prisoners.

Methods

We used baseline data from 349 male prisoners in a biobehavioral CVD risk reduction intervention. Health literacy was measured using the Newest Vital Sign and perceived control by the Control Attitudes Scale- Revised. CVD risk was quantified with the Framingham Risk Score (FRS). Three indirect effects of race on CVD risk were examined using serial mediation model with two sequential mediators (i.e., health literacy and perceived control) and 95% confidence intervals from 5000 bootstrap samples.

Results

Of the participants (mean age = 36 + 10 years), 64.2% were white and 35.8% were black. Mean education level was 12 years and most (85.8%) were not married or partnered. Mean BMI was 28.3 + 5.0. Mean FRS was 6.63 + 4.90, indicating risk percentages of 2.3 to 13.3% over the next ten years. Black prisoners were younger (35 + 9 versus 37 + 10, p = .047) and had lower levels of health literacy (3.84 + 1.90 versus 4.69 + 1.63, p < .001) than white prisoners. No statistically significant differences in perceived control, education, partner status, or body mass index were noted between races. All three indirect effects of race on CVD were significant while the direct effect of race was not. Compared to white prisoners, black prisoners had higher levels of CVD risk through health literacy (a1b1 = .3571, 95% CI [.0948, .7162]) and lower levels of CVD risk through perceived control (a2b2 = -.1855, 95% CI [-.4388, -.0077]). Black prisoners had higher levels of CVD risk through health literacy influenced by perceived control (a1b2d21 = .0627, 95% CI [.0028, .1409]) indicating that despite the protective effect of higher levels of perceived control in black prisoners, CVD risk remained higher compared to their white counterparts.

Conclusion

Future CVD risk reduction interventions in prisoners of all races, but specifically black male prisoners, should include goals of improving health literacy and perceived control in addition to the traditional modifiable risk factors often included in biobehavioral interventions.
Human connection: a valuable element for health-related quality of life outcomes in cardiac rehabilitation during COVID-19
Authors: Candelaria D , Gallagher R , Ladak L , Glinatsis H , Randall S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background The COVID-19 pandemic restrictions have pivoted in-person cardiac rehabilitation (CR) to remote delivery via telehealth. Patient perceptions on their CR participation in these models can guide CR coordinators improve program elements.

Purpose To qualitatively explore patient perceptions and experiences on how CR influenced their health-related quality of life (HRQL).

Methods A purposive sample of 16 patients were recruited, ensuring representation from four participating CR sites, gender, age, and mode of CR delivery. Semi-structured telephone or video interviews were conducted at six months following CR completion. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke’s six-step thematic analysis.

Results Perceptions and experiences of patients were positive overall and similar between the two models. Three main themes were identified: value of human connection, benefits of exercise and need for more individualised approaches, and importance of telehealth as an adjunct to in-person CR. Patients have expressed the value of interacting with health care professionals and socialising with peers in similar circumstances; and the absence of these interactions was palpable to those who attended telehealth. Exercises were beneficial but needed to be tailored to individual capabilities and preferences. Telehealth offered convenience and was generally accepted. However, telehealth should be complementary and not a replacement to in-person CR. 

Conclusions Meaningful personal interactions with health care providers and other CR participants are most appreciated by patients in both in-person and telehealth models. Exercises are perceived to be more beneficial when individualised. Long-term outcomes from alternative CR delivery models should be evaluated.
How the COVID pandemic affected utilisation of cardiac rehabilitation in rural Australia?
Authors: Beleigoli A , Champion S , Tirimacco R , Govin K , Tideman P , Clark RA
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Caring Futures Institute

Background

Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services.

Purpose

We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic. 

Methods

CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database.

Results

There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p < 0.001).  Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p < 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37).

Conclusion

Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.
Factors influencing adherence to medication in patients using anticoagulant drug
Authors: Arslan G , Tokem Y
Published: July 2021

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): Researcher

Introduction

Anticoagulant drugs are quite narrow in their therapeutic range, which should be closely monitored throughout the treatment. In addition to monitoring the responses to the drug in patients who are taking anticoagulant medication, informing the patient and his family is one of the important responsibilities of the nurse within the scope of the counseling and training roles.

Aim

The aim of this comparative study is to investigate the factors affecting drug compliance in young adult (18-65 years) and elderly (over 65 years) patients who using anticoagulant drugs.

Method

This research was carried out descriptively and cross-sectionally in a public hospital between October 1 and December 31, 2018, and was conducted with 100 patients in Cardiovascular Surgery and Cardiology outpatient clinics and clinics. Research data was obtained by; Patient Information Form (55 questions) and Morisky Medication Adherence Scale (9 questions).

Results

56% of the patients were female and 44% were male, the mean age of the patients was 63.3 ± 14.67 years. The mean scale score of young adult patients was 5.41 ± 2.44 (compatible) and the mean scale score of elderly patients was found to be 8.95 ± 2.21 (incompatible). 48.2% of the female patients and 54.5% of the male patients were found to be compatible with the treatment. When the relationship between the knowledge level of anticoagulant drugs and their compliance with the treatment according to age group is evaluated; patients in all age groups who expressed their own level of knowledge inadequately, were found to be incompatible with treatment. 46.2% of young adult patients who stated that they had hospitalization due to the drug and 64.3% of young adult patients who stated that they applied to the emergency department, were highly compatible; 93.8% of elderly patients who stated that they had hospitalized and 88.6% of the elderly patients who stated that they applied to the emergency department, had a low compliance. (p ˂0,05)

Conclusions and Recommendations: Many factors such as age, education, other people who they live together, level of knowledge about anticoagulant medication, forgetting to use the drug, thinking the treatment damages themselves or not wanting the treatment, carrying information about medication beside themselves and using other medications without asking a doctor were found as many cases which affect the compliance with the treatment. It was found that compliance with treatment in older patients was found to be more incompatible with treatment compared to young adult patients. It is recommended that healthcare professionals in healthcare environments in our country specialize in anticoagulant therapy management and establish certification programs. It is suggested to provide effective continuity of these programs by planning trainings for patients receiving anticoagulant therapy by specialized healthcare professionals.
Knowledge of heart failure patients about the disease
Authors: Catarino PAULA , Vaz Alexandre , Paiva SILVIA
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Despite all the technological advances that have made it possible to increase the life expectancy of patients with Heart Failure (HF), this continues to be a disease with an important socioeconomic impact and high hospital mortality. Education to understand HF and the development of capacities for selfcare are considered keys to improve adherence, avoid decompensation crises and maintain the clinical stability.

Purpose

Evaluate the knowledge of patients with HF about the disease, treatment, symptoms and its recognition.

Methods

Was developed a quantitative, cross-sectional, descriptive and correlational study. The questionnaire incorporated Dutch Heart Failure Knowledge Scale (DHFKS). Sampling was consecutive non-probability of patients followed in outpatient visit and hospitalized in the ward at a university hospital.

 Results

All elements of the sample answered that "it is important that I take my HF medication regularly". It is important to understand that adherence to therapy is not just taking medications, but also complying with the diet and modification habits or lifestyles. The item that followed with the highest correct rate (97%) was the one that questions what the meaning of HF is. The patient should be tried to understand the cause of the HF, the symptoms and the course of the disease and based on that, make realistic decisions, including decisions about treatment at the end of life.

When asked about the best thing to do in case of increased dyspnea or edema, 90.7% know that early contact with the doctor or nurse is important. The patient must be able to monitor and recognize changes in signs and symptoms so that understands when and how to contact a health professional. The nursing intervention should focus on educating patients and their families for the early recognition of these signs and symptoms, avoiding episodes of decompensation.

One of the items with the worst correct rate was "How often should patients with severe HF be weighed?" (37.2%). Daily weight have an important role in identifying signs of hypervolaemia. The other item with the worst correct rate was "Why should a patient with HF follow a low-salt diet" (34.9%). The knowledge of the patients in our sample needs to be probed about the area of food, particularly with the salt restriction and daily weight control. However, they recognize the importance of taking the medication and what to do in case of worsening symptoms.

Conclusions

We can conclude that about knowledge, patients recognize the importance of taking their medication on a regular basis, they know what "HF" means, what to do in case of dyspnea or edema and what diuretics are for. Instead, they have difficulty understanding the need to weigh themselves daily and the importance of reducing salt in them diet. With this study, it is concluded that it is important to invest in the education of patients and their families so that they adopt healthy lifestyles that can increase their life quality.
Self-perceived heart disease risk assessment in patients with hypertension
Authors: Negesa L , Magarey J , Rasmussen R , Hendriks J
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The University of Adelaide supported fieldwork

Introduction

Heart disease is the leading cause of morbidity and mortality worldwide. The risk of heart disease is significantly high among patients with hypertension. However, patients’ poor understanding of their risk even further intensifies the risk of heart disease. Therefore it is crucial to improve patients’ understanding of their lifetime risk and applying a healthy lifestyle, to reduce the risk of heart disease.

Purpose

The aim of this study was to explore self-perceived heart disease risk and knowledge of heart disease risk factors in patients with hypertension.

Methods

A cross-sectional study was conducted in patients with a confirmed diagnosis of hypertension who attended follow up care clinics at two referral hospitals in eastern Ethiopia. Data were collected through face-to-face interviews using two validated instruments (ABCD risk questionnaire for assessment of self-perceived risk and heart disease fact questionnaire for assessment of knowledge of cardiovascular risk factors). Data analysis was conducted using SPSS version 25, and descriptive and correlation analysis were conducted.

Results

A total of 203 patients were included in the study, 60% of them were females, and the mean age was 50 ± 9 years. The majority 143 (70.4%) perceived their future heart disease risk as low, however 60 (29.6%) perceived their future chance of developing heart disease as moderate. The mean heart disease risk factors knowledge score was 72.3 + 13.7, and more than half (57%) had optimal knowledge of heart disease risk factors (scored ≥70%), whereas, the remaining 43% had sub-optimal knowledge. Moreover, there is a statistically significant positive association between self-perceived heart disease risk and knowledge of heart disease risk factors (r = 0.28, p= 0.00).

Conclusion

Despite being at high risk, many patients with hypertension underestimate the chance of developing heart disease in their lifetime. Implementation of interventions to promote healthy lifestyle behaviour is crucial to prevent heart disease risk as well as to improve patient’s understanding of these risks.
Factors related to the quality of life in patients with pulmonary arterial hypertension
Authors: Sarzynska K , Polanski J , Kopec G , Mroczek E , Jankowska-Polanska B
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pulmonary arterial hypertension (PAH) is a rare disease, with an incidence of 15–50 cases per million annually. The disease is associated with further progress and worsening of symptoms despite pharmacotherapy. The severity of PAH symptoms and their effects reduce the patients" quality of life (QoL). Numerous studies show that the quality of life is related to the therapeutic effect of the treatment. Available studies demonstrate that patients QoL deteriorates as the condition progresses. Consequently, the goals of PAH therapy have expanded from increasing survival to improving health-related quality of life. The aim of the study was to determine the clinical and sociodemographic factors influencing the quality of life in PAH patients.

Methods

The study involved 55 patients with PAH who were examined using the Polish version of the PAH-SYMPACT quality of life questionnaire. The PAH-SYMPACT questionnaire results were correlated with several  variables.

Results

It was shown that the quality of life correlates significantly (p˂0,05) with WHO Functional Class, NT-pro BNP (N-terminal prohormone of brain natriuretic peptide) value, elderly age (the higher the value, the worse the QoL). On the other hand, the lower the 6MWT (6 minuts walk test) result, the worse the QoL. Moreover, the intensity of the accompanying PAH symptoms, such as chest pain, dyspnoea, arrhythmias, fatigue and weakness were associated with a lower quality of life in patients (p < 0,05).

Conclusion

Patients" quality of life correlates with many variables, both clinical and sociodemographic. In addition, there is a correlation between the quality of life of patients with PAH and the severity of several symptoms associated with this condition. Determination of factors affecting the quality of life of patients with PAH enables the selection of a more comprehensive therapy.
Education in daily life activities as fundamental care in heart surgery rehabilitation: a multifactorial approach to the patient and caregiver
Authors: Acqualagna R , Mazzariol E , Bernardi P , Feltrin C
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Education represents Fundamental Nursing Care that responds to a psycho-social need of the patient. Acute Coronary Syndrome and cardiac surgery have a strong impact from a psycho-emotional point of view and in the approach to daily activities after discharge: nursing care in this phase aims to obtain not only the full physical recovery of the person but above all to restore awareness of what will be the repercussions in everyday life. Therefore, it is necessary to develop a path that actively involves the client and the caregiver and that aims to recognize and analyse his potential and finally satisfy his educational needs to guarantee a person"s return home that is consistent with his expectations.

PURPOSE

identify the best nursing strategies in managing the educational need of the cardiac surgery patient in the rehabilitation phase involving the caregiver, and describe what aspects to be considered as priorities in personalizing care.

METHODS

a narrative literature review.

RESULTS

23 articles were included in the analysis. The literature has shown that the educational need in cardiac surgery patients in the rehabilitation phase can be detected through semi-structured interviews or self-report questionnaires and should be continued even after discharge. Once shared objectives were set with the client, the care process proved to be more effective with the active involvement of the caregiver, who also has educational and information needs that ensure a return to daily life activities and early recognition of any relapses. Furthermore, both for the client and for the caregiver, the literature emphasizes how the consideration of socio-economic, cultural and gender aspects are important in structuring the educational plan: if not considered, feelings of discomfort and frustration can emerge in the people involved and lead to further emotional problems that can compromise the complete recovery of the person. At the base of the path, however, relational competence is essential for the achievement of health objectives, in a continuum of care between hospital and territory.

CONCLUSION

The educational path of the person after cardiac surgery represents a central point of fundamental nursing care, even after discharge. Given the need to monitor the achievement of the objectives set, the use of nursing taxonomies could prove useful for this purpose in guaranteeing a timely verification of the educational path both before and after discharge: through the declination of objectives and diversified interventions for patient and caregiver, nurses can share the progress made in the care team and facilitate the transfer of care information between professionals in different settings.
How a pandemic changed advanced nurse practitioner (ANP) chest pain assessment from face-to-face to virtual: The impact on clinical workload, diagnosis & patient safety
Authors: Ingram S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Chest pain presentations to the Emergency Dept. (ED) account for 8% of ED cases annually. In response to the pandemic the usual care pathway of nurse-led assessment in ED and discharge to a chest pain clinic (Ingram  2017) ceased, as face-to-face clinics and diagnostics were curtailed, and staff redeployed. A virtual chest pain clinic was created by one ANP. Telehealth is defined as ‘the entire spectrum of activities used to deliver care remotely, without direct physical contact with the patient’ (Wosik  2020)

Purpose

This analysis aims to compare the outcomes of the Covid-19 virtual chest pain clinic in 2020 to the same face-to- face clinic period in 2019 with a focus on i. Clinic workload, ii. Patient Outcomes iii. Patient Safety,

Methods

The ANP performed a telephone consultation and referred for limited diagnostic testing or discharged to primary care. The patient management system (iPIMS) was used as a clinical and audit tool. This service evaluation was registered as quality improvement project.

Results

From 1/4/20 to 21/7/2020, 130 e-referrals were received compared to 154 face-to-face consults in the same period of 2019. The overall number of clinic episodes was 17% greater during the pandemic period (Fig.1), carried out by 1/3 of the 2019 staff quota. Access to exercise stress testing (EST) was reduced by 88%.  CHD was diagnosed in 26%. Virtual assessment in this high risk group in the absence of timely diagnostics is a risk however 30 day mortality was 0%.

Discussion

  The pandemic of covid-19 required a rapid redesign of the chest pain service in the midst of staff redeployment. Whilst the total number of referrals is less that the same timeframe in 2019 the ‘virtual’ nature of the service created additional episodes of care with the need for the return clinic in person or by telephone.

Conclusion

In response to the pandemic the change to a virtual clinic was enabled by ANP experience and permitted continued safe discharge of chest pain patients from the ED. The virtual service does add to the ANP clinical workload with potential risk. As it requires more office time, it prevents the ANP presence in the ED.  It is hoped in time to return to the original model of care as this will be more efficient for the service and the patient.
The role of the Advanced Clinical Practitioner (ACP) in triaging patients with Non ST-Elevation acute coronary syndromes (NSTE-ACS) patients for coronary angiographic procedures
Authors: Comer K
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The introduction of the ACP role to a cardiology service with emphasis on measuring the effect of this role on improving the Inter-hospital transfer pathway for patients with ACS by improving patient outcomes

ACPs triage a large number (estimated n = 2500 per year) of cardiology IHT referrals from these hospitals and ensure effective transfer to our centre for ACS treatment whilst supporting staff in the care of  those patients who do not meet our transfer criteria or are acutely unwell for transfer but cardiovascular stable

Patients are listed in order of presenting symptoms, presence or absence of chest pain on admission, relevant blood results such as infection markers, kidney function, and troponin a cardiac biomarkers, ECG findings, drug history ,  past medical history and arrival to hospital rather than clinical urgency .

Purpose

Therefore the purpose of this evaluation was to measure the patient outcomes of introduction of an ACP in triaging patients with NSTE-ACS)patients for coronary angiographic procedures.

Methods

Quantitative design approach with a specialist cardiology setting using a 2-year observational analysis of the data.The study population included all patients referred for angioplasty or PCI via the Inter-hospital transfer acute coronary syndrome network including all patients referred for PCI following NSTE-ACS. Results :

There were a total of n= 4976 patients referred for coronary angiogram +/-proceed procedures  between Feb 2018 and Feb 2020.

Overall significant positive outcomes were noted across a consistent patient group based on presenting symptoms and patient characteristics when comparing data in the year preceding ACP led triage.

A 2-sided p-value <0.05 defined statistical significance and to reject the null hypothesis.

There was a significant reduction in waiting time post introduction of ACP led triage (p < 0.0001) equating to one day

Comparison from pre ACP to post ACP led triage and clinical cancellation rates was reduced significantly (p = 0.0062).

Rates of revascularisation were significantly higher post ACP led triage with a corresponding decrease in those managed medically (47.2% pre vs 43.1% post, p = 0.0037). These higher rates consisted of increased rates of both CABG (12.4% pre vs 13.5% post, p = 0.04) and PCI 40.4% vs 43.4%, p = 0.0216)

Conclusion

ACP led triage of ACS patients requiring urgent treatment demonstrates improved patient outcomes with economic benefits for healthcare providers, enhancing the service provided and opens up discussions for further quality improvement and implications to practice.

Evidence of the benefits of advanced practice and the role of the advanced clinical practitioner is demonstrated within the cardiology setting and for the clinical triage of a patient group.
Discharging patients; does it need to be done by a doctor?
Authors: Harrison S , Bellchambers J , Deane S , Dent N , Mackay N , Pottle A
Published: July 2021

Funding Acknowledgements

None

Background

Patients undergoing angiography and percutaneous coronary intervention (PCI) were historically reviewed post procedure by a member of the medical team who assesses the patient’s suitability for discharge and completes the discharge letter. Over the past 10 years, the number of patients admitted for these procedures as day cases has increased significantly. In addition, there has been an expansion in nursing roles in the UK with the development of a variety of clinical nurse specialist (CNS) posts which have taken over many of the traditional medical roles.

The majority of patients undergoing elective angiography and PCI are admitted to a day case unit at this tertiary cardiac centre. There is no designated medical cover for the unit and medical staff from the acute cardiac unit are called to review patients and complete their discharge paperwork in addition to their other duties. This frequently results in delayed discharge and patients going home without a discharge summary.

It was therefore proposed that suitably qualified CNSs could be trained to discharge these patients and others undergoing day case cardiology procedures.  From June 2017, the CNS team took over the role of reviewing patients post procedure and completing the discharge letter.

Purpose

The aim of the study was to evaluate if CNSs were able to discharge patients and provide a timely and effective service following elective cardiology procedures and to obtain patient feedback.

Method

Data on the number of patients reviewed by the CNSs from June 2017 to the end of December 2019, were prospectively collected in a dedicated database. A pilot study of patient experience was carried out in January 2020. Patients were given a questionnaire which asked about the explanation they received from the CNS regarding the procedure they had undergone, if their medication was reviewed and discussed with them, and if they received a discharge summary to take home.

Results

1287 patients were reviewed by the CNS team during the above period. 811 (63.0%) patients had undergone angiography and 423 (32.9%) PCI.  Informal feedback from the staff working on the day case unit included that patients were discharged earlier, had improved knowledge about their procedure and that the discharge letter was more detailed when completed by the CNS team.

Eight patients completed the pilot questionnaire. Six were discharged by one of the CNS team, one by a doctor and one patient was not sure who did their discharge. All patients were very satisfied with the process and the information they were given.

Conclusion

Experienced CNSs can deliver high-quality, timely discharge of patients following cardiology procedures.  This process is being used as a template to expand nurse-led discharge to other areas in cardiology. Patient experience will continue to be audited with a larger sample size in 2020.
Prognostic roles of obstructive sleep apnea syndrome and right ventricular dysfunction in heart failure patients with preserved ejection
Authors: Grakova E , Yakovlev AV , Shilov SN , Teplyakov AT , Yakovleva NF , Berezikova EN , Kopeva K
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Objective. To study the prognostic roles of obstructive sleep apnea syndrome (OSAS) and right ventricular dysfunction in the development of heart failure (HF) progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. Methods. The severity of obstructive breathing disorders during sleep was assessed by the apnea/hypopnea index (AHI). A total of 86 men, median age of 62.0 (41.0; 78.0) years with moderate and severe OSAS (with AHI > 15 per hour) and HF of NYHA class I-III with baseline LVEF of 60% [52; 65]% were enrolled in the study. All patients had the abdominal obesity (WC > 92 cm), body mass index exceeded 30 kg/m2. Serum levels of NT-proBNP were measured using ELISA at baseline. Two-dimensional transthoracic echocardiography with assessment of right ventricular function and 6-minute walk test were performed at baseline and at 12 months. Results. At 12 months of follow-up period all patients were divided into 2 groups: group 1 (n = 33) comprised patients with HF progression, group 2 (n = 53) without it. The concentration of NT-proBNP at baseline was higher by 18% in group 1 than in group 2 (p = 0.024; 338 [168; 678] vs. 278 [177; 815] pg/mL, respectively). The median values of AHI (p < 0.0001) were 46.0 [20.6; 85] per hour in group 1 and 24.0 [21.0; 28.0] per hour in group 2. In group 1 than in group 2 fractional change in the area of the right ventricle (ΔSRV) was less by 9.1% (p = 0.031; 40 [35; 47] vs. 44 [40; 47]%, respectively) and right ventricular myocardial function index (RVSWI, Tey index) was less by 8% (p = 0.022; 0.23 [0.22; 0.25] vs. 0.25 [0.24; 0.26], respectively). Based on ROC-analysis, AHI ≥33.5 episodes per hour (sensitivity 75.8%, specificity 67.9%, AUC = 0.732; p < 0.0001), ΔSRV ≤18.6% (sensitivity 75.8%, specificity 54.7%, AUC = 0.62; p = 0.047) and NT-proBNP ≥311 pg/mL (sensitivity 63.6%, specificity 73.6%, AUC = 0.645; p < 0.0001) were identified as a cut-off values predicting the development of HF progression. The combined evaluation of NT-proBNP and AHI increased the predictive value of the analysis (sensitivity of 82.6%, specificity of 77.1%, and AUС of 0.821; p < 0.0001). Conclusion. Our data suggest that NT-proBNP, AHI and ΔSRV may be used as a diagnostic biomarker for HF progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. The combined use of NT-proBNP and AHI demonstrated higher diagnostic sensitivity and specificity for prediction of unfavorable course of HF.
The effect of cardiorehabilitation on the quality of life by congestive heart failure patients
Authors: Labudova M , Hudak M , Zambojova I , Durinova E , Simonova M , Machackova B , Vaska E , Stanova J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

To examine selected parameters of quality of life in patients with cardiac failure after cardiorehabilitation in outpatient and inpatient form and to compare the effect with each other.

Methods and methodology: The survey included 64 respondents without age restrictions with chronic heart failure NYHA I. - III. after undergoing inpatient or outpatient cardiorehabilitation, polymorbid, oncology and psychiatric patients were excluded. The questionnaire with 20 questions focused on 12 quality of life domains. Statistical processing: t-test, ANOVA, Chi-square test, Spearman correlation coefficient (p <0.05).

Results

35 men (54.7%) and 29 women (45.3%) were included, with a mean age of 58.07 years, with a mean duration of CHF treatment of 3.99 years, subgroups (internal 25, cardiology 21 and institute 18 probands) did not differ in age. We found that cardiorehabilitation has a positive effect on the quality of life of patients with CHF, if it is associated with social support, appropriate education and meets the conditions of a comprehensive approach. Patients rated their quality of life better compared to their quality of life a year ago. Outpatients are more satisfied with their health than patients in inpatient treatment, patients with a more severe manifestation of CHF have a greater anxiety from physical activity and therefore less motivation to move. All patients expressed dissatisfaction with their sex lives. Patients in outpatient treatment experience more depression. There were no differences between the subgroups in the evaluation of the degree of education by the nurse and the effect of the exercise on the subjective condition. All subgroups perceived the other person"s help more valuable than medical help. Patients from inpatient treatment have been more motivated to change their lifestyle on their own initiative and through the influence of information from healthcare professionals.

Conclusion

Comprehensive cardiovascular rehabilitation of patients with heart failure improves many of the prognostic indicators of heart failure, reduces mortality and the frequency of rehospitalizations, reduces treatment costs, improves quality of life. nevertheless, rehabilitation programs for chronic heart failure are being promoted only very slowly. The reason may be the absence of standard procedures, as well as organizational, economic and personnel demands.
Should I stay or should I go? An exploration of the decision-making behaviour of acute cardiac patients during the Covid-19 pandemic
Authors: Burton S , Hayes J , Scott-Morell N , Jones I , Sanders J , Walthall H , Wright J
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Liverpool John Moores University

Background

 The Covid-19 pandemic has resulted in excess mortality. With efforts to reduce population movement and the spread of the disease, non-emergency patients are deterred from seeking help. Reduction in the number of patients presenting with acute cardiac conditions has dropped significantly, impacting initial and follow-up treatment. In a national survey, 71% reported they were afraid to visit hospital due to fear of being exposed to the virus, and 46% worried about putting pressure on the health service. Internet searches for chest pain symptoms increased following the announcement of lockdown and public health messages, suggesting an influence of government messaging on patient behaviour. Current work suggests that patients are turning to informal support networks to facilitate decision making, while more formalised networks are blocked.

Purpose

 To qualitatively explore decision making of patients and their family members’ when faced with an acute cardiac event. This methodology provides insight into why patients made said decisions, and what factors influenced their decision making, during the Covid-19 pandemic.

Methods

 A qualitative methodology was employed using purposive sampling of cardiac patients, who had attended hospital during a Covid-19 lockdown. Data was collected using semi-structured, digitally recorded, telephone or video call interviews. Interviews were transcribed verbatim and subjected to thematic analysis.

Results

 Twenty-four participants were recruited, from three sites throughout England. 

Three themes were generated from the study

Reliance on informal support network, including disclosing their symptoms to family and friends, in turn leading to displaced or co-decision making. Secondly, a lack of awareness of cardiac symptoms leading to delayed help-seeking. Finally, an indirect Covid-19 effect, in which patients suggest that Covid-19 did not influence their decisions, yet a perception that their condition was non-urgent combined with a belief that GP services were limited resulted in delayed help-seeking

Conclusions

 Patients have turned to informal health support networks, especially when the cause of symptoms are unknown. While the presence of Covid-19 is not explicitly noted as being influential, indirect effects are noted. Findings highlight the need for informed public health messages, that allow those in need of treatment to access care as and when they need.
Decolonising Copyright: Reconsidering Copyright Exclusivity and the Role of the Public Interest in International Intellectual Property Frameworks
Authors: Kouletakis Jade
Published: July 2021

International intellectual property frameworks conceive of copyright exclusivity as a largely individualistic, westernised and capitalistic benefit which must be balanced against and limited by the non-commercial, competing public interest. This is expressed primarily by way of limitations to and exceptions from the norm of exclusivity recognised within these frameworks. This article argues for an alternative interpretation of copyright exclusivity as being justified by the public interest. However, unlike the works of Geiger et al., this interpretation is not premised upon the constitutional and quasi-constitutional patterns accounting for the public interest foundations of IP. Instead, it is premised upon the conceptualisations of indigenous communities within the Global South relating to exclusivity over intangible property for the communal benefit. This article argues that a paradigm shift in the international community at a supranational level, such as the removal of the TRIPS Agreement from the WTO, is needed in order to better reflect the norms and values of the Global South. By reassessing the nature of copyright exclusivity rather than delegating conversations about non-commercial communal needs to limitations and exceptions, the Global South is no longer seen as mere passive receptors of Western norms and values, but as active participants with inherent value in the creation of a truly global IP framework.
A visualizing analysis of Chinese character processing in the past 40 years (1981–2020)
Authors: Cheng Heben , Shinnick Elizabeth , Wang Xiaolu
Published: July 2021

The article uses CiteSpace to analyze the research of Chinese character processing through two analyses. A document co-citation analysis of the research in the past 40 years has found ten obvious clusters and described their transitional pattern by timeline visualization and betweenness centrality measurement. Additionally, an emerging trend analysis has also been carried out to describe the current directions of research in the field within the past 5 years, from which we found that multi-method research and acquisition of Chinese literacy are the most productive domains. By converging the results of the two analyses, we came up with a framework of combination between cognitive processes and anatomical structure, as well as a framework of development trajectory for Chinese character awareness. The two frameworks can be used to make predictions and show future directions in these two domains and other related domains, such as the research of Chinese character processing by Chinese foreign language learners.
Asteroseismology of overmassive, undermassive, and potential past members of the open cluster NGC 6791
Authors: Brogaard K , Arentoft T , Jessen-Hansen J , Miglio A
Published: July 2021

We perform an asteroseismic investigation of giant stars in the field of NGC 6791 with previous indications of atypical evolution. The analysis uses observations from Kepler and Gaia in combination with ground-based photometry, a literature radial-velocity study, and measurements of eclipsing binaries in the cluster. We derive mass, radius, effective temperature, evolutionary stage, and apparent distance modulus of each target. Among the investigated cluster giants we find clear evidence of overmassive and undermassive members, and non-members with strong hints of potential past membership. Our results indicate that about 10 per cent of the red giants in the cluster have experienced mass transfer or a merger. High-resolution high-S/N spectroscopic follow-up could confirm potential past membership of the non-members, and reveal whether certain element abundances might expose the non-standard evolution of overmassive and undermassive stars. If so, field stars of similar type could be identified as what they are, i.e. overmassive or undermassive stars, and not mistakenly classified as younger or older than they are.
Constraining properties of GRB central engines with X-ray flares
Authors: Yi Shuang-Xi , Xie Wei , Ma Shuai-Bing , Lei Wei-Hua , Du Mei
Published: July 2021

X-ray flares in gamma-ray bursts (GRBs) are believed to be generated by the late activities of central engine, and thus provide an useful tool to diagnose the properties of central objects. In this paper, we work on a GRB X-ray flare sample whose bulk Lorentz factors are constrained by two different methods and the jet opening angles are determined by the jet breaks in afterglow light curves. Considering a hyperaccreting stellar-mass black hole (BH) as the central engine of GRBs and the Blandford & Znajek process (BZ) as the jet production mechanism, we constrain the parameters of central engine by using the X-ray flare data. We find that the BZ mechanism is so powerful making it possible to interpret both GRB prompt emissions and bright X-ray flares. The wind parameter (p) and accreted mass (Md) fall into reasonable ranges. Our result is also applied to GRB 170817A. The late X-ray flare in GRB 170817A, if it is true, might not be a BH origin.
The origin of the dust extinction curve in milky way-like galaxies
Authors: Li Qi , Narayanan Desika , Torrey Paul , Davé Romeel , Vogelsberger Mark
Published: July 2021

We develop a cosmological model for the evolution of dust grains in galaxies with a distribution of sizes in order to understand the origin of the Milky Way dust extinction curve. Our model considers the formation of active dust in evolved stars, growth by accretion and coagulation, and destruction processes via shattering, sputtering, and astration in the ISM of galaxies over cosmic time. Our main results follow. Galaxies in our cosmological model with masses comparable to the Milky Way’s at z ∼ 0 exhibit a diverse range of extinction laws, though with slopes and bump strengths comparable to the range observed in the Galaxy. The progenitors of the Milky Way have steeper slopes, and only flatten to slopes comparable to the Galaxy at z ∼ 1. This owes to increased grain growth rates at late times/in high-metallicity environments driving up the ratio of large to small grains, with a secondary dependence on the graphite-to-silicate ratio evolution. The UV bump strengths depend primarily on the graphite-to-silicate ratio, and remain broadly constant in MW-like galaxies between z = 3 and z = 0, though show slight variability. Our models span comparable regions of bump-slope space as sightlines in the Galaxy do, though there is a lack of clear relationship between the model slopes and bump strengths owing to variations among galaxies in the graphite-to-silicate ratio. Our model provides a novel framework to study the origins and variations of dust extinction curves in galaxies over cosmic time.
A joint 2- and 3-point clustering analysis of the VIPERS PDR2 catalogue at z ∼ 1: breaking the degeneracy of cosmological parameters
Authors: Veropalumbo Alfonso , Sáez Casares Iñigo , Branchini Enzo , Granett Benjamin R , Guzzo Luigi , Marulli Federico , Moresco Michele , Moscardini Lauro , Pezzotta Andrea , de la Torre Sylvain
Published: July 2021

We measure the galaxy two- and three-point correlation functions at z = [0.5, 0.7] and z = [0.7, 0.9], from the Public Data Release 2 (PDR2) of the VIMOS Public Extragalactic Redshift Survey (VIPERS). We model the two statistics including a non-linear one-loop model for the two-point function and a tree-level model for the three-point function, and perform a joint likelihood analysis. The entire process and non-linear corrections are tested and validated through the use of the 153 highly realistic VIPERS mock catalogues, showing that they are robust down to scales as small as 10 $h^{-1} \, \mathrm{Mpc}$. The mocks are also adopted to compute the covariance matrix that we use for the joint two- and three-point analysis. Despite the limited statistics of the two (volume-limited) subsamples analysed, we demonstrate that such a combination successfully breaks the degeneracy existing at two-point level between clustering amplitude σ8, linear bias b1, and the linear growth rate of fluctuations f. For the latter, in particular, we measure $f(z=0.61)=0.64^{+0.55}_{-0.37}$ and f(z = 0.8) = 1.0 ± 1.0, while the amplitude of clustering is found to be σ8(z = 0.61) = 0.50 ± 0.12 and $\sigma _8(z=0.8)=0.39^{+0.11}_{-0.13}$. These values are in excellent agreement with the extrapolation of a Planck cosmology.