Abstract
The QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in ...the general population is poorly studied. So we aimed to explore if increased QRS duration from the age of 50–60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n = 86) or missing value of QRS duration in 2003 (n = 127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS < 4 ms, group 2: 4 ms ≤ ΔQRS < 8 ms, group 3: ΔQRS ≥ 8 ms. Endpoints were major cardiovascular events. And we found compared with men in group 1 (ΔQRS < 4 ms), men with ΔQRS ≥ 8 ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07–2.27, P = 0.022). In conclusion, in this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60 and the increased QRS duration in middle age is an independent predictor of major cardiovascular events.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Patients with neuropathic pain are heterogeneous in etiology, pathophysiology, and clinical appearance. They exhibit a variety of pain-related sensory symptoms and signs (sensory profile). Different ...sensory profiles might indicate different classes of neurobiological mechanisms, and hence subgroups with different sensory profiles might respond differently to treatment. The aim of the investigation was to identify subgroups in a large sample of patients with neuropathic pain using hypothesis-free statistical methods on the database of 3 large multinational research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, and Neuropain). Standardized quantitative sensory testing was used in 902 (test cohort) and 233 (validation cohort) patients with peripheral neuropathic pain of different etiologies. For subgrouping, we performed a cluster analysis using 13 quantitative sensory testing parameters. Three distinct subgroups with characteristic sensory profiles were identified and replicated. Cluster 1 (sensory loss, 42%) showed a loss of small and large fiber function in combination with paradoxical heat sensations. Cluster 2 (thermal hyperalgesia, 33%) was characterized by preserved sensory functions in combination with heat and cold hyperalgesia and mild dynamic mechanical allodynia. Cluster 3 (mechanical hyperalgesia, 24%) was characterized by a loss of small fiber function in combination with pinprick hyperalgesia and dynamic mechanical allodynia. All clusters occurred across etiologies but frequencies differed. We present a new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles. These 3 profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.
Land use affects the global climate through greenhouse gas and aerosol emissions, as well as through changes in biophysical properties of the surface. Anthropogenic land use change over time has ...caused substantial climate forcing related to albedo, i.e. the share of solar radiation reflected back off the ground. There is growing concern that albedo change may offset climate benefits provided by afforestation, bioenergy or other emission reduction measures that affect land cover. Conversely, land could be managed actively to increase albedo as a strategy to combat global warming.
Albedo change can be directly linked to radiative forcing, which allows its climate impact to be compared with that of greenhouse gases in Life Cycle Assessment (LCA). However, the most common LCA methods are static and linear and thus fail to account for the spatial and temporal dependence of albedo change and its strength as a climate forcer. This study sought to develop analytical methods that better estimate radiative forcing from albedo change by accounting for spatial and temporal variations in albedo, solar irradiance and transmission through the atmosphere. Simplifications concerning the temporal resolution and aggregation procedures of input data were evaluated.
The results highlight the importance of spatial and temporal variations in determining the climate impact of albedo change in LCA. Irradiance and atmospheric transmittance depend on season, latitude and climate zone, and they co-vary with instantaneous albedo. Ignoring these dependencies led to case-specific errors in radiative forcing. Extreme errors doubled the climate cooling of albedo change or resulted in warming rather than cooling in two Swedish cases considered. Further research is needed to understand how different land use strategies affect the climate due to albedo, and how this compares to the effect of greenhouse gases. Given that albedo change and greenhouse gases act on different time scales, LCAs can provide better information in relation to climate targets if the timing of flows is considered in life cycle inventory analysis and impact assessment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A model simulating an autonomous battery electric vehicle system for agricultural field use was created, assuming a 200-ha conventional cereal farm in Swedish conditions. The different subsystems ...were verified against sources in the literature, field experiments and general common practice. The model was used to compare two different charging systems (conductive charging and battery exchange) for battery electric tractors to each other. A comparative simulation was made with conventional diesel systems (fully autonomous or manned for 10 h d−1). The simulation results indicated that battery exchange was generally a faster system than conductive charging. The results also showed that both electric systems were able to achieve similar active time during spring field operations as a corresponding system of a simulated manned diesel tractor for battery sizes from 50 kWh and charge powers from 50 kW.
•A dynamic discrete-event model of a 200-ha Swedish grain farm was constructed.•Autonomous electric tractors and diesel counterparts were simulated and compared.•Weather and charging queues had high impacts on time requirements.•Electric tractors compared well with manned diesel systems in spring operations.•Battery exchange systems outperformed conductive charging in most cases studied.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The forest sector can play a pivotal role in mitigating climate warming by decreasing emissions to the atmosphere and increasing carbon removals. In an expanding bioeconomy, the pulp and paper ...industry provides opportunities for various low‐carbon wood products with promising substitution effects. However, assessing climate effects of wood product systems is complex and requires a holistic approach. The objective of this study was to advance time dynamic climate impact assessment of a bioeconomically promising wood product from a system perspective. For this purpose, a time dynamic life cycle assessment was conducted on a pulp‐based beverage carton. The assessment included fossil value chain emissions from cradle to grave, effects from biogenic carbon in a eucalyptus plantation, and credits from substitution. A polyethylene terephthalate (PET) bottle was considered for material substitution (MS) and differing marginal electricity and heat mixes for energy substitution. The results revealed dominating climate warming from value chain emissions and slight offsetting by biogenic carbon from standing biomass and soil organic carbon, and short‐term carbon storage in the beverage carton. MS and displacing marginal energy mixes transformed the climate warming into a substantial total cooling effect. However, substitution effects varied strongly in terms of substitution factors and temperature change with varying replacement rate of the beverage carton and different marginal energy mixes. A climate cooling range of −0.8 · 10−15 to −1.8 · 10−15 K per unit of beverage carton by 2050 was found, highlighting potential relevance for climate policy making. Thus, production and use of wood‐based beverage cartons over PET bottles can have climate cooling effects. Further assessments on alternative forestry systems (e.g., Nordic forests) are needed to identify the role of biogenic carbon in holistic climate assessments, with dynamic substitution effects included to increase the validity.
In an expanding bioeconomy, the pulp and paper industry provides opportunities for various low‐carbon wood products with promising substitution effects. The objective of this study was to advance time dynamic climate impact assessment of a bioeconomically promising wood product from a system perspective. For this purpose, a time dynamic life cycle assessment (LCA) was conducted on a pulp‐based beverage carton. The results revealed dominating climate warming from value chain emissions and slight offsetting by biogenic carbon while material substitution and displacing marginal energy mixes transformed the climate warming into a substantial total cooling effect.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
BACKGROUND:Patients with congenital heart disease (CHD) are assumed to be vulnerable to atrial fibrillation (AF) as a result of residual shunts, anomalous vessel anatomy, progressive valvulopathy, ...hypertension, and atrial scars from previous heart surgery. However, the risk of developing AF and the complications associated with AF in children and young adults with CHD have not been compared with those in control subjects.
METHODS:Data from the Swedish Patient and Cause of Death registers were used to identify all patients with a diagnosis of CHD who were born from 1970 to 1993. Each patient with CHD was matched by birth year, sex, and county with 10 control subjects from the Total Population Register in Sweden. Follow-up data were collected until 2011.
RESULTS:Among 21 982 patients (51.6% men) with CHD and 219 816 matched control subjects, 654 and 328 developed AF, respectively. The mean follow-up was 27 years. The risk of developing AF was 21.99 times higher (95% confidence interval, 19.26–25.12) in patients with CHD than control subjects. According to a hierarchical CHD classification, patients with conotruncal defects had the highest risk (hazard ratio, 84.27; 95% confidence interval, 56.86–124.89). At the age of 42 years, 8.3% of all patients with CHD had a recorded diagnosis of AF. Heart failure was the quantitatively most important complication in patients with CHD and AF, with a 10.7% (70 of 654) recorded diagnosis of heart failure.
CONCLUSIONS:The risk of AF in children and young adults with CHD was 22 times higher than that in matched control subjects. Up to the age of 42 years, 1 of 12 patients with CHD had developed AF, and 1 of 10 patients with CHD with AF had developed heart failure. The patient groups with the most complex congenital defects carried the greatest risk of AF and could be considered for targeted monitoring.
The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve ...the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary task force of pain specialists. Here, we present the case for a reclassification of nervous system lesions or diseases associated with persistent or recurrent pain for ≥3 months. The new classification lists the most common conditions of peripheral neuropathic pain: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy. Conditions of central neuropathic pain include pain caused by spinal cord or brain injury, poststroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are captured in residual categories of ICD-11. Conditions of chronic neuropathic pain are either insufficiently defined or missing in the current version of the ICD, despite their prevalence and clinical importance. We provide the short definitions of diagnostic entities for which we submitted more detailed content models to the WHO. Definitions and content models were established in collaboration with the Classification Committee of the IASP's Neuropathic Pain Special Interest Group (NeuPSIG). Up to 10% of the general population experience neuropathic pain. The majority of these patients do not receive satisfactory relief with existing treatments. A precise classification of chronic neuropathic pain in ICD-11 is necessary to document this public health need and the therapeutic challenges related to chronic neuropathic pain.
Transitioning from a fossil economy to a bio-economy will inevitably increase the demand for biomass production. One strategy to meet the demand is to re-cultivate set-aside arable land. This study ...investigated the climate impact and energy potential of grass-based biogas produced using fallow land in Uppsala municipality, Sweden. The assessment was performed on regional level for more than 1000 individual sites, using the agro-ecosystem model DeNitrification DeComposition (DNDC) in combination with time-dynamic life cycle assessment methodology. The results showed that the system could significantly increase biogas production within the region, which would reduce the climate impact by 9950 Mg CO2-eq per year. Compared with diesel fuel, the grass-based biogas gave a GWP reduction of 85%. However, the site-specific GWP reduction showed large spatial variability, ranging between 102 and 79% compared with diesel fuel, depending on where in the region the grass was cultivated. Two alternative scenarios were investigated, increased mineral N fertilisation and inclusion of N-fixing crops in the feedstock mixture. The highest mitigation per biogas energy produced was found for the N-fixing scenario but, because of lower yields, this scenario had lower total mitigation potential for the region than the increased fertilisation scenario. The increased fertilisation scenario had a lower climate mitigation effect per biogas energy produced, but the highest mitigation potential when the whole region was considered, because of the increased biogas production. The method applied in this study can guide land-use planning of local energy production from arable land, also for other regions.
•The grass-based biogas production significantly reduced the regional climate impact.•The climate impact showed large spatial variation within the region.•The most suitable locations, from a mitigation perspective, were identified.•Increasing fertilisation intensity increased total mitigation for the region.•N fixing feedstock resulted in the highest mitigation per MJ.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Severe electrocardiographic (ECG) abnormalities in asymptomatic subjects correlate with cardiovascular risk.
Hypothesis
The role of minor ECG abnormalities is less well‐known. We evaluated ...the association between a negative T‐wave and mortality, as a possible marker for prognosis.
Methods
A prospective, population‐based cohort, examined at 50 years, and followed until death. Time to death (event rates) and predictive role of a negative T‐wave (Cox regression) were analyzed.
Results
Participants (n = 839) with a negative T‐wave (7.3%) had significantly higher blood pressure (BP) (mean systolic 157.9 mmHg vs 136.8 mmHg without negative T‐wave, P = <.0001). A negative T‐wave correlated with elevated risk (hazard ratio HR 95% CI confidence interval) for all‐cause and cardiovascular (CV) death (1.59 (1.20‐2.11) P = .0012 vs 1.91 (1.34‐2.73) P = .0004). The association remained after excluding coexisting Q/QS patterns and ST‐junction/segment depression ECG abnormalities (1.66 1.13‐2.44 P = .0098 for all‐cause vs 1.87 1.13‐3.09 P = .015 for CV death). Death from other causes was not associated with a negative T‐wave. A major negative T‐wave carried higher risk than a minor (2.17 1.25‐3.76 P = .0062 vs 1.78 1.13‐2.79 P = .012) for CV death.
Conclusion
A negative T‐wave at 50 years, in asymptomatic individuals, carried an increased risk of all‐cause and CV death during lifetime follow‐up.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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