Abstract
Background
The benefits of specific cardiac rehabilitation (CR) programme components on patient outcomes after myocardial infarction (MI) remain unclear, as does their relative predictive ...strength compared to patient-level predictors.
Purpose
To identify CR organizational and patient-level predictors for reaching risk factor targets at one-year post-MI.
Methods
This was an observational survey- and registry-based study. Data on CR organization at all 78 CR centres in Sweden was collected in 2016 and merged with individual patient data from nationwide registries (n=7549, median age 64 years, 24% females). Cross-validation resampled orthogonal partial least squares discriminant analysis identified predictors for reaching treatment targets for low-density lipoprotein-cholesterol (LDL-C<1.8 mmol/L), blood pressure (BP<140/90 mmHg) and smoking abstinence (yes/no). Predictors with Variables of Importance for the Projection (VIP) value >0.8 and 95% confidence intervals (CI) excluding zero, were considered meaningful.
Results
Of the 71 analysed organizational variables, 36 were identified as meaningful predictors for reaching LDL-C and 35 for BP targets (Figure 1). The strongest predictors (VIP 95% CI) for LDL-C and BP were: offering psychosocial management at initial CR assessment 2.09 1.70–2.49; 2.34 1.90–2.78, having a CR team psychologist 1.59 1.28–1.91; 2.00 1.46–2.55, having extended CR centre opening hours 2.17 1.95–2.40; 1.51 1.03–2.00, staff reporting satisfaction with CR centre facilities 1.55 1.07–2.04; 1.96 1.64–2.28, having a medical director 1.71 1.45–1.97; 1.47 1.07–1.87, nurses using protocols for antihypertensive and/or lipid lowering medication adjustment 1.58 1.35–1.81; 1.56 1.03–2.08, having operational team meetings 1.36 1.08–1.64; 1.34 0.99–1.70, and using audit data for quality improvement 1.00 0.79–1.20; 1.27 0.99–1.56. Offering pre-exercise-based CR (exCR) assessment and different modes of exCR were predictors for reaching both targets. The strongest patient-level predictor of reaching LDL-C target was low baseline LDL-C 3.90 3.25–4.56, and for BP it was having no history of hypertension 2.93 2.74–3.12. Second, participation in exCR was the strongest predictor for both outcomes 1.60 0.83–2.37; 1.50 1.15–1.86. For smoking abstinence, 5 organizational variables were identified as meaningful predictors, the strongest being prescription of varenicline by the centre physicians 1.98 0.13–3.84 (Figure 2). The strongest patient-level predictors were exCR participation 2.51 2.24–2.79 and socioeconomic status variables e.g., income 1.67 1.28–2.06, living with partner 1.47 0.84–2.09 and education 0.80 0.48–1.12.
Conclusion
The study identified multiple CR organizational and patient-level predictors for reaching key risk factor targets one-year post-MI. The results might contribute to defining the optimal composition of comprehensive CR programmes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) The Swedish Research Council for Health, Working Life and Welfare (FORTE)2) The Swedish Heart and Lung Foundation (Hjärt Lung Fonden)
Introduction: National data in incidence of lower extremity amputations in the population of South Korea is lacking. Diabetes mellitus is a major risk factor for lower extremity amputations. The ...prevalence of diabetes mellitus is increasing faster than previously estimated in South Korea. Therefore, we investigated the trend of lower extremity amputations not only in people with diabetes, but also in the total (medically documented) population.
Method: We gathered and analyzed the data of the medically documented population, aged 20 years or older, from the Korean Health Insurance Service claims database between 2003 and 2021.
Results: Since 2003, incidence of lower extremity amputations among the total population has steadily increased, more than doubling by 2021 (6.8 to 14.5 amputations per 100,000 of population). The contribution of diabetes mellitus on lower extremity amputation has also elevated from 47% in 2003 to 70% in 2021. During the study period, the incidence of lower extremity amputations was consistently higher by more than three times in men (21.6) than in women (7.3), amputations per 100,000 of population in 2021. When foot amputations were classified by lower extremity parts, the proportion of major amputations (above ankle) has decreased slightly. In the last 10 years, the frequency and proportion of three or more repeated foot amputations has reduced (431 (9.2%) to 207 (4.1%)).
Conclusion: We reported the increasing trend of lower extremity amputation between 2003 and 2021 according to the increase in the prevalence of diabetes mellitus in South Korea. Among all lower extremity amputations, the major amputations and multiple amputations, 3 or more times, are decreasing.
Disclosure
J.Jeon: None. K.Lee: None. N.Kim: None. J.Back: None. N.Lee: None. S.Han: None. H.Kim: None. D.Kim: None. T.Kim: None. S.An: None.
We reanalyze data collected with the DarkSide-50 experiment and recently used to set limits on the spin-independent interaction rate of weakly interacting massive particles (WIMPs) on argon nuclei ...with an effective field theory framework. The dataset corresponds to a total (16660 ± 270) kg d exposure using a target of low-radioactivity argon extracted from underground sources. We obtain upper limits on the effective couplings of the 12 leading operators in the nonrelativistic systematic expansion. For each effective coupling we set constraints on WIMP-nucleon cross sections, setting upper limits between 2.4 × 10−45 cm2 and 2.3 × 10−42 cm2 ( 8.9 × 10−45 cm2 and 6.0 × 10−42 cm2 ) for WIMPs of mass of 100 GeV/c2 ( 1000 GeV/c2) at 90% confidence level.
While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac ...rehabilitation programme characteristics is less well described.
The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention.
Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines.
There was a wide variation in programme duration (2-14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% (
= 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training (
= 76, 97%) and group educational sessions (
= 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% (
= 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent (
= 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% (
= 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent (
= 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases.
The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.
We have experimentally determined the production rate of 39Ar and 37Ar from cosmic ray neutron interactions in argon at sea level. Understanding these production rates is important for argon-based ...dark matter experiments that plan to utilize argon extracted from deep underground because it is imperative to know what the ingrowth of 39Ar will be during the production, transport, and storage of the underground argon. These measurements also allow for the prediction of 39Ar and 37Ar concentrations in the atmosphere which can be used to determine the presence of other sources of these isotopes. Through controlled irradiation with a neutron beam that mimics the cosmic ray neutron spectrum, followed by direct counting of 39Ar and 37Ar decays with sensitive ultralow background proportional counters, we determined that the production rate from cosmic ray neutrons at sea level is expected to be (759 ± 128) atoms / (k Ar day) for 39Ar, and (51.0 ± 7.4) atoms / (kgAr day) for 37Ar . We also performed a survey of the alternate production mechanisms based on the state of knowledge of the associated cross sections to obtain a total sea-level cosmic ray production rate of (1048 ± 133) atoms / (kg Ar day) for 39Ar, (56.7 ± 7.5) atoms / (kgAr day) for 37Ar in underground argon, and (92 ± 13) atoms / (kgAr day) for 37Ar in atmospheric argon.
Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves ...health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.
The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.
Optimizing cardiac rehabilitation centres' delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.
ClinicalTrials.gov. Identifier: NCT05889416 . Registered 2023-03-23.
The measurement of 37Ar has been proposed as a method of detecting underground nuclear testing. The isotope 37Ar is generated by neutron activation of calcium by the reaction, 40Ca(n, a)37Ar, and, as ...a noble gas, is able to migrate more freely underground. Pacific Northwest National Laboratory has developed a high throughput 37Ar collection and measurement system using modified Ultra-Low Background Proportional Counters (ULBPCs). This system is capable of collecting, purifying, and measuring radioactivity in argon from either atmospheric or soil gas samples. This process is automated, with minimal operator intervention. This paper describes quantification of 37Ar and how we account for varying background conditions. An example is provided in which 39Ar has been shown to be a significant background in some sample sets, created by process 39K(n,p)39Ar during an underground nuclear explosion that would also create 37Ar. To account for the large background of 39Ar, we fit the data with a constant plus exponential background model with Gaussian signal model and use the results of a constrained fit to calculate 37Ar activity. We discuss the methods used to purify and count samples. We discuss the impact of increased 39Ar backgrounds on the measurement of 37Ar.
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