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Background Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD patients is challenging to assess in daily routine. Thus the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal. Methods A total of 558 (373 male/185 female) HD patients with a median age of 66 years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring, including wave intensity analysis [i.e. S:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8 months, 193 patients died (92 due to CV reasons). Results The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20–1.54], P  < .001} and CV [univariate HR 1.41 (95% CI 1.20–1.67), P  < .001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups. Conclusion This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal. [ABSTRACT FROM AUTHOR]

Regulation has a key role for medical devices throughout their lifecycle aiming to guarantee effectiveness and safety for users. Requirements of Regulation (EU) 2017/745 (MDR) have an impact on novel and previously approved systems. Identification of key stakeholders' needs can support effective implementation of MDR improving the translation to clinical practice of vascular ageing assessment. The aim of this work is to explore knowledge and perception of medical device regulatory framework in vascular ageing field. A survey was developed within VascAgeNet and distributed in the community by means of the EUSurvey platform. Results were derived from 94 participants (27% clinicians, 62% researchers, 11% companies) and evidenced mostly a fair knowledge of MDR (despite self-judged as poor by 51%). Safety (83%), validation (56%), risk management (50%) were considered relevant and associated with the regulatory process. Structured support and regulatory procedures connected with medical devices in daily practice at the institutional level are lacking (only 33% report availability of a regulatory department). Regulation was recognized relevant by the VascAgeNet community and specific support and training in medical device regulatory science was considered important. A direct link with the regulatory sector is not yet easily available. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with adverse CV outcomes. Vascular aging (VA), which is defined as the progressive deterioration of arterial function and structure over a lifetime, is an independent predictor of both AF development and CV events. A timing identification and treatment of early VA has therefore the potential to reduce the risk of AF incidence and related CV events. A network of scientists and clinicians from the COST Action VascAgeNet identified five clinically and methodologically relevant questions regarding the relationship between AF and VA and conducted a narrative review of the literature to find potential answers. These are: (1) Are VA biomarkers associated with AF? (2) Does early VA predict AF occurrence better than chronological aging? (3) Is early VA a risk enhancer for the occurrence of CV events in AF patients? (4) Are devices measuring VA suitable to perform subclinical AF detection? (5) Does atrial-fibrillation-related rhythm irregularity have a negative impact on the measurement of vascular age? Results showed that VA is a powerful and independent predictor of AF incidence, however, its role as risk modifier for the occurrence of CV events in patients with AF is debatable. Limited and inconclusive data exist regarding the reliability of VA measurement in the presence of rhythm irregularities associated with AF. To date, no device is equipped with tools capable of detecting AF during VA measurements. This represents a missed opportunity to effectively perform CV prevention in people at high risk. Further advances are needed to fill knowledge gaps in this field. [ABSTRACT FROM AUTHOR]

This article challenges the concept of a fixed target weight in hemodialysis (HD) patients. The authors conducted a study with 25 HD patients and used bioimpedance spectroscopy (BIS) measurements to analyze fluid status and body composition. They found that the patients' euvolemic body weight varied longitudinally, indicating that target weight might need to be adjusted in individual HD patients. The authors suggest that a soft target weight prescription could be more physiological and potentially reduce complications such as intradialytic hypotension. However, there are limitations to the study, including a small sample size and non-standardized recording of pre-dialysis weight. [Extracted from the article]

Assistive technologies have the potential for supporting people with memory complaints in their daily life. User-centered interaction design research helps developers to create systems that are suitable for users. The aim of this work is to describe the methodology and the results of the usability test for the first Memento prototype involving users. In each country, 5 subjects with different levels of cognitive reserve and technical proficiency were enrolled in Italy, Austria and Spain, respectively (15 subjects; 6 M; 9 F, age 72.8 ± 10.8 years, MMSE score 25.6 ± 1.6). Observation methods, performance metrics and the System Usability Scale were used to collect data. The results are presented in terms of design, technical problems, target-group-related challenges and usability perception from the participant perspective. Suggestions for improvement were pointed out by the users. Considering the usability scores interpretation, the first prototype was classified as "OK" and "Good" by users. The results of the Lab Trials provide important information on usability and the users' needs in order to improve the Memento prototype and to create a final system to be evaluated during the Field Trials phase of the project. The MEMENTO project mission is to improve the quality of life of people in the early and middle stages of dementia, by supporting the management of daily activities that are usually affected by the loss of memory and cognition. The Lab Trial phase is essential to have feedback on the usability of the Memento prototype to allow a better understanding of users' needs and expectations. [ABSTRACT FROM AUTHOR]

Arterial pulse waves (PWs) such as blood pressure and photoplethysmogram (PPG) signals contain a wealth of information on the cardiovascular (CV) system that can be exploited to assess vascular age and identify individuals at elevated CV risk. We review the possibilities, limitations, complementarity, and differences of reduced-order, biophysical models of arterial PW propagation, as well as theoretical and empirical methods for analyzing PW signals and extracting clinically relevant information for vascular age assessment. We provide detailed mathematical derivations of these models and theoretical methods, showing how they are related to each other. Finally, we outline directions for future research to realize the potential of modeling and analysis of PW signals for accurate assessment of vascular age in both the clinic and in daily life. [ABSTRACT FROM AUTHOR]

Introduction: Prescribing the ultrafiltration in hemodialysis patients remains challenging and might benefit from the information on absolute blood volume, estimated by intradialytic dialysate bolus administration. Here, we aimed at determining the relationship between absolute blood volume, normalized for body mass (specific blood volume, Vs), and ultrafiltration‐induced decrease in relative blood volume (∆RBV) as well as clinical parameters including body mass index (BMI). Methods: This retrospective analysis comprised 77 patients who had their dialysate bolus‐based absolute blood volume extracted routinely with an automated method. Patient‐specific characteristics and ∆RBV were analyzed as a function of Vs, dichotomizing the data above or below a previously proposed threshold of 65 ml/kg for Vs. Statistical methodology comprised descriptive analyses, two‐group comparisons, and correlation analyses. Findings: Median Vs was 68.6 ml/kg (54.9 ml/kg [Quartile 1], 83.4 ml/kg [Quartile 3]). Relative blood volume decreased by 6.3% (2.6%, 12.2%) over the entire hemodialysis session. Vs correlated inversely with BMI (rs = −0.688, p < 0.001). ∆RBV was 9.8% in the group of patients with Vs <65 ml/kg versus 6.0% in the group of patients with Vs ≥65 ml/kg (p = 0.024). The two groups did not differ significantly regarding their specific ultrafiltration volume, normalized for body mass, which amounted to 34.1 ml/kg and 36.0 ml/kg in both groups, respectively (p = 0.630). ∆RBV correlated inversely with Vs (rs = −0.299, p = 0.008). Discussion: The present study suggests that patients with higher BMI and lower Vs experience larger blood volume changes, despite similar ultrafiltration requirements. These results underline the clinical plausibility and importance of dialysate bolus‐based absolute blood volume determination in the assessment of target weight, especially in view of a previous study where intradialytic morbid events could be decreased when the target weight was adjusted, based on Vs. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic necessitated a decrease in non-Covid-19 related diagnostic and therapeutic procedures in many countries. We explored the impact on tertiary hypertension care. We conducted an electronic survey regarding 6 key procedures in hypertension care within the Excellence Center network of the European Society of Hypertension. Overall, 54 Excellence Centers from 18 European and 3 non-European countries participated. From 2019 to 2020, there were significant decreases in the median number per centre of ambulatory blood pressure monitorings (ABPM: 544/289 for 2019/2020), duplex ultrasound of renal arteries (Duplex RA: 88.5/55), computed tomographic/magnetic resonance imaging angiography of renal arteries (CT/MRI RA: 66/19.5), percutaneous angioplasties of renal arteries (PTA RA: 5/1), laboratory tests for catecholamines (116/67.5) and for renin/aldosterone (146/83.5) (p < 0.001 for all comparisons, respectively). While reductions in all assessed diagnostic and therapeutic procedures were observed in all annual 3-months periods in the comparisons between 2019 and 2020, the most pronounced reduction occurred between April and June 2020, which was the period of the first wave and the first lockdown in most affected countries. In this period, the median reductions in 2020, as compared to 2019, were 50.7% (ABPM), 47.1% (Duplex RA), 50% (CT/MRI RA), 57.1% (PTA RA), 46.9% (catecholamines) and 41.0% (renin/aldosterone), respectively. Overall differences in reduction between 3-month time intervals were statistically highly significant. Diagnostic and therapeutic procedures related to hypertension were dramatically reduced during the first year of the Covid-19 pandemic, with the largest reduction during the first lockdown. The long-term consequences regarding blood pressure control and, ultimately, cardiovascular events remain to be investigated. [ABSTRACT FROM AUTHOR]

Attractor reconstruction is a new way to quantify the morphology of a cardiovascular waveform by plotting all data points in the three-dimensional phase space, generating a trajectory of overlapping loops. The aim of this study is to show the feasibility of an automatic approach to quantify pulse wave attractors from a device-guided breathing study, and to link attractor features to pulse waveform features. The recently developed feature extraction technique is applied to arterial pulse waveform data of 30 patients with treated hypertension. The patients performed a device-guided slow breathing exercise. The generated attractors were categorized into three different shapes: triangular attractors, bent attractors and attractors with overlapping arms. The average height of the attractors continuously and progressively dropped from 41.8 [35.4, 55.1] AU to 34.5 [25.4, 47.3] AU (p < 0.001) during the breathing exercise. We have shown that the novel approach to quantify pulse wave attractors is feasible and can be used to detect changes in the morphology of arterial pulse waveforms. Device-guided slow breathing exercise has a shrinking effect on the average height of the attractors, which may indicate a reduction in blood pressure. [ABSTRACT FROM AUTHOR]

Many apoptotic thymocytes are generated during the course of T cell selection in the thymus, yet the machinery through which these dead cells are recognized and phagocytically cleared is incompletely understood. We found that the TAM receptor tyrosine kinases Axl and Mer, which are co-expressed by a specialized set of phagocytic thymic macrophages, are essential components of this machinery. Mutant mice lacking Axl and Mer exhibited a marked accumulation of apoptotic cells during the time that autoreactive and nonreactive thymocytes normally die. Unexpectedly, these double mutants also displayed a profound deficit in the total number of highly phagocytic macrophages in the thymus, and concomitantly exhibited diminished expression of TIM-4, CD163, and other non-TAM phagocytic engulfment systems in the macrophages that remained. Importantly, these previously unrecognized deficits were not confined to the thymus, as they were also evident in the spleen and bone marrow. They had pleiotropic consequences for the double mutants, also previously unrecognized, which included dysregulation of hemoglobin turnover and iron metabolism leading to anemia. [ABSTRACT FROM AUTHOR]

Medical devices are subject to strict regulatory and approval processes to enter the market and to be used by operators and patients. These are needed to guarantee the users' safety. The diferent activities of these processes have important implications for all involved stakeholders and for the whole lifecycle of a medical device. The aim of this work is to provide an overview of some key aspects of the new EU Medical Device Regulation and to show why researchers, innovators and clinicians should care about it. Awareness of regulatory requirements can improve the innovation process and its efciency in terms of both social and ethical impact, but this awareness needs to be raised in the upcoming months and years. One can shortly say "yes, one needs to take care" of the new EU Medical Device Regulation. First and foremost, it is crucial for the sake of the users' safety, which is the regulation's intrinsic goal. Second, it should not just be seen as an obstacle for new innovations in the medical domain, but as a chance as it can provide new opportunities. [ABSTRACT FROM AUTHOR]

In December 2021, the International Code of Conduct for Private Security Service Providers' Association (ICoCA) changed the definition of security services, expanding its scope and undertaking roles that include direct participation in hostilities. Christopher Kinsey and Christopher Mayer argue that, in promoting this broadened scope, the ICoCA did so without first identifying important principles and standards relevant to those new functions. Critically for the international order, the unintended consequences of these changes could be far reaching, legitimising quasi-mercenary organisations and fighting in combat.◼ [ABSTRACT FROM AUTHOR]

Background: Assistive technologies have the potential to facilitate everyday life of people with dementia and their families. Close collaboration with affected people and interdisciplinary research are essential to understand and address the needs of prospective users. In this study, we present the results of the evaluation of such an assistive system prototype. Aims: Challenges from the patient and caregiver side, technical and design problems and acceptance and usability with regard to our special target group were evaluated. Methods: MEMENTO, a system of two e-ink tablets and a smartwatch, was tested in the domestic environment of dementia patients. Thirty participants from Italy, Spain and Austria took part in a 3-month field trial and compared the MEMENTO system to traditional strategies in everyday life. Quantitative and qualitative data were collected and frequency of use of the system was monitored. Results: There were no significant changes in quantitative measurements, such as activities of daily living and caregiver burden over the duration of the 3-month field trial. More frequent usage was significantly correlated with positive attitude towards technology (r = 0.723, p < 0.05), but not with age. The design of the system was positively emphasized, reducing fear of the technology on the one hand and stigmatization on the other. Conclusion: We show that a positive attitude towards technology is the essential variable for successful implementation of such systems, regardless of age. Participants showed great interest in digital solutions and agreed that technological systems will help in maintaining independency of persons with cognitive dysfunction in the future. [ABSTRACT FROM AUTHOR]

The photoplethysmogram (PPG) signal is widely measured by clinical and consumer devices, and it is emerging as a potential tool for assessing vascular age. The shape and timing of the PPG pulse wave are both influenced by normal vascular aging, changes in arterial stiffness and blood pressure, and atherosclerosis. This review summarizes research into assessing vascular age from the PPG. Three categories of approaches are described: 1) those which use a single PPG signal (based on pulse wave analysis), 2) those which use multiple PPG signals (such as pulse transit time measurement), and 3) those which use PPG and other signals (such as pulse arrival time measurement). Evidence is then presented on the performance, repeatability and reproducibility, and clinical utility of PPG-derived parameters of vascular age. Finally, the review outlines key directions for future research to realize the full potential of photoplethysmography for assessing vascular age. [ABSTRACT FROM AUTHOR]

Medical devices are subject to strict regulatory and approval processes to enter the market and to be used by operators and patients. These are needed to guarantee the users' safety. The different activities of these processes have important implications for all involved stakeholders and for the whole lifecycle of a medical device. The aim of this work is to provide an overview of some key aspects of the new EU Medical Device Regulation and to show why researchers, innovators and clinicians should care about it. Awareness of regulatory requirements can improve the innovation process and its efficiency in terms of both social and ethical impact, but this awareness needs to be raised in the upcoming months and years. One can shortly say "yes, one needs to take care" of the new EU Medical Device Regulation. First and foremost, it is crucial for the sake of the users' safety, which is the regulation's intrinsic goal. Second, it should not just be seen as an obstacle for new innovations in the medical domain, but as a chance as it can provide new opportunities. [ABSTRACT FROM AUTHOR]

New Findings: What is the central question of this study?First, we validated easy‐to‐use oscillometric left ventricular ejection time (LVET) against echocardiographic LVET. Second, we investigated progression of left ventricular ejection time index (LVETI), pre‐ejection period index (PEPI), total electromechanical systole index (QS2I) and PEP/LVET ratio during 60 days of head‐down tilt (HDT).What is the main finding and its importance?The LVETosci and LVETecho showed good agreement in effect direction. Hence, LVETosci might be useful to evaluate cardiovascular responses during space flight. Moreover, the approach might be useful for individual follow‐up of patients with altered ejection times. Furthermore, significant effects of 60 days of HDT were captured by measurements of LVETI, PEPI, QS2I and PEP/LVET ratio. Systolic time intervals that are easy to detect might be used as parameters reflecting cardiovascular deconditioning. We compared left ventricular ejection time (LVET) measured via ultrasound Doppler on the left ventricular outflow tract with oscillometrically measured LVET, measured at the brachialis. Furthermore, we assessed the progression of the left ventricular ejection time index (LVETI), the pre‐ejection period index (PEPI), the Weissler index (PEP/LVET) and the total electromechanical systole index (QS2I) during prolonged strict head‐down tilt (HDT) bed rest, including 16 male and eight female subjects. Simultaneous oscillometric and echocardiographic LVET measurements showed significant correlation (r = 0.53 with P = 0.0084 before bed rest and r = 0.73 with P < 0.05 on the last day of bed rest). The shortening of LVET during HDT bed rest measured with both approaches was highly concordant in their effect direction, with a concordance rate of 0.96. Our results also demonstrated a significant decrease of LVETI (P < 0.0001) and QS2I (P = 0.0992) and a prolongation of PEPI (P = 0.0049) and PEP/LVET (P = 0.0003) during HDT bed rest over 60 days. Four days after bed rest, LVETI recovered completely to its baseline value. Owing to the relationship between shortening of LVETI and heart failure progression, the easy‐to‐use oscillometric method might not only be a useful way to evaluate the cardiovascular system during space flights, but could also be of high value in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: Older age is a substantial risk factor for serious illness from COVID-19. Moreover, isolation and quarantine are more likely to cause physical, mental and social deprivation in older age. Information and Communication Tools are means to prevent such consequences.Objective: This study aimed therefore to investigate the impact of the COVID-19 lockdown measures on the usage of an innovative technical support system deployed in Austria (AT) and Luxembourg (LU) consisting of several tools that allow independent living in older age.Methods: Thirty-nine older adults (11 male; 28 female) with a mean age of 74.3 (SD 7.3) years were included in the study. In total, 18 older people were recruited in AT and 21 in LU. Descriptive statistics were computed, and longitudinal models were fitted for technology use and self-reported mood.Results: The number of older adults using the system significantly decreased from the time before lockdown (39 [100%]) to during lockdown (26 [67%]) and thereafter (23 [59%]; p < 0.001). Multiple comparisons revealed a significant reduction in the average number of events for calendar and medication tools, but a substantial increase in communication and messaging events. Self-reported well-being declined during the lockdown and increased afterwards back to baseline levels.Conclusion: Communication was the main reason for using the support system. In addition, strategies and interventions are essential to support older adults when using information technology in the prolonged phases of the pandemic to sustain independent living.Clinical Trial Registration: The DAPAS protocol was published at www.researchgate.net. DOI: 10.13140/RG.2.2.24233.34401. [ABSTRACT FROM AUTHOR]

Neuropeptide Y (NPY) is a 36-amino-acid peptide member of a family also including peptide YY and pancreatic polypeptide, which are all ligands to Gi/Go coupled receptors. NPY regulates several fundamental biologic functions including appetite/satiety, sex and reproduction, learning and memory, cardiovascular and renal function and immune functions. The mesenteric circulation is a major source of NPY in the blood in man and this peptide is considered a key regulator of gut–brain cross talk. A progressive increase in circulating NPY accompanies the progression of chronic kidney disease (CKD) toward kidney failure and NPY robustly predicts cardiovascular events in this population. Furthermore, NPY is suspected as a possible player in accelerated cognitive function decline and dementia in patients with CKD and in dialysis patients. In theory, interfering with the NPY system has relevant potential for the treatment of diverse diseases from cardiovascular and renal diseases to diseases of the central nervous system. Pharmaceutical formulations for effective drug delivery and cost, as well as the complexity of diseases potentially addressable by NPY/NPY antagonists, have been a problem until now. This in part explains the slow progress of knowledge about the NPY system in the clinical arena. There is now renewed research interest in the NPY system in psychopharmacology and in pharmacology in general and new studies and a new breed of clinical trials may eventually bring the expected benefits in human health with drugs interfering with this system. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) perturbs the crosstalk with others organs, with the interaction between the kidneys and the heart having been studied most intensively. However, a growing body of data indicates that there is an association between kidney dysfunction and disorders of the central nervous system. In epidemiological studies, CKD is associated with a high prevalence of neurological complications, such as cerebrovascular disorders, movement disorders, cognitive impairment and depression. Along with traditional cardiovascular risk factors (such as diabetes, inflammation, hypertension and dyslipidaemia), non-traditional risk factors related to kidney damage (such as uraemic toxins) may predispose patients with CKD to neurological disorders. There is increasing evidence to show that uraemic toxins, for example indoxyl sulphate, have a neurotoxic effect. A better understanding of factors responsible for the elevated prevalence of neurological disorders among patients with CKD might facilitate the development of novel treatments. Here, we review (i) the potential clinical impact of CKD on cerebrovascular and neurological complications, (ii) the mechanisms underlying the uraemic toxins' putative action (based on pre-clinical and clinical research) and (iii) the potential impact of these findings on patient care. [ABSTRACT FROM AUTHOR]

Sudden proliferation of contractors in armed conflict and post-conflict situations and severe incidents in the first decade of this century drove to securitization of their regulation. Accomplishments included establishment of international principles and national regulations that improved contracting processes of Western governments and the practices of these contractors. The appearance of Russian-affiliated mercenary-like entities and assertions of their moral equivalence to western private military and security companies (PMSCs) threaten the outcome of the securitization effort. Further, the Russian model of mercenary-like entities may proliferate, propping up totalitarian governments and destabilizing at-risk democracies. We argue that re-securitization is necessary to safeguard the current progress in limiting the internationally accepted governmental use of PMSCs in military operations. This re-securitization must include addressing vocabulary and reviewing existing legal obligations regarding combat provider companies to determine applicability of existing law and make recommendations for good practices to set ordinary regulatory processes back on track. [ABSTRACT FROM AUTHOR]

This paper examines the contribution of out-of-town second-house buyers to mispricing in the housing market. We show that demand from out-of-town second-house buyers during the mid 2000s predicted not only house-price appreciation rates but also impliedto- actual-rent-ratio appreciation rates, a proxy for mispricing. We then apply a novel identification strategy to address the issue of reverse causality. We give supporting evidence that out-of-town second-house buyers behaved like misinformed speculators, earning lower capital gains (misinformed) and consuming smaller dividends (speculators). [ABSTRACT FROM AUTHOR]

In December 2019, an outbreak of pneumonia caused by a novel Coronavirus (COVID-19) spread rapidly worldwide. Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, the cardiovascular system is extensively affected at multiple levels. Due to the unprecedented consequences of the COVID-19 pandemic, the ARTERY society decided to launch the Covid-19 effects on ARTErial StIffness and vascular AgeiNg (CARTESIAN) study — the first international multicentre study into the effects of COVID-19 on non-invasive biomarkers of vascular ageing. The main study objective is to evaluate the presence of Early Vascular Ageing (EVA) 6 and 12 months after COVID-19 infection. Secondary objectives are to study the effect of COVID-19 disease severity on EVA, to investigate the role of psychosocial factors in COVID-19 induced EVA, and to investigate the potential modifying effect of comorbidities and chronic treatments. In the CARTESIAN study, a broad array of cardiovascular measurements, including carotid-femoral pulse wave velocity, central blood pressure, carotid ultrasound, brachial flow-mediated dilatation, will be performed. To date, 43 centres from 21 countries have agreed to participate, with an expected study population of >2500 individuals. To our knowledge, CARTESIAN will be the first study to provide insight into the relationship between COVID-19, its severity, and early vascular ageing in a large cohort, potentially enabling future care and diagnostics to be more focused on the most vulnerable. [ABSTRACT FROM AUTHOR]

VascAgeNet is a new European network which will join forces in order to refine, harmonize and promote the vascular ageing concept. It aims to bring innovations in cardiovascular research from bench to bedside and to establish assessment of vascular ageing in clinical practice. The interdisciplinary, inter-country and intersectional approach will enable all important players at the different stages of the innovation process to come together, as recommended in the triple or quadruple helix model of innovation, in order to guarantee best solutions. This is deemed necessary in order for economic and revolutionary solutions to be fit for wide-spread clinical use, especially in low-income and inclusiveness target countries. Thus, a clear case exists for a strong collaboration between science and industry, to foster innovations and breakthroughs in vascular ageing in order to improve clinical practice and to reduce the burden of cardiovascular diseases globally. [ABSTRACT FROM AUTHOR]

Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality worldwide, regardless of gender, ethnicity or income. Evidence that vascular age, as opposed to chronological age, is better related to the prognosis of CVD is convincing. Despite recent technological advances for the measurement of vascular ageing, unmet needs remain which currently limit the assessment of vascular ageing in routine clinical practice. These unmet needs include: (1) lack of easy-to-use, affordable techniques/devices, (2) insufficient validation in clinical settings, (3) fragmentation of expertise in few research laboratories globally, and (4) lack of investigator/research driven intervention studies and head-to-head comparisons between different measurement techniques. This paper summarises how a recently awarded European COoperation in Science and Technology (COST) Action on Vascular Ageing (VascAgeNet) will address these unmet needs. The broad aim of the COST Action VascAgeNet is to establish a network which will work to refine, harmonize and promote the use of vascular ageing biomarkers, in order to improve clinical practice and to reduce the burden of CVD globally. [ABSTRACT FROM AUTHOR]

Background: Steady state hemodynamics [Stroke Volume - SV, cardiac output, peripheral resistance (Rp)] have attracted researchers in hypertension for decades. However, due to technical difficulties, they never entered clinical medicine. Objective: To investigate the performance of a model-based algorithm, utilizing brachial pressure waveforms obtained with a cuff, to estimate stroke volume. The model combines a modified three-element like Windkessel system and transmission line theory. Participants and Methods: In study 1, 97 patients with reperfused acute myocardial infarction and two healthy controls underwent cardiac magnetic resonance imaging (1.5 Tesla Magnetom, Siemens, Germany), and SV was measured with standard protocols from short axis cine images (11 slices). In study 2, 19 healthy individuals (12 females) had SVs measured with inert gas rebreathing at rest, and during light exercise (20 watts) on a bicycle ergometer. In both studies, model-based SV, estimated with a brachial cuff, was the comparator. Results: In study 1, both SVs were moderately correlated (r = 0.54, p < 0.001). Using the method of Bland–Altman, mean difference between both methods was 8.7 ml (1.96 limits of agreement were 36.7 and –19.3 ml), with no systematic bias. In study 2, both SVs were moderately correlated at rest (r = 0.63, p = 0.004) and at light exercise (r = 0.70, p = 0.0057). Using the method of Bland-Altman, mean difference between both methods was 8.6 ml (1.96 limits of agreement were 39.2 and –22.0 ml) at rest, and 42.7 ml (1.96 limits of agreement were 95.4 and –10.1 ml) at light exercise. Conclusion: Brachial oscillometry and mathematical modeling provide a reasonable estimate of SV under static conditions, which may be a useful addition to 24-h measurements of blood pressure and pulsatile hemodynamics. [ABSTRACT FROM AUTHOR]

Background: Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods: A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results: During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69–92.03; P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS. Conclusion: Independent of known risk factors, HRT assessment allows identification of hemodialysis patients with low, intermediate, and high risk of cardiovascular mortality. Future prospective studies are needed to translate risk prediction into risk reduction in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Prior empirical evidence regarding the impact of dividend taxes on firm valuation is mixed. This study avoids some of the complications encountered in previous empirical work by exploiting institutional characteristics of REITs, such as their limited discretion over dividend policy and the relative transparency of REIT assets. We regress the market value of equity on the market value of assets and tax basis, which creates tax deductions that lower future dividend taxes without affecting future pretax cash flow. We find that firm value is positively related to tax basis, suggesting that future dividend taxes are capitalized into share prices. [ABSTRACT FROM AUTHOR]

Background: Regulation is part of the technology innovation process and has a key role within the lifecycle of a medical device aiming at ensuring effectiveness and safety for users (1). Ever-increasing regulatory requirements (e.g., the Regulation MDR (EU) 2017/745) impact on the development of novel and already approved systems (2, 3). Debating and raising awareness is important since it can improve the transfer of knowledge and expertise among the relevant stakeholders. Thus, the implementation of a survey to explore knowledge and perception of the regulatory framework of medical devices for the assessment of vascular age can be helpful for the involved community. Methods: A multidisciplinary team including clinicians, researchers and developers from VascAgeNet was established to design and implement a digital questionnaire. A secure, open-source, two-factor authentication system for generation, distribution, and data collection of the survey supported by the European Commission (EUSurvey, https://ec. europa. eu/eusur vey) was adopted. Results: The questionnaire has received ethical clearance by National Council of Research, Italy (Notification 0063984/2021) and University College London (17999/002) Research Ethics Committees and is being distributed digitally (e.g., within VascAgeNet, Artery Society etc.). The anonymous questionnaire is available at https://ec. europa. eu/eusur vey/runner/REGUL ATORY Surve y2022 or by scanning the QR code below, it takes approximately 10 min to complete. Conclusions: A survey related to regulation and medical devices for vascular ageing assessment has been developed and is available for the community. The results could inspire concrete actions reducing gap between research and clinical practice. [ABSTRACT FROM AUTHOR]

Stress is an increasing burden for our society and related to cardiovascular (CV) parameters and diseases. Effects of mental or physical stress were observed in CV parameters during task completion and recovery. These effects were measured using a novel handheld device, which can be incorporated in mHealth solutions. [ABSTRACT FROM AUTHOR]