Search

Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support.Response rate was 31% (44 of 143). Thirty-four percent (15 of 44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22 of 44) of respondents reported that an MRI is obtained in nearly all patients with CA, and 32% (14 of 44) obtain an MRI in those who do not return to baseline neurological status. Poor neurological examination was reported as the most common factor (91% [40 of 44]) determining the timing of the MRI. Conventional sequences (T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted imaging/apparent diffusion coefficient) are routinely used at greater than 97% of centers. Use of advanced imaging techniques (magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI) were reported by less than half of centers.Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.

BACKGROUND AND PURPOSE: The incretin hormone, gastric inhibitory peptide/glucose-dependent insulinotropic polypeptide (GIP), secreted by the enteroendocrine K-cells in the proximal intestine, may regulate lipid metabolism and adiposity, but its exact role in these processes is unclear.EXPERIMENTAL APPROACH: We characterized in vitro and in vivo antagonistic properties of a novel GIP analogue, mGIPAnt-1. We further assessed the in vivo pharmacokinetic profile of this antagonist, as well as its ability to affect high-fat diet (HFD)-induced body weight gain in ovariectomised mice during an 8-week treatment period.KEY RESULTS: mGIPAnt-1 showed competitive antagonistic properties to the GIP receptor in vitro as it inhibited GIP-induced cAMP accumulation in COS-7 cells. Furthermore, mGIPAnt-1 was capable of inhibiting GIP-induced glucoregulatory and insulinotropic effects in vivo and has a favourable pharmacokinetic profile with a half-life of 7.2 h in C57Bl6 female mice. Finally, sub-chronic treatment with mGIPAnt-1 in ovariectomised HFD mice resulted in a reduction of body weight and fat mass.CONCLUSION AND IMPLICATIONS: mGIPAnt-1 successfully inhibited acute GIP-induced effects in vitro and in vivo and sub-chronically induces resistance to HFD-induced weight gain in ovariectomised mice. Our results support the development of GIP antagonists for the therapy of obesity.

BACKGROUND AND PURPOSE: Glucagon-like peptide-2 (GLP-2) is secreted postprandially by enteroendocrine L-cells and stimulates growth of the gut and bone. One GLP-2 analogue is approved for short bowel syndrome (SBS). To improve therapeutic efficacy, we developed biased GLP-2 receptor (GLP-2R) agonists through N-terminal modifications.EXPERIMENTAL APPROACH: Variants with Ala and Trp substitutions of the first seven positions of GLP-2(1-33) were studied in vitro for affinity, G protein activation (cAMP accumulation), recruitment of β-arrestin 1 and 2, and internalization of the human and mouse GLP-2R. The intestinotrophic actions of the most efficacious (cAMP) biased variant was examined in mice.KEY RESULTS: Overall, Ala substitutions had more profound effects than Trp substitutions. For both, alterations at positions 1, 3 and 6 most severely impaired activity. β-arrestin recruitment was more affected than cAMP accumulation. Among the Ala substitutions, [H1A], [D3A] and [F6A] impaired potency for cAMP-accumulation >20-fold and efficacy (E max ) to 48-87%, and were unable to recruit arrestins. The Trp substitutions, [A2W], [D3W] and [G4W] were also partial agonists (E max of 46-59%) with 1.7-12-fold decreased potencies in cAMP and diminished β-arrestin recruitment. The biased variants, [F6A], [F6W] and [S7W] induced less GLP-2R internalization compared to GLP-2, which induced internalization in a partly arrestin-independent manner. In mice, [S7W] enhanced the gut trophic actions with increased weight of the small intestine, increased villus height and crypt depth compared to GLP-2. CONCLUSION AND IMPLICATIONS: G protein-biased GLP-2R agonists with diminished receptor desensitization have superior intestinotrophic effect and could represent improved treatment of intestinal insufficiency including SBS.

Balanced reciprocal translocation carriers are at increased risk of producing gametes with unbalanced forms of the translocation leading to miscarriage, fetal anomalies, and birth defects. We sought to determine if genome-wide cell-free DNA based noninvasive prenatal screening (gw-NIPS) could provide an alternative to prenatal diagnosis for carriers of these chromosomal rearrangements. This pilot series comprises a retrospective analysis of gw-NIPS and clinical outcome data from 42 singleton pregnancies where one parent carried a balanced reciprocal translocation. Gw-NIPS was performed between August 2015 and March 2018. Inclusion criteria required at least one translocation segment to be ≥15 Mb in size. Forty samples (95%) returned an informative result; 7 pregnancies (17.5%) were high risk for an unbalanced translocation and confirmed after diagnostic testing. The remaining 33 informative samples were low risk and confirmed after diagnostic testing or normal newborn physical exam. Test sensitivity of 100% (95% confidence interval [CI]: 64.6–100%) and specificity of 100% (95% CI: 89.6–100%) were observed for this pilot series. We demonstrate that gw-NIPS is a potential option for a majority of reciprocal translocation carriers. Further confirmation of this methodology could lead to adoption of this noninvasive alternative.

‘Medically unexplained symptoms’ are positioned in mainstream healthcare discourse as an individualistic psychosocial phenomenon; this positioning occurs through application of a particular variant of the biopsychosocial model that downplays biological influences whilst ignoring critically informed social and structural influences in illness. A critical counter-narrative to mainstream healthcare narratives, one that assumes that power has a central role in constructing health-related discourse and contributing to health outcomes, is that medically unexplained symptoms serve a number of purposes for mainstream institutions, associated actors and society more broadly. These purposes include reinforcement of and justification for neoliberal socio-economic policies (notably, welfare reform), management of medical and broader societal uncertainty and seeking of moral legitimacy in the face of socio-structural injustices. This article examines socio-structural factors engendering and reinforcing current constructions of MUS that mainstream literature has hitherto ignored, discussing implications for research, clinician education and practice. A structurally competent approach to healthcare, one that acknowledges and addresses socio-structural influences in health and illness, would generate a more contextualised, holistic understanding of MUS, allowing for more equitable and truly patient-centred care whilst offering an exculpatory framework for clinical encounters.

Since the 1980s, concerts of video game music have become a widespread phenomenon attracting video game fans to classical venues across the globe. The commercial success of these concerts is exceptional and, I propose in my research, is partly due to their nostalgic appeal. This chapter examines the commercialisation of nostalgia by demonstrating nostalgia’s role in informing repertoire curation and examining how certain video games have become artifacts symbolic of childhood. Through case studies of Video Games Live, The Legend of Zelda: Symphony of the Goddesses and Pokémon: Symphonic Evolutions, this chapter demonstrates different methods used to invoke nostalgia. Two concepts of concert success will be discussed in this chapter as case studies will analyze (1) commercial success via the commodification of nostalgia and (2) the triggering of nostalgic feelings to invoke positive emotions and enhance audience enjoyment.

PurposeDecreased circulating levels of food-intake-regulating gut hormones have been observed in type 2 diabetes and obesity. However, it is still unknown if this is due to decreased secretion from the gut mucosal cells or due to extra-intestinal processing of hormones.MethodsWe measured intestinal hormone content and assessed morphological differences in the intestinal mucosa by histology and immunohistochemistry. Secretion of hormones and absorption of glucose and bile acids (BA) were assessed in isolated perfused mouse intestine.ResultsGIP (glucose-dependent insulinotropic polypeptide) and SS (somatostatin) contents were higher in the duodenum of control mice (p < 0.001, and ConclusionOur data suggest that differences regarding production and secretion are unlikely to be responsible for the altered circulating gut hormone levels in obesity, since enteroendocrine morphology and hormone secretion capacity were largely unaffected in DIO mice.

National research agencies are responsible for promoting excellent research that benefits all of society (1). Integrating sex, gender, and diversity analysis (SG&DA) into the design of research, where relevant, can improve research methodology, enhance excellence in science, and make research more responsive to social needs (2). National funding agencies—encouraged by scientists and social movements—have thus begun to implement policies to integrate sex, gender, and, more recently, diversity analysis into the grant proposal process, where these factors have been shown to play a role. We develop a five-part analytical framework for implementing and evaluating SG&DA policies, and use it to evaluate the quality of SG&DA policies for 22 major national funding agencies across six continents. By collecting emerging global practices for policy implementation, we seek to improve understanding of these policies and practices in efforts to enhance international collaborations and research excellence.

Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period. Methods This was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed. Results During the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (− 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1–9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p

Background Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus, frequently found in patients with high-risk arrhythmogenic mitral valve prolapse syndrome. It is unknown whether the annulus disjunction extends to the right side of the heart as tricuspid annulus disjunction (TAD), and whether it is associated with right ventricular electrical instability. Purpose We aimed to explore the presence of TAD, and if extended annulus disjunction was associated with ventricular arrhythmias. Methods We included patients with previously described MAD assessed by cardiac magnetic resonance imaging (CMR) in an ambispective cohort study. MAD and TAD was defined as ≥1 mm separation between the respective atrial wall-valve leaflet junction and the top of the ventricular myocardium. TAD was assessed in the lateral and inferior right ventricular free wall by means of the 4-chamber and right ventricular 2-chamber views, respectively. MAD circumference was assessed by a CMR study protocol with six left ventricular long axis views separated by 30 degrees. Mitral valve prolapse was defined as ≥2 mm superior displacement of any part of the mitral leaflets beyond the mitral annulus. Ventricular arrhythmias were defined as aborted cardiac arrest or non-sustained/sustained ventricular tachycardias recorded by electrocardiogram (ECG), stress ECG or Holter monitoring. Results We included 92 patients with MAD (62% female, age 47±16 years, 71% mitral valve prolapse). TAD was found in 48 (52%) patients, both in the lateral (n=40, 83%) and inferior (n=30, 63%) right ventricular free wall. Patients with TAD were older (age 51±16 years vs. 43±14 years, p=0.01), had greater MAD circumference (168±56° vs. 117±62°, p=0.001) and greater MAD distance (9.2±2.9 mm vs. 6.4±2.8 mm, p Conclusions TAD by CMR was highly prevalent in patients with MAD and was a marker of severe annulus disjunction and mitral valve prolapse. TAD was not associated with more ventricular arrhythmias. This novel marker warrants further research to explore the clinical implications of right-sided annulus disjunction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council

Rationale: Sleep apnea (SA) is highly prevalent in patients with atrial fibrillation (AF), and both conditions are associated with adverse cardiovascular outcomes.Objectives: To determine the effec...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority Background Mitral valve prolapse is a common finding in patients with Marfan (MFS) and Loeys-Dietz syndromes (LDS). Mitral annulus disjunction (MAD) is an atrial displacement of the hinge point of the mitral valve that frequently coexists with mitral valve prolapse, but its clinical relevance in connective tissue disorders is unknown. Purpose To explore the association between MAD and severity of mitral valve and aortic disease in patients with MFS and LDS. Methods We included consecutive MFS patients and LDS patients fulfilling established diagnostic criteria. MAD was identified by echocardiography and defined as the distance from the ventricular myocardium to the hinge point of the posterior mitral leaflet (Figure, panel A). Aortic surgery was defined as emergency surgery for aortic dissection or prophylactic aortic surgery for aortic aneurysm. We recorded the need of mitral valve surgery including mitral valve repair or replacement. Results We included 168 patients of whom 103 (61%) had MFS and 65 (39%) had LDS. We identified MAD in 69 (41%) patients. Aortic surgery was performed in 112 (67%) patients (27 dissections and 85 prophylactic interventions). Patients with MAD were younger at the time of aortic surgery than those without MAD (p log rank = 0.02) (Figure, panel B). Patients needing aortic surgery had greater MAD distance (8 [7-10] mm vs. 7 [6-8] mm, p = 0.04). Mitral valve surgery was performed in 12 (7%) patients, more frequently in patients with MAD than in those without (16% vs. 1%, p Conclusion MAD was frequent and detected in 41% of patients with MFS and LDS. MAD was associated with a more severe disease phenotype including aortic surgery at younger age and frequent need for mitral valve surgery. Screening patients with MFS and LDS for MAD may provide prognostic information and may be relevant in planning surgical interventions. Abstract Figure

Dietary fiber has been linked to improved gut health, yet the mechanisms behind this association remain poorly understood. One proposed mechanism is through its influence on the secretion of gut hormones, including glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2). We aimed to: 1) investigate the impact of a fiber deficient diet on the intestinal morphological homeostasis; 2) evaluate L-cell secretion; and 3) to ascertain the role of GLP-1, GLP-2 and Takeda G protein-receptor-5 (TGR5) signaling in the response using GLP-1 receptor, GLP-2 receptor and TGR5 knockout mice. Female C57BL/6JRj mice (n = 8) either received a standard chow diet or were switched to a crude fiber-deficient diet for a short (21 days) and long (112 days) study period. Subsequent identical experiments were performed in GLP-1 receptor, GLP-2 receptor and TGR5 knockout mice. The removal of fiber from the diet for 21 days resulted in a decrease in small intestinal weight (p < 0.01) and a corresponding decrease in intestinal crypt depth in the duodenum, jejunum and ileum (p < 0.001, p < 0.05, and p < 0.01, respectively). Additionally, colon weight was decreased (p < 0.01). These changes were associated with a decrease in extractable GLP-1, GLP-2 and PYY in the colon (p < 0.05, p < 0.01, and p < 0.01). However, we could not show that the fiber-dependent size decrease was dependent on GLP-1 receptor, GLP-2 receptor or TGR5 signaling. Intestinal permeability was increased following the removal of fiber for 112 days. In conclusion, our study highlights the importance of dietary fiber to maintain intestinal weight, colonic L-cell secretion and intestinal integrity.

Background There is strong evidence for an association between atrial fibrillation (AF) and sleep apnea (SA). Purpose We aimed to examine the effect of treatment with continuous positive airway pressure (CPAP) on the burden of AF. Methods After a run-in period for CPAP-tolerance, we randomly assigned 108 eligible patients between 18–75 years, who had paroxysmal AF and moderate-to-severe obstructive SA (apnea-hypopnea index (AHI)≥15), to receive either CPAP treatment (n=54) plus usual care or usual care alone (n=54) for five months. An implanted loop recorder measured time in AF continuously. The primary endpoint was the difference in change of AF burden (% of time in AF) between CPAP treatment and usual care from baseline (one month prior to randomization) to the last three months of the intervention period. Secondary endpoints were changes in quality of life assessed by the Short Form-36 (SF-36), Epworth Sleepiness Scale (ESS), and the Functional Outcomes of Sleep Questionnaire (FOSQ). Results Mean (SD) age was 62.4 (7.7) years, BMI 29.4 (4.2) kg/m2, ESS 7.9 (3.2), and 76.1% were men. In the intervention group, the mean duration of adherence to CPAP therapy was 4.3 hours/night. During treatment mean AHI decreased from 27.6 events/hour at baseline to 2.3 events/hour during follow-up. Mean time in AF decreased from 5.0%-4.3% in the control group and from 5.6%-4.1% in the CPAP group, but the difference in change was not significant (p=0.52). Sub-analysis of those using CPAP> Conclusion This is the first randomized controlled trial to assess the effect of treatment of SA on the burden of AF, and did not detect a difference between those treated with CPAP compared to usual care alone. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Oslo University Hospital is the main funding Source. ResMed Science Center provided an unrestricted grant.

There is strong evidence for an association between atrial fibrillation (AF) and sleep apnea (SA). We aimed to examine the effect of treatment with continuous positive airway pressure (CPAP) on the burden of AF. We randomly assigned 108 patients between 18-75 years, who had paroxysmal AF and moderate-to-severe obstructive SA (apnea-hypopnea index (AHI)≥15) to receive either CPAP treatment (n=54) plus usual care or usual care alone (n=54) for five months. An implanted loop recorder measured time in AF continuously. The primary endpoint was the difference in change of AF burden (% of time in AF) between CPAP treatment and usual care from baseline (one month pre randomization) to the last three months of the intervention period. Secondary endpoints were changes in quality of life assessed by the Short Form-36 (SF-36), Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ) Mean (SD) age was 62.4 (7.7) years, BMI 29.4 (4.2) kg/m², ESS 7.9 (3.2), and 76.1% were men. In the intervention group, the mean duration of adherence to CPAP therapy was 4.3 hours/night. During treatment mean AHI decreased from 27.6 events/hour at baseline to 2.3 events/hour during follow-up. Mean time in AF decreased from 5.0%-4.3% in the control group and from 5.6%-4.1% in the CPAP group, but the difference in change was not significant (p=0.52). Subanalysis of those using CPAP> This is the first randomized controlled trial to assess the effect of treatment of SA on the burden of AF, and did not detect a difference between those treated with CPAP compared to usual care alone.

PurposeTo describe our experience of offering simultaneous genetic carrier screening for cystic fibrosis (CF), fragile X syndrome (FXS), and spinal muscular atrophy (SMA).MethodsCarrier screening is offered through general practice, obstetrics, fertility, and genetics settings before or in early pregnancy. Carriers are offered genetic counseling with prenatal/preimplantation genetic diagnosis available to those at increased risk.ResultsScreening of 12,000 individuals revealed 610 carriers (5.08%; 1 in 20): 342 CF, 35 FXS, 241 SMA (8 carriers of 2 conditions), approximately 88% of whom had no family history. At least 94% of CF and SMA carriers' partners were tested. Fifty couples (0.42%; 1 in 240) were at increased risk of having a child with one of the conditions (14 CF, 35 FXS, and 1 SMA) with 32 pregnant at the time of testing. Of these, 26 opted for prenatal diagnosis revealing 7 pregnancies affected (4 CF, 2 FXS, 1 SMA).ConclusionThe combined affected pregnancy rate is comparable to the population risk for Down syndrome, emphasizing the need to routinely offer carrier screening. The availability of appropriate genetic counseling support and a collaborative approach between laboratory teams, genetics services, health professionals offering screening, and support organizations is essential.

Balanced reciprocal translocation carriers are at increased risk of producing gametes with unbalanced forms of the translocation leading to miscarriage, fetal anomalies, and birth defects. We sought to determine if genome-wide cell-free DNA based noninvasive prenatal screening (gw-NIPS) could provide an alternative to prenatal diagnosis for carriers of these chromosomal rearrangements.This pilot series comprises a retrospective analysis of gw-NIPS and clinical outcome data from 42 singleton pregnancies where one parent carried a balanced reciprocal translocation. Gw-NIPS was performed between August 2015 and March 2018. Inclusion criteria required at least one translocation segment to be ≥15 Mb in size.Forty samples (95%) returned an informative result; 7 pregnancies (17.5%) were high risk for an unbalanced translocation and confirmed after diagnostic testing. The remaining 33 informative samples were low risk and confirmed after diagnostic testing or normal newborn physical exam. Test sensitivity of 100% (95% confidence interval [CI]: 64.6-100%) and specificity of 100% (95% CI: 89.6-100%) were observed for this pilot series.We demonstrate that gw-NIPS is a potential option for a majority of reciprocal translocation carriers. Further confirmation of this methodology could lead to adoption of this noninvasive alternative.

ObjectivesThe issue of polypharmacy and medication use in people with life limiting illness raises important questions from a clinical and ethical viewpoint. The objectives of our study were to (1) explore medication use among people with life limiting illness receiving hospice care; (2) apply consensus criteria to assess medication appropriateness; and (3) determine the overall pill burden in this patient population.MethodsSix hospices in the North East of England were included. All deceased adult patients who received hospice care in 2018 were eligible for study inclusion. Descriptive statistics were used to report medication details; while medication appropriateness was assessed according to consensus criteria developed by Morin and colleagues.ResultsSix hundred and ninety patients were included in the study. Patients were using a mean number of 8.8 medications per day, while polypharmacy was evident in 80% of patients. In terms of potentially questionable medication, patients were prescribed a mean number of 1.3 per day. Common potentially questionable medications included vitamin and mineral supplements, antihypertensives, antiplatelets, lipid regulating agents and anticoagulants. The pill burden in this population was also high with, on average, people using 13.7 oral doses per day.ConclusionsPolypharmacy is common in patients accessing hospice care, as is the use of potentially questionable medication. The pill burden in this patient population is also high, which may be an additional treatment burden to patients. Holistic deprescribing approaches for this population should be developed and implemented.

Background: The association between sleep apnea (SA) and atrial fibrillation (AF) is strong. SA is probably underdiagnosed in AF patients. Polysomnography (PSG) is time consuming and costly and a valid screening tool is warranted. Aims and Objectives: The aim was to determine if the Berlin Questionnaire (BQ) and the STOP-Bang Questionnaire (SBQ) can be used as a screening tool in patients with paroxysmal atrial fibrillation (PAF). Methods: We prospectively studied 565 PAF patients. Risk for sleep apnea was assessed with the BQ and the SBQ. SA was defined as an apnea-hypopnea index (AHI) ≥15/h obtained by polygraphy (PG) two nights at home. Sleep studies were analyzed by an experienced specialist, using standard American Academy of Sleep Medicine definitions. A BQ high risk subject was defined as ≥2 of 3 risk factors: (I) snoring; (II) daytime somnolence; and (III) hypertension or a body mass index (BMI) > 30 kg/m². A SBQ high risk subject was defined as ≥5 affirmative answers to the 8 STOP-Bang items. Results: Mean age was 60 (9) years and mean BMI 29 (4) kg/m². 238 (42%) had an AHI ≥ 15/h. According to SBQ low, intermediate and high risk of SA was 7%, 14% and 21% respectively. The SBQ score ≥3 was 84% sensitive and 45 % specific for diagnosis of SA. For those with low risk and high risk according to the BQ score 19% and 23% had SA, respectively. The BQ performed with 56% sensitivity and 70% specificity. Conclusions: Of two commonly used questionnaires to screen for SA, neither the SBQ nor the BQ questionnaire discriminated well between those with or without SA in patients with PAF. Until better screening tools are available PG or PSG needs to be used to detect SA in these patients.

Background: Recent studies have suggested a strong association between sleep apnea (SA) and atrial fibrillation (AF). Aims and Objectives: In this study we aimed to examine clinical predictors to identify SA and the prevalence and type of SA in patients with paroxysmal AF. Methods: We prospectively studied 578 patients with paroxysmal AF. SA was diagnosed using portable polygraphy two nights at home. Sleep studies were analyzed by an experienced specialist, using standard American Academy of Sleep Medicine definitions. The degree of subjective daytime sleepiness was assessed by Epworth Sleepiness Scale (ESS). Body composition data were collected using a body composition analyzer (Tanita BC-545N). We calculated differences in variables between SA categories by Chi-Square Test or ANOVA as appropriate. Results: 158 women (27 %) and 420 men (73%) were enrolled. Mean age (SD) was 60 (10) years and mean BMI 29 (4) kg/m². 477 (83%) of the patients had an apnea-hypopnea index (AHI) ≥ 5/h, while moderate/severe SA (AHI ≥ 15/h) was diagnosed in 243 patients (42%). The type of SA was predominantly obstructive, with mean AHI 15.3/h (12) (range 0.4/h-85.8/h). Mean central apnea index was 0.8/h (2). AHI increased with age, BMI, weight, neck-and waist circumference, body fat, visceral fat and metabolic age. Mean ESS score was 7 (4). There was no association between ESS and AHI/h, r=0.08. Conclusions: In our AF population the prevalence of SA (AHI ≥ 5/h) was 83 %, which is several times higher than in the general population (16%). The high prevalence of SA detected in this study may indicate that SA is under-recognized in patients with AF. We found a positive correlation between body composition and SA severity.

Background Repeat chlamydia infections are common, and the risk of receiving complications increases with the number of lifetime infections. However, retesting rates in the UK remain low and interventions to increase retesting have had variable effects. In order to change behaviour (e.g., to increase retesting), behavioural-science theoretical models may help identify influential factors. One such model, the COM-B Model proposes behaviour results from an interaction between capability, opportunity and motivation. The aim of this study was to identify theoretically-based demographic and psychosocial factors associated with retesting behaviour and intentions to retest amongst those previously diagnosed with chlamydia. Methods An online questionnaire was developed, based on a comprehensive literature review and expert and lay consultation. Participants were 263 young people (16–24 years) in the UK who had been diagnosed with chlamydia (via healthcare settings or online platforms). In addition to demographic questions, each measure was representative of COM-B components: susceptibility and severity, fear, stigma, shame, knowledge, social support, social norms, perceived advantages/disadvantages of retesting. Results 35% had not retested, the most common reason for which was unawareness of the need to retest (31%). In those who had not retested, moral norms, injunctive norms, and STI knowledge significantly predicted intentions to retest (F[1,53]=6.20,p=0.016,R2 =0.45,AdjR2=0.42). Retesters were slightly older and more likely to have had other STIs. The most common location of retest was a sexual health clinic (57%), followed by general practice (14%) and online services (11%). Multivariable regression demonstrated that social norms (injunctive, descriptive, and moral) significantly predicted having retested (F[1,171]=7.44, p=0.007,R2 =0.12,AdjR2=0.10]. Conclusion This research has identified potential targets for public health campaigns aimed at eliminating STIs. Specifically, future interventions should focus on social (e.g., social approval one expects from others for engaging in a responsible sexual health action) and psychological (awareness and education) to increase retesting rates. Disclosure No significant relationships.

Children with conduct problems benefit less from empirically supported interventions for disruptive behaviors when callous-unemotional (CU) traits (i.e., lack of empathy/guilt) are also present. Traditional “gold-standard” interventions for disruptive behavior disorders that focus primarily on improving parenting skills fail to address the core deficits in emotional processing and empathic responding unique to children with co-occurring conduct problems and CU traits (CP + CU). This case study presents a follow-up of the treatment of a young boy with severe disruptive behavior and pronounced CU traits using a novel, brief adjunctive treatment called Coaching and Rewarding Emotional Skills (CARES). Findings (a) indicate short-term improvements in empathic responding and emotion recognition with CARES and (b) provide preliminary support for supplementing parent training with a brief adjunctive intervention to improve socio-emotional behavior and CU traits. Novel targeted interventions for children with CP + CU are critically needed given their poor prognosis and long-term impairment.

The 2 dimensions of psychopathy as operationalized by various measurement tools show differential associations with psychopathology; however, evidence suggests that the statistical interaction of Factor 1 (F1) and Factor 2 (F2) may be important in understanding associations with psychopathology. Findings regarding the interactive effects of F1 and F2 are mixed, as both potentiating and protective effects have emerged. Moreover, approaches to measuring F1 (e.g., clinical interview vs. self-report) are based on different conceptualizations of F1, which may influence the interactive effects. The current study aims to (a) elucidate the influence of F1 and F2 on psychopathology by using both variable-centered and person-centered approaches and (b) determine whether the measurement of F1 influences the interactive effects of F1 and F2 by comparing the strength of interactive effects across F1 measures in a sample of over 1,500 offenders. Across analytic methods, there were very few cases in which F1 statistically influenced the association between F2 and psychopathology, such that F1 failed to evidence either potentiating or protective effects on F2. Furthermore, the conceptualization of F1 across psychopathy measures did not impact the interactive effects of F1 and F2. These findings suggest that F2 is probably driving the relations between psychopathy and other forms of psychopathology and that F1 may play less of a role in interacting with F2 than previously believed.

This chapter examines the progress of women's participation and representation in the House of Commons. It first considers women's descriptive representation in the House of Commons over the last century, with emphasis on the differences in the proportion of women Members of Parliament (MPs) elected by the main political parties. It explains improvements in the numbers of women MPs in the last decade or so, together with the party asymmetry, by reference to the supply and demand model of political recruitment. It then reviews arguments for women's equal participation in politics, taking into account how women's descriptive representation intersects with symbolic and substantive representation. It also discusses resistance to the claim that women's representation matters and concludes with an analysis of the masculinized nature of the political institution that women MPs inhabit, along with the recommendations made in the 2016 The Good Parliament report.