Subsequent Events Research Articles

The Anglo-Saxon migration and the formation of the early English gene pool

The history of the British Isles and Ireland is characterized by multiple periods of major cultural change, including the influential transformation after the end of Roman rule, which precipitated shifts in language, settlement patterns and material culture1. The extent to which migration from continental Europe mediated these transitions is a matter of long-standing debate2–4. Here we study genome-wide ancient DNA from 460 medieval northwestern Europeans—including 278 individuals from England—alongside archaeological data, to infer contemporary population dynamics. We identify a substantial increase of continental northern European ancestry in early medieval England, which is closely related to the early medieval and present-day inhabitants of Germany and Denmark, implying large-scale substantial migration across the North Sea into Britain during the Early Middle Ages. As a result, the individuals who we analysed from eastern England derived up to 76% of their ancestry from the continental North Sea zone, albeit with substantial regional variation and heterogeneity within sites. We show that women with immigrant ancestry were more often furnished with grave goods than women with local ancestry, whereas men with weapons were as likely not to be of immigrant ancestry. A comparison with present-day Britain indicates that subsequent demographic events reduced the fraction of continental northern European ancestry while introducing further ancestry components into the English gene pool, including substantial southwestern European ancestry most closely related to that seen in Iron Age France5,6.

Computed tomography coronary angiography in non-ST-segment elevation myocardial infarction.

Electrocardiography and high-sensitivity cardiac troponin testing are routinely applied as the initial step for clinical evaluation of patients with suspected non-ST-segment elevation myocardial infarction. Once diagnosed, patients with non-ST-segment elevation myocardial infarction are commenced on antithrombotic and secondary preventative therapies before undergoing invasive coronary angiography to determine the strategy of coronary revascularisation. However, this clinical pathway is imperfect and can lead to challenges in the diagnosis, management, and clinical outcomes of these patients. Computed tomography coronary angiography (CTCA) has increasingly been utilised in the setting of patients with suspected non-ST-segment elevation myocardial infarction, where it has an important role in avoiding unnecessary invasive coronary angiography and reducing downstream non-invasive functional testing for myocardial ischaemia. CTCA is an excellent gatekeeper for the cardiac catheterisation laboratory. In addition, CTCA provides complementary information for patients with myocardial infarction in the absence of obstructive coronary artery disease and highlights alternative or incidental diagnoses for those with cardiac troponin elevation. However, the routine application of CTCA has yet to demonstrate an impact on subsequent major adverse cardiovascular events. There are several ongoing studies evaluating CTCA and its associated technologies that will define and potentially expand its application in patients with suspected or diagnosed non-ST-segment elevation myocardial infarction. We here review the current evidence relating to the clinical application of CTCA in patients with non-ST-segment elevation myocardial infarction and highlight the areas where CTCA is likely to have an increasing important role and impact for our patients.

Atmospheric model inversion using infrasound signals from the North Korean underground nuclear explosion and the subsequent collapse event in 2017

SUMMARY This study focuses on the infrasound signals from the September 2017 North Korean underground nuclear explosion (UNE17) and subsequent collapse event (SCE17) that occurred close to the autumnal equinox when the atmospheric temperature structure undergoes rapid change. Multiple arrivals, including contributions from local, diffracted and epicentral infrasound, generated by UNE17, were observed at eight infrasound arrays in the Korean Peninsula and one IMS infrasound station (IS45) in Russia while at the closest five arrays for SCE17 only epicentral infrasound was observed. The UNE17 signals provide the opportunity to explore the utility of each distinct arrival in constraining atmospheric conditions during the change associated with the equinox. The observed characteristics of the multiple epicentral infrasonic phases (celerity, backazimuth, phase velocity and spectra) suggest propagation paths through the tropospheric, stratospheric and thermospheric waveguides, although geometric ray paths based on a global atmospheric model at the time of the explosion predict only thermospheric returns. The absence of predicted stratospheric returns may reflect errors in the atmospheric models due to the lack of predicted stratospheric winds which are weak and changing close to the autumnal equinox or the limited resolution of the fine-scale structure not captured by current atmospheric models. The differences between the model predictions and the observations suggest that the numerical weather forecast models need to be modified to fully explain the observations. In order to explore the model space that can explain the UNE17 data set, an inversion scheme is applied to atmospheric wind model parameters constrained by the multi-array observations. Zonal and meridional wind profiles are parametrized using empirical orthogonal functions (EOFs) estimated from 1-yr of Ground-to-Space atmospheric specifications. A best-fitting atmospheric model is estimated using a Bayesian approach that assesses the uncertainty in the inverse solution using a joint likelihood function combining components of azimuth deviation, traveltime and phase velocity. The updated atmospheric models from six different EOFs inversions have up to 20 m s–1 stronger zonal and meridional wind speeds in the stratosphere compared to the original model, and explain the stratospheric observations in the data set. This investigation illustrates that modest changes to atmospheric wind models at the time of autumnal equinox can improve the prediction of stratospheric returns.

A coloristic image of the modern northern city (the example of Norilsk)

In this paper, mutual influence of the color and image of the city in the perception of the residents is studied with the example of the city of Norilsk located 300 km north of the Arctic Circle. The chronological span is limited to the present moment, however, part of the study concerns the period since the foundation of the city (1935). The aim of the study is to determine how the coloristics supports the image of the city in the minds of its residents. Concerning the methods, the study was divided into several blocks. In the first part (the actual palette of the city), the method of categorization of color carriers and method of generalization of color shades were used. In the sec-ond part (hypotheses about the contours of group images), the content-analysis of the social networks and media was used. In the third part (hypotheses testing), the methods of questionnaires and quota sampling were em-ployed. In the fourth block, in-depth interviews with Photo-Voice were conducted. As a result, it was found that coloristics is closely interconnected with the image of the territory. In particular, the use of bright colors in the ar-chitecture of the 1950s in Leninsky Prospect accurately identifies the historical events associated with the builders of the city (political prisoners of GULAG). The architecture of other historical periods is less contemptable, thus the events are not integrated into group images. Therefore, the city is associated with the talent and resilience of the prisoners and supports a sense of self-continuity of the exiled intellectuals among the inhabitants. The life in the city is still thought of through the categories of ‘heroism’, whereas all subsequent events are perceived as imposed (industrial exploitation of resources, type-design practice in building). Therefore, when the residents con-trapose the beauty of Leninsky Prospekt to the rest of the city, actually, the talent, intelligence, and respect to the nature are opposed to the degradation of the territory. The presence of the blue-colored buildings and symbolism of the city-forming company reinforces the image of Norilsk as a center of metallurgy, since the production is pre-sent in the city in the form of symbols. The image of Norilsk as an isolated city is enhanced by the difference in color between the back yard and street facades. The city is perceived by the residents as a decoration, its prob-lems are not interesting to external observers. The perception of the city as a larger category of the Far North is reflected in the coloristic image of the city.

Monitoring cell loss through repetitive deposition.

Touch DNA deposited on items can be visualised by using fluorescent nucleic acid staining dyes. It might be expected that if a person contacts items multiple times, then at each contact fewer cells should be transferred and deposited. Here we report on the use of Diamond Dye (DD) to monitor any reduction in cellular deposition during multiple contacts. A volunteer, who was assigned as a heavy shedder, was asked to deposit a thumbprint using both left and right thumbs for 15 s onto separate clean glass slides. Thumbprints were collected in triplicate with each mark made for 15 s. Immediately after deposition, a second and then third mark was made in the same way. The three consecutive depositions were repeated 30 times to create 90 tested thumbprints. The number of cells within each entire thumbprint was scored using a cell-counting program, developed in-house. The number of cells deposited by the second and third depositions showed a decrease in the cell number compared to the first deposition, by ~70% and ~85% respectively. There was no difference between the percentage of cell persistence from whole thumbprints (16 frames) compared to only scoring part of thumbprints (4 frames). The data obtained provide insight into how cells are deposited by touch and how many cells remain on the thumb for subsequent contact events. Such information may account for cell deposition when performing actions (e.g. loading a firearm or repetitively opening a closing zip-lock bag).

A Rapid Translational Immune Response Program in CD8 Memory T Lymphocytes.

The activation of memory T cells is a very rapid and concerted cellular response that requires coordination between cellular processes in different compartments and on different time scales. In this study, we use ribosome profiling and deep RNA sequencing to define the acute mRNA translation changes in CD8 memory T cells following initial activation events. We find that initial translation enables subsequent events of human and mouse T cell activation and expansion. Briefly, early events in the activation of Ag-experienced CD8 T cells are insensitive to transcriptional blockade with actinomycin D, and instead depend on the translation of pre-existing mRNAs and are blocked by cycloheximide. Ribosome profiling identifies ∼92 mRNAs that are recruited into ribosomes following CD8 T cell stimulation. These mRNAs typically have structured GC and pyrimidine-rich 5' untranslated regions and they encode key regulators of T cell activation and proliferation such as Notch1, Ifngr1, Il2rb, and serine metabolism enzymes Psat1 and Shmt2 (serine hydroxymethyltransferase 2), as well as translation factors eEF1a1 (eukaryotic elongation factor α1) and eEF2 (eukaryotic elongation factor 2). The increased production of receptors of IL-2 and IFN-γ precedes the activation of gene expression and augments cellular signals and T cell activation. Taken together, we identify an early RNA translation program that acts in a feed-forward manner to enable the rapid and dramatic process of CD8 memory T cell expansion and activation.

Midterm outcomes of AFX2 endografts used in combination with aortic cuffs

ObjectiveType III endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with the Endologix unibody endograft remain a major concern, despite fabric, system, and instructional updates. The purpose of this study was to examine real-world outcomes of repairing AAAs using the current version of the AFX2 main body in combination with an aortic cuff, specifically focusing on type III endoleaks and morphological changes of the endograft. MethodsWe recruited facilities in Japan that used AFX2 combined with an aortic cuff for at least five cases between April 2017 and March 2018. A total of 175 cases in 24 facilities were analyzed. Patients’ background information, including anatomic factors, operative findings, device component variations, and midterm outcomes at 3 years after the EVAR were collected. The data on computed tomography scans from cases registered as types I and III endoleaks and migration from each institute were sent to our department for verification. ResultsThe mean patient age was 74.6 ± 8.1 years, and 48 cases (27%) were saccular aneurysms. The mean fusiform and saccular AAA diameters were 50.5 ± 5.8 mm and 43.5 ± 8.9 mm, respectively. No in-hospital deaths occurred. Data at 3 years, including computed tomography images, of 128 cases were analyzed. Overall survival, freedom from aneurysm-related mortality, and freedom from reintervention rates at 3 years were 85.8%, 99.3%, and 87.3%, respectively. There were three, one, and three cases of types I, IIIa, and IIIb endoleaks without sac dilatations, respectively. Among five migration cases, one case of aortic cuff migration presented as a type Ia endoleak, and four cases demonstrated sideways displacement, one of which presented as a type IIIa endoleak. The sac regression and enlargement rates at 3 years were 41.4% and 20.5% in the fusiform group and 44.2% and 16.7% in the saccular group, respectively. The proximal neck diameter slightly increased from 20.8 ± 2.7 mm before the EVAR to 22.2 ± 4.6 mm after the repair. ConclusionsMidterm outcomes of the AFX2 used in combination with an aortic cuff were acceptable, considering the rates of types I and III endoleaks. However, there were cases of sideways displacement that could cause future type IIIa endoleaks. When the AFX2 is used in combination with an aortic cuff, close surveillance for endograft deformations and subsequent adverse events, including type III endoleaks, is needed.

Association of obstructive sleep apnoea with cardiovascular events in women and men with acute coronary syndrome.

The impact of sex on the association of obstructive sleep apnoea (OSA) with recurrent cardiovascular events following acute coronary syndrome (ACS) remains uncertain. This study sought to examine the association between OSA and long-term cardiovascular outcomes in women and men with ACS. In this prospective cohort study, we recruited 2160 ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. The primary end-point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischaemia-driven revascularisation or hospitalisation for unstable angina or heart failure. After exclusion of patients with failed sleep studies, central sleep apnoea, regular continuous positive airway pressure therapy and loss of follow-up, 1927 patients were enrolled. Among them, 298 (15.5%) were women and 1014 (52.6%) had OSA (apnoea-hypopnoea index ≥15 events·h-1). The prevalence of OSA was 43.0% and 54.4% in women and men, respectively. In 4339 person-years (median 2.9 years, interquartile range 1.5-3.6 years), the cumulative incidence of MACCE was significantly higher in OSA versus non-OSA groups in the overall population (22.4% versus 17.7%; adjusted hazard ratio (HR) 1.29, 95% CI 1.04-1.59; p=0.018). OSA was associated with greater risk of MACCE in women (28.1% versus 18.8%; adjusted HR 1.68, 95% CI 1.02-2.78; p=0.042), but not in men (21.6% versus 17.5%; adjusted HR 1.22, 95% CI 0.96-1.54; p=0.10). No significant interaction was noted between sex and OSA for MACCE (interaction p=0.32). The incremental risk in women was attributable to higher rates of hospitalisation for unstable angina and ischaemia-driven revascularisation. In hospitalised ACS patients, OSA was associated with increased risk of subsequent events, particularly among women. Female patients with ACS should not be neglected for OSA screening and dedicated intervention studies focusing on women with ACS and comorbid OSA should be prioritised.

Ore forming and reworking processes in the Xitieshan Pb–Zn deposit, Qinghai Province, China: Constraints from in situ trace-element and S isotope compositions of sulfides

Although volcanogenic massive sulfide (VMS) deposits always form in extensional settings, many have been reworked by metamorphism, deformation, and the circulation of hydrothermal fluids during subsequent accretionary events. The genesis of VMS deposits has been well documented, however, the mechanisms that rework the mineralization have been relatively poorly constrained. An understanding of these mechanisms, though, is critical to the development of robust mineral deposit models as they are capable of remobilizing ore-forming metals. The Xitieshan Pb–Zn deposit, located in Qinghai Province, western China, is the third largest Pb–Zn deposit in China, with a total Pb–Zn metal reserve of 6.4 million tons. The occurrence of laminated and non-laminated orebodies in the Xitieshan deposit make it an ideal candidate to i) constrain the effects of metamorphic and hydrothermal processes on remobilization of metals in these base-metal systems, and ii) assess the genetic nature of this deposit. This is accomplished here by integrating new S isotope data and trace-element chemistry of sulfides from laminated ores with previous information on regional and deposit geology, and deformation characteristics preserved by the mineralized system. The S isotope composition of pyrite and sphalerite grains from laminated ores are consistently positive and range from 2.08 ‰ to 5.81 ‰, indicative of mixing of reduced sulfur from three distinct sources — volcanic rocks, seawater and thermochemical reduced sulfate, which is typical of VMS deposits globally. Greigite (Fe3S4) grains in laminated ores exhibit oscillatory zonation with respect to Cu, Co, Mn, Sb, and Tl concentrations; such compositional variations indicate that at least some of the primary VMS mineralization characteristics have been preserved despite subsequent reworking by metamorphism, deformation, and hydrothermal circulation. Combined with the results of previous studies, a two-stage genetic model is proposed for the formation and modification of the Xitieshan Pb–Zn deposit — i) initial formation of the primary Pb–Zn mineralization with minor of Cu, and ii) subsequent metamorphism and hydrothermal reworking of the deposit, which did not completely destroy the textural and chemical characteristics of the primary mineralization.

Paleogene forest fragmentation and out‐of‐Africa dispersal explain radiation of the Paleotropical dung beetle tribe Epactoidini trib. nov. (Coleoptera: Scarabaeinae)

AbstractPaleotropical clades with largely disjunct distributions are ideal models for biogeographic reconstructions. The dung beetle genera Grebennikovius Mlambo, Scholtz & Deschodt, Epactoides Olsouffief and Ochicanthon Vaz‐de‐Mello are distributed in Tanzania, Madagascar and Réunion, and the Oriental region, respectively. We combine morphology and molecular dataset to reconstruct the phylogenetic relationships between these taxa. Our analyses corroborate previous hypotheses of monophyly of the group, which is here described as new tribe Epactoidini trib. nov. Grebennikovius is recovered as sister to Epactoides, while Ochicanthon emerges as sister to them both. The disjunct distribution of our focal clade is unusual within the subfamily Scarabaeinae. Bayesian divergence time estimates and ancestral range reconstructions indicate an African origin of the crown group of the tribe Epactoidini trib. nov. in the early mid Eocene, ca. 46 Ma. The divergence between Epactoides and its sister is dated to 32.3 Ma, while the crown age for the genus Ochicanthon is dated to 27 Ma. We investigate the factors that may have shaped the current distribution of the tribe Epactoidini trib. nov. The formation of the Gomphotherium landbridge, along with favourable environmental conditions would have allowed dry‐intolerant organisms, such as Ochicanthon, to disperse out of Africa. Remarkable climatic stability of the Eastern Arc Mountains was critical for the retention of the monotypic genus Grebennikovius. We suggest two subsequent overwater dispersal events: the migration of the most recent common ancestor (MRCA) of Epactoides from Africa to Madagascar (32.3–29.5 Ma); the lately dispersal of the MRCA of the today's extinct Epactoides giganteus Rossini, Vaz‐de‐Mello & Montreuil to Réunion island from Madagascar (3.4 Ma). We suggest that the high potential of dispersal of Epactoidini trib. nov. dung beetles and the strict association to forest habitat might have triggered two major radiations, one in Madagascar and one in the Oriental Region.

“Single Sparks” and Legacies: An Eventful Account of the May Fourth Movement

AbstractThe watershed in modern Chinese politics known as the May Fourth Movement (1919) offers insights into how a single protest event can quickly diffuse to other regions, draw in new participants and produce legacies in contentious politics. This article examines the May Fourth protests from the perspective of “eventful sociology” – an approach that examines how protests, repression and other contingent events link together to bring about landmark political episodes. It traces the sequence of protest and repression events in Beijing and draws on an original database of protest and repression events in Shanghai to emphasize the haphazard sequencing of actions and information flows that led the Chinese government to reverse its stance and concede to protestors’ demands. An eventful account illustrates how past protest sequences can produce a long-term impact on subsequent protest events. It also calls for greater awareness of “single sparks” that initiate protest sequences and unexpected political outcomes.

Anticoagulant use and associated outcomes in older patients receiving home palliative care: a retrospective cohort study.

Background:The benefits and harms of anticoagulants for people near the end of life are not well understood, nor is it known what proportion of patients discontinue these medications. We aimed to characterize anticoagulant use in older recipients of home palliative care and describe patient and provider characteristics, as well as outcomes associated with anticoagulant discontinuation in this group.Methods:Using linked administrative health databases, we conducted a population-based cohort study of patients aged 66 years and older who initiated home palliative care in Ontario from 2010 to 2018. We calculated the prevalence of anticoagulant use. We used multilevel logistic regression models to assess patient (e.g., sociodemographic, comorbidities) and physician (e.g., demographic, training, practice) factors associated with anticoagulant discontinuation after initiation of home palliative care. We defined discontinuation as either primary (no anticoagulant claim within 1.5 times the days’ supply of the previous prescription) or secondary (no subsequent anticoagulant claim at any time after the index date). In secondary analyses, we used cause-specific hazards regression to explore subsequent thrombotic and bleeding events associated with anticoagulant discontinuation, and multivariable logistic regression for location of death.Results:We identified 98 089 recipients of home palliative care, of whom 15.5% were taking anticoagulants at the time of the first palliative care visit. Depending on the definition of discontinuation, 18.0% to 24.4% of patients discontinued anticoagulants after the first home palliative care visit. Compared with warfarin, use of a direct oral anticoagulant (adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.43–0.56) and low-molecular-weight heparin (adjusted OR 0.56, 95% CI 0.47–0.66) were associated with a lower likelihood of discontinuation. Few patient or physician characteristics — and no comorbidities or indications for therapeutic anticoagulation — were associated with discontinuation. Anticoagulant discontinuation after beginning home palliative care was associated with similar rates of thrombosis (adjusted hazard ratio [HR] 1.06, 95% CI 0.81–1.39), lower rates of bleeding (adjusted HR 0.75, 95% CI 0.62–0.90) and a higher likelihood of a home death (adjusted OR 1.22, 95% CI 1.09–1.36) compared with continuing anticoagulation.Interpretation:Among recipients of home palliative care in Ontario, anticoagulant use is common, and discontinuation is not influenced by comorbidities or indication for anticoagulation. Physician preference may play an important role; patients should be made aware of their options toward the end of life and supported in shared decision-making.

Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based Study

Patients with ischemic stroke are considered a very high risk population for subsequent cardiovascular events and guidelines recommend intensive preventive strategies. However, there is no clear recommendation that patients with hemorrhagic stroke should also be regarded as a very high cardiovascular risk population. To compare the risk of subsequent cardiovascular morbidity/mortality between patients with incident hemorrhagic and ischemic stroke. Patients aged ≥18 years with incident hemorrhagic or ischemic stroke between 1998 and 2017 and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics data. The cohort included 32,091 patients with an overall follow-up of 381,237 person-years (median: 11.8 years). After adjusting for potential confounders, patients with incident hemorrhagic stroke had no significantly different risk of subsequent cardiovascular morbidity compared with patients with incident ischemic stroke-coronary heart disease (CHD; hazard ratio [HR]: 0.86, 95% confidence interval [CI]: 0.56-1.32), recurrent stroke (HR: 0.92, 95% CI: 0.83-1.02), peripheral vascular disease (PVD; HR: 1.15, 95% CI:0.56-2.38), or heart failure (HR: 1.03, 95% CI: 0.61-1.74). Patients with incident hemorrhagic stroke had significantly higher risk of subsequent cardiovascular disease (CVD)-related mortality (HR: 2.35, 95% CI: 2.04-2.72) and all-cause mortality (HR: 2.16, 95% CI: 1.94-2.41). Propensity-score matched analysis of 1,039 patients with hemorrhagic stroke and 1,039 with ischemic stroke showed similar risk in subsequent cardiovascular morbidity-CHD (stratified HR [sHR]: 0.92, 95% CI: 0.55-1.54), recurrent stroke (sHR: 0.93, 95% CI: 0.82-1.02), PVD (sHR: 1.04 95% CI: 0.45-2.41), or heart failure (sHR: 0.71, 95% CI: 0.39-1.27). The risk of subsequent cardiovascular events is similar between patients with incident hemorrhagic and ischemic stroke. Patients with previous hemorrhagic stroke should be regarded as a population at very high risk for subsequent CVD.

Are mega-events super spreaders of infectious diseasessimilar to COVID-19? A look into Tokyo 2020 Olympics and Paralympics to improve preparedness of next international events.

Tokyo Summer Olympics and Paralympics have raised social issues regarding the potential rise in COVID-19 cases in Japan and risks associated with the safe organization of mega sporting events during the pandemic, such as the FIFA World Cup Qatar 2022. This study investigates the Tokyo Summer Olympics as a unique case study to clarify the drivers of infectivity and provide guidelines to host countries for the safe organization of subsequent international sporting events. The result here reveals that Tokyo and Japan did not experience a rise in confirmed cases of COVID-19 due to the hosting of the Summer Olympics. Still, transmission dynamics seems to be mainly driven by the high density of population (about 1.2%, p-value <0.001) like other larger cities in Japan (result confirmed with Mann-Whitney U test, significance at 0.05). Our study provided evidence that hosting mega sporting events during this COVID-19 pandemic is safe if strictly maintained the precautions with non-pharmaceutical (and pharmaceutical) measures of control of infections. The Tokyo Summer Olympics hosting will be exemplary for next international events due to the successful implementation of preventive measures during COVID-19 pandemic crisis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-022-22660-2.

Detection of Physical Impacts of Shipping Containers during Handling Operations Using the Impact Detection Methodology

The transportation of cargo inside shipping containers is a risky operation that requires constant monitoring activities and real-time operational actions. Yet, the detection of the real dynamics of the container and the surrounding infrastructure and extraction of true subsequent critical events is still an unresolved issue among engineers. In this paper, we analyze the new physical impact detection method, namely the Impact Detection Methodology (IDM), to detect the most obvious and force-dependent impacts from acceleration data, using the IoT sensor in an experimental environment using the heavy machinery of a seaport. By variating the threshold level, we have observed the changes in the number of impacts detected within three separate case studies. Results suggest that the optimal parameters tend to provide an adequate number of events, yet even the slightest change in the threshold level can increase or decrease the number of detected impacts in a non-linear fashion, making the detection harder, due to unforeseen external impacts on the dataset, the filtering of which is still the main priority of our future research.

Incidence and Predictors of Adverse Events Among Initially Stable ST-Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention.

BackgroundCardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI.Methods and ResultsBetween April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting.ConclusionsOnly 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion.

Higher serum triglyceride can predict recurrent coronary revascularization events in patients undergoing percutaneous coronary intervention with baseline LDL-C

Patients with low baseline low-density lipoprotein cholesterol (LDL-C) but experiencing recurrent coronary revascularization events have been rarely investigated. In this retrospective cohort study, we enrolled patients undergoing percutaneous coronary intervention...

Lipid lowering therapy patterns and the risk of cardiovascular events in the 1-year after acute myocardial infarction in United Arab Emirates.

AimIn United Arab Emirates, cardiovascular disease (CVD) is a leading cause of mortality and 22% of CVD deaths are attributable to acute myocardial infarction (MI). Adherence to guidelines for lipid management is incompletely described in the Middle East. This study aimed to characterize lipid lowering therapy (LLT) patterns and the risk of subsequent cardiovascular events (CVEs) in the first year after MI.MethodsThis was a retrospective cohort study using the Dubai Real-World Claims Database, including all patients discharged with MI between January 01, 2015 and December 31, 2018, followed-up until December 31, 2019.ResultsIn the first year after MI, 8.42% of 4,595 patients included experienced at least one recurrent MI (rate 6.77 events/100 person-years [PYs]), 2.94% had one revascularization (cumulative rate 0.55 events/100 PYs) and 2.66% had one hospitalization due to unstable angina (cumulative rate 5.16 new events/100 PYs). The majority (60.40%) of the patients presented with LDL-C levels ≥ 70 mg/dL after MI. In the first year after MI, 93.45% of the patients received LLT, mainly high-intensity statin (67.79%); with a minority of patients receiving statin + ezetimibe (4.55%), PCSK9i (0.20%) or ezetimibe alone (0.07%).ConclusionPatients hospitalized with MI in Dubai present an increased risk of CVEs in their first-year post-discharge. Majority of the patients presented with LDL-C levels above 70 mg/dL, which indicates suboptimal lipid control with existing LLT, particularly in high-risk patients.

Advertising strategies for maintaining nation brand equity in times of crisis “Egyptian tourism advertising campaigns as a model”

Nation branding is one of the tools by which states can positively influence their international reputation and image. Tourism has a major role in building this brand, as it directly contributes to creating a positive image of the country, it’s history and capabilities. The Egyptian tourism sector faced a crisis after January 2011 and the subsequent internal events in the country. However, by the year 2018, there was a major transformation and recovery of Egyptian tourism, and it increased in 2019 within the state’s strategic plan to make 2019 the “Year of tourism” and restored the previous tourist position, as tourism is affected by the economic, political and other conditions around it, the Covid-19 crisis, which emerged at the beginning of 2020, significantly affected Egyptian tourism again, as happened in all countries of the world, and it declined to a large extent. In addition to the repercussions of the pandemic crisis, the imposition of quarantine and the lockdown of aviation in crisis situations, it is more important to preserve the image and value of the state as a brand, and this depends on how to respond to and deal with the crisis Therefore, there was a thought of using alternative strategies for tourism promotion and advertising, such as focusing on advertising campaigns for domestic tourism, digital campaigns and virtual visits on the official websites of the various tourist places to support the mental image of the country as a brand. The research refers to the close relationship between the tourism advertising campaigns and its effect on the nation brand. It also reached several results, that Egypt is regaining the preservation of its identity and the value of its brand destination, while drawing a futuristic image that keeps pace with the times, provided that the content of its identity is properly communicated to the outside world by strengthening advertising messages and focusing on safety motives and competitive advantages as a unique tourist destination through a series of sequential campaigns and events, Which had a role in overcoming this crisis at the tourism sector. The research discusses in an analytical study to identify the various advertising strategies of that period, to identify their communication and marketing objectives, and to determine their importance and effectiveness in supporting the mental image and what it has achieved in maintaining the equity of the nation brand. Research Problem: The research problem is summarized in the following questions: How can tourism advertisements in times of crisis support and preserve the nation brand? How does nation brand communicate with the target audience in an effective and participatory manner in times of crisis? How can advertising strategies be developed in light of an international crisis in a positive way for the international audience? Research Objectives: The main purpose is to show how tourism advertising campaigns can support and promote a nation brand during crises. Identifying the values and objectives of tourism advertising campaigns in times of crisis in a way that supports and preserves the state’s image as a brand. Recognizing the role of integrated marketing communication strategies and advertising campaigns in creating and promoting nation brand in times of crisis.

The Limited Role for Botox in Achalasia: A Gastroenterologist’s Perspective

Botox injection during endoscopy is highly effective in patients with achalasia. However, treatment response is short in duration which poses a challenge in this chronic disease. There is limited data to suggest botox increases subsequent procedure technical difficulty or adverse events, and short term efficacy appears to be equal to other therapies. Therefore, botox is an appropriate therapy for those who require a bridge, like pregnant patients, or in high risk patients who are not candidates for myotomy. However, long term outcomes of treatment naïve patients undergoing definitive therapy may be better than previously treated patients, therefore, avoidance of botox is recommended when definitive therapy is possible. When the diagnosis of achalasia is in question, or if the presentation is not clear, botox could elucidate the treatment plan without major consequence on future therapies.