Impact of Coronary Artery Disease in Women With Newly Diagnosed Heart Failure and Reduced Ejection Fraction.

BACKGROUND: The representation of women in heart failure studies has been inadequate, resulting in a knowledge gap regarding the prognostic impact of coronary artery disease (CAD) on all-cause mortality in women with newly diagnosed heart failure and reduced ejection fraction (HFrEF). OBJECTIVES: This study aims to assess the prognostic impact of CAD in women with HFrEF. METHODS: Using the Western Denmark Heart Registry, the authors identified 891 women and 2,403 men referred for first-time coronary angiography because of HFrEF. The authors stratified for presence of CAD, estimated 10-year all-cause mortality, and calculated crude and adjusted HRs (aHRs) with 95% CIs. RESULTS: The 10-year mortality was 60% in women with CAD and 27% in women without CAD; for men, the corresponding numbers were 54% and 36%. When adjusted for comorbidities, women without CAD had a lower relative 10-year mortality than men without CAD (aHR: 0.73; 95% CI: 0.58-0.91), whereas women with CAD had similar relative mortality as men with CAD (aHR: 1.00; 95% CI: 0.81-1.24) (Pinteraction = 0.037). Assessed by the number of coronary vessels with significant stenosis, CAD extent was associated with mortality for both women (P < 0.01) and men (P < 0.01). However, compared to those without CAD, the aHR was higher for women with any degree of CAD (aHR ranging from 1.61 [95% CI: 1.09-2.38] for diffuse CAD to 2.01 [95% CI: 1.19-3.40] for 3-vessel disease) than for men with 3-vessel disease (aHR: 1.51; 95% CI: 1.19-1.91). CONCLUSIONS: In patients with newly diagnosed HFrEF, the presence and extent of CAD has significantly greater prognostic impact among women than among men.

Cold water swimming as an add-on treatment for depression: a feasibility study.

PURPOSE: Cold water swimming (CWS) involves taking a regular dip in cold, natural waters throughout the winter. The evidence for the health benefits of CWS has been anecdotal, or from small-sample size studies. The available literature reports that CWS abolishes general tiredness, improves mood, boosts self-esteem and improves general well-being. However, research on the effects and safety of CWS as an add-on to the regular treatment of depression is limited. The aim of this study was to investigate whether it is possible and safe for patients with depression to participate in CWS. MATERIAL AND METHODS: The study was designed as an open-label feasibility study. All patients aged 20-69 years with a diagnosis of depression from an outpatient clinic were eligible for inclusion. The intervention consisted of twice-weekly, group-based CWS. RESULTS: Thirteen patients were initially recruited, and five patients participated on a regular basis. Although several patients had somatic comorbidities, all patients passed the somatic evaluation and were physically fit to participate in CWS. Patients who participated regularly in the CWS sessions had a well-being score of 39.2; at the end of the study, their score had increased to 54.0 and PSQI score at baseline was 10.4 (3.7); at the end of the study it was 8.0 ((3.7). CONCLUSION: This study indicates that it is possible and safe for patients with depression to participate in regular, supervised CWS. Furthermore, regular participation in CWS may improve sleep and well-being.

Variation in Phosphorus Speciation of Sewage Sludge throughout Three Wastewater Treatment Plants: Determined by Sequential Extraction Combined with Microscopy, NMR Spectroscopy, and Powder X-ray Diffraction.

The variation in phosphorus (P) speciation of sewage sludge throughout three wastewater treatment plants (WWTPs) was obtained by combining sequential P extraction with optical and scanning electron microscopy (SEM), chemical analyses, powder X-ray diffraction (PXRD), and 27Al and 31P nuclear magnetic resonance (NMR) spectroscopy. The WWTPs combine chemical P removal (CPR) and enhanced biological P removal (EBPR) and were compared to understand the effect of iron (Fe) dosing with and without codosing of aluminum (Al) and thermal hydrolysis on the P speciation. 31P NMR showed comparable inorganic orthophosphate (ortho-P, 53-60% of total P) and organophosphate (organic-P, 37-45%) in primary sludge, whereas polyphosphate (poly-P, 23-44%) from poly-P accumulating organisms (PAOs) was mainly observed in the secondary sludge. Inorganic ortho-P (90-98%) dominated after anaerobic digestion, which degraded poly-P and most organic-P. The inorganic ortho-P was mainly Fe bound P (Fe-P), especially after anaerobic digestion (71%). Codosing of Fe and Al led to two comparable fractions: Fe-P (38%) and P sorbed on amorphous Al (hydr)oxides (38%). Vivianite was identified in all samples by microscopy and chemical extraction but was PXRD amorphous in 12 out of 17 samples. Thus, vivianite may be more common in sewage sludge than previously known.

Health-related quality of life in patients with COVID-19; international development of a patient-reported outcome measure.

BACKGROUND: We aimed to create a questionnaire to assess the health-related quality of life including functioning, symptoms, and general health status of adult patients with current or previous COVID-19. Here, we report on Phase I and II of the development. METHODS: Internationally recognized methodology for questionnaire development was followed. In Phase I, a comprehensive literature review was performed to identify relevant COVID-19 issues. Decisions for inclusion, exclusion, and data extraction were completed independently in teams of two and then compared. The resulting issues were discussed with health care professionals (HCPs) and current and former COVID-19 patients. The input of HCPs and patients was carefully considered, and the list of issues updated. In Phase II, this updated list was operationalized into items/questions. RESULTS: The literature review yielded 3342 publications, 339 of which were selected for full-text review, and 75 issues were identified. Discussions with 44 HCPs from seven countries and 52 patients from six countries showed that psychological symptoms, worries, and reduced functioning lasted the longest for patients, and there were considerable discrepancies between HCPs and patients concerning the importance of some of the symptoms. The final list included 73 issues, which were operationalized into an 80-item questionnaire. CONCLUSION: The resulting COVID-19 questionnaire covers health-related quality of life issues relevant to COVID-19 patients and is available in several languages. The next steps include testing of the applicability and patients' acceptability of the questionnaire (Phase IIIA) and preliminary psychometric testing (Phase IIIB).

Comparing the use of patient-reported outcomes in clinical studies in Europe in 2008 and 2018: a literature review.

PURPOSE: Several guidelines for the use of patient-reported outcomes (PROs) in clinical studies have been published in the past decade. This review primarily aimed to compare the number and compliance with selected PRO-specific criteria for reporting of clinical studies in Europe using PROs published in 2008 and 2018. Secondarily, to describe the study designs, PRO instruments used, patient groups studied, and countries where the clinical studies were conducted. METHODS: A literature search was conducted in MEDLINE to identify eligible publications. To assess the number of publications, all abstracts were screened for eligibility by pairs of reviewers. Compliance with PRO-specific criteria and other key characteristics was assessed in a random sample of 150 eligible full-text publications from each year. Randomized controlled trials (RCTs) were assessed according to the full CONSORT-PRO checklist. RESULTS: The search identified 1692 publications in 2008 and 4290 in 2018. After screening of abstracts, 1240 from 2008 and 2869 from 2018 were clinical studies using PROs. By full-text review, the proportion of studies discussing PRO-specific limitations and implications was higher in 2018 than in 2008, but there were no differences in the other selected PRO-specific criteria. In 2018, a higher proportion of studies were longitudinal/cohort studies, included ≥ 300 patients, and used electronic administration of PRO than in 2008. The most common patient groups studied were those with cancer or diseases of the musculoskeletal system or connective tissue. CONCLUSION: The number of clinical studies from Europe using PROs was higher in 2018 than in 2008, but there was little difference in compliance with the PRO-specific criteria. The studies varied in terms of study design and PRO instruments used in both publication years.

Quantitative determination of vivianite in sewage sludge by a phosphate extraction protocol validated by PXRD, SEM-EDS, and 31P NMR spectroscopy towards efficient vivianite recovery.

Vivianite (Fe3(PO4)2⋅8H2O) is a potential phosphorus (P) recovery product from wastewater treatment plants (WWTPs). However, routine methods for quantification of vivianite bound P (vivianite-P) are needed to establish the link between vivianite formation and operating conditions, as current approaches require specialized instrumentation (Mössbauer or synchrotron). This study modified a conventional sequential P extraction protocol by insertion of an extraction step (0.2% 2,2'-bipyridine + 0.1 M KCl) targeting vivianite-P (Gu et al., Water Research, 2016, 103, 352-361). This protocol was tested on digested and dewatered sludge from two WWTPs, in which vivianite (molar Fe:P ratios of 1.0-1.6) was unambiguously identified by optical microscopy, powder X-ray diffraction, and scanning electron microscopy with energy dispersive X-ray spectroscopy. The results showed that vivianite-P was separated from iron(III)-bound P (Fe(III)-P) in the sludge. Vivianite-P constituted about half of the total P (TP) in the sludge from a Fe dosing chemical P removal (CPR) WWTP, but only 16-26% of TP in the sludge from a WWTP using a combination of Fe dosing CPR and enhanced biological P removal (EBPR). The modified protocol revealed that Fe-bound P (Fe-P, i.e., vivianite-P + Fe(III)-P) was the dominant P fraction, in agreement with quantitative 31P nuclear magnetic resonance (NMR) experiments. Moreover, it was shown that the conventional P extraction protocol underestimated the Fe-P content by 6-35%. The established protocol represents a reliable in-house analytical method that can distinguish and quantify vivianite-P and Fe(III)-P in sludge, i.e. facilitate optimized vivianite production at WWTPs.

Health-related quality of life issues, including symptoms, in patients with active COVID-19 or post COVID-19; a systematic literature review.

PURPOSE: This systematic review was performed to identify all relevant health-related quality of life (HRQoL) issues associated with COVID-19. METHODS: A systematic literature search was undertaken in April 2020. In four teams of three reviewers each, all abstracts were independently reviewed for inclusion by two reviewers. Using a pre-defined checklist of 93 criteria for each publication, data extraction was performed independently by two reviewers and subsequently compared and discussed. If necessary, a third reviewer resolved any discrepancies. The search was updated in February 2021 to retrieve new publications on HRQoL issues including issues related to the long-term consequences of COVID-19. RESULTS: The search in April 2020 identified 3342 potentially relevant publications, and 339 publications were selected for full-text review and data extraction. We identified 75 distinct symptoms and other HRQoL issues categorized into 12 thematic areas; from general symptoms such as fever, myalgia, and fatigue, to neurological and psychological issues. The updated search revealed three extra issues experienced during active disease and long-term problems with fatigue, psychological issues and impaired cognitive function. CONCLUSION: This first comprehensive systematic review provides a detailed overview of the wide range of HRQoL issues experienced by patients with COVID-19 throughout the course of the disease. It demonstrates the devastating impact of the disease and provides critically important information for clinicians, to enable them to better recognize the disease and to provide knowledge important for treatment and follow-up. The results provided the foundation for the international development of a COVID-19 specific patient-reported HRQoL questionnaire.

Multi-elemental EDXRF mapping of polluted soil from former horticultural land.

The distribution of major and trace elements was systematically investigated by use of energy dispersive X-ray fluorescence spectrometry (EDXRF) on a former horticultural soil. The purpose of the study was to combine mapping of soil element concentration levels with multivariate statistics for characterisation of soil metal pollution in relation to previous and present land use. A 1-ha study site was chosen from a former horticulture where a previous preliminary survey indicated increased concentration levels of toxic elements. The soil was sampled from the top 20 cm of the soil surface in a 10 x 10-m grid-like pattern covering the 1-ha study area. In addition, three soil profiles were studied. The elemental composition of the soil samples was investigated by EDXRF while the composition of aqueous soil extracts was determined by total reflection X-ray fluorescence spectrometry (TXRF). Based on mapping and multivariate statistically analysis of the data obtained by EDXRF, most elements were found in almost constant concentration levels in the top soil throughout the investigated site. However, the contents of the toxic elements Zn, Cu, As, and Pb were found to vary significantly within the area. Hence, the samples with high accumulations of As also contained relatively high amounts of Zn, Cu, and Pb, which indicates that toxic-element-containing pesticides have been applied to the soil surface in the area of the former green houses at the study site. The Pb/As mass ratio in the soil indicates that PbHAsO3 was the preferential lead arsenate used for pest management at the investigated site, while Cu as Bordeaux liquid (CuSO4) and Zn were applied to minimize the leaf damaging effect from the former compounds. Calculations indicated that As annually was applied to the soil in the former greenhouses in doses up to 4 kg As/ha while Pb had been annually applied in doses up to 12 kg Pb/ha. The enrichment of Zn, Cu, As and Pb was greatest in the top 20 cm of the soil and no anthropogenic enrichment of these elements occurred below a depth of 50 cm, indicating that the toxic elements are rather immobile in this soil. The results of this investigation suggest that EDXRF used in combination with multivariate statistics is a strong tool for multi-element mapping of elemental contents, sources and mobility in the terrestrial environment.