Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial

In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up

How are gender equality and human rights interventions included in sexual and reproductive health programmes and policies: A systematic review of existing research foci and gaps

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994-2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations.Scopu

Location and Land use effects on Soil Carbon Accretion and Productivity in the Coastal Savanna Agro-ecological Zone of Ghana

Land use type, climate and soil properties are major determinants of soil carbon storage and productivity, especially in low-input agriculture. In this study, we investigated the interactions among these factors at four (4) locations, namely Accra Metropolis, Ga West, Ga East and Shai Osudoku, within the Coastal-Savannah agro-ecological zone of Ghana. The land use types were maize-based cropping, cassava-based cropping, woodlot/plantations and natural forests. The impact of these on soil productivity at a given location was assessed in terms of soil carbon stocks and a Soil Productivity Index (SPI). The SPI is a composite value derived from routine soil properties such as: soil texture, available water capacity, pH, cation exchange capacity, soil organic carbon, available P, exchangeable K, potentially mineralizable nitrogen, and basic cations, among others. Principal component analysis was used to select soil properties that were used to estimate SPI. The results showed that the locations differed with respect to rainfall regimes and soil types. Locations with slightly heavier soil texture and relatively higher rainfall regimes (Ga East and Shai Osudoku) had significantly higher soil carbon storage and SPI values than the lighter soil textured locations (Accra Metropolis and Ga West). With regards to land use, forest had significantly higher soil carbon storage and SPI than all the other land use types, irrespective of location. The order of soil carbon storage and SPI were: forest > woodlot/plantation > cassava > maize. It was observed that though the Accra Metropolis location hosted the oldest forest, soil carbon was still low, apparently due to the lighter soil texture. We concluded that the soil productivity restorative ability is an interactive effect of carbon management (land use), soil texture and other properties. This interaction hitherto has not been adequately investigated, especially in low-input agriculture

Patterns of ash (Fraxinus excelsior L.) colonization in mountain grasslands: the importance of management practices

International audienceWoody colonization of grasslands is often associated with changes in abiotic or biotic conditions or a combination of both. Widely used as fodder and litter in the past traditional agro-pastoral system, ash (Fraxinus excelsior L.) has now become a colonizing species of mountain grasslands in the French Pyrenees. Its present distribution is dependent on past human activities and it is locally controlled by propagule pressure and abiotic conditions. However, even when all favourable conditions are met, all the potentially colonizable grasslands are not invaded. We hypothesize that management practices should play a crucial role in the control of ash colonization. From empirical field surveys we have compared the botanical composition of a set of grasslands (present and former) differing in management practices and level of ash colonization. We have displayed a kind of successional gradient positively linked to both ash cover and height but not to the age of trees. We have tested the relationships between ash presence in grassland and management types i.e. cutting and/or grazing, management intensity and some grassland communities' features i.e. total and local specific richness and species heterogeneity. Mixed use (cutting and grazing) is negatively linked to ash presence in grassland whereas grazing alone positively. Mixed use and high grazing intensity are directly preventing ash seedlings establishment, when low grazing intensity is allowing ash seedlings establishment indirectly through herbaceous vegetation neglected by livestock. Our results show the existence of a limit between grasslands with and without established ashes corresponding to a threshold in the intensity of use. Under this threshold, when ash is established, the colonization process seems to become irreversible. Ash possesses the ability of compensatory growth and therefore under a high grazing intensity develops a subterranean vegetative reproduction. However the question remains at which stage of seedling development and grazing intensity these strategies could occur

Oct4 differentially regulates chromatin opening and enhancer transcription in pluripotent stem cells

The transcription factor Oct4 is essential for the maintenance and induction of stem cell pluripotency, but its functional roles are not fully understood. Here, we investigate the functions of Oct4 by depleting and subsequently recovering it in mouse embryonic stem cells (ESCs) and conducting a time-resolved multiomics analysis. Oct4 depletion leads to an immediate loss of its binding to enhancers, accompanied by a decrease in mRNA synthesis from its target genes that are part of the transcriptional network that maintains pluripotency. Gradual decrease of Oct4 binding to enhancers does not immediately change the chromatin accessibility but reduces transcription of enhancers. Conversely, partial recovery of Oct4 expression results in a rapid increase in chromatin accessibility, whereas enhancer transcription does not fully recover. These results indicate different concentration-dependent activities of Oct4. Whereas normal ESC levels of Oct4 are required for transcription of pluripotency enhancers, low levels of Oct4 are sufficient to retain chromatin accessibility, likely together with other factors such as Sox2

Quantitative health impact assessment of environmental exposures linked to urban transport and land use in Europe: state of research and research agenda

In this article, we summarise recent developments, identify gaps, and propose a research agenda for quantitative health impact assessment (HIA) of environmental exposures linked to urban transport and land use. This is based on a workshop of 30 experts, complemented by targeted literature identified by participants to illustrate the state of research and practice gaps. The practice of quantitative HIA in urban transport and land use interventions covers a diverse range of methods, models, and frameworks. The selection of an appropriate model depends upon the use case, i.e., the research question, resources and expertise, and application. The plurality of models can be a strength if differences are explicit and their implications are understood. A major gap in most assessments and frameworks is the lack of equity consideration. This should be integrated into all stages of the HIA, considering exposures, susceptibility, disease burden, capacity to benefit, household budgets, responsibility for harm, and participation in the process. Scenarios of environmental exposures in urban transport and land use interventions are often overly simple, while the scenario design process of spatial planning is often opaque. Researchers should specify the involvement of stakeholders and the data, evidence, or behavioural model used to construct the scenario. Recent developments in exposure assessment (remote sensing and modelling) have increased the capacity to conduct HIAs for small geographies at scale. At the same time, advances in simulation have enabled the representation of behaviours at high spatial and temporal resolution. The combination can enable person-centric measures accounting for location, activities, and behaviours, with HIA proceeding ahead of epidemiology. Most HIAs still use Comparative Risk Assessment. This is suitable for estimating the disease burdens of environmental exposures, but more advanced longitudinal methods are better suited for studying interventions. Beyond health outcomes, well-being must be incorporated. The monetisation of health outcomes through welfare economics remains contentious. Representation of uncertainty is increasingly acknowledged. Value of Information methods can inform where new data collection would most efficiently reduce final result uncertainty. In the context of the climate crisis and related environmental limits, methods are needed that consider adaptation alongside mitigation and prevention and test robustness to an increasingly unstable future

Prior Coronary Artery Bypass Graft Surgery and Outcome After Percutaneous Coronary Intervention: An Observational Study From the Pan-London Percutaneous Coronary Intervention Registry.

Background Limited information exists regarding procedural success and clinical outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without CABG. Methods and Results This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry from 2005 to 2015. The primary end point was all-cause mortality at a median follow-up of 3.0 years (interquartile range, 1.2-4.6 years). A total of 12 641(10.2%) patients had a history of previous CABG, of whom 29.3% (n=3703) underwent PCI to native vessels and 70.7% (n=8938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%; P=0.0005) compared with patients with no prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%; P<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (hazard ratio [HR],1.02; 95%CI, 0.77-1.34; P=0.89), but a significantly higher mortality was seen among patients with PCI to bypass grafts (HR,1.33; 95% CI, 1.03-1.71; P=0.026). This was seen after multivariate adjustment and propensity matching. Conclusions Patients with prior CABG were older with greater comorbidities and more complex procedural characteristics, but after adjustment for these differences, the clinical outcomes were similar to the patients undergoing PCI without prior CABG. In these patients, native-vessel PCI was associated with better outcomes compared with the treatment of vein grafts