Elevated troponin i levels but not low grade chronic inflammation is associated with cardiac-specific mortality in stable hemodialysis patients

Background: Elevated cardiac troponin I (TnI) levels are associated with all-cause mortality in stable hemodialysis patients. Their relationship to cardiac-specific death has been inconsistent, and the reason for their elevation is not well understood. We hypothesized that elevated TnI levels in chronic stable hemodialysis patients more specifically track with cardiac mortality, and this mechanism is independent of other contributors of cardiac mortality, such as inflammation. Methods. We conducted a single-centre, cohort study of prevalent hemodialysis patients at a tertiary care hospital. Plasma TnI levels were measured with routine monthly blood tests in clinically stable patients for two consecutive months. Plasma TnI was measured by immunoassay and a value above the laboratory reference range (0.06 μg/L) was considered elevated. The primary outcome of death was adjudicated separately for this study, and classified as cardiac, non-cardiac, or unknown. Cox proportional hazard models were used to examine the association of TnI with the all-cause and cardiac-specific mortality, adjusting for potential confounders, including C-reactive protein (CRP) as a marker of inflammation. Results: Of 133 patients followed for a median of 1.7 years, there were 38 deaths (58% non-cardiac, 39% cardiac, 3% unknown). Elevated TnI was associated with adjusted HR for all-cause mortality of 2.57 (95% CI 1.30-5.09) and an adjusted HR for cardiac death of 3.14 (95% CI 1.07-9.2), after accounting for age, time on dialysis, diabetes status, prior coronary artery disease history, and C-reactive protein. Although CRP was also independently associated with all-cause mortality, it did not add prognostic information to TnI for cardiac-specific death. Conclusion: Elevated TnI levels are independently associated with cardiac and all-cause mortality in asymptomatic hemodialysis patients. The mechanism for this risk is likely independent of inflammation, but may reflect chronic subclinical myocardial injury or unmask those with subclinical atherosclerotic heart disease. Whether those with elevated TnI levels may benefit from additional investigations or more aggressive therapies to treat cardiovascular disease remains to be determined. © 2013 Alam et al.; licensee BioMed Central Ltd

Has multiculturalism failed in Britain?

This paper subjects the criticisms advanced against multiculturalism to empirical test. It asks whether ethno-religious groups lead ?parallel lives? and, in consequence, fail to integrate with the wider society. It looks in particular at the alleged corrosive effects of multiculturalism, specifically at the maintenance of an ethnic rather than a British identity, social distance from white people and willingness to contemplate violent protest, but finds that all groups alike have displayed major change across the generations in the direction of a British identity and reduced social distance. It finds no evidence that rates of intergenerational change have been slower among ethno-religious groups that have made successful claims for cultural recognition. In contrast, lower levels of integration are associated with perceptions of individual or group discrimination

The Positive and Negative Framing of Affirmative Action: A Group Dominance Perspective

Using a sample of 328 While, Latino, and Black Los Angeles County adults, the authors examined the tendency to employ various affirmative action 'frames" (e.g., affirmative action as a "tie-breaking" device or as a quota-based policy). All three groups agreed about which frames cast affirmative action in a positive light and which cast it in a negative light. Although minorities had a tendency to frame affirmative action in terms that most people find morally acceptable, Whites had a tendency to frame affirmative action in terms most people find unacceptable. In addition, compared to minorities, Whites were less supportive of affirmative action regardless of how it was framed. LISREL modeling also was employed to test two competing models regarding predictors of the tendency to use frames that one personally finds to be relatively negative versus positive. Consistent with the expectations of social dominance theory and a motivated cognition perspective, the authors found that social dominance orientation (SDO) had significant net direct and indirect effects on one's framing of affirmative action.African and African American StudiesPsycholog

A study of prognostic factors in Chinese patients with diabetic foot ulcers

Objective: Few studies have identified factors as predictors of clinical prognosis of patients with diabetic foot ulcers (DFUs), especially of Chinese patients. In this study, we assessed the prognostic factors of Chinese patients with DFUs. Methods and materials: This was a retrospective study (January 2009–January 2011) of 194 DFUs conducted in an inpatient population at PLA 454 Hospital in Nanjing, China, to determine the prognostic influential factors of DFUs in Chinese patients. All of the studied patients were grouped into an amputation group, a non-healing group, and a cured group, according to the clinical prognosis. Patient parameters, including gender, age, smoking habits, education level, family history of diabetes mellitus, medical history, duration of foot lesions and complications, ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), urinary albumin/creatinine ratio (Alb/Cr), fundus oculi, electrocardiogram, DFU characteristics, bacterial nature, and neuropathy, were cross-studied among the three groups. Results: Compared with the other two groups, the amputation group showed a higher number of males, older in age, lower ABI and TcPO2 levels, higher Wagner wound grading and size, and significantly higher urinary Alb/Cr ratio, blood urea nitrogen, serum creatinine, white blood cell count, and erythrocyte sedimentation rate. Compared to the cured group (162 patients), more patients with an older age, smoking, family history of diabetes mellitus, medical history of foot ulcerations, lower ABI and TcPO2 levels, higher urine Alb/Cr ratio, and serum creatinine were found in the non-healing group. Regression analysis was used to study the correlation between various factors and clinical prognosis, and the results were as follows: age, Wagner wound classification, and heel ulcerations were negatively correlated to the DFU prognosis, whereas the female population, ABI, and TcPO2 were positively correlated with DFU prognosis. Conclusion: In this retrospective study, we conclude that the DFU prognosis may be related to age, gender, wound location (heel), Wagner wound classification, ABI, and TcPO2 levels in the Chinese population

Beyond the Dutch "Multicultural Model": The Coproduction of Integration Policy Frames in The Netherlands

The Netherlands has been internationally known for its multicultural approach to immigrant integration. The aim of this article is to delve into the "coproduction" by researchers and policy makers of this so-called Dutch "multicultural model". As this article shows, researchers and policy makers have in The Netherlands been joined in several discourse coalitions. Indeed, one of these discourse coalitions supported an integration paradigm with multicultural elements, but at least two other types of discourses can be identified in The Netherlands, one of more liberal-egalitarian nature and one more assimilationist. In spite of the persistent image of The Netherlands as a representative of the multicultural model, it is in fact this multiplicity of discourses that characterizes the Dutch case. Moreover, labeling Dutch integration p

Ideological Labels in America

This paper extends Ellis and Stimson’s (Ideology in America. New York: Cambridge UniversityPress, 2012) study of the operational-symbolic paradox using issue-level measures of ideological incongruence based on respondent positions and symbolic labels for these positions across 14 issues. Like Ellis and Stimson, we find that substantial numbers—over 30 %—of Americans experience conflicted conservatism. Our issue-level data reveal, furthermore, that conflicted conservatism is most common on the issues of education and welfare spending. In addition, we also find that 20 % of Americans exhibit conflicted liberalism. We then replicate Ellis and Stimson’s finding that conflicted conservatism is associated with low sophistication and religiosity, but also find that it is associated with being socialized in a post-1960s generation and using Fox News as a main news source. Finally, we show the important role played by identities, with both conflicted conservatism and conflicted liberalism linked with partisan and ideological identities, and conflicted liberalism additionally associated with ethnic identities

Telling the collective story? Moroccan-Dutch young adults’ negotiation of a collective identity through storytelling

Researchers taking a social constructionist perspective on identity agree that identities are constructed and negotiated in interaction. However, empirical studies in this field are often based on interviewer–interviewee interaction or focus on interactions with members of a socially dominant out-group. How identities are negotiated in interaction with in-group members remains understudied. In this article we use a narrative approach to study identity negotiation among Moroccan-Dutch young adults, who constitute both an ethnic and a religious (Muslim) minority in the Netherlands. Our analysis focuses on the topics that appear in focus group participants’ stories and on participants’ responses to each other’s stories. We find that Moroccan-Dutch young adults collectively narrate their experiences in Dutch society in terms of discrimination and injustice. Firmly grounded in media discourse and popular wisdom, a collective narrative of a disadvantaged minority identity emerges. However, we also find that this identity is not uncontested. We use the concept of second stories to explain how participants negotiate their collective identity by alternating stories in which the collective experience of deprivation is reaffirmed with stories in which challenging or new evaluations of the collective experience are offered. In particular, participants narrate their personal experiences to challenge recurring evaluations of discrimination and injustice. A new collective narrative emerges from this work of joint storytelling

Can narratives of white identity reduce opposition to immigration and support for Hard Brexit? A survey experiment

Britain’s vote to leave the European Union highlights the importance of white majority opposition to immigration. This article presents the results of a survey experiment examining whether priming an open form of ethno-nationalism based on immigrant assimilation reduces hostility to immigration and support for right-wing populism in Britain. Results show that drawing attention to the idea that assimilation leaves the ethnic majority unchanged significantly reduces hostility to immigration and support for Hard Brexit in the UK. Treatment effects are strongest among UKIP, Brexit and white working-class voters. This is arguably the first example of an experimental treatment leading to more liberal immigration policy preferences

Association Between Statin Use and Prevalence of Exercise-Related Injuries: A Cross-Sectional Survey of Amateur Runners in the Netherlands.

BACKGROUND: HMG-CoA reductase inhibitors (statins) are the first-choice therapy for primary prevention of cardiovascular disease. Some maintain that statins cause adverse musculoskeletal outcomes in highly active individuals, but few studies have examined the effects of statins on exercise-related injuries. OBJECTIVE: We sought to compare the prevalence of exercise-related injuries between runners who do or do not use statins. METHODS: Amateur runners (n = 4460) completed an extensive online questionnaire on their exercise patterns and health status. Participants replied to questions on the prevalence of exercise-related injuries in the previous year. Injuries were divided into general injuries, tendon- and ligament-related injuries, and muscle-related injuries. Participants were also queried about statin use: the type of statin, statin dose, and duration of treatment. Runners were divided into statin users, non-statin users with hypercholesterolemia, and controls for analysis. RESULTS: The crude odds ratios (ORs) for injuries, tendon- or ligament-related injuries, and muscle-related injuries in statin users compared with controls were 1.14 (95% confidence interval [CI] 0.79-1.66), 1.10 (95% CI 0.71-1.72), and 1.15 (95% CI 0.69-1.91), respectively. After adjustment for age, sex, body mass index (BMI), and metabolic equivalent of task (MET) h/week of exercise, the ORs were 1.11 (95% CI 0.76-1.62), 1.06 (95% CI 0.68-1.66), and 0.98 (95% CI 0.58-1.64), respectively. Similar effect measures were found when comparing non-statin users with hypercholesterolemia and controls. CONCLUSION: We did not find an association between statin use and the prevalence of exercise-related injuries or tendon-, ligament-, and muscle-related injuries. Runners receiving statins should continue normal physical activity without concern for increased risk of injuries