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It has been established that the human gut microbiota is central to health, and, consequently, there has been a growing desire to positively modulate its composition and/or function through, for example, the use of fermented foods, prebiotics or probiotics. Here, we compare the relative impact of the daily consumption of an inulin-enriched diet ( n  = 10), a commercial probiotic-containing fermented milk product (FMP) ( n  = 10), or a traditional kefir FMP ( n  = 9), over a 28-day period on the gut microbiome and urine metabolome of healthy human adults. None of the treatments resulted in significant changes to clinical parameters or biomarkers tested. However, shotgun metagenomic analysis revealed that kefir consumption resulted in a significant change in taxonomy, in the form of an increased abundance of the sub-dominant FMP-associated species Lactococcus raffinolactis , which further corresponded to shifts in the urine metabolome. Overall, our results indicated that daily consumption of a single portion of kefir alone resulted in detectable changes to the gut microbiota and metabolome of consumers.

Background: The last WHO definition of palliative care (PC) recognizes the integration of early PC in the course of illness and in conjunction with other therapies that are intended to treat disease as the way to provide optimal care. There is wide literature highlighting the benefits of early implementation of PC in oncological patients and there is a growing recognition of PC as an integral aspect of cancer treatment with the establishment of a range of specific guidelines concerning palliative cancer care. Nevertheless, these advances are not developed to the same extent in the approach of non-oncological chronic conditions. In this regard, patients of non-cancer diseases are rarely offered these services and even when they are admitted to a PC unit they are typically closer to death and have a lower functional level than those with cancer. It is important to highlight this situation as the great majority of adults in need of PC die from non-oncological diseases – such as cardiovascular diseases, chronic respiratory diseases or diabetes – accounting a higher percentage than those with cancer. Aims and objectives: INADVANCE project (funded under the H2020 Programme) seeks an earlier, integrated and more effective implementation of PC to adequately address the needs of non-oncological chronic patients. Thus, this workshop is focused on early PC among patients with chronic conditions. This analysis will be encouraged by presenting the current state of early PC among this profile of patients, some experiences in their management at different healthcare systems. Finally, at the end of the workshop a common discussion between all presenters and attendants will be performed in order to analyze main barriers and facilitators to organize and implement PC services addressed to chronic complex patients. Format: A 90-minutes workshop session will be organized in order to achieve the aforementioned objectives. Two people from INADVANCE project will be in charge of organizing and running the workshop with the participation of the following speakers in these topics: “Introduction” (5min): outline of the main objectives and structure of the session (Ascensión Doñate). “Early PC for patients with complex chronic conditions” (10min): presentation of INADVANCE project, the current state of the art of PC services among non-oncological chronic conditions, how to identify patients in need of PC (Ascensión Doñate). “Experiences in the provision of PC among non-oncological conditions” (40min): five presentations of local experiences (Soledad Giménez, Vania Dimitrova, Panagiotis Bamidis, Adriano Fernandes & Gordon Linklater). Time for questions. “Barriers and facilitators to effectively implement PC” (30min): open discussion with speakers and attendants to the workshop (Soledad Giménez). For this session several materials will be arranged, such as a boards, markers or post-it. “Sum up” (5min): main conclusions (Ascensión Doñate).          Target audience: People interested in PC, care and management of chronic conditions at clinical and organizational level. Learnings: Workshop participants will learn about differences in the provision of integrated PC between cancer vs. non-cancer diseases, real experiences improving the PC of chronic complex conditions and challenges for future improvement.

For patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose administration improves quality of life and exercise capacity in the short-term and reduces hospital admissions for heart failure up to 1 year. We aimed to evaluate the longer-term effects of intravenous ferric derisomaltose on cardiovascular events in patients with heart failure. IRONMAN was a prospective, randomised, open-label, blinded-endpoint trial done at 70 hospitals in the UK. Patients aged 18 years or older with heart failure (left ventricular ejection fraction ≤45%) and transferrin saturation less than 20% or serum ferritin less than 100 μg/L were eligible. Participants were randomly assigned (1:1) using a web-based system to intravenous ferric derisomaltose or usual care, stratified by recruitment context and trial site. The trial was open label, with masked adjudication of the outcomes. Intravenous ferric derisomaltose dose was determined by patient bodyweight and haemoglobin concentration. The primary outcome was recurrent hospital admissions for heart failure and cardiovascular death, assessed in all validly randomly assigned patients. Safety was assessed in all patients assigned to ferric derisomaltose who received at least one infusion and all patients assigned to usual care. A COVID-19 sensitivity analysis censoring follow-up on Sept 30, 2020, was prespecified. IRONMAN is registered with ClinicalTrials.gov, NCT02642562. Between Aug 25, 2016, and Oct 15, 2021, 1869 patients were screened for eligibility, of whom 1137 were randomly assigned to receive intravenous ferric derisomaltose (n=569) or usual care (n=568). Median follow-up was 2·7 years (IQR 1·8–3·6). 336 primary endpoints (22·4 per 100 patient-years) occurred in the ferric derisomaltose group and 411 (27·5 per 100 patient-years) occurred in the usual care group (rate ratio [RR] 0·82 [95% CI 0·66 to 1·02]; p=0·070). In the COVID-19 analysis, 210 primary endpoints (22·3 per 100 patient-years) occurred in the ferric derisomaltose group compared with 280 (29·3 per 100 patient-years) in the usual care group (RR 0·76 [95% CI 0·58 to 1·00]; p=0·047). No between-group differences in deaths or hospitalisations due to infections were observed. Fewer patients in the ferric derisomaltose group had cardiac serious adverse events (200 [36%]) than in the usual care group (243 [43%]; difference –7·00% [95% CI –12·69 to –1·32]; p=0·016). For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population. British Heart Foundation and Pharmacosmos.

Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease. ALL-HEART was a multicentre, prospective, randomised, open-label, blinded-endpoint trial done in 18 regional centres in England and Scotland, with patients recruited from 424 primary care practices. Eligible patients were aged 60 years or older, with ischaemic heart disease but no history of gout. Participants were randomly assigned (1:1), using a central web-based randomisation system accessed via a web-based application or an interactive voice response system, to receive oral allopurinol up-titrated to a dose of 600 mg daily (300 mg daily in participants with moderate renal impairment at baseline) or to continue usual care. The primary outcome was the composite cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. The hazard ratio (allopurinol vs usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis (excluding randomly assigned patients later found to have met one of the exclusion criteria). The safety analysis population included all patients in the modified intention-to-treat usual care group and those who took at least one dose of randomised medication in the allopurinol group. This study is registered with the EU Clinical Trials Register, EudraCT 2013-003559-39, and ISRCTN, ISRCTN32017426. Between Feb 7, 2014, and Oct 2, 2017, 5937 participants were enrolled and then randomly assigned to receive allopurinol or usual care. After exclusion of 216 patients after randomisation, 5721 participants (mean age 72·0 years [SD 6·8], 4321 [75·5%] males, and 5676 [99·2%] white) were included in the modified intention-to-treat population, with 2853 in the allopurinol group and 2868 in the usual care group. Mean follow-up time in the study was 4·8 years (1·5). There was no evidence of a difference between the randomised treatment groups in the rates of the primary endpoint. 314 (11·0%) participants in the allopurinol group (2·47 events per 100 patient-years) and 325 (11·3%) in the usual care group (2·37 events per 100 patient-years) had a primary endpoint (hazard ratio [HR] 1·04 [95% CI 0·89–1·21], p=0·65). 288 (10·1%) participants in the allopurinol group and 303 (10·6%) participants in the usual care group died from any cause (HR 1·02 [95% CI 0·87–1·20], p=0·77). In this large, randomised clinical trial in patients aged 60 years or older with ischaemic heart disease but no history of gout, there was no difference in the primary outcome of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death between participants randomised to allopurinol therapy and those randomised to usual care. UK National Institute for Health and Care Research.

[...] the comment that the oil industry claimed $20 billion in profits for first quarter 2011 is a meaningless figure used to inflame opinion without factual basis.

[...] recently, the Mormon church, which considers itself to be affiliated with the tribes of Israel, referred to those outside the faith as \"Gentiles.\"

Background Risk factors are often considered individually, we aimed to investigate the prevalence of combinations of multiple behavioural risk factors and their association with socioeconomic determinants. Methods Multinomial logistic regression was used to model the associations between socioeconomic factors and multiple risk factors from data in the Scottish Health Survey 2003. Prevalence of five key risk - smoking, alcohol, diet, overweight/obesity, and physical inactivity, and their risk in relation to demographic, individual and area socioeconomic factors were assessed. Results Full data were available on 6,574 subjects (80.7% of the survey sample). Nearly the whole adult population (97.5%) reported to have at least one behavioural risk factor; while 55% have three or more risk factors; and nearly 20% have four or all five risk factors. The most important determinants for having four or five multiple risk factors were low educational attainment which conferred over a 3-fold increased risk compared to high education; and residence in the most deprived communities (relative to least deprived) which had greater than 3-fold increased risk. Conclusions The prevalence of multiple behavioural risk factors was high and the prevalence of absence of all risk factors very low. These behavioural patterns were strongly associated with poorer socioeconomic circumstances. Policy to address factors needs to be joined up and better consider underlying socioeconomic circumstances.

This volume proposes a new approach to the Arab conquests and the spread of Islam in North Africa.In recent years, those studying the Islamic world have shown that the coming of Islam was not marked by devastation or decline, but rather by considerable cultural and economic continuity.In North Africa, with continuity came significant change.