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AimsSodium-glucose Cotransporter-2 (SGLT2) Inhibitors are now advised as standard front line therapy for heart failure reduced ejection fraction (HFrEF) patients irrespective of whether diabetes is present or not. There has now been a multitude of positive trials in favour of SGLT2 inhibitor use with little information on how routine community HFrEF populations respond to this intervention in the setting of already taking maximum tolerated conventional disease modifying therapies. We therefore set out to assess changes in left ventricular ejection fraction (LVEF) for patients attending our outpatient heart failure unit who were recently commenced on SGLT2 inhibitors.MethodsAll patients commenced on SGLT2 inhibitors as additional medical therapy for HFrEF in a twelve-month period were included in the study. SGLT2 inhibitor therapy was initiated once patients were fully optimised on conventional medical therapy and stable from a heart failure perspective. The patients most up-to-date echocardiogram prior to being initiated on a SGLT2 inhibitor was compared with the patients most recent echocardiogram after initiation. For it to be included the repeat echocardiogram must have occurred at least one month after initiation of the SGLT2 inhibitor and the patient had to be still prescribed their SGLT2 inhibitor. All data was obtained from the electronic patient record.ResultsThere were 184 patients commenced on SGLT2 in the 12-month period studied of which 78% (144 patients) were male and 26% (48 patients) were diabetic. The average age was 69 years old. Of the 184 patients enrolled, 176 patients (96%) had a recent echocardiogram prior to their SGLT2 inhibitor commencing and the mean left ventricular ejection fraction (LVEF) was 31%. There are 90 patients to date who have had a follow-up echocardiogram after initiating their SGLT2 inhibitor and the mean LVEF of these was 39% (carried out at a mean time interval of 6months). The difference in LVEF being significant (p value of 0.0001). 69 out of the 90 patients (77%) had an overall improvement in their LVEF and 48 patients (53%) had an LVEF improvement that was ≥5%. Of these 90 patients with a repeat echocardiogram, 48 patients (59%) had an initial LVEF that was <35%, and, of these 48 patients, 27 patients (56%) had LVEF ≥35% after the addition of the SGLT2 inhibitor which had brought these patients out of the territory for requiring an implantable cardiac defibrillator.ConclusionsWe have seen evidence of interval improvements in the LVEF of our cohort of HFrEF patients attending our heart failure unit who had been commenced on SGLT2 inhibitors as additional HFrEF therapy. Whilst half of our patients have yet to have a repeat echocardiogram, this initial analysis of the first 90 patients is promising and our observational study is ongoing.

AimsSodium-glucose Cotransporter-2 (SGLT2) Inhibitors are now advised as standard front line therapy for heart failure reduced ejection fraction (HFrEF) patients irrespective of whether diabetes is present or not. There has now been a multitude of positive trials in favour of SGLT2 inhibitor use with little information on how routine community HFrEF populations respond to this intervention in the setting of already taking maximum tolerated conventional disease modifying therapies. We therefore set out to assess the clinical response (using NYHA and NT-proBNP change) and tolerability of SGLT2 inhibitors in patients attending our outpatient heart failure unit.MethodsAll patients commenced on SGLT2 inhibitors as additional medical therapy for HFrEF in a twelve-month period were included in the study. SGLT2 inhibitor therapy was initiated once patients were fully optimised on conventional medical therapy and stable from a heart failure perspective. For all patients commenced on an SGLT2 inhibitor as part of their HFrEF pharmacotherapy we then studied what effect this had on each patients NYHA functional class and NT-proBNP levels before and after initiation of SGLT2 inhibitor. For all patients we recorded whether a not a patient was still taking their SGLT2 inhibitor at most recent follow up appointment at our heart failure unit. Where patients were no longer prescribed SGLT2 inhibitors at follow-up, we analysed the reasons documented for this in the patients electronic patient record.ResultsThere were 184 patients commenced on SGLT2 in the 12-month period studied of which 78% (144 patients) were male and 26% (48 patients) were diabetic. The average age was 69 years old. Out of the 184 patients, 158 patients (86%) had their initial NYHA class documented in their patient record. The average NYHA functional class at time of commencing SGLT2 inhibitor for these patients was 1.9. At a subsequent follow-up review, 120 patients had a repeat NYHA documented and the average NYHA functional class at this time was 1.7 (with a mean time interval of 4.2months). 86 patients (72%) were in the same NYHA functional class, 28 patients (23%) were now in a lower NYHA functional class whilst 6 patients (5%) were in a higher NYHA functional class. The mean NT-proBNP was 1610pg/mL at initiation of SGLT2 inhibitor and it was 1830pg/mL at the follow-up visit with a mean time interval of 4months. The difference in NT-proBNP’s not meeting statistical difference. 166 patients (90%) were still prescribed their SGLT2 inhibitor at most recent follow up. The most common reasons patients had stopped their SGLT2 inhibitors during follow-up was due to urinary tract infections (3% of total patients) and symptomatic hypotension (3% of total patients).ConclusionFor the majority of patients there was no significant change in their reported NYHA class or NT-proBNP levels at follow-up. Overall, we found SGLT2 inhibitors to be a well-tolerated with high adherence rates (90%) at follow up and relatively few side effects warranting discontinuation.

IntroductionA complex physiological relationship exists between obesity and heart failure (HF) with many large-scale studies reporting a paradoxical improvement in cardiovascular (CV) mortality in obese patients. Many of these studies retrospectively analyzed RCT trials not designed to investigate the role of obesity in HF outcomes. We aim to establish if different outcomes exist after HF programme completion based on body mass index (BMI).MethodsA multi-centre retrospective observational study was carried out in 3 hospitals’ HF clinics. New patients referred to each HF service over a 12 month period were reviewed, or in a 24 month period in one centre, with a left ventricular ejection fraction (LVEF) < 50% were eligible for inclusion. Patient records were obtained to collect patient demographics, New York Heart Association (NYHA) class symptoms, NT-proBNP, LVEF and medications at initial referral and at programme completion. Hospitalisation rate for HF and mortality was also noted. Patient characteristics and outcomes were compared between non-obese (BMI < 29.9) and obese (BMI >30).Results93 patients were included for analysis and a follow up of (mean (±SD) 16.5 months (±8.8) was obtained. 63 (67.7%) had a BMI <29.9 and 30 (32.3%) had a BMI >30. Obese patients were more likely to be male (p=0.03), diabetic (p=0.05) and have hypertension (p<0.001). No significant differences in medical or device therapy was noted between groups. Obese patients had a greater improvement in their LVEF following programme completion (10.5% (±11.7) versus 7.95% (±10.7)), although this did not reach statistical significance (p=0.34). Obese patients had significantly lower NT-pro BNP levels at HF programme completion ((median(IQR)) (546.4 () versus 962 (), P=0.02) however this improvement was not significantly greater than that seen in non-obese patients (p=0.8). Although no difference in mortality was noted between the groups (8 (12.7%) versus 3 (10%), p=0.73), obese patients had significantly fewer HF hospitalisations than the non-obese group (0.33 (±0.74) versus 0.04 (±0.2), p=0.005).ConclusionDespite higher rates of diabetes and hypertension in obese patients, there was no significant difference in mortality, LVEF improvement and NT-proBNP improvement following HF programme completion between the 2 groups. However, obese patients had significantly less HF hospitalisations during the study period than non-obese patients.

The potential for environmental and physiological modification of elemental incorporation in otoliths is significant and must be validated before otoliths can be used reliably to estimate water parameters over the life history of a fish. We experimentally manipulated temperature and diet quantity for juvenile, sub-adult, and adult Acanthochromis polyacanthus, a tropical damselfish of the SW Pacific. Significant interactive effects between life history stage, temperature and food quantity were observed for otolith Ba/Ca, while significant interactions between stage and food were observed for Sr/Ca. Specific growth rates were negatively correlated with DBa and DSr for juveniles and sub-adults. These interactions indicated elemental incorporation dynamics varied depending on the life history stage, suggesting variation in effects of stage-specific metabolism or reproductive status. Our results highlight complex responses of elemental incorporation to both endogenous and exogenous factors. Interpretations of life history transects across otoliths must account for these effects to avoid confounding environmental variability with ontogenetic changes in physiology.

The ecology of cubozoans is poorly understood and there are few quantitative studies on their distribution patterns. Sampling was designed to test first for variation in abundance with distance across the continental shelf in waters of the Great Barrier Reef, Australia. Second, we tested for the possible influence of islands versus submerged reefs on the abundances of cubozoan jellyfishes. Jellyfishes were collected after attraction to tethered night lights. Additional sampling focused on turbid near-shore waters. Carybdeid jellyfishes were found at mainland, inner, and mid-shelf reefs during summers between 2007 and 2010. No cubozoan medusae were found at outer reef sites. Copula sivickisi and Carukia barnesi were more abundant near reefs with islands than at fully submerged reefs. There was no evidence of lunar periodicity in abundance for these cubozoan taxa. Chironex fleckeri medusae were only found close to shore near the mainland, but they were rarely observed when riverine runoff was high. All taxa were characterized by high spatial and temporal variation and there was some evidence for small populations at spatial scales of less than one kilometer. “Blooms” and related intensity of predation and risk to humans are most likely at small spatial scales.

Cardinalfishes (Apogonidae) are abundant on corals reefs, but there are few data on demography to understand trophodynamics and population dynamics. Ostorhinchus doederleini is a small and abundant apogonid on the Great Barrier Reef (GBR) and throughout the western Pacific Ocean. We present key demographic parameters for the entire life history from the southern GBR. Daily deposition of increments in otoliths was validated. Fish had a Planktonic Larval Duration (PLD) of 16–26 days. PLD was established from fish collected immediately prior to settlement as no settlement mark was found. Fish grew at about 0.35 mm day⁻¹ for the first 20 days after settlement. Fish reached a maximum standard length at about 200 days, and no fish lived longer than 368 days at four reefs separated by kilometers to tens of kilometers. There was no evidence for differences in size at age between sexes. Mortality was very high, and for fish greater than 60 days old, mortality rates ranged from 2.9 to 4.6 % day⁻¹. Short lives and high mortality rates make O. doederleini, and potentially other apogonids, vulnerable to recruitment failure. Here, we review data on the demographic characteristics of other reef fishes. Although some taxa live to over 50 years, the short lives of apogonids are most aligned with the Gobiidae and Blenniidae (i.e., typically <1.5 years). Descriptions of fish size, age, longevity, growth and mortality, from hatching to age maxima, are very rare for most taxa, even at the level of family.

There has been broad adoption of DCB use across Ireland for in-stent restenosis and small vessel disease coronary lesions, but there remains variation in clinical practice with regards to treating other lesion subsets.Abstract 58 Figure 1Map of Ireland reflecting location of hospitals represented in the ‘DETECT’ survey[Image Omitted. See PDF.]Abstract 58 Figure 2Summary of main findings from the ‘DETECT’ survey[Image Omitted. See PDF.]

Brucellosis is usually acquired by humans through contact with infected animals or the consumption of raw milk from infected ruminants. Brucella suis biovar 2 (BSB2) is mainly encountered in hares and wild boars (Sus scrofa), and is known to have very low pathogenicity to humans with only two case reports published in the literature. Human cases of brucellosis caused by BSB2 were identified through the national mandatory notification of brucellosis. The identification of the bacterium species and biovar were confirmed by the national reference laboratory. Epidemiological data were obtained during medical follow-up visits. Seven human cases were identified between 2004 and 2016, all confirmed by the isolation of BSB2 in clinical specimens. All patients had direct contact with wild boars while hunting or preparing wild boar meat for consumption. Five patients had chronic medical conditions possibly responsible for an increased risk of infection. Our findings suggest that BSB2 might be an emerging pathogen in hunters with massive exposure through the dressing of wild boar carcasses. Hunters, especially those with chronic medical conditions, should be informed about the risk of BSB2 infection and should receive information on protective measures.

Recombined whole milk was renneted under constant conditions of pH, temperature, and added calcium, and the gel was cut at a constant firmness. The effects of cutting and stirring on syneresis and curd losses to whey were investigated during cheese making using a factorial design with 3 cutting modes designed to provide 3 different cutting intensity levels (i.e., total cutting revolutions), 3 levels of stirring speed, and 3 replications. These cutting intensities and stirring speeds were selected to give a wide range of curd grain sizes and curd shattering, respectively. Both factors affected curd losses, and correct selection of these factors is important in the cheesemaking industry. Decreased cutting intensity and increased stirring speed significantly increased the losses of fines and fat from the curd to the whey. Cutting intensities and stirring speeds in this study did not show significant effects on curd moisture content over the course of syneresis. Levels of total solids, fines, and fat in whey were shown to change significantly during syneresis. It is believed that larger curd particles resulting from low cutting intensities coupled with faster stirring speeds resulted in a higher degree of curd shattering during stirring, which caused significant curd losses.