BACKGROUND: Nurse-coordinated care (NCC) improves the achievement of low-density lipoprotein-cholesterol (LDL-C) targets after an acute coronary syndrome (ACS). We hypothesised that NCC improves achievement of LDL-C targets through more intensive medication titration.METHODS: We used data from Randomised Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE), a multicentre randomised trial on the efficacy of NCC in 754 ACS patients. Follow-up data were collected at 6 and 12 months. To enable comparison between the various types and dosages of statins, we used the average lipid-lowering potency (ALLP, % LDL-C lowering) as an indicator of lipid-lowering medication intensity.RESULTS: Most patients in NCC intervention and usual care groups (96%) had started lipid-lowering therapy during the index hospitalisation. At 6 months, titration activities (up or down) were applied in 45% of NCC patients compared with 24% of patients receiving usual care (p<0.001), and a difference was also seen at 12 months follow-up (52% vs 34%, p<0.001). In patients not on LDL-C target at baseline, titration activities at 6 months were recorded in 63% and 30% of NCC and usual care patients respectively (p<0.001), with increased titration activities in both groups at 12 months (69% vs 43%, p<0.001).CONCLUSION: NCC is associated with more frequent and intense lipid-lowering medication titration to reach LDL-C targets as compared with usual care alone. Further, merely starting the guideline-recommended dose is insufficient to reach the guideline-recommended LDL-C target level.TRIAL REGISTRATION NUMBER: TC1290 (Netherlands).
From Pubmed: " BACKGROUND: Antigen-specific immunotherapy (AIT) is a promising therapeutic approach for both cow's milk allergy (CMA) and peanut allergy (PNA), but needs optimization in terms of efficacy and safety. AIM: Compare oral immunotherapy (OIT) and subcutaneous immunotherapy (SCIT) in murine models for CMA and PNA and determine the dose of allergen needed to effectively modify parameters of allergy. METHODS: Female C3H/HeOuJ mice were sensitized intragastrically (i.g.) to whey or peanut extract with cholera toxin. Mice were treated orally (5 times/week) or subcutaneously (3 times/week) for three consecutive weeks. Hereafter, the acute allergic skin response, anaphylactic shock symptoms and body temperature were measured upon intradermal (i.d.) and intraperitoneal (i.p.) challenge, and mast cell degranulation was measured upon i.g. challenge. Allergen-specific IgE, IgG1 and IgG2a were measured in serum at different time points. Single cell suspensions derived from lymph organs were stimulated with allergen to induce cytokine production and T cell phenotypes were assessed using flow cytometry. RESULTS: Both OIT and SCIT decreased clinically related signs upon challenge in the CMA and PNA model. Interestingly, a rise in allergen-specific IgE was observed during immunotherapy, hereafter, treated mice were protected against the increase in IgE caused by allergen challenge. Allergen-specific IgG1 and IgG2a increased due to both types of AIT. In the CMA model, SCIT and OIT reduced the percentage of activated Th2 cells and increased the percentage of activated Th1 cells in the spleen. OIT increased the percentage of regulatory T cells (Tregs) and activated Th2 cells in the MLN. Th2 cytokines IL-5, IL-13 and IL-10 were reduced after OIT, but not after SCIT. In the PNA model, no differences were observed in percentages of T cell subsets. SCIT induced Th2 cytokines IL-5 and IL-10, whereas OIT had no effect. CONCLUSION: We have shown clinical protection against allergic manifestations after OIT and SCIT in a CMA and PNA model. Although similar allergen-specific antibody patterns were observed, differences in T cell and cytokine responses were shown. Whether these findings are related to a different mechanism of AIT in CMA and PNA needs to be elucidated."
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Journal of Physics: Conference Series Paper • The following article is Open access Exploring the relationship between light and subjective alertness using personal lighting conditions J. van Duijnhoven1, M.P.J. Aarts1, E.R. van den Heuvel2 and H.S.M. Kort3,4 Published under licence by IOP Publishing Ltd Journal of Physics: Conference Series, Volume 2042, CISBAT 2021 Carbon-neutral cities - energy efficiency and renewables in the digital era 8-10 September 2021, EPFL Lausanne, Switzerland Citation J. van Duijnhoven et al 2021 J. Phys.: Conf. Ser. 2042 012119 Download Article PDF References Download PDF 29 Total downloads Turn on MathJax Share this article Share this content via email Share on Facebook (opens new window) Share on Twitter (opens new window) Share on Mendeley (opens new window) Hide article information Author e-mails j.v.duijnhoven1@tue.nl Author affiliations 1 Building Lighting Group, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, The Netherlands 2 Stochastics, Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands 3 Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands 4 Building Healthy Environments for Future Users Group, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, The Netherlands DOI https://doi.org/10.1088/1742-6596/2042/1/012119 Buy this article in print Journal RSS Sign up for new issue notifications Create citation alert Abstract The discovery of the ipRGCs was thought to fully explain the mechanism behind the relationship between light and effects beyond vision such as alertness. However, this relationship turned out to be more complicated. The current paper describes, by using personal lighting conditions in a field study, further exploration of the relationship between light and subjective alertness during daytime. Findings show that this relationship is highly dependent on the individual. Although nearly all dose-response curves between personal lighting conditions and subjective alertness determined in this study turned out to be not significant, the results may be of high importance in the exploration of the exact relationship.
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