Barry Callebaut (Belgium)

Entities emitting CO2 are obliged to take appropriate steps to protect the environment. The Environmental Protection Law and the Greenhouse Gas and Other Substances Emissions Management System Act contain provisions and regulations regarding the above-mentioned compound. Owners of enterprises responsible for introducing CO2 into the environment must: obtain an administrative decision regarding the use of the environment, prepare annual emission reports, pay environmental fees, and submit appropriate reports. Research conducted among domestic enterprises from the SME sector showed that: the vast majority of surveyed enterprises use fuel in the form of hard coal, eco-pea coal and eco-pea coal for heating and generating hot water. The second dominant heating source is natural gas. Other fuels used are fuel oil and liquefied petroleum gas. Wood is used least often for heating. Progressing technology means that entrepreneurs are increasingly equipping their companies with modern heating furnaces and more ecological fuels. More ecological types of fuel include natural gas or eco-pea coal. A thorough analysis of CO2 emissions in the sector of small- and medium-sized enterprises has identified the industry that needs the most demanding changes. These are poultry producers. These entrepreneurs use significant amounts of coal. They often have archaic combustion stoves. In addition, they do not pay fees for releasing gases and dust into the air for heating poultry houses. They are also exempt from submitting information in this regard. Further research in this sector will allow for a deeper understanding of the problem of CO2 emissions and how to reduce them.

Correspondence: Barry Morton Brenner. Email: [email protected] Published online ahead of print. Publication date available at www.jasn.org.

Background: Minority and socioeconomically disadvantaged individuals are underrepresented in secondary stroke prevention trials. Little is known about factors associated with study retention in these populations. Objective: To evaluate the impact of sociodemographic characteristics on retention in the Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) trial. Methods: 487 participants ≥40 years with stroke/TIA were recruited from 4 safety-net hospitals and 1 stroke center serving low income zip codes. Strategies for boosting retention included: having bilingual research assistants from similar cultures establish rapport and follow participants; culturally and linguistically tailoring materials; arranging visits around participants’ schedules; offering transportation, and conducting assessments in the home and community. We compared sociodemographic characteristics among those retained at 12 months (n=412) vs. those not retained (n=75) using t-test, Chi Square, and Fisher exact tests. Independent factors associated with retention were determined using logistic regression. Results: Average age was 57 years, 18% were black, 71% were Hispanic, 58% were Spanish-speaking, and 72% were born outside the US. 12-month retention was 85%. On bivariate analysis, factors associated with retention were: Spanish-speaking, Hispanic ethnicity, younger age, born outside the US, and married status (all p<0.05). After multivariate analysis, study site, younger age (<64 vs ≥65 years OR 2.2, 95% CI 1.1,4.4), married status (OR 2.0, 1.0,4.2), government insurance (vs uninsured OR 25.1, 1.2,5.1), private insurance (vs uninsured, OR 4.6, 1.3,16.4), and inability to afford medical care (OR 2.9, 1.3,6.7) were associated with retention. Discussion: In this secondary prevention trial of stroke survivors from predominantly minority backgrounds, younger age, marriage, and insurance were associated with retention, suggesting that addressing barriers in the elderly, and those without insurance or spousal support may be beneficial. Financial constraints were associated with retention suggesting that study participation appealed to more socioeconomically vulnerable individuals.

Spiering, BA, Walker, LA, Larcom, K, Frykman, PN, Allison, SC, and Sharp, MA. Predicting soldier task performance from physical fitness tests: reliability and construct validity of a soldier task test battery. J Strength Cond Res 35(10): 2749-2755, 2021-The purpose of this study was to determine the reliability and construct validity of a battery of tests designed to assess soldier task performance. In the first part of the study (designed to assess test-retest reliability), 33 enlisted soldiers (31 men, 2 women; 23 ± 3 years; 1.75 ± 0.08 m; and 81.4 ± 12.8 kg) completed a 4-event "soldier task test battery" (STTB) on 4 occasions, each separated by at least 1 week. The STTB consisted of the following tests, in order: (a) 30-m grenade throw for accuracy; (b) running long jump while wearing a 20.5-kg load; (c) 1 repetition maximum box lift; and (d) 3.2-km load carriage time trial while wearing a 33-kg load. In the second part of the study (designed to assess construct validity), 41 male soldiers (22 ± 3 years; 1.75 ± 0.08 m; and 81.4 ± 12.9 kg) completed the STTB and a series of physical fitness tests. The physical fitness tests included measurements of body composition, muscular strength, muscular power, muscular endurance, and cardiovascular endurance. Overall performance on the STTB (reflected by the sum of z-scores across individual tests) demonstrated an intraclass correlation coefficient of 0.95 and was correlated to lean mass, V˙o2peak, and measures of muscular strength and power. Lean body mass and standing long jump predicted performance on the STTB (R2 = 0.41). In conclusion, this STTB can reliably assess performance of soldiering tasks. The relationships between the STTB and physical fitness tests can be used to develop training programs to prepare soldiers to perform physically demanding tasks.

James A. Arrighi, MD, FACC, Chair Lisa A. Mendes, MD, FACC, Co-Chair Jesse E. Adams III, MD, FACC John E. Brush Jr, MD, FACC[#][1] G. William Dec Jr, MD, FACC Ali Denktas, MD, FACC Susan Fernandes, LPD, PA-C Rosario Freeman, MD, MS, FACC[#][1] Rebecca T. Hahn, MD, FACC Jonathan L.

Background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are two of the most prevalent respiratory disorders in adults and are both independently associated with increased cardiovascular disease (CVD) risk. The coexistence of OSA in individuals with COPD is termed “overlap syndrome” and occurs in up to 65% of all COPD patients. Individuals with overlap syndrome have more frequent COPD exacerbations, poorer quality of life and increased CVD morbidity than patients with either COPD or OSA alone. COPD and OSA are both independently associated with increased carotid artery stiffness, a predictor of CVD events. However, the interaction of COPD and OSA on carotid artery stiffness remains unknown. We hypothesized that a) carotid artery stiffness would be greater in patients with overlap syndrome than COPD patients without OSA and non-COPD controls and b) overlap syndrome patients that reported using continuous positive airway pressure (CPAP) would have lower carotid artery stiffness than overlap patients not using a CPAP. Methods: Ninety-nine former smokers (n=62 with COPD and n=37 non-COPD controls; age 70 ± 7 yrs; 60M/39F) completed measurements of pulmonary function and common carotid artery stiffness and were retrospectively stratified by self-report of previous clinical diagnosis with OSA. Results: Participants with overlap syndrome had significantly greater carotid β-stiffness than COPD patients without OSA, non-COPD controls with OSA and non-COPD controls without OSA (overlap 5.7 ± 0.71 vs COPD only 3.9 ± 0.20, OSA only 3.6 ± 0.31, controls 3.7 ± 0.23 U; F=6.245, p<0.01) and this difference remained significant after adjustment for body mass index (p=0.01). There were no differences in blood pressure, heart rate, resting oxygen saturation (SpO 2 ) or nocturnal mean SpO 2 in those with overlap syndrome vs. the other groups. Furthermore, there was no difference in carotid β-stiffness between overlap syndrome patients that reported using vs. not using a CPAP (5.98 ± 0.7 vs 5.53 ± 1.9 U, p=0.80). Discussion: These data suggest that OSA exacerbates carotid artery stiffening in COPD patients and that carotid artery stiffness may be one mechanism that mediates the increased CVD risk observed in COPD patients with overlap syndrome.

We hypothesized that pulmonary venous hypertension in heart failure (HF) leads to predominate remodeling of pulmonary veins and that the severity of venous remodeling is associated with the severity of pulmonary hypertension (PH) in HF. Patients with HF (n=108; 53 preserved and 55 reduced ejection fraction) with PH (HF-PH; pulmonary artery systolic pressure [PASP] ≥40 mm Hg) were compared to normal controls (n=12) and patients with primary pulmonary veno-occlusive disease (PVOD; n=17). In lung specimens from autopsy (control, HF-PH, and 7 PVOD) or surgery (10 PVOD), quantitative histomorphometry was performed in all analyzable arteries (n=4949), veins (n=7630), and small indeterminate vessels (IV; n=2168) to define percent medial thickness (arteries) and percent intimal thickness (%IT) (arteries, veins, and IV) relative to external diameter. The average arterial percent medial thickness (control, 6.9; HF-PH, 11.0; PVOD, 15.0), arterial %IT (control, 4.9; HF-PH, 14.9; PVOD, 31.1), venous %IT (control, 14.0; HF-PH, 24.9; PVOD, 43.9), and IV %IT (control, 10.6; HF-PH, 25.8; PVOD, 50.0) in HF-PH were higher than controls (P<0.0001 for all) but lower than PVOD (P≤0.005 for all). PASP (mm Hg) was lower in HF-PH (median, 59 [interquartile range, 50-70]) than in PVOD (median, 91 [interquartile range, 82-103]). PASP correlated with arterial percent medial thickness (r=0.41) and arterial %IT (r=0.35) but more strongly with venous %IT (r=0.49) and IV %IT (r=0.55) (P<0.0001 for all). Associations between PASP and venous or IV %IT remained significant after adjusting for arterial percent medial thickness and %IT and did not vary by HF type. In patients with right heart catheterization (30 HF-PH, 14 PVOD), similar associations between the transpulmonary gradient and pulmonary vascular remodeling existed, with numerically stronger associations for venous and IV %IT. Although the PASP was slightly higher in patients with HF-PH with right ventricular dysfunction, pulmonary vascular remodeling was not more severe. Pulmonary vascular remodeling severity was associated with reductions in the diffusing capacity of the lungs. In HF, PH is associated with global pulmonary vascular remodeling, but the severity of PH correlates most strongly with venous and small IV intimal thickening, similar to the pattern observed in PVOD. These findings expand our understanding of the pathobiology of PH in HF.

Background: Understanding intergenerational differences in associations of urbanization-related lifestyle behaviors with cardiometabolic disease (CMD) risk factors in children and their parents is important in rapidly urbanizing China. Objective: We tested the intergenerational differences in longitudinal associations of away-from-home eating, snacking, screen time, and leisure-time sports with high waist-to-height ratio (WHtR), elevated blood pressure (BP), elevated hemoglobin A1c (HbA1c), and elevated C-reactive protein (CRP) among Chinese children and their parents. Method: We studied 5,180 children (aged 7-17y) and their parents participated in China Health and Nutrition Survey (1991-2009) with measured WHtR, BP, HbA1c, and CRP. We used three-day 24-hour dietary recall to derive away-from-home eating (non-consumer, &lt;1meal/day, and ≥1meals/day) and consumption of fruit/vegetable snacks (any/none) and other snacks (any/none). We used a seven-day physical activity recall to collect screen time (≤1hr/day, 1-2hrs/day, and &gt;2hrs/day) and leisure-time sports (any/none). Random-effects logistic regression was used to examine the associations of lagged behaviors with CMD risk factors. Results: We detected intergenerational differences in associations between lagged behaviors and risk factors ( P interaction &lt;0.1). Generation-specific models showed that lagged away-from-home eating ≥1 (versus no) meals/day was negatively associated with parents’ high WHtR (OR=0.68, 95% CI=0.53, 0.89) but positively associated with children’s high WHtR (OR=1.46, 95% CI=1.01, 2.12) at follow-up. Lagged fruit/vegetable snack consumption was negatively related to parents’ high WHtR, parents’ elevated BP, and children’s high WHtR at follow-up. Lagged screen time was positively associated with parents’ high WHtR and children’s high WHtR, elevated BP, and high CRP at follow-up. The behavior-risk factor associations did not differ across years. Conclusion: CMD risk factors were negatively associated with fruit/vegetable snack consumption and positively associated with screen time in both generations. Away-from-home eating was associated with higher WHtR in children but lower WHtR in parents. Generation-specific intervention strategies may be needed for behavioral changes to reduce CMD risk.

The cardiac channelopathies are a collection of primary, genetically mediated heart rhythm disorders (also referred to as the primary electrical disorders) that are generally associated with a structurally normal heart and a propensity for syncope, seizures, or sudden cardiac arrest precipitated by a channelopathy-mediated episode of nonsustained or sustained polymorphic ventricular tachycardia (torsade de pointes) or ventricular fibrillation. These cardiac channelopathies include long-QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome (BrS), early repolarization syndrome, short-QT syndrome, and potentially idiopathic ventricular fibrillation. Approximately 1 in 1000 people are affected by a cardiac channelopathy, with LQTS being most common, involving an estimated 1 in 2000 people.1 Presently, these channelopathies should be viewed as potentially lethal but highly treatable conditions. However, unlike the various bradyarrhythmias and tachyarrhythmias detailed in the Task Force 9 report,2 there remains significant variability and heterogeneity among pediatric and adult heart rhythm specialists in terms of their ability to diagnose, risk stratify, and treat patients with these conditions. For example, in 1 study, 40% of the patients who received a second opinion evaluation at a LQTS specialty center for a previously rendered diagnosis of LQTS by a heart rhythm specialist were reclassified as otherwise normal, having insufficient evidence to merit that diagnostic consideration.3 This is explained in part by the advanced knowledge and training required to evaluate and treat these less common channelopathies. Accordingly, any return-to-play decision for an athlete suspected of having a cardiac channelopathy necessitates that the athlete be evaluated, risk stratified, treated, and counseled by a heart rhythm specialist or genetic cardiologist with sufficient experience and expertise in these syndromes.4 For the most part, restriction from virtually all competitive sports has been the guideline-based recommendation since 2005 for athletes with a cardiac channelopathy, regardless of the underlying channelopathy.5, …