Dating the megalithic culture of laos: Radiocarbon, optically stimulated luminescence and U/Pb zircon results.

The megalithic jar sites of Laos (often referred to as the Plain of Jars) remain one of Southeast Asia's most mysterious and least understood archaeological cultures. The sites, recently inscribed as UNESCO World Heritage, host hollowed stone jars, up to three metres in height, which appear scattered across the landscape, alone or clustered in groups of up to more than 400. Until now, it has not been possible to estimate when the jars were first placed on the landscape or from where the stone was sourced. Geochronological analysis using the age of detrital zircons demonstrates a likely quarry source for one of the largest megalithic jar sites. Optically Stimulated Luminescence (OSL) dating suggests the jars were positioned at the sites potentially as early as the late second millennium BC. Radiocarbon dating of skeletal remains and charcoal samples places mortuary activity around the jars from the 9-13th century AD, suggesting the sites have maintained ritual significance from the period of their initial placement until historic times.

An analysis of the types of recently published research in the field of cachexia.

Introduction Cachexia is a common complication of many and varied chronic disease processes, yet it has received very little attention as an area of clinical research effort until recently. We sought to survey the contemporary literature on published research into cachexia to define where it is being published and the proportion of output classified into the main types of research output. Methods I searched the PubMed listings under the topic research term "cachexia" and related terms for articles published in the calendar years of 2015 and 2016, regardless of language. Searches were conducted and relevant papers extracted by two observers, and disagreements were resolved by consensus. Results There were 954 publications, 370 of which were review articles or commentaries, 254 clinical observations or non-randomised trials, 246 original basic science reports and only 26 were randomised controlled trials. These articles were published in 478 separate journals but with 36% of them being published in a core set of 23 journals. The H-index of these papers was 25 and there were 147 papers with 10 or more citations. Of the top 100 cited papers, 25% were published in five journals. Of the top cited papers, 48% were review articles, 18% were original basic science, and 7% were randomised clinical trials. Discussion This analysis shows a steady but modest increase in publications concerning cachexia with a strong pipeline of basic science research but still a relative lack of randomised clinical trials, with none exceeding 1000 patients. Research in cachexia is still in its infancy, but the solid basic science effort offers hope that translation into randomised controlled clinical trials may eventually lead to effective therapies for this troubling and complex clinical disease process.

A comparison of research into cachexia, wasting and related skeletal muscle syndromes in three chronic disease areas.

INTRODUCTION: We compared the frequency of cancer, heart and lung related cachexia and cachexia-related research articles in the specialist journal, Journal of Cachexia, Sarcopenia and Muscle (JCSM) to those seen in a leading European journal in each specialist area during 2015 and 2016 to assess whether work on cachexia and related fields is relatively over or under represented in each specialist area. RESULTS: In the dedicated journal, Journal of Cachexia, Sarcopenia and Muscle, there were 44 references related to cancer, 5 related to respiratory disease, 5 related to heart failure, and 21 related to more than one of these chronic diseases. Despite this cancer preponderance, in the European Journal of Cancer in the two publication years, there were only 5 relevant publications (0.67% of the journal output), compared to 16 (1.41%) in the European Respiratory Journal and 10 (2.19%) in the European Journal of Heart Failure. CONCLUSIONS: There is considerable under-representation of cancer cachexia-related papers in the major European Cancer journal despite a high proportion in the dedicated cachexia journal. The under-representation is even more marked when expressed as a percentage, 0.67%, compared to 1.41% and 2.19% of the lung and heart journals respectively. These results are consistent with a worrying lack of interest in, or publication of, cachexia and related syndromes research in the cancer literature in Europe compared to its importance as a clinical syndrome. Greater interest is shown in lung and cardiology journals.

Measuring therapeutic efficacy in the treatment of central sleep apnoea in patients with heart failure.

The goal of treating sleep disordered breathing (SDB) has traditionally focused on improving daytime sleepiness and fatigue. In heart failure (HF) patients with SDB, this is not as easy to ascertain as their symptoms overlap with HF. Thus, improvement in treating SDB in HF patients must focus more on overall quality of life. Over the past 5 years, there has been a shift in sleep medicine from only improving symptoms in SDB, to preventing the long term consequences. The specialist Heart Failure community is, however, desirous of also seeing benefit in reduction of major clinical events for their patients with interventions, such as effects on mortality or re-hospitalisation rates and so may wish to see other benefits beyond a reduction in sleep apnea events before either commencing therapy or referring their patients for sleep study evaluation and further management. To expect lower mortality as well may be asking for too much. Consequently, success in the treatment in SDB should focus on three items: 1) proof that the underlying disease is treated, 2) symptomatic benefit and 3) demonstration that the pathological consequences are prevented. These benefits must then be balanced with a strong safety profile. Here we evaluate a variety of end-points of value to our CSA patients, in an effort to see what may reasonably be required for treating physicians to recommend an intervention for their CHF patients with CSA by looking at candidate measures of treatment success in CSA within a heart failure population.

Consensus Meeting on "Uric Acid and Cardiovascular Risk" held at University Magna Graecia, Catanzaro, Italy, May 2014. Publication of the Proceedings as a special issue in the International Journal of Cardiology.

Introduction to a special supplement issue on the importance of uric acid in cardiovascular disorders.

Eplerenone's role in the management of complex cardiovascular disorders.

The accompanying special issue reviews the role of eplerenone and spironolactone in the management of various cardiovascular and renal conditions.

The Management of Heart Failure with Preserved Ejection Fraction.

Heart failure is defined as a clinical syndrome and is known to present with a number of different pathophysiological patterns. There is a remarkable degree of variation in measures of left ventricular systolic emptying and this has been used to categorise heart failure into two separate types: low ejection fraction (EF) heart failure or HF-REF and high EF heart failure or HF-PEF. Here we review the pathophysiology, epidemiology and management of HF-PEF and argue that sharp separation of heart failure into two forms is misguided and illogical, and the present scarcity of clinical trial evidence for effective treatment for HF-PEF is a problem of our own making; we should never have excluded patients from major trials on the basis of EF in the first place. Whilst as many heart failure patients have preserved EFs as reduced we have dramatically under-represented HF-PEF patients in trials. Only four trials have been performed in HF-PEF specifically, and another two trials that recruited both HF-PEF and HF-REF can be considered. When we consider the similarity in outcomes and neurohormonal activation between HF-REF and HF-REF, the vast corpus of trial data that we have to attest to the efficacy of various treatment (angiotensin-converting-enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], beta-blockers and aldosterone antagonists) in HF-REF, and the much more limited number of trials of similar agents showing near statistically significant benefits in HF-PEF the time has come rethink our management of HF-PEF, and in particular our selection of patients for trials.

Inconsistencies in the development of the ESC Clinical Practice Guidelines for Heart Failure.

The publication of the European Society of Cardiology (ESC) guidelines for the management of heart failure, in 2012 represented the latest and arguably the most comprehensive document to date summarising recommended treatment and diagnostic options for the care of heart failure patients. The impact of clinical practice guidelines is now so great that it is important to review the processes that underlie guideline development. The ESC guideline process is compared and contrasted to those of other guideline bodies. The ESC uses its own internal experts inclined to review source clinical trial data rather than published or commissioned meta-analyses and systematic reviews. Uncertainties exist in several areas, such as how are the scope of potential treatments to be reviewed chosen, if there is no call for proposals or external consultation?, Two illustrative discrepancies are highlighted i) the non-surgical MitraClip device for reducing mitral regurgitation is given the verbal equivalent of a Class IIb recommendation on the basis of 107 patients in an uncontrolled registry, whereas no drug is reviewed based on such data, and another device, the subject of 3 prospective randomised controlled trials, was not reviewed at all and ii) for Ivabradine the whole trial population was included in the recommendation, despite a subgroup not benefitting, whereas for CRT the sub-group not thought to benefit was excluded from the recommendation. We propose that more interaction is needed between ESC and stakeholders so each can better understand the processes for producing guidelines to improve some of these aspects.

A welcome to the new journal, International Journal of Cardiology - Heart and Vessels (IJC-H + V).

A new journal has been launched: IJC - Heart and Vessels [1]. It builds upon the success of the main journal International Journal of Cardiology. As an introduction to the new journal we will be publishing a series of summaries of the topics to be covered, highlighting the most important papers in the field that have been published recently in the main journal, International Journal of Cardiology. This article describes a topic review of congenital heart disease. IJC has become one of the most important sources of quality papers in this field and many excellent publications have been published in the main journal. The expansion of space occasioned by the launch of IJC - Heart and Vessels will allow us to publish more high quality papers in the expanding field of congenital heart disease.

Adherence to ethical standards in publishing scientific articles: a statement from the International Journal of Cardiology.

All authors of manuscripts in the International Journal of Cardiology are required to make a binding statement that they as authors adhere to the following principles: 1. That the corresponding author has the approval of all other listed authors for the submission and publication of all versions of the manuscript. 2. That all people who have the right to be recognised as authors have been included on the list of authors and everyone listed as an author has made an independent material contribution to the manuscript. 3. That the work submitted in the manuscript is original and has not been published elsewhere and is not presently under consideration of publication by any other journal other than in oral, poster or abstract format. 4. That the material in the manuscript has been acquired according to modern ethical standards and has been approved by the legally appropriate ethical committee. 5. That the article does not contain material copied from anyone else without their written permission and that all material which derives from prior work, including from the same authors, is properly attributed to the prior publication by proper citation. 6. That all material conflicts of interest have been declared including the use of paid medical writers and their funding source. 7. That the manuscript will be maintained on the servers of the journal and held to be a valid publication by the journal only as long as all statements in these principles remain true. 8. That if any of the statements above ceases to be true the authors have a duty to notify the journal as soon as possible so that the manuscript can be withdrawn.

The Research Quality Framework and its implications for health and medical research: time to take stock?

As the Australian university sector awaits final decisions about the introduction and stipulations of a research quality framework (RQF), to assess the quality and impact of research, we have studied international commentary on the value of such exercises. This suggests there is little hard evidence to recommend the proposed RQF. The UK government led the field in 1986 with its research assessment exercise (RAE), which is widely believed to have compromised clinical academic medicine by failing to satisfactorily acknowledge the contribution of clinical academics, not only to research but also to teaching and clinical practice. After the 2008 RAE, the UK government will move to a simpler, metrics-based system for assessing research quality and allocating funding. The New Zealand Performance Based Review Fund (PBRF), introduced in 2003, is based on a combination of peer review and performance indicators. Several concerns have been raised; among them is the real cost-benefit ratio of participation, with reports that many universities have spent more on the exercise than they will gain in funding increases. The scoring system has received the most criticism and, after the partial round assessment scheduled for this year, the controversial unit of assessment will be reviewed. It might be more cost-effective for Australia to modify existing research assessment processes than to undertake a potentially costly and arduous exercise.

Contemporary (post-Wills) survey of the views of Australian medical researchers: importance of funding, infrastructure and motivators for a research career.

OBJECTIVES: To investigate the perceptions of Australian health and medical researchers 4 years after the Wills Report recommended and led to a substantial increase in health and medical research funding in Australia. DESIGN, SETTING AND PARTICIPANTS: A telephone poll of 501 active health and medical researchers, conducted between 28 April and 5 May, 2003. MAIN OUTCOME MEASURES: Researchers' views on the adequacy of funding, infrastructure and support, salary, community recognition, the excitement of discovery and research outcomes such as publication and patenting in research. RESULTS: Research funding was the most important concern: 91% of researchers (455/498) viewed funding as "very" or "extremely" important to their role, but only 10% (52/500) were "very" or "extremely" satisfied with the level of funding. Research infrastructure and support were seen as "very" or "extremely" important by 90% of researchers (449/501), while only 21% (104/501) were "very" or "extremely" satisfied. Researchers in medical research institutes were significantly more likely to be satisfied (27% [56/205] "very" or "extremely" satisfied) with the level of infrastructure and support than those working in universities (15% [41/268] "very" or "extremely" satisfied; P = 0.001). Among the factors that motivate researchers, the excitement of discovery stood out in terms of both high importance and satisfaction. Publications were viewed as more important research outcomes than patenting or commercial ventures. CONCLUSIONS: Funding and infrastructure support remain overwhelmingly researchers' greatest concerns. University-based researchers were less satisfied with infrastructure and support than those in independent medical research institutes.