Vaccination practices and influenza in professional football players in Greece.

BACKGROUND: There is limited data on vaccination practices for professional footballers globally. AIMS: To record vaccination practices employed by medical staff of individual football teams of the Super League Greece, and absenteeism of footballers related to influenza illness. METHODS: A brief questionnaire was distributed to chief medical officers (CMOs) of the sixteen teams of the Super League Greece. Participants were asked to report vaccines they recommended for footballers. In addition, the questionnaire included questions on new cases of influenza and absenteeism due to influenza. Descriptive statistics (absolute and relative frequencies) were used for the presentation of the results. RESULTS: Overall, 87% of the CMOs recommended seasonal influenza vaccine, 62% hepatitis B vaccine and 50% pneumococcal vaccine. Fourteen CMOs (87%) reported that the occurrence of seasonal influenza in the 2016-17 northern hemisphere season ranged from one to five cases, while two medical officers (12%) reported zero workdays lost due to influenza. CONCLUSIONS: Our survey shows considerable variation in vaccination practices of CMOs of the Super League Greece. The results of this survey should stimulate further evaluation of vaccination policy and influenza-related absenteeism in footballers.

A simple score for early risk stratification in acute heart failure.

INTRODUCTION: The use of many acute heart failure (AHF) risk scores is cumbersome. We therefore developed a simple AHF risk score (AHFRS) for early risk stratification. METHODS: The study consisted of a prospective derivation cohort (PDC; N=104; age, 77[21] years; LVEF (%), 35[29]) and a retrospective validation cohort (RVC; N=141; age, 76[15] years; LVEF (%), 35[25]). Clinical, echocardiography and laboratory assessment was performed at admission. The study end-point was death from any cause or HF-rehospitalization at 1year. RESULTS: In the PDC 46 (44.2%) patients experienced the end-point. Independent prognostic factors of outcome were hypertension (HTN) history, myocardial infarction (MI) history, and admission red cell distribution width (RDW). Multivariate logistic regression indicated 8-, 4-, and 3-times higher odds ratio for development of study end-point in patients without a HTN history, with MI history, and RDW≥15% (median) respectively. Thus in AHFRS, 2 points were assigned for absence of HTN history, 1 point for presence of MI history, and 1 point for RDW values ≥15% (0 best possible, whereas 4 worst possible score). The AHFRS identified patients who developed the end-point in the PDC with an area under the ROC curve (AUC) of 0.80 [95% C.I.: (0.71, 0.87)] denoting a high discriminative ability. These findings were confirmed in the RVC, in which the endpoint occurred in 52 (36.9%) patients and the AUC for the AHFRS was 0.82 [95% C.I.: (0.73, 0.89)]. CONCLUSIONS: AHFRS is easily obtained at admission and accurately risk stratifies AHF patients.

On the optimal design of the disassembly and recovery processes.

This paper tackles the problem of the optimal design of the recovery processes of the end-of-life (EOL) electric and electronic products, with a special focus on the disassembly issues. The objective is to recover as much ecological and economic value as possible, and to reduce the overall produced quantities of waste. In this context, a medium-range tactical problem is defined and a novel two-phased algorithm is presented for a remanufacturing-driven reverse supply chain. In the first phase, we propose a multicriteria/goal-programming analysis for the identification and the optimal selection of the most 'desirable' subassemblies and components to be disassembled for recovery, from a set of different types of EOL products. In the second phase, a multi-product, multi-period mixed-integer linear programming (MILP) model is presented, which addresses the optimization of the recovery processes, while taking into account explicitly the lead times of the disassembly and recovery processes. Moreover, a simulation-based solution approach is proposed for capturing the uncertainties in reverse logistics. The overall approach leads to an easy-to-use methodology that could support effectively middle level management decisions. Finally, the applicability of the developed methodology is illustrated by its application on a specific case study.

Doppler flow parameters of left ventricular filling in infants: how long does it take for the maturation of the diastolic function in a normal left ventricle to occur?

OBJECTIVE: To study the impact of the maturational process of diastolic left ventricular function on trans-mitral Doppler flow parameters. METHODS AND PARTICIPANTS: In a survey we examined pulsed-wave Doppler signals and diastolic time intervals from 238 healthy neonates and infants. Using multiple linear regression analysis, we evaluated the impact of physiological determinants on parameter expression. RESULTS: Early-filling and atrial-filling peak velocities, early-filling acceleration and deceleration rates, and the atrial-filling time velocity integral reached a climax within 2 months after birth, while early-filling time velocity integral followed increasing throughout the study period. The isovolumic relaxation time was found to be significantly longer for neonates than for infants older than 2 months. The observed parameter movements could be attributed to changes of stroke volume and mitral valve area for early filling-time velocity integral (R2 = 0.93), and of heart rate, stroke volume, and mitral valve area for early filling peak velocity (R2 = 0.84), and atrial-filling time velocity integral (R2 = 0.65). Isovolumic relaxation time and atrial-filling peak velocity became heart rate dependent not before 3 months after birth. CONCLUSIONS: The observed parameter changes are powerful indicators for the maturational process in diastolic function. This process is mainly completed by 3 months of age.