Hypertension in Patients With Peripheral Artery Disease: An Updated Literature Review.

Peripheral artery disease (PAD), a condition where there is reduced blood flow due to narrowing or blockage of the arteries of the peripheral vasculature, is an epidemic that currently affects eight million people in the United States alone and is a major risk equivalent to having active coronary artery disease (CAD). However, it is commonly underdiagnosed in the general population. Hypertension is a common cardiovascular condition characterized by elevated blood pressure levels. There are several mitigating risk factors that can reduce the risk of complications of PAD, with hypertension playing a major role. This literature review aims to explore the relationship between hypertension and PAD, including their shared risk factors, pathophysiological mechanisms, and management strategies. In addition, we will analyze how this impacts major cardiovascular outcomes, such as critical limb ischemia, vascular amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular-related death by examining relevant studies, current guidelines, and evidence. This literature review is intended to guide practitioners on ideal blood pressure parameters and evidence-based anti-hypertensives that provide overall cardiovascular benefit in both the primary care and hospital-based setting. By understanding the association between hypertension and PAD and the underlying pathophysiological mechanisms, healthcare professionals can improve diagnosis, treatment, and management strategies for affected individuals.

Meta-analysis shows that wild large herbivores shape ecosystem properties and promote spatial heterogeneity.

Megafauna (animals ≥45 kg) have probably shaped the Earth's terrestrial ecosystems for millions of years with pronounced impacts on biogeochemistry, vegetation, ecological communities and evolutionary processes. However, a quantitative global synthesis on the generality of megafauna effects on ecosystems is lacking. Here we conducted a meta-analysis of 297 studies and 5,990 individual observations across six continents to determine how wild herbivorous megafauna influence ecosystem structure, ecological processes and spatial heterogeneity, and whether these impacts depend on body size and environmental factors. Despite large variability in megafauna effects, we show that megafauna significantly alter soil nutrient availability, promote open vegetation structure and reduce the abundance of smaller animals. Other responses (14 out of 26), including, for example, soil carbon, were not significantly affected. Further, megafauna significantly increase ecosystem heterogeneity by affecting spatial heterogeneity in vegetation structure and the abundance and diversity of smaller animals. Given that spatial heterogeneity is considered an important driver of biodiversity across taxonomic groups and scales, these results support the hypothesis that megafauna may promote biodiversity at large scales. Megafauna declined precipitously in diversity and abundance since the late Pleistocene, and our results indicate that their restoration would substantially influence Earth's terrestrial ecosystems.

Functionally unicuspid aortic valve in an adult: Case report and literature review.

Aortic stenosis is one of the most prevalent cardiac valvular diseases throughout the world and has a significant impact on quality of life. While there are several etiologies, we will be discussing the case of a male in his mid-thirties of southeast Asian descent with a bicuspid aortic valve which was found to be functionally unicuspid and complicated by aortic dilation. Following a comprehensive review of literature, it appears this subset of aortic stenosis is not commonly encountered. In addition to presenting this fascinating case, we will review the epidemiology, classification and management of aortic stenosis. Furthermore, we will examine the latest evidence-based literature on bicuspid aortic valve and unicuspid aortic valve and discuss interventions and diagnostic tools that may improve clinical prognosis.

Clostridium septicum Bacteremia As the Presenting Sign of Colon Cancer.

Colon cancer is one of the leading causes of morbidity and mortality throughout the world. Some of the most common presenting signs are a change in bowel habits, alteration of fecal contour or consistency, blood in stool, fatigue, and weight loss. However, it may present insidiously. This is the case of an 81-year-old female with Clostridium septicum bacteremia as the primary presenting sign of metastatic colon cancer. In further literature review, we discuss the genomic associations that contribute to the severity of the disease and explore the potential links between the gut microbiome and colorectal carcinoma. This article highlights risk factor modifications and lab abnormalities that may be useful for the primary care provider and acute care practitioner.

A Rare Case of Bartonella henselae Infective Endocarditis Causing an Embolic Cerebrovascular Accident.

Bartonella is a facultative intracellular Gram-negative aerobic rod that is an important cause of culture-negative endocarditis that only accounts for 3% of all infective endocarditis (IE) cases. Throughout the literature, there have been very few documented cases of an embolic stroke caused by Bartonella henselae (B. henselae) IE. Following a comprehensive review of the literature, it appears that only a small number of articles have reported on the correlation between cerebrovascular accidents (CVAs) and Bartonella IE. Here, we present a case of a 42-year-old male with a cerebral embolic event as a complication of B. henselae IE.

The sixth R: Revitalizing the natural phosphorus pump.

Phosphorus (P) is essential for all life on Earth and sustains food production. Yet, the easily accessible deposits of phosphate-rich rock, which underpin the green revolution are becoming rarer. Here we propose a mechanism to help alleviate the problem of "peak phosphorus". In the past, wild animals played a large role in returning P from ocean depths back to the continental interiors. In doing so, they collectively retained and redistributed P within the biosphere, supporting a more fertile planet. However, species extinctions and population reductions have reduced animal-mediated P transport >90% over the past 12,000 years. Recently a 5R strategy was developed to Realign P inputs, Reduce P losses, Recycle P in bio-resources, Recover P in wastes, and Redefine P in food systems. Here, we suggest a sixth R, to Revitalize the Natural Phosphorus Pump (RNPP). Countries are starting to mandate P recycling and we propose a P-trading scheme based on REDD+, where a country could partially achieve its recycling goals by restoring past animal-mediated P pathways. Accrued money from this scheme could be used to restore or conserve wild animal populations, while increasing natural P recycling.

COVID-19 and the cardiovascular system: an update.

As COVID-19 continues to cause an increasing number of deaths worldwide, it is important that providers stay abreast with new research related to the pathophysiology of COVID-19 disease presentation states and clinical management. It is now well recognized that COVID-19 affects extrapulmonary organs, particularly the cardiovascular system. For example, cardiogenic shock has been increasingly observed in patients with COVID-19, owing to the various mechanisms involved and the affinity of the SARS-CoV-2 virus to cells comprising the cardiovascular system. In this review, we have briefly discussed the link between the cardiovascular system and COVID-19 infection, focusing on underlying mechanisms including but not limited to cytokine storm, direct virus-induced myocarditis, and ST-elevation myocardial infarction leading to cardiogenic shock. We have highlighted the cardiovascular risk factors associated with disease prognostication in COVID-19 patients. We have also briefly discussed vasopressors and inotropes used for treating shock and presented their mechanism of action, contraindications, and side effects in the hopes of providing a quick reference to help the provider optimize management of COVID-19 patients presenting with cardiovascular complications such as shock.

Understanding a Player's Decision-Making Process in Team Sports: A Systematic Review of Empirical Evidence.

Three perspectives were taken to explain decision-making within team sports (information processing, recognition primed decision-making, and ecological dynamics perspectives), resulting in conceptual tension and practical confusion. The aim of this paper was to interrogate empirical evidence to (1) understand the process of decision-making within team sports and (2) capture the characteristics of decision-making expertise in a team sport context. Nine electronic databases (SPORTDiscus, PsycINFO, PsycArticles, PsycTests, PubMed, SAGE journals online, Web of Knowledge, Academic Search Complete, and Web of Science) were searched until the final return in March 2021. Fifty-three articles satisfied the inclusion criteria, were analysed thematically, and synthesised using a narrative approach. Findings indicate that the relative absence or presence of mental representation within the decision-making process depends on factors, including complexity, typicality, time available, and contextual priors available in the game situation. We recommend that future research integrate concepts and methodologies prevalent within each perspective to better understand decision-making within team sports before providing implications for practitioners.

What Cognitive Mechanism, When, Where, and Why? Exploring the Decision Making of University and Professional Rugby Union Players During Competitive Matches.

Over the past 50 years decision making research in team invasion sport has been dominated by three research perspectives, information processing, ecological dynamics, and naturalistic decision making. Recently, attempts have been made to integrate perspectives, as conceptual similarities demonstrate the decision making process as an interaction between a players perception of game information and the individual and collective capability to act on it. Despite this, no common ground has been found regarding what connects perception and action during performance. The differences between perspectives rest on the role of stored mental representations, that may, or may not facilitate the retrieval of appropriate responses in time pressured competitive environments. Additionally, in team invasion sports like rugby union, the time available to players to perceive, access memory and act, alters rapidly between specific game situations. Therefore, the aim of this study was to examine theoretical differences and the mechanisms that underpin them, through the vehicle of rugby union. Sixteen semi-elite rugby union players took part in two post-game procedures to explore the following research objectives; (i) to consider how game situations influence players perception of information; (ii) to consider how game situations influence the application of cognitive mechanisms whilst making decisions; and (iii) to identify the influence of tactics and/or strategy on player decision making. Deductive content analysis and elementary units of meaning derived from self-confrontation elicitation interviews indicate that specific game situations such as; the lineout, scrum or open phases of play or the tackle situation in attack or defence all provide players with varying complexity of perceptual information, formed through game information and time available to make decisions. As time increased, players were more likely to engage with task-specific declarative knowledge-of the game, stored as mental representations. As time diminished, players tended to diagnose and update their knowledge-in the game in a rapid fashion. Occasionally, when players described having no time, they verbalised reacting on instinct through a direct connection between perception and action. From these findings, clear practical implications and directions for future research and dissemination are discussed.

The impact of rule modifications on player behaviour in a talent identification and development environment: A case study of the Rugby Football Union's Wellington Academy Rugby Festival.

Research has suggested that competition within talent identification and development systems should be modified from the adult format of the sport to meet the developmental needs of those participating. Yet limited research has evaluated the success of game changes, particularly the effectiveness of modifying the rules of a game to purposefully engineer changes in player behaviour. The purpose of this study was to monitor the impact of rule modifications on player behaviour within a talent identification and development system in rugby union. Performance indicators (ball in play, pass, offload, kick) were collected during full length (70 min) and shortened durations (30-42 min) of competitive matches played during a weeklong under sixteen rugby union festival in 2016 and after rule modifications were introduced in 2017-2019. The findings indicate that rule modifications had the prescribed impact on player actions, particularly in the shortened duration formats of the game. Therefore, rule modifications provide talent developers a tool to manipulate player behaviour, in this case skill attempts, within full-sided competitive matches.

The megabiota are disproportionately important for biosphere functioning.

A prominent signal of the Anthropocene is the extinction and population reduction of the megabiota-the largest animals and plants on the planet. However, we lack a predictive framework for the sensitivity of megabiota during times of rapid global change and how they impact the functioning of ecosystems and the biosphere. Here, we extend metabolic scaling theory and use global simulation models to demonstrate that (i) megabiota are more prone to extinction due to human land use, hunting, and climate change; (ii) loss of megabiota has a negative impact on ecosystem metabolism and functioning; and (iii) their reduction has and will continue to significantly decrease biosphere functioning. Global simulations show that continued loss of large animals alone could lead to a 44%, 18% and 92% reduction in terrestrial heterotrophic biomass, metabolism, and fertility respectively. Our findings suggest that policies that emphasize the promotion of large trees and animals will have disproportionate impact on biodiversity, ecosystem processes, and climate mitigation.

The uneven weight distribution between predators and prey: Comparing gut fill between terrestrial herbivores and carnivores.

The general observation that secondary consumers ingest highly digestible food and have simple short guts and small abdominal cavities intuitively results in the assumption that mammalian carnivores carry less digesta in their gut compared to herbivores. Due to logistic constraints, this assumption has not been tested quantitatively so far. In this contribution, we estimated the dry matter gut contents (DMC) for 25 species of the order Carnivora (including two strictly herbivorous ones, the giant and the red panda) using the physical 'Occupancy Principle', based on a literature data collection on dry matter intake (DMI), apparent dry matter digestibility (aD DM) and retention time (RT), and compared the results to an existing collection for herbivores. Scaling exponents with body mass (BM) for both carnivores and herbivores were in the same range with DMI ~ BM0.75; aD DM ~ BM0; RT ~ BM0.11 and DMC ~ BM0.88. The trophic level (carnivore vs herbivore) significantly affected all digestive physiology parameters except for RT. Numerically, the carnivore DMI level reached 77%, the RT 32% and DMC only 29% of the corresponding herbivore values, whereas the herbivore aD DM only reached 82% of that of carnivores. Thus, we quantitatively show that carnivores carry less inert mass or gut content compared to herbivores, which putatively benefits them in predator-prey interactions and might have contributed to the evolution towards unguligradism in herbivores. As expected, the two panda species appeared as outliers in the dataset with low aD DM and RT for a herbivore but extremely high DMI values, resulting in DMC in the lower part of the herbivore range. Whereas the difference in DMI and DMC scaling in herbivores might allow larger herbivores to compensate for lower diet quality by ingesting more, this difference may allow larger carnivores not to go for less digestible prey parts, but mainly to increase meal intervals, i.e. not having to hunt on a daily basis.