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BackgroundBiomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves.MethodsWe will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25–64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants.DiscussionFindings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease.Trial registrationClinicalTrials.gov, ID: NCT02994680, Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2179-x) contains supplementary material, which is available to authorized users.

In patients with IVF, this meta-analysis revealed an estimated recurrent event rate of 31% and a pooled mortality rate of 3.1% during an average of 5 years follow-up. The results of baseline electrophysiological studies are not predictive of future ventricular arrhythmias.

MNF is an underrecognised condition with potential implications for patients. Children mostly present with pigmentary anomalies only. Most patients do not develop associated findings or complications before adulthood, but long-term follow-up will help determine outcomes and possible associations. Recognition and confirmation of the diagnosis is important to provide follow-up and genetic counselling to patients.

Objectives Fatigue is one of the most common symptoms reported in patients living with SLE. We aim to: 1) determine if different trajectories of fatigue associate with specific latent classes of disease activity and 2) define the patient characteristics and associated factors in different latent classes. Methods Data from an inception cohort of adult patients from the Toronto Lupus Clinic from 1997-2018 were analyzed. Fatigue levels were measured using Fatigue Severity Scale (FSS) and disease activity by the Adjusted Mean Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) (AMS). Dual latent class trajectory analysis, for fatigue and AMS, was performed. Univariable and multivariable logistic regression analyses assessed the association of baseline variables with class membership. Results Among 280 patients, 4 dual classes (C) of fatigue and disease activity were identified: C1- lowest disease activity and second highest fatigue trajectory (27%); C2- second highest disease activity and highest fatigue trajectory (30%); C3-moderate disease activity and lowest fatigue trajectory (33%); and C4- highest disease activity and moderate fatigue trajectory (10%). Conclusion 4 distinct latent classes of dual fatigue and disease activity trajectories were identified. Fatigue and disease activity follow distinct trajectories and disease activity alone cannot fully explain fatigue trajectories. Trajectories with higher FSS scores were associated with more fibromyalgia and trajectories with higher disease activity were associated with higher cumulative glucocorticoid use. Higher baseline glucocorticoid use was more likely associated with more fatigue while older age at SLE diagnosis was associated with less fatigue.

Purpose —To assess the impact of a structured duplex ultrasound hemodialysis access surveillance program on the frequency of diagnostic fistulograms and endovascular interventions. Methods —A structured ultrasound hemodialysis access surveillance program was implemented at our institution on March 1, 2010. The access ultrasound comprised the measurement of vessel diameter, velocity, and flow in the feeding artery, anastomosis, and at specific points along the outflow vein (2.5, 5.0, 7.5, and 10 cm beyond anastomosis) along with a waveform pattern in the ipsilateral axillary and internal jugular vein. In this retrospective multicenter study, we compared the frequency of diagnostic contrast fistulograms and endovascular interventions (angioplasty) performed from March 2010 to February 2011 (12 months) by using the implemented ultrasound access surveillance program (postsurveillance) to the preceding 12 month period (March 2009 to February 2010) where no ultrasound access surveillance program was used (pre-surveillance). Results —Within our hemodialysis program, there was an average of 119 active fistulae during the presurveillance period versus 141 in the postsurveillance period. There were no significant demographic differences in our study populations across the two time frames (p > 0.05). In the presurveillance period, 59 diagnostic contrast fistulograms were performed, whereas 47 diagnostic contrast fistulograms were performed during the post surveillance period. Using a two-sample test for equality of proportions, we found there was a significant decrease in the proportion of diagnostic contrast fistulograms after implementation of an access ultrasound surveillance program (p = 0.0114). Similarly, 81 endovascular interventions were performed during the presurveillance period, whereas a significantly decreased number of endovascular interventions (n = 50) were performed postsurveillance (p < 0.0001). Conclusions —There was a significant decrease in the number of invasive diagnostic contrast fistulograms and endovascular interventions upon implementation of an ultrasound access surveillance program. Such a structured surveillance program has the potential to provide significant reduction in patient discomfort and to minimize unnecessary invasive endovascular procedures.

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