Total (Canada)

The purpose of this paper was to systematically review the current literature and elucidate the effects of total weekly resistance training (RT) volume on changes in measures of muscle mass via meta-regression. The final analysis comprised 34 treatment groups from 15 studies. Outcomes for weekly sets as a continuous variable showed a significant effect of volume on changes in muscle size (P = 0.002). Each additional set was associated with an increase in effect size (ES) of 0.023 corresponding to an increase in the percentage gain by 0.37%. Outcomes for weekly sets categorised as lower or higher within each study showed a significant effect of volume on changes in muscle size (P = 0.03); the ES difference between higher and lower volumes was 0.241, which equated to a percentage gain difference of 3.9%. Outcomes for weekly sets as a three-level categorical variable (<5, 5-9 and 10+ per muscle) showed a trend for an effect of weekly sets (P = 0.074). The findings indicate a graded dose-response relationship whereby increases in RT volume produce greater gains in muscle hypertrophy.

BACKGROUND: Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease. The objective of this study was to determine the association between CR completion and mortality and resource use. METHODS AND RESULTS: We conducted a prospective cohort study of 5886 subjects (20.8% female; mean age, 60.6 years) who had undergone angiography and were referred for CR in Calgary, AB, Canada, between 1996 and 2009. Outcomes of interest included freedom from emergency room visits, hospitalization, and survival in CR completers versus noncompleters, adjusted for clinical covariates, treatment strategy, and coronary anatomy. Hazard ratios for events for CR completers versus noncompleters were also constructed. A propensity model was used to match completers to noncompleters on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted hazard ratio of 0.59 (95% confidence interval, 0.49-0.70). CR completion was also associated with a decreased risk of all-cause hospitalization (adjusted hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) and cardiac hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.55-0.83) but not with emergency room visits. Propensity-matched analysis demonstrated a persistent association between CR completion and reduced mortality. CONCLUSIONS: Among those coronary artery disease patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for nonattendance and to test interventions to improve attendance after referral.

Soil texture and its vertical spatial heterogeneity may greatly influence soil hydraulic properties and the distribution of water and solutes in the soil profile; therefore, they are of great importance for agricultural, environmental, and geo-engineering applications such as land reclamation and landfill construction. This paper reviews the following aspects on water and salt dynamics in the presence of a water table: (i) the effect of soil texture on the extent of upward movement of groundwater in homogenous soils and (ii) the impact of soil textural layering on water and salt dynamics. For a homogenous soil, the maximum height of capillary rise (h max ) or the evaporation characteristic length (ECL) is closely related to the soil texture. When the water table is deeper than h max , water will evaporate at some depth below surface and salts will be retained below the evaporation front, causing the separation of water and salt. For layered soils, flow barriers (capillary and hydraulic barriers) can make the soil hold more water than a nonlayered one. A capillary barrier may work when a fine-textured layer overlies a coarse-textured layer during infiltration or a coarse-textured layer overlies a fine-textured layer during evaporation, and a hydraulic barrier may occur when a poorly permeable layer exists in the soil profile. The extra water held by flow barriers may improve water availability to plants and may at the same time increase salinization and other environmental risks. Under special conditions, such as in seasonally frozen soils with a shallow water table, there is an additional soil salinization incentive caused by freeze–thaw cycles. Above all, further research is needed to understand the complex effects of soil texture and layering on water and salt dynamics, especially in artificial soils such as reclaimed soils with contrasting properties.

Abstract The random forest (RF) classifier is a relatively new machine learning algorithm that can handle data sets with large numbers and types of variables. Multi-scale object-based image analysis (MOBIA) can generate dozens, and sometimes hundreds, of variables used to classify earth observation (EO) imagery. In this study, a MOBIA approach is used to classify the land cover in an area undergoing intensive agricultural development. The information derived from the elevation data and imagery from two EO satellites are classified using the RF algorithm. Using a wrapper feature selection algorithm based on the RF, a large initial data set consisting of 418 variables was reduced by ∼60%, with relatively little loss in the overall classification accuracy. With this feature-reduced data set, the RF classifier produced a useable depiction of the land cover in the selected study area and achieved an overall classification accuracy of greater than 90%. Variable importance measures produced by the RF algorithm provided an insight into which object features were relatively more important for classifying the individual land-cover types. The MOBIA approach outlined in this study achieved the following: (i) consistently high overall classification accuracies (>85%) using the RF algorithm in all models examined, both before and after feature reduction; (ii) feature selection of a large data set with little expense to the overall classification accuracy; and (iii) increased interpretability of classification models due to the feature selection process and the use of variable importance scores generated by the RF algorithm. Acknowledgements The authors gratefully acknowledge the thoughtful comments by editors and constructive recommendations contributed by anonymous peer reviewers that helped to improve the original manuscript immensely. This research was supported by the Government of Saskatchewan's Go Green Fund awarded to Monique G. Dubé and by a Natural Science and Engineering Research Council Discovery Grant awarded to Steven E. Franklin.

BACKGROUND: Cardiac rehabilitation (CR) reduces mortality in women and men with coronary artery disease (CAD). The objective of this study was to examine sex differences in long-term mortality, based on CR referral rates and attendance patterns in a large CAD population. DESIGN: This is a retrospective cohort study. METHODS: The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) and Cardiac Wellness Institute of Calgary (CWIC) databases were used to obtain information on all patients. Rates of referral to and attendance at CR were compared by sex. Logistic regression models were constructed to assess whether sex predicted CR referral or completion. The association between referral, completion, and survival was assessed by sex using Cox proportional hazard models. RESULTS: 25,958 subjects (6374-24.6%-were women) with at least one vessel CAD were included. Females experienced reduced rates of CR referral (31.1% vs 42.2%, p < 0.0001) and completion (50.1 vs 60.4%, p < 0.0001). Adjusting for demographic and clinical characteristics, relative to men, CR referral was significantly lower in women (adjusted odds ratio (OR) 0.74, 95% CI 0.69, 0.79) as was CR completion (adjusted OR 0.73, 95% CI 0.66, 0.81). Women completing CR experienced the greatest reduction in mortality (HR 0.36, 95% CI 0.28, 0.45) with a relative benefit greater than men (HR 0.51, 95% CI 0.46, 0.56). CONCLUSION: This is the first large cohort study to demonstrate that referral to and attendance at CR is associated with a significant mortality reduction in women, comparatively better than that in men.

Schoenfeld, BJ, Ogborn, DI, Vigotsky, AD, Franchi, MV, and Krieger, JW. Hypertrophic effects of concentric vs. eccentric muscle actions: A systematic review and meta-analysis. J Strength Cond Res 31(9): 2599-2608, 2017-Controversy exists as to whether different dynamic muscle actions produce divergent hypertrophic responses. The purpose of this paper was to conduct a systematic review and meta-analysis of randomized controlled trials comparing the hypertrophic effects of concentric vs. eccentric training in healthy adults after regimented resistance training (RT). Studies were deemed eligible for inclusion if they met the following criteria: (a) were an experimental trial published in an English-language refereed journal; (b) directly compared concentric and eccentric actions without the use of external implements (i.e., blood pressure cuffs) and all other RT variables equivalent; (c) measured morphologic changes using biopsy, imaging (magnetic resonance imaging, computerized tomography, or ultrasound), bioelectrical impedance, and/or densitometry; (d) had a minimum duration of 6 weeks; and (e) used human participants without musculoskeletal injury or any health condition that could directly, or through the medications associated with the management of said condition, be expected to impact the hypertrophic response to resistance exercise. A systematic literature search determined that 15 studies met inclusion criteria. Results showed that eccentric muscle actions resulted in a greater effect size (ES) compared with concentric actions, but results did not reach statistical significance (ES difference = 0.25 ± 0.13; 95% confidence interval: -0.03 to 0.52; p = 0.076). The mean percent change in muscle growth across studies favored eccentric compared with concentric actions (10.0% vs. 6.8, respectively). The findings indicate the importance of including eccentric and concentric actions in a hypertrophy-oriented RT program, as both have shown to be effective in increasing muscle hypertrophy.

Abstract Background Canagliflozin reduces hospitalizations for heart failure (HF) in type 2 diabetes mellitus (T2DM). Its effect on cardiorespiratory fitness and cardiac function in patients with established HF with reduced ejection fraction (HFrEF) is unknown. Methods We conducted a double‐blind randomized controlled trial of canagliflozin 100 mg or sitagliptin 100 mg daily for 12 weeks in 88 patients, and measured peak oxygen consumption (VO 2 ) and minute ventilation/carbon dioxide production (VE/VCO 2 ) slope (co‐primary endpoints for repeated measure ANOVA time_x_group interaction), lean peak VO 2 , ventilatory anaerobic threshold (VAT), cardiac function and quality of life (ie, Minnesota Living with Heart Failure Questionnaire [MLHFQ]), at baseline and 12‐week follow‐up. Results The study was terminated early due to the new guidelines recommending canagliflozin over sitagliptin in HF: 17 patients were assigned to canagliflozin and 19 to sitagliptin, total of 36 patients. There were no significant changes in peak VO 2 and VE/VCO 2 slope between the two groups ( P = .083 and P = .98, respectively). Canagliflozin improved lean peak VO 2 (+2.4 mL kg LM −1 min −1 , P = .036), VAT (+1.5 mL kg −1 min −1 , P = .012) and VO 2 matched for respiratory exchange ratio (+2.4 mL Kg −1 min −1 , P = .002) compared to sitagliptin. Canagliflozin also reduced MLHFQ score (−12.1, P = .018). Conclusions In this small and short‐term study of patients with T2DM and HFrEF, interrupted early after only 36 patients, canagliflozin did not improve the primary endpoints of peak VO 2 or VE/VCO 2 slope compared to sitagliptin, while showing favourable trends observed on several additional surrogate endpoints such as lean peak VO 2 , VAT and quality of life.

Summary Heavy-oil production is one of the new challenges the oil and gas industry faces today, with trillions of barrels of reserves around the planet. To extract heavy oils, the viscosity has to be reduced to gain mobility and start the oil flowing. Of all the possible techniques, steam stimulation is, today, the most promising. Steam is injected through the well down to the reservoir to warm it to a temperature of up to 250°C, inducing extreme thermal stresses in the well (especially when the temperature gradient through its components is maximum, as it is during initial steam injection or during workover when the well has to be quickly cooled down and heated up again to restart production rapidly). To avoid zonal-isolation failure and steam release at the surface, new rules need to be considered in designing the barriers of a well exposed to steam stimulation, especially in very shallow fields. Where conventional rules may be applied for casing design, pioneering rules should be considered for designing the cement sheath. This paper presents an innovative methodology for designing robust cement sheaths in very shallow conditions. First, stresses in the field are assessed with a rock-mechanics simulation. Then, the thermal gradient in the well components during the heating process is evaluated with a thermal simulation of the well. Both results are entered into Total's dedicated software to determine the mechanical properties the cement should have to withstand the thermal stresses. Different cement systems from service companies are evaluated in a cell, reproducing the field conditions to validate the simulation results. This methodology was applied successfully to the Joslyn field wells, in Canada, where a resilient cement system with low Young's modulus and high tensile strength was selected and pumped. Because the results were positive, the methodology has been extended to other Total fields around the world where steam simulation is being considered.

PURPOSE: This study explored patients' decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes. METHOD: Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts. RESULTS: Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress. CONCLUSION: The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation. Implications for Rehabilitation Cardiovascular disease is a leading cause of mortality worldwide. Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll. After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.

Abstract Zonal isolation and cement sheath integrity are key requirements for heavy oil development and production. Current commercial production techniques use steam to provide heat to mobilize oil and allow production. One such technique is Steam Assisted Gravity Drainage (SAGD). Maintaining cement sheath integrity prevents unwanted fluid migration, especially oil, gas, and or steam. Flexible cement systems can be designed and installed so that the cement sheath can withstand the expected stresses in the well. Installation practices are critical to providing a high quality cement sheath. Challenges that are prevalent in SAGD wells are centralization in the soft formations, assessment of the cement bond between the cement and formation, and assessment of the cement bond after steaming. Case History - Comparison of two cement systems with flexible properties installed in seven SAGD well pairs (14 wells). Two cement systems were selected for installation and comparison in SAGD well pairs for a project in Alberta. These cement systems have flexible properties, with Young's Modulus varying from 2000 MPa to 6000 MPa. Careful planning and process control were required to deliver the system with the desired properties to the wellbore. Industry best practices were used for placement of the cement systems, including the use of centralizers, viscous fluid spacers and pipe movement. Zonal isolation and wellbore integrity are examined with the use of cement cement evaluation logs and ultrasonic cement evaluation tools. These logs provide evidence that zonal isolation is achieved and is improved with the use of industry best practices for cement placement. The flexible cement systems are proven for zonal isolation in these SAGD wells. More than half of the 9 to 13 trillion barrels of world oil resources in place are classified as "extra-heavy" and "oilsands and bitumen". Current commercial methods for developing these reserves such as SAGD may place significant stresses on the cement sheath which could lead to failure. The use of best practices for placing the cement slurry, and the use of cement systems with flexible properties improves well integrity enabling efficient development of world heavy oil reserves.

Abstract The initial steam chamber that developed during the circulation phase of a Steam Assisted Gravity Drainage (SAGD) process impacts the efficiency of bitumen recovery tremendously. The circulation phase, during which both horizontal injector and producer in a SAGD well pair are put under circulation, is designed to establish inter-well communication and create an initial steam chamber. It is desirable to know the mid-point temperatures between and along the horizontal well pair so that any development of the steam chamber can be predicted. This paper proposes a new analytical model to predict the temperature fronts and heating efficiency between and along the horizontal well pair during the SAGD circulation phase. By using the exponential integral solution for radial heating in a long cylinder and superposition in space for multi-heating sources, the proposed model can be used to predict these temperature profiles, provided that the steam temperatures or pressures are known during the circulation period. Knowing temperature profiles between and along the horizontal wells is of great importance when deciding how to design the circulation parameters, where to modify the process, and when to switch to the SAGD production phase in a timely manner. The results can be optimized under various operational conditions, wellbore profiles, tubing sizes, and convection flow effects. The proposed model is easy to use, provides quick results, and ideal for updating during operations. This model is also advantageous compared to numerical simulation because it reduces computational time if many well pairs are involved in the study, and models accurately any variation in distance between the wellbores. Generic data is used in this paper to illustrate the model application.

Abstract Heavy oil production is one of the new challenges the Oil and Gas industry faces today with reserves of trillions of barrels. When well production is considered, heavy oils viscosity must be reduced to gain mobility and have oil flowing. Between all possible techniques, steam stimulation is today the most promising. Steam is injected through the well down to the reservoir to warm it up with temperature up to 250°C, inducing extreme thermal stresses to the well, especially when the temperature gradient through the well components is maximum, like during first steam injection or during work-over when the well should be quickly cooled down and heated up again to rapidly restart production. To avoid zonal isolation failure and steam release at surface, new rules should be considered when designing barriers of a well exposed to steam stimulation, especially in very shallow fields. If classic rules could be applied for casing design, pioneering rules should be considered to design cement sheath. This paper presents a singular methodology to design cement sheath long term integrity in very shallow conditions. First, stresses in the field are evaluated with a rock mechanics simulation. Then, thermal gradient in well components while heating are evaluated with a thermal simulation of the well. Both results are injected in Total's dedicated software to determine the mechanical properties the cement should have to withstand thermal stresses. Different cement systems from service companies are then triaxial tested before being evaluated in a cell reproducing the field to validate simulations' results. This methodology was successfully applied to Joslyn field wells, Canada, where a resilient cement system with low Young's modulus and high tensile strength was selected and pumped. Since results are positive, this methodology has been extended to other Total's fields worldwide where steam simulation is considered.

Poor health behaviors (e.g., smoking, poor diet, and physical inactivity) are major risk factors for noncommunicable chronic diseases (NCDs). Evidence supporting traditional advice-giving approaches to promote behavior change is weak or short lived. Training physicians to improve their behavior change counseling/communication skills is important, yet the evidence for the efficacy and acceptability of existing training programs is lacking and there is little consensus on the core competencies that physicians should master in the context of NCD management. The purpose of this study is to generate an acceptable, evidence-based, stakeholder-informed list of the core communication competencies that physicians should master in the context of NCD management. Using a modified Delphi process for consensus achievement, international behavior change experts, physicians, and allied health care professionals completed four phases of research, including eight rounds of online surveys and in-person meetings over 2 years (n = 13-17 participated in Phases I, III, and IV and n = 39-46 in Phase II). Eleven core communication competencies were identified: reflective listening, expressing empathy, demonstrating acceptance, tolerance, and respect, responding to resistance, (not) negatively judging or blaming, (not) expressing hostility or impatience, eliciting "change-talk"/evocation, (not) being argumentative or confrontational, setting goals, being collaborative, and providing information neutrally. These competencies were used to define a unified approach for conducting behavior change counseling in medical settings: Motivational Communication. The results may be used to inform and standardize physician training in behavior change counseling and communication skills to reduce morbidity and mortality related to poor health behaviors in the context of NCD prevention and management.

We read with interest the letter to the editor entitled “Is it possible to reach reliable conclusions doing meta-analyses with resistance training studies?” (Arruda et al., 2016). We thank the jour...

Abstract Large quantity of heavy oil resources are present in variety of complex thin reservoirs in Lloydminster area which are situated in east-central Alberta and west-central Saskatchewan. Primary depletion and waterflooding are the principal recovery techniques. Although these techniques work, the recovery factors remain low and large volumes of oil are left unrecovered when these methods have been exhausted. Because of the large quantities of sand production, many of these reservoirs end up with a network of wormholes that makes most of the displacement type enhanced oil recovery techniques inapplicable. Because of these high conductivity channels, only gravity drainage based techniques have a good chance of success. Among the applicable methods in Lloydminster area, SAGD has not received adequate attention, mostly due to the notion that heat loss in thin reservoirs would make the process uneconomical. While this may be true, the limiting reservoir thickness for SAGD under varying conditions has not been established. These reservoirs contain light oil with sufficient mobility. Therefore the communication between the SAGD well pairs is no longer a hurdle. This opens up the possibility of increasing the distance between the two wells and introducing elements of steamflooding into the process in order to compensate for the small thickness of the reservoir. The main objective of this study was to evaluate the effect of well configuration on SAGD performance and develop a methodology for enhancement of the SAGD performance through optimizing the well configurations for Lloydminster type of reservoir. A new well configuration was able to significantly improve the application of SAGD in thin reservoirs of Lloydminster. It provided high RF at reasonable cSOR. The effects of some common Lloydminster reservoir characteristics, which are problematic for the SAGD process (such as initial gas saturation, bottom water, and gas-cap) were investigated for the most promising well configuration.

Purpose: Patients referred to cardiac rehabilitation after an acute coronary syndrome event commonly report strong intention to attend, but at least one-third do not participate. This study explored whether well-documented cardiac rehabilitation barriers (e.g., comorbidities, logistical/time constraints, and low social support) moderate the association between intention to participate and actual program enrollment and attendance.Method: Following referral but prior to commencing a 12-week outpatient cardiac rehabilitation program, 100 patients with acute coronary syndrome completed measures of intention to attend cardiac rehabilitation, perceived cardiac rehabilitation barriers, and social support. Program enrollment and attendance were determined by chart review.Results: Despite high reported intention to attend (M = 6.08/7.00, SD = 1.80), nearly one-in-five did not enroll. Weaker intention to attend (b = 0.46, SE = 0.16, p = 0.004) and greater cardiac rehabilitation barriers (b= −1.67, SE = 0.70, p = 0.017) corresponded to lower program enrollment. Similarly, weaker intention (b = 2.29, SE = 0.50, p < 0.001) and greater barriers (b =−6.19, SE = 1.55, p < 0.001) predicted poorer attendance. Barriers moderated the association between intention to participate and cardiac rehabilitation enrollment (b=−0.60, SE = 0.29, p = 0.037) and attendance (b = −3.12, SE = 1.02, p = 0.003).Conclusions: Perceived cardiac rehabilitation barriers influence whether patients successfully translate their intention to attend into actual program participation. Enhancing self-efficacy to overcome barriers may represent an important intervention target among prospective cardiac rehabilitation patients.Implications for RehabilitationPatients with acute coronary syndrome report strong intention to attend cardiac rehabilitation upon referral, yet cardiac rehabilitation programs remain underutilized.Assessing and addressing perceived barriers during the transition to cardiac rehabilitation, even when patients present as highly motivated to attend, may be critical to promoting program uptake.Rehabilitation professionals should ask patients about specific barriers to attending cardiac rehabilitation (e.g., financial constraints, transportation problems) and provide individualized solutions (e.g., fee subsidization, home- or web-based programs) to increase participation.

Abstract Finding a reliable artificial lift pumping system for heavy oil thermal recovery has been a challenge mainly due to the high operating temperatures (&amp;gt;150°C). Available options such as Rod Pumps and Electrical Submersible Pumps (ESP), which are well proven in the industry, are not particularly well suited to thermal production. While Rod Pumps offer high temperature service, they are limited in the flowrate they can deliver. ESPs on the other hand, can handle high volumes of low viscosity fluids, but are still limited in terms of maximum operating temperature. Progressing Cavity Pumps (PCP), with elastomeric stator, is economic to run and have done well in heavy oil cold production. These elastomers are however limited in temperature (&amp;lt;150°C). Through research work conducted by PCM and TOTAL, Metal PCP technology has been developed to meet the high temperature requirement of SAGD and other thermal recovery processes. Three models of the Metal PCP are now available to cover a wide range of flow rates for heavy oil production. This paper presents an update on the Metal PCP development and the results of the world's first SAGD field trial of this type of pump currently on-going in Canada in the Joslyn field. Field performance data are discussed comparing high temperature ESP and metal PCP in actual LP-SAGD conditions. Four SAGD well pairs were initially equipped with high temperature ESP. Another well pair was equipped with metal PCP. This well has been running since mid October 2006 without problems, in spite of low pressure at pump intake, close to steam flashing conditions. Production rate reached 200m3/d of liquid at 340rpm, giving a volumetric efficiency of 53%. Intake temperature is 160°C due to the LP-SAGD condition of the field. However, this pump is rated up to 350°C. This first field trial shows the metal PCP as a promising artificial lift technology for hot production. Following this encouraging trial, a second metal PCP has been installed with success in the same field and more installations were decided eventually. Thus, all ESP initially installed were replaced by PCP and nine wells are producing with Metal PCPs currently.

We report two patients with sagittal craniosynostosis, hypoplastic male genitalia, agenesis of the corpus callosum, thyroid abnormalities, and dysmorphic features which include short palpebral fissures and retrognathia. The clinical presentation of both patients was initially thought to be suggestive of Lin-Gettig syndrome (LGS), a multiple malformation syndrome associated with craniosynostosis that was initially reported in two brothers in 1990, with a third patient reported in 2003. Our first patient was subsequently found through exome sequencing to have a de novo mutation in KAT6B, c.4572dupT, p.(Thr1525Tyrfs*16). The second patient was ascertained as possible LGS, but KAT6B mutation testing was pursued clinically after the identification of the KAT6B mutation in Patient 1, and identified a de novo mutation, c.4205_4206delCT, p.(Ser1402Cysfs*5). The phenotypic spectrum of KAT6B mutations has been expanding since identification of KAT6B mutations in genitopatellar syndrome (GPS) and Say Barber Biesecker Young Simpson (SBBYS) syndrome patients. We show that craniosynostosis, which has not been previously reported in association with KAT6B mutations, may be part of the genitopatellar/Say Barber Biesecker Young Simpson spectrum. These two patients also further demonstrate the overlapping phenotypes of genitopatellar and SBBYS syndromes recently observed by others. Furthermore, we propose that it is possible that one or more of the previous cases of LGS may have also been due to mutation in KAT6B, and that LGS may actually be a variant within the KAT6B spectrum and not a distinct clinical entity.

Background Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. Methods and Results A retrospective mediation analysis was conducted among 11 196 patients referred to a 12‐week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All‐cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2‐year follow‐up (SD, 2.81 years). CR completion was associated with reduced all‐cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54–0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40–0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates ( P &lt;0.001). CR attendance had an indirect effect on all‐cause mortality via improved cardiorespiratory fitness ( ab =−0.006 [95% CI, −0.008 to −0.003]) and via low‐density lipoprotein cholesterol ( ab =−0.002 [95% CI, −0.003 to −0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness ( ab =−0.007 [95% CI, −0.012 to −0.003]). Conclusions Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.

Chemosynthetic ecosystems teeming with tubeworm colonies were discovered at hydrothermal vents in the Galapagos Ridge in 1977 and at cold seeps at the base of the Florida Escarpment in 1984. As a result of these reports a number of fossil examples were identified in the rock record. One such assemblage was recognized in the Western Interior Seaway, in the Middle Campanian Pierre Shale Formation, where previous researchers noted siboglinid (formerly vestimentiferan and pogonophoran) tubeworms in methane-derived nodular limestones with tubules. On the inside these tubules have an outer ring of micrite with microparticulate siliciclastic materials and a core of calcite cement. Alternatively, they have an outer annulus of calcite cement and a core of microparticulate siliciclastic materials with calcite cements. Interestingly, the cemented cores can contain meniscate and vesiculate fabrics in association with the microparticulate linings. With this evidence we infer that the tubules preserve fabrics of former gas bubbles; the microparticulate linings are deposits that accumulated on the walls of the tubules as fluids streamed through them. Methane bubbles would have carried adhered siliciclastic microparticles and bubble wakes would have held entrained microparticles. We, thus, interpret the tubules to be former, small, subseafloor conduits along which fluid and particulate transport occurred. Particle transport by gas bubbles is a well-known process in chemical and mineral industries. Our observations highlight this process for the first time in an ancient geologic conduit system and provide a mechanism for maintaining particulate plumes that accompany effusing methane streams at modern seeps and vents.