Patients with PLEA demonstrate high all-cause mortality. No traditional cardiovascular risk factors predicted mortality. Aspirin therapy at the time of first evaluation was a significant and independent predictor of improved survival in patients with PLEA.

Abnormalities of the microvasculature are linked to major cardiac events, but their role in the development of atrioventricular conduction abnormalities (AVCA) is unknown. We examined the association between central retinal arteriolar equivalent (CRAE), a measure of the microvasculature, and incident AVCA. This analysis included 3975 participants free of AVCA at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA). Incident AVCA was defined as a composite of new heart rate-adjusted PR interval ⩾ 200 ms (first-degree AV block) and advanced block (second-degree or complete AV block) detected from the MESA exam 5 electrocardiogram (ECG). CRAE was measured from retinal photographs at exam 2. Both ECGs and retinal photographs were collected using standardized methods and read and graded at central core labs. Incident AVCA were present in 7.4% (n=290) of the participants, of which 94% were first-degree AV block. Incident AVCA were increasingly more common in participants with narrower CRAE (4.6% in Q4, 6.4% in Q3, 7.0% in Q2 and 10.8% in Q1, p-value for trend < 0.0001). The socio-demographic and cardiovascular disease risk-adjusted odds of incident AVCA in the Q1 group (the group with the narrowest retinal arteriolar diameter) was nearly twice the odds in the Q4 group (OR: 1.68, 95% CI: 1.15-2.51). This association remained significant after adjustment for major ECG abnormalities and incident cardiovascular disease (Q1 vs Q4, OR: 1.65, 95% CI: 1.01-2.71). In conclusion, narrower retinal arteriolar caliber is associated with development of new AV conduction abnormalities.

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The creation and protection of ideal work and learning environments is garnering attention, and the absence of well-crafted mandates leaves room for hostile workplaces that have led to loss of life. Hierarchical social systems such as the police force, armed forces, and in medical training and workplaces are prone to a culture that aids and abets unhealthy, counterproductive and expensive behaviours often under the guise of routine 'chain-ofcommand' action. Individuals who occupy the lowest rungs have demanded and rightly deserve protection of their human dignity from each level of the hierarchy. The challenge in healthcare requires consequential, actionable codified procedures with external oversight, across silos of care, making leaders duty bound at every level, to reward (and penalize) validated feedback from anyone in their system.Dysfunctional Work and Learning Environments -Global Case Studies, was the lecture by Mr. Olufunso Adedeji, Consultant Colorectal Surgeon, University Hospital of North Durham, UK. He declared that Mr. George Floyd, the African American killed by the knee of a law enforcement officer in May 2020 in Minneapolis, United States, died because of abuse of power by an officer, in his workplace, who owed him a duty of care. The events that occurred laid bare the consequence of dysfunctional environments coupled with ineffective laws.He explained that in the United States, where more than 30,000 people were killed by the Police between 1990 and 2018, rising to greater that 1,000 deaths per year between 2015 and 2021, during which more than 200 victims had toy guns and more than 400 had no weapons, and yet, from 2005 to 2019, only four police officers have been convicted of murder. Mr. Floyd's killer was empowered by his certainty that he would legally get away with murder, as he nonchalantly and publicly knelt on Mr. Floyd's neck for 9 min and 29 sec. He wondered when ineffective laws power to transform the future. Dr. Boluwatife Ikwunne, 2019 MBBS graduate, with distinction in Psychiatry and Rhodes Scholar, was recognized, and the provost made the case for engineering the environment where medical students can and must thrive. The availability of a counselling service for medical students was announced, as but one step aimed at the theme of improved environments in medicine, and ultimately the task of nation building.