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Bank XYZ adalah bank swasta nasional yang beroperasi lebih dari sepuluh tahun dan melayani nasabahnya seluruh Indonesia menggunakan sistem online untuk seluruh cabang dan semua perangkat layanan elektronik bertanggung jawab melayani transaksi semua nasabah dengan tingkat akurasi dan keamanan yang tinggi. Bagian Pusat Data Bank XYZ menyediakan layanan berupa infrastruktur dan jaringan yang disini disebut supporting service, dalam rangka mendukung pelayanan transaksi finansial dan nonfinansial untuk nasabah. Penulis menemukan adanya masalah operasional bank yang penting yaitu belum sempurnanya kebijakan tentang manajemen layanan Teknologi Informasi sehingga mempengaruhi nilai layanan, juga kemampuan sumber daya manusia dibidang Teknologi Informasi yang masih belum memadai. Keterbatasan sumber daya dalam mengoperasikan tugas dan fungsi yang telah ditetapkan manajemen mengakibatkan Bagian Pusat Data Bank XYZ belum maksimal dalam menjaga keberlangsungan sistem operasional bank. Komitmen manajemen sangat dibutuhkan untuk meningkatkan kualitas layanan kepada nasabah. Untuk mengetahui kondisi pengelolaan layana nasabah ini perlu dilakukan evaluasi tingkat maturitas terhadap layanan pada infrastruktur Bagian Pusat Data. Evaluasi ini menggunakan ITIL Framework pada domain Service Operation yang hasilnya akan direkomendasikan guna meningkatkan manajemen layanan Teknologi Informasi. Pada saat proses evaluasi berlangsung penulis melakukan pengambilan data dengan studi dokumen, wawancara, dan kuesioner sehingga didapatkan analisis maturitas pada tingkat 1,79 (initial), yang artinya masih terdapat proses-proses pengelolaan layanan infrastruktur Bagian Pusat Data Bank XYZ yang belum berjalan serta fungsi manajemen layanan belum terdefinisikan dengan jelas.

Congestion is a cardinal sign of heart failure (HF). In the past, it was seen as a homogeneous epiphenomenon that identified patients with advanced HF. However, current evidence shows that congestion in HF varies in quantity and distribution. This updated view advocates for a congestive-driven classification of HF according to onset (acute vs. chronic), regional distribution (systemic vs. pulmonary), compartment of distribution (intravascular vs. extravascular), and clinical vs. subclinical. Thus, this review will focus on the utility of circulating biomarkers for assessing and managing the different fluid overload phenotypes. This discussion focused on the clinical utility of the natriuretic peptides, carbohydrate antigen 125 (also called mucin 16), bio-adrenomedullin and mid-regional pro-adrenomedullin, ST2 (also known as interleukin-1 receptor-like 1), cluster of differentiation 146, troponin, C-terminal pro-endothelin-1, and parameters of haemoconcentration. The utility of circulation biomarkers on top of clinical evaluation, haemodynamics, and imaging needs to be better determined by dedicated studies. Some multiparametric frameworks in which these tools contribute to management are proposed.

En los últimos años, el concepto de «ortodoxia» ha venido utilizándose en los estudios sobre comunismo para sustituir al de comunistas «prosoviéticos». Partiendo de una perspectiva híbrida, comparativa, procesual y anti-naturalista, en el presente artículo trataremos de demostrar que esta nueva denominación presenta serias limitaciones analíticas que, lejos de aportar una mayor claridad conceptual que permita catalogar y diferenciar mejor a unos comunistas de otros, genera nuevos problemas metodológicos para los historiadores del comunismo español. In recent years, the concept of “orthodoxy” has been used in communist studies to replace that of “pro-Soviet” communists. Taking a stance that hybridizes comparative, processual and anti-naturalist perspectives, this article demonstrates that this new denomination presents serious analytical limitations that, far from providing greater conceptual clarity which might make for better cataloguing and easier differentiation between communist actors, actually generates new methodological problems for historians of Spanish communism.

A presente pesquisa investiga a capacidade instalada de energia elétrica no Brasil, buscando um padrão de comportamento referente a essa temática, assim sendo, procura constatar se existe a necessidade de implementar melhorias ao processo produção. Analisou-se o desempenho por meio de algumas técnicas estatísticas recomendadas nos programas de qualidade, como medidas descritivas, gráficos e testes de hipóteses. Para tanto calculou-se os limites inferiores e superiores de controle para média e desvio padrão, verificou-se a normalidade e simetria. Os resultados mostraram que a capacidade instalada de energia das regiões brasileiras está relacionada ao desempenho e produção. Durante o período de 9 anos (2012-2020), não foi detectado um único ponto que se extrapola os limites de controle. Mesmo com a subjetividade envolvida no processo, os resultados encontrados indicaram a necessidade constante de monitoramento, fornecendo subsídios para melhoria do processo. Portanto, o controle estatístico de processo pode identificar aos distribuidores de energia se os geradores do sistema estão fornecendo e possuem a capacidade instalada com variáveis em estado de controle estatístico.

En la actualidad existe una problemática relacionada con la falta de modelos de innovación enfocado a las energías renovables, que permitan generar nueva tecnología, lo cual es una solución a la demanda de energía creciente en las últimas décadas. Este articulo presenta el desarrollo de un modelo de innovación enfocado en la generación de tecnologías para la producción de energías renovables. Para ello se analizó el estado del arte de los modelos existentes, lo que permitió observar que no existían modelos aplicables a pequeñas empresas enfocados en este tipo de energías. Se creó un modelo de innovación flexible y de fácil aplicación, el cual integra características de los modelos de red e integrados de cuarta y quinta generación, el cual ya fue puesto a prueba. A diferencia de otros modelos diseñados para empresas de gran tamaño, el modelo propuesto es fácilmente entendible, pudiéndose desarrollar paso a paso, para una aplicación exitosa, y evitando sesgos, presentando una ventaja frente a otros modelos. Este modelo de innovación puede servir de guía para la implementación, creación y mejora de tecnologías para sistemas de generación de energía renovable, y abarca los campos necesarios para tener una gestión de la innovación exitosa.

Esta investigación valoró la proximidad de las decisiones gerenciales de una universidad de México hacia la responsabilidad social universitaria humanista. Se realizó una encuesta social censada a 92 gerentes. Se diseñó un instrumento que obtuvo un coeficiente de confiabilidad de 0.8059. Se empleó estadística descriptiva y modelaje econométrico. Se obtuvo un modelo conceptual del cual se derivó un índice de proximidad a la responsabilidad social universitaria humanista. La fortaleza en las decisiones está al considerar la misión institucional y la debilidad en la evaluación de las decisiones. La Universidad obtuvo 5.4 puntos de 10 posibles. A partir del modelo e instrumento diseñado fue posible valorar, en una escala Likert, la proximidad de las decisiones a la responsabilidad social universitaria humanista y complementa los modelos tradicionales de gestión de responsabilidad social. Las universidades aportan al desarrollo sustentable si gestionan sus decisiones gerenciales con un enfoque humanista, esto es que las decisiones procuren: el involucramiento con la realidad del entorno, contar con marcos de referencia con un enfoque humanista y de beneficio social, emprender acciones de incidencia y desarrollar mecanismos de rendición de cuentas efectivas, indicadores de transparencia e incorporación de todos los grupos de interés en los procesos evaluativos, priorizando al alumnado, a las comunidades beneficiarias y a los colaboradores internos.

Este estudo tem como objetivo analisar como são caracterizadas as pesquisas que empregam o método etnográfico na área de Administração, utilizando a plataforma Spell como base para a coleta de dados. O estudo tem caráter descritivo e exploratório, com abordagem qualitativa. O primeiro critério de seleção foi apenas artigos em língua brasileira, coletados todos em um mesmo dia (04 de setembro de 2019) mas com uma perspectiva longitudinal. O estudo foi desenvolvido através de pesquisa documental e analisado a partir da análise de conteúdo. O corpus de análise foi composto de um total de 47 artigos. Na análise dos dados identificou-se que de acordo com a análise das escolas antropológicas, a maioria dos estudos vão ao encontro da Escola Inglesa; a escola Francesa apareceu em 17 artigos e a Escola Americana apareceu em 11 artigos, demonstrando tendências dos estudos com olhar voltado para a economia e ciências sociais.

To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region.Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS).The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283.Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region.II b - Retrospective Cohort Study - Oxford Centre for Evidence-Based Medicine (OCEBM).

Dengan metoda pengkodean parametrik (parametric coding) sinyal suara manusia dapat menghasilkan kecepatan bit (bit-rate) yang lebih rendah dibandingkan dengan metoda pengkodean bentuk gelombang (wave form coding). Contohnya pada metoda pengkodean bentuk gelombang akan dibatasi oleh batas minimal frekuensi cuplik (sampling frequency) yang menurut teorema Shannon-Nyquist menyatakan agar tidak ada informasi yang hilang ketika pencuplikan sinyal, maka kecepatan pencuplikan harus minimal dua kali dari lebar pita sinyal tersebut. Dengan demikian pada pengkodean bentuk gelombang kecepatan bit terendah yang dapat dicapai adalah oleh system Modulasi Delta (Delta Modulation) yaitu sebesar 8 Kbit/detik. Sedangkan pada pengkodean parametrik sinyal dapat dicapai kecepatan bit yang lebih rendah yaitu sebesar 2,4 Kbit/detik oleh system LPC (Linear Predictive Coding). Dengan kecepatan bit yang rendah akan diperoleh penghematan penggunaan lebar pita (bandwidth) saluran transmisi dan memori.

Introduction Surgical treatment of hyperparathyroidism related to chronic kidney disease is a real challenge for Brazilian public health care. High cost medications and long waiting lines to perform preoperative exams, especially technetium Tc 99m Sestamibi (MIBI) are some of the reasons. Despite the reality that the aid of localization exams are questionable in this scenario, doctors are too apprehensive in performing surgery without it. Objective The study aimed at evaluating the efficacy of surgery for renal hyperparathyroidism without preoperative MIBI. Methods A total of 114 patients were surgically treated. Total parathyroidectomy with autotransplantation and subtotal parathyroidectomy were carried out without preoperative MIBI. Results and conclusion Among the 114 patients undergoing surgery, 37 had secondary hyperparathyroidism in dialysis replacement, and 77 patients had post-renal transplant persistent disease. We were successful in 107 cases with only 7 failures (93.8% of success rate). Among these failures, only one parathyroid gland was not found in 4 cases, 2 parathyroid glands were not found in 2 cases and in 1 patient the 4 glands were found but this patient remained hypercalcemic and a postoperative diagnosis of supernumerary parathyroid gland was made. Surgery for treatment of renal hyperparathyroidism proved to be an effective (93.8%) and reproductible procedure, even without MIBI.

This project was initiated basically at promoting the rice-based integrated farming system cum mushroom, vegetable and vermicast production as climate change adaptation measures in the low land rain-fed areas. Thirty techno-demo farms were established to showcase the effectiveness of improved straw mushroom, vermin composting and rice production. Technical skills and knowledge of farmer cooperators and adopters were improved through capacity development on production technologies and farming systems. Farmer association was formed and registered to Department of Labor and Employment (DOLE). Project visibility and promotions were performed through radio broadcast, trainings, newspapers, IEC development and posting to Bataan official website, 1Bataan. The project has forge collaboration and partnership with Local Government Unit (LGUs), Agricultural Training Institute (ATI) and Department of Trade and industry for wider promotion and adoption of the technology. The interventions recorded 25.51 % increase on income of farmer beneficiaries., {"references":["https://bicol.da.gov.ph/wp-content/uploads/2019/03/DA-5-MUSHROOM-PRODUCTION-2017.pdf","https://ricetoday.irri.org/stepping-up-efforts-to-make-the-most-out-of-rice-straw-in-the-philippines","Chauhan, B. S., Jabran, K., & Mahajan, G. (Eds.). (2017). Rice production worldwide (Vol. 247). Cham, Switzerland: Springer International Publishing","De Datta, S. K. (1981). Principles and practices of rice production. Int. Rice Res. Inst..","Luh, B. S. (1980). Rice: production and utilization. AVI Publishing Co..","Prasad, R., Shivay, Y. S., & Kumar, D. (2017). Current status, challenges, and opportunities in rice production. Rice production worldwide, 1-32.","Panuju, D. R., Mizuno, K., &Trisasongko, B. H. (2013). The dynamics of rice production in Indonesia 1961–2009. Journal of the Saudi Society of Agricultural Sciences, 12(1), 27-37."]}

Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.

The objective of the study was to describe the characteristics, under a systemic approach, of two of the most important components of the territory: biodiversity and industry in the region of the Tula basin, Hidalgo, based on extensive documentation from official sources and scientific records to understand the operation of the graphic model: "Industry Biodiversity Interaction System", which was built based on said characterization. The industrial sector in the study region presents a spatial concentration of a dispersed type without being established in a particular way in any municipality. Pachuca and Tepeji del Rio are the municipalities that show a slightly higher industrial presence. The largest industry in the Region is that of products derived from non-metallic minerals, followed by chemicals and plastics. With the exception of Chilcuautla and Progreso de Obregón, the Region has a high rate of anthropogenic impact, which contributes to the fact that the Region has a low and very low ecological integrity. The Region has low vulnerability to climate change, but it is vulnerable to wastewater from Mexico City and the Tepeji del Río aquifer has a deficit in water availability. Therefore, the Region reflects processes of unsustainability and the need to restore it (34% of the area as a priority for restoration), which may be due in part to industrial production processes with a high impact on the natural environment and discharges from Mexico City.

Aunque la valoración de las agriculturas territorializadas ha funcionado en Europa como una política para favorecerlas frente al libre comercio, éstas han tenido dificultades para desarrollarse en Latinoamérica. El presente estudio tiene como objetivo identificar las tensiones que pueden enfrentar los maíces locales en las agriculturas territorializadas. Se abordan los debates actuales de estas agriculturas con respecto a la apropiación de recursos fitogenéticos, comercio justo y soberanía alimentaria, ilustrando con varios ejemplos latinoamericanos. Se concluye que bajo el contexto mexicano actual, los maíces locales pueden ser un elemento en disputa, como ha ocurrido con otros alimentos, por lo que el reto de los campesinos será desarrollar capacidades organizativas y políticas que les permitan defenderse de otros actores y aprovechar las oportunidades de mercados alternativos. Palabras clave: Apropiación. Comercio justo. Soberanía alimentaria. Sistemas agroalimentarios localizados (SIAL). Productos locales con denominación de origen (DO).

The lateral cutaneous branch of the iliohypogastric nerve (LCBIN) block combined with the lateral femoral cutaneous, superior cluneal and subcostal nerve blocks has been shown to provide complete anaesthetic coverage for the incisions used for hip arthroplasty. Successful ultrasound-guided selective nerve blocks have been described for these nerves, except for the LCBIN. The objective of this cadaveric study was to determine the position of the LCBIN in order to provide the anatomical basis for an ultrasound-guided nerve block approach. Furthermore, we aimed to evaluate the spread of injected dye after using the ultrasound-guided nerve block approach.The LCBIN and its relationship with iliac crest (IC) was assessed bilaterally in 27 adult cadaveric dissections. Bilaterally, in two cadavers, an ultrasound transducer was applied transversely above the IC and moved in caudal or cranial direction to identify the LCBIN. A needle was inserted in-plane and 3 ml of a solution with methylene blue was injected and confirmed by dissection.The mean distance from the anterior superior iliac spine to the point where the LCBIN crossed the IC was 9.74 ± 0.84 cm. The mean distance from the point where the nerve pierced the aponeurosis of the external oblique muscle to the point where it crossed the IC was 0.59 ± 0.77 cm. The nerve was easily visualised in 3 out of 4 sides using ultrasound. However, the nerve was coloured in all cases.The present study showed that the LCBIN has a constant location and is sonographically easy visualized in a well-defined anatomical space. Thus, the ultrasound guided LCBIN block may be an alternative to the blind injection technique.

Videoconference applications gained popularity when online learning became the new way of delivering instruction at all levels of education including graduate programs. However, excessive videoconferencing led to reports of fatigue among its users. Identifying the factors contributing to the videoconference exhaustion experience of graduate students is necessary. This study examined Zoom fatigue and selected associated factors among graduate students. An electronic one-shot survey using the Zoom Exhaustion and Fatigue scale was conducted among 109 graduate students of the College of Teacher Education in the Philippines. Correlation and predictive analysis were performed. Results of the study demonstrated a moderate level of Zoom fatigue with the highest level of fatigue in the general fatigue dimension. Pearson’s correlation analysis revealed a significant inverse correlation between attitude toward videoconferencing and Zoom fatigue. Non-verbal mechanisms of mirror anxiety, feeling physically trapped, hyper gaze, and cognitive load in producing non-verbal cues were significantly positively related to Zoom fatigue. Regression analysis revealed that the sense of being physically trapped and cognitive load in producing non-verbal cues remained significant predictors of Zoom fatigue. While videoconferencing supported educational activities and made schooling possible during the global disease outbreak, it is recommended to be mindful of the non-verbal factors contributing to Zoom fatigue.

Physicians are sometimes reluctant to initiate guideline-directed therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to concerns of adverse events. We explored the risk of hypotension, volume depletion, and acute kidney injury (AKI) on sodium-glucose cotransporter 2 (SGLT2) inhibitors in HFrEF populations.We determined summary risk ratios (RRs) by conducting a meta-analysis on reported aforementioned adverse events on SGLT2 inhibitors from randomized controlled trials. We explored robustness of meta-analyses by computing fragility and/or reverse fragility index (FI or RFI) and its corresponding fragility quotient (FQ or RFQ) for each outcome. A total of 10 050 patients with HFrEF entered the final meta-analysis. Hypotension was reported in 4.5% (219/4836) on SGLT2 inhibitors and in 4.1% (202/4846) on placebo (RR 1.09, 95% confidence interval [CI] 0.91-1.31, p = 0.36). An RFI of 21 and RFQ of 0.002 suggest robust findings for hypotension. Volume depletion occurred in 9.4% (473/5019) on SGLT2 inhibitors and in 8.7% (438/5031) on placebo (RR 1.07, 95% CI 0.95-1.21, p = 0.25), respectively. RFI of 19 and RFQ of 0.001 suggest moderately robust findings for volume depletion. AKI was reported in fewer patients (1.9% [95/4888]) on SGLT2 inhibitors than on placebo (2.8% [140/4899]) providing lower incidence of AKI (RR 0.69, 95% CI 0.51-0.93, p = 0.02). FI of 14 and RFQ of 0.001 suggest moderately robust findings for AKI.Sodium-glucose cotransporter 2 inhibitor therapy is not associated with a clinically relevant risk of hypotension and volume depletion. Its use reduces the risk of AKI. This analysis supports current guideline recommendations on early use of SGLT2 inhibitors.

A descriptive analysis of 416 documents was performed using bibliometric techniques, in order to gather existing knowledge in circular economy focusing on waste management (2007-2020). The results of this study indicate that annual scientific production increased 94% in the last 5 years, highlighting the countries of Italy, Spain, the UK, China, Brazil, and India. Between the most cited documents stand out those related to calorific value of municipal solid waste and waste to energy technologies for achieving circular economy systems. The conceptual analysis indicates strong linkage between circular economy and sustainable production, waste management, and recycling. Emerging research trends evolved from processes and industry-oriented approach (2017) toward waste management, recycling, and circular economy (2019) and sustainable development and urban solid waste (2020). The analysis reveals five dominant circular economy and waste research themes: (1) greenhouse gases; (2) circular economy, waste management, and recycling; (3) life cycle; (4) waste treatment; and (5) anaerobic digestion and recovery; trends research are related to policy interventions, and enforcement of authorities' regulations to foster circular economy transition, increase the use of practices of recycling and reusing, as well as discourage a growing consumption culture. Results found denote the challenge represented by the implementation of comprehensive policies in circular economy. The above being a key alternative for green recovery in response to the current COVID-19 pandemic.

Background Older females show greater cognitive gains from physical activity (PA) than males, which may be related to long-term consequences of female-specific reproductive events (eg, pregnancy) on cognitive health. Methods To determine whether previous parity could moderate the relationship between PA and cognitive decline in older women, we conducted secondary analyses of data from the Health, Aging, and Body Composition Study. We tested whether the association between average PA over 10 years and cognition (Modified Mini-Mental State Examination [3MS]) and executive functioning (digit symbol substitution test [DSST]) over 10 years varied by previous parity (nulliparity, low parity, medium parity, and grand multiparity). An analysis of covariance was performed with cognition (average and change over 10 years) as the dependent variables, parity as a categorical predictor, average PA as a continuous predictor, and a set of relevant covariates. Results Significant interactions were found between PA and parity group for all 4 comparisons: average 3MS (p = .014), average DSST (p = .032), change in 3MS (p = .016), and change in DSST (p = .017). Simple slope analyses indicated the positive relationship between PA and average 3MS and DSST was only significant in the nulliparity and grand multiparity groups, and the positive relationship between PA and change in 3MS and DSST was only significant in the grand multiparity group. Conclusion The findings suggest the relationship between self-reported walking and cognitive performance was strongest in the groups at risk for cognitive decline and dementia, the nulliparous and grand multiparous groups.

BACKGROUND Myostatin, a cytokine produced by skeletal muscle, may influence Alzheimer’s Disease (AD) pathogenesis, but sparse evidence exists in humans. We assessed the association between circulating levels of myostatin at year 1 and plasma levels of β-amyloid 42/40 at year 2, a marker of AD pathology, in a biracial cohort of older adults. METHODS We studied 403 community-dwelling older adults enrolled in the Health, Aging and Body Composition Study from Memphis, Tennessee, and Pittsburgh, Pennsylvania. Mean age was 73.8± 3 years; 54% were female; and 52% were Black. Serum myostatin levels were measured at year 1, plasma β-amyloid 42/40 levels in year 2 (higher ratio indicating lower amyloid load). Multivariable linear regression analyses tested the association of serum myostatin with plasma levels of β-amyloid 42/40 adjusted for computed tomography derived thigh muscle cross-sectional area, demographics, APOe4 allele, and risk factors for dementia. We tested for two-way .interactions between myostatin and race or sex; results were stratified by race and sex RESULTS In multivariable models, myostatin was positively associated with plasma levels of β-amyloid 42/40 (standardized regression coefficient: 0.145, p=0.004). Results were significant for white men and women (0.279, p=0.009, and 0.221, p=0.035, respectively) but not for black men or women; interactions by race and gender were not statistically significant. CONCLUSIONS Higher serum myostatin was associated with lower amyloid burden, independently of APOe4 alleles, muscle area and other established risk factors for dementia. The role of myostatin in AD pathogenesis, and the influence of race should be further investigated.

Este artigo foi construído com a finalidade de aprimorar estudos no campo sobre a influência das redes de relacionamento do empreendedor no marketing de pequenas empresas. Para obtenção dos resultados que constam na pesquisa foi desenvolvida uma pesquisa de orientação qualitativa, onde foram aplicadas entrevistas semiestruturadas com os empreendedores selecionados, as respostas serviram de embasamento teórico para as análises e resultados. Têm-se como resultados desse estudo a confirmação da influência das redes de relacionamento nas decisões das pequenas empresas, principalmente nas práticas de marketing onde foi constatado que o marketing boca a boca ainda é a ferramenta principal para a evolução dessas empresas.

Aims To evaluate the prevalence and associations of non-cardiac comorbidities (NCCs) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum. Methods and results The 9326 AHF patients from European Society of Cardiology (ESC)-Heart Failure Association (HFA)-EURObservational Research Programme Heart Failure Long-Term Registry had complete information for the following 12 NCCs: anaemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson’s disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, and stroke/transient ischaemic attack (TIA). Patients were classified by number of NCCs (0, 1, 2, 3, and ≥4). Of the AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC, and 12.5% had ≥4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ≥4 NCCs. Anaemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson, and depression were more prevalent in HF with preserved EF (HFpEF). The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anaemia 1.6 (1.4–1.8), diabetes 1.2 (1.1–1.4), kidney dysfunction 1.7 (1.5–1.9), COPD 1.4 (1.2–1.5), PVD 1.2 (1.1–1.4), stroke/TIA 1.3 (1.1–1.5), depression 1.2 (1.0–1.5), hepatic dysfunction 2.1 (1.8–2.5), malignancy 1.5 (1.2–1.8), sleep apnoea 1.2 (0.9–1.7), rheumatoid arthritis 1.5 (1.1–2.1), and Parkinson 1.4 (0.9–2.1). Anaemia, kidney dysfunction, COPD, and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA, and depression only in HF with reduced EF, and sleep apnoea and malignancy only in HFpEF. Conclusion Multiple NCCs conferred poor in-hospital and post-discharge outcomes. Ejection fraction categories had different prevalence and risk profile associated with individual NCCs.

Pathological processes associated with ageing increase the risk of cognitive deficits and dementia. Frailty syndrome, also known as weakness or reserve depletion syndrome, may significantly accelerate these pathological processes in the elderly population. Frailty syndrome is characterized by decreased physiological function and neuropsychiatric symptoms, including cognitive decline and depressive states. In people with cardiovascular disease, the risk of frailty is three times higher. Frailty syndrome is particularly prevalent in severe heart failure, which increases the risk of mortality, increases hospital readmission, and reduces patients' quality of life. In addition, co-occurrence of cognitive impairment and frailty syndrome significantly increases the risk of dementia and other adverse outcomes, including mortality, in the heart failure population.

AimsIron deficiency is a common finding among patients with heart failure (HF) and is associated with adverse outcomes, including decreased quality of life, increased risk of hospitalization, and decreased survival. Intravenous ferric carboxymaltose (FCM) has been shown to improve outcomes among patients with HF and concomitant iron deficiency, but FCM is associated with an increased risk of hypophosphataemia. We aimed to better characterize this risk among HF populations.Methods and resultsThis pooled analysis examined data from 41 studies of adults with iron deficiency across disease states and therapeutic areas. Among the 7931 patients treated with FCM available for analysis, 14% made up the HF subgroup. Additional subgroups included women's health (36%), non-dialysis-dependent chronic kidney disease (NDD-CKD; 27%), haemodialysis-dependent chronic kidney disease (HD-CKD; 1%), gastrointestinal (10%), neurology (3%), and other (10%). The incidence of post-baseline moderate or severe hypophosphataemia (i.e. serum phosphate [PO4 3- ] level 60mL/min/1.73m2 vs.

© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)., Chronic coronary syndrome (CCS) represents a major challenge for physicians, particularly in the context of an increasing aging population. Additionally, CCS is often underestimated and under-recognised, particularly in female patients. As patients are frequently affected by several chronic comorbidities requiring polypharmacy, this can have a negative impact on patients' adherence to treatment. To overcome this barrier, single-pill combination (SPC), or fixed-dose combination, therapies are already widely used in the management of conditions such as hypertension, dyslipidaemia, and diabetes mellitus. The use of SPC anti-anginal therapy deserves careful consideration, as it has the potential to substantially improve treatment adherence and clinical outcomes, along with reducing the failure of pharmacological treatment before considering other interventions in patients with CCS.

Objective To evaluate the specific effects of PCSK9 inhibitors (i.e. alirocumab and evolocumab) on major cardiovascular events (MACE) and lipid profile in patients with diabetes. Methods and results We conducted a systematic review of literature according to the PRISMA statement. A total of eight randomized control trials (RCTs) enrolling 20 651 patients with diabetes were included. The mean follow-up was 51 weeks. We included RCTs that had compared the subtilisin–kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab with placebo in subjects with hypercholesterolaemia and diabetes mellitus. MACE occurred in 8.7% of patients with diabetes randomized to PCSK9i vs. 11.0% of those randomized to placebo. Thus, the use of alirocumab or evolocumab reduced MACE by 18% [odds ratio (OR): 0.82; 95% confidence interval (CI): 0.74–0.90]. Compared with control group, the use of PCSK9 inhibitors was associated with a significant percentage change from baseline in low-density lipoprotein cholesterol [mean difference (MD) –58.48%; 95% CI: –63.73 to –53.22%, P Conclusion PCSK9i appear to be effective in reducing the risk of MACE and in improving lipid profiles of subjects with diabetes and dyslipidaemia.

Aims To investigate the use of guideline-directed medical therapies (GDMT) and associated outcomes in obese (body mass index >= 30 kg/m(2)) versus non-obese patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods and results Patients with HFrEF from the Swedish HF Registry were included. Of 16 116 patients, 24% were obese. In obese versus non-obese patients, use of treatments was 91% versus 86% for renin-angiotensin system inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi), 94% versus 91% for beta-blockers, 53% versus 43% for mineralocorticoid receptor antagonists. Obesity was shown to be independently associated with more likely use of each treatment, triple combination therapy, and the achievement of target dose by multivariable logistic regressions. Multivariable Cox regressions showed use of RASi/ARNi and beta-blockers being independently associated with lower risk of all-cause/cardiovascular death regardless of obesity, although, when considering competing risks, a lower risk of cardiovascular death with RASi/ARNi in obese versus non-obese patients was observed. RASi/ARNi were associated with lower risk of HF hospitalization in obese but not in non-obese patients, whereas beta-blockers were not associated with the risk of HF hospitalization regardless of obesity. At the competing risk analysis, RASi/ARNi use was associated with higher risk of HF hospitalization regardless of obesity. Conclusion Obese patients were more likely to receive optimal treatments after adjustment for factors affecting tolerability, suggesting that perceived beyond actual tolerance issues limit GDMT implementation. RASi/ARNi and beta-blockers were associated with lower mortality regardless of obesity, with a greater association between RASi/ARNi and lower cardiovascular death in obese versus non-obese patients when considering competing risk. Funding Agencies|Horizon Europe programme [101095479-More-EUROPA]; Swedish Heart and Lung Foundation [20220680]

Hasil pemeriksaan penurunan tegangan dan faktor daya bisa ditindaklanjuti dengan melakukan optimasi terhadap instalasi terpasang. Dalam penelitian ini adalah dengan melakukan pemasangan kapasitor bank sebesar 718,58 kVAR (sesuai rekomendasi program ETAP 12.6) saat kondisi beban tertinggi yang tercapai yakni sebesar 2500 kVA, terbukti bisa mengoreksi penurunan tegangan dan faktor daya menjadi lebih baik. Dari kondisi semula dengan penurunan tegangan menjadi 92,5 % (370 Volt dari tegangan yang diinginkan yaitu 400 Volt). Setelah pemasangan kapasitor bank, tegangan dapat diperbaiki menjadi 394,8 Volt atau 98,7% (penurunan tegangan 1,3% dari besar tegangan yang diinginkan). Faktor daya juga meningkat lebih baik dari 0,85 menjadi 0,95.