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Background: To prepare engineers who can address complex sociotechnical problems, a deep understanding of engineers' complex problem-solving approaches is needed. Purpose/Hypothesis: This study operationalizes comprehensive systems thinking as an analysis framework that attends to aspects of engineering work and relationships among those aspects. Leveraging this framework to analyze engineers' complex problem-solving approaches enables attention to social and technical dimensions. Design/Method: We interviewed 46 engineers about their specific complex problem-solving experiences. To explore a range of perspectives, we purposely sampled participants with varying academic, professional, and personal backgrounds and experiences. Data analysis focused on operationalizing comprehensive systems thinking; we first developed a set of aspects that captured the variety of considerations that participants discussed in their descriptions of solving a complex problem. We then inductively developed a scoring guide to differentiate response quality. Results: The scoring approach differentiated the quality of consideration based on a combination of the number of details provided, the degree of specificity, and analytical depth. While most participants discussed the consideration of a wide range of aspects of engineering work, they discussed far fewer possible relationships between these aspects. Contextual aspects of engineering work were consistently the least commonly identified and least likely to be considered in relation to other aspects of a given problem. Conclusions: Our differentiation of various complex problem-solving approaches can guide the development of educational interventions and tools, ultimately facilitating more comprehensive consideration of aspects--and in particular relationships among aspects--and setting up engineers to be more successful at developing appropriate solutions.

Background Despite improvement in devices, in‐stent restenosis remains a frequent and challenging complication of percutaneous coronary interventions. Methods and Results The RESTO (Morphological Parameters of In‐Stent Restenosis Assessed and Identified by OCT [Optical Coherence Tomography]; study NCT04268875) was a prospective multicenter registry including patients presenting with coronary syndromes related to in‐stent restenosis. All patients underwent preintervention OCT analysis, which led to analysis of in‐stent restenosis phenotype, number of strut layers, and presence of stent underexpansion. The primary end point was the in‐stent restenosis type according to the OCT morphological classification. The 1‐year incidence of target vessel failure (a composite of death from cardiac causes, target‐vessel myocardial infarction, or ischemia‐driven target‐vessel revascularization) was assessed. The study included 297 patients. The culprit stent was a drug‐eluting stent in 74.2% of cases. OCT analysis revealed the presence of neoatherosclerosis in 57% (52% calcified), neointimal hyperplasia in 43% (58% homogeneous), stent underexpansion (minimal stent area

El movimiento de las personas depende de la acción del sistema nervioso sobre grupos musculares específicos que se apoyan sobre la estructura ósea. Algunos procesos patológicos pueden causar alteraciones de la fuerza y coordinación que debe existir entre las respuestas musculares, causando alteraciones en el movimiento esperado. En su fase inicial, la mayoría de estas alteraciones pasan desapercibidas hasta que los daños físicos afectan notoriamente la actividad humana, y en muchos casos de manera irreparable. Actualmente, el método más utilizado para el análisis de la marcha humana se basa en el estudio fotométrico secuencial en espacio limitado, aunque en menor medida también se utilizan sistemas de posicionamiento digital. Este proyecto aborda el desarrollo de tecnología para la captura biométrica del movimiento humano mediante sensores de medición inercial. La idea es detallar el desplazamiento espacial de secciones específicas del cuerpo a partir de la medición de aceleración y la velocidad angular, con el propósito de valorar la respuesta de las articulaciones involucradas. El objetivo es desarrollar un sistema que permita a los médicos especialistas identificar anomalías en el movimiento del paciente en estudio. Los resultados preliminares demuestran la eficiencia del sensor inercial implementado. Utilizando 7 sensores ubicados estratégicamente en el cuerpo del paciente y con una velocidad de adquisición de 100 muestras por segundo en cada sensor, es posible detallar movimientos de marcha menores a 7,5 milímetros y precisión en velocidad angular de hasta 0,1°/0,01 segundo. Con el desarrollo de este instrumento se consigue la capacidad de visualizar y analizar movimientos que normalmente son imperceptibles para el ojo humano.

Abstract Conflicting results remain on the impacts of climate change on marine organisms, hindering our capacity to predict the future state of marine ecosystems. To account for species-specific responses and for the ambiguous relation of most metrics to fitness, we develop a meta-analytical approach based on the deviation of responses from reference values (absolute change) to complement meta-analyses of directional (relative) changes in responses. Using this approach, we evaluate responses of fish and invertebrates to warming and acidification. We find that climate drivers induce directional changes in calcification, survival, and metabolism, and significant deviations in twice as many biological responses, including physiology, reproduction, behavior, and development. Widespread deviations of responses are detected even under moderate intensity levels of warming and acidification, while directional changes are mostly limited to more severe intensity levels. Because such deviations may result in ecological shifts impacting ecosystem structures and processes, our results suggest that climate change will likely have stronger impacts than those previously predicted based on directional changes alone.

Lithodes santolla (SKC) and Paralomis granulosa (FSKC) are economically important resources exploited in southern South America. The effect of refrigerated storage (4 °C on flake ice) on physico-chemical (pH, thiobarbituric reactive substances (TBARs), total volatile basic nitrogen (TVB-N), water holding capacity (WHC), and water content (WC)), microbiological (total viable mesophilic bacteria (TVMC), psychrotrophic bacteria (TVPC), Staphylococcus spp, coliforms, enterobacteria, molds and yeasts) and sensory (odor, appearance, texture, juiciness, and taste) parameters was analyzed in the cooked SKC and FSKC merus. For each species, cooked merus from 36 animals were randomly distributed into 6 groups, corresponding to 0, 2, 5, 8, 11, and 14 days of storage. On each day, samples were taken for physico-chemical (n = 6), microbiological (n = 3), and sensory (n = 15) analyses. The pH values increased over time (P 0.05) in all cases. The presence of TVCM, TVCP, and Staphylococcus spp. in both species was observed from day 0. Furthermore, pathogenic microorganisms (S. aureus, coliforms, and enterobacteria) were not detected, and only the TVCP in SFKC reached the suggested microbial limit after 11 days. All sensory scores significantly decreased (P

Background The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline‐directed heart failure (HF) medical therapy (GDMT) and one‐year survival rate in patients who are post‐CS. Methods and Results FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in‐hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta‐blockers, renin‐angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P

Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study.

Summary: Background: Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods: From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings: Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56–44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06–28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33–6.98] and 1.66 [0.96–2.85] respectively). Interpretation: Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding: Grant from Fondation Coeur & Recherche.

Background: Percutaneous (PC) access has become the first‐line strategy for transfemoral (TF) transcatheter aortic valve replacement (TAVR), but surgical cutdown (SC) may be required in selected and usually challenging cases. We aimed to compare the efficacy and safety of SC versus echo‐guided PC approach in TF TAVR. Methods: Between November 2019 and December 2020, all patients undergoing TF TAVR were included in a prospective study. The choice of PC or SC strategy was left at operators' discretion, according to predictable access site difficulties. The primary endpoint included all vascular complications (VCs) and all bleeding at 1‐month follow‐up according to Valve Academic Research Consortium‐2 criteria. Results: Among 225 patients, 166 (73.8%) and 59 (26.2%) underwent PC or SC approach, respectively. Median age was 82 years, EuroSCORE 2 was higher (p = 0.02), and peripheral arterial disease (p < 0.001) was more common in the SC group. Femoral access was successful in 100% in the SC group vs 97.6% in the PC group (p = 0.2). The primary endpoint was reached in 32 patients (14.2%), 5 (8.4%) in the SC group and 27 (16.2%) in the PC group (p = 0.1) with low incidence of major VC in both groups (1.7% vs 3% in the SC and PC groups respectively, p = 0.6). Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study. Trial Registration: ClinicalTrials.gov identifier: NCT03865043 [ABSTRACT FROM AUTHOR]

Background: Systematic revascularization of asymptomatic coronary artery stenosis before transcatheter aortic valve replacement (TAVR) is controversial. Purpose: The purpose of this study was to evaluate the feasibility and safety of functional evaluation of coronary artery disease (CAD) followed by selective ischemia-guided percutaneous coronary revascularization following TAVR. Methods: This prospective, bi-centric, single-arm, open-label trial included all patients with severe aortic stenosis (AS) eligible for TAVR and with significant CAD defined as ≥1 coronary stenosis ≥ 70%. Patients with left main stenosis ≥ 50%, proximal left anterior descending artery (LAD) stenosis ≥ 90% or > class 2 Canadian Classification Society (CCS) angina were excluded. Myocardial ischemia was evaluated by stress cardiac imaging one month after TAVR. The primary endpoint was a composite of all-cause death, stroke, major bleeding (Bleeding Academic Research Consotium ≥ 3), major vascular complication (Valve Academic Research Consortium 3 criteria), acute coronary syndrome (ACS) and hospitalization for cardiac causes within 6 months of receiving TAVR. Results: Between June 2020 and June 2022, 64 patients were included in this study. The mean age was 84 ± 5.2 years. CAD mostly involved LAD (n = 27, 42%) with frequent multivessel disease (n = 30, 47%) and calcified lesions (n = 39, 61%). Stress cardiac imaging could be achieved in 70% (n = 46) of the patients, while 30% (n = 18) did not attend the stress test. Significant myocardial ischemia was observed in only three patients (4.5%). At 6-month follow-up, fifteen patients (23%) reached the primary endpoint, including death in six patients (9%), stroke in three patients (5%) and major bleeding in three patients (5%). ACS was observed in only two patients (3%) but both had severe coronary stenosis (≥90%) and did not refer for stress imaging for personal reasons. Hospital readmission (n = 27, 41%) was mostly related to non-cardiac causes (n = 17, 27%). Conclusions: In patients with asymptomatic CAD scheduled to undergo TAVR, a selective ischemia-guided coronary revascularization after TAVR seems to be safe, with a very low rate of ACS and few cases of myocardial ischemia requiring revascularization, despite low adherence to medical follow-up in this elderly population. This strategy could be evaluated in a randomized study. [ABSTRACT FROM AUTHOR]

This study explored how students in an intervention program for underrepresented populations pursuing engineering in a U.S. university perceived the program's benefits and the relationships of those perceptions with participants' engineering self-efficacy in their first year of undergraduate study. Data came from a multi-method, longitudinal study of the UENGIN program situated in a highly selective research university in the U.S. Midwest. Participants included 147 UENGIN students and 78 College of Engineering comparison group members for a total sample size of 225 over a time period of four years. Results are reported for Students of Color, White students, and a comparison group of students that did not participate in the intervention program. In this study, Students of Color refers to African Americans, American Indians or Native Americans, Asian Americans or Pacific Islanders, Latinx, and any non-White race specified by the respondents. Findings indicate the program contributed to increased engineering self-efficacy for Students of Color, while support networks cultivated through the program and exposure to engineering prerequisites prepared them for their academic experience. The study provides insight into how elements of a STEM intervention program can contribute to the self-efficacy of underrepresented students and potentially impact student success. [ABSTRACT FROM AUTHOR]

Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y 12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (P interaction = 0.47) nor the secondary endpoints. In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: To prepare engineers who can address complex sociotechnical problems, a deep understanding of engineers' complex problem‐solving approaches is needed. Purpose/Hypothesis: This study operationalizes comprehensive systems thinking as an analysis framework that attends to aspects of engineering work and relationships among those aspects. Leveraging this framework to analyze engineers' complex problem‐solving approaches enables attention to social and technical dimensions. Design/Method: We interviewed 46 engineers about their specific complex problem‐solving experiences. To explore a range of perspectives, we purposely sampled participants with varying academic, professional, and personal backgrounds and experiences. Data analysis focused on operationalizing comprehensive systems thinking; we first developed a set of aspects that captured the variety of considerations that participants discussed in their descriptions of solving a complex problem. We then inductively developed a scoring guide to differentiate response quality. Results: The scoring approach differentiated the quality of consideration based on a combination of the number of details provided, the degree of specificity, and analytical depth. While most participants discussed the consideration of a wide range of aspects of engineering work, they discussed far fewer possible relationships between these aspects. Contextual aspects of engineering work were consistently the least commonly identified and least likely to be considered in relation to other aspects of a given problem. Conclusions: Our differentiation of various complex problem‐solving approaches can guide the development of educational interventions and tools, ultimately facilitating more comprehensive consideration of aspects—and in particular relationships among aspects—and setting up engineers to be more successful at developing appropriate solutions. [ABSTRACT FROM AUTHOR]

In the context of global change, reviewing the relationships between marine fish traits and their range shifts is required to (1) identify ecological generalizations regarding the influence of traits on range shifts at a global scale and (2) investigate the rationale behind trait inclusion in models describing those relationships. We systematically searched for studies on marine fish assemblages that identified distributional shifts and analyzed the relationship between fish traits and these shifts. We reviewed 29 papers and identified 11 shift type characterizations and 41 traits, noting significant variation in measurement methods and model types used to describe their relationships. We identified global trait redundancies in the relationship between fish traits and latitudinal range shifts. These trends are related to the fishes' latitudinal range, trophic level, water column habitat, body size, size‐at‐settlement, growth rate, and larval swimming ability. The first four traits, along with fish bottom habitat, biogeographic affinity, diet, and thermal affinity, also showed significant relationships across four ways to characterize horizontal range shifts of fish species. The significance of these traits suggests their relevance in range shifting, regardless of the analyses conducted, biogeographic realm, and range shift type. However, trait redundancies require further consideration, mainly because some traits show opposing relationships in different studies, and important biogeographic research gaps limit global generalizations about the trait–range shift relationship. Half of the studies analyzed provided a rationale for 23 out of 41 traits. We also provide guidelines for future work to better understand the influence of traits on fish range shifts. [ABSTRACT FROM AUTHOR]