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In eastern Canada, the destruction of kelp beds by dense aggregations (fronts) of the omnivorous green sea urchin, Strongylocentrotus droebachiensis, is a key determinant of the structure and dynamics of shallow reef communities. Recent studies suggest that hydrodynamic forces, but not sea temperature, determine the strength of urchin-kelp interactions, which deviates from the tenets of the metabolic theory of ecology (MTE). We tested the hypothesis that water temperature can predict short-term kelp bed destruction by S. droebachiensis in calm hydrodynamic environments. Specifically, we experimentally determined relationships among water temperature, body size, and individual feeding in the absence of waves, as well as among wave velocity, season, and aggregative feeding. We quantified variation in kelp-bed boundary dynamics, sea temperature, and wave height over three months at one subtidal site in Newfoundland to test the validity of thermal tipping ranges and regression equations derived from laboratory results. Consistent with the MTE, individual feeding during early summer (June-July) obeyed a non-linear, size- and temperature-dependent relationship: feeding in large urchins was consistently highest and positively correlated with temperature

Abstract Few empirical research has attempted to determine the impact of Intelligent Computer-Assisted Language Assessment (ICALA) in philosophy-based language instruction (PBLI) on critical thinking, self-evaluation, and academic resilience, despite the significant role that higher-order thinking skills play in influencing English as a Foreign Language (EFL) learners’ cognition, including their learning processes. This research addresses this knowledge vacuum by examining how ICALA in PBLI influences the development of the four primary abilities associated with critical thinking, self-evaluation, and academic resilience. A quasi-experimental strategy was used in this study among 81 EFL learners. The participants were split into two groups: one to participate in the experiment and another to serve as a control. The books for both groups were revised or supplemented according to the underlying PBLI principles. The control group (CG) students were exposed to paper format assessment. In comparison, the experimental group (EG) attended ICALA. The statistical significance of the differences between the two groups was determined using multivariate analysis of variance (MANOVA). The results demonstrated that the learners in EG outperformed their peers in CG foreign language-speaking development. Moreover, they received better critical thinking, self-evaluation, and academic resilience results.

Abstract This study investigates the impact of Philosophy-Based Language Teaching (PBLT) on the critical thinking skills and learner engagement of English as a Foreign Language (EFL) students. A concurrent mixed-methods approach, including semi-structured interviews, document analysis, and academic achievement tests, was employed with an experimental group (EG) exposed to PBLT and a control group (CG) receiving traditional instruction. The results reveal a substantial positive effect of PBLT on the critical thinking abilities of EFL learners, as evidenced by thematic analyses of interviews and document content. Themes include heightened critical thinking awareness, collaborative knowledge construction, and increased learner engagement. Academic achievement tests further demonstrate significant improvement in the experimental group’s performance. A comparison with existing literature underscores the novelty of our mixed-methods approach. Implications for language teachers, materials developers, syllabus designers, and policy-makers are discussed, highlighting the potential of PBLT in cultivating critical thinking and learner engagement.

Abstract This research compared the impacts of computerized formative assessment (CFA) and computerized dynamic assessment (CDA) on students’ motivation, reading self-concept, autonomy, and self-regulation. Out of a total of 123 Bangladeshi pupils, 87 participants were carefully chosen as the study’s sample subject based on the Preliminary English Test (PET) results. Using the convenience sampling method, three equal groups—one control and two experimental ones (dynamic and formative) (n = 29)—were randomly selected. Pretests were then taken by each of the three groups to assess their reading motivation, reading self-concept, autonomy, and self-regulation. Then, various treatments were presented to the groups. The control group students underwent conventional assessment. C-DA was administered to students in the first experimental group participants, while CFA was run in the second experimental group. At the treatment finished, the groups completed reading motivation, reading self-concept, autonomy, and self-regulation posttests. The data were examined using the one-way ANOVA test as well as the post hoc Scheffe test. The one-way ANOVA analysis showed that the three groups’ posttest outcomes varied. The C-DA group outperformed the computerized formative group in reading motivation, reading self-concept, autonomy, and self-regulation, according to the data analysis. It was found that C-DA helped EFL students improve their motivation in reading, reading self-concept, autonomy, and self-regulation. Finally, recommendations for further studies were offered along with the conclusions, implications, and limitations.

The integration of digital technology in economic transformation can introduce new risks and threats caused by the emergence of new technologies and features in the digital economy. It is crucial for governments, as implementers and overseers of the economy, to identify potential risks and threats in order to ensure the security of the national economy during the digital economic transformation. The efficiency of the measures developed and implemented to minimize risks and eliminate threats to national economic security depends on the quality and precision of the policies implemented. A comprehensive approach to analyzing the risks and threats posed by cyber threats in the digital economy is necessary and should cover all economic processes, particularly the relationships among the actors involved in the economic process.

INTRODUCTION: Sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs. METHODS: the purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis. RESULTS: little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence. CONCLUSION: there is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.

Background: Postacute sequelae of SARS-CoV-2 infection (PASC) are a novel clinical syndrome characterized in part by endothelial dysfunction. Enhanced external counterpulsation (EECP) produces pulsatile shear stress, which has been associated with improvements in systemic endothelial function., Objective: To explore the effects of EECP on symptom burden, physical capacity, mental health, and health-related quality of life (HRQoL) in patients with PASC-associated angina and microvascular dysfunction (MVD)., Methods: An interventional pilot study was performed, including 10 patients (male = 5, mean age 50.3 years) recruited from a tertiary specialized PASC clinic. Patients with angina and MVD, defined as index of microcirculatory resistance (IMR) ≥25 and/or diagnosed through stress perfusion cardiac magnetic resonance imaging, were included. Patients underwent one modified EECP course (15 one-hour sessions over five weeks). Symptom burden, six-minute walk test, and validated generic self-reported instruments for measuring psychological distress and HRQoL were assessed before and one month after treatment., Results: At baseline, most commonly reported PASC symptoms were angina (100%), fatigue (80%), and dyspnea (80%). Other symptoms included palpitations (50%), concentration impairment (50%), muscle pain (30%), and brain fog (30%). Mean IMR was 63.6. After EECP, 6MWD increased (mean 29.5 m, median 21 m) and angina and fatigue improved. Mean depression scores showed reduced symptoms (-0.8). Mean HRQoL scores improved in seven out of eight subscales (+0.2 to 10.5)., Conclusions: Patients with PASC-associated angina and evidence of MVD experienced subjective and objective benefits from EECP. The treatment was well-tolerated. These findings warrant controlled studies in a larger cohort., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Eline Wu et al.)

Post-acute COVID-19 (PACS) are associated with cardiovascular dysfunction, especially postural orthostatic tachycardia syndrome (POTS). Patients with PACS, both in the absence or presence of POTS, exhibit a wide range of persisting symptoms long after the acute infection. Some of these symptoms may stem from alterations in cardiovascular homeostasis, but the exact mechanisms are poorly understood. The aim of this study was to provide a broad molecular characterization of patients with PACS with (PACS + POTS) and without (PACS-POTS) POTS compared to healthy subjects, including a broad proteomic characterization with a focus on plasma cardiometabolic proteins, quantification of cytokines/chemokines and determination of plasma sphingolipid levels. Twenty-one healthy subjects without a prior COVID-19 infection (mean age 43 years, 95% females), 20 non-hospitalized patients with PACS + POTS (mean age 39 years, 95% females) and 22 non-hospitalized patients with PACS-POTS (mean age 44 years, 100% females) were studied. PACS patients were non-hospitalized and recruited ≈18 months after the acute infection. Cardiometabolic proteomic analyses revealed a dysregulation of ≈200 out of 700 analyzed proteins in both PACS groups vs. healthy subjects with the majority (> 90%) being upregulated. There was a large overlap (> 90%) with no major differences between the PACS groups. Gene ontology enrichment analysis revealed alterations in hemostasis/coagulation, metabolism, immune responses, and angiogenesis in PACS vs. healthy controls. Furthermore, 11 out of 33 cytokines/chemokines were significantly upregulated both in PACS + POTS and PACS-POTS vs. healthy controls and none of the cytokines were downregulated. There were no differences in between the PACS groups in the cytokine levels. Lastly, 16 and 19 out of 88 sphingolipids were significantly dysregulated in PACS + POTS and PACS-POTS, respectively, compared to controls with no differences between the groups. Collectively, these observations suggest a clear and distinct dysregulation in the proteome, cytokines/chemokines, and sphingolipid levels in PACS patients compared to healthy subjects without any clear signature associated with POTS. This enhances our understanding and might pave the way for future experimental and clinical investigations to elucidate and/or target resolution of inflammation and micro-clots and restore the hemostasis and immunity in PACS., (© 2023. The Author(s).)

Competing Interests: Disclosures None.

Aims: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population., Methods and Results: In patients with MI included in the Swedish web-system for enhancement and development of evidence-based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF) < 50% and/or pulmonary congestion (subset 1); EF < 40% and/or pulmonary congestion (subset 2); EF < 40% and/or pulmonary congestion and at least one high-risk feature (subset 3, PARADISE-MI like); and EF < 50% and no diabetes mellitus (subset 4, DAPA-MI like). Subsets 1, 2, 3, and 4 constituted 31.6%, 15.0%, 12.8%, and 22.8% of all patients with MI (n = 87 177), respectively. The age and prevalence of different co-morbidities varied between subsets. For median age, 70 to 77, for diabetes mellitus, 22 to 33%; for chronic kidney disease, 22 to 38%, for prior MI, 17 to 21%, for atrial fibrillation, 7 to 14%, and for ST-elevations, 38 to 50%. The cumulative incidence of death or heart failure hospitalization at 3 years was 17.4% (95% CI: 17.1-17.7%) in all MIs; 26.9% (26.3-27.4%) in subset 1; 37.6% (36.7-38.5%) in subset 2; 41.8% (40.7-42.8%) in subset 3; and 22.6% (22.0-23.2%) in subset 4., Conclusions: Depending on the definition, LV systolic dysfunction or pulmonary congestion is present in 13-32% of all patients with MI and is associated with a two to three times higher risk of subsequent death or HF admission. There is a need to optimize management and improve outcomes for this high-risk population., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Purpose: The dismal combination of hypertension and chronic kidney disease potentiates both cardiovascular disease and loss of renal function. Research points to the importance of arterial and left ventricular stiffening in this process but few studies have compared aspects of central and peripheral hemodynamics in relation to renal function in hypertension., Materials and Methods: We investigated 107 hypertensive individuals with renal function ranging from normal to severe dysfunction with pulse wave analysis to obtain central blood pressures (BP), augmentation index, carotid-femoral and carotid-radial pulse wave velocity (cfPWV, crPWV), aortic-to-brachial stiffness mismatch (cfPWV/crPWV), endothelial function by forearm flow-mediated vasodilation and myocardial microvascular function by subendocardial viability ratio, and indices of left ventricular structure (left ventricular mass index and relative wall thickness, RWT) and diastolic function (left atrial volume index, E/A, and E/é)., Results: Mean age was 58 years, BP 149/87 mm Hg, 9% had cardiovascular disease, and 31% were on antihypertensive treatment. Mean estimated glomerular filtration rate (eGFR) was 74 (range 130-21) ml/min × 1.73 m 2 . Whereas cfPWV and cfPWV/crPWV were independently related to eGFR ( r  = -0.20, p  = 0.002, r  = -0.16, p  = 0.01), central diastolic BP ( r  = 0.21, p  = 0.04), RWT ( r  = -0.34, p  = 0.001), E/é ( r  = -0.39, p  < 0.001) and E/A ( r  = 0.27, p  = 0.01) were related to eGFR in bivariate correlations, but these findings were not retained in multivariate analyses. Remaining markers of hypertensive heart disease and measures of microvascular function were not related to eGFR., Conclusion: Increased aortic stiffness and aortic-to-brachial stiffness mismatch are independently related to reduced eGFR in hypertensive patients, suggesting an important role for aortic stiffness in the evolution of hypertension-mediated renal dysfunction. Aortic stiffness and aortic-brachial stiffness mismatch may be useful early markers to find hypertensive patients at risk for decline in renal function.

Aims: The aim of this study is to investigate the association between adherence to beta-blocker treatment after a first acute myocardial infarction (AMI) and long-term risk of heart failure (HF) and death., Methods and Results: All patients admitted for a first AMI included in the nationwide Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies register between 2005 and 2010 were eligible (n = 71 638). After exclusion of patients who died in-hospital, patients with previous HF, patients with unknown left ventricular ejection fraction (EF), and patients who died during the first year after the index event, 38 608 patients remained in the final analysis. Adherence to prescribed beta-blockers was determined for 1 year after the index event using the national registry for prescribed drugs and was measured as proportion of days covered, the ratio between the numbers of days covered by the dispensed prescriptions and number of days in the period. As customary, a threshold level for proportion of days covered ≥80% was used to classify patients as adherent or non-adherent. At discharge 90.6% (n = 36 869) of all patients were prescribed a beta-blocker. Among 38 608 1 year survivors, 31.1% (n = 12 013) were non-adherent to beta-blockers. Patients with reduced EF with and without HF were more likely to remain adherent to beta-blockers at 1-year compared with patients with normal EF without HF (NEF). Being married/cohabiting and having higher income level, hypertension, ST-elevation MI, and percutaneous coronary intervention were associated with better adherence. Adherence was independently associated with lower all-cause mortality [hazard ratio (HR) 0.77, 95% confidence interval [CI] 0.71-0.84] and a lower risk for the composite of HF readmission/death, (HR 0.83, 95% CI 0.78-0.89, P value <0.001) during the subsequent 4 years of follow up. These associations were favourable but less apparent in patients with HFNEF and NEF., Conclusions: Nearly one in three AMI patients was non-adherent to beta-blockers within the first year. Adherence was independently associated with improved long-term outcomes; however, uncertainty remains for patients with HFNEF and NEF., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Enhanced external counterpulsation (EECP) is a noninvasive treatment that can decrease limiting symptoms in patients with refractory angina pectoris (RAP). Identifying responders to EECP is important as EECP is not widely available and relatively time intensive., Hypothesis: The effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors., Methods: This explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders., Results: Of the 119 patients (men = 97, 40-91 years), 49 (41.2%) were responders. Multinomial regression analysis showed that functional status (i.e., CCS class ≥3) (OR 3.10, 95% CI 1.12-8.57), LVEF <50% (OR 2.82, 95% CI 1.02-7.80), and prior performed revascularization (i.e., ≤ 1 type of intervention) (OR 2.77, 95% CI 1.06-7.20) were predictors of response to EECP (p < .05, Accuracy 63.6%). Traditional risk factors (e.g., gender, smoking, and comorbidities) did not predict response., Conclusions: EECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well-being among patients with RAP., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Aim: Data are scant on the incidence and prognosis of heart failure (HF) with normal ejection fraction (HFNEF, EF >49%) in an acute myocardial infarction (AMI) setting. The aim of this study was to examine incidence and predictors of HFNEF during an index acute myocardial infarction (AMI) and its subsequent associations with patient outcomes., Methods and Results: This study analysed 91 360 patients with LVEF data from the SWEDEHEART registry on consecutive AMI patients between 1998 and 2010. Echocardiography or LV angiography was used to assess LVEF. In-hospital HF diagnoses required presence of crackles, and use of i.v. diuretics or inotropic drugs during admission. Among HF patients, the proportion of HFNEF patients increased (from 18% to 31%) during the period. Incidence of HFNEF in the AMI population remained fairly unchanged (from 7.7% to 8.1%). In contrast, the proportion of HF patients with reduced EF (HFREF, EF ≤49%) declined (from 47% to 26%), as did the proportion of REF patients without HF (from 20% to 16%). AMI patients with NEF without HF increased (from 25% to 50%). HFREF and HFNEF patients showed considerably higher long-term mortality compared with patients with no HF, irrespective of EF [the HFREF and HFNEF hazard ratio, compared with NEF, was 4.5 (4.4-4-6) and 3.3 (3.1-3.4), respectively, and 1.6 (1.5-1.65) for REF]. The adjusted HFNEF hazard ratio, compared with NEF, was 1.9 (1.8-2.0). Age, female gender, diabetes mellitus, hypertension, AF, and chronic kidney disease were strong predictors of HFNEF (P < 0.001)., Conclusion: The proportion of AMI patients with HFNEF is constant over time. HFNEF patients have a considerably worse long-term prognosis compared with patients without clinical HF, irrespective of EF., (© 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.)

Objectives: The aim of this study was to examine temporal trends in the incidence and outcomes of heart failure (HF) complicating acute myocardial infarction (AMI) in a large national cohort., Background: There are limited and conflicting data concerning temporal trends in the incidence and prognostic implication of in-hospital HF that complicates AMI., Methods: The nationwide coronary care unit registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) records baseline characteristics, treatments, and outcome of consecutive patients with AMIs admitted to all hospitals in Sweden. The diagnosis of HF requires the presence of crackles (Killip class ≥II) or the use of intravenous diuretic agents or intravenous inotropes. This study included 199,851 patients admitted for index AMIs between 1996 and 2008., Results: The incidence of HF declined from 46% to 28% (p < 0.001). This decrease was more pronounced in patients with ST-segment elevation myocardial infarctions and left bundle branch block (from 50% to 28%) compared with those with non-ST-segment elevation myocardial infarctions (from 42% to 28%) (p < 0.001). The in-hospital, 30-day, and 1-year mortality rates for patients who developed HF during the index myocardial infarction decreased over the years from 19% to 13%, from 23% to 17%, and from 36% to 31%, respectively (p < 0.001 for all). Thirteen-year survival analysis showed higher mortality in patients with HF compared with those without HF (adjusted hazard ratio: 2.1; 95% confidence interval: 2.06 to 2.13)., Conclusions: A marked decrease was found in the incidence of HF complicating AMI between 1996 and 2008. However, HF continues to worsen the early-, intermediate-, and long-term adverse prognostic risk after AMI., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)