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ObjectivesWe examined loop diuretic treatment before and 1-year after transcatheter aortic valve implantation (TAVI), as a proxy for changes in symptom severity and secondly assessed how changes in loop diuretics related to mortality risk.BackgroundRandomized clinical trials suggest that approximately one third of patients undergoing TAVI do not achieve symptom relief, but "all-comer" data are lacking.MethodsUsing Danish nationwide registries, we identified all citizens, who underwent TAVI from 2008 to 2019 and were alive at 1-year post-discharge. Loop diuretic treatment pre-TAVI and at 1-year post-TAVI were assessed and grouped as receiving 1) no-loop diuretics; 2) low: 1-40 mg of furosemide (or equivalent bumetanide) daily; 3) intermediate: 41-120 mg of furosemide daily; or 4) high: >120 mg furosemide daily.ResultsAmong the 4431 patients undergoing TAVI, 2173 (49%) patients were not treated with loop diuretics at the time of TAVI, 918 (21%) had low-loop diuretics, 881 (20%) had intermediate-loop diuretics, and 459 (10%) had high-loop diuretics. At 1-year post-TAVI, 893 (20%) patients had increased, 1010 (23%) had reduced, and 2528 (57%) had unchanged loop diuretic treatment. The cumulative 5-year risk of death in patients surviving one year, was 61% (95% CI: 56.4% to 65.3%) in patients with increased and 47% (95% CI: 44.9% to 49.9%) in patients with reduced/unchanged loop diuretic treatment, respectively. In multivariable Cox proportional hazard analysis, increased loop diuretic treatment was associated with a higher risk of death compared with reduced/unchanged loop diuretic treatment (Hazard ratio: 1.4; 95% CI: 1.22 to 1.52).ConclusionsAmong patients undergoing TAVI, surviving one year, one fifth of patients had increased loop diuretic treatment, and a little over one fifth had reduced loop diuretic treatment 1-year post-procedure. In patients with increased diuretic treatment, the risk of death was higher compared to those with reduced/unchanged loop diuretic treatment.

In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.

This paper proposes a solution to the problem of software absence for the quantitative fire safety analysis of complex objects, which is suitable not only for highly qualified scientists and experts but also for fire safety engineers and inspectors and is compatible with mobile devices. Existing software solutions for quantitative fire safety analysis are desktop-based, and all require a high level of competence of users. We propose a solution by combining the formalism of typical probabilistic structural–logical (TPSL) models, the Software-as-a-Service (SaaS) concept, and end-to-end encryption. Using TPSL models allows the development of cloud-based applications with a simple request-based application programming interface and intuitively understandable user interface to assess the level of safety of complex objects. As a result, we could use such mobile device-ready applications both for developing mobile device applications and developing mobile-device-friendly website-based services to carry out safety control inspections or level of safety management. [ABSTRACT FROM AUTHOR]

The North-Western Black Sea shelf is extremely vulnerable to disturbances of its habitats and ecosystems. In the past 10 years, this area has become targeted by beam trawl fisheries for the invasive gastropod Rapana venosa (Valenciennes, 1846), with a potentially destructive impact on the area’s soft bottoms. Not many studies have been performed in the region, and most investigations have focused on gear selectivity and by-catch rates. In this context, our novel research aimed, on the one hand, to assess and quantify the actual impact of beam trawling and, on the other hand, to propose effective spatial/temporal management measures for a sustainable zonation of the North-Western Black Sea shelf (marine zone of the Danube Delta Biosphere Reserve). The methodology used integrated beam trawl catch dynamics information, VMS data, geophysical investigations, and macrozoobenthos sampling. Our findings show that beam trawling activities can cause changes in the benthic habitat structure (lower number of taxa, lower values of ecological indicators, and an overall non-GES status). Further in-depth investigations are needed to underpin the ecosystem-based management of this marine protected area (MPA), aiming to allow the recovery of the affected benthic habitats, by alternating defined areas undergoing fishing with biological recovery polygons.

Objectives to study the mortality indicators, their dynamics and structure, in the population of the Orenburg region in the period of 20112017. Material and methods.The study was conducted using the data from the territorial authority of statistics in the Orenburg region in the period from 2011 to 2017. The analytical, demographic and statistical methods were implemented for the study of the demographic indicators. Results.Cities and municipal settlements of the Orenburg region with high mortality indicators were included in the second and fourth clusters during the cluster analysis. The first and third clusters included cities and municipal settlements with an average mortality. The most favorable position has the Orenburg area with the lowest mortality rate in the region in 2017 8.4. The dynamics of mortality rates among the male and female population tends to decrease, more pronounced dynamics is in men. Though, the male population is characterized by higher mortality rates in all age groups. The leading position among the causes of death is taken by diseases of the circulatory system (46.3% of the total mortality). The second position is occupied by tumors (17.2%), the third by external causes (8.4%). Mortality from circulatory system diseases and from external causes has reduced. The dynamics of mortality from tumors does not change significantly. The rank of leading causes of death is not identical in the clusters: in the third and fourth clusters, the other causes occupy the second place in the structure of mortality, while tumors occupy the third. Conclusion.In the Orenburg region, the mortality rate is higher than overage in the Russian Federation by 0.9 per 1000 people. The study revealed significant territorial differences in the mortality rates. In general, the mortality among men in all age groups is higher than the mortality of women. The mortality rate from diseases of the circulatory system plays the leading role in the structure of mortality, but has the tendency for decline. Until 2006, the mortality from external causes ranked the second place, now the second place is taken by death from tumors The mortality from external causes is decreasing; mortality from tumors does not change significantly. The obtained results could be used by local authorities in developing the program of public health protection and assessing its effectiveness.

Two interesting unanswered questions are the extent to which both the broad patterns and genetic details of adaptive divergence are repeatable across species, and the timescales over which parallel adaptation may be observed. Drosophila melanogaster is a key model system for population and evolutionary genomics. Findings from genetics and genomics suggest that recent adaptation to latitudinal environmental variation (on the timescale of hundreds or thousands of years) associated with Out-of-Africa colonization plays an important role in maintaining biological variation in the species. Additionally, studies of interspecific differences between D. melanogaster and its sister species D. simulans have revealed that a substantial proportion of proteins and amino acid residues exhibit adaptive divergence on a roughly few million years long timescale. Here we use population genomic approaches to attack the problem of parallelism between D. melanogaster and a highly diverged conger, D. hydei, on two timescales. D. hydei, a member of the repleta group of Drosophila, is similar to D. melanogaster, in that it too appears to be a recently cosmopolitan species and recent colonizer of high latitude environments. We observed parallelism both for genes exhibiting latitudinal allele frequency differentiation within species and for genes exhibiting recurrent adaptive protein divergence between species. Greater parallelism was observed for long-term adaptive protein evolution and this parallelism includes not only the specific genes/proteins that exhibit adaptive evolution, but extends even to the magnitudes of the selective effects on interspecific protein differences. Thus, despite the roughly 50 million years of time separating D. melanogaster and D. hydei, and despite their considerably divergent biology, they exhibit substantial parallelism, suggesting the existence of a fundamental predictability of adaptive evolution in the genus.

Background: Patient reported outcomes (PROs) are important measures in acquired heart disease but have not been well defined in Adult Congenital Heart Disease (ACHD). Our aim was to explore the discriminatory capacity of PRO survey tools in Fontan circulatory failure (FCF). Methods: Consecutive adults were enrolled from our ambulatory clinics. Inclusion criteria were age ≥18 years, a Fontan circulation or a hemodynamically insignificant shunt lesion, and sufficient cognitive/language abilities to complete PROs. A comprehensive package of PRO measures, designed to assess perceived health-related quality of life (HRQOL) was administered (including the Kansas City Cardiomyopathy Questionnaire [KCCQ-12], EuroQol-5-dimension [EQ5D], Short Form Health Status Survey [SF-12], self-reported New York Heart Association [NYHA] Functional Class, and Specific Activity Scale [SAS]). Results: We compared 54 Fontan patients (35 ± 10 years) to 25 simple shunt lesion patients (34 ± 11 years). The KCCQ-12 score was lower in Fontan versus shunt lesion patients (87 [IQR 79, 95] versus 100 [IQR 97, 100], p-value < 0.001). The FCF subgroup was associated with lower KCCQ-12 scores as compared with the non-FCF subgroup (82 [IQR 56, 89] versus 93 [IQR 81, 98], p-value = 0.002). Although the KCCQ-12 had the best discriminatory capacity for determination of FCF of all PRO tools studied (c-statistic 0.75 [CI 0.62, 0.88]), superior FCF discrimination was achieved when the KCCQ-12 was combined with all PRO tools (c-statistic 0.82 [CI 0.71, 0.93]). Conclusions: The KCCQ-12 questionnaire demonstrated good discriminatory capacity for the identification of FCF, which was further improved through the addition of complementary PRO tools. Further research will establish the value of PRO tools to guide management strategies in ACHD. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this scoping review is to systematically scope the literature on social work, the COVID-19 pandemic, and health policy. The research question guiding the scoping review is: What are the policy issues emerging during the COVID-19 pandemic that are of importance for social workers working in health and mental health? Method: Scoping review methodology following Arksey and O'Malley's five-stage framework. Results: A final sample of 191 articles were included in the scoping review. The five themes identified are: (a) strengthening social work's capacity to address structural issues in practice, (b) gaps in social work education, (c) need for new and updated standards and guidelines, (d) need for professional clarity and professional supports, and (e) inadequate government response. Conclusions: By strengthening uptake of the policy-practice framework, social work practitioners concurrently address immediate client issues and address upstream factors perpetuating inequities emerging during the pandemic. [ABSTRACT FROM AUTHOR]

This observational study evaluated the impact of a sponsor company-provided Patient Support Program (PSP) on discontinuation of adalimumab in adult Australian patients eligible for Pharmaceutical Benefit Scheme (PBS)-reimbursed adalimumab for Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Crohn's Disease (CD), Ulcerative Colitis (UC), or Hidradenitis Suppurativa (HS). Patients initiating adalimumab between May 2018 and September 2019 were enrolled into two prospective cohorts based on their decision to opt for or decline the PSP (PSP or non-PSP cohorts). In addition, a historical, retrospective Non-PSP cohort was established from the Services Australia 10% PBS dataset by extracting data of patients initiating adalimumab prior to the introduction of adalimumab PSPs and based on adalimumab PBS listing dates (AS: April 2007 to March 2009; PsA/RA: January 2007 to December 2008; CD: January 2009 to December 2010; HS and UC indications not included). Follow-up for all cohorts was 12 months. The primary endpoint was the time to discontinuation, compared between the prospective PSP cohort and the prospective or retrospective Non-PSP cohort. Inverse probability of treatment weighting was used to balance the cohorts. A Cox proportional hazards model indicated no difference in time to discontinuation between the prospective PSP (n = 162) and non-PSP (n = 65) cohorts (HR [95% CI] = 1.256 [0.616–2.563], p = 0.5304). The 12-month adalimumab persistence rates (95% CI) were 78% (69%, 84%) and 82% (67%, 90%), respectively. In contrast, discontinuation was less likely in the prospective PSP (n = 151) compared with the retrospective non-PSP (n = 297) cohort (HR [95% CI] = 0.44 [0.28–0.68], p<0.001). The 12-month persistence rates (95% CI) were 81% (76%, 90%) and 61% (56%, 67%), respectively. Overall, this study suggests that optimal adalimumab persistence can be achieved with either a structured PSP or healthcare support from other sources, but this was not the case more than a decade ago. [ABSTRACT FROM AUTHOR]

This pilot study qualitatively examined the benefits of engaging women experiencing homelessness in group-based improv activities as a means of enhancing health and wellness outcomes in this marginalized population. Seven women experiencing homelessness residing in a women's shelter and who participated in a professionally-facilitated improv workshop were engaged through in-depth qualitative interviews about their experiences. The workshop and data collection occurred in October 2021. Participants indicated that improv boosted their self-esteem and deepened social connections with others at the shelter. Participants were enthusiastic about accessing further improv opportunities, noting that improv should be embedded into other prevention and intervention approaches, particularly groups that are mandatory or that focus on stigmatized topics. Inclusion of improv activities in intervention and prevention efforts would benefit from additional exploration as ways by which services might be innovated and tailored to the specific health and wellness needs of women experiencing homelessness. [ABSTRACT FROM AUTHOR]