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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis. It is important to identify predictors of excellent outcomes (good clinical outcomes, more time spent at home) after TAVR that are potentially amenable to improvement. OBJECTIVES: The purpose of the study was to use machine learning to identify potentially modifiable predictors of clinically relevant patient-centered outcomes after TAVR. METHODS: We used data from 8,332 TAVR cases (January 2016-December 2021) from 21 hospitals to train random forest models with 57 patient characteristics (demographics, comorbidities, surgical risk score, lab values, health status scores) and care process parameters to predict the end point, a composite of parameters that designated an excellent outcome and included no major complications (in-hospital or at 30 days), post-TAVR length of stay of 1 day or less, discharge to home, no readmission, and alive at 30 days. We used recursive feature elimination with cross-validation and Shapley Additive Explanation feature importance to identify parameters with the highest predictive values. RESULTS: The final random forest model retained 29 predictors (15 patient characteristics and 14 care process components); the area under the curve, sensitivity, and specificity were 0.77, 0.67, and 0.73, respectively. Four potentially modifiable predictors with relatively high Shapley Additive Explanation values were identified: type of anesthesia, direct movement to stepdown unit post-TAVR, time between catheterization and TAVR, and preprocedural length of stay. CONCLUSIONS: This study identified four potentially modifiable predictors of excellent outcome after TAVR, suggesting that machine learning combined with hospital-level data can inform modifiable components of care, which could support better delivery of care for patients undergoing TAVR.

This Long Database Report describes the historical background and current contents of the Nordic-Baltic Grassland Vegetation Database (NBGVD) (GIVD-code EU-00-002). NBGVD is the EDGG-associated collaborative vegetation-plot database that collects vegetation-plot data of grasslands and other open habitats (except segetal and deep aquatic vegetation) from the Nordic-Baltic region excluding Germany, namely Belarus, Denmark, Estonia, Faroe Islands, Finland, Iceland, Latvia, Lithuania, Norway, N Poland, NW Russia, Svalbard and Jan Mayen, and Sweden. Target vegetation types are lowland grasslands and heathlands, arctic-alpine communities, coastal communities, non-forested mires and other wetlands, rocky, tall-herb and ruderal communities. As of March 2024, it included 12,694 relevés recorded between 1910 and 2023. These were mainly digitised from literature sources (84%), while the remainder comes from individual unpublished sources (16%). The data quality is high, with bryophytes and lichens being treated in more than 80% of all plots and measured environmental variables such as topography and soil characteristics often available in standardised form. A peculiarity of the Nordic-Baltic region are the relatively small plot sizes compared to other regions (median: 4 m2). The available data stem from 35 vegetation classes, with Koelerio-Corynephoretea, Festuco-Brometea, Sedo-Scleranthetea, Molinio-Arrhenatheretea and Scheuchzerio-Caricetea being most frequent. We conclude that NBGVD provides valuable data, allowing interesting analyses at the regional scale and fills gaps in continental to global analyses. Still, since there are many more data around, we ask interested readers to contribute their own data or help find and digitise old data from the literature. Taxonomic reference: TURBOVEG species list “Europe”. Syntaxonomic reference: Mucina et al. (2016). Abbreviations: EDGG = Eurasian Dry Grassland Group, EVA = European Vegetation Archive, GIVD = Global Index of Vegetation-Plot Databases, NBGVD = Nordic-Baltic Grassland Vegetation Database

This study aimed to explore oncological doctor-patients experiences concerning the neoplastic disease. The study involved 20 Polish doctors with cancer. Respondents answered open questions related to cancer management and opinions about themselves as oncological patients. The results of the study indicate that doctor-patients deny their susceptibility to illness, which leads to prophylaxis ignorance. Many doctors diagnosed themselves with the disease, but they needed a clear verbal confirmation of the diagnosis by another physician. Respondents well assessed professional skills of doctor-colleagues. However, communication competencies of their doctors were assessed critically. Medical narratives may become an incentive to deepen the discourse on the quality of the relationship between a doctor and a doctor-oncological patient. They may also lead to further research on the anthropological, psychological, and sociological understanding of disease.

OBJECTIVES:. Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated. DESIGN:. Retrospective analysis of prospectively collected database. SETTING:. A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men). PATIENTS:. Patients older than 18 years with acute COVID-19 infection in the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67). CONCLUSIONS:. In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.

Background: Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis. It is important to identify predictors of excellent outcomes (good clinical outcomes, more time spent at home) after TAVR that are potentially amenable to improvement. Objectives: The purpose of the study was to use machine learning to identify potentially modifiable predictors of clinically relevant patient-centered outcomes after TAVR. Methods: We used data from 8,332 TAVR cases (January 2016-December 2021) from 21 hospitals to train random forest models with 57 patient characteristics (demographics, comorbidities, surgical risk score, lab values, health status scores) and care process parameters to predict the end point, a composite of parameters that designated an excellent outcome and included no major complications (in-hospital or at 30 days), post-TAVR length of stay of 1 day or less, discharge to home, no readmission, and alive at 30 days. We used recursive feature elimination with cross-validation and Shapley Additive Explanation feature importance to identify parameters with the highest predictive values. Results: The final random forest model retained 29 predictors (15 patient characteristics and 14 care process components); the area under the curve, sensitivity, and specificity were 0.77, 0.67, and 0.73, respectively. Four potentially modifiable predictors with relatively high Shapley Additive Explanation values were identified: type of anesthesia, direct movement to stepdown unit post-TAVR, time between catheterization and TAVR, and preprocedural length of stay. Conclusions: This study identified four potentially modifiable predictors of excellent outcome after TAVR, suggesting that machine learning combined with hospital-level data can inform modifiable components of care, which could support better delivery of care for patients undergoing TAVR.

Introduction: The right to conscientious objection in the pharmacist profession, as in the case of other medical professions, has been the subject of a lively ethical and legal discussion in Poland and abroad for many years. This is related to the introduction to pharmacy trade of products and devices whose purpose of use or mechanism of action is inconsistent with the religious beliefs or moral convictions of some pharmacists. Pharmacists practicing in Poland do not have the so-called conscience clause in law regulating their professional activity, but there are attempts to introduce such a legal solution similarly to the doctors and nurses. Aim: The aim of our study was to analyze the attitudes of Polish society towards the conscientious objection of pharmacists. We tested the hypotheses that social attitudes may vary depending on the circumstances and are modified by psychological and sociodemographic variables, such as: perception of the prestige of the pharmacist profession, tendency to seek advice from pharmacists, age, gender, education, financial conditions, health status and place of residence. Material and methods: The research was conducted on a group of 600 people over 18 years of age. The sample was representative of the Polish population. A mix mode technique was used based on personal and telephone interviews, i.e. 84% CAPI (Computer Assisted Personal Interview) and 16% CATI (Computer Assisted Telephone Interviewing). Respondents were asked whether a pharmacist, guided by his or her own conscience, could refuse to sell selected products or devices such as: hormonal contraceptives, morning-after pills and intrauterine devices. Results: The majority (78-86% - depending on the case) of respondents believe that a pharmacist has no right to refuse to sell a product or device available in pharmacies. A small number of respondents indicated that the pharmacist has the right to refuse to sell contraceptives (2.7%, n=16), intrauterine device (8.7%, n=52), post-coital pill (10.5%, n=63). Statistically significant differences were observed between the level of acceptance of the pharmacist's conscientious objection in different cases: refusal to dispense hormonal contraceptives (Me=0.14), for intrauterine devices (Me=0.21) and post-coital pills (Me=0.25) (p=0.01). The acceptance of conscientious objection by pharmacists correlates statistically significantly negatively with the respondents' age, financial conditions, level of perceived prestige of the pharmacist profession, and positively with the tendency to consult OTC medicines with pharmacists. There was no relationship with education, health status and place of residence, and no differences between women and men. Conclusions: The level of social acceptance for introducing a conscience clause into laws regulating the practice of the pharmacist profession seems to be low. However, it varies depending on the type of pharmaceutical product or medical device, which may result from the perception of a different mechanism of action, which may be morally objectionable to a greater or lesser extent. The level of social acceptance of the pharmacist's right to conscientious objection is also dependent on the social perception of the pharmacist's role, and is also modified by psychological and sociodemographic variables such as: perception of the pharmacist's prestige, tendency to consult a pharmacist when purchasing medications, as well as age and financial conditions.

IntroductionThe development of the scientific potential linked with biobanking and research on human biological material is highly dependent on the willingness of potential donors to cooperate with entities that collect the material. For this reason, it is crucial to identify the circumstances and factors that may encourage potential participants to donate their biological material. In particular, knowledge of the motivational factors that can be modified by the persons managing a biobank may prove notably important for shaping the organizational and communication policy of the biobank and other scientific institutions.Material and methodsThe research was carried out on a group of 1,100 people over 18 years of age representing the adult population of Poland in 2021.ResultsMore than half of the respondents declared their willingness to donate a blood sample for research purposes to a biobank (57.8%). The most often indicated incentives among the factors supporting the donation of biological material were offers of: obtaining the results of genetic tests predicting the risk of diseases (77.1%), blood tests (71.3%), the possibility of obtaining a small remuneration (64.6%) and the carrying out of genetic ancestry tests (60.4%).ConclusionOffering the possibility of performing additional diagnostic tests, especially genetic tests, may significantly increase the willingness of potential donors to cooperate with biobanks and other entities collecting human biological material for the purpose of scientific research. However, attention should also be paid to the challenges and risks linked with respecting the privacy and autonomy of research participants.

Visible light communication (VLC) systems leverage illumination devices, such as light-emitting diodes (LEDs), to serve a dual role as indoor high-speed communication downlinks. Though high data rates are possible using orthogonal frequency-division (OFDM) in VLC systems, the impact on the complexity and luminous efficacy of the luminaire remain among the key challenges. In this paper, square-wave spatial optical OFDM (SW-SO-OFDM) is proposed which transmits an OFDM signal using $G$ square-wave subcarriers from $G$ LED groups and allowing them to sum in space. Using a binary-level square-wave carrier signal eliminates the need for digital-to-analog conversion, non-linear pre-distortion hardware and the transmitter inverse Fourier transform, thereby greatly reducing the complexity of the transmitter in the luminaire. Further, by coordinating the binary transmissions from pairs of LED groups, SW-SO-OFDM can transmit multi-level constellations, which further improves the bandwidth efficiency. Through simulation and experiment, SW-SO-OFDM is shown to provide communication performance comparable to SO-OFDM and to significantly outperform conventional DC-biased (DCO)-OFDM at high signal-to-noise ratios, while considerably reducing the overall transmitter complexity in the luminaire.

Dynamic recrystallisation (DRX) is one of the fundamental phenomena in materials science, significantly impacting the microstructure and mechanical properties of components subjected to large plastic deformations. Experimental research on that topic carried out for a wide range of new metallic materials is often supported by computational materials science. A direct consideration and detailed understanding of this phenomenon are possible with a class of full-field numerical models based on the cellular automata (CA) method. However, the classical CA approach is based on a regular, fixed computational space and has limitations in capturing large deformations of the computational domain. Therefore, the main goal of the work is to develop and implement an alternative solution to overcome this limitation. The proposed solution is based on coupling the finite element (FE) method with the random cellular automata (RCA) approach. Such a model can directly consider the influence of geometrical changes in microstructure during large plastic deformation on recrystallisation progress. Details of the developed RCA DRX model assumptions and coupling issues with FE mesh are discussed. Particular attention is also paid to increasing model efficiency and robustness studies.

RNA-binding proteins (RBPs), essential for skeletal muscle regeneration, cause muscle degeneration and neuromuscular disease when mutated. Why mutations in these ubiquitously expressed RBPs orchestrate complex tissue regeneration and direct cell fate decisions in skeletal muscle remains poorly understood. Single-cell RNA-sequencing of regenerating Mus musculus skeletal muscle reveals that RBP expression, including the expression of many neuromuscular disease-associated RBPs, is temporally regulated in skeletal muscle stem cells and correlates with specific stages of myogenic differentiation. By combining machine learning with RBP engagement scoring, we discovered that the neuromuscular disease-associated RBP Hnrnpa2b1 is a differentiation-specifying regulator of myogenesis that controls myogenic cell fate transitions during terminal differentiation in mice. The timing of RBP expression specifies cell fate transitions by providing post-transcriptional regulation of messenger RNAs that coordinate stem cell fate decisions during tissue regeneration.

# Background Previous research has reported that people with Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) generally experience a high rate of muscular injury and pain. However, there is limited research comparing the recovery times and length of Delayed Onset Muscle Soreness (DOMS) in individuals with JHS to non-hypermobile individuals in response to exercise. # Hypotheses/Purpose The purpose of this study was to investigate JHS and its effects on DOMS and its recovery time. # Study Design Quasi-experimental, observational comparison # Methods Two groups including a hypermobile group (score >4 on Beighton Scale) and a non-hypermobile group all took part in five-second long standing eccentric bicep curls based using their one- repetition maximum (1-RM) of their dominant arm to failure in order to induce DOMS. Visual analog pain scale (VAS), McGill pain scale, resting arm angle, girth, and the pressure pain threshold, all domains of DOMS, were measured over a five-day period. Results were analyzed using ANOVA with time as the repeated factor. # Results Both groups experienced DOMS following the eccentric exercise. However, VAS reporting was significantly greater in the hypermobile group compared to the non-hypermobile group and there was a significant difference over time. However, other variables did not reveal any other significant findings between groups. # Conclusion Individuals with JHS may experience greater DOMS and require more time to recover between treatment sessions. Therapists need to be aware that patients with hypermobility may experience higher pain levels related to exercise, and they need to adjust treatment parameters appropriately. # Level of Evidence 2b

Abstract Background Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome is a dental disease where the radiographic signs may be quantified using radiographic texture features. This study aimed to implement the scaled–pixel–counting protocol to quantify and compare the image structure of teeth and the density standard in order to improve the identification of the radiographic signs of tooth resorption and hypercementosis using the EOTRH syndrome model. Methods and results A detailed examination of the oral cavity was performed in 80 horses and maxillary incisor teeth were evaluated radiographically, including an assessment of the density standard. On each of the radiographs, pixel brightness (PB) was extracted for each of the ten steps of the density standard (S1–S10). Then, each evaluated incisor tooth was assigned to one of 0–3 EOTRH grade–related groups and annotated using region of interest (ROI). For each ROI, the number of pixels (NP) from each range was calculated. The linear relation between an original X–ray beam attenuation and PB was confirmed for the density standard. The NP values increased with the number of steps of the density standard as well as with EOTRH degrees. Similar accuracy of the EOTRH grade differentiation was noted for data pairs EOTRH 0–3 and EOTRH 0–1, allowing for the differentiation of both late and early radiographic signs of EOTRH. Conclusion The scaled–pixel–counting protocol based on the use of density standard has been successfully implemented for the differentiation of radiographic signs of EOTRH degrees.

Osteoarthritis (OA) of the tarsal joint, also known as bone spavin, is a progressive joint disease that increases in severity with age. It is a significant cause of hind limb lameness, leading to a deterioration in the quality of life of horses, particularly in old age. In this study, the tarsal joints of 20 older horses aged 15 to 35 years were radiographically imaged and processed using the computed digital absorptiometry (CDA) method for bone mineral density (BMD) assessment. The radiological signs of bone spavin were scored on a scale ranging from normal (0) to severe OA (3), and the examined joints were grouped according to the severity of OA. The percentage of color pixels (%color pixels), representing successive steps on the scale of X-ray absorption by a density standard, differed between the steps in a BMD characteristic manner for each group. Furthermore, two examined ranges of relative density allowed for the distinction of joints affected by severe OA from other joints, while another two ranges allowed for the differentiation of joints affected by moderate and severe OA from normal joints. The proposed color annotation-assisted decomposition of radiological images based on the CDA protocol shows promise for advancing research on the quantification of radiological signs of OA. This approach could be valuable for monitoring the progression of the disease in older horses.

Polyamide 12 (PA12) is vastly utilized in many additive manufacturing methods, such as Selective Laser Sintering (SLS), and a better understanding of its mechanical behaviors promotes available knowledge on the behaviors of 3D-printed parts made from this polymer. In this paper, SLS-produced standard tensile specimens are studied under monotonic and cyclic tension tests, as well as stress relaxation experiments, and the obtained force-displacement responses are shown to be consistent with a hyper-viscoelastic material model. This finding is also observed in typical pantographic structures produced by the same manufacturing parameters. To propose a constitutive model for predicting these behaviors, the convolution integral of a strain-dependent function and a time-dependent function is developed where the material parameters are determined with the use of both short-term and long-term responses of the specimens. Numerical results of the presented model for standard test specimens are shown to be in good agreements with the experimental ones under various loading conditions. To prove the capabilities of the proposed model in studying any SLS-produced part, finite element implementation of the constitutive equations is shown to provide numerical results in agreement with the empirical findings for tensile loading of the 3D-printed pantographic structure.

Rubus chamaemorus in Europe is currently only found in scattered sites in Central Europe, mainly in mountainous areas but also in lowlands, probably reflecting its relict nature. Unfortunately, so far, there is little information on the genetic diversity of R. chamaemorus populations in Central Europe. Therefore, in this study, we used genetic markers to investigate variation in 21 of its European populations. Using a Bayesian approach, STRUCTURE software analysis was applied to the six clusters that best represented the genetic structure of the cloudberry populations. The results indicated the presence of low genetic diversity between populations in geographical groups, but high diversity between geographical regions. These results were somewhat predictable because the vast lowlands that separate the mountains in Poland from the population of R. chamaemorus in the north are a significant geographical barrier to gene flow over long geographical distances. Isolation by distance may also explain the genetic distinctness between populations found in the various regions in Poland and populations found in Scandinavia. It is likely that there is a genetic melting pot for R. chamaemorus in the region of northern Poland. This is often the case in small areas where populations from different geographic regions meet. It is often difficult to indicate the migration routes of species and to confirm where individual populations come from, but their occurrence is favored by isolation in mountain valleys and in forests, which are a barrier to the spread of pollen.

The contrast in habitat complexity between emergent (EMV) and submerged vegetation (SUV) zones in aquatic ecosystems results from the differences in the structure of plant above- and belowground parts, subject to seasonal changes. Comparative studies on the influence of habitat complexity created by vegetation on benthic macroinvertebrates in coastal areas are scarce. In order to fill this knowledge gap, we performed a study on a seasonal basis in the brackish Vistula Lagoon (southern Baltic Sea) in two zones: EMV, dominated by a dense belt of Phragmites australis (Cav.) Trin. ex Steud, and SUV, with scattered stands of Potamogeton perfoliatus L. We assumed the following: i. Species richness, diversity, and density of invertebrates are higher in the EMV zone due to greater and less seasonally variable structural complexity than in the SUV zone, ii. High belowground complexity in the EMV zone due to the presence of the rhizome/root matrix, much more robust and denser than in the SUV zone limits the vertical distribution of macroinvertebrates. Both hypotheses were supported. Overall, our results pointing to higher animal diversity and density in more complex aquatic habitats are consistent with other studies, inferred mostly from comparative surveys of bare bottom and that covered with submerged vegetation. The results of this study highlight potentially far-reaching implications for benthic invertebrate fauna and their role in the aquatic ecosystem in the context of increasingly rapid loss of aquatic vegetation due to multiple anthropogenic stressors.

Abstract Study Objective The use of the HEART score to risk stratify patients for short‐term major adverse cardiac events in the emergency department (ED) setting is well established. Although discharge to home for low‐risk HEART score patients is widely accepted as safe practice, there are limited outcomes data on moderate‐risk HEART score patients discharged to home. We investigated the safety of discharging moderate‐risk HEART score patients to home from the ED with established early cardiology follow‐up. Methods We performed a retrospective cohort analysis of patients presenting to the ED with chest pain from April 2020 through December 2020. Patients were evaluated in the ED and underwent serial conventional troponin testing and electrocardiogram (ECG). Clinicians calculated a HEART score and employed shared decision‐making with moderate‐risk patients (score 4–6), offering hospital admission versus discharge home with a formalized process for rapid cardiology follow‐up (within 2 business days). We assessed the frequency of acute myocardial infarction or death at 30 days and before cardiology follow‐up. Results During our study period, 2939 patient encounters were screened for chest pain. Of these, 333 of 547 eligible moderate‐risk HEART score patients were referred for rapid follow‐up. The median time to follow‐up appointment was 2.9 business days (interquartile range 1.3, 6.5), and 264 (79%) of patients kept their follow‐up appointment. One patient (0.3%) suffered death within 30 days, before cardiology follow‐up. There were no myocardial infarctions. Conclusions These results suggest that moderate‐risk HEART score patients may be considered for discharge from the ED with rapid cardiology follow‐up. Formalizing processes to facilitate these early evaluations may represent a viable alternative to hospital admission, without diminishing patient outcomes.

The paper presents a new modulo N channel access scheme for wireless local area networks (WLANs). The novel solution derives from the distributed coordination function (DCF) of the IEEE 802.11 standard, further elaborated as enhanced distribution channel access (EDCA) by the 802.11e draft specification. The main innovation concerns improvement of the binary exponential backoff scheme used for collision avoidance in 802.11 networks. The most appealing feature of the new modulo N backoff scheme is that it outperforms the original 802.11 solution in terms of channel utilization ratio under any traffic conditions. Furthermore, the modulo N proposal can be naturally augmented with QoS differentiation mechanisms like 802.11e extensions. The prioritized modulo N scheme achieves better throughput-delay characteristics for multimedia traffic when compared with the original 802.11e proposal. At the same time, the new solution retains backward compatibility and includes all features which have made IEEE 802.11 networks extremely popular nowadays.

The role of reeds in the functioning of ecosystems and their significance for zoobenthos in the coastal lagoons is poorly understood. We hypothesise that next to the spatial zonal differentiation of abiotic factors in the apparently homogeneous habitat of reeds, benthic macroinvertebrate fauna is also unevenly distributed, and differs in taxonomic and functional diversity, as well as density and biomass across the reed stand. The research was carried out in the Vistula Lagoon (southern Baltic) along three designated sectors arranged parallel to the shoreline and differing in distance from the shore and depth. Mean density of reed stems in the analysed stand was within the range of values reported from different American and European wetlands. Regardless of the location within the reeds and the season, the fauna was dominated by detritivorous Tubificinae and larvae of Chironomidae. The highest diversity, density, and biomass of fauna were found in the middle littoral zone, and the lowest in the outer zone adjacent to the open water. The presented data support our hypothesis predicting the existence of a spatial variation pattern in the composition and distribution of macroinvertebrates in response to the changing zonal habitat conditions within the reed stand.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March–30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

IntroductionSex hormones may play an important role in age-related cardiac remodeling. However, their impact on cardiac structure and function in females of advanced age still remains unclear. The aim of this study is to evaluate the relationship between sex hormones level and echocardiographic parameters in older women with concomitant cardiovascular diseases.Materials and MethodsThe study group included 52 community-dwelling women with mean age 79.5 ± 2.8 years, consecutive patients of an outpatient geriatric clinic. In all the subjects, a transthoracic echocardiogram was performed and serum testosterone, estradiol, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulphate, and cortisol levels were determined.ResultsTestosterone level correlated positively with interventricular septum diastolic dimension (IVSd) (rS=0.293, p

Salix lapponum is a cold-tolerant relict species in Europe that occurs in several sites, probably reflecting previous migration routes of S. lapponum during the Pleistocene. However, only a few data are available on the genetic structures of populations of S. lapponum. In this study, we use PCR-ISSR markers to investigate genetic variation in 19 European populations of S. lapponum L. AMOVA analysis shows that most of the variation (55.8%) occurs within populations; variability among groups accounts for 19.7%. An AMOVA analysis based on four groups determined by STRUCTURE analysis shows similar results: variability of 54.1% within the population and variability of 18.9% between the four population groups, based on geographic regions. Within individual geographic groups, which are characterised by the studied populations, the lowest variability (as well as the highest homogeneity) was found in populations located in Belarus. The obtained results are consistent with our expectations that the European Lowland could be a significant geographic barrier for gene flow over large geographic distances for S. lapponum. Both the Scandinavian and Belarusian populations, as well as those coming from NE Poland, are characterised by significant genetic distinctiveness. However, some populations from NE Poland and the Sudetes show similarities with populations from other geographic regions, indicating existing genetic relationships between them. Moreover, the results suggest a fairly clear division of the population into 4 emerging geographic regions, although separated by a geographical barrier: the Polish lowland, which forms part of the larger geographic unit known as the European Lowland.

The willingness to donate human biological material for research purposes is shaped by socio-cultural factors; however, there is a lack of studies analysing the social perception of different human tissues, which may affect such willingness. This study aimed to distinguish different sociocultural categories of human tissues and types of potential donors based on their willingness to donate material. Quantitative research was conducted on a sample of 1,100 adult Poles representative in terms of sex, place of residence and education. According to the study, people were most willing to donate urine (73.9%), blood (69.7%), hair and tears (69.6%) and the least willing to donate post-mortem brain fragments (20%), sperm (males; 36.4%) and egg cells (females; 39.6%). A factor analysis revealed four sociocultural categories of donated tissues: irrelevant, redundant, ordinary and sensitive. Based on these sociocultural categories of tissues, four types of donors were identified: reluctant, highly cooperative, average cooperative and selectively cooperative. The willingness to donate human samples for research is shaped by the sociocultural perception of different body parts and tissues. The lower the sense of “personal relationship” with a specific type of tissue, organ or part of the body, the higher the motivation to donate such biological material for research purposes. Additionally, the willingness to donate is mostly shaped by social trust in physicians and scientists, and potential donors’ engagement in charity activities.

In the past, the dry mixed conifer forests of California’s Sierra Nevada mountains experienced frequent low to mixed severity fires. However, due to fire suppression and past management, forest structure has changed, and the new fire regimes are characterized by large, high severity fires which kill a majority of the overstory trees. These new disturbance patterns require novel approaches to regenerate the forest as they are not adapted to large, high severity fires. We forecasted growth and fire behavior of young plantations for 100 years into the future using the Forest Vegetation Simulator (FVS) and its Fire and Fuels Extension (FFE). In these simulations, we tested combinations of different fuel treatments (mastication only, mastication with prescribed burning, and no fuels treatments) with different overstory thinning intensities (residual densities of 370 SDI (stand density index), 495 SDI, 618 SDI (TPH), and no overstory thinning) on stand growth and potential fire behavior using analysis of variance. We compared growth and crowning index at the end of the simulation and the simulation age when the flame length, basal area mortality, and fire type reached low severity between fuel treatment, thinning intensity, and original management of stands (plantation with PCT [precommercial thinning], plantation without PCT, and natural regenerating stands). These comparisons are essential to identify which fuel treatment categories reduce fire risk. We found an overall pattern of decreasing crown fire occurrence and fire induced mortality across all simulations due to increasing canopy base height and decreasing canopy bulk density. In particular, stands with mastication and prescribed burning transitioned from crown fire types to surface fires 10 years earlier compared to mastication only or no fuel treatment. Furthermore, pre-commercially thinned stands transitioned from crown fire states to surface fires 10 years earlier in the simulations compared to un-thinned and naturally regenerating stands. Stands with mastication and burning went below 25% reference threshold of basal area mortality 11 and 17 years earlier before the mastication only and no fuel treatment, respectively. In addition, pre-commercially thinned stands went below 25% basal area mortality 9 and 5 years earlier in the simulation compared to un-thinned or naturally regenerated stands, respectively. Mastication with prescribed burning (MB) was the most effective treatment for quickly reducing fire behavior by consuming surface fuels, thus drastically lowing flame length (e.g., surface flame length of MB was 0.6 m compared to mastication only [1.3 m] and no treatment [1.4 m]). Furthermore, intensive thinning reduced risk of active crown fires spreading through the stand. Prioritizing prescribed burning, when possible, and thinning (both pre-commercially and from below) are the most effective ways to quickly improve fire resistance in mixed conifer plantations. Our results highlight the different stressors that post-fire planted forests experience and how different silvicultural treatments interact over time to reduce fire risk, which demonstrates the importance of treating stands early and the effectiveness of surface fuel treatments.

RNA-binding proteins (RBPs), essential for skeletal muscle regeneration, cause muscle degeneration and neuromuscular disease when mutated. Why mutations in these ubiquitously expressed RBPs orchestrate complex tissue regeneration and direct cell fate decisions in skeletal muscle remains poorly understood. Single-cell RNA-sequencing of regenerating Mus musculus skeletal muscle reveals that RBP expression, including the expression of many neuromuscular disease-associated RBPs, is temporally regulated in skeletal muscle stem cells and correlates with specific stages of myogenic differentiation. By combining machine learning with RBP engagement scoring, we discovered that the neuromuscular disease-associated RBP Hnrnpa2b1 is a differentiation-specifying regulator of myogenesis that controls myogenic cell fate transitions during terminal differentiation in mice. The timing of RBP expression specifies cell fate transitions by providing post-transcriptional regulation of messenger RNAs that coordinate stem cell fate decisions during tissue regeneration.

This paper discusses the impact of coal abrasive materials of varied petrographic composition and claystones containing admixtures of coal matter on the surface wear of wear-resistant martensitic steels. Wear tests were conducted at a test stand for three petrographic varieties of hard coal: vitrinite, clarinite, and durinite, and five samples of claystone. These tests revealed no significant effect of the type of coal abrasive used on the value of mass loss from the surface of the wear-resistant steel samples. The reason behind the foregoing is the observed tendency of coal abrasives, irrespective of their petrographic variety, to penetrate surface irregularities, especially those attributable to previous surface treatment of the samples and the impact of wear products. The dominant forms of surface damage were surface fatigue chipping and scratches caused by the particles which detached themselves from the surface of the steel samples, as observed for all the analysed coal variants. On the surfaces of the samples seasoned in the presence of claystones, highly varied forms of damage were observed: microcutting, scaly surface cracks, delamination, and deep cracks. In these cases, it was possible that the abrasive grains had been pressed into the steel surface irregularities, but no layered forms of the pressed-in abrasive material were observed to have developed. The paper also presents a model for the formation of coal films and discusses their possible effect on wear minimisation.

BackgroundTransition to home after hospitalization involves the potential risk of adverse patient events, such as knowledge deficits related to self-care, medication errors, and readmissions. Despite broad organizational efforts to provide better care transitions for patients, there are challenges in implementing interventions that effectively improve care transition outcomes, as evidenced by readmission rates. Collaborative efforts that require health care professionals, patients, and caregivers to work together are necessary to identify gaps associated with transitions of care and generate effective transitional care interventions. ObjectiveThis study aims to understand the usefulness of participatory design approaches in identifying the design implications of transition of care interventions in health care settings. Through a series of participatory design workshops, we have brought stakeholders of the health care system together. With a shared understanding of care transition and patient experience, we have provided participants with opportunities to generate possible design implications for care transitions. MethodsWe selected field observations in clinical settings and participatory design workshops to develop transitional care interventions that serve each hospital’s unique situation and context. Patient journey maps were created and functioned as tools for creating a shared understanding of the discharge process across different stakeholders in the health care environment. The intervention sustainability was also assessed. By applying thematic analysis methods, we analyzed the problem statements and proposed interventions collected from participatory design workshops. The findings showed patterns of major discussion during the workshop. ResultsOn the basis of the workshop results, we formalized the transition of care model—the socioeconomic, active engagement, follow-up, education, discharge readiness tool, and consistency (Integrated Michigan Patient-centered Alliance in Care Transitions transition of care model)—which other organizations can apply to improve patient experiences in care transition. This model highlights the most significant themes that should necessarily be considered to improve the transition of care. ConclusionsOur study presents the benefits of the participatory design approach in defining the challenges associated with transitions of care related to patient discharge and generating sustainable interventions to improve care transitions.

The Resettlement and Settlement Action in the Province of Lublin (May–October 1947) The resettlement and settlement action is one of the least known and explored aspects of Operation Vistula, which took place in 1947. Polish Army troops were made responsible for the reset­tlement of the Ukrainians inhabiting southern Poland. In the course of the Operation, between May and October 1947, about 9,684 families (33,946 people) were forced to leave the province of Lublin to be settled in northern and western Poland. They left behind 8,871 farms. Only 30% of them were later settled by new Polish settlers, while the rest was used as industrial-scale plough land and for forestry. The forces of the Ukrainian Insurgent Army and the Ukrainian Nationalist Organization tried to prevent both the resettlement action and the subsequent Polish settlement, but were unsuccessful. This action changed the ethnic, linguistic, religious and cultural face of the Lublin region. The author presents in detail both the numerical data and the course of these events.

La gangrena de Fournier es una patología que se encuentra predominantemente en varones adultos y extremadamente rara en niños. Se han descrito múltiples factores predisponentes en los niños, incluyendo la circuncisión, la dermatitis del pañal, la presencia de abscesos, traumatismos anorrectales y deficiencias inmunológicas. Los signos y síntomas característicos incluyen edema e hiperemia de rápida evolución en la región perineal acompañados de dolor intenso y fiebre. Una vez que se diagnostica la gangrena de Fournier, se debe instaurar tratamiento de forma inmediata, antibióticos endovenosos de amplio espectro y debridamiento quirúrgico temprano del tejido desvitalizado. A continuación presentamos un reporte de casos que incluye las características clínicas y epidemiológicas de dos pacientes pediátricos con gangrena de Fournier que recibieron tratamiento médico y quirúrgico en el Instituto Nacional de Salud del Niño de San Borja.