Examination of the Suitability of Vericiguat in Non-Heart Failure with Preserved Ejection Fraction Patients with Improved Ejection Fraction.

Background/Objectives: Vericiguat has been shown to reduce cardiovascular mortality and hospitalisation for heart failure in patients with reduced ejection fraction. While Vericiguat is considered one of the standard treatments for heart failure, it is unclear under which conditions Vericiguat would be most effective. With a focus on the prognosis and improved EF of heart failure, we aimed to investigate in which cases Vericiguat is suitable for use in addition to standard cardioprotective drugs. Methods: We prospectively compared echocardiograms taken before and after the administration of Vericiguat in 46 patients with non-dialysis and without heart failure with preserved ejection fraction (non-HFpEF) (left ventricle ejection fraction [LVEF] < 50%) who were able to continue Vericiguat in addition to other standard heart failure drugs (the "Fantastic Four") for more than 6 months at our hospital. Patients who showed an improvement of 10 points or more in LVEF were defined as improved EF+. Results: LVEF improved significantly from 38 [33-45]% at the time of administration to 46 [35-54.5]% at 6 months (p < 0.001). When comparing patients with and without improved EF, a significant difference was observed in the Hb (OR = 1.66, 95%CI = 1.12-2.83, p = 0.028), early introduction (OR = 12.5, 95%CI = 1.58-149, p = 0.025), and initiation of Vericiguat after the administration of the Fantastic Four (OR = 9.79, 95%CI = 1.71-100.2, p = 0.022). Conclusions: In this study, the early administration of Vericiguat, haemoglobin value, and initiation of Vericiguat after the introduction of the Fantastic Four were identified as independent factors for eligibility in non-dialysis, non-HFpEF patients who were able to continue GDMT treatment for more than 6 months after adding Vericiguat.

Strengthening Neuroplasticity in Substance Use Recovery Through Lifestyle Intervention.

The incidence of substance use and behavioral addictions continues to increase throughout the world. The Global Burden of Disease Study shows a growing impact in disability-adjusted life years due to substance use. Substance use impacts families, communities, health care, and legal systems; yet, the vast majority of individuals with substance use disorders do not seek treatment. Within the United States, new legislation has attempted to increase the availability of buprenorphine, but the impact of substance use continues. Although medications and group support therapy have been the mainstay of treatment for substance use, lifestyle medicine offers a valuable adjunct therapy that may help strengthen substance use recovery through healthy neuroplastic changes.

"It's going to get pretty tippy": Stakeholder perspectives on the (dys)function of a four pillars drug strategy.

A 'drug strategy' is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A 'pillars' drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders' perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of 'balance' of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars' architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged.

2024 AAFP intercat tension guidelines: recognition, prevention and management.

Social tension or conflict between household cats is common but, because it often manifests as subtle behavioral changes, it can go unnoticed; it is precisely because most signs are subtle and unrecognized that the term 'tension' is used. Where associated tension-related chronic fear-anxiety leads to more overt behavioral concerns and stress-associated disease, cats may face relinquishment by caregivers or even euthanasia if the tension is not relieved. The '2024 AAFP intercat tension guidelines: recognition, prevention and management' have been authored by a Task Force of board-certified veterinary and applied behaviorists and clinical experts in feline medicine and behavior convened by the American Association of Feline Practitioners. The aim is to support veterinary professionals in understanding social behavior between cats and, more specifically, in recognizing intercat tension, preventing or minimizing its occurrence and managing the stressors. In developing the Guidelines, the Task Force has modified the five pillars of a healthy feline environment to provide a framework to assist the prevention or management of intercat tension in households with two or more cats. Because feline social behavior is often misunderstood, the Guidelines debunk 10 common myths that have the potential to negatively impact the wellbeing of companion cats. Extensively illustrated with visual examples of intercat tension and an Appendix detailing a number of case studies, the Guidelines also include a comprehensive table of psychotherapeutic medications, and a detailed algorithm that outlines a systematic approach to preventing, recognizing and resolving intercat tension. A step-by-step approach to introducing a new cat into a household with one or more resident cats is included to further support veterinarians, and a range of management tools to promote client education accompany the Guidelines.

Cross-Linking CdSO4-Type Nets with Hexafluorosilicate Anions to Form an Ultramicroporous Material for Efficient C2H2/CO2 and C2H2/C2H4 Separation.

A 44.610.8 topology hybrid ultramicroporous material (HUM), {[Cu1.5F(SiF6)(L)2.5]·G}n, (L = 4,4'-bisimidazolylbiphenyl, G = guest molecules), 1, formed by cross-linking interpenetrated 3D four-connected CdSO4-type nets with hexafluorosilicate anions is synthesized and evaluated in the context of gas sorption and separation herein. 1 is the first HUM functionalized with two different types of fluorinated sites (SiF6 2- and F- anions) lining along the pore surface. The optimal pore size (≈5 Å) combining mixed and high-density electronegative fluorinated sites enable 1 to preferentially adsorb C2H2 over CO2 and C2H4 by hydrogen bonding interactions with a high C2H2 isosteric heat of adsorption (Qst) of ≈42.3 kJ mol-1 at zero loading. The pronounced discriminatory sorption behaviors lead to excellent separation performance for C2H2/CO2 and C2H2/C2H4 that surpasses many well-known sorbents. Dynamic breakthrough experiments are conducted to confirm the practical separation capability of 1, which reveal an impressive separation factor of 6.1 for equimolar C2H2/CO2 mixture. Furthermore, molecular simulation and density functional theory (DFT) calculations validate the strong binding of C2H2 stems from the chelating fix of C2H2 between SiF6 2- anion and coordinated F- anion.

Tunable and Reversible Adhesive of Liquid Metal Ferrofluid Pillars for Magnetically Actuated Noncontact Transfer Printing.

Transfer printing techniques based on tunable and reversible adhesives enable the heterogeneous integration of materials in desired layouts and are essential for developing both existing and envisioned electronic systems. Here, a novel tunable and reversible adhesive of liquid metal ferrofluid pillars for developing an efficient magnetically actuated noncontact transfer printing is reported. The liquid metal ferrofluid pillars offer the appealing advantages of gentle contact force by minimizing the preload effect and exceptional shape adaptability by maximizing the interfacial contact area due to their inherent fluidity, thus enabling a reliable damage-free pickup. Moreover, the liquid metal ferrofluid pillars harness the rapid stiffness increase and shape change with the magnetic field, generating an instantaneous ejection force to achieve a receiver-independent noncontact printing. Demonstrations of the adhesive of liquid metal ferrofluid pillars in transfer printing of diverse objects with different shapes, materials and dimensions onto various substrates illustrate its great potential in deterministic assembly.

Electrophysiological properties of dorsal root ganglion neurons cultured on 3D silicon micro-pillar substrates.

BACKGROUND: Silicon-based micro-pillar substrates (MPS), as three-dimensional cell culture platforms with vertically aligned micro-patterned scaffolding structures, are known to facilitate high-quality growth and morphology of dorsal root ganglion (DRG) sensory neurons, promote neurite outgrowth and enhance neurite alignment. However, the electrophysiological aspects of DRG neurons cultured on silicon MPSs have not been thoroughly investigated, which is of greatest importance to ensure that such substrates do not disrupt neuronal homeostasis and function before their widespread adoption in diverse biomedical applications. NEW METHOD: We conducted whole-cell patch-clamp recordings to explore the electrophysiological properties of DRG neurons cultured on MPS arrays, utilizing a custom-made upright patch-clamp setup. RESULTS: Our findings revealed that DRG neurons exhibited similar electrophysiological responses on patterned MPS samples when compared to the control planar glass surfaces. Notably, there were no significant differences observed in the action potential parameters or firing patterns of action potentials between neurons grown on either substrate. COMPARISON WITH EXISTING METHODS: In the current study we for the first time confirmed that successful electrophysiological recordings can be obtained from the cells grown on MPS. CONCLUSION: Our results imply that, despite the potential alterations caused by the cumulative trauma of tissue harvest and cell dissociation, essential functional cell properties of DRG neurons appear to be relatively maintained on MPS surfaces. Therefore, vertically aligned silicon MPSs could be considered as a potentially effective three-dimensional system for supporting a controlled cellular environment in culture.

AIP-based Professional Intervention Program for Adversity for trauma and stress reduction in groups: a pilot study in Ethiopia.

Introduction: Drawing from the principles of EMDR (Eye Movement Desensitization and Reprocessing) therapy and the AIP model, the Professional Intervention Program for Adversity (PIPA) was developed with the objective of amalgamating low-intensity group exercises into a unified framework, as a comprehensive intervention for group therapy. The PIPA Program integrates various aspects of EMDR therapy-such as stabilization, resourcing, desensitization, reprocessing, and forming beliefs about the self and future-into a cohesive program. The program's structure includes self-regulation exercises, the Pillars of Life, the Flash Technique, and the Quadrants exercise. Methods: The PIPA Program was administered to more than 220 individuals with a high probability of traumatization by the two-year civil war in Ethiopia (2020-2022). Results: The results of this study show a statistically significant improvement in PTSD symptoms on PCL-5 scores (from M = 38.58 to M = 20.59) after completing the entire PIPA Program and statistically significant lower SUDS scores within the program segments of the Flash Technique and the Quadrants exercises. Discussion: Future studies should explore the long-term effects of the PIPA Program and its broader application across different therapeutic contexts. The findings suggest that the PIPA Program is a promising group-based intervention for trauma treatment that is safe and effective, especially in non-clinical settings and for culturally diverse populations.

Maxillomandibular relationship and virtual facebow integration in complete-arch intraoral implant scan: A novel clinical technique.

This clinical report introduces a novel clinical technique to create a 3D virtual patient for transferring the edentulous maxillary arch position with maxillomandibular relationship by using a facial scan device and an intraoral scanner and omitting CBCT imaging.

Geometrically Amplified Wetting of Silver Nanosolder on a Rough Diamond Surface.

The wetting behavior of silver at the nanoscale on a textured diamond substrate is not absolutely roughness-dependent in printing diamond chips, tough bioimplant coating, and joining for cutting tool industries. This study uses a molecular dynamics simulation to capture the stochastic wetting behavior toward precision for given geometries. It is deduced that the metalophilic character of molten silver is increased with an increase in roughness on sinusoidal contoured diamond substrates rather than orthogonal pillars of the same roughness until an equilibration time of 210 ps at a temperature of 950 K. Increasing the roughness after the equilibrium time causes a supermetalophilic angle of 13° for the sinusoid at 500 ps, and the orthogonal design causes the Wenzel state. Therefore, wetting states are metastable and ultimately depend upon the wetting time and geometry rather than the roughness only. A high joining strength creates a long-lasting coating, owing to the high surface energy of the textured surface. This study presents effective thin seam development in the least possible time of 230 ps and silver consumption at the nanoscale for supermetalophilic and metalophobic coatings in electronic packaging.

Health equity in heart failure.

The treatment of heart failure (HF) with reduced ejection fraction (HFrEF) has substantially developed over the past decades. More than ever before, the application of appropriate evidence-based medical therapy for HFrEF is associated with remarkable improvements in survival, noteworthy increases in quality of life, and a marked reduction in symptomatic HF sufficient to warrant hospitalization. These enhanced clinical outcomes are driven by the "four pillars" of HF therapy: 1) evidence-based beta blockers, 2) Renin-angiotensin-aldosterone system inhibitors (angiotensin-converting enzyme inhibitors /angiotensin II receptor blockers or angiotensin receptor-neprilysin inhibitors, 3) mineralocorticoid receptor antagonists, and most recently, 4) sodium-glucose cotransporter-2 inhibitors. Despite robust evidence from well-conducted randomized clinical trials, guideline-directed medical therapies with established cardiovascular benefits remain significantly underutilized in clinical practice, particularly among under-represented minority populations. This phenomenon has led to class 1 level recommendations from the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines to address HF disparities among vulnerable populations as follows. In this article, we highlight the difference between health equality and health equity and discuss the need to address equity in the treatment of heart failure, ensuring that the impressive progress made in the treatment of HFrEF is equally beneficial to all individuals. We discuss strategies to reduce and ultimately eliminate disparities in the determinants of health that particularly affect marginalized groups, including the socioeconomic determinants and racism as a threat to public health. Finally, we discuss and propose a combination of the four pillars of ethics with the four pillars of GDMT to optimize and personalize treatment of all patients with HFrEF, to achieve true equity in the treatment of HF.

[Breast pillars reconstruction during mammoplasty]. / Technique de reconstitution des piliers du sein au cours des mammoplasties.

The reconstruction of the 2 contiguous breast pillars during a mammoplasty for reduction or treatment of ptosis represents an essential time to define a satisfactory breast curve, to avoid sub-mammary disunions postoperatively, and to contribute to the projection of the nipple areola thus stabilized. The pillars of the breast are the two glandular and fatty columns of segment III of the breast; these pillars have a variable thickness according to the habits of the surgeon but also according to the density of the gland and the residual fat that the practitioner chooses to keep to reformat the breast. Their repair or creation is essential to obtain a nice breast curve and long-term stability.

Differences in the biochemical content and radical scavenging activity of propolis from different parts of a Meliponula ferruginea hive.

Research on stingless bee products has increased in recent years, and of particular interest is propolis because of its biological activities such as antioxidant and antimicrobial. However, there is paucity of information regarding intra-hive variations in the biochemical composition and biofunctional properties of this propolis. In this study, we investigated the phytochemicals and radical scavenging activity (RSA) of Meliponula ferruginea propolis from 10 wooden hives (n = 49). The samples were collected from five different locations comprising the entrance, involucrum, pillars, pots and sealant. Principal component analysis showed that there is an intra-hive variation in phytochemical content and RSA. Phenolic content constituted the highest phytochemical content in all the locations. The sealant and entrance had the highest amounts of phytochemicals compared to the involucrum, pillars and pots. Further analysis of propolis extracts by gas chromatography-mass spectrometry revealed occurrence of different compounds such as monoterpenoids, hydrocarbons, triterpenoids and alkaloids. Hydrocarbons were common in all parts while monoterpenes and triterpenes were present in the entrance. The findings of our study indicates that there is an intra-hive variation in propolis of M. ferruginea and hence this information will provide further insight into better understanding of stingless bee propolis.

Na+ Preintercalated MoO3 Microrods for Aqueous Zinc/Sodium Batteries with Enhanced Performance.

Layered molybdenum trioxide (MoO3) is being investigated as a cathode material with high theoretical capacity and holds promise for aqueous secondary batteries. Unfortunately, the severe structural degradation of MoO3 and insufficient intrinsic properties hinder its practical application. Herein, a Na+ preintercalation strategy is reported as an effective method to construct cathodes with high performance for aqueous zinc/sodium batteries (AZSBs). Compared with pristine MoO3, the Na+ preintercalated Na0.25MoO3 cathode delivers a reversible capacity of 251.1 mAh g-1 at 1 A g-1, achieves a capacity retention of 79.2% after 500 cycles, and exhibits a high rate capability (121.5 mAh g-1 at 20 A g-1), which is superior to that in most of the previous reports. Through the experimental measurements and density functional theory (DFT) calculations, the preintercalation method could shorten the forbidden band gap and modulate the electronic structure and hence effectively inhibit the structural collapse of MoO3 microrods, induce reversible Na+ insertion, and enhance the discharge potential. This work is of significance for further research on molybdenum-based compounds as cathode materials for aqueous secondary batteries.

Alternative conceptions of COVID-19 and post-COVID-19 assumed by Basic Education pre-service teachers. A case study for Universidad Técnica del Norte, Ecuador.

BACKGROUND: Almost at the end of 2022, the world is experiencing a relative calm after the rigors imposed by the COVID-19 pandemic. Knowing the ideas, feelings and procedures used by people in this type of unexpected events, which exceeded all established standards of educational and health actions, can help us be prepared for the possible occurrence of similar events. This study aims to determine the main alternative conceptions that pre-service teachers hold about the pandemic and the post-pandemic within the framework of the four basic pillars of Education. METHODS: A case study was conducted using an ethnographic approach. The unit of analysis was made up of 227 students from the major of Primary Education at Universidad Técnica del Norte. Two research instruments were used to collect the data: a test for verbal associations where participants can express themselves freely with hierarchical, substitution and connotative evocations; and Specialized Analytical Summary sheets to revise and organize specialized scientific texts. The data was analyzed using the IRaMuTeQ software. RESULTS: At first glance, what was expressed in the two contexts, both in the pandemic and in the post-pandemic, show a similar structure; however, a deeper analysis reveals different perspectives. CONCLUSIONS: In the end, the alternative conceptions moved from expressing fear to tranquility.

Expanding the Lifestyle Medicine Inpatient Consultation Services at Loma Linda University Health: A Transformative Tool for Chronic Diseases Management in Tertiary Care Settings.

Lifestyle Medicine (LM) is an emerging field dedicated to the prevention, management, and reversal of chronic diseases by promoting healthy lifestyle choices. LM utilizes six pillars targeting the root causes of diseases to promote health, improve clinical outcomes and significantly enhance overall quality of life. They include plant-based nutrition, physical activity, sleep health, tobacco cessation/managing risky alcohol use, and spiritual/emotional well-being. LM holds great promise as an evidence-based solution for the rising rates of chronic diseases and healthcare costs in the United States. Loma Linda University Health (LLUH), a pioneer of LM, has successfully implemented a phased expansion of its novel LM inpatient consultation services to positively impact the trajectory of morbidity and mortality among patients with chronic conditions and/risk factors admitted to the hospital. This was achieved by boosting awareness, hiring LM-trained providers to meet growing demand, and making consultations accessible hospital-wide. The service has been very well received and saw a 50-fold increase in consultations between 2016 and 2022. It is also reimbursed by all major insurers. LLUH's experience shows that establishing and growing an inpatient LM consultation service is a viable clinical and cost-effective chronic care model that can be utilized in a tertiary care setting.

Quantitative Evaluation of the 3D Anatomy of the Human Osseous Spiral Lamina Using MicroCT.

PURPOSE: The osseous spiral lamina (OSL) is an inner cochlear bony structure that projects from the modiolus from base to apex, separating the cochlear canal into the scala vestibuli and scala tympani. The porosity of the OSL has recently attracted the attention of scientists due to its potential impact on the overall sound transduction. The bony pillars between the vestibular and tympanic plates of the OSL are not always visible in conventional histopathological studies, so imaging of such structures is usually lacking or incomplete. With this pilot study, we aimed, for the first time, to anatomically demonstrate the OSL in great detail and in 3D. METHODS: We measured width, thickness, and porosity of the human OSL by microCT using increasing nominal resolutions up to 2.5-µm voxel size. Additionally, 3D models of the individual plates at the basal and middle turns and the apex were created from the CT datasets. RESULTS: We found a constant presence of porosity in both tympanic plate and vestibular plate from basal turn to the apex. The tympanic plate appears to be more porous than vestibular plate in the basal and middle turns, while it is less porous in the apex. Furthermore, the 3D reconstruction allowed the bony pillars that lie between the OSL plates to be observed in great detail. CONCLUSION: By enhancing our comprehension of the OSL, we can advance our comprehension of hearing mechanisms and enhance the accuracy and effectiveness of cochlear models.

Ethnography and the digital scenario: a typological scheme of differences and evolutionary trajectories.

The ethnographic method has been a feature of the social sciences since its inception, and for some disciplines, it is markedly characterized by a strong aptitude for physical field research over extended periods in circumscribed communities. However, with the advent of the digital age, this process has undergone further acceleration, upsetting and partly undermining the solid assumptions on which the ethnographic method had been formed, precisely because in the digital scenario, the assumptions of boundaries of contexts, the agency of scenario, and the need for a long-term field investigation change radically. This conceptual analysis aims at providing an overview of the trajectory of the evolution of ethnographic studies in social sciences by trying to trace the main pillars of change and the future direction of the method.

Eligibility for the 4 Pharmacological Pillars in Heart Failure With Reduced Ejection Fraction at Discharge.

Background Guidelines recommend using multiple drugs in patients with heart failure (HF) with reduced ejection fraction, but there is a paucity of real-world data on the simultaneous initiation of the 4 pharmacological pillars at discharge after a decompensation event. Methods and Results A retrospective data mart, including patients diagnosed with HF, was implemented. Consecutively admitted patients with HF with reduced ejection fraction were selected through an automated approach and categorized according to the number/type of treatments prescribed at discharge. The prevalence of contraindications and cautions for HF with reduced ejection fraction treatments was systematically assessed. Logistic regression models were fitted to assess predictors of the number of treatments (≥2 versus <2 drugs) prescribed and the risk of rehospitalization. A population of 305 patients with a first episode of HF hospitalization and a diagnosis of HF with reduced ejection fraction (ejection fraction, <40%) was selected. At discharge, 49.2% received 2 current recommended drugs, ß-blockers were prescribed in 93.4%, while a renin-angiotensin system inhibitor or an angiotensin receptor-neprilysin inhibitor was prescribed in 68.2%. A mineralocorticoid receptor antagonist was prescribed in 32.5%, although none of the patients showed contraindications to mineralocorticoid receptor antagonist prescription. A sodium-glucose cotransporter 2 inhibitor could be prescribed in 71.1% of patients. On the basis of current recommendations, 46.2% could receive the 4 foundational drugs at discharge. Renal dysfunction was associated with <2 foundational drugs prescribed. After adjusting for age and renal function, use of ≥2 drugs was associated with lower risk of rehospitalization during the 30 days after discharge. Conclusions A quadruple therapy could be directly implementable at discharge, potentially providing prognostic advantages. Renal dysfunction was the main prevalent condition limiting this approach.