Systematic implementation of cardiopulmonary ultrasound imaging to optimize management of acute decompensated heart failure.

BACKGROUND: Heart failure (HF) poses a major health problem, where frequent HF rehospitalizations (HFH) heavily burden national health systems. HFH are predominantly linked to inadequate decongestion before discharge. It is uncertain if systematic implementation of cardio-pulmonary ultra-sound imaging (CPUSI) to standard HF management can improve outcomes and reduce HFH. RESULTS: This study recruited 50 patients admitted with acute decompensated heart failure (ADHF). Besides the conventional daily assessment, CPUSI was systematically performed to guide treatment decisions, focusing on ventricular filling pressure and 8-zone lung ultrasound (LUS) score. On-admission and predischarge LUS scores were correlated to clinical outcomes. The mean age of the study group was 55.7 ± 10.59 years, with predominance of male gender. Supplementing clinical judgment, CPUSI modified therapeutic strategy in 57 out of 241 assessments (24%), improving patients' care. Besides its value in guiding therapeutic decisions, the LUS score on admission had a significant positive correlation to the length of ICU stay and the total hospitalization length. Also, LUS score > 12 at discharge predicted 90-day HFH with sensitivity and specificity of 100% and 98%, respectively. CONCLUSIONS: Systematic CPUSI can improve HF management by complementing the often challenging judgment of pulmonary congestion. Adding periodic evaluation of ventricular filling pressures and LUS scores to clinical assessment can optimize treatment decisions and improve patient care. LUS score was a significant predictor for in-hospital and post-discharge clinical outcomes.

Measuring the performance of Antarctic Treaty decision-making.

Agreements reached at the Antarctic Treaty Consultative Meetings (ATCMs) are among the primary means for addressing Antarctic conservation and environmental protection issues. However, according to contemporary scholars, Antarctic Treaty decision-making is becoming increasingly unresponsive to the rising environmental challenges in the region. We assessed the performance of Antarctic Treaty decision-making by measuring the rate and diversity of decision-making over the last 6 decades. To measure the rate, we counted the number of inputs and outputs of ATCMs and calculated the time taken for legally binding outputs to enter into force. To measure diversity, we calculated the range of topics addressed by the inputs and outputs of ATCMs. The average number of agreements reached per ATCM increased from 1961 to 2022. Although the diversity of Antarctic topics discussed at ATCMs remained consistently high, the diversity of topics on which legally binding agreements were adopted declined significantly. Antarctic issues-including those of highest priority-are now almost entirely dealt with through nonbinding, soft-law agreements. It is plausible that this move away from binding decisions reflects a dynamic governance institution evolving to respond to new pressures. However, we suggest that the change reveals a concerning shift in decision-making behavior and performance, unique to the treaty's history. Soft law is beneficial in some cases, but its overuse diminishes accountability and transparency, significantly reducing the parties' abilities to understand and measure their performance, including the outcomes and impacts of decisions. Although the rate and diversity of ATCM inputs and outputs provide only a partial view of decision-making performance, the exploration of these metrics provides a foundation for asking essential questions about the impacts of Antarctic Treaty governance on the region's environmental protection and conservation.

Medida del desempeño de las decisiones del Tratado Antártico Resumen Los acuerdos logrados en las Reuniones Consultivas del Tratado Antártico (RCTA) son uno de los principales medios para abordar las cuestiones de conservación y protección ambiental de la Antártida. Sin embargo, según los académicos contemporáneos, la toma de decisiones del Tratado Antártico es cada vez menos receptiva a los crecientes retos ambientales de la región. Evaluamos el rendimiento de las decisiones del Tratado Antártico con la medida del ritmo y la diversidad de la toma de decisiones en las últimas seis décadas. Para medir el ritmo, contamos el número de entradas y salidas de las RCTA y calculamos el tiempo que tardan en entrar en vigor los resultados con vinculación jurídica. Para medir la diversidad, calculamos la gama de temas abordados por las entradas y salidas de las RCTA. El número medio de acuerdos alcanzados por cada RCTA aumentó de 1961 a 2022. Sin embargo, mientras que la diversidad de temas antárticos debatidos en las RCTA se mantuvo constantemente alta, la diversidad de temas sobre los que se adoptaron acuerdos con vinculación jurídica disminuyó significativamente. Las cuestiones antárticas ­incluidas las de máxima prioridad­ se abordan ahora casi en su totalidad mediante acuerdos no vinculantes y de derecho indicativo. Es plausible que este alejamiento de las decisiones vinculantes refleje una institución de gestión dinámica que evoluciona para responder a nuevas presiones. Sin embargo, sugerimos que el cambio revela una modificación preocupante en el comportamiento y los resultados de la toma de decisiones, único en la historia del tratado. El derecho indicativo es benéfico en algunos casos, pero su uso excesivo disminuye la responsabilidad y la transparencia, lo que reduce significativamente la capacidad de las partes para comprender y medir su rendimiento, incluidos los resultados y los impactos de las decisiones. Aunque la tasa y la diversidad de las entradas y salidas de las RCTA sólo proporcionan una visión parcial del rendimiento de la toma de decisiones, la exploración de estas métricas proporciona una base para plantear preguntas esenciales sobre los impactos de la gestión del Tratado Antártico para la protección y conservación ambiental de la región.

The impact of anthropogenic pressures on microbial diversity and river multifunctionality relationships on a global scale.

Conserving biodiversity is crucial for maintaining essential ecosystem functions, as indicated by the positive relationships between biodiversity and ecosystem functioning. However, the impacts of declining biodiversity on ecosystem functions in response to mounting human pressures remain uncertain. This uncertainty arises from the complexity of trade-offs among human activities, climate change, river properties, and biodiversity, which have not been comprehensively addressed collectively. Here, we provide evidence that river biodiversity was significantly and positively associated with multifunctionality and contributed to key ecosystem functions such as microbially driven water purification, leaf litter decomposition and pathogen control. However, human pressure led to abrupt changes in microbial diversity and river multifunctionality relationships at a human pressure value of 0.5. In approximately 30 % (N = 58) of countries globally, the ratio of area above this threshold exceeded the global average (∼11 %), especially in Europe. Results show that human pressure affected ecosystem functions through direct effects and interactive effects. We provide more direct evidence that the nonadditive effects triggered by prevailing human pressure impact the multifunctionality of rivers globally. Under high levels of human stress, the beneficial effects of biodiversity on nutrient cycling, carbon storage, gross primary productivity, leaf litter decomposition, and pathogen control tend to diminish. Our findings highlight that considering interactions between human pressure and local abiotic and biotic factors is key for understanding the fate of river ecosystems under climate change and increasing human pressure.

Enhancing Evidence-Based Practice in Rural Social Work: Applying the Theory of Planned Behavior to Identify Key Determinants.

PURPOSE: This study explores the application and extent of utilization of Evidence-Based Practice (EBP) among rural social workers, identifying key factors such as attitudes, social pressures, and perceived barriers that influence its use. METHODS: Utilizing the Theory of Planned Behavior as a framework, this research involved a comprehensive survey targeting rural social workers. The survey assessed their attitudes toward EBP, the social pressures, and the barriers in implementing EBP. Data from 91 participants were analyzed using multiple regression to determine how these factors impact EBP utilization. RESULTS: The analysis indicated that while attitudes toward EBP did not significantly affect its use, perceived ease of use, social pressures, and practical barriers were significant predictors. Interestingly, the data showed that external factors like organizational support and resource availability played a larger role than personal attitudes in the adoption of EBP. The regression model successfully explained 39% of the variance in EBP usage among rural social workers. DISCUSSION: The findings underscore the importance of external over internal factors in the adoption of EBP within rural settings. The study suggests that improving access to EBP resources and enhancing organizational support could facilitate more effective use of EBP among rural social workers. CONCLUSION: Effective implementation of EBP in rural areas necessitates addressing both perceived and actual barriers. Developing strategies to enhance resource availability and organizational support is recommended to boost EBP adoption, ultimately aiming to improve service outcomes and client well-being.

Predicting the potential distribution change of the endangered Francois' langur (Trachypithecus francoisi) across its entire range in China under climate change.

The Francois' langur (Trachypithecus francoisi) is a rare primate species indicated as endangered and distributed in karst areas in northern Vietnam and southwestern China. However, research limited to specific nature reserves or sites has hampered holistic conservation management. A comprehensive map of the potential distribution for the Francois' langur is essential to advance conservation efforts and ensure coordinated management across regions. Here, we used 82 occurrence records of Francois' langur surveyed in Guangxi, Guizhou, and Chongqing from 2017 to 2020, along with 12 environmental variables, to build the potential habitat model under current and future climate (2030, 2050, 2070, and 2090s) using maximum entropy models (MaxEnt). Our results indicated that (1) precipitation- and temperature-associated bioclimatic variables contributed the most to the distribution of Francois' langur. Vegetation, water sources, and anthropogenic variables also affected its distribution; (2) a total of 144,207.44 km2 of potential suitable habitat across the entire range in China was estimated by the current model. Moderate- and high-suitability habitats accounted for only 23.76% (34,265.96 km2) of the predicted suitable habitat and were mainly distributed in southwest Guangxi, east of Chongqing, and the border between Guizhou and Chongqing; (3) the suitable habitats of Francois' langur will contract considerably under future climate change, and the habitat centroid will move in the southeast direction with a shifting distance of approximately 2.84 km/year from current to 2100. The habitat prediction of Francois' langur and the main drivers proposed in this study could provide essential insights for the future conservation of this endangered species. The existing distribution areas should be monitored and protected, but conservation beyond existing habitats should also be a focus of effort, especially in future expansion areas. This would ensure effective and timely protection under climate change and anthropogenic pressures.

Hydromorphological degradation modifies long-term macroinvertebrate responses to water quality and climate changes in lowland rivers.

Due to decades of persistent anthropogenic pressures, lowland rivers represent one of the most severely impaired habitats in Europe. Despite improved water quality, novel stressors, particularly climate change, are emerging with most lowland rivers suffering from past hydromorphological degradation. We aim to elucidate how such degradation alters the biological response in multiple-stressor environments, as this has rarely been considered in studies documenting long-term development of anthropogenically impacted rivers. Here, benthic macroinvertebrates, water quality and hydroclimatic variables were monitored over a period of two decades in nine of the largest Czech rivers. Detailed data on hydromorphological degradation allowed us to track distinct patterns in rivers with high and low levels of degradation. Temporal changes in environmental variables showed similar patterns in both site groups, characterised by reduced organic and nutrient pollution but increased hydroclimatic and salinity stress. 150 % increase in total abundance, especially in abundance and richness of sediment-dwelling and non-native taxa was found in both site groups. While the increase in abundance was due to improved water quality and rising water temperature, the longer duration of minimal flows had a negative effect on species richness, hampering species gain particularly at highly degraded sites. Our results provide novel evidence that degree of hydromorphological degradation modifies long-term macroinvertebrate responses to anthropogenic pressures. Less degraded sites displayed several favourable changes, such as 27 % increase in total and 23 % increase in potamal indicator richness, and stabilisation of the assemblages with few functional changes. In contrast, highly degraded sites experienced 9 % reduction in evenness, 235 % increase in proportion of non-native taxa and functional reorganisation, changes congruent with continuous deterioration. While overall water quality at studied sites has improved, consequences of climate change and high degree of hydromorphological degradation limit biotic recovery in multiple-stressor lowland rivers.

Lactase persistence in the Jordanian population: Potential effects of the Arabian Peninsula and Sahara's aridification.

The single nucleotide polymorphism (SNP) -13910 C > T has proved a good predictor of the incidence of lactase persistence in Europe and South Asia. Yet, this is not the case in the Near East, although this region is a passageway between the two continents. Lactase persistence is associated with cattle breeding, which originated in the Fertile Crescent of the Near East and spread later during the Middle Neolithic throughout Europe. Here we analyzed five SNPs (-13915 T > G (rs41380347), -13910 C > T (rs4988235), -13907 C > G (rs41525747), -14009 T > G (rs869051967), and -14010 G > C (rs145946881)) in three Jordanian human groups, namely the Bedouins, Jordan valley farmers, and Jordanian urban people. The SNPs -14009 T > G and -14010 G > C were not detected in the sample, -13907 C > G was virtually non-existent, -13910 C > T showed low frequencies, and -13915 T > G exhibited salient frequencies. The estimated incidence of lactase persistence was lower in the urban population (16 %), intermediate in the Jordan Valley's farmer population (30 %), and higher among the Bedouins (62 %). In explaining our findings, we postulated climatic change brought about by the aridification episode of the Arabian Peninsula and the Sahara 4200 years ago. This climatic milestone caused the collapse of the Akkadian Empire and the Old Kingdom in Egypt. Also, it could have led to a drastic decline of cattle in the region, being replaced by the domestication of camels. Loss of traditional crops and increasing dependence on camel milk might have triggered local selective pressures, mainly associated with -13915 T > G and differentiated from the ones in Europe, associated with -13910 C > T.

Determinants of invasive left atrial pressure in patients with atrial fibrillation.

AIMS: Estimation of left ventricular (LV) filling pressures in patients with atrial fibrillation (AF) is challenging due to lack of reliable parameters. This study investigates the association between cardiac structure and function and invasive mean left atrial pressure (LAP). METHODS AND RESULTS: This is a multi-center prospective study enrolling patients undergoing transcatheter ablation for AF. The invasive measurement of LAP was performed at the time of the procedure while the echocardiography within the previous 24 hours. A mean LAP ≥ 15 mmHg was considered as increased. Overall, 101 patients were included (mean age 65.8 ± 8.5 years, 68% male, mean LV ejection fraction 56.6 ± 8.0%). No significant differences regarding clinical characteristics were detected between the group of patients with normal (n=47) or increased LAP (n=54). The latter showed lower values of LV global longitudinal strain, larger left atrial volumes (LAV) and worse right ventricular (RV) function. After multivariable adjustment, higher E/e' ratio (p=0.041) and minimal LAV index (LAVI min) (p=0.031), lower peak atrial longitudinal strain (PALS) (p=0.030) and RV free wall strain (p=0.037), but not maximal LAV index (LAVI max) (p=0.137), were significantly associated with mean LAP. The associations were not modified by cardiac rhythm. Overall, LAVI min showed the best diagnostic accuracy to predict elevated LAP (AUC 0.703). CONCLUSION: LA structure and function assessment well correlates with mean LAP in patients with AF. These measures may be used in the assessment of filling pressure in these patients.

Viral Envelope Evolution in Simian-HIV-Infected Neonate and Adult-Dam Pairs of Rhesus Macaques.

We recently demonstrated that Simian-HIV (SHIV)-infected neonate rhesus macaques (RMs) generated heterologous HIV-1 neutralizing antibodies (NAbs) with broadly-NAb (bNAb) characteristics at a higher frequency compared with their corresponding dam. Here, we characterized genetic diversity in Env sequences from four neonate or adult/dam RM pairs: in two pairs, neonate and dam RMs made heterologous HIV-1 NAbs; in one pair, neither the neonate nor the dam made heterologous HIV-1 NAbs; and in another pair, only the neonate made heterologous HIV-1 NAbs. Phylogenetic and sequence diversity analyses of longitudinal Envs revealed that a higher genetic diversity, within the host and away from the infecting SHIV strain, was correlated with heterologous HIV-1 NAb development. We identified 22 Env variable sites, of which 9 were associated with heterologous HIV-1 NAb development; 3/9 sites had mutations previously linked to HIV-1 Env bNAb development. These data suggested that viral diversity drives heterologous HIV-1 NAb development, and the faster accumulation of viral diversity in neonate RMs may be a potential mechanism underlying bNAb induction in pediatric populations. Moreover, these data may inform candidate Env immunogens to guide precursor B cells to bNAb status via vaccination by the Env-based selection of bNAb lineage members with the appropriate mutations associated with neutralization breadth.

Addressing ocean planning challenges in a highly crowded sea space: a case study for the regional sea of Catalonia (Western Mediterranean).

Background: This study performs an exploratory analysis of current-future sustainability challenges for ocean planning for the regional seas of Catalonia located in the Western Mediterranean (Spain). Methods: To address the challenges we develop an Maritime Spatial Planning (MSP)-oriented geodatabase of maritime activities and deploy three spatial models: 1) an analysis of regional contribution to the 30% protection commitment with Biodiversity Strategy 2030; 2) a spatial Maritime Use Conflict (MUC) analysis to address current and future maritime activities interactions and 3) the StressorGenerator QGIS application to locate current and anticipate future sea areas of highest anthropogenic stress. Results & Conclusions: Results show that the i) study area is one of the most protected sea areas in the Mediterranean (44-51% of sea space protected); ii) anthropogenic stressors are highest in 1-4 nautical miles coastal areas, where maritime activities agglomerate, in the Gulf of Roses and Gulf of Saint Jordi. iii) According to the available datasets commercial fishery is causing highest conflict score inside protected areas. Potential new aquaculture sites are causing highest conflict in Internal Waters and the high potential areas for energy cause comparably low to negligible spatial conflicts with other uses. We discuss the added value of performing regional MSP exercises and define five challenges for regional ocean sustainability, namely: Marine protection beyond percentage, offshore wind energy: a new space demand, crowded coastal areas, multi-level governance of the regional sea and MSP knowledge gaps.

Dilute concentrations of maritime fuel can modify sediment reworking activity of high-latitude marine invertebrates.

Multiple expressions of climate change, in particular warming-induced reductions in the type, extent and thickness of sea ice, are opening access and providing new viable development opportunities in high-latitude regions. Coastal margins are facing these challenges, but the vulnerability of species and ecosystems to the effects of fuel contamination associated with increased maritime traffic is largely unknown. Here, we show that low concentrations of the water-accommodated fraction of marine fuel oil, representative of a dilute fuel oil spill, can alter functionally important aspects of the behaviour of sediment-dwelling invertebrates. We find that the response to contamination is species specific, but that the range in response among individuals is modified by increasing fuel concentrations. Our study provides evidence that species responses to novel and/or unprecedented levels of anthropogenic activity associated with the opening up of high-latitude regions can have substantive ecological effects, even when human impacts are at, or below, commonly accepted safe thresholds. These secondary responses are often overlooked in broad-scale environmental assessments and marine planning yet, critically, they may act as an early warning signal for impending and more pronounced ecological transitions.

A follow-up study on respiratory outcomes, quality of life and performance perception of SARS-CoV-2 primary and reinfection in elite athletes: A 9-month prospective study.

The prolonged consequences of SARS-CoV-2 on young elite athletes recovering from primary and reinfection are unclear. This study aimed to assess inspiratory/expiratory muscle strength and respiratory function at the time of spontaneous recovery at 3, 6, and 9 months after SARS-CoV-2 primary and reinfection in elite athletes. The study enrolled 25 elite male judoists, including 11 primary infection cases, five reinfection cases, and nine controls from the Türkiye Olympic Preparation Center. Inspiratory/expiratory muscle strength and respiratory function were measured, including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) before and up to 9 months after SARS-CoV-2 infection in the early pre-competition preparation phases. The most common symptoms reported by reinfection cases were fatigue (80%), dyspnea (60%), and muscle/joint pain (60%), while primary infection cases reported fatigue (73%), muscle/joint pain (45%), and headache (45%). MIP decreased by -14% and MEP decreased by -13% following the SARS-CoV-2 infection in reinfection cases. Likewise, FEV1 and FVC decreased by -5% and -8%, respectively; consequently, FEV1/FVC increased by 3%. Inspiratory/expiratory muscle strength and respiratory function improved rapidly after 9 months of SARS-CoV-2 infection in primary cases, whereas dysfunction persisted in reinfection cases. PEF was unaffected throughout the 9-month follow-up period. Reinfection may lead to further alterations in respiratory system relative to the primary infection, with a suspected restrictive pattern that remains dysfunctional in the third month; however, it improves significantly during a 9-month follow-up period.

An ovine knee simulator: description and proof of concept.

Aims: The ovine stifle is an established model for evaluation of knee treatments, such as meniscus replacement. This study introduces a novel ovine gait simulator for pre-testing of surgical treatments prior to in vivo animal trials. Furthermore, we describe a pilot study that assessed gait kinematics and contact pressures of native ovine stifle joints and those implanted with a novel fiber-matrix reinforced polyvinyl alcohol-polyethylene glycol (PVA-PEG) hydrogel meniscus to illustrate the efficacy of the simulator. Methods: The gait simulator controlled femoral flexion-extension and applied a 980N axial contact force to the distal tibia, whose movement was guided by the natural ligaments. Five right ovine stifle joints were implanted with a PVA-PEG total medial meniscus replacement, fixed to the tibia via transosseous tunnels and interference screws. Six intact and five implanted right ovine stifle joints were tested for 500 k gait cycles at 1.55 Hz. Implanted stifle joint contact pressures and kinematics in the simulator were compared to the intact group. Contact pressures were measured at 55° flexion using pressure sensitive film inserted sub-meniscally. 3D kinematics were measured optically across two 30-s captures. Results: Peak contact pressures in intact stifles were 3.6 ± 1.0 MPa and 6.0 ± 2.1 MPa in the medial and lateral condyles (p < 0.05) and did not differ significantly from previous studies (p > 0.4). Medial peak implanted pressures were 4.3 ± 2.2 MPa (p > 0.4 versus intact), while lateral peak pressures (9.4 ± 0.8 MPa) were raised post medial compartment implantation (p < 0.01). The range of motion for intact joints was flexion/extension 37° ± 1°, varus/valgus 1° ± 1°, external/internal rotation 5° ± 3°, lateral/medial translation 2 ± 1 mm, anterior/posterior translation 3 ± 1 mm and distraction/compression 1 ± 1 mm. Ovine joint kinematics in the simulator did not differ significantly from published in vivo data for the intact group, and the intact and implanted groups were comparable (p > 0.01), except for in distraction-compression (p < 0.01). Conclusion: These findings show correspondence of the ovine simulator kinematics with in vivo gait parameters. The efficacy of the simulator to evaluate novel treatments was demonstrated by implanting a PVA-PEG hydrogel medial meniscal replacement, which restored the medial peak contact pressures but not lateral. This novel simulator may enable future work on the development of surgical procedures, derisking subsequent work in live animals.

The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography.

Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.

Human adaptations to diet: Biological and cultural coevolution.

Modern humans evolved in Africa some 200,000 years ago, and since then, human populations have expanded and diversified to occupy a broad range of habitats and use different subsistence modes. This has resulted in different adaptations, such as differential responses to diseases and different abilities to digest or tolerate certain foods. The shift from a subsistence strategy based on hunting and gathering during the Palaeolithic to a lifestyle based on the consumption of domesticated animals and plants in the Neolithic can be considered one of the most important dietary transitions of Homo sapiens. In this text, we review four examples of gene-culture coevolution: (i) the persistence of the enzyme lactase after weaning, which allows the digestion of milk in adulthood, related to the emergence of dairy farming during the Neolithic; (ii) the population differences in alcohol susceptibility, in particular the ethanol intolerance of Asian populations due to the increased accumulation of the toxic acetaldehyde, related to the spread of rice domestication; (iii) the maintenance of gluten intolerance (celiac disease) with the subsequent reduced fitness of its sufferers, related to the emergence of agriculture and (iv) the considerable variation in the biosynthetic pathway of long-chain polyunsaturated fatty acids in native populations with extreme diets.

Serial cardiac biomarkers, pulmonary artery pressures and traditional parameters of fluid status in relation to prognosis in patients with chronic heart failure: Design and rationale of the BioMEMS study.

AIMS: Heart failure (HF), a global pandemic affecting millions of individuals, calls for adequate predictive guidance for improved therapy. Congestion, a key factor in HF-related hospitalizations, further underscores the need for timely interventions. Proactive monitoring of intracardiac pressures, guided by pulmonary artery (PA) pressure, offers opportunities for efficient early-stage intervention, since haemodynamic congestion precedes clinical symptoms. METHODS: The BioMEMS study, a substudy of the MONITOR-HF trial, proposes a multifaceted approach integrating blood biobank data with traditional and novel HF parameters. Two additional blood samples from 340 active participants in the MONITOR-HF trial were collected at baseline, 3-, 6-, and 12-month visits and stored for the BioMEMS biobank. The main aims are to identify the relationship between temporal biomarker patterns and PA pressures derived from the CardioMEMS-HF system, and to identify the biomarker profile(s) associated with the risk of HF events and cardiovascular death. CONCLUSION: Since the prognostic value of single baseline measurements of biomarkers like N-terminal pro-B-type natriuretic peptide is limited, with the BioMEMS study we advocate a dynamic, serial approach to better capture HF progression. We will substantiate this by relating repeated biomarker measurements to PA pressures. This design rationale presents a comprehensive review on cardiac biomarkers in HF, and aims to contribute valuable insights into personalized HF therapy and patient risk assessment, advancing our ability to address the evolving nature of HF effectively.

Eating disorder symptoms and weight pressure in female rowers: associations between self-concept, psychological well-being and body composition.

BACKGROUND: Female rowers may be at risk of eating disorders and high weight pressure. AIM: The purpose of the study was to investigate the prevalence of disordered eating symptoms and weight-related pressure and the associations with self-concept, psychological well-being, socio-demographic data, experience, performance level and body composition in female fixed-bench rowers. METHODS: Female rowers (n = 208; age ranged mean ± SD 23.6 ± 6.5 years) completed the SCOFF scale, Weight-Pressures in Sport-Females (WPS-F), Physical Self-Concept Questionnaire and the Ryff scales of psychological well-being and provided information on their experience and level of competition. In a subgroup of 115 athletes, body composition was assessed using bioimpedance. RESULTS: It was found that 42.3% of the athletes scored ≥ 2 on SCOFF and mean ± SD value of WPS-F score was 3.65 ± 0.82. Stepwise regression analysis revealed that self-concept of strength and pressure from teammates and the uniform were associated with higher ED symptoms, whereas better psychological well-being in terms of autonomy, self-concept of attractiveness, and age were protective factors for ED symptoms. BMI, athletes' physical condition, strength, and experience were associated with more weight-related pressure and better self-concept of attractiveness and physical well-being of autonomy were significantly associated with less pressure. In body composition analysis, higher extra cellular water, self-acceptance, and physical condition were associated with more weight-related pressure in female rowers, being attractiveness and the environmental mastery protective elements. CONCLUSIONS: The prevalence of ED symptomatology and weight-related pressure are high in female fixed bench rowing. The psychological factors of well-being and self-concept, team environment, body image concerns and body composition analysis should be considered to promote healthy eating behaviours in female rowers.

Athletes may be at increased risk of developing disordered eating behaviours that, if persistent, may lead to a diagnosis of an eating disorder. This can affect their health in the short and long term. The risk factors are many, and perceived weight-related pressures and psychological attitudes towards body image, appearance and concerns are less well understood. Female rowers are at high risk for eating disorder symptoms, and athletes' self-concept of strength and pressure from teammates and the uniform were associated as negative factors for eating disorder symptoms. On the other hand, better psychological well-being in terms of autonomy, self-concept of attractiveness and age were protective factors for eating disorder symptoms. Weight pressure was associated with higher body mass index, water retention, physical condition, strength and experience, whereas better self-concept of attractiveness and physical well-being were significantly associated with less pressure. Weight pressure and psychological attitudes towards body image have the role of protective/facilitating factors against the development of eating disorders. They should be taken into account when designing prevention and intervention programmes for athletes, coaches, parents and technical staff.

Causes of Chronic Kidney Disease and Their Associations with Cardiovascular Risk and Disease in a Sub-Saharan Low-Income Population.

Introduction: The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain. Methods: In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population. Results: Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%). Conclusion: HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.

Suicidal Ideation Among Kenyan Youth: A Qualitative Analysis of Online Life Stories.

This study examines the experiences of suicidal ideation among Kenyan youth through a qualitative analysis of online narratives, a sample that comprised 15 young individuals aged 17-26 who shared their stories on online platforms. Employing Interpretative Phenomenological Analysis (IPA), the study highlights complex interactions of societal pressures, mental health challenges, and identity struggles that contribute to suicidal ideation. Key themes identified include the impact of cultural expectations, mental health stigma, isolation, and identity crises. By prioritizing the personal voices of the youth, the study sheds light on the deeply contextual nature of suicidal ideation and offers insights into the meanings individuals ascribe to their experiences. The findings advocate for culturally sensitive interventions and underscore the need to address mental health stigma, aiming to foster a supportive societal environment for Kenyan youth grappling with these issues.

A Multi-Level Model of Institutional Innovation and Knowledge Creation Capabilities: Insights From the Development of Taiwan's Nation Health Insurance.

This study proposes a multi-level model of institutional innovation in the healthcare sector-in other words, field-level institutional change pressures that start as network-level institutional innovation by hospitals and government for their organizational performance, with an emphasis on the effect of organizational-level construct-knowledge creation capabilities. A case study using in-depth interviews and a historical inquiry approach has been used to qualitatively analyze our cases during the development of Taiwan's National Health Insurance (NHI). Our results propose a multi-level explanation of institutional innovation by showing how field-level institutional change pressures can stimulate the government's institutional innovation at the network level. Moreover, knowledge creation capabilities may positively influence the government hospitals' ongoing institutional change pressures induced institutional innovation activity for their performance at the organizational level in an institutional setting. This study contributes to health organization management researchers and administrators by developing explanations of institutional innovation and creating a much-needed multi-level insight into hospital behavior in the highly institutionalized healthcare sector.