Abstract Background Ventricular-arterial coupling (VAC) represents a key pathophysiological component for the preservation of left ventricular (LV) contractile efficiency. Increased age, hypertension and evolving atherosclerosis may induce VAC mismatch in asymptomatic severe aortic stenosis (AS). Purpose Purpose of the study was to assess the effect of supine ergometry (Ex) on VAC in AS and to interrogate potential relationship with the clinical outcome. Methods Forty eight AS patients, followed-up on valve clinic in a tertiary center (age 66±12 years), were referred for Ex. AS-related cardiac events (independent decision for surgery, occurrence of AS-related symptoms) during a follow-up of 33±21 months occurred in 19 patients (EV group). The following parameters were estimated noninvasively both at rest-R/Ex: LV ejection fraction (EF:%), strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure, AV mean gradient (meanGR: mmHg), valvuloarterial impedance (Za: mm Hg·ml-1m2), effective arterial elastance (Ea: mmHg/ml), LV endsystolic elastance (Ees: mmHg/ml) and VAC as the ratio Ea/Ees. Results Event (EV) and non-event (nEV) groups had similar % target heart rate at Ex (96±17 vs 100±12), age (66±12 vs 66±12 years), women/men ratio (9/19 vs 14/29), EF-R (55±8 vs 56±7%), SR-R (15.0±4.0 vs 14.5±3.5%), SR-Ex (16±5 vs 17±4%) but lower EF-Ex (59±9 vs 64±6%, p=0.03). EV group had greater meanGR at R (45±16 vs 37±12mmHg, p=0.03), but similar Za both at R and Ex (2.3±1.0 vs 2.0±0.8mm Hg·ml-1m2 and 2.7±0.8 vs 2.7±1.0mm Hg·ml-1m2). EV group had lower Ees at Ex (4.0±2.0 vs 5.6±2.3mmHg/ml, p=0.026) but similar Ees at R (3.0±1.3 vs 3.3±1.5 mmHg/ml) as well Ea both at R and Ex (2.4±1.0 vs 2.6±1.0 mmHg/ml and 2.7±1.0 vs 3.1±1.1 mmHg/ml). Despite similar VAC at R (0.84±0.24 vs 0.79±0.25), EV group showed worsening VAC during Ex (0.75±0.29 vs 0.58±0.12, p=0.01). Binary logistic regression analysis for events, including the different parameters between groups (meanGR, VAC Ex, EF Ex), selected only the VAC Ex (exp(b)=0.01, p=0.02) as independent predictor. ROC event cut off for VAC Ex was 0.69 (area 0.68, p=0.05, sensitivity 0.6 specificity=0.9, figure 1). Kaplan Meier analysis for the greater values of the VAC Ex than 0.69 showed an increased hazard ratio for events (log rank=6.9 p=0.009, figure 2). Conclusion In asymptomatic patients with AS, noninvasive VAC at Ex provides an independent prognostic yield for cardiac outcome from conventional indices of either LV function or hydraulic aortic valve performance.

Abstract Introduction Degenerative aortic stenosis (AS) is a part of a continuum that may also include a reduction in systemic arterial compliance (Ac). Lower Ac affects cardiovascular prognosis but there are scarce data concerning AS and especially during exercise. Purpose Aim of the study was to assess the prognostic role of calculated Ac at rest (R) and during supine ergometry (Ex) in the outcome of asymptomatic severe AS. Methods Forty eight AS patients, followed-up on valve clinic in a tertiary center (age 66±12 years), were referred for Ex. AS-related cardiac events (independent decision for surgery, occurrence of AS-related symptoms) during a follow-up of 33±21 months occurred in 19 patients (EV group). The following parameters were estimated noninvasively both at R/Ex: LV ejection fraction (EF:%), strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure (TRPG: mmHg), AV mean gradient (meanGR: mmHg), valvuloarterial impedance (Za: mm Hg·ml-1m2), peripheral vascular resistance (PVR: Wood units) and arterial compliance (Doppler stoke volume/pulse pressure=Ac: ml/mmHg). Results Event (EV) and non-event (nEV) groups had similar % target heart rate at Ex, (96±17 vs 100±12%), age (66±12 vs 66±12 years), women/men ratio (9/19 vs 14/29), EF-R (55±8 vs 56±7%), ST-R (15.0±4.0 vs 14.5±3.5%), TRPG R/Ex (35±14 vs 30±8 and 60±15 vs 54±11mmHg), SR-Ex (16.0±5.0 vs 17.0±4.0%) but lower EF-Ex (59±9 vs 64±6%, p=0.03). EV group had greater meanGR at R (45±16 vs 37±12mmHg, p=0.03), but similar Za both at R/Ex (2.3±1.0 vs 2.0±0.8 and 2.7±0.8 vs 2.7±1.0mm Hg·ml-1m2 ). PVR at R/Ex was similar (29.3±12.0 vs 32.0±13.0 and 20.5±6.0 vs 22±9.0 Wood). Ac was similar between the 2 groups at R but it showed a greater reduction during Ex in EV group (R: 0.85±0.44 vs 0.92±0.60 and Ex: 0.70±0.60 vs 0.84±0.40, p=0.05). Binary logistic regression analysis for events, including the different parameters between groups (meanGR, Ac-Ex, EF-Ex), selected only EF-Ex [exp(b)=1.15 (1-1.3 p=0.02] as independent predictor. ROC analysis for event provided a cut off for Ac-Ex of 0.56 (area 0.65, sens=0.72, spec=0.60). ROC classification for events was better for age>70 years (cut off 0.52, area 0.82, sens=0.88, spec=0.77-figure 1). Kaplan Meier event analysis for a greater Ac-Ex than 0.56 provided an increased hazard ratio (log rank =8, p=0.003 figure 2). Conclusion Arterial compliance provides prognostic yield for the outcome of asymptomatic severe AS especially in the aged population. The additive value becomes evident when this parameter is calculated during supine ergometry.

The article concerns the legal nature of the cash equivalent as a benefit paid to firefighters of the Volunteer FireDepartment for participating in a rescue operation, rescue operation, training or exercise. This benefit was grantedto members for rescue activities in order to show gratitude for risking life and health to save other people,property and the environment by performing work identical to that of professional firefighters without receivingremuneration. This article presents legal regulations regarding the concept and conditions of payment of thebenefit in question, as well as regulations regarding exemptions from the collection of public law liabilities, compensationfor lost earnings and waiver of the right to obtain an equivalent. Due to the multi-faceted nature of thebenefit in question and the narrow regulation, it is necessary to supplement the knowledge with developed thesesof case law, in particular regarding the calculation of compensation for breaks in training, remaining in combatreadiness, the time of arming the vehicle and securing mass eve nts.

Role of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis

BackgroundEmbolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan. The present study aimed to describe the role of thoracoabdominal imaging, either thoracoabdominal-pelvic Computed Tomography or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography, on diagnosis and management of patients with suspected IE. MethodsThis study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. ResultsAmong 966 episodes with suspected IE and thoracoabdominal imaging, 528 (55%) patients were asymptomatic. At least one EE was found in 205 (21%) episodes. Based on thoracoabdominal imaging findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively. Among the 413 patients with IE, at least one EE was found on thoracoabdominal imaging in 143 (35%) episodes. Together with the presence of left-side valvular vegetation >10 mm, the results of thoracoabdominal imaging established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. ConclusionsThoracoabdominal imaging performed in asymptomatic patients with suspected IE improved the diagnosis in only a small proportion of patients. Thoracoabdominal imaging led to a new surgical indication (in association with left-side valvular vegetation >10 mm) in only a small percentage of patients.

El artículo, una vez hecha una síntesis de las características del siglo XIV en la Corona de Aragón y Cataluña y de los acontecimientos históricos y económicos más relevantes, ofrece unas líneas sobre el monasterio de Poblet, su creación en 1150 a partir de los terrenos entregados por el conde de Barcelona, la evolución hasta llegar al siglo XIV, época en la que el rey Pedro el Ceremonioso instituye al limosnero real, que representa el núcleo central de nuestro estudio. A partir de unos manuscritos datados a finales del siglo XIV por el limosnero real y que son las anotaciones correspondientes a los movimientos de entrada y salida de las limosnas y de las Ordenanzas dictadas por el rey Pedro IV, tenemos conocimiento de las cantidades que éste disponía que debían ser entregadas en forma de dádivas a los beneficiarios de las mismas, así como sus destinatarios, que abarcan a casi todos los estamentos sociales, puesto que además de ser recibidas por los pobres menesterosos en auxilio de pitanza o de vestimenta, también son destinatarios los mo nasterios, los clérigos para recibir alimento tanto para el cuerpo como para la mente -formación-, las pecadoras para redimirse y los peregrinos, así como algún noble sobre el que pendiera la desgracia. Los documentos nos permiten conocer como se donaba la limosna real, las personas que intervenían (dos limosneros, dos monaguillos y un asistente o servidor), el lugar que ocupaban en la corte real -privilegios y obligaciones-, y lo que para nosotros ha sido más importante, los documentos que toda su administración conllevaba, así como conocer el proceso sobre el que se sustentaba la rendición de las cuentas de la limosna real, y como se produce un endurecimiento en el control de los registros a medida que nos acercamos a las postrimerías del siglo XIV.

European coasts are regularly exposed to severe storms that trigger extreme water-level conditions, leading to coastal flooding and erosion. Early Warning Systems (EWS) are important tools for the increased preparedness and response against coastal flood events, hence greatly reducing associated risks. With this objective, a proof-of-concept for a European Coastal Flood Awareness System (ECFAS) was developed in the framework of the H2020 ECFAS project, which capitalizes on the Copernicus products. In this context, this manuscript evaluates for the first time the capability of the current Copernicus Marine operational ocean models to forecast extreme coastal water levels and hence to feed coastal flood awareness applications at European scale. A methodology is developed to focus the assessment on storm-driven extreme sea level events (EEs) from tide-gauge records. For the detected EEs, the event peak representation is validated, and the impact of forecast lead time is evaluated. Results show satisfactory performance but a general underprediction of peak magnitudes of 10% for water levels and 18% for surges across the detected EEs. In average, the models are capable of independently flagging 76% of the observed EEs. Forecasts show limited lead time impact up to a 4-day lead time, demonstrating the suitability of the systems for early warning applications. Finally, by separating the surge and tidal contributions to the extremes, the potential sources of the prediction misfits are discussed and consequent recommendations for the evolution of the Copernicus Marine Service forecasting models towards coastal flooding applications are provided.

Fluids in subduction zones play a key role in controlling seismic activity, drastically affecting the rheology of rocks, triggering mineral reactions, and lowering the effective stress. Fluctuating pore pressure is one important parameter for the switch between brittle and ductile deformation, thus impacting seismogenesis. Episodic tremor and slow slip events (ETS) have been proposed as a common feature of the geophysical signature of subduction zones. Their geological record, however, remains scanty. Only the detailed and further characterization of exhumed fossil geological settings can help fill this knowledge gap. Here we propose that fluctuating pore pressure linked to metamorphic dehydration reactions steered cyclic and ETS-related brittle and ductile deformation of continental crustal rocks in the subduction channel of the Apennines. Dilational shear veins and ductile mylonitic shear zones formed broadly coevally at minimum 1 GPa and 350 °C, corresponding to ~ 30–40 km depth in the subduction zone. We identify carpholite in Ca-poor metasediments as an important carrier of H2O to depths > 40 km in cold subduction zones. Our results suggest that the described (micro)structures and mineralogical changes can be ascribed to deep ETS and provide a useful reference for the interpretation of similar tectonic settings worldwide.

The negative effects of loud anthropic sounds on non-human health and welfare urges attention. We report here the results of a technical study we conducted attending a Public Prosecutor’s request at Ribeirão Preto, SP, Brazil. A Civil Inquiry informed against nocive effects of human concentration on captive and free-living animals around the municipal zoo. The zoo is part of a natural protected area that paradoxically was used as a locale for public festivities. We aimed to compare two weekends, one of a traditional Italian event (EV) and another with no event (NE), and check sound level and behavioral changes in a sample of captive animals and in the soundscape. We employed three procedures: (1) Sound Pressure level (SPL) assessment at different localities; (2) Comparative behavior analysis; and (3) Soundscape description. Our results provided cues of how the festivities may be affecting free-living animals in the APA Morro do São Bento and captive ones. Peak SPL exposure was higher in EV in almost all the localities of the zoo; the six monitored individuals (two ocelots, two crassow, the European cervid and the maned-wolf) changed their activity and resting patterns and the soundscape was more diverse and intense in vocal activity than in NE.

Disentangling relations between urban form and urban accessibility for resilience to extreme weather and climate events

Palace museums harbour important animal remains (trophies), this is the case too with palace museums of the West region of Cameroon. Here we present a preliminary study into the animal-based collections of palace museums from a genetic conservation perspective. We surveyed 11 chiefdom palace museums in the West Region of Cameroon. We collected samples of these trophies. We extracted and purified DNA from these trophies using the DNeasy® Blood and Tissue Kit. Quantification and quality control were done using the agarose gel electrophoresis and spectrophotometric methods. From agarose gel electrophoresis, 64% of specimens have DNA that could be of good quality, 12% of specimens have contaminated DNA, while 12% of specimens have degraded DNA. Spectrophotometric determination reveals that 28% of the specimens has quantifiable DNA against 72% that was of poor DNA quantity. Specimens with good quality DNA could be used for further studies (for instance, DNA sequencing for wildlife traceability). In order to perpetuate the conservation role played by the tradition through museums, the administration has to regulate the acquisition and use of trophies in traditional and cultural events in the forest law actually under revision. Museums have to ensure compliance with the criteria of acquisition and management of wildlife trophies

Over the last 50 years, cue competition phenomena have shaped theoretical developments in animal and human learning. However, recent failures to obtain the well-known blocking effect in standard conditioning procedures, as well as the lengthy and on-going debate surrounding cue competition in the spatial learning literature, have cast doubts on the generality of competition phenomena. In the present study, we manipulated temporal contiguity between predictors and outcomes (Experiments 1-4), and spatial contiguity between landmarks and goals in spatial learning (Experiments 5-7). Across different parametric variations, we observed overshadowing when temporal and spatial contiguity were strong, but no overshadowing when contiguity was weak. Thus, across temporal and spatial domains, we observed that contiguity is necessary for competition to occur, and that competition between cues during learning is absent when cues were either spatially or temporally discontiguous. Consequently, we advance a model in which the contiguity of cues is accounted for, and which can reconcile the previously contradictory findings observed in spatial and non-spatial domains.

Effect of antimicrobial therapy on the embolic events in patients with infective endocarditis

Iran, not just as an oil-exporting country, but also because of its geopolitical position, is one of the world’s most important countries. Since the recent events of the Middle East, the importance of the country has grown globally. Because of this growing importance, the short term future of Iran is significant to be studied. In this study, a descriptive approach has been taken to synthesize the world’s energy portfolio and the global energy balance outlook to provide insights into the development of local energy portfolio scenarios focusing on Iran. The shell company represents two basic scenarios, which are the scramble and blueprint. According to shell scenarios world energy portfolio might be organized in two images in which each image concludes different energy portfolios. Thus, developing energy portfolio scenarios is essential. In this paper, after reviewing the four selected developing countries’ energy portfolios and developed countries, the scenarios of Iran’s energy portfolio in 2020-2025 will be presented. For this purpose, a combination of qualitative and quantitative methods will be used for scenario building.

Nutrients and solids removal in bioretention columns using recycled materials under intermittent and frequent flow operations

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