Mechanical Support Research Articles

STEMI SHOCK outcomes with SCAI classification

Abstract Background Patients with ST-elevation myocardial infarction who develop cardiogenic shock (STEMI-SHOCK) face significantly increased risk compared to those without shock. Mechanical circulatory support (MCS) devices are commonly utilized in STEMI-SHOCK patients, but the benefits of MCS remain uncertain. This study aims to apply the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification system to STEMI-SHOCK patients, examining outcomes and identifying subgroups that may benefit from MCS. Purpose Our study assessed SHOCK severity in STEMI-SHOCK patients using the updated 2021 SCAI-SHOCK classification system and determined survival at various endpoints (30 days, 1 year, and 3 years), along with other outcomes such as vascular access complications and major adverse cardiac events, based on the severity class. Methods Patients with angiograms and indications of STEMI-SHOCK between 2012 and 2021 admitted to Liverpool Hospital Australia, were included after adjudication they had STEMI-SHOCK. Angiograms were eligible for adjudication if they met criteria for both STEMI and SHOCK. Each patient underwent individual adjudication by three researchers to confirm STEMI-SHOCK status. Patients were followed from the time of the first SHOCK diagnosis until censoring at the last follow-up. Data were retrieved from electronic and paper-based patient records. The primary outcome was 30-day survival, and secondary outcomes were 1-year and 3-year survival. Results The SCAI stages of 160 (Estimated 220) STEMI-SHOCK patients were determined, with 17 in Stage A, 39 in Stage B, 53 in Stage C, 25 in Stage D, and 26 in Stage E. Worse SCAI stages were associated with significantly lower 30-day, 1-year, and 3-year survival. No difference in survival between the time periods 2013-2015 and 2018-2021 was found. An eGFR < 60 millilitres/minute/1.73 meters^2 (hazard ratio [HR] 3.41; 95% confidence interval [CI] 1.18 – 9.92, p=0.024) and lactate greater than 4.15 millimoles/liter (HR 6.48; 95% CI [2.84 – 51.64], p=0.001) at shock were associated with lower 30-day and 3-year survival. Patients in the SCAI C subgroup treated with an IABP had significantly higher 1-year (p=0.001) and 3-year (p=0.001) survival compared to those not treated with an IABP. Conclusion The SCAI classification system successfully predicted short and long-term survival in STEMI-CS patients, with worse stages having progressively worse outcomes. No improvement in survival outcomes was observed in the overall SCAI C-E group of patients treated with mechanical support. However, patients in the SCAI C subgroup of SHOCK treated with mechanical support showed a statistically significant improvement in survival outcomes compared to those treated without mechanical support. Further studies with adequate sample sizes are required to investigate sub-populations of SCAI classes that may benefit from MCS devices.

Direct comparison of mechanical circulatory support devices in porcine model of acute myocardial infarction complicated by ventricular septal defect and cardiogenic shock

Abstract Introduction Despite urgent clinical need, until now optimal strategy for mechanical circulatory support in acute myocardial infarction (AMI) complicated by ventricular septal defect (VSD) and cardiogenic shock has not been determined. Purpose The aim of our study was to compare hemodynamic effects of intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) and Impella CP in the animal model of AMI complicated by VSD and cardiogenic shock. Methods Under general anesthesia and mechanical ventilation in pigs (sus scrofa domestica), using partial sternotomy, AMI was induced by ligation of left anterior descending. VSD was simulated by insertion of 25F cannulas into the left and right ventricles and their extracorporeal connection by 3/8 tubes generating left-to-right shunt. The hemodynamic effect of ECMO (2 L/min), IABP, and Impella CP (2 L/min) was evaluated by the measurement of the left ventricular end-diastolic pressure (LVEDP), mean arterial pressure (MAP), carotid flow (CAR) as a surrogate of total circulatory output, and VSD flow. Data are presented as mean (SD), P < 0.05 was considered statistically significant. Results Eleven animals were used, one died after induction of AMI, ten pigs completed all study procedures. Baseline (no mechanical support) LVEDP was 13.8 (3.0) mmHg, MAP 54.5 (11.0) mmHg, CAR 290.9 (37.3) mL/min, and VSD 1174.0 (499.3) mL/min (Table 1). IABP significantly improved all parameters in comparison to Baseline (Table 1). ECMO significantly improved MAP and CAR not only in comparison to Baseline but also in comparison to IABP and Impella; on the other hand, ECMO increased VSD flow (Table 1). Impella significantly improved all parameters with the largest effect on LVEDP and VSD flow (Table 1). Conclusions All tested devices improved the key hemodynamic parameters of MAP and CAR, however each to different extent. Individual devices influenced differently LVEDP and VSD flow. The results of this study may help in selection of optimal therapeutic strategy in AMI complicated by VSD and cardiogenic shock.Table 1.Hemodynamic outcomes.

Support mechanisms and obstacles for developing public health practitioners’ core competences

Abstract Community health needs assessment is one of the central activities for local governments in Estonia, specifically under the health promotion strategic planning, and this includes developing health and well-being profiles for evidence-based public health promotion. For effective implementation of the profile, sufficiently trained public health practitioners are needed. Therefore, analysis of the needs of the additional study programmes according to the core competences of professional standard for health promotion was carried out among public health practitioners and the leaders of local governments. The study was based on the 19 semi-structured interviews carried out in 2022-2023 with leaders (10) and public health practitioners (9) in Estonian local governments. Based on the local government’s size, status of the health and well-being profile and the employment and educational background of the public health practitioner three sub-groups were developed. The collected data was analysed using qualitative content analysis with focus on support mechanisms and obstacles of core competences of public health practitioners. The respondents indicated the need for training on communication (leadership and advocacy) and analytical skills (evaluation and research). Core competence training is however limited by resources (time, energy, motivation, funding), employer expectations (overload at work) and working full-time. Training is supported by personal motivation (e.g., wish to stay competent, understanding the need for training), employer support (including flexible work arrangements), and curriculum support (funding is covered). The results indicate there is a need for flexible education as the need for developing and maintaining core competences emerges in practical work. The results can be used for developing the public health curriculum, to assess and provide training for public health practitioners to better meet the needs of the labor market in the future. Key messages • Local government employees performing health promotion tasks feel the need to upgrade various core competences: e.g., communication, management, data analysis and assessment. • In health promotion, there is a growing need for flexible education, which creates challenges for higher educational institutions to meet the needs of the labor market.

Safety and mid-term outcomes of impella compared to intra-aortic balloon pumping in patients who required mechanical cardiac support

Abstract Background Impella (Abiomed USA) is a promising alternative to improve prognosis in patients with cardiogenic shock requiring mechanical cardiac support (MCS). Despite of its advanced hemodynamic profile, its superiority regarding prognosis has not been established yet. Aims The aims of this study were to investigate safety and mid-term outcomes of Impella compared to IABP in patients who required MCS. Methods In this single-center study, consecutive 205 patients who required IABP or Impella from January 2017 to June 2023 were evaluated retrospectively. The primary outcome was 180-day mortality. Secondary outcomes were the rate of complications including hemolysis, thrombocytopenia, bleeding, limb ischemia, acute kidney impairment and stroke. Major complication was defined as major bleeding (BARC 3-5), limb ischemia and stroke. Results Of all patients, 62 (30.2%) received Impella and 143 (69.8%) IABP. The rate of patients required extracorporeal membrane oxygenation (ECMO) support was not significantly different between two groups (31.4 % vs 38.7%; p=0.34. There were no significant differences in 180-day mortality between two groups (36.2% vs 31.1%; p=0.55). Further investigation according to SCAI classification demonstrated that the mortality rate in SCAI C group was significantly lower in Impella than IABP group (34.1% vs 6.7%; p=0.02), whereas there were not significant differences in mortality between two groups in SCAI D and E groups (54.8% vs 61.4%; p=0.71). The rate of major complications was significantly higher in Impella group (54.4% vs 72.1%; p=0.02). The rate of hemolysis (19.6% vs. 58.1%, p<0.01), thrombocytopenia (19.6% vs. 58.1%, p<0.01), limb ischemia (4.3% vs. 17.7%, p<0.01), acute kidney impairment (37.7% vs 64.5%, p<0.01) and initiation of renal replacement therapy (13.8% vs 29%, p=0.02) were significantly higher in Impella group. Multivariate analysis adjusting for Impella use, out of hospital cardiopulmonary arrest (OHCPA), initial lactate ≥60 md/dL and major complication, revealed that age ≥70 (hazard ratio (HR): 3.1, 95%CI: 1.73-5.61) and use of ECMO (HR: 4.3, 95%CI: 2.54-7.31) were independent predictor of mortality. The mortality rate arose up to 83.3% in patients with age ≥70, OHCPA and use of ECMO (HR: 9.7, 95%CI: 4.07-23.02). Conclusion The mortality rate did not differ between Impella and IABP, however Impella was associated with improved mortality in patients with SCAI C group. The complications were high likely seen in patients with Impella compared to IABP. Our findings indicate that Impella results in better outcomes with careful selection of patients, defining its indication and appropriate care. A further investigation would be of value to elucidate whether Impella improve prognosis.

Transcatheter versus surgical aortic valve replacement in aortic stenosis patients requiring mechanical circulation support: a nationwide Japanese study

Abstract Introduction Transcatheter aortic valve replacement (TAVR) has demonstrated comparable clinical outcomes to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS). However, previous trials excluded patients who had required mechanical circulatory support (MCS) for cardiogenic shock. Thus, the clinical feature of aortic valve replacement requiring MCS and the efficacy of TAVR compared to SAVR has not been fully exhibited in AS patients. Purpose This study investigated the demography and clinical outcomes comparing TAVR and SAVR for AS demanding MCS. Methods The current study was an observational retrospective study using Japanese nationwide data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Between April 1, 2012, and March 31, 2022, AS patients undergoing TAVR or SAVR who required MCS were evaluated. The primary outcome was 30-day mortality. In addition, we assessed ischemic stroke, hemorrhagic stroke during hospitalization. Result During the period, 80,752 patients (TAVR=36,546 and SAVR=44,206) were identified. The frequency of MCS (intra-aortic balloon pumping and/or extracorporeal membrane oxygenation) was 3.0% (1,097 patients) of the TAVR group and 4.8% (2,133 patients) of the SAVR group. In the TAVR group, 78% of patients were implanted balloon-expandable valve and 7.1% of patients were transapical apical approach. TAVR was performed in older (median age: 85 years vs. 76 years, p<0.001), lower body mass index (BMI) (median BMI: 21.5 kg/m2 vs. 22.7 kg/m2, p<0.001), and more female patients (42% vs. 27%, p<0.001) than SAVR. The 30-day mortality was lower in TAVR than SAVR (12% in TAVR and 19% in SAVR, p<0.001) (Figure). After adjusting age, gender, TAVR was significantly associated with decreased 30-day mortality compared to SAVR (adjusted HR 0.52 (0.41–0.67), p<0.001). In contrast, the incidence of ischemic stroke and hemorrhagic stroke were comparable in 2 groups (ischemic stroke; 4.2% in TAVR vs. 4.1% in SAVR, p=0.93 and hemorrhagic stroke; 0.3% vs. 0.3%, respectively). Conclusion According to nationwide real-world clinical data on aortic valve replacement for AS, the frequency of patients requiring MCS due to cardiogenic shock was 3.0% in the TAVR group and 4.8% in the SAVR group. Our findings demonstrated short-term outcomes following TAVR for patients requiring MCS for cardiogenic shock was better than those following SAVR.

6.Q. Round table: Artificial Intelligence in healthcare: navigating ethically with equity and workforce empowerment

Abstract Background Artificial Intelligence (AI) is emerging as a pivotal technology with vast promises for healthcare. However, integrating AI into clinical and public health settings must be cautiously approached to ensure that it does not inadvertently exacerbate existing health system problems. The healthcare workers, already under severe stress, could view AI as a threat to job security rather than as a support mechanism. Moreover, past experiences with digital transformations, such as Electronic Health Records, have shown that technological integration can sometimes increase rather than decrease the burden on healthcare workers, leading to burnout and dissatisfaction, and thus worsening the healthcare workforce crisis. Furthermore, equity and ethical considerations are paramount in the deployment of AI in healthcare. Data privacy, patient consent, and algorithmic bias must be addressed to ensure that AI applications are designed to support and enhance human decision-making that is sensitive to the social determinants of health and accountable to equity and social inclusion, to the needs and rights of the healthcare workforce, and the dignity of the patients and populations. While AI presents significant opportunities for health systems and healthcare workers, there is a lack of knowledge, evidence-based policies, and ethical frameworks that support equitable and human-centred approaches to AI implementation. Objectives This round table workshop aligns three major public health challenges: the integration of AI in health systems, the global healthcare workforce crisis, and the improvement of equity and equality. It critically explores capacity building for AI, equity in AI implementation, and regulatory measures for ethical and responsible AI deployment, addressing the following major questions: What are the critical impacts of AI on the healthcare workforce? How can the healthcare workforce be effectively upskilled and supported to adapt to the changes brought by AI technologies? What regulatory frameworks and governance models are necessary to ensure AI’s safe and ethical implementation in healthcare, that is also sensitive to equity, gender equality and the needs of minority groups? Finally, what actionable steps and leadership can public health take to implement AI technologies while addressing the healthcare workforce needs, equity issues, and ethical guidelines? The panellists will illuminate these questions from different disciplinary approaches, helping us to disentangle complexity and to build capacity for evidence-based and socially inclusive AI policies. The workshop contributes to better understand the risks and benefits of AI. It seeks to advance knowledge exchange of good practice experiences and effective implementation. Key messages • The effects of AI on the healthcare workforce must be monitored and strategies adapted to mitigate the healthcare workforce crisis and to upskill and empower healthcare workers. • There is a need for human-centred and ethically responsive AI implementation and governance measures that support equity, gender equality, and diversity in healthcare settings. Speakers/Panelists Abi Sriharan Schulich School of Business York University, York, Canada Kasia Czabanowska Maastricht University, Maastricht, Netherlands Bernadette Kumar Migration Health Unit, Norwegian Institute of Public Health, Oslo, Norway Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Farhang Tahzib Faculty of Public Health, Haywards heath, UK

Bilateral multiple ribs and sternum fracture causing central flail chest with respiratory failure

Bilateral thoracic blunt injuries in a patient may present with central Flail chest, and acute respiratory failure which is one of the life-threatening complications. We present a case of central flail chest caused by blunt trauma, successfully managed with operative rib and sternum fixation. A 35-year male with a central flail chest with acute respiratory failure caused by road-traffic accident who was managed initially with bilateral intercostal chest-tube drainage for significant bilateral hemopneumothorax and lung contusions. The patient was intubated and connected to mechanical ventilatory support with positive pressure ventilation for the internal pneumatic stabilization. There were multiple rib fractures anteriorly (first to seventh rib bilaterally) and fracture of the sternum - the flail chest, for which he underwent bilateral rib fixation and fixation of sternum with titanium reconstruction plate and screws on the 9th postinjury day. Tracheostomy was done along with fixation in the same sitting. Post-operatively, after 48 hours of positive pressure mechanical ventilation, the weaning was started and by the 4-5th day, the patient was on room air with a tracheostomy tube. The patient recovered uneventfully and was discharged on the eighth postoperative day.

Family Social Support Can Reduce Work Stress In Farmers

Background: Farmers often work alone in remote environments with little time for rest or socialization, leading to mental health problems and poor psychological well-being. The imbalance between physical and psychological aspects leads to physical responses such as difficulty concentrating, and psychological responses such as anxiety. Social support, self-efficacy, and coping mechanisms play a role in addressing farmers' work-related stress. Objective: This study aims to analyze family social support can reduce work stress in farmers Methods: The method used in this research is a literature study using 3 databases, namely Google Scholar, Science Direct, and PubMed with a range of publication years 2019-2024. Results: The results showed that farmers' work stress can be caused by various factors, including heavy workload, long working hours, as well as pressure from weather, pests, and changes in market prices. Furthermore, it has been found that high family social support can reduce farmers' work-related stress. However, it has also been found that family social support has a significant impact on farmers' stress but not on farmers' psychological well-being. Conclusion: It is important for nurses to provide education to farmers to address work-related stress by first observing the causes of farmers' work-related stress and their experiences in coping with it. Family social support is one alternative that can be provided as education to farmers to address their work-related stress. Therefore, it is necessary to further understand how family social support affects farmers' work stress and how effective coping strategies can reduce this pressure.

Interventional Applications for an Ostial Protection Guidewire-The WALPO Technique.

Coronary atherosclerotic lesions at the ostium and proximal coronary arteries pose significant challenges in percutaneous coronary interventions (PCI), especially in the left main coronary artery (LMCA). Guide catheter-induced damage can lead to severe complications such as vessel dissection or myocardial infarction. Ostial stent placement with drug-eluting stents offers mechanical support and reduces restenosis but is technically challenging due to the anatomical complexity of the ostium. Complications like longitudinal stent deformation and hydraulic dissection from contrast media are specific concerns. The aortic free-floating wire technique, expanded in this article to Wire in Aorta for Localization and Protection of the Ostium (WALPO), provides a method for safely locating and protecting the ostium during PCI, aiming to improve the safety and efficacy of PCI at this location.

Outcomes of intra-aortic balloon pump in patients with advanced heart failure and cardiogenic shock undergoing heart transplantation

Abstract Background Intra-aortic balloon pump (IABP) is generally used as a short-term device to maintain adequate organ perfusion in patients with cardiogenic shock (CS). However, whether IABP improves clinical outcomes as a bridge therapy for heart transplant (HTx) remains controversial. Purpose Evaluate the survival rate 30 days after heart transplant (HTx) in patients with advanced heart failure (HF) and CS using IABP pre transplant compared to non-IABP group. Methods We retrospectively analyzed consecutive patients with advanced HF and CS, admitted in the cardiac intensive care unit (ICU) of a tertiary university center, between 2009 and 2020, who underwent HTx. Study group included patients submitted to IABP implantation before HTx, and a non-IABP group submitted to HTx without left ventricular mechanical support. Propensity Score Matching was used to pair the groups according to relevant clinical covariates. The primary outcome of survival rate 30 days after HTx was estimated by the Kaplan-Meier method. Results 326 were enrolled, 199 in IABP group and 127 in non-IABP group. For non-IABP and IABP group, respectively, the most frequent etiology was Chagas disease (29,9% and 47,2%, p=0,006) followed by idiopathic cardiomyopathy and ischemic cardiomyopathy, the majority of patients were male (63% and 61,3%, p=0,760), the mean age was 46,9 ± 14,4 and 46,5 ± 12 years (p=0,791) and mean left ventricular ejection fraction was 25,9 ± 9,5% and 23,5 ± 5,9% (p=0,010). The Simplified Acute Physiology Score 3 (SAPS 3) at ICU admission was compared in both groups, which was 36,8% ± 17,8% in non-IABP group and 32,6% ± 18,6% in IABP group (p=0,042). At 30 days after HTx, there was no statistical difference in overall survival (p=0,459) between the groups (IABP: 18,1% mortality; non-IABP: 14,2% mortality). Survival rate after HTx was also similar in patients with Chagas disease compared to the other etiologies in both study groups (IABP group: p=0,221; non-IABP group: p=0,421). Conclusion In patients with advanced HF and CS submitted to HTx, the survival rate 30 days after HTx was equivalent in the IABP and non-IABP groups. In patients with Chagas disease the survival was also similar compared to other etiologies in both groups.Characteristics according to groupsKaplan-Meier survival estimates

Shining light on the shadows: The role of corruption control in the relationship between board composition and SDG disclosure

AbstractThis paper investigates how corruption control moderates the relationship between board composition and Sustainable Development Goals (SDG) disclosure. We analyze a sample of 269 companies from Mediterranean capitalism countries (Portugal, Greece, Italy, Spain, Malta, and Cyprus) combining a symmetric method (panel data analysis) and an asymmetric approach (fuzzy‐set qualitative comparative analysis). Our findings show that larger boards enhance SDG disclosure and female presence negatively impacts SDG disclosure. Corruption control is a driver of SDG disclosure, and the effect of board size on SDG disclosure is greater when companies are operating in countries with low rates of corruption. This the first paper that investigates the relationship between board composition and SDG disclosure, highlighting the moderating effect of controlling corruption at the country level. Managers should be aware that some board characteristics drive greater SDG disclosure. Additionally, governments can support SDG disclosure by combating corrupt practices in their countries, and by creating support mechanisms for companies to incorporate SDGs into business strategies.

Living with Dementia: exploring the challenges and needs of informal Dementia caregivers in Portugal

Abstract Background Dementia profoundly impacts not only those diagnosed but also their informal caregivers. The Nova Center for Global Health at NOVA-IMS, in collaboration with the Alzheimer Portugal Association, embarked on a comprehensive study to explore the various aspects of daily life that affect informal caregivers of people with dementia in Portugal. Understanding these impacts is important for developing targeted interventions that address the caregivers’ needs effectively, particularly given the current lack of research on informal dementia caregivers. Methods The study utilized a crafted survey developed through initial scripting on key topics identified by informal caregivers and validated by experts on dementia. This phase was followed by a series of in-depth interviews with professionals in neurology, psychology, and social work, as well as with the caregivers themselves. The final survey was distributed among members of the Alzheimer Portugal Association and other volunteers, resulting in 305 valid responses. Results Preliminary findings reveal significant emotional, physical, and financial challenges faced by caregivers, underlining the diverse needs across 14 key areas of their lives. The study highlights specific areas where support is lacking, providing a grounded basis for developing more effective support mechanisms. Conclusions The ‘Living with Dementia’ project underscores the complex reality faced by informal caregivers. It calls for innovative, practical solutions that can alleviate the burden on these caregivers and improve their quality of life. By addressing the specific needs identified through this research, policy-makers and support organizations can better tailor their interventions to help those at the front lines of caregiving in dementia. Key messages • Informal caregivers of people with dementia face challenges that necessitate a comprehensive understanding to tailor effective support systems. • Interventions are needed that address the emotional, physical, and financial hardships caregivers face, improving their overall well-being and capacity to care.

A realist change model for community-based perinatal mental health peer support from peer volunteers

ABSTRACT Aims To investigate what it is about community-based perinatal mental health peer support from trained volunteers that works, for whom, in what circumstances, in what respects, and why; and build a change model that includes positive and negative mechanisms and outcomes. Methods Realist evaluation methods based on semi-structured interviews were used to create a change model for a third sector programme in England. Results Mothers who received peer support (n = 20), peer support volunteers (n = 27), and programme staff (n = 9) were interviewed. Positive impact on mothers was primarily based on feeling understood and accepted, social comparison (including normalisation, hope, and gaining perspective) and sharing non-directive information from experiential knowledge. Negative impact on mothers was based on negative social comparison, or absence of key peer support mechanisms. Mothers were affected in different ways, depending on individual contexts: their backgrounds, personalities, social situations, resources, experiences, beliefs, and needs. Some different mechanisms were present in one-to-one and group situations. All participants considered the benefits of peer support to greatly outweigh the risks. Conclusion Individual contextual factors affect the multiple mechanisms through which mental health peer support can improve mothers’ emotional wellbeing and social participation. Peer support has potential risks as well as benefits, which can be mitigated. Programmes could use this understanding of how contexts and mechanisms interact to produce peer support outcomes to improve training for peer support volunteers and to design future evaluations that take into account diversity of peer support experience.

Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis.

We planned this study considering that complications of deep neck infections can be seriously life threatening. To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity. This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications. There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years. Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.

Leaf architecture and functional traits for 122 species at the University of California Botanical Garden at Berkeley.

The dataset contains leaf venation architecture and functional traits for a phylogenetically diverse set of 122 plant species (including ferns, basal angiosperms, monocots, basal eudicots, asterids, and rosids) collected from the living collections of the University of California Botanical Garden at Berkeley (37.87° N, 122.23° W; CA, USA) from February to September 2021. The sampled species originated from all continents, except Antarctica, and are distributed in different growth forms (aquatic, herb, climbing, tree, shrub). The functional dataset comprises 31 traits (mechanical, hydraulic, anatomical, physiological, economical, and chemical) and describes six main leaf functional axes (hydraulic conductance, resistance and resilience to damages caused by drought and herbivory, mechanical support, and construction cost). It also describes how architecture features vary across venation networks. Our trait dataset is suitable for (1) functional and architectural characterization of plant species; (2) identification of venation architecture-function trade-offs; (3) investigation of evolutionary trends in leaf venation networks; and (4) mechanistic modeling of leaf function. Data are made available under the Open Data Commons Attribution License.

IMPLEMENTATION OF INTERNATIONAL EXPERIENCE OF STATE PROTECTION OF NATIONAL VALUES IN UKRAINE

The author of the article reveals the purpose of implementing the international experience of the system of state protection of national values through the prism of two important trends that should be implemented and and enshrined in the practice of state-building processes in modern Ukraine. One of them stipulates that national values are the central core of the national security system security system, they define the triad of ‘values-interests-goals’. The second trend defines the system of creating mechanisms for legislative support of guaranteeing and protecting of national values, which is embodied in the systemic nature of the state policy on national development and is the actual consolidation of the civilisational civilisational choice of the Ukrainian nation at the level of legal acts. The purpose of the article is to analyse practical aspects of implementation of the state mechanisms for protection of national values in foreign countries and their implementation in the Ukrainian State. The author emphasises that national values of of modern Ukraine should not be subject to political bargaining, speculation, etc. They are are always an element of political struggle. Without this, political processes are impossible, and therefore, national values should be defined and prohibited for political speculation on them, which, by the way, requires the development of an institution of for their criminal law protection; and - to have its own system of mechanisms of legislative protection. It is determined that the first step towards the implementation of the experience of foreign countries in protecting national values should be the introduction of an all-Ukrainian analytical study of the system of national values. It should should be based on long-term and medium-term forecasts of domestic development and the development of the system of world politics, its specific regional and functional subsystems. This means that the full potential of national research institutes in the field of public opinion, civil society, and sociological research should be used to society, and sociological research should be directed within the framework of a single state policy to study and define national values.

Cardiomyopathy: pathogenesis and therapeutic interventions.

Cardiomyopathy is a group of disease characterized by structural and functional damage to the myocardium. The etiologies of cardiomyopathies are diverse, spanning from genetic mutations impacting fundamental myocardial functions to systemic disorders that result in widespread cardiac damage. Many specific gene mutations cause primary cardiomyopathy. Environmental factors and metabolic disorders may also lead to the occurrence of cardiomyopathy. This review provides an in-depth analysis of the current understanding of the pathogenesis of various cardiomyopathies, highlighting the molecular and cellular mechanisms that contribute to their development and progression. The current therapeutic interventions for cardiomyopathies range from pharmacological interventions to mechanical support and heart transplantation. Gene therapy and cell therapy, propelled by ongoing advancements in overarching strategies and methodologies, has also emerged as a pivotal clinical intervention for a variety of diseases. The increasing number of causal gene of cardiomyopathies have been identified in recent studies. Therefore, gene therapy targeting causal genes holds promise in offering therapeutic advantages to individuals diagnosed with cardiomyopathies. Acting as a more precise approach to gene therapy, they are gradually emerging as a substitute for traditional gene therapy. This article reviews pathogenesis and therapeutic interventions for different cardiomyopathies.

Intangible Cultural Heritage Kangwei Paintings: Literature Review and Outlook

In recent years, many countries around the world have been implementing their own protective practices for intangible cultural heritage under the impetus of the Intangible Cultural Heritage Convention. This study will conduct an in-depth investigation into the intangible cultural heritage of Kangwei paintings in Yuanping City, Shanxi Province, China, exploring the process of cultural identity formation and the role of commercialization in the context of intangible cultural heritage revitalization, an area that has not been deeply researched before.Using the systematic literature review method, a review was conducted on 102 relevant documents and journal articles sourced from China National Knowledge Infrastructure (CNKI). Conduct a literature review from the perspectives of overall research characteristics, highly cited literature, theoretical foundations, and research methods.The results of the literature analysis are systematically elaborated from the aspects of the connotation and extension of Kangwei paintings, the practical mechanisms for the revitalization of Kangwei paintings as intangible cultural heritage, and related suggestions. The study found that the practical mechanisms for the revitalization of Kangwei paintings as intangible cultural heritage include institutional support mechanisms, theoretical consolidation mechanisms, collaborative mechanisms, social education mechanisms, application innovation mechanisms, and efficiency evaluation mechanisms, with no related research proposed.Therefore, based on the framework for the revitalization of Yuanping Kangwei paintings, the prospects of cultural identity and commercialization concepts are proposed: solidifying the theoretical foundation for the revitalization of Kangwei paintings as intangible cultural heritage, scientifically defining the connotations and extensions of Kangwei paintings, refining the cultural identity mechanism for the revitalization of Kangwei paintings as intangible cultural heritage, and enriching the theoretical foundation for the study of the commercialization of Kangwei paintings.

Beyond the school: principals’ insights on expanded roles in times of crisis. The case of COVID-19 in Turkey

ABSTRACT This study examined the perspectives of school principals on the workload of the additional administrative responsibilities they were assigned during COVID-19 in Turkey. The purpose of this study was to gain insight into the nature of these additional responsibilities and to assess their impact on the principals who took them on. The research group consisted of 62 school administrators (principals and vice principals), from public elementary schools. The research data were collected through semi-structured interviews. The collected data were analyzed using content analysis. The results showed that principals were assigned tasks without regard to their specific roles, with no differentiation based on their positions. The study also revealed a variety of emotional experiences among the participants, ranging from fear and anxiety to feelings of satisfaction and commitment. Overall, this study provided valuable insights into the complex dynamics of principals’ experiences during COVID-19 and highlighted the need for transparent communication, equitable task allocation, and adequate support mechanisms to maintain their well-being and commitment.

Teacher education in Israel: a fifty-year journey (1974–2024)

ABSTRACT This study explores the evolution of teacher education in Israel from 1974 to 2024, analysing key policy actions, reforms, and initiatives that have shaped the field over the past five decades. During these years, extensive efforts were undertaken at the state level by the Ministry of Education and the Council for Higher Education to elevate the status of the teaching profession by advocating for the professionalisation and professionalism of teaching and teachers. These efforts include the academisation process of all teacher education colleges, the establishment of task forces and standing committees to address challenges, continuous upgrades and adjustments to the initial teacher education curriculum, support mechanisms for newly qualified teachers, ongoing professional development for practicing teachers, including master’s degree programmes, salary adjustments, and the decision to move the colleges of education to the sole auspices of the Council for Higher Education and the Planning and Budgeting Committee. Despite these numerous attempts, the status of teachers has continued to decline, and the profession has struggled with low public perception and prestige, leading to both quantitative and qualitative teacher shortages. The repeated policy shifts and inconsistent implementation strategies have often exacerbated rather than resolved these issues. By providing a comprehensive historical analysis, the study offers insights into the successes and significant shortcomings of past initiatives, aiming to inform future policy-making and strategic planning to enhance the effectiveness and appeal of the teaching profession in Israel.