Néhány gondolat a klímaváltozáshoz való társadalmi-gazdasági alkalmazkodás kérdéseinek kutatásához

Az ezredforduló környékén, amikor már megerősödtek a Balaton-régió fejlesztésének intézményes keretei, létrejött a Balaton Fejlesztési Tanács, megalakult annak háttérszervezete, növekvő igény támadt a térség társadalmi, gazdasági fejlődéséhez szükséges statisztikai adatok elemzésére, illetve az adatgyűjtés körének bővítésére. Vizsgálati szempont volt az is, hogy helyesen történt-e a Balaton-régió lehatárolása, s hogy létezik-e balatoni identitás. Olyan kérdések vizsgálata is előtérbe került, mint ami a Balaton régió állandó és üdülőnépessége közötti különbség okainak vizsgálata, a népesség korösszetételének változása, a vándorlási különbözet okai

Impact of Modifiable Bleeding Risk Factors on Major Bleeding in Patients With Atrial Fibrillation Anticoagulated With Rivaroxaban.

Background Reducing major bleeding events is a challenge when managing anticoagulation in patients with atrial fibrillation. This study evaluated the impact of modifiable and nonmodifiable bleeding risk factors in patients with atrial fibrillation receiving rivaroxaban and estimated the impact of risk factor modification on major bleeding events. Methods and Results Modifiable and nonmodifiable risk factors associated with major bleeding events were identified from the XANTUS (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation) prospective registry data set (6784 rivaroxaban-treated patients). Parameters showing univariate association with bleeding were used to construct a multivariable model identifying independent risk factors. Modeling was used to estimate attributed weights to risk factors. Heavy alcohol use (hazard ratio [HR]=2.37; 95% CI 1.24-4.53); uncontrolled hypertension (HR after parameter-wise shrinkage=1.79; 95% CI 1.05-3.05); and concomitant treatment with antiplatelets, nonsteroidal anti-inflammatory drugs, or paracetamol (HR=1.80; 95% CI 1.24-2.61) were identified as modifiable, independent bleeding risk factors. Increasing age (HR=1.25 [per 5-year increment]; 95% CI 1.12-1.38); heart failure (HR=1.97; 95% CI 1.36-2.86); and vascular disease (HR=1.91; 95% CI 1.32-2.77) were identified as nonmodifiable bleeding risk factors. Overall, 128 (1.9%) patients experienced major bleeding events; of these, 11% had no identified bleeding risk factors, 50% had nonmodifiable bleeding risk factors only, and 39% had modifiable bleeding risk factors (with or without nonmodifiable risk factors). The presence of 1 modifiable bleeding risk factor doubled the risk of major bleeding. Conclusions Elimination of modifiable bleeding risk factors is a potentially effective strategy to reduce bleeding risk in atrial fibrillation patients receiving rivaroxaban. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01606995

Outcomes Associated With Oral Anticoagulants Plus Antiplatelets in Patients With Newly Diagnosed Atrial Fibrillation.

Importance: Patients with nonvalvular atrial fibrillation at risk of stroke should receive oral anticoagulants (OAC). However, approximately 1 in 8 patients in the Global Anticoagulant Registry in the Field (GARFIELD-AF) registry are treated with antiplatelet (AP) drugs in addition to OAC, with or without documented vascular disease or other indications for AP therapy. Objective: To investigate baseline characteristics and outcomes of patients who were prescribed OAC plus AP therapy vs OAC alone. Design, Setting, and Participants: Prospective cohort study of the GARFIELD-AF registry, an international, multicenter, observational study of adults aged 18 years and older with recently diagnosed nonvalvular atrial fibrillation and at least 1 risk factor for stroke enrolled between March 2010 and August 2016. Data were extracted for analysis in October 2017 and analyzed from April 2018 to June 2019. Exposure: Participants received either OAC plus AP or OAC alone. Main Outcomes and Measures: Clinical outcomes were measured over 3 and 12 months. Outcomes were adjusted for 40 covariates, including baseline conditions and medications. Results: A total of 24 436 patients (13 438 [55.0%] male; median [interquartile range] age, 71 [64-78] years) were analyzed. Among eligible patients, those receiving OAC plus AP therapy had a greater prevalence of cardiovascular indications for AP, including acute coronary syndromes (22.0% vs 4.3%), coronary artery disease (39.1% vs 9.8%), and carotid occlusive disease (4.8% vs 2.0%). Over 1 year, patients treated with OAC plus AP had significantly higher incidence rates of stroke (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.01-2.20) and any bleeding event (aHR, 1.41; 95% CI, 1.17-1.70) than those treated with OAC alone. These patients did not show evidence of reduced all-cause mortality (aHR, 1.22; 95% CI, 0.98-1.51). Risk of acute coronary syndrome was not reduced in patients taking OAC plus AP compared with OAC alone (aHR, 1.16; 95% CI, 0.70-1.94). Patients treated with OAC plus AP also had higher rates of all clinical outcomes than those treated with OAC alone over the short term (3 months). Conclusions and Relevance: This study challenges the practice of coprescribing OAC plus AP unless there is a clear indication for adding AP to OAC therapy in newly diagnosed atrial fibrillation

Bentall procedure: quarter century of clinical experiences of a single surgeon

BACKGROUND: We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results. METHODS: Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 +/- 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart. RESULTS: The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 +/- 2.3 %, 84.3 +/- 3.1 %, 76.3 +/- 4.9 % and 59.5 +/- 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739-10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158-7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283-8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339-35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246-7.883, p = 0.015) as significant risk factors for the late overall death. The survival rate for freedom from early complication was 94.3 +/- 2.2 %, 88.0 +/- 3.3 %, 82.9 +/- 4.7 % and 69.2 +/- 8.4 % at 1,5,10 and 20 years. The main pathological findings of the aortic wall were cystic medial degeneration in 75 %, fibrosis in 6 %, atherosclerosis in 13 % and no pathological alteration in 6 % of the samples. The overall survival rate was significantly lower in patients operated in first 15 years compared to patients operated in the last decade (log-rank p = 0.011). CONCLUSION: According to our long-term follow-up the Bentall operation provides an appropriate functional result by resolving the lesions of the ascending aorta. Based on our results, 25-30 operations done is necessary to gain such a level of confidence and experince to aquire better results on long-term survival. In addition, we discussed that there were no co-morbidities affecting on the survival of Marfan patients and prophylactic aortic root replacement ensures a longer survival among patients with Marfan syndrome

In vivo biocompatibility and pacing function study of silver ion-based antimicrobial surface technology applied to cardiac pacemakers

INTRODUCTION Evidence suggests that the rate of cardiovascular implantable electronic device (CIED) infections is increasing more rapidly than the rates of CIED implantation and is associated with considerable mortality, morbidity and health economic impact. Antimicrobial surface treatments are being developed for CIEDs to reduce the risk of postimplantation infection within the subcutaneous implant pocket. METHODS AND ANALYSIS The feasibility of processing cardiac pacemakers with the Agluna antimicrobial silver ion surface technology and in vivo biocompatibility were evaluated. Antimicrobially processed (n=6) and control pacemakers (n=6) were implanted into subcutaneous pockets and connected to a part of the muscle using an ovine model for 12 weeks. Pacemaker function was monitored preimplantation and postimplantation. RESULTS Neither local infection nor systemic toxicity were detected in antimicrobial or control devices, and surrounding tissues showed no abnormal pathology or over-reactivity. Semiquantitative scores of membrane formation, cellular orientation and vascularity were applied over five regions of the pacemaker capsule and average scores compared. Results showed no significant difference between antimicrobially processed and control pacemakers. Silver analysis of whole blood at 7 days found that levels were a maximum of 10 parts per billion (ppb) for one sample, more typically ≤2 ppb, compared with <2 ppb for preimplantation levels, well below reported toxic levels. CONCLUSIONS There was no evidence of adverse or abnormal pathology in tissue surrounding antimicrobially processed pacemakers, or deleterious effect on basic pacing capabilities and parameters at 12 weeks. This proof of concept study provides evidence of basic biocompatibility and feasibility of applying this silver ion-based antimicrobial surface to a titanium pacemaker surface

'Country life'? Rurality, folk music and 'Show of Hands'

This paper examines the contribution of folk music to understanding the dynamic, fluid and multi-experiential nature of the countryside. Drawing from literature on the geographies of music, it examines the work of 'Show of Hands', a contemporary folk band from Devon in England. Three areas are studied. First, the paper examines the musical style of Show of Hands in order to explore how hybridised, yet distinctive, styles of music emerge in particular places. Second, it demonstrates how Show of Hands' hybrid musical style has become closely associated with the Southwest of England. Finally, within these spatial and hybrid contexts, attention is given to the ways in which their music represents the 'everyday lives of the rural'. Taken together these themes assess the relevance of music in the understanding of rurality as hybrid space. © 2008 Elsevier Ltd. All rights reserved

Consumo de combustible en vehículos para transporte por carretera –modelos predictivos–

En este artículo se presentan modelos para la estimación del consumo de combustible en vehículos para transporte por carretera, con base en literatura especializada del tema y de costos de operación vehicular en los cuales está inmerso el combustible necesario para la locomoción de los vehículos. El consumo de combustible está asociado a variables como las características del vehículo, carga transportada y carretera por la que se circula, por lo que se considera dentro de la estructura de costos de operación vehicular como una componente variable, representando entre el 20 % y60 % de estos costos. Para su cuantificación existen métodos directos e indirectos que han permitido la creación de algunos modelos que predicen, con cierto grado de exactitud, el consumo para condiciones particulares de operación de los vehículos, los cuales deben ser adaptados a las condiciones particulares de cada lugar

Impact of personal values on learning approaches and academic achievements in UK higher education

In the post-Covid era of higher education, blended teaching has become the standard method of instruction. This approach incorporates various modes of delivery, and it is important for students to engage in the diverse form of learning. Considering students’ preferences for learning approaches, especially independent learning, is crucial in the development of blended teaching methods. One of the key factors affecting students’ preferences is personal values, which can influence student’s adoption of learning approaches. This, in turn, affects their engagement in the learning community and their academic performance (Gamage, Dehideniya and Ekanayake, 2021). Personal values vary culturally, and this is particularly relevant when developing blended teaching strategies for cohorts of mixed nationalities. This issue is especially pronounced in the departments and schools across the UK universities, which often have a diverse student body with mixed cultural backgrounds. Our research aims to examine the role of personal values (specifically self-direction values and conformity values) in students’ adoption of independent learning and the impact of these values on their academic achievement in blended teaching context. &nbsp; Our research was conducted in 2022 through an internship scheme sponsored by WMG. We conducted a Qualtrics survey with the convenient sample of 162 among which 146 from China (including Hong Kong S.A.R.). The results indicated that self-direction values were closely correlated with both independent learning and academic achievement while no significant correlation was found between conformity values and independent learning or between conformity values and academic performance were found. The research results hold considerable importance for educators in design self-directed study for students from varied cultural backgrounds in higher education settings