Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study

Aims: Episodes of acute heart failure (AHF) unfavourably affect multiple organs, which may have an adverse impact on the outcomes. We investigated the prevalence and clinical consequences of abnormal liver function tests (LFTs) in AHF patients enrolled in the PROTECT study. Methods and results: The LFTs comprised serial assessment of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and albumin at baseline and during follow-up (daily until discharge, on days 7 and 14). The prevalence of abnormal LFTs (above upper limit of normal for AST and ALT or below lower limit of normal for albumin) was: at baseline AST 20%, ALT 12%, albumin 40%; and at day 14: AST 15%, ALT 9%, albumin 26%. Abnormal LFTs at baseline were associated with a higher risk of in-hospital death with odds ratios [95% confidence interval (CI)] of 3.5 (1.7–7.3) for AST, 3.9 (1.8–8.4) for ALT, and 2.8 (1.3–5.9) for albumin (all P < 0.01). Abnormal baseline and discharge LFTs had an unfavourable impact on 180-day mortality with hazard ratios (95% CI) for baseline AST, ALT, and albumin of 1.3 (1.0–1.7), 1.1 (1.0–1.2), 1.4 (1.1–1.8), respectively, and 1.5 (1.1–2.0), 1.5 (1.0–2.2), and 1.6 (1.2–2.1), for discharge AST, ALT, albumin, respectively (all P < 0.05). Analysis of LFTs trajectories (calculated as changes in LFTs over time) revealed that increasing AST and ALT on day 3 as well as decreasing albumin on day 4 were independent prognosticators of 180-day outcome (all P < 0.05). Conclusions: Abnormal LFTs are frequent in AHF at baseline and during hospital stay and predict worse outcomes. Whether this association is causal and what are the underlying mechanisms involved require further study

Securitisation of the response to rhinoceros poaching in South Africa

The thesis examines conditions and nature of securitisation of a rhinoceros antipoaching response in South Africa after 2010. In a surge of rising numbers of animals being illegally hunt for their horns and other parts, the country awoke in a scramble over effective mitigation measures. Through lenses of securitisation theory, I analyse historical and social contexts, that led a range of state and nonstate actors in framing rhinoceros poaching as an emergency and helped in proclaiming it a national security threat. Aimed to secure the survival of rhinoceros in South Africa and beyond, the securitisation was achieved through chain of practices that have been introduced over the last decade in the country. Applying sociological understanding of the theory that draws on Bourdieu’s concept of the field and Foucauldian elements of theory of governmentality, I focus on evolving character of such practices, which effected in a securitised response to poaching. According to this approach, actors and audience inclined in power relations produce new meanings and practices that aim to eliminate, the threat. They do so by applying extraordinary measures, such as creating new policies or drawing attention and resources to the pronounced threat. I argue that international actors initiated the security framing of broader wildlife crime issues, which South Africa eventually accepted and reinforced as a dominant narrative. Aligning with the global actors was possible because of the historical security-based politics and aimed to achieve more favourable image of country’s tourism industry and attract financial support. On the other hand, donors help did not come without interests. These were linked to Western -oriented concepts of nature and wildlife conservation reoriented by security discourse. By using national security as a justification for extraordinary measures, such as delegating anti-poaching agenda to the security cluster and allocating more funds, South Africa was able to gain more control over resources rich areas though applying wildlife security narrative. The research utilises information from South African government agencies, nongovernmental organisation as well as other actors engaged in broadly understood conservation topic within last decade. By analysing laws, strategies, policies, official briefings, independent and academic reports as well as media articles, I construct a timeline of practices that led to securitising the rhinoceros antipoaching strategies. The thesis comprises of review of the existing literature on security and securitisation studies as well as critical analysis of trends global environmental politics, followed by specific theoretical approach and methodology that allows to analyse key elements. The research concludes with identifying potential risks and opportunities of securitisation, depending on development scenarios and provides the list of recommendations to mitigate potential negative impacts

Przyczyny przedawaryjnego stanu technicznego płatwi hali stalowej

In the exanimated steel hall, the system of purlins made of Z cold-formed profiles and bar ties was used. A periodic inspection of the technical state of the hall reveals some deformations, bends and torsion of purlins and buckling of ties. The results of tests on the resistance and rigidity of the roof covering structure, carried out to clarify the causes of described state were performed.W badanej hali stalowej przyjęto systemowe rozwiązanie płatwi z kształtowników Z (giętych z blach na zimno) oraz ich ściągów (z prętów pełnych). Okresowa kontrola jej stanu technicznego ujawniła deformacje, wygięcia i skręcenia płatwi oraz wyboczenie ściągów. Stan techniczny konstrukcji wsporczej obudowy dachu był przedawaryjny. W pracy przedstawiono wyniki badań nośności i sztywności konstrukcji wsporczej obudowy dachu, których celem była identyfikacja przyczyn powstania jej zagrożenia awarią

Equivalent stabilizing force of members parabolically compressed by longitudinally variable axial force

The EN 1993-1-1 model of equivalent stabilizing force qd and Rd of bracings conservatively assumes that the braced member is compressed with a force constant along its length. This assumption is incorrect since the axial force distribution varies along the length of the braced member. As a result, the braced member generates equivalent stabilizing forces different from equivalent force qd and Rd acc. to EN 1993-1-1. This paper presents parametric studies of the equivalent stabilizing forces of the braced, compression top chord of roof trusses. The girder’s top chord is compressed parabolically by a variable axial force. The values of the axial compressive forces is: Nsupp in the support zone of truss and Nspan in the central zone of truss. Parametric analyses of the equivalent stabilizing force and the stress of the purlins and the bracings depending on axial forces Nsupp and Nspan in the braced member were carried out. The investigated problem is illustrated with exemplary calculations of the equivalent force in trusses

Sacubitril/valsartan in a wide spectrum of heart failure patients (from mechanisms of action to outcomes in specific populations)

Heart failure (HF) represents a significant global health challenge, characterized by high morbidity and mortality rates, decreased quality of life and a significant financial and economic burden. The prevalence of HF continues to rise, driven by an ageing population and an increasing burden of comorbidities such as hypertension, diabetes and obesity. Understanding the complex pathophysiology and developing effective treatments are critical for improving patient outcomes, yet the range of effective, life-prolonging medication classes has remained mostly constant in the last few decades. The introduction of angiotensin receptor neprilysin inhibitors (ARNI) was a major breakthrough in HF management, for the first time targeting the natriuretic peptide system in addition to the renin–angiotensin–aldosterone pathway to potentiate the effects of older drug classes. ARNI shows superiority in clinical outcomes compared to previous guideline-directed therapies, especially in patients with reduced ejection fraction (EF). It has now been implemented into international guidelines, endorsing its use in patients with HF and reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF). This review summarises the mechanism of action of Sac/Val, presents key clinical trials in a range of patient populations and HF aetiologies and outlines gaps in knowledge and potential novel uses of Sac/Val

Analytical and numerical research of equivalent stabilizing force of stiffened truss chords

The aim of this paper is research of the equivalent stabilizing forces of the braced top flange of the truss. The study takes into account the initial bow imperfection e0 of the braced top flange and the im-perfection consisting in a twist of the roof girder’s principal plane by angle ϕ0(x). Moreover, axial force N3(x) in the top flange of the truss is assumed to be longitudinally parabolically variable. The values of the axial forces is: Nsupp in the support zone of the truss and Nspan in the central zone of truss. As part of this study parametric analyses of the equivalent stabilizing forces and the stress of the bracings depending on axial forces Nsupp and Nspan in the braced member were carried out. The results are compared with the results of numerical analyses of 3D models taking the geometric nonlinearity of the structure into account

Effective implementation of preventive cardiology guidelines: pathways to success

This review highlights the importance of implementing preventive cardiology guidelines—both for primary and secondary prevention—to improve patient outcomes and reduce the burden of cardiovascular disease. Despite the availability of comprehensive guidelines, adherence remains suboptimal, resulting in a persistent gap between evidence-based recommendations and real-world clinical practice. To address this, we conducted a narrative review of studies published between January 2010 and March 2024 using PubMed, Scopus, and Web of Science. Studies were included if they focused on the implementation of cardiology guidelines and identified either barriers or facilitators to adherence. The synthesis of findings was structured using the Consolidated Framework for Implementation Research (CFIR), which organizes implementation factors into five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process. Key strategies identified include continuous education and training for healthcare providers, integration of guidelines into clinical workflows through Clinical Decision Support Systems (CDSS), and strengthening of organizational infrastructure. Simplifying guidelines to increase usability and fostering patient engagement via educational interventions and digital tools were also emphasized. By aligning identified barriers with evidence-based solutions through the CFIR framework, this review provides a structured and practical roadmap for enhancing guideline adherence. Ultimately, these strategies aim to bridge the evidence–practice gap in preventive cardiology, enhancing the effectiveness, equity, and consistency of both primary and secondary cardiovascular prevention efforts