The Effect of Regional Airline Attendance Policies on Pilot Self-Removal from Duty for Illness or Fatigue

The purpose of this paper was to study the effect of current regional airline attendance policies on the willingness of crewmembers to remove themselves from duty when ill or fatigued. This study sought to determine if the current punitive attendance policies are encouraging crewmembers to operate contrary to federal regulation. A survey was given to current pilots of four regional airlines with similar attendance policies. The responses were correlated with supplied demographic and experiential data. The goal of the paper was to examine the major areas of concern and suggested solutions. The overwhelming majority of respondents felt that their companies’ fatigue, illness, and attendance policies were punitive, either by design or implementation, and were also more likely to state that these policies affected their decision to remove themselves from duty when ill or fatigued

Risk Factors for Heart Failure 20-Year Population-Based Trends by Sex, Socioeconomic Status, and Ethnicity

Background: There are multiple risk factors for heart failure, but contemporary temporal trends according to sex, socioeconomic status, and ethnicity are unknown. Methods: Using a national UK general practice database linked to hospitalizations (1998-2017), 108 638 incident heart failure patients were identified. Differences in risk factors among patient groups adjusted for sociodemographic factors and age-adjusted temporal trends were investigated using logistic and linear regression. Results: Over time, a 5.3 year (95% CI, 5.2-5.5) age difference between men and women remained. Women had higher blood pressure, body mass index, and cholesterol than men (P<0.0001). Ischemic heart disease prevalence increased for all to 2006 before reducing in women by 0.5% per annum, reaching 42.7% (95% CI, 41.7-43.6), but not in men, remaining at 57.7% (95% CI, 56.9-58.6; interaction P=0.002). Diabetes mellitus prevalence increased more in men than in women (interaction P<0.0001). Age between the most deprived (74.6 years [95% CI, 74.1-75.1]) and most affluent (79.9 [95% CI, 79.6-80.2]) diverged (interaction P<0.0001), generating a 5-year gap. The most deprived had significantly higher annual increases in comorbidity numbers (+0.14 versus +0.11), body mass index (+0.14 versus +0.11 kg/m(2)), and lower smoking reductions (-1.2% versus -1.7%) than the most affluent. Ethnicity trend differences were insignificant, but South Asians were overall 6 years and the black group 9 years younger than whites. South Asians had more ischemic heart disease (+16.5% [95% CI, 14.3-18.6]), hypertension (+12.5% [95% CI, 10.5-14.3]), and diabetes mellitus (+24.3% [95% CI, 22.0-26.6]), and the black group had more hypertension (+12.3% [95% CI, 9.7-14.8]) and diabetes mellitus (+13.1% [95% CI, 10.1-16.0]) but lower ischemic heart disease (-10.6% [95% CI, -13.6 to -7.6]) than the white group. Conclusions: Population groups show distinct risk factor trend differences, indicating the need for contemporary tailored prevention programs

Conservation-compatible retrofit solutions in historic buildings: An integrated approach

Historic, listed, or unlisted, buildings account for 30% of the European building stock. Since they are complex systems of cultural, architectural, and identity value, they need particular attention to ensure that they are preserved, used, and managed over time in a sustainable way. This implies a demand for retrofit solutions able to improve indoor thermal conditions while reducing the use of energy sources and preserving the heritage significance. Often, however, the choice and implementation of retrofit solutions in historic buildings is limited by socio-technical barriers (regulations, lack of knowledge on the hygrothermal behaviour of built heritage, economic viability, etc.). This paper presents the approach devised in the IEA-SHC Task 59 project (Renovating Historic Buildings Towards Zero Energy) to support decision makers in selecting retrofit solutions, in accordance with the provision of the EN 16883:2017 standard. In particular, the method followed by the project partners to gather and assess compatible solutions for historic buildings retrofitting is presented. It focuses on best practices for walls, windows, HVAC systems, and solar technologies. This work demonstrates that well-balanced retrofit solutions can exist and can be evaluated case-by-case through detailed assessment criteria. As a main result, the paper encourages decision makers to opt for tailored energy retrofit to solve the conflict between conservation and energy performance requirements

Donacija ILC - povratak u zavičaj (I. dio)

Summary Background Heart failure is an important public health issue affecting about 1 million people in the UK, but contemporary trends in cause-specific outcomes among different population groups are unknown. Methods In this retrospective, population-based study, we used the UK Clinical Practice Research Datalink and Hospital Episodes Statistics databases to identify a cohort of patients who had a diagnosis of incident heart failure between Jan 1, 1998, and July 31, 2017. Patients were eligible for inclusion if they were aged 30 years or older with a first code for heart failure in their primary care or hospital record during the study period. We assessed cause-specific admission to hospital (ie, hospitalisation) and mortality, by age, sex, socioeconomic status, and place of diagnosis (ie, hospital vs community diagnosis). We calculated outcome rates separately for the first year (first-year rates) and for the second-year onwards (subsequent-year rates). Patients were followed up until death or study end. This study is registered with Clinical Practice Research Datalink Independent Scientific Advisory Committee, protocol number 18_037R. Findings We identified 88 416 individuals with incident heart failure over the study period, of whom 43 461 (49%) were female. The mean age was 77·8 years (SD 11·3) and median follow-up was 2·4 years (IQR 0·5 to 5·7). Age-adjusted first-year rates of hospitalisation increased by 28% for all-cause admissions, from 97·1 (95% CI 94·3 to 99·9) to 124·2 (120·9 to 127·5) per 100 person-years; by 28% for heart failure-specific admissions, from 17·2 (16·2 to 18·2) to 22·1 (20·9 to 23·2) per 100 person-years; and by 42% for non-cardiovascular admissions, from 59·2 (57·2 to 61·2) to 83·9 (81·3 to 86·5) per 100 person-years. 167 641 (73%) of 228 113 hospitalisations were for non-cardiovascular causes and annual rate increases were higher for women (3·9%, 95% CI 2·8 to 4·9) than for men (1·4%, 0·6 to 2·1; p<0·0001); and for patients diagnosed with heart failure in hospital (2·4%, 1·4 to 3·3) than those diagnosed in the community (1·2%, 0·3 to 2·2). Annual increases in hospitalisation due to heart failure were 2·6% (1·9 to 3·4) for women compared with stable rates in men (0·6%, −0·9 to 2·1), and 1·6% (0·6 to 2·6) for the most deprived group compared with stable rates for the most affluent group (1·2%, −0·3 to 2·8). A significantly higher risk of all-cause hospitalisation was found for the most deprived than for the most affluent (incident rate ratio 1·34, 95% CI 1·32 to 1·35) and for the hospital-diagnosed group than for the community-diagnosed group (1·76, 1·73 to 1·80). Age-adjusted first-year rates of all-cause mortality decreased by 6% from 24·5 (95% CI 23·4 to 39·2) to 23·0 (22·0 to 24·1) per 100 person-years. Annual change in mortality was −1·4% (95% CI −2·3 to −0·5) in men but was stable for women (0·3%, −0·5 to 1·1), and −2·7% (–3·2 to −2·2) for the community-diagnosed group compared with −1·1% (–1·8 to −0·4) in the hospital-diagnosed group (p<0·0001). A significantly higher risk of all-cause mortality was seen in the most deprived group than in the most affluent group (hazard ratio 1·08, 95% CI 1·05 to 1·11) and in the hospital-diagnosed group than in the community-diagnosed group (1·55, 1·53 to 1·58). Interpretation Tailored management strategies and specialist care for patients with heart failure are needed to address persisting and increasing inequalities for men, the most deprived, and for those who are diagnosed with heart failure in hospital, and to address the worrying trends in women. Funding Wellcome Trust

Impact of cardiometabolic multimorbidity and ethnicity on cardiovascular/renal complications in patients with COVID-19

OBJECTIVE: Using a large national database of people hospitalised with COVID-19, we investigated the contribution of cardio-metabolic conditions, multi-morbidity and ethnicity on the risk of in-hospital cardiovascular complications and death. METHODS: A multicentre, prospective cohort study in 302 UK healthcare facilities of adults hospitalised with COVID-19 between 6 February 2020 and 16 March 2021. Logistic models were used to explore associations between baseline patient ethnicity, cardiometabolic conditions and multimorbidity (0, 1, 2, >2 conditions), and in-hospital cardiovascular complications (heart failure, arrhythmia, cardiac ischaemia, cardiac arrest, coagulation complications, stroke), renal injury and death. RESULTS: Of 65 624 patients hospitalised with COVID-19, 44 598 (68.0%) reported at least one cardiometabolic condition on admission. Cardiovascular/renal complications or death occurred in 24 609 (38.0%) patients. Baseline cardiometabolic conditions were independently associated with increased odds of in-hospital complications and this risk increased in the presence of cardiometabolic multimorbidity. For example, compared with having no cardiometabolic conditions, 1, 2 or ≥3 conditions was associated with 1.46 (95% CI 1.39 to 1.54), 2.04 (95% CI 1.93 to 2.15) and 3.10 (95% CI 2.92 to 3.29) times higher odds of any cardiovascular/renal complication, respectively. A similar pattern was observed for all-cause death. Compared with the white group, the South Asian (OR 1.19, 95% CI 1.10 to 1.29) and black (OR 1.53 to 95% CI 1.37 to 1.72) ethnic groups had higher risk of any cardiovascular/renal complication. CONCLUSIONS: In hospitalised patients with COVID-19, cardiovascular complications or death impacts just under half of all patients, with the highest risk in those of South Asian or Black ethnicity and in patients with cardiometabolic multimorbidit

The Contemporary Role of Interventional Radiologists in Endovascular Aortic Repair: A Survey of CIRSE Members

Purpose To describe the outcomes of a survey conducted among CIRSE members on endovascular aortic repair and to outline the future practice and needs of CIRSE members in this area. Materials and methods An anonymous online survey with 21 questions was designed by the authors and sent to CIRSE members worldwide; data were collected for 12 weeks. Results The survey collected 326 complete responses, with most respondents practicing in Europe. Two-thirds of respondents indicated that aortic repair is performed by multidisciplinary teams including IRs, with more than half reporting that they are equal partners in performing the procedure, and 27% acting as primary operators. In their practice, the most frequently performed endovascular aortic procedures were EVAR and embolisation of endoleaks, followed by FEVAR and TEVAR. A majority of 64% of respondents predict a growth in their endovascular aortic practice in the next 5 to 10 years that could further be supported by training, an increase in the workforce, societal guidelines, and additional qualifications. Hindrances for growth include turf competition as well as hospital management decisions. Conclusion The survey indicates that Interventional Radiologists continue to play a significant role in endovascular aortic procedures and identifies challenges and opportunities to further increase the role of IR in endovascular aortic aneurysm procedures for the benefit of patients. The authors consider it essential for national societies as well as CIRSE to facilitate and encourage the clinical role of IRs in standard and complex EVAR to best guide future developments for optimal patient management in aortic disease

Cardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs The CVD-REAL 2 Study

BACKGROUND: Randomized trials demonstrated a lower risk of cardiovascular (CV) events with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes (T2D) at high CV risk. Prior real-world data suggested similar SGLT-2i effects in T2D patients with a broader risk profile, but these studies focused on heart failure and death and were limited to the United States and Europe. OBJECTIVES: The purpose of this study was to examine a broad range of CV outcomes in patients initiated on SGLT-2i versus other glucose-lowering drugs (oGLDs) across 6 countries in the Asia Pacific, the Middle East, and North American regions. METHODS: New users of SGLT-2i and oGLDs were identified via claims, medical records, and national registries in South Korea, Japan, Singapore, Israel, Australia, and Canada. Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching. Hazard ratios (HRs) for death, hospitalization for heart failure (HHF), death or HHF, MI, and stroke were assessed by country and pooled using weighted meta-analysis. RESULTS: After propensity-matching, there were 235,064 episodes of treatment initiation in each group: approximately 27% had established CV disease. Patient characteristics were well-balanced between groups. Dapagliflozin, empagliflozin, ipragliflozin, canagliflozin, tofogliflozin, and luseogliflozin accounted for 75%, 9%, 8%, 4%, 3%, and 1% of exposure time in the SGLT-2i group, respectively. Use of SGLT-2i versus oGLDs was associated with a lower risk of death (HR: 0.51: 95% confidence interval [CI]: 0.37 to 0.70: p < 0.001), HHF (HR: 0.64: 95% CI: 0.50 to 0.82: p = 0.001), death or HHF (HR: 0.60: 95% CI: 0.47 to 0.76: p < 0.001), MI (HR: 0.81: 95% CI: 0.74 to 0.88: p < 0.001), and stroke (HR: 0.68: 95% CI: 0.55 to 0.84: p < 0.001). Results were directionally consistent across both countries and patient subgroups, including those with and without CV disease. CONCLUSIONS: In this large, international study of patients with T2D from the Asia Pacific, the Middle East, and North America, initiation of SGLT-2i was associated with a lower risk of CV events across a broad range of outcomes and patient characteristics. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]: NCT02993614)