Conservative management in very elderly patients with severe aortic stenosis: Time to change?

Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 were included. Baseline clinical characteristics, echocardiographic data, Charlson index, and EuroSCORE-II were registered, including vital status and performance of valve intervention during one-year follow-up. For the purpose of this substudy we assessed symptomatic patients undergoing conservative management, including them in 5 groups according to the reason for performing conservative management [I: comorbidity/frailty (128, 43.8%); II: dementia 18 (6.2%); III: advanced age 34 (11.6%); IV: patients’ refusal 62 (21.2%); and V: other reasons 50 (17.1%)]. We included 292 patients aged 81.5 ± 9 years. Patients from group I had higher Charlson index (4 ± 2.3), higher EuroSCORE-II (7.5 ± 6), and a higher overall (42.2%) and non-cardiac mortality (16.4%) than the other groups. In contrast, patients from group III had fewer comorbidities, lower EuroSCORE-II (4 ± 2.5), and low overall (20.6%) and non-cardiac mortality (5.9%). Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative management. A prospective assessment of comorbidity and other geriatric syndromes might contribute to improve therapeutic strategy in this clinical setting.

Tourism and arctic observation systems : Exploring the relationships

The Arctic is affected by global environmental change and also by diverse interests from many economic sectors and industries. Over the last decade, various actors have attempted to explore the options for setting up integrated and comprehensive trans-boundary systems for monitoring and observing these impacts. These Arctic Observation Systems (AOS) contribute to the planning, implementation, monitoring and evaluation of environmental change and responsible social and economic development in the Arctic. The aim of this article is to identify the two-way relationship between AOS and tourism. On the one hand, tourism activities account for diverse changes across a broad spectrum of impact fields. On the other hand, due to its multiple and diverse agents and far-reaching activities, tourism is also well-positioned to collect observational data and participate as an actor in monitoring activities. To accomplish our goals, we provide an inventory of tourism-embedded issues and concerns of interest to AOS from a range of destinations in the circumpolar Arctic region, including Alaska, Arctic Canada, Iceland, Svalbard, the mainland European Arctic and Russia. The article also draws comparisons with the situation in Antarctica. On the basis of a collective analysis provided by members of the International Polar Tourism Research Network from across the polar regions, we conclude that the potential role for tourism in the development and implementation of AOS is significant and has been overlooked.

Land use change from rainforests to oil palm plantations and food gardens in Papua New Guinea: Effects on soil properties and S fractions

Changes in soil sulfur (S) fractions were assessed in oil palm and food garden land use systems developed on forest vegetation in humid tropical areas of Popondetta in northern Province. The study tested a hypothesis that S in food gardens are limiting nutrient factor and are significantly lower than in plantations and forests. Subsistence food gardens are under long-term slash and burn practice of cropping and such practice is expected to accelerate loss of biomass S from the ecosystem. From each land use, surface soil (0–15 cm) samples were characterised and further pseudocomplete fractionated for S. Conversion of forest to oil palm production decreased (p<0.001) soil pH and electrical conductivity values. The reserve S fraction in soil increased significantly (p<0.05) due to oil palm production ( 28 %) and food gardening activity (∼ 54 %). However, plant available SO42--S was below 15 mg kg^(−1) in the food garden soils and foliar samples of sweet potato crop indicating deficiency of plant available S. Soil organic carbon content (OC) was positively and significantly correlated to total S content (r=0.533; p<0.001) among the land use systems. Thus, crop management practices that affect OC status of the soils would potentially affect the S availability in soils. The possible changes in the chemical nature of mineralisable organic S compounds leading to enhanced mineralisation and leaching losses could be the reasons for the deficiency of S in the food garden soils. The results of this study conclude that long-term subsistence food gardening activity enriched top soils with reserve S or total S content at the expense of soluble S fraction. The subsistence cropping practices such as biomass burning in food gardens and reduced fallow periods are apparently threatening food security of oil palm households. Improved soil OC management strategies such as avoiding burning of fallow vegetation, improved fallows, mulching with fallow biomass, use of manures and S containing fertilisers must be promoted to sustain food security in smallholder oil palm system.

Metaphors of Time and Installed Knowledge Organization Systems: Ouroboros, Architectonics, or Lachesis?

This paper describes three metaphors for time drawn from contemporary and historical literature on knowledge organization systems (KOS). It then links these metaphors to the evaluation of knowledge organization by describing the dominant paradigm in KOS evaluation to be judging whether a KOS is correct. We conclude by saying a foundational view of evaluating and theorizing about KOS must account for change and time in order for us to take a long view of improving knowledge organization and our understanding of KOS.

Some Temporal Aspects of Indexing and Classification: Toward a Metrics for Measuring Scheme Change

In this paper we discuss the temporal aspects of indexing and classification in information systems. Basing this discussion off of the three sources of research of scheme change: of indexing: (1) analytical research on the types of scheme change and (2) empirical data on scheme change in systems and (3) evidence of cataloguer decision-making in the context of scheme change. From this general discussion we propose two constructs along which we might craft metrics to measure scheme change: collocative integrity and semantic gravity. The paper closes with a discussion of these constructs.

A Kaleidoscope Perspective: Change in the Semantics and Structure of Facets and Isolates in Analytico-Synthetic Classification

Examines the limitations of the dynamic theory of classification in accommodating the changes and rapid growth of new topics in the universe of knowledge. Change in an analytico-synthetic scheme for classification is much more a web of connections and mapping these changes is a complex process. Suggests that there is need for exploration of this complexity for both improving systems, and revisiting our theory.

An R package for simulating metapopulation dynamics and range expansion under environmental change

The metapopulation paradigm is central in ecology and conservation biology to understand the dynamics of spatially-structured populations in fragmented landscapes. Metapopulations are often studied using simulation modelling, and there is an increasing demand of user-friendly software tools to simulate metapopulation responses to environmental change. Here we describe the MetaLandSim R package, mwhich integrates ideas from metapopulation and graph theories to simulate the dynamics of real and virtual metapopulations. The package offers tools to (i) estimate metapopulation parameters from empirical data, (ii) to predict variation in patch occupancy over time in static and dynamic landscapes, either real or virtual, and (iii) to quantify the patterns and speed of metapopulation expansion into empty landscapes. MetaLandSim thus provides detailed information on metapopulation processes, which can be easily combined with land use and climate change scenarios to predict metapopulation dynamics and range expansion for a variety of taxa and ecological systems.

The Impacts of Climate Change on Irrigated Agriculture in Southern Portugal

Climate change projections point to increasing air temperature and reduced precipitation in southern Portugal, which would affect farming systems. This study aims to assess the impacts of climate change on irrigated agriculture in southern Portugal. These impacts were assessed by combining climate model data with a soil water balance model and a numerical model for the design of irrigation systems. Meteorological data from two weather stations were used along with three climate models (HadRM3P, HIRHAMh and HIRHAMhh; 2071–2100). The crop rotations studied included sugar beet–maize–tomato–wheat and sunflower–wheat–barley. Two adaptation measures were considered: (i) maintaining the current crop varieties; (ii) using new crop varieties. The results from the considered climate change scenarios indicated that the impacts of climate change on irrigation requirements depend on the adopted adaptation measures. On average, the seasonal irrigation requirements increased by 13–70% when new crop varieties were used and by −13 to 7% when the current crop varieties were maintained. The impacts of climate change on irrigation system design were considerable, with the design flow rate increasing by 5–24%.

Repertory of best practices to mitigate the effects of climate change and expand the resilience of the Built Environment.

The way we live has revealed a lot about the choices made in the last decades. These choices are mostly based on a predatory socioeconomic structure, based on the pillars of anthropocentrism and inconsistent with the principles of global sustainability. This structure based on fossil fuels degrades the environment and directly and indirectly impacts the biomes. According to The International Energy Agency (2020), the sector was responsible for more than a third of global energy consumption and 40% of total GHG emissions into the atmosphere (directly and indirectly). This thesis presents the main effects of climate change observed in the built environment and at the urban territorial scale, through a review of the state of the art of the subject in the last decade (2010-2021). The thesis breaks down the projectual process seeking to identify how the architect and urban planner can mitigate the effects of climate change, adapting existing structures or in projects, and also promoting the expansion of the resilience of these building systems.

Multi-Principal Agency and the Compliance with Professional Guidelines in Health Systems: Economic and Regulatory Perspectives

Amid the trend of rising health expenditure in developed economies, changing the healthcare delivery models is an important point of action for service regulators to contain this trend. Such a change is mostly induced by either financial incentives or regulatory tools issued by the regulators and targeting service providers and patients. This creates a tripartite interaction between service regulators, professionals, and patients that manifests a multi-principal agent relationship, in which professionals are agents to two principals: regulators and patients. This thesis is concerned with such a multi-principal agent relationship in healthcare and attempts to investigate the determinants of the (non-)compliance to regulatory tools in light of this tripartite relationship. In addition, the thesis provides insights into the different institutional, economic, and regulatory settings, which govern the multi-principal agent relationship in healthcare in different countries. Furthermore, the thesis provides and empirically tests a conceptual framework of the possible determinants of (non-)compliance by physicians to regulatory tools issued by the regulator. The main findings of the thesis are first, in a multi-principal agent setting, the utilization of financial incentives to align the objectives of professionals and the regulator is important but not the only solution. This finding is based on the heterogeneity in the financial incentives provided to professionals in different health markets, which does not provide a one-size-fits-all model of financial incentives to influence clinical decisions. Second, soft law tools as clinical practice guidelines (CPGs) are important tools to mitigate the problems of the multi-principal agent setting in health markets as they reduce information asymmetries while preserving the autonomy of professionals. Third, CPGs are complex and heterogeneous and so are the determinants of (non-)compliance to them. Fourth, CPGs work but under conditions. Factors such as intra-professional competition between service providers or practitioners might lead to non-compliance to CPGs – if CPGs are likely to reduce the professional’s utility. Finally, different degrees of soft law mandate have different effects on providers’ compliance. Generally, the stronger the mandate, the stronger the compliance, however, even with a strong mandate, drivers such as intra-professional competition and co-management of patients by different professionals affected the (non-)compliance.

Governing the water conservation in the Urmia Lake Basin: addressing macro systems’ fit and micro users’ behavior

To change unadapted water governing systems, and water users’ traditional conducts in line with climate change, understanding of systems’ structures and users’ behaviors is necessary. To this aim, comprehensive and pragmatic research was designed and implemented in the Urmia Lake Basin where due to the severe droughts, and human-made influences, especially through the agricultural development, the lake has been shrunken drastically. To analyze the water governance and conservation issues in the basin, an innovative framework was developed based on mathematical physics concepts and pro-environmental behavior theories. Accordingly, in system level (macro/meso), the problem of fit of the early-shaped water governing system associating with the function of “political-security” and “political-economic” factors in the basin was identified through mean-field models. Furthermore, the effect of a “political-environmental” factor, the Urmia Lake Restoration Program (ULRP), on reforming the system structure and hence its fit was assessed. The analysis results revealed that by revising the provincial boundaries (horizontal alternation) for the entity of Kurdistan province to permit that interact with the headquarter of West Azerbaijan province for its water demand-supply initiatives, the system fit can increase. Also, the constitution of the ULRP (vertical arrangement) not only could increase the structural fit of the water governing system to the basin, but also significantly could enhance the system fit through its water-saving policy. Besides, in individual level (micro), the governing factors of water conservation behavior of the major users/farmers were identified through rational and moral socio-psychological models. In rational approach, incorporating PMT and TPB, the SEM results demonstrated that “Perceived Vulnerability”, “Self-Efficacy”, “Response Efficacy”, “Response Cost”, “Subjective Norms” and “Institutional Trust” significantly affect the water-saving intention/behavior. Likewise, NAM based analysis as a moral approach, uncovered the significant effects of “Awareness of Consequences”, “Appraisal of Responsibility”, “Personal Norms” as well as “Place Attachment” and “Emotions” on water-saving intention.

Towards the circularity of outdoor lighting systems

In recent years, there has been increasing attention to lighting energy efficiency, due to economics - lower energy costs - and environmental reasons - maninduced climate change. Driven by strict energy-efficiency requirements, the lighting industry started to replace the traditional lamps with LED lighting solutions, ignoring the limits of their maintenance and recycling. Faced with an increasing global population, rising resource consumption and associated negative environmental impacts, shifting from a traditional economic linear model to a more sustainable paradigm of growth is now becoming increasingly urgent. Whereas the topic of circular economy has been widely investigated in literature in the past, little attention has been reserved for the different evaluation tools to assess and improve product circularity and how companies can become more resource-efficient. Hence, the present thesis investigates the implementation of a circular economy in the lighting industry through the use of circularity indicators and ecodesign strategies. Concerning the real luminaire products, the role of the luminaire in the circular economy and recycling industry is explored, highlighting the limits of their End-of-life process. The main conclusions of the thesis reveal the significance of initial product development, reuse, remanufacturing and repair strategies in a transition towards a circular economy.

Effect Of Simulated Microwave Disinfection On The Linear Dimensional Change, Hardness And Impact Strength Of Acrylic Resins Processed By Different Polymerizing Cycles.

This study investigated the effect of simulated microwave disinfection (SMD) on the linear dimensional changes, hardness and impact strength of acrylic resins under different polymerization cycles. Metal dies with referential points were embedded in flasks with dental stone. Samples of Classico and Vipi acrylic resins were made following the manufacturers' recommendations. The assessed polymerization cycles were: A-- water bath at 74ºC for 9 h; B-- water bath at 74ºC for 8 h and temperature increased to 100ºC for 1 h; C-- water bath at 74ºC for 2 h and temperature increased to 100ºC for 1 h;; and D-- water bath at 120ºC and pressure of 60 pounds. Linear dimensional distances in length and width were measured after SMD and water storage at 37ºC for 7 and 30 days using an optical microscope. SMD was carried out with the samples immersed in 150 mL of water in an oven (650 W for 3 min). A load of 25 gf for 10 sec was used in the hardness test. Charpy impact test was performed with 40 kpcm. Data were submitted to ANOVA and Tukey's test (5%). The Classico resin was dimensionally steady in length in the A and D cycles for all periods, while the Vipi resin was steady in the A, B and C cycles for all periods. The Classico resin was dimensionally steady in width in the C and D cycles for all periods, and the Vipi resin was steady in all cycles and periods. The hardness values for Classico resin were steady in all cycles and periods, while the Vipi resin was steady only in the C cycle for all periods. Impact strength values for Classico resin were steady in the A, C and D cycles for all periods, while Vipi resin was steady in all cycles and periods. SMD promoted different effects on the linear dimensional changes, hardness and impact strength of acrylic resins submitted to different polymerization cycles when after SMD and water storage were considered.

The Crystal-t Algorithm: A New Approach To Calculate The Sle Of Lipidic Mixtures Presenting Solid Solutions.

Lipidic mixtures present a particular phase change profile highly affected by their unique crystalline structure. However, classical solid-liquid equilibrium (SLE) thermodynamic modeling approaches, which assume the solid phase to be a pure component, sometimes fail in the correct description of the phase behavior. In addition, their inability increases with the complexity of the system. To overcome some of these problems, this study describes a new procedure to depict the SLE of fatty binary mixtures presenting solid solutions, namely the Crystal-T algorithm. Considering the non-ideality of both liquid and solid phases, this algorithm is aimed at the determination of the temperature in which the first and last crystal of the mixture melts. The evaluation is focused on experimental data measured and reported in this work for systems composed of triacylglycerols and fatty alcohols. The liquidus and solidus lines of the SLE phase diagrams were described by using excess Gibbs energy based equations, and the group contribution UNIFAC model for the calculation of the activity coefficients of both liquid and solid phases. Very low deviations of theoretical and experimental data evidenced the strength of the algorithm, contributing to the enlargement of the scope of the SLE modeling.

A Microleakage Study Of Gutta-percha/ah Plus And Resilon/real Self-etch Systems After Different Irrigation Protocols.

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.