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Global patterns of polypharmacy after acute heart failure hospitalization: prevalence and outcomes from the REPORT-HF registry
No full textAims:
Polypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy.
Methods and results:
Medication counts were classified as no polypharmacy (<5), polypharmacy (5–9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08–1.25) for polypharmacy and 1.46 (95% CI 1.31–1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01–1.33).
Conclusions:
Non-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF
Social, cultural & structural factors in reporting: a paradigmatic case study of medical trainee sexual abuse
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Mastanocracy: the legitimization of criminal governance and violence in Bangladesh’s garment industry
No full textThe operation of criminal governance within formal-legal industrial contexts connected
to global supply chains remains insufficiently theorized in management and organization
studies (MOS). How such governance legitimizes violence against marginalized
workers both within and beyond organizational boundaries also remains critically
underexplored. By analysing the paradoxical normalization of criminality and violence
within Bangladesh’s garment industry, this study exposes the systemic embeddedness of
mastans, politically connected criminals, within export-oriented industrial governance.
We conceptualize this entanglement as mastanocracy, a hybrid political formation of
violent criminal governance that operates legitimately at the nexus of corruption,
democratic erosion, elite power and social polarization, advancing the neoliberal
economic and political agendas of dominant actors. This research extends MOS by
broadening the boundary conditions under which criminal governance is legitimized
in a formal-legal industrial environment in the Global South. It also advances the
discourse on violence in contemporary organizations by revealing the broader cultural,
social and political dynamics that normalize violence within and beyond organizational boundaries, compelling millions of marginalized workers to live and work under
regimes of criminal governance
Surgical trainees' lived experience of entrustable professional activities: assessment in the Australasian context
Get PDFBackground: The Royal Australasian College of Surgeons' Board in General Surgery implemented Entrustable Professional Activities (EPAs) in its competency‐based training programme in 2022. As this is a new method for surgical trainees, a qualitative study was performed to evaluate its implementation and use by exploring the pioneer trainees' perceptions and experiences of EPAs.
Methods: Seven first‐year general surgery trainees were recruited to participate in semi‐structured interviews. The interviews explored the trainees' experiences of EPAs, their perceptions of the effect on their independence with completing clinical activities and patient safety, and their suggestions for how to improve this form of assessment in the training program.ResultsThe findings of the study suggest that EPAs can be a useful tool for assessing the competence of trainees. However, the study also found that EPAs can be challenging for trainees, particularly in terms of the level of self‐regulation and independence required.
Conclusion: Although EPAs may positively contribute to a trainee's experience, considerations to support trainees and trainers in their practical implementation may increase the value of the learning encounter. Graded assessment of entrustment and explicit year‐level milestone progress points could promote more effective learning and support developmental feedback by trainers
Just a joke? Humour and gender in a far-right party
Get PDFThe populist radical right (PRR), or far right, frequently resorts to jokes, irony, and humour, particularly in relation to major markers of ideology and identity such as gender/sexuality. Despite the empirical factuality of such humour—from the sexist outbursts of Trump to the homophobic jokes of Bolsonaro—few contributions have analysed the humoristic performances of this political family. The article aims to fill this gap by focusing on the Italian League (former Northern League). Based on ethnographic fieldwork in a local branch, I identify two main humorous codes, corresponding to two different socio-political functions: ‘humour as male-inflicted punishment’ and ‘humour as virility battle’. The paper illuminates the intertwinement of power and gender hierarchies, reproduced through sexist humour in the branch. It also shows how humoristic codes employed by national leaders circulate in the branch, in a process of remodulation of gender, ideology, and sexism between micro and macro levels of politics
National 10-year cohort study of life-threatening Invasive group A streptococcal infection in children, 2013-2023
Get PDFInvasive group A streptococcal disease (iGAS) is an important cause of pediatric morbidity and mortality. We aimed to describe severe, life-threatening, iGAS cases to inform critical care services planning and identify potential opportunities for early intervention to prevent progression to death. Retrospective, multicenter, national cohort study in Scotland investigating critically unwell iGAS cases ≤15 years old from October 01, 2013 to September 30, 2023. We included children and young people (CYP) who required advanced intensive care or died with iGAS as the primary cause of death. Information collected included demographics, Streptococcus pyogenes emm types, viral coinfections and clinical outcomes. Eighty-two cases of severe, life-threatening iGAS were identified, with 20 resulting in death. The annual iGAS pediatric intensive care unit (PICU) admission rate was 0.69/100,000 CYP, with a mean annual mortality rate of 0.22/100,000. iGAS PICU admissions dropped during 2020-2021, returned to baseline in 2021-2022, and then increased sharply in 2022-2023 without an increase in death rates. Across the cohort, the predominant emm type was type 1. In 9.8% of cases, GAS was identified using a nonculture molecular method (specific polymerase chain reaction or 16S rRNA sequencing). Prior primary or secondary care contact was sought by 9/20 (45%) of CYP who died; there was no significant association between time-to-care to PICU and illness severity or risk of death. Viral coinfections were common and associated with higher severity scores. We demonstrate a significant annual burden of severe, life-threatening iGAS at the national level. High rates of viral coinfections and care-seeking before PICU admission or death, suggest potential opportunities for intervention
Evaluation of reporting methods for assessment and surgical planning of perianal fistulas.
Get PDFPerianal fistula is a complex condition where surgeons conduct surgeries based on the mentally mapped images they created from the information found in the radiology report. If not properly treated, a fistula could reoccur. To reduce the chances of reoccurrence, a patient-specific, visual, and accurate depiction of the internal tracts in relation to the pelvic floor is required. A three-dimensional (3D) parametric model generation software was previously developed and evaluated successfully with radiologists. In this paper, the software output is evaluated with two colorectal surgeons for 10 fistula cases. The paper compares three reporting different modes: (1) 3D models only, (2) conventional radiology report and picture archiving and communication system (PACS) magnetic resonance (MR) images, and (3) 3D models + standardized radiology report. The percentage of agreement between surgeons across cases and cognitive load are the primary metrics used for evaluation. Mode 3 superseded both modes 1 and 2, meaning that surgeons prefer to see a 3D model along with a standardized report to plan a case's surgical intervention. Mode 1 superseded mode 2, which also shows surgeons preference to inspect a 3D model rather than inspecting cases the conventional way. Surgeons' agreement in opinions across cases in mode 3 was 85%, whereas it was 18% and 5% in mode 1 and mode 2, respectively. This shows that information was conveyed more consistently across surgeons in mode 3. NASA TLX tests show that surgeons had the least cognitive load while working with mode 3, followed by mode 1 and then mode 2. Overall, the findings indicate that 3D models, even without radiologists' written input, outperform the current standard practice of delivering unstructured radiology reports alongside raw PACS images. [Abstract copyright: © 2025. The Author(s).
Dynamics of monopile-supported offshore wind turbines under ship impact loading: a generalised frequency domain approach
No full textThis study conducts the dynamic analysis of a monopile-supported offshore wind turbine (MSWT) under ship impact in frequency domain analysis. The approach utilises dynamic stiffness formulation to capture the force-displacement relationship of both the tower and the monopile. The tower and the monopile are modelled using the Euler-Bernoulli beam theory, where the exact solutions for the non-uniform geometry of the tower are obtained using Bessel function solutions. The effect of fluid-structure interaction (FSI) and the soil-structure interaction (SSI) is incorporated using the hydrodynamic mass and viscoelastic springs distributed along the length of the monopile. The study focuses on capturing the dynamic response at the tower top within the frequency domain when subjected to impact loading at its base. A parametric analysis investigates how this response varies concerning ship mass, impact velocity, and water depth. Further, a simplified non-dimensional model is proposed, accounting for the tower's non-uniformity and representing the foundation with lateral and rotational springs. Finally, an analytical, approximate, closed-form expression for natural frequency is developed, aiding in the preliminary design of beam-like structures with conical shapes and flexible supports. These analytical tools complement experiments and finite element studies, offering early insights into MSWT dynamics under impact. The proposed model effectively captures the dynamic response of MSWTs under varying impact energies and deformation modes from local indentations to global bending and incorporates foundation and geometric effects for diverse design scenarios
The invisibility of the self-translator and its implications: between the nationalist paradigm of monolingualism and neoliberal language ideologies
No full textThis article investigates the self-translator’s ‘invisibility’ and its implications in relation to the ideological predominance of the nationalist paradigm of monolingualism and neoliberal language ideologies. Invisibility is interpreted here as the under-representation of the self-translator in peritexts and a lack of public awareness of the fact that a writer undertook self-translation. Building on research in (self-)translation, sociolinguistics, and literary and cultural studies, the article discusses the ways in which self-translators challenge the monolingual ideals of nationhood and neoliberal language ideologies which, simultaneously, render invisible the self-translator and their work in ‘minor’, non-national, or non-native languages. Based on paratexts and relevant contextual elements, the paper outlines the invisibility of twentieth-and twenty-first-century Italian and Polish self-translators in accounts of national literature and qualitatively analyzes the peritexts of self-translated works by Nino De Vita and Czesław Miłosz. The article stresses how the self-translator’s invisibility reinforces the nationalist paradigm of monolingualism and power hierarchies between languages, thus perpetuating social inequalities. It advocates for the visibility of self-translators as agents of sociocultural change, leading to an inclusive, multilingual paradigm and greater social equality
Public health interactions with palliative and end of life care
Get PDFIn this chapter we sketch out the evolution of public health approaches in palliative and end of life care and explore in more detail some of the key sites of engagement. We build on our earlier thesis that the relationship between the two fields is asymmetrical and that end of life care remains a low priority in public health discourse (Whitelaw and Clark, 2019). We argue that the palliative care field continues to operate with idealised and simplistic notions of public health and that this is demonstrable in the continuing gap between population needs and demands and the available provision of end of life care
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