AN ANALYSIS OF STUDENT SATISFACTION WITH THE ORGANIZATION OF HYBRID TEACHING IN THE DEPARTMENT OF HEALTH ECONOMICS

The PURPOSE of this research is for a survey to be conducted among the students of the Faculty of Public Health “Prof. Tzekomir Vodenicharov, МD, DSc” at Medical University – Sofia to study whether they are satisfied with how hybrid teaching has been organized in the Department of Health Economics. MATERIALS AND METHODS: An anonymous questionnaire survey was conducted. Out of all students who were invited to participate, 309 joined. The questionnaire was distributed through the Google Forms platform from June to October 2022. Chi-Quadrant analysis was used in order to find relationships between categorical variables. RESULTS: the result shows a statistically significant connection between the students who are studying different specialties in the FPH and their satisfaction with the organization of the hybrid classes carried out by the Department (p <0.001). From the participants’ responses, it is clear that the implementation of hybrid form of teaching (in-person classes for practical training and online classes for theoretical study) carried out through open educational resources and implementing innovative teaching methodology is preferred by the students. CONCLUSION: The scientific evidence arising from our empirical research can aid in the development of guidelines for practical improvement of the hybrid teaching organization in disciplines taught in the Department. The conclusions drawn presuppose continuous research with proper methodologies applied

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Existing monitoring of Mediterranean sea: a gap analysis

The Marine Strategy Framework Directive (2008/56/EC) of the European Parliament and of the Council (17th June 2008) establishes a framework for community action in the field of marine environmental policy. A crucial issue will be to improve the existing marine monitoring programs to cover the MSFD requirements. The comparison and identification of gaps in the existent national monitoring is a first step to include new parameters and frequencies of observation according to all relevant Directives and specially to MSFD. Our report is a first, integrated, cross-state assessment of the present state of Mediterranean monitoring networks. Data on monitoring stations have been provided from all member states of IRIS-SES + Croatia and joint in a unique georeferenced dataset. We used the cross-classification to build contingency tables of the counts at each combination of factor levels. Distances from coastline, densities of sampling stations, spatial overlap across descriptors, were also reported. As main results, we observed a large heterogeneity across MS on the parameters measured for each descriptors, on the density of sampling stations and on the frequency of sampling. Larger gaps have been identified for the descriptors Mammals, Birds, Reptiles (D1, D4, D6), Litter (D10), Energy & Noise (D11). The outputs from this work will be included into a GIS planning tool (Activity 3) including many scales and levels on which the MSFD Directive has been built on, such as the characteristics level (e.g. biological features, physicochemical features), pressure and impact, indicator/threshold, spatial (location of monitoring stations) and temporal (frequency-periodicity) across regions-subregions-countries

Spatial and temporal extent of monitoring water column and seabed habitats indicators, based on their scales of natural variation

The Marine Framework Strategy Directive (MFSD, 2008/56/EC) aims for clean, healthy and productive marine ecosystems within all the EU Members states. The MFSD promotes an holistic, ecosystem based approach to marine conservation and monitoring (Art. 13) Monitoring strategies should: 1) focus on the potential of scale dependence in the observed dynamics and 2) be able to integrate the effect of mediating factors operating at different scale levels. However, present knowledge on spatial and temporal fluctuations in marine ecosystems is scarce. The boundaries of natural variation of several important marine ecosystem processes are still undefined. A major source of complexity is the fact that ecosystem processes are occurred across different spatial as well as temporal scales. The present knowledge gap results in uncertainty on the selection of measured parameters and the definition of sampling frequency and sites. Hereby, we discuss theoretical and applied issues related to definition of optimal cross-scale monitoring strategies. Literature data and existing databases were analyzed, to define the connectivity across nested scales of principal D1 (Biodiversity), D5 (Eutrophication), D6 (Seabed habitat integrity) MFSD descriptors. We conclude that present monitoring strategy does not completely fulfil the scaling issues due to lack of theoretical knowledge on cross-scale processes and poor coordination across monitoring operators. A stronger cooperation among member states and regional environmental agencies is needed to implement efficient cross-scale environmental monitoring. This research was developed by partners of the Integrated Regional monitoring Implementation Strategy in the South European Seas (IRIS-SES, http://iris-ses.eu) Project, a pilot project on new knowledge for an integrated management of human activities in the sea (PP/ENV D2/SEA 2012), funded by the European Union

Implementation of Marine Framework Directive for descriptors D1, D5, D6: milestones to cope monitoring plans with natural variability. Spatial and temporal extent of monitoring water column and seabed habitats indicators, based on their scales of natural variation

A major source of complexity in marine ecosystem monitoring is represented by the fact that ecosystem processes occurring across different spatial and temporal scales. The implementation of the monitoring strategies applied in accordance to Marine Framework Strategy Directive (MFSD, 2008/56/EC) is a step-by-step process, which should be focus on the potential of scale dependence in the observed dynamics and should be able to integrate the effect of mediating factors operating at different scale levels. Nevertheless, the correct definition of monitoring efforts for each indicator needs to reach a well-defined knowledge on the actual assessment of the “object” of monitoring including ranges of natural variability in terms of spatial and temporal natural fluctuations. Unluckily natural fluctuations are not yet well defined in marine environments for all of the MSFD indicators. For these reasons the achievement of MSFD goals could be severely affected by the lack of knowledge which led to the lack of clear and rationale criteria on the basis of which to align and cope the scale of the assessment with the ecosystem natural fluctuations. Hereby we address the design of monitoring programmes concerning water column and seabed habitats integrity indicators (Descriptors D1, D5, D6) by discussing spatial and temporal extent of monitoring based on their scales of natural variation. The multiple layer approach developed on mesoscales could allow reducing mistakes due to sampling and methodological limits and could allow reducing problems ranging within the comprehension of mechanisms to the anticipation of consequences. The opportune mesoscale is dependent on the indicator considered and range within 0.5 – 100 km for the spatial scale and from 0.2 to 12 months for the temporal scale