Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

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 <.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

Cancer data quality and harmonization in Europe: the experience of the BENCHISTA Project – international benchmarking of childhood cancer survival by stage

IntroductionVariation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to understand these differences and to encourage the application of the Toronto Staging Guidelines (TG) by Population-Based Cancer Registries (PBCRs) to the most common solid paediatric cancers.MethodsPBCRs within and outside Europe were invited to participate and identify all cases of Neuroblastoma, Wilms Tumour, Medulloblastoma, Ewing Sarcoma, Rhabdomyosarcoma and Osteosarcoma diagnosed in a consecutive three-year period (2014-2017) and apply TG at diagnosis. Other non-stage prognostic factors, treatment, progression/recurrence, and cause of death information were collected as optional variables. A minimum of three-year follow-up was required. To standardise TG application by PBCRs, on-line workshops led by six tumour-specific clinical experts were held. To understand the role of data availability and quality, a survey focused on data collection/sharing processes and a quality assurance exercise were generated. To support data harmonization and query resolution a dedicated email and a question-and-answers bank were created.Results67 PBCRs from 28 countries participated and provided a maximally de-personalized, patient-level dataset. For 26 PBCRs, data format and ethical approval obtained by the two sponsoring institutions (UCL and INT) was sufficient for data sharing. 41 participating PBCRs required a Data Transfer Agreement (DTA) to comply with data protection regulations. Due to heterogeneity found in legal aspects, 18 months were spent on finalizing the DTA. The data collection survey was answered by 68 respondents from 63 PBCRs; 44% of them confirmed the ability to re-consult a clinician in cases where stage ascertainment was difficult/uncertain. Of the total participating PBCRs, 75% completed the staging quality assurance exercise, with a median correct answer proportion of 92% [range: 70% (rhabdomyosarcoma) to 100% (Wilms tumour)].ConclusionDifferences in interpretation and processes required to harmonize general data protection regulations across countries were encountered causing delays in data transfer. Despite challenges, the BENCHISTA Project has established a large collaboration between PBCRs and clinicians to collect detailed and standardised TG at a population-level enhancing the understanding of the reasons for variation in overall survival rates for CC, stimulate research and improve national/regional child health plans

Settlement structure as a system

System interpretations study the essence of settlement structure on two ontological planes: on the plane of interactio of elements and on the plane of creating of a separate category of integrity. The ontological substance of interaction consists in the fact that it constitutes the basic mechanism joining elements of the class into a whole. However, freedom of interpretation of the interaction notion results in recognizing the system either as an analogue of an organic system whose purposedly organized elements are kept in dynamic balance, or in treating it as a sui generis convention understood as a useful tool of study. However, with the use of only the interpretation of the substance of interaction mechanisms it is impossible to prove existence of settlement system as a separate category of entity. Between all elements of the class of settlements always there are some interactions, and they can be of mechanical, field or thermodynamic character. However, it is impossible to determine which of the internations have system-creative properties and which are devoid of these properties. These diffilculties cause that settlement theories look for the essence of the system in a class of settlements, constituted into a specific wholeness. This means that a settlement system cannot be constructed by adding elements one by one, thait is it cannot be analysed through application of theories concerning its parts and their interrelations. In other words, an interpretation of a settlement system in system categories resolves itself into recognizing it as an organic whole which requires during in analysis appliiation of irreducible principles of such systems. This is determined by the system's structure which excludes the possibility to analyse it from the so-called „summatiive” point of view. To recognize a settlement system as a separate ontological category requires to show how a „summative” analysis differs from analysis of another „non-summative” type. This differentiation seems to be based on a statement that elements of an organic whole do not behave independently of one another, and one may assume that the principles applying to them when they are not elements of an organic whole, are valid for them as elements of such a whole. Therefore it seems that a „summative” analysis is such which explains properties of a system basing on principles concerning its elements and the prtinciples do not refer to features of the elements as components of a system. And „non-summative” analysis seems to be an analysis describing a system basinig on principles on connections between elements as functional elements of the system. But if these are the differences between such aellegedly different methods of analysis, the differenees are not important. This proves that border between systems cannot be determined aceurately - between „organic wholes” and other systems - „non-summative”. If even elements of summative wholes relate casually to one another (e.g. in gravitational systems), summative analysis of such wholes must contain special assumptions describing organization of elements of such wholes so that a basic theory can be applied to them, similairly to systems recognized as „summative”. This means that from the ontological point of view there is no justification to recognize a „non-summative” whole, which is a substratum of settlement system, as a separate real entity

Prognosis of growth and distribution of population in the Suwalki Province until 1990

The human element is contemporarily considered to be one of the most crucial factors in the social - economic development of the region. The knowledge of the people's resources and the distribution of population is a starting point to constructing a model of economic development of the region. The prognosis of growth and distribution of population of the Suwałki region was based on the past developmental tendencies measured with the so-called geometric weighted average. The calculated yearly rate of changes in the density of country population and changes in the number of town population for four peniods (1950-1960, 1950-1975, 1960-1970, and 1970-1975) made it possible to define the tendencies of changes incoming in the future. The number of population is treated as a function of time lapse. In this case the extrapolation formula was used which permits to calculate the number of population for any point of time provided that the number of population in the starting moment and the yearly rate of growth are known. In this way the total number of population of the Suwałki Province, the number of town population and the density of country population in the communal system were calculated for the year 1990. The population of the Suwałki Province will grow as compared with the year 1975 by 9-15% reaching the walue of 450-480 thousand inhabitants. Although the urbanization ratio will grow to the level of 50-51 %, i.e. Almost by 10 points, it will differ much from the national level. Two towns will prevail in the town network, i.e. Suwałki and Ełk, counting about 42-55 thousand inhabitants. On the otheir hand, a group of the smallest towns will not undergo any substantial changes. Almost half of the total number of towns will consist of iowns having less than 5.000 inhabitants. Therefore, these centres having a relatively small demographic and economic potential, will have a bearing on the urbanization level and its spacial differentiatton. The system of settlements shaped in this way will have a substantial influence on the distribution of country population. Generally, the country areas will undergo de-population. According to the most moderate variant, assuming preservation of the tendencies from the years 1960-1970, it is expected that only the population in the central region of the province (delimited by the railway line Ełk - Olecko - Gołdap) will be preserved. It is obvious that the outflow of people from the country areas cannot be infinite. The social - economic consequences depends obviously on the degree of industrialization, investment of fixed assets, character of settlement system, or finally on the forms of agricultural economy. However, it is necessary at present to seek methods of keeping a considerable part of youth in the country in order that the region may not be de-populated derivatively and the agricultural production may not be disturbed. Preservation of the above discussed tendencies may also limit to a great extent the rational utilization of natural resources of the Suwałki Province, may restrain not only the development of agriculture, but also the tourist – recreation services

Settlement processes in the suburban zone of Warsaw

The main functions and the spatial shape of the settlement system of the suburban zone of Warsaw have been formed in a complex and dynamic process of industrialization. Along main transport axes, aspecially along railroad lines, seven multifunctional settlement belts have been formed: three located to the West of Vistula river (Błonie, Grodzisk and Piaseczno belts) and four located to the East of Vistula (Legionowo, Wołomin, Otwock and Mińsk belts). Thcse belts, differentiated as to the degree of their urbanization, concentrate an important part of demographic and economic potential of the suburban zone

Theories of settlement systems as a neopositivistic paradigm

Theories of settlement systems interpreting the notion of a system in physical categories, derive from a very fertile current fo European philosophy, namely neopositivism (logical empiricism). They contain three fundamental postulates of neopositivistic learning; physicalism, formalism and conventionalism. The postulate of physicalism means that empiricial propositions can be considered as such only in the case when they describe intersubjectively ascertainble phenomena, that is objects and their states. The language that each science should use whould be the langauge of objects. Statements which cannot be fully translated into the language of objects are not worth treatment as statements of science. The second of the above mentioned postulates is the postulate of formalism which as a matter of fact is just another expression of the first postulate. It says that the language of mathematics is the basic language of all theories. In theoretical physics, to which the theory of settlement systems reduces, the first language that is being formed in the course of scientific explanation of phenomena is usually the language of mathematics - mathematical schema which makes it possible to foretell future states of the system. In physics notions occurring in general theorties must be declined as precisely as possible and this can be achieved only due to mathematical abstraction. Thus the process of transfer from empirical statement to formulation of general, basic theories of settlement systems requires abandoning of the natural language in favour of the language of mathematics. And finally the third postulate of the neopositivistic paradigm is contained in a principally metaphysical thesis which says that in reality there exist only objects and physical processes which proceed according to the laws of physics. And all the rest either will be possible to be reduced to those physical objects or does not exist at all. Physicalism of theories of settlement systems in consequence reaches so far that even logical formations are treated as physical objects. This is connected with extreme nominalism and this in turn ds intertwined with strong conventional and rational tendencies

Changes in population concentration in the Suwalki Province in the years 1946-1975

Population of the Suwałki Province underwent substantial transformations in the post - war period. The transformations were due to the migration processes connected with peopleing the western and northern areas as well as with growing industrialization aind urbanization. The above mentioned trasformations were expressed in the chainges of population concentration in the province. In the process of population growth in the Suwałki Province, two basic stages can be distinguished. The first, comprising the years 1946-1950, was connected above all with peopleing of the western part of the region. The sence of population transformations in that period consisted in liquidating the differences in peopleing between the eastern and western parts of the province; the differences which considerably limited the possibilities of economic development. The process of peopleing the country area produced in the years 1946-1960 a tendency of more even distribrution of the population in the province. This phenomenon was closely related to the growing hierarchization of country settlements. The network of country settlements underwent considerable disorders directly after II World War. There was a shortage of settlements with super - regional functions, i.e. settlements that modify considerably distribution of population. However, at the beginning of the sixties, a growth of population concentration occurred in the Suwałki Province, being a consequence of the growing role of towns. Three main town centres, i.e. Suwałki, Ełk and Augustów, have always been playing the dominant role in the process. These towns, due to a relatively high level of industrialization, became the main areas of population conentration, at the same time the process included the immediate vicinity of the towns. The role of remaining towns of the region, on the other hand, was (and still is) much smaller in the process of population concentration, which seems to be a reflection of their small economic potential. In the consequence of the above mentioned processes, population concentration has advanced slower in the Suwałki Province averagely than in whole Poland, not mentioning highly industrialized and urbanized regions. This tendency reveals that the town network of the Suwałki Province does not conform to the requirements of the contemporary social - economic life. The town network of the Suwałki Province is still a relatively homogeneous system whose individual elements are relatively little differentiated with regard to size and functions performed. The result is that the character of the town network is unfit for stemming migrations of people from the country areas of the Suwałki Province which process has been intensified in the recent years. This can be of considerable importance for preparing the optimum wariant of the economic structure and for realization of basic directions of social-economic development of the region

Renewable thiol-yne ‘click’ networks based on propargylated lignin for adhesive resin applications

In this study, the development of lignin-based resins for wood adhesion applications was demonstrated. We investigated two lignin fractions: commercial Protobind 1000 lignin and methanol-soluble Protobind 1000 lignin fraction after mild solvolysis. Although lignin has previously been incorporated into various cross-linked systems, this is the first report on lignin-based thermosets obtained via thiol–yne “click” chemistry. In this approach, lignin was functionalized with terminal alkyne groups followed by cross-linking with a multifunctional thiol, resulting in polymeric network formation. The influence of the curing conditions on the resin characteristics and performance was studied, by varying the amount of reactive monomeric diluents. Additionally, a post-curing strategy utilizing the Claisen rearrangement was investigated. These resins were tested as a wood adhesive and were proven to possess a desirable performance, comparable to the state-of-art phenol-formaldehyde resins. Lignin-based thiol–yne resins turn out to be an alternative to phenol-formaldehyde resins, currently used as adhesives and coatings. Although it is possible to use lignin in phenol-formaldehyde resins, lignin addition is compromising the resin’s performance. The main benefits over the phenol-formaldehyde approach are that higher lignin loadings are possible to achieve, and no volatiles are emitted during the resin processing and use