Generation of optimal trajectories for Earth hybrid pole sitters

A pole-sitter orbit is a closed path that is constantly above one of the Earth's poles, by means of continuous low thrust. This work proposes to hybridize solar sail propulsion and solar electric propulsion (SEP) on the same spacecraft, to enable such a pole-sitter orbit. Locally-optimal control laws are found with a semi-analytical inverse method, starting from a trajectory that satisfies the pole-sitter condition in the Sun-Earth circular restricted three-body problem. These solutions are subsequently used as first guess to find optimal orbits, using a direct method based on pseudospectral transcription. The orbital dynamics of both the pure SEP case and the hybrid case are investigated and compared. It is found that the hybrid spacecraft allows savings on propellant mass fraction. Finally, it is shown that for sufficiently long missions, a hybrid pole-sitter, based on mid-term technology, enables a consistent reduction in the launch mass for a given payload, with respect to a pure SEP spacecraft

Effects of semaglutide on stroke subtypes in type 2 diabetes: post hoc analysis of the randomised SUSTAIN 6 & PIONEER 6

This is the final version. Available on open access from Lippincott, Williams & Wilkins via the DOI in this record Background: Glucagon-like peptide-1 receptor agonists, including semaglutide, may reduce stroke risk in people with type 2 diabetes (T2D). This post hoc analysis examined the subcutaneous and oral semaglutide effects, versus placebo, on stroke and its subtypes in people with T2D at high cardiovascular (CV) risk. Methods: SUSTAIN 6 and PIONEER 6 were randomised CV outcome trials of subcutaneous and oral semaglutide in people with T2D at high CV risk, respectively. Time to first stroke and stroke subtypes were analysed using a Cox proportional hazards model stratified by trial with pooled treatment as a factor. The impact of prior stroke, prior myocardial infarction or stroke, age, sex, systolic blood pressure, estimated glomerular filtration rate, and prior atrial fibrillation on treatment effects was assessed using interaction p-values. Risk of major adverse CV event (MACE) was analysed according to prior stroke. Results: 106/6480 participants had a stroke (1.0 event/100 patient-years of observation [PYO]). Semaglutide reduced incidence of any stroke versus placebo (0.8 vs 1.1 events/100 PYO; HR 0.68, 95%CI 0.46–1.00;p=0.048), driven by significant reductions in risk of small-vessel occlusion (0.3 vs 0.7 events/100 PYO; HR 0.51, 95%CI 0.29–0.89;p=0.017). HRs for risk of any stroke with semaglutide versus placebo were 0.60 (95%CI 0.37–0.99; 0.5 vs 0.9 events/100 PYO) and 0.89 (95%CI 0.47–1.69; 2.7 vs 3.0 events/100 PYO) in those without and with prior stroke, respectively. Except for prior atrial fibrillation (pinteraction=0.025), no significant interactions were observed between treatment effects on risk of any stroke and subgroups investigated, or between treatment effects on risk of MACE and prior stroke (pinteraction>0.05 for all). Conclusions: Semaglutide reduced incidence of any first stroke during the trials versus placebo in people with T2D at high CV risk, primarily driven by small-vessel occlusion prevention. Semaglutide treatment, versus placebo, lowered the risk of stroke irrespective of prior stroke at baseline. Clinical Trial Registration Information: SUSTAIN 6: NCT01720446 (https://clinicaltrials.gov/ct2/show/NCT01720446); PIONEER 6: NCT02692716 (https://clinicaltrials.gov/ct2/show/NCT02692716).Novo Nordisk A/S (Søborg, Denmark

Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract

Aims: To objectively appraise evidence for possible adverse effects of long-term statin therapy on glucose homeostasis, cognitive, renal and hepatic function, and risk for haemorrhagic stroke or cataract. Methods and results: A literature search covering 2000-2017 was performed. The Panel critically appraised the data and agreed by consensus on the categorization of reported adverse effects. Randomized controlled trials (RCTs) and genetic studies show that statin therapy is associated with a modest increase in the risk of new-onset diabetes mellitus (about one per thousand patient-years), generally defined by laboratory findings (glycated haemoglobin ≥6.5); this risk is significantly higher in the metabolic syndrome or prediabetes. Statin treatment does not adversely affect cognitive function, even at very low levels of low-density lipoprotein cholesterol and is not associated with clinically significant deterioration of renal function, or development of cataract. Transient increases in liver enzymes occur in 0.5-2% of patients taking statins but are not clinically relevant; idiosyncratic liver injury due to statins is very rare and causality difficult to prove. The evidence base does not support an increased risk of haemorrhagic stroke in individuals without cerebrovascular disease; a small increase in risk was suggested by the Stroke Prevention by Aggressive Reduction of Cholesterol Levels study in subjects with prior stroke but has not been confirmed in the substantive evidence base of RCTs, cohort studies and case-control studies. Conclusion: Long-term statin treatment is remarkably safe with a low risk of clinically relevant adverse effects as defined above; statin-associated muscle symptoms were discussed in a previous Consensus Statement. Importantly, the established cardiovascular benefits of statin therapy far outweigh the risk of adverse effects

Prevalence, risk factors and prevention of burnout syndrome among healthcare workers: An umbrella review of systematic reviews and meta-analyses

Introduction: Burnout syndrome (BOS) is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. This umbrella review aimed to investigate BOS among healthcare workers (HCWs). Methods: An umbrella review of systematic reviews and meta-analyses concerning the prevalence of BOS among physicians, nurses, medical students and other HCWs, and its associated factors was conducted across PubMed Central/Medline, Cochrane Library, PROSPERO and Epistemonikos databases. Only systematic reviews and meta-analyses from inception to 15 January 2020 and restricted to English language documents were included. Results: A total of 43 studies met the full inclusion criteria and were included. Among them, there were 3 meta-analyses, 26 systematic reviews, and 14 systematic reviews with meta-analysis. The prevalence of BOS was highest among nurses, younger persons, and trainees. The most frequent risk factors associated with BOS included stress, lack of family support, and organizational risk factors such as prolonged night shifts, length of experience, and exposure to traumatic events. Individual coping strategies such as exercise and communication with peers, and organizational strategies such as periodic review of shift schedule should be undertaken. Discussion: BOS has profound effects on the mental health states of HCWs. Individuals and the hospital authority need to pay specific attention to work-related stress risk factors to improve the psychological well-being of HCWs

Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary

BACKGROUND: There is a worldwide rising tendency of women deciding to become physicians; hence, one of the most remarkable fields of investigation is the wellbeing of female doctors. The aim of this study was to describe female physicians' reproductive health in Hungary and to explore the potential correlation between their reproductive disorders and burnout symptoms. Up to our present knowledge, there have not been any studies investigating the correlation between reproductive disorders and burnout of female physicians; therefore, our study represents a unique approach. METHODS: Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 3039 female physicians. Participants in a representative nationwide survey (Hungarostudy, 2013) served as controls (n = 1069). Differences between physicians and the control group were disclosed by chi-square test. Correlations between certain factors of reproductive health and the three dimensions of burnout were detected by Pearson correlations and X2 test. Binary logistic regression analysis was used to determine the association between burnout and reproductive health. RESULTS: Female physicians were more often characterised by time-to-pregnancy interval longer than one year (18.4% vs. 9.8%), were bearing more high-risk pregnancies (26.3% vs.16.3%), and were more likely to be undergoing infertility therapy (8.5% vs. 3.4%) and experiencing miscarriage (20.8% vs. 14.6%) during their reproductive years, compared with the general female population. With the exception of miscarriages, the difference remained significant in all comparisons with the professional control group. Both high-risk pregnancies and miscarriages of doctors were associated with depersonalisation (p = 0.028 and p = 0.012 respectively) and personal accomplishment (p = 0.016 and p = 0.008 respectively) dimensions of burnout. Results of the multivariate analysis showed that, beside traditional risk factors, depersonalisation acted as an important explanatory factor in case of high-risk pregnancies (OR = 1.086). CONCLUSIONS: There is a circulatory causality between burnout and the development of reproductive disorders. Burnout is an important risk factor for high-risk pregnancies and miscarriages, and it has a negative effect on the outcome of pregnancies. At the same time, women suffering from reproductive disorders are more likely to develop burnout syndrome. Improvement of working conditions and prevention of burnout in female doctors are equally important tasks

Convergence Without Hard Criteria: Does EU Soft Law Affect Domestic Unemployment Protection Schemes?

(VLID)177126

Analysis of risk factors linked to social educator profession in different residential settings of Alicante Province

[EN] One of the most important professions in the field of intervention with underage at social risk that are cared for in different residential settings is, undoubtedly, that of the social educator. In that sense, although there are many professionals involved with these underage (psychologists, social workers, psychiatrists, teachers, etc.), social educators are the ones who, through the carrying out of functions specific to their profession, often work as the "front line" of action, given that they are the ones who are more in touch with the underage and therefore the most likely to be exposed to different variables that could eventually put them in a situation of risk of psycho-social problems related to their work. Hence, the task of identifying the risk variables related to the teaching profession becomes a key objective in order to prevent the occurrence of likely problems that could undermine their psychosocial health. Therefore, through this communication we intend to expose the results that we obtained with a sample of 50 educators who perform their work in different residential-type services in the province of Alicante.[ES] Una de las profesiones más importantes en el ámbito de la intervención con menores en situación de riesgo social que son atendidos en diferentes contextos residenciales es, sin lugar a dudas, la de educador social. En este sentido, si bien son diversos los profesionales que intervienen con los citados menores (psicólogos, trabajadores sociales, psiquiatras, profesores, etc.), son los educadores sociales quienes, a través del desempeño de las funciones propias de su profesión, suelen formar la “primera línea” de actuación, siendo los que mayor contacto tienen con los menores y, en consecuencia, los que con mayor probabilidad se vean expuestos a diferentes variables que les sitúen en una situación de riesgo de sufrir problemas de índole psicosocial relacionados con su trabajo. Identificar las variables de riesgo relacionadas con la profesión de educador se convierte, por tanto, en un objetivo fundamental en aras de prevenir la aparición de posibles problemas que menoscaben la salud psicosocial de éstos. Por todo ello, mediante la presente comunicación, pretendemos exponer los resultados obtenidos con una muestra de 50 educadores quienes desempeñan su labor en diferentes rescursos de carácter residencial de la provincia de Alicante.Heliz Llopis, J.; Navarro Sória, I.; Tortosa Casado, N.; Jodra Jiménez, P. (2015). Análisis de factores de riesgo de la profesión de educador en diferentes contextos residenciales de la provincia de Alicante. Revista sobre la infancia y la adolescencia. (9):47-59. doi:10.4995/reinad.2015.3877.SWORD47599Anderson, D. G. (2000). Coping strategies and burnout among veteran child protection workers. Child Abuse & Neglect, 24(6), 839-848. doi:10.1016/s0145-2134(00)00143-5Blanch, A., Aluja, A. y Biscarri, J. (2002). 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