Why do SGLT2 inhibitors reduce heart failure hospitalization? A differential volume regulation hypothesis

The effect of a sodium glucose cotransporter 2 inhibitor (SGLT2i) in reducing heart failure hospitalization in the EMPA-REG OUTCOMES trial has raised the possibility of using these agents to treat established heart failure. We hypothesize that osmotic diuresis induced by SGLT2 inhibition, a distinctly different diuretic mechanism than other diuretic classes, results in greater electrolyte-free water clearance, and ultimately in greater fluid clearance from the interstitial fluid (IF) space than from the circulation, potentially resulting in congestion relief with minimal impact on blood volume, arterial filling, and organ perfusion. We utilize a mathematical model to illustrate that electrolyte-free water clearance results in a greater reduction in IF volume compared to blood volume, and that this difference may be mediated by peripheral sequestration of osmotically inactive sodium. By coupling the model with data on plasma and urinary sodium and water in healthy subjects administered either the SGLT2i dapagliflozin or loop diuretic bumetanide, we predict that dapagliflozin produces a 2-fold greater reduction in IF volume compared to blood volume, while the reduction in IF volume with bumetanide is only 78% of the reduction in blood volume. Heart failure is characterized by excess fluid accumulation, in both the vascular compartment and interstitial space, yet many heart failure patients have arterial underfilling due to low cardiac output, which may be aggravated by conventional diuretic treatment. Thus, we hypothesize that by reducing IF volume to a greater extent than blood volume, SGLT2 inhibitors might provide better control of congestion without reducing arterial filling and perfusion

Austrian Students’ Perceptions of Social Distancing and Their Emotional Experiences During Distance Learning Due to the COVID-19 Pandemic

The COVID-19 pandemic has led to far-reaching changes in various aspects of students’ lives. In the particular case of the educational field, classroom teaching was drastically shifted to a distance learning format. Consequently, students needed to deal with a completely different everyday school life. Learning was carried out online, which implied that students could not see some of their regular, important social contacts such as teachers, classmates or friends. It is already proven that such social distancing measures had impacts on students’ emotional experiences during the lockdown. Following a mixed-methods concurrent single-phase design, this study examined students’ perceptions of social distancing and their emotional experiences during the first school lockdown in Austria. Data from an online survey (n = 263 students) and from qualitative interviews (n = 56 students) were analyzed. The results show that distance learning drastically reduced interaction among students and between students and their teachers. Furthermore, the results indicate negative emotional experiences due to less social contact, increased learning pressures, and less structure. However, findings revealed that students also experience and perceived positive emotional experiences during distance learning because of more freedom, autonomy, and to some extent, less performance pressure. Based on the findings, the present study discusses possible perspectives on how to support students during and after distance learning, as well as further lines of research.Peer Reviewe

Exploring inclusive education in times of COVID-19: an international comparison of German, Austrian and Portuguese teachers

With the start of the Coronavirus (COVID-19) pandemic, the global education system has a faced immense challenges and disruptions resulting in and the necessity for an immediate redesign of teaching and learning in the school context. Face-to-face classroom instruction had to be replaced by ‘emergency remote teaching’, requiring teacher to adapt their daily routines to a new and unprecedented educational reality. Researchers and policymakers worldwide have agreed that, despite the fact that efforts were made to immediately adapt to emergency remote teaching, disadvantaged and vulnerable students may be especially at risk in emergency remote teaching. Given the differences in schooling organization across countries during the COVID-19 pandemic it can be expected that teachers performed inclusive instructional practices significantly different. Against the unpredictable situation, cross-country research has been urgently required to provide data that could inform education policy. Thus, this study explored teachers’ perceptions of supporting at risk students during the first COVID-19 school closures, as well as examining teachers’ inclusive teaching practices in three countries: Germany, Austria and Portugal. ANOVA results revealed important country differences. In general, it appears that teachers in Germany and Austria reported to have implemented less practices to address vulnerable and at-risk students compared to Portuguese teachers. Implications of the results, as well as further lines of research are outlined.info:eu-repo/semantics/publishedVersio

Agreement between administrative data and the Resident Assessment Instrument Minimum Dataset (RAI-MDS) for medication use in long-term care facilities: a population-based study

Background: Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include surveys, medical charts, administrative health databases, and clinical assessment records, may not collect concordant information, which can result in comparable prevalence and effect size estimates. The purpose of this research was to estimate agreement between two population-based electronic data sources for measuring use of several medication classes among LTCF residents: outpatient prescription drug administrative data and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0. Methods: Prescription drug and RAI-MDS data from the province of Saskatchewan, Canada (population 1.1 million) were linked for 2010/11 in this cross-sectional study. Agreement for anti-psychotic, anti-depressant, and anti-anxiety/hypnotic medication classes was examined using prevalence estimates, Cohen’s κ, and positive and negative agreement. Mixed-effects logistic regression models tested resident and facility characteristics associated with disagreement. Results: The cohort was comprised of 8,866 LTCF residents. In the RAI-MDS data, prevalence of anti-psychotics was 35.7%, while for anti-depressants it was 37.9% and for hypnotics it was 27.1%. Prevalence was similar in prescription drug data for anti-psychotics and anti-depressants, but lower for hypnotics (18.0%). Cohen’s κ ranged from 0.39 to 0.85 and was highest for the first two medication classes. Diagnosis of a mood disorder and facility affiliation was associated with disagreement for hypnotics. Conclusions: Agreement between prescription drug administrative data and RAI-MDS assessment data was influenced by the type of medication class, as well as selected patient and facility characteristics. Researchers should carefully consider the purpose of their study, whether it is to capture medication that are dispensed or medications that are currently used by residents, when selecting a data source for research on LTCF populations