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 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&nbsp;&lt;.001. Over 24&nbsp;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&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;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 &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

Effect of annealing on properties of sputtered and nitrogen-implanted ZnO:Ga thin films

Thin films of gallium-doped zinc oxide (ZnO:Ga) were deposited on Corning glass substrates by rf diode sputtering and then implanted with 180 keV nitrogen ions in the dose range of 1 × 1015 ÷ 2 × 1016 cm-2. After the ion implantation, the films were annealed under oxygen and nitrogen ambient, at different temperatures and time, and the effect on their microstructure, type and range of conductivity, and optical properties was investigated. Post-implantation annealing at 550 °C resulted in n-type conductivity films with the highest electron concentration of 1.4 × 1020 cm-3. It was found that the annealing parameters had a profound impact on the film’s properties. A p-type conductivity (a hole concentration of 2.8 × 1019 cm-3, mobility of 0.6 cm2/V s) was observed in a sample implanted with 1 × 1016 cm-2 after a rapid thermal annealing (RTA) in N2 at 400 °C. Optical transmittance of all films was >84% in the wavelength range of 390–1100 nm. The SIMS depth profile of the complex 30NO− ions reproduces well a Gaussian profile of ion implantation. XRD patterns reveal a polycrystalline structure of N-implanted ZnO:Ga films with a c-axis preferred orientation of the crystallites. Depending on the annealing conditions, the estimated crystallite size increased 25 ÷ 42 nm and average micro-strains decreased 1.19 × 10-2 ÷ 6.5 × 10-3 respectively

Effect of annealing on properties of sputtered and nitrogen-implanted ZnO:Ga thin films

Thin films of gallium-doped zinc oxide (ZnO:Ga) were deposited on Corning glass substrates by rf diode sputtering and then implanted with 180 keV nitrogen ions in the dose range of 1 × 1015 ÷ 2 × 1016 cm-2. After the ion implantation, the films were annealed under oxygen and nitrogen ambient, at different temperatures and time, and the effect on their microstructure, type and range of conductivity, and optical properties was investigated. Post-implantation annealing at 550 °C resulted in n-type conductivity films with the highest electron concentration of 1.4 × 1020 cm-3. It was found that the annealing parameters had a profound impact on the film’s properties. A p-type conductivity (a hole concentration of 2.8 × 1019 cm-3, mobility of 0.6 cm2/V s) was observed in a sample implanted with 1 × 1016 cm-2 after a rapid thermal annealing (RTA) in N2 at 400 °C. Optical transmittance of all films was >84% in the wavelength range of 390–1100 nm. The SIMS depth profile of the complex 30NO− ions reproduces well a Gaussian profile of ion implantation. XRD patterns reveal a polycrystalline structure of N-implanted ZnO:Ga films with a c-axis preferred orientation of the crystallites. Depending on the annealing conditions, the estimated crystallite size increased 25 ÷ 42 nm and average micro-strains decreased 1.19 × 10-2 ÷ 6.5 × 10-3 respectively

Carrier Control in Polycrystalline ZnO:Ga Thin Films via Nitrogen Implantation Electronic Materials and Processing

The electrical characteristics of gallium-doped zinc oxide (ZnO:Ga) thin films prepared by rf diode sputtering were altered via nitrogen implantation by performing two implants at 40 keV and 80 keV with doses of 1×1015 and 1×1016 cm−2 to achieve a p-type semiconductor. An implantation of 1×1015 cm−2 N+-ions yielded a p-type with hole concentrations 1017–1018 cm−3 in some as-implanted samples. The films annealed at temperatures above 200°C in O2 and above 400°C in N2 were n-type with electron concentrations 1017–1020 cm−3. The higher nitrogen concentration (confirmed by SRIM and SIMS), in the films implanted with a 1×1016 cm−2 dose, resulted in lower electron concentrations, respectively, higher resistivity, due to compensation of donors by nitrogen acceptors. The electron concentrations ratio n(1×1015)/n(1×1016) decreases with increasing annealing temperature. Hall measurements showed that 1×1016 cm−2 N-implanted films became p-type after low temperature annealing in O2 at 200°C and in N2 at 400°C with hole concentrations of 3.2×1017 cm−3 and 1.6×1019 cm−3, respectively. Nitrogen-implanted ZnO:Ga films showed a c-axes preferred orientation of the crystallites. Annealing is shown to increase the average transmittance (>80%) of the films and to cause bandgap widening (3.19–3.3 eV)

Carrier Control in Polycrystalline ZnO:Ga Thin Films via Nitrogen Implantation

The electrical characteristics of gallium-doped zinc oxide (ZnO:Ga) thin films prepared by rf diode sputtering were altered via nitrogen implantation by performing two implants at 40 keV and 80 keV with doses of 1 x 10(15) and 1 x 10(16) cm(-2) to achieve a p-type semiconductor. An implantation of 1 x 10(15) cm(-2) N+-ions yielded a p-type with hole concentrations 10(17)-10(18) cm(-3) in some as-implanted samples. The films annealed at temperatures above 200 degrees C in O-2 and above 400 degrees C in N-2 were n-type with electron concentrations 10(17)-10(20) cm(-3). The higher nitrogen concentration (confirmed by SRIM and SIMS), in the films implanted with a 1 x 10(16) cm(-2) dose, resulted in lower electron concentrations, respectively, higher resistivity, due to compensation of donors by nitrogen acceptors. The electron concentrations ratio n((1) (x) (1015))/ n((1 x 1016)) decreases with increasing annealing temperature. Hall measurements showed that 1 x 10(16) cm(-2) N-implanted films became p-type after low temperature annealing in O-2 at 200 degrees C and in N-2 at 400 degrees C with hole concentrations of 3.2 x 10(17) cm(-3) and 1.6 x 10(19) cm(-3), respectively. Nitrogen-implanted ZnO:Ga films showed a c-axes preferred orientation of the crystallites. Annealing is shown to increase the average transmittance ( GT 80%) of the films and to cause bandgap widening (3.19-3.3 eV). (C) 2012 The Electrochemical Society. All rights reserved

Reprogramming of cassava (Manihot esculenta) microspores towards sporophytic development

Gametes have the unique potential to enter the sporophytic pathway, called androgenesis. The plants produced are usually haploid and recombinant due to the preceding meiosis and they can double their chromosome number to form doubled haploids, which are completely homozygous. Availability of the doubled haploids facilitates mapping the genes of agronomically important traits, shortening the time of the breeding process required to produce new hybrids and homozygous varieties, and saving the time and cost for inbreeding. This study aimed to test the feasibility of using isolated and in vitro cultured immature cassava (Manihot esculenta) microspores to reprogramme and initiate sporophytic development. Different culture media and different concentrations of two ion components (Cu(2+) and Fe(2+)) were tested in two genotypes of cassava. External structural changes, nuclear divisions and cellular changes during reprogramming were analysed by scanning electron microscopy, by staining with 4′,6-diamidino-2-phenylindole, and through classical histology and transmission electron microscopy. In two cassava genotypes, different developmental stages of microspores were found to initiate sporophytic cell divisions, that is, with tetrads of TMS 60444 and with mid or late uni-nucleate microspores of SM 1219-9. In the modified NLN medium (NLNS), microspore enlargements were observed. The medium supplemented with either sodium ferrous ethylene-diamine-tetraacetic acid (NaFeEDTA) or CuSO(4)·5H(2)O induced sporophytic cell division in both genotypes. A low frequency of the reprogramming and the presence of non-responsive microspores among the responsive ones in tetrads were found to be related to the viability and exine formation of the microspores. The present study clearly demonstrated that reprogramming occurs much faster in isolated microspore culture than in anther culture. This paves the way for the development of an efficient technique for the production of homozygous lines in cassava. This is the first ever detailed report of microspore reprogramming at the tetrad stage and the first report of microspore embryogenesis induction in cassava with detailed evidence