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Abstract Aims Our aim was to investigate haemodynamics at rest and during exercise in patients with transthyretin cardiomyopathy (ATTR‐CM) in light of the 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines on pulmonary hypertension (PH). Methods and results We performed right heart catheterization (RHC) in 57 subjects with ATTR‐CM. The proportion of patients with PH was 77% according to the 2022 guidelines versus 47% when applying the 2015 guidelines. Isolated post‐capillary PH and combined pre‐ and post‐capillary PH were most prevalent. Thirty‐six patients underwent a supine bicycle cardiopulmonary exercise test during RHC. Exercise‐induced PH was defined as an increase in mean pulmonary arterial pressure from rest to exercise per increase in cardiac output (ΔmPAP/ΔCO) of > 3 mmHg/L/min. An increase in pulmonary arterial wedge pressure per change in cardiac output (ΔPAWP/ΔCO) from rest to exercise >2 mmHg/L/min was considered suggestive of post‐capillary exercise‐induced PH. All but two patients who exercised during RHC developed exercise‐induced PH. The median ΔmPAP/ΔCO was 7.2 mmHg/L/min and ΔPAWP/ΔCO was 5.1 mmHg/L/min. The median ΔRAP/ΔCO was 3.6 mmHg/L/min and ΔRAP/ΔPAWP was 0.6 mmHg/L/min. Conclusions Most patients with ATTR‐CM have isolated post‐capillary or combined pre‐ and post‐capillary PH at rest, and almost all patients develop exercise‐induced PH with a large post‐capillary component. There was a pronounced, but balanced increase in atrial pressures on exercise.

Abstract Aims Transthyretin amyloid cardiomyopathy (ATTR CM) is a progressive and severe heart disease with physical and psychological implications. The Nordic PROACT study was conducted to investigate the health‐related quality of life (HRQoL) in ATTR CM patients. Methods and results The Nordic PROACT study was a cross‐sectional non‐interventional study conducted in 12 cardiology hospital clinics across Norway, Sweden, Finland and Denmark. Men and women aged ≥18 years diagnosed with symptomatic ATTR CM were included. The investigator provided information on medical history, biomarkers, current treatment, co‐morbidities and disease severity according to the New York Heart Association (NYHA) class and the National Amyloidosis Centre (NAC) staging. Patients completed the HRQoL questionnaires in the form of the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ‐5D‐5L index with Visual Analog Scale (VAS), and the Major Depression Inventory (MDI). A total of 169 patients (mean ± SD age 77.7 ± 6.2 years) were included. Ninety‐two per cent were men. Seventy‐six per cent had wildtype ATTR CM (ATTRwt CM) and 15% had a hereditary form of ATTR CM (ATTRv CM) while 9% were genetically unclassified. Most patients were in NYHA class II (54%) and NAC stage 1 (53%). Participation in randomized clinical trials (RCT) was noted in 58% of the patients. The 169 ATTR CM patients had a mean ± SD KCCQ score of 64.3 ± 23.1 for total symptom score, 64.8 ± 20.9 for overall summary score (OSS) and 65.1 ± 21.5 for clinical summary score. The EQ‐5D‐5L total utility score was 0.8 ± 0.2 and the EQ‐5D‐5L VAS score was 62.9 ± 20.6. The vast majority (89%) did not report any signs of depression. Patients with ATTRv CM had a higher KCCQ OSS as compared with ATTRwt CM, while EQ‐5D‐5L utility score, EQ‐5D‐5L VAS and MDI were similar. Non‐RCT participants had a poorer HRQoL as compared with RCT participants as reflected in lower KCCQ OSS and EQ‐5D‐5L VAS scores and a higher MDI score. Patients with higher NYHA classes and NAC disease stages had a poorer HRQoL as demonstrated by lower KCCQ and EQ‐5D‐5L scores and higher MDI scores. Correlation between KCCQ, EQ‐5D‐5L and MDI and the covariate NYHA class remained significant (P

Abstract Hunter populations can provide a tremendous workforce of citizen scientists afield when queried for data. Soliciting incidental observations of non‐target species from hunters may be a relatively important but untapped population monitoring resource in systems where hunter effort is common and widespread. During 2012–2016, we queried hunters of deer and elk for observations of a non‐target species, moose, across their statewide distribution in Montana. We analysed data in an abundance‐detection framework with n‐mixture models and evaluated the effects of covariates such as hunter effort, survey response totals, weekly session and forest cover on detection probability before using models to predict moose abundance. We collected an average of 3409 moose observations per year and our best n‐mixture model included effects of week, year (number of responses), site (proportionate forest cover) and site‐year (hunter effort) on detection probability, as well as an effect of site (area of forest and shrub habitat) on abundance. Density estimates averaged 0.099 (range 0.002–0.439) moose/km2 across sites or 0.200 (range 0.017–0.799) moose/km2 when limited to density within shrub and forest cover specifically. Statewide abundance totals across the 5‐year study period averaged 10,755 (range 9925–11,620). Goodness‐of‐fit tests showed that models were identifiable and overdispersion of the data was low, yet some caution is still warranted when extrapolating these data to abundance estimates. Querying a sample of deer‐elk hunters for observations of a non‐target species yielded thousands of spatially georeferenced detections per year and analysis in a temporally structured framework yielded estimates of both detection probability and abundance. Abundance estimates at this scale are unprecedented for moose in Montana and are encouraging for long‐term monitoring over space and time.

Abstract Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is a progressive condition caused by deposition of transthyretin amyloid fibrils in the heart and is associated with poor quality of life and a shortened lifespan. This study aimed to describe the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using multiple national health registers in Denmark, Finland, Norway, and Sweden. Methods and results Transthyretin amyloid cardiomyopathy patients were identified during 2008–2018 using a combination of diagnosis codes for amyloidosis and heart disease and were matched to patients with non‐ATTR heart failure (HF). An identical study design was used in each country to facilitate comparison and aggregation of results. A total of 1930 ATTR‐CM patients were identified from national health registers in the four countries. In 2018, prevalence of ATTR‐CM per 100 000 inhabitants ranged from 1.4 in Denmark to 5.0 in Sweden; a steep increase over time was observed in Sweden and Norway. Median survival from diagnosis was 30 months for ATTR‐CM patients and 67 months for matched HF patients. Survival was significantly lower for female than for male ATTR‐CM patients (median survival: 22 and 36 months), while no significant difference was observed in the HF cohort. Conclusions This study provides the first nationwide estimates of the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using identical study design across several countries. Findings corroborate previous case series showing high mortality in ATTR‐CM, two‐fold higher than for other HF patients and higher in women than men, highlighting the need for more precise and early diagnosis to reduce the disease burden.

Abstract A growing body of evidence shows that some ungulates alternate between migratory and nonmigratory behaviors over time. Yet it remains unclear whether such short‐term behavioral changes can help explain reported declines in ungulate migration worldwide, as opposed to long‐term demographic changes. Furthermore, advances in tracking technology reveal that a simple distinction between migration and nonmigration may not sufficiently describe all individual behaviors. To better understand the dynamics and drivers of ungulate switching behavior, we investigated 14 years of movement data from 361 elk in 20 herds across the Greater Yellowstone Ecosystem (GYE). First, we categorized yearly individual behaviors using a clustering algorithm that identified similar migratory tactics across a continuum of behaviors. Then, we tested seven hypotheses to explain why some ungulates switch behaviors, and we evaluated how behavioral changes affected the proportions of different behaviors across the system. We identified four distinct behavioral tactics: residents (4.8% of elk‐years), short‐distance migrants (53.7%), elevational migrants (21.9%) and long‐distance migrants (19.6%). Of the 20 herds, 18 were partially migratory, and 5 had all four movement tactics present. We observed switches between migratory tactics in all sets of consecutive years during our study period, with an average of 22.5% of individual elk changing movement tactics from one year to the next. Elk in herds with higher movement tactic diversity were significantly more likely to switch tactics and often responded more effectively to adverse environmental conditions, compared to those in herds with low movement tactic diversity. During our study period, switching increased the prevalence of both short‐ and long‐distance migrants, decreased the prevalence of elevational migrants, and had no effect on the prevalence of residents. Our findings suggest that rather than contributing to the declining migratory behavior found in the GYE, switching behavior may enable greater resiliency to continuously changing environmental and anthropogenic conditions.

Abstract Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is the cardiac manifestation of transthyretin amyloidosis (ATTR). The aim of this study was to estimate healthcare resource use for ATTR‐CM patients compared with heart failure (HF) patients, in Denmark, Finland, Norway, and Sweden. Methods and results Data from nationwide healthcare registers in the four countries were used. ATTR‐CM patients were defined as individuals diagnosed with amyloidosis and cardiomyopathy or HF between 2008 and 2018. Patients in the ATTR‐CM cohort were matched to patients with HF but without ATTR‐CM diagnosis. Resource use included number of visits to specialty outpatient and inpatient hospital care. A total of 1831 ATTR‐CM and 1831 HF patients were included in the analysis. The mean number of hospital‐based healthcare contacts increased in both the ATTR‐CM and HF cohort during 3 years pre‐diagnosis and was consistently higher for the ATTR‐CM cohort compared with the HF cohort, with 6.1 [CI: 5.9–6.3] vs. 3.2 [CI: 3.1–3.3] outpatient visits and 1.03 [CI: 0.96–1.1] vs. 0.7 [CI: 0.7–0.8] hospitalizations. In the first year following diagnosis, patients with ATTR‐CM continued to visit outpatient care (10.2 [CI: 10.1, 10.4] vs. 5.7 [CI: 5.6, 5.9]) and were admitted to hospital more frequently (3.3 [CI: 3.2, 3.4] vs. 2.5 [CI: 2.5, 2.6]) than HF patients. Conclusions Transthyretin amyloid cardiomyopathy imposes a high burden on healthcare systems with twice as many outpatient specialist visits and 50% more hospitalizations in the year after diagnosis compared with HF patients without ATTR‐CM. Studies to investigate if earlier diagnosis and treatment of ATTR‐CM may lower resource use are warranted.

Abstract Coexistence between large carnivores and humans is a global conservation concern. Montana (USA) is home to recovering grizzly bear (Ursus arctos) populations and increasing human–grizzly interactions. In 2019, we administered a survey of Montanans to investigate factors influencing normative beliefs about grizzly bear population sizes and quantify the relationship between these beliefs and satisfaction with grizzly management in the state. Using a linear regression (r2 = .61), we found that residents with positive attitudes and emotional dispositions toward grizzlies or who trusted the agency were more likely to believe grizzly populations were too low. Residents who believed hunting should be used to manage conflict, were themselves hunters, had vicarious wildlife experience with property damage, believed grizzly populations were expanding, or were older were more likely to believe populations were too high. We found a negative quadratic relationship between normative grizzly bear population size beliefs and satisfaction with management, suggesting an optimal “Goldilocks” zone where coexistence is most possible. In practice, if observed Goldilocks zones are incompatible with population numbers required to meet conservation goals, considering factors influencing these beliefs may help bolster acceptance of larger population sizes.

Abstract The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce. In this single‐center observational cohort study, we compared hemodynamics by right heart catheterization and peak oxygen consumption before and 5 months (±14 days) after either PEA or BPA. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Fourty‐two and fourty consecutive patients were treated with PEA or BPA, respectively. Demographics were similar between groups. Both PEA and BPA significantly reduced mean pulmonary artery pressure (from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow‐up; p

Abstract Understanding animal distribution is important for management of populations and their habitats. Across the western United States, elk (Cervus canadensis) provide important ecological, cultural, and economic benefits and the sound management of their habitats is of vital importance. In western Montana, National Forest lands are managed in part to provide and protect elk habitat needs, and summer elk habitat is managed with consideration to motorized routes. We evaluated the relative importance of nutritional resources, access routes, and other landscape attributes on elk summer resource selection at multiple spatial scales, and compared resource selection among nine different southwestern Montana elk populations to determine the applicability of generalized regional models for informing habitat management recommendations. First, we developed nine population‐specific and two regional summer resource selection models. Second, we evaluated the predictive performance of each model within and among elk populations using cross‐validation scores to identify the best model. We found that in all populations nutritional resources, best represented using normalized difference vegetation index (NDVI) metrics, were the most important factors associated with elk summer resource selection. Access routes affected resource selection in all populations; however, the influence of access routes was relatively modest as compared with nutritional resources. Of the access route covariates we considered, density of all routes (i.e., routes open and closed to motorized use) explained most variation in summer elk resource selection. Validation of population‐specific resource selection models among populations revealed that in many cases model predictions extrapolated to areas outside of the development area had modest to poor predictive performance, especially as distance from the modeled population increased. Thus, caution should be used when extrapolating resource selection models based on a single study population to other populations. Regional models of resource selection predicted resource selection across populations better than population‐specific models, particularly when constructed by pooling data from multiple populations, and we recommend these types of models be used to inform regional habitat management policies. Our results suggest that managers should expand any current management paradigm for elk summer habitat that is focused on limiting access route density to also consider nutritional resources as an important component of elk summer habitat.

Abstract The recovery of carnivore populations in North American has consequences for trophic interactions and population dynamics of prey. In addition to direct effects on prey populations through killing, predators can influence prey behavior by imposing the risk of predation. The mechanisms through which patterns of space use by predators are linked to behavioral response by prey and nonconsumptive effects on prey population dynamics are poorly understood. Our goal was to characterize population‐ and individual‐level patterns of resource selection by elk (Cervus canadensis) in response to risk of wolves (Canis lupus) and mountain lions (Puma concolor) and evaluate potential nonconsumptive effects of these behavioral patterns. We tested the hypothesis that individual elk risk‐avoidance behavior during summer would result in exposure to lower‐quality forage and reduced body fat and pregnancy rates. First, we evaluated individuals' second‐order and third‐order resource selection with a used‐available sampling design. At the population level, we found evidence for a positive relationship between second‐ and third‐order selection and forage, and an interaction between forage quality and mountain lion risk such that the relative probability of use at low mountain lion risk increased with forage quality but decreased at high risk at both orders of selection. We found no evidence of a population‐level trade‐off between forage quality and wolf risk. However, we found substantial among‐individual heterogeneity in resource selection patterns such that population‐level patterns were potentially misleading. We found no evidence that the diversity of individual resource selection patterns varied predictably with available resources, or that patterns of individual risk‐related resource selection translated into biologically meaningful changes in body fat or pregnancy rates. Our work highlights the importance of evaluating individual responses to predation risk and predator hunting technique when assessing responses to predators and suggests nonconsumptive effects are not operating at a population scale in this system.

Abstract Modeling sheet metal forming of materials for lightweight construction requires an understanding of their plastic behavior in different loading directions. The presented work focuses on twin‐roll‐casted magnesium alloy AZ31. It is characterized by unique mechanical properties compared to other magnesium alloys due to the employed twin‐roll‐casting‐process. In general, magnesium alloys with their hexagonal closed‐packed structure possess a complex forming behavior including a deformation‐induced anisotropy evolution. In the context of a fast design approach, an adaptation of the Yield2000‐2d criteria usually used for body‐centered cubic or face‐centered cubic materials is tested. The goal is a simple, versatile material model which parameters are determined just by tensile tests with moderate testing effort. In the investigated model, the yield locus definition is modified by adding a term for the yield exponent evolution during the forming process. The modeling approach is presented and the necessary tests for material data acquisition and evaluation are described. After experimental identification of the model parameters, the material model is applied in a forming simulation. The investigation provides promising results matching well with experimental data. Thus, the application of this model in a fast design step is feasible, offering valuable data like deformed shape, process‐related material properties and induced stresses for further processing.

Abstract Numerical optimization of the manufacturing process of hybrid lightweight structures consisting of fiber‐reinforced plastics is of great importance. This article introduces an industry‐oriented modeling approach for the thermoforming process of thermoplastic prepregs. A laminate model combined with established elastic‐plastic constitutive laws is used for the numerical treatment of the temperature dependent material behavior of the composite. The mechanical properties of the Polyamide 66 (PA66) matrix are acquired from a data sheet provided by the manufacturer. Experiments including tensile, shear, and bending tests are performed to characterize the effective deformation behavior of the prepreg in the full temperature range. Appropriate model parameters are determined to represent the temperature dependent deformation behavior of the composite according to the experimental observations. The parameterized material model for the prepreg is eventually applied in the simulation of thermoforming processes to show the influence of process and material parameters on the forming behavior of thermoplastic prepregs.

Abstract Introduction The benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) have been observed in the first year. However, there are few data on long‐term follow‐up and the effect of changes of LVEF on mortality. This study aimed to assess the LV remodeling after CRT implantation and the probable effect of changes in LVEF with repeated measures on mortality over time in a real‐world registry. Methods Among our cohort of 328 consecutive CRT patients, mixed model effect analysis have been made to describe the temporal evolution of LVEF and LVESV changes over time up with several explanatory variables. Besides, the effect of LVEF along time on the probability of mortality was evaluated using joint modeling for longitudinal and survival data. Results The study population included 328 patients (253 men; 70.2 ± 9.5 years) in 4.2 (2.9) years follow‐up. There was an increase in LVEF of 11% and a reduction in LVESV of 42 mL during the first year. These changes are more important during the first year, but slight changes remain during the follow‐up. The largest reduction in LVESV occurred in patients with left bundle branch block (LBBB) and the smallest reduction in patients with NYHA IV. The smallest increase in LVEF was an ischemic etiology, longer QRS, and LV electrode in a nonlateral vein. Besides, the results showed that the LVEF profiles taken during follow‐up after CRT were associated with changes in the risk of death. Conclusion Reverse remodeling of the left ventricle is observed especially during the first year, but it seems to be maintained later after CRT implantation in a contemporary cohort of patients. Longitudinal measurements could give us additional information at predicting the individual mortality risk after adjusting by age and sex compared to a single LVEF measurement after CRT.

Introduction. This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods. A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results. In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 (p

In this paper, a general procedure for identifying a fractional first-order plus dead-time (FFOPDT) model is presented. This procedure is based on fitting three arbitrary points on the process reaction curve, where process information is obtained from a simple open-loop test. A simplification of the general identification procedure is also considered, where only points symmetrically located on the reaction curve are selected. The proposed symmetrical procedure has been applied to the following sets of representative points: (5–50–95%), (10–50–90%), (15–50–85%), (20–50–80%), (25–50–75%), and (30–50–70%). Analytical expressions of the corresponding FFOPDT model parameters for these sets of symmetrical points have been obtained. In order to show the effectiveness and applicability of this procedure for the identification of fractional-order models and to get insight into the influence of selection of the set of symmetrical points on the accuracy of the identified model, some numerical examples are proposed. This identification procedure gives good results in comparison with other integer- and fractional-order identification methods. Finally, some conclusions and final remarks are offered in this context.

Abstract Aims Invasive haemodynamic profiles at rest and during exercise after heart transplantation (HTx) have never been described in a randomized trial where de novo everolimus (EVR)‐based therapy with early calcineurin inhibitor (CNI) withdrawal has been compared with conventional CNI treatment. We report central invasive haemodynamic parameters at rest and exercise during a 3 year follow‐up after HTx in a sub‐study of the SCandiavian Heart transplant Everolimus De novo stUdy with earLy calcineurin inhibitor avoidancE trial. We hypothesized that the nephroprotective properties, the less development of cardiac allograft vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison with CNI‐based immunosuppression, would demonstrate favourable invasive haemodynamic profiles in patients at rest and during exercise. Methods and results Ninety of 115 HTx recipients randomized to EVR or CNI treatment performed right heart catheterization at rest and 68 performed right heart catheterization at exercise up to 3 years after HTx. Haemodynamic profiles were compared between EVR and CNI treatment groups. Resting haemodynamics improved in both groups from pre‐HTx to the first follow‐up at 7–11 weeks post‐HTx and thereafter remained unchanged up to 3 years of follow‐up. During follow‐up, cardiac reserve during exercise increased with higher levels of maximum heart rate (118 to 148 b.p.m., P < 0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac output (10.3 to 12.2 l/min, P < 0.001). No significant differences in haemodynamic parameters were observed between the EVR and CNI groups at rest or exercise. Isolated post‐capillary pulmonary hypertension (mean pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure ≥ 15 mmHg, and pulmonary vascular resistance

Abstract Background Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long‐term benefits of CRT in symptomatic HF patients receiving or not OMT. Methods We investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow‐up, and OMT only at the 1‐year follow‐up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes. Results One hundred and twenty‐two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50‐1.02; P = 0.067) compared with no‐basal‐OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow‐up (HR 1.72, 95% CI 1.07‐2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1‐year follow‐up was similar to that of the patients who achieved OMT at the 1‐year follow‐up (HR 0.90, 95% CI 0.54‐1.50, P = 0.682). Conclusion Basal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1‐year follow‐up exhibited a reduced risk of HF and death compared with patients who did not.