Gutierrezwhitley2000

01), and recreational drug use was also a significant factor (OR = 16.18; p = 0.01) associated with MHCs. There is sub-optimal access and heterogeneity in the modes of referral to mental health support services. Commissioning constraints will further detrimentally affect our ability to provide support in an already deprived area, thus widening health inequalities affecting the most vulnerable.BACKGROUND In prevention, sedentary behaviour and physical activity have been associated with risk of cardiovascular disease and mortality. Less is known about associations with utilization of hospital care. AIM To investigate whether physical activity level and sedentary behaviour prior to cardiac ward admission can predict utilization of hospital care and mortality among patients with cardiovascular disease. METHODS Longitudinal observational study including 1148 patients admitted and treated in cardiac wards in two hospitals. Subjective reports of physical activity levels and sedentary time prior to admission were collected during inpatient care and categorized as low, medium or high. The associations between physical activity level and sedentary time with hospital stay, readmission and mortality were analysed using linear, logistic and Cox regressions. RESULTS Median hospital stay was 2.1 days. One higher step in the physical activity level, or lower sedentary time, was related to an approximately 0.9 days shorter hospital stay. Sixty per cent of patients were readmitted to hospital. The risk of being readmitted was lower for individuals reporting high physical activity and low sedentary time (odds ratios ranging between 0.44 and 0.91). A total of 200 deaths occurred during the study. Rapamycin Mortality was lower among those with high and medium physical activity levels and low sedentary time (hazard ratios ranging between 0.36 and 0.90). CONCLUSION Both physical activity level and sedentary time during the period preceding hospitalization for cardiac events were predictors of hospital utilization and mortality. This highlights the prognostic value of assessing patients' physical activity and sedentary behaviour.BACKGROUND Palliative care can improve outcomes for patients with advanced chronic heart failure and their families, but timely recognition of palliative care needs remains challenging. AIM The aim of this study was to identify characteristics of a tool to assess palliative care needs in chronic heart failure that are needed for successful implementation, according to patients, their family and healthcare professionals in The Netherlands. METHODS Explorative qualitative study, part of the project 'Identification of patients with HeARt failure with PC needs' (I-HARP), focus groups and individual interviews were held with healthcare professionals, patients with chronic heart failure, and family members. Data were analysed using the Consolidated Framework for Implementation Research. RESULTS A total of 13 patients, 10 family members and 26 healthcare professionals participated. Direct-content analysis revealed desired tool characteristics for successful implementation in four constructs relative advantage, adaptability, complexity, and design quality and packaging. Healthcare professionals indicated that a tool should increase awareness, understanding and knowledge concerning palliative care needs. A tool needs to be adaptable to different disease stages, facilitate early identification of palliative care needs and ease open conversations about palliative care. The complexity of chronic heart failure should be considered in a personalized approach. CONCLUSIONS The current study revealed the characteristics of a tool for timely identification of palliative care needs in chronic heart failure needed for successful implementation. The next steps will be to define the content of the tool, followed by development of a preliminary version and iterative testing of this version by the different stakeholders.The timing of migration and migratory steps is highly relevant for fitness. Because environmental conditions vary between years, the optimal time for migration varies accordingly. Therefore, migratory animals could clearly benefit from acquiring information as to when it is the best time to migrate in a specific year. Thus, environmental predictability and variability are fundamental characteristics of migration systems but their relationship and consequence for migratory progression has remained unexplored. We develop a simple dynamic model to identify the optimal migration behaviour in environments that differ in predictability, variability and the number of intermediate stop-over sites. Our results indicate that higher predictability along migration routes enables organisms to better time migration when phenology deviates from its long-term average and thus, increases fitness. Information is particularly valuable in highly variable environments and in the final migration-step, i.e. before the destination. Furthermore, we show that a general strategy for obtaining information in relatively uninformative but variable environments is using intermediate stop-over sites that enable migrants to better predict conditions ahead. Our study contributes to a better understanding of the relationship between animal movement and environmental predictability-an important, yet underappreciated factor that strongly influences migratory progression.The formation of memories within the vertebrate brain is lateralized between hemispheres across multiple modalities. However, in invertebrates evidence for lateralization is restricted to olfactory memories, primarily from social bees. Here, we use a classical conditioning paradigm with a visual conditioned stimulus to show that visual memories are lateralized in the wood ant, Formica rufa. We show that a brief contact between a sugar reward and either the right or left antenna (reinforcement) is sufficient to produce a lateralized memory, even though the visual cue is visible to both eyes throughout training and testing. Reinforcement given to the right antenna induced short-term memories, whereas reinforcement given to the left antenna induced long-term memories. Thus, short- and long-term visual memories are lateralized in wood ants. This extends the modalities across which memories are lateralized in insects and suggests that such memory lateralization may have evolved multiple times, possibly linked to the evolution of eusociality in the Hymenoptera.