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In heart failure, fluid overload is a major pathological mechanism leading to vascular congestion, pulmonary congestion and elevated jugular venous pressures. Diuretics play a significant role in the management of patients with congestive heart failure. It is used to relieve the congestive symptoms of heart failure. However, the appropriate use of diuretics remains challenging due to various complications like electrolyte abnormalities, worsening renal function and diuretic resistance. This has prompted towards the search of safer and effective alternatives. This review evaluates the use of diuretics in congestive heart failure and discusses the complications of different types of diuretics, which is essential for successful management of congestion in patients with heart failure and hence to optimise the outcome for the patients.

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OBJECTIVES: In March 2020, the WHO declared SARS-CoV-2 a pandemic. Hospitals across the world faced staff, bed and supply shortages, with some European hospitals calling on medical students to fill the staffing gaps. This study aimed to document the impact of volunteering during the COVID-19 pandemic on students' professional development, resilience and future perceived career choices. DESIGN: This is a retrospective, qualitative study of student reflections, using purposive sampling.The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences recruited 26 medical student volunteers to assist in pronation and supination of ventilated patients affected by SARS-CoV-2. These students were invited to complete an anonymous survey based on their experiences as volunteers. Thematic analysis was performed on these written reflections. RESULTS: The results showed that volunteering during the COVID-19 pandemic developed key skills from RCSI's medical curriculum, significantly fostered medical students' resilience and guided their career choices. Major areas of development included communication, teamwork, compassion and altruism, which are not easily developed through the formal curriculum. A further area that was highlighted was the importance of evidence-based health in a pandemic. Finally, our respondents were early stage medical students with limited clinical exposure. Some found the experience difficult to cope with and therefore supports should be established for students volunteering in such a crisis. CONCLUSION: These results suggest that clinical exposure is an important driver in developing students' resilience and that volunteering during a pandemic has multiple benefits to students' professional development and professional identity formation.

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The survival of a bird's developing embryo depends on the egg's ability to stay within strict thermal limits. How eggshell colours help maintain thermal balance is a long-standing and contested question. Using data spanning a wide phylogenetic diversity of birds on a global spatial scale, we find evidence that eggshell pigmentation may have been shaped by thermoregulatory needs. Birds living in cold habitats, particularly those with nests exposed to incident solar radiation, have darker eggs. We show evidence that darker eggs heat more rapidly than lighter ones when exposed to solar radiation. This evidence suggests that egg pigmentation could play an important role in thermoregulation in cold climates, while a range of competing selective pressures further influence eggshell colours in warmer climates. These findings advance our understanding of thermoregulation in the distribution of natural colours.

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The effectiveness of vertical drop jumps (VDJs) to screen for non-contact ACL injuries is unclear. This may be contributed to by discrete point analysis, which does not evaluate patterns of movement. Also, limited research exists on the second landing of VDJs, potential lower limb performance asymmetries and the effect of fatigue. Statistical parametric mapping investigated the main effects of landing, limb dominance and a high intensity, intermittent exercise protocol (HIIP) on VDJ biomechanics. Twenty-two male athletes (21.9 ± 1.1 years, 180.5 ± 5.5 cm, 79.4 ± 7.8 kg) performed VDJs pre- and post-HIIP. Repeated measures ANOVA identified pattern differences during the eccentric phases of the first and second landings bilaterally. The first landing displayed greater (internal) knee flexor (η2 = 0.165), external rotator (η2 = 0.113) and valgus (η2 = 0.126) moments and greater hip (η2 = 0.062) and knee (η2 = 0.080) flexion. The dominant limb generated greater knee flexor (η2 = 0.062), external rotator (η2 = 0.110) and valgus (η2 = 0.065) moments. The HIIP only had one effect, increased thoracic flexion relative to the pelvis (η2 = 0.088). Finally, the dominant limb demonstrated greater knee extensor moments during the second landing (η2 = 0.100). ACL injury risk factors were present in both landings of VDJs with the dominant limb at potentially greater injury risk. Therefore, VDJ screenings should analyse both landings bilaterally.

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SUMMARY: In California, the annual number of children under age 6 y of age with blood lead levels (BLL) ≥10µg/dL is estimated at over 1,000 cases, and up to 10,000 cases when BLL between 4.5 and 9.5 µg/dL are included. State-issued health alerts for food contamination provide one strategy for tracking sources of food-related lead exposures. As well, California passed legislation in 2006 for the Food and Drug Branch (FDB) of the state health department to test and identify lead in candy. This report presents health alert data from California over a 14-y period, compares data before and after the candy testing program began, and examines country of origin, ZIP code data, and time from candy testing to release of health alerts for lead-contaminated candies for 2011-2012. After 2007, health alerts issued for lead in candy and food increased significantly. Analysis of candy-testing data indicated that multiple counties and ZIP codes were affected. Seventeen candies with high lead concentrations were identified, resulting in rapid dissemination (<2wk) of health alerts to local health departments and community clinicians and to the public. Surveillance of lead exposures from state-based food and candy testing programs provides an opportunity to identify and immediately act to remove nonpaint sources of lead affecting children. https://doi.org/10.1289/EHP2582.

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Hydrogeologists often are called upon to estimate surfaces from discrete, sparse data points. This estimation is often accomplished by manually drawing contours on maps using interpolation methods between points of known value while accounting for features known to influence the water table's surface. By contrast, geographic information systems (GIS) are good at creating smooth continuous surfaces from limited data points and allowing the user to represent the resulting surface resulting with contours, but these automated methods often fail to meet the expectations of many hydrogeologists because they do not include knowledge of other influences on the water table. In this study, we seek to fill this gap in the GIS-based methodology for hydrogeologists through an interactive tool that shapes an interpolated surface based on additional knowledge of the water table inferred from gaining or losing streams. The modified surface is reflected in water table contours that, for example, "V" upstream for gaining streams, and can be interactively adjusted to fit the user's expectations. By modifying not only the contours but also the associated interpolated surface, additional contours will follow the same trend, and the modified surface can be used for other analyses like calculating average gradients and flow paths. The tool leverages Esri's ArcGIS Desktop software, building upon a robust suite of mapping tools. We see this as a prototype for other tools that could be developed for hydrogeologists to account for variations in the water table inferred from local topographic trends, pumping or injection wells, and other hydrogeologic features.

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The Hempstead Plains, located in Nassau County, New York, contains remnants of the only naturally occurring prairie east of the Appalachian Mountains. It originally encompassed approximately 12,500 ha. Although the area receives higher amounts of rainfall for a typical tall-grass prairie ecosystem, approximately 114 cm of precipitation per year, its well-drained, dark-colored soil sited above glacial outwash, available natural seed bank, and history of fires enabled development of a tall-grass prairie. This study identified prairie remnants within the historical extent of the Hempstead Plains delineated by the 1928 soil survey from the United States Department of Agriculture. Image analysis of infrared color 8-bit orthophotographs was used for an unsupervised classification on a 156-ha primary study area containing a known prairie remnant, centered on the Red Golf Course at Eisenhower Park in East Meadow. The resulting 16 classes were combined into six more general classes before undergoing an error assessment based on field and orthoimagery ground-truthing of 1,000 random points. As confirmed by site visits, analysis was generally able to distinguish prairie grass from non-native grasses using remote sensing, as native warm-season prairie grasses are dormant from late fall to early spring. Overall accuracy for the six classes was 89 %. Accuracy of the warm-season grass class was 81 % for producer's accuracy and 83 % for user's accuracy. This study identified additional sites containing warm-season grasses and potential prairie remnants in Nassau County.

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Traceback methods by state regulatory agencies were used to complement traditional epidemiological cluster investigation methods and confirmed hazelnuts (also referred to as filberts) as the vehicle in a multistate outbreak of Escherichia coli O157:H7 infections. Bulk in-shell hazelnut and mixed-nut purchase locations were identified during the initial epidemiological interviews. Based on purchase dates and case onset dates, regulators in Minnesota, Michigan, and Wisconsin traced product back through the supply chain. Six (86%) retail locations received the suspect hazelnut or mixed-nut shipments from a Minnesota distributor, with one retailer (14%) receiving products from a Wisconsin distributor. Both distributors received 100% of their bulk in-shell hazelnuts and mixed nuts from a distributor in California. The California distributor received 99% of their hazelnuts from a packing company in Oregon. The California distributor received the hazelnuts in 50-lb (22.7-kg) bags and either resold them without opening the bags or used the in-shell hazelnuts in the manufacture of their in-shell mixed nuts. Records at the packing company in Oregon were incomplete or lacked sufficient detail needed to identify a suspect farm or group of suspect farms. Laboratory samples collected from human cases and subsequently recalled product matched the outbreak pulsed-field gel electrophoresis subtype of E. coli O157:H7. Hazelnut harvesting practices create a plausible route of contamination from fecal matter from domestic ruminants or wild deer. This outbreak investigation demonstrates the use of product traceback data to rapidly test an epidemiological hypothesis.

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