Revista Jurídica Digital UANDES
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Timing and Causes of Unplanned Readmissions After Percutaneous Coronary Intervention:Insights From the Nationwide Readmission Database
No full textOBJECTIVES: The aim of this study was to describe the rates and causes of unplanned readmissions at different time periods following percutaneous coronary intervention (PCI).BACKGROUND: The rates and causes of readmission at different time periods after PCI remain incompletely elucidated.METHODS: Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for the rates, causes, predictors, and costs of unplanned readmission between 0 and 7 days, 8 and 30 days, 31 and 90 days, and 91 and 180 days after index discharge.RESULTS: This analysis included 2,412,000 patients; 2.5% were readmitted between 0 and 7 days, 7.6% between 8 and 30 days, 8.9% between 31 and 90 days, and 8.0% between 91 and 180 days (cumulative rates 2.5%, 9.9%, 18.0%, and 24.8%, respectively). The majority of readmissions during each time period were due to noncardiac causes (53.1% to 59.6%). Nonspecific chest pain was the most common identifiable noncardiac cause for readmission during each time period (14.2% to 22.7% of noncardiac readmissions). Coronary artery disease including angina was the most common cardiac cause for readmission during each time period (37.4% to 39.3% of cardiac readmissions). The second most common cardiac cause for readmission was acute myocardial infarction between 0 and 7 days (27.6% of cardiac readmissions) and heart failure during all subsequent time periods (22.2% to 23.7% of cardiac readmissions).CONCLUSIONS: Approximately 25% of patients following PCI have unplanned readmissions within 6 months. Causes of readmission depend on the timing at which they are assessed, with noncardiovascular causes becoming more important at longer time points.</p
Co-electrospraying of tumour cell mimicking hollow polymeric microspheres for diffusion magnetic resonance imaging
No full text Diffusion magnetic resonance imaging (dMRI) is considered as a useful tool to study solid tumours. However, the interpretation of dMRI signal and validation of quantitative measurements of is challenging. One way to address these challenges is by using a standard reference material that can mimic tumour cell microstructure. There is a growing interest in using hollow polymeric microspheres, mainly prepared by multiple steps, as mimics of cells in healthy and diseased tissue. The present work reports on tumour cell-mimicking materials composed of hollow microspheres for application as a standard material in dMRI. These microspheres were prepared via one-step co-electrospraying process. The shell material was poly(D,L-lactic-co-glycolic acid) (PLGA) polymers with different molecule weights and/or ratios of glycolic acid-to-lactic, while the core was polyethylene glycol (PEG) or ethylene glycol. The resultant co-electrosprayed products were characterised by optical microscopy, scanning electron microscopy (SEM) and synchrotron X-ray micro-CT. These products were found to have variable structures and morphologies, e.g. from spherical particles with/without surface hole, through beaded fibres to smooth fibres, which mainly depend on PLGA composition and core materials. Only the shell material of PLGA polymer with ester terminated, Mw 50,000–75,000 g mol −1 , and lactide:glycolide 85:15 formed hollow microspheres via the co-electrospraying process using the core material of 8 wt% PEG/chloroform as the core. A water-filled test object (or phantom) was designed and constructed from samples of the material generated from co-electrosprayed PLGA microspheres and tested on a 7 T MRI scanner. The preliminary MRI results provide evidence that hollow PLGA microspheres can restrict/hinder water diffusion as cells do in tumour tissue, implying that the phantom may be suitable for use as a quantitative validation and calibration tool for dMRI. </p
Leisure Pursuits: The ‘selective tradition’ in culture and well-being evidence for policy
No full textThis article reconsiders the value of leisure studies to well-being evidence for policy-making. It presents secondary analyses of Office for National Statistics data from the Measuring National Well-being (MNW) debate (2010). It finds that leisure is more important to the nation than accounted for in official reports. Using Raymond Williams’ framework of ‘lived culture’ and ‘recorded culture’, the article interprets this analytical discrepancy as demonstrating the culture of ‘the selective tradition’.Raymond Williams’ work is used to understand the side-lining of leisure in the MNW programme in two ways. Firstly, the article addresses survey design and analysis. It finds a methodological bias against free text data as evidence, affecting which aspects of cultural and social life appear central to well-being. Secondly, the article takes a discourse approach to cultural sector advocacy, which, in arguing the value of arts-related activity, relegates aspects of ‘culture as ordinary’ by default. These two selective traditions mean that ‘everyday participation’ is not valued in discussions of well-being evidence, advocacy or in the final MNW measures, despite their value to the public. This article prioritises everyday understandings of well-being over those of experts, offering an ethical and practical contribution to leisure studies and policy-making for well-being
The Influence of an Air Gap at the Needle/Polymer Interface on Electrical Tree Growth
No full textThe impact of air gaps between a metallic needle tip and the polymer on electrical tree growth has been studied in low density polyethylene (LDPE). Gaps of 115 µm, 212 µm and 1037 µm have been experimentally investigated. Corona discharges of different types were measured within those air gaps. Accelerated treeing to breakdown was found in the sample with a 115 µm air gap. In this case the streamer coronas were slightly higher in magnitude than the maximum partial discharge (PD) during the tree growth in the no-gap sample. In contrast, lower corona discharge magnitudes were associated with larger air gaps, and electrical trees gradually stopped propagating to the counter electrodes and developed into pine-branch tree structures. This work highlights the differences between electrical trees that effectively grew from a metallic electrode in direct contact with the polymer and a point of corona source
Integrating Data Mining and Microsimulation Modelling to Reduce Traffic Congestion: A Case Study of Signalized Intersections in Dhaka, Bangladesh
No full textA growing body of research has applied intelligent transportation technologies to reduce traffic congestion at signalized intersections. However, most of these studies have not considered the systematic integration of traffic data collection methods when simulating optimum signal timing. The present study developed a three-part system to create optimized variable signal timing profiles for a congested intersection in Dhaka, regulated by fixed-time traffic signals. Video footage of traffic from the studied intersection was analyzed using a computer vision tool that extracted traffic flow data. The data underwent a further data-mining process, resulting in greater than 90% data accuracy. The final data set was then analyzed by a local traffic expert. Two hybrid scenarios based on the data and the expert’s input were created and simulated at the micro level. The resultant, custom, variable timing profiles for the traffic signals yielded a 40% reduction in vehicle queue length, increases in average travel speed, and a significant overall reduction in traffic congestion
Significance of the endocannabinoid system in migraine
No full textBased on the traditional pain-relieving effect of Cannabis species an endogenous cannabinoidlike system was discovered in the human body. Endocannabinoids have important role in the homeostasis of the body, such as stress response and mood control, feeding behaviour, energy balance and metabolism, immunological processes, and also play important role in controlling pain processing. Previous studies suggested that an endokannabinoid dysfunction, namely endokannabinoid deficit, might contribute to the development of migraine and its chronification. Although, the exact nature of the relationship between migraine and endokannabinoid system is not fully understood yet, in this brief review we summarise research results suggesting that the endokannabinoid system may be a potential drug target in the migraine therapy.</p
Anxiety and depression - the role of blood-brain barrier integrity
No full textAmong mental illnesses, anxiety disorders represent the second most frequent disorder. According to WHO Survey 2017, 264 million people suffer from their different types globally. The emergence of anxiety disorders can often increase the likelihood of developing other psychiatric illnesses such as depression, which is the most common mental illness with 300 million people affected worldwide. Although the two diseases mentioned above are widespread throughout the world, the exact physiological causes of their development and the way they are connected are not well understood. However, in order to be able to use right treatment it would be important to know the physiological background in their development. The use of anxiolytics and antidepressants is not always effective and safe, which may be due to the subtypes of these mental disorders with different etiologies. Identifying the right therapeutic strategies could be also challenging because of the phenotypic overlap between anxiety disorders and depression. Their comorbidity has been confirmed by many studies, but their exact physiological relationship is still unclear. Previous studies suggested that blood-brain barrier proteins play an important role in the development of depression and anxiety disorders and might partially explain their comorbidities. In our summary we review the current literature related to this topic.</p
Safety and efficacy of intravenous bimagrumab in inclusion body myositis: a phase 2b, randomised, double-blind, placebo-controlled study (RESILIENT)
No full textSummaryBackgroundInclusion body myositis is an idiopathic inflammatory myopathy and the most common myopathy affecting people older than 50 years. To date, there are no effective drug treatments. We aimed to assess the safety, efficacy, and tolerability of bimagrumab—a fully human monoclonal antibody—in individuals with inclusion body myositis.MethodsWe did a multicentre, double-blind, placebo-controlled study (RESILIENT) at 38 academic clinical sites in Australia, Europe, Japan, and the USA. Individuals (aged 36–85 years) were eligible for the study if they met modified 2010 Medical Research Council criteria for inclusion body myositis. We randomly assigned participants (1:1:1:1) using a blocked randomisation schedule (block size of four) to either bimagrumab (10 mg/kg, 3 mg/kg, or 1 mg/kg) or placebo matched in appearance to bimagrumab, administered as intravenous infusions every 4 weeks for at least 48 weeks. All study participants, the funder, investigators, site personnel, and people doing assessments were masked to treatment assignment. The primary outcome measure was 6-min walking distance (6MWD), which was assessed at week 52 in the primary analysis population and analysed by intention-to-treat principles. We used a multivariate normal repeated measures model to analyse data for 6MWD. Safety was assessed by recording adverse events and by electrocardiography, echocardiography, haematological testing, urinalysis, and blood chemistry. This trial is registered with ClinicalTrials.gov, number NCT01925209; this report represents the final analysis.FindingsBetween Sept 26, 2013, and Jan 6, 2016, 251 participants were enrolled to the study, of whom 63 were assigned to each bimagrumab group and 62 were allocated to the placebo group. At week 52, 6MWD change from baseline did not differ between any bimagrumab dose and placebo (least squares mean treatment difference for bimagrumab 10 mg/kg group, 17·6 m, SE 14·3, 99% CI –19·6 to 54·8; p=0·22; for 3 mg/kg group, 18·6 m, 14·2, –18·2 to 55·4; p=0·19; and for 1 mg/kg group, –1·3 m, 14·1, –38·0 to 35·4; p=0·93). 63 (100%) participants in each bimagrumab group and 61 (98%) of 62 in the placebo group had at least one adverse event. Falls were the most frequent adverse event (48 [76%] in the bimagrumab 10 mg/kg group, 55 [87%] in the 3 mg/kg group, 54 [86%] in the 1 mg/kg group, and 52 [84%] in the placebo group). The most frequently reported adverse events with bimagrumab were muscle spasms (32 [51%] in the bimagrumab 10 mg/kg group, 43 [68%] in the 3 mg/kg group, 25 [40%] in the 1 mg/kg group, and 13 [21%] in the placebo group) and diarrhoea (33 [52%], 28 [44%], 20 [32%], and 11 [18%], respectively). Adverse events leading to discontinuation were reported in four (6%) participants in each bimagrumab group compared with one (2%) participant in the placebo group. At least one serious adverse event was reported by 21 (33%) participants in the 10 mg/kg group, 11 (17%) in the 3 mg/kg group, 20 (32%) in the 1 mg/kg group, and 20 (32%) in the placebo group. No significant adverse cardiac effects were recorded on electrocardiography or echocardiography. Two deaths were reported during the study, one attributable to subendocardial myocardial infarction (secondary to gastrointestinal bleeding after an intentional overdose of concomitant sedatives and antidepressants) and one attributable to lung adenocarcinoma. Neither death was considered by the investigator to be related to bimagrumab.InterpretationBimagrumab showed a good safety profile, relative to placebo, in individuals with inclusion body myositis but did not improve 6MWD. The strengths of our study are that, to the best of our knowledge, it is the largest randomised controlled trial done in people with inclusion body myositis, and it provides important natural history data over 12 months.FundingNovartis Pharma
The unexpected explosive sub-Plinian eruption of Calbuco volcano (22–23 April 2015; southern Chile): Triggering mechanism implications
No full textPlinian-type eruptions are extremely hazardous, producing pyroclastic fallout and flows extending many kilometres from the vent. The most commonly invoked eruption trigger for Plinian-type eruptions is the intrusion of fresh magma, generally associated with precursory ground deformation and seismicity days/weeks before eruption. Closed-system internal triggering has also been proposed, such as protracted crystallisation of magma, which can produce a build-up of exsolved volatiles and thus pressurise the system prior to eruption. On 22–23 April 2015 Calbuco volcano, Chile, produced a sub-Plinian eruption with <3 h seismic precursory activity and no clear deformation signals in the preceding months. Here, we show that petrological and geochemical evidence do not support a hypothesis of eruption triggering due to pre-eruptive intrusion of fresh magma, but instead are consistent with an internal trigger. We found that basaltic andesitic magma was stored at depths between 8 and 12 km (i.e. 230–320 MPa) beneath Calbuco volcano before the 2015 eruption. The stored magma had an initial temperature of 900–950 °C, was water-saturated (5.5–6.5 wt% H2O) and formed phenocrysts of titanomagnetite, orthopyroxene, clinopyroxene and plagioclase cores (An78–93). Gradual cooling of the magma chamber produced thermal gradients and magma convection, evidenced by plagioclase overgrowth rims (An58–77) and blocky microlites (25–250 μm). Our interpretation is that this continuing crystallisation induced second boiling and an over-pressurisation of the system, leading to the rapid onset of the 2015 eruption. Petrological and geochemical evidence therefore shows that a closed-system magma chamber can evolve into a highly explosive eruption with very little precursory warning, posing a challenge for current volcano monitoring paradigms. We propose that internal triggering should be carefully considered as a mechanism for unexpected sub-Plinian eruptions, prompting a potential revision of existing hazard management strategies
Simple Semi-Grant-Free Transmission Strategies Assisted by Non-Orthogonal Multiple Access
No full textGrant-free transmission is an important feature to be supported by future wireless networks since it reduces the signalling overhead caused by conventional grant-based schemes. However, for grant-free transmission, the number of users admitted to the same channel is not capped, which can lead to a failure of multi-user detection. This paper proposes non-orthogonal multiple-access (NOMA) assisted semi-grant-free (SGF) transmission, which is a compromise between grant-free and grant-based schemes. In particular, instead of reserving channels either for grant-based users or grant-free users, we focus on an SGF communication scenario, where users are admitted to the same channel via a combination of grant-based and grant-free protocols. As a result, a channel reserved by a grant-based user can be shared by grant-free users, which improves both connectivity and spectral efficiency. Two NOMA assisted SGF contention control mechanisms are developed to ensure that, with a small amount of signalling overhead, the number of admitted grant-free users is carefully controlled and the interference from the grant-free users to the grant-based users is effectively suppressed. Analytical results are provided to demonstrate that the two proposed SGF mechanisms employing different successive interference cancelation decoding orders are applicable to different practical network scenarios