45 research outputs found
Prevalence of comorbidities in patients with obstructive sleep apnea syndrome, overlap syndrome and obesity hypoventilation syndrome
No full textSleep-disordered breathing causes a burden to the sufferer, the health care system and the society. Most studies have focused on obstructive sleep apnea (OSA); however, the prevalence of comorbidities in patients affected by overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) has not been carefully evaluated
Analysis and modeling of the behavior of hydrogels-based systems for biomedical and agro-food applications
No full text2015 - 2016Hydrogels are three-dimensional, hydrophilic, polymeric networks capable of imbibing large amounts of water or biological fluids. Depending on the type of polymer, number of cross-links, presence of ionic species the swelling/shrinking behavior can be greatly modified. This peculiar behavior, which has led to define this soft matter as “smart materials”, makes hydrogels and hydrogel-based systems very attractive by several frontier fields, such as biomedical applications, as well as for sectors that are less demanding technology, i.e. agro-food applications. The general aim of this Ph.D. thesis is to analyze, with ad hoc experiments, and to describe/simulate, through mathematical modeling, the behavior of hydrogels and hydrogel-based systems. A first question to answer when approaching hydrogels is: “are they multiphasic or monophasic systems”? The answer cannot be taken for granted. Despite in most experimental cases the response is simply avoided, it become fundamental when the aim is to develop a mechanistic mathematical model of the system. The most natural approach is to consider hydrogels as single-phase matter, in which several components can coexist, like it would be indisputably done for polymeric solutions (hydrosols). Another vision is to consider hydrogels as made of different phases, i.e. the water phase is separated from the polymeric phase, and these can exchange momentum. During this work a general modeling framework has been proposed to which several models from literature, multiphasic or monophasic, can be traced back or, vice versa, depending on the chosen approach the framework can be particularized to give the multiphasic or the monophasic balance equations. In this thesis, in light of its thermodynamic and numerical robustness, the monophasic approach, which is more consistent, has been chosen. Another important question is related to the need of modeling/analyze the full behavior, mass transport plus mechanics, or just one aspect, mass transport only. The difficulties related to the solution/analysis of the full hydrogels behavior have led many researchers to describe hydrogel-based systems with a “mass transport only” approach. This is, in example, common in drug delivery applications. During this PhD a mechanistic model based on a “mass transport only” approach for drug release from hydrogel-based system has been developed and validated against experimental data. HPMC-based tablets, loaded with Theophylline have been studied. Differently to what is normally done in dissolution tests, in this work besides the evaluation of the drug release via spectrophotometric analysis, the water and polymer residue have been determined by gravimetric analysis. This has been done on the entire tablets, as well as on portion of them, obtaining internal profiles of the components. The partially swollen tablets have been also subjected to indentation tests, which after an opportune calibration have allowed obtaining information on the water distribution inside the system. A 2Daxisymmetric model has been built on the water and drug mass transport equations; the polymer has been obtained from the mass fraction constraint. The deformations have been described with an ALE moving mesh method, whose boundaries move in relation to the amount of water and drug entering or leaving the system. The comparison between the detailed experimental results and the modeling results has shown a good agreement, in terms of masses, shape and components distribution, demonstrating that the main features had been correctly described. Such a formulated model has been applied to describe commercial-like tablets (in which excipients were present), with two type of HPMC with different substitution pattern (i.e. different degree of cross-links) and tested in non-standard apparatus (NMR cell). Despite after a proper tuning the model has been able to describe the drug and polymer release, the shape and the water distribution inside the system (experimentally taken from MRI technique) have not been correctly described. This application demonstrated the limits of a “mass transport only” approach. In the analyzed case the forces acting on the swelling tablet (shear, centrifugal, gravitational) could have a relevant impact, but most of all the different degree of cross-links of the HPMC played the major role.
In order to consider the hydrogel mechanics, the pure hydrogel behavior has been studied. Hydrogels normally couple solvent mass transport to system deformation and vice versa. This phenomenon is generally called poroelasticity and it is characteristic also of other materials (i.e. biological tissues, soils etc.). Another peculiarity of hydrogels is that the constituent polymeric network can have viscoelastic characteristics (i.e. like polymeric melts), which eventually translate in an overall hydrogel viscoelastic behavior. Depending on the time interval of interest and on the characteristic times of relaxation and diffusion, hydrogels can behave viscoelastically, poroelastically or poroviscoelastically (when the diffusion time is comparable with the relaxation time). A 3D model describing the poroviscoelastic behavior of hydrogels, still scarcely implemented in literature, has been developed within the field of non-equilibrium thermodynamics and non-linear solid mechanics (large deformations) and implemented in a commercial FEM-based software. The results of such kind of model permit to discriminate between and to study the poroelastic and viscoelastic regime as well as
Abstract Diego Caccavo
it permits to study the poroviscoelastic behavior. Experimental unconfined stress-relaxation tests have been performed on agarose-gels at different concentrations with radius and height of 1 cm, and imposing a deformation of 10%. In the time range analyzed (1200 s) the agarose-gel has shown a predominant viscoelastic behavior, releasing only little amount of water. The model, after an initial tuning of the parameters, has been able to fairly predict the experimental data. Characteristic of the developed approach is that, once the model parameters are derived, it is possible to describe the hydrogel subjected to different stimuli (mechanicals or chemicals).
The proposed poroviscoelastic model is extendable to multicomponent diffusion systems, which could be, in example, controlled release systems based on hydrogels. For the first time, to the author’s knowledge, in the hydrogel-based systems modeling literature, in this thesis it has been shown how to extend the poroviscoelastic model to consider the presence of another diffusing species. The transport and constitutive model equations, opportunely modified, have been implemented in a commercial FEM-based software and, as an example, the drug release from a swelling system has been reported. [edited by Author]XV n.
Successful practice in early career networks : Insights from the polar sciences
No full textAcquiring not only field-specific knowledge but also a set of transferable professional skills becomes increasingly important for Early Career Scientists (ECS) in Geosciences and other academic disciplines. Although the need for training in transferable skills adds to the work-load of an individual Early Career Scientist, it is often neglected within the traditional academic environments. International Early Career Networks (ECN) are global voluntary communities of early career scientists aiming (i) to advocate for early stage researchers; and (ii) to advance the careers of their members by raising their profiles and training them in specific transferable skills, such as networking, collaborating and outreach. Accordingly, ECN can be a tool to move beyond institutional barriers and to improve the inclusion of ECS into the international scientific community. In 2019 we conducted three surveys in order to assess ECN from the perspective of its members and regarding the structures of different ECN within a specific discipline and across disciplines. We use the survey results alongside with case studies from well-established and long term networks to elucidate the attributes that make a successful, sustainable ECN. Important characteristics of these international ECN include (1) developing the ECN organizational schemes to promote early career scientists within a specific discipline and across disciplines, (2) scoping for members needs, evaluating the performance of the network, and adapting to feedback, (3) continuity of the organizing committee by ensuring representation of different stages of ECS, and (4) diverse membership to provide strong foundational and personnel support within the network. These characteristics can support the development of best practices for developing ECN successfully, which can guide existing and future networks within Geosciences and other scientific disciplines. © Author(s) 2020. This work is distributed under the Creative Commons Attribution 4.0 License
Características de los pacientes mayores de 75 años en el Registro ARGEN-IAM-ST
No full textBackground: Older adults represent a growing population in clinical practice.Objectives: The aim of this study was to learn the clinical characteristics and outcome of older adults hospitalized with myocardialinfarction in Argentina.Methods: Patients included in the ARGEN-IAM-ST registry were analyzed depending on whether they were older or youngerthan 75 years of age.Results: Among the 1,714 patients included in the registry, 233 (13.6%) were aged 75 years or older. These patients hadgreater prevalence of female sex and hypertension and lower incidence of smoking habits, while the prevalence of diabetes,dyslipidemia, anterior myocardial infarction and time from onset of symptoms was similar. They were less likely to receivereperfusion therapy and progression to heart failure (31% vs. 14%; p <0.01), reinfarction (3.9 vs. 1.4%; p=0.009), minorbleeding (7.7% vs. 3.2%; p <0.002) and mortality (21.5% vs. 6.7%, p <0.001) were more common.Conclusions: Older adults with myocardial infarction have a more unfavorable outcome and mortality is three times greaterthan that of patients <75 years.Introducción: Los adultos mayores representan una población cada vez más numerosa en la práctica clínica.Objetivos: Conocer las características clínicas y evolución de los adultos mayores que se internan por infarto en Argentina.Material y métodos: Se analizaron los pacientes de acuerdo con la edad mayor o menor de 75 años incluidos en el registroARGEN-IAM-ST.Resultados: De 1714 pacientes ingresados, 233 (13,6%) tenían una edad ≥ 75 años. Se observó en estos una mayor prevalenciade sexo femenino, de hipertensión arterial, menor de tabaquismo y similar de diabetes, dislipidemia, infarto agudo de miocardiode localización anterior y tiempo de evolución al ingreso. Recibieron menos tratamiento de reperfusión y evolucionaronmás frecuentemente con insuficiencia cardíaca (el 31% vs. a 14%; p < 0,01), reinfarto (3,9 vs. 1,4%; p = 0,009), sangrado nomayor (7,7% vs. 3,2%, p < 0,002) y muerte (21,5% vs. 6,7%, p < 0,001).Conclusiones: Los adultos mayores con infarto tienen una evolución más tórpida y una mortalidad que triplica la de los pacientesmenores de 75 años
Effect of Colchicine vs Usual Care Alone on Intubation and 28-Day Mortality in Patients Hospitalized with COVID-19: A Randomized Clinical Trial
No full textImportance Hospitalized patients with COVID-19 pneumonia have high rates of morbidity and mortality. Objective To assess the efficacy of colchicine in hospitalized patients with COVID-19 pneumonia. Design, Setting, and Participants The Estudios Clínicos Latino América (ECLA) Population Health Research Institute (PHRI) COLCOVID trial was a multicenter, open-label, randomized clinical trial performed from April 17, 2020, to March 28, 2021, in adults with confirmed or suspected SARS-CoV-2 infection followed for up to 28 days. Participants received colchicine vs usual care if they were hospitalized with COVID-19 symptoms and had severe acute respiratory syndrome or oxygen desaturation. The main exclusion criteria were clear indications or contraindications for colchicine, chronic kidney disease, and negative results on a reverse transcription–polymerase chain reaction test for SARS-CoV-2 before randomization. Data were analyzed from June 20 to July 25, 2021. Interventions Patients were assigned in a 1:1 ratio to usual care or usual care plus colchicine. Colchicine was administered orally in a loading dose of 1.5 mg immediately after randomization, followed by 0.5 mg orally within 2 hours of the initial dose and 0.5 mg orally twice a day for 14 days or discharge, whichever occurred first. Main Outcomes and Measures The first coprimary outcome was the composite of a new requirement for mechanical ventilation or death evaluated at 28 days. The second coprimary outcome was death at 28 days. Results A total of 1279 hospitalized patients (mean [SD] age, 61.8 [14.6] years; 449 [35.1%] women and 830 [64.9%] men) were randomized, including 639 patients in the usual care group and 640 patients in the colchicine group. Corticosteroids were used in 1171 patients (91.5%). The coprimary outcome of mechanical ventilation or 28-day death occurred in 160 patients (25.0%) in the colchicine group and 184 patients (28.8%) in the usual care group (hazard ratio [HR], 0.83; 95% CI, 0.67-1.02; P = .08). The second coprimary outcome, 28-day death, occurred in 131 patients (20.5%) in the colchicine group and 142 patients (22.2%) in the usual care group (HR, 0.88; 95% CI, 0.70-1.12). Diarrhea was the most frequent adverse effect of colchicine, reported in 68 patients (11.3%). Conclusions and Relevance This randomized clinical trial found that compared with usual care, colchicine did not significantly reduce mechanical ventilation or 28-day mortality in patients hospitalized with COVID-19 pneumonia.Fil: Diaz, Rafael. Estudios Clínicos Latino América; Argentina. Instituto Cardiovascular de Rosario; ArgentinaFil: Orlandini, Andrés. Estudios Clínicos Latino América; Argentina. Instituto Cardiovascular de Rosario; ArgentinaFil: Castellana, Noelia. Estudios Clínicos Latino América; Argentina. Universidad Nacional de Rosario; ArgentinaFil: Caccavo, Alberto. Provincia de Buenos Aires. Dirección General de Cultura y Educación. Universidad Provincial del Sudoeste; ArgentinaFil: Corral, Pablo. Universidad FASTA "Santo Tomas de Aquino"; ArgentinaFil: Corral, Gonzalo. Infectología Clínica de Mayo; ArgentinaFil: Chacón, Carolina. Estudios Clínicos Latino América; Argentina. Universidad Abierta Interamericana; Argentina. Unidad Coronaria de Sanatorio Delta de Rosario; Argentina. Comite de Epidemiologia y Prevención Cardiovascular de la Federación Argentina de Cardiologia; ArgentinaFil: Lamelas, Pablo. McMaster University; Canadá. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Botto, Fernando. Instituto Cardiovascular de Buenos Aires; ArgentinaFil: Díaz, María Luz. Estudios Clínicos Latino América; Argentina. Instituto Cardiovascular de Rosario; ArgentinaFil: Domínguez, Juan Manuel. Estudios Clínicos Latino América; Argentina. Instituto Cardiovascular de Rosario; ArgentinaFil: Pascual, Andrea. Estudios Clínicos Latino América; ArgentinaFil: Rovito, Carla. Estudios Clínicos Latino América; ArgentinaFil: Galatte, Agustina. Estudios Clínicos Latino América; ArgentinaFil: Scarafia, Franco. Estudios Clínicos Latino América; Argentina. Universidad Nacional de Rosario; ArgentinaFil: Sued, Omar. Fundación Huésped; ArgentinaFil: Gutierrez, Omar. Ministerio de Salud de Jujuy; ArgentinaFil: Jolly, Sanjit S.. McMaster University; CanadáFil: Miró, José M.. Universidad de Barcelona; EspañaFil: Eikelboom, John. McMaster University; CanadáFil: Loeb, Mark. McMaster University; CanadáFil: Maggioni, Aldo Pietro. Associazione Nazionale Medici Cardiologi Ospedalieri Research Center; ItaliaFil: Bhatt, Deepak L.. Brigham and Women’s Hospital; Estados Unidos. Harvard Medical School; Estados UnidosFil: Yusuf, Salim. McMaster University; CanadáFil: Lopez, Lorena. No especifíca;Fil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Pública. Hospital Papa Francisco; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Forciniti, Cristian C. G.. No especifíca;Fil: Colombo, Hugo. No especifíca;Fil: Sabas, Nicolas. No especifíca;Fil: Pilón, Leonardo. No especifíca;Fil: Steren, Adriana P.. No especifíca
La situación actual de los cardiólogos en nuestro país. Resultados de la encuesta del Área de Políticas de Salud
No full textBackground: The current crisis in the national healthcare system is impacting on the development of cardiology practice.Objectives: To know the current situation of cardiologists in their professional practice in terms of working conditions, sat-isfaction with their salaries and their representation by the Argentine Society of Cardiology, and their opinion on forms of continuing medical education Methods: A closed anonymous survey was sent via the Society corporate email, social networks, and direct WhatsApp contacts. The RedCap platform was used. The Likert scale was implemented in multiple choice answers.Results: A total of 393 cardiologists were surveyed; 27% were female. The mean age was 56±9 years. Fifty percent of cardiolo-gists worked in public or private healthcare institutions without medical residency, an average of 40±10 hours per week. A high percentage believed it would be useful to create care networks for main diseases. More than 90% felt that they are not adequately paid and that they are not properly represented by the trade union. A total of 89.9% considered that the medical residency is the best system of training. Between 76.1% and 80.2% were in favor of completing the residency with a doctorate or master's degree, respectively. Finally, 53% agreed with the need for recertification.Conclusions: Medical professional practice is evenly distributed between public and private institutions, with and without medical residency. Most cardiologists do not work in care networks, but a high percentage express the need and willingness to do so.Most cardiologists are dissatisfied with their salaries, and also feel they lack an adequate trade union representation. Regarding postgraduate education and training, as in previous surveys, it is confirmed that the medical residency is the best system of training and it should be complemented by a doctorate and/or master's degree in the specialty in view of the constant updating and advances in cardiologyIntroducción: La crisis actual del sistema de salud nacional afecta el desarrollo de la práctica cardiológica.Objetivos: Conocer la situación actual del cardiólogo en su actividad profesional respecto a las condiciones de trabajo, confor-midad con su remuneración y representación ante la Sociedad Argentina de Cardiología, y su opinión en cuanto a las formas de educación médica continua.Material y métodos: Encuesta cerrada, anónima, enviada a través del mail corporativo de la Sociedad, redes sociales y contac-tos directos de WhatsApp. Se utilizó la plataforma RedCap. Se implementó la escala de Likert en las respuestas que tenían múltiples opciones.Resultados: Se encuestó a 393 cardiólogos, el 27 % mujeres. La edad media fue 56 ± 9 años. El 50 % trabaja en el ámbito público o privado sin residencia, una media de 40± 10 horas semanales. Un alto porcentaje cree conveniente generar redes de atención en las principales patologías. Más del 90 % piensa que no está correctamente remunerado y que no tiene una representación gremial adecuada. El 89,9 % considera que la residencia es el mejor sistema formativo y entre el 76,1 % y el 80,2 % aprueba completarlo con doctorado o máster de posgrado, respectivamente. Finalmente, 53 % está de acuerdo con la necesidad de la recertificación.Conclusiones: El accionar médico está distribuido de manera similar entre entidades públicas y privadas, con y sin residencias médicas. La mayoría no trabaja en redes de atención, pero en un alto porcentaje expresa la necesidad y adherencia a realizarlo.La mayor parte de los cardiólogos está disconforme con su remuneración, y siente que carece de una representación gremial adecuada. Con respecto a la educación y formación de posgrado, se ratifica, como en encuestas previas, que la residencia es el mejor sistema formativo y debería complementarse con doctorados y/o maestrías de la especialidad atento a la permanente actual-ización y progreso de la cardiologí
Climate and landscape composition explain agronomic practices, pesticide use and grape yield in vineyards across Italy
No full textContext
Worldwide, organic farming is being promoted as one of the main alternatives to intensive conventional farming. However, the benefits of organic agriculture are still controversial and need to be tested across wide environmental gradients.
Objective
Here, we carried out an observational study to test how agronomic practices, pest management, environmental impact and yield of conventional and organic vineyards changed along wide climatic and landscape gradients across Italy.
Methods
We used a block design with 38 pairs of conventional and organic vineyards across Italy.
Results and conclusions
Most agronomic practices did not differ between conventional and organic vineyards. By contrast, landscape composition and climate were strong predictors of management in both systems. First, increasing semi-natural areas around the vineyards reduced pesticide pressure and related environmental impacts, but was also associated with lower yield. Second, irrespective of the farming system, a warm and dry climate was associated with reduced fungicide pressure. Conventional farming had a yield gain of 40% in cold and wet climate compared to organic but the yield gap disappeared in the warmest regions.
Significance
In both farming systems, we observed a large variability in management practices that was mainly explained by climate and landscape composition. This large variability should be considered when evaluating the benefits and drawbacks of different farming systems under contrasting environmental contexts
Pluralidade cultural: análise e reflexão
No full textBe talked about cultural diversity in the historical and legal context, on Art. 26 of the Law of Guidelines and Bases of National Education (LDB), which must be accomplished in its entirety in the elementary and secondary education. In this context, both the Federal Constitution of 1988, and also in the LDB, the issue of cultural diversity is addressed in a generic and comprehensive manner. Dance promotes know ledge of various cultures, has a strong Power of integration that facilitates the Discovery of diversity. Natural environmental resources permit to produce practical classes where the physical qualities of the students are developed and the awakening of environmental awareness. Thus, it is shown the Eco Sports integrating man and nature. Presents the Physical Education for Special as an affordable reality for any professional of the area. The methodology is based on a qualitative and quantitative descriptive model, expostfacto type. Was used as a focus group, students of the 1st semester of the Physical Education of the University Castelo Branco (UCB). Compiled the results of research and discussion was compared with another article, to conclude that there is need to develop the professional future of physical education, empowering you to create a legacy of opportunities.Discorreuse sobre a pluralidade cultural no contexto histórico e legal, sobre o Art. 26, da Lei de Diretrizes e Bases do Ensino Nacional (LDB), que precisa ser cumprido na sua íntegra, no ensino fundamental e médio. Nesse contexto, tanto a Constituição Federal de 1988, e também na LDB, a questão da diversidade cultural é tratada de maneira genérica e abrangente. A dança promove o conhecimento de várias culturas, tem um forte poder de integração que facilita a descoberta da diversidade. Recursos naturais ambientais permitem produzir aulas práticas onde sejam desenvolvidas as qualidades físicas dos educandos e o despertar de uma consciência ecológica. Dessa forma, mostramse os Eco Esportes integrando o homem com a natureza. Apresentase a Educação Física para Especiais como uma realidade acessível a qualquer profissional da área. A Metodologia se baseia em um modelo descritivo qualitativo e quantitativo, tipo expostfacto. Utilizouse como grupo focal, os
alunos do 1º período do curso de Educação Física da Universidade Castelo Branco (UCB). Compilouse os resultados da pesquisa e na discussão comparouse com outro
artigo, para concluir que há necessidade de se desenvolver o futuro profissional de educação física, capacitandoo a criar um legado de oportunidades
Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study
No full textBRACKGROUND: The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF.METHOD: Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed.RESULTS: At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (Delta PAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (Delta RV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and Delta RV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo(2) ; P < .0001). Delta RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001).CONCLUSION RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic
