Definition of tachycardia for risk stratification of pulmonary embolism.

Tachycardia is a reliable predictor of adverse outcomes in normotensive patients with acute pulmonary embolism (PE). However, different prognostic relevant heart rate thresholds have been proposed. The aim of the study was to investigate the prognostic performance of different thresholds used for defining tachycardia in normotensive PE patients.We performed a post-hoc analysis of normotensive patients with confirmed PE consecutively included in a single-centre and a multi-centre registry. An adverse outcome was defined as PE-related death, need for mechanical ventilation, cardiopulmonary resuscitation or administration of catecholamines.Of 1567 patients (median age: 72 [IQR, 59-79] years; females: 46.1%) included in the analysis, 78 patients (5.0%) had an in-hospital adverse outcome. The rate of an adverse outcome was higher in patients with a heart rate ≥100 bpm (7.6%) and ≥110 bpm (8.3%) compared to patients with a heart rate100 bpm (3.0%). A heart rate ≥100 bpm and ≥110 bpm was associated with a 2.7 (95% CI 1.7-4.3) and 2.4-fold (95% CI 1.5-3.7) increased risk for an adverse outcome, respectively. Receiver operating characteristics analysis revealed a similar area under the curve with regard to an adverse outcome for all scores and algorithm (ESC 2019 algorithm, modified FAST and Bova score) if calculated with a heart rate threshold of ≥100 bpm or of ≥110 bpm.Defining tachycardia by a heart rate ≥100 bpm is sufficient for risk stratification of normotensive patients with acute PE. The use of different heart rate thresholds for calculation of scores and algorithm does not appear necessary

Elevate to Alleviate – Evidence Based Vascular Nursing Study

Background: Venous return in the circulatory system of lower limbs results from the interaction of several mechanisms and reflects the balance between blood inflow and outflow. Blood outflow improves during the lying position especially with leg elevation both in patients with chronic venous disease (CVD) and in healthy subjects in sedentary settings with short-term immobilization. This study evaluated the level of comfort of hospital inpatients, without CVD, lying with a moderate leg elevation during hospital stay. Methods: This was a clinical trial examining 60 consecutive patients referred to vascular surgery, cardiac surgery, and nephrology units. After inclusion, patients were randomly assigned to two groups: A (leg elevation) in which patients were made to lie in the hospital bed with moderate elevation of the legs, and B (no leg elevation) in which patients were made to lie in the hospital bed without leg elevation. Results: The whole population consisted of 40 patients undergoing leg elevation (group A) and 20 without leg elevation (group B). During each day of hospitalization, measurements such as ankle and calf circumference, heart rate, blood pressure, and body temperature were collected. Subjective data such as perceived heaviness in the lower limbs, comfort perception and hours of sleep were also collected. In this study, patients of group A recorded a decrease in calf and ankle circumference (delta in ankle and calf circumference (difference between end of study visit and baseline visit) were significantly decreased in group A vs group B (p< 0.001 for both sides), and patients perceived less leg heaviness and even reported more leg comfort compared to patients of Group B (p< 0.001)). Among patients of group A, the bigger advantage in terms of comfort perception was recorded in patients with 15° leg elevation. Conclusion: Moderate leg elevation during hospital stay seems to effectively improve leg comfort in hospitalized patients

Rising Sound Intensity: An Intrinsic Warning Cue Activating the Amygdala

Human subjects overestimate the change of rising intensity sounds compared with falling intensity sounds. Rising sound intensity has therefore been proposed to be an intrinsic warning cue. In order to test this hypothesis, we presented rising, falling, and constant intensity sounds to healthy humans and gathered psychophysiological and behavioral responses. Brain activity was measured using event-related functional magnetic resonance imaging. We found that rising compared with falling sound intensity facilitates autonomic orienting reflex and phasic alertness to auditory targets. Rising intensity sounds produced neural activity in the amygdala, which was accompanied by activity in intraparietal sulcus, superior temporal sulcus, and temporal plane. Our results indicate that rising sound intensity is an elementary warning cue eliciting adaptive responses by recruiting attentional and physiological resources. Regions involved in cross-modal integration were activated by rising sound intensity, while the right-hemisphere phasic alertness network could not be supported by this stud

Contactless heart rate measurement in newborn infants using a multimodal 3D camera system

Newborns and preterm infants require accurate and continuous monitoring of their vital parameters. Contact-based methods of monitoring have several disadvantages, thus, contactless systems have increasingly attracted the neonatal communities' attention. Camera-based photoplethysmography is an emerging method of contactless heart rate monitoring. We conducted a pilot study in 42 healthy newborn and near-term preterm infants for assessing the feasibility and accuracy of a multimodal 3D camera system on heart rates (HR) in beats per min (bpm) compared to conventional pulse oximetry. Simultaneously, we compared the accuracy of 2D and 3D vision on HR measurements. The mean difference in HR between pulse oximetry and 2D-technique added up to + 3.0 bpm [CI−3.7 – 9.7; p = 0.359, limits of agreement (LOA) ± 36.6]. In contrast, 3D-technique represented a mean difference in HR of + 8.6 bpm (CI 2.0–14.9; p = 0.010, LOA ± 44.7) compared to pulse oximetry HR. Both, intra- and interindividual variance of patient characteristics could be eliminated as a source for the results and the measuring accuracy achieved. Additionally, we proved the feasibility of this emerging method. Camera-based photoplethysmography seems to be a promising approach for HR measurement of newborns with adequate precision; however, further research is warranted

Hyperoxia improves exercise capacity in cardiopulmonary disease: a series of randomised controlled trials

Background: The aim of this study was to investigate the overall and differential effect of breathing hyperoxia (inspiratory oxygen fraction (F$_{IO_{2}}$) 0.5)versusplacebo (ambient air,F$_{IO_{2}}$0.21) to enhance exercise performance in healthy people, patients with pulmonary vascular disease (PVD) with precapillary pulmonary hypertension (PH), COPD, PH due to heart failure with preserved ejection fraction (HFpEF) and cyanotic congenital heart disease (CHD) using data from five randomised controlled trials performed with identical protocols. Methods: 91 subjects (32 healthy, 22 with PVD with pulmonary arterial or distal chronic thromboembolic PH, 20 with COPD, 10 with PH in HFpEF and seven with CHD) performed two cycle incremental (IET) and two constant work-rate exercise tests (CWRET) at 75% of maximal load (W$_{max}$), each with ambient air and hyperoxia in single-blinded, randomised, controlled, crossover trials. The main outcomes were differences in W$_{max}$(IET) and cycling time (CWRET) with hyperoxiaversusambient air. Results: Overall, hyperoxia increased W$_{max}$by +12 W (95% CI: 9–16, p<0.001) and cycling time by +6:13 min (4:50–7:35, p<0.001), with improvements being highest in patients with PVD (W$_{max}$/min: +18%/+118%versusCOPD: +8%/+60%, healthy: +5%/+44%, HFpEF: +6%/+28%, CHD: +9%/+14%). Conclusion: This large sample of healthy subjects and patients with various cardiopulmonary diseases confirms that hyperoxia significantly prolongs cycling exercise with improvements being highest in endurance CWRET and patients with PVD. These results call for studies investigating optimal oxygen levels to prolong exercise time and effects on training

BPMS : Análisis de aspectos funcionales avanzados: una clasificación propuesta

Los sistemas de gestión de procesos de negocio, en inglés BPMS (Business Process Management Systems) facilitan el modelado, despliegue y monitoreo de los procesos de negocio. En la actualidad existen diversas implementaciones de tales herramientas y su uso se encuentra medianamente difundido, pero como toda solución de software requiere revisarse a la luz de nuevos modelos computacionales, nuevas exigencias de la industria y nuevos modelos de servicio. En este trabajo se propone analizar nuevos aspectos funcionales surgidos de las actualizaciones tecnológicas previamente mencionadas e identificarlos en un BMPS concreto, como lo es BonitaSoft. El trabajo contribuye a la definición de un conjunto de características funcionales no clásicas de un BPMS que permite clasificar los mismos según el grado de adopción de dichas funcionalidades.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informátic

Workflow Automatizado, Implantación de un Workflow Automatizado en el Proceso “Culminación de Estudios Superiores en la UNI-IES, en el segundo semestre de 2016”

Este Proyecto de Seminario de Graduación está basado en la implementación de la herramienta BPM ProcessMaker para la automatización de un proceso clave dentro de Universidad Nacional de Ingeniería UNI-IES, como es “Culminación de Estudios Superiores, durante el segundo semestre del 2016”. Lo primero que se realizó fue un estudio de diferentes herramientas BPM y la facilidad de uso de cada una de ellas, para lo cual se realizó una comparación entre las soluciones Alfresco, Bonitasoft y Processmaker. El mencionado estudio se basó en puntos como: facilidad de uso, soporte y funcionalidad, luego de realizada la comparación se optó por aplicar Processmaker en la automatización del proceso “Culminación de Estudios Superiores en la UNI-IES durante el segundo semestre del 2016”, ya que fue la herramienta que mejores opciones nos proporcionó en cuanto a desarrollo de procesos, facilidad de instalación, facilidad de utilización y a Soporte. Además de la fácil utilización y confiabilidad del sistema, Processmaker maneja un estándar BPM 3.0 que es utilizado por varias herramientas diseñadas para la gestión de procesos. Se realizó el levantamiento del proceso existente dentro de la Institución UNI-IES, se realizó un estudio de todas las actividades desarrolladas como parte del proceso, así como las áreas involucradas, para la posterior creación del workflow automatizado al proceso “Culminación de Estudios superiores en la UNI-IES durante el segundo semestre del 2016”. El proceso consta de la solicitud de la Carta de Egresado por parte del estudiante que ha culminado su Plan de Estudios Superiores, la cual es remitida a la Secretaría Académica para realizar el debido trámite, la Secretaría Académica a su vez, lo remite al Registro de la UNI-IES y éste a su vez lo envía a Secretaría de Facultad de la Universidad Nacional de Ingeniería para la gestión del correspondiente Título universitario