Hypertension in the very old; prevalence, awareness, treatment and control: a cross-sectional population-based study in a Spanish municipality

<p>Abstract</p> <p>Background</p> <p>Information on hypertension in the very elderly is sparse. Until recently evidence of benefits from pharmacological treatment was inconclusive. We estimated the prevalence of hypertension in subjects aged 80 or more, the proportion of awareness, treatment and control. Explanatory variables associated with good control were also studied.</p> <p>Methods</p> <p>Cross sectional, population-based study, conducted in Martorell, an urban Spanish municipality, in 2005. By simple random sampling from the census, 323 subjects aged 80 or more were included. Patients were visited at home or in the geriatric institution and after giving informed consent, the study variables were collected. These included: supine and standing blood pressure and information about diagnosis and treatment of hypertension. The estimation and 95% confidence interval were obtained and a logistic regression model was used to study explanatory variables associated with blood pressure below 140/90 mm Hg.</p> <p>Results</p> <p>The prevalence of hypertension was 72.8% (95%CI: 69.5 – 76.6%) and 93% of the patients were aware of this condition, of whom 96.3% (95%CI: 93.65 – 97.9%) had been prescribed pharmacological treatment and 30.7% (95%CI: 25.8 – 36.1%) had blood pressure below 140/90 mm Hg. Some of the patients (43%) had one antihypertensive drug and 39.5% had two in combination. Explanatory variables associated with blood pressure below 140/90 mm Hg included prescription of a diuretic, OR: 0.31 (95%CI: 0.14 – 0.66), and history of ischemic heart disease, OR: 0.21 (95%CI: 0.1 – 0.47).</p> <p>Conclusion</p> <p>The prevalence of hypertension in population aged 80 or more was over 70%. Most patients were aware of this condition and they had antihypertensive medication prescribed. Approximately one third of treated patients had blood pressure below 140/90 mm Hg. Patients with heart disease and with diuretics had more frequently blood pressure below this value.</p

The Strategies of the Spanish cotton textile companies before the Civil War: the road to longevity

This study, based on family business theories, offers an innovative vision of the Spanish cotton industry. It proves that Spanish cotton companies, just like their European counterparts, implemented a strategy that was consistent with their nature as family businesses and went beyond the economic-institutional frames within which they developed. The article identifies this strategy as `conservative, because its main objectives were longevity and family control and because it was based on a high percentage of own resources, low levels of indebtedness and organic growth, thus sacrificing profitability for the sake of security.Universidad Pablo de OlavidePostprin

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

A Multilevel Bottom-up Optimization Methodology for the Automated Synthesis of RF Systems

In recent years there has been a growing interest in electronic design automation methodologies for the optimizationbased design of radiofrequency circuits and systems. While for simple circuits several successful methodologies have been proposed, these very same methodologies exhibit significant deficiencies when the complexity of the circuit is increased. The majority of the published methodologies that can tackle radiofrequency systems are either based on high-level system specification tools or use models to estimate the system performances. Hence, such approaches do not usually provide the desired accuracy for RF systems. In this work, a methodology based on hierarchical multilevel bottom-up design approaches is presented, where multi-objective optimization algorithms are used to design an entire radiofrequency system from the passive component level up to the system level. Furthermore, each level of the hierarchy is simulated with the highest accuracy possible: electromagnetic simulation accuracy at device-level and electrical simulations at circuit/system-level.Peer reviewe

Ready-to-Fabricate RF Circuit Synthesis Using a Layout- and Variability-Aware Optimization-Based Methodology

In this paper, physical implementations and measurement results are presented for several Voltage Controlled Oscillators that were designed using a fully-automated, layout- and variability-aware optimization-based methodology. The methodology uses a highly accurate model, based on machinelearning techniques, to characterize inductors, and a multi-objective optimization algorithm to achieve a Pareto-optimal front containing optimal circuit designs offering different performance trade-offs. The nal outcome of the proposed methodology is a set of design solutions (with their GDSII description available and ready-to-fabricate) that need no further designer intervention. Two key elements of the proposed methodology are the use of an optimization algorithm linked to an off-the-shelf simulator and an inductor model that yield EM-like accuracy but with much shorter evaluation times. Furthermore, the methodology guarantees the same high level of robustness against layout parasitics and variability that an expert designer would achieve with the veri cation tools at his/her disposal. The methodology is technology-independent and can be used for the design of radio frequency circuits. The results are validated with experimental measurements on a physical prototype.Peer reviewe

Applications of NMR to the development of novel protein ligands using dynamic combinatorial chemistry

XXXVI Reunión Bienal de la Real Sociedad Española de Química, Sitges (Barcelona), del 25 al 29 de junio de 2017 ; http://geqo.es/xxxvi-reunion-bienal-de-la-real-sociedad-espanola-de-quimica