Spanish study of anticoagulation in haemodialysis

This study's objectives were to determine which anticoagulation methods are commonly used in patients who are undergoing haemodialysis (HD) in Spain, on what criteria do they depend, and the consequences arising from their use. MATERIAL AND METHOD: Ours was a cross-sectional study based on two types of surveys: a "HD Centre Survey" and a "Patient Survey". The first survey was answered by 87 adult HD units serving a total of 6093 patients, as well as 2 paediatric units. Among these units, 48.3% were part of the public health system and the remaining 51.7% units were part of the private health system. The patient survey analysed 758 patients who were chosen at random from among the aforementioned 78 HD units. RESULTs: A) HD Centre Survey: The majority of adult HD units (n=61, 70.2%) used both kinds of heparin, 19 of them (21.8%) only used LMWH and 7 of them (8%) only used UFH. The most frequently applied criteria for the use of LMWH were medical indications (83.3% of HD units) and ease of administration (29.5%). The most frequently used methods for adjusting the dosage were clotting of the circuit (88.2% of units), bleeding of the vascular access after disconnection (75.3%), and patient weight (57.6%). B) Patient Survey: The distribution of the types of heparin used was: UFH: 44.1%, LMWH: 51.5%, and dialysis without heparin in 4.4% of patients. LMWH was more frequently used in public medical centres (64.2% of patients) than in private medical centres (46.1%) (P<.001). LMWH was more frequently used in on-line haemodiafiltration (HF) than in high-flux HD (P<.001). Antiplatelet agents were given to 45.5% of patients, oral anticoagulants to 18.4% of patients, and both to 5% of patients. Additionally, 4.4% of patients had suffered bleeding complications during the previous week, and 1.9% of patients suffered thrombotic complications. Bleeding complications were more frequent in patients with oral anticoagulants (P=.001), although there was no association between the type of heparin and the occurrence of bleeding or thrombotic complications. CONCLUSIONS: We are able to conclude that there is a great amount of disparity in the criteria used for the medical prescription of anticoagulation in HD. It is advisable that each HD unit revise their own results as well as those from other centres, and possibly to create an Anticoagulation Guide in Haemodialysis

Vector Bin Packing with Multiple-Choice

We consider a variant of bin packing called multiple-choice vector bin packing. In this problem we are given a set of items, where each item can be selected in one of several $D$-dimensional incarnations. We are also given $T$ bin types, each with its own cost and $D$-dimensional size. Our goal is to pack the items in a set of bins of minimum overall cost. The problem is motivated by scheduling in networks with guaranteed quality of service (QoS), but due to its general formulation it has many other applications as well. We present an approximation algorithm that is guaranteed to produce a solution whose cost is about $\ln D$ times the optimum. For the running time to be polynomial we require $D=O(1)$ and $T=O(\log n)$. This extends previous results for vector bin packing, in which each item has a single incarnation and there is only one bin type. To obtain our result we also present a PTAS for the multiple-choice version of multidimensional knapsack, where we are given only one bin and the goal is to pack a maximum weight set of (incarnations of) items in that bin

Effectiveness of a cardiovascular risk management program in the reduction of premature mortality associated to cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the effectiveness of a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] in the reduction of premature mortality associated to cardiovascular events (CVE) (male , 55 years, female , 60 years). Methods: The population eligible for the study were patients over 18 years of age affiliated to Mutual SER insurance company between June 2015 and June 2018 and residents of the Caribbean region of Colombia, enrolled or not to DTC program in which a cardiovascular event (CVE) occurred. The main outcomes considered were age of occurrence of cardiovascular events (AOCVE), age at death due to CVE (ADCVE) and years life lost (YLL). For the evaluation of the effectiveness, differences in AOCVO, ADCVO and the YPLL between the patients enrolled and nonenrolled in the DTC program were estimated using a Simple Linear Regression model. Results: A total of 3.902 CVE occurred in the study period among both groups. The enrolled patients had an average of AOCVE of 4.96 years (95% CI 3.85-6.06) higher than in non-enrolled patients. The ADCVE average was 4.64 years (95% CI 1.47 - 7.81) higher in the enrolled patients compared with the non-enrolled patients. Patients enrolled in the DTC program had on average -3.54 (95% CI -5.62 - -1.46) YLL compared to the non-enrolled patients. Conclusions: The DTC program in Mutual SER-EPS was effective to delay the AOCVE, ADCVE and YPLL. DTC program is an effective strategy to reduce the incidence and premature mortality due to CVE in the Caribbean region of Colombia

Towards the automated localisation of targets in rapid image-sifting by collaborative brain-computer interfaces

The N2pc is a lateralised Event-Related Potential (ERP) that signals a shift of attention towards the location of a potential object of interest. We propose a single-trial target-localisation collaborative Brain-Computer Interface (cBCI) that exploits this ERP to automatically approximate the horizontal position of targets in aerial images. Images were presented by means of the rapid serial visual presentation technique at rates of 5, 6 and 10 Hz. We created three different cBCIs and tested a participant selection method in which groups are formed according to the similarity of participants’ performance. The N2pc that is elicited in our experiments contains information about the position of the target along the horizontal axis. Moreover, combining information from multiple participants provides absolute median improvements in the area under the receiver operating characteristic curve of up to 21% (for groups of size 3) with respect to single-user BCIs. These improvements are bigger when groups are formed by participants with similar individual performance, and much of this effect can be explained using simple theoretical models. Our results suggest that BCIs for automated triaging can be improved by integrating two classification systems: one devoted to target detection and another to detect the attentional shifts associated with lateral targets

Age and growth of the blue shark (Prionace glauca) in the Indian Ocean

Since there is still a lack of biological information regarding Prionace glauca in the Indian Ocean, specifically in terms of age estimation and growth modelling, the age and growth of this species was studied by analysing vertebral samples. All samples were collected from specimens captured by pelagic longliners between March 2013 and September 2016, with sizes ranging from 82 to 301 cm fork length (LF). Two growth models were fitted to the age data, a three-parameter von Bertalanffy growth function (VBGF) re-parameterized to calculate L0 (size at birth) and a two-parameter VBGF with a fixed L0. The latter was considered the most adequate to describe the growth of the species, with the estimated parameters being L∞ = 283.8 cm LF, k  = 0.13 year−1 for males and L∞ = 290.6 cm LF, k = 0.12 year−1 for females. These results suggest that females have a slower growth than males. The maximum age estimated was 25 years, representing the oldest attributed age to this species so far. Further work is needed regarding P. glauca in the Indian Ocean, but this study adds important life-history information that can contribute for the management and conservation of the species.IF/00253/2014) from the Portuguese Foundation for Science and Technologyinfo:eu-repo/semantics/publishedVersio

Spaceflight Alters Bacterial Gene Expression and Virulence and Reveals Role for Global Regulator Hfq

A comprehensive analysis of both the molecular genetic and phenotypic responses of any organism to the spaceflight environment has never been accomplished due to significant technological and logistical hurdles. Moreover, the effects of spaceflight on microbial pathogenicity and associated infectious disease risks have not been studied. The bacterial pathogen Salmonella typhimurium was grown aboard Space Shuttle mission STS-115 and compared to identical ground control cultures. Global microarray and proteomic analyses revealed 167 transcripts and 73 proteins changed expression with the conserved RNA-binding protein Hfq identified as a likely global regulator involved in the response to this environment. Hfq involvement was confirmed with a ground based microgravity culture model. Spaceflight samples exhibited enhanced virulence in a murine infection model and extracellular matrix accumulation consistent with a biofilm. Strategies to target Hfq and related regulators could potentially decrease infectious disease risks during spaceflight missions and provide novel therapeutic options on Earth

Association between exposure/adherence to a cardiovascular risk management program and the incidence and mortality of cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the association between the exposure to a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] and the reduction of incidence and mortality by cardiovascular events (CVE: AMI, Stroke, congestive heart failure). Methods: Cohort study that compared the occurrence of CVE among patients over 18 years of age exposed and non-exposed to the DTC program (N = 113,277). Enrolled patients in the DTC program between June 2015 and June 2017 were considered as the exposed population and patients enrolled in the DTC program between July 2017 and July 2018 were considered as the unexposed population. Patients who achieved clinical goals (blood pressure, 140/90 mmHg, HbA1c, 7.5% and LDL cholesterol, 100 mg/dl) were considered adherent to the DTC program. Incidence and mortality rates were compared and Incidence rate ratio (IRR) was used to evaluate the effect of the program. A Poisson regression model was used to assess the association between exposure to the program and CVE adjusting by socio-demographic characteristics and clinical goals. Results: The incidence of CVE in exposed and unexposed patients was 6.8 and 9.5 per 1.000 persons per year, respectively [IRR of 0.72 (95% CI 0.60-0.87)]. Mortality associated to CVE in exposed and unexposed patients was 0.46 and 0.56 per 1.000 persons per year, respectively [IRR 0.82 (95% CI 0.40-1.95)]. When adjusting the estimation by age, sex and achievement of clinical goals, a lower incidence rate of CVE among patients who were adherent to the program was observed [IRR = 0.62 (CI 95% 0.46 - 0.86)]. Conclusions: Exposure to the DTC program significantly decreased the incidence and mortality CVE by 28% and 18%, respectively. Adherence to the DTC program significantly decreased the incidence of CVE by 38%