A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen­tial coronary stenosis without balloon inflation is hereby proposed. Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu­la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls’ formula. FFR of the remaining lesion was finally recorded (measured FFR). Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls’ formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640–0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy

Radiation tests on commercial instrumentation amplifiers, analog switches & DAC's

A study of several commercial instrumentation amplifiers (INA110, INA111, INA114, INA116, INA118 & INA121) under neutron and vestigial gamma radiation was done. Some parameters (Gain, input offset voltage, input bias currents) were measured on-line and bandwidth, and slew rate were determined before and after radiation. The results of the testing of some voltage references REF102 and ADR290GR and the DG412 analog switch are shown. Finally, different digital-to-analog converters were tested under radiation

Izaña Atmospheric Research Center. Activity Report 2015-2016

This report is a summary of the many activities at the Izaña Atmospheric Research Center to the broader community. The combination of operational activities, research and development in state-of-the-art measurement techniques, calibration and validation and international cooperation encompass the vision of WMO to provide world leadership in expertise and international cooperation in weather, climate, hydrology and related environmental issues

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Cultura y droga (Año 20 no. 22 ene-dic 2015)

EDITORIAL Manuel Ignacio Moreno-Ospina PRODUCCIÓN CIENTÍFICA E INTELECTUAL / SCIENTIFIC AND INTELLECTUAL PRODUCTION ARTE CHAMÁNICO VISIONARIO. UNA INVITACIÓN AL CAMBIO DE PARADIGMAS VISIONARY SHAMANIC ART. AN INVITATION TO A SHIFT IN PARADIGMS Ana María Llamazares UM PANORAMA DO CONSUMO DE DROGAS NO BRASIL OITOCENTISTA AN OUTLOOK OF DRUG CONSUMPTION IN BRAZIL IN NINETIENTH CENTURY Carlos Eduardo Martins-Torcato POLÍTICA DE DROGAS Y NARCOTRÁFICO EN EL PERÚ: DEL TRIUNFALISMO PERUANO AL LABERINTO DE LA COCAÍNA la presente edición de la RevistaCultura y Droga inicia con el estudio realizado por la investigadora de la Universidad de Buenos Aires, Ana María Llamazares. El artículo forma parte de los fundamentos epistemológicos de investigación sobre la iconografía visionaria de la cultura de La Aguada, y el uso de plantas psicoactivas en el Noroeste prehispánico de Argentina, cuya tesis central es que las imágenes nacidas de los estados ampliados de consciencia, sobre todo las que emergen como un fenómeno sinestésico concurrente con los rituales chamánicos, constituyen un lenguaje simbólico y como tal su significación se articula y despliega en múltiples niveles. 8 Continuamos con la investigación de Carlos Eduardo Martins, de la Universidad de Sao Paulo (Brasil) cuyo propósito es comprender la naturaleza del consumo de drogas psicoactivas en el esclavo de la sociedad brasileña del siglo XIX. Los resultados del estudio mostraron que Brasil participó en el fenómeno mundial llamado revolución psicoactiva tanto como consumidor como proveedor de medicamentos para el mercado mundial. Posteriormente, el académico de la Pontificia Universidad Católica del Perú, Hernán Arturo Manrique, nos socializa la investigación en torno a la política de drogas y el narcotráfico en el Perú. A partir de los estudios de casos de San Martín y el Monzón, se expone como el Estado peruano ha construido un discurso incompleto sobre los procesos de desarrollo alternativo en donde este aparece como el principal responsable en el primero; mientras que en el segundo se oculta la violación a los derechos humanos. El supuesto éxito peruano en torno a la lucha contra el tráfico de derivados cocaínicos ha servido como pretexto para dejar pasar la ola de reformas que se vienen dando en América Latina, sin que se generen mayores cambios en la legislación peruana. Finalmente, esta postura evita que el país escape del laberinto de la cocaína en el que se encuentra perdido hasta hoy. De la Universidad Nacional de Tres de Febrero de Argentina, Andrés Arias López presenta un artículo de investigación que sintetiza un proceso de creación sonora e investigación interdisciplinar cuyo propósito radica en cohesionar la música, el saber ancestral (especialmente andino-amazónico), el trabajo corporal y los recursos tecnológicos, proponiendo a través de la creación sonora un proceso de transformación interior que posibilite retornar a las raíces ontológicas de América. El artículo se fundamenta en la experiencia ritual y el encuentro con sabedores de la comunidad Kamëntsá del alto y medio Putumayo; develando con esta búsqueda la importancia de la oralidad, el saber concebido desde la acción y el reconocimiento de lo ancestral como recurso de vital importancia para la concepción de nuevos paradigmas. Luego, las investigadoras en salud, Zoila Rosa Franco y Sandra Milena Franco divulgan los resultados de una investigación regional en la que encontraron serios problemas de tipo moral y ético debido a la degradación social de sectores populares pertenecientes a los municipios seleccionados; encontrando quejas permanentes del personal de enfermería que labora en Atención Primaria en Salud. 9 El objetivo de la investigación es desentrañar las situaciones a las que se ven abocadas las enfermeras y sus auxiliares para tomar decisiones éticas que riñen con la normativa establecida, así como explicar el tipo de interacciones humanas e interrelaciones sociales que se encuentran en los escenarios de prestación de servicios de salud y cuidado de enfermería. Finalmente, los investigadores Juan Carlos Pérez Vásquez y Noé Arley Arteaga de la Universidad de Caldas analizan las políticas públicas formuladas para tratar el consumo de drogas en menores de edad de la ciudad de Manizales con el fin de examinar su incidencia en el incremento del consumo por parte de esta población. Llegan a la conclusión de que las políticas públicas no son efectivas, ya que expresan cierta incertidumbre jurídica que simultáneamente prohíbe y permite el consumo de drogas. Proponen la construcción de una política social a partir de un modelo alternativo enfocado en una gobernanza equilibrada y horizontal.DRUG POLICY AND DRUG TRAFFICKING IN PERU: FROM PERUVIAN TRIUMPHALISM TO THE COCAINE LABYRINTH Hernán Manrique-López VOLVER A LA MALOKA. EL SABER ANCESTRAL AMERICANO COMO FUNDAMENTO PARA LA CREACIÓN MUSICAL CONTEMPORÁNEA BACK TO MALOKA. THE AMERICAN ANCESTRAL KNOWLEDGE AS A BASIS FOR CONTEMPORARY MUSICAL CREATION Andrés Arias-López PROBLEMAS ÉTICOS DE ENFERMERÍA EN ATENCIÓN PRIMARIA DE SALUD: MUNICIPIOS DE CALDAS 2012-2013 ETHICAL PROBLEMS OF NURSING IN PRIMARY HEALTH CARE: MUNICIPALITIES OF CALDAS 2012-2013 Zoila Rosa Franco-Peláez, Sandra Milena Franco-Idarraga INCERTIDUMBRE JURÍDICA DE LAS POLÍTICAS PÚBLICAS PARA TRATAR EL CONSUMO DE DROGAS EN MENORES DE EDAD. EL CASO DE MANIZALES UNCERTAINTY LEGAL OF THE PUBLIC POLICIES TO TREAT DRUG USE IN THE POPULATION YOUNGER. THE CASE OF MANIZALES Juan Carlos Pérez-Vásquez, Noé Arley Arteaga-Tor

Instrumentation amplifiers and voltage controlled current sources for LHC cryogenic instrumentation

Instrumentation amplifiers and voltage controlled current sources have been designed by using single operational amplifiers (OPA124, TLE2071 and OPA627). Their performance has been evaluated in the laboratory and under neutron radiation. On line measurements of the offset voltages, offset currents, closed loop gain, CMRR and bias currents were performed on the amplifiers. The current sources were set to a constant value and the current was monitored on-line. The radiation tolerance of commercial voltage references has also been investigated. The radiation was performed out in ITN (Portugal) research nuclear reactor. In comparison to previous experimental campaigns the gamma radiation has been reduced by a factor 15 for a given neutron dose. This is achieved thanks to a recently constructed facility for neutron beam extractio

Izaña Atmospheric Research Center. Activity Report 2012-2014

This report is a summary of the many activities at the Izaña Atmospheric Research Center to the broader community. The combination of operational activities, research and development in state-of-the-art measurement techniques, calibration and validation and international cooperation encompass the vision of WMO to provide world leadership in expertise and international cooperation in weather, climate, hydrology and related environmental issues