Use of rivaroxaban and acetylsalicylic acid as a combined treatment for peripheral arterial disease in Central Military Hospital

Background: The objective of this research was to evaluate the behavior of 3 risk indicators for peripheral arterial disease in patients under oral treatment with rivaroxaban 2.5 mg every 12 hours plus, acetylsalicylic acid 100 mg every 24 hours. It was hypothesized that the oral combination of rivaroxaban and acetylsalicylic acid presents a therapeutic advantage over other treatments.Methods: A prospective longitudinal and non-randomized study of a single center was performed. 59 patients with peripheral arterial disease were included and treated with acetylsalicylic acid + rivaroxaban. Peak systolic velocity, ankle-brachial index and C reactive protein index were evaluated.Results: Significant changes were found at month 1 and 3 of follow-up in maximum systolic velocity, ankle-arm index and C-reactive protein index. The baseline peak systolic velocity (PSV) in the anterior tibial artery had significant differences after one month of treatment (p=0.001) and after 3 months (p=0.001). The baseline PSV in the posterior tibial artery had significant differences compared to the values found at the month of treatment (p=0.001) and 3 months (p=0.001). In the ankle-brachial index a baseline median of 0.790 was found, one month after the treatment of 0.795 (p=0.147) and 3 months after 0.800 (p=0.019). The mean baseline C-reactive protein obtained was 73.142 mg/l, at one month 87.233 mg/l (p=0.001) and at 3 months at 79.009 mg/l (p=0.294) with a standard deviation of 67.18, 74.78 and 69.69 respectively.Conclusions: The combined use of acetylsalicylic acid and rivaroxaban allows a clinical improvement in patients with peripheral arterial disease

The human resources management contribution to social responsibility and environmental sustainability: explorations from Ibero-America

[EN] In this paper we aim to advance the discussion on HRM¿s quest to create value around social responsibility and environmental sustainability. We explore the perceptions reported by Human Resource managers in three Ibero-American countries (Spain, the Dominican Republic and Costa Rica). We focus on the hospitality sector, one of particular relevancy for these countries and with significant sustainability challenges. Relying on in-depth interviews in twenty-eight organizations and a mixed-methods approach, we examine HR managers¿ underlying notions around social and environmental issues, stakeholder collaboration, HRM practices, roles and internal organization. Analysis of the interviews suggests varying views on those dimensions, as well as identifies Active and Advanced firms, the latter showing more commitment to sustainability (as part of the organizational culture), usage of HRM practices and engagement with multiple stakeholders. From this empirical exploration and relying on current sustainability developments, we contribute to the literature by outlining an externally-oriented model (centred on corporate priorities, communities¿ flourishing and ecosystems¿ resilience) aiming to advance HRM¿s engagement with sustainability-driven agendas.Alcaraz, JM.; Susaeta-Erburu, L.; Suárez-Ruz, ME.; Colón, C.; Gutierrez, I.; Cunha, R.; Leguizamon, F.... (2017). The human resources management contribution to social responsibility and environmental sustainability: explorations from Ibero-America. The International Journal of Human Resource Management. https://doi.org/10.1080/09585192.2017.1350732

KELT-25 B And KELT-26 B: A Hot Jupiter And A Substellar Companion Transiting Young A Stars Observed By TESS

We present the discoveries of KELT-25 b (TIC 65412605, TOI-626.01) and KELT-26 b (TIC 160708862, TOI-1337.01), two transiting companions orbiting relatively bright, early A stars. The transit signals were initially detected by the KELT survey and subsequently confirmed by Transiting Exoplanet Survey Satellite (TESS) photometry. KELT-25 b is on a 4.40 day orbit around the V = 9.66 star CD-24 5016 (${T}_{\mathrm{eff}}={8280}_{-180}^{+440}$ K, Msstarf = ${2.18}_{-0.11}^{+0.12}$ M⊙), while KELT-26 b is on a 3.34 day orbit around the V = 9.95 star HD 134004 (${T}_{\mathrm{eff}}$ = ${8640}_{-240}^{+500}$K, Msstarf = ${1.93}_{-0.16}^{+0.14}$M⊙), which is likely an Am star. We have confirmed the substellar nature of both companions through detailed characterization of each system using ground-based and TESS photometry, radial velocity measurements, Doppler tomography, and high-resolution imaging. For KELT-25, we determine a companion radius of RP = ${1.64}_{-0.043}^{+0.039}$RJ and a 3σ upper limit on the companion\u27s mass of ~64 MJ. For KELT-26 b, we infer a planetary mass and radius of MP = ${1.41}_{-0.51}^{+0.43}$${M}_{{\rm{J}}}$and RP = ${1.94}_{-0.058}^{+0.060}$RJ. From Doppler tomographic observations, we find KELT-26 b to reside in a highly misaligned orbit. This conclusion is weakly corroborated by a subtle asymmetry in the transit light curve from the TESS data. KELT-25 b appears to be in a well-aligned, prograde orbit, and the system is likely a member of the cluster Theia 449

Submarine record of volcanic island construction and collapse in the Lesser Antilles arc: First scientific drilling of submarine volcanic island landslides by IODP Expedition 340

IODP Expedition 340 successfully drilled a series of sites offshore Montserrat, Martinique and Dominica in the Lesser Antilles from March to April 2012. These are among the few drill sites gathered around volcanic islands, and the first scientific drilling of large and likely tsunamigenic volcanic island-arc landslide deposits. These cores provide evidence and tests of previous hypotheses for the composition and origin of those deposits. Sites U1394, U1399, and U1400 that penetrated landslide deposits recovered exclusively seafloor-sediment, comprising mainly turbidites and hemipelagic deposits, and lacked debris avalanche deposits. This supports the concepts that i/ volcanic debris avalanches tend to stop at the slope break, and ii/ widespread and voluminous failures of pre-existing low-gradient seafloor sediment can be triggered by initial emplacement of material from the volcano. Offshore Martinique (U1399 and 1400), the landslide deposits comprised blocks of parallel strata that were tilted or micro-faulted, sometimes separated by intervals of homogenized sediment (intense shearing), while Site U1394 offshore Montserrat penetrated a flat-lying block of intact strata. The most likely mechanism for generating these large-scale seafloor-sediment failures appears to be propagation of a decollement from proximal areas loaded and incised by a volcanic debris avalanche. These results have implications for the magnitude of tsunami generation. Under some conditions, volcanic island landslide deposits comprised of mainly seafloor sediment will tend to form smaller magnitude tsunamis than equivalent volumes of subaerial block-rich mass flows rapidly entering water. Expedition 340 also successfully drilled sites to access the undisturbed record of eruption fallout layers intercalated with marine sediment which provide an outstanding high-resolution dataset to analyze eruption and landslides cycles, improve understanding of magmatic evolution as well as offshore sedimentation processes. This article is protected by copyright. All rights reserved

Latitude dictates plant diversity effects on instream decomposition

Running waters contribute substantially to global carbon fluxes through decomposition of terrestrial plant litter by aquatic microorganisms and detritivores. Diversity of this litter may influence instream decomposition globally in ways that are not yet understood. We investigated latitudinal differences in decomposition of litter mixtures of low and high functional diversity in 40 streams on 6 continents and spanning 113 degrees of latitude. Despite important variability in our dataset, we found latitudinal differences in the effect of litter functional diversity on decomposition, which we explained as evolutionary adaptations of litter-consuming detritivores to resource availability. Specifically, a balanced diet effect appears to operate at lower latitudes versus a resource concentration effect at higher latitudes. The latitudinal pattern indicates that loss of plant functional diversity will have different consequences on carbon fluxes across the globe, with greater repercussions likely at low latitudes

Extrasolar enigmas: from disintegrating exoplanets to exoasteroids

Thousands of transiting exoplanets have been discovered to date, thanks in great part to the {\em Kepler} space mission. As in all populations, and certainly in the case of exoplanets, one finds unique objects with distinct characteristics. Here we will describe the properties and behaviour of a small group of `disintegrating' exoplanets discovered over the last few years (KIC 12557548b, K2-22b, and others). They evaporate, lose mass unraveling their naked cores, produce spectacular dusty comet-like tails, and feature highly variable asymmetric transits. Apart from these exoplanets, there is observational evidence for even smaller `exo-'objects orbiting other stars: exoasteroids and exocomets. Most probably, such objects are also behind the mystery of Boyajian's star. Ongoing and upcoming space missions such as {\em TESS} and PLATO will hopefully discover more objects of this kind, and a new era of the exploration of small extrasolar systems bodies will be upon us.Comment: Accepted for publication in the book "Reviews in Frontiers of Modern Astrophysics: From Space Debris to Cosmology" (eds Kabath, Jones and Skarka; publisher Springer Nature) funded by the European Union Erasmus+ Strategic Partnership grant "Per Aspera Ad Astra Simul" 2017-1-CZ01-KA203-03556

KELT-25 b and KELT-26 b: A Hot Jupiter and a Substellar Companion Transiting Young A Stars Observed by TESS

We present the discoveries of KELT-25 b (TIC 65412605, TOI-626.01) and KELT-26 b (TIC 160708862, TOI-1337.01), two transiting companions orbiting relatively bright, early A stars. The transit signals were initially detected by the KELT survey and subsequently confirmed by Transiting Exoplanet Survey Satellite (TESS) photometry. KELT-25 b is on a 4.40 day orbit around the V = 9.66 star CD-24 5016 (Teff=8280-180+440 K, M ∗ = 2.18-0.11+0.12 M o˙), while KELT-26 b is on a 3.34 day orbit around the V = 9.95 star HD 134004 (Teff = 8640-240+500 K, M ∗ = 1.93-0.16+0.14 M o˙), which is likely an Am star. We have confirmed the substellar nature of both companions through detailed characterization of each system using ground-based and TESS photometry, radial velocity measurements, Doppler tomography, and high-resolution imaging. For KELT-25, we determine a companion radius of R P = 1.64-0.043+0.039 R J and a 3σ upper limit on the companion's mass of ∼64 M J. For KELT-26 b, we infer a planetary mass and radius of M P = 1.41-0.51+0.43MJ and R P = 1.94-0.058+0.060 R J. From Doppler tomographic observations, we find KELT-26 b to reside in a highly misaligned orbit. This conclusion is weakly corroborated by a subtle asymmetry in the transit light curve from the TESS data. KELT-25 b appears to be in a well-aligned, prograde orbit, and the system is likely a member of the cluster Theia 449

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

How reproducible are surface areas calculated from the BET equation?

Porosity and surface area analysis play a prominent role in modern materials science. At the heart of this sits the Brunauer-Emmett-Teller (BET) theory, which has been a remarkably successful contribution to the field of materials science. The BET method was developed in the 1930s for open surfaces but is now the most widely used metric for the estimation of surface areas of micro- and mesoporous materials. Despite its widespread use, the calculation of BET surface areas causes a spread in reported areas, resulting in reproducibility problems in both academia and industry. To prove this, for this analysis, 18 already-measured raw adsorption isotherms were provided to sixty-one labs, who were asked to calculate the corresponding BET areas. This round-robin exercise resulted in a wide range of values. Here, the reproducibility of BET area determination from identical isotherms is demonstrated to be a largely ignored issue, raising critical concerns over the reliability of reported BET areas. To solve this major issue, a new computational approach to accurately and systematically determine the BET area of nanoporous materials is developed. The software, called "BET surface identification" (BETSI), expands on the well-known Rouquerol criteria and makes an unambiguous BET area assignment possible

Lo que todo profesional de la salud debe saber sobre las convulsiones psicógenas no-epilépticas (CPNE)

Psychogenic nonepileptic seizures (PNES) are likely to be confused with epileptic seizures. The main difference is that PNES are not produced by anomalous electrical brain discharges, but by emotional and psychological dysfunctions. In the present article, we present an empirical and conceptual update on PNES, emphasizing the phenomenological, diagnostic and natural course of the disorder. To illustrate the clinical complexity of PNES, we present several clinical vignettes. We conclude that PNES are related to psychosocial burden and to impairment in several important areas of living. This situation is aggravated when the research literature indicate that many PNES patients are misdiagnosed with epilepsy and do not receive adequate psychological/psychiatric care. Furthermore, patients with PNES typically report high rates of a wide plethora of abusive childhood experiences. Lastly, we present a biopsychosocial conceptual framework to understand the emergence of this disorder.Las convulsiones psicógenas no-epilépticas (CPNE) son parecidas a las convulsiones de tipo epiléptico, lo que suele traer mucha confusión al momento de ofrecer un diagnóstico diferencial. La diferencia medular radica en que las CPNE no son producidas por anomalías electrocorticales, y sí por factores psico-emocionales. En el presente artículo, presentamos una revisión actualizada del tema, con énfasis en aspectos fenomenológicos, de diagnóstico y de curso clínico. Para ilustrar la complejidad de las CPNE, presentamos varias viñetas clínicas que se basan en la experiencia del primer autor con más de 100 pacientes con CPNE. De nuestra revisión se desprende que las CPNE se relacionan a un menoscabo y a un deterioro marcado generalizado psicosocial. Esta situación se agrava cuando típicamente pasan años antes de ofrecerse el diagnóstico correcto. Asimismo, estudios retrospectivos y prospectivos documentan el punto de que típicamente más del 50% de estos pacientes presentan un historial previo de abuso físico, emocional y sexual. Al respecto, se presenta un modelo multicausal/multifactorial para dar cuenta de las variables que predisponen, precipitan y perpetúan la aparición de las CPNE