901-5 Intravenous Amiodarone Restores Sinus Rhythm in Acute Myocardial Infarction Complicated with Atrial Fibrillation

The effectiveness and tolerance of intravenous (IV) amiodarone (Am) in atrialfibrillation (AF) complicated acute myocardial infarction (AMI) is not well studied. Thus, twenty patients (Pts) with AMI complicated with AF occurring within 30h (11.9 ± 10) of the onset of AMI symptoms were treated with IV administration of digitalis (d, 0.5mg and an additional 0.25mg later) followed by IV Am 300mg over 2h (starting 2h after the initial dose of d) and followed by 44mg/h for up to 3 days, if sinus rhythm (SR) was not restored. Intravenous d restored SR within 2h in 5/20pts. AF relapsed in 2 of them. Subsequent administration of Am for 2 h restored SR in the remaining 15/20pts and in the 2pts in whom AF had relapsed after the initial restoration of SR by d. Am restored SR within an average of 12.8 (range 0.5–56) h of infusion. Total dose of Am was 1922 ± 720mg in 4pts and 425 ± 241mg in the remaining 13. Am was well tolerated by all pts including 1 with cardiogenic shock assisted with the intraaortic balloon pump. In conclusion, IV Am administration ishighly effective in restoring sinusrhythm in AF complicating AMI and is well tolerated

Enthalpy and the Mechanics of AdS Black Holes

We present geometric derivations of the Smarr formula for static AdS black holes and an expanded first law that includes variations in the cosmological constant. These two results are further related by a scaling argument based on Euler's theorem. The key new ingredient in the constructions is a two-form potential for the static Killing field. Surface integrals of the Killing potential determine the coefficient of the variation of the cosmological constant in the first law. This coefficient is proportional to a finite, effective volume for the region outside the AdS black hole horizon, which can also be interpreted as minus the volume excluded from a spatial slice by the black hole horizon. This effective volume also contributes to the Smarr formula. Since the cosmological constant is naturally thought of as a pressure, the new term in the first law has the form of effective volume times change in pressure that arises in the variation of the enthalpy in classical thermodynamics. This and related arguments suggest that the mass of an AdS black hole should be interpreted as the enthalpy of the spacetime.Comment: 21 pages; v2 references adde

The impact of different strategies to handle missing data on both precision and bias in a drug safety study: a multidatabase multinational population-based cohort study

BACKGROUND: Missing data are often an issue in electronic medical records (EMRs) research. However, there are many ways that people deal with missing data in drug safety studies. AIM: To compare the risk estimates resulting from different strategies for the handling of missing data in the study of venous thromboembolism (VTE) risk associated with antiosteoporotic medications (AOM). METHODS: New users of AOM (alendronic acid, other bisphosphonates, strontium ranelate, selective estrogen receptor modulators, teriparatide, or denosumab) aged ≥50 years during 1998–2014 were identified in two Spanish (the Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria [BIFAP] and EpiChron cohort) and one UK (Clinical Practice Research Datalink [CPRD]) EMR. Hazard ratios (HRs) according to AOM (with alendronic acid as reference) were calculated adjusting for VTE risk factors, body mass index (that was missing in 61% of patients included in the three databases), and smoking (that was missing in 23% of patients) in the year of AOM therapy initiation. HRs and standard errors obtained using cross-sectional multiple imputation (MI) (reference method) were compared to complete case (CC) analysis – using only patients with complete data – and longitudinal MI – adding to the cross-sectional MI model the body mass index/smoking values as recorded in the year before and after therapy initiation. RESULTS: Overall, 422/95,057 (0.4%), 19/12,688 (0.1%), and 2,051/161,202 (1.3%) VTE cases/participants were seen in BIFAP, EpiChron, and CPRD, respectively. HRs moved from 100.00% underestimation to 40.31% overestimation in CC compared with cross-sectional MI, while longitudinal MI methods provided similar risk estimates compared with cross-sectional MI. Precision for HR improved in cross-sectional MI versus CC by up to 160.28%, while longitudinal MI improved precision (compared with cross-sectional) only minimally (up to 0.80%). CONCLUSIONS: CC may substantially affect relative risk estimation in EMR-based drug safety studies, since missing data are not often completely at random. Little improvement was seen in these data in terms of power with the inclusion of longitudinal MI compared with cross-sectional MI. The strategy for handling missing data in drug safety studies can have a large impact on both risk estimates and precision

Black Holes in Ho\v{r}ava Gravity with Higher Derivative Magnetic Terms

We consider Horava gravity coupled to Maxwell and higher derivative magnetic terms. We construct static spherically symmetric black hole solutions in the low-energy approximation. We calculate the horizon locations and temperatures in the near-extremal limit, for asymptotically flat and (anti-)de Sitter spaces. We also construct a detailed balanced version of the theory, for which we find projectable and non-projectable, non-perturbative solutions.Comment: 17 pages. v2: Up to date with published version; some minor remarks and more reference

Spherical magnetic nanoparticles fabricated by laser target evaporation

Magnetic nanoparticles of iron oxide (MNPs) were prepared by the laser target evaporation technique (LTE). The main focus was on the fabrication of de-aggregated spherical maghemite MNPs with a narrow size distribution and enhanced effective magnetization. X-ray diffraction, transmission electron microscopy, magnetization and microwave absorption measurements were comparatively analyzed. The shape of the MNPs (mean diameter of 9 nm) was very close to being spherical. The lattice constant of the crystalline phase was substantially smaller than that of stoichiometric magnetite but larger than the lattice constant of maghemite. High value of Ms up to 300 K was established. The 300 K ferromagnetic resonance signal is a single line located at a field expected from spherical magnetic particles with negligible magnetic anisotropy. The maximum obtained concentration of water based ferrofluid was as high as 10g/l of magnetic material. In order to understand the temperature and field dependence of MNPs magnetization, we invoke the core-shell model. The nanoparticles is said to have a ferrimagnetic core (roughly 70 percent of the caliper size) while the shell consists of surface layers in which the spins are frozen having no long range magnetic order. The core-shell interactions were estimated in frame of random anisotropy model. The obtained assembly of de-aggregated nanoparticles is an example of magnetic nanofluid stable under ambient conditions even without an electrostatic stabilizer

C3-Cloud personalised care plan development platform for addressing the needs of multi-morbidity and managing poly-pharmacy : protocol for a pilot technology trial

Background: There is an increasing need to organise the care around the patient and not the disease, as well as taking into account the complex realities of multiple physical, psycho-social conditions and polypharmacy. Integrated patient-centred care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced ICT solutions. Objective: The C3-Cloud project has developed two collaborative computer platforms for patients and members of the Multi-Disciplinary Team and deployed these in three different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients, informal caregivers, healthcare professionals and, in extend, healthcare systems. Methods: This paper describes the protocol for conducting an evaluation of the user-centred design, user experience, acceptability, and usefulness of the platforms. For this, four ‘testing and evaluation’ phases have been defined, involving multiple qualitative methods, and advanced impact modelling. Results: The technology trial in this 4-year funded project (2016-2020) is currently in its execution phase. The testing and evaluation phase 1 and 2 have been completed with satisfying results on system component tests, and promising results on application and usability tests. The pilot technology trial for evaluation phase 3 and 4 was launched in August 2019. Data collection for these phases is underway and results are forthcoming, approximately in April 2020. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. Conclusions: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalised care plan platforms for patients and collaboration platforms for members of Multi-Disciplinary Teams can help to tackle the specific challenges of clinical guideline reconciliation for multimorbid patients and improved the management of poly-pharmacy. The initial evaluative phases have indicated promising results of platform usability. The phased methodology has shown useful results in the first two phases, while results of phase 3 and 4 are pending. Clinical Trial: https://www.clinicaltrials.gov/ct2/show/NCT0383420

Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) - Sex differences and associations with morbidity and medication use

INTRODUCTION: Multimorbidity in advanced age and the need for drug treatment may lead to polypharmacy, while pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug events (ADEs). OBJECTIVE: The aim of this study was to determine the proportion of subjects using potentially inappropriate medication (PIM) in a cohort of older and predominantly healthy adults in relation to polypharmacy and morbidity. METHODS: Cross-sectional data were available from 1,382 study participants (median age 69 years, IQR 67-71, 51.3% females) of the Berlin Aging Study II (BASE-II). PIM was classified according to the EU(7)-PIM and German PRISCUS (representing a subset of the former) list. Polypharmacy was defined as the concomitant use of at least five drugs. A morbidity index (MI) largely based on the Charlson Index was applied to evaluate the morbidity burden. RESULTS: Overall, 24.1% of the participants were affected by polypharmacy. On average, men used 2 (IQR 1-4) and women 3 drugs (IQR 1-5). According to PRISCUS and EU(7)-PIM, 5.9% and 22.6% of participants received at least one PIM, while use was significantly more prevalent in females (25.5%) compared to males (19.6%) considering EU(7)-PIM (p = 0.01). In addition, morbidity in males receiving PIM according to EU(7)-PIM was higher (median MI 1, IQR 1-3) compared to males without PIM use (median MI 1, IQR 0-2, p<0.001). CONCLUSION: PIM use occurred more frequently in women than in men, while it was associated with higher morbidity in males. As expected, EU(7)-PIM identifies more subjects as PIM users than the PRISCUS list but further studies are needed to investigate the differential impact of both lists on ADEs and outcome. KEY POINTS: We found PIM use to be associated with a higher number of regular medications and with increased morbidity. Additionally, we detected a higher prevalence of PIM use in females compared to males, suggesting that women and people needing intensive drug treatment are patient groups, who are particularly affected by PIM use

Thin accretion disk signatures of slowly rotating black holes in Ho\v{r}ava gravity

In the present work, we consider the possibility of observationally testing Ho\v{r}ava gravity by using the accretion disk properties around slowly rotating black holes of the Kehagias-Sfetsos solution in asymptotically flat spacetimes. The energy flux, temperature distribution, the emission spectrum as well as the energy conversion efficiency are obtained, and compared to the standard slowly rotating general relativistic Kerr solution. Comparing the mass accretion in a slowly rotating Kehagias-Sfetsos geometry in Ho\v{r}ava gravity with the one of a slowly rotating Kerr black hole, we verify that the intensity of the flux emerging from the disk surface is greater for the slowly rotating Kehagias-Sfetsos solution than for rotating black holes with the same geometrical mass and accretion rate. We also present the conversion efficiency of the accreting mass into radiation, and show that the rotating Kehagias-Sfetsos solution provides a much more efficient engine for the transformation of the accreting mass into radiation than the Kerr black holes. Thus, distinct signatures appear in the electromagnetic spectrum, leading to the possibility of directly testing Ho\v{r}ava gravity models by using astrophysical observations of the emission spectra from accretion disks.Comment: 12 pages, 15 figures. V2: 13 pages, clarifications and discussion added; version accepted for publication in Classical and Quantum Gravit

Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours

Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network