P14 282. Endocarditis protésica. experiencia de 20 años

ObjetivosRevisamos la experiencia de nuestro centro en endocarditis protésica (EP).Material y métodosEntre 1990–2010, se intervienen 62 casos, que representaron el 23% de 276 casos totales de endocarditis y 2,46% de pacientes valvulares (precoces 0,58% con 20 casos, tardías 1,68% con 42 casos). No hubo diferencias en tipo ni localización de las prótesis, ni en incidencia entre las dos décadas (2,59% en 1990–2000 y 2,32% en 2000–2010). Edad media 59 años. Gérmenes: S. viridans 20,9%; S. epidermidis 16,1%; S. aureus 11,6%; C. burnetii 9,6%; enterococos 8%; difteroides 6,4%; hongos 6,4%. En un 8% de los casos se encontraron gérmenes raros aislados, mientras que no se identificó germen en 12,9%. Se intervinieron de forma urgente el 30% de pacientes (19 casos, el 45% de formas precoces y el 23% de formas tardías).ResultadosLa mortalidad precoz fue del 16%, a expensas sobre todo de EP precoz (12%). La supervivencia global a 10 años fue del 50%, con diferencias entre los dos grupos (EP precoz 15%; EP tardía 66%). El 70% de supervivientes se encuentra actualmente en clase funcional I-II/IV.ConclusiónLa EP sigue teniendo una incidencia relativamente elevada en nuestro medio. La EP precoz tiene una mortalidad muy elevada. La cirugía de la EP tardía tiene muy buenos resultados a largo plazo

Sistema informático para el proceso de referencia-contrarreferencia de pacientes

La incesante y creciente demanda de la población por una buena atención médica ha hecho de la referencia y contra-referencia de pacientes, un procedimiento administrativo asistencial de significativa importancia. Tal proceso comienza con una referencia o derivación de un paciente desde un establecimiento de menor capacidad resolutiva hacia otro de mayor complejidad en la asistencia, complementación diagnóstica o terapéutica, y finaliza con una contra-referencia o traslado del paciente al establecimiento del que provino, acompañado de un diagnóstico concreto, información sobre los servicios prestados y respuestas e indicaciones a las solicitudes de apoyo asistencial. Este artículo presenta un sistema informático desarrollado con tecnologías Free/Libre Open Source Software (FLOSS) [1] para promover la utilización adecuada y eficiente del Hospital Especializado “Dr. Noel H. Sbarra” [2], mejorar la interacción entre los profesionales pertenecientes a la “red” de salud descripta, de manera de aumentar la capacidad resolutiva del primer nivel de atención y evitar derivaciones innecesarias de niños y jóvenes. Cabe destacar que la implementación del sistema informático ha estado a cargo de alumnos de una cátedra perteneciente al último año de una de las carreras de grado de la Facultad de Informática de la Universidad Nacional de La Plata [3].Sociedad Argentina de Informática e Investigación Operativ

Microwave Observations of Venus with CLASS

We report on the disk-averaged absolute brightness temperatures of Venus measured at four microwave frequency bands with the Cosmology Large Angular Scale Surveyor (CLASS). We measure temperatures of 432.3 $\pm$ 2.8 K, 355.6 $\pm$ 1.3 K, 317.9 $\pm$ 1.7 K, and 294.7 $\pm$ 1.9 K for frequency bands centered at 38.8, 93.7, 147.9, and 217.5 GHz, respectively. We do not observe any dependence of the measured brightness temperatures on solar illumination for all four frequency bands. A joint analysis of our measurements with lower frequency Very Large Array (VLA) observations suggests relatively warmer ($\sim$ 7 K higher) mean atmospheric temperatures and lower abundances of microwave continuum absorbers than those inferred from prior radio occultation measurements.Comment: 10 pages, 3 figures, published in PS

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

<p>Abstract</p> <p>Background</p> <p>Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis.</p> <p>The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.</p> <p>Methods/design</p> <p>This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity.</p> <p>Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic scoliosis.</p> <p>Discussion</p> <p>This study will determine the value of many maturity indicators and will be useful as well for other clinicians treating children with disorders of growth. Since not all clinicians have access to the presented new 3D X-ray system or have the time to make EMG's, for example, all indicators will be correlated to the timing of the peak growth velocity of total body height and curve progression in idiopathic scoliosis. Therefore each clinician can chose which indicators can be used best in their practice.</p> <p>Trial registration number</p> <p>NTR2048</p

The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force: Findings from the consumer Delphi process

OnlinePublObjectives: To develop guidelines, informed by health-care consumer values and preferences, for sarcopenia prevention, assessment and management for use by clinicians and researchers in Australia and New Zealand. Methods: A three-phase Consumer Expert Delphi process was undertaken between July 2020 and August 2021. Consumer experts included adults with lived experience of sarcopenia or health-care utilisation. Phase 1 involved a structured meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force and consumer representatives from which the Phase 2 survey was developed. In Phase 2, consumers from Australia and New Zealand were surveyed online with opinions sought on sarcopenia outcome priorities, consultation preferences and interventions. Findings were confirmed and disseminated in Phase 3. Descriptive statistical analyses were performed. Results: Twenty-four consumers (mean±standard deviation age 67.5 ±12.8 years, 18 women) participated in Phase 2. Ten (42%) identified as being interested in sarcopenia, 7 (29%) were health-care consumers and 6 (25%) self-reported having/believing they have sarcopenia. Consumers identified physical performance, living circumstances, morale, quality of life and social connectedness as the most important outcomes related to sarcopenia. Consumers either had no preference (46%) or preferred their doctor (40%) to diagnose sarcopenia and preferred to undergo assessments at least yearly (54%). For prevention and treatment, 46% of consumers preferred resistance exercise, 2–3 times per week (54%). Conclusions: Consumer preferences reported in this study can inform the implementation of sarcopenia guidelines into clinical practice at local, state and national levels across Australia and New Zealand.Jesse Zanke ... Elsa Dent ... Renuka Visvanathan ... Solomon Yu ... et al

Longitudinal machine learning modeling of MS patient trajectories improves predictions of disability progression

Background and Objectives: Research in Multiple Sclerosis (MS) has recently focused on extracting knowledge from real-world clinical data sources. This type of data is more abundant than data produced during clinical trials and potentially more informative about real-world clinical practice. However, this comes at the cost of less curated and controlled data sets. In this work we aim to predict disability progression by optimally extracting information from longitudinal patient data in the real-world setting, with a special focus on the sporadic sampling problem. Methods: We use machine learning methods suited for patient trajectories modeling, such as recurrent neural networks and tensor factorization. A subset of 6682 patients from the MSBase registry is used. Results: We can predict disability progression of patients in a two-year horizon with an ROC-AUC of 0.85, which represents a 32% decrease in the ranking pair error (1-AUC) compared to reference methods using static clinical features. Conclusions: Compared to the models available in the literature, this work uses the most complete patient history for MS disease progression prediction and represents a step forward towards AI-assisted precision medicine in MS

The Simons Observatory: Characterizing the Large Aperture Telescope Receiver with Radio Holography

We present near-field radio holography measurements of the Simons Observatory Large Aperture Telescope Receiver optics. These measurements demonstrate that radio holography of complex millimeter-wave optical systems comprising cryogenic lenses, filters, and feed horns can provide detailed characterization of wave propagation before deployment. We used the measured amplitude and phase, at 4K, of the receiver near-field beam pattern to predict two key performance parameters: 1) the amount of scattered light that will spill past the telescope to 300K and 2) the beam pattern expected from the receiver when fielded on the telescope. These cryogenic measurements informed the removal of a filter, which led to improved optical efficiency and reduced side-lobes at the exit of the receiver. Holography measurements of this system suggest that the spilled power past the telescope mirrors will be less than 1% and the main beam with its near side-lobes are consistent with the nominal telescope design. This is the first time such parameters have been confirmed in the lab prior to deployment of a new receiver. This approach is broadly applicable to millimeter and sub-millimeter instruments.Comment: in proces

Excited State Vibrations of Isotopically Labeled FMN Free and Bound to a Light–Oxygen–Voltage (LOV) Protein

Flavoproteins are important blue light sensors in photobiology and play a key role in optogenetics. The characterization of their excited state structure and dynamics is thus an important objective. Here, we present a detailed study of excited state vibrational spectra of flavin mononucleotide (FMN), in solution and bound to the LOV-2 (Light-Oxygen-Voltage) domain of Avena sativa phototropin. Vibrational frequencies are determined for the optically excited singlet state and the reactive triplet state, through resonant ultrafast femtosecond stimulated Raman spectroscopy (FSRS). To assign the observed spectra, vibrational frequencies of the excited states are calculated using density functional theory, and both measurement and theory are applied to four different isotopologues of FMN. Excited state mode assignments are refined in both states, and their sensitivity to deuteration and protein environment are investigated. We show that resonant FSRS provides a useful tool for characterizing photoactive flavoproteins and is able to highlight chromophore localized modes and to record hydrogen/deuterium exchange

Persistence on therapy and propensity matched outcome comparison of two subcutaneous interferon beta 1a dosages for multiple sclerosis

To compare treatment persistence between two dosages of interferon &beta;-1a in a large observational multiple sclerosis registry and assess disease outcomes of first line MS treatment at these dosages using propensity scoring to adjust for baseline imbalance in disease characteristics. Treatment discontinuations were evaluated in all patients within the MSBase registry who commenced interferon &beta;-1a SC thrice weekly (n = 4678). Furthermore, we assessed 2-year clinical outcomes in 1220 patients treated with interferon &beta;-1a in either dosage (22 &micro;g or 44 &micro;g) as their first disease modifying agent, matched on propensity score calculated from pre-treatment demographic and clinical variables. A subgroup analysis was performed on 456 matched patients who also had baseline MRI variables recorded. Overall, 4054 treatment discontinuations were recorded in 3059 patients. The patients receiving the lower interferon dosage were more likely to discontinue treatment than those with the higher dosage (25% vs. 20% annual probability of discontinuation, respectively). This was seen in discontinuations with reasons recorded as &ldquo;lack of efficacy&rdquo; (3.3% vs. 1.7%), &ldquo;scheduled stop&rdquo; (2.2% vs. 1.3%) or without the reason recorded (16.7% vs. 13.3% annual discontinuation rate, 22 &micro;g vs. 44 &micro;g dosage, respectively). Propensity score was determined by treating centre and disability (score without MRI parameters) or centre, sex and number of contrast-enhancing lesions (score including MRI parameters). No differences in clinical outcomes at two years (relapse rate, time relapse-free and disability) were observed between the matched patients treated with either of the interferon dosages. Treatment discontinuations were more common in interferon &beta;-1a 22 &micro;g SC thrice weekly. However, 2-year clinical outcomes did not differ between patients receiving the different dosages, thus replicating in a registry dataset derived from &ldquo;real-world&rdquo; database the results of the pivotal randomised trial. Propensity score matching effectively minimised baseline covariate imbalance between two directly compared sub-populations from a large observational registry