7 research outputs found
Effect of Power Control Imperfections on the Reverse Link of Cellular CDMA Networks Under Multipath Fading
Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes
Objective
To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED).
Methods and results
Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk.
Conclusions
Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival
Effect of constrained fast power control on cellular DS-CDMA systems with base station diversity
Analysis of the Effect of Sand and Dust Storms (SDSs) and Rain on the Performance of Cellular Networks in the Millimeter Wave Band
Future cellular systems are expected to use millimeter-wave (mm-Wave) frequency bands in addition to the existing microwave bands under 6 GHz. Severe weather conditions, including sand and dust storms (SDSs) and heavy rainfalls, challenge reliable communications over wireless links at those higher frequencies. In such conditions, besides frequency-dependent path-loss, radio signals experience additional attenuation. The SDS attenuation is related to visibility, receiver distance to the storm origin point, soil type, frequency, temperature and humidity. On the other hand, the rainfall attenuation is affected by rainfall rate, polarization, carrier frequency, temperature and raindrop size distribution. Leveraging on experimental measurements carried out in previous works, a novel unified mathematical framework is introduced in this paper to include SDS/rainfall-dependent attenuation in the performance evaluation of terrestrial wireless cellular networks in terms of coverage probability, bit error rate (BER) and achievable rate in the mm-Wave band. Extensive numerical results are presented to show the effects of the different SDS/rainfall parameters on performance, showing that the degradation due to SDS is generally higher than that due to rain and may cause a reduction of even six orders of magnitude in the average achievable bit rate when the frequency increases from 28 to 38 GHz
Atención integral del neonato con encefalopatía hipóxico-isquémica en España
Introducción
Apenas conocemos cómo es la asistencia de los recién nacidos (RN) con encefalopatía hipóxico-isquémica (EHI) en hipotermia terapéutica (HT), especialmente si existen protocolos asistenciales, la neuromonitorización que se realiza o cómo es la aproximación al pronóstico neurológico. Este conocimiento permite detectar e implementar áreas de mejora asistencial.
Método
Estudio transversal de los 57 hospitales españoles que realizaban HT en 2015, mediante cuestionario sobre: 1) la disponibilidad de protocolos y de recursos tecnológicos; 2) el uso de herramientas de neuromonitorización; 3) los conocimientos de los profesionales; 4) la información pronóstica que se da los padres, y 5) el informe al alta y del plan de seguimiento.
Resultados
El 95% utiliza enfriamiento corporal-total servocontrolado y dispone de protocolos específicos de actuación. El 70% utiliza sedación y el 68% deja al paciente a dieta absoluta. La monitorización con electroencefalografía integrada por amplitud se utiliza en más del 80% de los centros, aunque solo en el 50% la enfermera es capaz de interpretarlo. La saturación de oxígeno cerebral es escasamente monitorizada (16%). Entre los estudios diagnóstico-pronósticos, la neuroimagen es universal, pero los neurobiomarcadores apenas se utilizan (29%). Solo el 21% ofrece información pronóstica antes de las 72 h de vida; sin presencia de la enfermera en el 70%. El seguimiento lo realiza el neuropediatra (84%), con una duración desigual entre centros.
Conclusiones
La asistencia del RN con EHI en España es adecuada, con áreas de mejora en: neuromonitorización, sedación, marco temporal de la información pronóstica, trabajo en equipo y estandarización de la duración del seguimiento