Management of Hypnotics in Patients with Insomnia and Heart Failure during Hospitalization: A Systematic Review

Background: Heart failure is a chronic, progressive syndrome of signs and symptoms, which has been associated to a range of comorbidities including insomnia. Acute decompensation of heart failure frequently leads to hospital admission. During hospital admission, long-term pharmacological treatments such as hypnotics can be modified or stopped. Aim: To synthesize the scientific evidence available about the effect of withdrawing hypnotic drugs during hospital admission in patients with decompensated heart failure and insomnia. Method: A systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was carried out in the following scientific databases: PubMed, Scopus, Dialnet and Cochrane. Inclusion criteria: studies including a population of adults with heart failure and sleep disorders in treatment with hypnotics and admitted to hospital, studies written in English or Spanish and published until June 2020. Exclusion criteria: studies involving children, patients admitted to intensive care and patients diagnosed with sleep apnea. Results: We identified a total of 265 documents; only nine papers met the selection criteria. The most frequently used drugs for the treatment of insomnia in patients with heart failure were benzodiazepines and benzodiazepine agonists; their secondary effects can alter perceived quality of life and increase the risk of adverse effects. Withdrawal of these drugs during hospital admission could increase the risk of delirium. Future research in this area should evaluate the management of hypnotics during hospital admission in patients with decompensated heart failure. In addition, safe and efficient non-pharmacological alternatives for the treatment of insomnia in this population should be tested and implemented

Small-scale distributions in an indoor environment at 94GHz

[EN] In this paper, an extensive multiple-input multiple-output measurement campaign in a lab environment has been conducted at the 94GHz band. Using a vector network analyzer, updown converters, and omnidirectional antennas displaced in virtual arrays, we have obtained an estimation of the distribution parameters for the most usual distributions employed in the small-scale fading modeling, i.e., Rayleigh, Rice, Nakagami-m and -, by using statistical inference techniques. Moreover, in this scenario the best fit distribution to the experimental data is the Weibull distribution, using the Kolmogorov-Smirnov test. However, the - distribution provides the best fitting to the experimental results in terms of the lower tails of the distributions.This work was supported by the Ministerio de Economia y Competitividad MINECO, Spain (TEC2016-78028-C3-2-P) and by the European FEDER funds. Further information regarding the data obtained and included in this paper can be attained by contacting the author, Jose M. Molina ([email protected]).Reig, J.; Martinez-Ingles, M.; Molina-Garcia-Pardo, J.; Rubio Arjona, L.; Rodrigo Peñarrocha, VM. (2017). Small-scale distributions in an indoor environment at 94GHz. Radio Science. 52(7):852-861. https://doi.org/10.1002/2017RS006335S852861527Cudak, M., Ghosh, A., Kovarik, T., Ratasuk, R., Thomas, T. A., Vook, F. W., & Moorut, P. (2013). Moving Towards Mmwave-Based Beyond-4G (B-4G) Technology. 2013 IEEE 77th Vehicular Technology Conference (VTC Spring). doi:10.1109/vtcspring.2013.6692638Everitt, B. S., & Skrondal, A. (2010). The Cambridge Dictionary of Statistics. doi:10.1017/cbo9780511779633Helminger, J., Detlefsen, J., & Groll, H. (s. f.). Propagation properties of an indoor-channel at 94 GHz. ICMMT’98. 1998 International Conference on Microwave and Millimeter Wave Technology. Proceedings (Cat. No.98EX106). doi:10.1109/icmmt.1998.768215Moon-Soon Choi, Grosskopf, G., & Rohde, D. (s. f.). Statistical Characteristics of 60 GHz Wideband Indoor Propagation Channel. 2005 IEEE 16th International Symposium on Personal, Indoor and Mobile Radio Communications. doi:10.1109/pimrc.2005.1651506Kajiwara, A. (s. f.). Indoor propagation measurements at 94 GHz. Proceedings of 6th International Symposium on Personal, Indoor and Mobile Radio Communications. doi:10.1109/pimrc.1995.477099Maccartney, G. R., Rappaport, T. S., Sun, S., & Deng, S. (2015). Indoor Office Wideband Millimeter-Wave Propagation Measurements and Channel Models at 28 and 73 GHz for Ultra-Dense 5G Wireless Networks. IEEE Access, 3, 2388-2424. doi:10.1109/access.2015.2486778Marcum J. I. 1950 Table of Q functionsMartinez-Ingles, M.-T., Gaillot, D. P., Pascual-Garcia, J., Molina-Garcia-Pardo, J.-M., Rodríguez, J.-V., Rubio, L., & Juan-Llácer, L. (2016). Channel sounding and indoor radio channel characteristics in the W-band. EURASIP Journal on Wireless Communications and Networking, 2016(1). doi:10.1186/s13638-016-0530-7Rangan, S., Rappaport, T. S., & Erkip, E. (2014). Millimeter-Wave Cellular Wireless Networks: Potentials and Challenges. Proceedings of the IEEE, 102(3), 366-385. doi:10.1109/jproc.2014.2299397Reig, J., Martínez-Inglés, M.-T., Rubio, L., Rodrigo-Peñarrocha, V.-M., & Molina-García-Pardo, J.-M. (2014). Fading Evaluation in the 60 GHz Band in Line-of-Sight Conditions. International Journal of Antennas and Propagation, 2014, 1-12. doi:10.1155/2014/984102Thomas, H. J., Cole, R. S., & Siqueira, G. L. (1994). An experimental study of the propagation of 55 GHz millimeter waves in an urban mobile radio environment. IEEE Transactions on Vehicular Technology, 43(1), 140-146. doi:10.1109/25.282274Thomas, T. A., Vook, F. W., & Sun, S. (2015). Investigation into the effects of polarization in the indoor mmWave environment. 2015 IEEE International Conference on Communications (ICC). doi:10.1109/icc.2015.724851

Sleep quality in patients with heart failure in the spanish population: A cross-sectional study

Background: Heart failure is a major problem in western societies. Sleep Disorders maintain a bidirectional relationship with heart failure, as shown by studies conducted in other countries. This study aims to describe the quality of sleep in Spanish patients with heart failure. Materials and methods: We carried out a cross-sectional study to analyze the quality of sleep in a sample of 203 patients with a diagnosis of heart failure admitted to an Internal Medicine Service. The Pittsburg Sleep Quality Index (PSQI) was used to evaluate sleep quality in our sample over a one-month period. Results: 75% of the sample presented sleep disorders. The most common problems included the interruption of sleep (73.5% nocturia and 30% breathing difficulties); 35% had poor sleep efficiency; 33% showed a decrease in daytime performance; 84% had used hypnotics at some point to induce sleep and 35% used them regularly. Conclusions: This is the first study to report on the perceived sleep quality of patients with heart failure in Spain. Self-perception of sleep quality differed from that estimated by the PSQI. The prevalence of the use of sleep-inducing medication was very high. The diurnal dysfunction generated by sleep disorders in a heart failure environment can contribute to the development of self-care and cognitive deterioration problems

Scattering amplitudes with massive fermions using BCFW recursion

We study the QCD scattering amplitudes for \bar{q}q \to gg and \bar{q}q \to ggg where q is a massive fermion. Using a particular choice of massive fermion spinor we are able to derive very compact expressions for the partial spin amplitudes for the 2 \to 2 process. We then investigate the corresponding 2 \to 3 amplitudes using the BCFW recursion technique. For the helicity conserving partial amplitudes we again derive very compact expressions, but were unable to treat the helicity-flip amplitudes recursively, except for the case where all the gluon helicities are the same. We therefore evaluate the remaining partial amplitudes using standard Feynman diagram techniques.Comment: 21 page

Effect of iron addition to the electrolyte on alkaline water electrolysis performance

Improvement of alkaline water electrolysis is a key enabler for quickly scaling up green hydrogen production. Fe is omnipresent within most industrial alkaline water electrolyzers and its effect on electrolyzer performance needs to be assessed. We conducted three-electrode and flow cell experiments with electrolyte Fe and Ni electrodes. Three-electrode cell experiments show that Fe ([Fe] = 6–357 μM; ICP-OES) promotes HER and OER by lowering both overpotentials by at least 100 mV at high current densities (T = 35°C–91°C). The overpotential of a zero-gap flow cell was decreased by 200 mV when increasing the Fe concentration ([Fe] = 13–549 μM, T = 21°C–75°C). HER benefits from the formation of Fe dendrite layers (SEM/EDX, XPS), which prevent NiHx formation and increase the overall active area. The OER benefits from the formation of mixed Ni/Fe oxyhydroxides leading to better catalytic activity and Tafel slope reduction

The TELE-DD project on treatment nonadherence in the population with type 2 diabetes and comorbid depression

Diabetic patients have increased depression rates, diminished quality of life, and higher death rates due to depression comorbidity or diabetes complications. Treatment adherence (TA) and the maintenance of an adequate and competent self-care are crucial factors to reach optimal glycaemic control and stable quality of life in these patients. In this report, we present the baseline population analyses in phase I of the TELE-DD project, a three-phased population-based study in 23 Health Centres from the Aragonian Health Service Sector II in Zaragoza, Spain. The objectives of the present report are: (1) to determine the point prevalence of T2D and clinical depression comorbidity and treatment nonadherence; (2) to test if HbA1c and LDL-C, as primary DM outcomes, are related to TA in this population; and (3) to test if these DM primary outcomes are associated with TA independently of shared risk factors for DM and depression, and patients’ health behaviours. A population of 7,271 patients with type-2 diabetes and comorbid clinical depression was investigated for inclusion. Individuals with confirmed diagnoses and drug treatment for both illnesses (n = 3340) were included in the current phase I. A point prevalence of 1.9% was found for the T2D-depression comorbidity. The prevalence of patients nonadherent to treatment for these diseases was 35.4%. Multivariate analyses confirmed that lower diabetes duration, increased yearly PCS visits, HbA1c and LDL-C levels were independently related to treatment nonadherence. These findings informed the development of a telephonic monitoring platform for treatment of nonadherence for people with diabetes and comorbid depression and further trial, cost-effectiveness, and prognostic studies (phases II and III)

Agresiones externas hacia los profesionales del Servicio Aragonés de Salud en los servicios de Atención Primaria y Especializada durante el año 2018

Objetivo: El riesgo que tiene el personal sanitario de sufrir una agresión en el lugar de trabajo no es homogéneo. Factores como la categoría profesional, el nivel asistencial o el servicio modulan su probabilidad. El objetivo del presente trabajo fue analizar las agresiones registradas por los profesionales del Servicio Aragonés de Salud, comparando las características de aquellas que sucedieron en Atención Primaria con las que tuvieron lugar en Atención Especializada durante el año 2018. Metodos: Se realizó un estudio descriptivo transversal, llevado a cabo a través de la información disponible en la base de datos del registro de agresiones aragonés durante el año 2018. Las variables del estudio incluyeron características sociodemográficas de las personas agredidas, tipo de agresión, nivel de asistencia y baja laboral. Se calcularon frecuencias y porcentajes para las variables cualitativas, y media y desviación típica para las cuantitativas. La relación entre las variables se realizó mediante las pruebas de Mann-Whitney y Chi-Cuadrado. Resultados: Se registraron 236 agresiones, de las que el 75, 4% tuvieron lugar en Atención Especializada. La edad media se situó en 45 años. Los médicos fueron más agredidos en Atención Primaria, mientras que el personal de enfermería lo fue más en especializada. En primaria se produjeron más agresiones verbales, mientras que en especializada se registraron más agresiones físicas. Conclusiones: La violencia laboral que sufren los profesionales sanitarios varía en función del nivel asistencial, donde se observa una mayor incidencia de agresiones en Atención Especializada. Es necesario establecer mejoras en el registro de agresiones de Aragón, para perfeccionar la prevención y seguridad de los trabajadores. Objective: The risk that health personnel have of being assaulted in the workplace is not homogeneous. Factors such as professional category, level of care or service, modulate their probability. The objective of this work was to analyze the aggressions registered by the Servicio Aragonés de Salud professionals, comparing the characteristics of those that occurred in primary care with those that took place in specialized care during 2018. Methods: A cross-sectional descriptive study was made, carried out using the information available in the Aragon aggression registry database, during the year 2018. The study variables included sociodemographic characteristics of the people attacked, type of aggression, level of assistance and sick leave. Frequencies and percentages were calculated for the qualitative variables and mean and standard deviation for the quantitative ones; the relationship between the variables was made using the Mann-Whitney and Chi-Square tests. Results: 236 assaults were registered, of which 75.4% took place in AE. The average age was 45 years. Doctors were more attacked in primary care, while nursing staff was more attacked in specialized care. In primary there were more verbal attacks, while in specialized there were more physical attacks. Conclusions: Occupational violence suffered by health professionals change depending on the level of care, where a higher incidence of assaults is observed in specialized care. It is necessary to establish improvements in the registry of aggressions in Aragón, to improve the prevention and safety of workers

Prevalence and progression of chronic kidney disease after a liver transplant: a prospective, real-life, observational, two-year multicenter study

Introduction: chronic kidney disease is a frequent complication after liver transplantation. The use of calcineurin inhibitors is one of the causes of this complication. Current immunsuppression regimens that reduce the use of calcineurin inhibitors may be associated with an improved preservation of renal function. Objective: the study aimed to assess the evolution of renal function after liver transplantation in the current routine clinical practice. Methods: an observational, prospective, multicenter study in adult liver transplant recipients was performed. Two hundred and thirty patients with a good renal function before transplantation were assessed six months post-transplantation (baseline) and every six months until month 30. Results: at baseline, 32% of the patients had a reduction in the glomerular filtration rate below < 60 ml/min/1.73 m2. The mean glomerular filtration rate increased from 72.3 to 75.6 ml/min/1.73 m2 at baseline and month 30 respectively (p < 0.01). The mean serum creatinine levels (mg/dl) decreased from 1.13 to 1.09 (p < 0.01). The percentage of patients with stage 3 chronic kidney disease decreased from 31.7% to 26.4%, whereas the percentage of patients with stage 4 remained unchanged (0.4% at baseline and 0.5% at month 30). No patients progressed to end-stage kidney disease that required dialysis or renal transplantation. Conclusion: in the routine clinical practice, a moderate deterioration of renal function is frequent after liver transplantation. However, advanced chronic kidney disease is infrequent in patients with a good pre-transplant renal function

Fading Evaluation in the 60GHz Band in Line-of-Sight Conditions

An exhaustive analysis of the small-scale fading amplitude in the 60GHz band is addressed for line-of-sight conditions (LOS). From a measurement campaign carried out in a laboratory, we have estimated the distribution of the small-scale fading amplitude over a bandwidth of 9GHz. From the measured data, we have estimated the parameters of the Rayleigh, Rice, Nakagami-m, Weibull, and \alpha-\mu distributions for the small-scale amplitudes. The test of Kolmogorov-Smirnov (K-S) for each frequency bin is used to evaluate the performance of such statistical distributions. Moreover, the distributions of the main estimated parameters for such distributions are calculated and approximated for lognormal statistics in some cases. The matching of the above distributions to the experimental distribution has also been analyzed for the lower tail of the cumulative distribution function (CDF).These parameters offer information about the narrowband channel behavior that is useful for a better knowledge of the propagation characteristics at 60GHz.This work was supported in part by the Spanish Ministerio de Ciencia e Innovacion TEC-2010-20841-C04-1 and by the Universitat Politecnica de Valencia, PAID 05-11 ref. 2702. The authors thank the anonymous reviewers for their valuable remarks and suggestions which have considerably enriched the final paper.Reig, J.; Martínez Inglés, M.; Rubio Arjona, L.; Rodrigo Peñarrocha, VM.; Molina-García-Pardo, J. (2014). Fading Evaluation in the 60GHz Band in Line-of-Sight Conditions. International Journal of Antennas and Propagation. 2014:1-12. https://doi.org/10.1155/2014/984102S1122014Smulders, P. (2002). Exploiting the 60 GHz band for local wireless multimedia access: prospects and future directions. IEEE Communications Magazine, 40(1), 140-147. doi:10.1109/35.978061Park, C., & Rappaport, T. (2007). Short-Range Wireless Communications for Next-Generation Networks: UWB, 60 GHz Millimeter-Wave WPAN, And ZigBee. IEEE Wireless Communications, 14(4), 70-78. doi:10.1109/mwc.2007.4300986Daniels, R. C., & Heath, R. W. (2007). 60 GHz wireless communications: Emerging requirements and design recommendations. IEEE Vehicular Technology Magazine, 2(3), 41-50. doi:10.1109/mvt.2008.915320Zwick, T., Beukema, T. J., & Haewoon Nam. (2005). Wideband channel sounder with measurements and model for the 60 GHz indoor radio channel. IEEE Transactions on Vehicular Technology, 54(4), 1266-1277. doi:10.1109/tvt.2005.851354Shoji, Y., Sawada, H., Chang-Soon Choi, & Ogawa, H. (2009). A Modified SV-Model Suitable for Line-of-Sight Desktop Usage of Millimeter-Wave WPAN Systems. IEEE Transactions on Antennas and Propagation, 57(10), 2940-2948. doi:10.1109/tap.2009.2029286Hao Xu, Kukshya, V., & Rappaport, T. S. (2002). Spatial and temporal characteristics of 60-GHz indoor channels. IEEE Journal on Selected Areas in Communications, 20(3), 620-630. doi:10.1109/49.995521Anderson, C. R., & Rappaport, T. S. (2004). In-Building Wideband Partition Loss Measurements at 2.5 and 60 GHz. IEEE Transactions on Wireless Communications, 3(3), 922-928. doi:10.1109/twc.2004.826328Smulders, P. (2009). Statistical Characterization of 60-GHz Indoor Radio Channels. IEEE Transactions on Antennas and Propagation, 57(10), 2820-2829. doi:10.1109/tap.2009.2030524Thomas, H. J., Cole, R. S., & Siqueira, G. L. (1994). An experimental study of the propagation of 55 GHz millimeter waves in an urban mobile radio environment. IEEE Transactions on Vehicular Technology, 43(1), 140-146. doi:10.1109/25.282274Kyro, M., Haneda, K., Simola, J., Takizawa, K., Hagiwara, H., & Vainikainen, P. (2012). Statistical Channel Models for 60 GHz Radio Propagation in Hospital Environments. IEEE Transactions on Antennas and Propagation, 60(3), 1569-1577. doi:10.1109/tap.2011.2180349Durgin, G. D., Rappaport, T. S., & de Wolf, D. A. (2002). New analytical models and probability density functions for fading in wireless communications. IEEE Transactions on Communications, 50(6), 1005-1015. doi:10.1109/tcomm.2002.1010620Yacoub, M. D. (2007). The κ-μ distribution and the η-μ distribution. IEEE Antennas and Propagation Magazine, 49(1), 68-81. doi:10.1109/map.2007.370983Martinez-Ingles, M.-T., Sanchis-Borras, C., Molina-Garcia-Pardo, J.-M., Rodriguez, J.-V., & Juan-Llacer, L. (2013). Experimental Evaluation of an Indoor MIMO-OFDM System at 60 GHz Based on the IEEE802.15.3c Standard. IEEE Antennas and Wireless Propagation Letters, 12, 1562-1565. doi:10.1109/lawp.2013.2293275Koay, C. G., & Basser, P. J. (2006). 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Identificación en aguas recreativas de bacterias patógenas en amebas de vida libre, que actúan como nicho ecológico, mediante técnicas de biología molecular.

Las amebas de vida libre (AVL) son protozoos que se encuentran ampliamente distribuidos en la naturaleza, siendo algunas de ellas patógenos oportunistas. Existe una interacción en el medio ambiente entre AVL y bacterias, siendo estas su sustrato alimenticio, aunque se ha demostrado la capacidad de algunas especies para sobrevivir en el interior de la ameba1. Este hecho supone que bacterias consideradas patógenas para el ser humano, permanezcan protegidas en el interior de las amebas cuya forma quística es altamente resistente y cuando las condiciones que hacían adverso el medio desaparecen, sean liberadas persistiendo en lugares como torres de refrigeración, piscinas, fuentes ornamentales, lo que supone un riesgo para la salud pública1-2. Se estudió la presencia de bacterias patóge