13 research outputs found
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
Improving the geomagnetic field modeling with a selection of high-quality archaeointensity data
International audienc
First Archaeomagnetic field intensity data from Ethiopia, Africa (1615 AD)
International audienceFirst archaeointensity determinations have been obtained from Ethiopia. Seven bricks (34 specimens) from the DĂ€bsan archaeological remains were subjected to archaeointensity determination by means of classical ThellierâThellier experiment including tests for magnetic anisotropy and magnetic cooling rate dependency. The age of the DĂ€bsan Palace is well controlled by historical information: between 1603, when land grants were conceded to the Jesuits and the Catholicism was established as the official religion in Ethiopia, and the age of the Palace foundation in 1626â27. Successful archaeointensity determinations were obtained in 27 specimens from five individual bricks revealing an average field value of 33.5 ± 1.1 ÎŒT, which is 11â26% lower than expected values from global geomagnetic models based on historical and archaeomagnetic data.Global models for 1615 AD predict a low in central-southern Africa related to past location of the present Southern Atlantic Anomaly (SAA). Our results suggest that the field intensity in central Africa may have been slightly lower than global model predictions. This would indicate that the low could be probably more extended towards central-eastern Africa (or more intense) than previously considered. Further data from this region are especially welcome to delineate the evolution of the SAA
Initial SCHA.DI.00 regional archaeomagnetic model for Europe for the last 2000 years
International audienceThe available Bayesian European Palaeosecular Variation Curves (PSVC) based on archaeomagnetic data have been used to derive an initial regional model for the geomagnetic field in Europe for the last 2000 years by using the Spherical Cap Harmonic Analysis (SCHA) technique. The resulting SCHA.DI.00 model provides the directional behaviour of the Earth's magnetic field, but no information about intensity is supplied because input data are only directional. The first spherical cap harmonic coefficient, , has been used to normalise the rest of the coefficients. The spherical expansion extends up to Kint = 2 which, given the size of the spherical cap used and the maximum data resolution, is equivalent, in terms of spatial wavelength, to a maximum degree of approximately 5 in the ordinary Spherical Harmonic Analysis (SHA). The SCHA.DI.00 model fits the present archaeomagnetic database for Europe more accurately than global models, although it is necessary to consider that regional SCHA model and global models did not use the same database. Palaeosecular variation curves given by SCHA.DI.00 are compared with available archaeomagnetic data from Bulgaria (Sofia), Italy (Etna) and Austria (Radstadt), not used in the development of the model. The SCHA.DI.00 model improves the fit to these palaeomagnetic data with respect to the CALS7K.2 [Korte, M., Constable, C.G., 2005. Continuous geomagnetic field models for the past 7 millennia: 2. CALS7K. Geochem. Geophys. Geosyst. 6, Q02H16. doi:10.1029/2004GC000801] global model, especially for Italy
Potentiel de lâarchĂ©ointensitĂ© en datation archĂ©omagnĂ©tique au haut MoyenĂge et au premier millĂ©naire av. J.-C. : illustration avec cinq fours de Cumes, MĂ©gara Hyblaea et Incoronata (Italie)
International audienceCette communication prĂ©sente les datations archĂ©omagnĂ©tiques de cinq fours mis au jour sur les sites de Megara Hyblaea (Sicile), dâIncoronata (Basilicate) et de Cumes (Campanie). Le contexte archĂ©ologique place le fonctionnement de ces fours Ă lâĂ©poque grecque (premier millĂ©naire av. J.-C.) Ă MĂ©gara Hyblaea et Incoronata et au haut Moyen-Ăge Ă Cumes. Au moins 15 prĂ©lĂšvements par structure ont Ă©tĂ© effectuĂ©s suivant la mĂ©thode du chapeau de plĂątre ou par carottage des parois. Les archĂ©odirections moyennes ont Ă©tĂ© dĂ©terminĂ©es aprĂšs dĂ©saimantation thermique et par champ alternatif et les archĂ©ointensitĂ©s par le protocole de Thellier-Thellier avec corrections dâanisotropie et de vitesse de refroidissement. La datation archĂ©omagnĂ©tique de ces structures illustre la difficultĂ© du choix du rĂ©fĂ©rentiel en Italie mĂ©ridionale. En effet, les courbes de variation sĂ©culaire italiennes demeurent trop imprĂ©cises ou incomplĂštes du fait dâun nombre insuffisant de donnĂ©es de rĂ©fĂ©rence (Tema et al., 2006 ; 2013). Lâutilisation des courbes dâEurope occidentale, construites Ă partir dâarchĂ©ointensitĂ©s de rĂ©fĂ©rence de qualitĂ©, est discutable en raison de lâĂ©loignement par rapport au point de rĂ©fĂ©rence Paris (1300 Ă 1600 km). Les rĂ©fĂ©rentiels dâEurope de lâEst sont plus proches (800 km), mais le faible nombre dâarchĂ©ointensitĂ©s de rĂ©fĂ©rence de qualitĂ© ne permet pas une datation fiable. Aussi, lâalternative la plus fiable aux courbes italiennes sâavĂšre le modĂšle europĂ©en SCHA.DIF.3k construit aprĂšs sĂ©lection des donnĂ©es dâintensitĂ© suivant le protocole de mesure au laboratoire et le nombre dâĂ©chantillons (Pavon-Carrasco et al., en rĂ©vision). Les rĂ©sultats mettent en Ă©vidence le potentiel de datation de lâarchĂ©ointensitĂ© grĂące Ă sa forte variation sĂ©culaire au haut Moyen-Ăge et au premier millĂ©naire av. J.-C. (Gomez-Paccard et al., 2012 ; HervĂ© et al., 2013). LâarchĂ©ointensitĂ© affine en effet de 20 Ă 30% la datation obtenue avec lâarchĂ©odirection seule. De nouvelles intensitĂ©s de rĂ©fĂ©rence en Europe permettraient dâoptimiser encore ce potentiel
New archeointensity data from NW Argentina (1300-1500 AD)
International audienceA good characterization of the geomagnetic field strength at centennial to millennial time scales in the Southern Hemisphere is particularly crucial to disentangle the long-term evolution of the South Atlantic Anomaly (SAA), an intriguing geomagnetic feature currently observed at the EarthÌs surface. Here we present 59 new archeointensities obtained from four well-dated groups of potteries with ages ranging between 1300 and 1500 AD and collected in Northwest Argentina. The new data were obtained in accordance with the Thellier paleointensity method including partial thermoremanent magnetization (pTRM) checks and TRM anisotropy and cooling rate corrections. We have also performed a comparative study of the efficiency of magnetic the susceptibility, ARM and TRM anisotropy tensors to correct the TRM anisotropy effect upon intensity estimates. Our results suggest that the magnetic susceptibility tensor systematically underestimates the TRM anisotropy effect by 10 to 30 %. Our new data, together with a selection of selected archeointensities already published, confirm that the decrease of the geomagnetic field intensity in South America started around 1600-1650 AD, due to the arrival of the SAA
Evidence of high F-18-fluorodeoxyglucose uptake in the subcutaneous adipose tissue of the dorsocervical area in young adults
Diabetes mellitus: pathophysiological changes and therap