RespiraConNosotros: A Viable Home-Based Telerehabilitation System for Respiratory Patients

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Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality

Background: The available evidence about the effect of gender and/or sex on mortality differences is contradictory. Our aim is to assess the impact of gender on the access to reperfusion therapy in patients with acute coronary syndrome with ST-segment elevation (STEMI), and secondly, to analyze the effect of delay on the differences with regard to hospital mortality. Methods: A retrospective cohort study was conducted among consecutive patients with STEMI included in the ARIAM-SEMICYUC registry (2010-2013).Results: A total of 4816 patients were included (22.09% women). Women were older, presented with longer patient delay (90 vs. 75 minutes, p=0.0066), higher risk profile (GRACE>140: 75.1% vs. 56.05%, p<0.0001), and received less reperfusion therapy (68.8% vs. 74.7%, p<0.0001) with longer total reperfusion time (307 vs. 240 minutes, p<0.0001). Women received less thrombolysis (24.53% vs. 29.98%, p<0.0001) and longer door-to-needle time (85 vs. 70 minutes, p 0.0023). We found no differences regarding primary percutaneous coronary intervention or door-to-balloon time. Women also had higher hospital mortality (crude odds ratio 2.54, 95% confidence interval 1.99-3.26, p<0.0001), which persisted after controlling the effect of patient delay, age, risk (GRACE), and reperfusion (adjusted odds ratio 1.43, 95% confidence interval 1.0-2.06, p=0.0492). Using TIMI or Killip risk scores as risk estimates yielded nonsignificant results.Conclusions: Compared with men, women with STEMI have worse access to reperfusion and higher hospital mortality. The impact of the differences in accessibility on mortality gap remains uncertain

Concurrent validity of supraclavicular skin temperature measured with iButtons and infrared thermography as a surrogate marker of brown adipose tissue

Brown adipose tissue (BAT) thermogenic activity is commonly assessed with a positron emission tomography with computed tomography scan (PET/CT). This technique has several limitations and alternative techniques are needed. Supraclavicular skin temperature measured with iButtons and infrared thermography (IRT) has been proposed as an indirect marker of BAT activity. We studied the concurrent validity of skin temperature measured with iButtons vs. IRT and the association of supraclavicular skin temperature measured with iButtons and IRT with BAT. We measured skin temperature upon a shivering threshold test with iButtons and IRT in 6 different regions in 12 participants (n = 2 men). On a separate day, we determined supraclavicular skin temperature with an iButton and IRT after 2 h of a personalized cooling protocol. Thereafter, we quantified BAT volume and activity by PET/CT. We observed that the absolute differences between the devices were statistically different from 0 (all P < 0.05) after the shivering threshold test. Moreover, we did not find any association between supraclavicular skin temperature measured with iButtons or IRT and BAT 18F-FDG activity (r = −0.213; P = 0.530 and r = −0.079; P = 0.817). However, we observed a negative association of supraclavicular skin temperature measured by IRT with BAT 18F-FDG volume (r = −0.764; P = 0.006), but not with supraclavicular skin temperature measured with iButtons (r = −0.546; P = 0.082). In light of these results, we concluded that the measurement of skin temperature obtained by iButtons and IRT are not comparable. Furthermore, it seems that supraclavicular skin temperature is not associated with BAT 18F-FDG activity, but it appears to be negatively associated with BAT 18F-FDG volume in the case of IRT

La clase Pino-Juniperetea en la provincia de León

In this paper a phytosociological study about montanous savin forets and, subalpine and oromediterranean creeping juniper shrubs in Leon province (NW Spain) is made. Four new subassociations are described: Juniperetum sahino -thunferae quercetosum fagineae, Gen isto sanabrensis-Juniperetum nanae echinospartetosum iberici and vaccinietosum uliginosi and Vaccinio myrtilli-Juniperetum nanae jasionetosumbrevisepalae.Se ha realizado un estudio fitosociológico tanto de los sabinares montanos, como de los enebrales rastreros subalpinos y oromediterraneos, en la provincia de León, describiéndose cuatro nuevas subasociaciones: Juniperetum sabino-thuriferae quercetosum fagineae, Genisto sanabrensis-Juniperetum nanae echinospartetosum iberici y vaccinietosum uliginosi y Vaccinio myrtilli-Juniperetum nanae jasionetosum brevisepalae

Inoculum sources and Preservation in Soils of Phytophthora parasitica from Cherry Tomato in Continental Crop Areas in Southeast Spain

Inoculum sources and Preservation in Soils of Phytophthora parasitica from Cherry Tomato in Continental Crop Areas in Southeast Spai

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia en el Departamento de Sucre

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia en el Departamento de Sucre.Resumen A partir del estudio y análisis reflexivo de los contenidos del curso, en este trabajo se presenta el abordaje realizado por el grupo, sobre la violencia del conflicto armado en Colombia, tomando como estrategia de acompañamiento la imagen y la narrativa. Se presenta el análisis del “Relato N° 2. Angélica”, escogido por el grupo, en el cual se analizan distintos fragmentos en los que se identifican situaciones vividas durante su desplazamiento de su sitio de origen, los traumas, tristeza, miedos y desolación, ocasionados por las distintas formas de violencia que enfrento junto a sus hijas. Basados en los interrogantes planteados, se profundiza desde la perspectiva psicosocial en aspectos relacionados con sus vivencias, mediante la narrativa, como una estrategia de intervención, pues según (White, 2016a, p. 29) cuando se realiza trabajo psicosocial con personas que han sufrido alguna alteración psicológica y emocional por la violencia, es importante estar atentos a lo que desean hablar con relación a su experiencia, a fin de que se convierta en una terapia, para la reconstrucción de sus vidas; se pueden ver en el relato, hechos relacionados con las dificultades y experiencias de miedo, dolor, rabia, la manera en que mediante recursos de afrontamiento, comienza a entender y enfrentar su realidad, se analizan los impactos psicosociales, el posicionamiento que asume como víctima y sobreviviente, la imágenes naturalizadas de la violencia, la emancipación discursiva, los significados alternos, de las imágenes dominantes de violencia y los emergentes psicosociales . Asumiendo el Rol de Psicólogo, en las experiencias relatadas en el caso, se realizan tres preguntas estratégicas, tres circulares y tres reflexivas, relacionadas con el relato escogido; entendiendo la pregunta como una forma de intervención, con la que las personas pueden hacer un examen a su situación y reflexionar de manera positiva, para la reconstrucción de sus vidas. De acuerdo a los interrogantes planteados, se analiza el Caso Cacarica y se diseñan tres estrategas de Acompañamiento Psicosocial, con base al enfoque Psicosocial, las técnicas narrativas, expresivas y performativas, el informe del paso 2, las conclusiones y Link página Wix.Abstract From the revision and reflexive analysis of the course contents, in this written will be posed the approach made by the study group and it is about the violence of the armed conflict in Colombia, taking the image and narrative as a strategy. The analysis of the tale number 2 “Relato No. 2 Angelica” was selected by the study group in which some different paragraphs are studied and are identified experiences lived by Angelica during her displacement from her home site, her traumas, sadness, fears and desolation caused by different ways of violence which she and her daughters had to face. Based in the question posed, it made deeper from the psychosocial perspective features relative with her experiences through the narrative as an intervention strategy according to (White, 2016b, p. 29) When a psychosocial job is made with people who has suffered any psychological modification because of the violence, is imperative to be attentive and listen to them when they want to express their experience and become a therapy as a purpose for construction of their lives. Also in the story it can detect facts associated with the difficulties and fear, painful, rage experiences, the way that they understand and face the reality through the coping resources. The psychosocial effects are analyzed, the situation such as victim and survivor she assumes, the naturalized images of violence, the discursive emancipation, the alternates meaning of the dominant images of violence and the emergent psychosocial. Taking the role of psychologist in accordance with all the experiences posed in the selected story it is formulated 3 strategic questions, 3 circular questions and 3 reflexive questions. Understanding the questions as a kind of intervention in which people can examine their situation and reflex in a positive way for recover their lives. Regarding to the interrogation, the group analyze the “Cacarica” case and create 3 strategies of psychosocial accompaniment based in the psychosocial focus, narrative, expressive and performative technics the report of the step 2, the conclusions and the link of the Wix page. Keywords: Conflict, coping, difficulties, painful, emerging, experiences, fear, psychosocial, trauma, violence

Concurrent validity of supraclavicular skin temperature measured with iButtons and infrared thermography as a surrogate marker of brown adipose tissue

We are grateful to Ms. Carmen Sainz-Quinn for assistance with the English language. We are grateful to Alberto Quesada-Aranda for helping with the development of the Temperatus software (Free trial in http://profth.ugr.es/temperatus).This study is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain.Brown adipose tissue (BAT) thermogenic activity is commonly assessed with a positron emission tomography with computed tomography scan (PET/CT). This technique has several limitations and alternative techniques are needed. Supraclavicular skin temperature measured with iButtons and infrared thermography (IRT) has been proposed as an indirect marker of BAT activity. We studied the concurrent validity of skin temperature measured with iButtons vs. IRT and the association of supraclavicular skin temperature measured with iButtons and IRT with BAT. We measured skin temperature upon a shivering threshold test with iButtons and IRT in 6 different regions in 12 participants (n = 2 men). On a separate day, we determined supraclavicular skin temperature with an iButton and IRT after 2 h of a personalized cooling protocol. Thereafter, we quantified BAT volume and activity by PET/CT. We observed that the absolute differences between the devices were statistically different from 0 (all P < 0.05) after the shivering threshold test. Moreover, we did not find any association between supraclavicular skin temperature measured with iButtons or IRT and BAT 18F-FDG activity (r = −0.213; P = 0.530 and r = −0.079; P = 0.817). However, we observed a negative association of supraclavicular skin temperature measured by IRT with BAT 18F-FDG volume (r = −0.764; P = 0.006), but not with supraclavicular skin temperature measured with iButtons (r = −0.546; P = 0.082). In light of these results, we concluded that the measurement of skin temperature obtained by iButtons and IRT are not comparable. Furthermore, it seems that supraclavicular skin temperature is not associated with BAT 18F-FDG activity, but it appears to be negatively associated with BAT 18F-FDG volume in the case of IRT.This study was supported by the Spanish Ministry of Economy and Competitiveness via the Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI13/01393), Retos de la Sociedad (DEP2016-79512-R), PTA 12264-I, and European Regional Development Fund (ERDF), the Spanish Ministry of Education (FPU 13/04365, FPU14/04172, FPU15/05337, and FPU15/04059), by the Spanish Ministry of Science and Innovation-MINECO (RYC-2014-16938), the Fundación Iberoamericana de Nutrición (FINUT), the Redes Temáticas de Investigación Cooperativa RETIC (Red SAMID RD16/0022), the AstraZeneca HealthCare Foundation, the University of Granada Plan Propio de Investigación 2016 -Excellence actions: Unit of Excellence on Exercise and Health (UCEES) - and Plan Propio de Investigación 2018 - Programa Contratos-Puente, and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades (ERDF, ref. SOMM17/6107/UGR). This study is part of a Ph.D

State space modelling and data analysis exercises in LISA Pathfinder

LISA Pathfinder is a mission planned by the European Space Agency to test the key technologies that will allow the detection of gravitational waves in space. The instrument on-board, the LISA Technology package, will undergo an exhaustive campaign of calibrations and noise characterisation campaigns in order to fully describe the noise model. Data analysis plays an important role in the mission and for that reason the data analysis team has been developing a toolbox which contains all the functionalities required during operations. In this contribution we give an overview of recent activities, focusing on the improvements in the modelling of the instrument and in the data analysis campaigns performed both with real and simulated data.Comment: Plenary talk presented at the 9th International LISA Symposium, 21-25 May 2012, Pari

Delineation of intracavitary electrograms for the automatic quantification of decrement-evoked potentials in the coronary sinus with deep-learning techniques

Cardiac arrhythmias cause depolarization waves to conduct unevenly on the myocardial surface, potentially delaying local components with respect to a previous beat when stimulated at faster frequencies. Despite the diagnostic value of localizing the distinct local electrocardiogram (EGM) components for identifying regions with decrement-evoked potentials (DEEPs), current software solutions do not perform automatic signal quantification. Electrophysiologists must manually measure distances on the EGM signals to assess the existence of DEEPs during pacing or extra-stimuli protocols. In this work, we present a deep learning (DL)-based algorithm to identify decrement in atrial components (measured in the coronary sinus) with respect to their ventricular counterparts from EGM signals, for disambiguating between accessory pathways (APs) and atrioventricular re-entrant tachycardias (AVRTs). Several U-Net and W-Net neural networks with different configurations were trained on a private dataset of signals from the coronary sinus (312 EGM recordings from 77 patients who underwent AP or AVRT ablation). A second, separate dataset was annotated for clinical validation, with clinical labels associated to EGM fragments in which decremental conduction was elucidated. To alleviate data scarcity, a synthetic data augmentation method was developed for generating EGM recordings. Moreover, two novel loss functions were developed to minimize false negatives and delineation errors. Finally, the addition of self-attention mechanisms and their effect on model performance was explored. The best performing model was a W-Net model with 6 levels, optimized solely with the Dice loss. The model obtained precisions of 91.28%, 77.78% and of 100.0%, and recalls of 94.86%, 95.25% and 100.0% for localizing local field, far field activations, and extra-stimuli, respectively. The clinical validation model demonstrated good overall agreement with respect to the evaluation of decremental properties. When compared to the criteria of electrophysiologists, the automatic exclusion step reached a sensitivity of 87.06% and a specificity of 97.03%. Out of the non-excluded signals, a sensitivity of 96.77% and a specificity of 95.24% was obtained for classifying them into decremental and non-decremental potentials. Current results show great promise while being, to the best of our knowledge, the first tool in the literature allowing the delineation of all local components present in an EGM recording. This is of capital importance at advancing processing for cardiac electrophysiological procedures and reducing intervention times, as many diagnosis procedures are performed by comparing segments or late potentials in subsequent cardiac cycles