Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado

Objective. The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). Methods. We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. Results. We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p= 2 and 0.698 (IC 95% 0.635- 0.761; p= 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). Conclusions. Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index

Role of physical fitness in the obesity paradox. Long-term major adverse cardiovascular events in the Women's Ischemia Syndrome Evaluation (WISE)

Abstract Background Emerging data suggests there is an “obesity paradox” where obesity may be protective against cardiovascular morbidity and mortality in patients with cardiovascular disease. However, weight status primarily assessed through body mass index (BMI) is limited in its ability to discern contributions from fat vs. lean muscle mass. Most studies on BMI have not accounted for physical fitness, which is a known modifier of weight status and a potential mediator of effects of obesity on major adverse cardiovascular events (MACE). Purpose To investigate the relationship between BMI and physical fitness, measured by self-reported Duke Activity Status Index (DASI) score, with long-term MACE in women evaluated for suspected myocardial ischemia. Methods The National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation (WISE) study is a multicenter prospective cohort study. From 1996–2000, 936 women were enrolled at the time of clinically indicated coronary angiography and assessed with a median follow up of 5.8 (range 0–9 years) for MACE. MACE was defined as a composite of death, nonfatal myocardial infarction, stroke, or congestive heart failure. Proportional hazards regression was used to estimate adjusted hazard ratios of MACE in relation to metabolic status and physical fitness. DASI scores ≥25, equivalent to ≥7 metabolic equivalents [METs]) was used as cut point to define high physical fitness, in our prior studies DASI &amp;gt;25 approximates completion of the second stage of a Bruce treadmill protocol. Results Among the 899 women with complete data, 69.5% had low physical fitness (DASI scores &amp;lt;25), 34.9% overweight (BMl ≥25 to 30), 40.5% obese (BMI ≥30). In fit women, obesity was associated with lower hazard ratio for MACE (HR 0.64, p=0.01); while low fitness in normal weight women was associated with 60% excess risk of MACE (HR 1.61, p=0.01) (Figure 1). Conclusions Among women undergoing coronary angiography for suspected myocardial ischemia, obesity was inversely related with long-term MACE in physically fit women. Our findings suggest that physical fitness may play a role in the obesity paradox. These results support the inclusion of fitness in understanding the relations between body weight and long-term MACE. The DASI is a simple, self reported tool that can identify higher-risk symptomatic women and should be considered in future investigations and routine examination of normal, overweight and obese women. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): U01 HL064829 </jats:sec

Determination of wavefront structure for a HartmannWavefront Sensor using a phase-retrieval method

We apply a phase retrieval algorithm to the intensity pattern of a Hartmann wavefront sensor to measure with enhanced accuracy the phase structure of a Hartmann hole array. It is shown that the rms wavefront error achieved by phase reconstruction is one order of magnitude smaller than the one obtained from a typical centroid algorithm. Experimental results are consistent with a phase measurement performed independently using a Shack-Hartmann wavefront sensor.IST/Imaging Science and TechnologyApplied Science

Persistent chest pain at 1-year predicts long-term angina hospitalization in women with and without obstructive coronary artery disease: results from Women's Ischemia Syndrome Evaluation (WISE)

Abstract Background There is growing evidence that women with ischemia and no obstructive coronary artery disease (INOCA) have an increased risk of major adverse cardiovascular events (MACE). Half of these women continue to experience persistent chest pain (PChP); however longer-term outcomes are unknown. Purpose To investigate the relationships between PChP at 1-year with obstructive and nonobstructive coronary artery disease (CAD) and longer-term all-cause mortality, MACE and angina hospitalization in women with suspected myocardial ischemia. Methods We studied 673 women with chest pain undergoing coronary angiography for suspected myocardial ischemia in the National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation (WISE) study. PChP was defined as self-reported continuing chest pain at 1-year, obstructive CAD as &amp;gt;50 stenosis in any coronary artery and non-obstructive CAD was further divided as &amp;lt;20% stenosis and 20–50% stenosis in any coronary artery. The Kaplan-Meier method was used to estimate cumulative incidence rates of all-cause mortality, MACE, and angina hospitalization. Proportional hazards regression estimated adjusted hazard ratios of mortality, MACE and angina hospitalization in relation to PChP at 1-year in obstructive and nonobstructive CAD. Results The median age was 58 years, 45% had PChP, and 39% had obstructive CAD with a median follow-up time of 9 years (range 1 to 11) for mortality and 5 years (range 0 to 9) for MACE and anginal hospitalization. There was no difference in mortality or MACE in women with PChP compared to women without PChP in any of the 3 groups (&amp;lt;20%, 20–50%, or &amp;gt;50% CAD), however differences were noted in long-term angina hospitalization (Figure 1). Notably,angina hospitalization rates in women with PChP and nonobstructive CAD were 2.2 times those of women without PChP, and comparable to those of women with obstructive CAD and no PChP (p&amp;lt;0.0001). Conclusions Among women undergoing coronary angiography for suspected myocardial ischemia, women with nonobstructive CAD and PChP have rates of angina hospitalization comparable to patients with obstructive CAD without PChP. Thus, PChP increases the hazard of long term anginal hospitalization regardless of the presence or absence of obstructive CAD. Given the economic burden of angina hospitalization, further studies are needed to determine whether aggressive treatment in women with PChP without obstructive CAD changes outcomes and impact on the health care system. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH) </jats:sec

50^{50}Cr and 53^{53}Cr neutron capture cross sections measurement at the n_TOF facility at CERN

$^{50}$Cr and $^{53}$Cr are very relevant in criticality safety benchmarks related to nuclear reactors. The discrepancies of up to 30% between the neutron capture cross section evaluations have an important effect on the $k_{eff}$ and $k_{\infty}$ in criticality benchmarks particularly sensitive to chromium. In this work, the $^{50,53}$Cr(n,$γ$) cross sections are to be determined between 1 and 100 keV with an 8-10% accuracy following the requirements of the NEA High Priority Request List (HPRL) to solve the current discrepancies. We have measured these reactions by the time-of-flight technique at the EAR1 experimental area of the n_TOF facility, using an array of four C$_6$D$_6$ detectors with very low neutron sensitivity. The highly-enriched samples used are significantly thinner than in previous measurements, thus minimizing the multiple-scattering effects. We have produced, and analysed with the R-matrix analysis code SAMMY, capture yields featuring 33 resonances of $^{50}$Cr and 51 of $^{53}$Cr with an accuracy between 5% and 9%, hence fulfilling the requirements made by the NEA. The differential and integral cross sections have been compared to previous data and evaluations. The new measured $^{50,53}$Cr(n,$γ$) cross sections provide a valuable input for upcoming evaluations, which are deemed necessary given that the results presented herein do not support the increase in both cross sections proposed in the recent INDEN evaluation

Neutron capture measurements for s-process nucleosynthesis; A review about CERN n_TOF developments and contributions

This article presents a review about the main CERN n_TOF contributions to the field of neutron-capture experiments of interest for $s$-process nucleosynthesis studies over the last 25 years, with special focus on the measurement of radioactive isotopes. A few recent capture experiments on stable isotopes of astrophysical interest are also discussed. Results on $s$-process branching nuclei are appropriate to illustrate how advances in detection systems and upgrades in the facility have enabled increasingly challenging experiments and, as a consequence, have led to a better understanding and modeling of the $s$-process mechanism of nucleosynthesis. New endeavors combining radioactive-ion beams from ISOLDE for the production of radioisotopically pure samples for activation experiments at the new NEAR facility at n_TOF are briefly discussed. On the basis of these new exciting results, also current limitations of state-of-the-art TOF and activation techniques will be depicted, thereby showing the pressing need for further upgrades and enhancements on both facilities and detection systems. A brief account of the potential technique based on inverse kinematics for direct neutron-capture measurements is also presented