A New Approach to the Modeling of Anisotropic Media with the Transmission Line Matrix Method

A reformulation of the Transmission Line Matrix (TLM) method is presented to model non-dispersive anisotropic media. Two TLM-based solutions to solve this problem can already be found in the literature, each one with an interesting feature. One can be considered a more conceptual approach, close to the TLM fundamentals, which identifies each TLM in Maxwell's equations with a specific line. But this simplicity is achieved at the expense of an increase in the memory storage requirements of a general situation. The second existing solution is a more powerful and general formulation that avoids this increase in memory storage. However, it is based on signal processing techniques and considerably deviates from the original TLM method, which may complicate its dissemination in the scientific community. The reformulation presented in this work exploits the benefits of both methods. On the one hand, it maintains the direct and conceptual approach of the original TLM, which may help to better understand it, allowing for its future use and improvement by other authors. On the other hand, the proposal includes an optimized treatment of the signals stored at the stub lines in order to limit the requirement of memory storage to only one accumulative term per field component, as in the original TLM versions used for isotropic media. The good behavior of the proposed algorithm when applied to anisotropic media is shown by its application to different situations involving diagonal and off-diagonal tensor properties

Haptic interface with four degrees of freedom for surgical applications

El presente artículo muestra el diseño de un dispositivo háptico concebido para aplicaciones biomédicas, específicamente para medicina quirúrgica en la que el operador, a través del sentido del tacto, sienta y manipule objetos simulados en un ambiente tridimensional y tele-operado. La interfaz háptica que se presenta corresponde a un robot tipo serie, con una arquitectura de cuatro grados de libertad que le permite al usuario posicionar y orientar el efector final en el entorno de trabajo. Para el estudio de los movimientos del robot se parte del modelado geométrico y dinámico del mismo, hasta la implementación de un controlador por par calculado. Finalmente, se realiza la simulación de la interfaz háptica en un ambiente virtual.This paper presents the design of haptic device that is conceived for biomedical applications. Specifically, the device can be used for surgery training allowing the user to feel and handle simulated objects a tridimensional and tele-operated environment. The haptic interface is a serial robot with four degrees of freedom that allows to set the orientation and position of the end-effector into the work environment. Kinematic and dynamic models are used to study the robot movements and to build a calculated torque controller. Finally, a simulation of the haptic interface is done in a virtual environment

Accelerating environmental flow implementation to bend the curve of global freshwater biodiversity loss

Environmental flows (e-flows) aim to mitigate the threat of altered hydrological regimes in river systems and connected waterbodies and are an important component of integrated strategies to address multiple threats to freshwater biodiversity. Expanding and accelerating implementation of e-flows can support river conservation and help to restore the biodiversity and resilience of hydrologically altered and water-stressed rivers and connected freshwater ecosystems. While there have been significant developments in e-flow science, assessment, and societal acceptance, implementation of e-flows within water resource management has been slower than required and geographically uneven. This review explores critical factors that enable successful e-flow implementation and biodiversity outcomes in particular, drawing on 13 case studies and the literature. It presents e-flow implementation as an adaptive management cycle enabled by 10 factors: legislation and governance, financial and human resourcing, stakeholder engagement and co-production of knowledge, collaborative monitoring of ecological and social-economic outcomes, capacity training and research, exploration of trade-offs among water users, removing or retrofitting water infrastructure to facilitate e-flows and connectivity, and adaptation to climate change. Recognising that there may be barriers and limitations to the full and effective enablement of each factor, the authors have identified corresponding options and generalizable recommendations for actions to overcome prominent constraints, drawing on the case studies and wider literature. The urgency of addressing flow-related freshwater biodiversity loss demands collaborative networks to train and empower a new generation of e-flow practitioners equipped with the latest tools and insights to lead adaptive environmental water management globally. Mainstreaming e-flows within conservation planning, integrated water resource management, river restoration strategies, and adaptations to climate change is imperative. The policy drivers and associated funding commitments of the Kunming–Montreal Global Biodiversity Framework offer crucial opportunities to achieve the human benefits contributed by e-flows as nature-based solutions, such as flood risk management, floodplain fisheries restoration, and increased river resilience to climate change

Type 2 Diabetes Variants Disrupt Function of SLC16A11 through Two Distinct Mechanisms

Type 2 diabetes (T2D) affects Latinos at twice the rate seen in populations of European descent. We recently identified a risk haplotype spanning SLC16A11 that explains ∼20% of the increased T2D prevalence in Mexico. Here, through genetic fine-mapping, we define a set of tightly linked variants likely to contain the causal allele(s). We show that variants on the T2D-associated haplotype have two distinct effects: (1) decreasing SLC16A11 expression in liver and (2) disrupting a key interaction with basigin, thereby reducing cell-surface localization. Both independent mechanisms reduce SLC16A11 function and suggest SLC16A11 is the causal gene at this locus. To gain insight into how SLC16A11 disruption impacts T2D risk, we demonstrate that SLC16A11 is a proton-coupled monocarboxylate transporter and that genetic perturbation of SLC16A11 induces changes in fatty acid and lipid metabolism that are associated with increased T2D risk. Our findings suggest that increasing SLC16A11 function could be therapeutically beneficial for T2D. Video Abstract [Figure presented] Keywords: type 2 diabetes (T2D); genetics; disease mechanism; SLC16A11; MCT11; solute carrier (SLC); monocarboxylates; fatty acid metabolism; lipid metabolism; precision medicin

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe