Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Abstract Background This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. Methods Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. Results A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p Conclusions In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Stroke risk in the early period after carotid related symptoms: a systematic review.

Current guidelines recommend performing carotid endarterectomy in patients with symptomatic carotid disease as soon as possible after the neurological index event. However, early stroke risk has not been well documented for this patient group. We therefore conducted a systematic analysis of the current literature on the recurrent risk of ischemic events in patients with symptomatic carotid stenosis. Systematic review was performed by searching the MEDLINE® database from 1950 until June 8, 2015 (key words: cerebral ischemia, transient ischemic attack, amaurosis fugax, stroke, symptomatic carotid stenosis, recurrent risk, outcome, prognosis, follow-up, cohort and natural history). All studies reporting stroke risks in patients with symptomatic carotid stenosis after neurologic index events within a period of 7 days were included. Cumulative stroke risks with 95% confidence intervals after a neurologic index event were recalculated at 2-3, 7, 14 and 30 days and a meta-analysis including an analysis of heterogeneity were performed using the statistical package R and Excel for Mac 2003. Ten studies with a total number of 2634 patients were included. Results of an overall stroke risk were as follows: 2.0-17.2% at 2-3 days, 0-22.1% at 7 days, 0-29.6% at 14 days and 0-11.1% at 30 days in patients with a symptomatic extracranial carotid stenosis. The pooled stroke risk in the six studies with active follow-up was 6.0% (95% CI 2.4-14.4) at 2-3 days, 10.9% (6.1-18.7) at 7 days and 17.6% (9.7-29.9) at 14 days. Pooled stroke risk in the three studies with uncensored populations was even higher with 6.4% (1.5-23.8%) at 2-3 days, 19.5% (12.7-28.7) at 7 days and 26.1% (20.6-32.5%) at 14 days. Significant heterogeneity (P<0.001) could be explained by the different inclusion criteria and the study's design. Retrospective studies with passive follow-up had the lowest stroke risk whereas prospective studies with active follow-up and without bias through early intervention by carotid endarterectomy or carotid stenting had the highest stroke risk. The risk of recurrence of cerebrovascular events in patients with symptomatic carotid stenosis within the first days after a neurologic index event is as high as 6.4% (1.5-23.8), 19.5% (12.7-28.7) and 26.1% (20.6-32.5) after 2-3, 7 and 14 days respectively. Patients with a symptomatic carotid stenosis are therefore at a very high risk of a definitive stroke. Recommendations by current guidelines to perform carotid endarterectomy as soon as possible after the neurologic index event are therefore justified

Implementation of a platform elastic engine for web applications in cloud environments, based on user-driven QoS

167 σ.Σήμερα, το υπολογιστικό νέφος αναδύεται ως ένα ιδιαίτερα δημοφιλές μοντέλο και αναπτύσσεται σαν μία ενδιαφέρουσα νέα τεχνική κι επιχειρηματική λύση. Ανάμεσα στα κυριότερα χαρακτηριστικά του βρίσκεται η ελαστικότητα, η οποία του δίνει τη δυνατότητα να παρέχει ένα δυναμικό περιβάλλον διάθεσης υπηρεσιών. Αυτό το ελαστικό περιβάλλον δίνει τη δυνατότητα σε μία εφαρμογή να προσαρμόζει αυτόματα τους υπολογιστικούς πόρους που χρησιμοποιεί, ανάλογα με φόρτο εργασίας και τις προτεραιότητες που έχουν τεθεί. Ανάμεσα στους διάφορους παρόχους υπολογιστικού νέφους, η υλοποίηση της ελαστικότητας γίνεται με ποικίλλους τρόπους. Μία προσέγγιση βασίζεται στον ορισμό κανόνων από τον πάροχο της πλατφόρμας, ενώ μία άλλη προβλέπει στατικά τους απαιτούμενους πόρους, ώστε να προσδιορίσει το μέσο φόρτο του συστήματος, κι εν συνεχεία ορίζει κανόνες. Ιδιαίτερο ενδιαφέρον παρουσιάζει η προσέγγιση παροχής της ελαστικότητας ως υπηρεσία (\lat{Elasticity-as-a-Service}), δίνοντας τη δυνατότητα στους παρόχους να ορίζουν παραμέτρους ελαστικότητας που διαφέρουν από εφαρμογή σε εφαρμογή. Έτσι, σκοπός αυτής της διπλωματικής εργασίας είναι η ανάπτυξη μιας πλατφόρμας υπολογιστικού νέφους, η οποία διαχειρίζεται αυτόματα την κλιμάκωση των υπολογιστικών πόρων διαδικτυακών εφαρμογών, εγκατεστημένες σε περιβάλλον υπολογιστικού νέφους. Η κλιμάκωση γίνεται με βάση διάφορες παραμέτρους που ορίζει ο πάροχος της κάθε εφαρμογής-υπηρεσίας και με τη βοήθεια αλγορίθμoυ βασισμένου σε κανόνες.Cloud computing has recently emerged as a new paradigm for hosting and delivering services over the Internet and the general interest on clouds as a technical and business solution is growing. Elasticity stands as one of the fundamental features of clouds, providing a dynamic environment of services. This elastic environment gives an application the ability to automatically adjust the infrastructure resources it uses, to accommodate varied workloads and priorities. The implementation of the elasticity mechanism differs among the various cloud providers. One approach is based on rule criteria, defined by the application provider, while another provisions application resources statically in order to identify the ordinary traffic load and then it specifies rules. There is special interest in an innovative approach that implements elasticity as a SaaS application, which allows an application provider define some application-specific resource requirements and required QoS. Thus, the main purpose of this thesis project is the development of a cloud platform, that automatically scales the resources of web applications deployed in a cloud computing environment. This is achieved taking into account the parameters given by the provider of each application and uses a rule-based algorithm.Αλέξανδρος Π. Τσαντήλα

A holistic view of the W UMA type TY BOO

New CCD four-color light curves of TY Boo made on eight nights over 2010-2011 were analyzed in comparison with historical light curves obtained from 1969 through 2011. The light curves could all be represented by a unique geometry and by wavelength consistent phototometric parameters of a two-spot model on either stellar component. It is confirmed that TY Boo is a shallow W-type contact binary system with a degree of contact factor of f = 7.6% (±0.8). A period investigation based on all available data shows a long-term decrease (dP/dt = -3.65 × 10 -8daysyr -1) and an oscillation (P 3 = 58.9yr, A = 0.0254days). Without ruling out the presence of a tertiary companion, the weight of evidence points to an active cyclic magnetic activity that causes spot formation rather than an unseen companion. Mass transfer between the components and angular momentum loss are also considered as possible mechanisms. © 2012. The American Astronomical Society. All rights reserved.

THE FIRST PHOTOMETRIC STUDY AND ORBITAL SOLUTION/PERIOD ANALYSIS OF THE MISCLASSIFIED BINARY SYSTEM V380 CAS

We present the first multicolor CCD photometry for the eclipsing binary V380 Cassiopeia (V380 Cas) observed on 34 nights in 2009 and 2010 at the University of Patras Observatory. The PHOEBE program based on the Wilson-Devinney algorithm was used to analyze the first complete BVRcIc light curves. It was found that V380 Cas was misclassified and it is a well-detached system consisting of two main-sequence stars. A range of solutions found to give satisfactory fits to the observations is also investigated. The first orbital solution based on the photometric mass ratio q = 1.08 of almost equal temperatures and masses and orbital inclination of i = 86 degrees.57 was obtained. In addition, based on all available times of light minima, including 12 new ones, a new orbital period of P = 2.714539884 days is given

The eclipsing binary bx andromedae and its orbital period behaviour

The orbital period variations of the eclipsing binary BX And are examined analysing its (O-C) diagram 1) with the standard method, in which the minima times are fitted by the quadratic ephemeris combined with an assumed light-time effect, and 2) with the first continuous method. The results from the use of the two methods are, as was expected, different. © Springer 2005