Impact of Blood Pressure Variability on Cardiac and Cerebrovascular Complications in Hypertension

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DecidArch: Playing Cards as Software Architects

Teaching software architecture is a challenge because of the difficulty to expose students to actual meaningful design situations. Games can provide a useful illustration of the design decision making process, and teach students the power of team interaction for making sound decisions. We introduce a game –DecidArch– developed to achieve three learning objectives: _x0001_1) create awareness about the rationale involved in design decision making, _x0002_2) enable appreciation of the reasoning behind candidate design decisions proposed by others, and _x0003_3) create awareness about interdependencies between design decisions. The game has been played by _x0002__x0002_ groups with a total of _x0008__x0003_ players, all of them students of the VU software architecture course. We present some of the lessons learned, both from our observation and through participant survey. We conclude that the game well supports our three learning objectives, and we identify several improvement points for future game editions

Edad U/Pb SHRIMP en circones detríticos al sureste de Pie de palo, San Juan, Argentina: Evidencias de sedimentación y magmatismo paleozoico en las Sierras Pampeanas Occidentales

Fil: Ramacciotti, C. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.Fil: Baldo, Edgardo G. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.Fil: Casquet, C. Universidad Complutense. Instituto de Geociencias. Departamento de Petrología y Geoquímica; España.Fil: Galindo, C. Universidad Complutense. Instituto de Geociencias. Departamento de Petrología y Geoquímica; España.Fil: Verdecchia, S. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.La Sierra de Pie de Palo consiste de un sistema de corrimientos de vergencia oeste, cuyas láminas están compuestas por un basamento mesoproterozoico (Casquet et al., 2001; Vujovich et al., 2004; Rapela et al., 2010) aflorante en el centro oeste de la sierra, una cobertera metasedimentaria denominada Secuencia Metasedimentaria Difunta Correa (SMDC) de edad neoproterozoica (Baldo et al., 1998; Galindo et al., 2004; Vujovich et al., 2004; Rapela et al., 2005) cuyos principales afloramientos se encuentran en el sureste de la sierra; y por último, en el sector más occidental afloran rocas correspondientes a una plataforma carbonáticasiliciclástica con un metamorfísmo de bajo grado sobreimpuesto, denominadas Grupo Caucete, el cual posee una edad neoproterozoica-cámbrica (por ej.: Galindo et al., 2004; Naipauer et al., 2010). Cabe destacar la presencia de un magmatismo anorogénico de 774 ± 6 Ma (Baldo et al., 2006) y un magmatismo de arco ordovícico (Pankhurst et al., 1998).Fil: Ramacciotti, C. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.Fil: Baldo, Edgardo G. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.Fil: Casquet, C. Universidad Complutense. Instituto de Geociencias. Departamento de Petrología y Geoquímica; España.Fil: Galindo, C. Universidad Complutense. Instituto de Geociencias. Departamento de Petrología y Geoquímica; España.Fil: Verdecchia, S. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Ciencias de la Tierra; Argentina.Geologí

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings (1) in a controlled laboratory experiment and (2) during long-term recording in a true naturalistic setting. Participants: Six normotensive subjects participated in the laboratory study. A total of 109 male white-collar workers underwent ambulatory monitoring, of which 30 were mildly hypertensive. Methods: Four different laboratory conditions (postures: lying, sitting, standing, walking), repeated twice, were used to assess the short-term effects of cuff inflation on the HR. To test the actual ambulatory validity, participants simultaneously wore a continuous HR recorder and the ABP monitor from early morning to late evening on 2 workdays and one non-workday. Diary and vertical accelerometery information was used to obtain periods of fixed posture and (physical) activity across which HR from both devices was compared. Results: Laboratory results showed that the ABP device reliably detected HR during blood pressure measurement, but that this HR was systematically lower than the HR directly before and after the blood pressure measurement. The ambulatory study confirmed this systematic underestimation of the ongoing HR, but additionally showed that its amount increased when subjects went from sitting to standing to light physical activity (2.9; 4.3 and 9.1 bpm (beats/min), respectively). In spite of this activity-dependent underestimation of HR, the correlation of continuous ECG and intermittent ABP-derived HR was high (median r = 0.81). Also, underestimation was not different for normotensives and mild hypertensives. Conclusions: A direct effect of cuff inflation leads to the underestimation of ongoing HR during cuff-based ABP measurement. Additional underestimation of HR occurs during periods with physical activity, probably due to behavioural freezing during blood pressure measurements. HR underestimation was not affected by hypertensive state. When its limitations are taken into account, ABP-derived ambulatory HR can be considered a reliable and valid measure. © 2001 Lippincott Williams & Wilkins

P2393Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a novel whole-organ high-definition CT scanner

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Renin Angiotensin System Blockers and Risk of Mortality in Hypertensive Patients Hospitalized for COVID-19: An Italian Registry

Background: It is uncertain whether exposure to renin\u2013angiotensin system (RAS) modifiers affects the severity of the new coronavirus disease 2019 (COVID-19) because most of the available studies are retrospective. Methods: We tested the prognostic value of exposure to RAS modifiers (either angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin receptor blockers [ARBs]) in a prospective study of hypertensive patients with COVID-19. We analyzed data from 566 patients (mean age 75 years, 54% males, 162 ACE-Is users, and 147 ARBs users) hospitalized in five Italian hospitals. The study used systematic prospective data collection according to a pre-specified protocol. All-cause mortality during hospitalization was the primary outcome. Results: Sixty-six patients died during hospitalization. Exposure to RAS modifiers was associated with a significant reduction in the risk of in-hospital mortality when compared to other BP-lowering strategies (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.32 to 0.90, p = 0.019). Exposure to ACE-Is was not significantly associated with a reduced risk of in-hospital mortality when compared with patients not treated with RAS modifiers (OR: 0.66, 95% CI: 0.36 to 1.20, p = 0.172). Conversely, ARBs users showed a 59% lower risk of death (OR: 0.41, 95% CI: 0.20 to 0.84, p = 0.016) even after allowance for several prognostic markers, including age, oxygen saturation, occurrence of severe hypotension during hospitalization, and lymphocyte count (adjusted OR: 0.37, 95% CI: 0.17 to 0.80, p = 0.012). The discontinuation of RAS modifiers during hospitalization did not exert a significant effect (p = 0.515). Conclusions: This prospective study indicates that exposure to ARBs reduces mortality in hospitalized patients with COVID-19

Should colorectal cancer screening start at the same age in European countries? Contributions from descriptive epidemiology

We assessed incidence and mortality of colorectal cancer (CRC) at various ages among women and men in 38 European countries. The ages at which defined levels of incidence and mortality were reached varied between 9 and 17 years between countries. This variation requires consideration in the definition of screening guidelines