Neuromuscular Electrical Stimulation for Intermittent Claudication (NESIC): multicentre, randomized controlled trial

\ua9 The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. METHODS: This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication. The primary outcome was change in absolute walking distance, measured by a standardized treadmill test at 3 months. Secondary outcomes included intermittent claudication (IC) distance, adherence, quality of life, and haemodynamic changes. RESULTS: Of 200 participants randomized, 160 were included in the primary analysis (intention to treat, Tobit regression model). The square root of absolute walking distance was analysed (due to a right-skewed distribution) and, although adjunctive NMES improved it at 3 months, no statistically significant effect was observed. SET as local standard care seemed to improve distance compared to best medical therapy at 3 months (3.29 units; 95 per cent c.i., 1.77 to 4.82; P < 0.001). Adjunctive NMES improved distance in mild claudication (2.88 units; 95 per cent c.i., 0.51 to 5.25; P = 0.02) compared to local standard care at 3 months. No serious adverse events relating to the device were reported. CONCLUSION: Supervised exercise therapy is effective and NMES may provide further benefit in mild IC.This trial was supported by a grant from the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health and Care Research partnership. Trial registration: ISRCTN18242823.Patients with intermittent claudication experience pain in their legs during walking or exercise which ends with rest. This severely impairs physical activity and quality of life. Treatment for such patients typically involves best medical therapy, which includes exercise advice. This study aimed to determine whether a neuromuscular electrical stimulation device improved the walking distance of patients with intermittent claudication compared to local standard care available (which may include supervised exercise therapy) in a trial. Supervised exercise improved walking distances but there was no difference in those that received a device in this patient group

Accretion, ejection and reprocessing in supermassive black holes

This is a White Paper in support of the mission concept of the Large Observatory for X-ray Timing (LOFT), proposed as a medium-sized ESA mission. We discuss the potential of LOFT for the study of active galactic nuclei. For a summary, we refer to the paper.Comment: White Paper in Support of the Mission Concept of the Large Observatory for X-ray Timin

Expected performance of the ASTRI-SST-2M telescope prototype

ASTRI (Astrofisica con Specchi a Tecnologia Replicante Italiana) is an Italian flagship project pursued by INAF (Istituto Nazionale di Astrofisica) strictly linked to the development of the Cherenkov Telescope Array, CTA. Primary goal of the ASTRI program is the design and production of an end-to-end prototype of a Small Size Telescope for the CTA sub-array devoted to the highest gamma-ray energy region. The prototype, named ASTRI SST-2M, will be tested on field in Italy during 2014. This telescope will be the first Cherenkov telescope adopting the double reflection layout in a Schwarzschild-Couder configuration with a tessellated primary mirror and a monolithic secondary mirror. The collected light will be focused on a compact and light-weight camera based on silicon photo-multipliers covering a 9.6 deg full field of view. Detailed Monte Carlo simulations have been performed to estimate the performance of the planned telescope. The results regarding its energy threshold, sensitivity and angular resolution are shown and discussed.Comment: In Proceedings of the 33rd International Cosmic Ray Conference (ICRC2013), Rio de Janeiro (Brazil). All CTA contributions at arXiv:1307.223

The QUIJOTE experiment: project overview and first results

QUIJOTE (Q-U-I JOint TEnerife) is a new polarimeter aimed to characterize the polarization of the Cosmic Microwave Background and other Galactic and extragalactic signals at medium and large angular scales in the frequency range 10-40 GHz. The multi-frequency (10-20~GHz) instrument, mounted on the first QUIJOTE telescope, saw first light on November 2012 from the Teide Observatory (2400~m a.s.l). During 2014 the second telescope has been installed at this observatory. A second instrument at 30~GHz will be ready for commissioning at this telescope during summer 2015, and a third additional instrument at 40~GHz is now being developed. These instruments will have nominal sensitivities to detect the B-mode polarization due to the primordial gravitational-wave component if the tensor-to-scalar ratio is larger than r=0.05.Comment: To appear in "Highlights of Spanish Astrophysics VIII", Proceedings of the XI Scientific Meeting of the Spanish Astronomical Society, Teruel, Spain (2014

Microbiological profile of infections in the Intensive Care Units of Colombia (EPISEPSIS Colombia)

Introducción y objetivo En Colombia faltan datos fiables sobre el comportamiento de la sepsis. Se pretende determinar la prevalencia de los microorganismos en las principales infecciones tratadas en las unidades de cuidados intensivos (UCI) de nuestro país. Métodos Este es un subestudio de una cohorte prospectiva recolectada en 10 hospitales durante 6 meses. Los criterios de inclusión eran hospitalización en UCI y confirmación de una infección según las definiciones del CDC, considerando tres grupos (comunidad, hospital, UCI) según el sitio de adquisición de la infección. Resultados Se incluyó en el análisis a 826 pacientes; el 51% contrajeron procesos infecciosos extrahospitalarios; el 5,33%, en el hospital y el 43,7%, en UCI. Los diagnósticos más frecuentes fueron neumonía (29,54%), infección intraabdominal (18,16%) e infección del tracto urinario (11,62%). El microorganismo más frecuente en las infecciones extrahospitalarias fue Escherichia coli —pulmón (16,4%), peritoneo (57,7%), orina (55,5%) y sangre (22,4%)—. En las adquiridas en UCI predomina también E. coli —peritoneo (29,3%) y orina (52,9%)—, excepto en pulmón y sangre, en los que fueron Staphylococcus aureus (32,4%) y Klebsiella pneumoniae (15,7%) los más prevalentes. Se tomaron cultivos a 655 pacientes, de los que el 40% recibió antibióticos antes de la toma, sin que esto afectara al porcentaje de positividad (p=0,583). Conclusiones La neumonía fue la infección más frecuente independientemente del sitio de adquisición. E. coli fue el patógeno más prevalente, excepto en las infecciones pulmonares adquiridas en UCI, donde lo fue S. aureus.Q2Artículo original75-83Background and objective:Valid and reliable data regarding sepsis is lacking in Colombia. Ouraim was to determine the prevalence of the microorganisms in the main infections treated inIntensive Care Units (ICUs) in our country.Methods:This is a sub-study of a prospective cohort with 10 general hospitals in Colombiaduring a 6-month period. The inclusion criteria were hospitalization in ICU and confirmation ofinfection according to the CDC definitions. Patients were classified into three groups, that is,community, hospital and intensive care, according to the site where the infection was acquired.Results:A total of 826 patients were included in this analysis. Of these, 51% developed infec-tions in the community, 5.33% in the hospital and 43.7% in intensive care unit. Overall, themost common diagnoses were pneumonia (29.54%), intra-abdominal infection (18.16%) and uri-nary tract infection (11.62%). The most frequent germ in community-acquired infections wasE. coli—–lung (16. 4%), peritoneum (57.7%), urine (55.5%), blood (22.4%)—–.E. coli—–peritoneum(29.3%), urine (52.9%)—– also predominated in the ICU-acquired infections, except for lung andblood in whichStaphylococcus aureus(32.4%) andKlebsiella pneumoniae(15.7%) were the mostprevalent. Cultures were requested from 655 patients, 40% of them having received antibioticsbefore cultures were taken, although this did not affected the percentages of positive cultures(P= 0.583).Conclusions:Pneumonia was the main cause of infection regardless of the site of acquisition.E. coliwas the most prevalent germ, except in the pulmonary infections acquired in UCI inwhichS. aureuswas the most prevalent