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The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various cutoffs based on the differences (ΔBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes coupled with adverse prognosis. This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, 24 h-ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7220 (Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, 24 h-ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH) unique individuals who underwent 24 h-ABPM. We compared the sensitivity, specificity, positive and negative predictive values and area under the curve (AUC) of diverse ΔBP cutoffs to detect WCH (ΔsystolicBP/ΔdiastolicBP = 28/17, 20/15, 20/10, 16/11, 15/9, 14/9 mmHg and ΔsystolicBP = 13 and 10 mmHg) and MH (ΔsystolicBP/ΔdiastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, 2/2 mmHg and ΔsystolicBP = -5 and -3mmHg). The 20/15 mmHg cutoff showed the best AUC (0.804, 95%CI = 0.794-0.814) to detect WCH, while the 2/2 mmHg cutoff showed the highest AUC (0.741, 95%CI = 0.728-0.754) to detect MH in the Derivation cohort. Both cutoffs also had the best accuracy to detect WCH (0.767, 95%CI = 0.754-0.780) and MH (0.767, 95%CI = 0.750-0.784) in the Validation cohort. In secondary analyses, these cutoffs had the best accuracy to detect individuals with higher and lower office-than-ABPM grades in both cohorts. In conclusion, the 20/15 and 2/2 mmHg ΔBP cutoffs had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and can serve as indicators of marked white-coat and masked BP effects derived from 24 h-ABPM.
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Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Hipertensión Enmascarada , Hipertensión de la Bata Blanca , Humanos , Masculino , Persona de Mediana Edad , Femenino , Hipertensión de la Bata Blanca/diagnóstico , Hipertensión de la Bata Blanca/fisiopatología , Hipertensión Enmascarada/diagnóstico , Hipertensión Enmascarada/fisiopatología , Estudios Transversales , Anciano , Adulto , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosAsunto(s)
Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Hipertensión , Humanos , Brasil , Hipertensión/diagnóstico , Determinación de la Presión Sanguínea/normas , Determinación de la Presión Sanguínea/métodos , Monitoreo Ambulatorio de la Presión Arterial/normas , Monitoreo Ambulatorio de la Presión Arterial/métodos , Visita a Consultorio Médico , Presión Sanguínea/fisiología , FemeninoRESUMEN
Increasing interest has been shown in the subject of non-additive entropic forms during recent years, which has essentially been due to their potential applications in the area of complex systems. Based on the fact that a given entropic form should depend only on a set of probabilities, its time evolution is directly related to the evolution of these probabilities. In the present work, we discuss some basic aspects related to non-additive entropies considering their time evolution in the cases of continuous and discrete probabilities, for which nonlinear forms of Fokker-Planck and master equations are considered, respectively. For continuous probabilities, we discuss an H-theorem, which is proven by connecting functionals that appear in a nonlinear Fokker-Planck equation with a general entropic form. This theorem ensures that the stationary-state solution of the Fokker-Planck equation coincides with the equilibrium solution that emerges from the extremization of the entropic form. At equilibrium, we show that a Carnot cycle holds for a general entropic form under standard thermodynamic requirements. In the case of discrete probabilities, we also prove an H-theorem considering the time evolution of probabilities described by a master equation. The stationary-state solution that comes from the master equation is shown to coincide with the equilibrium solution that emerges from the extremization of the entropic form. For this case, we also discuss how the third law of thermodynamics applies to equilibrium non-additive entropic forms in general. The physical consequences related to the fact that the equilibrium-state distributions, which are obtained from the corresponding evolution equations (for both continuous and discrete probabilities), coincide with those obtained from the extremization of the entropic form, the restrictions for the validity of a Carnot cycle, and an appropriate formulation of the third law of thermodynamics for general entropic forms are discussed.
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The Beck-Cohen superstatistics became an important theory in the scenario of complex systems because it generates distributions representing regions of a nonequilibrium system, characterized by different temperatures T≡ß^{-1}, leading to a probability distribution f(ß). In superstatistics, some classes have been most frequently considered for f(ß), like χ^{2}, χ^{2} inverse, and log-normal ones. Herein we investigate the superstatistics resulting from a χ_{η}^{2} distribution through a modification of the usual χ^{2} by introducing a real index η (0<η≤1). In this way, one covers two common and relevant distributions as particular cases, proportional to the q-exponential (e_{q}^{-ßx}=[1-(1-q)ßx]^{1/1-q}) and the stretched exponential (e^{-(ßx)^{η}}). Furthermore, an associated generalized entropic form is found. Since these two particular-case distributions have been frequently found in the literature, we expect that the present results should be applicable to a wide range of classes of complex systems.
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The thermal conductance of a one-dimensional classical inertial Heisenberg model of linear size L is computed, considering the first and last particles in thermal contact with heat baths at higher and lower temperatures, Th and Tl (Th>Tl), respectively. These particles at the extremities of the chain are subjected to standard Langevin dynamics, whereas all remaining rotators (i=2,â¯,L-1) interact by means of nearest-neighbor ferromagnetic couplings and evolve in time following their own equations of motion, being investigated numerically through molecular-dynamics numerical simulations. Fourier's law for the heat flux is verified numerically, with the thermal conductivity becoming independent of the lattice size in the limit Lâ∞, scaling with the temperature, as κ(T)â¼T-2.25, where T=(Th+Tl)/2. Moreover, the thermal conductance, σ(L,T)≡κ(T)/L, is well-fitted by a function, which is typical of nonextensive statistical mechanics, according to σ(L,T)=Aexpq(-Bxη), where A and B are constants, x=L0.475T, q=2.28±0.04, and η=2.88±0.04.
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We numerically study, from first principles, the temperature T_{QSS} and duration t_{QSS} of the longstanding initial quasi-stationary state of the isolated d-dimensional classical inertial α-XY ferromagnet with two-body interactions decaying as 1/r_{ij}^{α} (α≥0). It is shown that this temperature T_{QSS} (defined proportional to the kinetic energy per particle) depends, for the long-range regime 0≤α/d≤1, on (α,d,U,N) with numerically negligible changes for dimensions d=1,2,3, with U the energy per particle and N the number of particles. We verify the finite-size scaling T_{QSS}-T_{∞}â1/N^{ß} where T_{∞}≡2U-1 for Uâ²U_{c}, and ß appears to depend sensibly only on α/d. Our numerical results indicate that neither the scaling with N of T_{QSS} nor that of t_{QSS} depend on U.
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Based on the behavior of living beings, which react mostly to external stimuli, we introduce a neural-network model that uses external patterns as a fundamental tool for the process of recognition. In this proposal, external stimuli appear as an additional field, and basins of attraction, representing memories, arise in accordance with this new field. This is in contrast to the more-common attractor neural networks, where memories are attractors inside well-defined basins of attraction. We show that this procedure considerably increases the storage capabilities of the neural network; this property is illustrated by the standard Hopfield model, which reveals that the recognition capacity of our model may be enlarged, typically, by a factor 102. The primary challenge here consists in calibrating the influence of the external stimulus, in order to attenuate the noise generated by memories that are not correlated with the external pattern. The system is analyzed primarily through numerical simulations. However, since there is the possibility of performing analytical calculations for the Hopfield model, the agreement between these two approaches can be tested-matching results are indicated in some cases. We also show that the present proposal exhibits a crucial attribute of living beings, which concerns their ability to react promptly to changes in the external environment. Additionally, we illustrate that this new approach may significantly enlarge the recognition capacity of neural networks in various situations; with correlated and non-correlated memories, as well as diluted, symmetric, or asymmetric interactions (synapses). This demonstrates that it can be implemented easily on a wide diversity of models.
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The duration of the quasistationary states (QSSs) emerging in the d-dimensional classical inertial α-XY model, i.e., N planar rotators whose interactions decay with the distance r_{ij} as 1/r_{ij}^{α} (α≥0), is studied through first-principles molecular dynamics. These QSSs appear along the whole long-range interaction regime (0≤α/d≤1), for an average energy per rotator U
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This study investigated the impact of changing abnormal home blood pressure monitoring (HBPM) cutoff from 135/85 to 130/80 mmHg on the prevalence of hypertension phenotypes, considering an abnormal office blood pressure cutoff of 140/90 mmHg. We evaluated 57 768 individuals (26 876 untreated and 30 892 treated with antihypertensive medications) from 719 Brazilian centers who performed HBPM. Changing the HBPM cutoff was associated with increases in masked (from 10% to 22%) and sustained (from 27% to 35%) hypertension, and decreases in white-coat hypertension (from 16% to 7%) and normotension (from 47% to 36%) among untreated participants, and increases in masked (from 11% to 22%) and sustained (from 29% to 36%) uncontrolled hypertension, and decreases in white-coat uncontrolled hypertension (from 15% to 8%) and controlled hypertension (from 45% to 34%) among treated participants. In conclusion, adoption of an abnormal HBPM cutoff of 130/80 mmHg markedly increased the prevalence of out-of-office hypertension and uncontrolled hypertension phenotypes.
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Hipertensión , Hipertensión Enmascarada , Hipertensión de la Bata Blanca , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión Enmascarada/diagnóstico , Hipertensión Enmascarada/epidemiología , Fenotipo , Hipertensión de la Bata Blanca/diagnóstico , Hipertensión de la Bata Blanca/epidemiologíaRESUMEN
A classical α-XY inertial model, consisting of N two-component rotators and characterized by interactions decaying with the distance r_{ij} as 1/r_{ij}^{α} (α≥0) is studied through first-principle molecular-dynamics simulations on d-dimensional lattices of linear size L (N≡L^{d} and d=1,2,3). The limits α=0 and αâ∞ correspond to infinite-range and nearest-neighbor interactions, respectively, whereas the ratio α/d>1 (0≤α/d≤1) is associated with short-range (long-range) interactions. By analyzing the time evolution of the kinetic temperature T(t) in the long-range-interaction regime, one finds a quasi-stationary state (QSS) characterized by a temperature T_{QSS}; for fixed N and after a sufficiently long time, a crossover to a second plateau occurs, corresponding to the Boltzmann-Gibbs temperature T_{BG} (as predicted within the BG theory), with T_{BG}>T_{QSS}. It is shown that the QSS duration (t_{QSS}) depends on N, α, and d, although the dependence on α appears only through the ratio α/d; in fact, t_{QSS} decreases with α/d and increases with both N and d. Considering a fixed energy value, a scaling for t_{QSS} is proposed, namely, t_{QSS}âN^{A(α/d)}e^{-B(N)(α/d)^{2}}, analogous to a recent analysis carried out for the classical α-Heisenberg inertial model. It is shown that the exponent A(α/d) and the coefficient B(N) present universal behavior (within error bars), comparing the XY and Heisenberg cases. The present results should be useful for other long-range systems, very common in nature, like those characterized by gravitational and Coulomb forces.