Prediction of significant coronary artery disease in acute chest pain without infarction in emergency department: MAPAC Cardio-PreTest model.

Acute nontraumatic chest pain is a frequent reaso n for consultation in emergency departments and represents a diagnostic challenge. The objective is to estimate the risk of significant coronary artery disease (CAD) in patients with cardiogenic acute chest pain for whom the diagnosis of infarction was ruled out in the emergency department with a nondiagnostic ECG and negative high-sensitivity troponins. We prospectively recruited 1625 patients from emergency departments of seven Spanish hospitals. The outcome was presence of significant CAD determined by presence of ischaemia in functional tests or more than 70% stenosis in imaging tests. In this study, we developed a predictive model and evaluated its performance and clinical utility. The prevalence of significant CAD was 14% [227/1625; 95% confidence interval (CI), 12-16]. MAPAC Cardio-PreTest model included seven predictors: age, sex, smoking, history of hypertension, family history of CAD, history of hyperuricaemia, and type of chest pain. The optimism-adjusted model discrimination was C-statistic 0.654 (95% CI, 0.618-0.693). Calibration plot showed good agreement between the predicted and observed risks, and calibration slope was 0.880 (95% CI, 0.731-1.108) and calibration-in-the-large -0.001 (95% CI, -0.141 to 0.132). The model increased net benefit and improved risk classification over the recommended approach by the European Society of Cardiology [Net Reclassification Index (NRI) of events = 5.3%, NRI of nonevents = 7.0%]. MAPAC Cardio-PreTest model is an online prediction tool to estimate the individualised probability of significant CAD in patients with acute chest pain without a diagnosis of infarction in emergency department. The model was more useful than the current alternatives in helping patients and clinicians make individually tailored choices about the intensity of monitoring or additional coronary tests.

Spectral measurements with hybrid LMR and SAW platform for dual parameter sensing.

Lossy mode resonance (LMR)-based optical sensors change their wavelength upon contact with substances or gases. This allows developing applications to detect the refractive index of the surrounding medium and even the thickness of the biolayers deposited on the waveguide. In the same way, when acoustic sensors are in contact with a liquid, it is possible to determine parameters, especially mechanical ones such as shape of the particle or molecule, mass load, elastic constants and viscosity of the liquid. This work reports the development of a system that combines LMR with surface acoustic wave (SAW) technologies to characterize a liquid in terms of its refractive index and viscosity simultaneously. Conveniently prepared glucose solutions are used for sensor calibration. The refractive index of the solutions ranges from 1.33 to 1.41 and its viscosity ranges from 1.005 mPa·s to 9 mPa·s, respectively. A sensitivity of 332 nm per RIU has been achieved with the optical sensor while the acoustic sensor has shown a sensitivity of -1.5 dB/(mPa·s). This new combinational concept could be expanded to the development of more demanding applications such as chemical sensors or biosensors.

Interdigital concept in photonic sensors based on an array of lossy mode resonances.

Multi-parameter detection is key in the domain of sensors. Here it is demonstrated that an indium tin oxide (ITO) nanocoating can be used to generate multiple lossy mode resonances (LMRs) in the optical spectrum. To achieve this, a nanocoating with a gradient in thickness is generated on the surface of a planar waveguide, permitting broadening of the LMR because the position of an LMR in the optical spectrum is directly related to the nanocoating thickness. The nanocoating with a gradient in thickness contributes multiple LMRs, each one centred at a different wavelength. With a further etching or deposition using a mask, a pattern of deposited and non-deposited regions can be created, resulting in isolation of the LMRs by preventing LMR overlap. This enables tracking of each central wavelength separately, which can be tuned through control of the gradient or nanocoating pattern. The array of LMR-based sensors is a photonics analogue to the interdigital concept in electronics, enabling multiple resonances to be used for multiparameter sensing.

Dually nanocoated planar waveguides towards multi-parameter sensing.

The incidence of light on the edge of a glass coverslip for a microscope slide, deposited with a thin film on both faces, permits exciting two resonances in each polarisation state of the input light, TE and TM. This dually nanocoated waveguide can be used for detecting simultaneously two different parameters on the basis of a further deposition of suitable materials on each face. As an example, the possibility of detecting temperature and humidity by using polydimethylsiloxane and agarose coatings, respectively, was demonstrated, which opens the path for the development of other dual-parameter sensors, and for even more parameters in cases in which each face of the coverslip is patterned. Moreover, the device was optimised in order to position two resonances in the near infrared (NIR) and two resonances in the visible region, with sensitivities of 0.34 nm/°C and 0.23 nm/%RH in the visible region and 1.16 nm/°C and 0.34 nm/%RH in the NIR, respectively, demonstrating the possibility of using the device in both spectral ranges and opening the path for the development of sensors based on multiple resonances, each one related to a different parameter to be detected.

Improving the width of lossy mode resonances in a reflection configuration D-shaped fiber by nanocoating laser ablation.

The full width at half maximum (FWHM) of lossy mode resonances (LMRs) in the optical spectrum depends on the homogeneity of the thin film deposited. In this Letter, a method for improving the FWHM is applied for an LMR generated by a D-shaped optical fiber in reflection configuration. For this purpose, three samples with different attenuation were deposited with DC sputtering thin films of SnO2-x, and a further controlled immersion of the samples in water was performed. A laser-cleaner method was used to improve the FWHM characteristics of one of the samples from 106 to 53 nm. This improvement can be applied to thin-film-based sensors where there is a problem with the inhomogeneity of the coating thickness. Moreover, with this technique, it was proved that a coated length of just 3-4 mm permits the generation of an LMR, with implications for the miniaturization of the final device.

Generation of lossy mode resonances with different nanocoatings deposited on coverslips.

The generation of lossy mode resonances (LMRs) with a setup based on lateral incidence of light in coverslips is a simple platform that can be used for sensing. Here the versatility of this platform is proved by studying the deposition of different coating materials. The devices were characterized with both SEM and AFM microscopy, as well as ellipsometry, which allowed obtaining the main parameters of the coatings (thickness, refractive index and extinction coefficient) and relating them with the different sensitivities to refractive index attained with each material. In this way it was possible to confirm and complete the basic rules observed with lossy mode resonance based optical fiber sensors towards the design of simpler and more compact applications in domains such as chemical sensors or biosensors.

Author Correction: Lossy mode resonance sensors based on lateral light incidence in nanocoated planar waveguides.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Implementation of a Computerized Decision Support System for Computed Tomography Scan Requests for Nontraumatic Headache in the Emergency Department.

BACKGROUND: Nontraumatic headache is a frequent complaint in the emergency department (ED). Cranial computed tomography (CT) is a widely available test for the diagnostic work-up, despite the risk of exposure to ionizing radiation. OBJECTIVES: We sought to develop and evaluate a cranial CT request computerized decision support system (CDSS) for adults with their first presentation of unusual severe nontraumatic headache in the ED. METHODS: Electronic database searches identified clinical decision and prediction rules and studies delineating risk factors in nontraumatic headache. A long list of risk factors extracted from these articles was reduced by a 30-member multidisciplinary expert panel (radiologists, emergency physicians, methodologists), using a 90% agreement threshold. This shortlist was used to develop the algorithm for the cranial CT request CDSS, which was implemented in March 2016. Impact evaluation compared CT scan frequency and diagnostic yield of pathologic findings before (March-August 2015) and after (March-August 2016) implementation. RESULTS: From the 10 selected studies, 10 risk factors were shortlisted to activate a request for cranial CT. Before implementation, 377 cranial CTs were ordered (15.3% of 2469 CT scans) compared with 244 after (9.5% of 2561 CT scans; pre-post difference 5.74%; 95% confidence interval [CI] 3.92-7.56%; p < 0.001), corresponding to a 37.6% relative reduction in the test ordering rate (95% CI 25.7-49.5%; p < 0.001). Despite the reduction in cranial CT scans, we did not observe an increase in pathological findings after introducing the decision support system (70 cases before [18.5%] vs. 35 cases after [14.3%]; pre-post difference -4.0% [95% CI -10.0 to 1.6%]; p = 0.170). CONCLUSION: In nontraumatic headache among adults seen in the ED, CDSS decreased the cranial CT request rate but the diagnostic yield did not improve.

Lossy mode resonance sensors based on lateral light incidence in nanocoated planar waveguides.

The deposition of an indium oxide (In2O3) thin film on conventional planar waveguides (a coverslip and a glass slide) allows generating lossy mode resonances (LMR) by lateral incidence of light on the waveguide and by registering the optical spectrum in a spectrometer. This novel sensing system becomes an alternative to optical fibre, the substrate where LMR-based sensors have been developed so far, since it is easier to handle and more robust. An additional advantage is that cost effective waveguides, such as slides or coverslips, can be used in a platform that resembles surface plasmon resonance-based sensors in the Kretschmann configuration but without the need for a coupling prism and with the advantage of being able to generate TE and TM LMR resonances with metallic oxide or polymer thin films. The results are corroborated with simulations, which provide in-depth understanding of the phenomena involved in the sensing system. As a proof-of-concept for the optical platform, two refractometers were developed, one with low sensitivity and for a wide range of refractive indices, and the other with higher sensitivity but for a narrower refractive index range. The sensors presented here open up the path for the development of LMR-based chemical sensors, environmental sensors, biosensors, or even the generation of other optical phenomena with the deposition of multilayer structures, gratings or nanostructures, which is much easier in a planar waveguide than in an optical fibre.

Fluorescent Sensors for the Detection of Heavy Metal Ions in Aqueous Media.

Due to the risks that water contamination implies for human health and environmental protection, monitoring the quality of water is a major concern of the present era. Therefore, in recent years several efforts have been dedicated to the development of fast, sensitive, and selective sensors for the detection of heavy metal ions. In particular, fluorescent sensors have gained in popularity due to their interesting features, such as high specificity, sensitivity, and reversibility. Thus, this review is devoted to the recent advances in fluorescent sensors for the monitoring of these contaminants, and special focus is placed on those devices based on fluorescent aptasensors, quantum dots, and organic dyes.

Fabrication of Long Period Gratings by Periodically Removing the Coating of Cladding-Etched Single Mode Optical Fiber Towards Optical Fiber Sensor Development.

Here, we present a novel method to fabricate long period gratings using standard single mode optical fibers (SMF). These optical devices were fabricated in a three-step process, which consisted of etching the SMF, then coating it with a thin-film and, the final step, which involved removing sections of the coating periodically by laser ablation. Tin dioxide was chosen as the material for this study and it was sputtered using a pulsed DC sputtering system. Theoretical simulations were performed in order to select the appropriate parameters for the experiments. The responses of two different devices to different external refractive indices was studied, and the maximum sensitivity obtained was 6430 nm/RIU for external refractive indices ranging from 1.37 to 1.39.

Diclofenac for reversal of right ventricular dysfunction in acute normotensive pulmonary embolism: A pilot study.

BACKGROUND: The inflammatory response associated with acute pulmonary embolism (PE) contributes to the development of right ventricular (RV) dysfunction. Nonsteroidal anti-inflammatory drugs (NSAIDs) may facilitate the reversal of PE-associated RV dysfunction. METHODS: We randomly assigned normotensive patients who had acute PE associated with echocardiographic RV dysfunction and normal systemic blood pressure to receive intravenous (IV) diclofenac (two doses of 75mg in the first 24h after diagnosis) or IV placebo. All patients received standard anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) and an oral vitamin K antagonist. RV dysfunction was defined by the presence of, at least, two of the following criteria: i) RV diastolic diameter>30mm in the parasternal window; ii) RV diameter>left ventricle diameter in the apical or subcostal space; iii) RV free wall hypokinesis; and iv) estimated pulmonary artery systolic pressure>30mmHg. Persistence of RV dysfunction at 48h and 7days after randomization were the primary and secondary efficacy outcomes, respectively. The primary safety outcome was major bleeding within 7days after randomization. RESULTS: Of the 34 patients randomly assigned to diclofenac or placebo, the intention-to-treat analysis showed persistent RV dysfunction at 48h in 59% (95% confidence interval [CI], 33-82%) of the diclofenac group and in 76% (95% CI, 50-93%) of the placebo group (difference in risk [diclofenac minus standard anticoagulation], -17 percentage points; 95% CI, -47 to 17). Similar proportions (35%) of patients in the diclofenac and placebo groups had persistent RV dysfunction at 7days. Major bleeding occurred in none of patients in the diclofenac group and in 5.9% (95% CI, 0.2-29%) of patient in the placebo group. CONCLUSIONS: Due to slow recruitment, our study is inconclusive as to a potential benefit of diclofenac over placebo to reverse RV dysfunction in normotensive patients with acute PE. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01590342.

Micro and Nanostructured Materials for the Development of Optical Fibre Sensors.

The measurement of chemical and biomedical parameters can take advantage of the features exclusively offered by optical fibre: passive nature, electromagnetic immunity and chemical stability are some of the most relevant ones. The small dimensions of the fibre generally require that the sensing material be loaded into a supporting matrix whose morphology is adjusted at a nanometric scale. Thanks to the advances in nanotechnology new deposition methods have been developed: they allow reagents from different chemical nature to be embedded into films with a thickness always below a few microns that also show a relevant aspect ratio to ensure a high transduction interface. This review reveals some of the main techniques that are currently been employed to develop this kind of sensors, describing in detail both the resulting supporting matrices as well as the sensing materials used. The main objective is to offer a general view of the state of the art to expose the main challenges and chances that this technology is facing currently.

Sensitivity Enhancement in Low Cutoff Wavelength Long-Period Fiber Gratings by Cladding Diameter Reduction.

The diameter of long-period fiber gratings (LPFGs) fabricated in optical fibers with a low cutoff wavelength was be reduced by hydrofluoric acid etching, enhancing the sensitivity to refractive index by more than a factor of 3, to 2611 nm/refractive index unit in the range from 1.333 to 1.4278. The grating period selected for the LPFGs allowed access to the dispersion turning point at wavelengths close to the visible range of the optical spectrum, where optical equipment is less expensive. As an example of an application, a pH sensor based on the deposition of a polymeric coating was analyzed in two situations: with an LPFG without diameter reduction and with an LPFG with diameter reduction. Again, a sensitivity increase of a factor of near 3 was obtained, demonstrating the ability of this method to enhance the sensitivity of thin-film-coated LPFG chemical sensors.

Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista / Clinical characteristics and prognosis of pulmonary embolism caused by economy class syndrome

Objetivo: No se conocen suficientemente las características clínicas y el pronóstico de los pacientes con tromboembolia de pulmón (TEP) aguda sintomática asociada a los viajes prolongados (síndrome de clase turista [SCT]). Métodos: Se analizaron retrospectivamente las características basales de los pacientes con TEP aguda y se estratificaron según el factor de riesgo desencadenante. Se determinaron la mortalidad por todas las causas, la mortalidad por la propia TEP, las recurrencias trombóticas no fatales y los sangrados mayores no fatales durante los primeros 30 días de seguimiento. Resultados: De los 2.333 pacientes incluidos, un total de 124 (5,3%; intervalo de confianza del 95%: 4,4-6,3) fueron diagnosticados de TEP secundaria a SCT. Estos pacientes fueron más jóvenes, presentaron menos frecuentemente comorbilidad y más frecuentemente síncope (48% vs. 14%; p<0,001), taquicardia (37% vs. 21%; p<0,001), disfunción de ventrículo derecho (VD) (31% vs. 19%; p<0,01) y daño miocárdico (57% vs. 28%; p<0,001) que los demás pacientes con TEP. La mortalidad por todas las causas a 30 días fue significativamente menor para los pacientes con TEP secundaria a SCT (1,6% vs. 9,6%; p<0,01). La mortalidad a 30 días por TEP no fue diferente entre los dos grupos de pacientes (0,8% vs. 3,1%; p=0,18). Conclusiones: Los pacientes con TEP y SCT son más jóvenes y tienen menos comorbilidad que los demás pacientes con TEP. Aunque se presentan más frecuentemente con disfunción de VD y daño miocárdico, el pronóstico a corto plazo es excelente (AU)

Objective: Clinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood. Methods: In this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30 days after initiation of PE treatment. Results: Of the 2,333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4-6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs. 14%; P<.001], tachycardia [37% vs. 21%; P<.001], right ventricular dysfunction [31% vs. 19%; P<.01] and myocardial injury [57% vs. 28%; P<.001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs. 9.6%; P<.01). We did not detect a difference in PE-related mortality at 30 days between those with and those without ECS (0.8% vs. 3.1%; P=.18). Conclusions: PE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent (AU)

Humidity Sensor Based on Bragg Gratings Developed on the End Facet of an Optical Fiber by Sputtering of One Single Material.

The refractive index of sputtered indium oxide nanocoatings has been altered just by changing the sputtering parameters, such as pressure. These induced changes have been exploited for the generation of a grating on the end facet of an optical fiber towards the development of wavelength-modulated optical fiber humidity sensors. A theoretical analysis has also been performed in order to study the different parameters involved in the fabrication of this optical structure and how they would affect the sensitivity of these devices. Experimental and theoretical results are in good agreement. A sensitivity of 150 pm/%RH was obtained for relative humidity changes from 20% to 60%. This kind of humidity sensors shows a maximum hysteresis of 1.3% relative humidity.

Clinical Characteristics and Prognosis of Pulmonary Embolism Caused by Economy Class Syndrome. / Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista.

OBJECTIVE: Clinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood. METHODS: In this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30days after initiation of PE treatment. RESULTS: Of the 2,333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4-6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs. 14%; P<.001], tachycardia [37% vs. 21%; P<.001], right ventricular dysfunction [31% vs. 19%; P<.01] and myocardial injury [57% vs. 28%; P<.001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs. 9.6%; P<.01). We did not detect a difference in PE-related mortality at 30days between those with and those without ECS (0.8% vs. 3.1%; P=.18). CONCLUSIONS: PE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent.

Recent Developments in Fiber Optics Humidity Sensors.

A wide range of applications such as health, human comfort, agriculture, food processing and storage, and electronic manufacturing, among others, require fast and accurate measurement of humidity. Sensors based on optical fibers present several advantages over electronic sensors and great research efforts have been made in recent years in this field. The present paper reports the current trends of optical fiber humidity sensors. The evolution of optical structures developed towards humidity sensing, as well as the novel materials used for this purpose, will be analyzed. Well-known optical structures, such as long-period fiber gratings or fiber Bragg gratings, are still being studied towards an enhancement of their sensitivity. Sensors based on lossy mode resonances constitute a platform that combines high sensitivity with low complexity, both in terms of their fabrication process and the equipment required. Novel structures, such as resonators, are being studied in order to improve the resolution of humidity sensors. Moreover, recent research on polymer optical fibers suggests that the sensitivity of this kind of sensor has not yet reached its limit. Therefore, there is still room for improvement in terms of sensitivity and resolution.

Sensitivity optimization with cladding-etched long period fiber gratings at the dispersion turning point.

This work presents a refractive index sensor based on a long period fiber grating (LPFG) made in a reduced cladding fiber whose low order cladding modes have the turning point at large wavelengths. The combination of these parameters results in an improved sensitivity of 8734 nm/refractive index unit (RIU) for the LP0,3 mode in the 1400-1650 wavelength range. This value is similar to that obtained with thin-film coated LPFGs, which permits to avoid the coating deposition step. The numerical simulations are in agreement with the experimental results.

Analysis of lossy mode resonances on thin-film coated cladding removed plastic fiber.

In this work, the modal transition induced by lossy mode resonances has been analyzed as a function of wavelength for thin-film coated cladding removed fibers. The wavelength dependence of the modal structure allows us to explain the resonance phenomenon. The numerical data obtained were calculated with a method based on the exact calculation of core modes. Theoretical simulations have been compared with experimental results showing good agreement.