A distributed geometric rewiring model.

We propose a distributed rewiring model which starts with a planar graph embedded into the Euclidean space and then behaves as a distributed system, where each node is provided with a set of dynamic links. The proposed rewiring evolves through cycles, where nodes explore the network to identify possible shortcuts and rewire their dynamic links. The rewiring decisions are subject to Euclidean and geodesic distance constrains. The emerging networks were assessed through topological and robustness analyses. We found that the networks display a variety of characteristics observed in complex networks encompassing phenomena such as preferential attachment, the distinctive traits of small-world networks, the presence of community structures, and robustness against degradation process. We consider that our proposal can be applied in the design of those self-managed systems in which there is a limitation on communication resources that can be represented by the Euclidean distance and, however, the components themselves can deploy strategies to optimize the transport of information and develop tolerance before contingencies.

Sites and Mobility of Lithium along the Li1+xTi2-xInx(PO4)3 (0 ≤ x ≤ 2) Series Deduced by XRD, NMR, and Impedance Spectroscopy.

The structure and Li conductivity has been investigated in the Li1+xTi2-xInx(PO4)3 (0 ≤ x ≤ 2) series prepared by the ceramic route at 900 °C. The XRD patterns of 0 ≤ x ≤ 0.2 samples show the presence of rhombohedral (S.G. R3̅c); those of 0.2 ≤ x ≤ 1 samples display both rhombohedral and orthorhombic (S.G. Pbca), and 1 ≤ x ≤ 2 samples exhibit only monoclinic (S.G. P21/n) phases. At intermediate compositions, the secondary LiTiPO5 phase was detected. The Rietveld analysis of XRD patterns was used to deduce unit-cell parameters, chemical composition, and percentage of phases. The amount of In3+, deduced from structural refinements of three phases, was confirmed by 31P MAS NMR spectroscopy. The Li mobility was investigated by 7Li MAS NMR and impedance spectroscopies. The Li conductivity increased with the Li content in rhombohedral but decreased in orthorhombic, increasing again in monoclinic samples. The maximum conductivity was obtained in the rhombohedral x = 0.2 sample (σb = 1.9 × 10-3 S·cm-1), with an activation energy Eb = 0.27 eV. In this composition, the overall Li conductivity was σov = 1.7 × 10-4 S·cm-1 and Eov = 0.32 eV, making this composition a potential solid electrolyte for all-solid-state batteries. Another maximum conductivity was detected in the monoclinic x ∼ 1.25 sample (σov = 1.4 × 10-5 S·cm-1), with an activation energy Eov = 0.39 eV. Structural models deduced with the Rietveld technique were used to analyze the conduction channels and justify the transport properties of different Li1+xTi2-x Inx(PO4)3 phases.

Evaluating the Reach of a Patient Navigation Program for Follow-up Colonoscopy in a Large Federally Qualified Health Center.

Patient navigation (PN) has been shown to improve participation in cancer screening, including colorectal cancer screening, and the Community Preventive Services Task Force now recommends the practice. Despite the effectiveness of PN programs, little is known about the number of contacts needed to successfully reach patients or about the demographic and healthcare utilization factors associated with reach. PRECISE was an individual randomized study of PN vs. usual care conducted as a partnership between two large health systems in the Pacific Northwest. The navigation program was a six topic-area telephonic program designed to support patients with an abnormal fecal test result to obtain a follow-up colonoscopy. We report the number of contact attempts needed to successfully reach navigated patients. We used logistic regression to report the demographic and healthcare utilization characteristics associated with patients allocated to PN who were successfully reached. We identified 1200 patients with an abnormal FIT result, among whom 970 were randomized into the study (45.7% were female, 17.5% were Spanish-speaking, mean age was 60.8). Of the 479 patients allocated to the PN intervention, 382 (79.7%) were reached within 18 call attempts and nearly all (n = 356; 93.2%) were reached within six contact attempts. Patient characteristics associated with reach were race, county of residence, and body mass index. Our findings can guide future efforts to optimize the reach of PN programs.

Decision-Making Algorithm with Geographic Mobility for Cognitive Radio.

The proposed novel algorithm named decision-making algorithm with geographic mobility (DMAGM) includes detailed analysis of decision-making for cognitive radio (CR) that considers a multivariable algorithm with geographic mobility (GM). Scarce research work considers the analysis of GM in depth, even though it plays a crucial role to improve communication performance. The DMAGM considerably reduces latency in order to accurately determine the best communication channels and includes GM analysis, which is not addressed in other algorithms found in the literature. The DMAGM was evaluated and validated by simulating a cognitive radio network that comprises a base station (BS), primary users (PUs), and CRs considering random arrivals and disappearance of mobile devices. The proposed algorithm exhibits better performance, through the reduction in latency and computational complexity, than other algorithms used for comparison using 200 channel tests per simulation. The DMAGM significantly reduces the decision-making process from 12.77% to 94.27% compared with ATDDiM, FAHP, AHP, and Dijkstra algorithms in terms of latency reduction. An improved version of the DMAGM is also proposed where feedback of the output is incorporated. This version is named feedback-decision-making algorithm with geographic mobility (FDMAGM), and it shows that a feedback system has the advantage of being able to continually adjust and adapt based on the feedback received. In addition, the feedback version helps to identify and correct problems, which can be beneficial in situations where the quality of communication is critical. Despite the fact that the FDMAGM may take longer than the DMAGM to calculate the best communication channel, constant feedback improves efficiency and effectiveness over time. Both the DMAGM and the FDMAGM improve performance in practical scenarios, the former in terms of latency and the latter in terms of accuracy and stability.

The recalibration and redevelopment of a model to calculate patients' probability of completing a colonoscopy following an abnormal fecal test.

OBJECTIVES: Fecal immunochemical testing (FIT) is an effective screening tool for colorectal cancer. If an FIT is abnormal, a follow-up colonoscopy is necessary to remove polyps or find cancers. We sought to develop a usable risk prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test. METHODS: We recalibrated and then redeveloped a prediction model in federally qualified health centers (FQHCs), using a retrospective cohort of patients aged 50-75 with an abnormal FIT test and clinical data. Logistic and Cox regressions were used to recalibrate and then redevelop the model. RESULTS: The initial risk model used data from eight FQHCs (26 clinics) including 1723 patients. When we applied the model to a single large FQHC (34 clinics, 884 eligible patients), the model did not recalibrate successfully (c-statistic dropped more than 0.05, from 0.66 to 0.61). The model was redeveloped in the same FQHC in a cohort of 1401 patients with a c-statistic of 0.65. CONCLUSIONS: The original model developed in a group of FQHCs did not adequately recalibrate in the single large FQHC. Health system, patient characteristics or data differences may have led to the inability to recalibrate the model. However, the redeveloped model provides an adequate model for the single FQHC.

Self-diffusion in polycrystalline Li1+x Ti2-x Al x (PO4)3 (0.2 ≤ x ≤ 0.4) samples followed by 7Li PFG (pulse field gradient) NMR spectroscopy.

Short and long range lithium motions in powder Li1+x Ti2-x Al x (PO4)3 (LTAP) NASICON compounds prepared by ceramic (x = 0.2 and 0.4) and sol-gel (x = 0.3 and 0.4) routes are discussed. ND diffraction and MAS-NMR spectroscopy were previously used to investigate structural features of these compounds. In particular, Fourier map differences showed that the amount of Li atoms allocated at M3 increases at the expense of M1 sites when the Li content increases. In this work, PFG-NMR results show that diffusion coefficients rise with the amount of lithium and temperature. The restricted diffusion inside NASICON particles is compared with "free" diffusion processes. At 300 K, diffusion coefficients D PFG ∼ 5 × 10-12 m2 s-1 have been deduced in ceramic x = 0.2 and 0.4 samples, decreasing with diffusion time Δ used in PFG experiments. In sol-gel samples, diffusion coefficients are near those of ceramic samples, but decrease faster with diffusion Δ times, as a consequence of the Li confinement inside sub-micrometric crystallites. The NMR spin-echo signal displays minima at specific q(γgδ) values that are related to the crystallite size. From R dif ∼ q m -1 distances, calculated from the position of minima, and from diffusion coefficients deduced for high Δ values, the mean crystallite size was estimated. Finally, from the temperature dependence of conductivity and diffusion coefficients, the activation energy and charge carriers concentrations were determined.

Influence of Cation Vacancies on Li Conductivity of La1/2Li1/2-2x Sr x TiO3 Perovskites (0 < x ≤ 0.25): The Role of Nominal and Effective Vacancies.

The Li1/2-2x Sr x La1/2TiO3 series (0 ≤ x ≤ 0.25) is investigated with X-ray diffraction, nuclear magnetic resonance, and impedance spectroscopy techniques. The substitution of two Li+ by one Sr2+ in Li1/2La1/2TiO3 perovskite generates cation vacancies that, when ordered in alternating planes along the c-axis, confer a two-dimensional character to Li mobility. In previous works, it was shown that Li+ ions partially occupy the center of the six faces of the cubic perovskite, resulting in the associated A-sites to participate like a vacancy in the definition of the percolation vacancy threshold. The results obtained in the Li1/2-2x Sr x La1/2TiO3 series are compared with those obtained in the Li3x La2/3-x TiO3 series, and other Sr-doped solid solutions (Li1/2-x Sr2x La1/2-x TiO3 and Li x Sr x La2/3-x TiO3), to highlight the importance of the effective vacancies with respect to the nominal ones in conductivity. The analysis of four series, belonging to the ternary SrTiO3-La2/3TiO3-Li2TiO3 phase diagram, permits a better understanding of the ionic conduction mechanism in perovskites. The results show that the vacancy percolation model is more adequate to explain Li conductivity than the conventional hopping probability model. In the analyzed series, Li conductivity is maximum when a small amount of Sr is incorporated into the pseudo-cubic La1/2Li1/2TiO3 end member, while it decreases as the amount of strontium increases.

Impact on Glycemic Variation Caused by a Change in the Dietary Intake Sequence.

This work presents an analysis of the effect on glycemic variation caused by modifying the macronutrient intake sequence in a person without a diagnosis of diabetes. In this work, three types of nutritional studies were developed: (1) glucose variation under conditions of daily intake (food mixture); (2) glucose variation under conditions of daily intake modifying the macronutrient intake sequence; (3) glucose variation after a modification in the diet and macronutrient intake sequence. The focus of this research is to obtain preliminary results on the effectiveness of a nutritional intervention based on the modification of the sequence of macronutrient intake in a healthy person during 14-day periods. The results obtained corroborate the positive effect on the glucose of consuming vegetables, fiber, or proteins before carbohydrates, decreasing the peaks in the postprandial glucose curves (vegetables: 113-117 mg/dL; proteins: 107-112 mg/dL; carbohydrates: 115-125 mg/dL) and reducing the average levels of blood glucose concentrations (vegetables: 87-95 mg/dL; proteins: 82-99 mg/dL; carbohydrates: 90-98 mg/dL). The present work demonstrates the preliminary potential of the sequence in the macronutrient intake for the generation of alternatives of prevention and solution of chronic degenerative diseases, improving the management of glucose in the organism and permeating in the reduction of weight and the state of health of the individuals.

Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III.

BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.

Effect of Induced Mechanical Leaf Damage on the Yield and Content of Bioactive Molecules in Leaves and Seeds of Tepary Beans (Phaseolus acutifolius).

Growing interest has recently been shown in Tepary beans (Phaseolus acutifolius) because they contain lectins and protease inhibitors that have been shown to have a specific cytotoxic effect on human cancer cells. Bean lectins offer protection against biotic and abiotic stress factors, so it is possible that mechanical foliar damage may increase lectin production. This study evaluates the effect of mechanical stress (foliar damage) on lectin and protease inhibitor content in Tepary beans. Seed yield was also analyzed, and phenolic content and antioxidant capacity (DPPH and TEAC) were determined in the leaves. An experimental design with random blocks of three treatments (T1: control group, T2: 50% mechanical foliar damage and T3: 80% mechanical foliar damage) was carried out. Mechanical foliar damage increased the amount of lectin binding units (LBUs) fivefold (from 1280 to 6542 LBUs in T3) but did not affect units of enzymatic activity (UEA) against trypsin (from 60.8 to 51 UEA in T3). Results show that controlled mechanical foliar damage could be used to induce overexpression of lectins in the seeds of Tepary beans. Mechanical foliar damage reduced seed production (-14.6%: from 1890 g to 1615 g in T3) and did not significantly increase phenolic compound levels in leaves.

The shrunk genetic diversity of coral populations in North-Central Patagonia calls for management and conservation plans for marine resources.

The Chilean Patagonia is a complex puzzle of numerous fjords, channels, bays, estuaries, and islands. The largest part of it is very remote, hampering the generation of scientific knowledge and effective management planning that could balance conservation of the marine resources with the increasing development of aquaculture activities. The present study focuses on the deep-water emergent cold-water coral Desmophyllum dianthus, dwelling in Chilean Patagonia, with the aim to illustrate its population genetic structure, demography and adaptation of the species along this coast. Microsatellite loci analysis included D. dianthus individuals from twelve sampling localities along bathymetric and oceanographic gradients from the latitude 40°S to 48°S. The results showed a lack of genetic structure with an asymmetric dispersion of individuals, and relevant heterozygosity deficiency in some populations. This study also analyses the natural and human impacts affecting the region (e.g., climate change, increasing salmon farming activities), and stresses the importance of including genetic information in the process of management and conservation of marine resources. In particular, the relevance of using interdisciplinary approaches to fill the gaps in scientific knowledge especially in remote and pristine areas of western Patagonia. Therefore, information on genetic spatial distribution of marine fauna could become pivotal to develop a holistic ecosystem-based approach for marine spatial planning.

Hiperplasia Adenomatoide en Reborde Alveolar Maxilar: Una Presentación Inusual

RESUMEN: La hiperplasia adenomatoide (HA) se considera una patología no neoplásica de etiología desconocida asociada principalmente a trauma como principal factor causal, con localización frecuente en paladar duro y blando. El presente caso muestra el primer caso de HA en reborde alveolar asociado a prótesis removible mal adaptada. Hombre de 81 años con diabetes mellitus y HTA controlada presentaba un aumento de volumen nodular en reborde alveolar maxilar del color de la mucosa, de consistencia firme y márgenes definidos que medía 1,5 x 0,7 cm de diámetro, asintomático y asociada a falta de diente 1.3 protésico reportando 6 años de evolución. Se realizó biopsia excisional y estudio histopatológic o con hiperplasia de acinos glandulares. El 80 % de los casos se observa en paladar seguida de la mucosa oral, lengua y zona retromolar, pero sin reportes en encía o reborde alveolar. El factor causal mayormente asociado es el trauma crónico principalmente asociado a prótesis mal adaptadas, aunque existen estudios de un cromosoma aberrante con un rol desconocido tanto en su patogénesis como en su posible potencial maligno. En el caso actual, la lesión se asocia fuertemente a prótesis removible mal adaptada sugiriendo una lesión de aspecto reactivo. Por lo tanto, la HA se debe incluir como diagnóstico diferencial tanto a nivel palatino como en otras localizaciones incluyendo reborde alveolar. Además, se debe considerar cuando existe un factor etiológico traumático como prótesis removibles mal adaptadas, siendo necesario su confirmación mediante estudio histopatológico especialmente por su similitud con otras patologías.

ABSTRACT: Adenomatoid hyperplasia (AH) is considered a non-neoplastic pathology of unknown etiology but mainly associated with trauma as the main causal factor, with frequent localization on hard and soft palate. The present case shows the first case of AH on the alveolar ridge associated with a poorly adapted removable prosthesis. An 81-year-old man with diabetes mellitus and arterial hypertension controlled presents a nodular tumor in the maxillary alveolar ridge of the color of the mucosa, with a firm consistency and defined edges measuring 1.5 x 0.7 cm in diameter, asymptomatic and associated with a lack of a 1.3 prosthetic tooth reporting 6 years of evolution. Excisional biopsy and histopathological study were performed with glandular acini hyperplasia. The AH is observed in 80 % of cases on the palate followed by the oral mucosa, tongue and retromolar area, but without reports on the gingiva or alveolar ridge. The most associated causal factor is chronic trauma, mainly associated with poorly adapted prostheses, although there are studies of an aberrant chromosome with an unknown role both in his pathogenesis and possible malignant potential. In the current case, the lesion is strongly associated with a poorly adapted removable prosthesis, suggesting a lesion with a reactive appearance. Therefore, AH should be included as a differential diagnosis both at the palatal level and in other locations including the alveolar ridge. In addition, it should be considered when there is a traumatic etiological factor such as poorly adapted removable prostheses, It's confirmation by histopathological study being necessary, especially due to its similarity with other pathologies.

Magnetic resonance imaging in patients with cardiac implantable electronic devices: A prospective study.

BACKGROUND: The number of patients with cardiac implantable electronic devices in whom magnetic resonance imaging (MRI) is indicated is constantly increasing. The potential risk of electromagnetic interference has limited its use and it is still contraindicated by the Food and Drug Administration in some cases. The aim of this study is to evaluate the safety and efficacy of MRI in these patients. METHODS: A prospective registry comprising patients with a pacemaker (PM) or implantable cardioverter-defibrillator (ICD), MRI-conditional or not, who were candidates for MRI (at 1.5 T) with no suitable alternative diagnostic technique. All devices were programmed before the procedure and patients were monitored throughout the test. Clinical, electrical, and technical parameters were evaluated before and after MRI. RESULTS: 147 MRI examinations (132 PM and 15 ICD) were performed. There were no clinical events or significant differences in the electrical parameters of the leads after MRI. A variation in the impedance of the ventricular leads was detected, although the difference was not clinically relevant. In one patient with a PM, a failure in release of the safety impulse was detected in the auto-threshold test, although the threshold was correctly determined. In 11 of the 17 thoracic MRIs, image artifacts were detected, preventing the diagnosis in two of them. CONCLUSIONS: In patients with cardiac implantable electronic devices, MRIs performed under a specific protocol has been shown to be safe in the short term even in the thoracic region, as well as interpretable in most cases.

Direct Epitaxial Growth of Polar Hf0.5Zr0.5O2 Films on Corundum.

Single-phase epitaxial Hf0.5Zr0.5O2 films with non-centrosymmetric orthorhombic structure have been grown directly on electrode-free corundum (α-Al2O3) substrates by pulsed laser deposition. A combination of high-resolution X-ray diffraction and X-ray absorption spectroscopy confirms the epitaxial growth of high-quality films belonging to the Pca21 space group, with [111] out-of-plane orientation. The surface of a 7-nm-thick sample exhibits an atomic step-terrace structure with a corrugation of the order of one atomic layer, as proved by atomic force microscopy. Scanning transmission electron microscopy reveals that it consists of grains with around 10 nm lateral size. The polar nature of this film has been corroborated by pyroelectric measurements. These results shed light on the mechanisms of the epitaxial stabilization of the ferroelectric phase of hafnia.

An evaluation of errors in the mitochondrial COI sequences of Hydrachnidia (Acari, Parasitengona) in public databases.

Public molecular databases are fundamental tools for modern taxonomic studies whose usefulness rely on the soundness of the data within them. Here, we study potential errors that can arise along the data pipeline from sampling, specimen identification and molecular processing (digestion, amplification and sequencing) to the submission of sequences to these databases by using the DNA sequences of Hydrachnidia (Acari, Parasitengona) as a case study. Our results indicate that molecular information is available for only about 3% of the Hydrachnidia species known to date; yet, within this small percentage, errors are present in almost 5% of the species analyzed (0.5% of the sequences and almost 11% of the genera). This study underscores the scarcity of genetic data available for Hydrachnidia, but also that the proportion of errors in DNA sequences is relatively small. Even so, it highlights the danger associated with using DNA sequences from public databases, particularly for species identification, and reinforces the need for greater quality control measures and/or protocols to avoid an intensification of errors in the (post) genomics era. Finally, our study emphasizes that potential errors may also reveal cryptic diversity within a species.

Propuesta de intervención de gamificación en educación física basada en el universo de Harry Potter / Gamification intervention proposal in physical education based on the Harry Potter universe

En el presente trabajo se elabora y desarrolla una propuesta de innovación docente en el área de Educación Física para el primer curso de Educación Secundaria Obligatoria en la que se utilizó la metodología de gamificación para trabajar los deportes alternativos. La gamificación es una metodología que consigue aumentar uno de los aspectos más relevantes para el aprendizaje del alumnado, como es la motivación. A través de esta intervención se pretende, ofrecer un recurso educativo que ayude a mejorar la motivación e implicación del alumnado en las clases de Educación Física de acuerdo con los antecedentes de investigación existentes sobre la gamificación. En esta propuesta se trabajaron los deportes alternativos “Juego de Palas” y “Ultimabola” a través de una unidad didáctica gamificada basada en el universo de Harry Potter, con los objetivos de mejorar los elementos técnico-tácticos propios de estos deportes y mostrar habilidades y actitudes de respeto, trabajo en equipo y deportividad. La propuesta fue dividida metodológicamente en cuatro partes interconectadas que incluyen, a su vez, los instrumentos necesarios para evaluar al alumnado acerca de los contenidos trabajados, siendo estas partes el desempeño mágico individual, el desempeño mágico colectivo, la actitud mágica y el diario mágico. Los resultados indican que se produce buenos resultados de aprendizaje así como una gran implicación de los estudiantes tanto en los desempeños individuales como colectivos. (AU)

In the present article, a teaching innovation proposal in the area of Physical Education was elaborated and developed, in which the innovative methodology of gamification was used to work on alternative sports in the first year of secondary education. Gamification is a methodology that manages to improve one of the most important aspects for the students learning, such as motivation. Through this intervention it is intended to offer an educational resource that helps to improve the motivation and involvement of the students in Physical Education classes in accordance with the existing research background on gamification. In this proposal, the alternative sports "Juego de Palas" and "Ultimabola" were worked through a gamified didactic unit based on the Harry Potter universe, with the aim of improving the technical-tactical elements of these sports and showing skills and attitudes of respect, teamwork and sportsmanship. The proposal was methodologically divided into four interconnected parts that include, in turn, the necessary instruments to evaluate the students about the contents worked on, these parts being the individual magical performance, the collective magical performance, the magical attitude and the magical diary. The results indicate that good learning results were obtained as well as a great involvement of the students in both individual and collective performances. (AU)

Dexmedetomidine Clearance Decreases with Increasing Drug Exposure: Implications for Current Dosing Regimens and Target-controlled Infusion Models Assuming Linear Pharmacokinetics.

BACKGROUND: Numerous pharmacokinetic models have been published aiming at more accurate and safer dosing of dexmedetomidine. The vast majority of the developed models underpredict the measured plasma concentrations with respect to the target concentration, especially at plasma concentrations higher than those used in the original studies. The aim of this article was to develop a dexmedetomidine pharmacokinetic model in healthy adults emphasizing linear versus nonlinear kinetics. METHODS: The data of two previously published clinical trials with stepwise increasing dexmedetomidine target-controlled infusion were pooled to build a pharmacokinetic model using the NONMEM software package (ICON Development Solutions, USA). Data from 48 healthy subjects, included in a stratified manner, were utilized to build the model. RESULTS: A three-compartment mamillary model with nonlinear elimination from the central compartment was superior to a model assuming linear pharmacokinetics. Covariates included in the final model were age, sex, and total body weight. Cardiac output did not explain between-subject or within-subject variability in dexmedetomidine clearance. The results of a simulation study based on the final model showed that at concentrations up to 2 ng · ml-1, the predicted dexmedetomidine plasma concentrations were similar between the currently available Hannivoort model assuming linear pharmacokinetics and the nonlinear model developed in this study. At higher simulated plasma concentrations, exposure increased nonlinearly with target concentration due to the decreasing dexmedetomidine clearance with increasing plasma concentrations. Simulations also show that currently approved dosing regimens in the intensive care unit may potentially lead to higher-than-expected dexmedetomidine plasma concentrations. CONCLUSIONS: This study developed a nonlinear three-compartment pharmacokinetic model that accurately described dexmedetomidine plasma concentrations. Dexmedetomidine may be safely administered up to target-controlled infusion targets under 2 ng · ml-1 using the Hannivoort model, which assumed linear pharmacokinetics. Consideration should be taken during long-term administration and during an initial loading dose when following the dosing strategies of the current guidelines.

Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado / Atrial fibrillation predictors in patients with embolic stroke of undetermined source

Antecedentes y objetivos: En el accidente cerebrovascular embólico de origen indeterminado (ESUS) la detección de fibrilación auricular (FA) conlleva un cambio de tratamiento y una reducción drástica en la incidencia de nuevos ictus. Es necesario determinar qué pacientes se benefician en mayor medida de una monitorización electrocardiográfica prolongada. Nuestro objetivo fue la búsqueda de predictores electrocardiográficos y ecocardiográficos de FA en pacientes con ESUS.Materiales y métodosSe diseñó un estudio observacional de cohortes en el que se incluyeron 95 pacientes consecutivos que ingresaron por ESUS en un hospital terciario. A todos se les realizó un electrocardiograma (ECG), un Holter electrocardiograma (Holter-ECG) de 24h y un ecocardiograma durante el ingreso. Se realizó un seguimiento presencial durante 2años mediante Holter-ECG de 24h, trimestral durante el primer año y semestral durante el segundo.ResultadosDurante el seguimiento se detectó FA en 11 pacientes (11,6%), siendo la tasa detección del 3,2% a los 6meses, del 7,4% a los 12meses y del 11,6% a los 18 y a los 24meses. Las variables que se relacionaron de forma independiente con el desarrollo de FA fueron la dilatación en grado moderado o severo de la aurícula izquierda (AI) (p=0,02), el bloqueo interauricular avanzado (BIA-A) (p=0,04) y la presencia de más de 1.000 extrasístoles auriculares (EA) en Holter-ECG de 24h (p=0,01).ConclusionesLa dilatación en un grado moderado o severo de AI, el BIA-A y la presencia de más de 1.000 EA en Holter-ECG de 24h se comportan como predictores independientes de FA en pacientes con ESUS. (AU)

Background and objectives: Atrial fibrillation (AF) detection in patients with embolic stroke of underdetermined source (ESUS) entails a change of medical treatment and a significant decrease in the incidence of new strokes. It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring. Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS.MethodsWe performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS. An electrocardiogram, each subject in the study underwent a 24-hour Holter-electrocardiogram (Holter-ECG) and an echocardiogram. A 2-year follow up was also conducted, with a 24-hour Holter-ECG every 3months for the first year, and every 6months during the second one.ResultsDuring the follow-up, AF was detected in 11 patients (11.6%), with a detection rate of 3.2% at 6months, 7.4% at 12months, and 11.6% at 18months as well as at 24months. The variables that were independently related to AF detection included moderate or severe left atrium dilation (P=.02), interatrial advanced block (P=.04) and more than 1000 premature atrial beats on 24-hour Holter-ECG (P=.01).ConclusionsModerate or severe atrial dilation, interatrial advanced block, and the presence of more than 1000 premature atrial beats on 24-hour Holter-ECG behave as AF predictors in patients with ESUS. (AU)

Solvent-Free Design of Biobased Non-isocyanate Polyurethanes with Ferroelectric Properties.

Increasing energy autonomy and lowering dependence on lithium-based batteries are more and more appealing to meet our current and future needs of energy-demanding applications such as data acquisition, storage, and communication. In this respect, energy harvesting solutions from ambient sources represent a relevant solution by unravelling these challenges and giving access to an unlimited source of portable/renewable energy. Despite more than five decades of intensive study, most of these energy harvesting solutions are exclusively designed from ferroelectric ceramics such as Pb(Zr,Ti)O3 and/or ferroelectric polymers such as polyvinylidene fluoride and its related copolymers, but the large implementation of these piezoelectric materials into these technologies is environmentally problematic, related with elevated toxicity and poor recyclability. In this work, we reveal that fully biobased non-isocyanate polyurethane-based materials could afford a sustainable platform to produce piezoelectric materials of high interest. Interestingly, these non-isocyanate polyurethanes (NIPUs) with ferroelectric properties could be successfully synthesized using a solvent-free reactive extrusion process on the basis of an aminolysis reaction between resorcinol bis-carbonate and different diamine extension agents. Structure-property relationships were established, indicating that the ferroelectric behavior of these NIPUs depends on the nanophase separation inside these materials. These promising results indicate a significant potential for fulfilling the requirements of basic connected sensors equipped with low-power communication technologies.

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process.

BACKGROUND: Delays in receiving follow-up colonoscopy after an abnormal fecal immunochemical test (FIT) result are associated with increased colorectal cancer incidence and mortality. Little is known about patterns of follow-up colonoscopy completion in federally qualified health centers. METHODS: We abstracted the medical records of health center patients, aged 50-75 years, who had an abnormal FIT result between August 5, 2017 and August 4, 2018 (N = 711). We assessed one-year rates of colonoscopy referral, pre-procedure visit completion, colonoscopy completion, and time to colonoscopy; associations between these outcomes and patient characteristics; and reasons for non-completion found in the medical record. RESULTS: Of the 711 patients with an abnormal FIT result, 90% were referred to colonoscopy, but only 52% completed a pre-procedure visit, and 43% completed a colonoscopy within 1 year. Median time to colonoscopy was 83 days (interquartile range: 52-131 days). Pre-procedure visit and colonoscopy completion rates were relatively low in patients aged 65-75 (vs. 50-64), who were uninsured (vs. insured) or had no clinic visit in the prior year (vs. ≥ 1 clinic visit). Common reasons listed for non-completion were that the patient declined, or the provider could not reach the patient. DISCUSSION: Efforts to improve follow-up colonoscopy rates in health centers might focus on supporting the care transition from primary to specialty gastroenterology care and emphasize care for older uninsured patients and those having no recent clinic visits. Our findings can inform efforts to improve follow-up colonoscopy uptake, reduce time to colonoscopy receipt, and save lives from colorectal cancer. TRIAL REGISTRATION: National Clinical Trial (NCT) Identifier: NCT03925883.