Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, ...and risk factors after hospital admission for CAP.
This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses.
In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies.
After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
•A simplified model of the ITER Vacuum Vessel has been created for dynamic analyses.•The simplified model is based on a novel substructuring method.•Creating a model by combining many small ...superelements speeds up calculations.•The dynamic fidelity of the simplified model is excellent.
In order to characterize the behaviour of the ITER Tokamak during seismic events, it is desirable to integrate Finite Element (FE) models of the Tokamak into the model of the building (Tokamak complex). Detailed FE models exist for each of the main Tokamak systems, but these are so large that combining them is computationally impractical.
The aim of this paper is to present work performed on the creation of simplified models of the ITER Vacuum Vessel (VV) for use in global seismic analyses.
Two different methodologies have been considered for creating simplified models whose dynamic behaviour matches that of a detailed benchmark model. In the first method, a coarse mesh representing the shape of the VV is created. The element properties of this mesh are then modified using optimization algorithms until the desired dynamic behaviour is achieved.
The second method makes use of substructuring. In order to minimize the wavefront (and hence computational time), the simplified model is created from multiple superelements, each representing part of the VV.
The suitability of the simplified model based on substructuring is quantified by means of the Modal Assurance Criterion (MAC) and Power Spectrum Density (PSD) analysis.
In this paper, a methodology developed in Fusion for Energy (F4E) for interpolating mechanical loads both between compatible (i.e. from solid to solid models different in discretization) and ...incompatible (e.g. from solid models to shell/beam models) FE models is described. This novel procedure is able of transferring a force vector field (i.e. Lorentz forces) from a three-dimensional solid mesh (e.g. electromagnetic model) onto a target mesh (e.g. mechanical model), being it either three-dimensional solid or simplified beam/shell model. This interpolation procedure is developed with the aim of preserving both the global and local mechanical equilibrium of the system in terms of resultant of forces and overturning moments. The quality assessment of this procedure is based on the comparison between the global and local force and moment resultants of the source and the transferred load field. A few examples and their related results will be discussed in support of this methodology.
Tissue factor pathway inhibitor 2 (TFPI2) is a serine protease inhibitor critical for the regulation of extracellular matrix remodeling and atherosclerotic plaque stability. Previously, we ...demonstrated that TFPI2 expression is increased in monocytes from patients with familial combined hyperlipidemia (FCH). To gain insight into the molecular mechanisms responsible for this upregulation, we examined TFPI2 expression in THP-1 macrophages exposed to lipoproteins and thrombin. Our results showed that TFPI2 expression was not affected by treatment with very low density lipoproteins (VLDL), but was induced by thrombin (10 U/ml) in THP-1 (1.9-fold increase, p<0.001) and human monocyte-derived macrophages (2.3-fold increase, p<0.005). The specificity of the inductive effect was demonstrated by preincubation with the thrombin inhibitors hirudin and PPACK, which ablated thrombin effects. TFPI2 induction was prevented by pre-incubation with MEK1/2 and JNK inhibitors, but not by the EGF receptor antagonist AG1478. In the presence of parthenolide, an inhibitor of NFκB, but not of SR-11302, a selective AP-1 inhibitor, thrombin-mediated TFPI2 induction was blunted. Our results also show that thrombin treatment increased ERK1/2, JNK and IκBα phosphorylation. Finally, we ruled out the possibility that TFPI2 induction by thrombin was mediated by COX-2, as preincubation with a selective COX-2 inhibitor did not prevent the inductive effect. In conclusion, thrombin induces TFPI2 expression by a mechanism involving ERK1/2 and JNK phosphorylation, leading finally to NFkB activation. In the context of atherosclerosis, thrombin-induced macrophage TFPI2 expression could represent a means of avoiding excessive activation of matrix metalloproteases at sites of inflammation.
► TFPI2 expression is upregulated in human macrophages by thrombin exposure. ► Thrombin induced TFPI2 expression involves cAMP, ERK1/2 and JNK pathways, leading finally to NFkB activation. ► TFPI2 induction by thrombin is independent of EGFR and COX-2, and does not involve AP-1 activation. ► In the context of atherosclerosis TFPI2 induction could represent a regulatory mechanism to avoid excessive MMP activation.
•Improved detail design of several NHF FW panels for ITER.•Implemented design solutions to improve the manufacturing of NHF FW panels.•Performed FEM simulations for the overall assessment of NHF FW ...panels.•Performed detailed analyses for integration of diagnostics in the NHF FW panels.
A typical NHF FW panel consists of a series of fingers, which represent the elementary plasma facing units and are designed to withstand 15,000 cycles at 2MW/m2. The fingers are mechanically joined and supported by a back structural element or “supporting beam”. The structure of a finger is made of three different materials: stainless steel for the supporting structure, copper chromium zirconium for the heat sink, and beryllium as armour material. Due to their location and to the interfaces with other systems (e.g. Diagnostics, Remote Handling), the NHF FW panels are divided in different main and minor variants.
The aim of this paper is to present the design work performed towards the PA signature. CAD detailed models have been created in CATIA for main and minor variants. Examples of local design solutions, as well as design work to achieve the global configuration of specific modules are provided. Finite Element (FE) analyses have been carried out, in order to simulate the operational scenario of ITER and assess the thermo-mechanical behaviour of the most important FW panels against the required design criteria. This design and analyses activity is required to progress towards the finalization of the detailed design of the NHF FW main and minor variants.
Type II interleukin-1 receptor (IL-1R2) is a non-signaling decoy receptor that negatively regulates the activity of interleukin-1 (IL-1), a pro-inflammatory cytokine involved in atherogenesis. In ...this article we assessed the relevance of IL-1R2 in atherosclerosis by studying its expression in monocytes from hyperlipidemic patients, in THP-1 macrophages exposed to lipoproteins and in human atherosclerotic lesions. Our results showed that the mRNA and protein expression of IL-1R2 was reduced in monocytes from patients with familial combined hyperlipidemia (−
30%, p
<
0.05). THP-1 macrophages incubated with increasing concentrations of acetylated low density (ac-LDL) and very low density (VLDL) lipoproteins also exhibit a decrease in IL-1R2 mRNA and protein levels. Pre-incubation with agents that block intracellular accumulation of lipids prevents the decrease in IL-1R2 mRNA caused by lipoproteins. Lipoproteins also prevented the increase in IL-1R1 and IL-1R2 caused by a 4-h stimulation with LPS and reduced protein expression of total and phosphorylated IL-1 receptor-associated kinase-1. Finally, IL-1R2 expression in human atherosclerotic vessels was markedly lower than in non-atherosclerotic arteries (−
80%, p
<
0.0005). Overall, our results suggest that under atherogenic conditions, there is a decrease in IL-1R2 expression in monocytes/macrophages and in the vascular wall that may facilitate IL-1 signaling.
► IL-1R2 expression is lower in monocytes from patients with FCH. ► Acetylated LDL and VLDL reduce IL-1R2 expression in THP-1 macrophages. ► These lipoproteins prevent the increase in IL-1R2 expression induced by LPS. ► IL-1R2 protein expression is lower in atherosclerotic vs. normal human vessels. ► Reduced IL-1R2 expression could facilitate IL-1 signaling.
Asynchronous iterative methods for solving linear systems are gaining renewed interest due to the high cost of synchronization points in massively parallel codes. Historically, theory on asynchronous ...iterative methods has focused on asymptotic behavior, while the transient behavior remains poorly understood. In this paper, we study a model of the asynchronous Jacobi method without communication delays, which we call simplified asynchronous Jacobi. Simplified asynchronous Jacobi can be used to model asynchronous Jacobi implemented in shared memory or distributed memory with fast communication networks. Our analysis uses the idea of a propagation matrix, which is similar in concept to an iteration matrix. We show that simplified asynchronous Jacobi can continue to reduce the residual when some processes are slower than other processes. We also show that simplified asynchronous Jacobi can converge when synchronous Jacobi does not. We verify our analysis of simplified asynchronous Jacobi using results from asynchronous Jacobi implemented in shared and distributed memory.
•We study the asynchronous Jacobi (AJ) method for solving sparse linear systems.•A model of AJ that assumes no communication delays is analyzed.•We show that AJ can reduce the residual when a process is slower than others.•We show that AJ can converge when synchronous Jacobi does not.•Results for shared and distributed memory support our analysis of AJ.
Communication costs are an important factor in the performance of massively parallel algorithms. We present a new asynchronous parallel algorithm for solving sparse linear systems that reduces ...communication compared to other algorithms on distributed memory machines. Implemented using passive one-sided remote memory access (RMA) MPI functions, the new method is a variation of the Southwell method, where rows are relaxed greedily, instead of sequentially, by choosing the row with the maximum residual norm. A process relaxes its rows if it holds the maximum residual norm among its neighbors at any given moment. Experimental results show that this method reduces communication costs compared to several other asynchronous iterative methods and the classic synchronous Jacobi method.
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