Treatment delay is a powerful predictor of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated effectiveness ...of pre-hospital diagnosis of STEMI with direct referral to PCI, alongside more conventional referral strategies.
From January 2003 to December 2004, 658 STEMI patients were referred for primary PCI at our intervention laboratory. Three predefined referral routes were compared: (1) for patients within 90 min drive of the PCI centre, pre-hospital diagnosis and direct transportation (n=166), (2) diagnosis at the interventional hospital emergency department (n=316), (3) diagnosis at local hospitals before transportation (n = 176). Pre-hospital diagnosis was associated with more than 45 min reduction in treatment delay (P = 0.001). No significant difference in in-hospital mortality was apparent in the overall study population. In the cardiogenic shock subgroup (n = 80), pre-hospital diagnosis was associated with a two-thirds reduction in in-hospital mortality (P = 0.019); mortality was only 6.2% in shock patients who underwent PCI in < 2 h.
This study shows that pre-hospital diagnosis can provide a reduction in primary PCI treatment delay, and suggests the hypothesis that this referral strategy might provide survival benefits to patients with cardiogenic shock.
Rationale, aims and objectives Early reperfusion is the key to therapeutic success in acute myocardial infarction (AMI). The duration of the process is influenced by various factors which in most of ...the cases are not easily modifiable. The aim of this study is to analyse AMI treatment process duration to identify determining factors. The objective is to better exploit time intervals imposed by spatial distance from the hospital.
Method One‐year data regarding acute coronary syndromes with elevated ST segment for patients presenting to Policlinico teaching hospital (Modena, Italy) have been studied. Patients were divided into two groups for hospital access: A – ambulance access to Policlinico emergency room (ER); B – self‐referral to ER.
Results A total of 141 patients have undergone percutaneous transluminal coronary angioplasty for AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B, P 0.002), with an average age of 66.09 ± 14.30 years in group A and 60.90 ± 13.47 in B (P 0.047). Mean pre‐hospital time for group A was 122.54 ± 130.69 minutes and B 171.49 ± 353.60 (P 0.25), mean hospital time in group A was 196.03 ± 67.66 and B 255.14 ± 113.16 (P < 0.001), mean total time in group A was 318.56 ± 146.91 and B 426.63 ± 382.01 (P 0.02).
Discussion Data show that group B suffered on average a 108‐minute delay from symptoms insurgence to definitive treatment. The duration of hospital time plays more important role in this finding than distance from the medical facility. In fact, on the ambulance a medical crew starts the diagnostic and therapeutic process relieving ER from initial evaluation.
The synthesis of a novel and efficient π-extended D-A-π-A organic sensitizer (G3, η = 8.64%) for dye-sensitized solar cells has been accomplished by applying the green chemistry pillars, aiming at ...overriding traditional routes involving organometallic intermediates with innovative synthetic strategies for reducing the waste burden and dye production costs. It has been demonstrated that the obtainment of a complex target sensitizer can be exclusively pursued via direct arylation reactions. Green metrics comparison with those of a traditional synthetic pathway clearly indicates that the new approach has a lower environmental impact in terms of chemical procedures and generated wastes, stressing the importance of the synergy between the molecular design and the synthetic plan in the framework of environmentally friendly routes to back up sustainable development of third-generation photovoltaics. Additionally, the stability of the G3-based photovoltaic devices was also investigated in aging tests on large area devices, evidencing the excellent potentialities of the proposed structure for all practical applications involving inorganic semiconductor/organic dye interfaces.
We present a large area trifunctional glass prototype combining a photo-electrochromic (PEC) device and an organic light-emitting diode (OLED), interfaced through a properly designed electronic ...control system. A 12×17cm2 PEC glass-on-glass module was realized, containing four dyesensitized solar cells (DSSCs) and a central electrochromic (EC) section deposited on the same glass panel. All PEC layers are screen-printed, including the mesoporous electrochromic layer, obtained from a custommade tungsten paste. DSSCs show an efficiency of 2.4%, while the coloration efficiency of the EC section reaches a value of 40 cm2C−1 at 700nm. A 10×8cm2 transparent white OLED was also realized, designed and tailored in order to unbalance the emission of light, i.e. maximizing the bottom emission. The efficiency of large area OLED section reaches 8cd A-1 in the operative conditions and without light outcoupling enhancement systems. The OLED device is clamped on the back of the PEC module and all sections are electrically connected to an external electronic control system. The energy collected by the DSSCs is stored in supercapacitors and used when requested, either applied to the EC section to produce a light shading effect in the daytime, or to the OLED for illumination at night.
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•Trifunctional panel combining a photo-electrochromic device and an OLED module.•All-printed 12×17cm2 PEC module, with DSSC (η=2.4%) and EC area (ΔT =42% @700nm).•10×8cm2 transparent white OLED with an efficiency of 3cd/A at 100mAcm−2.•Screen printable tungsten paste for EC layer low-cost deposition.
Heart rate time series are widely used to characterize physiological states and athletic performance. Among the main indicators of metabolic and physiological states, the detection of metabolic ...thresholds is an important tool in establishing training protocols in both sport and clinical fields. This paper reviews the most common methods, applied to heart rate (HR) time series, aiming to detect metabolic thresholds. These methodologies have been largely used to assess energy metabolism and to identify the appropriate intensity of physical exercise which can reduce body weight and improve physical fitness. Specifically, we focused on the main nonlinear signal evaluation methods using HR to identify metabolic thresholds with the purpose of identifying a method which can represent a useful tool for the real-time settings of wearable devices in sport activities. While the advantages and disadvantages of each method, and the possible applications, are presented, this review confirms that the nonlinear analysis of HR time series represents a solid, robust and noninvasive approach to assess metabolic thresholds.
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