In order to cope with the occupancy and radiation doses expected at the High-Luminosity LHC, the ATLAS experiment will replace its Inner Detector with an all-silicon Inner Tracker (ITk), consisting ...of pixel and strip subsystems.
In the last two years, several prototype ITk strip modules have been tested using beams of high energy electrons produced at the DESY-II testbeam facility. Tracking was provided by EUDET telescopes. The modules tested are built from two sensor types: the rectangular ATLAS17LS, which will be used in the outer layers of the central barrel region of the detector, and the annular ATLAS12EC, which will be used in the innermost ring (R0) of the forward region. Additionally, a structure with two R0 modules positioned back-to-back has been measured, demonstrating space point reconstruction using the stereo angle of the strips. Finally, one barrel and one R0 module have been measured after irradiation to 40% beyond the expected end-of-lifetime fluence. The data obtained allow for thorough tests of the module performance, including charge collection, noise occupancy, detection efficiency, and tracking performance. The results give confidence that the ITk strip detector will meet the requirements of the ATLAS experiment.
Abstract
Neurodegeneration has multiscalar impacts, including behavioral, neuroanatomical, and neurofunctional disruptions. Can disease-differential alterations be captured across such dimensions ...using naturalistic stimuli? To address this question, we assessed comprehension of four naturalistic stories, highlighting action, nonaction, social, and nonsocial events, in Parkinson’s disease (PD) and behavioral variant frontotemporal dementia (bvFTD) relative to Alzheimer’s disease patients and healthy controls. Text-specific correlates were evaluated via voxel-based morphometry, spatial (fMRI), and temporal (hd-EEG) functional connectivity. PD patients presented action–text deficits related to the volume of action–observation regions, connectivity across motor-related and multimodal-semantic hubs, and frontal hd-EEG hypoconnectivity. BvFTD patients exhibited social–text deficits, associated with atrophy and spatial connectivity patterns along social-network hubs, alongside right frontotemporal hd-EEG hypoconnectivity. Alzheimer’s disease patients showed impairments in all stories, widespread atrophy and spatial connectivity patterns, and heightened occipitotemporal hd-EEG connectivity. Our framework revealed disease-specific signatures across behavioral, neuroanatomical, and neurofunctional dimensions, highlighting the sensitivity and specificity of a single naturalistic task. This investigation opens a translational agenda combining ecological approaches and multimodal cognitive neuroscience for the study of neurodegeneration.
This investigation proposes a lean model of production management for a small and micro enterprise (SME) dealing in packaging production in the auto parts sector, with the purpose of increasing ...efficiency in its production line. To this end, this model integrates study method tools and SMED, seeking to reduce waiting times and unnecessary operations, which have been identified as causing the problem on the basis of an initial diagnosis of the situation. Furthermore, to support and guarantee success in implementing these tools, John Kotter's Change Model is used. After two months of implementation, the results showed a 50% reduction in setup operation time and a 32% decrease in filing operation time, which are bottlenecks in the production process. Thus, with the new indicators, the line efficiency increased by 7% from the initial situation, thus showing improvement.
The cardiovascular disease pandemic has promoted the cardiovascular polypill as one of the most scalable public health strategies to improve cardiovascular risk by increasing accessibility and ...adherence to treatments. Data from randomized clinical trials has shown that the polypill strategy significantly improves adherence as well as risk factor control (cholesterol and blood pressure), however, to date, no information from phase IV registries has been available.
We conducted a multicentre, observational and prospective registry of a polypill-based treatment strategy. A total of 1193 patients in Mexico were included. Patient demographics, clinical history, blood pressure, analysis of blood lipids and the Framingham risk score were measured at baseline and after 12 months of treatment with the CNIC-Ferrer polypill.
At one year with the polypill, systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels changed from mean 146.9 mmHg to 128 mmHg (p <0.001), and from 89.1 mmHg to 80.4 mmHg (p <0.001) respectively. LDLc levels were significantly reduced 132.5–107.6 mg/dL (p <0.001). The 10 year Framingham cardiovascular disease risk was also reduced in the high-risk group (33.7 + 22.0 vs. 21.2 + 14.8; p <0.001) and in the intermediate risk group (23.7 + 14.8 vs. 12.7 + 11.4; p <0.001).
To our knowledge, the results of the current study constitute the first real life data on the impact of a polypill therapy on cardiovascular risk factor control. The results show major improvements on the primary outcome, above and beyond those presented previously in the setting of randomized clinical trials.
To determine the operational characteristics of salivary gland ultrasound (SGU) in the diagnosis of Sjögren’s syndrome (SS) in a population of colombian patients with dry symptoms.
Study of ...diagnostic tests in patients with dry symptoms who consecutively attended the rheumatology consultation (2018–2020). Sociodemographic and clinical data were obtained through a survey, paraclinical and ophthalmological tests, minor salivary gland biopsy, unstimulated salivary flow and SGU (score 0–6 based on De Vita) were done. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (Stata 15®) were calculated. The receiver operating characteristics (ROC) curve was developed.
102 patients were included (34 SS and 68 non-SS), mean age 55.69 (±11.93) years, 94% women. Positive ultrasound (score of 2 or more) was more frequent in the SS group, (70.6% vs. 22.1%, P<0.0001). The sensitivity was the same for grade 2 and 3 (70.59%), with a higher specificity (89.71%) for grade 3 (PPV 77.42% NPV 85.92). The ROC curve from the sum of the glands by means of ultrasound was better than those of the independent glands. The ROC curve of the ultrasound presented a greater area under the curve (0.72 0.61−0.82) than that of the histological analysis (focus score) (0.68 0.59−0.78), P=0.0252.
Salivary gland ultrasound is a useful and reliable method for the classification of SS. Its use could be considered in the future within the SS classification criteria.
Determinar las características operativas de la ecografía de glándula salival (EGS) en el diagnóstico del síndrome de Sjögren (SS) en una población de pacientes colombianos con síntomas secos.
Estudio de pruebas diagnósticas en pacientes con síntomas secos que asistieron a la consulta de reumatología (2018-2020). Se obtuvieron datos sociodemográficos y clínicos a través de una encuesta, pruebas paraclínicas, oftalmológicas, biopsia de glándula salival menor, flujo salival no estimulado y EGS (puntuación 0-6 basada en De Vita). Se calculó la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) (Stata 15®). Se desarrolló la curva de características operativas del receptor (COR).
Se incluyó a 102 pacientes (34 con SS y 68 sin SS), edad media±desviación estándar de 55,69±11,93 años, 94% mujeres. La ecografía positiva (puntuación de 2 o más) fue más frecuente en el grupo de SS, (70,6% vs. 22,1%, p<0,0001). La sensibilidad fue igual para el grado 2 y 3 (70,59%), con una especificidad mayor (89,71%) para el grado 3 (VPP 77,42% VPN 85,92). La curva COR a partir de la sumatoria de las glándulas por medio de ecografía, fue mejor que las de las glándulas independientes. La curva COR de la ecografía presentó una mayor área bajo la curva (0,72 0,61-0,82) que la del análisis histológico (puntuación por focos) (0,68 0,59-0,78), p=0,0252.
La EGS es un método útil y confiable para la clasificación del SS. Se podría plantear su uso a futuro dentro de los criterios clasificatorios de SS.
Resumen: La colitis ulcerativa (CU) es una enfermedad crónica de etiología desconocida, incurable, su curso clínico es intermitente, caracterizado por periodos de remisión y recaídas, su prevalencia ...e incidencia mundial ha venido incrementando. En esta actualización participaron profesionales de la salud, tomadores decisiones y un representante de los pacientes. Todos los involucrados declararon sus conflictos de interés. Se formularon preguntas clínicas contestables y se graduaron los desenlaces. La pesquisa de la información se realizó en Medline/PubMed, Embase, Epistemonikos y LILACS. La búsqueda también abarcó fuentes de literatura gris y se actualizó el 30 de noviembre de 2020 sin restricciones por fecha o idioma. Se implementó la aproximación Grading of Recommendations Assessment, Development and Evaluation (GRADE) para establecer la calidad de la evidencia y la fuerza de las recomendación. Se realizó consenso formal implementando la metodología RAND/UCLA. El documento fue objeto de revisión por pares. Se presenta aquí la versión corta de la Guía de Práctica Clínica para el Tratamiento de la Colitis Ulcerativa en Población Adulta, junto con la evidencia de apoyo y las recomendaciones respectivas. En CU leve a moderada, la budesonida MMX es una opción en caso de falla a 5-ASA, y antes de usar esteroides sistémicos. En CU moderada a severa, infliximab y adalimumab, vedolizumab, ustekinumab y tofacitinib pueden ser usados como terapia de primera línea. En caso de falla a anti-TNF, los mejores resultados son con ustekinumab y tofacitinib. En pacientes con reservoritis refractaria a antibióticos, el tratamiento de elección son los anti-TNF. Abstract: Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.
Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and ...incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice. Resumen: La colitis ulcerativa (CU) es una enfermedad crónica de etiología desconocida, incurable, su curso clínico es intermitente, caracterizado por periodos de remisión y recaídas, su prevalencia e incidencia mundial ha venido incrementando. En esta actualización participaron profesionales de la salud, tomadores decisiones y un representante de los pacientes. Todos los involucrados declararon sus conflictos de interés. Se formularon preguntas clínicas contestables y se graduaron los desenlaces. La pesquisa de la información se realizó en Medline/PubMed, Embase, Epistemonikos y LILACS. La búsqueda también abarcó fuentes de literatura gris y se actualizó el 30 de noviembre de 2020 sin restricciones por fecha o idioma. Se implementó la aproximación GRADE (Grading of Recommendations Assessment, Development and Evaluation) para establecer la calidad de la evidencia y la fuerza de las recomendación. Se realizó consenso formal implementando la metodología RAND/UCLA. El documento fue objeto de revisión por pares. Se presenta aquí la versión corta de La Guía de Práctica Clínica para el Tratamiento de la Colitis Ulcerativa en Población Adulta, junto con la evidencia de apoyo y las recomendaciones respectivas. En CU leve a moderada, la budesonida MMX es una opción en caso de falla a 5-ASA, y antes de usar esteroides sistémicos. En colitis ulcerativa moderada a severa, infliximab y adalimumab, vedolizumab, ustekinumab y tofacitinib pueden ser usado como terapia de primera línea. En caso de falla a anti-TNFs, los mejores resultados son con ustekinumab y tofacitinib. En pacientes con reservoritis refractaria a antibióticos, el tratamiento de elección son los anti-TNFs.
Since the early 2000’s, the Atlas of Variations in Medical Practice in the Spanish National Health System (namely, Atlas VPM) has been analysing and informing unwarranted variations in health care ...provision and outcomes in the Spanish Health System.
Atlas VPM covers a two-fold perspective: a geographic one, where unwarranted variations would reflect the uneven exposure of the population to health care as a consequence of the place of residence; and, a provider-specific approach, where unwarranted variations would reflect differences in utilisation and outcomes that are at provider-level.
Building on routine data (hospital and primary care electronic records, administrative data, geographic information, etc.) Atlas VPM has adapted the classical small area methods and has included a large panoply of techniques, such as Bayesian methods, hierarchical modelling or time-series forecasting.
Led by the Data Science for Health Services and Policy Research group at the Institute for Health Sciences in Aragon, Atlas VPM implies a linkage and exchange process with the 17 Departments of Health of the Spanish regions where the research agenda is shared and research outcomes are translated into profiling and benchmarking interactive tools meant to facilitate clinical and policy decision-making.
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