The growing energy consumption in the residential sector represents about 30% of global demand. This calls for Demand Side Management solutions propelling change in behaviors of end consumers, with ...the aim to reduce overall consumption as well as shift it to periods in which demand is lower and where the cost of generating energy is lower. Demand Side Management solutions require detailed knowledge about the patterns of energy consumption. The profile of electricity demand in the residential sector is highly correlated with the time of active occupancy of the dwellings; therefore in this study the occupancy patterns in Spanish properties was determined using the 2009–2010 Time Use Survey (TUS), conducted by the National Statistical Institute of Spain. The survey identifies three peaks in active occupancy, which coincide with morning, noon and evening. This information has been used to input into a stochastic model which generates active occupancy profiles of dwellings, with the aim to simulate domestic electricity consumption. TUS data were also used to identify which appliance-related activities could be considered for Demand Side Management solutions during the three peaks of occupancy.
•Active occupancy profiles of Spanish dwellings has been obtained and modeled from Time Use Survey data.•Occupancy profiles resulting from the model can be used to model domestic energy consumption.•The presence of three peaks of active occupation was verified, which coincide with morning, noon and evening.•Manual and incentive-based DSM programmes are considered the most suitable for Spanish dwellings.•TV electricity consumption becomes important at aggregate level.
Background
Hereditary haemorrhagic telangiectasia (HHT) is a rare hereditary multisystem vascular disorder causing visceral arteriovenous malformations and mucocutaneous bleeding. Chronic ...gastrointestinal bleeding and epistaxis often produce profound anaemia refractory to conventional treatment. Bevacizumab, an anti‐vascular endothelial growth factor monoclonal antibody, may be effective in treatment of bleeding in HHT.
Methods
All HHT patients treated with systemic bevacizumab for chronic bleeding were selected for retrospective analysis. Data collected included demographics, baseline HHT characteristics, epistaxis grade, surgical interventions, bevacizumab dosing, adverse events, haemoglobin, red cell transfusions, intravenous iron infusions, and other anaemia and/or bleeding‐directed therapies.
Results
Thirteen HHT patients were treated with bevacizumab for a median of 13.9 (range 4.9–30.1) months. Compared with pretreatment values, bevacizumab treatment increased the mean haemoglobin by 4.0 g dL−1 (95% CI, 2.6–5.3 g dL−1) mean (95% CI) haemoglobin 8.5 (7.8, 9.9) g dL−1 vs. 12.5 (11.2, 13.7) g dL−1, P < 0.001), reduced red cell units transfused by 92% median of 6 (range 0–59) units vs. 0 (range 0–15) units, P = 0.004 and reduced quantity of iron infused by 73% mean (95% CI) 462 (257, 668) mg month−1 vs. 126 (75, 178) mg month−1, P = 0.002. Epistaxis control was achieved in 85% with bevacizumab versus 0% before treatment (P < 0.001). No patient required nasal or GI procedures during the maintenance period. Two patients (15%) developed grade 3 hypertension requiring medical management.
Conclusion
Systemic bevacizumab was highly effective to treat chronic bleeding in HHT. Further study is needed to confirm the magnitude of benefit and further define optimal dosing, treatment duration and long‐term safety.
Studies have shown that some patients with coronavirus disease 2019 (COVID-19) and acute hypoxaemic respiratory failure have preserved lung compliance, suggesting that processes other than alveolar ...damage might be involved in hypoxaemia related to COVID-19 pneumonia.1 The typical imaging features of COVID-19 pneumonia, including peripheral ground-glass opacities with or without consolidation, are also non-specific and can be seen in many other diseases.2 There has been increasing attention on microvascular thrombi as a possible explanation for the severe hypoxaemia related to COVID-19.3,4 Dual-energy CT imaging can be used to characterise lung perfusion and is done as part of the standard protocol for imaging pulmonary embolism at our institution. Three patients with COVID-19, as confirmed by nasopharyngeal RT-PCR at our hospital, who did not have a history of smoking, asthma, chronic obstructive pulmonary disease, or other pulmonary conditions, underwent dual-energy CT imaging for elevated concentrations of D-dimer (>1000 ng/mL) and clinical suspicion of pulmonary emboli. Additionally, the mosaic perfusion pattern did not correspond to findings of bronchial wall thickening or secretions, making airway disease as the main underlying cause of hypoxaemia unlikely. ...these perfusion abnormalities, combined with the pulmonary vascular dilation we observed, are suggestive of intrapulmonary shunting toward areas where gas exchange is impaired, resulting in a worsening ventilation–perfusion mismatch and clinical hypoxia.
The alloy Au–Ag system is an important noble bimetallic phase, both historically (as “Electrum”) and now especially in nanotechnology, as it is applied in catalysis and nanomedicine. To comprehend ...the structural characteristics and the thermodynamic stability of this alloy, a knowledge of its phase diagram is required that considers explicitly its size and shape (morphology) dependence. However, as the experimental determination remains quite challenging at the nanoscale, theoretical guidance can provide significant advantages. Using a regular solution model within a nanothermodynamic approach to evaluate the size effect on all the parameters (melting temperature, melting enthalpy, and interaction parameters in both phases), the nanophase diagram is predicted. Besides an overall shift downward, there is a “tilting” effect on the solidus–liquidus curves for some particular shapes exposing the (100) and (110) facets (cube, rhombic dodecahedron, and cuboctahedron). The segregation calculation reveals the preferential presence of silver at the surface for all the polyhedral shapes considered, in excellent agreement with the latest transmission electron microscopy observations and energy dispersive spectroscopy analysis. By reviewing the nature of the surface segregated element of different bimetallic nanoalloys, two surface segregation rules, based on the melting temperatures and surface energies, are deduced. Finally, the optical properties of Au–Ag nanoparticles, calculated within the discrete dipole approximation, show the control that can be achieved in the tuning of the local surface plasmon resonance, depending of the alloy content, the chemical ordering, the morphology, the size of the nanoparticle, and the nature of the surrounding environment.
Background Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve ...prescription, such as implicit and explicit criteria. Objective To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria.sup.#174; (2015, 2019), the Screening Tool of Older Person's Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. Results A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. Conclusions The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.
Background. The type III secretion system (TTSS) is a major virulence determinant of Pseudomonas aeruginosa. The objective of this study was to determine whether the TTSS genotype is a useful ...prognostic marker of P. aeruginosa bacteremia mortality. We also studied the potential association between TTSS genotypes and multidrug-resistant (MDR) profiles, and how this interaction impacts the outcome of bloodstream infections. Methods. We performed a post hoc analysis of a published prospective multicenter cohort of P. aeruginosa bloodstream infections. The impact in mortality of TTSS genotypes (exoS, exoT, exoU, and exoY genes) and resistance profiles was investigated. Cox regression analysis was used to control for confounding variables. Results. Among 590 patients, the 30-day mortality rate was 30% (175 patients), and 53% of them died in the first 5 days (early mortality). The unadjusted probabilities of survival until 5 days was 31.4% (95% confidence interval CI, 17.4%–49.4%) for the patients with exoU-positive isolates and 53.2% (95% CI, 44.6%–61.5%) for exoU-negative isolates (log rank P = .005). After adjustment for confounders, exoU genotype (adjusted hazard ratio aHR, 1.90 95% CI, 1.15–3.14; P = .01) showed association with early mortality. In contrast, late (30-day) mortality was not influenced by TTSS genotype but was independently associated with MDR profiles (aHR, 1.40 95% CI, 1.01–1.94; P = .04). Moreover, the exoU genotype (21% of all isolates) was significantly less frequent (13%) among MDR strains (particularly among extensively drug-resistant isolates, 5%), but was positively linked to moderately resistant (1–2 antipseudomonals) phenotypes (34%). Conclusions. Our results indicate that the exoU genotype, which is associated with specific susceptibility profiles, is a relevant independent marker of early mortality in P. aeruginosa bacteremia.
Skeletal muscle power has been demonstrated to be a stronger predictor of functional limitations than any other physical capability. However, no validated alternatives exist to the usually expensive ...instruments and/or time-consuming methods to evaluate muscle power in older populations. Our aim was to validate an easily applicable procedure to assess muscle power in large cohort studies and the clinical setting and to assess its association with other age-related outcomes.
Forty community dwelling older adults (70–87 years) and 1804 older subjects (67–101 years) participating in the Toledo Study for Healthy Aging were included in this investigation. Sit-to-stand (STS) velocity and muscle power were calculated using the subject's body mass and height, chair height and the time needed to complete five STS repetitions, and compared with those obtained in the leg press exercise using a linear position transducer. In addition, STS performance, physical (gait speed) and cognitive function, sarcopenia (skeletal muscle index (SMI)) and health-related quality of life (HRQoL) were recorded to assess the association with the STS muscle power values.
No significant differences were found between STS velocity and power values and those obtained from the leg press force-velocity measurements (mean difference ± 95% CI = 0.02 ± 0.05 m·s−1 and 6.9 ± 29.8 W, respectively) (both p > 0.05). STS muscle power was strongly associated with maximal muscle power registered in the leg press exercise (r = 0.72; p < 0.001). In addition, cognitive function and SMI, and physical function, were better associated with absolute and relative STS muscle power, respectively, than STS time values after adjusting by different covariates. In contrast, STS time was slightly more associated with HRQoL than STS muscle power measures.
The STS muscle power test proved to be a valid, and in general, a more clinically relevant tool to assess functional trajectory in older people compared to traditional STS time values. The low time, space and material requirements of the STS muscle power test, make this test an excellent choice for its application in large cohort studies and the clinical setting.
•Sit-to-stand power was calculated from: sit-to-stand time, chair height, body mass and height.•Sit-to-stand power was similar to that obtained from a validated instrument in the leg press exercise.•Sit-to-stand power was independently associated with physical and cognitive function, sarcopenia and quality of life.
Microbial communities of natural subaerial biofilms developed on granitic historic buildings of a World Heritage Site (Santiago de Compostela, NW Spain) were characterized and cultured in liquid BG11 ...medium. Environmental barcoding through next-generation sequencing (Pacific Biosciences) revealed that the biofilms were mainly composed of species of Chlorophyta (green algae) and Ascomycota (fungi) commonly associated with rock substrata. Richness and diversity were higher for the fungal than for the algal assemblages and fungi showed higher heterogeneity among samples. Cultures derived from natural biofilms showed the establishment of stable microbial communities mainly composed of Chlorophyta and Cyanobacteria. Although most taxa found in these cultures were not common in the original biofilms, they are likely common pioneer colonizers of building stone surfaces, including granite. Stable phototrophic multi-species cultures of known microbial diversity were thus obtained and their reliability to emulate natural colonization on granite should be confirmed in further experiments.
Neutrophils eliminate pathogens efficiently but can inflict severe damage to the host if they over-activate within blood vessels. It is unclear how immunity solves the dilemma of mounting an ...efficient anti-microbial defense while preserving vascular health. Here, we identify a neutrophil-intrinsic program that enabled both. The gene Bmal1 regulated expression of the chemokine CXCL2 to induce chemokine receptor CXCR2-dependent diurnal changes in the transcriptional and migratory properties of circulating neutrophils. These diurnal alterations, referred to as neutrophil aging, were antagonized by CXCR4 (C-X-C chemokine receptor type 4) and regulated the outer topology of neutrophils to favor homeostatic egress from blood vessels at night, resulting in boosted anti-microbial activity in tissues. Mice engineered for constitutive neutrophil aging became resistant to infection, but the persistence of intravascular aged neutrophils predisposed them to thrombo-inflammation and death. Thus, diurnal compartmentalization of neutrophils, driven by an internal timer, coordinates immune defense and vascular protection.
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•Neutrophil aging is an intrinsically driven, bona fide circadian process•Bmal1 and CXCR2 induce neutrophil aging, whereas CXCR4 antagonizes it•Diurnal aging critically dictates how and when neutrophils migrate into tissues•Aging favors neutrophil clearance, thereby protecting the cardiovascular system
Neutrophils display circadian oscillations in numbers and phenotype in the circulation. Adrover and colleagues now identify the molecular regulators of neutrophil aging and show that genetic disruption of this process has major consequences in immune cell trafficking, anti-microbial defense, and vascular health.
We present an atlas of mid-infrared (mid-IR) ∼ 7.5-13 μm spectra of 45 local active galactic nuclei (AGN) obtained with CanariCam on the 10.4 m Gran Telescopio CANARIAS (GTC) as part of an ESO/GTC ...large programme. The sample includes Seyferts and other low-luminosity AGN (LLAGN) at a median distance of 35 Mpc and luminous AGN, namely PG quasars, (U)LIRGs, and radio galaxies (RG) at a median distance of 254 Mpc. To date, this is the largest mid-IR spectroscopic catalogue of local AGN at sub-arcsecond resolution (median 0.3 arcsec). The goal of this work is to give an overview of the spectroscopic properties of the sample. The nuclear 12 μm luminosities of the AGN span more than four orders of magnitude, νL
12 μm ∼ 3 × 1041–1046 erg s−1. In a simple mid-IR spectral index versus strength of the 9.7 μm silicate feature diagram most LLAGN, Seyfert nuclei, PG quasars, and RGs lie in the region occupied by clumpy torus model tracks. However, the mid-IR spectra of some might include contributions from other mechanisms. Most (U)LIRG nuclei in our sample have deeper silicate features and flatter spectral indices than predicted by these models suggesting deeply embedded dust heating sources and/or contribution from star formation. The 11.3 μm polycyclic aromatic hydrocarbon (PAH) feature is clearly detected in approximately half of the Seyfert nuclei, LLAGN, and (U)LIRGs. While the RG, PG quasars, and (U)LIRGs in our sample have similar nuclear νL
12 μm, we do not detect nuclear PAH emission in the RGs and PG quasars.
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