A novel approach for designing the next generation of vertex detectors foresees to employ wafer-scale sensors that can be bent to truly cylindrical geometries after thinning them to thicknesses of ...20–40 μm. To solidify this concept, the feasibility of operating bent MAPS was demonstrated using 1.5cm×3cm ALPIDE chips. Already with their thickness of 50µm, they can be successfully bent to radii of about 2cm without any signs of mechanical or electrical damage. During a subsequent characterisation using a 5.4GeV electron beam, it was further confirmed that they preserve their full electrical functionality as well as particle detection performance.
In this article, the bending procedure and the setup used for characterisation are detailed. Furthermore, the analysis of the beam test, including the measurement of the detection efficiency as a function of beam position and local inclination angle, is discussed. The results show that the sensors maintain their excellent performance after bending to radii of 2cm, with detection efficiencies above 99.9% at typical operating conditions, paving the way towards a new class of detectors with unprecedented low material budget and ideal geometrical properties.
This paper describes the simulation framework of the extreme energy events (EEE) experiment. EEE is a network of cosmic muon trackers, each made of three multi-gap resistive plate chambers (MRPC), ...able to precisely measure the absolute muon crossing time and the muon integrated angular flux at the ground level. The response of a single MRPC and the combination of three chambers have been implemented in a GEANT4-based framework (GEMC) to study the telescope response. The detector geometry, as well as details about the surrounding materials and the location of the telescopes have been included in the simulations in order to realistically reproduce the experimental set-up of each telescope. A model based on the latest parametrization of the cosmic muon flux has been used to generate single muon events. After validating the framework by comparing simulations to selected EEE telescope data, it has been used to determine detector parameters not accessible by analysing experimental data only, such as detection efficiency, angular and spatial resolution.
The MIS-HF in clinical practice Gingele, A. J.; Boyne, J.; Knackstedt, C. ...
Netherlands heart journal,
12/2022, Letnik:
30, Številka:
12
Journal Article
Odprti dostop
...we tried to recruit general physicians to use the recommendations from MIS-HF for the referral of heart failure patients. ...scoring of NYHA class may not be seen in isolation. ...bridging the gap ...between risk assessment and clinical decision-making is urgently warranted.
The goal of the PolarquEEEst experiment was to measure the cosmic charged particle rate at latitudes greater than 66
∘
N, where no systematic and accurate measurements at sea level have ever been ...performed. A latitude range well above the Arctic Circle was explored on board of a sailboat, up to the unprecedented northernmost value of
82
∘
07
′
N. In this paper a description of the experimental set-up is reported, then the procedures for calibration and data analysis are described in detail. The results show that the rate measured in this latitude range stays constant within a novel accuracy of
±
1
%.
An experimental investigation of cosmic muons has been carried out with the Muography of Etna Volcano (MEV) tracking telescope, installed at an altitude of about 3100 m a.s.l. in front of the ...North-East Etna crater. The analysis of a statistically significant data sample (
∼
10
7
events), taken during a period of approximately 2 months, has been carried out to investigate the angular distribution of cosmic muons originating both from the open sky side and from a large solid rock thickness (Etna side). Due to the geographical orientation of the MEV telescope, anisotropies caused by the East–West effect could also be observed, extracting the asymmetry factor in small steps of the zenithal angle.
Aims
The aim of this study was to evaluate whether biomarkers reflecting pathophysiological pathways are different between heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) ...and whether the prognostic value of biomarkers is different in HFpEF vs. HFrEF.
Methods and results
A total of 458 HFrEF (LVEF ≤40%) and 112 HFpEF (LVEF ≥50%) patients aged ≥60 years with NYHA class ≥II from TIME‐CHF were included. Endpoints are 18‐month overall and HF hospitalization‐free survival. After correction for baseline characteristics that differed between the HF types, i.e. age, gender, body mass index, systolic blood pressure, cause of HF, and AF, HFpEF patients exhibited higher soluble interleukin 1 receptor‐like 1 ST2; 37.6 (28.5–54.7) vs. 35.7 (25.6–52.2), P = 0.02, high sensitivity C‐reactive protein (hsCRP; 8.54 (3.39–25.86) vs. 6.66 (2.42–15.39), P = 0.01), and cystatin‐C 1.94 (1.57–2.37) vs. 1.75 (1.39–2.12), P = 0.01. In contrast, HFrEF patients exhibited higher NT‐proBNP 2142 (1473–4294) vs. 4202 (2239–7411), P < 0.001, high sensitivity troponin T hsTnT; 27.7 (16.8–48.0) vs. 32.4 (19.2–59.0), P = 0.03, and haemoglobin 124 (110–135) vs. 134 (122–145), P < 0.001. In addition to these clinical characteristics, NT‐proBNP, haemoglobin, cystatin‐C, hsTnT, and ST2 improved the area under the curve from 0.86 (0.82–0.89) to 0.91 (0.87–0.94; P < 0.001) for discriminating HFpEF from HFrEF. There were no significant interactions between HFpEF and HFrEF when considering the prognostic value of the investigated biomarkers (P > 0.10 for both endpoints), except for cystatin‐C which had less prognostic impact in HFpEF (P < 0.01).
Conclusion
Biomarker levels suggest a different amount of activation of several pathophysiological pathways between HFpEF and HFrEF. No important differences in the prognostic value of biomarkers in HFpEF vs. HFrEF were found except for cystatin‐C, and for NT‐proBNP in the NT‐proBNP‐guided study arm only, both of which had less prognostic value in HFpEF.
Trial registration
ISRCTN43596477
Background
Clinical management of heart failure with preserved ejection fraction (HFpEF) centres on treating comorbidities and is likely to vary between countries. Thus, to provide insight into the ...current management of HFpEF, studies from multiple countries are required. We evaluated the clinical profiles and current management of patients with HFpEF in the Netherlands.
Methods
We included 2153 patients with HFpEF (defined as a left ventricular ejection fraction ≥ 50%) from the CHECK-HF registry, which included patients from 2013 to 2016.
Results
Median age was 77 (IQR 15) years, 55% were women and the most frequent comorbidities were hypertension (51%), renal insufficiency (45%) and atrial fibrillation (AF, 38%). Patients between 65 and 80 years and those over 80 years had on average more comorbidities (up to 64% and 74%, respectively, with two or more comorbidities) than patients younger than 65 years (38% with two or more comorbidities,
p
-value < 0.001). Although no specific drugs are available for HFpEF, treating comorbidities is advised. Beta-blockers were most frequently prescribed (78%), followed by loop diuretics (74%), renin-angiotensin system (RAS) inhibitors (67%) and mineralocorticoid receptor antagonists (MRAs, 39%). Strongest predictors for loop-diuretic use were older age, higher New York Heart Association class and AF.
Conclusion
The medical HFpEF profile is determined by the underlying comorbidities, sex and age. Comorbidities are highly prevalent in HFpEF patients, especially in elderly HFpEF patients. Despite the lack of evidence, many HFpEF patients receive regular beta-blockers, RAS inhibitors and MRAs, often for the treatment of comorbidities.
Introduction
Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient ...referral is lacking.
Methods
The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre.
Results
Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care.
Conclusion
The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care.
Telemedicine in chronic diseases like heart failure is rapidly evolving and has two important goals: improving and individualising care as well as reducing costs. In this paper, we provide a critical ...and an updated review of the current evidence by discussing the most important trials, meta-analyses and systematic reviews. So far, evidence for the CardioMEMS device is most convincing. Other trials regarding invasive and non-invasive telemonitoring and telephone support show divergent results, but several meta-analyses and systematic reviews uniformly reported a beneficial effect. Voice-over systems and ECG monitoring had neutral results. Lack of direct comparison between different modalities makes it impossible to determine the most effective method. Dutch studies showed predominantly non-significant results, mainly due to underpowered studies or because of a high standard of usual care. There are no conclusive results on cost-effectiveness of telemedicine because of the above shortcomings. The adherence of elderly patients was good in the trials, being essential for the compliance of telemedicine in the entire heart failure population. In the future perspective, telemedicine should be better standardised and evolve to be more than an addition to standard care to improve care and reduce costs.
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