Background: Prophylaxis of venous thromboembolism (VTE) in hospitalized medical patients is largely underused. We sought to assess the value of a simple risk assessment model (RAM) for the ...identification of patients at risk of VTE. Methods: In a prospective cohort study, 1180 consecutive patients admitted to a department of internal medicine in a 2‐year period were classified as having a high or low risk of VTE according to a predefined RAM. They were followed‐up for up to 90 days to assess the occurrence of symptomatic VTE complications. The primary study outcome was to assess the adjusted hazard ratio (HR) of VTE in high‐risk patients who had adequate in‐hospital thromboprophylaxis in comparison with those who did not, and that of VTE in the latter group in comparison with low‐risk patients. Results: Four hundred and sixty‐nine patients (39.7%) were labelled as having a high risk of thrombosis. VTE developed in four of the 186 (2.2%) who received thromboprophylaxis, and in 31 of the 283 (11.0%) who did not (HR of VTE, 0.13; 95% CI, 0.04–0.40). VTE developed also in two of the 711 (0.3%) low‐risk patients (HR of VTE in high‐risk patients without prophylaxis as compared with low‐risk patients, 32.0; 95% CI, 4.1–251.0). Bleeding occurred in three of the 186 (1.6%) high‐risk patients who had thromboprophylaxis. Conclusions: Our RAM can help discriminate between medical patients at high and low risk of VTE. The adoption of adequate thromboprophylaxis in high‐risk patients during hospitalization leads to longstanding protection against thromboembolic events with a low risk of bleeding.
There is a growing number of applications demanding highly sensitive photodetectors in the mid-infrared. Thermal photodetectors, such as bolometers, have emerged as the technology of choice, because ...they do not need cooling. The performance of a bolometer is linked to its temperature coefficient of resistance (TCR, ∼2-4% K
for state-of-the-art materials). Graphene is ideally suited for optoelectronic applications, with a variety of reported photodetectors ranging from visible to THz frequencies. For the mid-infrared, graphene-based detectors with TCRs ∼4-11% K
have been demonstrated. Here we present an uncooled, mid-infrared photodetector, where the pyroelectric response of a LiNbO
crystal is transduced with high gain (up to 200) into resistivity modulation for graphene. This is achieved by fabricating a floating metallic structure that concentrates the pyroelectric charge on the top-gate capacitor of the graphene channel, leading to TCRs up to 900% K
, and the ability to resolve temperature variations down to 15 μK.
The FLUKA Monte Carlo code is used extensively at CERN for all beam-machine interactions, radioprotection calculations and facility design of forthcoming projects. Such needs require the code to be ...consistently reliable over the entire energy range (from MeV to TeV) for all projectiles (full suite of elementary particles and heavy ions). Outside CERN, among various applications worldwide, FLUKA serves as a core tool for the HIT and CNAO hadron-therapy facilities in Europe. Therefore, medical applications further impose stringent requirements in terms of reliability and predictive power, which demands constant refinement of sophisticated nuclear models and continuous code improvement. Some of the latest developments implemented in FLUKA are presented in this paper, with particular emphasis on issues and concerns pertaining to CERN and medical applications.
Graphene edges are of particular interest since their orientation determines the electronic properties. Here we present a detailed Raman investigation of graphene flakes with edges oriented at ...different crystallographic directions. We also develop a real space theory for Raman scattering to analyze the general case of disordered edges. The position, width, and intensity of G and D peaks are studied as a function of the incident light polarization. The D-band is strongest for polarization parallel to the edge and minimum for perpendicular. Raman mapping shows that the D peak is localized in proximity of the edge. For ideal edges, the D peak is zero for zigzag orientation and large for armchair, allowing in principle the use of Raman spectroscopy as a sensitive tool for edge orientation. However, for real samples, the D to G ratio does not always show a significant dependence on edge orientation. Thus, even though edges can appear macroscopically smooth and oriented at well-defined angles, they are not necessarily microscopically ordered.
Mental and substance use disorders are common and often persistent, with many emerging in early life. Compared to adult mental and substance use disorders, the global burden attributable to these ...disorders in children and youth has received relatively little attention.
Data from the Global Burden of Disease Study 2010 was used to investigate the burden of mental and substance disorders in children and youth aged 0-24 years. Burden was estimated in terms of disability-adjusted life years (DALYs), derived from the sum of years lived with disability (YLDs) and years of life lost (YLLs).
Globally, mental and substance use disorders are the leading cause of disability in children and youth, accounting for a quarter of all YLDs (54.2 million). In terms of DALYs, they ranked 6th with 55.5 million DALYs (5.7%) and rose to 5th when mortality burden of suicide was reattributed. While mental and substance use disorders were the leading cause of DALYs in high-income countries (HICs), they ranked 7th in low- and middle-income countries (LMICs) due to mortality attributable to infectious diseases.
Mental and substance use disorders are significant contributors to disease burden in children and youth across the globe. As reproductive health and the management of infectious diseases improves in LMICs, the proportion of disease burden in children and youth attributable to mental and substance use disorders will increase, necessitating a realignment of health services in these countries.
We show that strong photoluminescence (PL) can be induced in single-layer graphene using an oxygen plasma treatment. The PL is spatially uniform across the flakes and connected to elastic scattering ...spectra distinctly different from those of gapless pristine graphene. Oxygen plasma can be used to selectively convert the topmost layer when multilayer samples are treated.
•The working principle of indirect acting solenoid and indirect acting piezoelectric injectors is illustrated.•The hydraulic performance of solenoid and piezoelectric injectors is compared.•Results ...of tests on emissions, noise and fuel consumption are discussed for solenoid and piezoelectric injectors.•Cause and effect relationships between injector hydraulic performance and engine test results are analysed.•A final evaluation on the effectiveness of the application of piezoelectric injectors to diesel engines is provided.
A comprehensive comparison between solenoid and indirect acting piezoelectric injectors has been carried out. The working principle of these injector typologies is illustrated, and their hydraulic performance has been analysed and discussed on the basis of experimental data collected at a hydraulic test rig. The injector characteristics, injected flow-rate profiles, nozzle opening and closure delays, injector leakages and injected volume fluctuations with the dwell time have been compared in order to evaluate the impact of the injector driving system.
The solenoid and piezoelectric injectors have been installed on a Euro 5 diesel engine, which has been tested experimentally at a dynamometer cell. Optimized double and triple injection strategies have been considered at some representative key points of the New European Driving Cycle. Engine-out emissions, brake specific fuel consumption and combustion noise are presented and discussed, with the support of a three-zone, diesel combustion diagnostic model. The research has focused on the cause-and-effect relationships between the hydraulic performance of the injectors and the results of the engine tests. The primary goal has been to assess if the differences in engine performance between the solenoidal and indirect-acting piezoelectric injector setups are due to the injector driving system or to specific features that are present in the hydraulic circuit of the considered injectors and which are not closely related to the driving system.
A final evaluation of the potential of the piezoelectric technology for driving indirect acting injectors is provided on the basis of real engine results.
Summary
In this study, we compare the extent to which seven available definitions of sarcopenia and two related definitions predict the rate of falling. Our results suggest that the definitions of ...Baumgartner and Cruz-Jentoft best predict the rate of falls among sarcopenic versus non-sarcopenic community-dwelling seniors.
Introduction
The purpose of the study is to compare the extent to which seven available definitions of sarcopenia and two related definitions predict the prospective rate of falling.
Methods
We studied a cohort of 445 seniors (mean age 71 years, 45 % men) living in the community who were followed with a detailed fall assessment for 3 years. For comparing the rate of falls in sarcopenic versus non-sarcopenic individuals, we used multivariate Poisson regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the seven available definitions, three were based on low lean mass alone (Baumgartner, Delmonico 1 and 2) and four required both low muscle mass and decreased performance in a functional test (Fielding, Cruz-Jentoft, Morley, Muscaritoli). The two related definitions were based on low lean mass alone (Studenski 1) and low lean mass contributing to weakness (Studenski 2).
Results
Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non-sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone (RR = 1.54; 95 % CI 1.09–2.18) with 11 % prevalence of sarcopenia and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance (RR = 1.82; 95 % CI 1.24–2.69) with 7.1 % prevalence of sarcopenia. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico 1, Fielding, and Morley.
Conclusion
Among the definitions investigated, the Baumgartner definition and the Cruz-Jentoft definition had the highest validity for predicting the rate of falls.
PDF
