Background and purpose
There are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated. We evaluated the safety and efficacy of combining ...oral anticoagulation (OAC) with percutaneous left atrial appendage closure (LAAC) in patients with well‐anticoagulated atrial fibrillation (AF) with recurrent strokes.
Methods
In an explorative, prospective, observational study, LAAC was performed in patients with AF with at least two ischaemic strokes in the previous year, despite good anticoagulation using the Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) or Amulet Abbot device (Abbot Vascular, Santa Clara, CA, USA). We recorded age, type of AF, CHA2DS2‐VASC and HAS‐BLED scores, types of OAC and risk factors. After closure, treatment with aspirin (100 mg/day) was continued for 3 months in combination with indefinite OAC. Clinical status, recurrent embolisms and bleeding complications were recorded during follow‐up.
Results
A total of 19 patients were included (mean age, 72.1 ± 9.6 years; mean CHA2DS2‐VASC score, 5.3 ± 1.48; mean number of previous strokes, 2.78 ± 1.15). Thirteen had spontaneous echocardiographic contrast and all had dilatation of the left atrium. Eighteen patients had a multilobulated left atrial appendage, 17 with ‘chicken‐wing’ morphology and one patient had a left atrial appendage thrombus. There were no complications during the procedure. Only one patient had a transient ischaemic attack and no major bleeding occurred during a mean follow‐up of 17.4 ± 11.5 months.
Conclusion
Combination therapy with indefinite OAC plus LAAC in patients with AF with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke.
The crystal growth and morphology of cyclopentane (CP) hydrates at a quiescent water/oil interface in the presence of 10 different surfactants were observed under a microscope. In most cases, the oil ...was CP, but for some of the observations a 50/50 vol % mixture of CP and n-octane (n-C8) (or n-dodecane (n-C12)) was used instead. For some of the surfactants, gas hydrates formed from a methane (CH4)/propane (C3H8) gas mixture at a quiescent water/n-C8 interface were also observed. The capacity of the surfactants to prevent the hydrate particles from agglomerating was assessed by measuring torque on oil-dominated systems (70 vol %) in a stirred autoclave at subcoolings of 6 and 10 °C for the CP hydrates and CH4/C3H8 hydrates, respectively. The oil phases were the same as those used in the morphology study. In the case of CP hydrates, the agglomeration state of the system was directly observed by opening the autoclave at the end of the hydrate formation. The size of the CP hydrate particles was measured, and their wettability was determined. The effect of the presence of salt (NaCl) on the crystal morphology and AA performance was also studied for some systems. All the surfactants that induced the formation of hydrate crystals that rapidly agglomerated at the water/CP interface showed poor AA performance. Whenever the surfactants induced the formation of individual oil-wettable crystals, their AA performance was good. If the individual crystals formed were water-wettable, two main behaviors were observed: (1) when the surfactant induced a very low water/CP interfacial tension (<1 mN/m), its AA performance was good, (2) but when it induced a higher interfacial tension (>1 mN/m), it exhibited poor AA performance. These trends in the AA performance of the surfactants were observed on both hydrate systems (CP hydrates and CH4/C3H8 hydrates). From the experimental results obtained in this work, we can infer that the microscopic observation of the morphology and growth pattern of CP hydrate crystals formed at a quiescent water/CP interface might be a simple way to rapidly assess if a surface-active molecule has an antiagglomeration effect on sII gas hydrates.
Even though reverse logistics has existed as long as forward logistics, growing social concern for the environment has caused reverse logistics activities to become a critical function for many ...organizations. Yet, barriers to implementation of environmentally oriented aspects of reverse logistics still exist. The aim of the present study is to identify the barriers that impede or hinder the implementation of environmentally oriented reverse logistics practices, with a focus on the automotive industry. Empirical evidence and robust statistical analysis provide insights into the practices of environmentally oriented reverse logistics and barriers encountered in the Spanish automotive sector. Using structural equation modelling we are able identify two types of barriers, external and internal, and to study whether these barriers, previously identified in the literature, hinder environmentally oriented reverse logistics practices. The model also allows for identification of the most relevant barriers for the automotive sector.
A review of the impact of noise restrictions at airports Rodríguez-Díaz, A.; Adenso-Díaz, B.; González-Torre, P.L.
Transportation research. Part D, Transport and environment,
January 2017, 2017-01-00, 20170101, Volume:
50
Journal Article
Peer reviewed
Open access
•One big obstacles of air traffic management expansion is environmental concerns.•A regulation and operation procedures implemented summary is provided.•It is necessary to improve ...modelling-simulation-monitoring noise evaluation tools.•Optimization tools that take into account the noise problem are analysed.
One of the biggest obstacles to the building of new airports and expanding runway capacity is environmental concerns, especially noise. In this paper, we review what has been previously studied in the literature concerning the noise reduction problem around airports from the Air Traffic Control (ATC) perspective. In order to facilitate the knowledge of the current situation, a regulation summary from the USA and EU is provided. We mainly focus our research on operational procedures, since they are one of the easiest improvements nowadays for reducing the impact of noise around airports. Moreover, the paper sums up the modelling, monitoring and simulation tools related to noise at airports proposed in the literature. Finally, special care is taken to review the optimization tools, the objective of which is to take into account the noise problem in order to help, or propose alternatives, to reduce its impact from airport operations.
Introduction
Parkinson’s disease (PD) is more frequent in the elderly and increases the risk of respiratory infections. Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in ...advanced disease and second-line therapies.
Methods
A retrospective case–control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st–July 31st 2020) in a tertiary university hospital.
Results
Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included. Fifty-nine percent were males in both groups, with similar age (75.9 ± 9.0 COVID-19 + , 73.9 ± 10.0 COVID-19-), disease duration (8.9 ± 6.2 COVID-19 + , 8.5 ± 5.6 COVID-19-) and PD treatments. COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients. Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs. 14%,
p
= 0.0013). However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17.0, 95% CI 5.0–60.0,
p
< 0.001). When considering severe COVID-19 (admission or death) vs. mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19. In multivariate analysis, only institutionalization OR 5.17, 95% CI 1.57–17,
p
= 0.004 and neoplasm OR 8.0, 95%CI 1.27–49.8,
p
= 0.027 remained significantly associated.
Conclusion
In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity. These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD. Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis.
The dynamic nature of airports demands the development of scheduling algorithms that are computationally efficient and therefore amenable to replanning when new traffic events occur. The main ...objective of this research is to design an algorithm with very low computational times able to minimize delays in the scheduled times of arrival and departure flights in an airport with a mixed-operation runway, under wake vortex separation and Constrained Position Shifting restrictions. The simulated annealing algorithm obtains a 95% improvement on time delays in less than one second of computation for the test instances generated, which means that it can be used online for high-demand scenarios to reduce delays. It has also been tested in a public testbed as well as in a real environment, showing an improvement of 30% in the time delays of real operations at London Gatwick airport.
•New quick algorithm is presented to decide online scheduling of landings•Extensive experiments were conducted with generated and published data•The algorithm produces very competitive solutions in less than one second•Using data from Gatwick airport showed significant improvements vs. current operation
Abstract Despite the evidence of an association between depression and increased inflammatory markers, still little is known in relation to the most severe cases of the disorder i.e., those who fail ...to respond to antidepressants. We have assessed the cytokine profile and cortisol levels in 21 healthy controls (HC) and 19 medicated patients with depression with treatment-resistance (TRD) moderately ill. As an initial exploratory analysis, we have also related cytokine profile to the patient’s clinical treatment outcome after an inpatient admission. Cytokine profile was measured in the serum by the Cytokine Array I kit (Randox® ). Plasma cortisol was carried out using a commercially available for the IMMULITE® system. When compared to healthy controls, depressed patients had higher levels of cortisol, IL-6, IL-10, but lower levels of IL-4 and VEGF. Our exploratory analysis showed subjects who did not go on to respond to the inpatient admission treatment package had lower levels of MCP-1, and a trend toward lower levels of VEGF. Taking together, these data suggest that lack of clinical therapeutic benefit of antidepressants is associated with overall activation of the inflammatory system.
Hundreds of thousands of people in Europe are daily receiving food, thanks to local food banks, run basically by volunteers who collect donations and distribute them to organizations. In this paper, ...data from a sample of food banks working in 13 European countries are analysed using Data Envelopment Analysis (DEA), trying to learn about their profiles and find some clues about the efficiency of their operations, comparing them according to variables such as the number of volunteers and permanent staff, the tonnage of food delivered and the number of people served. Significant inefficiencies were found in the sector as a result of high performance of some food banks, thus setting a high level standard of operational efficiency. Some additional results regarding food bank sizes and performance are presented. En Europe, des centaines de milliers de personnes reçoivent chaque jour de la nourriture grâce à des banques alimentaires locales, qui sont pratiquement exploitées par des bénévoles qui recueillent les dons et les distribuent aux organismes. Dans le présent article, les données d'un échantillon de banques alimentaires oeuvrant dans 13 pays européens sont analysées à l'aide de la méthode d'enveloppement des données pour en savoir plus sur leur profil et le rendement de leurs activités. Elles sont comparées selon des variables comme le nombre de bénévoles et d'employés permanents, la quantité, en tonnes, d'aliments livrés et le nombre de personnes servies. D'importantes inefficacités ont été décelées dans le secteur en raison du rendement élevé de certaines banques alimentaires, fixant ainsi une norme de rendement opérationnel de haut niveau. Des résultats additionnels sur la taille des banques alimentaires et leur rendement sont aussi présentés. Hundert Tausende von Menschen in Europa erhalten täglich Lebensmittel dank der Lebensmittelbanken vor Ort, die hauptsächlich von Ehrenamtlichen betrieben werden, die Spenden sammeln und sie an Organisationen weiterleiten. In diesem Beitrag werden die Daten aus einer Stichprobe von Lebensmittelbanken in 13 europäischen Ländern mithilfe der Data Envelopment Analysis (DEA) analysiert, um über ihre Profile zu erfahren und Anhaltspunkte zur Effizienz ihrer Tätigkeiten zu finden und sie anhand von Variablen miteinander zu vergleichen, wie zum Beispiel die Anzahl der ehrenamtlichen und festen Mitarbeiter, die Tonnenzahl der bereitgestellten Lebensmittel und die Zahl der Empfänger der Lebensmittelhilfe. Man stellte erhebliche Ineffizienzen in dem Sektor fest, die auf die hohe Leistungsfähigkeit einiger Lebensmittelbanken zurückgeht, welche einen hohen Standard der betrieblichen Effizienz vorgeben. Einige weitere Ergebnisse zur Größe und Leistungsfähigkeit von Lebensmittelbanken werden ebenso präsentiert. Cientos de miles de personas en Europa reciben diariamente alimentos gracias a los bancos locales de alimentos, gestionados basicamente por voluntarios que recogen donaciones, y las distribuyen a organizaciones. En el presente documento, se analizan los datos de una muestra de bancos de alimentos que funcionan en 13 países europeos utilizando datos del Análisis Envolvente de Datos (DEA, por sus siglas en inglés), tratando de aprender a partir de sus perfiles y de encontrar algunas pistas sobre la eficiencia de sus operaciones, comparándolas según variables, tales como el número de voluntarios y personal permanente, el tonelaje de alimentos entregados y el número de personas atendidas. Se encontraron ineficiencias significativas en el sector como resultado del alto rendimiento de algunos bancos de alimentos, que establecieron de este modo un estándar de alto nivel de eficiencia operativa. Se presentaron algunos resultados adicionales relativos a los tamaños y al rendimiento de los bancos.
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