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Aims: Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high-risk population. The aim of the present study was to assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65 years or older. Methods: Data were obtained from the retrospective phase of Simulation-based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM-AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. Results: A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% (N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug (N = 88). Among the patients prescribed OACs (N = 221), errors in the prescribed doses were the most frequent cause of inappropriate use (N = 55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription. Conclusions: In hospitalized older patients with AF, there is still a high prevalence of inappropriate OAC prescribing. Characteristics usually related to frailty are associated with the inappropriate prescribing. These findings point to the need for targeted interventions designed for internists and geriatricians, aimed at improving the appropriate prescribing of OACs in this complex and high-risk population.

Aims: Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high-risk population. The aim of the present study was to assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65 years or older. Methods: Data were obtained from the retrospective phase of Simulation-based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM-AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. Results: A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% (N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug (N = 88). Among the patients prescribed OACs (N = 221), errors in the prescribed doses were the most frequent cause of inappropriate use (N = 55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription. Conclusions: In hospitalized older patients with AF, there is still a high prevalence of inappropriate OAC prescribing. Characteristics usually related to frailty are associated with the inappropriate prescribing. These findings point to the need for targeted interventions designed for internists and geriatricians, aimed at improving the appropriate prescribing of OACs in this complex and high-risk population.

OBJECTIVES: To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil. METHODS: A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity. RESULTS: Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity. CONCLUSIONS: Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.

Contains fulltext : 96335.pdf (publisher's version ) (Open Access), OBJECTIVE: Increased body iron stores and hepcidin have been hypothesized to promote atherosclerosis by inducing macrophage iron accumulation and release of cytokines, but direct demonstration in human cells is lacking. The aim of this study was to evaluate the effect of iron on cytokine release in monocytes ex vivo and the correlation with vascular damage and to evaluate the relationship among serum levels of hepcidin, cytokines, and vascular damage in patients with metabolic syndrome alterations. METHODS AND RESULTS: Manipulation of iron status with ferric ammonium citrate and hepcidin-25 induced monocyte chemoattractant protein (MCP)-1 and interleukin-6 in human differentiating monocytes of patients with hyperferritinemia associated with the metabolic syndrome (n=11), but not in subjects with hemochromatosis or HFE mutations impairing iron accumulation (n=15), and the degree of induction correlated with the presence of carotid plaques, detected by echocolor-Doppler. In monocytes of healthy subjects (n=7), iron and hepcidin increased the mRNA levels and release of MCP-1, but not of interleukin-6. In 130 patients with metabolic alterations, MCP-1 levels, as detected by ELISA, were correlated with hepcidin-25 measured by time-of-flight mass spectrometry (P=0.005) and were an independent predictor of the presence of carotid plaques (P=0.05). CONCLUSIONS: Hepcidin and macrophage iron correlate with MCP-1 release and vascular damage in high-risk individuals with metabolic alterations.

Contains fulltext : 98343.pdf (publisher's version ) (Closed access), BACKGROUND AND AIMS: Increased ferritin and body iron stores are frequently observed in nonalcoholic fatty liver disease (NAFLD), associated with heightened susceptibility to vascular damage. Conflicting data have been reported on the role of iron in atherosclerosis, with recent data suggesting that excess iron induces vascular damage by increasing levels of the hormone hepcidin, which would determine iron trapping into macrophages, oxidative stress, and promotion of transformation into foam cells. Aim of this study was to investigate the relationship between iron status and cardiovascular damage in NAFLD. METHODS AND RESULTS: Vascular damage was evaluated by common carotid arteries intima-media thickness (CC-IMT) measurement and plaque detection by ecocolor-doppler ultrasonography in 506 patients with clinical and ultrasonographic diagnosis of NAFLD, hemochromatosis gene (HFE) mutations by restriction analysis in 342 patients. Serum hepcidin-25 was measured by time-of-flight mass spectrometry in 143 patients. At multivariate analysis CC-IMT was associated with systolic blood pressure, glucose, LDL cholesterol, abdominal circumference, age, and ferritin (p=0.048). Carotid plaques were independently associated with age, ferritin, glucose, and hypertension. Ferritin reflected iron stores and metabolic syndrome components, but not inflammation or liver damage. Hyperferritinemia was associated with increased vascular damage only in patients with HFE genotypes associated with hepcidin upregulation by iron stores (p<0.0001), and serum hepcidin-25 was independently associated with carotid plaques (p=0.05). CONCLUSION: Ferritin levels, reflecting iron stores, are independent predictors of vascular damage in NAFLD. The mechanism may involve upregulation of hepcidin by increased iron stores in patients not carrying HFE mutations, and iron compartmentalization into macrophages.

Although the main problems with test ban treaty monitoring involve improving methods for discrimination of source types, there are certain problems of continuing interest in the field of yield estimation. In terms of short period body waves and the dependence of mb on yield, these involve the effects of anelastic attenuation, pP, nonlinear phenomena such as spall and influence of 3D structure on amplitude,. A related problem involves the transportability of yield scaling relation, hips between sites in different tectonic settings. We have carried out a number of studies directed at solving these problems. Much of the work has been presented in previous reports, but common themes among the studies are the use of a waveform analysis technique called intercorrelation and a focus on the use of the newly released data from internal Soviet stations. Tile first study reported here concerns the use of the intercorrelation approach on the onset of regional Pn waves to estimate yield. The yield dependence of the source time functions can be clearly observed and measured in the data. The importance of the method is that it provides a yield estimate based on an entirely new type of information (the waveform of the onset of Pn), and it is the type of information available from very small events at short distances. These are the types of data most crucial in the current treaty monitoring environment. The second study is an examination of broad-band yield scaling laws from all U.S. test sites and a correlation with them of results from Soviet sites.

The time and frequency domains are equivalent displays of seismic trace, information, though some qualities of the signal are more easily observed in one domain than the other. The relative frequency excitation of Lg, for instance, is most easily viewed in the frequency domain, but such waveform qualities as the sequence in which pulses arrive in the wave train or the sharpness of pulse onset are most easily studied in the time domain (Murphy and Bennett, 1982, Blandford, 1981). Because of the tremendous complexity of high frequency regional data, most attempts at using it for discrimination purposes have involved analysis of the frequency content of the various arrivals either through transforming selected windows or through multiple bandpass filtering. We report here on our initial attempts to explore the alternative and to discriminate events using those waveform characteristics most easily observed in the time domain. A second advantage of time domain analysis approaches is that they permit a deeper insight into the physical processes creating a seismic signal's character. For this reason, they can be more e3silv used to evaluate the transportabilty of a discriminant to varying geophysical and tectonic regimes. This is an especially important feature in the development of regional discriminants. The most prominent and successful spectral regional discriminants have been empirically developed. This means that they must be redeveloped and reverified in each new area. As we shall show in the following, through rigorous time domain analysis such features as regional depth phases can be identified and used to discriminate. Discriminants based on such simple physical features as source depth should be transportable anywhere. In work recently completed under the treaty verification program, we have proved that such time domain discriminants do exist. In analyzing a test discrimination data set from the western U. S., we have discovered that the onset of P_n is always v

The first part of this report presents a method for simultaneous inversion of near-field explosion waveforms for parameters of the source and structure. The inversion automatically provides information on the trade offs between parameters and error analyses of the resultant models. The source may be parameterized by any of several effective source functions. The structure is parameterized as a layered stack of gradients defined by the velocity at the top of the layer, the velocity gradient within the layer and the depth to the top of the layer. The gradient model is then discretized into homogeneous plane layers, with the layer thickness defined as the wavelength of the predominant period in the data, and synthetics are computed using asymptotic generalized ray theory. For each observed waveform, the residuals consist of the normalized cross-correlation coefficient between the data and synthetics, the difference in normalization factors and the time lag to the peak of cross-correlation. The second part of the report addresses the implications of choosing a particular representation of the RDP on the determination of teleseismic attenuation. This time-domain analysis is based on a near-field to far-field amplitude comparison. The near-field amplitude information is contained in the parameters of the explosion source model assuming amplitude information is contained in the parameters of the explosion source model assuming either the Mueller-Murphy or Helmberger-Hadley representations.

The first part compares the Mueller Murphy and Helmberger Hadley source representations and investigate whether there are any features of the near-field observations which tend to favor one over the other. The scaling relations in the two formalisms are such that the spectra are virtually indistinguishable between 2 and 5 Hz. Although the Mueller Murphy source is too rich in high frequency energy, a moderately low Q value for the near-field crust can make it agree with the observations. In the second part, the vertical particle velocity records for three nuclear explosions (DISCUS THROWER, MUDPACK and MERLIN) detonated in dry tuff of alluvium were modeled using generalized ray theory to determine the effective source functions. It was found that simple ray theory can be used to consistently predict the amplitude of the initial P wave for ranges greater than one depth of burial. At closer ranges the amplitudes are systematically overpredicted. Using the announced yields of the events, a scaling law was determined for source strength of nuclear explosions detonated in dry tuff or alluvium, and was used to predict the amplitudes from several other Yucca Flats events. The third part, introduces a method for the simultaneous inversion of near-field waveforms for source and structure parameters. The source may be parameterized by any of several effective source functions.

It is unlikely that regional data recorded at a newly installed array of stations could be used immediately to reliably discriminate events because of uncertainties about the local characteristics of wave propagation. However, the stations would immediately begin to record P sub nl data from small local events. This raises the possibility that the earthquake data base could be used to calibrate the array for discrimination purposes. The relationships is studied between long period P sub nl data and high frequency regional phases in the western U.S. This report examines the phase P sub g. The high frequency p sub g phase for small, shallow events typically appears as a complex arrival with a duration of several tens of seconds. This is much longer than the possible duration of the effective source time function even with depth phases taken into account. This phenomenon can be explained by synthesizing P sub g using generalized rays which is a practical computational procedure for a simple layer over a half space crustal model. If model responses are computed by progressively adding in rays with one reverberation in the crust, then two and so on, it is observed that a sequence of high frequency arrivals develops spanning the typical duration of P sub g. Each successive resonance phase is associated with a higher order reverberation in the crust. If each arrival contributes a typical amount of high frequency scattered energy, the long duration of P sub g is simple to understand. Keywords: Seismic discrimination.