Abstract Introduction Our goal was to evaluate if traffic-light driven personalized care for COVID-19 was associated with improved survival in acute hospital settings. Methods Discharge outcomes were evaluated before and after prospective implementation of a real-time dashboard with feedback to ward-based clinicians. Thromboembolism categories were “medium-risk” (D-dimer >1000 ng/mL or CRP >200 mg/L); “high-risk” (D-dimer >3000 ng/mL or CRP >250 mg/L) or “suspected” (D-dimer >5000 ng/mL). Cytokine storm risk was categorized by ferritin. Results 939/1039 COVID-19 positive patients (median age 67 years, 563/939 (60%) male) completed hospital encounters to death or discharge by 21st May 2020. Thromboembolism flag criteria were reached by 568/939 (60.5%), including 238/275 (86.6%) of the patients who died, and 330/664 (49.7%) of the patients who survived to discharge, p < 0.0001. Cytokine storm flag criteria were reached by 212 (22.6%) of admissions, including 80/275 (29.1%) of the patients who died, and 132/664 (19.9%) of the patients who survived, p < 0.0001. The maximum thromboembolism flag discriminated completed encounter mortality (no flag: 37/371 [9.97%] died; medium-risk: 68/239 [28.5%]; high-risk: 105/205 [51.2%]; and suspected thromboembolism: 65/124 [52.4%], p < 0.0001). Flag criteria were reached by 535 consecutive COVID-19 positive patients whose hospital encounter completed before traffic-light introduction: 173/535 (32.3% [95% confidence intervals 28.0, 36.0]) died. For the 200 consecutive admissions after implementation of real-time traffic light flags, 46/200 (23.0% [95% confidence intervals 17.1, 28.9]) died, p = 0.013. Adjusted for age and sex, the probability of death was 0.33 (95% confidence intervals 0.30, 0.37) before traffic light implementation, 0.22 (0.17, 0.27) after implementation, p < 0.001. In subgroup analyses, older patients, males, and patients with hypertension (p ≤ 0.01), and/or diabetes (p = 0.05) derived the greatest benefit from admission under the traffic light system. Conclusion Personalized early interventions were associated with a 33% reduction in early mortality. We suggest benefit predominantly resulted from early triggers to review/enhance anticoagulation management, without exposing lower-risk patients to potential risks of full anticoagulation therapy.

Abstract In this investigation, a spectral analysis of the structural response of two reinforced concrete buildings, of 18 m and 56 m of height and with different plan regularity, subjected to ambient vibrations was done. Specifically, natural frequencies and modes of vibrations were determined through applying basic frequency domain (BFD) and frequency domain decomposition (FDD) methods to ambient vibration data acquired by three triaxial accelerometers. At least three vibration modes were identified for each building in a range of frequencies comprehended between 1,0 Hz and 6,0 Hz. Modes with more spectral density were exhibited between frequencies of 1,0 Hz and 3,0 Hz. From mode shapes, it was determined that structures with more plan irregularity presents more torsional modes and coupling of these with flexural modes.

Resumen En esta investigación se realizó un análisis espectral de la respuesta estructural de dos edificios de concreto reforzado, de 18 m y 56 m de altura y con distintos niveles de irregularidad en planta, al ser sometidos a vibraciones ambientales. Específicamente, se han usado el método básico (BFD) y de descomposición en el dominio de la frecuencia (FDD) sobre registros de vibración ambiental adquiridos mediante tres acelerómetros triaxiales para la identificación de las frecuencias y los modos naturales de vibración. Para cada edificio se identificaron al menos tres modos de vibración en un rango de frecuencias comprendido entre 1,0 Hz y 6,0 Hz. Los modos con mayor densidad espectral fueron exhibidos entre las frecuencias de 1,0 Hz y 3,0 Hz. De las formas modales, se evidenció que, entre más irregularidad en planta, mayor será la presencia de modos de torsión y el acoplamiento de estos con modos de flexión.

A doença de McArdle é o tipo mais frequente das glicogenoses. A apresentação clínica característica na infância inclui mialgia e intolerância aos esforços/exercício físico. Frequentemente, os sinais e sintomas das crianças não são considerados devidamente, sendo muitas vezes interpretados como “dores do crescimento”, retardando o diagnóstico. Erros diagnósticos não são raros uma vez que outras doenças, como distrofia muscular ou canalopatias musculares, podem apresentar sintomas semelhantes. Entretanto, um simples teste de exercício físico realizado no ambulatório/consultório médico pode ajudar a identificar estes pacientes pois evidencia o fenômeno second wind, patognomônico da doença de McArdle. Aqui é descrito um relato de caso de um paciente ilustrando o valor do simples 12 minutes walk test.

McArdle disease is the most common of the glycogen storage diseases. Onset of symptoms is usually in childhood with muscle pain and restricted exercise capacity. Signs and symptoms are often ignored in children or put down to ‘growing pains’ and thus diagnosis is often delayed. Misdiagnosis is not uncommon because several other conditions such as muscular dystrophy and muscle channelopathies can manifest with similar symptoms. A simple exercise test performed in the clinic can however help to identify patients by revealing the second wind phenomenon which is pathognomonic of the condition. Here a patient is reported illustrating the value of using a simple 12 minute walk test.