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Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

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World Journal of Clinical Cases 2025年第3期13卷 35-41页

作者： andres Fontalba-Navas Francisco Pozo Muñoz Rogelio Garcia Cisneros Maria Jose Garcia Larrosa Maria del Mar Callejon Gil Ignacio Garcia Delgado Maria Belen Jimenez Martinez Antequera Hospital Northern Málaga Integrated Healthcare AreaAntequera 29200AndalusiaSpain Department of Public Health and Psychiatry University of MálagaMálaga 29010Spain Antequera Hospital Northern Málaga Antequera Integrated Healthcare AreaAntequera 29200MálagaSpain

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot *** diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient *** proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid *** To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital *** The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary *** coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient *** superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of ca

关键词： High complexity unit Chronic multimorbidity Patient-centered care Integrated care Healthcare management

The Early Evolutionary History and Adaptive Radiation of the Pterosauria

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Acta Geologica Sinica(English Edition) 2012年第6期86卷 1356-1365页

作者： Brian andres Department of Geology University of South Florida

Phylogenetic analyses of early pterosaur species are relatively new and contradictory. However, they imply a similar evolutionary history for early pterosaurs： a large divergence of all major early groups of pterosaurs before the first named pterosaur species appeared in the fossil record. This large, unsampled divergence may be a record of the initial adaptive radiation of the pterosaurs, but a recent comprehensive phylogenetic analysis reconstructs named Triassic pterosaur species grouped together in a monophyletic clade with all other major groups diverging later. Ten patterns that characterize adaptive radiations put forward by Gavrilets and Losos （2009） are assessed for congruence with the comprehensive phylogeny and two previous phylogenies to determine which are consistent with our notions of an adaptive radiation. Of the eight patterns that can be applied to pterosaurs, only six vary between pterosaur phylogenies. Of these six patterns, all apply to the three phylogenies with varying amounts of support. For many patterns, however, the comprehensive phylogeny has a greater magnitude, shorter time span, or is the only topology within which they can be assessed. Pterosaurs are characterized by an adaptive radiation no matter which phylogeny is considered, but congruence with the fossil record increases the support and information content of a phylogeny by reducing the time and area within which to reconstruct evolutionary history.

关键词： Pterosauria adaptive radiation phylogeny Triassic

Phylogenetic framework for coevolutionary studies： a compass for exploring jungles of tangled trees

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Current Zoology 2016年第4期62卷 393-403页

作者： andres MARTiNEZ-AQUINO Division Zoologfa Invertebrados Museo de La Plata FCNyM UNLP Paseo del Bosque s/n 1900 La Plata Argentina

Phylogenetics is used to detect past evolutionary events, from how species originated to how their ecological interactions with other species arose, which can mirror cophylogenetic patterns. Cophylogenetic reconstructions uncover past ecological relationships between taxa through inferred coevolutionary events on trees, for example, codivergence, duplication, host-switching, and loss. These events can be detected by cophylogenetic analyses based on nodes and the length and branching pattern of the phylogenetic trees of symbiotic associations, for example, host-parasite. In the past 2 decades, algorithms have been developed for cophylogetenic analyses and implemented in different software, for ex ample, statistical congruence index and event-based methods. Based on the combination of these approaches, it is possible to integrate temporal information into cophylogenetical inference, such as es- timates of lineage divergence times between 2 taxa, for example, hosts and parasites. Additionally, the advances in phylogenetic biogeography applying methods based on parametric process models and combined Bayesian approaches, can be useful for interpreting coevolutionary histories in a scenario of biogeographical area connectivity through time. This article briefly reviews the basics of parasitology and provides an overview of software packages in cophylogenetic methods. Thus, the objective here is to present a phylogenetic framework for coevolutionary studies, with special emphasis on groups of parasitic organisms. Researchers wishing to undertake phylogeny-based coevolutionary studies can use this review as a ＂compass＂ when ＂walking＂ through jungles of tangled phylogenetic trees.

关键词： coevolution cophylogenetic analyses host-parasite molecular systematics parametric biogeography symbiosis.

Fetkin-hydro,a new thermo-hydrological algorithm for low-temperature thermochronological modeling

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Geoscience Frontiers 2021年第3期12卷 186-200页

作者： Francisco Sánchez andres Barrea Federico M.Dávila andres Mora Centro de Investigaciones en Ciencias de la Tierra(CICTERRA) CONICET-UNCFCEFyNCiudad UniversitariaAv.Vélez Sarsfield 16115000 CórdobaArgentina Facultad de Matemática AstronomíaFísica y Computación(FAMAF)Ciudad UniversitariaAv.Medida Allende 21445000 CórdobaArgentina Ecopetrol BotafogoRio de JaneiroBrazil

Despite two decades of major advances in the field of thermochronological modeling,state-of-the-art numerical implementations still rely mostly on burial and exhumation processes to explain radiometric *** though such an approach has proved valuable,failing to account for other first-order geological variables has led to misinterpretations and therefore,calls for a *** this study a new version of the Fetkin(finite element temperature kinematics,Ecopetrol)program is *** new algorithm couples time-dependent hydrological and thermal calculations,thus rendering thermochronological ages that,instead of being solely dependent on the kinematical evolution of a system,conditioning by the fluid flow is also *** contrast with previous thermochronological models,this work considers the influence of effective stress on rock properties(porosity and permeability)and therefore,in thermal *** analyses addressing relevant geological questions show not only the versatility of the code but also,new perspectives on forward low-temperature thermochronological *** circulation through pure-sandstone settings produce colder thermal architectures than those obtained in impermeable *** in cooling ages from models with and without fluid circulation are up to 5 Myr.A 4-fold variation in thrusting rates(0.5 km/Myr to 2 km/Myr)produces a 15-Myr difference in cooling ages in models with fluid flow,which contrasts to much lower differences,only 2 Myr,in domains without(or minimal)fluid circulation.2D thermal solutions in fold-bend-fold thrust belts composed of sandstones remain static despite substantial relief development by kinematic folding.A case-study from Western Argentina,in the Andean Precordillera,confirms the plausibility of the numerical algorithm here posed and raises new questions on the first-order thermal controls in settings under deformation.

关键词： Thermochronology Hydrogeology Fluid flow Numerical modeling

Ascites, refractory ascites and hyponatremia in cirrhosis

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Gastroenterology Report 2017年第2期5卷 104-112,I0001页

作者： Brett Fortune andres Cardenas Department of Gastroenterology and Hepatology Weill Cornell Medical CollegeNYUSA Institut de Malalties Digestivesi Metabolique Hospital ClinicUniversity of BarcelonaBarcelonaSpain

Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and *** is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal *** order to maintain effective arterial blood volume,vasoconstrictor and antinatriuretic pathways are activated,which increase overall sodiumand fluid *** a result of progressive splanchnic arterial vasodilation,intestinal capillary pressure increases and results in the formation of protein-poor fluid within the abdominal cavity due to increased capillary permeability from the hepatic sinusoidal *** some patients,the fluid can translocate across diaphragmatic fenestrations into the pleural space,leading to hepatic *** addition,infectious complications such as spontaneous bacterial peritonitis can ***,as the liver disease progresses related to higher portal pressures,loss of a compensatory cardiac output and further splanchnic vasodilation,kidney function becomes compromised fromworsening renal vasoconstriction as well as the development of impaired solute-free water excretion and severe sodium *** then translate into significant clinical complications,such as refractory ascites,hepatorenal syndrome and hyponatremia,and all are linked to increased ***,liver transplantation is the only curative option for this spectrumof clinical manifestations but ongoing research has led to further insight on alternative *** review will further explore the current understanding on the pathophysiology andmanagement of ascites as well as expand on two advanced clinical consequences of advanced liver disease,refractory ascites and hyponatremia.

关键词： ascites portal hypertension cirrhosis hyponatremia

CNN and MLP neural network ensembles for packet classification and adversary defense

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Intelligent and Converged Networks 2021年第1期2卷 66-82页

作者： Bruce Hartpence andres Kwasinski the GCCIS i-School at the Rochester Institute of Technology RochesterNew YorkNY 14623USA the Department of Computer Engineering KGCOE at the Rochester Institute of TechnologyRochesterNew YorkNY 14623USA

Machine learning techniques such as artificial neural networks are seeing increased use in the examination of communication network research *** to many of these research questions is the need to classify packets and improve ***-Layer Perceptron(MLP)neural networks and Convolutional Neural Networks(CNNs)have been used to successfully identify individual ***,some datasets create instability in neural network *** learning can also be subject to data injection and misclassification *** addition,when attempting to address complex communication network challenges,extremely high classification accuracy is *** network ensembles can work towards minimizing or even eliminating some of these problems by comparing results from multiple *** ensembles tuning,training time can be reduced,and a viable and effective architecture can be *** of their effectiveness,ensembles can be utilized to defend against data poisoning attacks attempting to create classification *** this work,ensemble tuning and several voting strategies are explored that consistently result in classification accuracy above 99%.In addition,ensembles are shown to be effective against these types of attack by maintaining accuracy above 98%.

关键词： Convolutional Neural Network(CNN) Multi-Layer Perception(MLP) ensemble classification adversary

Endotoxin-induced alterations of adipose tissue function:a pathway to bovine metabolic stress

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Journal of Animal Science and Biotechnology 2024年第4期15卷 1391-1407页

作者： Miguel Chirivi G.andres Contreras Department of Large Animal Clinical Sciences Michigan State UniversityEast LansingMIUSA

During the periparturient period, dairy cows exhibit negative energy balance due to limited appetite and increased energy requirements for lactogenesis. The delicate equilibrium between energy availability and expenditure puts cows in a state of metabolic stress characterized by excessive lipolysis in white adipose tissues(AT), increased production of reactive oxygen species, and immune cell dysfunction. Metabolic stress, especially in AT, increases the risk for metabolic and inflammatory diseases. Around parturition, cows are also susceptible to endotoxemia. Bacterial-derived toxins cause endotoxemia by promoting inflammatory processes and immune cell infiltration in different organs and systems while impacting metabolic function by altering lipolysis, mitochondrial activity, and insulin sensitivity. In dairy cows, endotoxins enter the bloodstream after overcoming the defense mechanisms of the epithelial barriers, particularly during common periparturient conditions such as mastitis, metritis, and pneumonia, or after abrupt changes in the gut microbiome. In the bovine AT, endotoxins induce a pro-inflammatory response and stimulate lipolysis in AT, leading to the release of free fatty acids into the bloodstream. When excessive and protracted, endotoxin-induced lipolysis can impair adipocyte's insulin signaling pathways and lipid synthesis. Endotoxin exposure can also induce oxidative stress in AT through the production of reactive oxygen species by inflammatory cells and other cellular components. This review provides insights into endotoxins' impact on AT function, highlighting the gaps in our knowledge of the mechanisms underlying AT dysfunction, its connection with periparturient cows' disease risk, and the need to develop effective interventions to prevent and treat endotoxemia-related inflammatory conditions in dairy cattle.

关键词： Adipose tissue dysfunction Endotoxin Inflammation Insulin resistance

Topological circuit of a versatile non-Hermitian quantum system

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Science China(Physics,Mechanics & Astronomy) 2022年第1期65卷 53-60页

作者： David-andres Galeano Xiao-Xiao Zhang Jorge Mahecha Instituto de F´ısica Facultad de Ciencias Exactas y NaturalesUniversidad de AntioquiaMedell´ın 050010Colombia Unidad Transacciones T&D Energ´ıa Gerencia Comercial T&D Energ´ıaV.P.T&D Energ´ıaEPMMedell´ın 050015Colombia Department of Physics and Astronomy&Stewart Blusson Quantum Matter Institute University of British ColumbiaVancouver V6T 1Z4Canada RIKEN Center for Emergent Matter Science(CEMS) Saitama 351-0198Japan Department of Chemistry University of British ColumbiaVancouver V6T 1Z4Canada

We propose a resistors,inductors and capacitors(RLC)electrical circuit to theoretically analyze and fully simulate a new type of non-Hermitian Su-Schrieffer-Heeger(SSH)model with complex *** formulate its construction and investigate its properties by taking advantage of the circuit’s *** physical properties can be identified in this system from the normal modes of oscillation of the RLC circuit,including the highly tunable bulk-edge correspondence between topological winding numbers and edge states and the non-Hermitian skin phenomenon originating from a novel complex energy plane *** present study is able to show the wide and appealing topological physics inherent to electric circuits,which is readily generalizable to a plenty of both Hermitian and non-Hermitian nontrivial systems.

关键词： topolectric circuit SSH model non-Hermitian topology skin effect

Biaxial versus uniaxial strain tuning of single-layer MoS_(2)

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Nano Materials Science 2022年第1期4卷 44-51页

作者： Felix Carrascoso Riccardo Frisenda andres Castellanos-Gomez Materials Science Factory Instituto de Ciencia de Materiales de Madrid(ICMM-CSIC)28049Madrid Spain

Strain engineering has arisen as a powerful technique to tune the electronic and optical properties of twod imensional semiconductors like molybdenum disulfide(MoS_(2)).Although several theoretical works predicted that biaxial strain would be more effective than uniaxial strain to tune the band structure of MoS_(2),a direct experimental verification is still missing in the *** we implemented a simple experimental setup that allows to apply biaxial strain through the bending of a cruciform polymer *** used the setup to study the effect of biaxial strain on the differential reflectance spectra of 12 single-layer MoS_(2)flakes finding a redshift of the excitonic features at a rate between-40 meV/%and-110 meV/%of biaxial *** also directly compare the effect of biaxi al and uniaxial strain on the same single-layer MoS_(2)finding that the biaxial strain gauge factor is 2.3 times larger than the uniaxial strain one.

关键词： finding layer gauge