Thermally Promoted Cation Exchange at the Solid State in the Transmission Electron Microscope: How It Actually Works.

Cation exchange offers a strong postsynthetic tool for nanoparticles that are unachievable via direct synthesis, but its velocity makes observing the onset of the reaction in the liquid state almost impossible. After successfully proving that cation exchange reactions can be triggered, performed, and followed live at the solid state by an in situ transmission electron microscopy approach, we studied the deep mechanisms ruling the onset of cation exchange reactions, i.e., the adsorption, penetration, and diffusion of cations in the host matrices of two crystal phases of CdSe. Exploiting an in situ scanning transmission electron microscopy approach with a latest generation heating holder, we were able to trigger, freeze, and image the initial stages of cation exchange with much higher detail. Also, we found a connection between the crystal structure of CdSe, the starting temperature, and the route of the cation exchange reaction. All the experimental results were further reviewed by molecular dynamics simulations of the whole cation exchange reaction divided in subsequent steps. The simulations highlighted how the cation exchange mechanism and the activation energies change with the host crystal structures. Furthermore, the simulative results strongly corroborated the activation temperatures and the cation exchange rates obtained experimentally, providing a deeper understanding of its phenomenology and mechanism at the atomic scale.

Arsenosugar extracted from algae: Isolation by anionic exchange solid-phase extraction.

Obtaining reliable speciation data for evaluating dietary exposure, and increasing understanding of arsenic biochemistry in algae, are hindered by the availability of suitable standards of arsenosugars, the major species in these types of samples. Moreover, chemical syntheses of such compounds have been reported to be complex and tedious. The aim of this work was to investigate the feasibility of the anionic exchange SPE cartridges (SAX and WAX) as an easy and quick alternative for the isolation and preconcentration of arsenosugars. Two commercial silica-based SPE cartridges strong anion exchange sorbent (DSC-SAX) and weak anion exchange sorbent (DSC-NH2) were compared for the SPE of three arsenosugars (PO4-Sug, SO3-Sug and SO4-Sug). The effect of pH, ionic strength, type of salt and elution solvent on the elution protocols of these arsenosugars are studied. Eluted solutions from SPE were analyzed by ICP-MS for total arsenic content and IC-ICP-MS for the study of arsenic speciation. The developed SPE procedure allows to obtain a solution containing the three arsenosugars isolated from other arsenic species with recoveries over 75% for SO3-Sug and SO4-Sug, whereas for PO4-Sug were around 45%.

Análisis descriptivo de la simulación de síntomas psicológicos en una muestra forense / Descriptive analysis of malingered psychological symptoms in a forensic sample

INTRODUCCIÓN: La simulación, definida como intento deliberado de mentir o engañar en relación con una enfermedad o discapacidad, exagerando la sintomatología, con el objetivo de obtener un beneficio personal, es un fenómeno complejo, poco estudiado en nuestro contexto profesional. El objetivo de este estudio fue analizar el modo en que se manifiesta dicho fenómeno en el ámbito forense. MATERIAL Y MÉTODOS: Se seleccionó una muestra incidental de 190 sujetos atendidos en la Unidad de Psicología (IMLCFC) durante 16 meses. Se les administró el Inventario estructurado de simulación de síntomas, a la vez que se valoraban ciertos indicadores clínicos de simulación y otros resultados psicométricos. Se realizó un análisis estadístico descriptivo de la muestra, así como de las correlaciones entre sospecha clínica y psicométrica, y entre sensibilidad del instrumento específico y de los instrumentos genéricos. RESULTADOS: El criterio clínico estructurado para detectar la simulación correlaciona moderadamente con el resultado obtenido en el Inventario estructurado de simulación de síntomas; la puntuación total en esta prueba presenta una correlación positiva, aunque atenuada, con los indicadores de exageración del principal test de psicopatología; la simulación es un estilo de respuesta altamente prevalente en sujetos de la jurisdicción social, con un patrón de respuestas significativamente incrementado respecto al observado en muestras penales. DISCUSIÓN: La valoración de la simulación de síntomas psicológicos en el contexto forense requiere de una estrategia multimétodo que incluya el juicio clínico estructurado, instrumentos específicos de detección y otras pruebas psicométricas complementarias, al efecto de generar validez convergente que contribuya a la detección de dicho fenómeno

INTRODUCTION: Malingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. MATERIAL AND METHODS: An incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. RESULTS: The structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. DISCUSSION: The assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon

Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults--Ineffectiveness of Oral Anticoagulation Treatment with VKA.

OBJECTIVE: This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. METHOD: A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. RESULTS: The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC ≥ 2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC < 2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. CONCLUSIONS: The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7-36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%.

El circuito asistencial de la fibrilación auricular en pacientes ambulatorios: estudio observacional Audit fibrilación auricular en el Baix Ebre / The management of atrial fibrillation and characteristics of its current care in outpatients. AFABE observational study

OBJETIVO: Conocer el circuito asistencial de la fibrilación auricular (FA): diagnóstico, tratamiento y seguimiento en el contexto asistencial del sistema sanitario público. DISEÑO: AFABE es un estudio observacional, multicéntrico y descriptivo, con datos retrospectivos relacionados con el diagnóstico, tratamiento y seguimiento de una cohorte de pacientes ambulatorios con FA en el contexto de la atención primaria, servicios de urgencias y cardiología referentes. Emplazamiento: Atención primaria y especializada. Comarca del Baix Ebre. Tarragona. España. Participantes: Muestra representativa de pacientes con FA > 60 años, seleccionados aleatoriamente entre los pacientes registrados en los 22 centros de atención primaria existentes en el territorio del estudio. Mediciones principales: Datos demográficos, comorbilidades, valor CHA2DS2-VASc y HAS_BLED, y patrones asistenciales resultantes entre la atención primaria y servicios referentes. RESULTADOS: Se incluyeron 182 pacientes, de 78,5; DE:7,3 años, y el 50% mujeres. En atención primaria (AP) se realizó el primer contacto en el 68,3% (IC 95% 60,3-76,3) de los casos de FA, de los que un 56,3% (IC 95% 45,2-66,0) fueron enviados al servicio de urgencias del hospital referente. El 72,7% (IC 95% 63,5-79,0) de los tratamientos anticoagulantes orales y el 58,44% (IC 95% 49,4-66,9) de los tratamientos antiarrítmicos se iniciaron en el servicio de urgencias referente. Un 55,9% (IC 95% 47,2-64,7) de los pacientes son seguidos por el servicio de cardiología referente. CONCLUSIONES: El médico de AP realiza el primer contacto de la mayoría de FA y deriva el 55% de los casos al servicio de urgencias hospitalario donde se inician la mayoría de tratamientos específicos de la FA

AIM: To provide insights into the characteristics and management of outpatients when their atrial fibrillation (AF) was first detected: diagnosis, treatment and follow-up in the context of the public health system. DESIGN: AFABE is an observational, multicentre descriptive study with retrospective data collection relating to the practice patterns, management and initial strategies of treatment of patients with diagnosed AF in the context of primary care, emergency and cardiologists of the public health system. Setting: Primary and Specialist care. Baix Ebre region. Tarragona. Spain. Subjects: A representative sample of 182 subjects > 60-year-old with AF who have been randomized, recruited among the registered patients with AF in 22 primary care centres in the area of the study. Mesurements: Demographic data, comorbidities (AF), CHA2DS2-VASc and HAS BLED scores, and practice patterns results between Primary Care and referral services. RESULTS: A total of 182 patients were included (mean age 78.5 SD: 7.3 years; 50% women). Most patients (68.3% 95%CI; 60.3-76.3) had the first contact in Primary Care, of which 56.3% (95%CI;45.2-66.0) were sent to Hospital Emergency Department where 72.7% (95%CI: 63.5-79.0) of the oral anticoagulation and 58.4% (95%CI: 49.4-66.9) of antiarrhytmic treatments were started. More than half (55.9%:95%CI; 47.2-64.7, of patients with permanent AF were followed-up by the Cardiology department. CONCLUSIONS: Most patients with newly diagnosed AF made a first contact with Primary Care, but around half were sent to Hospital Emergency departments, where they were treated with an antiarrhythmic and/or oral anticoagulation

[The management of atrial fibrillation and characteristics of its current care in outpatients. AFABE observational study]. / El circuito asistencial de la fibrilación auricular en pacientes ambulatorios: estudio observacional Audit fibrilación auricular en el Baix Ebre.

AIM: To provide insights into the characteristics and management of outpatients when their atrial fibrillation (AF) was first detected: diagnosis, treatment and follow-up in the context of the public health system. DESIGN: AFABE is an observational, multicentre descriptive study with retrospective data collection relating to the practice patterns, management and initial strategies of treatment of patients with diagnosed AF in the context of primary care, emergency and cardiologists of the public health system. SETTING: Primary and Specialist care. Baix Ebre region. Tarragona. Spain. SUBJECTS: A representative sample of 182 subjects > 60-year-old with AF who have been randomized, recruited among the registered patients with AF in 22 primary care centres in the area of the study. MESUREMENTS: Demographic data, comorbidities (AF), CHA2DS2-VASc and HAS_BLED scores, and practice patterns results between Primary Care and referral services. RESULTS: A total of 182 patients were included (mean age 78.5 SD:7.3 years; 50% women). Most patients (68.3% 95%CI; 60.3-76.3) had the first contact in Primary Care, of which 56.3% (95%CI; 45.2-66.0) were sent to Hospital Emergency Department where 72.7% (95%CI: 63.5-79.0) of the oral anticoagulation and 58.4% (95%CI: 49.4-66.9) of antiarrhytmic treatments were started. More than half (55.9%:95%CI; 47.2-64.7, of patients with permanent AF were followed-up by the Cardiology department. CONCLUSIONS: Most patients with newly diagnosed AF made a first contact with Primary Care, but around half were sent to Hospital Emergency departments, where they were treated with an antiarrhythmic and/or oral anticoagulation.

Prevalencia de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Estudio AFABE / Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study

Introducción y objetivos. La fibrilación auricular significa un grave problema de salud pública por sus complicaciones, por lo que su manejo debería incluir no sólo su tratamiento, sino también la prevención de las complicaciones tromboembólicas. El objetivo principal es conocer las proporciones de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Métodos. Estudio observacional, transversal, retrospectivo, de base poblacional y multicéntrico. Se seleccionó aleatoriamente a 1.043 sujetos mayores de 60 años para realizarles un electrocardiograma en visita concertada. Se registraron variables sociodemográficas, valores en las escalas CHA2DS2-VASc y HAS-BLED, razón internacional normalizada y motivos de no recibir tratamiento anticoagulante oral. Resultados. La prevalencia total de fibrilación auricular fue del 10,9% (intervalo de confianza del 95%, 9,1-12,8%), de la que el 20,1% era desconocida. De la fibrilación auricular conocida, el 23,5% con un valor de CHA2DS2-VASc ≥ 2 no recibía tratamiento anticoagulante y el 47,9% tenía un valor HAS-BLED ≥ 3. La odds ratio de no recibir tratamiento anticoagulante fue 2,04 (intervalo de confianza del 95%, 1,11-3,77) para las mujeres, 1,10 (intervalo de confianza del 95%, 1,05-1,15) para la mayor edad de diagnóstico y 8,61 (intervalo de confianza del 95%, 2,38-31,0) si el valor de CHA2DS2-VASc es < 2. El deterioro cognitivo (15,2%) fue el motivo principal de no recibir tratamiento anticoagulante. Conclusiones. El 20,1% de las fibrilaciones auriculares de pacientes mayores de 60 años son desconocidas previamente y no se trata con anticoagulantes al 23,5% del total (AU)

Introduction and objectives. Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. Methods. A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. Results. The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. Conclusions. The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants (AU)

Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study.

INTRODUCTION AND OBJECTIVES: Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. METHODS: A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. RESULTS: The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. CONCLUSIONS: The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants.