The cardiac surgery–associated neutrophil gelatinase-associated lipocalin (CSA-NGAL) score: A potential tool to monitor acute tubular damage

AbstractAcute kidney injury (AKI), defined as a rise in serum creatinine (functional AKI), is a frequent complication after cardiac surgery. The expression pattern of acute tubular damage biomarkers such as neutrophil gelatinase–associated lipocalin (NGAL) has been shown to precede functional AKI and, therefore, may be useful to identify very early tubular damage. The term subclinical AKI represents acute tubular damage in the absence of functional AKI (biomarker positivity without a rise in serum creatinine) and affects hard outcome measures. This potentiates an tubular-damage–based identification of renal injury, which may guide clinical management, allowing for very early preventive-protective strategies. The aim of this paper was to review the current available evidence on NGAL applicability in adult cardiac surgery patients and combine this knowledge with the expert consensus of the authors to generate an NGAL based tubular damage score: The cardiac surgery–associated NGAL Score (CSA-NGAL score). The CSA-NGAL score might be the tool needed to improve awareness and enable interventions to possibly modify these detrimental outcomes. In boldly doing so, it is intended to introduce a different approach in study designs, which will undoubtedly expand our knowledge and will hopefully move the AKI biomarker field forward

Fourteen-year experience with homovital homografts for aortic valve replacement

Two hundred seventy-five unprocessed, viable homograft (“homovital”) aortic valves were used for aortic valve replacement in patients aged 1.5 to 79 years (mean 45.8±19 years) with maximum follow-up of a 14-year period (mean 4.8 years). Ninety-two percent (252 patients) had New York Heart Association class III or IV functional status before operation and 25 underwent emergency operation. Valves were harvested under sterile conditions and kept in nutrient medium 199. Freehand (subcoronary) technique was used in 147 patients and freestanding root replacement was used in 128. Cumulative survival rates for the whole group were 92%±2% at 5 years and 85%±3% at 10 years, as compared with 96%±2% and 94%±4%, respectively, for the 98 patients who underwent isolated root replacement. Multivariate analysis determined that root replacement with associated procedures and operation for prosthetic endocarditis were risk factors for death, whereas previous xenograft valve, operation for endocarditis, and operation for aortic regurgitation were risk factors for reoperation. Actuarial rates for freedom from degenerative valve failure diagnosed at operation, by postmortem examination, or by routine echocardiography were 94%±2% at 5 years and 89%±3% at 10 years. Recipient age younger than 30 years and previous xenograft valve were risk factors for late degeneration. We conclude that homovital valves demonstrate good durability, particularly in patients older than 30 years, who had a 10-year freedom from degeneration rate of 97%

Organizing the Corn-Belt farm for profitable production : based on studies of farms in east-central Illinois

Includes bibliographical references

lidR : an R package for analysis of Airborne Laser Scanning (ALS) data

Airborne laser scanning (ALS) is a remote sensing technology known for its applicability in natural resources management. By quantifying the three-dimensional structure of vegetation and underlying terrain using laser technology, ALS has been used extensively for enhancing geospatial knowledge in the fields of forestry and ecology. Structural descriptions of vegetation provide a means of estimating a range of ecologically pertinent attributes, such as height, volume, and above-ground biomass. The efficient processing of large, often technically complex datasets requires dedicated algorithms and software. The continued promise of ALS as a tool for improving ecological understanding is often dependent on user-created tools, methods, and approaches. Due to the proliferation of ALS among academic, governmental, and private-sector communities, paired with requirements to address a growing demand for open and accessible data, the ALS community is recognising the importance of free and open-source software (FOSS) and the importance of user-defined workflows. Herein, we describe the philosophy behind the development of the lidR package. Implemented in the R environment with a C/C++ backend, lidR is free, open-source and cross-platform software created to enable simple and creative processing workflows for forestry and ecology communities using ALS data. We review current algorithms used by the research community, and in doing so raise awareness of current successes and challenges associated with parameterisation and common implementation approaches. Through a detailed description of the package, we address the key considerations and the design philosophy that enables users to implement user-defined tools. We also discuss algorithm choices that make the package representative of the ‘state-of-the-art' and we highlight some internal limitations through examples of processing time discrepancies. We conclude that the development of applications like lidR are of fundamental importance for developing transparent, flexible and open ALS tools to ensure not only reproducible workflows, but also to offer researchers the creative space required for the progress and development of the discipline

Network development in biological gels: role in lymphatic vessel development

In this paper, we present a model that explains the prepatterning of lymphatic vessel morphology in collagen gels. This model is derived using the theory of two phase rubber material due to Flory and coworkers and it consists of two coupled fourth order partial differential equations describing the evolution of the collagen volume fraction, and the evolution of the proton concentration in a collagen implant; as described in experiments of Boardman and Swartz (Circ. Res. 92, 801–808, 2003). Using linear stability analysis, we find that above a critical level of proton concentration, spatial patterns form due to small perturbations in the initially uniform steady state. Using a long wavelength reduction, we can reduce the two coupled partial differential equations to one fourth order equation that is very similar to the Cahn–Hilliard equation; however, it has more complex nonlinearities and degeneracies. We present the results of numerical simulations and discuss the biological implications of our model

Inflation, cold dark matter, and the central density problem

A problem with high central densities in dark halos has arisen in the context of LCDM cosmologies with scale-invariant initial power spectra. Although n=1 is often justified by appealing to the inflation scenario, inflationary models with mild deviations from scale-invariance are not uncommon and models with significant running of the spectral index are plausible. Even mild deviations from scale-invariance can be important because halo collapse times and densities depend on the relative amount of small-scale power. We choose several popular models of inflation and work out the ramifications for galaxy central densities. For each model, we calculate its COBE-normalized power spectrum and deduce the implied halo densities using a semi-analytic method calibrated against N-body simulations. We compare our predictions to a sample of dark matter-dominated galaxies using a non-parametric measure of the density. While standard n=1, LCDM halos are overdense by a factor of 6, several of our example inflation+CDM models predict halo densities well within the range preferred by observations. We also show how the presence of massive (0.5 eV) neutrinos may help to alleviate the central density problem even with n=1. We conclude that galaxy central densities may not be as problematic for the CDM paradigm as is sometimes assumed: rather than telling us something about the nature of the dark matter, galaxy rotation curves may be telling us something about inflation and/or neutrinos. An important test of this idea will be an eventual consensus on the value of sigma_8, the rms overdensity on the scale 8 h^-1 Mpc. Our successful models have values of sigma_8 approximately 0.75, which is within the range of recent determinations. Finally, models with n>1 (or sigma_8 > 1) are highly disfavored.Comment: 13 pages, 6 figures. Minor changes made to reflect referee's Comments, error in Eq. (18) corrected, references updated and corrected, conclusions unchanged. Version accepted for publication in Phys. Rev. D, scheduled for 15 August 200

Cosmological parameters from SDSS and WMAP

We measure cosmological parameters using the three-dimensional power spectrum P(k) from over 200,000 galaxies in the Sloan Digital Sky Survey (SDSS) in combination with WMAP and other data. Our results are consistent with a ``vanilla'' flat adiabatic Lambda-CDM model without tilt (n=1), running tilt, tensor modes or massive neutrinos. Adding SDSS information more than halves the WMAP-only error bars on some parameters, tightening 1 sigma constraints on the Hubble parameter from h~0.74+0.18-0.07 to h~0.70+0.04-0.03, on the matter density from Omega_m~0.25+/-0.10 to Omega_m~0.30+/-0.04 (1 sigma) and on neutrino masses from <11 eV to <0.6 eV (95%). SDSS helps even more when dropping prior assumptions about curvature, neutrinos, tensor modes and the equation of state. Our results are in substantial agreement with the joint analysis of WMAP and the 2dF Galaxy Redshift Survey, which is an impressive consistency check with independent redshift survey data and analysis techniques. In this paper, we place particular emphasis on clarifying the physical origin of the constraints, i.e., what we do and do not know when using different data sets and prior assumptions. For instance, dropping the assumption that space is perfectly flat, the WMAP-only constraint on the measured age of the Universe tightens from t0~16.3+2.3-1.8 Gyr to t0~14.1+1.0-0.9 Gyr by adding SDSS and SN Ia data. Including tensors, running tilt, neutrino mass and equation of state in the list of free parameters, many constraints are still quite weak, but future cosmological measurements from SDSS and other sources should allow these to be substantially tightened.Comment: Minor revisions to match accepted PRD version. SDSS data and ppt figures available at http://www.hep.upenn.edu/~max/sdsspars.htm

Cosmic CARNage II: the evolution of the galaxy stellar mass functionin observations and galaxy formation models

We present a comparison of the observed evolving galaxy stellar mass functions with the predictions of eight semi-analytic models and one halo occupation distribution model. While most models are able to fit the data at low redshift, some of them struggle to simultaneously fit observations at high redshift. We separate the galaxies into ‘passive’ and ‘star-forming’ classes and find that several of the models produce too many low-mass star-forming galaxies at high redshift compared to observations, in some cases by nearly a factor of 10 in the redshift range 2.5 < z < 3.0. We also find important differences in the implied mass of the dark matter haloes the galaxies inhabit, by comparing with halo masses inferred from observations. Galaxies at high redshift in the models are in lower mass haloes than suggested by observations, and the star formation efficiency in low-mass haloes is higher than observed. We conclude that many of the models require a physical prescription that acts to dissociate the growth of low-mass galaxies from the growth of their dark matter haloes at high redshift

Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

Background: Oral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.Aim: To investigate the implementation of the software in UK general practice.Design and setting: Process evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.Method: An initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.Results: In a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.Conclusion: Automated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake