105 research outputs found

    A Period Graph Throughput Estimator for Multiprocessor Systems

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    (Also cross-referenced as UMIACS-TR-2000-49

    Assessing fossil fuel CO_2 emissions in California using atmospheric observations and models

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    Analysis systems incorporating atmospheric observations could provide a powerful tool for validating fossil fuel CO_2 (ffCO_2) emissions reported for individual regions, provided that fossil fuel sources can be separated from other CO_2 sources or sinks and atmospheric transport can be accurately accounted for. We quantified ffCO_2 by measuring radiocarbon (^(14)C) in CO_2, an accurate fossil-carbon tracer, at nine observation sites in California for three months in 2014โ€“15. There is strong agreement between the measurements and ffCO_2 simulated using a high-resolution atmospheric model and a spatiotemporally-resolved fossil fuel flux estimate. Inverse estimates of total in-state ffCO_2 emissions are consistent with the California Air Resources Board's reported ffCO_2 emissions, providing tentative validation of California's reported ffCO_2 emissions in 2014โ€“15. Continuing this prototype analysis system could provide critical independent evaluation of reported ffCO_2 emissions and emissions reductions in California, and the system could be expanded to other, more data-poor regions

    Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

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    <p>Abstract</p> <p>Background</p> <p>Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate.</p> <p>Methods</p> <p>Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores.</p> <p>Results</p> <p>In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p < 0.05), whereas serum creatinine and urea showed no difference.</p> <p>Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of โ‰ฅ9 and a MELD score of โ‰ฅ14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091).</p> <p>Conclusion</p> <p>The long term prediction of mortality or removal from waiting list in patients awaiting liver transplantation might be better assessed by the CTP score than the MELD score. This might have implications for the development of new improved scoring systems.</p

    The prevalence, incidence and natural history of primary sclerosing cholangitis in an ethnically diverse population

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    <p>Abstract</p> <p>Background</p> <p>Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease often associated with inflammatory bowel diseases (IBD). Current epidemiological data are limited to studies of predominantly Caucasian populations. Our aim was to define the epidemiology of PSC in a large, ethnically diverse US population.</p> <p>Methods</p> <p>The Northern California Kaiser Permanente (KP) database includes records from over 3 million people and was searched for cases of PSC between January 2000 and October 2006. All identified charts were reviewed for diagnosis confirmation, IBD co-morbidity, and major natural history endpoints.</p> <p>Results</p> <p>We identified 169 (101 males) cases fulfilling PSC diagnostic criteria with a mean age at diagnosis of 44 years (range 11-81). The age-adjusted point prevalence was 4.15 per 100,000 on December 31, 2005. The age-adjusted incidence per 100,000 person-years was not significantly greater in men 0.45 (95% CI 0.33 - 0.61) than women 0.37 (95% CI 0.26 - 0.51). IBD was present in 109/169 (64.5%) cases and was significantly more frequent in men than women with PSC (73.3% and 51.5%, respectively, p = 0.005). The cumulative average yearly mortality rate was 1.9%. Age and serum sodium, creatinine and bilirubin at diagnosis and albumin at last entry were identified as significant factors associated with death, liver transplant or cholangiocarcinoma.</p> <p>Conclusions</p> <p>The incidence and prevalence of PSC observed in a representative Northern California population are lower compared to previous studies in Caucasian populations and this might reflect differences in the incidence of PSC among various ethnic groups.</p

    Primary sclerosing cholangitis

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    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The mean age at diagnosis is 40 years and men are affected twice as often as women. There is a reported annual incidence of PSC of 0.9โ€“1.31/100,000 and point prevalence of 8.5โ€“13.6/100,000. The onset of PSC is usually insidious and many patients are asymptomatic at diagnosis or have mild symptoms only such as fatigue, abdominal discomfort and pruritus In late stages, splenomegaly and jaundice may be a feature. In most, the disease progresses to cirrhosis and liver failure. Cholangiocarcinoma develops in 8โ€“30% of patients. PSC is thought to be immune mediated and is often associated with inflammatory bowel disease, especially ulcerative colitis. The disease is diagnosed on typical cholangiographic and histological findings and after exclusion of secondary sclerosing cholangitis. Median survival has been estimated to be 12 years from diagnosis in symptomatic patients. Patients who are asymptomatic at diagnosis, the majority of whom will develop progressive disease, have a survival rate greater than 70% at 16 years after diagnosis. Liver transplantation remains the only effective therapeutic option for patients with end-stage liver disease from PSC, although high dose ursodeoxycholic acid may have a beneficial effect

    Assessing fossil fuel CO_2 emissions in California using atmospheric observations and models

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    Analysis systems incorporating atmospheric observations could provide a powerful tool for validating fossil fuel CO_2 (ffCO_2) emissions reported for individual regions, provided that fossil fuel sources can be separated from other CO_2 sources or sinks and atmospheric transport can be accurately accounted for. We quantified ffCO_2 by measuring radiocarbon (^(14)C) in CO_2, an accurate fossil-carbon tracer, at nine observation sites in California for three months in 2014โ€“15. There is strong agreement between the measurements and ffCO_2 simulated using a high-resolution atmospheric model and a spatiotemporally-resolved fossil fuel flux estimate. Inverse estimates of total in-state ffCO_2 emissions are consistent with the California Air Resources Board's reported ffCO_2 emissions, providing tentative validation of California's reported ffCO_2 emissions in 2014โ€“15. Continuing this prototype analysis system could provide critical independent evaluation of reported ffCO_2 emissions and emissions reductions in California, and the system could be expanded to other, more data-poor regions

    The immunobiology of primary sclerosing cholangitis

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    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease histologically characterized by the presence of intrahepatic and/or extrahepatic biliary duct concentric, obliterative fibrosis, eventually leading to cirrhosis. Approximately 75% of patients with PSC have inflammatory bowel disease. The male predominance of PSC, the lack of a defined, pathogenic autoantigen, and the potential role of the innate immune system suggest that it may be due to dysregulation of immunity rather than a classic autoimmune disease. However, PSC is associated with several classic autoimmune diseases, and the strongest genetic link to PSC identified to date is with the human leukocyte antigen DRB01*03 haplotype. The precise immunopathogenesis of PSC is largely unknown but likely involves activation of the innate immune system by bacterial components delivered to the liver via the portal vein. Induction of adhesion molecules and chemokines leads to the recruitment of intestinal lymphocytes. Bile duct injury results from the sustained inflammation and production of inflammatory cytokines. Biliary strictures may cause further damage as a result of bile stasis and recurrent secondary bacterial cholangitis. Currently, there is no effective therapy for PSC and developing a rational therapeutic strategy demands a better understanding of the disease
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