363 research outputs found
Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system
Purpose: Older people often present to the Emergency Department with nonspecific complaints. We aimed (1) to examine characteristics of older patients presenting to the ED triaged with the presentational flowchart âunwell adultâ of the Manchester triage system (MTS) and (2) to assess the different mortality and admission rates among triage categories. Methods: Retrospective cohort study including all consecutive patients aged 70Â years and older who visited the ED of a tertiary care hospital in the Netherlands during a 1-year period. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, hospital admission and ED length of stay. Results: 4255 patients were included in this study. Mean age was 78Â years (IQR 73.9â83.4) and 2098 were male (49.3%). The MTS presentational flowchart âunwell adultâ was the most commonly used flowchart (n = 815, 19.3%). After the infrequent flowchart âmajor traumaâ (n = 9, 13.8%), âunwell adultâ had the highest 30-day mortality (n = 88, 10.8%). When compared to all other flowcharts, patients assigned as âunwell adultâ have significantly higher 30-day mortality rates (OR 1.89 (95%CI 1.46â2.46), p = < 0.001), also when adjusted for age, gender and triage priority (OR 1.75 (95%CI 1.32â2.31), p = < 0.001). Patients from the âunwell adultâ flowchart had the highest hospital admission rate (n = 540, 66.3%), and had among the longest ED length of stay. Conclusions: Older ED patients are most commonly assigned the presentational flowchart âunwell adultâ when using the MTS. Patients in this category have the highest non-trauma mortality and highest hospital admission rates when compared to other presenting complaints
Modern compact star observations and the quark matter equation of state
We present a hybrid equation of state (EoS) for dense matter that satisfies
phenomenological constraints from modern compact star (CS) observations which
indicate high maximum masses (M = 2 M_sun) and large radii (R> 12 km). The
corresponding isospin symmetric EoS is consistent with flow data analyses of
heavy-ion collisions and a deconfinement transition at approx. 0.55 fm^{-3}.
The quark matter phase is described by a 3-flavor Nambu--Jona-Lasinio model
that accounts for scalar diquark condensation and vector meson interactions
while the nuclear matter phase is obtained within the
Dirac-Brueckner-Hartree-Fock (DBHF) approach using the Bonn-A potential. We
demonstrate that both pure neutron stars and neutron stars with quark matter
cores (QCSs) are consistent with modern CS observations. Hybrid star
configurations with a CFL quark core are unstable.Comment: 16 pages, 4 figures; published version, important note added in proo
The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department
The hypothalamic-pituitary-adrenal axis is activated in response to stress. One of the activated hypothalamic hormones is arginine vasopressin, a hormone involved in hemodynamics and osmoregulation. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is a sensitive and stable surrogate marker for arginine vasopressin release. Measurement of copeptin levels has been shown to be useful in a variety of clinical scenarios, particularly as a prognostic marker in patients with acute diseases such as lower respiratory tract infection, heart disease and stroke. The measurement of copeptin levels may provide crucial information for risk stratification in a variety of clinical situations. As such, the emergency department appears to be the ideal setting for its potential use. This review summarizes the recent progress towards determining the prognostic and diagnostic value of copeptin in the emergency department
Eliashberg-type equations for correlated superconductors
The derivation of the Eliashberg -- type equations for a superconductor with
strong correlations and electron--phonon interaction has been presented. The
proper account of short range Coulomb interactions results in a strongly
anisotropic equations. Possible symmetries of the order parameter include s, p
and d wave. We found the carrier concentration dependence of the coupling
constants corresponding to these symmetries. At low hole doping the d-wave
component is the largest one.Comment: RevTeX, 18 pages, 5 ps figures added at the end of source file, to be
published in Phys.Rev. B, contact: [email protected]
Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS
Background: We wished to determine if there were differences in pelvic and non-pelvic tenderness between men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) Type III and men without pelvic pain.
Methods: We performed the Manual Tender Point Survey (MTPS) as described by the American College of Rheumatology on 62 men with CP/CPPS Type IIIA and IIIB and 98 men without pelvic pain. We also assessed tenderness of 10 external pelvic tender points (EPTP) and of 7 internal
pelvic tender points (IPTP). All study participants completed the National Institutes of Health Chronic Prostatitis Symptom Inventory (NIH CPSI).
Results: We found that men with CPPS were significantly more tender in the MTPS, the EPTPS and the IPTPS. CPSI scores correlated with EPTP scale but not with IPTP scale or prostate tenderness. Prostatic tenderness was present in 75% of men with CPPS and in 50% of men without
CPPS. Expressed prostatic fluid leukocytosis was not associated with prostatic tenderness.
Conclusion: Men with CP/CPPS have more tenderness compared to men without CPPS. Tenderness in men with CPPS is distributed throughout the pelvis and not specific to the prostate
Observation of hard scattering in photoproduction events with a large rapidity gap at HERA
Events with a large rapidity gap and total transverse energy greater than 5
GeV have been observed in quasi-real photoproduction at HERA with the ZEUS
detector. The distribution of these events as a function of the
centre of mass energy is consistent with diffractive scattering. For total
transverse energies above 12 GeV, the hadronic final states show predominantly
a two-jet structure with each jet having a transverse energy greater than 4
GeV. For the two-jet events, little energy flow is found outside the jets. This
observation is consistent with the hard scattering of a quasi-real photon with
a colourless object in the proton.Comment: 19 pages, latex, 4 figures appended as uuencoded fil
Measurement of the diffractive structure function in deep inelastic scattering at HERA
This paper presents an analysis of the inclusive properties of diffractive
deep inelastic scattering events produced in interactions at HERA. The
events are characterised by a rapidity gap between the outgoing proton system
and the remaining hadronic system. Inclusive distributions are presented and
compared with Monte Carlo models for diffractive processes. The data are
consistent with models where the pomeron structure function has a hard and a
soft contribution. The diffractive structure function is measured as a function
of \xpom, the momentum fraction lost by the proton, of , the momentum
fraction of the struck quark with respect to \xpom, and of . The \xpom
dependence is consistent with the form \xpoma where
in all bins of and
. In the measured range, the diffractive structure function
approximately scales with at fixed . In an Ingelman-Schlein type
model, where commonly used pomeron flux factor normalisations are assumed, it
is found that the quarks within the pomeron do not saturate the momentum sum
rule.Comment: 36 pages, latex, 11 figures appended as uuencoded fil
Invariant-mass and [gamma]-ray spectroscopy using secondary, radioactive ion beams
Coulomb excitation of secondary beams (5 < Z < 20) at energies
around 250 .1 MeV was explored at GSI. For low-lying states, 7-ray spectroscopy
was utilized, while high-lying excitations were investigated by
means of invariant-mass spectroscopy
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