5,928 research outputs found
Intermingled basins in coupled Lorenz systems
We consider a system of two identical linearly coupled Lorenz oscillators,
presenting synchro- nization of chaotic motion for a specified range of the
coupling strength. We verify the existence of global synchronization and
antisynchronization attractors with intermingled basins of attraction, such
that the basin of one attractor is riddled with holes belonging to the basin of
the other attractor and vice versa. We investigated this phenomenon by
verifying the fulfillment of the mathematical requirements for intermingled
basins, and also obtained scaling laws that characterize quantitatively the
riddling of both basins for this system
SP-Sephadex equilibrium chromatography of bradykinin and related peptides: Application to trypsin-treated human plasma
An analytical method is deseribed for the separation of bradykinin, Lys-bradykinin, and Met-Lys-bradykinin by equilibrium chromatography on SP-Sephadex C-25 eluted in 0.02 Tris-HCl buffer, pH 8.10, 0.12 NaCl. A second elution buffer, 0.02 Tris-HCl buffer, pH 7.70, 0.06 NaCl, serves as a second parameter for the identification of bradykinin and also separates the hormone from plasma bradykinin-potentiating peptides. Ten to one-hundred nanomoles of each peptide can be recovered in high yields, identified by elution position, and measured by bioassay with the isolated guinea pig ileum. The identification of bradykinin as the peptide released by trypsin acting on acid-denatured plasma is documented as an illustration of the method
Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia
IMPORTANCE:
Febrile neutropenia (FN) is the most common oncologic emergency and is among the most deadly. Guidelines recommend risk stratification and outpatient management of both pediatric and adult FN patients deemed to be at low risk of complications or mortality, but our prior single-center research demonstrated that the vast majority (95%) are hospitalized.
OBJECTIVE:
From a nationwide perspective, to determine the proportion of cancer patients of all ages hospitalized after an emergency department (ED) visit for FN, and to analyze variability in hospitalization rates. Our a priori hypothesis was that >90% of US cancer-associated ED FN visits would end in hospitalization.
DESIGN:
Analysis of data from the Nationwide Emergency Department Sample, 2006-2014.
SETTING:
Stratified probability sample of all US ED visits.
PARTICIPANTS:
Inclusion criteria were: (1) Clinical Classification Software code indicating cancer, (2) diagnostic code indicating fever, and (3) diagnostic code indicating neutropenia. We excluded visits ending in transfer.
EXPOSURE:
The hospital at which the visit took place.
MAIN OUTCOMES AND MEASURES:
Our main outcome is the proportion of ED FN visits ending in hospitalization, with an a priori hypothesis of >90%. Our secondary outcomes are: (a) hospitalization rates among subsets, and (b) proportion of variability in the hospitalization rate attributable to which hospital the patient visited, as measured by the intra-class correlation coefficient (ICC).
RESULTS:
Of 348,868 visits selected to be representative of all US ED visits, 94% ended in hospitalization (95% Confidence Interval [CI] 93-94%). Each additional decade of age conferred 1.23x increased odds of hospitalization. Those with private (92%), self-pay (92%), and other (93%) insurance were less likely to be hospitalized than those with public insurance (95%, odds ratios [OR] 0.74-0.76). Hospitalization was least likely at non-metropolitan hospitals (84%, OR 0.15 relative to metropolitan teaching hospitals), and was also less likely at metropolitan non-teaching hospitals (94%, OR 0.64 relative to metropolitan teaching hospitals). The ICC adjusted for hospital random effects and patient and hospital characteristics was 26% (95%CI 23-29%), indicating that 26% of the variability in hospitalization rate was attributable to which hospital the patient visited.
CONCLUSIONS AND RELEVANCE:
Nearly all cancer-associated ED FN visits in the US end in hospitalization. Inter-hospital variation in hospitalization practices explains 26% of the limited variability in hospitalization decisions. Simple, objective tools are needed to improve risk stratification for ED FN patients
Recommended from our members
Variations in Tropical Cyclone Genesis Factors in Simulations of the Holocene Epoch
The thermodynamic factors related to tropical cyclone genesis are examined in several simulations of the middle part of the Holocene epoch when the precession of Earth’s orbit altered the seasonal distribution of solar radiation and in one transient simulation of the millennium preceding the industrial era. The thermodynamic properties most crucial for genesis display a broad stability across both periods, although both orbital variations during the mid-Holocene (MH) 6000 years ago (6ka) and volcanic eruptions in the transient simulation have detectable effects. It is shown that the distribution of top-of-the-atmosphere radiation 6ka altered the Northern Hemisphere seasonal cycle of the potential intensity of tropical cyclones in addition to slightly increasing the difference between middle tropospheric and boundary layer entropy, a parameter that has been related to the incubation period required for genesis. The Southern Hemisphere, which receives more solar radiation during its storm season today than it did 6ka, displays slightly more favorable thermodynamic properties during the MH than in the preindustrial era control. Surface temperatures over the ocean in both hemispheres respond to radiation anomalies more slowly than those in upper levels, altering the thermal stability.
Volcanism produces a sharp but transient temperature response in the last-millennium simulation that strongly reduces potential intensity during the seasons immediately following a major eruption. Here, too, the differential vertical temperature response is key: temperatures in the lower and middle troposphere cool, while those near the tropopause rise. Aside from these deviations, there is no substantial variation in thermodynamic properties over the 1000-yr simulation
Recommended from our members
Tropical Cyclone Genesis Factors in Simulations of the Last Glacial Maximum
Large-scale environmental factors that favor tropical cyclogenesis are calculated and examined in simulations of the Last Glacial Maximum (LGM) from the Paleoclimate Modelling Intercomparison Project Phase 2 (PMIP2). Despite universally colder conditions at the LGM, values of tropical cyclone potential intensity, which both serves as an upper bound on thermodynamically achievable intensity and indicates regions supportive of the deep convection required, are broadly similar in magnitude to those in preindustrial era control simulation. Some regions, including large areas of the central and western North Pacific, feature higher potential intensities at the LGM than they do in the control runs, while other regions including much of the Atlantic and Indian Oceans are lower. Changes in potential intensity are strongly correlated with the degree of surface cooling during the LGM. Additionally, two thermodynamic parameters—one that measures midtropospheric entropy deficits relevant for tropical cyclogenesis and another related to the time required for genesis—are broadly more favorable in the LGM simulation than in the preindustrial era control. A genesis potential index yields higher values for the LGM in much of the western Pacific, a feature common to nearly all of the individual models examined
- …