A new approach to scoring systems to improve identification of acute medical admissions that will require critical care

Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years

All-optical versus electro-optical quantum-limited feedback

All-optical feedback can be effected by putting the output of a source cavity through a Faraday isolator and into a second cavity which is coupled to the source cavity by a nonlinear crystal. If the driven cavity is heavily damped, then it can be adiabatically eliminated and a master equation or quantum Langevin equation derived for the first cavity alone. This is done for an input bath in an arbitrary state, and for an arbitrary nonlinear coupling. If the intercavity coupling involves only the intensity (or one quadrature) of the driven cavity, then the effect on the source cavity is identical to that which can be obtained from electro-optical feedback using direct (or homodyne) detection. If the coupling involves both quadratures, this equivalence no longer holds, and a coupling linear in the source amplitude can produce a nonclassical state in the source cavity. The analogous electro-optic scheme using heterodyne detection introduces extra noise which prevents the production of nonclassical light. Unlike the electro-optic case, the all-optical feedback loop has an output beam (reflected from the second cavity). We show that this may be squeezed, even if the source cavity remains in a classical state.Comment: 21 pages. This is an old (1994) paper, but one which I thought was worth posting because in addition to what is described in abstract it has: (1) the first formulation (to my knowledge) of quantum trajectories for an arbitrary (i.e. squeezed, thermal etc.) broadband bath; (2) the prediction of a periodic modification to the detuning and damping of an oscillator for the simplest sort of all-optical feedback (i.e. a mirror) as seen in the recent experiment "Forces between a Single Atom and Its Distant Mirror Image", P. Bushev et al, Phys. Rev. Lett. 92, 223602 (2004

Radiating dipoles in photonic crystals

The radiation dynamics of a dipole antenna embedded in a Photonic Crystal are modeled by an initially excited harmonic oscillator coupled to a non--Markovian bath of harmonic oscillators representing the colored electromagnetic vacuum within the crystal. Realistic coupling constants based on the natural modes of the Photonic Crystal, i.e., Bloch waves and their associated dispersion relation, are derived. For simple model systems, well-known results such as decay times and emission spectra are reproduced. This approach enables direct incorporation of realistic band structure computations into studies of radiative emission from atoms and molecules within photonic crystals. We therefore provide a predictive and interpretative tool for experiments in both the microwave and optical regimes.Comment: Phys. Rev. E, accepte

A single-center, observational study of 607 children & young people presenting with Differences in Sex Development (DSD)

Context Differences in sex development (DSD) represent a wide range of conditions presenting at different ages to various health professionals. Establishing a diagnosis, supporting the family and developing a management plan are important. Objective We aimed to better understand the presentation and prevalence of pediatric DSD. Design A retrospective, observational cohort study was undertaken of all children and young people (CYP) referred to a DSD multi-disciplinary team over 25 years (1995-2019). Setting A single tertiary paediatric center. Participants In total, 607 CYP (520 regional referrals) were included. Main Outcome Measures Data were analyzed for diagnosis, sex-assignment, age and mode of presentation, additional phenotypic features, mortality, and approximate point prevalence. Results Amongst the three major DSD categories, sex chromosome DSD was diagnosed in 11.2% (68/607) (most commonly 45, X/46, XY mosaicism), 46, XY DSD in 61.1% (371/607) (multiple diagnoses often with associated features), while 46, XX DSD occurred in 27.7% (168/607) (often 21-hydroxylase deficiency). Most children (80.1%) presented as neonates, usually with atypical genitalia, adrenal insufficiency, undescended testes or herniae. Those presenting later had diverse features. Rarely, the diagnosis was made antenatally (3.8%, n = 23) or following incidental karyotyping/family history (n = 14). Mortality was surprisingly high in 46, XY children, usually due to complex associated features (46, XY girls, 8.3%; 46, XY boys, 2.7%). The approximate point prevalence of neonatal referrals for investigation of DSD was 1 in 6,347 births, and 1 in 5,101 overall throughout childhood. Conclusions DSD represent a diverse range of conditions that can present at different ages. Pathways for expert diagnosis and management are important to optimize care

Global stabilization of feedforward systems under perturbations in sampling schedule

For nonlinear systems that are known to be globally asymptotically stabilizable, control over networks introduces a major challenge because of the asynchrony in the transmission schedule. Maintaining global asymptotic stabilization in sampled-data implementations with zero-order hold and with perturbations in the sampling schedule is not achievable in general but we show in this paper that it is achievable for the class of feedforward systems. We develop sampled-data feedback stabilizers which are not approximations of continuous-time designs but are discontinuous feedback laws that are specifically developed for maintaining global asymptotic stabilizability under any sequence of sampling periods that is uniformly bounded by a certain "maximum allowable sampling period".Comment: 27 pages, 5 figures, submitted for possible publication to SIAM Journal Control and Optimization. Second version with added remark

A Quantitative Model of Energy Release and Heating by Time-dependent, Localized Reconnection in a Flare with a Thermal Loop-top X-ray Source

We present a quantitative model of the magnetic energy stored and then released through magnetic reconnection for a flare on 26 Feb 2004. This flare, well observed by RHESSI and TRACE, shows evidence of non-thermal electrons only for a brief, early phase. Throughout the main period of energy release there is a super-hot (T>30 MK) plasma emitting thermal bremsstrahlung atop the flare loops. Our model describes the heating and compression of such a source by localized, transient magnetic reconnection. It is a three-dimensional generalization of the Petschek model whereby Alfven-speed retraction following reconnection drives supersonic inflows parallel to the field lines, which form shocks heating, compressing, and confining a loop-top plasma plug. The confining inflows provide longer life than a freely-expanding or conductively-cooling plasma of similar size and temperature. Superposition of successive transient episodes of localized reconnection across a current sheet produces an apparently persistent, localized source of high-temperature emission. The temperature of the source decreases smoothly on a time scale consistent with observations, far longer than the cooling time of a single plug. Built from a disordered collection of small plugs, the source need not have the coherent jet-like structure predicted by steady-state reconnection models. This new model predicts temperatures and emission measure consistent with the observations of 26 Feb 2004. Furthermore, the total energy released by the flare is found to be roughly consistent with that predicted by the model. Only a small fraction of the energy released appears in the super-hot source at any one time, but roughly a quarter of the flare energy is thermalized by the reconnection shocks over the course of the flare. All energy is presumed to ultimately appear in the lower-temperature T<20 MK, post-flare loops

Problems associated with the presence of cyanobacteria in recreational and drinking waters

Eutrophication of waters can lead to the development of blooms of cyanobacteria (blue-green algae) and consequent health and environmental problems. The presence of these organisms in recreational and drinking waters is generally undesirable or even hazardous, although nitrogen fixing blue-green algae can be beneficially used as biofertilisers for plantation crops. This paper reviews the characteristics of cyanobacteria and particularly their toxins. The mechanisms of toxic algal blooms are discussed, as are the factors influencing toxin production. The nuisance and health hazards associated with freshwater bluegreen algae are discussed and the options for public health control are evaluated. The problems associated with statutory control of toxic algae problems is also considered