Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study

OBJECTIVES: Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets. METHODS: We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Project (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES or both were included in the study cohort. CKD status was defined using eGFR, derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR <60 mL/min/1.73 m2, and mild CKD or at risk of CKD was defined as eGFR ≥60 mL/min/1.73 m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD and Stages 1-2 (eGFR missing or ≥60 mL/min/1.73 m2), (2) Stage 3a (eGFR 45-59 mL/min/1.73 m2), (3) Stage 3b (eGFR 30-44 mL/min/1.73 m2) and (4) Stages 4-5 (eGFR <30 mL/min/1.73 m2). RESULTS: We identified 6748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared with people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs 11%, respectively), or MINAP only (22% vs 5%), and less likely to be recorded in HES only (36% vs 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared with those recorded in both (adjusted OR 1.61, 95% CI 1.32 to 1.96 and OR 1.60, 95% CI 1.26 to 2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, SE 0.012). CONCLUSIONS: AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity

Three-layer model with absorption for conservative estimation of the maximum acoustic transmission coefficient through the human skull for transcranial ultrasound stimulation.

Transcranial ultrasound stimulation (TUS) has been shown to be a safe and effective technique for non-invasive superficial and deep brain stimulation. Safe and efficient translation to humans requires estimating the acoustic attenuation of the human skull. Nevertheless, there are no international guidelines for estimating the impact of the skull bone. A tissue independent, arbitrary derating was developed by the U.S. Food and Drug Administration to take into account tissue absorption (0.3 dB/cm-MHz) for diagnostic ultrasound. However, for the case of transcranial ultrasound imaging, the FDA model does not take into account the insertion loss induced by the skull bone, nor the absorption by brain tissue. Therefore, the estimated absorption is overly conservative which could potentially limit TUS applications if the same guidelines were to be adopted. Here we propose a three-layer model including bone absorption to calculate the maximum pressure transmission through the human skull for frequencies ranging between 100 kHz and 1.5 MHz. The calculated pressure transmission decreases with the frequency and the thickness of the bone, with peaks for each thickness corresponding to a multiple of half the wavelength. The 95th percentile maximum transmission was calculated over the accessible surface of 20 human skulls for 12 typical diameters of the ultrasound beam on the skull surface, and varies between 40% and 78%. To facilitate the safe adjustment of the acoustic pressure for short ultrasound pulses, such as transcranial imaging or transcranial ultrasound stimulation, a table summarizes the maximum pressure transmission for each ultrasound beam diameter and each frequency

Comparison of Source Images for protons, π−\pi^-'s and Λ\Lambda's in 6 AGeV Au+Au collisions

Source images are extracted from two-particle correlations constructed from strange and non-strange hadrons produced in 6 AGeV Au + Au collisions. Very different source images result from pp vs p$\Lambda$ vs $\pi^-\pi^-$ correlations. These observations suggest important differences in the space-time emission histories for protons, pions and neutral strange baryons produced in the same events

Laying the groundwork at the AGS: Recent results from experiment E895

The E895 Collaboration at the Brookhaven AGS has performed a systematic investigation of Au+Au collisions at 2-8 AGeV, using a large-acceptance Time Projection Chamber. In addition to extensive measurements of particle flow, spectra, two-particle interferometry, and strangeness production, we have performed novel hybrid analyses, including azimuthally-sensitive pion HBT, extraction of the six-dimensional pion phasespace density, and a first measurement of the Lambda-proton correlation function.Comment: Presented at Quark Matter 2001, 8 pages, 5 figure

Charged Pion Production in 2 to 8 AGeV Central Au+Au Collisions

Momentum spectra of charged pions over nearly full rapidity coverage from target to beam rapidity have been measured in the 0-5% most central Au+Au collisions in the beam energy range from 2 to 8 AGeV by the E895 Experiment. Using a thermal parameterization to fit the transverse mass spectra, rapidity density distributions are extracted. The observed spectra are compared with predictions from the RQMD v2.3 cascade model and also to a thermal model including longitudinal flow. The total 4$\pi$ yields of the charged pions are used to infer an initial state entropy produced in the collisions.Comment: 13 pgs, 19 figs, accepted by Phys. Rev. C. Data tables available at http://nuclear.ucdavis.edu/~e895/published_spectra.htm