Frailty and the Burden of Concurrent and Incident Disability in Patients With Cirrhosis: A Prospective Cohort Study.

Frailty results from the chronic effects of malnutrition and muscle wasting in patients with cirrhosis. It is well-established that frailty is strongly associated with mortality in this population. However, little is known of its relationship with physical disability, a critical patient-centered outcome. Adults with cirrhosis underwent outpatient testing of frailty using the Liver Frailty Index (LFI) and disability using activities of daily living (ADL; range 0-6) and Instrumental ADL (IADL; range 0-8) scales at one center between 2012 and 2016. We used adjusted multilevel logistic mixed-effects regression to test the association between frailty and current disability (impairment with ≥1 ADL or IADL) and incident disability at 6 months among those without baseline disability. Of the 983 participants, 20% were robust, 32% were less robust, 33% were prefrail, and 15% were frail; 587 (60%) had at least 1 assessment. The percentage of participants with at least 1 baseline ADL or IADL impairment was 28% and 37%, respectively. In adjusted regression models, each point LFI increase was associated with a 3.3 and 4.6 higher odds of current difficulty with at least 1 ADL and IADL (P < 0.001 for each), respectively. Among participants without baseline disability, each point LFI increase was associated with a 2.6 and 1.7 higher odds of having difficulty with at least 1 ADL and IADL at 6 months, respectively. Conclusion: Frailty is strongly associated with concurrent and incident disability in patients with cirrhosis. In the clinic, the LFI can be used to identify those in greatest need for additional support/resources to maintain functional independence. In research settings, the LFI may help to identify an enriched population for clinical trials of interventions aimed at those most vulnerable to disability

Mitochondrial Utilization of Competing Fuels is Altered in Insulin Resistant Skeletal Muscle of Non-Obese Rats (Goto-Kakizaki)

Aim: Insulin-resistant skeletal muscle is characterized by metabolic inflexibility with associated alterations in substrate selection, mediated by peroxisome-proliferator activated receptor (PPAR). Although it is established that PPAR contributes to the alteration of energy metabolism, it is not clear whether it plays a role in mitochondrial fuel competition. While nutrient overload may impair metabolic flexibility by fuel congestion within mitochondria, in absence of obesity defects at a mitochondrial level have not yet been excluded. We sought to determine whether reduced PPAR content in insulin-resistant rat skeletal muscle of a non-obese rat model of T2DM (Goto-Kakizaki, GK) ameliorate the inhibitory effect of fatty acid (i.e., palmitoylcarnitine) on mitochondrial carbohydrate oxidization (i.e., pyruvate) in muscle fibers. Methods: Bioenergetic function was characterized in oxidative soleus (S) and glycolytic white gastrocnemius (WG) muscles with measurement of respiration rates in permeabilized fibers in the presence of complex I, II, IV, and fatty acid substrates. Mitochondrial content was measured by citrate synthase (CS) and succinate dehydrogenase activity (SDH). Western blot was used to determine protein expression of PPAR, PDK isoform 2 and 4. Results: CS and SDH activity, key markers of mitochondrial content, were reduced by similar to 10-30% in diabetic vs. control, and the effect was evident in both oxidative and glycolytic muscles. PPAR (p\u3c 0.01), PDK2 (p\u3c 0.01), and PDK4 (p= 0.06) protein content was reduced in GK animals compared to Wistar rats (N= 6 per group). Ex vivorespiration rates in permeabilized muscle fibers determined in the presence of complex I, II, IV, and fatty acid substrates, suggested unaltered mitochondrial bioenergetic function in T2DM muscle. Respiration in the presence of pyruvate was higher compared to palmitoylcarnitine in both animal groups and fiber types. Moreover, respiration rates in the presence of both palmitoylcarnitine and pyruvate were reduced by 25 ± 6% (S), 37 ± 6% (WG) and 63 ± 6% (S), 57 ± 8% (WG) compared to pyruvate for both controls and GK, respectively. The inhibitory effect of palmitoylcarnitine on respiration was significantly greater in GK than controls (p \u3c 10-3). Conclusion: With competing fuels, the presence of fatty acids diminishes mitochondria ability to utilize carbohydrate derived substrates in insulin-resistant muscle despite reduced PPAR delta content

V344 Lyrae: A Touchstone SU UMa Cataclysmic Variable in the Kepler Field

We report on the analysis of the Kepler short-cadence (SC) light curve of V344 Lyr obtained during 2009 June 20 through 2010 Mar 19 (Q2--Q4). The system is an SU UMa star showing dwarf nova outbursts and superoutbursts, and promises to be a touchstone for CV studies for the foreseeable future. The system displays both positive and negative superhumps with periods of 2.20 and 2.06-hr, respectively, and we identify an orbital period of 2.11-hr. The positive superhumps have a maximum amplitude of ~0.25-mag, the negative superhumps a maximum amplitude of ~0.8 mag, and the orbital period at quiescence has an amplitude of ~0.025 mag. The quality of the Kepler data is such that we can test vigorously the models for accretion disk dynamics that have been emerging in the past several years. The SC data for V344 Lyr are consistent with the model that two physical sources yield positive superhumps: early in the superoutburst, the superhump signal is generated by viscous dissipation within the periodically flexing disk, but late in the superoutburst, the signal is generated as the accretion stream bright spot sweeps around the rim of the non-axisymmetric disk. The disk superhumps are roughly anti-phased with the stream/late superhumps. The V344 Lyr data also reveal negative superhumps arising from accretion onto a tilted disk precessing in the retrograde direction, and suggest that negative superhumps may appear during the decline of DN outbursts. The period of negative superhumps has a positive dP/dt in between outbursts.Comment: ApJ, In Press (20 pages, 27 figures) A version with full-resolution figures is available at http://www.astro.fit.edu/wood/WoodV344.pd

Dilepton-tagged jets in relativistic nucleus-nucleus collisions: A case study

We study the A+B -> l+ l- + jet +X process in nucleus-nucleus collisions at relativistic energies. The dilepton as well as the jet will pass through the matter produced in such collisions. The recoiling dilepton will carry information about the kinematical features of the jet, and will thus prove to be a very effective tool in isolating in-medium effects such as energy-loss and fragmentation function modifications. We estimate the contributions due to correlated charm and bottom decay and we identify a window where they are small as compared to pairs from the NLO Drell-Yan process.Comment: 7 pages, 9 figures Two figures modified, references adde

The Spitzer c2d Survey of Weak-line T Tauri Stars II: New Constraints on the Timescale for Planet Building

One of the central goals of the Spitzer Legacy Project ``From Molecular Cores to Planet-forming Disks'' (c2d) is to determine the frequency of remnant circumstellar disks around weak-line T Tauri stars (wTTs) and to study the properties and evolutionary status of these disks. Here we present a census of disks for a sample of over 230 spectroscopically identified wTTs located in the c2d IRAC (3.6, 4.5, 4.8, and 8.0 um) and MIPS (24 um) maps of the Ophiuchus, Lupus, and Perseus Molecular Clouds. We find that ~20% of the wTTs in a magnitude limited subsample have noticeable IR-excesses at IRAC wavelengths indicating the presence of a circumstellar disk. The disk frequencies we find in these 3 regions are ~3-6 times larger than that recently found for a sample of 83 relatively isolated wTTs located, for the most part, outside the highest extinction regions covered by the c2d IRAC and MIPS maps. The disk fractions we find are more consistent with those obtained in recent Spitzer studies of wTTs in young clusters such as IC 348 and Tr 37. From their location in the H-R diagram, we find that, in our sample, the wTTs with excesses are among the younger part of the age distribution. Still, up to ~50% of the apparently youngest stars in the sample show no evidence of IR excess, suggesting that the circumstellar disks of a sizable fraction of pre-main-sequence stars dissipate in a timescale of ~1 Myr. We also find that none of the stars in our sample apparently older than ~10 Myrs have detectable circumstellar disks at wavelengths < 24 um. Also, we find that the wTTs disks in our sample exhibit a wide range of properties (SED morphology, inner radius, L_DISK/L*, etc) which bridge the gaps observed between the cTTs and the debris disk regimes.Comment: 54 pages, 13 figures, Accepted by Ap

Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study.

The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes. We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis. Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts

Quality of life impact and recovery after ureteroscopy and stent insertion: Insights from daily surveys in STENTS

BACKGROUND: Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains. METHODS: In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30. RESULTS: The median age was 44 years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5 mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2 days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability. CONCLUSIONS: This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients\u27 experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS

On the multi-periodicities in the X-ray dipper XB 1916-053

Using the Rossi X-ray Timing Explorer and the Nordic Optical Telescope we have obtained the highest ever quality X-ray/white-light high-speed photometry of XB 1916-053. We refine the X-ray period (P_X) to 3000.6+/-0.2s via a restricted cycle counting approach. Using our complete optical lightcurve, we have extended the optical period (P_opt) ephemeris by another 4 years, providing further evidence for its stability, although a slightly longer period of 3027.555+/-0.002s now provides a marginally better fit. Moreover, modulations at both P_X and P_opt are present in the optical data, with the former dominating the nightly lightcurves (i.e. a few cycles of data). We have also attempted to determine the ``beat'' period, as seen in the repeating evolution of the X-ray dip structure, and the variation in primary dip phase. We find that a quasi-period of 4.74+/-0.05d provides the best fit to the data, even then requiring phase shifts between cycles, with the expected 3.90d ``beat'' of P_X and P_opt appearing to be less likely. Finally, considering the nature of each of these temporal phenomena, we outline possible models, which could explain all of the observed behaviour of this enigmatic source, focusing on which of P_X or P_opt is the binary period.Comment: 22 pages, 17 figures (none require colour printing), accepted for publication in MNRA

Measurement of the ratio of branching fractions BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma)

The ratio of branching fractions of the radiative B decays B0 -> K*0 gamma and Bs0 -> phi gamma has been measured using 0.37 fb-1 of pp collisions at a centre of mass energy of sqrt(s) = 7 TeV, collected by the LHCb experiment. The value obtained is BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma) = 1.12 +/- 0.08 ^{+0.06}_{-0.04} ^{+0.09}_{-0.08}, where the first uncertainty is statistical, the second systematic and the third is associated to the ratio of fragmentation fractions fs/fd. Using the world average for BR(B0 -> K*0 gamma) = (4.33 +/- 0.15) x 10^{-5}, the branching fraction BR(Bs0 -> phi gamma) is measured to be (3.9 +/- 0.5) x 10^{-5}, which is the most precise measurement to date.Comment: 15 pages, 1 figure, 2 table

Reduction of liver stiffness following resolution of acute flares of chronic hepatitis B

Background: Measuring liver stiffness is becoming more popular as a non-invasive tool for assessing liver fibrosis. Aim: To assess the effect of severe hepatitis B flare on liver stiffness and determine factors that correlate with liver stiffness measurements. Methods: Twenty-nine patients with severe hepatitis B flare (ALT > 10 × upper limit of normal) were followed up for 1 year. Serial transient elastography was performed at the time of flare, 3-6, and 12 months after flare. Results: At the time of flare, the median liver stiffness was 16.8 kPa, with no patients having normal liver stiffness (<6 kPa). There was a significant decrease in liver stiffness from baseline to 3-6 months (16.8 vs. 7.9 kPa, respectively, P < 0.001), and a further smaller decline from 3-6 to 12 months (7.9 vs. 6.9 kPa, respectively, P = 0.039). By 12 months, 10 (34%) had normalized their liver stiffness. Baseline parameters which correlated with liver stiffness include bilirubin, ALT, albumin, prothrombin time and platelet levels (all P < 0.05). Conclusion: Liver stiffness was increased in patients with severe hepatitis B flares, with return to near normal levels by 6 months. Transient elastography for proper assessment of liver fibrosis should be performed at least 6 months after flare. © 2010 The Author(s).published_or_final_versionSpringer Open Choice, 31 May 201