Evidence-based rules from family practice to inform family practice; The learning healthcare system case study on urinary tract infections

Background: Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Methods: Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. Results: The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis". The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. Conclusions: We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data

Green Up-Conversion Laser-Emission In Er-Doped Crystals At Room-Temperature

We report room-temperature pulsed up-conversion laser oscillation in Er-doped LiYF4 and KYF4 at 551 and 562 nm, respectively. In both crystals laser oscillation is observed on the S-4(3/2)-I-4(15/2) ground state transition. Excitation was provided by a tunable flashlamp-pumped Ti:sapphire laser in the spectral region around 810 nm. Additional pumping with a continuous wave krypton ion laser at 647 nm was beneficial to both lasers. Laser action has also been observed in Er-doped Y3Al5O12 on the same transition

The management and integration of biomedical knowledge: Application in the health-e-child project (position paper)

The Health-e-Child project aims to develop an integrated healthcare platform for European paediatrics. In order to achieve a comprehensive view of children’s health, a complex integration of biomedical data, information, and knowledge is necessary. Ontologies will be used to formally define this domain knowledge and will form the basis for the medical knowledge management system. This paper introduces an innovative methodology for the vertical integration of biomedical knowledge. This approach will be largely clinician-centered and will enable the definition of ontology fragments, connections between them (semantic bridges) and enriched ontology fragments (views). The strategy for the specification and capture of fragments, bridges and views is outlined with preliminary examples demonstrated in the collection of biomedical information from hospital databases, biomedical ontologies, and biomedical public databases

Spectroscopy And Green Up-Conversion Laser-Emission Of Er(3+)-Doped Crystals At Room-Temperature

The spectroscopic parameters of Er3+-doped crystals were determined with regard to the upconversion laser parameters of the green transition S-4(3/2) -- \u3e I-4(15/2), The influence of excited-state absorption on this laser channel was determined. Furthermore, upconversion pump mechanisms using ground-state and excited-state absorption around 810 and 970 nm were investigated by direct measurements of excited-state absorption. The spectroscopic results confirm the pulsed room-temperature laser experiments on the S-4(3/2) -- \u3e I-5(5/2) transition. The lasers based on Er:LiYF4, Er:Y3Al5O12, and Er:Lu3Al5O12 were directly excited into the upper laser level by an excimer laser pumped dye laser in the blue spectral range. In Er:LiYF4, Er:KYF4, and Er:Y3Al5O12, laser action was achieved with two-step upconversion pumping by a Ti:sapphire laser and a krypton ion laser. In the case of the fluorides, the additional pumping with the krypton ion laser was not necessary. The laser emission wavelengths were 551 nm for Er:LiYF4, 561 nm for Er:Y3Al5012 and Er:Lu3Al5O12, and 562 nm for Er:KYF4. In addition, green quasi-cw laser emission of Er:LiYF4 pumped with an argon-ion laser was realized at room temperature

Living on borrowed time – Amazonian trees use decade‐old storage carbon to survive for months after complete stem girdling

Nonstructural carbon (NSC) reserves act as buffers to sustain tree activity during periods when carbon (C) assimilation does not meet C demand, but little is known about their age and accessibility; we designed a controlled girdling experiment in the Amazon to study tree survival on NSC reserves. We used bomb-radiocarbon (14C) to monitor the time elapsed between C fixation and release (‘age’ of substrates). We simultaneously monitored how the mobilization of reserve C affected δ13CO2. Six ungirdled control trees relied almost exclusively on recent assimilates throughout the 17 months of measurement. The Δ14C of CO2 emitted from the six girdled stems increased significantly over time after girdling, indicating substantial remobilization of storage NSC fixed up to 13–14 yr previously. This remobilization was not accompanied by a consistent change in observed δ13CO2. These trees have access to storage pools integrating C accumulated over more than a decade. Remobilization follows a very clear reverse chronological mobilization with younger reserve pools being mobilized first. The lack of a shift in the δ13CO2 might indicate a constant contribution of starch hydrolysis to the soluble sugar pool even outside pronounced stress periods (regular mixing). © 2018 The Authors. New Phytologist © 2018 New Phytologist Trus

Synthesis of Molecular Oxygen via Irradiation of Ice Grains in the Protosolar Nebula

Molecular oxygen has been detected in the coma of comet 67P/Churyumov–Gerasimenko with a mean abundance of 3.80±0.85% by the ROSINA mass spectrometer on board the Rosetta spacecraft. To account for the presence of this species in comet 67P/Churyumov–Gerasimenko, it has been shown that the radiolysis of ice grain precursors of comets is a viable mechanism in low-density environments, such as molecular clouds. Here, we investigate the alternative possibility that the icy grains present in the midplane of the protosolar nebula were irradiated during their vertical transport between the midplane and the upper layers over a large number of cycles, as a result of turbulent mixing. Consequently, these grains spent a non-negligible fraction of their lifetime in the disk’s upper regions, where the irradiation by cosmic rays was strong. To do so, we used a coupled disk-transportirradiation model to calculate the time evolution of the molecular oxygen abundance radiolytically produced in ice grains. Our computations show that, even if a significant fraction of the icy particles has followed a back and forth cycle toward the upper layers of the disk over tens of millions of years, a timespan far exceeding the formation timescale of comet 67P/Churyumov–Gerasimenko, the amount of produced molecular oxygen is at least two orders of magnitude lower than the Rosetta observations. We conclude that the most likely scenario remains the formation of molecular oxygen in low-density environments, such as the presolar cloud, prior to the genesis of the protosolar nebula

Molecular Pathways Underlying Adaptive Repair of the Injured Kidney: Novel Donation After Cardiac Death and Acute Kidney Injury Platforms

International audienceObjective: To test the hypothesis that gene expression profiling in peripheral blood from patients who have undergone kidney transplantation (KT) will provide mechanistic insights regarding graft repair and regeneration.Background: Renal grafts obtained from living donors (LD) typically function immediately, whereas organs from donation after cardiac death (DCD) or acute kidney injury (AKI) donors may experience delayed function with eventual recovery. Thus, recipients of LD, DCD, and AKI kidneys were studied to provide a more complete understanding of the molecular basis for renal recovery.Methods: Peripheral blood was collected from LD and DCD/AKI recipients before transplant and throughout the first 30 days thereafter. Total RNA was isolated and assayed on whole genome microarrays.Results: Comparison of longitudinal gene expression between LD and AKI/DCD revealed 2 clusters, representing 141 differentially expressed transcripts. A subset of 11 transcripts was found to be differentially expressed in AKI/DCD versus LD. In all recipients, the most robust gene expression changes were observed in the first day after transplantation. After day 1, gene expression profiles differed depending upon the source of the graft. In patients receiving LD grafts, the expression of most genes did not remain markedly elevated beyond the first day post-KT. In the AKI/DCD groups, elevations in gene expression were maintained for at least 5 days post-KT. In all recipients, the pattern of coordinate gene overexpression subsided by 28 to 30 days.Conclusions: Gene expression in peripheral blood of AKI/DCD recipients offers a novel platform to understand the potential mechanisms and timing of kidney repair and regeneration after transplantation

Two microcrustaceans affect microbial and macroinvertebrate-driven litter breakdown

1. Leaf litter degradation in fresh waters is a fundamental ecosystem process performed by a wide array of decomposers. The meiofauna is an important component of aquatic heterotrophic assemblages, which can provide a trophic link between plant detritus and associated microbial and macroinvertebrate communities, but their contribution to leaf breakdown remains poorly understood. 2. We hypothesised that, through their feeding activity, microcrustaceans influence the structure of fungal assemblages and consequently microbially mediated litter breakdown. Litter-associated microcrustaceans were predicted to change the pathways of energy transfer in the food web according to the positive (e.g. complementarity) or negative (e.g. predation) interactions with macroinvertebrate detritivore taxa. 3. We evaluated experimentally in the laboratory, over 6 and 13 days, the potential contribution of two freshwater microcrustaceans (a cladoceran and a copepod) to litter breakdown in the presence of microfungi (aquatic hyphomycetes), with and without macroinvertebrate detritivores (a trichopteran and a gammarid amphipod). 4. The presence of microcrustaceans enhanced leaf mass loss by 62 and 22% in treatments with fungi or trichopteran alone, respectively, while no significant effect was observed for treatments with the amphipod. Microcrustaceans strongly increased the production of fine particulate organic matter, particularly in treatments with fungi alone (+637%). The leaf consumption rate by the amphipod significantly decreased ( 61%) at 13 days in the presence of microcrustaceans, likely due to predation on cladocerans. 5. Our study supports the potential role of microcrustaceans in the detrital food web of streams and rivers. Interestingly, microcrustaceans may interact with microbial and macroinvertebrate decomposers in either positive or negative ways. Therefore, microcrustaceans add complexity to detrital food webs by increasing vertical diversity and modulating biotic interactions with important consequences for carbon and energy transfers in stream ecosystems