Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation

Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach-Global Ultrasound Check for the Critically Ill (GUCCI)-that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.info:eu-repo/semantics/publishedVersio

Adaptive Seeding for Gaussian Mixture Models

We present new initialization methods for the expectation-maximization algorithm for multivariate Gaussian mixture models. Our methods are adaptions of the well-known $K$-means++ initialization and the Gonzalez algorithm. Thereby we aim to close the gap between simple random, e.g. uniform, and complex methods, that crucially depend on the right choice of hyperparameters. Our extensive experiments indicate the usefulness of our methods compared to common techniques and methods, which e.g. apply the original $K$-means++ and Gonzalez directly, with respect to artificial as well as real-world data sets.Comment: This is a preprint of a paper that has been accepted for publication in the Proceedings of the 20th Pacific Asia Conference on Knowledge Discovery and Data Mining (PAKDD) 2016. The final publication is available at link.springer.com (http://link.springer.com/chapter/10.1007/978-3-319-31750-2 24

Stellar Populations in Bulges of Spiral Galaxies

We have conducted a spectroscopic analysis of the bulges of a sample of 31 spiral galaxies, spanning the Hubble sequence from S0 to Scd type, in order to study the radial distribution of their stellar population properties.Comment: To be published in "The Evolution of Galaxies. II. Basic Building Blocks", ed. M. Sauvage et al., Kluwe

Dynamic risk control by human nucleus accumbens

Real-world decisions about reward often involve a complex counterbalance of risk and value. Although the nucleus accumbens has been implicated in the underlying neural substrate, its criticality to human behaviour remains an open question, best addressed with interventional methodology that probes the behavioural consequences of focal neural modulation. Combining a psychometric index of risky decision-making with transient electrical modulation of the nucleus accumbens, here we reveal profound, highly dynamic alteration of the relation between probability of reward and choice during therapeutic deep brain stimulation in four patients with treatment-resistant psychiatric disease. Short-lived phasic electrical stimulation of the region of the nucleus accumbens dynamically altered risk behaviour, transiently shifting the psychometric function towards more risky decisions only for the duration of stimulation. A critical, on-line role of human nucleus accumbens in dynamic risk control is thereby established

Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study

Backgroundintrinsic capacity (IC) is a construct encompassing people’s physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains.Objectivesto investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes.Methodssecondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity.Resultsamongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel’s C = 0.73 (95%CI 0.72;0.74)).Conclusionshalf of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses

Black shale deposition and early diagenetic dolomite cementation during Oceanic Anoxic Event 1: The mid-Cretaceous Maracaibo Platform, northwestern South America

Thin laterally continuous organic-rich dolomitic marlstones were deposited in the extended Late Aptian - Early Albian epicontinental sea of northwestern South America. These intervals are the proximal equivalents of thick hemipelagic black shale-ammonitic floatstone couplets, deposited in the distally stepped, differentially subsiding part of the Maracaibo Platform. The marlstones reflect the dynamic conditions resulting from orbital forcing mechanisms and can be genetically related to (1) minor sea-level changes, (2) proximal turnovers in marine productivity, and (3) sudden climate shifts affecting mid-Cretaceous shoaling upward, shallow marine, carbonate cyclicity. Therefore, the marlstones may well be linked to the multiple environmental perturbations collectively referred to as Oceanic Anoxic Event 1. The interstitial euhedral dolomite has a medium crystallinity, and exhibits unusual textural relations with framboidal pyrite and gypsum. The authigenic mineral assemblage also includes quartz, Ca-F apatite, and barite, which together with the chemical signals of dolomite, point to an unsteady climate regime. Bulk-rock biomarker parameters, rare earth element geochemistry, and iron speciation data point to widespread photic zone anoxia and transient shallow marine euxinia by the time of deposition, with climatic instability driving the delivery of oxidized detritus from the hinterlands. These conditions led to a schizohaline redox stratified environment favorable to dolomite precipitation. In such a depositional setting, the bio-utilization of Fe, Mn, and sulfur for organic matter respiration sustained elevated pore-water alkalinity and pH, and allowed for the pre-compactional growth of interstitial dolomite

Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture.

To determine the predictive value and sensitivity of demographic features and injuries (indicators) for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture

F-theory and Neutrinos: Kaluza-Klein Dilution of Flavor Hierarchy

We study minimal implementations of Majorana and Dirac neutrino scenarios in F-theory GUT models. In both cases the mass scale of the neutrinos m_nu ~ (M_weak)^2/M_UV arises from integrating out Kaluza-Klein modes, where M_UV is close to the GUT scale. The participation of non-holomorphic Kaluza-Klein mode wave functions dilutes the mass hierarchy in comparison to the quark and charged lepton sectors, in agreement with experimentally measured mass splittings. The neutrinos are predicted to exhibit a "normal" mass hierarchy, with masses m_3,m_2,m_1 ~ .05*(1,(alpha_GUT)^(1/2),alpha_GUT) eV. When the interactions of the neutrino and charged lepton sectors geometrically unify, the neutrino mixing matrix exhibits a mild hierarchical structure such that the mixing angles theta_23 and theta_12 are large and comparable, while theta_13 is expected to be smaller and close to the Cabibbo angle: theta_13 ~ theta_C ~ (alpha_GUT)^(1/2) ~ 0.2. This suggests that theta_13 should be near the current experimental upper bound.Comment: v2: 83 pages, 10 figures, references adde