1,227 research outputs found

    Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice.

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    Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversation

    Circulating Precursor Levels of Endothelin-1 and Adrenomedullin, Two Endothelium-Derived, Counteracting Substances, in Sepsis

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    Plasma levels of endothelin-1 (ET-1) and adrenomedullin (ADM), two opposingly acting peptides, correlate with mortality in endotoxemia, but their measurement is cumbersome. New sandwich assays have been introduced that measure more stable precursor fragments. The objective of this study was to investigate the counterplay of their precursor peptides in septic patients and to compare them with disease severity and other biomarkers. Blood samples of an observational study in 95 consecutive critically ill patients admitted to the intensive care unit (ICU) were analyzed. CT-proET-1 and MR-proADM concentrations on admission were measured using new sandwich immunoassays. Depending on the clinical severity of the infection, both CT-proET-1 and MR-proADM levels exhibited a gradual increase from Systemic Inflammatory Response Syndrome (SIRS) to sepsis and septic shock (p < .001). Compared to the group of survivors, the group of non-survivors had higher median values of MR-proADM (5.7 nmol/L [range 0.4 to 21.0] versus 1.9 nmol/L [range 0.3 to 17.1], p < .02) and similar CT-proET-1 levels (56.0pmol/L [range 0.5 to 271.0] versus 54.1pmol/L [range 1.0 to 506.0], p = .86). Receiver operating characteristics (ROC) curve analysis showed a higher prognostic accuracy of the calculated ratio of both counteracting substances as compared to CT-proET-1 (p = 0.001) and C-reactive protein (CRP) (p = .001) and in the range of MR-proADM (p = .51), procalcitonin (p = 0.22), and the APACHE II score (p = .61). Endothelin-1 and adrenomedullin precursor peptides gradually increase with increasing severities of infection in critically ill patients. The ratio of the two counteracting peptides correlates with mortality and shows aprognostic accuracy to predict adverse outcome comparable to the APACHE II score

    Entrepreneurial Strategic Posture and New Technology Ventures in an Emerging Economy

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    Purpose: Although start-ups have gained increasing scholarly attention, we lack sufficient understanding of their entrepreneurial strategic posture (ESP) in emerging economies. The purpose of this study is to examine the processes of ESP of new technology venture start-ups (NTVs) in an emerging market context. Design/methodology/approach: In line with grounded theory guidelines and the inductive research traditions, we adopted a qualitative approach involving 42 in-depth semi-structured interviews with Ghanaian NTV entrepreneurs to gain a comprehensive analysis at the micro-level on their strategic posturing. A systematic procedure for data analysis was adopted. Findings: From our analysis of Ghanaian NTVs, we derived a three-stage model to elucidate the nature and process of ESP Phase 1 spotting and exploiting market opportunities, Phase II identifying initial advantages, and Phase III ascertaining and responding to change. Originality/value: The study contributes to advancing research on ESP by explicating the process through which informal ties and networks are utilised by NTVs and their founders to overcome extreme resource constraints and information vacuums in contexts of institutional voids. We depart from past studies in demonstrating how such ties can be harnessed in spotting and exploiting market opportunities by NTVs. On this basis, the paper makes original contributions to ESP theory and practice

    Aquaporin-4–binding autoantibodies in patients with neuromyelitis optica impair glutamate transport by down-regulating EAAT2

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    Neuromyelitis optica (NMO)-immunoglobulin G (IgG) is a clinically validated serum biomarker that distinguishes relapsing central nervous system (CNS) inflammatory demyelinating disorders related to NMO from multiple sclerosis. This autoantibody targets astrocytic aquaporin-4 (AQP4) water channels. Clinical, radiological, and immunopathological data suggest that NMO-IgG might be pathogenic. Characteristic CNS lesions exhibit selective depletion of AQP4, with and without associated myelin loss; focal vasculocentric deposits of IgG, IgM, and complement; prominent edema; and inflammation. The effect of NMO-IgG on astrocytes has not been studied. In this study, we demonstrate that exposure to NMO patient serum and active complement compromises the membrane integrity of CNS-derived astrocytes. Without complement, astrocytic membranes remain intact, but AQP4 is endocytosed with concomitant loss of Na+-dependent glutamate transport and loss of the excitatory amino acid transporter 2 (EAAT2) . Our data suggest that EAAT2 and AQP4 exist in astrocytic membranes as a macromolecular complex. Transport-competent EAAT2 protein is up-regulated in differentiating astrocyte progenitors and in nonneural cells expressing AQP4 transgenically. Marked reduction of EAAT2 in AQP4-deficient regions of NMO patient spinal cord lesions supports our immunocytochemical and immunoprecipitation data. Thus, binding of NMO-IgG to astrocytic AQP4 initiates several potentially neuropathogenic mechanisms: complement activation, AQP4 and EAAT2 down-regulation, and disruption of glutamate homeostasis

    Observation of New States Decaying into Λc+ππ+\Lambda_{c}^{+}\pi^{-}\pi^{+}

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    Using 13.7 fb^{-1} of data recorded by the CLEO detector at CESR, we investigate the spectrum of charmed baryons which decay into Lambda_c^+ pi^- pi^+ and are more massive than the Lambda_{c1} baryons. We find evidence for two new states: one is broad and has an invariant mass roughly 480 MeV above that of the Lambda_c^+; the other is narrow with an invariant mass of 596 +- 1 +- 2 MeV above the Lambda_c^+ mass. These results are preliminary.Comment: 11 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN

    First Observation of the Σc+\Sigma_{c}^{*+} Baryon and a New Measurement of the Σc+\Sigma_{c}^{+} Mass

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    Using data recorded with the CLEO II and CLEO II.V detector configurations at the Cornell Electron Storage Rings, we report the first observation and mass measurement of the Σc+\Sigma_c^{*+} charmed baryon, and an updated measurement of the mass of the Σc+\Sigma_c^+ baryon. We find M(Σc+)M(Λc+)M(\Sigma_c^{*+})-M(\Lambda_c^+)= 231.0 +- 1.1 +- 2.0 MeV, and M(Σc+)M(Λc+)M(\Sigma_c^{+})-M(\Lambda_c^+)= 166.4 +- 0.2 +- 0.3 MeV, where the errors are statistical and systematic respectively.Comment: 8 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN

    Branching Fractions of tau Leptons to Three Charged Hadrons

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    From electron-positron collision data collected with the CLEO detector operating at CESR near \sqrt{s}=10.6 GeV, improved measurements of the branching fractions for tau decays into three explicitly identified hadrons and a neutrino are presented as {\cal B}(\tau^-\to\pi^-\pi^+\pi^-\nu_\tau)=(9.13\pm0.05\pm0.46)%, {\cal B}(\tau^-\to K^-\pi^+\pi^-\nu_\tau)=(3.84\pm0.14\pm0.38)\times10^{-3}, {\cal B}(\tau^-\to K^-K^+\pi^-\nu_\tau)=(1.55\pm0.06\pm0.09)\times10^{-3}, and {\cal B}(\tau^-\to K^-K^+K^-\nu_\tau)<3.7\times10^{-5} at 90% C.L., where the uncertainties are statistical and systematic, respectively.Comment: 10 pages postscript, also available through http://w4.lns.cornell.edu/public/CLNS, to appear in Phys. Rev. Let

    A Measurement of the Decay Asymmetry Parameters in \Xi_{c}^{0}\to \X^{-}\pi^{+}

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    Using the CLEO II detector at the Cornell Electron Storage Ring we have measured the Ξc0\Xi_c^{0} decay asymmetry parameter in the decay Ξc0Ξπ+\Xi_c^{0} \to \Xi^{-} \pi^+. We find αΞc0αΞ=0.26±0.18(stat)0.04+0.05(syst)\alpha_{\Xi_c^{0}} \alpha_{\Xi} = 0.26 \pm 0.18{(stat)}^{+0.05}_{-0.04}{(syst)}, using the world average value of αΞ=0.456±0.014\alpha_{\Xi} = -0.456 \pm 0.014 we obtain αΞc0=0.56±0.39(stat)0.09+0.10(syst)\alpha_{\Xi_c^{0}} = -0.56 \pm 0.39{(stat)}^{+0.10}_{-0.09}{(syst)}. The physically allowed range of a decay asymmetry parameter is 1<α<+1-1<\alpha<+1. Our result prefers a negative value: αΞc0\alpha_{\Xi_c^{0}} is <0.1<0.1 at the 90% CL. The central value occupies the middle of the theoretically expected range but is not yet precise enough to choose between models.Comment: 10 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN
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