The first step in utilizing immune-modulating therapies: immune status determination

Recently, a single center study conducted by Oiva and coworkers and published in Critical Care demonstrated that phospho-specific whole blood flow cytometry could be used to assess activated signaling pathways in leukocytes isolated from pancreatitis patients. The authors demonstrated that this methodology had the potential to determine the current status of a patient's immune state. Although the experimental cohort was clinically homogeneous, the observed data were heterogeneous. Altogether, these results suggest that prior to administering immune-modulatory therapies in inflammatory diseases, it will be beneficial to first determine immune status. Rapid results from whole blood phospho-specific flow cytometry may allow for determination of immune status, improve early diagnosis, and provide a rational basis for immunomodulatory therapies

Discoloration of Polyvinyl Chloride (PVC) Tape as a Proxy for Water-Table Depth in Peatlands: Validation and Assessment of Seasonal Variability

Summary 1. Discoloration of polyvinyl chloride (PVC) tape has been used in peatland ecological and hydrological studies as an inexpensive way to monitor changes in water-table depth and reducing conditions. 2. We investigated the relationship between depth of PVC tape discoloration and measured water-table depth at monthly time steps during the growing season within nine kettle peatlands of northern Wisconsin. Our specific objectives were to: (1) determine if PVC discoloration is an accurate method of inferring water-table depth in Sphagnum -dominated kettle peatlands of the region; (2) assess seasonal variability in the accuracy of the method; and (3) determine if systematic differences in accuracy occurred among microhabitats, PVC tape colour and peatlands. 3. Our results indicated that PVC tape discoloration can be used to describe gradients of water-table depth in kettle peatlands. However, accuracy differed among the peatlands studied, and was systematically biased in early spring and late summer/autumn. Regardless of the month when the tape was installed, the highest elevations of PVC tape discoloration showed the strongest correlation with midsummer (around July) water-table depth and average water-table depth during the growing season. 4. The PVC tape discoloration method should be used cautiously when precise estimates are needed of seasonal changes in the water-table

Epidemiology of bloodstream infections in a multicenter retrospective cohort of liver transplant recipients

Although some studies have examined the epidemiology of bloodstream infections after liver transplantation, they were based in single centers and did not identify bloodstream infections treated in other hospitals. METHODS: We retrospectively examined a cohort of 7912 adult liver transplant recipients from 24 transplant centers using 2004 to 2012 International Classification of Diseases, Ninth Revision, Clinical Modification billing data from 3 State Inpatient Databases, and identified bloodstream infections, inpatient death, and cumulative 1-year hospital costs. Multilevel Cox regression analyses were used to determine factors associated with bloodstream infections and death. RESULTS: Bloodstream infections were identified in 29% (n = 2326) of liver transplant recipients, with a range of 19% to 40% across transplant centers. Only 63% of bloodstream infections occurring more than 100 days posttransplant were identified at the original transplant center. Bloodstream infections were associated with posttransplant laparotomy (adjusted hazard ratio [aHR], 1.52), prior liver transplant (aHR, 1.42), increasing age (aHR, 1.07/decade), and some comorbidities. Death was associated with bloodstream infections with and without septic shock (aHR, 10.96 and 3.71, respectively), transplant failure or rejection (aHR, 1.41), posttransplant laparotomy (aHR, 1.40), prior solid-organ transplant (aHR, 1.48), increasing age (aHR, 1.15/decade), and hepatitis C cirrhosis (aHR, 1.20). The risk of bloodstream infections and death varied across transplant centers. Median 1-year cumulative hospital costs were higher for patients who developed bloodstream infections within 1 year of transplant compared with patients who were bloodstream infection-free (US $229 806 vs US$111 313; P < 0.001). CONCLUSIONS: Bloodstream infections are common and costly complications after liver transplantation that are associated with a markedly increased risk of death. The incidence and risk of developing bloodstream infections may vary across transplant centers

Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: A case-control study

INTRODUCTION: Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients. METHODS: Retrospective case-control study of 32 septic and 29 non-septic patients in an adult medical and surgical ICU. Temperature curves for the period starting 72 hours and ending 8 hours prior to the clinical suspicion of sepsis (for septic patients) and for the 72-hour period prior to discharge from the ICU (for non-septic patients) were rated as normal or abnormal by seven blinded physicians. Multivariable logistic regression was used to compare groups in regard to maximum temperature, minimum temperature, greatest change in temperature in any 24-hour period, and whether the majority of evaluators rated the curve to be abnormal. RESULTS: Baseline characteristics of the groups were similar except the septic group had more trauma patients (31.3% vs. 6.9%, p = .02) and more patients requiring mechanical ventilation (75.0% vs. 41.4%, p = .008). Multivariable logistic regression to control for baseline differences demonstrated that septic patients had significantly larger temperature deviations in any 24-hour period compared to control patients (1.5°C vs. 1.1°C, p = .02). An abnormal temperature pattern was noted by a majority of the evaluators in 22 (68.8%) septic patients and 7 (24.1%) control patients (adjusted OR 4.43, p = .017). This resulted in a sensitivity of 0.69 (95% CI [confidence interval] 0.50, 0.83) and specificity of 0.76 (95% CI 0.56, 0.89) of abnormal temperature curves to predict sepsis. The median time from the temperature plot to the first culture was 9.40 hours (IQR [inter-quartile range] 8.00, 18.20) and to the first dose of antibiotics was 16.90 hours (IQR 8.35, 34.20). CONCLUSIONS: Abnormal body temperature curves were predictive of the diagnosis of sepsis in afebrile critically ill patients. Analysis of temperature patterns, rather than absolute values, may facilitate decreased time to antimicrobial therapy

Tomato Fertilizers at Troupe.

15 p

A Field Range Bound for General Single-Field Inflation

We explore the consequences of a detection of primordial tensor fluctuations for general single-field models of inflation. Using the effective theory of inflation, we propose a generalization of the Lyth bound. Our bound applies to all single-field models with two-derivative kinetic terms for the scalar fluctuations and is always stronger than the corresponding bound for slow-roll models. This shows that non-trivial dynamics can't evade the Lyth bound. We also present a weaker, but completely universal bound that holds whenever the Null Energy Condition (NEC) is satisfied at horizon crossing.Comment: 16 page

Echinoderms have bilateral tendencies

Echinoderms take many forms of symmetry. Pentameral symmetry is the major form and the other forms are derived from it. However, the ancestors of echinoderms, which originated from Cambrian period, were believed to be bilaterians. Echinoderm larvae are bilateral during their early development. During embryonic development of starfish and sea urchins, the position and the developmental sequence of each arm are fixed, implying an auxological anterior/posterior axis. Starfish also possess the Hox gene cluster, which controls symmetrical development. Overall, echinoderms are thought to have a bilateral developmental mechanism and process. In this article, we focused on adult starfish behaviors to corroborate its bilateral tendency. We weighed their central disk and each arm to measure the position of the center of gravity. We then studied their turning-over behavior, crawling behavior and fleeing behavior statistically to obtain the center of frequency of each behavior. By joining the center of gravity and each center of frequency, we obtained three behavioral symmetric planes. These behavioral bilateral tendencies might be related to the A/P axis during the embryonic development of the starfish. It is very likely that the adult starfish is, to some extent, bilaterian because it displays some bilateral propensity and has a definite behavioral symmetric plane. The remainder of bilateral symmetry may have benefited echinoderms during their evolution from the Cambrian period to the present

Adiposity has differing associations with incident coronary heart disease and mortality in the Scottish population: cross-sectional surveys with follow-up

Objective: Investigation of the association of excess adiposity with three different outcomes: all-cause mortality, coronary heart disease (CHD) mortality and incident CHD. Design: Cross-sectional surveys linked to hospital admissions and death records. Subjects: 19 329 adults (aged 18–86 years) from a representative sample of the Scottish population. Measurements: Gender-stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, CHD mortality and incident CHD. Separate models incorporating the anthropometric measurements body mass index (BMI), waist circumference (WC) or waist–hip ratio (WHR) were created adjusted for age, year of survey, smoking status and alcohol consumption. Results: For both genders, BMI-defined obesity (greater than or equal to30 kg m−2) was not associated with either an increased risk of all-cause mortality or CHD mortality. However, there was an increased risk of incident CHD among the obese men (hazard ratio (HR)=1.78; 95% confidence interval=1.37–2.31) and obese women (HR=1.93; 95% confidence interval=1.44–2.59). There was a similar pattern for WC with regard to the three outcomes; for incident CHD, the HR=1.70 (1.35–2.14) for men and 1.71 (1.28–2.29) for women in the highest WC category (men greater than or equal to102 cm, women greater than or equal to88 cm), synonymous with abdominal obesity. For men, the highest category of WHR (greater than or equal to1.0) was associated with an increased risk of all-cause mortality (1.29; 1.04–1.60) and incident CHD (1.55; 1.19–2.01). Among women with a high WHR (greater than or equal to0.85) there was an increased risk of all outcomes: all-cause mortality (1.56; 1.26–1.94), CHD mortality (2.49; 1.36–4.56) and incident CHD (1.76; 1.31–2.38). Conclusions: In this study excess adiposity was associated with an increased risk of incident CHD but not necessarily death. One possibility is that modern medical intervention has contributed to improved survival of first CHD events. The future health burden of increased obesity levels may manifest as an increase in the prevalence of individuals living with CHD and its consequences

Primordial Non-Gaussianity and Extreme-Value Statistics of Galaxy Clusters

What is the size of the most massive object one expects to find in a survey of a given volume? In this paper, we present a solution to this problem using Extreme-Value Statistics, taking into account primordial non-Gaussianity and its effects on the abundance and the clustering of rare objects. We calculate the probability density function (pdf) of extreme-mass clusters in a survey volume, and show how primordial non-Gaussianity shifts the peak of this pdf. We also study the sensitivity of the extreme-value pdfs to changes in the mass functions, survey volume, redshift coverage and the normalization of the matter power spectrum, {\sigma}_8. For 'local' non-Gaussianity parametrized by f_NL, our correction for the extreme-value pdf due to the bias is important when f_NL > O(100), and becomes more significant for wider and deeper surveys. Applying our formalism to the massive high-redshift cluster XMMUJ0044.0-2-33, we find that its existence is consistent with f_NL = 0, although the conclusion is sensitive to the assumed values of the survey area and {\sigma}_8. We also discuss the convergence of the extreme-value distribution to one of the three possible asymptotic forms, and argue that the convergence is insensitive to the presence of non-Gaussianity.Comment: Revised version, 20 pages, 10 figures. Major improvement in the treatment of non-Gaussian bias. Previous claim of large f_NL associated with the cluster is no longer supporte