A Pilot Study of the Performance Characteristics of the D-dimer in Presumed Sepsis

Objectives: To determine if a sensitive D-dimer assay can exclude progression to organ dysfunction, death, and intensive care unit (ICU) admission in patients presenting to the emergency department (ED) with suspected infection, and if increasing levels of D-dimer are predictive of those end points.Methods: The study took place at two academic EDs, both located in tertiary care hospitals. This was a prospective convenience sample of adult patients presenting with an infective process and at least two of four criteria for the Systemic Inflammatory Response Syndrome. We measured D-dimer levels in the participants and abstracted their records for the end points. Sensitivity and specificity were calculated and receiver operating characteristic analysis was performed to determine if a higher cutoff would have a greater specificity for our end points.Results: We enrolled 134 patients. Twelve were excluded from analysis (10 for lack of a D-dimer, one for recent surgery, and one for complete loss to follow up). Using the cutoff of 0.4 established by our laboratories as positive, the D-dimer had a sensitivity of 94% (CI95; 76-99) for organ dysfunction in the ED, 93% (72-99) for organ dysfunction at 48 hours, 93% (81-98) for ICU admission, and 100% (63-100) for 30-day mortality. However, at this cutoff, specificity was not statistically significant. Significantly raising the cutoff for a positive resulted in a decrease in sensitivity but improved specificity.Conclusion: This study was limited by its nonconsecutive patient recruitment and sample size. A normal D-dimer may exclude progression to organ dysfunction, ICU admission, and death and, at higher cutoff levels, could help risk stratify patients presenting to the ED with signs of sepsis.[West J Emerg Med. 2010;11(2):173-179.

Vegetation, Ground Cover, Soil, Rainfall Simulation, and Overland Flow Experiments Before and After Tree Removal in Woodland-Encroached Sagebrush Steppe: The Hydrology Component of the Sagebrush Steppe Treatment Evaluation Project (SageSTEP)

Rainfall simulation and overland-flow experiments enhance understanding of surface hydrology and erosion processes, quantify runoff and erosion rates, and provide valuable data for developing and testing predictive models. We present a unique dataset (1021 experimental plots) of rainfall simulation (1300 plot runs) and overland flow (838 plot runs) experimental plot data paired with measures of vegetation, ground cover, and surface soil physical properties spanning point to hillslope scales. The experimental data were collected at three sloping sagebrush (Artemisia spp.) sites in the Great Basin, USA, each subjected to woodland-encroachment and with conditions representative of intact wooded-shrublands and 1–9 yr following wildfire, prescribed fire, and/or tree cutting and shredding tree-removal treatments. The methodologies applied in data collection and the cross-scale experimental design uniquely provide scale-dependent, separate measures of interrill (rainsplash and sheetflow processes) and concentrated overland-flow runoff and erosion rates along with collective rates for these same processes combined over the patch scale (tens of meters). The dataset provides a valuable source for developing, assessing, and calibrating/validating runoff and erosion models applicable to diverse plant community dynamics with varying vegetation, ground cover, and surface soil conditions. The experimental data advance understanding and quantification of surface hydrologic and erosion processes for the research domain and potentially for other patchy-vegetated rangeland landscapes elsewhere. Lastly, the unique nature of repeated measures spanning numerous treatments and time scales delivers a valuable dataset for examining long-term landscape vegetation, soil, hydrology, and erosion responses to various management actions, land use, and natural disturbances. The dataset is available from the National Agricultural Library at https://data.nal.usda.gov/search/type/dataset (DOI: https://doi.org/10.15482/USDA.ADC/1504518; Pierson et al., 2019)

Idd9.2 and Idd9.3 Protective Alleles Function in CD4+ T-Cells and Nonlymphoid Cells to Prevent Expansion of Pathogenic Islet-Specific CD8+ T-Cells

OBJECTIVE - Multiple type 1 diabetes susceptibility genes have now been identified in both humans and mice, yet mechanistic understanding of how they impact disease pathogenesis is still minimal. We have sought to dissect the cellular basis for how the highly protective mouse Idd9 region limits the expansion of autoreactive CD8 T-cells, a key cell type in destruction of the islets. RESEARCH DESIGN AND METHODS - We assess the endogenous CD8 T-cell repertoire for reactivity to the islet antigen glucose-6-phosphatase-related protein (IGRP). Through the use of adoptively transferred T-cells, bone marrow chimeras, and reconstituted severe combined immunodeficient mice, we identify the protective cell types involved. RESULTS - IGRP-specific CD8 T-cells are present at low frequency in the insulitic lesions of Idd9 mice and could not be recalled in the periphery by viral expansion. We show that Idd9 genes act extrinsically to the CD8 T-cell to prevent the massive expansion of pathogenic effectors near the time of disease onset that occurs in NOD mice. The subregions Idd9.2 and Idd9.3 mediated this effect. Interestingly, the Idd9.1 region, which provides significant protection from disease, did not prevent the expansion of autoreactive CD8 T-cells. Expression of Idd9 genes was required by both CD4 T-cells and a nonlymphoid cell to induce optimal tolerance. CONCLUSIONS - Idd9 protective alleles are associated with reduced expansion of IGRP-specific CD8 T-cells. Intrinsic expression of protective Idd9 alleles in CD4 T-cells and nonlymphoid cells is required to achieve an optimal level of tolerance. Protective alleles in the Idd9.2 congenic subregion are required for the maximal reduction of islet-specific CD8 T-cells

Long-Term Effectiveness of Tree Removal to Re-Establish Sagebrush Steppe Vegetation and Associated Spatial Patterns in Surface Conditions and Soil Hydrologic Properties

Pinyon (Pinus spp.) and juniper (Juniperus spp.) woodland encroachment into sagebrush (Artemisia spp.) steppe communities throughout western North America has substantially altered the vegetation structure and hydrologic function of one of the most ecologically important rangeland ecosystems in the world. Various pinyon and juniper tree removal practices are employed to re-establish sagebrush steppe vegetation and an associated resource-conserving ecohydrologic function. The effectiveness of these practices is highly variable owing to the vast domain in which woodland encroachment occurs, climate fluctuations, differences in treatment applications, and myriads of pre-treatment conditions and post-treatment land uses. This study evaluated the long-term (13 years post-treatment) effectiveness of prescribed fire and mechanical tree removal to re-establish sagebrush steppe vegetation and associated spatial patterns in ground surface conditions and soil hydrologic properties of two woodland-encroached sites. Specifically, we assessed the effects of tree removal on: (1) vegetation and ground cover at the hillslope scale (990 m2 plots) and (2) associated spatial patterns in point-scale ground surface conditions and soil hydrologic properties along transects extending from tree bases and into the intercanopy areas between trees. Both sites were in mid to late stages of woodland encroachment with extensive bare conditions (~60–80% bare ground) throughout a degraded intercanopy area (~75% of the domain) surrounding tree islands (~25% of domain, subcanopy areas). All treatments effectively removed mature tree cover and increased hillslope vegetation. Enhanced herbaceous cover (4–15-fold increases) in burned areas reduced bare interspace (bare area between plants) by at least 4-fold and improved intercanopy hydraulic conductivity (\u3e than 2-fold) and overall ecohydrologic function. Mechanical treatments retained or increased sagebrush and generally increased the intercanopy herbaceous vegetation. Intercanopy ground surface conditions and soil hydrologic properties in mechanical treatments were generally similar to those in burned areas but were also statistically similar to the same measures in untreated areas in most cases. This suggests that vegetation and ground surface conditions in mechanical treatments are trending toward a significantly improved hydrologic function over time. Treatments had limited impact on soil hydrologic properties within subcanopy areas; however, burning did reduce the soil water repellency strength and the occurrence of strong soil water repellency underneath trees by three- to four-fold. Overall, the treatments over a 13-year period enhanced the vegetation, ground surface conditions, and soil hydrologic properties that promote infiltration and limit runoff generation for intercanopy areas representing ~75% of the area at the sites. However, ecological tradeoffs in treatment alternatives were evident. The variations in woodland responses across sites, treatments, and measurement scales in this long-term study illustrate the complexity in predicting vegetation and hydrologic responses to tree removal on woodland-encroached sagebrush sites and underpin the need and value of multi-scale long-term studies

The effect of distance on reaction time in aiming movements

Target distance affects movement duration in aiming tasks but its effect on reaction time (RT) is poorly documented. RT is a function of both preparation and initiation. Experiment 1 pre-cued movement (allowing advanced preparation) and found no influence of distance on RT. Thus, target distance does not affect initiation time. Experiment 2 removed pre-cue information and found that preparing a movement of increased distance lengthens RT. Experiment 3 explored movements to targets of cued size at non-cued distances and found size altered peak speed and movement duration but RT was influenced by distance alone. Thus, amplitude influences preparation time (for reasons other than altered duration) but not initiation time. We hypothesise that the RT distance effect might be due to the increased number of possible trajectories associated with further targets: a hypothesis that can be tested in future experiments

A retrospective look at the predictions and recommendations from the 2009 AMIA Policy Meeting: Did we see EHR-related clinician burnout coming?

Clinicians often attribute much of their burnout experience to use of the electronic health record, the adoption of which was greatly accelerated by the Health Information Technology for Economic and Clinical Health Act of 2009. That same year, AMIA\u27s Policy Meeting focused on possible unintended consequences associated with rapid implementation of electronic health records, generating 17 potential consequences and 15 recommendations to address them. At the 2020 annual meeting of the American College of Medical Informatics (ACMI), ACMI fellows participated in a modified Delphi process to assess the accuracy of the 2009 predictions and the response to the recommendations. Among the findings, the fellows concluded that the degree of clinician burnout and its contributing factors, such as increased documentation requirements, were significantly underestimated. Conversely, problems related to identify theft and fraud were overestimated. Only 3 of the 15 recommendations were adjudged more than half-addressed

Renormalization Group Running of Newton's G: The Static Isotropic Case

Corrections are computed to the classical static isotropic solution of general relativity, arising from non-perturbative quantum gravity effects. A slow rise of the effective gravitational coupling with distance is shown to involve a genuinely non-perturbative scale, closely connected with the gravitational vacuum condensate, and thereby, it is argued, related to the observed effective cosmological constant. Several analogies between the proposed vacuum condensate picture of quantum gravitation, and non-perturbative aspects of vacuum condensation in strongly coupled non-abelian gauge theories are developed. In contrast to phenomenological approaches, the underlying functional integral formulation of the theory severely constrains possible scenarios for the renormalization group evolution of couplings. The expected running of Newton's constant $G$ is compared to known vacuum polarization induced effects in QED and QCD. The general analysis is then extended to a set of covariant non-local effective field equations, intended to incorporate the full scale dependence of $G$, and examined in the case of the static isotropic metric. The existence of vacuum solutions to the effective field equations in general severely restricts the possible values of the scaling exponent $\nu$.Comment: 61 pages, 3 figure

Non-Perturbative Gravity and the Spin of the Lattice Graviton

The lattice formulation of quantum gravity provides a natural framework in which non-perturbative properties of the ground state can be studied in detail. In this paper we investigate how the lattice results relate to the continuum semiclassical expansion about smooth manifolds. As an example we give an explicit form for the lattice ground state wave functional for semiclassical geometries. We then do a detailed comparison between the more recent predictions from the lattice regularized theory, and results obtained in the continuum for the non-trivial ultraviolet fixed point of quantum gravity found using weak field and non-perturbative methods. In particular we focus on the derivative of the beta function at the fixed point and the related universal critical exponent $\nu$ for gravitation. Based on recently available lattice and continuum results we assess the evidence for the presence of a massless spin two particle in the continuum limit of the strongly coupled lattice theory. Finally we compare the lattice prediction for the vacuum-polarization induced weak scale dependence of the gravitational coupling with recent calculations in the continuum, finding similar effects.Comment: 46 pages, one figur

Predicting the critical density of topological defects in O(N) scalar field theories

O(N) symmetric $\lambda \phi^4$ field theories describe many critical phenomena in the laboratory and in the early Universe. Given N and $D\leq 3$, the dimension of space, these models exhibit topological defect classical solutions that in some cases fully determine their critical behavior. For N=2, D=3 it has been observed that the defect density is seemingly a universal quantity at T_c. We prove this conjecture and show how to predict its value based on the universal critical exponents of the field theory. Analogously, for general N and D we predict the universal critical densities of domain walls and monopoles, for which no detailed thermodynamic study exists. This procedure can also be inverted, producing an algorithm for generating typical defect networks at criticality, in contrast to the canonical procedure, which applies only in the unphysical limit of infinite temperature.Comment: 4 pages, 3 figures, uses RevTex, typos in Eq.(11) and (14) correcte