Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients

Background: We aimed to determine the correlation between the functional status at discharge in non-cardiac vascular surgery patients and the out-of-hospital mortality. Methods: We performed a retrospective cohort study including adult non-cardiac vascular surgery patients (open, endovascular and venous procedures) surviving hospitalization in Boston, Massachusetts, USA. The exposure of interest was functional status determined by a licensed physical therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90 day mortality after hospital discharge. The secondary outcome was readmission within 30days. Adjusted odds ratios were estimated by multivariable logistic regression models. Results: This cohort included 2318 patients (male 51%; mean age 61 +/- 17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 moderately high and 581 scored the highest functional status. The lowest functional status was associated with a 3.41-fold increased adjusted odds for 90-day mortality (95%CI, 1.70- 6.84) compared to patients with the highest functional status. When excluding venous intervention patients, the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post discharge. The adjusted odds for readmission within 30-days was 1.5-fold increase in patients with the lowest functional status (95%CI, 1.04-2.20). Conclusions: In vascular surgery patients surviving hospitalization, functional status is strongly associated with out-of-hospital mortality and readmission rate. Future trials could provide evidence if improvement of functional status could prevent adverse outcomes in the postoperative setting

Features of turbulence during wildland fires in forested and grassland environments

Fire-induced turbulence and the feedback into the fire, following ambient changes, differ for forested (sub-canopy) and grassland environments. Here, we synthesize observations from multiple experimental surface fires: two sub-canopy backing fires, one sub-canopy heading fire, and a grassland heading fire. We identify and compare the most essential coherent structures and processes of each case from the turbulent momentum fluxes and turbulent kinetic energy (TKE) budget terms. In the sub-canopy burns, turbulent eddies are strongest near the canopy top: high streamwise turbulent flux accompanies low cross-stream turbulent flux and vice versa. In the grassland fire, both streamwise and cross-stream eddies strengthen simultaneously until a certain height, informing a vertical length scale for the fire-influence. Moreover, the forward sweep from streamwise eddies assists in the fire spread by pushing hot gases towards unburnt fuel. In the sub-canopy fires, shear production and buoyancy production are more substantial near the canopy top for more intense fires, while their magnitudes decrease with decreasing fire intensity. At mid-canopy-height scales, buoyancy production dominates shear production, becoming the key mechanism for vertical transport of TKE. In the grassland fire, shear production dominates buoyancy production near the surface and is insignificant beyond a certain height relative to the flame length, while buoyancy production increases with height, becoming substantial further away from the surface. Turbulent transport terms are also active in both environments. For intense sub-canopy fires, there is a loss in TKE due to its expulsion to the boundary layer aloft via the transport term, compensated by a reversal process: TKE influx via the transport term. In the grassland fire, the transport term mimics this behavior until a certain height. The insights into the relative significance of the respective turbulent fluxes and TKE budget terms in each environment can help simplify the complex system of equations governing fire physics

Localization and chiral symmetry in 2+1 flavor domain wall QCD

We present results for the dependence of the residual mass of domain wall fermions (DWF) on the size of the fifth dimension and its relation to the density and localization properties of low-lying eigenvectors of the corresponding hermitian Wilson Dirac operator relevant to simulations of 2+1 flavor domain wall QCD. Using the DBW2 and Iwasaki gauge actions, we generate ensembles of configurations with a $16^3\times 32$ space-time volume and an extent of 8 in the fifth dimension for the sea quarks. We demonstrate the existence of a regime where the degree of locality, the size of chiral symmetry breaking and the rate of topology change can be acceptable for inverse lattice spacings $a^{-1} \ge 1.6$ GeV.Comment: 59 Pages, 23 figures, 1 MPG linke

Effects of IRF5 Lupus Risk Haplotype on Pathways Predicted to Influence B Cell Functions

Both genetic and environmental interactions affect systemic lupus erythematosus (SLE) development and pathogenesis. One known genetic factor associated with lupus is a haplotype of the interferon regulatory factor 5 (IRF5) gene. Analysis of global gene expression microarray data using gene set enrichment analysis identified multiple interferon- and inflammation-related gene sets significantly overrepresented in cells with the risk haplotype. Pathway analysis using expressed genes from the significant gene sets impacted by the IRF5 risk haplotype confirmed significant correlation with the interferon pathway, Toll-like receptor pathway, and the B-cell receptor pathway. SLE patients with the IRF5 risk haplotype have a heightened interferon signature, even in an unstimulated state (P = 0.011), while patients with the IRF5 protective haplotype have a B cell interferon signature similar to that of controls. These results identify multiple genes in functionally significant pathways which are affected by IRF5 genotype. They also establish the IRF5 risk haplotype as a key determinant of not only the interferon response, but also other B-cell pathways involved in SLE