Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.; Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.; Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.; Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.; Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov

Occam's Razor and Petascale Visual Data Analysis

One of the central challenges facing visualization research is how to effectively enable knowledge discovery. An effective approach will likely combine application architectures that are capable of running on today?s largest platforms to address the challenges posed by large data with visual data analysis techniques that help find, represent, and effectively convey scientifically interesting features and phenomena

Moho depth across the Trans-European Suture Zone from P-and S-receiver functions

The Mohorovicic discontinuity, Moho for short, which marks the boundary between crust and mantle, is the main first-order structure within the lithosphere. Geodynamics and tectonic evolution determine its depth level and properties. Here, we present a map of the Moho in central Europe across the Teisseyre-Tornquist Zone, a region for which a number of previous studies are available. Our results are based on homogeneous and consistent processing of P- and S-receiver functions for the largest passive seismological data set in this region yet, consisting of more than 40 000 receiver functions from almost 500 station. Besides, we also provide new results for the crustal Vp/Vs ratio for the whole area. Our results are in good agreement with previous, more localized receiver function studies, as well as with the interpretation of seismic profiles, while at the same time resolving a higher level of detail than previous maps covering the area, for example regarding the Eifel Plume region, Rhine Graben and northern Alps. The close correspondence with the seismic data regarding crustal structure also increases confidence in use of the data in crustal corrections and the imaging of deeper structure, for which no independent seismic information is available. In addition to the pronounced, stepwise transition from crustal thicknesses of 30km in Phanerozoic Europe to more than 45 beneath the East European Craton, we can distinguish other terrane boundaries based on Moho depth as well as average crustal Vp/Vsratio and Moho phase amplitudes. The terranes with distinct crustal properties span a wide range of ages, from Palaeoproterozoic in Lithuania to Cenozoic in the Alps, reflecting the complex tectonic history of Europe. Crustal thickness and properties in the study area are also markedly influenced by tectonic overprinting, for example the formation of the Central European Basin System, and the European Cenozoic Rift System. In the areas affected by Cenozoic rifting and volcanism, thinning of the crust corresponds to lithospheric updoming reported in recent surface wave and S-receiver function studies, as expected for thermally induced deformation. The same correlation applies for crustal thickening, not only across the Trans-European Suture Zone, but also within the southern part of the Bohemian Massif. A high Poisson’s ratio of 0.27 is obtained for the craton, which is consistent with a thick mafic lower crust. In contrast, we typically find Poisson’s ratios around 0.25 for Phanerozoic Europe outside of deep sedimentary basins. Mapping of the thickness of the shallowest crustal layer, that is low-velocity sediments or weathered rock, indicates values in excess of 6km for the most pronounced basins in the study area, while thicknesses of less than 4km are found within the craton, central Germany and most of the Czech Republic.Peer reviewe

Gateways to the FANTOM5 promoter level mammalian expression atlas

The FANTOM5 project investigates transcription initiation activities in more than 1,000 human and mouse primary cells, cell lines and tissues using CAGE. Based on manual curation of sample information and development of an ontology for sample classification, we assemble the resulting data into a centralized data resource (http://fantom.gsc.riken.jp/5/). This resource contains web-based tools and data-access points for the research community to search and extract data related to samples, genes, promoter activities, transcription factors and enhancers across the FANTOM5 atlas. Electronic supplementary material The online version of this article (doi:10.1186/s13059-014-0560-6) contains supplementary material, which is available to authorized users

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Information to go: Exploring in-situ information pick-up in the wild

Abstract. This paper presents a case study on the iterative design of a system for delivering in-situ information services to users ’ mobile devices using proximity-based technologies. The design advances from a questionnaire study of the users ’ attitudes and needs toward such information services via several incremental prototypes evaluated in a usability lab and at a university campus to the final version subjected to longitudinal evaluation "in-the-wild " in a city center. The final prototype is a hybrid interface where the users can select from an interactive public display the information services to be downloaded to their personal mobile devices over no-cost Bluetooth connection. The results include an empirical comparison of different models for delivering such information services, and a quantitative analysis of the usage of the system by the general public over a period of 100 days. Our findings suggest that multiple environmental factors strongly affect the usage of the system. Furthermore, the usage varies distinctly between different contexts, and there is a strong correlation between location and usage patterns. Finally, we present a number of guidelines for designing and deploying this type of hybrid user interfaces

Compensatory Cell Movements Confer Robustness to Mechanical Deformatio during Embryonic Developmentn

Embryonic development must proceed despite both internal molecular fluctuations and external perturbations. However, mechanisms that provide robustness to mechanical perturbation remain largely uncharacterized. Here, we use light-sheet microscopy, comprehensive single-cell tracking, and targeted cell ablation to study the response of Caenorhabditis elegans embryos to external compression. Compression changes the relative positions of many cells and causes severe distortions of the embryonic axes. A large-scale movement of cells then corrects this distortion. Only a few specific cells are required for these compensatory movements, and one cell, ABarppap, appears to generate force, dramatically changing as it moves to its correct local cellular environment. During these movements, we also observed "egressions", cells moving out onto the surface, and lineages that undergo both ingression and egression. In total, our work describes how the embryo responds to a major mechanical deformation that can occur during the early development in situ and puts forward a model to explain how the response is coordinated.publisher: Elsevier articletitle: Compensatory Cell Movements Confer Robustness to Mechanical Deformation during Embryonic Development journaltitle: Cell Systems articlelink: http://dx.doi.org/10.1016/j.cels.2016.07.005 content_type: article copyright: © 2016 Elsevier Inc.status: publishe