Echocardiographic estimation of mean pulmonary artery pressure in critically ill patients

BACKGROUND: Indirect assessment of mean pulmonary arterial pressure (MPAP) may assist management of critically ill patients with pulmonary hypertension and right heart dysfunction. MPAP can be estimated as the sum of echocardiographically derived mean right ventricular to right atrial systolic pressure gradient and right atrial pressure; however, this has not been validated in critically ill patients. METHODS: This prospective validation study was conducted in patients undergoing pulmonary artery catheterisation during intensive care admission. Pulmonary artery catheter (PAC) measurements of MPAP were contemporaneously compared to MPAP estimated utilising transthoracic echocardiography (TTE)-derived mean right ventricular to right atrial systolic pressure gradient added to invasively measured right atrial pressure. RESULTS: Of 53 patients assessed, 23 had estimable MPAP using TTE. The mean difference between TTE- and PAC-derived MPAP was 1.9 mmHg (SD 5.0), with upper and lower limits of agreement of 11.6 and −7.9 mmHg, respectively. The median absolute percentage difference between TTE- and PAC-derived MPAP was 7.5%. Inter-rater reliability assessment was performed for 15 patients, giving an intra-class correlation coefficient of 0.96 (95% confidence intervals, 0.89 to 0.99). CONCLUSIONS: This echocardiographic method of estimating MPAP in critically ill patients was not equivalent to invasively measured MPAP, based on our predefined clinically acceptable range (±5 mmHg). The accuracy of this method in critically ill patients was similar to the results obtained in ambulatory patients and compared favourably with regard to the accuracy with echocardiographic estimation of systolic pulmonary arterial pressure. The utility of this technique is limited by frequent inability to obtain an adequate tricuspid regurgitant time-velocity integral in critically ill patients

Cross-linguistic study of vocal pathology: perceptual features of spasmodic dysphonia in French-speaking subjects

Clinical characterisation of Spasmodic Dysphonia of the adductor type (SD) in French speakers by Klap and colleagues (1993) appears to differ from that of SD in English. This perceptual analysis aims to describe the phonetic features of French SD. A video of 6 French speakers with SD supplied by Klap and colleagues was analysed for frequency of phonatory breaks, pitch breaks, harshness, creak, breathiness and falsetto voice, rate of production, and quantity of speech output. In contrast to English SD, the French speaking SD patients demonstrated no evidence pitch breaks, but phonatory breaks, harshness and breathiness were prominent features. This verifies the French authors’ (1993) clinical description. These findings suggest that phonetic properties of a specific language may affect the manifestation of pathology in neurogenic voice disorders

Trans-biome diversity in Australian grass-specialist lizards (Diplodactylidae: Strophurus)

Comparisons of biodiversity patterns within lineages that occur across major climate gradients and biomes, can provide insights into the relative roles that lineage history, landscape and climatic variation, and environmental change have played in shaping regional biotas. In Australia, while there has been extensive research into the origins and patterns of diversity in the Australian Arid Zone (AAZ), how diversity is distributed across this biome and the Australian Monsoonal Tropics (AMT) to the north, has been less studied. We compared the timing and patterns of diversification across this broad aridity gradient in a clade of lizards (Strophurus: phasmid geckos) that only occur in association with a unique Australian radiation of sclerophyllous grasses (Triodia: spinifex). Our results indicate that overall genetic diversity is much higher, older and more finely geographically structured within the AMT, including distantly related clades endemic to the sandstone escarpments of the Kimberley and Arnhem Plateau. Niche modelling analyses also suggest that the distribution of taxa in the AMT is more strongly correlated with variation in topographic relief than in the AAZ. The two broad patterns that we recovered - (i) lineage endemism increases as latitude decreases, and (ii) endemism is tightly correlated to rocky regions - parallel and corroborate other recent studies of habitat generalists and specialised saxicoline lineages occurring across these same regions. Early Miocene diversification estimates also suggest that, soon after Triodia grasses colonised Australia and began to diversify in the Miocene, phasmid geckos with Gondwanan ancestry shifted into these grasses, and have subsequently remained closely associated with this unique vegetation type.This work was supported by a linkage grant from the Australian Research Council to PMO, Michael Lee and Paul Doughty, a McKenzie Postdoctoral fellowship to PMO from the University of Melbourne, and an ARC Discovery Early Career Researcher Award to PMO

The Origin of (90) Antiope From Component-Resolved Near-Infrared Spectroscopy

The origin of the similary-sized binary asteroid (90) Antiope remains an unsolved puzzle. To constrain the origin of this unique double system, we recorded individual spectra of the components using SPIFFI, a near-infrared integral field spectrograph fed by SINFONI, an adaptive optics module available on VLT-UT4. Using our previously published orbital model, we requested telescope time when the separation of the components of (90) Antiope was larger than 0.087", to minimize the contamination between components, during the February 2009 opposition. Several multi-spectral data-cubes in J band (SNR=40) and H+K band (SNR=100) were recorded in three epochs and revealed the two components of (90) Antiope. After developing a specific photometric extraction method and running an error analysis by Monte-Carlo simulations, we successfully extracted reliable spectra of both components from 1.1 to 2.4 um taken on the night of February 21, 2009. These spectra do not display any significant absorption features due to mafic mineral, ices, or organics, and their slopes are in agreement with both components being C- or Cb- type asteroids. Their constant flux ratio indicates that both components' surface reflectances are quite similar, with a 1-sigma variation of 7%. By comparison with 2MASS J, H, K color distribution of observed Themis family members, we conclude that both bodies were most likely formed at the same time and from the same material. The similarly-sized system could indeed be the result of the breakup of a rubble-pile proto-Antiope into two equal-sized bodies, but other scenarios of formation implying a common origin should also be considered.Comment: 46 pages, 1 table, 11 figures accepted for publication to Icaru

The declining representativeness of the British party system, and why it matters

In a recent article, Michael Laver has explained ‘Why Vote-Seeking Parties May Make Voters Miserable’. His model shows that, while ideological convergence may boost congruence between governments and the median voter, it can reduce congruence between the party system and the electorate as a whole. Specifically, convergence can increase the mean distance between voters and their nearest party. In this article we show that this captures the reality of today’s British party system. Policy scale placements in British Election Studies from 1987 to 2010 confirm that the pronounced convergence during the past decade has left the Conservatives and Labour closer together than would be optimal in terms of minimising the policy distance between the average voter and the nearest major party. We go on to demonstrate that this comes at a cost. Respondents who perceive themselves as further away from one of the major parties in the system tend to score lower on satisfaction with democracy. In short, vote-seeking parties have left the British party system less representative of the ideological diversity in the electorate, and thus made at least some British voters miserable

A CACNA1D mutation in a patient with persistent hyperinsulinaemic hypoglycaemia, heart defects, and severe hypotonia.

Congenital hyperinsulinaemic hypoglycaemia (HH) can occur in isolation or it may present as part of a wider syndrome. For approximately 40%-50% of individuals with this condition, sequence analysis of the known HH genes identifies a causative mutation. Identifying the underlying genetic aetiology in the remaining cases is important as a genetic diagnosis will inform on recurrence risk, may guide medical management and will provide valuable insights into β-cell physiology. We sequenced the exome of a child with persistent diazoxide-responsive HH, mild aortic insufficiency, severe hypotonia, and developmental delay as well as the unaffected parents. This analysis identified a de novo mutation, p.G403D, in the proband's CACNA1D gene. CACNA1D encodes the main L-type voltage-gated calcium channel in the pancreatic β-cell, a key component of the insulin secretion pathway. The p.G403D mutation had been reported previously as an activating mutation in an individual with primary hyper-aldosteronism, neuromuscular abnormalities, and transient hypoglycaemia. Sequence analysis of the CACNA1D gene in 60 further cases with HH did not identify a pathogenic mutation. Identification of an activating CACNA1D mutation in a second patient with congenital HH confirms the aetiological role of CACNA1D mutations in this disorder. A genetic diagnosis is important as treatment with a calcium channel blocker may be an option for the medical management of this patient

The universal Glivenko-Cantelli property

Let F be a separable uniformly bounded family of measurable functions on a standard measurable space, and let N_{[]}(F,\epsilon,\mu) be the smallest number of \epsilon-brackets in L^1(\mu) needed to cover F. The following are equivalent: 1. F is a universal Glivenko-Cantelli class. 2. N_{[]}(F,\epsilon,\mu)0 and every probability measure \mu. 3. F is totally bounded in L^1(\mu) for every probability measure \mu. 4. F does not contain a Boolean \sigma-independent sequence. It follows that universal Glivenko-Cantelli classes are uniformity classes for general sequences of almost surely convergent random measures.Comment: 26 page