Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial

Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases.We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to .86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (.0.21 ng/mL) had a worse outcome if not treated with antibiotics (P ¼ 0.046), while patients with low PCT values (,0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P ¼ 0.049). Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection

The development and transfer of undergraduate group work skills

This research concentrates on the experiences of a cohort of undergraduate students as they took part in two assessed group projects. The research concentrates on the following key question: In what ways were students becoming more or less able to participate effectively in group projects because of their experience of similar projects? The literature review features an extensive overview of transfer research and experiential learning, in addition to charting the rise of skills-based initiatives in Higher Education. It also reviews the available literature on experiential learning in group situations revealing a dearth of research into the specific dynamics of students groups in Higher Education. After an initial design based on quasi-experimentation, the researcher adopted a more interpretive position. A significant feature of the methodology is a reflective account of the process of social science research as experienced by the researcher. The results section describes the key dynamics around which the students made sense of group work and in turn how they framed it in terms of a learning experience. In brief, the students' accounts of group work were characterised by several main themes: the issue of control and influence over others (which the role of 'student' was perceived to limit); the reciprocal nature of group work with its potential to influence grades; the public nature of group work through which the students presented themselves to others and the discrepancies which were revealed in group work between different ways of working. The discussion places the student firmly within the learning milieu that they create as students on a particular degree course. In doing so it provides a socia-interpretive explanation of development and transfer

Backward recall and the word length effect

The word length effect, the finding that words that have fewer syllables are recalled better than otherwise comparable words that have more syllables, is one of the benchmark effects that must be accounted for in any model of serial recall, and simulation models of immediate memory rely heavily on the finding. However, previous research has shown that the effect disappears when participants are asked to recall the items in strict backward order. The present 2 experiments replicate and extend that finding by manipulating the participant’s foreknowledge of recall direction (Experiment 1) and by giving the participant repeated practice with one direction by blocking recall direction (Experiment 2). In both experiments, a word length effect obtained with forward but not backward recall. The results are problematic for all models that currently have an a priori explanation for word length effects. The finding can be accounted for but is not predicted by Scale-Independent Memory, Perception, and Learning (SIMPLE), a model in which item and order information are differentially attended to in the 2 recall directions

Influence of age, race, sex, and body mass index on interpretation of midregional pro atrial natriuretic peptide for the diagnosis of acute heart failure: results from the BACH multinational study

Aims Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF. Methods and results The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90% sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old. Conclusion Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity