Synergies between ground-based and space-based observations in the solar system and beyond

The goal of this white paper is to provide examples where ground-based and space-based observations are combined, and used to obtain understanding or constrain parameters beyond what the separate measurements could yield

The Effects of Mental Fatigue on Physical Performance: A Systematic Review.

Background: Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity. It has recently been suggested that mental fatigue can affect physical performance. Objective: Our objective was to evaluate the literature on impairment of physical performance due to mental fatigue and to create an overview of the potential factors underlying this effect. \ud Methods: Two electronic databases, PubMed and Web of Science (until 28 April 2016), were searched for studies designed to test whether mental fatigue influenced performance of a physical task or influenced physiological and/or perceptual responses during the physical task. Studies using short (<30 min) self-regulatory depletion tasks were excluded from the review. Results: A total of 11 articles were included, of which six were of strong and five of moderate quality. The general finding was a decline in endurance performance (decreased time to exhaustion and self-selected power output/velocity or increased completion time) associated with a higher than normal perceived exertion. Physiological variables traditionally associated with endurance performance (heart rate, blood lactate, oxygen uptake, cardiac output, maximal aerobic capacity) were unaffected by mental fatigue. Maximal strength, power, and anaerobic work were not affected by mental fatigue. Conclusion: The duration and intensity of the physical task appear to be important factors in the decrease in physical performance due to mental fatigue. The most important factor responsible for the negative impact of mental fatigue on endurance performance is a higher perceived exertion

Asymmetric dimethylarginine predicts outcome and time of stay in hospital in patients attending an internal medicine emergency room

Introduction: For patients attending the emergency room (ER) valid diagnostic criteria which identify patients at risk for an adverse outcome are needed. We investigated the predictive value of asymmetric dimethylarginine (ADMA) in unselected patients attending an internal medicine ER regarding outcome of the patients and duration of stay in the hospital.\ud \ud Patients and methods: Patients (n = 417) attending the ER were classified according to their primary diagnosis. Routine laboratory tests were performed and ADMA was determined. Patients were followed for a primary endpoint of in hospital death and complicated outcome.\ud \ud Results: ADMA levels were highest in patients with a cancer-related diagnosis (0.76 (0.63–0.93) µmol/L) and in patients with a cardiovascular diagnosis (0.69 (0.60–0.80) µmol/L; p < 0.001). Overall, we found increasing proportions of patients experiencing the primary end point over the quartiles of ADMA (4.6%, 8.2%, 9.6%, and 15.8%; p = 0.007). ADMA had the highest predictive value for the primary endpoint in patients with cardiovascular disease (odds ratio 19.4; p = 0.029). In a Cox proportional hazard model ADMA was an independent predictor of the length of hospitalization (hazard ratio 2.0 (95% CI: 1.3–3.3); p = 0.006) in the entire cohort.\ud \ud Conclusion: We conclude that ADMA independently predicts future complications and hospitalization in patients attending an ER

Mid-regional pro-adrenomedullin (MR-proADM) Improves Disposition Strategies for Patients with Acute Dyspnoea: Results from the BACH trial

Objectives: To assess the value of Mid-regional pro-adrenomedullin (MR-proADM) in guiding patient disposition from the Emergency Department (ED), as one of the key factors of hospital resource utilization, in undifferentiated patients with acute dyspnoea. Methods: We used clinical and outcome data from a large international biomarker study (BACH trial) and analyzed data of all 1557 patients of the European and US sites presenting with acute dyspnoea. Patients were discharged or transferred from the ED to different levels of care (general ward, monitoring unit, intensive care unit). This original patient disposition was compared with the hypothetical disposition based on an adapted method of net reclassification improvement (NRI), which up-or downgraded patients from one level of care to the other based on the MR-proADM test result. Results: MR-pro-ADM was significantly higher in patients who died during the follow-up than in survivors (p<0.0001). When applying the adapted NRI model, 30 additional patients from the EU and 55 additional patients from the US were theoretically discharged (increase of 16.5%) had MR-proADM been used for patient management. The overall NRI, adding up the rates of up-and downgrades, in the EU was 16.0% (95% CI 8.2%-23.9%). A total of n=72 (9.9%) patients changed disposition when adding MR-pro ADM. In the US, the overall NRI was 12.0% (5.7%-18.4%) and a total of n=81 (11.2%) patients changed disposition. Conclusions: MR-proADM has the potential to guide initial disposition of undifferentiated ED patients with acute dyspnoea and might therefore be helpful to improve resource utilization and patient care

Role of N-terminal pro-B-type natriuretic peptide in risk stratification in patients presenting in the emergency room

Background: Natriuretic peptides are promising markers in diagnosing acute and chronic heart failure and assessing prognosis in these patients. Increasing routine use to unselected patients is challenged by false-positive results. The aims of this study were to assess (a) the distributions of N-terminal B-type natriuretic peptide (NT-proBNP) values in various diagnostic groups, (b) factors that influence NT-proBNP, and (c) the value of NT-proBNP in risk stratification in unselected emergency room (ER) patients.\ud Methods: NT-proBNP was measured in 876 unselected consecutive patients [mean (SD) age, 58 (18) years; 53% male] attending the ERs of 2 university hospitals and 1 community hospital. Diagnoses, age, sex, hemoglobin, creatinine (CREA), C-reactive protein (CRP), troponin T, and intensity of care were documented. In a subset consisting of all 417 patients at 1 center, in-hospital follow-up was completed with respect to a complicated clinical course, including intensive care treatment and death.\ud Results: NT-proBNP was significantly increased in patients with cardiac diagnoses or histories compared with patients with only pulmonary or other diagnoses. In patients with other diagnoses, NT-proBNP values increased significantly with the number of atherosclerotic risk factors (P = 0.044). Age, renal function, CRP, and to a much lesser extent, hemoglobin significantly influenced NT-proBNP values. The amount of care was positively correlated with NT-proBNP (P <0.001). Classification and regression tree analysis showed a superior impact of NT-proBNP for identification of high-risk patients.\ud Conclusions: NT-proBNP is a promising marker for identification of patients with structural heart disease in the ER and a suitable tool for risk stratification. Its use in the ER should be limited to clearly clinically defined patient groups at present to avoid a potential excess of additional diagnostic procedures in positive but asymptomatic patients

Layer-by-layer assemblies in nanoporous templates : nano-organized design and applications of soft nanotechnology

The synergistic combination of layer-by-layer (LbL) assembly and nanoporous membrane templating has greatly facilitated the creation of complex and functional nanotubular structures. The approach takes advantage of both the new properties conferred by assembling diverse LbL building blocks and the tight dimensional control offered by nanotemplating to enable new functionalities that arise from the highly anisotropic "one-dimensional'' LbL-nanotube format. In this review, we aim to convey the key developments and provide a current snap-shot of such templated LbL nanoarchitectures. We survey recent developments that have enabled the assembly of polymers, biomolecules and inorganic nanoparticles "a la carte'', via electrostatic, covalent and specific (bio)recognition interactions. We also discuss the emerging mechanistic understanding of the LbL assembly process within the nanopore environment. Finally, we present a diverse range of LbL nanotube "devices'' to illustrate the versatility of the nanotemplated LbL toolbox for generating functional soft nanotechnology