Risk factors for respiratory hospitalizations in a population of patients with a clinical diagnosis of COPD

Purpose: The purpose of this study was to examine differences between patients clinically diagnosed with COPD with and without obstruction by spirometry and to identify risk factors for respiratory hospitalizations. Materials and methods: This is a retrospective analysis of all patients diagnosed with COPD at a large academic Internal Medicine Clinic in 2014, who had spirometry performed during the period 2013-2014. Two groups existed: one with obstruction termed classical COPD and another without obstruction. Demographics, comorbidities, prescribed medications, spirometry, respiratory hospitalization, and eosinophilia among other variables were compared between patients with and without obstruction. Risk factors for two or more respiratory hospitalizations during the period 2014-2015 were sought for both populations by both univariate and multivariate analyses. Subsequently, we studied the population without obstruction for risk factors for one or more respiratory hospitalizations first by univariate analysis and then by multivariate analysis. Results: Among 657 patients, 210 met inclusion criteria, with 157 having obstruction on spirometry and 53 without obstruction. There was no difference between those with and without obstruction on the rate of respiratory hospitalization when using two or more respiratory hospitalizations ( Conclusion: In a clinically diagnosed COPD population who had spirometry performed, the presence of airflow obstruction was not a risk factor for respiratory hospitalizations. The most significantly associated nontreatment factor associated with respiratory hospitalization, both in the study population as a whole and in the cohort without obstruction, was MENT above the threshold of 0.5 K/µL

The Stroke-related Effects of Hip Flexion Fatigue on Over Ground Walking

Individuals post stroke often rely more on hip flexors for limb advancement during walking due to distal weakness but the effects of muscle fatigue in this group is not known. The purpose of this study was to quantify how stroke affects the influence of hip flexor fatigue on over ground walking kinematics and performance and muscle activation. Ten individuals with chronic stroke and 10 without stroke (controls) participated in the study. Maximal walking speed, walking distance, muscle electromyograms (EMG), and lower extremity joint kinematics were compared before and after dynamic, submaximal fatiguing contractions of the hip flexors (30% maximal load) performed until failure of the task. Task duration and decline in hip flexion maximal voluntary contraction (MVC) and power were used to assess fatigue. The stroke and control groups had similar task durations and percent reductions in MVC force following fatiguing contractions. Compared with controls, individuals with stroke had larger percent reductions in maximal walking speed, greater decrements in hip range of motion and peak velocity during swing, greater decrements in ankle velocity and lack of modulation of hip flexor EMG following fatiguing dynamic hip flexion contractions. For a given level of fatigue, the impact on walking function was more profound in individuals with stroke than neurologically intact individuals, and a decreased ability to up regulate hip flexor muscle activity may contribute. These data highlight the importance of monitoring the effect of hip flexor muscle activity during exercise or performance of activities of daily living on walking function post stroke

Carrier-controlled ferromagnetism in SrTiO3

Magnetotransport and superconducting properties are investigated for uniformly La-doped SrTiO3 films and GdTiO3/SrTiO3 heterostructures, respectively. GdTiO3/SrTiO3 interfaces exhibit a high-density two-dimensional electron gas on the SrTiO3-side of the interface, while for the SrTiO3 films carriers are provided by the dopant atoms. Both types of samples exhibit ferromagnetism at low temperatures, as evidenced by a hysteresis in the magnetoresistance. For the uniformly doped SrTiO3 films, the Curie temperature is found to increase with doping and to coexist with superconductivity for carrier concentrations on the high-density side of the superconducting dome. The Curie temperature of the GdTiO3/SrTiO3 heterostructures scales with the thickness of the SrTiO3 quantum well. The results are used to construct a stability diagram for the ferromagnetic and superconducting phases of SrTiO3.Comment: Revised version that is closer to the published version; Fig. 2 correcte

Erythropoietin response in critically ill mechanically ventilated patients: a prospective observational study

INTRODUCTION: Anemia is a common problem in critically ill patients. The etiology of anemia of critical illness is often determined to be multifactorial in the clinical setting, but the pathophysiology remains to be elucidated. Erythropoietin (EPO) is an endogenous glycoprotein hormone that serves as the primary stimulus for erythropoiesis. Recent evidence has demonstrated a blunted EPO response as a factor contributing to anemia of critical illness in specific subsets of patients. Critically ill patients requiring mechanical ventilation who exhibit anemia have not been the subject of previous studies. Our goal was to evaluate the erythropoietic response to anemia in the critically ill mechanically ventilated patient. METHODS: A prospective observational study was undertaken in the medical intensive care unit of a tertiary care, military hospital. Twenty patients admitted to the medical intensive care unit requiring mechanical ventilation for at least 72 hours were enrolled as study patients. EPO levels and complete blood count were measured 72 hours after admission and initiation of mechanical ventilation. Admission clinical and demographic data were recorded, and patients were followed for the duration of mechanical ventilation. Twenty patients diagnosed with iron deficiency anemia in the outpatient setting were enrolled as a control population. Control patients had baseline complete blood count and iron panel recorded by primary care physicians. EPO levels were measured at the time of enrollment in conjunction with complete blood count. RESULTS: The mean EPO level for the control population was 60.9 mU/ml. The mean EPO level in the mechanically ventilated patient group was 28.7 mU/ml, which was significantly less than in the control group (P = 0.035). The mean hemoglobin value was not significantly different between groups (10.6 g/dl in mechanically ventilated patients versus 10.2 g/dl in control patients; P > 0.05). CONCLUSION: Mechanically ventilated patients demonstrate a blunted EPO response to anemia. Further study of therapies directed at treating anemia of critical illness and evaluating its potential impact on mechanical ventilation outcomes and mortality is warranted

VETA-1 x ray detection system

The alignment and X-ray imaging performance of the Advanced X-ray Astrophysics Facility (AXAF) Verification Engineering Test Article-I (VETA-I) was measured by the VETA-I X-Ray Detection System (VXDS). The VXDS was based on the X-ray detection system utilized in the AXAF Technology Mirror Assembly (TMA) program, upgraded to meet the more stringent requirements of the VETA-I test program. The VXDS includes two types of X-ray detectors: (1) a High Resolution Imager (HRI) which provides X-ray imaging capabilities, and (2) sealed and flow proportional counters which, in conjunction with apertures of various types and precision translation stages, provide the most accurate measurement of VETA-I performance. Herein we give an overview of the VXDS hardware including X-ray detectors, translation stages, apertures, proportional counters and flow counter gas supply system and associated electronics. We also describe the installation of the VXDS into the Marshall Space Flight Center (MSFC) X-Ray Calibration Facility (XRCF). We discuss in detail the design and performance of those elements of the VXDS which have not been discussed elsewhere; translation systems, flow counter gas supply system, apertures and thermal monitoring system

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS). DESIGN: Retrospective cohort study. SETTING: This investigation took place at a single-center, tertiary referral multidisciplinary comprehensive healthcare hospital in metropolitan Detroit, Michigan. PATIENTS: Adult patients 18 years old or older hospitalized in the ICU and diagnosed with ARDS on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three hundred eight patients were included in the final analysis. Risk factors associated with mortality included advanced age (p \u3c 0.001), increased body mass index (p = 0.008), and a history of chronic kidney disease (p = 0.023). Presence of AKI by day 1 of intubation, with elevated creatinine (p = 0.003) and oliguria (p \u3c 0.001), was significantly associated with mortality. On multivariate analysis, advanced age (relative risk [RR], 1.02), urine output on the day of intubation (RR, 0.388), bicarbonate level (RR, 0.948), and Sequential Organ Failure Assessment severity score (RR, 1.09) were independently associated with mortality. A receiver operating characteristic curve identified a threshold urine output on the day of intubation of 0.7 mL/kg/hr (area under the curve, 0.75; p \u3c 0.001) as most closely associated with inpatient mortality (i.e., urine output \u3c 0.7 mL/kg/hr is associated with mortality). CONCLUSIONS: For patients with ARDS, oliguria on the day of intubation was independently associated with increased mortality. Urine output of less than 0.7 mL/kg/hr predicted 80% of inpatient deaths. These findings herald an augmented understanding of the role of urine output in medical decision-making and prognostication