1,452 research outputs found
Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records
BACKGROUND: The aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection. METHODS: We undertook a single centre, retrospective cohort study examining COVID-19 related mortality using Electronic Health Records, for older people (65 and over) with frailty, hospitalised with or without COVID-19 infection. Baseline covariates included demographics, Early Warning Scores, Charlson Comorbidity Indices and frailty (Clinical Frailty Scale, CFS), linked to COVID-19 status. FINDINGS: We analysed outcomes on 1,071 patients with COVID-19 test results; 285 (27%) were positive for COVID-19.)The mean age at ED arrival was 79.7 and 49.4% were female. All-cause mortality (by 30 days) rose from 9% (not frail) through to 33% (severely frail) in the COVID negative cohort but was around 60% for all frailty categories in the COVID positive cohort. In adjusted analyses, the hazard ratio for death in those with COVID-19 compared to those without COVID-19 was 7.3, 95% CI: 3.00, 18.0) with age, comorbidities and illness severity making small additional contributions. INTERPRETATION: In this study frailty, measured using the Clinical Frailty Scale, appeared to make little incremental contribution to the hazard of dying in older people hospitalised with COVID-19 infection; illness severity and comorbidity had a modest association with the overall adjusted hazard of death, whereas confirmed COVID-19 infection dominated, with a seven-fold hazard for death
A combined transmission spectrum of the Earth-sized exoplanets TRAPPIST-1 b and c
Three Earth-sized exoplanets were recently discovered close to the habitable
zone of the nearby ultracool dwarf star TRAPPIST-1. The nature of these planets
has yet to be determined, since their masses remain unmeasured and no
observational constraint is available for the planetary population surrounding
ultracool dwarfs, of which the TRAPPIST-1 planets are the first transiting
example. Theoretical predictions span the entire atmospheric range from
depleted to extended hydrogen-dominated atmospheres. Here, we report a
space-based measurement of the combined transmission spectrum of the two inner
planets made possible by a favorable alignment resulting in their simultaneous
transits on 04 May 2016. The lack of features in the combined spectrum rules
out cloud-free hydrogen-dominated atmospheres for each planet at 10-
levels; TRAPPIST-1 b and c are hence unlikely to harbor an extended gas
envelope as they lie in a region of parameter space where high-altitude
cloud/haze formation is not expected to be significant for hydrogen-dominated
atmospheres. Many denser atmospheres remain consistent with the featureless
transmission spectrum---from a cloud-free water vapour atmosphere to a
Venus-like atmosphere.Comment: Early release to inform further the upcoming review of HST's Cycle 24
proposal
Autoimmune cholangitis mimicking a klatskin tumor: a case report
<p>Abstract</p> <p>Introduction</p> <p>Autoimmune cholangitis remains an elusive manifestation of immunoglobulin G4-associated systemic disease most commonly encountered in patients with autoimmune pancreatitis. No strict diagnostic criteria have been described to date and diagnosis mainly relies on a combination of clinical and histopathologic findings. It is hence even more challenging to diagnose autoimmune cholangitis in patients with late or atypical presentations, such as without concomitant pancreatic involvement. Early diagnosis of this rare disorder can significantly improve outcomes considering high rates of surgical intervention, as well as high relapse rates in the absence of steroid treatment. To the best of our knowledge the literature is quite sparse on cases with atypical presentations of autoimmune cholangitis.</p> <p>Case presentation</p> <p>We report a case of a previously healthy 65-year-old man of Middle-Eastern origin, with a history of pancreatic insufficiency of unknown etiology, evaluated for elevated liver function tests found incidentally on a routine physical examination. Imaging studies revealed an atrophic pancreas and biliary duct dilatation consistent with obstruction. Subsequent endoscopic retrograde cholangiopancreatography showed a bile duct narrowing pattern suggestive of cholangiocarcinoma, but brushings failed to reveal malignant cells. Our patient proceeded to undergo surgical resection. Histological examination of the resected mass revealed lymphoplasmacytic infiltrate with no malignant features. Our patient returned three months later with persistently high liver function tests and no evidence of biliary obstruction on imaging. A presumptive diagnosis of autoimmune cholangitis was made and our patient's symptoms resolved after a short course of an oral steroid regimen. Post factum staining of the resection specimen revealed an immunoglobulin G4 antibody positive immune cell infiltrate, consistent with the proposed diagnosis.</p> <p>Conclusion</p> <p>Our case thus highlights the importance of clinician awareness of the autoimmune spectrum of biliary pathologies when confronted with atypical clinical presentations, the paucity of diagnostic measures and the benefit from long-term steroid and/or immunosuppressive treatment.</p
SPECULOOS exoplanet search and its prototype on TRAPPIST
One of the most significant goals of modern science is establishing whether
life exists around other suns. The most direct path towards its achievement is
the detection and atmospheric characterization of terrestrial exoplanets with
potentially habitable surface conditions. The nearest ultracool dwarfs (UCDs),
i.e. very-low-mass stars and brown dwarfs with effective temperatures lower
than 2700 K, represent a unique opportunity to reach this goal within the next
decade. The potential of the transit method for detecting potentially habitable
Earth-sized planets around these objects is drastically increased compared to
Earth-Sun analogs. Furthermore, only a terrestrial planet transiting a nearby
UCD would be amenable for a thorough atmospheric characterization, including
the search for possible biosignatures, with near-future facilities such as the
James Webb Space Telescope. In this chapter, we first describe the physical
properties of UCDs as well as the unique potential they offer for the detection
of potentially habitable Earth-sized planets suitable for atmospheric
characterization. Then, we present the SPECULOOS ground-based transit survey,
that will search for Earth-sized planets transiting the nearest UCDs, as well
as its prototype survey on the TRAPPIST telescopes. We conclude by discussing
the prospects offered by the recent detection by this prototype survey of a
system of seven temperate Earth-sized planets transiting a nearby UCD,
TRAPPIST-1.Comment: Submitted as a chapter in the "Handbook of Exoplanets" (editors: H.
Deeg & J.A. Belmonte; Section Editor: N. Narita). 16 pages, 4 figure
Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
BACKGROUND:
Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.
METHODS:
Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000–2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.
FINDINGS:
In total, 965,905 individuals aged 5–104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (−0.45 years (99% CI: −0.45, −0.44)) and in 70 year old males dying after developing multimorbidity (−1.98 years (99% CI: −2.01, −1.95)).
INTERPRETATION:
This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks.
FUNDING:
UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales
Agent based modelling helps in understanding the rules by which fibroblasts support keratinocyte colony formation
Background: Autologous keratincoytes are routinely expanded using irradiated mouse fibroblasts and bovine serum for clinical use. With growing concerns about the safety of these xenobiotic materials, it is desirable to culture keratinocytes in media without animal derived products. An improved understanding of epithelial/mesenchymal interactions could assist in this.
Methodology/Principal Findings: A keratincyte/fibroblast o-culture model was developed by extending an agent-based keratinocyte colony formation model to include the response of keratinocytes to both fibroblasts and serum. The model was validated by comparison of the in virtuo and in vitro multicellular behaviour of keratinocytes and fibroblasts in single and co-culture in Greens medium. To test the robustness of the model, several properties of the fibroblasts were changed to investigate their influence on the multicellular morphogenesis of keratinocyes and fibroblasts. The model was then used to generate hypotheses to explore the interactions of both proliferative and growth arrested fibroblasts with keratinocytes. The key predictions arising from the model which were confirmed by in vitro experiments were that 1) the ratio of fibroblasts to keratinocytes would critically influence keratinocyte colony expansion, 2) this ratio needed to be optimum at the beginning of the co-culture, 3) proliferative fibroblasts would be more effective than irradiated cells in expanding keratinocytes and 4) in the presence of an adequate number of fibroblasts, keratinocyte expansion would be independent of serum.
Conclusions: A closely associated computational and biological approach is a powerful tool for understanding complex biological systems such as the interactions between keratinocytes and fibroblasts. The key outcome of this study is the finding that the early addition of a critical ratio of proliferative fibroblasts can give rapid keratinocyte expansion without the use of irradiated mouse fibroblasts and bovine serum
Gravitational Radiation from Post-Newtonian Sources and Inspiralling Compact Binaries
The article reviews the current status of a theoretical approach to the
problem of the emission of gravitational waves by isolated systems in the
context of general relativity. Part A of the article deals with general
post-Newtonian sources. The exterior field of the source is investigated by
means of a combination of analytic post-Minkowskian and multipolar
approximations. The physical observables in the far-zone of the source are
described by a specific set of radiative multipole moments. By matching the
exterior solution to the metric of the post-Newtonian source in the near-zone
we obtain the explicit expressions of the source multipole moments. The
relationships between the radiative and source moments involve many non-linear
multipole interactions, among them those associated with the tails (and
tails-of-tails) of gravitational waves. Part B of the article is devoted to the
application to compact binary systems. We present the equations of binary
motion, and the associated Lagrangian and Hamiltonian, at the third
post-Newtonian (3PN) order beyond the Newtonian acceleration. The
gravitational-wave energy flux, taking consistently into account the
relativistic corrections in the binary moments as well as the various tail
effects, is derived through 3.5PN order with respect to the quadrupole
formalism. The binary's orbital phase, whose prior knowledge is crucial for
searching and analyzing the signals from inspiralling compact binaries, is
deduced from an energy balance argument.Comment: 109 pages, 1 figure; this version is an update of the Living Review
article originally published in 2002; available on-line at
http://www.livingreviews.org
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Clustering of glycoprotein VI (GPVI) dimers upon adhesion to collagen as a mechanism to regulate GPVI signaling in platelets.
Essentials
- Dimeric high-affinity collagen receptor glycoprotein VI (GPVI) is present on resting platelets.
- Spatio-temporal organization of platelet GPVI-dimers was evaluated using advanced microscopy.
- Upon platelet adhesion to collagenous substrates, GPVI-dimers coalesce to form clusters.
- Clustering of GPVI-dimers may increase avidity and facilitate platelet activation
SUMMARY:
Background
Platelet glycoprotein VI (GPVI) binding to subendothelial collagen exposed upon blood vessel injury initiates thrombus formation. Dimeric GPVI has high affinity for collagen, and occurs constitutively on resting platelets.
Objective
To identify higher-order oligomerization (clustering) of pre-existing GPVI dimers upon interaction with collagen as a mechanism to initiate GPVI-mediated signaling.
Methods
GPVI was located by use of fluorophore-conjugated GPVI dimer-specific Fab (antigen-binding fragment). The tested substrates include Horm collagen I fibers, soluble collagen III, GPVI-specific collagen peptides, and fibrinogen. GPVI dimer clusters on the platelet surface interacting with these substrates were visualized with complementary imaging techniques: total internal reflection fluorescence microscopy to monitor real-time interactions, and direct stochastic optical reconstruction microscopy (dSTORM), providing relative quantification of GPVI cluster size and density. Confocal microscopy was used to locate GPVI dimer clusters, glycoprotein Ib, integrin αβ , and phosphotyrosine.
Results
Upon platelet adhesion to all collagenous substrates, GPVI dimers coalesced to form clusters; notably clusters formed along the fibers of Horm collagen. dSTORM revealed that GPVI density within clusters depended on the substrate, collagen III being the most effective. Clusters on fibrinogen-adhered platelets were much smaller and more numerous; whether these are pre-existing oligomers of GPVI dimers or fibrinogen-induced is not clear. Some GPVI dimer clusters colocalized with areas of phosphotyrosine, indicative of signaling activity. Integrin αβ was localized to collagen fibers close to GPVI dimer clusters. GPVI clustering depends on a dynamic actin cytoskeleton.
Conclusions
Platelet adhesion to collagen induces GPVI dimer clustering. GPVI clustering increases both avidity for collagen and the proximity of GPVI-associated signaling molecules, which may be crucial for the initiation and persistence of signaling.These studies were supported by a Project Grant (PG/10/011/28199, to S. M. Jung, M. Moroi, R. W. Farndale, and S. P. Watson) and a Special Project Grant (SP/13/7/30575, to S. M. Jung) from the British Heart Foundation and a Wellcome Trust Biomedical Resource Grant (09440/Z/10/Z, to R. W. Farndale). S. P. Watson and N. S. Poulter are supported by the British Heart Foundation (CH/03/003). A. Y. Pollitt was funded by Wellcome Trust Grant 088410 (to S. P. Watson)
Design of Experiments for Screening
The aim of this paper is to review methods of designing screening
experiments, ranging from designs originally developed for physical experiments
to those especially tailored to experiments on numerical models. The strengths
and weaknesses of the various designs for screening variables in numerical
models are discussed. First, classes of factorial designs for experiments to
estimate main effects and interactions through a linear statistical model are
described, specifically regular and nonregular fractional factorial designs,
supersaturated designs and systematic fractional replicate designs. Generic
issues of aliasing, bias and cancellation of factorial effects are discussed.
Second, group screening experiments are considered including factorial group
screening and sequential bifurcation. Third, random sampling plans are
discussed including Latin hypercube sampling and sampling plans to estimate
elementary effects. Fourth, a variety of modelling methods commonly employed
with screening designs are briefly described. Finally, a novel study
demonstrates six screening methods on two frequently-used exemplars, and their
performances are compared
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