Unscheduled care pathways in patients with myocardial infarction in Scotland

OBJECTIVE: Treatment of acute myocardial infarction (MI) requires rapid transfer of people with chest pain to hospital, however, unscheduled care pathways vary in their directness (the minimal number of contacts to hospital admission). The aim was to examine unscheduled care pathways and the associations with mortality in people admitted with MI. METHODS: Retrospective population study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. Linked data for all National Health Service Scotland unscheduled care services (NHS24 telephone triage service, primary care out of hours, ambulance, emergency department (ED)) was used to define continuous unscheduled care pathways (pathways), which were categorised by initial contact, and whether they were 'direct' (had minimum number of contacts between first contact and admission). Analysis estimated ORs and 95% CIs in adjusted models in which all covariates were included. RESULTS: 26 325 people admitted with MI (63.1% men, 61.6% aged 65+ years), of whom 5.6% died from coronary heart disease within 28 days. For 47.0%, the first unscheduled care contact was ambulance, 23.3% attended ED directly and 18.7% called telephone triage. 92.1% of pathways were direct. Pathways starting with telephone triage were more likely to be indirect compared with other initial contacts (adjusted OR (aOR) 1.97, 95% CI 1.61 to 2.40). Compared to direct pathways, indirect pathways starting with telephone triage were associated with higher mortality (aOR 1.97, 95% CI 1.61 to 2.40) as were indirect pathways starting with another service (aOR 1.55, 95% CI 1.19 to 2.01), but not direct pathways starting with telephone triage (aOR 0.87, 95% CI 0.74 to 1.02). CONCLUSION: Unscheduled care pathways leading to admission with MI in Scotland are usually direct, but those starting with telephone triage were more commonly indirect. Those indirect pathways were associated with higher mortality

On the problem of mass-dependence of the two-point function of the real scalar free massive field on the light cone

We investigate the generally assumed inconsistency in light cone quantum field theory that the restriction of a massive, real, scalar, free field to the nullplane $\Sigma=\{x^0+x^3=0\}$ is independent of mass \cite{LKS}, but the restriction of the two-point function depends on it (see, e.g., \cite{NakYam77, Yam97}). We resolve this inconsistency by showing that the two-point function has no canonical restriction to $\Sigma$ in the sense of distribution theory. Only the so-called tame restriction of the two-point function exists which we have introduced in \cite{Ull04sub}. Furthermore, we show that this tame restriction is indeed independent of mass. Hence the inconsistency appears only by the erroneous assumption that the two-point function would have a (canonical) restriction to $\Sigma$.Comment: 10 pages, 2 figure

Increasing Incidence and Age at Diagnosis among Children with Type 1 Diabetes Mellitus over a 20-Year Period in Auckland (New Zealand)

BACKGROUND: We aimed to evaluate the incidence of type 1 diabetes mellitus in children <15 years of age (yr) in the Auckland region (New Zealand) over 20 years (1990-2009). METHODS: We performed a retrospective review of all patients <15 yr diagnosed with type 1 diabetes, from an unselected complete regional cohort. RESULTS: There were 884 new cases of type 1 diabetes, and age at diagnosis rose from 7.6 yr in 1990/1 to 8.9 yr in 2008/9 (r(2) = 0.31, p = 0.009). There was a progressive increase in type 1 diabetes incidence among children <15 yr (p<0.0001), reaching 22.5 per 100,000 in 2009. However, the rise in incidence did not occur evenly among age groups, being 2.5-fold higher in older children (10-14 yr) than in the youngest group (0-4 yr). The incidence of new cases of type 1 diabetes was highest in New Zealand Europeans throughout the study period in all age groups (p<0.0001), but the rate of increase was similar in New Zealand Europeans and Non-Europeans. Type 1 diabetes incidence and average annual increase were similar in both sexes. There was no change in BMI SDS shortly after diagnosis, and no association between BMI SDS and age at diagnosis. CONCLUSIONS: There has been a steady increase in type 1 diabetes incidence among children <15 yr in Auckland over 20 years. Contrary to other studies, age at diagnosis has increased and the greatest rise in incidence occurred in children 10-14 yr. There was little change in BMI SDS in this population, providing no support for the 'accelerator hypothesis'

Phosphorus and nitrogen limitation of primary production in a simulated estuarine gradient

The transition between phosphorus limitation of primary production in freshwater and nitrogen limitation in seawater was examined along an estuarine gradient simulated in 4 large 13 m3 enclosures connected in a series and containing pelagic and benthic subsystems. Nominal salinities of 0, 5, 10 and 25 ppt were maintained by exchanging appropriate volumes of water between enclosures. River water, which served as a freshwater endmember, was naturally high in N relative to P, while the oceanic endmember (water from Narragansett Bay, RI, USA) was low in N relative to P. Production in the water column was supported by external inputs and recycled nutrients. Bioassays, inorganic nutrient concentrations and N:P ratios of the seston and inorganic nutrients indicated that phosphorus was limiting at 0, 5 and 10 ppt, while nitrogen was limiting at 25 ppt. Coincident with this shift in limiting nutrient was a shift in the N:P ratio of nutrient supply from greater than the Redfield ratio of 16 to less than 16. External inputs established relative rates of supply in each enclosure. The relative proportion of N and P in external inputs was largely a function of the hydrodynamic mixing of fresh (high N, low P) and salt water (low N, high P) endmembers. At the scale of the estuarine segment or enclosure, neither recycled inputs from the benthos and water column, nitrogen fixation nor internal losses of N and P to sedimentation and/or denitrification materially altered relative supply rates, despite a hydrodynamic residence time of 27 d

Passive solid state microdosimeter with electronic readout

Apparatus and method for qualitatively and quantitatively analyzing a complex radiation field are provided. A passive microdosimetry detector device records the energy deposition of incident radiation using an array of microstructure non-volatile memory devices. Each microstructure non-volatile memory device is capable of storing a predetermined initial charge without requiring a power source. A radiation particle incident to a microstructure non-volatile memory device is termed an event . Each such event may generate a charge within a sensitive volume defined by the microstructure non-volatile memory device. The charge generated within the sensitive volume alters the stored initial charge by an amount falling within a range corresponding to the energy deposited by certain particle types. Data corresponding to such charge alterations for a plurality of microstructure non-volatile memory devices within an array of such devices are presented to a qualitative analyzing device. The qualitative analyzing device converts the data to a spectral analysis of the incident radiation field by applying ICRP-recommended weighting factors to individual events or approximations thereof

Faint dwarfs as a test of DM models: WDM vs. CDM

We use high resolution Hydro$+$N-Body cosmological simulations to compare the assembly and evolution of a small field dwarf (stellar mass ~ 10$^{6-7}$ M$\odot$, total mass 10$^{10}$ M$\odot$ in $\Lambda$ dominated CDM and 2keV WDM cosmologies. We find that star formation (SF) in the WDM model is reduced and delayed by 1-2 Gyr relative to the CDM model, independently of the details of SF and feedback. Independent of the DM model, but proportionally to the SF efficiency, gas outflows lower the central mass density through `dynamical heating', such that all realizations have circular velocities $<$ 20kms at 500$~$pc, in agreement with local kinematic constraints. As a result of dynamical heating, older stars are less centrally concentrated than younger stars, similar to stellar population gradients observed in nearby dwarf galaxies. Introducing an important diagnostic of SF and feedback models, we translate our simulations into artificial color-magnitude diagrams and star formation histories in order to directly compare to available observations. The simulated galaxies formed most of their stars in many $\sim$10 Myr long bursts. The CDM galaxy has a global SFH, HI abundance and Fe/H and alpha-elements distribution well matched to current observations of dwarf galaxies. These results highlight the importance of directly including `baryon physics' in simulations when 1) comparing predictions of galaxy formation models with the kinematics and number density of local dwarf galaxies and 2) differentiating between CDM and non-standard models with different DM or power spectra.Comment: 13 pages including Appendix on Color Magnitude Diagrams. Accepted by MNRAS. Added one plot and details on ChaNGa implementation. Reduced number of citations after editorial reques

Sarcoidosis of the hypothalamus and pituitary stalk

We report a rare case of sarcoidosis of the hypothalamic and suprasellar region, with clinical course and the magnetic resonance imaging follow-up

On Petition for a Writ of Certiorari to The United States Court of Appeals for The Eighth Circuit, Brief of Law Professors Paul F. Rothstein, et. al., Office of the President v. Office of Independent Counsel

This Court should grant review not only because this is a case of national importance and prominence, but also because the decision below is a conspicuous departure from settled principles of evidence law. The panel majority concluded that communications between government lawyers and government officials are not protected by the attorney-client privilege, at least when those communications are sought by a federal grand jury. That conclusion conflicts with the predominant common-law understanding that the attorney-client privilege applies to government entities and that where the privilege applies, it is absolute (i.e., it protects against disclosure in all types of legal and investigative proceedings). In particular, the Court of Appeals\u27 decision rests on a fundamental misunderstanding of this Court\u27s decisions in Upjohn Co. v. United States, 449 U.S. 383 (1981), and United States v. Nixon, 418 U.s. 683 (1974). Moreover, this case warrants further review because the decision below has profound implications beyond the parties to this dispute. The Court of Appeals\u27 ruling, if allowed to stand, will create widespread uncertainty among federal, state, and local officials concerning the extent to which their communications with their agency lawyers, for the purpose of seeking legal advice in the conduct of governmental affairs, are protected by the attorney-client privilege. Unless this Court grants review and resolves this uncertainty, the decision below will likely have an adverse effect on the current and future operation of not only the Office of the President of the United States, but also government at all levels. At the very least, a decision of such vast implications (as in the present case) should be made by the highest court in the land. We accordingly urge the Court to grant the petition for review

Scheduling Discovery in the 2020s

The 2020s will be the most data-rich decade of astronomy in history. As the scale and complexity of our surveys increase, the problem of scheduling becomes more critical. We must develop high-quality scheduling approaches, implement them as open-source software, and begin linking the typically separate stages of observation and data analysis