Impact of Technetium-99m Sestamibi Imaging on the Emergency Department Management and Costs in the Evaluation of Low-risk Chest Pain

Objectives: To assess the impact of rest sestamibi scanning on emergency physicians' (EPs') diagnostic certainty and decision making (as assessed by the hypothetical disposition of patients) for 69 consenting stable patients with suspected acute cardiac ischemia and nondiagnostic electrocardiograms. The resultant impact on costs was examined as a secondary outcome. Methods: Patients with suspected acute cardiac ischemia were injected with 25 mCi of sestamibi within two hours of active pain in one of three emergency department study sites. The probability of acute myocardial infarction (AMI) and unstable angina (UA), and hypothetical disposition decisions were recorded immediately before and after physicians were notified of scan results. Changes in disposition were classified as optimal or suboptimal. For the cost determinations, a cost-based decision support program was used. Results: For the subgroup found to be free of acute cardiac events (ACEs) ( n = 62), the EPs' post-sestamibi scan probabilities for AMI decreased by 11% and UA by 18% (p < 0.001 for both conditions). In seven patients with ACEs, the post-scan probabilities of AMI and UA increased, but neither was statistically significant. Scan results led to hypothetical disposition changes in 29 patients (42%), of which 27 (93%) were optimal (nine patients were reassigned to a lower level of care, two to a higher level, and 16 additional patients to “discharge-home” status). The strategy of scanning all patients who were low to moderate risk for acute cardiac ischemia would result in an increase of direct costs of care of $222 per patient evaluated, due to added cost of sestamibi scanning. Conclusions: Sestamibi scanning results appropriately affected the EPs' estimates of the probability of AMI and UA and improved disposition decisions. Scanning all low-risk patients would likely be associated with increased costs at this medical center.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73784/1/j.1553-2712.2001.tb02108.x.pd

Multifrequency Strategies for the Identification of Gamma-Ray Sources

More than half the sources in the Third EGRET (3EG) catalog have no firmly established counterparts at other wavelengths and are unidentified. Some of these unidentified sources have remained a mystery since the first surveys of the gamma-ray sky with the COS-B satellite. The unidentified sources generally have large error circles, and finding counterparts has often been a challenging job. A multiwavelength approach, using X-ray, optical, and radio data, is often needed to understand the nature of these sources. This chapter reviews the technique of identification of EGRET sources using multiwavelength studies of the gamma-ray fields.Comment: 35 pages, 22 figures. Chapter prepared for the book "Cosmic Gamma-ray Sources", edited by K.S. Cheng and G.E. Romero, to be published by Kluwer Academic Press, 2004. For complete article and higher resolution figures, go to: http://www.astro.columbia.edu/~muk/mukherjee_multiwave.pd

Non-linear dynamic response of a cable system with a tuned mass damper to stochastic base excitation via equivalent linearization technique

Abstract: Non-linear dynamic model of a cable–mass system with a transverse tuned mass damper is considered. The system is moving in a vertical host structure therefore the cable length varies slowly over time. Under the time-dependent external loads the sway of host structure with low frequencies and high amplitudes can be observed. That yields the base excitation which in turn results in the excitation of a cable system. The original model is governed by a system of non-linear partial differential equations with corresponding boundary conditions defined in a slowly time-variant space domain. To discretise the continuous model the Galerkin method is used. The assumption of the analysis is that the lateral displacements of the cable are coupled with its longitudinal elastic stretching. This brings the quadratic couplings between the longitudinal and transverse modes and cubic nonlinear terms due to the couplings between the transverse modes. To mitigate the dynamic response of the cable in the resonance region the tuned mass damper is applied. The stochastic base excitation, assumed as a narrow-band process mean-square equivalent to the harmonic process, is idealized with the aid of two linear filters: one second-order and one first-order. To determine the stochastic response the equivalent linearization technique is used. Mean values and variances of particular random state variable have been calculated numerically under various operational conditions. The stochastic results have been compared with the deterministic response to a harmonic process base excitation

Hyperactivation of HUSH complex function by Charcot-Marie-Tooth disease mutation in MORC2

Dominant mutations in the $\textit{MORC2}$ gene have recently been shown to cause axonal Charcot–Marie–Tooth (CMT) disease, but the cellular function of MORC2 is poorly understood. Here, through a genome-wide CRISPR–Cas9-mediated forward genetic screen, we identified $\textit{MORC2}$ as an essential gene required for epigenetic silencing by the HUSH complex. HUSH recruits MORC2 to target sites in heterochromatin. We exploited a new method, differential viral accessibility (DIVA), to show that loss of MORC2 results in chromatin decompaction at these target loci, which is concomitant with a loss of H3K9me3 deposition and transcriptional derepression. The ATPase activity of MORC2 is critical for HUSH-mediated silencing, and the most common alteration affecting the ATPase domain in CMT patients (p.Arg252Trp) hyperactivates HUSH-mediated repression in neuronal cells. These data define a critical role for MORC2 in epigenetic silencing by the HUSH complex and provide a mechanistic basis underpinning the role of $\textit{MORC2}$ mutations in CMT disease.This work was supported by the Wellcome Trust, through a Principal Research Fellowship to P.J.L. (101835/Z/13/Z), a Senior Research Fellowship to Y.M. (101908/Z/13/Z), a Sir Henry Wellcome Postdoctoral Fellowship to R.T.T. (201387/Z/16/Z) and a PhD studentship to I.A.T., and by the BBSRC, through a Future Leader Fellowship to C.H.D. I.A.T. is supported as a Damon Runyon Fellow by the Damon Runyon Cancer Research Foundation (DRG-2277-16). The CIMR is in receipt of a Wellcome Trust strategic award

Measurement of Aerosols at the Pierre Auger Observatory

The air fluorescence detectors (FDs) of the Pierre Auger Observatory are vital for the determination of the air shower energy scale. To compensate for variations in atmospheric conditions that affect the energy measurement, the Observatory operates an array of monitoring instruments to record hourly atmospheric conditions across the detector site, an area exceeding 3,000 square km. This paper presents results from four instruments used to characterize the aerosol component of the atmosphere: the Central Laser Facility (CLF), which provides the FDs with calibrated laser shots; the scanning backscatter lidars, which operate at three FD sites; the Aerosol Phase Function monitors (APFs), which measure the aerosol scattering cross section at two FD locations; and the Horizontal Attenuation Monitor (HAM), which measures the wavelength dependence of aerosol attenuation.Comment: Contribution to the 30th International Cosmic Ray Conference, Merida Mexico, July 2007; 4 pages, 4 figure

Microbial catabolic activities are naturally selected by metabolic energy harvest rate

The fundamental trade-off between yield and rate of energy harvest per unit of substrate has been largely discussed as a main characteristic for microbial established cooperation or competition. In this study, this point is addressed by developing a generalized model that simulates competition between existing and not experimentally reported microbial catabolic activities defined only based on well-known biochemical pathways. No specific microbial physiological adaptations are considered, growth yield is calculated coupled to catabolism energetics and a common maximum biomass-specific catabolism rate (expressed as electron transfer rate) is assumed for all microbial groups. Under this approach, successful microbial metabolisms are predicted in line with experimental observations under the hypothesis of maximum energy harvest rate. Two microbial ecosystems, typically found in wastewater treatment plants, are simulated, namely: (i) the anaerobic fermentation of glucose and (ii) the oxidation and reduction of nitrogen under aerobic autotrophic (nitrification) and anoxic heterotrophic and autotrophic (denitrification) conditions. The experimentally observed cross feeding in glucose fermentation, through multiple intermediate fermentation pathways, towards ultimately methane and carbon dioxide is predicted. Analogously, two-stage nitrification (by ammonium and nitrite oxidizers) is predicted as prevailing over nitrification in one stage. Conversely, denitrification is predicted in one stage (by denitrifiers) as well as anammox (anaerobic ammonium oxidation). The model results suggest that these observations are a direct consequence of the different energy yields per electron transferred at the different steps of the pathways. Overall, our results theoretically support the hypothesis that successful microbial catabolic activities are selected by an overall maximum energy harvest rate

Investigating the melt pool properties and thermal effects of multi-laser diode area melting

Diode area melting (DAM) is a new additive manufacturing process that utilises customised architectural arrays of low-power laser diode emitters for high-speed parallel processing of metallic feedstock. The laser diodes operate at shorter laser wavelengths (808 nm) than conventional SLM fibre lasers (1064 nm) theoretically enabling more efficient energy absorption for specific materials. This investigation presents the first work investigating the melt pool properties and thermal effects of the multi-laser DAM process, modelling generated melt pools the unique thermal profiles created along a powder bed during processing. Using this approach process, optimisation can be improved by analysing this thermal temperature distribution, targeting processing conditions that induce full melting for variable powder layer thicknesses. In this work, the developed thermal model simulates the DAM processing of 316L stainless steel and is validated with experimental trials. The simulation indicates that multi-laser DAM methodology can reduce residual stress formation compared to the single point laser scanning methods used during selective laser melting