Prospective observational study of point-of-care creatinine in trauma.

Background:Patients with trauma are at risk for renal dysfunction from hypovolemia or urological injury. In austere environments, creatinine values are not available to guide resuscitation. A new portable device, the Stat Sensor Point-of-care (POC) Whole Blood Creatinine Analyzer, provides accurate results in <30 s and requires minimal training. This device has not been evaluated in trauma despite the theoretical benefit it provides. The purpose of this study is to determine the clinical impact of the POC device in trauma. Methods:40 patients with trauma were enrolled in a prospective observational study. One drop of blood was used for creatinine determination on the Statsensor POC device. POC creatinine results were compared to the laboratory. Turnaround time (TAT) for POC and laboratory methods was calculated as well as time elapsed to CT scan if applicable. Results:Patients (n=40) were enrolled between December 2014 and March 2015. POC creatinine values were similar to laboratory methods with a mean bias of 0.075±0.27 (p=0.08). Mean analytical TATs for the POC measurements were significantly faster than the laboratory method (11.6±10.0 min vs 78.1±27.9 min, n=40, p<0.0001). Mean elapsed time before arrival at the CT scanner was 52.9±34.2 min. Conclusions:The POC device reported similar creatinine values to the laboratory and provided significantly faster results. POC creatinine testing is a promising development for trauma practice in austere environments and workup of a subset of stable patients with trauma. Further study is warranted to determine clinical impact, both in hospital-based trauma and austere environments

Calibrating mars orbiter laser altimeter pulse widths at mars science laboratory candidate landing sites

Accurate estimates of surface roughness allow quantitative comparisons between planetary terrains. These comparisons enable us to improve our understanding of commonly occurring surface processes, and develop a more complete analysis of candidate landing and roving sites. A (secondary) science goal of the Mars Orbiter Laser Altimeter was to map surface roughness within the laser footprint using the backscatter pulse-widths of individual pulses, at finer scales than can be derived from the elevation profiles. On arrival at the surface, these pulses are thought to have diverged to between 70 and 170 m, corresponding to surface roughness estimates at 35 and 70 m baselines respectively; however, the true baseline and relationship remains unknown. This work compares the Mars Orbiter Laser Altimeter pulse-widths to surface roughness estimates at various baselines from high-resolution digital terrain models at the final four candidate landing sites of Mars Science Laboratory. The objective was to determine the true baseline at which surface roughness can be estimated, and the relationship between surface roughness and the pulse-widths, to improve the reliability of current global surface roughness estimates from pulse-width maps. The results seem to indicate that pulse-widths from individual shots are an unreliable indicator of surface roughness, and instead, the pulse-widths should be downsampled to indicate regional roughness, with the Slope-Corrected pulse-width dataset performing best. Where Rough Patches are spatially large compared to the footprint of the pulse, pulse-widths can be used as an indicator of surface roughness at baselines of 150 to 300 m; where these patches are spatially small, as observed at Mawrth Vallis, pulse-widths show no correlation to surface roughness. This suggests that a more complex relationship exists, with varying correlations observed, which appear dependent on the distribution of roughness across the sites

Evaluation of the Physical Activity and Public Health Course for Practitioners

From 1996–2013, a 6-day Physical Activity and Public Health Course for Practitioners has been offered yearly in the United States. An evaluation was conducted to assess the impact of the course on building public health capacity for physical activity and on shaping the physical activity and public health careers of fellows since taking the courses

Entropy of near-extremal black holes in AdS_5

We construct the microstates of near-extremal black holes in AdS_5 x S^5 as gases of defects distributed in heavy BPS operators in the dual SU(N) Yang-Mills theory. These defects describe open strings on spherical D3-branes in the S^5, and we show that they dominate the entropy by directly enumerating them and comparing the results with a partition sum calculation. We display new decoupling limits in which the field theory of the lightest open strings on the D-branes becomes dual to a near-horizon region of the black hole geometry. In the single-charge black hole we find evidence for an infrared duality between SU(N) Yang-Mills theories that exchanges the rank of the gauge group with an R-charge. In the two-charge case (where pairs of branes intersect on a line), the decoupled geometry includes an AdS_3 factor with a two-dimensional CFT dual. The degeneracy in this CFT accounts for the black hole entropy. In the three-charge case (where triples of branes intersect at a point), the decoupled geometry contains an AdS_2 factor. Below a certain critical mass, the two-charge system displays solutions with naked timelike singularities even though they do not violate a BPS bound. We suggest a string theoretic resolution of these singularities.Comment: LaTeX; v2: references and a few additional comments adde

The Library of Babel: On the origin of gravitational thermodynamics

We show that heavy pure states of gravity can appear to be mixed states to almost all probes. For AdS_5 Schwarzschild black holes, our arguments are made using the field theory dual to string theory in such spacetimes. Our results follow from applying information theoretic notions to field theory operators capable of describing very heavy states in gravity. For half-BPS states of the theory which are incipient black holes, our account is exact: typical microstates are described in gravity by a spacetime ``foam'', the precise details of which are almost invisible to almost all probes. We show that universal low-energy effective description of a foam of given global charges is via certain singular spacetime geometries. When one of the specified charges is the number of D-branes, the effective singular geometry is the half-BPS ``superstar''. We propose this as the general mechanism by which the effective thermodynamic character of gravity emerges.Comment: LaTeX, 6 eps figures, uses young.sty and wick.sty; Version 2: typos corrected, minor rewordings and clarifications, references adde

Dynamics of Vector-Host Interactions in Avian Communities in Four Eastern Equine Encephalitis Virus Foci in the Northeastern US

Background: Eastern equine encephalitis (EEE) virus (Togaviridae, Alphavirus) is a highly pathogenic mosquito-borne zoonosis that is responsible for occasional outbreaks of severe disease in humans and equines, resulting in high mortality and neurological impairment in most survivors. In the past, human disease outbreaks in the northeastern U.S. have occurred intermittently with no apparent pattern; however, during the last decade we have witnessed recurring annual emergence where EEE virus activity had been historically rare, and expansion into northern New England where the virus had been previously unknown. In the northeastern U.S., EEE virus is maintained in an enzootic cycle involving the ornithophagic mosquito, Culiseta melanura, and wild passerine (perching) birds in freshwater hardwood swamps. However, the identity of key avian species that serve as principal virus reservoir and amplification hosts has not been established. The efficiency with which pathogen transmission occurs within an avian community is largely determined by the relative reservoir competence of each species and by ecological factors that influence contact rates between these avian hosts and mosquito vectors. Methodology and principle findings: Contacts between vector mosquitoes and potential avian hosts may be directly quantified by analyzing the blood meal contents of field-collected specimens. We used PCR-based molecular methods and direct sequencing of the mitochondrial cytochrome b gene for profiling of blood meals in Cs. melanura, in an effort to quantify its feeding behavior on specific vertebrate hosts, and to infer epidemiologic implications in four historic EEE virus foci in the northeastern U.S. Avian point count surveys were conducted to determine spatiotemporal host community composition. Of 1,127 blood meals successfully identified to species level, >99% of blood meals were from 65 avian hosts in 27 families and 11 orders, and only seven were from mammalian hosts representing three species. We developed an empirically informed mathematical model for EEE virus transmission using Cs. melanura abundance and preferred and non-preferred avian hosts. To our knowledge this is the first mathematical model for EEE virus, a pathogen with many potential hosts, in the northeastern U.S. We measured strong feeding preferences for a number of avian species based on the proportion of mosquito blood meals identified from these bird species in relation to their observed frequencies. These included: American Robin, Tufted Titmouse, Common Grackle, Wood Thrush, Chipping Sparrow, Black-capped Chickadee, Northern Cardinal, and Warbling Vireo. We found that these bird species, most notably Wood Thrush, play a dominant role in supporting EEE virus amplification. It is also noteworthy that the competence of some of the aforementioned avian species for EEE virus has not been established. Our findings indicate that heterogeneity induced by mosquito host preference, is a key mediator of the epizootic transmission of vector-borne pathogens. Conclusion and significance: Detailed knowledge of the vector-host interactions of mosquito populations in nature is essential for evaluating their vectorial capacity and for assessing the role of individual vertebrates as reservoir hosts involved in the maintenance and amplification of zoonotic agents of human diseases. Our study clarifies the host associations of Cs. melanura in four EEE virus foci in the northeastern U.S., identifies vector host preferences as the most important transmission parameter, and quantifies the contribution of preference-induced contact heterogeneity to enzootic transmission. Our study identifies Wood Thrush, American Robin and a few avian species that may serve as superspreaders of EEE virus. Our study elucidates spatiotemporal host species utilization by Cs. melanura in relation to avian host community. This research provides a basis to better understand the involvement of Cs. melanura and avian hosts in the transmission and ecology of EEE virus and the risk of human infection in virus foci

Costs analysis of the treatment of imported malaria

<p>Abstract</p> <p>Background</p> <p>To document the status of imported malaria infections and estimate the costs of treating of patients hospitalized with the diagnosis of imported malaria in the Slovak Republic during 2003 to 2008.</p> <p>Case study</p> <p>Calculating and comparing the direct and indirect costs of treatment of patients diagnosed with imported malaria (ICD-10: B50 - B54) who used and not used chemoprophylaxis. The target sample included 19 patients diagnosed with imported malaria from 2003 to 2008, with 11 whose treatment did not include chemoprophylaxis and eight whose treatment did.</p> <p>Results</p> <p>The mean direct cost of malaria treatment for patients without chemoprophylaxis was 1,776.0 EUR, and the mean indirect cost 524.2 EUR. In patients with chemoprophylaxis the mean direct cost was 405.6 EUR, and the mean indirect cost 257.4 EUR.</p> <p>Conclusions</p> <p>The analysis confirmed statistically-significant differences between the direct and indirect costs of treatment with and without chemoprophylaxis for patients with imported malaria.</p

Inarticulate devices: Critical encounters with network technology in research through design

Research through design (RTD) is commonly conceived as a material and discursive practice of articulating knowledge. This paper contributes to the understanding of RTD as a form of critical inquiry by considering how inarticulacy can also be a productive element of this process. We present two reflective accounts of critically-engaged RTD practices in which our attempts to articulate concerns or questions were met with resistance from technology that was both the subject and medium of our investigation. We argue that encountering inarticulacy is not a failure of RTD but instead points to how material exploration can sensitise us to how network technology resists articulating certain values or concerns. Encountering inarticulacy led us to formulate new problems and new lines of inquiry. We conclude by suggesting that the central role given to ambiguity in RTD prepares us to witness and respond to inarticulacy in our practices, design outcomes and critical understandings

Glucocorticoid receptor gene polymorphisms do not affect growth in fetal and early postnatal life. The Generation R Study

Background: Glucocorticoids have an important role in early growth and development. Glucocorticoid receptor gene polymorphisms have been identified that contribute to the variability in glucocorticoid sensitivity. We examined whether these glucocorticoid receptor gene polymorphisms are associated with growth in fetal and early postnatal life.Methods: This study was embedded in a population-based prospective cohort study from fetal life onwards. The studied glucocorticoid receptor gene polymorphisms included BclI (rs41423247), TthIIII (rs10052957), GR-9β (rs6198), N363S (rs6195) and R23K (rs6789 and6190). Fetal growth was assessed by ultrasounds in second and third trimester of pregnancy. Anthropometric measurements in early childhood were performed at birth and at the ages of 6, 14 and 24 months postnatally. Analyses focused on weight, length and head circumference. Analyses were based on 2,414 healthy, Caucasian children.Results: Glucocorticoid receptor gene polymorphisms were not associated with fetal weight, birth weight and early postnatal weight. Also, no associations were found with length and head circumference. Neither were these polymorphisms associated with the risks of low birth weight or growth acceleration from birth to 24 months of age.Conclusions: We found in a large population-based cohort no evidence for an effect of known glucocorticoid receptor gene polymorphisms on fetal and early post