1,143 research outputs found
Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis".
Acute unilateral peripheral and central vestibular lesions
can cause similar signs and symptoms, but they require
different diagnostics and management. We therefore
correlated clinical signs to differentiate vestibular neuritis
(40 patients) from central ‘‘vestibular pseudoneuritis’’ (43
patients) in the acute situation with the final diagnosis
assessed by neuroimaging. Skew deviation was the only
specific but non-sensitive (40%) sign for pseudoneuritis.
None of the other isolated signs (head thrust test,
saccadic pursuit, gaze evoked nystagmus, subjective
visual vertical) were reliable; however, multivariate
logistic regression increased their sensitivity and specificity
to 92%
Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice.
Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances.
Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application.
The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversation
Antagonists of Calcium Fluxes and Calmodulin Block Activation of the p21-Activated Protein Kinases in Neutrophils
Neutrophils stimulated with fMLP or a variety of other chemoattractants that bind to serpentine receptors coupled to heterotrimeric
G proteins exhibit rapid activation of two p21-activated protein kinases (Paks) with molecular masses of ~63 and 69 kDa
(y- and a-Pak). Previous studies have shown that products of phosphatidylinositol 3-kinase and tyrosine kinases are required for
the activation of Paks. We now report that a variety of structurally distinct compounds which interrupt different stages in
calcium/calmodulin (CaM) signaling block activation of the 63- and 69-kDa Paks in fMLP-stimulated neutrophils. These antagonists
included selective inhibitors of phospholipase C (1-[6-((17ß-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl]-1H-pyrrole-
2,5-dione), the intracellular Ca^(2+) channel (8-(N,N-diethylamino)-octyl-3,4,5-trimethoxybenzoate), CaM (N-(6-aminohexyl)-5-
chloro-1-naphthalenesulfonamide; N-(4-aminobutyl)-5-chloro-1-naphthalenesulfonamide; trifluoperazine), and CaM-activated
protein kinases (N-[2-(N-(chlorocinnamyl)-N-methylaminomethyl)phenyl]-N-[2-hydroxyethyl]-4-methoxybenzenesulfonamide).
This inhibition was dose-dependent with IC50 values very similar to those that interrupt CaM-dependent reactions in vitro. In
contrast, less active analogues of these compounds (1-[6-((17ß-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl]-2,5-pyrrolidinedione;
N-(6-aminohexyl)-1-naphthalenesulfonamide; N-(4-aminobutyl)-1-naphthalenesulfonamide; promethazine; 2-[N-(4-
methoxybenzenesulfonyl)]amino-N-(4-chlorocinnamyl)-N-methylbenzyl-amine]) did not affect activation of Paks in these cells.
CaM antagonists (N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide; trifluoperazine), but not their less-active analogues (N-
(6-aminohexyl)-1-naphthalenesulfonamide; promethazine), were also found to block activation of the small GTPases Ras and Rac
in stimulated neutrophils along with the extracellular signal-regulated kinases. These data strongly suggest that the Ca^(2+)/CaM
complex plays a major role in the activation of a number of enzyme systems in neutrophils that are regulated by small
GTPases
The Electrical-Thermal Switching in Carbon Black-Polymer Composites as a Local Effect
Following the lack of microscopic information about the intriguing well-known
electrical-thermal switching mechanism in Carbon Black-Polymer composites, we
applied atomic force microscopy in order to reveal the local nature of the
process and correlated it with the characteristics of the widely used
commercial switches. We conclude that the switching events take place in
critical interparticle tunneling junctions that carry most of the current. The
macroscopic switched state is then a result of a dynamic-stationary state of
fast switching and slow reconnection of the corresponding junctions.Comment: 14 pages, 5 figures,Typographic correctio
Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments
Objectives Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department ( ED ). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. Methods This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined public‐use ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey ( NHAMCS ) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey ( MEPS ). We calculated total visits, test utilization, and ED diagnoses from NHAMCS . Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit cost‐per‐diagnosis‐group from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. Results The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [ CI ] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography ( CT ), magnetic resonance imaging ( MRI ), or both in 2011 was estimated to be 39.9% (39.4% CT , 2.3% MRI ). The mean per‐ ED ‐dizziness‐visit cost was 3.9 billion. HCUP ‐ CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, cost‐per‐ ED ‐visit, attributable annual national costs): otologic/vestibular (25.7%; 757 million), cardiovascular (16.5%, 941 million), and cerebrovascular (3.1%; 127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 ( CT scans 110 million). Conclusions Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced. Resumen Incremento Anual de los Costes de las Atenciones por Mareo en los Servicios de Urgencias de Estados Unidos Objectivos El mareo y el vértigo suman aproximadamente el 4% de los motivos de consulta en el servicio de urgencias ( SU ). Se conoce poco sobre los costes globales de las evaluaciones del SU en estos pacientes. Se buscó estimar los costes anuales nacionales asociados con las visitas al SU por mareo. Metodología Este estudio de costes de visitas al SU de adultos norteamericanos que acudieron con mareo o vértigo combinó los datos públicos de las visitas a los SU (1995 a 2009) recogidos por el National Hospital Ambulatory Medical Care Survey ( NHAMCS ) y los costes (2003 a 2008) recogidos por el Medical Expenditure Panel Survey ( MEPS ). Se calcularon el total de visitas, el uso de pruebas diagnósticas y los diagnósticos del SU del NHAMCS . Los grupos diagnósticos se definieron según el Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Los datos del año 2011 se documentaron en dólares de 2011. El total de visitas y la proporción de neuroimagen llevada a cabo en los futuros años se extrapoló usando un modelo predictivo autorregresivo. La media del coste por visita al SU por grupo diagnóstico del MEPS se calculó, ajustándose a dólares de 2011, mediante el índice de precios de los Hospital Personal Health Care Expenditures. Se utilizó una media ponderada global entre los grupos diagnósticos para estimar los costes totales nacionales. Resultados El número de visitas al SU en Estados Unidos en 2011 por mareo o vértigo fue de 3,9 millones ( IC 95% = 3,6 a 4,2 millones). El porcentaje de pruebas diagnósticas de imagen llevadas a cabo por tomografía computarizada ( TC ), resonancia magnética ( RM ) o ambas en 2011 se estimó en un 39,9% (39,4% TC , 2,3% RM ). La media de coste por visita al SU por mareo fue de 1.004 dólares de 2011. Los costes totales, extrapolados para todo el país, fueron de 3.900 millones de dólares. Los grupos diagnósticos HCUP ‐ CCS para aquéllos que presentaron mareo o vértigo incluyeron los siguientes (proporción de visitas por mareo; coste por visita al SU ; costes anuales nacionales atribuibles): otológico/vestibular (25,7%; 768 dólares; 757 millones de dólares), cardiovascular (16,5%, 1.489 dólares; 941 millones de dólares) y cerebrovascular (3,1%; 1.059 dólares; 127 millones de dólares). Se estimó una suma en la neuroimagen del 12% del total de costes para las visitas por mareo en 2011 (360 millones de dólares para la TC y 110 millones de dólares para la RM ). Conclusiones Los costes totales en Estados Unidos para los pacientes que acuden por mareo al SU son sustanciales, y se estima que sobrepasan en estos momentos los 4.000 millones de dólares por año (aproximadamente un 4% de los costes totales del SU ). El incremento de los costes con el paso del tiempo parece reflejar el crecimiento de la prevalencia de las visitas al SU por mareo y el aumento de porcentajes de utilización de la neuroimagen. Futuros estudios económicos deberían centrarse en el desglose de los costes totales, y hacer énfasis en las áreas de alto uso y coste que pueden ser reducidas sin riesgo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/1/acem12168.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/99059/2/acem12168-sup-0001-DataSupplementS1.pd
Segregated tunneling-percolation model for transport nonuniversality
We propose a theory of the origin of transport nonuniversality in disordered
insulating-conducting compounds based on the interplay between microstructure
and tunneling processes between metallic grains dispersed in the insulating
host. We show that if the metallic phase is arranged in quasi-one dimensional
chains of conducting grains, then the distribution function of the chain
conductivities g has a power-law divergence for g -> 0 leading to nonuniversal
values of the transport critical exponent t. We evaluate the critical exponent
t by Monte Carlo calculations on a cubic lattice and show that our model can
describe universal as well nonuniversal behavior of transport depending on the
value of few microstructural parameters. Such segregated tunneling-percolation
model can describe the microstructure of a quite vast class of materials known
as thick-film resistors which display universal or nonuniversal values of t
depending on the composition.Comment: 8 pages, 5 figures (Phys. Rev. B - 1 August 2003)(fig1 replaced
A new perspective on the Faddeev equations and the system from chiral dynamics and unitarity in coupled channels
We review recent work concerning the interaction and Faddeev
equations with chiral dynamics which allow us to look at the from a
different perspective and pay attention to problems that have been posed in
previous studies on the subject. We show results which provide extra
experimental evidence on the existence of two states. We then
show the findings of a recent approach to Faddeev equations using chiral
unitary dynamics, where an explicit cancellation of the two body off shell
amplitude with three body forces stemming from the same chiral Lagrangians
takes place. This removal of the unphysical off shell part of the amplitudes is
most welcome and renders the approach unambiguous, showing that only on shell
two body amplitudes need to be used. With this information in mind we use an
approximation to the Faddeev equations within the fixed center approximation to
study the system, providing answers within this approximation to
questions that have been brought before and evaluating binding energies and
widths of this three body system. As a novelty with respect to recent work on
the topic we find a bound state of the system with spin S=1, like a bound state
of -deuteron, less bound that the one of S=0, where all recent efforts
have been devoted. The width is relatively large in this case, suggesting
problems in a possible experimental observation.Comment: 18 pages, 7 figures, one misprint corrected, Nuclear Physics A in
pres
On the SigmaN cusp in the pp -> pK+Lambda reaction
Measurements of the reaction at = 2.28 GeV have
been carried out at COSY-TOF. In addition to the FSI and
resonance excitation effects a pronounced narrow structure is observed in the
Dalitz plot and in its projection on the -invariant mass. The
structure appears at the N threshold and is interpreted as
N cusp effect. The observed width of 20 MeV/ is substantially
broader than anticipated from previous inclusive measurements. Angular
distributions of this cusp structure are shown to be dissimilar to those in the
residual channel, but similar to those observed in the
channel
Registration of AWC 612M Chickpea Mutant Germplasm Line Resistant to Leaf Miner (Liriomyza cicerina)
Chickpea leaf miner (Liriomyza cicerina Rond.) (Diptera: Agromyzidae) is a distinctive, important insect pest of chickpea (Cicer arietinum L.) that can cause substantial yield losses if it is not adequately controlled. Host plant resistance to leaf miner is one of the best control options in sustainable farming. Since there are insufficient resistant sources in cultivated chickpea, an accession (AWC 612) of C. reticulatum Ladiz., crossable with cultivated chickpea, was subjected to 200, 300, and 400 Gy gamma rays to increase variation through mutating, and the mutant germplasm line AWC 612M (Reg. No. GP-305, PI 688421), with a multipinnate leaf type, was developed and selected in the M3. AWC 612M was selected for its resistance against leaf miner under natural epidemic conditions in the field for 10 yr from 2007 to 2016. AWC 612M was free from damage, while the susceptible chickpea line ILC 3397 had numerous mines in >91% of leaflets and leaf drop >31%. AWC 612M, derived from C. reticulatum, which is compatible with the cultivated chickpea, represents a new source for breeding programs of resistance to leaf miner
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