Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure

BACKGROUND: Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10–20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. METHODS: We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED diagnosis of decompensated heart failure were compared to patients with a criterion standard of decompensated heart failure but no ED diagnosis of decompensated heart failure. Two senior cardiology fellows retrospectively determined the patient's heart failure status during their acute ED presentation. The Mann-Whitney u-test for two groups, the Kruskall-Wallis test for multiple groups, or Chi-square tests, were used as appropriate. RESULTS: There were 173 (39.4%) patients with a criterion standard diagnosis of decompensated heart failure. Among those with this criterion standard diagnosis of decompensated heart failure, discordant patients without an ED diagnosis of decompensated heart failure (n = 58) were more likely to have a history of COPD (p = 0.017), less likely to have a previous history of heart failure (p = 0.014), and less likely to have an elevated b-type natriuretic peptide (BNP) level (median 518 vs 764 pg/ml; p = 0.038) than those who were given a concordant ED diagnosis of decompensated heart failure. BNP levels were higher in those with a criterion standard diagnosis of decompensated heart failure than in those without a criterion standard diagnosis (median 657 vs 62.7 pg/ml). However, 34.6% of patients with decompensated heart failure had BNP levels in the normal (<100 pg/ml; 6.1%) or indeterminate range (100–500 pg/ml; 28.5%). CONCLUSION: We found the ED diagnoses of decompensated heart failure to be discordant with the criterion standard in 14.3% of patients, the vast majority of which were due to a failure to diagnose heart failure when it was present. Patients with a previous history of COPD, without a previous history of heart failure and with lower BNP levels were more likely to have an ED misdiagnosis of non-decompensated heart failure. Readily available, accurate, objective ED tests are needed to improve the early diagnosis of decompensated heart failure in ED patients

Galaxy And Mass Assembly (GAMA): the halo mass of galaxy groups from maximum-likelihood weak lensing

We present a maximum-likelihood weak lensing analysis of the mass distribution in optically selected spectroscopic Galaxy Groups (G3Cv5) in the Galaxy And Mass Assembly (GAMA) survey, using background Sloan Digital Sky Survey (SDSS) pho-tometric galaxies. The scaling of halo mass, Mh, with various group observables is investigated. Our main results are: 1) the measured relations of halo mass with group luminosity, virial volume and central galaxy stellar mass,M⋆, agree very well with predictions from mock group catalogues constructed from a GALFORM semi-analytical galaxy formation model implemented in the Millennium _CDM N-body simulation; 2) the measured relations of halo mass with velocity dispersion and projected half-abundance radius show weak tension with mock predictions, hinting at problems in the mock galaxy dynamics and their small scale distribution; 3) the median Mh|M⋆ measured from weak lensing depends more sensitively on the lognormal dispersion in M⋆ at fixed Mh than it does on the median M⋆|Mh. Our measurements suggest an intrinsic dispersion of σlog(M⋆) _ 0.15; 4) Comparing our mass estimates with those in the catalogue, we find that the G3Cv5 mass can give biased results when used to select subsets of the group sample. Of the various new halo mass estimators that we calibrate using our weak lensing measurements, group luminosity is the best single-proxy estimator of group mass

Galaxy And Mass Assembly (GAMA): the halo mass of galaxy groups from maximum-likelihood weak lensing

We present a maximum-likelihood weak lensing analysis of the mass distribution in optically selected spectroscopic Galaxy Groups (G3Cv5) in the Galaxy And Mass Assembly (GAMA) survey, using background Sloan Digital Sky Survey (SDSS) pho-tometric galaxies. The scaling of halo mass, Mh, with various group observables is investigated. Our main results are: 1) the measured relations of halo mass with group luminosity, virial volume and central galaxy stellar mass,M⋆, agree very well with predictions from mock group catalogues constructed from a GALFORM semi-analytical galaxy formation model implemented in the Millennium _CDM N-body simulation; 2) the measured relations of halo mass with velocity dispersion and projected half-abundance radius show weak tension with mock predictions, hinting at problems in the mock galaxy dynamics and their small scale distribution; 3) the median Mh|M⋆ measured from weak lensing depends more sensitively on the lognormal dispersion in M⋆ at fixed Mh than it does on the median M⋆|Mh. Our measurements suggest an intrinsic dispersion of σlog(M⋆) _ 0.15; 4) Comparing our mass estimates with those in the catalogue, we find that the G3Cv5 mass can give biased results when used to select subsets of the group sample. Of the various new halo mass estimators that we calibrate using our weak lensing measurements, group luminosity is the best single-proxy estimator of group mass

The Hubble Constant

I review the current state of determinations of the Hubble constant, which gives the length scale of the Universe by relating the expansion velocity of objects to their distance. There are two broad categories of measurements. The first uses individual astrophysical objects which have some property that allows their intrinsic luminosity or size to be determined, or allows the determination of their distance by geometric means. The second category comprises the use of all-sky cosmic microwave background, or correlations between large samples of galaxies, to determine information about the geometry of the Universe and hence the Hubble constant, typically in a combination with other cosmological parameters. Many, but not all, object-based measurements give $H_0$ values of around 72-74km/s/Mpc , with typical errors of 2-3km/s/Mpc. This is in mild discrepancy with CMB-based measurements, in particular those from the Planck satellite, which give values of 67-68km/s/Mpc and typical errors of 1-2km/s/Mpc. The size of the remaining systematics indicate that accuracy rather than precision is the remaining problem in a good determination of the Hubble constant. Whether a discrepancy exists, and whether new physics is needed to resolve it, depends on details of the systematics of the object-based methods, and also on the assumptions about other cosmological parameters and which datasets are combined in the case of the all-sky methods.Comment: Extensively revised and updated since the 2007 version: accepted by Living Reviews in Relativity as a major (2014) update of LRR 10, 4, 200

A Genomic-Based Approach Combining In Vivo Selection in Mice to Identify a Novel Virulence Gene in Leishmania

Parasites of the genus Leishmania cause a variety of human diseases that range from destructive skin lesions caused by L. major to visceral infections of the liver and spleen caused by L. donovani that result in death. The Leishmania genes responsible for these different pathologies are not known. In the present study, we used a comparative genome-based approach to introduce and over-express L. donovani genes in L. major to determine whether this results in increased virulence of L. major in visceral organs of infected mice. Through this approach, a novel gene termed Li1040 was identified that is potentially involved in protein transport and was shown to increase pathogenesis in the visceral organs in mice. The Li1040 gene may therefore represent a Leishmania virulence gene that has the potential to regulate the pathology of infection in the mammalian host. These observations help to define how Leishmania causes fatal infections in humans and therefore provide a parasite-specific target for therapy

The role of viral genomics in understanding COVID-19 outbreaks in long-term care facilities

We reviewed all genomic epidemiology studies on COVID-19 in long-term care facilities (LTCFs) that had been published to date. We found that staff and residents were usually infected with identical, or near identical, SARS-CoV-2 genomes. Outbreaks usually involved one predominant cluster, and the same lineages persisted in LTCFs despite infection control measures. Outbreaks were most commonly due to single or few introductions followed by a spread rather than a series of seeding events from the community into LTCFs. The sequencing of samples taken consecutively from the same individuals at the same facilities showed the persistence of the same genome sequence, indicating that the sequencing technique was robust over time. When combined with local epidemiology, genomics allowed probable transmission sources to be better characterised. The transmission between LTCFs was detected in multiple studies. The mortality rate among residents was high in all facilities, regardless of the lineage. Bioinformatics methods were inadequate in a third of the studies reviewed, and reproducing the analyses was difficult because sequencing data were not available in many facilities

The genome sequence of <i>Trypanosoma brucei gambiense</i>, causative agent of chronic Human African Trypanosomiasis

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; &lt;i&gt;Trypanosoma brucei gambiense&lt;/i&gt; is the causative agent of chronic Human African Trypanosomiasis or sleeping sickness, a disease endemic across often poor and rural areas of Western and Central Africa. We have previously published the genome sequence of a &lt;i&gt;T. b. brucei&lt;/i&gt; isolate, and have now employed a comparative genomics approach to understand the scale of genomic variation between &lt;i&gt;T. b. gambiense&lt;/i&gt; and the reference genome. We sought to identify features that were uniquely associated with &lt;i&gt;T. b. gambiense&lt;/i&gt; and its ability to infect humans.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods and findings:&lt;/b&gt; An improved high-quality draft genome sequence for the group 1 &lt;i&gt;T. b. gambiense&lt;/i&gt; DAL 972 isolate was produced using a whole-genome shotgun strategy. Comparison with &lt;i&gt;T. b. brucei&lt;/i&gt; showed that sequence identity averages 99.2% in coding regions, and gene order is largely collinear. However, variation associated with segmental duplications and tandem gene arrays suggests some reduction of functional repertoire in &lt;i&gt;T. b. gambiense&lt;/i&gt; DAL 972. A comparison of the variant surface glycoproteins (VSG) in &lt;i&gt;T. b. brucei&lt;/i&gt; with all &lt;i&gt;T. b. gambiense&lt;/i&gt; sequence reads showed that the essential structural repertoire of VSG domains is conserved across &lt;i&gt;T. brucei&lt;/i&gt;.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; This study provides the first estimate of intraspecific genomic variation within &lt;i&gt;T. brucei&lt;/i&gt;, and so has important consequences for future population genomics studies. We have shown that the &lt;i&gt;T. b. gambiense&lt;/i&gt; genome corresponds closely with the reference, which should therefore be an effective scaffold for any &lt;i&gt;T. brucei&lt;/i&gt; genome sequence data. As VSG repertoire is also well conserved, it may be feasible to describe the total diversity of variant antigens. While we describe several as yet uncharacterized gene families with predicted cell surface roles that were expanded in number in &lt;i&gt;T. b. brucei&lt;/i&gt;, no &lt;i&gt;T. b. gambiense&lt;/i&gt;-specific gene was identified outside of the subtelomeres that could explain the ability to infect humans.&lt;/p&gt

Leishmania-Specific Surface Antigens Show Sub-Genus Sequence Variation and Immune Recognition

Single-celled Leishmania parasites, transmitted by sand flies, infect humans and other mammals in many tropical and sub-tropical regions, giving rise to a spectrum of diseases called the leishmaniases. Species of parasite within the Leishmania genus can be divided into two groups (referred to as sub-genera) that are separated by up to 100 million years of evolution yet are highly related at the genome level. Our research is focused on identifying gene differences between these sub-genera that may identify proteins that impact on the transmission and pathogenicity of different Leishmania species. Here we report the presence of a highly-variant genomic locus (OHL) that was previously described as absent in parasites of the L. (Viannia) subgenus (on the basis of lack of key genes) but is present and well-characterised (as the LmcDNA16 locus) in all members of the alternative subgenus, L. (Leishmania). We demonstrate that the proteins encoded within the LmcDNA16 and OHL loci are similar in their structure and surface localisation in mammalian-infective amastigotes, despite significant differences in their DNA sequences. Most importantly, we demonstrate that the OHL locus proteins, like the HASP proteins from the LmcDNA16 locus, contain highly variable amino acid repeats that are antigenic in man and may therefore contribute to future vaccine development

The 2dF galaxy redshift survey: near-infrared galaxy luminosity functions

We combine the Two Micron All Sky Survey (2MASS) Extended Source Catalogue and the 2dF Galaxy Redshift Survey to produce an infrared selected galaxy catalogue with 17 173 measured redshifts. We use this extensive data set to estimate the galaxy luminosity functions in the J- and KS-bands. The luminosity functions are fairly well fitted by Schechter functions with parameters MJ*−5 log h=−22.36±0.02, αJ=−0.93±0.04, ΦJ*=0.0104±0.0016 h3 Mpc3 in the J-band and MKS*−5 log h=−23.44±0.03, αKS=−0.96±0.05, ΦKS*=0.0108±0.0016 h3 Mpc3 in the KS-band (2MASS Kron magnitudes). These parameters are derived assuming a cosmological model with Ω0=0.3 and Λ0=0.7. With data sets of this size, systematic rather than random errors are the dominant source of uncertainty in the determination of the luminosity function. We carry out a careful investigation of possible systematic effects in our data. The surface brightness distribution of the sample shows no evidence that significant numbers of low surface brightness or compact galaxies are missed by the survey. We estimate the present-day distributions of bJ−KS and J−KS colours as a function of the absolute magnitude and use models of the galaxy stellar populations, constrained by the observed optical and infrared colours, to infer the galaxy stellar mass function. Integrated over all galaxy masses, this yields a total mass fraction in stars (in units of the critical mass density) of Ωstarsh =(1.6±0.24)×103 for a Kennicutt initial mass function (IMF) and Ωstarsh =(2.9±0.43)×103 for a Salpeter IMF. These values are consistent with those inferred from observational estimates of the total star formation history of the Universe provided that dust extinction corrections are modest