Infective endocarditis, 1983–1988: Echocardiographic findings and factors influencing morbidity and mortality

The echocardiograms and clinical records of 70 patients with infective endocarditis seen between 1983 and 1988 were examined to evaluate the role of two-dimensional and Doppler echocardiography in the diagnosis of infective endocarditis and identify risk factors for morbidity and mortality. A blinded observer reviewed the echocardiograms for the presence and size of vegetations and the severity of the valvular regurgitation. Vegetations were identified in 54 (78%) of 69 technically satisfactory echocardiograms. In 38 patients whose heart was examined at surgery or autopsy, all vegetations diagnosed by echocardiography were confirmed, but six additional vegetations were found.Abnormal (≥2+) valvular regurgitation was present in 88% of patients. No patient with ≤1+ regurgitation (n = 8) died or required valve surgery for heart failure, but three of the eight patients did undergo surgery for mycotic aneurysm, recurrent embolism or paravalvular abscess. In patients without embolism before echocardiography, there was a trend toward a greater incidence of subsequent embolism in those with vegetations >10 mm in size (26% [8 of 31] compared with 11% [2 of 18] with vegetations ≤10 mm) (p = 0.19). By multivariate analysis, risk factors for in-hospital death (n = 7) were an infected prosthetic valve (p < 0.007), systemic embolism (p < 0.02) and infection with Staphylococcus aureus(p = 0.05).It is concluded that 1) if valvular regurgitation is ≤1+, the risk of in-hospital death is low, and progression to cardiac surgery for hemodynamic instability is unlikely; 2) there is a trend toward a higher risk of embolization in patients with vegetations >10 mm in size; 3) early mortality now relates to infected prosthetic heart valves, embolism and Staphylococcus aureus; and 4) when a paravalvular abscess or prosthetic valve endocarditis is suspected, transthoracic echocardiographic findings are often equivocal and transesophageal echocardiography may be of benefit

Bright Localized Near-Infrared Emission at 1-4 AU in the AB Aurigae Disk Revealed by IOTA Closure Phases

We report on the detection of localized off-center emission at 1-4 AU in the circumstellar environment of the young stellar object AB Aurigae. We used closure phase measurements in the near-infrared made at the long baseline interferometer IOTA, the first obtained on a young stellar object using this technique. When probing sub-AU scales, all closure phases are close to zero degrees, as expected given the previously-determined size of the AB Aurigae inner dust disk. However, a clear closure phase signal of -3.5 +/- 0.5 degrees is detected on one triangle containing relatively short baselines, requiring a high degree of non-point symmetry from emission at larger (AU-sized) scales in the disk. We have not identified any alternative explanation for these closure phase results and demonstrate that a ``disk hot spot'' model can fit our data. We speculate that such asymmetric near-infrared emission detected might arise as a result of localized viscous heating due to a gravitational instability in the AB Aurigae disk, or to the presence of a close stellar companion or accreting sub-stellar object.Comment: Accepted by Astrophysical Journal Letter

Incoming Interns Perceived Preparedness for Core Entrustable Professional Activities

© 2019, International Association of Medical Science Educators. Introduction: The AAMC described 13 core entrustable professional activities (EPAs) for which every graduating medical student should perform proficiently on day 1 of residency. We studied how prepared starting interns felt in the core EPAs. Methods: Interns from a diverse health system were surveyed on how well medical school prepared them in the 13 core EPAs. Data were collected on type of medical school, participation in an acting/sub-internship (AI/SI), knowledge of EPAs, and participation in an EPA experience. Results: We collected 224 surveys out of 384 (58%) interns. 61.2% attended allopathic, 14.6% attended osteopathic, and 24.2% attended international schools. 67% had not heard of EPAs. 29% had an EPA experience of which 82% were required. 80% or more felt prepared in all EPAs except orders (60.7%) and handovers (73%). Allopathic interns were significantly more likely to have heard of EPAs and participated in an EPA experience than international. Allopathic interns felt more prepared than international in oral presentations and evidence-based medicine. Interns who participated in an EPA experience felt more prepared for oral presentation and evidence-based medicine. There were small but significant differences in feeling prepared in certain EPAs and types of AI/SI taken. Conclusion: The majority of interns entering residency have not heard of EPAs with fewer than 1/3 of interns participating in an EPA experience. International graduates were less likely to be aware or have experience with EPAs and report being less prepared in oral presentation and evidence-based medicine compared to allopathic graduates

A modern coastal ocean observing system using data from advanced satellite and in situ sensors – an example

Report of the Ocean Observation Research Coordination Network In-situ-Satellite Observation Working GroupThis report is intended to illustrate and provide recommendations for how ocean observing systems of the next decade could focus on coastal environments using combined satellite and in situ measurements. Until recently, space-based observations have had surface footprints typically spanning hundreds of meters to kilometers. These provide excellent synoptic views for a wide variety of ocean characteristics. In situ observations are instead generally point or linear measurements. The interrelation between space-based and in-situ observations can be challenging. Both are necessary and as sensors and platforms evolve during the next decade, the trend to facilitate interfacing space and in-situ observations must continue and be expanded. In this report, we use coastal observation and analyses to illustrate an observing system concept that combines in situ and satellite observing technologies with numerical models to quantify subseasonal time scale transport of freshwater and its constituents from terrestrial water storage bodies across and along continental shelves, as well as the impacts on some key biological/biogeochemical properties of coastal waters.Ocean Research Coordination Network and the National Science Foundatio

National Geodetic Satellite Program, Part II: Smithsonian Astrophysical Observatory

A sequence of advances in the determination of geodetic parameters presented by the Smithsonian Astrophysical Observatory are described. A Baker-Nunn photographic system was used in addition to a ruby-laser ranging system to obtain data for refinement of geodetic parameters. A summary of the data employed to: (1) derive coordinates for the locations of various tracking stations; and (2) determine the gravitational potential of the earth, is presented

Efficacy of Galcanezumab for Migraine Prevention in Patients With a Medical History of Anxiety and/or Depression: A Post Hoc Analysis of the Phase 3, Randomized, Double-Blind, Placebo-Controlled REGAIN, and Pooled EVOLVE-1 and EVOLVE-2 Studies

© 2020 Eli Lilly and Company. Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC, on behalf of American Headache Society Objective: This post hoc analysis evaluated the efficacy of galcanezumab for the prevention of migraine in patients with and without comorbid anxiety and/or depression. Background: Patients with migraine have a higher risk of anxiety and/or depression. Given the high prevalence of psychiatric symptoms and their potential negative prognostic impact, determining the efficacy of migraine treatments in patients with these comorbidities is important. Methods: The results of 2 phase 3 episodic migraine studies of patients with 4-14 migraine headache days (MHD) per month were pooled. A third chronic migraine study, which was evaluated separately, enrolled patients with ≥15 headache days per month, of which ≥8 had migraine-like features. Patients in all 3 studies were randomized 2:1:1 to placebo, galcanezumab 120 mg, or galcanezumab 240 mg. The efficacy of galcanezumab on migraine was measured in subgroups of patients with anxiety and/or depression (current or past) and patients without. A repeated measures model was used to compare treatment groups within each subgroup and to test for consistency of treatment effect across the anxiety/depression subgroups (subgroup-by-treatment interaction) during the double-blind treatment phases. Results: Among 1773 intent-to-treat patients with episodic migraine, both doses of galcanezumab demonstrated statistically significant improvements relative to placebo in overall number of MHD for the subgroups of patients with anxiety and/or depression (mean change difference from placebo [95% CI]: −2.07 [−2.81, −1.33] for galcanezumab 120 mg [P \u3c.001], −1.91 [−2.78, −1.04] for 240 mg [P \u3c.001]) and without anxiety and/or depression (mean change difference from placebo [95% CI]: −1.92 [−2.36, −1.47] for 120 mg [P \u3c.001], −1.77 [−2.20, −1.33] for 240 mg [P \u3c.001]), as was observed for the secondary outcomes of MHD with acute medication use and functional impairment. Among 1113 intent-to-treat patients with chronic migraine, those with anxiety and/or depression had significant reductions in overall MHD frequency with the 240-mg dose (mean change difference from placebo [95% CI]: −1.92 [−3.52, −0.33]; P =.018), whereas significant reductions were observed at both the 120-mg (mean change difference from placebo [95% CI]: −2.29 [−3.26, −1.31]; P \u3c.001) and 240-mg (−1.85 [−2.83, −0.87]; P \u3c.001) doses in patients without anxiety and/or depressions. Significant reductions (P \u3c.01) in MHD with acute medication use were observed at both doses within both anxiety/depression subgroups and for overall functional impairment for patients without anxiety and/or depression, though neither dose significantly reduced overall functional impairment beyond placebo in the subgroup with anxiety and/or depression. In the episodic and chronic migraine studies, the subgroup-by-treatment interaction was not statistically significant for MHD, MHD with acute medication use, or functional impairment (chronic study only), suggesting a lack of evidence of differential effect between subgroups. Furthermore, differences between subgroups in the mean change differences from placebo, as well as overlapping 95% confidence intervals for the subgroups, indicated lack of a clinical or statistical difference between subgroups for these outcome variables. There was a significantly higher percentage of patients with episodic migraine attaining ≥50%, ≥75%, and 100% reductions, and a higher percentage of patients with chronic migraine attaining ≥50% and ≥75% reductions from baseline with galcanezumab compared with placebo, regardless of medical history of anxiety and/or depression. Conclusions: A medical history of anxiety and/or depression does not seem to interfere with response to galcanezumab among patients with episodic migraine, and both doses of galcanezumab appear efficacious for these individuals regardless of this psychiatric history. Among patients with chronic migraine and comorbid anxiety and/or depression, the 240-mg dose, but not the 120-mg dose, significantly decreased overall MHD, but neither dose resulted in significantly greater functional improvement. Patients with migraine and comorbid anxiety and/or depression often require additional interventions, and this may be more important in chronic migraine