4,318 research outputs found

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

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    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

    Exclusive Production of Higgs Bosons in Hadron Colliders

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    We study the exclusive, double--diffractive production of the Standard Model Higgs particle in hadronic collisions at LHC and FNAL (upgraded) energies. Such a mechanism would provide an exceptionally clean signal for experimental detection in which the usual penalty for triggering on the rare decays of the Higgs could be avoided. In addition, because of the color singlet nature of the hard interaction, factorization is expected to be preserved, allowing the cross--section to be related to similar hard--diffractive events at HERA. Starting from a Fock state expansion in perturbative QCD, we obtain an estimate for the cross section in terms of the gluon structure functions squared of the colliding hadrons. Unfortunately, our estimates yield a production rate well below what is likely to be experimentally feasible.Comment: 17 pages, RevTeX file, four uufiled PostScript figures. UMPP #94-177. (Revised version. Some mistakenly missing Feynman diagrams are now added. Results do not change qualitatively. Paper reorganized.

    Exposure to benzene at work and the risk of leukemia: a systematic review and meta-analysis

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    Background A substantial number of epidemiologic studies have provided estimates of the relation between exposure to benzene at work and the risk of leukemia, but the results have been heterogeneous. To bridge this gap in knowledge, we synthesized the existing epidemiologic evidence on the relation between occupational exposure to benzene and the risk of leukemia, including all types combined and the four main subgroups acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML). Methods A systematic literature review was carried out using two databases 'Medline' and 'Embase' from 1950 through to July 2009. We selected articles which provided information that can be used to estimate the relation between benzene exposure and cancer risk (effect size). Results In total 15 studies were identified in the search, providing 16 effect estimates for the main analysis. The summary effect size for any leukemia from the fixed-effects model was 1.40 (95% CI, 1.23-1.57), but the study-specific estimates were strongly heterogeneous (I2 = 56.5%, Q stat = 34.47, p = 0.003). The random-effects model yielded a summary- effect size estimate of 1.72 (95% CI, 1.37-2.17). Effect estimates from 9 studies were based on cumulative exposures. In these studies the risk of leukemia increased with a dose-response pattern with a summary-effect estimate of 1.64 (95% CI, 1.13-2.39) for low (< 40 ppm-years), 1.90 (95% CI, 1.26-2.89) for medium (40-99.9 ppm-years), and 2.62 (95% CI, 1.57-4.39) for high exposure category (> 100 ppm-years). In a meta-regression, the trend was statistically significant (P = 0.015). Use of cumulative exposure eliminated heterogeneity. The risk of AML also increased from low (1.94, 95% CI, 0.95-3.95), medium (2.32, 95% CI, 0.91-5.94) to high exposure category (3.20, 95% CI, 1.09-9.45), but the trend was not statistically significant. Conclusions Our study provides consistent evidence that exposure to benzene at work increases the risk of leukemia with a dose-response pattern. There was some evidence of an increased risk of AML and CLL. The meta-analysis indicated a lack of association between benzene exposure and the risk of CML

    A multi-phenotypic imaging screen to identify bacterial effectors by exogenous expression in a HeLa cell line

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    We present a high-content screen (HCS) for the simultaneous analysis of multiple phenotypes in HeLa cells expressing an autophagy reporter (mcherry-LC3) and one of 209 GFP-fused proteins from the Crohn’s Disease (CD)-associated bacterium, Adherent Invasive E. coli (AIEC) strain LF82. Using automated confocal microscopy and image analysis (CellProfiler), we localised GFP fusions within cells, and monitored their effects upon autophagy (an important innate cellular defence mechanism), cellular and nuclear morphology, and the actin cytoskeleton. This data will provide an atlas for the localisation of 209 AIEC proteins within human cells, as well as a dataset to analyse their effects upon many aspects of host cell morphology. We also describe an open-source, automated, image-analysis workflow to identify bacterial effectors and their roles via the perturbations induced in reporter cell lines when candidate effectors are exogenously expressed

    Signal Propagation in Feedforward Neuronal Networks with Unreliable Synapses

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    In this paper, we systematically investigate both the synfire propagation and firing rate propagation in feedforward neuronal network coupled in an all-to-all fashion. In contrast to most earlier work, where only reliable synaptic connections are considered, we mainly examine the effects of unreliable synapses on both types of neural activity propagation in this work. We first study networks composed of purely excitatory neurons. Our results show that both the successful transmission probability and excitatory synaptic strength largely influence the propagation of these two types of neural activities, and better tuning of these synaptic parameters makes the considered network support stable signal propagation. It is also found that noise has significant but different impacts on these two types of propagation. The additive Gaussian white noise has the tendency to reduce the precision of the synfire activity, whereas noise with appropriate intensity can enhance the performance of firing rate propagation. Further simulations indicate that the propagation dynamics of the considered neuronal network is not simply determined by the average amount of received neurotransmitter for each neuron in a time instant, but also largely influenced by the stochastic effect of neurotransmitter release. Second, we compare our results with those obtained in corresponding feedforward neuronal networks connected with reliable synapses but in a random coupling fashion. We confirm that some differences can be observed in these two different feedforward neuronal network models. Finally, we study the signal propagation in feedforward neuronal networks consisting of both excitatory and inhibitory neurons, and demonstrate that inhibition also plays an important role in signal propagation in the considered networks.Comment: 33pages, 16 figures; Journal of Computational Neuroscience (published

    PCV13 induced IgG responses in serum associate with serotype-specific IgG in the lung

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    Pneumococcal conjugate vaccine efficacy is lower for non-invasive pneumonia than invasive disease. In this study, participants were vaccinated with PCV13 or HepA (control). Bronchoalveolar lavage samples were taken between 2-6 months and serum at 4- and 7-weeks post vaccination. In the lung, anti-capsular IgG levels were higher in the PCV13 group compared to control for all serotypes, except 3 and 6B. Systemically, IgG levels were elevated in the PCV group at 4-weeks for all serotypes, except 3. IgG in BAL and serum positively correlated for nearly all serotypes. PCV13 shows poor immunogenicity to serotype 3, implying lack of protective efficacy. Clinical trial registration with ISRCTN: 4534043

    Investigation of engineering properties of normal and high strength fly ash based geopolymer and alkali-activated slag concrete compared to ordinary Portland cement concrete

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    Fly ash-based geopolymer (FAGP) and alkali-activated slag (AAS) concrete are produced by mixing alkaline solutions with aluminosilicate materials. As the FAGP and AAS concrete are free of Portland cement, they have a low carbon footprint and consume low energy during the production process. This paper compares the engineering properties of normal strength and high strength FAGP and AAS concrete with OPC concrete. The engineering properties considered in this study included workability, dry density, ultrasonic pulse velocity (UPV), compressive strength, indirect tensile strength, flexural strength, direct tensile strength, and stress-strain behaviour in compression and direct tension. Microstructural observations using scanning electronic microscopy (SEM) are also presented. It was found that the dry density and UPV of FAGP and AAS concrete were lower than those of OPC concrete of similar compressive strength. The tensile strength of FAGP and AAS concrete was comparable to the tensile strength of OPC concrete when the compressive strength of the concrete was about 35 MPa (normal strength concrete). However, the tensile strength of FAGP and AAS concrete was higher than the tensile strength of OPC concrete when the compressive strength of concrete was about 65 MPa (high strength concrete). The modulus of elasticity of FAGP and AAS concrete in compression and direct tension was lower than the modulus of elasticity of OPC concrete of similar compressive strength. The SEM results indicated that the microstructures of FAGP and AAS concrete were more compact and homogeneous than the microstructures of OPC concrete at 7 days, but less compact and homogeneous than the microstructures of OPC concrete at 28 days for the concrete of similar compressive strength

    CMIP5 Intermodel Relationships in the Baseline Southern Ocean Climate System and With Future Projections

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    This is the final version. Available on open access from Wiley via the DOI in this recordClimate models exhibit a broad range in the simulated properties of the climate system. In the early historical period, the absolute global mean surface air temperature in Coupled Model Intercomparison Project, phase 5 (CMIP5) models spans a range of ~12-15 °C. Other climate variables may be linked to global mean temperature, and so accurate representation of the baseline climate state is crucial for meaningful future climate projections. In CMIP5 baseline climate states, statistically significant intermodel correlations between Southern Ocean surface temperature, outgoing shortwave radiation, cloudiness, the position of the mid-latitude eddy-driven jet, and Antarctic sea ice area are found. The baseline temperature relationships extend to projected future changes in the same set of variables. The tendency for models with initially cooler Southern Ocean to exhibit more global warming, and vice versa for initially warmer models, is linked to baseline Southern Ocean climate system biases. Some of these intermodel correlations arise due to a ‘capacity for change’. For example, models with more sea ice initially have greater capacity to lose sea ice as the planet warms, whereas models with little sea ice initially are constrained in the amount they can lose. Similar constraints apply to Southern Ocean clouds, which are projected to reduce under radiative forcing, and the jet latitude, which is projected to migrate poleward. A first look at emerging data from CMIP6 reveals a shift of the relationship from the Southern Ocean towards the Antarctic region, possibly due to reductions in Southern Ocean biases, such westerly wind representation.Natural Environment Research Council (NERC)Centre for Southern Hemisphere Oceans ResearchAustralian Government National Environmental Science ProgramAustralian Research Council (ARC
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