Application of Appropriateness Criteria to Stress Single-Photon Emission Computed Tomography Sestamibi Studies and Stress Echocardiograms in an Academic Medical Center

ObjectivesThe purpose of this study was to apply published appropriateness criteria for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in a single academic medical center.BackgroundThe American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) have developed appropriateness criteria for stress SPECT MPI to address concern about the growth in cardiac imaging studies.MethodsWe retrospectively examined 284 patients who underwent stress SPECT MPI and 298 patients who underwent stress echocardiography before publication of these criteria.ResultsThe overall level of agreement in characterizing appropriateness between 2 experienced cardiovascular nurse abstractors was modest (kappa = 0.56), but noticeably poorer (kappa = 0.27) for patients with previous SPECT or echo studies. Similar percentages of each imaging modality were assigned to the 3 appropriateness categories: 64% of stress SPECT and 64% of stress echo studies were classified appropriate; 11% of stress SPECT and 9% of stress echo were of uncertain appropriateness; and 14% of stress SPECT and 18% of stress echo were inappropriate. Of the inappropriate studies, 88% were performed for 1 of 4 indications. Approximately 10% of the patients were unclassifiable.ConclusionsApplication of existing SPECT MPI appropriateness criteria is demanding and requires an established database or detailed data collection, as well as a number of assumptions. Fourteen percent of stress SPECT studies and 18% of stress echo studies were performed for inappropriate reasons. Quality improvement efforts directed at reducing the number of these inappropriate studies may improve efficiency in the health care system

Immunologically reactive M. leprae antigens with relevance to diagnosis and vaccine development

<p>Abstract</p> <p>Background</p> <p>Leprosy is a chronic infectious disease caused by <it>Mycobacterium leprae </it>that can manifest a wide variety of immunological and clinical outcomes ranging from potent humoral responses among borderline lepromatous (BL) and lepromatous (LL) patients to strong cellular responses among tuberculoid (TT) and borderline tuberculoid (BT) patients. Until recently, relatively little has been known about the immune responses to individual proteins of <it>M. leprae </it>recognized during leprosy.</p> <p>Methods</p> <p>The immune reactivity to a panel of 33 <it>M. leprae </it>recombinant proteins was evaluated among leprosy patients and controls from a high endemic area for leprosy (Goiania/GO, Central Brazil). Serum IgG responses were measured by ELISA (45 participants/group) and T cell responses (20 participants/group) were evaluated by IFN-gamma production in 24 hours whole blood cultures with antigen (whole blood assay-WBA). Study groups were newly diagnosed, untreated TT/BT and BL/LL leprosy patients classified by Ridley Jopling criteria and household contacts of BL/LL patients (HHC). Control groups were HIV-1 negative pulmonary tuberculosis patients (TB) and healthy individuals from the same endemic area (EC). In silico predictions indicated the level of identity of <it>M. leprae </it>proteins with homologues in other mycobacteria and the presence of T cell and B cell epitopes.</p> <p>Results</p> <p>Despite the prediction that all proteins would be reactive, 16 of 33 (48%) of the single proteins tested were immunogenic (recognized in WBA or ELISA) and seventeen were non-immunogenic (not recognized in either assay). Among the 16 immunogenic proteins, 9 were considered leprosy specific in WBA inducing cell-mediated IFN-gamma secretion from TT/BT patients and HHC. Three of these proteins were also leprosy specific in serology being recognized by serum IgG from LL/BL patients. Seven of the immunogenic proteins were not leprosy specific.</p> <p>Conclusions</p> <p>New <it>M. leprae </it>antigens recognized by antibody responses of BL/LL patients and cellular responses of TT/BT leprosy patients were identified. An improved serological diagnostic test for leprosy could be developed by incorporating these IgG-reactive antigens to the current PGL-I based tests. Moreover our data indicate that the WBA is a robust, relatively simple and user friendly format for a T cell based diagnostic test. The field use of these test formats in leprosy endemic countries could contribute to early leprosy diagnosis before the development of deformities and disabilities.</p

Formation of a ZnS Zn S,O bilayer buffer on CuInS2 thin film solar cell absorbers by chemical bath deposition

The application of Zn compounds as buffer layers was recently extended to wide gap CuInS2 CIS based thin film solar cells. Using a new chemical deposition route for the buffer preparation aiming at the deposition of a single layer, nominal ZnS buffer without the need for any toxic reactants such as, e.g. hydrazine, has helped to achieve a similar efficiency as respective CdS buffered reference devices. In order to shed light on the differences of other Zn compound buffers deposited in conventional chemical baths CBD compared to the buffer layers deposited by this alternative CBD process, the composition of the deposited buffers was investigated by x ray excited Auger electron and x ray photoelectron spectroscopy to potentially clarify their superiority in terms of device performance. We have found that in the early stages of this alternative CBD process a thin ZnS layer is formed on the CIS, whereas in the second half of the CBD the growth rate is greatly increased and Zn S,O with a ZnS ZnS ZnO ratio of approx. 80 is deposited. Thus, a ZnS Zn S,O bi layer buffer is deposited on the CIS thin film solar cell absorbers by the alternative chemical deposition route used in this investigation. No major changes of these findings after a postannealing of the buffer CIS sample series and re characterization could be identified

Water seepage beneath dams on soluble evaporite deposits: a laboratory and field study (Caspe Dam, Spain)

The paper presents analytical methods and results for assessing the variation in the concentration of sulphate (and other ions) over space and time in groundwater flowing through a soluble evaporite terrain beneath a dam. The influence of effective porosity, groundwater flow velocity and the specific rate of dissolution (K′) are considered. The theoretical analysis was tested in a scale model simulating a dam constructed on heavily karstified bedrock. A simple and useful method for assessing how much material is lost through dissolution and how the rate of dissolution changes over time is considered in the context of the Caspe Dam, Spain

Case Report Copious Podocyturia without Proteinuria and with Normal Renal Function in a Young Adult with Fabry Disease

The time for starting a patient with Fabry disease on enzyme replacement therapy is still a matter of debate, particularly when no overt classical clinical signs or symptoms are present. With respect to Fabry nephropathy, a dual problem coexists: the reluctance of many nephrologists to start enzyme replacement infusion until signs of renal disease appear as the appearance of proteinuria or an elevation in serum creatinine and the lack of validated biomarkers of early renal damage. In this regard, proteinuria is nowadays considered as an early and appropriate marker of kidney disease and of cardiovascular morbidity and mortality. However, in this report we demonstrate that podocyturia antedates the classical appearance of proteinuria and could be considered as an even earlier biomarker of kidney damage. Podocyturia may be a novel indication for the initiation of therapy in Fabry disease

An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1‐year follow‐up efficacy data

This is the pre-peer reviewed version of the following article: An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1‐year follow‐up efficacy data, which has been published in final form at https://doi.org/10.1002/cpp.2342. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD‐11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long‐term efficacy data from a between‐groups controlled study that compares two treatment conditions (AD‐protocol applied in a traditional way: N = 18 and the same protocol supported by virtual reality (VR); VR‐protocol applied in a traditional way: N = 18) and a waiting list (WL) control group (N = 18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6‐month) and long‐term (12‐month follow‐up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face‐to‐face protocol for the treatment of stress‐related disorders with the same protocol supported by VR and a WL control group

Thrombus or tumor? a case of fibroelastoma as indicated during the submission process

We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 × 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery

Sialic Acid Glycobiology Unveils Trypanosoma cruzi Trypomastigote Membrane Physiology.

Trypanosoma cruzi, the flagellate protozoan agent of Chagas disease or American trypanosomiasis, is unable to synthesize sialic acids de novo. Mucins and trans-sialidase (TS) are substrate and enzyme, respectively, of the glycobiological system that scavenges sialic acid from the host in a crucial interplay for T. cruzi life cycle. The acquisition of the sialyl residue allows the parasite to avoid lysis by serum factors and to interact with the host cell. A major drawback to studying the sialylation kinetics and turnover of the trypomastigote glycoconjugates is the difficulty to identify and follow the recently acquired sialyl residues. To tackle this issue, we followed an unnatural sugar approach as bioorthogonal chemical reporters, where the use of azidosialyl residues allowed identifying the acquired sugar. Advanced microscopy techniques, together with biochemical methods, were used to study the trypomastigote membrane from its glycobiological perspective. Main sialyl acceptors were identified as mucins by biochemical procedures and protein markers. Together with determining their shedding and turnover rates, we also report that several membrane proteins, including TS and its substrates, both glycosylphosphatidylinositol-anchored proteins, are separately distributed on parasite surface and contained in different and highly stable membrane microdomains. Notably, labeling for α(1,3)Galactosyl residues only partially colocalize with sialylated mucins, indicating that two species of glycosylated mucins do exist, which are segregated at the parasite surface. Moreover, sialylated mucins were included in lipid-raft-domains, whereas TS molecules are not. The location of the surface-anchored TS resulted too far off as to be capable to sialylate mucins, a role played by the shed TS instead. Phosphatidylinositol-phospholipase-C activity is actually not present in trypomastigotes. Therefore, shedding of TS occurs via microvesicles instead of as a fully soluble form

Intermixing at the heterointerface between ZnS Zn S,O bilayer buffer and CuInS2 thin film solar cell absorber

The application of Zn compounds as buffer layers was recently extended to wide gap CuInS2 CIS based thin film solar cells. Using a new chemical deposition route for the buffer preparation aiming at the deposition of a single layer, nominal ZnS buffer without the need for any toxic reactants such as, e.g. hydrazine has helped to achieve a similar efficiency as respective CdS buffered reference devices. After identifying the deposited Zn compound, as ZnS Zn S,O bi layer buffer in former investigations [M. Bär, A. Ennaoui, J. Klaer, T. Kropp, R. S ez Araoz, N. Allsop, I. Lauermann, H. W. Schock, and M.C. Lux Steiner, Formation of a ZnS Zn S,O bilayer buffer on CuInS2 thin film solar cell absorbers by chemical bath deposition , J. Appl. Phys., accepted.], this time the focus lies on potential diffusion intermixing processes at the buffer absorber interface possibly, clarifying the effect of the heat treatment, which drastically enhances the device performance of respective final solar cells. The interface formation was investigated by x ray photoelectron and x ray excited Auger electron spectroscopy. In addition, photoelectron spectroscopy PES measurements were also conducted using tuneable monochromatized synchrotron radiation in order to gain depth resolved information. The buffer side of the buffer absorber heterointerface were investigated by means of the characterization of Zn S,O ZnS CIS structures where the ZnS Zn S,O bi layer buffer was deposited successively by different deposition times. In order to make the in terms of PES information depth deeply buried absorber side of the buffer absorber heterointerface accessible for characterization, in these cases the buffer layer was etched away by dilute HClaq. We found that while out leached Cu from the absorber layer forms together with the educts in the chemical bath a Zn 1 Z ,Cu2Z S like interlayer between buffer and absorber, Zn is incorporated in the uppermost region of the absorber. Both effects are strongly enhanced by postannealing the Zn S,O ZnS CIS samples. However, it was determined that the major fraction of the Cu and Zn can be found quite close to the heterointerface in the buffer and absorber layer, respectively. Due to this limited in the range of one monolayer spatial extent, these diffusion mechanisms were rather interpreted as a CBD induced and heat treatment promoted Cu Zn ion exchange at the buffer absorber interface. Possible impacts of this intermixing on the performance of the final solar cell devices will also be discusse