A systematic review of the overlap of fluid biomarkers in delirium and advanced cancer-related syndromes.

BACKGROUND:Delirium is a serious and distressing neurocognitive disorder of physiological aetiology that is common in advanced cancer. Understanding of delirium pathophysiology is largely hypothetical, with some evidence for involvement of inflammatory systems, neurotransmitter alterations and glucose metabolism. To date, there has been limited empirical consideration of the distinction between delirium pathophysiology and that of the underlying disease, for example, cancer where these mechanisms are also common in advanced cancer syndromes such as pain and fatigue. This systematic review explores biomarker overlap in delirium, specific advanced cancer-related syndromes and prediction of cancer prognosis. METHODS:A systematic review (PROSPERO CRD42017068662) was conducted, using MEDLINE, PubMed, Embase, CINAHL, CENTRAL and Web of Science, to identify body fluid biomarkers in delirium, cancer prognosis and advanced cancer-related syndromes of interest. Studies were excluded if they reported delirium tremens only; did not measure delirium using a validated tool; the sample had less than 75% of participants with advanced cancer; measured tissue, genetic or animal biomarkers, or were conducted post-mortem. Articles were screened for inclusion independently by two authors, and data extraction and an in-depth quality assessment conducted by one author, and checked by two others. RESULTS:The 151 included studies were conducted in diverse settings in 32 countries between 1985 and 2017, involving 28130 participants with a mean age of 69.3 years. Seventy-one studies investigated delirium biomarkers, and 80 studies investigated biomarkers of an advanced cancer-related syndrome or cancer prognosis. Overall, 41 biomarkers were studied in relation to both delirium and either an advanced cancer-related syndrome or prognosis; and of these, 24 biomarkers were positively associated with either delirium or advanced cancer syndromes/prognosis in at least one study. The quality assessment showed large inconsistency in reporting. CONCLUSION:There is considerable overlap in the biomarkers in delirium and advanced cancer-related syndromes. Improving the design of delirium biomarker studies and considering appropriate comparator/controls will help to better understanding the discrete pathophysiology of delirium in the context of co-existing illness

Selling Zoning: Do Density Bonus Incentives for Moderate-Cost Housing Work

This Article reviews the housing affordability problem, the California legislation, and previous research findings. The Article outlines our methods, presents our results, and recommends program improvements

Continuous macroscopic limit of a discrete stochastic model for interaction of living cells

In the development of multiscale biological models it is crucial to establish a connection between discrete microscopic or mesoscopic stochastic models and macroscopic continuous descriptions based on cellular density. In this paper a continuous limit of a two-dimensional Cellular Potts Model (CPM) with excluded volume is derived, describing cells moving in a medium and reacting to each other through both direct contact and long range chemotaxis. The continuous macroscopic model is obtained as a Fokker-Planck equation describing evolution of the cell probability density function. All coefficients of the general macroscopic model are derived from parameters of the CPM and a very good agreement is demonstrated between CPM Monte Carlo simulations and numerical solution of the macroscopic model. It is also shown that in the absence of contact cell-cell interactions, the obtained model reduces to the classical macroscopic Keller-Segel model. General multiscale approach is demonstrated by simulating spongy bone formation from loosely packed mesenchyme via the intramembranous route suggesting that self-organizing physical mechanisms can account for this developmental process.Comment: 4 pages, 3 figure

Star Formation and Selective Dust Extinction in Luminous Starburst Galaxies

We investigate the star formation and dust extinction properties of very luminous infrared galaxies whose spectra display a strong Hdelta line in absorption and a moderate [OII] emission (e[a] spectrum). This spectral combination has been suggested to be a useful method to identify dusty starburst galaxies at any redshift on the basis of optical data alone. We compare the average e(a) optical spectrum with synthetic spectra that include both the stellar and the nebular contribution, allowing dust extinction to affect differentially the stellar populations of different ages. We find that reproducing the e(a) spectrum requires the youngest stellar generations to be significantly more extinguished by dust than older stellar populations, and implies a strong ongoing star formation activity at a level higher than in quiescent spirals. A model fitting the optical spectrum does not necessarily produce the observed FIR luminosity and this can be explained by the existence of stellar populations which are practically obscured at optical wavelengths. Models in which dust and stars are uniformly mixed yield a reddening of the emerging emission lines which is too low compared to observations: additional foreground reddening is required.Comment: 17 pages, 4 Postscript figures, ApJ in pres

A first--order irreversible thermodynamic approach to a simple energy converter

Several authors have shown that dissipative thermal cycle models based on Finite-Time Thermodynamics exhibit loop-shaped curves of power output versus efficiency, such as it occurs with actual dissipative thermal engines. Within the context of First-Order Irreversible Thermodynamics (FOIT), in this work we show that for an energy converter consisting of two coupled fluxes it is also possible to find loop-shaped curves of both power output and the so-called ecological function against efficiency. In a previous work Stucki [J.W. Stucki, Eur. J. Biochem. vol. 109, 269 (1980)] used a FOIT-approach to describe the modes of thermodynamic performance of oxidative phosphorylation involved in ATP-synthesis within mithochondrias. In that work the author did not use the mentioned loop-shaped curves and he proposed that oxidative phosphorylation operates in a steady state simultaneously at minimum entropy production and maximum efficiency, by means of a conductance matching condition between extreme states of zero and infinite conductances respectively. In the present work we show that all Stucki's results about the oxidative phosphorylation energetics can be obtained without the so-called conductance matching condition. On the other hand, we also show that the minimum entropy production state implies both null power output and efficiency and therefore this state is not fulfilled by the oxidative phosphorylation performance. Our results suggest that actual efficiency values of oxidative phosphorylation performance are better described by a mode of operation consisting in the simultaneous maximization of the so-called ecological function and the efficiency.Comment: 20 pages, 7 figures, submitted to Phys. Rev.

Sequential star formation at the periphery of the HII regions Sh 217 and Sh 219

The HII regions Sh 217 and Sh 219 are textbook examples of a Stromgren sphere surrounded by an annular photodissociation region (PDR). The annular PDR is observed in both the 21 cm atomic hydrogen emission and the dust (PAH) emission near 8 micron (MSX Survey). An ultracompact radio continuum source is observed in the direction of the annular PDR, in both Sh 217 and Sh 219. JHKobservations show the presence of highly reddened stellar clusters (AV ~ 20 mag) in the directions of these radio sources. These clusters are also IRAS sources, of luminosities 22700 Lo for Sh 217 and 5900 Lo for Sh 219. Each cluster contains at least one luminous star with an IR colour excess; the one in the Sh 219 cluster shows H-alpha emission. The cluster associated with Sh 217 is almost spherical and contains luminous objects at its centre. The cluster associated with Sh 219 is elongated along the ionization front of this HII region. We argue that these are `second-generation clusters', which means that the physical conditions present in the PDRs, close to the ionization fronts, have favoured the formation of clusters containing massive objects. We discuss the physical mechanisms which may be at the origin of the observed triggered star formation.Comment: 12 pages, Late

Global MHD Simulations of the Time-Dependent Corona

We describe, test, and apply a technique to incorporate full-sun, surface flux evolution into an MHD model of the global solar corona. Requiring only maps of the evolving surface flux, our method is similar to that of Lionello et al. (2013), but we introduce two ways to correct the electric field at the lower boundary to mitigate spurious currents. We verify the accuracy of our procedures by comparing to a reference simulation, driven with known flows and electric fields. We then present a thermodynamic MHD calculation lasting one solar rotation driven by maps from the magnetic flux evolution model of Schrijver & DeRosa (2003). The dynamic, time-dependent nature of the model corona is illustrated by examining the evolution of the open flux boundaries and forward modeled EUV emission, which evolve in response to surface flows and the emergence and cancellation flux. Although our main goal is to present the method, we briefly investigate the relevance of this evolution to properties of the slow solar wind, examining the mapping of dipped field lines to the topological signatures of the "S-Web" and comparing charge state ratios computed in the time-dependently driven run to a steady state equivalent. Interestingly, we find that driving on its own does not significantly improve the charge states ratios, at least in this modest resolution run that injects minimal helicity. Still, many aspects of the time-dependently driven model cannot be captured with traditional steady-state methods, and such a technique may be particularly relevant for the next generation of solar wind and CME models

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)Supported by an unrestricted grant from Sanofi and Bristol-Myers Squibb