424 research outputs found

    Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis

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    ABSTRACT: BACKGROUND: In secondary care the Wells clinical decision rule (CDR) combined with a quantitative D-dimer test can exclude pulmonary embolism (PE) safely. The introduction of point-of-care (POC) D-dimer tests facilitates a similar diagnostic strategy in primary care. We estimated failure-rate and efficiency of a diagnostic strategy using the Wells-CDR combined with a POC-D-dimer test for excluding PE in primary care. We considered ruling out PE safe if the failure rate was <2% with a maximum upper confidence limit of 2.7%. METHODS: We performed a scenario-analysis on data of 2701 outpatients suspected of PE. We used test characteristics of two qualitative POC-D-dimer tests, as derived from a meta-analysis and combined these with the Wells-CDR-score. RESULTS: In scenario 1 (SimpliRed-D-dimer sensitivity 85%, specificity 74%) PE was excluded safely in 23.8% of patients but only by lowering the cut-off value of the Wells rule to <2. (failure rate: 1.4%, 95% CI 0.6-2.6%) In scenario 2 (Simplify-D-dimer sensitivity 87%, specificity 62%) PE was excluded safely in 12.4% of patients provided that the Wells-cut-off value was set at 0. (failure rate: 0.9%, 95% CI 0.2-2.6%) CONCLUSION: Theoretically a diagnostic strategy using the Wells-CDR combined with a qualitative POC-D-dimer test can be used safely to exclude PE in primary care albeit with only moderate efficienc

    Potential Modes of Interaction of 9-Aminomethyl-9,10-dihydroanthracene (AMDA) Derivatives with the 5-HT 2A Receptor: A Ligand Structure-Affinity Relationship, Receptor Mutagenesis and Receptor Modeling Investigation

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    The effects of 3-position substitution of 9-aminomethyl-9,10-dihydroanthracene (AMDA) on 5-HT2A receptor affinity were determined and compared to a parallel series of DOB-like 1-(2,5-dimethoxyphenyl)-2-aminopropanes substituted at the 4-position. The results were interpreted within the context of 5-HT2A receptor models that suggest that members of the DOB-like series can bind to the receptor in two distinct modes that correlate with the compounds’ functional activity. Automated ligand docking and molecular dynamics suggest that all of the AMDA derivatives, the parent of which is a 5-HT2A antagonist, bind in a fashion analogous to that for the sterically demanding antagonist DOB-like compounds. The failure of the F3406.52L mutation to adversely affect the affinity of AMDA and the 3-bromo derivative is consistent with the proposed modes of orientation. Evaluation of ligand-receptor complex models suggest that a valine/threonine exchange between the 5-HT2A and D2 receptors may be the origin of selectivity for AMDA and two substituted derivatives

    Two Regional Mental Health Treatment Facilities

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    One of the major social programs of the 1960s was the development of community mental health centers. As with most early attempts at evaluation, the results were pessimistic. This article reanalyzes one of the earliest, and best-known, evaluations of a community-based treatment facility. Following the conceptual framework of Campbell and his associates, it was found that the various threats to the validity of the findings indicate a consistent and systematic bias against detecting a positive effect for the new mental health center. In light of recent federal legislation mandating formal evaluations, appropriate procedures are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68090/2/10.1177_0193841X7900300403.pd

    Pluto's Far Side

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    The New Horizons spacecraft provided near-global observations of Pluto that far exceed the resolution of Earth-based datasets. However, most previous Pluto New Horizons analyses focused on the New Horizons encounter hemisphere (i.e., the anti-Charon hemisphere containing Sputnik Planitia). In this work, we summarize and interpret data on Pluto's “far side” (i.e., its non-encounter or alternatively, its sub-Charon hemisphere), providing the first integrated New Horizons overview of Pluto's far side terrains. We find strong evidence for widespread bladed (i.e., aligned CH₄-mountain) deposits, evidence for an impact crater about as large as any on the “near side” hemisphere, evidence for complex lineations approximately antipodal to Sputnik Planitia that may be causally related, evidence that the far side maculae (i.e., equatorial dark regions) are smaller and more structured than Pluto's encounter hemisphere maculae, and more

    Managing Invasive Plants on Great Plains Grasslands: A Discussion of Current Challenges

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    The Great Plains of North America encompass approximately 1,300,000 km2 of land from Texas to Saskatchewan. The integrity of these lands is under continual assault by long-established and newly-arrived invasive plant species, which can threaten native species and diminish land values and ecological goods and services by degrading desired grassland resources. The Great Plains are a mixture of privately and publicly owned lands, which leads to a patchwork of varying management goals and strategies for controlling invasive plants. Continually updated knowledge is required for efficient and effective management of threats posed by changing environments and invasive plants. Here we discuss current challenges, contemporary management strategies, and management tools and their integration, in hopes of presenting a knowledge resource for new and experienced land managers and others involved in making decisions regarding invasive plant management in the Great Plains
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