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The aim of this study was to perform a systematic review and meta-analysis of the diagnostic accuracy of a point-of-care ultrasound exam for undifferentiated shock in patients presenting to the emergency department.
Ovid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and research meeting abstracts were searched from 1966 to June 2018 for relevant studies. QUADAS-2 was used to assess study quality, and meta-analysis was conducted to pool performance data of individual categories of shock.
A total of 5,097 non-duplicated studies were identified, of which 58 underwent full-text review; 4 were included for analysis. Study quality by QUADAS-2 was considered overall a low risk of bias. Pooled positive likelihood ratio values ranged from 8.25 (95% CI 3.29 to 20.69) for hypovolemic shock to 40.54 (95% CI 12.06 to 136.28) for obstructive shock. Pooled negative likelihood ratio values ranged from 0.13 (95% CI 0.04 to 0.48) for obstructive shock to 0.32 (95% CI 0.16 to 0.62) for mixed-etiology shock.
The rapid ultrasound for shock and hypotension (RUSH) exam performs better when used to rule in causes of shock, rather than to definitively exclude specific etiologies. The negative likelihood ratios of the exam by subtype suggest that it most accurately rules out obstructive shock.
We present results from a multiwavelength study of the blazar PKS 1954–388 at radio, UV, X-ray, and gamma-ray energies. A RadioAstron observation at 1.66 GHz in June 2012 resulted in the detection of interferometric fringes on baselines of 6.2 Earth-diameters. This suggests a source frame brightness temperature of greater than 2 × 1012 K, well in excess of both equipartition and inverse Compton limits and implying the existence of Doppler boosting in the core. An 8.4-GHz TANAMI VLBI image, made less than a month after the RadioAstron observations, is consistent with a previously reported superluminal motion for a jet component. Flux density monitoring with the Australia Telescope Compact Array confirms previous evidence for long-term variability that increases with observing frequency. A search for more rapid variability revealed no evidence for significant day-scale flux density variation. The ATCA light-curve reveals a strong radio flare beginning in late 2013, which peaks higher, and earlier, at higher frequencies. Comparison with the Fermi gamma-ray light-curve indicates this followed ~ 9 months after the start of a prolonged gamma-ray high-state—a radio lag comparable to that seen in other blazars. The multiwavelength data are combined to derive a Spectral Energy Distribution, which is fitted by a one-zone synchrotron-self-Compton (SSC) model with the addition of external Compton (EC) emission.
Life has been described as information flowing in molecular streams (Dawkins, 1996).Our growing understanding of the impact of horizontal gene transfer on evolutionary dynamics reinforces this fluid-like flow of molecular information (Joyce, 2002). The diversity of nucleic acid sequences, those known and yet to be characterized across Earth's varied environments, along with the vast repertoire of catalytic and structural proteins, presents as more of a dynamic molecular river than a tree of life. These informational biopolymers function as a mutualistic union so universal as to have been termed the Central Dogma (Crick, 1958). It is the distinct folding dynamics-the digital-like base pairing dominating nucleic acids, and the environmentally responsive and diverse range of analog-like interactions dictating protein folding (Goodwin et al., 2012)-that provides the basis for the mutualism. The intertwined functioning of these analog and digital forms of information (Goodwin et al., 2012) unified within diverse chemical networks is heralded as the Darwinian threshold of cellular life (Woese, 2002).
The discovery of prion diseases (Chien et al., 2004; Jablonka and Raz, 2009; Paravastu et al., 2008) introduced the paradigm of protein templates that propagate conformational information, suggesting a new context for Darwinian evolution. When taking both protein and nucleic acid moelcular evolution into consideration (Cairns- Smith, 1966; Joyce, 2002), the conceptual framework for chemical evolution can be generalized into three orthogonal dimensions as shown in Figure 5.1 (Goodwin et al., 2014). The 1st dimension manifests structural order through covalent polymerization reactions and includes chain length, sequence, and linkage chemistry inherent to a dynamic chemical network. The 2nd dimension extends the order in dynamic conformational networks through noncovalent interactions of the polymers. This dimension includes intramolecular and intermolecular forces, from macromolecular folding to supramolecular assembly to multicomponent quaternary structure. Folding in this 2nd dimension certainly depends on the primary polymer sequence, and the folding/assembly diversity yields an additional set of environmentally constrained supramolecular folding codes. For example, double-stranded DNA assemblies are dominated by the rules of complementary base pairing, while the self-propagating conformations of prions are based on additional noncovalent, environmentally-dependent interactions.
Introduction: The Medical University of South Carolina (MUSC) hospital implemented an inpatient opt-out smoking-cessation service where smokers received a mandatory smoking-cessation consult and phone follow-up within 1-month post-discharge.
Aim: To examine predictors of patients who opted-out of bedside counselling or follow-up phone calls.
Methods: Eligible adult cigarette smokers admitted to the MUSC hospital were enrolled in the programme. Opting-out of bedside consult or follow-up calls were assessed separately using log-linear modelling where predictors included patient demographics, length of hospitalisation, insurance type, smoking history, and motivation/confidence to quit.
Results: Of the 38,758 admitted patients (February 2014–May 2015), 6,684 reported currently smoking and were automatically referred to bedside-consult. Approximately 26% of smokers made contact with the counselor, most of whom (83%) accepted the consult. Amongst patients eligible for post-discharge follow-up (n = 3485), 49% responded to the calls. Those who opted-out of the bedside-consult were mostly males (RR = 1.29). Those who did not respond to follow-up calls were younger age (RR = 1.33), with Medicaid/no insurance (RR = 1.17), and had not received a bedside consult (RR = 1.32).
Conclusions: An opt-out smoking-cessation programme was feasible and acceptable to most patients and was able to reach 65% of eligible smokers; 17% opted-out of bedside counselling; <1% asked to be removed from further phone calls.
Introduction: A rapid and accurate weight of a child can be of critical importance during pediatric emergencies. The Broselow Tape (BT) is the gold standard for estimating a child’s weight based on their length. It separates children into incremental weight categories. Studies have shown that the BT is not accurate. We created a new pediatric spine board (PedEBoard) that weighs the child. The objective of this study was to compare the agreement between the actual weight vs. the PedEBoard weight and BT estimated weight of children presenting to a pediatric emergency department (ED). Methods: Ethics approval was obtained from McMaster University. A power calculation was done for sample size to detect 10% error. Consecutive children were recruited who presented to McMaster University’s Children’s ED on two days in March 2015. Children were excluded if their length was outside the BT range, non-English speaking or critically ill. Children had their weight taken by the triage nurse either on an infant scale or on a traditional standing scale. The nurse also took the child’s length using a standard measuring tape or height on the standing medical scale. Infants were placed on the PedEBoard by investigators while older children were asked to lie down on the board. Investigators were blinded to the actual weight. BT weight was determined by the palmPEDi Lite app. Bland-Altman analysis was performed, comparing the percent difference between the actual weight vs. PedEBoard weight and actual weight vs. BT weight. The correlation between the PedEBoard and BT was assessed using the Spearman coefficient of rank. Data was entered into MedCalc for Windows 98, Version 15.2.2 Results: A total of 157 children were included in the study. The mean actual weight was 19.4kg (95% CI 17.4 to 21.3) vs. the PedEBoard weight 19.4kg (95% CI 17.4 to 21.3) vs. the BT weight 16.9kg (95% CI 15.6 to 18.2). Bland-Altman percent difference was 0.1% (95% CI -2.0 to 1.8%) between the actual weight and the PedEBoard weight and 9.6% (95% CI -22.0% to 41.2%) between the actual weight and the BT weight. The Spearman coefficient of rank correlation was 1.000 p<0.0001 (95% CI 0.999 to 1.000) for the PedEBoard and 0.969 p<0.001 (95% CI 0.957 to 0.977) for the BT. The BT provided the wrong weight category 80% of the time vs. 8% for the PedEBoard. Conclusion: The PedEBoard closely agreed with the actual weight of the child while the Broselow Tape estimate often did not.
A preliminary orbit has been derived for the high luminosity, 27-d classical Cepheid T Mon. Velocities for the hot companion have been measured from an HST GHRS spectrum and 3 IUE spectra. The companion velocities are inconsistent with binary orbital motion and it is likely that the companion is itself a short period binary. The HST spectrum also shows that the companion is a chemically peculiar star, probably magnetic.