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Many mentally distressed individuals seek emergency department (ED) care in the US, but the extent and correlates of significant mental health problems in such patients is unknown.
All patients aged 18-60 presenting to an inner-city midwestern US ED April 2006-March 2007 were approached to participate in brief health screening. Exclusions were serious trauma preventing interview, unable to provide informed consent, pregnancy, acute suicidality, or presenting for psychiatric evaluation. Consenting patients completed a short web-tablet screen, including SF-12 for mental and physical health status, recent substance use and DSM-IV diagnoses of substance use disorders.
The lowest 25% on the SF-12 Mental Health Component were assigned to “poor mental health functioning” (PMHF). 5641 patients participated (58% female, 57% African-American). In bivariate analysis, the PMHF group was significantly more likely to be unmarried, female, use cocaine and marijuana, and binge drink in the past year, and have DSM-IV substance use disorders. Multiple logistic regression found that being female (OR=1.8), older (OR=1.01), not being married (OR=1.2) and DSM-IV alcohol abuse and dependence (OR=1.7, 2.4), cocaine abuse and dependence (OR=1.9, 2.0), and marijuana dependence (OR=1.7) were all independent predictors of PMHF. In a separate model, use of cocaine (OR=2.7) and marijuana (OR=1.7) but not use of alcohol, were independent predictors of PMHF as well as gender, age, and marital status.
Therefore PMHF in ED patients is strongly associated with recent substance use. ED clinicians should regularly ascertain both mental health status and substance use and refer for additional services where appropriate.
A developing application of laser-driven currents is the generation of magnetic fields of picosecond–nanosecond duration with magnitudes exceeding
. Single-loop and helical coil targets can direct laser-driven discharge currents along wires to generate spatially uniform, quasi-static magnetic fields on the millimetre scale. Here, we present proton deflectometry across two axes of a single-loop coil ranging from 1 to 2 mm in diameter. Comparison with proton tracking simulations shows that measured magnetic fields are the result of kiloampere currents in the coil and electric charges distributed around the coil target. Using this dual-axis platform for proton deflectometry, robust measurements can be made of the evolution of magnetic fields in a capacitor coil target.
Introduction: Our team developed “The Ottawa Troponin Pathway” (OTP) for Non-ST Elevation Myocardial Infarction (NSTEMI) diagnosis using serial conventional troponin (cTnI) 3 hours apart to aid in safe and early disposition of ED patients. The primary objective of this study is to validate the diagnostic accuracy of the OTP in the cohort of patients with cTnI values above the 99th percentile ( > 45ng/L). Methods: This study is a health records review conducted at the Civic and General Campuses of The Ottawa Hospital from August 2017 to December 2017. Adults (≥18 years) who presented to the ED with symptoms of ACS, and who had serial cTnI (at least two values 3 hours ±15 minutes apart) performed for diagnosis of NSTEMI and at least one cTnI value > 45ng/L were included. Patients with cardiac arrest, STEMI, unstable angina or those with TnI values ≤45ng/L were excluded. The outcomes were death due to unknown cause or NSTEMI adjudicated by two blinded investigators within 30 days. Data collected include baseline characteristics, ED management, length of stay, cTnI values and times of measurement, disposition, and outcome. We used descriptive statistics and test diagnostic characteristics to analyze our data. Results: We screened 53,077 patients, of whom 635 patients were included in the study (mean age 71.6 years; 57.6% males; 59.7% hospitalized; median ED length of stay 4.7 hours.). 107 patients (16.9%; 95%CI 14.1%-20.0%) were diagnosed with NSTEMI within 30 days. Among patients with TNI values above the 99th percentile, the OTP did not miss any patients diagnosed with NSTEMI. The sensitivity and the specificity of the OTP were 100% (95%CI 96.6%-100%) and 32.2% (95%CI 28.2%-36.4%) respectively. Conclusion: Our results show that the OTP is diagnostically accurate in ruling out NSTEMI among patients with cTNI values above the 99th percentile with symptoms concerning for ACS. Using the OTP will allow for early referral to consulting services for management, safe and early discharge home, and improve ED crowding.
Introduction: Guidelines recommend serial conventional cardiac troponin (cTn) measurements 6-9 hours apart for non-ST-elevation myocardial infarction (NSTEMI) diagnosis. We sought to develop a pathway based on absolute/relative changes between two serial conventional cardiac troponin I (cTnI) values 3-hours apart for 15-day MACE identification. Methods: This was a prospective cohort study conducted in the two large ED's at the Ottawa Hospital. Adults with NSTEMI symptoms were enrolled over 32 months. Patients with STEMI, hospitalized for unstable angina, or with only one cTnI were excluded. We collected baseline characteristics, Siemens Vista cTnI at 0 and 3-hours after ED presentation, disposition, and ED length of stay (LOS). Adjudicated primary outcome was 15-day MACE (AMI, revascularization, or death due to cardiac ischemia/unknown cause). We analysed cTnI values by 99th percentile cut-off multiples (45, 100 and 250ng/L). Results: 1,683 patients (mean age 64.7 years; 55.3% female; median ED LOS 7 hours; 88 patients with 15-day MACE) were included. 1,346 (80.0%) patients with both cTnI ≤45ng/L; and 58 (3.4%) of the 213 patients with one value≥100ng/L but both <250ng/L or ≤20% change did not suffer MACE. Among 124 patients (7.4%) with one value >45ng/L but both <100ng/L based on 3 or 6-hour cTnI, one patient with Δ<10ng/L and 6 of 19 patients with Δ≥20ng/L were diagnosed with NSTEMI (patients with Δ10-19ng/L between first and second cTnI had third one at 6-hours). Based on the results, we developed the Ottawa Troponin Pathway (OTP) with a 98.9% sensitivity (95%CI 96.7-100%) and 94.6% specificity (95%CI 93.4-95.7%). Conclusion: The OTP, using two conventional cTnI measurements performed 3-hours apart, should lead to better identification of NSTEMI particularly those with values >99th percentile cut-off, standardize management and reduce the ED LOS.
The use of targets with surface structures for laser-driven particle acceleration has potential to significantly boost the particle and radiation energies because of enhanced laser absorption. We investigate, via experiment and particle-in-cell simulations, the impact of micron-scale surface-structured targets on the spectrum of electrons and protons accelerated by a picosecond laser pulse at relativistic intensity. Our results show that, compared with flat-surfaced targets, structures on this scale give rise to a significant enhancement in particle and radiation emission over a wide range of laser–target interaction parameters. This is due to the longer plasma scale length when using micro-structures on the target front surface. We do not observe an increase in the proton cutoff energy with our microstructured targets, and this is due to the large volume of the relief.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Introduction: Creatine kinase (CK) measurement, despite not being recommended for the diagnosis of a Non-ST Elevation Myocardial Infarction (NSTEMI) is still routinely performed in the emergency department (ED) for the workup of NSTEMI. The diagnostic utility of CK among ED patients with suspected NSTEMI is still not well understood. The objectives of this study were to assess: the additional value of CK in NSTEMI diagnosis and the correlation between the highest CK/TNI values and ejection fraction (EF) on follow-up echocardiography among patients with suspected NSTEMI. Methods: This was a prospective cohort study conducted at the Civic and General Campuses of The Ottawa Hospital from March 2014 to March 2016. We enrolled adults (18 years) for whom troponin (TNI) and CK were ordered for chest pain or non-chest pain symptoms within the past 24 hours concerning for NSTEMI and excluded those with suspected ST-Elevation Myocardial Infarction (STEMI). Primary outcome was a 30-day NSTEMI adjudicated by two blinded physicians. Demographics, medical history, and ED CK/TNI values were collected. We used descriptive statistics and report test diagnostic characteristics. Results: Of the 1,663 patients enrolled, 84 patients (5.1%) suffered NSTEMI. The sensitivity and specificity of CK was 30.9% (95%CI 21.1, 40.8) and 91.4% (95%CI 90.0, 92.8) respectively. The sensitivity and specificity of troponin was 96.4% (95%CI 92.4, 100) and 88.1% (95%CI 86.5, 89.7) respectively. Among 3 (0.2%) patients with missed NSTEMI diagnosis with TNI, CK measurements did not add value. The mean CK values were not significantly different between those with normal and abnormal EF on follow-up (132.4 U/L and 146.3 U/L respectively; p=0.44), whereas the mean TNI values were significantly different (0.5 µg/L and 1.3 µg/L respectively; p=0.046). Conclusion: CK measurements neither provide any additional value in the work-up of NSTEMI in the ED nor correlate with EF on follow-up. Discontinuing routine CK measurements would reduce overall costs and improve resource utilization in the ED, and streamline the management of patients in the ED with chest pain.
OBJECTIVES/SPECIFIC AIMS: Clinical guidelines recommend using predicted atherosclerotic cardiovascular disease (ASCVD) risk to inform treatment decisions. The objective was to compare the contribution of changes in modifiable risk factors Versus aging to the development of high 10-year predicted ASCVD risk. METHODS/STUDY POPULATION: Prospective follow-up of the Jackson Heart Study, an exclusively African-American cohort, at visit 1 (2000–2004) and visit 3 (2009–2012). Analyses included 1115 African-American participants without a high 10-year predicted ASCVD risk (<7.5%), hypertension, diabetes, or ASCVD at visit 1. We used the Pooled Cohort equations to calculate the incidence of high (≥7.5%) 10-year predicted ASCVD risk at visit 3. We recalculated the percentage with a high 10-year predicted ASCVD risk at visit 3 assuming each risk factor [age, systolic blood pressure (SBP), antihypertensive medication use, diabetes, smoking, total and high-density lipoprotein cholesterol], one at a time, did not change from visit 1. RESULTS/ANTICIPATED RESULTS: The mean age at visit 1 was 45.2±9.5 years. Overall, 30.9% (95% CI 28.3%–33.4%) of participants developed high 10-year predicted ASCVD risk. Aging accounted for 59.7% (95% CI 54.2%–65.1%) of the development of high 10-year predicted ASCVD risk compared with 32.8% (95% CI 27.0%–38.2%) for increases in SBP or antihypertensive medication initiation and 12.8% (95% CI 9.6%–16.5%) for incident diabetes. Among participants <50 years, the contribution of increases in SBP or antihypertensive medication initiation was similar to aging. DISCUSSION/SIGNIFICANCE OF IMPACT: Increases in SBP and antihypertensive medication initiation are major contributors to the development of high 10-year predicted ASCVD risk in African Americans, particularly among younger adults.
The Amdeh Formation is a 3.4 km stack of sparsely fossiliferous quartzites and shales which crops out in the Al Hajar mountains near Muscat. Here we describe the uppermost member (Am5) that can be dated biostratigraphically as Darriwilian and which is the outcrop equivalent, and probably the seaward continuation, of the Saih Nihayda Formation in the Ghaba Salt Basin of northern Oman. The outcrops at Wadi Daiqa and Hayl al Quwasim consist of 690 m of quartzitic sandstones, shales and bivalve-rich shell beds. Trace fossils referable to the Cruziana and Skolithos ichnofacies abound. The member comprises storm-dominated shelf, shoreface and delta deposits. A number of new discoveries have been made in the outcrops: fragments of the arandaspid fish Sacabambaspis, ossicles and moulds of the early disparid crinoid Iocrinus, two new genera of conodont, an occurrence of the rare trinucleid trilobite Yinpanolithus, and palynological and sedimentological evidence of more continuous Floian–Darriwilian deposition than is usual in the region. Sea levels during Middle Ordovician time are estimated to have been 50–200 m above present levels and a wide, low-gradient shelf covered much of Arabia. Similar trace fossils and storm-dominated, micro-tidal, sedimentary rocks occur throughout the region. Small changes of sea level, possibly caused by the growth and melting of polar ice sheets, could lead to substantial seaward or landward shifts of facies belts. The Am5 deposits are thick compared to most equivalents in Arabia implying active subsidence and a ready supply of sediment.
Over the last four decades the transactional model has emerged as a central fixture of modern developmental science. Despite this, we are aware of no principled approach for determining (a) whether it is actually necessary to invoke transactional mechanisms to explain observed patterns of stability in a given domain of adaptive functioning and (b) the extent to which transactional processes, once identified in aggregate, are accounted for by measured domains with which an aspect of adaptive functioning is theoretically in transaction. Leveraging the fact that transactional mechanisms produce excess stability in an outcome domain above and beyond autoregressive processes, along with the basic logic of mediational analysis, we introduce two novel indexes for studying transactional processes strategically. We apply these metrics to data from the NICHD Study of Early Child Care and Youth Development cohort on mother- and teacher-reported externalizing problems and social competence along with teacher-reported and objective assessments of academic skills acquired in Grades 1, 3, and 5. During this developmental period we find that (a) transactional contributions to stability are strongest for teacher-reported outcomes, next strongest for mother-reported outcomes, and relatively weak for objective assessments of academic skills and (b) observed maternal sensitivity (but not child-reported friendship quality) accounts for a modest proportion of the total transactional effects operative in most of the domains of adaptive functioning we studied. Discussion focuses on extending the logic of our approach to additional waves of measurement.
Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis.
Temperature is arguably the most important abiotic factor influencing the life history of ectotherms. It limits survival and affects all physiological and metabolic processes, including energy and nutrient procurement and processing, development and growth rates, locomotion ability and ultimately reproductive success. However, the influence of temperature on the energetic cost of development has not been thoroughly investigated. We show that in the diamondback moth [Plutella xylostella L. (Lepidoptera: Plutellidae)] rearing temperature (range10–30°C) affected growth and development rates, the energetic cost of development and fecundity. Rearing at lower temperatures increased development times and slowed growth rate, but resulted in larger adult mass. Fecundity was lowest at 10°C, highest at 15°C and intermediate at temperatures of 20°C and above. At a given rearing temperature fecundity was correlated with pupal mass and most eggs were laid on the first day of oviposition, there was no correlation between total eggs laid and adult longevity. The highest production cost was incurred at 10°C; this decreased with increasing temperature, was minimized in the range 20–25°C, and then increased again at 30°C. These minimized production costs occurred at temperatures close to the intrinsic optimum temperature for this species and may reflect the rearing temperature for optimal fitness. Thus at sub-optimal temperatures greater food resources are required during the development period. Predicted increased temperatures at the margins of the current core distribution of P. xylostella could ameliorate current seasonal effects on fecundity, thereby increasing the probability of winter survival leading to more resilient range expansion and an increased probability of pest outbreaks.
Investigation of an outbreak of Clostridium difficile infection (CDI) at a hemodialysis facility revealed evidence that limited intrafacility transmission occurred despite adherence to published infection control standards for dialysis clinics. Outpatient dialysis facilities should consider CDI prevention, including environmental disinfection for C. difficile, when formulating their infection control plans.
Infect. Control Hosp. Epidemiol. 2015;36(8):972–974
Trends in the populations of large herbivores in Niassa Reserve, Mozambique, have been monitored through biennial aerial surveys since 1998. The elephant Loxodonta africana population has been subjected to intensive illegal hunting since 2006. We used a simple population model to mimic the observed trends in the numbers of live and dead elephants to demonstrate the impact of poaching. The number of fresh or recent carcasses recorded was used in the model as an index of the annual mortality rate. A maximum likelihood analysis to compare population models revealed that the best fit to the survey estimates of both live elephants and old or very old carcasses was a model that started with 6,635 elephants in 1987. This number increased through births by 4.6% annually and decreased through deaths from natural and anthropogenic causes. In the best-fit model, the mean mortality rate in any year was 3.2 times the observed 1 + 2 carcass ratio (ratio for carcasses in age categories 1 and 2), and carcasses remained visible for a mean of 6 years. The model suggested that c. 900 elephants were poached during 2007–2010 and another c. 1,000 during 2011. Population estimates for live elephants and carcasses are now routine outcomes of aerial surveys conducted as part of the CITES programme for Monitoring the Illegal Killing of Elephants, and our method can be applied to any population with a time series of estimates for live and dead elephants.
Acute doses of Ca rapidly increase serum Ca and reduce bone resorption concomitant with a reduction in serum parathyroid hormone (PTH) levels. The physiological response to a dose of Ca in milk and to a Ca salt may be different. The present study investigated Ca absorption patterns with increasing levels of fortification in milk, and the response to one dose of a Ca salt. A group of twenty-eight Asian women aged 20–45 years volunteered to attend the laboratory over several weeks. The fasted volunteers were randomised to one of three experimental drinks: 200 ml skimmed milk containing 250, 500 or 1000 mg Ca. A subgroup of seven volunteers also received a calcium gluconate/carbonate salt containing 1000 mg Ca in 200 ml water. Serial blood samples and urine were collected for 5 h from baseline. Different doses of Ca in milk resulted in a graded response in serum corrected Ca, PTH and C-telopeptide of type I collagen (CTx) but not ionised Ca. Serum Ca increased in response to all milk drinks and from 2 to 5 h the blood Ca levels were significantly different for the 250 and 1000 mg doses, as was the integrated response between the loads. The PTH response to the two higher doses was significantly more than following the 250 mg dose. The integrated response for CTx and urinary Ca between all three doses of Ca in milk was significantly different. A dose of Ca salt elicited a more immediate response reaching a plateau faster, and declining faster to baseline. Fortified milk is a safe matrix for delivering larger doses of Ca.
Until recently, three-dimensional reconstruction on an ultrastructural level was only possible using serial section transmission electron microscopy (ssTEM). However, ssTEM is highly challenging and prone to artifacts as, e.g., section loss and image distortions. New methods, such as serial block-face scanning electron microscopy (SBFSEM) overcome these limitations and promise a high lateral resolution. However, little is known about the usability of SBFSEM in diminutive, but highly complex cellular systems. We used spider sperm (~3 µm in diameter), which fulfills these conditions, to analyze the potential of SBFSEM compared with ssTEM. Our data suggest that the resolution obtained by SBFSEM allows depicting structures on a cellular level and is sufficient to discriminate subcellular components, but is highly dependent on previous staining procedures and electron density of the target structures.
Recent research indicates that cognitive reserve mitigates the clinical expression of neuropsychological impairment in multiple sclerosis (MS). This literature primarily uses premorbid intelligence and lifetime experiences as indicators. However, changes in current recreational activities may also contribute to the maintenance of neural function despite brain atrophy. We examined the moderation effects of current changes in recreational activity on the relationship between brain atrophy and information processing speed in 57 relapsing-remitting MS patients. Current enrichment was assessed using the Recreation and Pastimes subscale from the Sickness Impact Profile. In patients reporting current declines in recreational activities, brain atrophy was negatively associated with cognition, but there was no such association in participants reporting stable participation. The MRI metric-by-recreational activity interaction was significant in separate hierarchical regression analyses conducted using third ventricle width, neocortical volume, T2 lesion volume, and thalamic volume as brain measures. Results suggest that recreational activities protect against brain atrophy's detrimental influence on cognition. (JINS, 2013, 19, 1–6)
New angular diameter determinations for the bright southern F8 supergiant δ CMa enable the bolometric emergent flux and effective temperature of the star to be determined with improved accuracy. The spectral flux distribution and bolometric flux have been determined from published photometry and spectrophotometry and combined with the angular diameter to derive the bolometric emergent flux ℱ = (6.50 ± 0.24) × 107 Wm−2 and the effective temperature Teff = 5818 ± 53 K. The new value for the effective temperature is compared with previous interferometric and infrared flux method determinations. The accuracy of the effective temperature is now limited by the uncertainty in the bolometric flux rather than by the uncertainty in the angular diameter.
A new Mo potential, developed recently by using an ab initio quantum mechanics theory, was used to study formation and time evolution of radiation defects, such as self-interstitial atoms (SIAs), vacancies, and small clusters of SIAs, using molecular dynamics (MD). MD models were developed for calculation of the diffusion coefficients of vacancies, self-interstitials, and small dislocation loops containing 2 to 37 SIAs; and the rate constants were calculated. Interactions of small SIA loops with SIAs were simulated. The results show that rotation of SIA from one <111> to another equivalent direction is an important mechanism that significantly contributes to kinetic coefficients.