To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
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.
IRAS 15194-5115 was discovered by IRAS and identified as a carbon star by Meadows et al. (1987). It is the third brightest carbon star at 12 μm, the brighter ones are IRC+10216 and CIT6. Its infrared properties are similar to those of IRC+10216. Le Bertre and Epchtein (1990) have monitored the star in the near-infrared and derived a period of 578 days. The distance to IRAS 15194-5115 is estimated to about 1 kpc from infrared observations, and also by comparing its bolometric luminosity with that of IRC+10216.
Synthesis maps of stellar OH maser emission have revealed that the OH lies in expanding spherical shells typically about 1016 cm in diameter. From the maps and the expansion velocity, derived from the OH spectrum, stellar mass loss rates may be determined. Typical values are 10−5 M⊙/yr. An important application of the stellar OH masers is in the estimation of stellar distances.
Preston et al (1976) and Burke (1982, these proceedings) have long extolled the virtues of launching a radio telescope into space to increase VLBI baseline lengths and thus angular resolution, and to provide a much enhanced image formation capability. The scientific motivation for this has been covered in a number of memoranda referenced by Burke in these proceedings, and by Anderson et al (1982). Efforts to mobilise western astronomical support for space VLBI met with success in late 1982 at a meeting of US and European radio astronomers in Toulouse, France, at which a decision was taken to propose a joint mission to ESA and NASA. Shortly thereafter, a formal proposal was made to ESA (Anderson et al 1982) for a free flying satellite in an elliptical orbit out to 15000 km from the Earth, designed to observe in concert with the major ground-based VLBI networks and arrays. The mission, dubbed QUASAT, was received favourably in both ESA and NASA, with the result that formal Assessment Studies are scheduled to begin in both agencies in October 1983.
The flocculent spiral galaxy NGC 5055 has been mapped along the major axis in the 12CO (J = 1-0) line using the Onsala 20-m telescope (HPBW = 33″). Figure 1, which gives the spatial velocity diagram of CO emission on the major axis with observed Hα velocities (Kruit and Bosma, 1978) superimposed, seems to imply higher velocities of the regions responsible for the optical emission. Taking into account the cruder spatial resolution of the CO observations, this effect is expected in a region where the rotation curve rises rapidly provided that the CO emission increases toward the centre. Figure 2 shows the rotation velocities for the eastern and western parts of the galaxy separately, as observed in Hα and CO. For CO we only give the portion of the rotation curve which is accurately determined, i.e. where it is relatively flat. The CO velocities in this region agree closely with those observed in HI (Bosma, 1978). These data suggest a difference of 10-20 km s−1 between the Hα and CO velocities at a distance of ∼ 60″ from the centre. The radial distribution of the CO emission, also indicated in Fig. 2, is defined by an iterative fitting procedure to the observed line profiles (see Scoville et al. 1983). This procedure requests an a priori knowledge of the velocity field, here assumed to be defined by the Hα data inside a radius of 60″. However, the shapes of the observed spectra and “best fit” model profiles differ significantly in some cases, again indicating that the Hα velocities do not apply to the molecular gas. The derived radial distribution of the CO emission is dependent on the assumed velocity field; however, the gross characteristics are retained for more feasible rotation curves (i.e. rotation curves giving better fits to the observed profiles).
Scattering of radio waves off inhomogeneities in electron density in the interstellar medium can produce an apparent broadening in the angular diameter of an intrinsically compact background radio source. The magnitude and distribution of this effect at low galactic latitudes (|b|<5°) is not well known, although several cases suggest substantial broadening in certain directions, such as the Cygnus X region (Anderson et al. 1972), and the galactic center (Davies, Walsh, and Booth 1976). Large scattering in the plane is consistent with the scintillation properties of pulsars seen through substantial thicknesses (≳ 1 kpc) of the galactic disk.
3C 120 is a nearby radio galaxy (z = 0.033) that shows superluminal motions in its radio jet within one parsec of the nucleus. The apparent velocities of the moving features are approximately 1.5 mas/yr. This object is of particular interest because it is clearly identified with an N-type galaxy, unlike all other superluminal radio sources which are only seen in quasars and BL Lac objects. Because of the close proximity of 3C 120, we have been able to make a series of VLBI and VLA images at stepped resolutions, and thereby map the radio jet continuously from the radio nucleus (0.5 h−1 parsec) into the diffuse 400 h−1 kpc structure.
VLBI synthesis observations of the 2Π1/2, J = 1/2 excited-state of OH at 6.3 cm (ΔF = 1–0 = 4765.562 MHz) have been made towards four compact HII regions. Detailed maps have been produced for W3(OH) where three groups of sources are distributed over a region ∼ 0.01 pc in size. The brightest sources are shown to be saturated masers with TB ≳ 109 K. In ONl a weak feature gives fringes with a ∼ 0.05″ lobe spacing.
We review the state of the Onsala blind survey of the galactic plane, searching for new 6.7 GHz methanol masers. We also describe preliminary results of millimeter follow-up observations of the new detections and high resolution observations using the EVN. We conclude that blind surveys are important to complement targeted searches done until now and give the possibility to detect new classes of objects.
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.
We present a description of the pathlength compensation system used in the Sydney University Stellar Interferometer, and report on the method of fringe tracking that is being implemented. The components of this system are discussed, including the PAPA camera used to detect chromatic fringes, the fringe tracking servo, the delay line and its control.
Using the Swedish-ESO Submillimetre Telescope, we have mapped the CO (1-0) emission in two small areas of the LMC near 30 Dor. Some 20 molecular clouds have been identified and analysed. Cloud masses are calculated assuming virial equilibrium and the relationship between mass and CO luminosity is discussed.
In this short review we describe recent new observations of millimetre transitions of molecules in selected regions of the Magellanic Clouds. The observations were made using the Swedish-ESO Submillimetre Telescope, SEST, (Booth et al. 1989), the relatively high resolution of which facilitates, for the first time, observations of individual giant molecular clouds in the Magellanic Clouds. We have mapped the distribution of the emission from the two lowest rotational transitions of 12CO and 13CO and hence have derived excitation conditions for the molecule. In addition, we have observed several well-known interstellar molecules in the same regions, thus doubling the number of known molecules in the Large Magellanic Cloud (LMC). The fact that all the observations have been made under controlled conditions with the same telescope enables a reasonable intercomparison of the molecular column densities. In particular, we are able to observe the relative abundances among the different isotopically substituted species of CO.
The SUSI control system is a distributed real-time system currently consisting of 17 processors. A custom real-time operating system and network protocols ensure synchronous operation of servo loops across multiple processors.
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.