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The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
Self-assembling peptides (SAPs) have the ability to spontaneously assemble into
ordered nanostructures enabling the manufacture of
‘designer’ nanomaterials. The reversible molecular
association of SAPs has been shown to offer great promise in therapeutics via
for example, the design of biomimetic assemblies for hard tissue regeneration.
This could be further exploited for novel nano/micro diagnostic tools. However,
self-assembled peptide gels are often associated with inherent weak and
transient mechanical properties. Their incorporation into polymeric matrices has
been considered as a potential strategy to enhance their mechanical stability.
This study focuses on the incorporation of an 11-residue peptide,
P11-8 (peptide sequence:
within a fibrous scaffold of poly (ε-caprolactone) (PCL). In this
study an electrospinning technique was used to fabricate a biomimetic porous
scaffold out of a solution of P11-8 and PCL which resulted in a
biphasic structure composed of submicron fibers (diameter of 100-700 nm) and
nanofibers (diameter of 10-100 nm). The internal morphology of the fabric and
its micro-structure can be easily controlled by changing the peptide
concentration. The secondary conformation of P11-8 was investigated
in the as-spun fibers by ATR-FTIR spectroscopy and it is shown that peptide
self-assembly into β-sheet tapes has taken place during fiber
formation and the deposition of the fibrous web.
Two broad aims drive weed science research: improved management and improved
understanding of weed biology and ecology. In recent years, agricultural
weed research addressing these two aims has effectively split into separate
subdisciplines despite repeated calls for greater integration. Although some
excellent work is being done, agricultural weed research has developed a
very high level of repetitiveness, a preponderance of purely descriptive
studies, and has failed to clearly articulate novel hypotheses linked to
established bodies of ecological and evolutionary theory. In contrast,
invasive plant research attracts a diverse cadre of nonweed scientists using
invasions to explore broader and more integrated biological questions
grounded in theory. We propose that although studies focused on weed
management remain vitally important, agricultural weed research would
benefit from deeper theoretical justification, a broader vision, and
increased collaboration across diverse disciplines. To initiate change in
this direction, we call for more emphasis on interdisciplinary training for
weed scientists, and for focused workshops and working groups to develop
specific areas of research and promote interactions among weed scientists
and with the wider scientific community.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
A compact spectrometer-on-a-chip featuring a plasmonic molecular interaction region has been conceived, designed, modeled, and partially fabricated. The silicon-on-insulator (SOI) system is the chosen platform for the integration. The low loss of both silicon and SiO2 between 3 and 4 μm wavelengths enables silicon waveguides on SiO2 as the basis for molecular sensors at these wavelengths. Important characteristic molecular vibrations occur in this range, namely the bond stretching modes C-H (Alkynes), O-H (monomeric alcohols, phenols) and N-H (Amines), as well as CO double bonds, NH2, and CN. The device consists of a broad-band infrared LED, photonic waveguides, photon-to-plasmon transformers, a molecular interaction region, dispersive structures, and detectors. Photonic waveguide modes are adiabatically converted into SPPs on a neighboring metal surface by a tapered waveguide. The plasmonic interaction region enhances optical intensity, which allows a reduction of the overall device size without a reduction of the interaction length, in comparison to ordinary optical methods. After the SPPs propagate through the interaction region, they are converted back into photonic waveguide modes by a second taper. The dispersing region consists of a series of micro-ring resonators with photodetectors coupled to each resonator. Design parameters were optimized via electro-dynamic simulations. Fabrication was performed using a combination of photo- and electron-beam-lithography together with standard silicon processing techniques.
The Twins Early Development Study (TEDS) is a large longitudinal sample of twins born in England and Wales between 1994 and 1996. The focus of TEDS has been on cognitive and behavioral development, including difficulties in the context of normal development. TEDS began when multiple births were identified from birth records and the families were invited to take part in the study; 16,810 pairs of twins were originally enrolled in TEDS. More than 10,000 of these twin pairs remain enrolled in the study to date. DNA has been collected for more than 7,000 pairs, and genome-wide genotyping data for two million DNA markers are available for 3,500 individuals. The TEDS families have taken part in studies when the twins were aged 2, 3, 4, 7, 8, 9, 10, 12, 14, and 16 years of age. Data collection is currently underway to assess the adult destinations of the twins as they move from school to university and the workplace. Between January 2012 and December 2014, all of the TEDS twins will turn 18, and the study will transition to an adult sample. TEDS represents an outstanding resource for investigating the developmental effects of genes and environments on complex quantitative traits from childhood to young adulthood and beyond.
Psychological traits and disorders are often interrelated through shared genetic influences. A combination of maximum-likelihood structural equation modelling and multidimensional scaling enables us to open a window onto the genetic architecture at the symptom level, rather than at the level of latent genetic factors. We illustrate this approach using a study of cognitive abilities involving over 5,000 pairs of twins.