Objective
Unplanned readmission to the pediatric cardiac intensive care unit (CICU) is associated with significant morbidity and mortality. The Pediatric Early Warning Score (PEWS) predicts ward ...patients at risk for decompensation but has not been previously reported to identify at‐risk patients with cardiac disease prior to ward transfer. This study aimed to determine whether PEWS prior to transfer may serve as a predictor of unplanned readmission to the CICU.
Design
All patients discharged from a tertiary children's hospital CICU from September 2012 through August 2015 were included for analysis. PEWS assessment was performed following transfer to the cardiac ward, and starting in January 2014, PEWS scores were also assigned by bedside CICU nurse prior to transfer from the CICU. Scores exceeding a predetermined threshold prompted further stability assessment by provider team prior to transfer.
Results
Among 1320 discharges of 1082 patients during the study period, there were 130 unplanned readmissions during their hospitalization. Following implementation of pretransfer PEWS scoring, there was no significant reduction in unplanned readmission frequency (10.2% vs 9.2%, P = .39). A secondary analysis of PEWS scores revealed cardiac scoring as a strong discriminator of those likely to experience an unplanned readmission, independent of other significant clinical predictors of readmission (OR 1.78, 95% CI 1.17–2.71, P = .007). The resultant multivariate model was a good predictor of unplanned readmission (AUC 0.77, 95% CI 0.71‐0.83, P < .001).
Conclusion
While implementation of a pretransfer PEWS assessment did not reduce the frequency of unplanned readmissions in this small single‐center cohort, a multivariate model including pretransfer elements of an early warning scoring system, along with other patient characteristics serves as a good discriminator of patients likely to experience an unplanned readmission following CICU discharge. Further prospective investigation is needed to define objective measures of pretransfer discharge readiness to potentially reduce the likelihood of unplanned readmissions.
The Mississippi River Healthy Basins Initiative calls for best management practices (BMPs) that actively avoid, control, and trap non-point source pollutants such as sediments and nutrients. Typical ...edge-of-field practices of forested riparian buffers and native warm season grass buffers control and trap sheet flow surface runoff. Slotted inlet pipes are drainage water management structures that theoretically slow runoff velocities, detain a variable pool of water, and encourage sedimentation. The objective of this study was to document sediment accumulation behind four newly installed slotted inlet pipes in the Lower Mississippi Alluvial Valley. Further analysis of installation geometry and total phosphorus (TP) of accumulated sediments provided sediment volumes and TP loads retained on agricultural landscapes as a result of slotted inlet pipes. There were significant differences (p<0.001) in sediment accumulation (mm) between all sites, however, there were no significant differences in sediment accumulation rates (mm/day) between the four pipes (H=2.611; p=0.625). Overall curvi-linear trend (r2=0.76) and the Von Bertalanffy non-linear model for sediment accumulation through time for all four sites, suggests highest sediment accumulation occurs at approximately 235 days following pipe installation at 65±22% of pipe volume. A Mann–Whitney U test showed highly significant differences in sediment accumulation rates between T0–235 (1.5mm/day) and T235–624 (−0.0357mm/day). Overall sediment volumes and TP loads retained ranged between 3.88 and11.5m3 and thus 3.32–18.86kg TP respectively, with average present value costs per kg per ha of TP accumulated ranging from $250.66 (low TP concentration) to $136.51 (high TP concentration) over the 15 yr project horizon. Results document performance measures of slotted inlet pipes for sediment accumulation and phosphorus load retention per pipe. Furthermore, estimates of time that maximize sediment accumulation (t=235 days) provide a potential management protocol that could maximize sediment and nutrient reductions with slotted inlet pipes as edge-of-field management practices.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In this paper, we report an enhancement of the anisotropy constant K AF of IrMn/CoFe exchange bias systems with the variation of the NiCr seed layer thickness. This is related to an increase in the ...(111) texture of IrMn parallel to the interface. Silang100rang /NiCr (Xnm)/IrMn (7 nm)/CoFe (3 nm)/Ta (10 nm) with X = 2, 4, 6, 10, 15, 20 nm were prepared by direct current (dc) sputtering. X-ray diffraction studies revealed a peak in the (111) texture of the IrMn parallel to the interface for the samples with a 6-nm NiCr seed layer which reduced with increasing NiCr thickness. NiCr seed layer thicknesses of 2, 4, and 20 nm had negligible (111) texture. Measurement of the grain size distribution and thermal activation measurements were used to calculate the anisotropy constant of the IrMn. This was found to increase from (0.4 plusmn 0.1) times 10 7 ergs/cm 3 for the sample with a 20-nm NiCr seed layer to (4.5 plusmn 2) times10 7 ergs/cm 3 for the sample with a 6-nm NiCr seed layer. TEM studies of the seed layers showed the 6-nm NiCr layer was amorphous/nanocrystalline, and the grain size increased with NiCr thickness. This change in the morphology of the seed layer results in a lattice mismatch with the IrMn reducing the (111) texture of the IrMn and hence K AF . This allows tuning of the anisotropy by controlling the lattice mismatch between the seed layer and the IrMn.
Our previous in vivo studies show that both the amount of Ag and the number of available naive CD4 T cells affect the Th1/Th2 phenotype of the effector CD4 T cells generated. We examined how the ...number of OVA-specific CD4 TCR transgenic T cells affects the Th1/Th2 phenotype of anti-SRBC CD4 T cells generated in vivo upon immunization with different amounts of OVA-SRBC. Our observations show that a greater number of Ag-dependent CD4 T cell interactions are required to generate Th2 than Th1 cells. We established an in vitro system that recapitulates our main in vivo findings to more readily analyze the underlying mechanism. The in vitro generation of Th2 cells depends, as in vivo, upon both the number of responding CD4 T cells and the amount of Ag. We demonstrate, using agonostic/antagonistic Abs to various costimulatory molecules or their receptors, that the greater number of CD4 T cell interactions, required to generate Th2 over Th1 cells, does not involve CD40, OX40, or ICOS costimulation, but does involve B7/CD28 interactions. A comparison of the level of expression of B7 molecules by APC and CD4 T cells, under different conditions resulting in the substantial generation of Th1 and Th2 cells, leads us to propose that the critical CD28/B7 interactions, required to generate Th2 cells, may directly occur between CD4 T cells engaged with the same B cell acting as an APC.
The number of patients with immunosuppression is rising worldwide. The spectrum of diseases and pathogens in these patients differs widely from that of immunocompetent patients due to frequent ...opportunistic infections. Symptoms are sometimes unspecific, and imaging plays a key role in the management of these patients. The lungs are a frequent site of infection in immunosuppressed patients. Chest X‑ray is the starting point for radiological diagnostics, but shows only limited sensitivity and specificity for infections with atypical pathogens. Thus, computed tomography (CT) is of great importance and allows a better distinction between viral, bacterial, or fungal infections, as well as other noninfectious diseases. Even with CT, however, is exact specification of the pathogen unfortunately not possible. CT is also the main diagnostic tool for assessment of the abdomen, particularly in patients presenting with acute abdomen or when sonographic findings are inconclusive. Moreover, CT allows diagnostic and therapeutic interventions such as percutaneous biopsies, or abscess and fluid drainage.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We present a new measurement of the Cabibbo-Kobayashi-Maskawa matrix element |Vcb| from B0→D*−ℓ+νℓ decays, reconstructed with the full Belle data set of 711 fb−1 integrated luminosity. Two form ...factor parametrizations, originally conceived by the Caprini-Lellouch-Neubert (CLN) and the Boyd, Grinstein and Lebed (BGL) groups, are used to extract the product F(1)ηEW|Vcb| and the decay form factors, where F(1) is the normalization factor and ηEW is a small electroweak correction. In the CLN parametrization we find F(1)ηEW|Vcb|=(35.06±0.15±0.56)×10−3, ρ2=1.106±0.031±0.007, R1(1)=1.229±0.028±0.009, R2(1)=0.852±0.021±0.006. For the BGL parametrization we obtain F(1)ηEW|Vcb|=(34.93±0.23±0.59)×10−3, which is consistent with the world average when correcting for F(1)ηEW. The branching fraction of B0→D*−ℓ+νℓ is measured to be B(B0→D*−ℓ+νℓ)=(4.90±0.02±0.16)%. We also present a new test of lepton flavor universality violation in semileptonic B decays, B(B0→D*−e+ν)B(B0→D*−μ+ν)=1.01±0.01±0.03. The errors quoted correspond to the statistical and systematic uncertainties, respectively. This is the most precise measurement of F(1)ηEW|Vcb| and form factors to date and the first experimental study of the BGL form factor parametrization in an experimental measurement.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UM
This research presents a combined experimental-modeling study of lattice rotations and deviatoric strain gradients induced by focused-ion beam (FIB) milling in nitride heterostructures. 3D X-ray ...polychromatic microdiffraction (PXM) is used to map the local lattice orientation distribution in FIB-structured areas. Results are discussed in connection with microphotoluminescence (μ-PL), fluorescent analysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) data. It is demonstrated that FIB-milling causes both direct and indirect damage to the InGaN/GaN layers. In films subjected to direct ion beam impact, a narrow amorphidized top layer is formed. Near the milling area, FIB-induced stress relaxation and formation of complicated 3D strain fields are observed. The resulting lattice orientation changes are found to correlate with a decrease and/or loss of PL intensity, and agree well with finite element simulations of the three-dimensional strain fields near the relaxed trenches. Experimentally, it is found that the lattice surface normal has an in-plane rotation, which only appears in simulations when the GaN-substrate lattice mismatch annihilates the InGaN-substrate mismatch. This behavior further supports the notion that the film/substrate interface is incoherent.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This book provides an introduction to the study of meaning in human language, from a linguistic perspective. It covers a fairly broad range of topics, including lexical semantics, compositional ...semantics, and pragmatics. The chapters are organized into six units: (1) Foundational concepts; (2) Word meanings; (3) Implicature (including indirect speech acts); (4) Compositional semantics; (5) Modals, conditionals, and causation; (6) Tense & aspect. Most of the chapters include exercises which can be used for class discussion and/or homework assignments, and each chapter contains references for additional reading on the topics covered. As the title indicates, this book is truly an introduction: it provides a solid foundation which will prepare students to take more advanced and specialized courses in semantics and/or pragmatics. It is also intended as a reference for fieldworkers doing primary research on under-documented languages, to help them write grammatical descriptions that deal carefully and clearly with semantic issues. The approach adopted here is largely descriptive and non-formal (or, in some places, semi-formal), although some basic logical notation is introduced. The book is written at level which should be appropriate for advanced undergraduate or beginning graduate students. It presupposes some previous coursework in linguistics, but does not presuppose any background in formal logic or set theory.
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