**Objectives:** Elevated serum troponin values, regardless of cause, are associated with increased short-term and long-term mortality. The objective of this study was to describe and quantify use of ...troponin-related terms in hospital discharge summaries. **Study Design:** Retrospective chart review. **Methods:** We included patients admitted to the medical service of three Rhode Island hospitals in 2018. Patients had to have two or more troponin measurements, including at least one elevated value, as well as a rise-and-fall pattern. We reviewed text from three sections in the discharge summary—the problem list, hospital course, and attending attestation—to identify terms referring to troponin. We double-coded 10% of the sample to assess inter-rater reliability. Troponin terms were grouped by whether they referenced an abnormal level, as well as by the etiology of the elevation. Descriptive statistics were used. **Results:** 257 patients were included; 66% of their discharge summaries had a troponin descriptor. We identified 19 unique troponin terms: three of these terms implied a normal troponin level (e.g., “flat troponin”), seven described an abnormal elevation without specifically referencing myocardial injury as the etiology (e.g., “troponin bump”), and the rest referenced ischemia or infarction (e.g., “NSTEMI”). Over one-third (34%) of the records had no troponin terms in the discharge summary, despite those patients having at least one abnormal troponin level during their hospitalization. **Conclusions:** We found that clinicians used a wide variety of terms to describe troponin elevations in their discharge summaries, including minimizing language and potentially conflicting terms; a third of discharge summaries omitted any mention of the abnormal troponin value. More precise language may facilitate appropriate evaluation and management of these higher risk patients after hospital discharge.
The newly invasive soybean aphid, Aphis glycines Matsumura, has seriously threatened soybean production in North America, after having spread to >20 states in the United States and several southern ...provinces of Canada. Control of A. glycines has focused on applications of insecticides, which are not a long-term solution to soybean aphid pest management. In autumn, soybean aphids start producing alate females (gynoparae) that search for their overwintering host plants, the common buckthorn, Rhamnus cathartica. The gynoparae then produce pheromone-emitting wingless female offspring (oviparae) that attract male aphids. In this study, we report the chemical identification of the soybean aphid sex pheromone using gas chromatography–electroantennogram, gas chromatography–mass spectrometry, and nuclear magnetic resonance spectroscopy. Behavioral activities of males and gynoparous females in the field were also characterized. The potential applications using formulations containing specific soybean aphid pheromone compositions for reducing overwintering populations are discussed.
Signalling cascades first described in Drosophila have been found to regulate patterning and outgrowth in a number of structures in higher vertebrates. We sought to determine whether the ...evolutionarily conserved genes were important during the development of the tongue. In situ hybridisation was used to determine the temporo-spatial expression of a panel of conserved genes. Histological examination and incorporation of BrdU were used to determine the mechanism by which the tongue develops. We show that evolutionarily conserved genes were expressed in distinct dynamic patterns during tongue development. Sonic Hedgehog (Shh) and Patched (Ptc) were found only in the dorsal tongue epithelium. Shh expression was only observed in the suprabasal layers, whereas Ptc was observed in both basal and suprabasal layers. Cell division in the epithelium was concentrated in regions devoid of Shh. Expression of bone morphogenetic protein-7 (BMP) was identical to that of Shh. Shh and Ptc expression were never detected in the mesenchyme. Ectopic expression of Noggin (a potent antagonist of the BMPs) caused severe abnormalities in tongue morphology, including swelling of the mesenchymal component and a thickening of the epithelial layer. Data from this study suggests that the epithelium and mesenchyme express quite different genes during development. However BMP activity acts to inhibit growth in both tissues.
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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
Abstract
Background
Pneumococcal community acquired pneumonia (CAP-Spn) and invasive pneumococcal disease (IPD) cause significant morbidity and mortality worldwide. Although childhood immunization ...programs have reduced the overall burden of pneumococcal disease in both children and adults (through herd immunity), there is insufficient data in Canada to inform immunization policy in immunocompetent adults. Given the routine use of 13-valent pneumococcal vaccine (PCV13) in childhood immunization programs in Canada since 2010, this study aimed to assess the impact of herd immunity on adults by determining the proportion of pneumococcal disease in hospitalized Canadian adults caused by PCV13 serotypes from 2011 to 2015.
Methods
Active surveillance for CAP-Spn and IPD in hospitalized adults was performed in hospitals across five Canadian provinces from December 2010 to 2015. For serotyping, S. pneumoniae isolates recovered from sputum or blood culture were characterized by Quellung reaction, or CAP-Spn were serotyped using a PCV13-specific urine antigen detection (UAD-PCV13) assay.
Results
From 2011 to 2015, 8.7% (326/3758) of adults hospitalized with CAP overall had a positive UAD-PCV13. When assessed individually by year, the proportion of PCV13 serotypes declined over this study period: 13.6% (44/323) in 2011, 11.9% (75/633) in 2012, 8.3% (99/1192) in 2013, 5.3% (50/944) in 2014, and 8.7% (58/666) in 2015. While the proportion of some PCV13 serotypes remained unchanged (i.e., serotype 3), others showed significant decreases over time (i.e., serotype 7F). Comparison of UAD-PCV13 data to S. pneumoniae isolates characterized by Quellung reactions is underway.
Conclusion
In the five years following infant PCV13 immunization program implementation in Canada, S. pneumoniae serotypes contained in PCV13 remain an important cause of adults hospitalized with CAP. However, the proportion of PCV13 serotypes is decreasing over time. In order to inform recommendations on the use of PCV13 in adults, it will be important to maintain active surveillance for pneumococcal CAP and IPD to characterize the proportion of adult disease caused by PCV13 serotypes as the impact of herd protection conferred by childhood immunization programs is fully realized.
Disclosures
M. Elsherif, Canadian Institutes of Health Research: Investigator, Research grant; Public Health Agency of Canada: Investigator, Research grant; GSK: Investigator, Research grant; T. Hatchette, GSK: Grant Investigator, Grant recipient; Pfizer: Grant Investigator, Grant recipient; Abbvie: Speaker for a talk on biologics and risk of TB reactivation, Speaker honorarium; M. K. Andrew, GSK: Grant Investigator, Research grant; Pfizer: Grant Investigator, Research grant; Sanofi-Pasteur: Grant Investigator, Research grant; A. Mcgeer, Hoffman La Roche: Investigator, Research grant; GSK: Investigator, Research grant; sanofi pasteur: Investigator, Research grant; M. Semret, GSK: Investigator, Research grant; Pfizer: Investigator, Research grant; S. Trottier, Canadian Institutes of Health Research: Investigator, Research grant; L. Valiquette, GSK: Investigator, Research grant; S. McNeil, GSK: Contract Clinical Trials and Grant Investigator, Research grant; Merck: Contract Clinical Trials and Speaker’s Bureau, Speaker honorarium; Novartis: Contract Clinical Trials, No personal renumeration; sanofi pasteur: Contract Clinical Trials, No personal renumeration
Electromechanical models are crucial in the design and control of motors and actuators. Modeling, identification, drive, and current control loop of a limited-rotation actuator with magnetic ...restoration is presented. New nonlinear and linearized electromechanical models are developed for the design of the drive as well as small and large signal controls of the actuator. To attain a higher accuracy and an efficient design, and the eddy-currents in the laminations and magnet are modeled. This involves analytically solving 1-D and 2-D diffusion equations, leading to the derivation of a lumped-element circuit for system-level analyses, such as control system design. Additionally, the study analyzes and incorporates the impact of pre-sliding friction. The actuator is prototyped, and the paper delves into the identification of the model, presenting a procedure for parameter extraction. A close agreement is observed between the results obtained from the model, finite element analysis, and experimental results. The superiority of the proposed model over previous approaches is highlighted. Part II of the paper is dedicated to the drive circuit, the current control, as well as linear and nonlinear position control system designs.
In part II, an op-amp-based drive is proposed and designed. Subsequently, a very accurate model for the drive circuit and the current loop is developed as a simulation platform, while its simplified ...version is derived, tailored for efficient design purposes. Through a comprehensive evaluation, the accuracy and efficacy of both the actuator and drive circuit modeling is scrutinized, showcasing their superiorities over existing approaches. The importance of eddy current modeling is underscored. Also, the effectiveness of the designed current loop and its practical trade-offs are engineered and discussed. Then, three DSP-based position control techniques are implemented: pole placement with voltage drive, pole placement with current drive, and nonlinear control with feed linearization. Both full-order and reduced-order observers are leveraged to estimate the unmeasured states. The performance of control designs across various applications are evaluated through indices such as rise time, overshoot, steady-state error, and large-signal tracking in the step response as well as bandwidth, robustness, phase margin, sensitivity, disturbance rejection, and noise rejection in the frequency domain. The distinctive features of implemented control strategy are compared, offering a nuanced discussion of their respective advantages and drawbacks, shedding light on their potential applications.
In modern industrial systems, it can be shown that there is a large advantage in total cost of ownership to match driven equipment, variable speed drives, and motors at ratings which fully utilize ...said components. Many industries see a demand for larger and larger power ratings where the sizing of the components and selection of operating points becomes much more critical than their smaller predecessors. These operating points include, at which speed the equipment is capable of operating, at what voltage, and at what temperature. These factors will impact the initial capital cost of the system, the operating cost in terms of power consumption, as well as the flexibility or robustness of the system. The goal of this paper is to demonstrate the importance of selecting the appropriate operating voltage, as well as the benefits of matching fully utilized components. These benefits can be shown to provide enough return on investment to justify collaborative development efforts between various equipment manufacturers, thusly providing most cost effective, reliable solutions.
Single‐shot turbo spin‐echo sequences are heavily
T
2‐weighted sequences that are exceptionally well suited to evaluate the subarachnoid space. In the
T
2‐weighted fast spin‐echo sequences that are ...used routinely in spinal magnetic resonance (
MR
) imaging, the subarachnoid space is not well differentiated from the surrounding epidural fat, which could lead to decreased detection of lesions of the subarachnoid space such as arachnoid diverticula. Our purpose was to determine the added value of a single‐shot turbo spin‐echo sequence in identifying cystic lesions of the subarachnoid space in dogs.
MR
images of six dogs with a confirmed arachnoid diverticulum and 24 dogs with other spinal disease were included. Six observers were asked to interpret only
T
2‐weighted images initially, and in a second session,
T
2‐weighted and half‐
F
ourier acquisition single‐shot turbo spin‐echo (
HASTE
) sequences. The
MR
images were anonymized, and no signalment, history, or clinical information was provided. Without the
HASTE
sequences, 25% of arachnoid diverticula were identified. Adding the
HASTE
sequence increased the diagnosis of arachnoid diverticulum to 52.8%. The resulting difference, after adding the
HASTE
sequence, of 27.8% was statistically significant (
P
= 0.002). No false‐positive diagnoses of arachnoid diverticulum were made with either sequence. Although sensitivity in this study was likely artificially low, the significantly increased detection rate of arachnoid diverticula when using
HASTE
imaging indicates that this sequence is a valuable addition to
MR
imaging protocols for the canine spine.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The design of peptides that assemble in membranes to form functional ion channels is challenging. Specifically, hydrophobic interactions must be designed between the peptides and at the peptide-lipid ...interfaces simultaneously. Here, we take a multi-step approach towards this problem. First, we use rational de novo design to generate water-soluble α-helical barrels with polar interiors, and confirm their structures using high-resolution X-ray crystallography. These α-helical barrels have water-filled lumens like those of transmembrane channels. Next, we modify the sequences to facilitate their insertion into lipid bilayers. Single-channel electrical recordings and fluorescent imaging of the peptides in membranes show monodisperse, cation-selective channels of unitary conductance. Surprisingly, however, an X-ray structure solved from the lipidic cubic phase for one peptide reveals an alternative state with tightly packed helices and a constricted channel. To reconcile these observations, we perform computational analyses to compare the properties of possible different states of the peptide.
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GEOZS, IJS, IMTLJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK, ZAGLJ
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