The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes.
We performed a prospective study of 91 patients ...with chronic pancreatitis; data were collected from patients seen at academic centers in Europe from January 2011 through April 2014. We analyzed correlations between clinical, laboratory, and imaging data with number of hospital readmissions and in-hospital days over the next 12 months; the parameters with the highest degree of correlation were used to develop a 3-stage chronic pancreatitis prognosis score (COPPS). The predictive strength was validated in 129 independent subjects identified from 2 prospective databases.
The mean number of hospital admissions was 1.9 (95% confidence interval CI, 1.39–2.44) and 15.2 for hospital days (95% CI, 10.76–19.71) for the development cohort and 10.9 for the validation cohort (95% CI, 7.54–14.30) (P = .08). Based on bivariate correlations, pain (numeric rating scale), level of glycated hemoglobin A1c, level of C-reactive protein, body mass index, and platelet count were used to develop the COPPS system. The patients’ median COPPS was 8.9 points (range, 5–14). The system accurately discriminated stages of disease severity (low to high): A (5–6 points), B (7–9), and C (10–15). In Pearson correlation analysis of the development cohort, the COPPS correlated with hospital admissions (0.39; P < .01) and number of hospital days (0.33; P < .01). The correlation was validated in the validation set (Pearson correlation values of 0.36 and 0.44; P < .01). COPPS did not correlate with results from the Cambridge classification system.
We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.
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The purpose of this study was to determine which factors most impact North Carolina elementary school principals' decisions to retain or socially promote students while implementing the North ...Carolina Gateways. Data were collected utilizing a two-phase design. Phase one of the study was a survey, which was distributed to all elementary principals in the state of North Carolina. Phase two of the study utilized follow-up interviews to gather qualitative data. An analysis of the data indicated that North Carolina elementary school principals believe retention can be used as a tool to improve student achievement. Factors that most impact a principal's decision to retain students are discussed. North Carolina elementary school principals also indicated that they do not socially promote children. Factors that most impact a principal's decision to promote a child not on grade level are discussed. North Carolina elementary school principals indicated that neither retention nor social promotion is the answer to improving student achievement. Principals across the state have implemented intensive remediation and intervention strategies designed to provide all students with developmentally appropriate instruction. Implications of the research findings are discussed and recommendations for future research are given.
Phylogenetically resolving epidemiologic linkage Romero-Severson, Ethan O.; Bulla, Ingo; Leitner, Thomas
Proceedings of the National Academy of Sciences - PNAS,
03/2016, Letnik:
113, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Although the use of phylogenetic trees in epidemiological investigations has become commonplace, their epidemiological interpretation has not been systematically evaluated. Here, we use an HIV-1 ...within-host coalescent model to probabilistically evaluate transmission histories of two epidemiologically linked hosts. Previous critique of phylogenetic reconstruction has claimed that direction of transmission is difficult to infer, and that the existence of unsampled intermediary links or common sources can never be excluded. The phylogenetic relationship between the HIV populations of epidemiologically linked hosts can be classified into six types of trees, based on cladistic relationships and whether the reconstruction is consistent with the true transmission history or not. We show that the direction of transmission and whether unsampled intermediary links or common sources existed make very different predictions about expected phylogenetic relationships: (i) Direction of transmission can often be established when paraphyly exists, (ii) intermediary links can be excluded when multiple lineages were transmitted, and (iii) when the sampled individuals’ HIV populations both are monophyletic a common source was likely the origin. Inconsistent results, suggesting the wrong transmission direction, were generally rare. In addition, the expected tree topology also depends on the number of transmitted lineages, the sample size, the time of the sample relative to transmission, and how fast the diversity increases after infection. Typically, 20 or more sequences per subject give robust results. We confirm our theoretical evaluations with analyses of real transmission histories and discuss how our findings should aid in interpreting phylogenetic results.
Spectroscopic detection of narrow emission lines traces the presence of circumstellar mass distributions around massive stars exploding as core-collapse supernovae. Transient emission lines ...disappearing shortly after the supernova explosion suggest that the material spatial extent is compact and implies an increased mass loss shortly prior to explosion. Here, we present a systematic survey for such transient emission lines (Flash Spectroscopy) among Type II supernovae detected in the first year of the Zwicky Transient Facility survey. We find that at least six out of ten events for which a spectrum was obtained within two days of the estimated explosion time show evidence for such transient flash lines. Our measured flash event fraction (>30% at 95% confidence level) indicates that elevated mass loss is a common process occurring in massive stars that are about to explode as supernovae.
In this Letter, we present a cosmic Bell experiment with polarization-entangled photons, in which measurement settings were determined based on real-time measurements of the wavelength of photons ...from high-redshift quasars, whose light was emitted billions of years ago; the experiment simultaneously ensures locality. Assuming fair sampling for all detected photons and that the wavelength of the quasar photons had not been selectively altered or previewed between emission and detection, we observe statistically significant violation of Bell's inequality by 9.3 standard deviations, corresponding to an estimated p value of ≲7.4×10^{-21}. This experiment pushes back to at least ∼7.8 Gyr ago the most recent time by which any local-realist influences could have exploited the "freedom-of-choice" loophole to engineer the observed Bell violation, excluding any such mechanism from 96% of the space-time volume of the past light cone of our experiment, extending from the big bang to today.
Abstract
In recent years, there have been significant advances in multimessenger astronomy due to the discovery of the first, and so far only confirmed, gravitational wave event with a simultaneous ...electromagnetic (EM) counterpart, as well as improvements in numerical simulations, gravitational wave (GW) detectors, and transient astronomy. This has led to the exciting possibility of performing joint analyses of the GW and EM data, providing additional constraints on fundamental properties of the binary progenitor and merger remnant. Here, we present a new Bayesian framework that allows inference of these properties, while taking into account the systematic modeling uncertainties that arise when mapping from GW binary progenitor properties to photometric light curves. We extend the relative binning method presented in Zackay et al. to include extrinsic GW parameters for fast analysis of the GW signal. The focus of our EM framework is on light curves arising from
r
-process nucleosynthesis in the ejected material during and after merger, the so-called kilonova, and particularly on black hole−neutron star systems. As a case study, we examine the recent detection of GW190425, where the primary object is consistent with being either a black hole or a neutron star. We show quantitatively how improved mapping between binary progenitor and outflow properties, and/or an increase in EM data quantity and quality are required in order to break degeneracies in the fundamental source parameters.
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