Background The prevalence of chronic kidney disease (CKD) increases with age; however, the prognostic significance in older people is uncertain. This study aims to determine the association of CKD ...with all-cause and cardiovascular mortality in community-dwelling older people 75 years and older. Study Design Cohort study of people 75 years and older recruited in 1994 to 1999 to 1 arm of a trial of multidimensional health assessment with mortality follow-up. Setting & Participants 53 general practices in Great Britain. 15,336 (73%) of those eligible participated. 13,177 (86%) had serum creatinine measured at baseline. Main Factor Estimated glomerular filtration rate (eGFR). Outcomes All-cause and cardiovascular mortality. Measurements eGFR derived from serum creatinine level using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation in milliliters per minute per 1.73 m2 ; dipstick proteinuria. Mortality by linkage to national death registration and death certification. Results After a median follow-up of 7.3 years (interquartile range, 5.0), 7,633 (58%) had died, 42% of cardiovascular causes. In the first 2 years of follow-up, adjusted hazard ratios for all-cause mortality in eGFR bands of 45 to 59, 30 to 44, and less than 30 compared with eGFR greater than 60 mL/min/1.73 m2 were 1.13 (95% confidence interval, 0.93 to 1.37), 1.69 (95% confidence interval, 1.26 to 2.28), and 3.87 (95% confidence interval, 2.78 to 5.38) in men and 1.14 (95% confidence interval, 0.93 to 1.40), 1.33 (95% confidence interval, 1.06 to 1.68), and 2.44 (95% confidence interval, 1.68 to 3.56) in women, respectively. Hazard ratios were greater for cardiovascular mortality and lower after 2 years. Dipstick proteinuria was independently associated with all-cause, but not cardiovascular, mortality risk in both sexes. Limitations Single serum creatinine measurement, no calibration of serum creatinine, MDRD Study equation not validated in older people. Conclusion As kidney function decreases, there is a graded and independent increase in all-cause and cardiovascular mortality risk in older people 75 years and older, especially in men and those with eGFR less than 45 mL/min/1.73 m2 . Dipstick proteinuria did not add to cardiovascular mortality risk in this elderly population. In older people, identification and management of CKD should prioritize the smaller numbers with more severe CKD.
Greg crater, located in Promethei Terra, Mars is a ∼66 km diameter impact crater. The crater has been widely studied, both in terms of its overall geomorphological evolution and, more specifically, ...its ice-rich landforms. One category of these, glacier-like forms, appears to be closely analogous to valley glaciers on Earth. However, Greg crater hosts many other features, the origins and inter-relationships between which are of continuing interest. Here, the surficial geology and geomorphology of Greg crater is presented, identifying seven distinct groups of terrain types or landforms. We identify and classify these based on their physical appearance, guided by published descriptions and interpretations to illustrate the wide variety of landforms and terrain types that, elsewhere, could be used to investigate landscape development.
The Cassini spacecraft's Grand Finale orbits provided a unique opportunity to probe Saturn's gravity field and interior structure. Doppler measurements yielded unexpectedly large values for the ...gravity harmonics J6, J8, and J10, which cannot be matched using planetary interior models that assume uniform rotation. Instead we present a suite of models that assume the planet's interior rotates on cylinders, which allows us to match all the observed even gravity harmonics. For every interior model, the gravity field is calculated self-consistently with high precision using the Concentric Maclaurin Spheroid method. We present an acceleration technique for this method, which drastically reduces the computational cost, allows us to efficiently optimize model parameters and map out allowed parameter regions with Monte Carlo sampling, and increases the precision of the calculated J2n gravity harmonics to match the error bars of the observations, which would be difficult without acceleration. Based on our models, Saturn is predicted to have a dense central core of ∼15-18 Earth masses and an additional 1.5-5 Earth masses of heavy elements in the envelope. Finally, we vary the rotation period in the planet's deep interior and determine the resulting oblateness, which we compare with the value from radio occultation measurements by the Voyager spacecraft. We predict a rotation period of 10:33:34 hr 55 s, which is in agreement with recent estimates derived from ring seismology.
Although studies of Ames and Snell dwarf mice have suggested possible important roles of the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis in aging and age-related diseases, the ...results cannot rule out the possibility of other hormonal changes playing an important role in the life extension exhibited by these dwarf mice. Therefore, growth hormone receptor/binding protein (GHR/BP) knockout (KO) mice would be valuable animals to directly assess the roles of somatotropic axis in aging and age-related diseases because the primary hormonal change is due to GH/IGF-1 deficiency. Our pathological findings showed GHR/BP KO mice to have a lower incidence and delayed occurrence of fatal neoplastic lesions compared with their wild-type littermates. These changes of fatal neoplasms are similar to the effects observed with calorie restriction and therefore could possibly be a major contributing factor to the extended life span observed in the GHR/BP KO mice.
Many receptors for neurotransmitters and hormones rely upon members of the Gqα family of heterotrimeric G proteins to exert their actions on target cells. Gα subunits of the Gq class of G proteins ...(Gqα, G11α, G14α and G15/16α) directly link receptors to activation of PLC-β isoforms which, in turn, stimulate inositol lipid (i.e. calcium/PKC) signalling. Although Gqα family members share a capacity to activate PLC-β, they also differ markedly in their biochemical properties and tissue distribution which predicts functional diversity. Nevertheless, established models suggest that Gqα family members are functionally redundant and that their cellular responses are a result of PLC-β activation and downstream calcium/PKC signalling. Growing evidence, however, indicates that Gqα, G11α, G14α and G15/16α are functionally diverse and that many of their cellular actions are independent of inositol lipid signalling. Recent findings show that Gqα family members differ with regard to their linked receptors and downstream binding partners. Reported binding partners distinct from PLC-β include novel candidate effector proteins, various regulatory proteins, and a growing list of scaffolding/adaptor proteins. Downstream of these signalling proteins, Gqα family members exhibit unexpected differences in the signalling pathways and the gene expression profiles they regulate. Finally, genetic studies using whole animal models demonstrate the importance of certain Gqα family members in cardiac, lung, brain and platelet functions among other physiological processes. Taken together, these findings demonstrate that Gqα, G11α, G14α and G15/16α regulate both overlapping and distinct signalling pathways, indicating that they are more functionally diverse than previously thought.
Abstract
As technology becomes ubiquitous in the architecture, engineering and construction (AEC) industry, there is a need to evaluate how construction education is incorporating technology in the ...undergraduate curriculum. Given recent trends, we are especially interested in emerging technologies that facilitate AEC integration. In the first phase of the study, a scoping review of literature was used to identify publications related to eight emerging construction-related technology types. Following, the second phase focused on how these emerging technologies were taught in construction education. Of the 58 papers identified in the second phase, the overwhelming majoring discussed technology as pedagogical aid to improve visualization, while only 10 focused on instruction about the technology itself. Some technology types did not have any education specific publications identified by the researchers. Emerging themes from the data also suggest alignments between drones and surveying, and robotics and programming and computational thinking. A majority of the papers mention several technology types and Building Information Modelling (BIM), suggesting an integrated view of emerging construction technology. We conclude the review by suggesting the need for more publications related to teaching of new technology, so that instructors can share best practices in integrating them into the construction curriculum.
Abstract Introduction Survival after diagnosis of lung cancer is poor and seemingly lower in the UK than other Western countries, due in large part to late presentation with advanced disease ...precluding curative treatment. Recent research suggests that around one-third of lung cancer patients reach specialist care after emergency presentation and have a worse survival outcome. Confirmation of these data and understanding which patients are affected may allow a targeted approach to improving outcomes. Methods We used data from the UK National Lung Cancer Audit in a multivariate logistic regression model to quantify the association of non-elective referral in non-small cell lung cancer patients with covariates including age, sex, stage, performance status, co-morbidity and socioeconomic status and used the Kaplan–Meier method and Cox proportional hazards model to quantify survival by source of referral. Results In an analysis of 133,530 cases of NSCLC who presented 2006–2011, 19% of patients were referred non-electively (following an emergency admission to hospital or following an emergency presentation to A&E). This route of referral was strongly associated with more advanced disease stage (e.g. in Stage IV – OR: 2.34, 95% CI: 2.14–2.57, p < 0.001) and worse performance status (e.g. in PS 4 – OR: 7.28, 95% CI: 6.75–7.86, p < 0.001), but was also independently associated with worse socioeconomic status, and extremes of age. These patients were more likely to have died within 1 year of diagnosis (hazard ratio of 1.51 (95% CI: 1.49–1.54) after adjustment for key clinical variables. Conclusion Our data confirm and quantify poorer survival in lung cancer patients who are referred non-electively to specialist care, which is more common in patients with poorer performance status, higher disease stage and less advantaged socioeconomic status. Work to tackle this late presentation should be urgently accelerated, since its realisation holds the promise of improved outcomes and better healthcare resource utilisation.
Jupiter’s inhomogeneous envelope Miguel, Y.; Bazot, M.; Guillot, T. ...
Astronomy and astrophysics (Berlin),
06/2022, Letnik:
662
Journal Article
Recenzirano
Odprti dostop
Context.
While Jupiter’s massive gas envelope consists mainly of hydrogen and helium, the key to understanding Jupiter’s formation and evolution lies in the distribution of the remaining (heavy) ...elements. Before the Juno mission, the lack of high-precision gravity harmonics precluded the use of statistical analyses in a robust determination of the heavy-element distribution in Jupiter’s envelope.
Aims.
In this paper, we assemble the most comprehensive and diverse collection of Jupiter interior models to date and use it to study the distribution of heavy elements in the planet’s envelope.
Methods.
We apply a Bayesian statistical approach to our interior model calculations, reproducing the Juno gravitational and atmospheric measurements and constraints from the deep zonal flows.
Results.
Our results show that the gravity constraints lead to a deep entropy of Jupiter corresponding to a 1 bar temperature that is 515 K higher than traditionally assumed. We also find that uncertainties in the equation of state are crucial when determining the amount of heavy elements in Jupiter’s interior. Our models put an upper limit to the inner compact core of Jupiter of 7
M
Earth
, independently of the structure model (with or without a dilute core) and the equation of state considered. Furthermore, we robustly demonstrate that Jupiter’s envelope is inhomogeneous, with a heavy-element enrichment in the interior relative to the outer envelope. This implies that heavy-element enrichment continued through the gas accretion phase, with important implications for the formation of giant planets in our Solar System and beyond.
Many patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place ...and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus at home.
We used the National Lung Cancer Audit linked to Hospital Episode Statistics and Office for National Statistics data to determine cause and place of death in those with lung cancer; both overall and by cancer Network. We used multivariate logistic regression to compare features of those who died in an acute hospital versus those who died at home.
Of 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route. There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively.
A substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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