Department of Cardiac Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK
*Corresponding author. Tel.: +44 141 211 2807; fax: +44 141 211 1751. E-mail address : ...geoff.berg{at}northglasgow.scot.nhs.uk (G. Berg).
We compared the performances of the additive and logistic EuroSCORE in predicting mortality in high-risk cardiac surgical patients, at a single institution. Both models were applied to 6535 patients, operated on at the Western Infirmary, Glasgow from March 1994 to August 2004. Calibration and discrimination were assessed using the Hosmer-Lemeshow HL Chi-square test and areas under the ROC curve. Overall mortality was 2.95%. Predicted mortalities were 4.1% additive and 5.2% logistic. Actual mortality was 0.6% in the low risk (additive EuroSCORE 12), 2.1% in the medium risk (EuroSCORE 35) and 7% in the high-risk groups (EuroSCORE 6 plus). Actual mortality increased beyond a predicted risk of 810%. At the low risks both systems slightly over-estimated mortality, with the logistic EuroSCORE being more accurate. At EuroSCOREs between 1020, the additive EuroSCORE under-estimated risk, while the logistic EuroSCORE over-estimated mortality. Both systems were inaccurate at high risk. The HL statistics were 11.15 P <0.64 for the additive and 37.78 P <0.47 for the logistic models. ROC curve areas were 0.749±0.04 additive and 0.746±0.03 logistic. The additive EuroSCORE model remains a simple system for cardiac risk assessment. The logistic EuroSCORE was not more accurate even in high-risk patients.
Key Words: EuroSCORE; Validation; Quality control; Risk stratification; Mortality
Stroke is a devastating complication during coronary artery bypass grafting. Screening may identify patients at highest risk. Surgical timing, sequence strategies and carotid stenting remain ...unresolved. Selective use of techniques could prevent adverse neurological sequelae while achieving complete myocardial revascularization.
DNA sequencing continues to decrease in cost with the Illumina HiSeq2000 generating up to 600 Gb of paired-end 100 base reads in a ten-day run. Here we present a protocol for community amplicon ...sequencing on the HiSeq2000 and MiSeq Illumina platforms, and apply that protocol to sequence 24 microbial communities from host-associated and free-living environments. A critical question as more sequencing platforms become available is whether biological conclusions derived on one platform are consistent with what would be derived on a different platform. We show that the protocol developed for these instruments successfully recaptures known biological results, and additionally that biological conclusions are consistent across sequencing platforms (the HiSeq2000 versus the MiSeq) and across the sequenced regions of amplicons.
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•We harmonised nine macrophyte-based approaches for assessing lake ecological status.•We established relationships between the common view and nutrient concentrations.•Submerged ...vegetation decrease and free-floating plants increase along the status gradient.•We describe indicator taxa for ‘good’ and ‘less than good’ ecological status.•We establish a ‘guiding image’ of the macrophyte community at ‘good’ ecological status.
The European Water Framework Directive has been adopted by Member States to assess and manage the ecological integrity of surface waters. Specific challenges include harmonizing diverse assessment systems across Europe, linking ecological assessment to restoration measures and reaching a common view on ‘good’ ecological status.
In this study, nine national macrophyte-based approaches for assessing ecological status were compared and harmonized, using a large dataset of 539 European lakes. A macrophyte common metric, representing the average standardized view of each lake by all countries, was used to compare national methods. This was also shown to reflect the total phosphorus (r2 = 0.32), total nitrogen (r2 = 0.22) as well as chlorophyll-a (r2 = 0.35–0.38) gradients, providing a link between ecological data, stressors and management decisions. Despite differing assessment approaches and initial differences in classification, a consensus was reached on how type-specific macrophyte assemblages change across the ecological status gradient and where ecological status boundaries should lie.
A marked decline in submerged vegetation, especially Charophyta (characterizing ‘good’ status), and an increase in abundance of free-floating plants (characterizing ‘less than good’ status) were the most significant changes along the ecological status gradient. Macrophyte communities of ‘good’ status lakes were diverse with many charophytes and several Potamogeton species. A large number of taxa occurred across the entire gradient, but only a minority dominated at ‘less than good’ status, including filamentous algae, lemnids, nymphaeids, and several elodeids (e.g., Zannichellia palustris and Elodea nuttallii). Our findings establish a ‘guiding image’ of the macrophyte community at ‘good’ ecological status in hard-water lakes of the Central-Baltic region of Europe.
The Arctic region forms a unique environment with specific physical, chemical, and biological processes affecting mercury (Hg) cycles and limited anthropogenic Hg sources. However, historic global ...emissions and long range atmospheric transport has led to elevated Hg in Arctic wildlife and waterways. Continuous atmospheric Hg measurements, spanning 20 years, and increased monitoring sites has allowed a more comprehensive understanding of how Arctic atmospheric mercury is changing over time. Time-series trend analysis of TGM (Total Gaseous Mercury) in air was performed from 10 circumpolar air monitoring stations, comprising of high-Arctic, and sub-Arctic sites. GOM (gaseous oxidised mercury) and PHg (particulate bound mercury) measurements were also available at 2 high-Arctic sites. Seasonal mean TGM for sub-Arctic sites were lowest during fall ranging from 1.1 ng m−3 Hyytiälä to 1.3 ng m−3, Little Fox Lake. Mean TGM concentrations at high-Arctic sites showed the greatest variability, with highest daily means in spring ranging between 4.2 ng m−3 at Amderma and 2.4 ng m−3 at Zeppelin, largely driven by local chemistry. Annual TGM trend analysis was negative for 8 of the 10 sites. High-Arctic seasonal TGM trends saw smallest decline during summer. Fall trends ranged from −0.8% to −2.6% yr−1. Across the sub-Arctic sites spring showed the largest significant decreases, ranging between −7.7% to −0.36% yr−1, while fall generally had no significant trends. High-Arctic speciation of GOM and PHg at Alert and Zeppelin showed that the timing and composition of atmospheric mercury deposition events are shifting. Alert GOM trends are increasing throughout the year, while PHg trends decreased or not significant. Zeppelin saw the opposite, moving towards increasing PHg and decreasing GOM. Atmospheric mercury trends over the last 20 years indicate that Hg concentrations are decreasing across the Arctic, though not uniformly. This is potentially driven by environmental change, such as plant productivity and sea ice dynamics.
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•Annual mean TGM trends were negative for 8 of the 10 sites.•Sub-Arctic sites generally showed greatest TGM decreases.•High Arctic smallest overall TGM trend but increased from 1995–2018 to 2008–2018.•High-arctic Hg speciation suggests changes to the gas-particle separation affecting deposition.
•Manual contouring consistency increased relative to modern guidelines during trial.•Cardiac doses decreased over the study duration.•Mean whole heart dose is highly correlated with mean doses to ...cardiac substructures.•Predictive models: a useful tool for retrospective datasets.
Radiotherapy for breast cancer can increase the risks of heart disease. Patient-specific risk assessment may be improved with the inclusion of doses to cardiac substructures. The purpose of this work was to use automatic segmentation to evaluate substructure doses and develop predictive models for these based on the dose to the whole heart.
Automatic segmentation was used to delineate cardiac substructures in a Danish breast cancer trial (DBCG HYPO) dataset comprising over 1500 Danish women treated between 2009 and 2014. Trends in contouring practices and cardiac doses over time were investigated, and models to predict substructure doses from whole heart dose parameters were fit to the data.
Manual contouring consistency improved over the study period when compared with automatic segmentation; systematic differences between automatically and manually defined heart volume decreased from 106 cm3 to 12.0 cm3. Doses to the heart and cardiac substructures also decreased. Mean whole heart doses for left-sided treatments in 2009 and 2014 were 1.94±1.19 Gy and 1.29±0.69 Gy (average ± SD), respectively. Prediction of mean substructure doses is accurate, with R2 scores in the range 0.45–0.95 (average 0.77), depending on the particular structure.
This study reports heart and cardiac substructure doses in a large breast cancer cohort. Predictive models generated in this work can be used to estimate mean cardiac substructure doses for datasets where patient imaging and dose distributions are not available, provided the tangential field techniques are consistent with those used in the trial.
The implementation of the Water Framework Directive requires EU member states to establish and harmonize ecological status class boundaries for biological quality elements. In this paper, we describe ...an approach for defining ecological class boundaries that delineates shifts in lake ecosystem functioning and, therefore, provides ecologically meaningful targets for water policy in Europe. We collected an extensive data set of 810 lake‐years from nine Central European countries, and we used phytoplankton chlorophyll a, a metric widely used to measure the impact of eutrophication in lakes. Our approach establishes chlorophyll a target values in relation to three significant ecological effects of eutrophication: the decline of aquatic macrophytes, the dominance of potentially harmful cyanobacteria and the major functional switch from a clear water to a turbid state. Ranges of threshold chlorophyll a concentrations are given for the two most common lake types in lowland Central Europe: for moderately deep lakes (mean depth 3–15 m), the greatest ecological shifts occur in the range 10–12 μg L⁻¹ chlorophyll a, and for shallow lakes (<3 m mean depth), in the range 21–23 μg L⁻¹ chlorophyll a. Synthesis and applications. Our study provides class boundaries for determining the ecological status of lakes, which have robust ecological consequences for lake functioning and which, therefore, provide strong and objective targets for sustainable water management in Europe. The results have been endorsed by all participant member states and adopted in the European Commission legislation, marking the first attempt in international water policy to move from physico‐chemical quality standards to harmonized ecologically based quality targets.
The significance of donor cell differentiation status for successful cloning by somatic cell nuclear transfer (SCNT) is unclear. Here, we cloned a new species, red deer (Cervus elaphus), from ...multipotent antler stem cells and their differentiated progeny. Cultured donor cell lines from male antlerogenic periosteum (AP) were left undifferentiated or chemically induced to initiate osteogenesis or adipogenesis. Based on their morphology and marker gene expression profile, donor cells were classified as undifferentiated AP cells, presumptive osteoblasts, or adipocytes. Adipocytes upregulated adipogenic markers procollagen type I alpha 2 (COL1A2), peroxisome proliferator-activated receptor gamma 2 (PPARG), and gylceraldehyde-3-phosphate dehydrogenase (GAPDH), and downregulated antlerogenic transcripts POU-domain class 5 transcription factor (POU5F1) and parathyroid hormone (PTH)-like hormone (PTHLH). Despite differences prior to NT, transcript abundance of donor-specific markers COL1A2, PPARG, GAPDH, and POU5F1 did not differ significantly in cloned blastocysts (P = 0.10, 0.50, 0.61, and 0.16, respectively). However, donor cell and blastocyst expression levels were completely different for most genes analyzed, indicating their successful reprogramming. The type of donor cell used for NT (AP, bone, and fat cells), had no effect on in vitro development to blastocysts (93 38% of 248 vs. 32 44% of 73 vs. 59 32% of 183, respectively). Likewise, development to weaning was not significantly different between the three cell types (2 4% of 46 vs. 2 29% of 7 vs. 4 13% of 31, for AP vs. bone vs. fat, respectively). Microsatellite DNA analysis confirmed that the eight cloned red deer calves were genetically identical to the cells used for NT.
Globally 37.9 million people are living with HIV/AIDS, and with mortality rates declining, there is an increasing focus on comorbidities including musculoskeletal (MSK) disorders. Therefore, the aim ...of this scoping review was to generate and summarize an overview of the existing scientific literature dealing with MSK complaints in people living with HIV/AIDS (PLWHAs).
This scoping review followed the five-stage methodological framework proposed by Arksey and O'Malley. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to June 1, 2020. Two reviewers independently reviewed the articles for eligibility. A data extraction form was used to chart information such as author, year of publication, data source, sample size, country of origin, ethnicity, age, gender, antiretroviral therapy, MSK condition prevalence, and anatomical location.
The search identified 10 522 articles. Of these, 27 studies were included after full-text screening for data extraction. Studies were conducted in thirteen different countries with diverse data sources such as outpatient clinic files, hospital records, primary care clinic files, and AIDS Service Organization files. PLWHAs have a variety of MSK conditions. Most studies reported spinal pain such as lower back or neck pain, but pain in the extremities and osteoarthritis (OA) were also represented. However, the frequencies of pain at various anatomical sites were highly variable.
There is a lack of knowledge regarding MSK conditions in PLWHAs. Future studies designed to specifically study MSK complaints and disabilities are needed to gain a better picture of the impact of these conditions in PLWHAs and to inform prevention and treatment strategies globally in this often-underserved population.
•Over 90 lake ecological assessment methods are currently in use across Europe.•To ensure methods comparability, intercalibration was carried out by Member States.•62 lake assessment methods were ...intercalibrated and published in an EC Decision.•We present an overview of the lake assessment methods and their intercalibration.•Furthermore, the gaps of lake assessment in Europe and way forward are discussed.
The Water Framework Directive is the first international legislation to require European countries to establish comparable ecological assessment schemes for their freshwaters. A key element in harmonising quality classification within and between Europe's river basins is an “Intercalibration” exercise, stipulated by the WFD, to ensure that the good status boundaries in all of the biological assessment methods correspond to similar levels of anthropogenic pressure. In this article, we provide a comprehensive overview of this international comparison, focusing on the assessment schemes developed for freshwater lakes. Out of 82 lake ecological assessment methods reported for the comparison, 62 were successfully intercalibrated and included in the EC Decision on intercalibration, with a high proportion of phytoplankton (18), macrophyte (17) and benthic fauna (13) assessment methods. All the lake assessment methods are reviewed in this article, including the results of intercalibration. Furthermore, the current gaps and way forward to reach consistent management objectives for European lakes are discussed.
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