This study investigates the reasons for hospitalisation in patients with low-risk (CURB-65 score 0-1) community-acquired pneumonia (CAP), with a view to identifying the potential for improving ...outpatient management. As part of a prospective observational study of CAP, we evaluated reasons for hospitalisation in these low-risk patients. 565 patients had low-risk CAP and 420 of these were admitted (for >12 h). 39.3% had additional markers of severity justifying admission, 29.5% of the admissions were required for further management that could not be provided rapidly in the community, 11.9% had unsafe social circumstances and 19.3% had no clinical reason justifying hospitalisation. 30-day mortality was increased in patients with additional severity markers (6.7%), which was significantly higher compared with 0% for patients awaiting investigations (p=0.009) and 0% without a clear indication for hospitalisation (p=0.04). In a logistic regression analysis, parameters associated with 30-day mortality were chronic cardiac comorbidity (adjusted odds ratio (aOR) 5.73, 95% CI 1.52-21.6; p=0.01), acidosis (aOR 5.14, 95% CI 1.44-18.3; p=0.01), hypoxia (aOR 9.86, 95% CI 2.39-40.7; p=0.002) and multilobar chest radiograph shadowing (aOR 4.54, 95% CI 1.21-17.1; p=0.03). This study supports recommendations from international guidelines that pneumonia severity scores should be used as an adjunct to clinical judgement, when deciding on hospitalisation.
Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly ...arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored.
Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli ('Watch') or detaching themselves ('Distance'). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously.
FNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, η
=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, η
=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527-0.672, p values=0.006-0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541-0.919, η
=<0.001-0.015).
Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.
The study of nuclei farther from the valley of β-stability than ever before goes hand-in-hand with shorter-lived nuclei produced in smaller abundances than their less exotic counterparts. The ...measurement, to high precision, of nuclear masses therefore requires innovations in technique in order to keep up. TRIUMF’s Ion Trap for Atomic and Nuclear science (TITAN) facility deploys three ion traps, with a fourth in the commissioning phase, to perform and support Penning trap mass spectrometry and in-trap decay spectroscopy on some of the shortest-lived nuclei ever studied. We report on recent advances and updates to the TITAN facility since the 2012 EMIS conference.
TITAN’s charge breeding capabilities have been improved and in-trap decay spectroscopy can be performed in TITAN’s Electron Beam Ion Trap (EBIT). Higher charge states can improve the precision of mass measurements, reduce the beam-time requirements for a given measurement, improve beam purity, and open the door to access isotopes not available from the ISOL method via in-trap decay and recapture. This was recently demonstrated during TITAN’s mass measurement of 30Al. The EBIT’s decay spectroscopy setup was commissioned with a successful branching ratio and half-life measurement of 124Cs. Charge breeding in the EBIT increases the energy spread of the ion bunch sent to the Penning trap for mass measurement, so a new Cooler PEnning Trap (CPET), which aims to cool highly charged ions with an electron plasma, is undergoing offline commissioning. Already CPET has demonstrated the trapping and self-cooling of a room-temperature electron plasma that was stored for several minutes. A new detector has been installed inside the CPET magnetic field which will allow for in-magnet charged particle detection.
International guidelines recommend a severity-based approach to management in community-acquired pneumonia. CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended ...severity scores. The aim of this study was to compare the performance characteristics of these scores for predicting mortality in community-acquired pneumonia.
A systematic review and meta-analysis was conducted according to MOOSE (meta-analysis of observational studies in epidemiology) guidelines. PUBMED and EMBASE were searched (1980-2009). 40 studies reporting prognostic information for the PSI, CURB65 and CRB65 severity scores were identified. Performance characteristics were pooled using a random effects model. Relationships between sensitivity and specificity were plotted using summary receiver operator characteristic (sROC) curves.
All three scores predicted 30 day mortality. The PSI had the highest area under the sROC curve, 0.81 (SE 0.008), compared with CURB65, 0.80 (SE 0.008), p=0.1, and CRB65, 0.79 (0.01), p=0.09. These differences were not statistically significant. Performance characteristics were similar across comparable cut-offs for low, intermediate and high risk for each score. In identifying low risk patients, PSI (groups I and II) had the best negative likelihood ratio 0.08 (0.06-0.12) compared with CURB65 (score 0-1) 0.21 (0.15-0.30) and CRB65 (score 0), 0.15 (0.10-0.22).
There were no significant differences in overall test performance between PSI, CURB65 and CRB65 for predicting mortality from community-acquired pneumonia.
The changes due to pulsed plasma flow irradiation on the near-surface microstructure and mechanical properties of the high-chromium, ferritic–martensitic steel EK-181 (Fe16Cr12W2VTaB) have been ...quantified. Irradiation of EK-181 in this manner produces a microstructural gradient near the material surface, with a two dimensional nanostructured cellular surface. The microstructure and mechanical properties of the modified layer are independent of the initial microstructure and phase composition, and are strongly defined solely by parameters of the plasma flow. High thermal stability of the pulsed plasma-modified layer was explicitly demonstrated.
The Gaia mission Vallenari, A.; Bailer-Jones, C. A. L.; Milligan, D. J. ...
Astronomy and astrophysics (Berlin),
11/2016, Letnik:
595
Journal Article, Web Resource
Recenzirano
Odprti dostop
Gaia is a cornerstone mission in the science programme of the EuropeanSpace Agency (ESA). The spacecraft construction was approved in 2006, following a study in which the original interferometric ...concept was changed to a direct-imaging approach. Both the spacecraft and the payload were built by European industry. The involvement of the scientific community focusses on data processing for which the international Gaia Data Processing and Analysis Consortium (DPAC) was selected in 2007. Gaia was launched on 19 December 2013 and arrived at its operating point, the second Lagrange point of the Sun-Earth-Moon system, a few weeks later. The commissioning of the spacecraft and payload was completed on 19 July 2014. The nominal five-year mission started with four weeks of special, ecliptic-pole scanning and subsequently transferred into full-sky scanning mode. We recall the scientific goals of Gaia and give a description of the as-built spacecraft that is currently (mid-2016) being operated to achieve these goals. We pay special attention to the payload module, the performance of which is closely related to the scientific performance of the mission. We provide a summary of the commissioning activities and findings, followed by a description of the routine operational mode. We summarise scientific performance estimates on the basis of in-orbit operations. Several intermediate Gaia data releases are planned and the data can be retrieved from the Gaia Archive, which is available through the Gaia home page.
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