Abstract Background A 1-h algorithm based on high-sensitivity cardiac troponin T (hs-cTnT) testing at presentation and again 1 h thereafter has been shown to accurately rule out acute myocardial ...infarction. Objectives The goal of the study was to evaluate the diagnostic accuracy of the 1-h algorithm when supplemented with patient history and an electrocardiogram (ECG) (the extended algorithm) for predicting 30-day major adverse cardiac events (MACE) and to compare it with the algorithm using hs-cTnT alone (the troponin algorithm). Methods This prospective observational study enrolled consecutive patients presenting to the emergency department (ED) with chest pain, for whom hs-cTnT testing was ordered at presentation. Hs-cTnT results at 1 h and the ED physician’s assessments of patient history and ECG were collected. The primary outcome was an adjudicated diagnosis of 30-day MACE defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of a cardiac or unknown cause. Results In the final analysis, 1,038 patients were included. The extended algorithm identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm (97.5% vs. 87.6%; p < 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm versus 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs. 56.2%; p < 0.001) but a slightly lower specificity (94.0% vs. 96.4%; p < 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10. Conclusions A 1-h combination algorithm allowed fast rule-out and rule-in of 30-day MACE in a majority of ED patients with chest pain and performed better than the troponin-alone algorithm.
Atrial fibrillatory rate (AFR) is considered a non-invasive index of atrial remodelling. Low AFR has been associated with favourable outcome of interventions in patients with persistent atrial ...fibrillation (AF). However, AFR has never been studied in unselected patients with short duration of AF, prone to regain sinus rhythm (SR) spontaneously. The aim of the study was to assess if AFR can predict spontaneous conversion in patients with recent-onset AF.
Files of consecutive patients with AF < 48 h seeking emergency room care during a 12-month period were screened (n = 225). Patients with thyroid illness, acute ischaemic heart disease (IHD) or acute congestive heart failure, significant valvular heart disease, congenital heart disease, history of cardiac surgery or catheter ablation, or on class I/III antiarrhythmics were excluded. Atrial fibrillatory rate was obtained by QRST cancellation and time frequency analysis of electrocardiogram at admission. The study population comprised 148 patients (age 64 ± 13 years, 52 men), of whom 48 converted to SR within 18 h. Those converting spontaneously comprised more women, had a higher prevalence of first-ever AF episode, IHD, and a lower AFR. The multivariate analysis revealed: AFR < 350 fibrillations per minute odds ratio (OR) 3.7, 95% confidence interval (CI) 1.3-10.5, P = 0.016, IHD (OR 5.7, 95% CI 1.5-22.4, P = 0.012) and first-ever AF episode (OR 4.1, 95% CI 1.3-13.0, P = 0.015) as independent predictors of spontaneous conversion.
A low AFR was predictive of spontaneous conversion in patients with recent-onset AF. Along with first-ever AF episode and IHD, AFR can be used in assessing likelihood of spontaneous conversion, if proven in prospective studies.
Natural logics are formal logics characterized by expressions that bear a resemblance to simplified natural language sentences. The inherent readability of natural logics renders them suitable also ...for large knowledge bases. Within the realm of natural logics, the rules of logical proof are applicable directly to the sentences constructed using this framework. This direct application ensures explainability of query inferences. In the paper we describe a specific natural logic named
NaturaLog
, suited for ontology-structured knowledge bases. We outline how
NaturaLog
can be effectively implemented into a database system to facilitate deductive querying. The primary focus of this paper lies in exploring various query functionalities and elucidating methods to achieve these capabilities, also when dealing with large-scale knowledge bases.
The traditional square of opposition is generalized and extended to a cube of opposition covering and conveniently visualizing inter-sentential oppositions in relational syllogistic logic with the ...usual syllogistic logic sentences obtained as special cases. The cube comes about by considering Frege–Russell’s quantifier predicate logic with one relation comprising categorical syllogistic sentence forms. The relationships to Buridan’s octagon, to Aristotelian modal logic, and to Klein’s 4-group are discussed.
Graphic Abstract
The photo shows a prototype sculpture for the cube.
Scratching the skin, while instantly relieving itch, often aggravates itch over time due to skin injury. To relieve itch, without damaging the skin, a new technique termed cutaneous field stimulation ...(CFS) was developed and tested on 21 subjects. CFS uses a flexible plate with needle-like electrodes (n = 16) to electrically stimulate nerve fibres in the superficial skin. The electrodes were stimulated consecutively (4 Hz per electrode, pulse duration 1 ms, intensity 0.4-0.8 mA, 25 min). CFS resulted in a pricking and burning sensation that usually faded rather quickly. The burning sensation was still present during a selective block of impulse conduction in myelinated fibres indicating that nociceptive C-fibres are activated by CFS. Furthermore, a flare reaction developed around the CFS electrodes indicating activation of axon reflexes in nociceptive C-fibres. Itch, elicited by transdermal iontophoresis of histamine, was abolished within the skin area pre-treated with CFS, and was reduced to 14% of control 10 cm distally. Contralateral effects were small or non-existent. After 4 h, itch was reduced ipsilaterally to 32% of control. In comparison, 2 h after transcutaneous electrical nerve stimulation (TENS; 10-20 mA, 100 Hz, 25 min) ipsilateral itch was reduced to 56% of control. In conclusion, CFS offers a powerful new method for combating itch. It is suggested that CFS acts through endogenous central inhibitory mechanisms that are normally activated by scratching the skin.
Purpose
This paper aims to automate pre-ingest workflow for preserving digital content, such as records, through middleware that integrates potentially many information systems with potentially ...several alternative digital preservation services.
Design/methodology/approach
This design research approach resulted in a design for model- and component-based software for such workflow. A proof-of-concept prototype was implemented and demonstrated in context of a European research project, ForgetIT.
Findings
The study identifies design issues of automated pre-ingest for digital preservation while using middleware as a design choice for this purpose. The resulting model and solution suggest functionalities and interaction patterns based on open interface protocols between the source systems of digital content, middleware and digital preservation services. The resulting workflow automates the tasks of fetching digital objects from the source system with metadata extraction, preservation preparation and transfer to a selected preservation service. The proof-of-concept verified that the suggested model for pre-ingest workflow and the suggested component architecture was technologically implementable. Future research and development needs to include new solutions to support context-aware preservation management with increased support for configuring submission agreements as a basis for dynamic automation of pre-ingest and more automated error handling.
Originality/value
The paper addresses design issues for middleware as a design choice to support automated pre-ingest in digital preservation. The suggested middleware architecture supports many-to-many relationships between the source information systems and digital preservation services through open interface protocols, thus enabling dynamic digital preservation solutions for records management.
Interesterification of a blend of palm stearin and coconut oil (75∶25, w/w), catalyzed by an immobilized Thermomyces lanuginosa lipase by silica granulation, Lipozyme TL IM, was studied for ...production of margarine fats in a 1‐ or 300‐kg pilot‐scale batch‐stirred tank reactor. Parameters and reusability were investigated. The comparison was carried out between enzymatic and chemical interesterified products. Experimentally, Lipozyme TL IM had similar activity to Lipozyme IM for the interesterification of the blend. Within the range of 55–80°C, temperature had little influence on the degree of interesterification for 6‐h reaction, but it had slight impact on the content of free fatty acids (FFA). Drying of Lipozyme TL IM from water content 6 to 3% did not affect its activity, whereas it greatly reduced FFA and diacylglycerol contents in the products. Lipozyme TL IM was stable in the 1‐kg scale reactor at least for 11 batches and the 300‐kg pilot‐scale reactor at least for nine batches. Due to regiospecificity of the lipase (sn‐1,3 specific), enzymatically interesterified products had different fatty acid distribution at sn‐2 position from the chemically randomized products, implying the potential nutritional benefits of the new technology.
We have recently shown that stimulation, through a multi-electrode array, of thin nerve fibres close to the dermo-epidermal junction in the skin, produces powerful inhibition of itch and, to a lesser ...degree, cutaneous pain in humans. Here, we have studied the induction time and frequency dependency (range 1–10
Hz) of the inhibitory effects of such stimulation on itch, mechanical, and thermal pain, in 20 healthy subjects. Sixteen electrodes applied on the skin were consecutively stimulated using a method termed cutaneous field stimulation (CFS). The results show that different treatment periods with CFS were required for the induction of significant inhibitory effects on different nociceptive qualities: 1st heat pain (1
min), itch (3
min), 2nd heat pain (6
min), pinch evoked pain (8
min). Six to ten minutes stimulation sufficed to induce peak inhibitory effects on all these sensory qualities while longer stimulation (up to 40
min) did not cause significantly stronger inhibition. The effects on itch, 1st and 2nd heat pain lasted over 55
min after termination of CFS. There was no effect on prickle. No significant difference in inhibitory effects of different stimulation frequencies (1, 4 and 10
Hz/electrode) was found. The induction time and effective stimulation frequencies may suggest that the underlying mechanisms are similar to those of long term depression (LTD) previously described in the spinal cord in animal experiments.
BACKGROUND: Improved diagnostics in suspected acute coronary syndrome (ACS) are considered to be needed. To help clarify the current situation and the improvement potential, judged risk in the ...emergency department (ED) and outcome were analyzed among patients with suspected ACS at a university hospital. METHODS: 157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS). RESULTS: 4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit. CONCLUSIONS: Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large.
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