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"Smith, Lane"
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Abe Lincoln's dream
When a schoolgirl gets separated from her tour of the White House and finds herself in the Lincoln bedroom, she also discovers the ghost of the great man himself.
Book
Prehospital use of a modified HEART Pathway and point-of-care troponin to predict cardiovascular events
The HEART Pathway is a validated risk stratification protocol for Emergency Department patients with chest pain that has yet to be tested in the prehospital setting. This study seeks to test the performance of a prehospital modified HEART Pathway (PMHP). A prospective cohort study of adults with chest pain without ST-segment elevation myocardial infarction was conducted at three EMS agencies between 12/2016-1/2018. To complete a PMHP assessment, paramedics drew blood, measured point-of-care (POC) troponin (i-STAT; Abbott Point of Care) and calculated a HEAR score. Patients were stratified into three groups: high-risk based on an elevated troponin, low-risk based on a HEAR score <4 with a negative troponin, or moderate risk for a HEAR score [greater than or equal to]4 with a negative troponin. Sensitivity, specificity, negative and positive predictive values of the PMHP for detection of major adverse cardiac events (MACE: cardiac death, MI, or coronary revascularization) at 30-days were calculated. A total of 506 patients were accrued, with PMHP completed in 78.1% (395/506). MACE at 30-days occurred in 18.7% (74/395). Among these patients, 7.1% (28/395) were high risk yielding a specificity and PPV for 30-day MACE of 96.6% (95%CI: 94.0-98.3%) and 60.7% (95%CI: 40.6-78.6%) respectively. Low-risk assessments occurred in 31.4% (124/395), which were 90.5% (95%CI: 81.5-96.1%) sensitive for 30-day MACE with a NPV of 94.4% (95%CI: 88.7-97.7%). Moderate-risk assessments occurred in 61.5% (243/395), of which 20.6% had 30-day MACE. The PMHP is able to identify high-risk and low-risk groups with high specificity and negative predictive value for 30-day MACE.
Journal Article
It's a book
A donkey with a laptop computer and a gorilla with a printed book discuss the merits of their preferred formats.
Book
Absolute Measurement of Thoron in Surface Waters
Thoron (radon-220, 220Rn, half-life 55.6 s) is a useful aqueous tracer suitable for applications such as locating and measuring groundwater discharge in surface waters (including the coastal ocean) and detecting radium-224 (224Ra) bearing scale inside water pipes. Generally, such applications require only relative thoron measurements in the water. However, if a thoron-in-water quantification in absolute numbers is desired the knowledge of the thoron sensitivity of the measurement system is obligatory. Absolute readings would, e.g., give a measure of the 224Ra activity in the sediment, supporting the thoron, or of the quantity of 224Ra in the pipe scale. Since there is no standardised source of thoron-in-water (such as a NIST standard), there is no way to calibrate a thoron-in-water measurement system, in the usual sense. Up until now, therefore, it has not been possible to make absolute measurements of thoron in water. This paper presents a novel method of assessing the sensitivity of a mobile thoron-in-water measurement system. The paper analyses such systems and describes a straightforward experimental approach to obtain all setup-specific values of critical parameters that will allow a reasonably precise determination of the system thoron sensitivity. The method is simple enough that a thoron sensitivity calibration can be performed on site with no additional equipment.
Journal Article
Grandpa Green
A child explores the ordinary life of his extraordinary great-grandfather, as expressed in his topiary garden.
Book
A Framework for the in Vivo Pathomechanics of Osteoarthritis at the Knee
The in vivo pathomechanics of osteoarthritis (OA) at the knee is described in a framework that is based on an analysis of studies describing assays of biomarkers, cartilage morphology, and human function (gait analysis). The framework is divided into an Initiation Phase and a Progression Phase. The Initiation Phase is associated with kinematic changes that shift load bearing to infrequently loaded regions of the cartilage that cannot accommodate the loads. The Progression Phase is defined following cartilage breakdown. During the Progression Phase, the disease progresses more rapidly with increased load. While this framework was developed from an analysis of in vivo pathomechanics, it also explains how the convergence of biological, morphological, and neuromuscular changes to the musculoskeletal system during aging or during menopause lead to the increased rate of idiopathic OA with aging. Understanding the in vivo response of articular cartilage to its physical environment requires an integrated view of the problem that considers functional, anatomical, and biological interactions. The integrated in vivo framework presented here will be helpful for the interpretation of laboratory experiments as well as for the development of new methods for the evaluation of OA at the knee.
Journal Article
There is a tribe of kids
Simple text follows a young boy and the many animals he meets on his adventure through the jungle.
Book
Managing Severe Hypoxic Respiratory Failure in COVID-19
Purpose of Review
Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic.
Recent Findings
Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation. Once intubated, a lung protective ventilation strategy should be employed that limits tidal volumes to 6 ml/kg of predicted body weight and employs sufficient positive end-expiratory pressure to maximize oxygen delivery while minimizing the fraction of inspired oxygen. Intermittent prone positioning is effective at improving survival, and there is a growing body of evidence that it can be safely performed in spontaneously breathing patients to reduce the need for invasive mechanical ventilation. Inhaled pulmonary vasodilators have not been shown to improve survival or cost-effectiveness in COVID-19 and should be used selectively.
Summary
Finally, the best outcomes are likely achieved at centers with experience at severe ARDS management and protocols for escalation of care.
Journal Article
إنه كتاب
يصور لين سميث ببراعة مخاوف محبي الكتب اليوم من القراءة الإلكترونية في كتاب يتوجه به للأطفال وهو يفعل ذلك بكثير من المرح، كتاب مضحك وممتع، عن قرد لا يعرف ما هو الكتاب ويستمر في مقارنته في شاشات الكمبيوتر، ولكن عندما يجرب القراءة تمضي به الساعات بلا ملل، كلمات قليلة ولغة بسيطة.
BOOK
Identification of very low-risk acute chest pain patients without troponin testing
BackgroundThe HEART Pathway combines a History ECG Age Risk factor (HEAR) score and serial troponins to risk stratify patients with acute chest pain. However, it is unclear whether patients with HEAR scores of <1 require troponin testing. The objective of this study is to measure the major adverse cardiac event (MACE) rate among patients with <1 HEAR scores and determine whether serial troponin testing is needed to achieve a miss rate <1%.MethodsA secondary analysis of the HEART Pathway Implementation Study was conducted. HEART Pathway risk assessments (HEAR scores and serial troponin testing at 0 and 3 hours) were completed by the providers on adult patients with chest pain from three US sites between November 2014 and January 2016. MACE (composite of death, myocardial infarction (MI) and coronary revascularisation) at 30 days was determined. The proportion of patients with HEAR scores of <1 diagnosed with MACE within 30 days was calculated. The impact of troponin testing on patients with HEAR scores of <1 was determined using Net Reclassification Improvement Index (NRI).ResultsProviders completed HEAR assessments on 4979 patients and HEAR scores<1 occurred in 9.0% (447/4979) of patients. Among these patients, MACE at 30 days occurred in 0.9% (4/447; 95% CI 0.2% to 2.3%) with two deaths, two MIs and 0 revascularisations. The sensitivity and negative predictive value for MACE in the HEAR <1 was 97.8% (95%CI 94.5% to 99.4%) and 99.1% (95% CI 97.7% to 99.8%), respectively, and were not improved by troponin testing. Troponin testing in patients with HEAR <1 correctly reclassified two patients diagnosed with MACE, and was elevated among seven patients without MACE yielding an NRI of 0.9% (95%CI −0.7 to 2.4%).ConclusionThese data suggest that patients with HEAR scores of 0 and 1 represent a very low-risk group that may not require troponin testing to achieve a missed MACE rate <1%. Trial registration number NCT02056964
Journal Article