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Objective: the aim of this study was to investigate the association of obesity with in-hospital coronavirus disease 2019 (COVID-19) outcomes in different ethnic groups.Methods: patients admitted to hospital with COVID-19 in the United Kingdom through the Clinical Characterisation Protocol UK (CCP-UK) developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) were included from February 6 to October 12, 2020. Ethnicity was classified as White, South Asian, Black, and other minority ethnic groups. Outcomes were admission to critical care, mechanical ventilation, and in-hospital mortality, adjusted for age, sex, and chronic diseases.Results: of the participants included, 54,254 (age = 76 years; 45.0% women) were White, 3,728 (57 years; 41.1% women) were South Asian, 2,523 (58 years; 44.9% women) were Black, and 5,427 (61 years; 40.8% women) were other ethnicities. Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black ethnicities with obesity were 3.91 (3.13-4.88), 5.03 (3.94-6.63), and 1.93 (1.49-2.51), respectively, compared with White ethnicities without obesity.Conclusions: obesity was associated with an elevated risk of in-hospital COVID-19 outcomes in all ethnic groups, with associations strongest in Black ethnicities.

OBJECTIVE. The purpose of this study is to assess the use of cross-sectional imaging to qualitatively and quantitatively categorize trochlear dysplasia as low grade (type A) or high grade (types B-D) according to the Dejour classification. MATERIALS AND METHODS. A retrospective review of CT and MRI knee examinations performed before patients underwent deepening trochleoplasty was independently conducted by two musculoskeletal radiologists. Each case of trochlear dysplasia was qualitatively assigned a Dejour type. Subsequently, quantitative measurements of the sulcus angle, distance from the tibial tubercle to the trochlear groove, trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and degree of patellar lateralization were performed. RESULTS. A total of 35 patients (29 female patients and six male patients; mean age, 21.1 years) with 39 affected knees (17 right knees and 22 left knees) were included. Readers had exact qualitative agreement using Dejour classification for 30 of 39 knees (77% [κ = 0.77; 95% CI, 0.62-0.91]) and agreement on classification of low-grade versus high-grade dysplasia for 36 of 39 knees (92%). For these 36 knees, the mean differences in measurements of low- versus high-grade dysplasia, respectively, were as follows: for sulcus angle, 153° versus 168° (p < 0.001); for trochlear depth, 4 versus 1 mm (p < 0.001); for lateral trochlear inclination, 12 versus 7 mm (p < 0.02); and for decreased trochlear facet asymmetry, 13% versus 92% (p < 0.001). Trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry were also different in comparisons of knees with Dejour type B and C trochlear dysplasia versus those with Dejour types B and D (all p < 0.05). No quantitative measurement differentiated between trochlear dysplasia of Dejour types C and D. The distance from the tibial tubercle to the trochlear groove and the degree of patellar lateralization were not statistically different between low- and high-grade dysplasia. CONCLUSION. Qualitative use of the Dejour classification accurately categorizes trochlear dysplasia as low grade or high grade in 92% of cases, with exact agreement reached in 77% of cases. Furthermore, the trochlear depth, lateral trochlear inclination, trochlear facet asymmetry, and sulcus angle can differentiate between low-grade and high-grade dysplasia, with trochlear depth, lateral trochlear inclination, and trochlear facet asymmetry useful for differentiating between Dejour types B and C and Dejour types B and D.

The hemlock woolly adelgid (HWA) (Hemiptera: Adelges tsugae Annand) is an invasive insect causing damage to Eastern ( Tsuga canadensis (L.) Carr.) and Carolina ( Tsuga caroliniana Engelm.) hemlock trees in the eastern United States. Maine and New Hampshire are currently the northernmost front of HWA's range. Developing methods to locate newly infested stands is paramount in the effort to monitor HWA range expansion; presently, the most reliable method of detection requires extensive on-the-ground manual surveying. Field surveys for invasive pests like HWA consume multiple resources, limiting the amount of area that can be surveyed, and the results often misrepresent the true extent or patchiness of an invasion. Satellite based remote sensing, using vegetation indices, enables us to detect insect driven changes in forest health at a landscape scale. Our objectives were to classify HWA infested hemlock stands along the infestation front and demonstrate how the classification product could be used to improve HWA survey planning. Our workflow consisted of 1) modeling hemlock habitat suitability using a Maximum Entropy algorithm; 2) developing decision tree rules to classify likely infested stands from a Landsat time series, using the habitat suitability model to mask out non-hemlock areas; and 3) field check the final classification product. The hemlock habitat suitability model attained an overall accuracy of 68.2%. Partitioning of leaf-on multi-year (1995–2013) Landsat 5 and 8 data resulted in seven probability of infestation classes with a training R 2 = 0.782. Agreement between the classification and previously reported HWA infestations was 75.0% in conifer forests, 33.3% in mixed forests and 50.0% in deciduous forests. Agreement between the classification and test-survey locations was 78.6%; verified new infestations were detected as far as 19 km away from previously reported infestations. The methods presented outline how Landsat could be used to detect low-level HWA infestations. Classification products such as this ultimately could be used by federal and state agencies to target specific areas for efficient survey, suppression, and eradication efforts.

We report a case of a 42-year-old woman who presented with a one-year history of a painless right orbital mass and right upper lid ptosis. Magnetic resonance imaging (MRI) revealed a superotemporal right orbital mass involving the lacrimal gland, and subsequent tissue biopsy and histopathologic evaluation was consistent with amyloidosis. An otherwise negative workup by hematology/oncology confirmed a diagnosis of primary isolated lacrimal gland amyloidosis. To the best of our knowledge, this is the first documented case of isolated lacrimal gland amyloidosis without immunoglobulin (Ig) light chain restriction on in situ hybridization testing with a report of MRI findings. In addition, this is the second reported case of the disease without Ig light chain restriction on immunohistochemistry staining, and it is the third case with reported MRI results.

We report the first case of congenital ocular neuromyotonia (ONM) and the results of strabismus surgery for this patient's co-existing cranial nerve (CN) III palsy.The patient presented at 18 months with strabismus that had reportedly been present since the time of birth. On exam, she had persistent exotropia (RXT) and hypertropia (RHT) with episodes of esotropia in the right eye that could be evoked by sustained left gaze. A diagnosis of ONM with partial CN III palsy was made. T1-weighted, T2-weighted, and fluid-attenuated inversion recovery magnetic resonance imaging failed to reveal intracranial pathology.Gaze induced intermittent esotropia resolved with carbamazepine. Surgery was performed to improve the patient's RXT and RHT. Post-operatively, the patient's RXT had improved from 12 to 15 prism diopters (∆) at near and 20∆ at a distance to 10∆ RXT at near with no horizontal deviation at distance. Her deviation has remained stable for 13 years, as has her neurological exam and good state of health.This case demonstrates that ONM may present congenitally and adds to the body of knowledge regarding surgical outcomes on concurrent CN palsies in these patients.

Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction studies and a worker biorepository. National and international standard-setting organizations use cancer risk estimates computed from epidemiological and historical dose reconstruction studies to validate or revise radiation protection standards. An overview of the most important research results will be presented.

Mast cells are evolutionarily ancient sentinel cells. Like basophils, mast cells express the high-affinity receptor for immunoglobulin E (IgE) and have been linked to host defense and diverse immune-system-mediated diseases. To better characterize the function of these cells, we assessed the transcriptional profiles of mast cells isolated from peripheral connective tissues and basophils isolated from spleen and blood. We found that mast cells were transcriptionally distinct, clustering independently from all other profiled cells, and that mast cells demonstrated considerably greater heterogeneity across tissues than previously appreciated. We observed minimal homology between mast cells and basophils, which shared more overlap with other circulating granulocytes than with mast cells. The derivation of mast-cell and basophil transcriptional signatures underscores their differential capacities to detect environmental signals and influence the inflammatory milieu.

The hemlock woolly adelgid (HWA) (Adelges tsugae Annand) is an invasive insect in the eastern United States. Since its initial detection in Richmond, Virginia, in 1951, HWA has spread to half of the eastern hemlock (Tsuga canadensis (L.) Carr.) natural range. Detection of early infestation symptoms via remote sensing requires the knowledge of the changes in reflectance resulting from physiological changes in the host as inflicted by the insect and the selection of equipment with the appropriate sensor characteristics. Laboratory-based reflectance measurements of infested and non-infested hemlock foliage collected from four sites in southern New Hampshire and Maine occurred biweekly over 6 months in 2012 and weekly over 5 weeks in 2013. Vegetation indices (red edge inflection point (REIP), normalized difference vegetation index (NDVI), moisture stress index (MSI), and near infrared (NIR) 3/1 ratio) were associated with concurrent chlorophyll and moisture content data. Infested first-year foliage contained greater concentrations of chlorophyll and moisture, resulting in reduced visible spectral reflectance, greater REIP and NDVI values, and lower MSI and NIR 3/1 values than non-infested foliage. Furthermore, fluorescence measurements indicated greater photosystem function during the early stages of infestation, suggesting a possible compensatory response by hemlock to infestation. Significant differences in reflectance between infested and non-infested foliage were observed in late June and July in the weeks immediately following HWA settlement on new growth. Implementing these observations during remote sensing mission planning may increase the likelihood of detecting early HWA infestation symptoms at landscape scales.

Background Symptoms secondary to dumping have been suggested to help patients refrain from simple carbohydrate ingestion after Roux-en-Y gastric bypass (RYGB). During follow-up examinations, we noted many patients with weight regain complaining of fatigue shortly after eating. Thus, we decided to study the glucose tolerance test (GTT) results in a cohort of post-RYGB patients. Methods A total of 63 RYGB patients, >6 months postoperatively, were studied with a GTT and measurement of insulin levels. The mean age was 48.5 ± 10.8 years, mean preoperative body mass index was 49.0 ± 6.5 kg/m 2 , mean percentage of excess body mass index lost was 64.5% ± 29.0%, mean weight regain at follow-up was 11.6 ± 12.4 lb, and mean follow-up period was 47.9 months. Results Of the 63 patients, 49 had abnormal GTT results. Of the 63 patients, 6 were diabetic; however, only 1 of these patients had an elevated fasting glucose level. All 6 patients were diabetic preoperatively. Of the 63 patients, 43 had evidence of reactive hypoglycemia at 1–2 hours after the glucose load. Of these patients, 22 had a maximum/minimum glucose ratio >3:1, including 7 with a ratio >4:1. Conclusion The results of the present study have demonstrated that an abnormal GTT result is a common finding after RYGB. Reactive hypoglycemia was found in 43 of 63 patients, with insulin values that do not support nesidioblastosis. It is our hypothesis, that rather than preventing simple carbohydrate ingestion, the induced hypoglycemia that occurs might contribute to weight regain and maladaptive eating in certain post-RYGB patients.

Current broadband sensors are not capable of separating the initial stages of forest damage. The current investigation evaluates the potential of hyperspectral data for detecting the initial stages of forest damage at the canopy level in the Norway spruce (Picea abies (L.) Karst) forests of Czech Republic. Hyperspectral canopy reflectance imagery and foliar samples were acquired contemporaneously for 23 study sites in August 1998. The sites were selected along an air pollution gradient to represent the full range of damage conditions in even-aged spruce forests. The changes in canopy and foliar reflectance, chemistry and pigments associated with forest damage were established. The potential of a large number of spectral indices to identify initial forest damage was determined. Canopy hyperspectral data were able to separate healthy from initially damaged canopies, and therefore provided an improved capability for assessment of forest physiology as compared to broadband systems. The 673-724 nm region exhibited maximum sensitivity to initial damage. The nine spectral indices having the highest potential as indicators of the initial damage included: three simple band ratios, two derivative indices, two modelled red-edge parameters and two normalized bands. The sensitivity of these indices to damage was explained primarily by their relationship to foliar structural chemical compounds, which differed significantly by damage class.

BACKGROUND: To obtain more reliable and precise estimates of the effect of direct thrombin inhibitors in the management of acute coronary syndromes, including patients undergoing percutaneous coronary intervention, we undertook a meta-analysis based on individual patients' data from randomised trials comparing a direct thrombin inhibitor (hirudin, bivalirudin, argatroban, efegatran, or inogatran) with heparin. METHODS: We included trials that involved at least 200 patients. The primary efficacy outcome was death or myocardial infarction, and the primary safety outcome was major bleeding. Data from individual trials were combined by use of a modified Mantel-Haenszel method. FINDINGS: In 11 randomised trials, 35,970 patients were assigned up to 7 days' treatment with a direct thrombin inhibitor or heparin and followed up for at least 30 days. Compared with heparin, direct thrombin inhibitors were associated with a lower risk of death or myocardial infarction at the end of treatment (4.3% vs 5.1%; odds ratio 0.85 [95% CI 0.77-0.94]; p=0.001) and at 30 days (7.4% vs 8.2%; 0.91 [0.84-0.99]; p=0.02). This was due primarily to a reduction in myocardial infarctions (2.8% vs 3.5%; 0.80 [0.71-0.90]; p

In PNAS, M. Boslough (1) raises issues about carbon spherules and nanodiamonds unrelated to our magnetic spherule focused research (2). Boslough should instead address the questions he raises to the appropriate investigators.

The GLOBE (Global Learning and Observations to Benefit the Environment) Program is a hands-on, international environmental science and education program that creates a partnership between students, their teachers, and the scientific research community. The students participating in GLOBE make measurements of selected atmospheric, hydrologic, and biologic parameters, following protocols developed by the research community, which, in turn, uses these student-collected data sets in their own research.

Insulin-like growth factors (IGFs), when isolated from serum or tissue fluids, are usually found as part of a protein complex which also contains one of several IGF binding proteins (IGFBPs). Although some IGFBPs have been shown to alter interactions of IGFs with their receptors in vitro and can modify the responses of cultured cells to exogenous IGFs, the in vivo functions of IGFBPs remain unclear. This study examines expression of a recently described IGFBP gene, IGFBP-5, in the rat embryo and fetus and in selected adult tissues. Embryonic IGFBP-5 messenger RNA (mRNA) can be detected as early as embryonic day 10.5 and has an mRNA expression pattern distinct from the previously characterized pattern of IGFBP-2 mRNA expression. Major sites of IGFBP-5 expression during early postimplantation stages of development include the notochord, the floor plate, regions of the surface ectoderm, muscle precursor cells, and specific axial regions of neuroepithelium. Later in development IGFBP-5 mRNA is found in several regions of the central nervous system, including the proliferative zone of the external granule layer of the cerebellum and the mitral neurons of the olfactory bulb, as well as in muscle precursor populations of the developing limb, and in most cells of the anterior pituitary. In addition, only a subset of pituicytes in the adult posterior pituitary express IGFBP-5, which provides the first evidence that this cell population is biochemically heterogeneous. Taken together, these data suggest functions for IGFBP-5 during development of several organ systems.

Subclavian catheterisation is frequently used for acute vascular access for haemodialysis and is thought to rarely result in long-term clinical problems. Venography in 36 cases, however, revealed subclavian stenosis in 18 (50%), of whom five developed clinical problems. The incidence of subclavian-vein stenosis was related to the duration of catheterisation (P less than 0.05). It may also be more common in black patients. Subclavian catheterisation is therefore not necessarily an ideal form of acute vascular access.

ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published

The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient's vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer's product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians. info:eu-repo/semantics/publishedVersion

Objective To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). Participants 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. Main outcome measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; Pv 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); Pv 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); Pv 8% (21/270); Pv (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P9 /L (32% (16/50) v 11% (38/348); P Conclusions Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). Study registration ISRCTN66726260.

ObjectiveTo develop and validate a pragmatic risk score to predict mortality in patients admitted to hospital with coronavirus disease 2019 (covid-19).DesignProspective observational cohort study.SettingInternational Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterisation Protocol UK (CCP-UK) study (performed by the ISARIC Coronavirus Clinical Characterisation Consortium—ISARIC-4C) in 260 hospitals across England, Scotland, and Wales. Model training was performed on a cohort of patients recruited between 6 February and 20 May 2020, with validation conducted on a second cohort of patients recruited after model development between 21 May and 29 June 2020.ParticipantsAdults (age ≥18 years) admitted to hospital with covid-19 at least four weeks before final data extraction.Main outcome measureIn-hospital mortality.Results35 463 patients were included in the derivation dataset (mortality rate 32.2%) and 22 361 in the validation dataset (mortality rate 30.1%). The final 4C Mortality Score included eight variables readily available at initial hospital assessment: age, sex, number of comorbidities, respiratory rate, peripheral oxygen saturation, level of consciousness, urea level, and C reactive protein (score range 0-21 points). The 4C Score showed high discrimination for mortality (derivation cohort: area under the receiver operating characteristic curve 0.79, 95% confidence interval 0.78 to 0.79; validation cohort: 0.77, 0.76 to 0.77) with excellent calibration (validation: calibration-in-the-large=0, slope=1.0). Patients with a score of at least 15 (n=4158, 19%) had a 62% mortality (positive predictive value 62%) compared with 1% mortality for those with a score of 3 or less (n=1650, 7%; negative predictive value 99%). Discriminatory performance was higher than 15 pre-existing risk stratification scores (area under the receiver operating characteristic curve range 0.61-0.76), with scores developed in other covid-19 cohorts often performing poorly (range 0.63-0.73).ConclusionsAn easy-to-use risk stratification score has been developed and validated based on commonly available parameters at hospital presentation. The 4C Mortality Score outperformed existing scores, showed utility to directly inform clinical decision making, and can be used to stratify patients admitted to hospital with covid-19 into different management groups. The score should be further validated to determine its applicability in other populations.Study registrationISRCTN66726260

Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille's law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille's law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille's law is questionable for prediction of cannula properties in clinical practice. Pressure-flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure-flow data with human whole blood in addition to manufacturers' water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended. info:eu-repo/semantics/publishedVersion