Mortality post inpatient alcohol detoxification: a descriptive case series

<br>Background: Individuals with alcohol dependence often die prematurely. Scotland in particular has high rates of alcohol misuse compared to the rest of the UK and Europe. Although there is some evidence that rates of alcoholrelated harm and alcohol-related deaths are reducing in Europe, there is little evidence of this trend occurring in Scotland. Inpatient detoxification is an important, but expensive, option in the management of alcohol dependence. Little work has been done with regard possible clinical characteristics associated with mortality post discharge in this cohort of patients.</br> <br>Methods: Retrospective electronic records were used to identify patients admitted electively for alcohol detoxification into a psychiatric ward in a district general hospital under the care of a single consultant addiction psychiatrist between 1/1/05 and 31/12/07 inclusively. Demographic and clinical factors were recorded. 5-year mortality data was obtained by linkage to the National Records of Scotland.</br> <br>Results: 25.2% of patients admitted for elective alcohol detoxification died during the 5-year follow up period. 42.9% of deaths (n=12) were due to alcoholic liver disease, one death (3.6%) was of undetermined intent. A higher proportion of the deceased cohort was likely to have continued disulfiram (93% vs. 80%) and acamprosate (81% vs. 60%) than those surviving. There was no statistically significant difference in survival between individuals on medication and those not on medications in our cohort. The average consumption of units of alcohol per week in the deceased cohort was significantly higher than that calculated for the surviving cohort (298.8 units vs. 233.3 units p=0.0137).</br> <br>Conclusion: Inpatient detoxification was associated with significant mortality at 5-year follow up post- discharge. The majority of deaths were due to liver disease while deaths due to accidents and of undetermined intent were relatively infrequent. Increased education and practical strategies such as “space and pace” aimed both at an individual and societal level to reduce alcohol consumption may help to reduce mortality associated with alcohol dependence post inpatient detoxification.</br&gt

The RRAT Trap: Interferometric Localization of Radio Pulses from J0628+0909

We present the first blind interferometric detection and imaging of a millisecond radio transient with an observation of transient pulsar J0628+0909. We developed a special observing mode of the Karl G. Jansky Very Large Array (VLA) to produce correlated data products (i.e., visibilities and images) on a time scale of 10 ms. Correlated data effectively produce thousands of beams on the sky that can localize sources anywhere over a wide field of view. We used this new observing mode to find and image pulses from the rotating radio transient (RRAT) J0628+0909, improving its localization by two orders of magnitude. Since the location of the RRAT was only approximately known when first observed, we searched for transients using a wide-field detection algorithm based on the bispectrum, an interferometric closure quantity. Over 16 minutes of observing, this algorithm detected one transient offset roughly 1' from its nominal location; this allowed us to image the RRAT to localize it with an accuracy of 1.6". With a priori knowledge of the RRAT location, a traditional beamforming search of the same data found two, lower significance pulses. The refined RRAT position excludes all potential multiwavelength counterparts, limiting its optical luminosity to L_i'<1.1x10^31 erg/s and excluding its association with a young, luminous neutron star.Comment: Submitted to ApJ, 7 pages, 5 figure

Luminosity-Diameter Relations for Globular Clusters and Dwarf Spheroidal Galaxies

It is shown that globular clusters and the dwarf spheroidal companions of the Galaxy have a different distribution of flattening values, and appear to occupy adjacent regions of the M_v versus log R_h plane that can be separated by what will be referred to as the Shapley line. Surprisingly, typical dwarf spheroidal companions to the Milky Way System are fainter than the average Galactic globular cluster.Comment: includes two colour figures; MNRAS (Letters) in pres

Effect of rurality on screening for breast cancer: a systematic review and meta-analysis comparing mammography

Introduction: The lower breast cancer survival rate observed among rural women may be related to differences in screening access and utilization. We evaluated existing evidence for rural and urban differences in mammography service use in adult women

Mass Conservation and Positivity Preservation with Ensemble-type Kalman Filter Algorithms

Maintaining conservative physical laws numerically has long been recognized as being important in the development of numerical weather prediction (NWP) models. In the broader context of data assimilation, concerted efforts to maintain conservation laws numerically and to understand the significance of doing so have begun only recently. In order to enforce physically based conservation laws of total mass and positivity in the ensemble Kalman filter, we incorporate constraints to ensure that the filter ensemble members and the ensemble mean conserve mass and remain nonnegative through measurement updates. We show that the analysis steps of ensemble transform Kalman filter (ETKF) algorithm and ensemble Kalman filter algorithm (EnKF) can conserve the mass integral, but do not preserve positivity. Further, if localization is applied or if negative values are simply set to zero, then the total mass is not conserved either. In order to ensure mass conservation, a projection matrix that corrects for localization effects is constructed. In order to maintain both mass conservation and positivity preservation through the analysis step, we construct a data assimilation algorithms based on quadratic programming and ensemble Kalman filtering. Mass and positivity are both preserved by formulating the filter update as a set of quadratic programming problems that incorporate constraints. Some simple numerical experiments indicate that this approach can have a significant positive impact on the posterior ensemble distribution, giving results that are more physically plausible both for individual ensemble members and for the ensemble mean. The results show clear improvements in both analyses and forecasts, particularly in the presence of localized features. Behavior of the algorithm is also tested in presence of model error

Diffraction in the Semiclassical Approximation to Feynman's Path Integral Representation of the Green Function

We derive the semiclassical approximation to Feynman's path integral representation of the energy Green function of a massless particle in the shadow region of an ideal obstacle in a medium. The wavelength of the particle is assumed to be comparable to or smaller than any relevant length of the problem. Classical paths with extremal length partially creep along the obstacle and their fluctuations are subject to non-holonomic constraints. If the medium is a vacuum, the asymptotic contribution from a single classical path of overall length L to the energy Green function at energy E is that of a non-relativistic particle of mass E/c^2 moving in the two-dimensional space orthogonal to the classical path for a time \tau=L/c. Dirichlet boundary conditions at the surface of the obstacle constrain the motion of the particle to the exterior half-space and result in an effective time-dependent but spatially constant force that is inversely proportional to the radius of curvature of the classical path. We relate the diffractive, classically forbidden motion in the "creeping" case to the classically allowed motion in the "whispering gallery" case by analytic continuation in the curvature of the classical path. The non-holonomic constraint implies that the surface of the obstacle becomes a zero-dimensional caustic of the particle's motion. We solve this problem for extremal rays with piecewise constant curvature and provide uniform asymptotic expressions that are approximately valid in the penumbra as well as in the deep shadow of a sphere.Comment: 37 pages, 5 figure

Conservation of Mass and Preservation of Positivity with Ensemble-Type Kalman Filter Algorithms

This paper considers the incorporation of constraints to enforce physically based conservation laws in the ensemble Kalman filter. In particular, constraints are used to ensure that the ensemble members and the ensemble mean conserve mass and remain nonnegative through measurement updates. In certain situations filtering algorithms such as the ensemble Kalman filter (EnKF) and ensemble transform Kalman filter (ETKF) yield updated ensembles that conserve mass but are negative, even though the actual states must be nonnegative. In such situations if negative values are set to zero, or a log transform is introduced, the total mass will not be conserved. In this study, mass and positivity are both preserved by formulating the filter update as a set of quadratic programming problems that incorporate non-negativity constraints. Simple numerical experiments indicate that this approach can have a significant positive impact on the posterior ensemble distribution, giving results that are more physically plausible both for individual ensemble members and for the ensemble mean. In two examples, an update that includes a non-negativity constraint is able to properly describe the transport of a sharp feature (e.g., a triangle or cone). A number of implementation questions still need to be addressed, particularly the need to develop a computationally efficient quadratic programming update for large ensemble

IC 3418: Star Formation in a Turbulent Wake

Galaxy Evolution Explorer observations of IC 3418, a low surface brightness galaxy in the Virgo Cluster, revealed a striking 17 kpc UV tail of bright knots and diffuse emission. H alpha imaging confirms that star formation is ongoing in the tail. IC 3418 was likely recently ram pressure stripped on its first pass through Virgo. We suggest that star formation is occurring in molecular clouds that formed in IC 3418's turbulent stripped wake. Tides and ram pressure stripping (RPS) of molecular clouds are both disfavored as tail formation mechanisms. The tail is similar to the few other observed star-forming tails, all of which likely formed during RPS. The tails' morphologies reflect the forces present during their formation and can be used to test for dynamical coupling between molecular and diffuse gas, thereby probing the origin of the star forming molecular gas.Comment: 5 pages, 4 figure

Predicting VO2max in Collegiate American-Style Football Athletes

Introduction: Maximal oxygen uptake (VO2max) is an important measurement for athletic performance. A common method of VO2max prediction is the Foster equation (MSSE, 1996). This equation produces accurate predictions in a normal population, however, significant difference has been noted between predicted and measured VO2max values when testing athletes. While other studies have produced new equations for athletes in general or even for soccer players, to our knowledge none have made one specifically for American-style football players. Purpose: The aim of this study is to develop an accurate VO2max prediction equation for collegiate American-style football athletes for testing on the treadmill with the standard Bruce protocol. Methods: Over 13 years, a total of 413 collegiate American football players (age: 18.5±1.15 yrs, height: 186.8±7.0 cm, weight 102.1±20.8 kg) were assessed for VO2max (Medical Graphics, Corp® Metabolic Cart) using the standard Bruce treadmill protocol. Linear regression analysis (JMP v. 12) determined which factor out of height, weight, or time spent on the test had a greater impact on VO2max. The linear regression analysis of the most significant factor against VO2max produced a prediction equation. Predicted VO2max was calculated using these data in both the Foster equation and this novel equation. Predicted values were compared to actual measured values with a t-test. α=0.05 for all statistical tests. Results: Of all the factors, time had the strongest relationship (p\u3c0.0001; r2=0.6464). The linear regression between VO2max and time produced a prediction equation: VO2max= -3.546 + 3.904(time in minutes). Both the Foster equation and this new equation were significantly and positively correlated with the actual VO2max values (Foster=0.805, New r=0.804). However, t-tests indicate that the Foster equation results were significantly different from the measured values (p=0.0007), and the new model’s results were not significantly different (p=1.0). Conclusion: The Foster equation is not a reliable predictor of VO2max as assessed on a treadmill in collegiate American-style football athletes. This new equation is more accurate to predict VO2max in this population

Crystallographic snapshots of sulfur insertion by lipoyl synthase

Lipoyl synthase (LipA) catalyzes the insertion of two sulfur atoms at the unactivated C6 and C8 positions of a protein-bound octanoyl chain to produce the lipoyl cofactor. To activate its substrate for sulfur insertion, LipA uses a [4Fe-4S] cluster and S-adenosylmethionine (AdoMet) radical chemistry; the remainder of the reaction mechanism, especially the source of the sulfur, has been less clear. One controversial proposal involves the removal of sulfur from a second (auxiliary) [4Fe-4S] cluster on the enzyme, resulting in destruction of the cluster during each round of catalysis. Here, we present two high-resolution crystal structures of LipA from Mycobacterium tuberculosis: one in its resting state and one at an intermediate state during turnover. In the resting state, an auxiliary [4Fe-4S] cluster has an unusual serine ligation to one of the irons. After reaction with an octanoyllysine-containing 8-mer peptide substrate and 1 eq AdoMet, conditions that allow for the first sulfur insertion but not the second insertion, the serine ligand dissociates from the cluster, the iron ion is lost, and a sulfur atom that is still part of the cluster becomes covalently attached to C6 of the octanoyl substrate. This intermediate structure provides a clear picture of iron-sulfur cluster destruction in action, supporting the role of the auxiliary cluster as the sulfur source in the LipA reaction and describing a radical strategy for sulfur incorporation into completely unactivated substrates. Keywords: iron–sulfur cluster; radical SAM enzyme; lipoic acidNational Science Foundation (U.S.) (Grant MCB-0543833