Relationship of Circulating Soluble Urokinase Plasminogen Activator Receptor (suPAR) Levels to Disease Control in Asthma and Asthmatic Pregnancy

Asthma has a high burden of morbidity if not controlled and may frequently complicate pregnancy, posing a risk for pregnancy outcomes. Elevated plasma level of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is related to a worse prognosis in many conditions such as infectious, autoimmune, or pregnancy-related diseases; however the value of suPAR in asthma and asthmatic pregnancy is unknown. The present study aimed to investigate the suPAR, CRP and IL-6 levels in asthma (asthmatic non-pregnant, ANP; N = 38; female N = 27) and asthmatic pregnancy (AP; N = 15), compared to healthy non-pregnant controls (HNP; N = 29; female N = 19) and to healthy pregnant women (HP; N = 58). The relationship between suPAR levels and asthma control was also evaluated. The diagnostic efficacy of suPAR in asthma control was analyzed using ROC analysis. IL-6 and CRP levels were comparable in all study groups. Circulating suPAR levels were lower in HP and AP than in HNP and ANP subjects, respectively (2.01 [1.81-2.38] and 2.39 [2.07-2.69] vs. 2.60 [1.82-3.49] and 2.84 [2.33-3.72] ng/mL, respectively, p = 0.0001). suPAR and airway resistance correlated in ANP (r = 0.47, p = 0.004). ROC analysis of suPAR values in ANP patients with PEF above and below 80% yielded an AUC of 0.75 (95% CI: 0.57-0.92, p = 0.023) and with ACT total score above and below 20 an AUC of 0.80 (95% CI: 0.64-0.95, p = 0.006). The cut-off value of suPAR to discriminate between controlled and not controlled AP and ANP was 4.04 ng/mL. In conclusion, suPAR may help the objective assessment of asthma control, since it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease in circulating suPAR levels detected both in healthy and asthmatic pregnant women presumably represents pregnancy induced immune tolerance

The KELT Follow-Up Network And Transit False-Positive Catalog: Pre-Vetted False Positives For TESS

The Kilodegree Extremely Little Telescope (KELT) project has been conducting a photometric survey of transiting planets orbiting bright stars for over 10 years. The KELT images have a pixel scale of ~23\u27\u27 pixel⁻¹—very similar to that of NASA\u27s Transiting Exoplanet Survey Satellite (TESS)—as well as a large point-spread function, and the KELT reduction pipeline uses a weighted photometric aperture with radius 3\u27. At this angular scale, multiple stars are typically blended in the photometric apertures. In order to identify false positives and confirm transiting exoplanets, we have assembled a follow-up network (KELT-FUN) to conduct imaging with spatial resolution, cadence, and photometric precision higher than the KELT telescopes, as well as spectroscopic observations of the candidate host stars. The KELT-FUN team has followed-up over 1600 planet candidates since 2011, resulting in more than 20 planet discoveries. Excluding ~450 false alarms of non-astrophysical origin (i.e., instrumental noise or systematics), we present an all-sky catalog of the 1128 bright stars (6 \u3c V \u3c 13) that show transit-like features in the KELT light curves, but which were subsequently determined to be astrophysical false positives (FPs) after photometric and/or spectroscopic follow-up observations. The KELT-FUN team continues to pursue KELT and other planet candidates and will eventually follow up certain classes of TESS candidates. The KELT FP catalog will help minimize the duplication of follow-up observations by current and future transit surveys such as TESS

Gender Differences in the Combined Effects of Cardiovascular Disease and Osteoarthritis on Progression to Functional Impairment in Older Mexican Americans

Comorbidity (COM) is an important issue in aging. Cardiovascular disease (CVD) and osteoarthritis separately and together may modify the trajectories of functional decline. This analysis examines whether specific and unrelated COMs influence functional change differently and vary by gender

The DES bright arcs survey: hundreds of candidate strongly lensed galaxy systems from the Dark Energy Survey Science Verification and year 1 observations

We report the results of searches for strong gravitational lens systems in the Dark Energy Survey (DES) Science Verification and Year 1 observations. The Science Verification data span approximately 250 sq. deg. with a median i-band limiting magnitude for extended objects (10σ) of 23.0. The Year 1 data span approximately 2000 sq. deg. and have an i-band limiting magnitude for extended objects (10σ) of 22.9. As these data sets are both wide and deep, they are particularly useful for identifying strong gravitational lens candidates. Potential strong gravitational lens candidate systems were initially identified based on a color and magnitude selection in the DES object catalogs or because the system is at the location of a previously identified galaxy cluster. Cutout images of potential candidates were then visually scanned using an object viewer and numerically ranked according to whether or not we judged them to be likely strong gravitational lens systems. Having scanned nearly 400,000 cutouts, we present 374 candidate strong lens systems, of which 348 are identified for the first time. We provide the R.A. and decl., the magnitudes and photometric properties of the lens and source objects, and the distance (radius) of the source(s) from the lens center for each system

Young Stellar Object Candidates in IC 417

IC 417 is in the Galactic Plane, and likely part of the Aur OB2 association; it is ~2 kpc away. Stock 8 is one of the densest cluster constituents; off of it to the East, there is a 'Nebulous Stream' (NS) that is dramatic in the infrared (IR). We have assembled a list of literature-identified young stellar objects (YSOs), new candidate YSOs from the NS, and new candidate YSOs from IR excesses. We vetted this list via inspection of the images, spectral energy distributions (SEDs), and color-color/color-magnitude diagrams. We placed the 710 surviving YSOs and candidate YSOs in ranked bins, nearly two-thirds of which have more than 20 points defining their SEDs. The lowest-ranked bins include stars that are confused, or likely carbon stars. There are 503 in the higher-ranked bins; half are SED Class III, and $\sim$40\% are SED Class II. Our results agree with the literature in that we find that the NS and Stock 8 are at about the same distance as each other (and as the rest of the YSOs), and that the NS is the youngest region, with Stock 8 a little older. We do not find any evidence for an age spread within the NS, consistent with the idea that the star formation trigger came from the north. We do not find that the other literature-identified clusters here are as young as either the NS or Stock 8; at best they are older than Stock 8, and they may not all be legitimate clusters.Comment: Accepted by AAS Journal

Association between more intensive vs less intensive blood pressure lowering and risk of mortality in chronic kidney disease stages 3 to 5: A systematic review and meta-analysis.

Importance Trials in patients with hypertension have demonstrated that intensive blood pressure (BP) lowering reduces the risk of cardiovascular disease and all-cause mortality but may increase the risk of chronic kidney disease (CKD) incidence and progression. Whether intensive BP lowering is associated with a mortality benefit in patients with prevalent CKD remains unknown. Objectives To conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to investigate if more intensive compared with less intensive BP control is associated with reduced mortality risk in persons with CKD stages 3 to 5. Data Sources Ovid MEDLINE, Cochrane Library, EMBASE, PubMed, Science Citation Index, Google Scholar, and clinicaltrials.gov electronic databases. Study Selection All RCTs were included that compared 2 defined BP targets (either active BP treatment vs placebo or no treatment, or intensive vs less intensive BP control) and enrolled adults (≥18 years) with CKD stages 3 to 5 (estimated glomerular filtration rate <60 mL/min/1.73m2) exclusively or that included a CKD subgroup between January 1, 1950, and June 1, 2016. Data Extraction and Synthesis Two of us independently evaluated study quality and extracted characteristics and mortality events among persons with CKD within the intervention phase for each trial. When outcomes within the CKD group had not previously been published, trial investigators were contacted to request data within the CKD subset of their original trials. Main Outcome and Measure All-cause mortality during the active treatment phase of each trial. Results This study identified 30 RCTs that potentially met the inclusion criteria. The CKD subset mortality data were extracted in 18 trials, among which there were 1293 deaths in 15 924 participants with CKD. The mean (SD) baseline systolic BP (SBP) was 148 (16)mmHg in both the more intensive and less intensive arms. The mean SBP dropped by 16mmHg to 132mmHg in the more intensive arm and by 8mmHg to 140mmHg in the less intensive arm. More intensive vs less intensive BP control resulted in 14.0%lower risk of all-cause mortality (odds ratio, 0.86; 95%CI, 0.76-0.97; P = .01), a finding that was without significant heterogeneity and appeared consistent across multiple subgroups. Conclusions and Relevance Randomization to more intensive BP control is associated with lower mortality risk among trial participants with hypertension and CKD. Further studies are required to define absolute BP targets for maximal benefit and minimal harm

Åndelig omsorg. Hvilke aspekter ved muslimsk tro og praksis bør en sykepleier kjenne til for å kunne bidra til at døende muslimske pasienters åndelige behov blir ivaretatt?

Problemstilling: “Hvilke aspekter ved muslimsk tro og praksis bør en sykepleier kjenne til for å kunne bidra til at døende muslimske pasienters åndelige behov blir ivaretatt?” Metode: Litteraturstudie. Jeg har benyttet meg av relevante forskningsartikler, selvvalgt pensum og pensumlitteratur. Funn: Det ble funnet ti relevante artikler. De fleste artiklene handler om pasientens åndelige behov i møte med døden sett fra både pasientens og sykepleiers perspektiv, resten omhandler Islam, og muslimske ritualer. Drøfting: Drøftingen er basert på artiklene og annen relevant litteratur. Det blir drøftet pasientens behov for åndelig omsorg, og hva sykepleieren bør kjenne til i møte med den døende muslimske pasienten. Konklusjon: Det kommer frem at det er viktig at sykepleieren har kunnskap om den muslimske pasientens åndelige behov, og hvordan det kommer til uttrykk. Viktige aspekter å kjenne til er pasientens behov for bønn, rituell renhet, diett, og at familien har en viktig rolle for pasienten

The Epidemiology of Acute Organ System Dysfunction From Severe Sepsis Outside of the Intensive Care Unit

BACKGROUND: Severe sepsis is a common, costly, and complex problem, the epidemiology of which has only been well studied in the intensive care unit (ICU). However, nearly half of all patients with severe sepsis are cared for outside the ICU. OBJECTIVE: To determine rates of infection and organ sys- tem dysfunction in patients with severe sepsis admitted to non-ICU services. DESIGN: Retrospective cohort study. SETTING: A large, tertiary, academic medical center in the United States. PATIENTS: Adult patients initially admitted to non-ICU medical services from 2009 through 2010. MEASUREMENTS: All International Classification of Dis- eases, 9th Revision, Clinical Modification diagnosis codes were screened for severe sepsis. Three hospitalists reviewed a sample of medical records evaluating the char- acteristics of severe sepsis. The International Consensus Conference (ICC) for sepsis defines severe sepsis as an infection leading to acute organ dysfunction.1,2 Severe sepsis afflicts over 1 million patients each year in Medicare alone, and is substantially more common among older Americans than acute myocardial infarction.3–5 Recently, the Agency for Healthcare Research and Quality identified severe sepsis as the single most expensive cause of hospitalization in the United States.6 The incidence of severe sepsis continues to rise.4,5 Severe sepsis is often mischaracterized as a diagno- sis cared for primarily in the intensive care unit (ICU). Yet, studies indicate that only 32% to 50% of patients with severe sepsis require ICU care, leaving *Address for correspondence and reprint requests: Jeffrey M. Rohde, MD, Department of Internal Medicine, University of Michigan Medical School, 3119 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5376; Telephone: 734-647-1599; Fax: 734-233-9343; E-mail: [email protected] Additional Supporting Information may be found in the online version of this article. Received: July 15, 2012; Revised: December 16, 2012; Accepted: December 26, 2012 2013SocietyofHospitalMedicine DOI10.1002/jhm.2012 Published online in Wiley Online Library (Wileyonlinelibrary.com). RESULTS: Of 23,288 hospitalizations, 14% screened posi- tive for severe sepsis. A sample of 111 cases was manually reviewed, identifying 64 cases of severe sepsis. The mean age of patients with severe sepsis was 63 years, and 39% were immunosuppressed prior to presentation. The most common site of infection was the urinary tract (41%). The most common organ system dysfunctions were cardiovas- cular (hypotension) and renal dysfunction occurring in 66% and 64% of patients, respectively. An increase in the num- ber of organ systems affected was associated with an increase in mortality and eventual ICU utilization. Severe sepsis was documented by the treating clinicians in 47% of cases. CONCLUSIONS: Severe sepsis was commonly found and poorly documented on the wards at our medical center. The epidemiology and organ dysfunctions among patients with severe sepsis appear to be different from previously described ICU severe sepsis populations.This work was supported in part by the US National Insti- tutes of Health–K08, HL091249 (TJI) and the University of Michigan Specialist–Hospitalist Allied Research Program (SHARP). This work was also supported in part by VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102728/1/Rohde 13 JHM epi acute organ dysfxn sepsis outside ICU.pdf11

Patterns of variation in reproductive parameters in Eurasian lynx (Lynx lynx)

Detailed knowledge of the variation in demographic rates is central for our ability to understand the evolution of life history strategies and population dynamics, and to plan for the conservation of endangered species. We studied variation in reproductive output of 61 radio-collared Eurasian lynx females in four Scandinavian study sites spanning a total of 223 lynx-years. Specifically, we examined how the breeding proportion and litter size varied among study areas and age classes (2-year-old vs. >2-year-old females). In general, the breeding proportion varied between age classes and study sites, whereas we did not detect such variation in litter size. The lack of differences in litter sizes among age classes is at odds with most findings in large mammals, and we argue that this is because the level of prenatal investment is relatively low in felids compared to their substantial levels of postnatal care

Selected social and lifestyle correlates of brain health markers:the Cross‐Cohort Collaboration Consortium

INTRODUCTION:To investigate the associations of education level, marital status, and physical activity with dementia risk and brain MRI markers.METHODS:Data from six community-based samples from the Cross-Cohort Collaboration Consortium were analyzed. Self-reported education level, marital status, and physical activity at age 60 to 75 years were harmonized. Subsamples of participants with brain MRI markers at time of exposure were selected. Associations with dementia risk and cross-sectional MRI markers were meta-analyzed.RESULTS:Higher education level was associated with lower dementia risk (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.59; 0.72 vs low level) but not significantly with brain MRI markers. Compared with being unmarried, being married was only associated with higher total brain and hippocampal volumes. Being physically active was associated with lower dementia risk (HR = 0.73, 95% CI = 0.52; 1.04), as well as larger total brain volume and smaller white matter hyperintensity volume.DISCUSSION:This study provides further evidence regarding the contribution of education level and physical activity to dementia resilience.Highlights:Education level, marital status, and physical activity are thought to contribute to resilience against ADRD.We used random-effects meta-analysis to summarize results from six community-based samples from the CCC.In this cross-cohort meta-analysis, higher education level and being physically active were associated with lower risk of dementia.In cross-sectional analyses, being married was associated with larger TBV and HV, while being physically active was associated with larger TBV and lower WMHV