Impact of high-sensitivity cardiac troponin I assays on patients presenting to an emergency department with suspected acute coronary syndrome

 Objective: To determine whether introduction of high-sensitivity cardiac troponin I (hscTn-I) assays aff ected management of patients presenting with suspected acute coronary syndrome (ACS) to the emergency department (ED) of a tertiary referral hospital. Design, patients and setting: A retrospective analysis of all patients presenting to the Geelong Hospital ED with suspected ACS from 23 April 2010 to 22 April 2013 -2 years before and 1 year after the changeover to hscTn-I assays on 23 April 2012. Main outcome measures: Hospital admission rates, time spent in the ED, rates of coronary angiography, rates of percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABGS), rates of discharge with a diagnosis of ACS, and rates of inhospital mortality. Results: 12 360 consecutive patients presented with suspected ACS during the study period; 1897 were admitted to Geelong Hospital in the 2 years before and 944 in the 1 year after the changeover to hscTn-I assays. Comparing the two patient groups, there was no statistically signifi cant diff erence in allhospital admission rates (95% CI for the diff erence, - 3.1% to 0.3%; P = 0.10) or proportion of patients subsequently discharged with a diagnosis of ACS (95% CI for the diff erence, - 2.3% to 5.4%; P = 0.43). After the changeover, the median time patients spent in the ED was 11.5% shorter (3.85 h v 4.35 h; 95% CI for the diff erence, - 0.59 to - 0.43; P < 0.001) and the proportion of admitted patients undergoing coronary angiography was higher (53.4% v 45.2%; 95% CI for the diff erence, 4.3 to 12.0 percentage points; P < 0.001), but there was no statistically signifi cant rise in the proportion of patients who had invasive treatment (PCI and/or CABGS) (95% CI for the diff erence, - 0.4% to 6.3%; P = 0.08). Inhospital mortality rates from ACS did not change signifi cantly (95% CI for the diff erence, - 1.5% to 0.8%; P = 0.43). Conclusion: The introduction of hscTn-I assays appeared to be associated with more rapid diagnosis, resulting in less time spent in the ED, without a change in hospital admission rates. A higher proportion of patients had coronary angiographies after the changeover, but there was no signifi cant change in rates of invasive treatment or inhospital mortality.

Association of high-sensitivity C-reactive protein with de novo major depression

Background: Although there is cross-sectional evidence that changes in the immune system contribute to the pathophysiology of depression, longitudinal data capable of elucidating cause and effect relationships are lacking.

Aims: We aimed to determine whether subclinical systemic inflammation, as measured by serum high-sensitivity C-reactive protein (hsCRP) concentration, is associated with an increased risk of de novo major depressive disorder.

Method: Major depressive disorder was diagnosed using a clinical interview (SCID-I/NP). This is a retrospective cohort study; from a population-based sample of 1494 randomly selected women recruited at baseline during the period 1994-7, 822 were followed for a decade and provided measures of both exposure and outcome. Of these women, 644 (aged 20-84 years) had no prior history of depression at baseline and were eligible for analysis.

Results: During 5827 person-years of follow-up, 48 cases of de novo major depressive disorder were identified. The hazard ratio (HR) for depression increased by 44% for each standard deviation increase in log-transformed hsCRP (ln-hsCRP) (HR = 1.44, 95% CI 1.04-1.99), after adjusting for weight, smoking and use of non-steroidal anti-inflammatory drugs. Further adjustment for other lifestyle factors, medications and comorbidity failed to explain the observed increased risk for depression.

Conclusions: Serum hsCRP is an independent risk marker for de novo major depressive disorder in women. This supports an aetiological role for inflammatory activity in the pathophysiology of depression.

High-sensitivity acoustic sensors from nanofibre webs

Considerable interest has been devoted to converting mechanical energy into electricity using polymer nanofibres. In particular, piezoelectric nanofibres produced by electrospinning have shown remarkable mechanical energy-to-electricity conversion ability. However, there is little data for the acoustic-to-electric conversion of electrospun nanofibres. Here we show that electrospun piezoelectric nanofibre webs have a strong acoustic-to-electric conversion ability. Using poly(vinylidene fluoride) as a model polymer and a sensor device that transfers sound directly to the nanofibre layer, we show that the sensor devices can detect low-frequency sound with a sensitivity as high as 266 mV Pa(-1). They can precisely distinguish sound waves in low to middle frequency region. These features make them especially suitable for noise detection. Our nanofibre device has more than five times higher sensitivity than a commercial piezoelectric poly(vinylidene fluoride) film device. Electrospun piezoelectric nanofibres may be useful for developing high-performance acoustic sensors.

Autonomous capillary microfluidic system with embedded optics for improved troponin I cardiac biomarker detection

 Cardiovascular diseases are the most prevalent medical conditions affecting the modern world, reducing the quality of life for those affected and causing an ever increasing burden on clinical resources. Cardiac biomarkers are crucial in the diagnosis and management of patient outcomes. In that respect, such proteins are desirable to be measured at the point of care, overcoming the shortcomings of current instrumentation. We present a CO2 laser engraving technique for the rapid prototyping of a polymeric autonomous capillary system with embedded on-chip planar lenses and biosensing elements, the first step towards a fully miniaturised and integrated cardiac biosensing platform. The system has been applied to the detection of cardiac Troponin I, the gold standard biomarker for the diagnosis of acute myocardial infarction. The devised lab-on-a-chip device was demonstrated to have 24 pg/ml limit of detection, which is well within the minimum threshold for clinically applicable concentrations. Assays were completed within approximately 7–9 min. Initial results suggest that, given the portability, low power consumption and high sensitivity of the device, this technology could be developed further into point of care instrumentation useful in the diagnosis of various forms of cardiovascular diseases. 2014 Elsevier B.V. All rights reserved.

Graphene nanodots encaged 3-D gold substrate as enzyme loading platform for the fabrication of high performance biosensors

Herein, a uniform three-dimensional (3-D) graphene nanodots-encaged porous gold electrode was prepared via ion beam sputtering deposition (IBSD) and mild corrosion chemistry for efficient enzyme electrode fabrication. Enzymes, like glucose oxidase and catalase, were modified with pyrene functionalities and then loaded into the graphene nanodots encaged porous gold electrode via non-covalent π-π stacking interaction between pyrene and graphene. The fabricated enzyme electrodes showed profound reusability and repeatability, high sensitivity, inherent selectivity and enhanced detection range. As for glucose analysis a broad linear range from 0.05 to 100 mM was obtained and the linear range for hydrogen peroxide was 0.005 to 4 mM. Detection limits of 30 μM for glucose and 1 μM for hydrogen peroxide were achieved (S/N = 3), respectively. These electrodes can be applied to analyze the clinical samples with reliable results. The formation mechanism and 3-D structure of the porous electrode were investigated using high resolution transmission electron microscope (HRTEM), atomic force microscopy (AFM), scanning electron microscope (SEM) and electrochemical impedance spectroscopy (EIS). Most importantly, various other ideal biosensors can be fabricated using the same porous electrode and the same enzyme modification methodology.

Strain sensors with adjustable sensitivity by tailoring the microstructure of graphene aerogel/PDMS nanocomposites

Strain sensors with high elastic limit and high sensitivity are required to meet the rising demand for wearable electronics. Here, we present the fabrication of highly sensitive strain sensors based on nanocomposites consisting of graphene aerogel (GA) and polydimethylsiloxane (PDMS), with the primary focus being to tune the sensitivity of the sensors by tailoring the cellular microstructure through controlling the manufacturing processes. The resultant nanocomposite sensors exhibit a high sensitivity with a gauge factor of up to approximately 61.3. Of significant importance is that the sensitivity of the strain sensors can be readily altered by changing the concentration of the precursor (i.e., an aqueous dispersion of graphene oxide) and the freezing temperature used to process the GA. The results reveal that these two parameters control the cell size and cell-wall thickness of the resultant GA, which may be correlated to the observed variations in the sensitivities of the strain sensors. The higher is the concentration of graphene oxide, then the lower is the sensitivity of the resultant nanocomposite strain sensor. Upon increasing the freezing temperature from −196 to −20 °C, the sensitivity increases and reaches a maximum value of 61.3 at −50 °C and then decreases with a further increase in freezing temperature to −20 °C. Furthermore, the strain sensors offer excellent durability and stability, with their piezoresistivities remaining virtually unchanged even after 10 000 cycles of high-strain loading−unloading. These novel findings pave the way to custom design strain sensors with a desirable piezoresistive behavior.

Safeguard information infrastructure against DDoS attacks: experiments and modeling

Nowadays Distributed Denial of Service (DDoS) attacks have made one of the most serious threats to the information infrastructure. In this paper we firstly present a new filtering approach, Mark-Aided Distributed Filtering (MADF), which is to find the network anomalies by using a back-propagation neural network, deploy the defense system at distributed routers, identify and filtering the attack packets before they can reach the victim; and secondly propose an analytical model for the interactions between DDoS attack party and defense party, which allows us to have a deep insight of the interactions between the attack and defense parties. According to the experimental results, we find that MADF can detect and filter DDoS attack packets with high sensitivity and accuracy, thus provide high legitimate traffic throughput and low attack traffic throughput. Through the comparison between experiments and numerical results, we also demonstrate the validity of the analytical model that can precisely estimate the effectiveness of a DDoS defense system before it encounters different attacks.

Comparison of MLP and Bayesian approaches on mineral prospectivity mapping tasks

Mineral Prospectivity Mapping is the process of combining maps containing different geoscientific data sets to produce a single map depicting areas ranked according to their potential to host mineral deposits of a particular type. This paper outlines two approaches for deriving a function which can be used to assign to each cell in the study area a value representing the posterior probability that the cell contains a deposit of the sought-after mineral. One approach is based on estimating probability density functions (pdfs); the second uses multilayer perceptrons (MLPs). Results are provided from applying these approaches to geoscientific datasets covering a region in North Western Victoria, Australia. The results demonstrate that while both the Bayesian approach and the MLP approach yield similar results when the number of input dimensions is small, the Bayesian approach rapidly becomes unstable as the number of input dimensions increases, with the resulting maps displaying high sensitivity to the number of mixtures used to model the distributions. However, despite the fact that Bayesian assigned values cannot be interpreted as posterior probabilities in high dimensional input spaces, the pixel favorability rankings produced by the two methods is similar.

A comparison of four functional test in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.
Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.
Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.
Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.

Determination of lower-bound ductility for AZ31 magnesium alloy by use of the bulge specimens

Despite the high demand for industrial applications of magnesium, the forming technology for wrought magnesium alloys is not fully developed due to the limited ductility and high sensitivity to the processing parameters. The processing window for magnesium alloys could be significantly widened if the lower-bound ductility (LBD) for a range of stresses, temperature, and strain rates was known. LBD is the critical strain at the moment of fracture as a function of stress state and temperature. Measurements of LBD are normally performed by testing in a hyperbaric chamber, which is highly specialized, complex, and rare equipment. In this paper an alternative approach to determine LBD is demonstrated using wrought magnesium alloy AZ31 as an example. A series of compression tests of bulge specimens combined with finite element simulation of the tests were performed. The LBD diagram was then deduced by backward calculation.

Markers of inflammation in South Asian and European infants from birth to 2 years in Manchester, UK

Inflammatory markers, including serum C-reactive protein (CRP), are predictors of coronary heart disease (CHD) in adults. South Asians in the UK have higher rates of CHD in adulthood than national rates.We tested the hypotheses that South Asian infants would have higher serum concentrations of CRP and homocysteine than European infants up to 2 years of age and that higher infant weight is associated with elevation of inflammatory markers. Infants of South Asian and European origin were investigated in a mixed cross sectional-longitudinal cohort study. Mothers were recruited ante-natally from St Mary’s Hospital,Manchester by postal invitation and telephone call to non-responders. Infants with metabolic or congenital abnormalities, known syndromes or pre-maturity were excluded. Measurements were collected at birth and either 3, 6, 12 or 24 months. High sensitivity CRP and homocysteine were measured by an immulite immunoassay. We used mixed linear modelling to assess whether infant weight, ethnicity, length of follow-up or their interaction were associated with inflammatory makers in infants during follow-up. Data are presented on 306 infants (109 South Asian and 197 European). We found that European infants had higher serum CRP than South Asian infants during follow-up which was of borderline significance.There was no difference in serum homocysteine between ethnic groups during followup and no significant interaction between ethnicity and follow-up. Infant weight was significantly associated with CRP but not homocysteine. In this ongoing longitudinal study,we found little difference in inflammatory markers in infants from birth to 2 years despite markedly higher rates of CHD in South Asian than European adults. Life course exposure to risk factors may play a more dominant role in the development of CHD.