Safety and Feasibility of a Diagnostic Algorithm Combining Clinical Probability, d-Dimer Testing, and Ultrasonography for Suspected Upper Extremity Deep Venous Thrombosis: A Prospective Management Study.

BACKGROUND Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, d-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). OBJECTIVE To assess the safety and feasibility of a new diagnostic algorithm in patients with clinically suspected UEDVT. DESIGN Diagnostic management study. (ClinicalTrials.gov: NCT01324037) SETTING: 16 hospitals in Europe and the United States. PATIENTS 406 inpatients and outpatients with suspected UEDVT. MEASUREMENTS The algorithm consisted of the sequential application of a clinical decision score, d-dimer testing, and ultrasonography. Patients were first categorized as likely or unlikely to have UEDVT; in those with an unlikely score and normal d-dimer levels, UEDVT was excluded. All other patients had (repeated) compression ultrasonography. The primary outcome was the 3-month incidence of symptomatic UEDVT and pulmonary embolism in patients with a normal diagnostic work-up. RESULTS The algorithm was feasible and completed in 390 of the 406 patients (96%). In 87 patients (21%), an unlikely score combined with normal d-dimer levels excluded UEDVT. Superficial venous thrombosis and UEDVT were diagnosed in 54 (13%) and 103 (25%) patients, respectively. All 249 patients with a normal diagnostic work-up, including those with protocol violations (n = 16), were followed for 3 months. One patient developed UEDVT during follow-up, for an overall failure rate of 0.4% (95% CI, 0.0% to 2.2%). LIMITATIONS This study was not powered to show the safety of the substrategies. d-Dimer testing was done locally. CONCLUSION The combination of a clinical decision score, d-dimer testing, and ultrasonography can safely and effectively exclude UEDVT. If confirmed by other studies, this algorithm has potential as a standard approach to suspected UEDVT. PRIMARY FUNDING SOURCE None.

Measurement of inclusive jet charged-particle fragmentation functions in Pb+Pb collisions at √sNN = 2.76 TeV with the ATLAS detector

Measurements of charged-particle fragmentation functions of jets produced in ultra-relativistic nuclear collisions can provide insight into the modification of parton showers in the hot, dense medium created in the collisions. ATLAS has measured jets in √sNN=2.76 TeV Pb+Pb collisions at the LHC using a data set recorded in 2011 with an integrated luminosity of 0.14 nb−1. Jets were reconstructed using the anti-kt algorithm with distance parameter values R = 0.2, 0.3, and 0.4. Distributions of charged-particle transverse momentum and longitudinal momentum fraction are reported for seven bins in collision centrality for R=0.4 jets with pjetT>100 GeV. Commensurate minimum pT values are used for the other radii. Ratios of fragment distributions in each centrality bin to those measured in the most peripheral bin are presented. These ratios show a reduction of fragment yield in central collisions relative to peripheral collisions at intermediate z values, 0.04≲z≲0.2 and an enhancement in fragment yield for z≲0.04. A smaller, less significant enhancement is observed at large z and large pT in central collisions.

Impact of Acquired Pellicle Modification on Adhesion of Early Colonizers

New preventive approaches against dental erosion caused by acidic drinks and beverages include fortification of beverages with natural polymers. We have shown that the mixture of casein and mucin significantly improved the erosion-inhibiting properties of the human pellicle layer. This study aimed to investigate the effect of pellicle modification by casein, mucin and a casein-mucin mixture on the adhesion of early bacterial colonizers. Test specimens of human tooth enamel were prepared, covered with saliva and coated with 0.5% aqueous (aq.) casein, 0.27% aq. mucin or with 0.5% aq. casein-0.27% aq. mucin, after which the adhesion of Streptococcus gordonii, Streptococcus oralis, and Actinomyces odontolyticus was measured after incubation for 30 min and 2 h. log10 colony-forming units were compared by nonparametric tests. All three bacterial strains adhered in higher number to pellicle-coated enamel than to native enamel. The protein modifications of pellicle all decreased the counts of adhering bacteria up to 0.34 log10/mm2, the most efficient being the casein-mucin mixture. In addition to the recently shown erosion-reducing effect by casein-mucin, modification of the pellicle may inhibit bacterial adherence compared to untreated human pellicle.

EVALUATION OF THE EFFECTIVENESS OF ANISOTROPIC ANALYTICAL ALGORITHM IN FLATTENED AND FLATTENING-FILTER-FREE BEAMS FOR HIGH ENERGY LUNG DOSE DELIVERY USING THE RADIOLOGICAL PHYSICS CENTER LUNG PHANTOM

The effectiveness of the Anisotropic Analytical Algorithm (AAA) implemented in the Eclipse treatment planning system (TPS) was evaluated using theRadiologicalPhysicsCenteranthropomorphic lung phantom using both flattened and flattening-filter-free high energy beams. Radiation treatment plans were developed following the Radiation Therapy Oncology Group and theRadiologicalPhysicsCenterguidelines for lung treatment using Stereotactic Radiation Body Therapy. The tumor was covered such that at least 95% of Planning Target Volume (PTV) received 100% of the prescribed dose while ensuring that normal tissue constraints were followed as well. Calculated doses were exported from the Eclipse TPS and compared with the experimental data as measured using thermoluminescence detectors (TLD) and radiochromic films that were placed inside the phantom. The results demonstrate that the AAA superposition-convolution algorithm is able to calculate SBRT treatment plans with all clinically used photon beams in the range from 6 MV to 18 MV. The measured dose distribution showed a good agreement with the calculated distribution using clinically acceptable criteria of ±5% dose or 3mm distance to agreement. These results show that in a heterogeneous environment a 3D pencil beam superposition-convolution algorithms with Monte Carlo pre-calculated scatter kernels, such as AAA, are able to reliably calculate dose, accounting for increased lateral scattering due to the loss of electronic equilibrium in low density medium. The data for high energy plans (15 MV and 18 MV) showed very good tumor coverage in contrast to findings by other investigators for less sophisticated dose calculation algorithms, which demonstrated less than expected tumor doses and generally worse tumor coverage for high energy plans compared to 6MV plans. This demonstrates that the modern superposition-convolution AAA algorithm is a significant improvement over previous algorithms and is able to calculate doses accurately for SBRT treatment plans in the highly heterogeneous environment of the thorax for both lower (≤12 MV) and higher (greater than 12 MV) beam energies.

Pathway analysis of genome-wide association study data in primary biliary cirrhosisa

Genome-wide association studies (GWAS) have successfully identified several genetic loci associated with inherited predisposition to primary biliary cirrhosis (PBC), the most common autoimmune disease of the liver. Pathway-based tests constitute a novel paradigm for GWAS analysis. By evaluating genetic variation across a biological pathway (gene set), these tests have the potential to determine the collective impact of variants with subtle effects that are individually too weak to be detected in traditional single variant GWAS analysis. To identify biological pathways associated with the risk of development of PBC, GWAS of PBC from Italy (449 cases and 940 controls) and Canada (530 cases and 398 controls) were independently analyzed. The linear combination test (LCT), a recently developed pathway-level statistical method was used for this analysis. For additional validation, pathways that were replicated at the P <0.05 level of significance in both GWAS on LCT analysis were also tested for association with PBC in each dataset using two complementary GWAS pathway approaches. The complementary approaches included a modification of the gene set enrichment analysis algorithm (i-GSEA4GWAS) and Fisher's exact test for pathway enrichment ratios. Twenty-five pathways were associated with PBC risk on LCT analysis in the Italian dataset at P<0.05, of which eight had an FDR<0.25. The top pathway in the Italian dataset was the TNF/stress related signaling pathway (p=7.38×10 -4, FDR=0.18). Twenty-six pathways were associated with PBC at the P<0.05 level using the LCT in the Canadian dataset with the regulation and function of ChREBP in liver pathway (p=5.68×10-4, FDR=0.285) emerging as the most significant pathway. Two pathways, phosphatidylinositol signaling system (Italian: p=0.016, FDR=0.436; Canadian: p=0.034, FDR=0.693) and hedgehog signaling (Italian: p=0.044, FDR=0.636; Canadian: p=0.041, FDR=0.693), were replicated at LCT P<0.05 in both datasets. Statistically significant association of both pathways with PBC genetic susceptibility was confirmed in the Italian dataset on i-GSEA4GWAS. Results for the phosphatidylinositol signaling system were also significant in both datasets on applying Fisher's exact test for pathway enrichment ratios. This study identified a combination of known and novel pathway-level associations with PBC risk. If functionally validated, the findings may yield fresh insights into the etiology of this complex autoimmune disease with possible preventive and therapeutic application.^

Geochemistry and oxygen and iron isotope ratios of mafic rocks

Recycling of oceanic crust into the deep mantle via subduction is a widely accepted mechanism for creating compositional heterogeneity in the upper mantle and for explaining the distinct geochemistry of mantle plumes. The oxygen isotope ratios (d18O) of some ocean island basalts (OIB) span values both above and below that of unmetasomatised upper mantle (5.5 ± 0.4 per mil) and provide support for this hypothesis, as it is widely assumed that most variations in d18O are produced by near-surface low-temperature processes. Here we show a significant linear relationship between d18O and stable iron isotope ratios (d57Fe) in a suite of pristine eclogite xenoliths. The d18O values of both bulk samples and garnets range from values within error of normal mantle to significantly lighter values. The observed range and correlation between d18O and d57Fe is unlikely to be inherited from oceanic crust, as d57Fe values determined for samples of hydrothermally altered oceanic crust do not differ significantly from the mantle value and show no correlation with d18O. It is proposed that the correlated d57Fe and d18O variations in this particular eclogite suite are predominantly related to isotopic fractionation by disequilibrium partial melting although modification by melt percolation processes cannot be ruled out. Fractionation of Fe and O isotopes by removal of partial melt enriched in isotopically heavy Fe and O is supported by negative correlations between bulk sample d57Fe and Cr content and bulk sample and garnet d18O and Sc contents, as Cr and Sc are elements that become enriched in garnet- and pyroxene-bearing melt residues. Melt extraction could take place either during subduction, where the eclogites represent the residues of melted oceanic lithosphere, or could take place during long-term residence within the lithospheric mantle, in which case the protoliths of the eclogites could be of either crustal or mantle origin. This modification of both d57Fe and d18O by melting processes and specifically the production of low-d18O signatures in mafic rocks implies that some of the isotopically light d18O values observed in OIB and eclogite xenoliths may not necessarily reflect near-surface processes or components.

Sistematización de suelos : eficiencia en la ejecución del proyecto en suelos complejos

El manejo sustentable de los recursos naturales relacionados con proyectos de utilización de los recursos hídricos (entre otros), requiere en muchos casos de la modificación del relieve existente. Esto conlleva la necesidad de adecuación de la capa homogénea superior del suelo, operación que suele denominarse "sistematización", la cual facilita una distribución más uniforme de las lluvias y del agua de riego. Esta modificación de la capa superior del suelo es realizada en base a un proyecto, cuya inclinación responda a las pendientes naturales o a las establecidas por el diseñador. En la ejecución del diseño proyectado, en superficies superiores a una hectárea, el movimiento de tierra se realiza con equipos pesados, que no aseguran un alto porcentaje de eficiencia en lo que al movimiento de tierra se refiere, ya que parte del material se pierde en el acarreo, pero muy especialmente, por la compactación desuniforme del mismo, asociada con las texturas complejas del suelo a trabajar. El presente trabajo determinó el índice de precisión en la ejecución del proyecto de sistematización a partir de un índice estadístico internacionalmente aceptado, el "Root Mean Squared Error (RMSE)", comparando los valores altimétricos proyectados y los realmente obtenidos luego de la ejecución del proyecto, en tres parcelas con distinta secuencia de labores y maquinaria utilizadas, pero con el mismo tipo de suelo en el área del eje Pilar - La Plata (Argentina). Los resultados obtenidos, que varían de un RMSE de 4 a 6 cm, permiten concluir, para los sitios y las condiciones estudiadas, que no pueden asegurarse en la sistematización índices de precisión en la ejecución de la obra, inferiores a los 4 cm.

Evaluación integrada de la sostenibilidad ambiental, económica y social del cultivo de maíz en Chiapas, México

En este estudio se evaluó la sostenibilidad de los agroecosistemas tradicionales y alternativos de producción de maíz en tres Ejidos de la Región Selva de Chiapas, mediante la aplicación del enfoque agroecológico (MESMIS). El estudio se realizó en dos ciclos agrícolas: milpa y tornamil. En el primero se evaluaron los sistemas de roza-tumba-quema (R‑T‑Q), sin quema y en sucesión de nescafé (Mucuna deeringiana Bort.). En el segundo ciclo se analizaron tres sistemas sin quema con diferentes periodos de nescafé, y se modificó la densidad poblacional para analizar su efecto sobre la producción. Los valores de los indicadores económicos y sociales se obtuvieron a través de técnicas participativas. En la milpa se determinó el efecto positivo del fuego en el control de las arvenses y de la plaga Diatraea liniolata (Walker). Los sistemas alternativos con uso de abono verde presentaron mejores resultados en los aspectos agronómicos. Los sistemas con modificación de la densidad poblacional obtuvieron un mayor rendimiento de grano y una mayor rentabilidad financiera. En el análisis final integrado, los sistemas alternativos obtuvieron mejores resultados, aunque los sistemas de R‑T‑Q, por la adaptación al medio ambiente, obtuvieron resultados positivos en algunas variables. Por tanto, su uso en la región constituye una realidad etnocultural lejos de desaparecer en el futuro cercano.

Consideraciones en torno a la construcción de la frontera del río Salado del Norte en Santiago del Estero

En este artículo estudiamos la construcción de la frontera del río Salado del Norte en Santiago del Estero, un espacio pensado como un escenario multidimensional cuyo análisis requiere incorporar variables sociopolíticas, socioeconómicas, religiosas, étnicas y culturales. Para mediados de 1850, la introducción del capitalismo y los procesos de modernización reorientaron la importancia de los territorios fronterizos al asignar valor de mercado al principal recurso económico que la frontera tenía: las maderas de sus dilatados bosques. La modificación drástica del espacio ecológico tendrá como correlato, al final del proceso, la notable modificación de la composición social y de las relaciones sociales de producción.

Consideraciones en torno a la construcción de la frontera del río Salado del Norte en Santiago del Estero

En este artículo estudiamos la construcción de la frontera del río Salado del Norte en Santiago del Estero, un espacio pensado como un escenario multidimensional cuyo análisis requiere incorporar variables sociopolíticas, socioeconómicas, religiosas, étnicas y culturales. Para mediados de 1850, la introducción del capitalismo y los procesos de modernización reorientaron la importancia de los territorios fronterizos al asignar valor de mercado al principal recurso económico que la frontera tenía: las maderas de sus dilatados bosques. La modificación drástica del espacio ecológico tendrá como correlato, al final del proceso, la notable modificación de la composición social y de las relaciones sociales de producción.

Consideraciones en torno a la construcción de la frontera del río Salado del Norte en Santiago del Estero

En este artículo estudiamos la construcción de la frontera del río Salado del Norte en Santiago del Estero, un espacio pensado como un escenario multidimensional cuyo análisis requiere incorporar variables sociopolíticas, socioeconómicas, religiosas, étnicas y culturales. Para mediados de 1850, la introducción del capitalismo y los procesos de modernización reorientaron la importancia de los territorios fronterizos al asignar valor de mercado al principal recurso económico que la frontera tenía: las maderas de sus dilatados bosques. La modificación drástica del espacio ecológico tendrá como correlato, al final del proceso, la notable modificación de la composición social y de las relaciones sociales de producción.

Bulk geochemistry and grain-size composition of surface sediments from the SW Atlantic

Surface sediments from the South American continental margin surrounding tbe Argentine Basin were studied with respect to bulk geochemistry (Caeo) and C ) and grain-size composition (sand/silt/clay relation and terrigenous silt grain-size distribution). The grain-size distributions of the terrigenous silt fraction were unmixed into three end members (EMs), using an end-member modelling algorithm. Three unimodal EMs appear to satisfactorily explain the variations in the data set of the grain-size distributions ofterrigenous silt. The EMs are related to sediment supply by rivers, downslope transport, winnowing, dispersal and re-deposition by currents. The bulk geochemical composition was used to trace the distribution of prominent water masses within the vertical profile. The sediments of the eastern South American continental margin are generally divided into a coarse-grained and carbonate-depleted southwestern part, and a finer-grained and carbonate-rich northeastern part. The transition of both environments is located at the position of the Brazil Malvinas Confluence (BMC). The sediments below the confluence mixing zone of the Malvinas and Brazil Currents and its extensions are characterised by high concentrations of organic carbon, low carbonate contents and high proportions of the intennediate grain-size end member. Tracing these properties, the BMC emerges as a distinct north-south striking feature centered at 52-54°W crossing the continental margin diagonally. Adjacent to this prominent feature in the southwest, the direct detrital sediment discharge of the Rio de la Plata is clearly recognised by a downslope tongue of sand and high proportions of the coarsest EM. A similar coarse grain-size composition extends further south along the continental slope. However, it displays bener sorting due to intense winnowing by the vigorous Malvinas Current. Fine-grained sedimentary deposition zones are located at the southwestern deeper part of the Rio Grande Rise and the southern abyssal Brazil Basin, both within the AABW domain. Less conspicuous winnowing/accumulation panerns are indicated north of the La Plata within the NADW level according to the continental margin topography. We demonstrate that combined bulk geochemical and grain-size properties of surface sediments, unmixed with an end-member algorithm, provide a powerful tool to reconstruct the complex interplay of sedimentology and oceanography along a time slice.