Relationship between aetiology and left ventricular systolic dysfunction in hypertrophic cardiomyopathy

Background: Hypertrophic cardiomyopathy (HCM) is a common cardiac disease caused by a range of genetic and acquired disorders. The most common cause is genetic variation in sarcomeric proteins genes. Current ESC guidelines suggest that particular clinical features (‘red flags’) assist in differential diagnosis. Aims: To test the hypothesis that left ventricular (LV) systolic dysfunction in the presence of increased wall thickness is an age-specific ‘red flag’ for aetiological diagnosis and to determine long-term outcomes in adult patients with various types of HCM. Methods: A cohort of 1697 adult patients with HCM followed at two European referral centres were studied. Aetiological diagnosis was based on clinical examination, cardiac imaging and targeted genetic and biochemical testing. Main outcomes were: all-cause mortality or heart transplantation (HTx) and heart failure (HF) related-death. All-cause mortality included sudden cardiac death or equivalents, HF and stroke-related death and non-cardiovascular death. Results: Prevalence of different aetiologies was as follows: sarcomeric HCM 1288 (76%); AL amyloidosis 115 (7%), hereditary TTR amyloidosis 86 (5%), Anderson-Fabry disease 85 (5%), wild-type TTR amyloidosis 48 (3%), Noonan syndrome 15 (0.9%), mitochondrial disease 23 (1%), Friedreich’s ataxia 11 (0.6%), glycogen storage disease 16 (0.9%), LEOPARD syndrome 7 (0.4%), FHL1 2 (0.1%) and CPT II deficiency 1 (0.1%). Systolic dysfunction at first evaluation was significantly more frequent in phenocopies than sarcomeric HCM [105/409 (26%) versus 40/1288 (3%), (p<0.0001)]. All-cause mortality/HTx and HF-related death were higher in phenocopies compared to sarcomeric HCM (p<0.001, respectively). When considering specific aetiologies, all-cause mortality and HF-related death were higher in cardiac amyloidosis (p<0.001, respectively). Conclusion: Systolic dysfunction at first evaluation is more common in phenocopies compared to sarcomeric HCM representing an age-specific ‘red flag’ for differential diagnosis. Long-term prognosis was more severe in phenocopies compared to sarcomeric HCM and when comparing specific aetiologies, cardiac amyloidosis showed the worse outcomes.

Under the Crimson Flag: Fahle Burman's Two Trips to the Michigan Supreme Court

Erick Fahle Burman. a Swedish-born, Finnish-speaking labor and political activist, twice had cases argued on his behalf before the Michigan Supreme Court. In People vs. Burman, Burman, along with nine other defendants, had his conviction affirmed by the court and all ten were forced to pay a fine of $25 each for disturbing the peace. In People vs. Immonen, Burman and his co-defendant, Unto Immonen, had their convictions overturned because of improper evidence being admitted in their lower court trial. Though the conviction was overturned, the two men had already spent several months as prisoners at hard labor in Marquette State Prison located in Michigan's Upper Peninsula. Over twenty-five years separate Burman's two trips to Michigan's high court. On the first occasion, his arrest came less than five years after his arrival as an immigrant to the U. S. On the second occasion, his arrest came less than two years after his return to the state after being away for nearly two decades. On both occasions, Burman was arrested for his involvement with red flags. Though separated by decades, these cases, taken together, are important indicators of the state of Finnish-American radicalism in the years surrounding the red flag incidents and provide interesting insights into the delicacies of political suppression. Examination of these cases within the larger career of Fahle Burman points up his overlooked importance in the history of Finnish-American socialism and communism.

A case of EDTA-dependent pseudothrombocytopenia: simple recognition of an underdiagnosed and misleading phenomenon

1. BMC Clin Pathol. 2014 May 1;14:19. doi: 10.1186/1472-6890-14-19. eCollection 2014. A case of EDTA-dependent pseudothrombocytopenia: simple recognition of an underdiagnosed and misleading phenomenon. Nagler M, Keller P, Siegrist D, Alberio L. Author information: Department of Hematology and Central Hematology Laboratory, Inselspital University Hospital and University of Berne, CH-3010 Berne, Switzerland. BACKGROUND: EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is a common laboratory phenomenon with a prevalence ranging from 0.1-2% in hospitalized patients to 15-17% in outpatients evaluated for isolated thrombocytopenia. Despite its harmlessness, EDTA-PTCP frequently leads to time-consuming, costly and even invasive diagnostic investigations. EDTA-PTCP is often overlooked because blood smears are not evaluated visually in routine practice and histograms as well as warning flags of hematology analyzers are not interpreted correctly. Nonetheless, EDTA-PTCP may be diagnosed easily even by general practitioners without any experiences in blood film examinations. This is the first report illustrating the typical patterns of a platelet (PLT) and white blood cell (WBC) histograms of hematology analyzers. CASE PRESENTATION: A 37-year-old female patient of Caucasian origin was referred with suspected acute leukemia and the crew of the emergency unit arranged extensive investigations for work-up. However, examination of EDTA blood sample revealed atypical lymphocytes and an isolated thrombocytopenia together with typical patterns of WBC and PLT histograms: a serrated curve of the platelet histogram and a peculiar peak on the left side of the WBC histogram. EDTA-PTCP was confirmed by a normal platelet count when examining citrated blood. CONCLUSION: Awareness of typical PLT and WBC patterns may alert to the presence of EDTA-PTCP in routine laboratory practice helping to avoid unnecessary investigations and over-treatment. PMCID: PMC4012027 PMID: 24808761 [PubMed]

Driving ability, mental illness and psychotropic medication in the elderly

Fitness to drive in elderly drivers is most commonly discussed with a focus on cognitive impairment. Therefore, this article is focussing on mental illness and the use of psychotropic drugs in elderly drivers, which can both interfere with fitness to drive. Based on a detailed literature review and on clinical judgement, we propose signposts and "red flags" to judge the individual risks. Health professionals dealing with elderly patients should in particular be aware of the dangers related to cumulative risks and need to inform the patients appropriately. For medico-legal reasons the information provided to patients must be written down in the medical record. Individual counselling is important as fitness to drive is a complex topic.

Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic

BACKGROUND AND OBJECTIVES Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain. METHODS The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy. RESULTS Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1-C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography. CONCLUSIONS Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.

Radiance, irradiance, and remote sensing reflectance during the North Sea Coast Harmful Algal Bloom (NORCOHAB II) HEINCKE cruise HE302

In this study four data quality flags are presented for automated and unmanned above-water hyperspectral optical measurements collected underway in the North Sea, The Minch, Irish Sea and Celtic Sea in April/May 2009. Coincident to these optical measurements a DualDome D12 (Mobotix, Germany) camera system was used to capture sea surface and sky images. The first three flags are based on meteorological conditions, to select erroneous incoming solar irradiance (ES) taken during dusk, dawn, before significant incoming solar radiation could be detected or under rainfall. Furthermore, the relative azimuthal angle of the optical sensors to the sun is used to identify possible sunglint free sea surface zones. A total of 629 spectra remained after applying the meteorological masks (first three flags). Based on this dataset, a fourth flag for sunglint was generated by analysing and evaluating water leaving radiance (LW) and remote sensing reflectance (RRS) spectral behaviour in the presence and absence of sunglint salient in the simultaneously available sea surface images. Spectra conditions satisfying "mean LW (700-950 nm) < 2 mW/m**2/nm/Sr" or alternatively "minimum RRS (700-950 nm) < 0.010/Sr", mask the most measurements affected by sunglint, providing efficient flagging of sunglint in automated quality control. It is confirmed that valid optical measurements can be performed 0° <= theta <= 360° although 90° <= theta <= 135° is recommended.

El neoperonismo en Mendoza (1961-1966) : notas sobre su origen y apogeo

El Neoperonismo o peronismo sin Perón fue uno de los resultantes de la política proscriptiva ideada por los vencedores de la llamada Revolución Libertadora. Representó el intento de algunos dirigentes peronistas locales de evitar la dispersión de los votos peronistas y, al mismo tiempo, apoderarse de una cuota del poder vacante debido al exilio del jefe del Movimiento Gral. Juan Domingo Perón. El neoperonismo tuvo gran auge en las provincias del interior, y Mendoza fue uno de los principales centros donde se gestó y alcanzó un inusitado desarrollo, a través de los partidos Tres Banderas y posteriormente del Movimiento Popular Mendocino. De allí que el propósito de este trabajo es dilucidar las razones por las cuales el neoperonismo surgió y alcanzó tanto éxito en nuestra provincia, así como también el entramado político que hizo posible su estrepitosa caída.

Multi-year high-frequency current and water quality in-situ observations at the Guadiana Estuary

High-frequency data collected continuously over a multiyear time frame are required for investigating the various agents that drive ecological and hydrodynamic processes in estuaries. Here, we present water quality and current in-situ observations from a fixed monitoring station operating from 2008 to 2014 in the lower Guadiana Estuary, southern Portugal (37°11.30' N, 7°24.67' W). The data were recorded by a multi-parametric probe providing hourly records (temperature, salinity, chlorophyll, dissolved oxygen, turbidity, and pH) at a water depth of ~1 m, and by a bottom-mounted acoustic Doppler current profiler measuring the pressure, near-bottom temperature, and flow velocity through the water column every 15 min. The time-series data, in particular the probe ones, present substantial gaps arising from equipment failure and maintenance, which are ineluctable with this type of observations in harsh environments. However, prolonged (months-long) periods of multi-parametric observations during contrasted external forcing conditions are available. The raw data are reported together with flags indicating the quality status of each record. River discharge data from two hydrographic stations located near the estuary head are also provided to support data analysis and interpretation.

Reflectances transect from coast to open sea, Baltic Sea

In this study, retrievals of the medium resolution imaging spectrometer (MERIS) reflectances and water quality products using 4 different coastal processing algorithms freely available are assessed by comparison against sea-truthing data. The study is based on a pair-wise comparison using processor-dependent quality flags for the retrieval of valid common macro-pixels. This assessment is required in order to ensure the reliability of monitoring systems based on MERIS data, such as the Swedish coastal and lake monitoring system (http.vattenkvalitet.se). The results show that the pre-processing with the Improved Contrast between Ocean and Land (ICOL) processor, correcting for adjacency effects, improve the retrieval of spectral reflectance for all processors, Therefore, it is recommended that the ICOL processor should be applied when Baltic coastal waters are investigated. Chlorophyll was retrieved best using the FUB (Free University of Berlin) processing algorithm, although overestimations in the range 18-26.5%, dependent on the compared pairs, were obtained. At low chlorophyll concentrations (< 2.5 mg/m**3), random errors dominated in the retrievals with the MEGS (MERIS ground segment processor) processor. The lowest bias and random errors were obtained with MEGS for suspended particulate matter, for which overestimations in te range of 8-16% were found. Only the FUB retrieved CDOM (Coloured Dissolved Organic Matter) correlate with in situ values. However, a large systematic underestimation appears in the estimates that nevertheless may be corrected for by using a~local correction factor. The MEGS has the potential to be used as an operational processing algorithm for the Himmerfjärden bay and adjacent areas, but it requires further improvement of the atmospheric correction for the blue bands and better definition at relatively low chlorophyll concentrations in presence of high CDOM attenuation.

La calle rojinegra. Anarcosindicalismo, rituales de movilización y símbolos en el espacio público (1931-1936)

Este artículo se centra en el análisis de la tipología, características y evolución de algunos de los diversos rituales de movilización y símbolos desplegados en el espacio público por las distintas organizaciones y núcleos de militantes de signo confederal y anarquista en España durante los años de la Segunda República, antes del estallido de la sublevación militar de julio de 1936. Entre ellos: huelgas, insurrecciones revolucionarias, mítines, manifestaciones, excursiones, entierros de militantes, etc. El propósito de estas acciones era claro: tanto la cohesión y reafirmación identitaria internas, como la proyección externa del movimiento. Con estas estrategias de acción colectiva, que suponían una “salida” al espacio público, se trataba de hacer visible allí la fuerza del movimiento y reafirmar la presencia física de este, sus reivindicaciones y aspiraciones. Esta visibilidad se reforzaba mediante el despliegue de los símbolos propios: himnos, canciones, banderas, etc.

Vertical profiles of environmental parameters measured on discrete water samples collected with Niskin bottles during the Tara Oceans expedition 2009-2013

The present data publication provides permanent links to original and updated versions of validated data files. The data files include properties of seawater, particulate matter and dissolved matter that were measured from discrete water samples collected with Niskin bottles during the 2009-2013 Tara Oceans expedition. Properties include pigment concentrations from HPLC analysis (10 depths per vertical profile, 25 pigments per depth), the carbonate system (Surface and 400m; pH (total scale), CO2, pCO2, fCO2, HCO3, CO3, Total alkalinity, Total carbon, OmegaAragonite, OmegaCalcite, and dosage Flags), nutrients (10 depths per vertical profile; NO2, PO4, N02/NO3, SI, quality Flags), DOC, CDOM, and dissolved oxygen isotopes. The Service National d'Analyse des Paramètres Océaniques du CO2, at the Université Pierre et Marie Curie, determined CT and AT potentiometrically (Edmond 1970; DOE 1994) on samples preserved according to Dickson et al. (2007). More than 250 vertical profiles of these properties were made across the world ocean. DOC, CDOM and dissolved oxygen isotopes are available only for the Arctic Ocean and Arctic Seas (2013).

Homeopathic Hospital Building

Originally West Professor's house on North University. Became Homeopathic Hospital. Wing added in rear of building in 1879. School of Dentistry 1875-1877. Psychological Lab 1903-1914. Building razed in 1914. On verso: Prof's House; North Univ. [University], West Res. [Residence] In another hand: Homeo [Homeopathic] Bldg

Commencement. Ferry Field

Regents purchased south ten acres for $3000 in 1890. In 1902 UM received seven acres of land to the north from Dexter M. Ferry; became Ferry Field. In 1904 brick wall constructed on three sides and in 1906 gate and ticket office at northeast corner added (gift of Mr. Ferry). Wooden stands to accommodate 400 put up in 1893; burned in 1895. Rebuilt to seat 800 with later additions to facililties. By 1914, 13,600 accommodated. New stadium built in 1927. Stamp on verso: Ivory Photo

Rackham Educational Memorial Building, Detroit, erected 1941

Harley & Ellington, architects. W.E. Wood Co., contractor. Built from July 1940 to January 1942. Built jointly for the Engineering Society of Detroit and the University as an Extension Service facility in Detroit. Funded by the Horace H. and Mary A. Rackham Fund. Sculptures on exterior by Marshall Fredericks.