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The study objective was to develop and validate a clinical decision support system (CDSS) to guide clinicians through the diagnostic evaluation of hospitalized individuals with suspected pulmonary tuberculosis (TB) in low-prevalence settings.
Methods:
The “TBorNotTB” CDSS was developed using a modified Delphi method. The CDSS assigns points based on epidemiologic risk factors, TB history, symptoms, chest imaging, and sputum/bronchoscopy results. Below a set point threshold, airborne isolation precautions are automatically discontinued; otherwise, additional evaluation, including infection control review, is recommended. The model was validated through retrospective application of the CDSS to all individuals hospitalized in the Mass General Brigham system from July 2016 to December 2022 with culture-confirmed pulmonary TB (cases) and equal numbers of age and date of testing-matched controls with three negative respiratory mycobacterial cultures.
Results:
104 individuals with TB (cases) and 104 controls were identified. Prior residence in a highly endemic country, positive interferon release assay, weight loss, absence of symptom resolution with treatment for alternative diagnoses, and findings concerning for TB on chest imaging were significant predictors of TB (all P < 0.05). CDSS contents and scoring were refined based on the case–control analysis. The final CDSS demonstrated 100% sensitivity and 27% specificity for TB with an AUC of 0.87.
Conclusions:
The TBorNotTB CDSS demonstrated modest specificity and high sensitivity to detect TB even when AFB smears were negative. This CDSS, embedded into the electronic medical record system, could help reduce risks of nosocomial TB transmission, patient-time in airborne isolation, and person-time spent reviewing individuals with suspected TB.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
The dispersion relation of a deuterium –hydrogen plasma is investigated near the ion cyclotron frequency of hydrogen at varying hydrogen temperatures. It is found that at low hydrogen-to-deuterium temperature ratios, only the fast mode and the ion Bernstein mode are coupled around the hybrid layer. Above a certain critical temperature ratio Th< Thc, these two modes become coupled also to a third mode. Around and above Thc, the wave equation is of sixth order rather than of the fourth order previously discussed.
This paper presents the theory of an inhomogeneous source of cyclotron emission from a three-branch mode-conversion layer in a non-uniformly magnetized plasma. The physical formulation of the problem is based on the generalized Kirchhoff's law that relates, branch by branch, the emission to the absorption. General integral expressions for both absorbed and emitted energy fractions along each wave branch are obtained. A discrete multi-point model of absorbers and emitters is analysed. A variational principle for the integral of the emitted power is formulated.
High hydrostatic pressure disruption of casein micelle isolates was studied by analytical ultracentrifugation and transmission electron microscopy. Casein micelles were isolated from skim milk and subjected to combinations of thermal treatment (85°C, 20 min) and high hydrostatic pressure (up to 676 MPa) with and without whey protein added. High hydrostatic pressure promoted extensive disruption of the casein micelles in the 250 to 310 MPa pressure range. At pressures greater than 310 MPa no further disruption was observed. The addition of whey protein to casein micelle isolates protected the micelles from high hydrostatic pressure induced disruption only when the mix was thermally processed before pressure treatment. The more whey protein was added (up to 5 g/l) the more the protection against high hydrostatic pressure induced micelle disruption was observed in thermally treated samples subjected to 310 MPa.
A finite-difference numerical method for the solution of the unsteady flow of a viscous incompressible fluid through axisymmetric circular ducts of variable axial geometry is developed and applied to the flow in a spherical-cavity geometry approximating the human aortic valve. The presence and motion of the valve leaflets are considered only as long as they can be assumed to present negligible impedance to the flow. The numerical solution is based on the vorticity/streamfunction approach, and is carried out for the systolic acceleration phase of the heart beat. A hybrid-mesh design consisting of a fine cell structure in the region close to the solid walls and a coarser grid in the core region is used. An experimental flow-visualization study in an acrylic model of the spherical cavity shows good agreement with the numerical simulation. An early separation of flow occurs at the entrance to the cavity, and an annular eddy grows in the wake until it occupies most of the cavity. The use of the hybrid mesh also makes possible the simulation of fine secondary-flow features in the cavity under peak-flow conditions.
Friction factor data from two recent pipe flow experiments are combined to provide a comprehensive picture of the friction factor variation for Reynolds numbers from 10 to 36,000,000.
Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.
We have used RBS/Channeling, perturbed angular correlation (PAC) and optical absorption to study the regrowth of disordered layers in diamond produced by implantation with carbon, or with carbon plus boron or indium ions. For C or C plus B implantation doses of 2 ×1015 cm−2 or less, complete recovery of channeling damage occurred after RTA at 1100°C or furnace annealing at 900°C. Optical measurements on samples implanted with high energy carbon ions show better recovery compared to the shallower implantations. PAC results showed that co-implantation with C and In caused a considerable fraction (∼15%) of the In-atoms to occupy well-defined lattice sites characterized by an electric field gradient having its major component along <111>, and a frequency of 116 MHz.
Ion backscattering and channeling of 2.0 MeV He+ has been used to observe the effects of excimer laser annealing on unimplanted and nitrogen implanted single crystal austenitic stainless steel. The laser annealing was done either in air or in flowing helium. In general, laser annealing resulted in a significant increase in lattice disorder of both unimplanted and implanted specimens. Laser annealing in helium atmosphere caused a near-surface decrease of disorder in the implanted specimens with, however, a higher dechanneling rate at greater depths. Channeling with nuclear reaction analysis shows that the as - implanted nitrogen occupies octahedral interstitial sites as evidenced by flux peaking along the <110> axis and a decreased signal along the <100> axis. A similar effect is observed after laser annealing in a helium atmosphere.
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