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Introduction Pulmonary embolism (PE) can be difficult to rule out without computed tomography pulmonary angiograms (CTPAs), as presentations vary. Multiple clinical decision rules (CDRs) exist to risk-stratify patients to avoid unnecessary CTPAs. However, the currently used CDRs are complex, and research has shown low compliance with their usage. The YEARS algorithm is less complex and excludes patients from CTPA if PE is not the most likely diagnosis, they do not have a history of hemoptysis, and no clinical signs of deep vein thrombosis, is less complex. However, no studies have evaluated YEARS in the U.S. Military health care beneficiary population. Therefore, this study sought to determine if implementing the YEARS algorithm could decrease the number of CTPAs ordered to rule out PE in low-risk patients. Methods This retrospective, single-center cohort study applied the YEARS algorithm to low-risk military beneficiaries presenting to the emergency department in the calendar year 2020 at a single U.S. Army MTF. The primary outcome was the number of CTPAs indicated by the YEARS algorithm versus the number ordered via standard practice. We used chi-square testing to compare the number of subjects in whom YEARS indicated CTPA (meets criteria/does not meet criteria) versus the actual number of subjects who underwent CTPA (meets criteria/does not meet criteria). The secondary outcomes included applying YEARS similarly to the number of subjects >50 years of age (as opposed to age-adjusted d-dimer), determining the number of pregnant patients who could have avoided CTPA via application of YEARS, and assessing possible cost savings via reduction of CTPA. Results We included 353 subjects during the study period, 271 of whom underwent CTPA. YEARS would have only indicated 25 of them, P = .018. In patients >50 years of age, 164 underwent CTPA versus nine who met YEARS criteria, P = .014. Among pregnant patients, six underwent CTPA versus one who YEARS would have indicated, P = .130. Application of the YEARS algorithm would have led to a 90.8% reduction in CTPAs ordered with an overall known missed PE rate of 1.1%. Applying the YEARS algorithm in 2020 could have led to 246 fewer CTPAs at a minimum cost savings of $38,762.22 for the MTF based on the coded billing cost of $157.57 per CTPA when local staff radiologists performed image interpretation. This estimate does not consider the additional undisclosed cost of contracted radiologists interpreting after regular duty hours. Conclusions For our military beneficiaries, our study indicates that the YEARS algorithm would have reduced CTPA utilization in all age ranges and potentially among pregnant patients with a known missed PE rate of 1.1%.

Additional file 1. Supplementary analyses at the global scale. Fig. S1. Baseline amyloid load for each participant in regional SUVRs and in target (implant) region (ROI1). All participants had a positive amyloid load in the region targeted by the sonication except for Patient 10 (threshold of 1.1 assumed for amyloid positivity). Fig. S2. Violin plots representing the distribution of the annualized percent changes (APC) in PET uptake for the current study ("BOREAL", n=9) and reference cohort ("ADNI", n=45) populations. The APC were computed for both the cognitive (left) amyloid PET (middle) and FDG PET (right) in the large (top) and small (bottom) regions of interest for PET imaging. No statistical difference was observed between BOREAL and ADNI (Kruskal-Wallis H-test with the Benjamini-Hochberg procedure to correct for multiple testing). Fig. S3. Typical Gd-DOTA concentration map obtained after a successful sonication session. Images are reoriented in order to contain the central axis of the implanted ultrasound implant (shown in pink). The implant region of interest covering brain tissues in the white and gray matter targeted by the ultrasound beam is shown in green. A non-sonicated control region defined in the contralateral hemisphere is also shown. Fig. S4. Acoustic field simulated in the brain for the SonoCloud-1 device at a nominal pressure of 1.03 MPa. The nominal pressure is calibrated in water at the natural focus (red cross) during manufacturing. The acoustic field in brain is evaluated from the measurement in water and considering an attenuation of 0.6 dB/cm/MHz. Table S1. Evaluation of BBB-disruption efficacy with metrics computed from T1 maps acquired after sonication. The differences of Gd-DOTA marked with * are above the criterion for detectable BBB disruption (2 times the standard deviation of all control ROIs, i.e. 13.9 ��g). Table S2. Regional standardized uptake value ratios (SUVR) obtained for the amyloid and FDG PET tracers at M0, M4 and M8, presented as average �� standard deviation. The amyloid uptake remained on average stable between M0 and M8 (no statistical difference according to the Wilcoxon signed rank test), while the FDG uptake decreased on average between M0 and M8 (significant difference in the left cortex, and in both the left and right angular + supramarginal + superior temporal gyri according to the Wilcoxon signed rank test after correction for multiple comparisons following the Benjamini-Hochberg procedure). L: left, R: right. Table S3. Comparison of the BOREAL and ADNI populations. No statistical difference exists in terms of age and mini mental state examination (MMSE) score (Kruskal-Wallis H-test) between the BOREAL and ADNI populations, nor in terms of regional PET standardized uptake value ratio (SUVR) at baseline and annualized percent change (APC) computed in both the large and small regions of interest (Kruskal-Wallis H-test with the Benjamini-Hochberg procedure to correct for multiple testing). L: left, R: right.

International audience; We report a fatal case of measles inclusion-body encephalitis occurring in a woman from Romania with AIDS. After an extensive but unsuccessful diagnostic evaluation, a pan-pathogen shotgun metagenomic approach revealed a measles virus infection. We identified no mutations previously associated with neurovirulence.

International audience; Objectives: Aortic distensibility estimation of local aortic stiffness is based on local aortic strains and central pulse pressure (cPP) measurements. Most MRI studies used either brachial PP (bPP) despite differences with cPP, or direct cPP estimates obtained after MRI examination, assuming no major pressure variations. We evaluated the feasibility of assessment of cPP with a specific device fitted with a 6 m long hose (study1) and looked at the influence of using such cPP within the magnet instead of bPP on aortic distensibility in a control population (study 2).Methods: Brachial and central pressures values were recorded with the SphygmoCor XCEL system fitted with 2 and 6 m long tubing randomly assigned on arms. A 6 m long tubing was used in the second study to measure aortic distensibility with MRI. Aortic distensibility was calculated using either bPP (bAD) or cPP (cAD).Results: Study1, performed on 38 patients (mean age: 43 ± 17 years), showed no statistical difference between bPP and cPP measured with 2 or 6 m long tubing (0.41 ± 4.45 and 0.78 ± 3.18 mmHg, respectively, both P = ns). In study 2, cAD provided statistically higher values than bAD (1.87 ± 1.43 10 · mmHg, P < 0.001) especially in younger individuals (3.28 ± 0.86 10 · mmHg). The correlation between age and aortic distensibility was stronger with cAD (r = -0.92; P < 0,001) than with bAD (r = -0.88; P < 0.001).Conclusion: cPP can be estimated with reasonable accuracy during MRI acquisition using a 6 m long tube. Using either cPP or bPP greatly influences aortic distensibility values, especially in young individuals in whom an accurate detection of early or accelerated vascular aging can be of major importance.

Close double degenerate binaries are one of the favoured progenitor channels for type Ia supernovae, but it is unclear how many suitable systems there are in the Galaxy. We report results of a large radial velocity survey for double degenerate (DD) binaries using the UVES spectrograph at the ESO VLT (ESO SN Ia Progenitor surveY – SPY). Exposures taken at different epochs are checked for radial velocity shifts indicating close binary systems. We observed 689 targets classified as DA white dwarfs (displaying hydrogen-rich atmospheres), of which 46 were found to possess a cool companion. We measured radial velocities (RV) of the remaining 643 DA white dwarfs. We managed to secure observations at two or more epochs for 625 targets, supplemented by eleven objects meeting our selection criteria from literature. The data reduction and analysis methods applied to the survey data are described in detail. The sample contains 39 double degenerate binaries, only four of which were previously known. Twenty are double-lined systems, in which features from both components are visible, the other 19 are single-lined binaries. We provide absolute RVs transformed to the heliocentric system suitable for kinematic studies. Our sample is large enough to sub-divide by mass: 16 out of 44 low mass targets (≤0.45 M⊙) are detected as DDs, while just 23 of the remaining 567 targets with multiple spectra and mass > 0.45 M⊙are double. The detected fraction amongst the low mass objects (36.4 ± 7.3%) is significantly higher than for the higher-mass, carbon-oxygen core dominated part of the sample (3.9 ± 0.8%), but it is much lower than expected from the detection efficiency for companion masses of 0.05 M⊙or higher and a 100% binary fraction. This suggests either companion stars of with a mass below 0.05 M⊙or some of the low mass white dwarfs are single.

International audience; Frontotemporal lobar degeneration (FTLD) has a high frequency of genetic forms; the 2 most common are GRN (progranulin) and C9ORF72 mutations. Recently, our group reported extensive white matter (WM) lesions in 4 patients with FTLD caused by GRN mutation, in the absence of noteworthy cardi- ovascular risk factors,1 in line with other studies in GRN mutation carriers.2,3 Here we compared the characteristics of frontal WM lesions in patients with behavioral variant of FTLD (bv-FTLD) caused by GRN and C9ORF72 mutations.

We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programing of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.

Background Magnetic resonance imaging (MRI) offers the possibility to measure local and regional indices of aortic function. However calculations of these indices usually require blood pressure (BP) values. Up to now, because of its easier availability, brachial BP was used instead of local aortic pressure. The SphygmoCor Xcel system (AtCor Medical, Australia) estimates aortic pressure noninvasively. It consists in a MRI compatible brachial cuff connected via a hose to a recording unit and computer. The aim of this study was to compare brachial and central BP values given by SphgymoCor Xcel with the standard 2 meters hose and a 6 meters hose more suitable for central BP assessment during MRI.

This report summarizes research investigating the technical and economic feasibility of several pilot deep energy retrofits, or retrofits that save 30% to 50% or more on a whole-house basis while increasing comfort, durability, combustion safety, and indoor air quality. The work is being conducted for the U.S. Department of Energy Building Technologies Program as part of the Building America Program. As part of the overall program, Pacific Northwest National Laboratory (PNNL) researchers are collecting and analyzing a comprehensive dataset that describes pre- and post-retrofit energy consumption, retrofit measure cost, health and comfort impacts, and other pertinent information for each home participating in the study. The research and data collection protocol includes recruitment of candidate residences, a thorough test-in audit, home energy modeling, and generation of retrofit measure recommendations, implementation of the measures, test-out, and continued evaluation. On some homes, more detailed data will be collected to disaggregate energy-consumption information. This multi-year effort began in October 2010. To date, the PNNL team has performed test-in audits on 51 homes in the marine, cold, and hot-humid climate zones, and completed 3 retrofits in Texas, 10 in Florida, and 2 in the Pacific Northwest. Two of the retrofits are anticipated to save 50% or more in energy bills and the others - savings are in the 30% to 40% range. Fourteen other retrofits are under way in the three climate zones. Metering equipment has been installed in seven of these retrofits - three in Texas, three in Florida, and one in the Pacific Northwest. This report is an interim update, providing information on the research protocol and status of the PNNL deep energy retrofit project as of December, 2011. The report also presents key findings and lessons learned, based on the body of work to date. In addition, the report summarizes the status of the PNNL Lab Homes that are new manufactured homes procured with minimal energy-efficiency specifications typical of existing homes in the region, and sited on the PNNL campus. The Lab Homes serve as a flexible test facility (the first of its kind in the Pacific Northwest) to rapidly evaluate energy-efficient and grid-smart technologies that are applicable to residential construction.

This report summarizes the work conducted by the Building America Industrialized Housing Partnership (BAIHP - www.baihp.org) during the final budget period (BP5) of our contract, January 1, 2010 to November 30, 2010. Highlights from the four previous budget periods are included for context. BAIHP is led by the Florida Solar Energy Center (FSEC) of the University of Central Florida. With over 50 Industry Partners including factory and site builders, work in BP5 was performed in six tasks areas: Building America System Research Management, Documentation and Technical Support; System Performance Evaluations; Prototype House Evaluations; Initial Community Scale Evaluations; Project Closeout, Final Review of BA Communities; and Other Research Activities.

This study examined the variables that contribute to the large individual differences in the speech perception skills of children with the Nucleus multichannel cochlear implant. Sixty-one children were tested on four measures of speech perception: two tests of closed-set word recognition, one test of open-set recognition of phrases, and one open-set monosyllabic word test, scored on the basis of the percentage of phonemes as well as words identified correctly. The results of a series of multiple regression analyses revealed that the variables of processor type, duration of deafness, communication mode, age at onset of deafness, length of implant use, and age implanted accounted for roughly 35% of the variance on two tests of closed-set word recognition, and 40% of the variance on measures that assessed recognition of words or phomenes in an open set. Length of implant use accounted for the most variance on all of the speech perception measures.