Author contributions In an academic-industry partnership, SomaLogic, Inc. and the academic collaborators worked together on study design, interpretation of the data and preparation of the manuscript. S.A.W., P.G. and N.W. were responsible for designing, writing and final editing of the manuscript and responses to reviewer comments. In addition to all authors being generally involved in the program, specific contributions were as follows: M.K. and M.J.S. were accountable for the data from the Whitehall II study and advised on the study design for the CV and diabetes models. C.L. and N.W. were accountable for the data from the Fenland study and advising on diabetes risk and behavioral models. C.B. and M.A.S. were accountable for the data from the Heritage Family study. C.J. was accountable for the data from the HUNT3 study. R.O. was accountable for the data from the Covance study.

Introduction:Screening for severe sepsis in adult emergency department (ED) patients may involve potential delays while waiting for laboratory testing, leading to postponed identification or over-utilization of resources. The systemic inflammatory response syndrome (SIRS) criteria are inaccurate at predicting clinical outcomes in sepsis. Shock index (SI), defined as heart rate / systolic blood pressure, has previously been shown to identify high risk septic patients. Our objective was to compare the ability of SI, individual vital signs, and the systemic inflammatory response syndrome (SIRS) criteria to predict the primary outcome of hyperlactatemia (serum lactate ≥ 4.0 mmol/L) as a surrogate for disease severity, and the secondary outcome of 28-day mortality.Methods:We performed a retrospective analysis of a cohort of adult ED patients at an academic community trauma center with 95,000 annual visits, from February 1st, 2007 to May 28th, 2008. Adult patients presenting to the ED with a suspected infection were screened for severe sepsis using a standardized institutional electronic order set, which included triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for two outcomes: hyperlactatemia (marker for morbidity) and 28-day mortality. We considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure < 65 mmHg; respiratory rate > 20 breaths/min; ≥ 2 SIRS with vital signs only; ≥2 SIRS including white blood cell count; SI ≥ 0.7; and SI ≥ 1.0. We report sensitivities, specificities, and positive and negative predictive values for the primary and secondary outcomes.Results:2524 patients (89.4%) had complete records and were included in the analysis. 290 (11.5%) patients presented with hyperlactatemia and 361 (14%) patients died within 28 days. Subjects with an abnormal SI of 0.7 or greater (15.8%) were three times more likely to present with hyperlactatemia than those with a normal SI (4.9%). The negative predictive value (NPV) of a SI ≥ 0.7 was 95%, identical to the NPV of SIRS.Conclusion:In this cohort, SI ≥ 0.7 performed as well as SIRS in NPV and was the most sensitive screening test for hyperlactatemia and 28-day mortality. SI ≥ 1.0 was the most specific predictor of both outcomes. Future research should focus on multi-site validation, with implications for early identification of at-risk patients and resource utilization.

Background-Risk for mood and anxiety disorders associated with US-nativity may vary across immigrant groups.

Household cooking using solid biomass fuels is a major global health and environmental concern. As part of the Research on Emissions Air quality Climate and Cooking Technologies in Northern Ghana study, we conducted 75 in-field uncontrolled cooking tests designed to assess emissions and efficiency of the Gyapa woodstove, Philips HD4012, threestone fire and coalpot (local charcoal stove). Emission factors (EFs) were calculated for carbon monoxide (CO), carbon dioxide (CO), and particulate matter (PM). Moreover, modified combustion (MCE), heat transfer (HTE) and overall thermal efficiencies (OTE) were calculated across a variety of fuel, stove and meal type combinations. Mixed effect models suggest that compared to traditional stove/fuel combinations, the Philips burning wood or charcoal showed significant fuel and energy based EF differences for CO, but no significant PM changes with wood fuel. MCEs were significantly higher for Philips wood and charcoal-burning stoves compared to the threestone fire and coalpot. The Gyapa emitted significantly higher ratios of elemental to organic carbon. Fuel moisture, firepower and MCE fluctuation effects on stove performance were investigated with mixed findings. Results show agreement with other in-field findings and discrepancies with some lab-based findings, with important implications for estimated health and air quality impacts.