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1.
PNAS Nexus ; 2(10): pgad298, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37822766

ABSTRACT

During behavior, the work done by actuators on the body can be resisted by the body's inertia, elastic forces, gravity, or viscosity. The dominant forces that resist actuation have major consequences on the control of that behavior. In the literature, features and actuation of locomotion, for example, have been successfully predicted by nondimensional numbers (e.g. Froude number and Reynolds number) that generally express the ratio between two of these forces (gravitational, inertial, elastic, and viscous). However, animals of different sizes or motions at different speeds may not share the same dominant forces within a behavior, making ratios of just two of these forces less useful. Thus, for a broad comparison of behavior across many orders of magnitude of limb length and cycle period, a dimensionless number that includes gravitational, inertial, elastic, and viscous forces is needed. This study proposes a nondimensional number that relates these four forces: the phase shift (ϕ) between the displacement of the limb and the actuator force that moves it. Using allometric scaling laws, ϕ for terrestrial walking is expressed as a function of the limb length and the cycle period at which the limb steps. Scale-dependent values of ϕ are used to explain and predict the electromyographic (EMG) patterns employed by different animals as they walk.

2.
Bioinspir Biomim ; 18(2)2023 01 11.
Article in English | MEDLINE | ID: mdl-36595244

ABSTRACT

Ultrafast movements propelled by springs and released by latches are thought limited to energetic adjustments prior to movement, and seemingly cannot adjust once movement begins. Even so, across the tree of life, ultrafast organisms navigate dynamic environments and generate a range of movements, suggesting unrecognized capabilities for control. We develop a framework of control pathways leveraging the non-linear dynamics of spring-propelled, latch-released systems. We analytically model spring dynamics and develop reduced-parameter models of latch dynamics to quantify how they can be tuned internally or through changing external environments. Using Lagrangian mechanics, we test feedforward and feedback control implementation via spring and latch dynamics. We establish through empirically-informed modeling that ultrafast movement can be controllably varied during latch release and spring propulsion. A deeper understanding of the interconnection between multiple control pathways, and the tunability of each control pathway, in ultrafast biomechanical systems presented here has the potential to expand the capabilities of synthetic ultra-fast systems and provides a new framework to understand the behaviors of fast organisms subject to perturbations and environmental non-idealities.


Subject(s)
Movement , Nonlinear Dynamics , Biomechanical Phenomena
3.
Vet J ; 291: 105914, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36220539

ABSTRACT

Transient hypophosphatemia is often detected in humans following generalized tonic-clonic seizures (GTCS), and serum phosphorus concentration (sPi) serves as a marker to differentiate GTCS from syncope. The objective of this retrospective study was to assess the usefulness of hypophosphatemia as a diagnostic marker for GTCS in dogs. Eighty-seven and 26 client-owned dogs with GTCS or syncope, respectively, were enrolled. Dogs were included if the episode occurred ≤ 3 h from presentation, and if sPi and serum creatinine (sCr) were measured. Dogs were excluded if aged < 1 year or if sCr exceeded 176.8 µmol/L. There were no group differences in sCr. Hypophosphatemia (sPi ≤ 0.97 mmol/L) occurred in 28 dogs (32%) in the seizure group, and in no dogs in the syncope group. Median sPi was significantly (P < 0.001) lower in the seizure group (1 mmol/L, [range, 0.31-2.87 mmol/L]) compared to the syncope group (1.35 mmol/L [range, 0.97-2.71 mmol/L]). Furthermore, in dogs presented while seizing (n = 24/87; 28%) median sPi was significantly lower compared to those that were not (0.9 mmol/L [range, 0.3-1.74 mmol/L] vs. 1 mmol/L [range, 0.33-2.18 mmol/L], P = 0.050). ROC analysis of sPi as a marker of GTCS yielded an AUC of 0.757 (95% confidence interval 0.667-0.847), with an optimum cutoff point of 0.97 mmol/L, corresponding to specificity and sensitivity levels of 100% and 44%, respectively. In conclusion, sPi may, in certain cases, serve as an additional diagnostic tool to differentiate GTCS from syncope in dogs. Hypophosphatemia, especially with sPi < 0.97 mmol/L, may be useful in clinical practice to rule in GTCS.


Subject(s)
Hypophosphatemia , Seizures , Animals , Humans , Case-Control Studies , Retrospective Studies , Seizures/diagnosis , Seizures/veterinary , Syncope/diagnosis , Syncope/etiology , Syncope/veterinary , Hypophosphatemia/diagnosis , Hypophosphatemia/veterinary , Electroencephalography
4.
R Soc Open Sci ; 9(6): 211171, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35719883

ABSTRACT

Quantifying prey characteristics is important for understanding the foraging behaviour of predators, which ultimately influence the structure and function of entire ecosystems. However, information available on prey is often at magnitudes which cannot be used to infer the fine-scale behaviour of predators, especially so in marine environments where direct observation of predator-prey interactions is rarely possible. In the present study, animal-borne video data loggers were used to determine the influence of prey type and patch density on the foraging behaviour of the little penguin (Eudyptula minor), an important predator in southeastern Australia. We found that numerical density positively influenced time spent foraging at a patch. However, when accounting for calorific value in density estimates, individuals spent longer at dense patches of low-quality prey. This may reflect a trade-off between capture effort and calorific gain as lower quality prey were captured at higher rates. During the breeding season, foraging trip distance and duration is constrained by the need to return to the colony each day to feed offspring. The results of the study suggest that, under these spatio-temporal constraints, little penguins maximize foraging performance by concentrating efforts at larger quantities of prey, irrespective of their calorific quality.

5.
Theriogenology ; 189: 31-41, 2022 Sep 01.
Article in English | MEDLINE | ID: mdl-35716430

ABSTRACT

Although fetal fluids, amnion (AM) and allantois (AL), have been studied at the end of pregnancy in the bitch, little is known about their composition during gestation. The aim of this study was to characterize and compare the biochemical parameters of fetal fluids collected from healthy pregnant bitches in mid pregnancy. Fetal fluids were collected from 26 pregnant bitches between 35 and 62 days from ovulation based on ultrasonography. A total of 149 samples were analyzed; 94 samples of known origin (61 a.m. and 33 AL) from 17 dams, which included 17 paired samples (AM and AL from the same fetus; 34 samples), and 55 of unknown origin from nine dams. Reference ranges were formulated for 22 biochemical parameters in AM and AL based on the samples of known origin (n = 94). All parameters (creatinine, albumin, GGT and urea) significantly different between AM and AL were included (by mixed model ANOVA) in the analysis and an algorithm to predict the origin of the fluid was developed (by logistic regression). Overall, of the 94 samples, 79 samples (84%) were correctly identified by the algorithm. For the 33 allantois samples, and for the 61 amnion samples, 23 (69.7%) and 56 (91.8%) were correctly identified by the algorithm, respectively. Based on the algorithm, 31 of the unknown samples (58%) were classified as amnion and 22 samples (42%), as allantois fluid. For all the unknown samples, the average certainty was 86% (compared to 81% for the samples whose fluid type was known), showing the degree of precision of the classification.


Subject(s)
Amniotic Fluid , Body Fluids , Allantois , Amniotic Fluid/chemistry , Animals , Body Fluids/chemistry , Dogs , Female , Pregnancy , Urea
6.
Curr Biol ; 32(10): R472-R474, 2022 05 23.
Article in English | MEDLINE | ID: mdl-35609546

ABSTRACT

For small animals like insects, passive elastic forces within their joints are extremely important to control of limb motion. A new study shows that these passive forces are tuned to the needs of individual joints.


Subject(s)
Extremities , Insecta , Animals , Biomechanical Phenomena , Biophysics
8.
J Exp Biol ; 224(23)2021 12 01.
Article in English | MEDLINE | ID: mdl-34755862

ABSTRACT

Lantern bugs are amongst the largest of the jumping hemipteran bugs, with body lengths reaching 44 mm and masses reaching 0.7 g. They are up to 600 times heavier than smaller hemipterans that jump powerfully using catapult mechanisms to store energy. Does a similar mechanism also propel jumping in these much larger insects? The jumping performance of two species of lantern bugs (Hemiptera, Auchenorrhyncha, family Fulgoridae) from India and Malaysia was therefore analysed from high-speed videos. The kinematics showed that jumps were propelled by rapid and synchronous movements of both hind legs, with their trochantera moving first. The hind legs were 20-40% longer than the front legs, which was attributable to longer tibiae. It took 5-6 ms to accelerate to take-off velocities reaching 4.65 m s-1 in the best jumps by female Kalidasa lanata. During these jumps, adults experienced an acceleration of 77 g, required an energy expenditure of 4800 µJ and a power output of 900 mW, and exerted a force of 400 mN. The required power output of the thoracic jumping muscles was 21,000 W kg-1, 40 times greater than the maximum active contractile limit of muscle. Such a jumping performance therefore required a power amplification mechanism with energy storage in advance of the movement, as in their smaller relatives. These large lantern bugs are near isometrically scaled-up versions of their smaller relatives, still achieve comparable, if not higher, take-off velocities, and outperform other large jumping insects such as grasshoppers.


Subject(s)
Hemiptera , Animals , Biomechanical Phenomena , Extremities , Female , Locomotion , Muscle, Skeletal
9.
J R Soc Interface ; 18(178): 20210058, 2021 05.
Article in English | MEDLINE | ID: mdl-34034531

ABSTRACT

Insects that predate aerially usually contrast prey against the sky and attack upwards. However, killer flies (Coenosia attenuata) can attack prey flying below them, performing what we term 'aerial dives'. During these dives, killer flies accelerate up to 36 m s-2. Although the trajectories of the killer fly's dives appear highly variable, proportional navigation explains them, as long as the model has the lateral acceleration limit of a real killer fly. The trajectory's steepness is explained by the initial geometry of engagement; steep attacks result from the killer fly taking off when the target is approaching the predator. Under such circumstances, the killer fly dives almost vertically towards the target, and gravity significantly increases its acceleration. Although killer flies usually time their take-off to minimize flight duration, during aerial dives killer flies cannot reach the lateral accelerations necessary to match the increase in speed caused by gravity. Since a close miss still leads the predator closer to the target, and might even slow the prey down, there may not be a selective pressure for killer flies to account for gravity during aerial dives.


Subject(s)
Diptera , Predatory Behavior , Acceleration , Animals , Flight, Animal , Gravitation , Insecta
10.
Biol Open ; 10(4)2021 04 01.
Article in English | MEDLINE | ID: mdl-33722801

ABSTRACT

Understanding energy use is central to understanding an animal's physiological and behavioural ecology. However, directly measuring energy expenditure in free-ranging animals is inherently difficult. The doubly labelled water (DLW) method is widely used to investigate energy expenditure in a range of taxa. Although reliable, DLW data collection and analysis is both financially costly and time consuming. Dynamic body acceleration (e.g. VeDBA) calculated from animal-borne accelerometers has been used to determine behavioural patterns, and is increasingly being used as a proxy for energy expenditure. Still its performance as a proxy for energy expenditure in free-ranging animals is not well established and requires validation against established methods. In the present study, the relationship between VeDBA and the at-sea metabolic rate calculated from DLW was investigated in little penguins (Eudyptula minor) using three approaches. Both in a simple correlation and activity-specific approaches were shown to be good predictors of at-sea metabolic rate. The third approach using activity-specific energy expenditure values obtained from literature did not accurately calculate the energy expended by individuals. However, all three approaches were significantly strengthened by the addition of mean horizontal travel speed. These results provide validation for the use of accelerometry as a proxy for energy expenditure and show how energy expenditure may be influenced by both individual behaviour and environmental conditions.


Subject(s)
Accelerometry/methods , Energy Metabolism , Spheniscidae/metabolism , Water/metabolism , Algorithms , Animals , Humans , Models, Theoretical , Staining and Labeling
11.
Mol Psychiatry ; 26(5): 1589-1605, 2021 05.
Article in English | MEDLINE | ID: mdl-32060413

ABSTRACT

Evaluation of expression profile in autism spectrum disorder (ASD) patients is an important approach to understand possible similar functional consequences that may underlie disease pathophysiology regardless of its genetic heterogeneity. Induced pluripotent stem cell (iPSC)-derived neuronal models have been useful to explore this question, but larger cohorts and different ASD endophenotypes still need to be investigated. Moreover, whether changes seen in this in vitro model reflect previous findings in ASD postmortem brains and how consistent they are across the studies remain underexplored questions. We examined the transcriptome of iPSC-derived neuronal cells from a normocephalic ASD cohort composed mostly of high-functioning individuals and from non-ASD individuals. ASD patients presented expression dysregulation of a module of co-expressed genes involved in protein synthesis in neuronal progenitor cells (NPC), and a module of genes related to synapse/neurotransmission and a module related to translation in neurons. Proteomic analysis in NPC revealed potential molecular links between the modules dysregulated in NPC and in neurons. Remarkably, the comparison of our results to a series of transcriptome studies revealed that the module related to synapse has been consistently found as upregulated in iPSC-derived neurons-which has an expression profile more closely related to fetal brain-while downregulated in postmortem brain tissue, indicating a reliable association of this network to the disease and suggesting that its dysregulation might occur in different directions across development in ASD individuals. Therefore, the expression pattern of this network might be used as biomarker for ASD and should be experimentally explored as a therapeutic target.


Subject(s)
Autism Spectrum Disorder , Induced Pluripotent Stem Cells , Autism Spectrum Disorder/genetics , Humans , Neurons , Proteomics , Transcriptome/genetics
12.
Equine Vet J ; 52(1): 41-45, 2020 Jan.
Article in English | MEDLINE | ID: mdl-30895637

ABSTRACT

BACKGROUND: Infection and dehiscence of simple lacerations is common in horses, and consistently effective methods of prevention are yet to be found. Honey has been shown to promote wound healing when applied topically; however, intralesional application prior to wound closure has not been reported. OBJECTIVES: To examine whether intralesional application of medical grade honey (MGH) would reduce the incidence of infection and dehiscence following wound closure. STUDY DESIGN: Prospective, open-label randomised block design clinical study. METHODS: Lacerations, treated by field practitioners, were divided into treatment and control groups using block randomisation. Horses in the treatment group received a single intralesional treatment with l-mesitran gel (MGH). Data were collected at the time of wound closure and at suture removal. RESULTS: Data from 127 horses were included, 69 MGH-treated and 58 control cases. No adverse effects of the MGH were recorded. MGH-treated horses were more likely to completely heal (P = 0.006, odds ratio [OR] 3.40 95% confidence interval [CI] 1.41-8.20), to have no signs of infection (P = 0.007, OR 3.64, CI 1.42-9.26) and for the veterinarians to report some degree of satisfaction (P = 0.04, OR 2.72, CI 1.05-7.09) compared to control cases. Numbers needed to treat for complete healing was 5.1 (CI 2.8-40). MAIN LIMITATIONS: Clinical studies have inherent flaws compared to wound healing models, because of variability between wounds. There were more horses with limb injuries in the control group, although not statistically significant, this may have biased the results. Clinical satisfaction and signs of infection were subjective evaluations and evaluators were not blinded to the treatment group. CONCLUSIONS: Intralesional application of MGH to lacerations prior to wound closure may be beneficial in preventing infection and dehiscence. Larger, blinded studies focusing on wounds at a specific location with more objective assessment should be pursued.


Subject(s)
Bacterial Infections/veterinary , Honey , Horse Diseases/prevention & control , Lacerations/veterinary , Wound Healing , Animals , Bacterial Infections/prevention & control , Female , Horses , Male
13.
J Exp Biol ; 222(Pt 15)2019 08 08.
Article in English | MEDLINE | ID: mdl-31395610

ABSTRACT

Jumping is often achieved using propulsive legs, yet legless leaping has evolved multiple times. We examined the kinematics, energetics and morphology of long-distance jumps produced by the legless larvae of gall midges (Asphondylia sp.). They store elastic energy by forming their body into a loop and pressurizing part of their body to form a transient 'leg'. They prevent movement during elastic loading by placing two regions covered with microstructures against each other, which likely serve as a newly described adhesive latch. Once the latch releases, the transient 'leg' launches the body into the air. Their average takeoff speeds (mean: 0.85 m s-1; range: 0.39-1.27 m s-1) and horizontal travel distances (up to 36 times body length or 121 mm) rival those of legged insect jumpers and their mass-specific power density (mean: 910 W kg-1; range: 150-2420 W kg-1) indicates the use of elastic energy storage to launch the jump. Based on the forces reported for other microscale adhesive structures, the adhesive latching surfaces are sufficient to oppose the loading forces prior to jumping. Energetic comparisons of insect larval crawling versus jumping indicate that these jumps are orders of magnitude more efficient than would be possible if the animals had crawled an equivalent distance. These discoveries integrate three vibrant areas in engineering and biology - soft robotics, small, high-acceleration systems, and adhesive systems - and point toward a rich, and as-yet untapped area of biological diversity of worm-like, small, legless jumpers.


Subject(s)
Locomotion , Animals , Biomechanical Phenomena , Larva/anatomy & histology , Larva/physiology , Microscopy, Electron, Scanning , Nematocera/anatomy & histology , Nematocera/growth & development , Nematocera/physiology , Video Recording
14.
Vet J ; 246: 71-77, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30902193

ABSTRACT

A valid, reliable and usable scale is needed for assessing severity of acute abdominal pain in horses. The study aim was to compare three different scales: (1) the equine acute abdominal pain scale (EAAPS); (2) a scale described by Mair and Smith (2005; M and S); and (3) a numerical rating scale (NRS). Forty brief films of horses (35 of colic cases and five of control horses) were randomly presented to 46 equine veterinarians from different countries. Participants, randomly divided into three groups, each used one scale. Five randomly selected films were shown twice for determining intra-observer reliability. Speed, ease of use and face validity of the scales were evaluated based on expert opinion. Response rate was excellent: 89% for the EAAPS (16/18), and 100% for the M and S (18/18) and NRS groups (10/10). The intraclass correlation (ICC) of 0.86 [95% confidence interval (CI); 0.80-0.92] for EAAPS indicated significantly better inter-observer reliability compared to 0.68 for the M and S and 0.71 for the NRS. Moreover, intra-observer reliability of EAAPS (weighted κ 0.95 [95%CI; 0.92-0.98]) was superior to the other scales (weighted κ 0.78, 0.77, for the M and S and NRS, respectively). Other validity measures (convergent, extreme group, predictive validities), usability (time taken to score the films-speed) and the ease of use of the scales were not significantly different. Face validity (endorsement by experts) was better for the M and S scale than for the EAAPS. The EAAPS showed superior reliability, the M and S scale better face validity, with comparable usability and other tests of validity.


Subject(s)
Colic/veterinary , Horse Diseases/physiopathology , Pain Measurement/veterinary , Acute Pain/veterinary , Animals , Colic/physiopathology , Female , Horses , Male , Observer Variation , Random Allocation , Reproducibility of Results , Veterinarians
15.
Curr Biol ; 28(4): R142-R143, 2018 02 19.
Article in English | MEDLINE | ID: mdl-29462575

ABSTRACT

A quick guide to the springs used by insects to achieve remarkable feats of jumping.


Subject(s)
Insecta/physiology , Locomotion , Animals , Biomechanical Phenomena
16.
Metrologia ; 552018.
Article in English | MEDLINE | ID: mdl-31080297

ABSTRACT

The International Committee for Weights and Measures (CIPM), at its meeting in October 2017, followed the recommendation of the Consultative Committee for Units (CCU) on the redefinition of the kilogram, ampere, kelvin and mole. For the redefinition of the kelvin, the Boltzmann constant will be fixed with the numerical value 1.380 649 × 10-23 J K-1. The relative standard uncertainty to be transferred to the thermodynamic temperature value of the triple point of water will be 3.7 × 10-7, corresponding to an uncertainty in temperature of 0.10 mK, sufficiently low for all practical purposes. With the redefinition of the kelvin, the broad research activities of the temperature community on the determination of the Boltzmann constant have been very successfully completed. In the following, a review of the determinations of the Boltzmann constant k, important for the new definition of the kelvin and performed in the last decade, is given.

17.
BMC Biol ; 15(1): 63, 2017 07 31.
Article in English | MEDLINE | ID: mdl-28756777

ABSTRACT

BACKGROUND: Helicoverpa armigera and Helicoverpa zea are major caterpillar pests of Old and New World agriculture, respectively. Both, particularly H. armigera, are extremely polyphagous, and H. armigera has developed resistance to many insecticides. Here we use comparative genomics, transcriptomics and resequencing to elucidate the genetic basis for their properties as pests. RESULTS: We find that, prior to their divergence about 1.5 Mya, the H. armigera/H. zea lineage had accumulated up to more than 100 more members of specific detoxification and digestion gene families and more than 100 extra gustatory receptor genes, compared to other lepidopterans with narrower host ranges. The two genomes remain very similar in gene content and order, but H. armigera is more polymorphic overall, and H. zea has lost several detoxification genes, as well as about 50 gustatory receptor genes. It also lacks certain genes and alleles conferring insecticide resistance found in H. armigera. Non-synonymous sites in the expanded gene families above are rapidly diverging, both between paralogues and between orthologues in the two species. Whole genome transcriptomic analyses of H. armigera larvae show widely divergent responses to different host plants, including responses among many of the duplicated detoxification and digestion genes. CONCLUSIONS: The extreme polyphagy of the two heliothines is associated with extensive amplification and neofunctionalisation of genes involved in host finding and use, coupled with versatile transcriptional responses on different hosts. H. armigera's invasion of the Americas in recent years means that hybridisation could generate populations that are both locally adapted and insecticide resistant.


Subject(s)
Genome, Insect , Herbivory , Moths/genetics , Animals , Gene Expression Profiling , Genomics , Introduced Species , Larva/genetics , Larva/growth & development , Moths/classification , Moths/growth & development , Sequence Analysis, DNA
19.
Int J Syst Evol Microbiol ; 67(2): 502-504, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27902205

ABSTRACT

Enterobacter aerogenes Hormaeche and Edwards 1960 (Approved Lists 1980) and Klebsiella mobilis Bascomb et al. 1971 (Approved Lists 1980) were placed on the Approved Lists of Bacterial Names and were based on the same nomenclatural type, ATCC 13048. Consequently they are to be treated as homotypic synonyms. However, the names of homotypic synonyms at the rank of species normally are based on the same epithet. Examination of the Rules of the International Code of Nomenclature of Bacteria in force at the time indicates that the epithet mobilis in Klebsiella mobilis Bascomb et al. 1971 (Approved Lists 1980) was illegitimate at the time the Approved Lists were published and according to the Rules of the current International Code of Nomenclature of Prokaryotes continues to be illegitimate.


Subject(s)
Enterobacter aerogenes/classification , Phylogeny , Terminology as Topic
20.
Br J Gen Pract ; 67(655): e94-e102, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27919937

ABSTRACT

BACKGROUND: Symptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging. AIM: To evaluate the performance of a clinical decision rule (CDR), with or without N-Terminal pro-B type natriuretic peptide (NT-proBNP) assay, for identifying heart failure. DESIGN AND SETTING: Prospective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England. METHOD: The outcome was test performance of the CDR and natriuretic peptide test in determining a diagnosis of heart failure. The reference standard was an expert consensus panel of three cardiologists. RESULTS: Three hundred and four participants were recruited, with 104 (34.2%; 95% confidence interval [CI] = 28.9 to 39.8) having a confirmed diagnosis of heart failure. The CDR+NT-proBNP had a sensitivity of 90.4% (95% CI = 83.0 to 95.3) and specificity 45.5% (95% CI = 38.5 to 52.7). NT-proBNP level alone with a cut-off <400 pg/ml had sensitivity 76.9% (95% CI = 67.6 to 84.6) and specificity 91.5% (95% CI = 86.7 to 95.0). At the lower cut-off of NT-proBNP <125 pg/ml, sensitivity was 94.2% (95% CI = 87.9 to 97.9) and specificity 49.0% (95% CI = 41.9 to 56.1). CONCLUSION: At the low threshold of NT-proBNP <125 pg/ml, natriuretic peptide testing alone was better than a validated CDR+NT-proBNP in determining which patients presenting with symptoms went on to have a diagnosis of heart failure. The higher NT-proBNP threshold of 400 pg/ml may mean more than one in five patients with heart failure are not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised.


Subject(s)
Electrocardiography , Heart Failure/diagnosis , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Primary Health Care , Adult , Aged , Biomarkers/blood , Clinical Protocols , Dyspnea , England , Fatigue , Female , Humans , Male , Middle Aged , Prospective Studies , ROC Curve , Referral and Consultation , Research Design
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