Resource utilization and outcome among patients with selective versus nonselective troponin testing.

OBJECTIVE: In patients with suspected acute coronary syndrome (ACS), troponin testing is effective for diagnosis and prognosis. Troponin testing has now expanded to include patients without suspected ACS. This nonselective troponin testing has unknown consequences for resource utilization and outcome. Therefore, we examined selective versus nonselective troponin testing with respect to patient characteristics, resource utilization, and outcome. METHODS: This retrospective 1-year study included all patients with troponin testing at a U.S. emergency department. Testing was classified as selective (ACS) or nonselective (non-ACS) based on admission ICD-9 codes. Troponin upper reference limit (URL) was ≥99th percentile. RESULTS: Among 47,053 patients, troponin was measured in 9109 (19%) of whom 5764 were hospitalized. Admission diagnosis was non-ACS in 4427 (77%) and ACS in 1337 (23%). Non-ACS patients were older, 71±17 versus 65±16 years, with longer hospital stay, 77 versus 32 h, and greater 1-year mortality 22% versus 6.7%; P<.001. In patients with troponin ≥URL, revascularization was performed in 64 (4.7%) of non-ACS versus 213 (48%) of ACS; P<.001. In patients with troponin 80% of the non-ACS population CONCLUSIONS: Contemporary troponin testing is frequently nonselective. The non-ACS and ACS populations differ significantly regarding clinical characteristics, revascularization rates, and outcomes. Troponin elevation is a powerful predictor of 1-year mortality in non-ACS, this association reveals an opportunity for risk stratification and targeted therapy. KEY QUESTIONS: In patients with suspected acute coronary syndrome (ACS), troponin testing is effective for diagnosis and prognosis. However, troponin testing has now expanded to include patients without suspected ACS. This nonselective troponin testing has unknown consequences for hospital resource utilization and patient outcome. Our findings demonstrate contemporary troponin testing is largely nonselective (77% of testing was performed in patients without acute coronary syndrome). In comparison to patients with acute coronary syndrome, those with non-acute coronary syndrome are older, with longer hospital stay, lower revascularization rates, and greater 1-year mortality. Troponin elevation identifies a high-risk population in both acute coronary syndrome and non-acute coronary syndrome populations, yet effective treatment for the latter is lacking.

Volatile Organic Compounds Sensing Using Optical Fibre Long Period Grating with Mesoporous Nano-Scale Coating.

A long period grating (LPG) modified with a mesoporous film infused with a calixarene as a functional compound was employed for the detection of individual volatile organic compounds (VOCs) and their mixtures. The mesoporous film consisted of an inorganic part, SiO2 nanoparticles (NPs), along with an organic moiety of poly(allylamine hydrochloride) polycation PAH, which was finally infused with the functional compound, p-sulphanato calix[4]arene (CA[4]) or p-sulphanato calix[8]arene (CA[8]). The LPG sensor was designed to operate at the phase matching turning point to provide the highest sensitivity. The sensing mechanism is based on the measurement of the refractive index (RI) change induced by a complex of the VOCs with calixarene. The LPG, modified with a coating of 5 cycles of (SiO2 NPs/PAH) and infused with CA[4] or CA[8], was exposed to chloroform, benzene, toluene and acetone vapours. The British Standards test of the VOCs emissions from material (BS EN ISO 16000-9:2006) was used to test the LPG sensor performance.

Sensitivity Enhancement in Low Cutoff Wavelength Long-Period Fiber Gratings by Cladding Diameter Reduction.

The diameter of long-period fiber gratings (LPFGs) fabricated in optical fibers with a low cutoff wavelength was be reduced by hydrofluoric acid etching, enhancing the sensitivity to refractive index by more than a factor of 3, to 2611 nm/refractive index unit in the range from 1.333 to 1.4278. The grating period selected for the LPFGs allowed access to the dispersion turning point at wavelengths close to the visible range of the optical spectrum, where optical equipment is less expensive. As an example of an application, a pH sensor based on the deposition of a polymeric coating was analyzed in two situations: with an LPFG without diameter reduction and with an LPFG with diameter reduction. Again, a sensitivity increase of a factor of near 3 was obtained, demonstrating the ability of this method to enhance the sensitivity of thin-film-coated LPFG chemical sensors.

Overwrite fabrication and tuning of long period gratings.

The central wavelengths of the resonance bands are critical aspect of the performance of long period gratings (LPGs) as sensors, particularly for devices designed to operate near the phase matching turning point (PMTP), where the sensitivity to measurements can vary rapidly. Generally, LPGs are characterized by their period, but the amplitude of the amplitude of the index modulation is also an important factor in determining the wavelengths of the resonance bands. Variations in fabrication between LPG sensors can increase or decrease the sensitivity of the LPG to strain, temperature or surrounding refractive index. Here, the technique of overwritten UV laser fabrication is demonstrated. It is shown that, on repeated overwriting, the resonance bands of an LPG exhibit significant wavelength shift, which can be monitored and which can be used to tune the resonance bands to the desired wavelengths. This technique is applied to periods in the range 100 to 200 µm, showing the cycle-to-cycle evolution of the resonance bands near the PMTPs of a number of cladding modes. The use of online monitoring is shown to reduce the resonance band sensor-to-sensor central wavelength variation from 10 nm to 3 nm.