More importantly, the use of any rule is associated with reduction in recurrent thromboembolism.The Wells score:
clinically suspected DVT – 3.0 points
alternative diagnosis is less likely than PE – 3.0 points
tachycardia (heart rate > 100) – 1.5 points
immobilization (≥ 3d)/surgery in previous four weeks – 1.5 points
history of DVT or PE – 1.5 points
hemoptysis – 1.0 points
malignancy (with treatment within six months) or palliative – 1.0 pointsTraditional interpretation
Score >6.0 – High (probability 59% based on pooled data)
Score 2.0 to 6.0 – Moderate (probability 29% based on pooled data)
Score <2.0 – Low (probability 15% based on pooled data)Alternative interpretation
Score > 4 – PE likely. Consider diagnostic imaging. Score 4 or less – PE unlikely. Consider D-dimer to rule out PE.Recommendations for a diagnostic algorithm were published by the PIOPED investigators; however, these recommendations do not reflect research using 64 slice MDCT. These investigators recommended:

Low clinical probability. If negative D-dimer, PE is excluded. If positive D-dimer, obtain MDCT and base treatment on results. Moderate clinical probability. If negative D-dimer, PE is excluded. However, the authors were not concerned that a negative MDCT with negative D-dimer in this setting has a 5% probability of being false. Presumably, the 5% error rate will fall as 64 slice MDCT is more commonly used. If positive D-dimer, obtain MDCT and base treatment on results. High clinical probability. Proceed to MDCT. If positive, treat, if negative, more tests are needed to exclude PE. A D-dimer of less than 750 ug/L does not rule out PE in those who are at high risk.
Epidemiological studies found that Dow had been adding cobalt sulfate to the beer for foam stability since July 1965 and that the concentration added in the Quebec city brewery was ten times that of the same beer brewed in Montreal where there were no reported cases. A 1972 paper noted that several dozen cases were also identified over a similar time period in Omaha, Nebraska; Minneapolis, Minnesota; and Belgium. Cobalt in the environment
Plants, animals, and humans can all be affected by high cobalt concentrations in the environment. For plants, the uptake and distribution of cobalt is entirely species-specific. In some species of plants, the overaccumulation of cobalt can lead to an iron deficiency. This in turn leads to poor growth of the plant as well as leaf loss which overall decreases the amount of oxygen produced by plants during photosynthesis. Eventually the deficiency would lead to plant death. One such example was seen in an experiment involving the effects of increased cobalt concentration on tomato plants. As the dosage of cobalt in the soil surrounding the plants increased, so too did the rate of necrosis of the leaves of the tomato plant. Over time this led to an inability of the plant to produce fruit and eventually the plant died. References


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