Long-term outcomes of a randomized clinical trial of supervised exercise, percutaneous transluminal angioplasty or combined treatment for patients with intermittent claudication due to femoropopliteal disease

Background: To compare the long-term outcomes of angioplasty (PTA), supervised exercise (SEP) and combined treatment (PTA+SEP) in patients with intermittent claudication (IC) due to femoropopliteal disease. Methods: Patients recruited to PTA, SEP and PTA+SEP arms of RCT were invited for long-term follow-up from 2010 to 2011.Indicators of limb ischaemia were recorded (ankle-brachial pressure indices, treadmill walking distances (ICD, MWD, PRWD). Duplex ultrasound was also performed. Patients completed SF36 and Vascuqol quality of life(QOL) questionnaires. Results: Of the 178 patients recruited in the trial, 139 were alive at the time of follow-up (PTA=46, SEP=47, PTA+SEP=46). Assessments were completed for 111 patients. Median time to follow-up was 5.2years (IQR 3.8-7.4years). Median age of patients at follow up was 75years. 62.2%(N=69) of patients were symptomatic.16.2%(N= 18) had experienced major cardiovascular event since their last follow-up visit. Intra-group analysis: Improvement was observed in ankle brachial pressure index (ABPI) in all groups. QOL outcomes were inconsistent across individual groups. Inter-group analysis: PTA and PTA+SEP groups demonstrated a significantly higher ABPI as compared to SEP group. No significant difference was observed in walking distances, QOL outcomes, restenosis rates, and new ipsilateral and contralateral lesions on duplex scan. Patients required re-interventions in all group (PTA=14, SEP=10, PTA+SEP=6). Number of re-interventions was higher in PTA group(N=29) as compared to SEP(N=17) and PTA+SEP(N=9) but failed to reach statistical significance. Conclusion: PTA, SEP and combined treatment are equally effective long-term treatment options for patients with femoropopliteal claudication. Addition of SEP to PTA can reduce the symptomatic restenosis and re-intervention rates

Duration of Posttraumatic Amnesia Predicts Neuropsychological and Global Outcome in Complicated Mild Traumatic Brain Injury.

OBJECTIVES: Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI). PARTICIPANTS: A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging. METHODS: Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months. MEASURES: Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury. RESULTS: Despite all having a Glasgow Coma Scale Score of 13 to 15, a quarter of the sample had a PTA duration of greater than 7 days; half had PTA duration of 1 of 7 days. Both cognitive performance and Extended Glasgow Outcome Scale outcomes were strongly associated with time since injury and PTA duration, with those with PTA duration of greater than 1 week showing residual moderate disability at 6-month assessment. CONCLUSIONS: Findings reinforce importance of careful measurement of duration of PTA to refine outcome prediction and allocation of resources to those with cmTBI. Future research would benefit from standardization in computed tomographic criteria and use of severity indices beyond Glasgow Coma Scale to characterize cmTBI

Percutaneous transluminal angioplasty in patients with peripheral arterial disease does not affect circulating monocyte subpopulations

Monocytes are mononuclear cells characterized by distinct morphology and expression of CD14 and CD16 surface receptors. Classical, quiescent monocytes are positive for CD14 (lipopolysaccharide receptor) but do not express Fc gamma receptor III (CD16). Intermediate monocytes coexpress CD16 and CD14. Nonclassical monocytes with low expression of CD14 represent mature macrophage-like monocytes. Monocyte behavior in peripheral arterial disease (PAD) and during vessel wall directed treatment is not well defined. This observation study aimed at monitoring of acute changes in monocyte subpopulations during percutaneous transluminal angioplasty (PTA) in PAD patients. Patients with Rutherford 3 and 4 PAD with no signs of inflammatory process underwent PTA of iliac, femoral, or popliteal segments. Flow cytometry for CD14, CD16, HLA-DR, CD11b, CD11c, and CD45RA antigens allowed characterization of monocyte subpopulations in blood sampled before and after PTA (direct angioplasty catheter sampling). Patients were clinically followed up for 12 months. All 61 enrolled patients completed 12-month follow-up. Target vessel failure occurred in 12 patients. While absolute counts of monocyte were significantly lower after PTA, only subtle monocyte activation after PTA (CD45RA and β-integrins) occurred. None of the monocyte parameters correlated with long-term adverse clinical outcome. Changes in absolute monocyte counts and subtle changes towards an activation phenotype after PTA may reflect local cell adhesion phenomenon in patients with Rutherford 3 or 4 peripheral arterial disease

Placing limits on the stochastic gravitational-wave background using European Pulsar Timing Array data

Direct detection of low-frequency gravitational waves ($10^{-9} - 10^{-8}$ Hz) is the main goal of pulsar timing array (PTA) projects. One of the main targets for the PTAs is to measure the stochastic background of gravitational waves (GWB) whose characteristic strain is expected to approximately follow a power-law of the form $h_c(f)=A (f/\hbox{yr}^{-1})^{\alpha}$, where $f$ is the gravitational-wave frequency. In this paper we use the current data from the European PTA to determine an upper limit on the GWB amplitude $A$ as a function of the unknown spectral slope $\alpha$ with a Bayesian algorithm, by modelling the GWB as a random Gaussian process. For the case $\alpha=-2/3$, which is expected if the GWB is produced by supermassive black-hole binaries, we obtain a 95% confidence upper limit on $A$ of $6\times 10^{-15}$, which is 1.8 times lower than the 95% confidence GWB limit obtained by the Parkes PTA in 2006. Our approach to the data analysis incorporates the multi-telescope nature of the European PTA and thus can serve as a useful template for future intercontinental PTA collaborations.Comment: 14 pages, 8 figures, 3 tables, mnras accepte

Preferential Trade Agreements: Endogenous Response of the Third Country

In most of the current debate on regionalism versus multilateralism, the countries excluded from a Preferential Trading Agreement (PTA) are assumed to be passive players with exogenously fixed trade policies. In reality however, non-members do react to the creation of a trading bloc and relaxing this assumption can provide useful insights. Using a political economy model, this paper explore the case where those excluded countries can adjust their commercial policies in order to minimize the negative effects of the PTA. It is shown that the creation of a PTA can lead the excluded countries to increase their trade barriers with respect to the PTA members.Political Economy

Optimizing Pulsar Timing Arrays to Maximize Gravitational Wave Single Source Detection: a First Cut

Pulsar Timing Arrays (PTAs) use high accuracy timing of a collection of low timing noise pulsars to search for gravitational waves in the microhertz to nanohertz frequency band. The sensitivity of such a PTA depends on (a) the direction of the gravitational wave source, (b) the timing accuracy of the pulsars in the array and (c) how the available observing time is allocated among those pulsars. Here, we present a simple way to calculate the sensitivity of the PTA as a function of direction of a single GW source, based only on the location and root-mean-square residual of the pulsars in the array. We use this calculation to suggest future strategies for the current North American Nanohertz Observatory for Gravitational Waves (NANOGrav) PTA in its goal of detecting single GW sources. We also investigate the affects of an additional pulsar on the array sensitivity, with the goal of suggesting where PTA pulsar searches might be best directed. We demonstrate that, in the case of single GW sources, if we are interested in maximizing the volume of space to which PTAs are sensitive, there exists a slight advantage to finding a new pulsar near where the array is already most sensitive. Further, the study suggests that more observing time should be dedicated to the already low noise pulsars in order to have the greatest positive effect on the PTA sensitivity. We have made a web-based sensitivity mapping tool available at http://gwastro.psu.edu/ptasm.Comment: 14 pages, 3 figures, accepted by Ap

Outfitting a Born-Digital Archives Program

Archival repositories that intend to develop programmatic solutions for managing and preserving born-digital holdings will need to establish a dedicated computer workstation (and related devices) to support responsible capture, transfer, appraisal, and preservation steps. This brief examination provides baseline recommendations for implementing and equipping a dedicated Windows-based PC workstation