Novel risk calculator performance in athletes with arrhythmogenic right ventricular cardiomyopathy

Background: Disease progression and ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) are correlated with physical exercise, and clinical detraining and avoidance of competitive sport practice are suggested for ARVC patients. An algorithm assessing primary arrhythmic risk in ARVC patients was recently developed by Cadrin-Tourigny et al. Data regarding its transferability to athletes are lacking. Objective: The purpose of this study was to assess the reliability of the Cadrin-Tourigny risk prediction algorithm in a cohort of athletes with ARVC and to describe the impact of clinical detraining on disease progression. Methods: All athletes undergoing clinical detraining after ARVC diagnosis at our institution were enrolled. Baseline and follow-up clinical characteristics and data on VA events occurring during follow-up were collected. The Cadrin-Tourigny algorithm was used to calculate the a priori predicted VA risk, which was compared with the observed outcomes. Results: Twenty-five athletes (age 36.1 \ub1 14.0 years; 80% male) with definite ARVC who were undergoing clinical detraining were enrolled. Over median (interquartile range) follow-up of 5.3 (3.2\u20136.6) years, a reduction in premature ventricular complex (PVC) burden (P = .001) was assessed, and 10 VA events (40%) were recorded. The a priori algorithm-predicted risk seemed to fit with the observed cohort arrhythmic risk [mean observed\u2013predicted risk difference over 5 years \u20130.85% (interquartile range \u20134.8% to +3.1%); P = .85]. At 1-year follow-up, 11 patients (44%) had an improved stress ECG response, and no significant changes in right ventricular ejection fraction were observed. Conclusion: Clinical detraining is associated with PVC burden reduction in athletes with ARVC. The novel risk prediction algorithm does not seem to require any correction for its application to ARVC athletes

Accretion and ejection in black-hole X-ray transients

Aims: We summarize the current observational picture of the outbursts of black-hole X-ray transients (BHTs), based on the evolution traced in a hardness-luminosity diagram (HLD), and we offer a physical interpretation. Methods: The basic ingredient in our interpretation is the Poynting-Robertson Cosmic Battery (PRCB, Contopoulos & Kazanas 1998), which provides locally the poloidal magnetic field needed for the ejection of the jet. In addition, we make two assumptions, easily justifiable. The first is that the mass-accretion rate to the black hole in a BHT outburst has a generic bell-shaped form. This is guaranteed by the observational fact that all BHTs start their outburst and end it at the quiescent state. The second assumption is that at low accretion rates the accretion flow is geometrically thick, ADAF-like, while at high accretion rates it is geometrically thin. Results: Both, at the beginning and the end of an outburst, the PRCB establishes a strong poloidal magnetic field in the ADAF-like part of the accretion flow, and this explains naturally why a jet is always present in the right part of the HLD. In the left part of the HLD, the accretion flow is in the form of a thin disk, and such a disk cannot sustain a strong poloidal magnetic filed. Thus, no jet is expected in this part of the HLD. The counterclockwise traversal of the HLD is explained as follows: the poloidal magnetic field in the ADAF forces the flow to remain ADAF and the source to move upwards in the HLD rather than to turn left. Thus, the history of the system determines the counterclockwise traversal of the HLD. As a result, no BHT is expected to ever traverse the entire HLD curve in the clockwise direction. Conclusions: We offer a physical interpretation of accretion and ejection in BHTs with only one parameter, the mass transfer rate.Comment: Accepted for publication in A&

Detection of inconsistencies in geospatial data with geostatistics

Almost every researcher has come through observations that “drift” from the rest of the sample, suggesting some inconsistency. The aim of this paper is to propose a new inconsistent data detection method for continuous geospatial data based in Geostatistics, independently from the generative cause (measuring and execution errors and inherent variability data). The choice of Geostatistics is based in its ideal characteristics, as avoiding systematic errors, for example. The importance of a new inconsistent detection method proposal is in the fact that some existing methods used in geospatial data consider theoretical assumptions hardly attended. Equally, the choice of the data set is related to the importance of the LiDAR technology (Light Detection and Ranging) in the production of Digital Elevation Models (DEM). Thus, with the new methodology it was possible to detect and map discrepant data. Comparing it to a much utilized detections method, BoxPlot, the importance and functionality of the new method was verified, since the BoxPlot did not detect any data classified as discrepant. The proposed method pointed that, in average, 1,2% of the data of possible regionalized inferior outliers and, in average, 1,4% of possible regionalized superior outliers, in relation to the set of data used in the study

Modelling spectral and timing properties of accreting black holes: the hybrid hot flow paradigm

The general picture that emerged by the end of 1990s from a large set of optical and X-ray, spectral and timing data was that the X-rays are produced in the innermost hot part of the accretion flow, while the optical/infrared (OIR) emission is mainly produced by the irradiated outer thin accretion disc. Recent multiwavelength observations of Galactic black hole transients show that the situation is not so simple. Fast variability in the OIR band, OIR excesses above the thermal emission and a complicated interplay between the X-ray and the OIR light curves imply that the OIR emitting region is much more compact. One of the popular hypotheses is that the jet contributes to the OIR emission and even is responsible for the bulk of the X-rays. However, this scenario is largely ad hoc and is in contradiction with many previously established facts. Alternatively, the hot accretion flow, known to be consistent with the X-ray spectral and timing data, is also a viable candidate to produce the OIR radiation. The hot-flow scenario naturally explains the power-law like OIR spectra, fast OIR variability and its complex relation to the X-rays if the hot flow contains non-thermal electrons (even in energetically negligible quantities), which are required by the presence of the MeV tail in Cyg X-1. The presence of non-thermal electrons also lowers the equilibrium electron temperature in the hot flow model to <100 keV, making it more consistent with observations. Here we argue that any viable model should simultaneously explain a large set of spectral and timing data and show that the hybrid (thermal/non-thermal) hot flow model satisfies most of the constraints.Comment: 26 pages, 13 figures. To be published in the Space Science Reviews and as hard cover in the Space Sciences Series of ISSI - The Physics of Accretion on to Black Holes (Springer Publisher

An actively vetoed Clover gamma-detector for nuclear astrophysics at LUNA

An escape-suppressed, composite high-purity germanium detector of the Clover type has been installed at the Laboratory for Underground Nuclear Astrophysics (LUNA) facility, deep underground in the Gran Sasso Laboratory, Italy. The laboratory gamma-ray background of the Clover detector has been studied underground at LUNA and, for comparison, also in an overground laboratory. Spectra have been recorded both for the single segments and for the virtual detector formed by online addition of all four segments. The effect of the escape-suppression shield has been studied as well. Despite their generally higher intrinsic background, escape-suppressed detectors are found to be well suited for underground nuclear astrophysics studies. As an example for the advantage of using a composite detector deep underground, the weak ground state branching of the Ep = 223 keV resonance in the 24Mg(p,gamma)25Al reaction is determined with improved precision.Comment: 8 pages, 6 figures, 3 tables; as accepted by Eur. Phys. J.

Primordial Nucleosynthesis for the New Cosmology: Determining Uncertainties and Examining Concordance

Big bang nucleosynthesis (BBN) and the cosmic microwave background (CMB) have a long history together in the standard cosmology. The general concordance between the predicted and observed light element abundances provides a direct probe of the universal baryon density. Recent CMB anisotropy measurements, particularly the observations performed by the WMAP satellite, examine this concordance by independently measuring the cosmic baryon density. Key to this test of concordance is a quantitative understanding of the uncertainties in the BBN light element abundance predictions. These uncertainties are dominated by systematic errors in nuclear cross sections. We critically analyze the cross section data, producing representations that describe this data and its uncertainties, taking into account the correlations among data, and explicitly treating the systematic errors between data sets. Using these updated nuclear inputs, we compute the new BBN abundance predictions, and quantitatively examine their concordance with observations. Depending on what deuterium observations are adopted, one gets the following constraints on the baryon density: OmegaBh^2=0.0229\pm0.0013 or OmegaBh^2 = 0.0216^{+0.0020}_{-0.0021} at 68% confidence, fixing N_{\nu,eff}=3.0. Concerns over systematics in helium and lithium observations limit the confidence constraints based on this data provide. With new nuclear cross section data, light element abundance observations and the ever increasing resolution of the CMB anisotropy, tighter constraints can be placed on nuclear and particle astrophysics. ABRIDGEDComment: 54 pages, 20 figures, 5 tables v2: reflects PRD version minor changes to text and reference

Dexamethasone intravitreal implant in previously treated patients with diabetic macular edema : Subgroup analysis of the MEAD study

Background: Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Methods: Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34.68 Early Treatment Diabetic Retinopathy Study letters (20/200.20/50 Snellen equivalent), and central retinal thickness (CRT) 65300 \u3bcm measured by time-domain optical coherence tomography. Patients were randomized to 1 of 2 doses of DEX (0.7 mg or 0.35 mg), or to sham procedure, with retreatment no more than every 6 months. The primary endpoint was 6515-letter gain in BCVA at study end. Average change in BCVA and CRT from baseline during the study (area-under-the-curve approach) and adverse events were also evaluated. The present subgroup analysis evaluated outcomes in patients randomized to DEX 0.7 (marketed dose) or sham based on prior treatment for DME at study entry. Results: Baseline characteristics of previously treated DEX 0.7 (n = 247) and sham (n=261) patients were similar. In the previously treated subgroup, mean number of treatments over 3 years was 4.1 for DEX 0.7 and 3.2 for sham, 21.5 % of DEX 0.7 patients versus 11.1 % of sham had 6515-letter BCVA gain from baseline at study end (P = 0.002), mean average BCVA change from baseline was +3.2 letters with DEX 0.7 versus +1.5 letters with sham (P = 0.024), and mean average CRT change from baseline was -126.1 \u3bcm with DEX 0.7 versus -39.0 \u3bcm with sham(P < 0.001). Cataract-related adverse events were reported in 70.3 % of baseline phakic patients in the previously treated DEX 0.7 subgroup; vision gains were restored following cataract surgery. Conclusions: DEX 0.7 significantly improved visual and anatomic outcomes in patients with DME previously treated with laser, intravitreal anti-vascular endothelial growth factor, intravitreal triamcinolone acetonide, or a combination of these therapies. The safety profile of DEX 0.7 in previously treated patients was similar to its safety profile in the total study population