A Galerkin boundary element method for high frequency scattering by convex polygons

In this paper we consider the problem of time-harmonic acoustic scattering in two dimensions by convex polygons. Standard boundary or finite element methods for acoustic scattering problems have a computational cost that grows at least linearly as a function of the frequency of the incident wave. Here we present a novel Galerkin boundary element method, which uses an approximation space consisting of the products of plane waves with piecewise polynomials supported on a graded mesh, with smaller elements closer to the corners of the polygon. We prove that the best approximation from the approximation space requires a number of degrees of freedom to achieve a prescribed level of accuracy that grows only logarithmically as a function of the frequency. Numerical results demonstrate the same logarithmic dependence on the frequency for the Galerkin method solution. Our boundary element method is a discretization of a well-known second kind combined-layer-potential integral equation. We provide a proof that this equation and its adjoint are well-posed and equivalent to the boundary value problem in a Sobolev space setting for general Lipschitz domains

Glenoid Dysplasia: Radiographic, Direct MR Arthrographic and Arthroscopic Appearances

AbstractGlenoid dysplasia is an uncommon developmental abnormality of the scapula that is frequently overlooked. We report a case of severe glenoid dysplasia in a 55 year old man and demonstrate its radiographic, direct MR arthrographic and arthroscopic appearances

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom durationmodel, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration \u3e270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration \u3c6 \u3eh. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification

Endothelin stimulates PDGF secretion in cultured human mesangial cells

Endothelin stimulates PDGF secretion in cultured human mesangial cells. Endothelin, a 17-DKa peptide originally described as a potent vasoconstrictor, also stimulates the release of important regulators of glomerular hemodynamics such as atrial natriuretic factor and renin. In the present study we investigated the role of endothelin in the release of another potent vasoconstrictor and mitogen of human mesangial cells, the platelet-derived growth factor. Endothelin stimulated PDGF release at 12 hours and the effect was sustained for 36 hours. This effect was associated with the enhanced induction of mRNAs encoding PDGF A-and B-chain. Endothelin also induced mitogenesis in human mesangial cells which was accompanied by activation of phospholipase C with increased inositol phosphate turnover. These data suggest a mechanism by which endothelin may regulate mesangial cell function in disease states

Can You Solve Closest String Faster than Exhaustive Search?

We study the fundamental problem of finding the best string to represent a given set, in the form of the Closest String problem: Given a set $X \subseteq \Sigma^d$ of $n$ strings, find the string $x^*$ minimizing the radius of the smallest Hamming ball around $x^*$ that encloses all the strings in $X$. In this paper, we investigate whether the Closest String problem admits algorithms that are faster than the trivial exhaustive search algorithm. We obtain the following results for the two natural versions of the problem: $\bullet$ In the continuous Closest String problem, the goal is to find the solution string $x^*$ anywhere in $\Sigma^d$. For binary strings, the exhaustive search algorithm runs in time $O(2^d poly(nd))$ and we prove that it cannot be improved to time $O(2^{(1-\epsilon) d} poly(nd))$, for any $\epsilon > 0$, unless the Strong Exponential Time Hypothesis fails. $\bullet$ In the discrete Closest String problem, $x^*$ is required to be in the input set $X$. While this problem is clearly in polynomial time, its fine-grained complexity has been pinpointed to be quadratic time $n^{2 \pm o(1)}$ whenever the dimension is $\omega(\log n) < d < n^{o(1)}$. We complement this known hardness result with new algorithms, proving essentially that whenever $d$ falls out of this hard range, the discrete Closest String problem can be solved faster than exhaustive search. In the small-$d$ regime, our algorithm is based on a novel application of the inclusion-exclusion principle. Interestingly, all of our results apply (and some are even stronger) to the natural dual of the Closest String problem, called the Remotest String problem, where the task is to find a string maximizing the Hamming distance to all the strings in $X$

A Survey of Expert Opinion Regarding Rotator Cuff Repair.

Many patients with rotator cuff tears have questions for their surgeons regarding the surgical procedure, perioperative management, restrictions, therapy, and ability to work after a rotator cuff repair. The purpose of our study was to determine common clinical practices among experts regarding rotator cuff repair and to assist them in counseling patients. We surveyed 372 members of the American Shoulder and Elbow Surgeons (ASES) and the Association of Clinical Elbow and Shoulder Surgeons (ACESS); 111 members (29.8%) completed all or part of the survey, and 92.8% of the respondents answered every question. A consensus response (\u3e50% agreement) was achieved on 49% (24 of 49) of the questions. Variability in responses likely reflects the fact that clinical practices have evolved over time based on clinical experience

On Complexity of 1-Center in Various Metrics

We consider the classic 1-center problem: Given a set P of n points in a metric space find the point in P that minimizes the maximum distance to the other points of P. We study the complexity of this problem in d-dimensional $\ell_p$-metrics and in edit and Ulam metrics over strings of length d. Our results for the 1-center problem may be classified based on d as follows. $\bullet$ Small d: We provide the first linear-time algorithm for 1-center problem in fixed-dimensional $\ell_1$ metrics. On the other hand, assuming the hitting set conjecture (HSC), we show that when $d=\omega(\log n)$, no subquadratic algorithm can solve 1-center problem in any of the $\ell_p$-metrics, or in edit or Ulam metrics. $\bullet$ Large d. When $d=\Omega(n)$, we extend our conditional lower bound to rule out sub quartic algorithms for 1-center problem in edit metric (assuming Quantified SETH). On the other hand, we give a $(1+\epsilon)$-approximation for 1-center in Ulam metric with running time $\tilde{O_{\epsilon}}(nd+n^2\sqrt{d})$. We also strengthen some of the above lower bounds by allowing approximations or by reducing the dimension d, but only against a weaker class of algorithms which list all requisite solutions. Moreover, we extend one of our hardness results to rule out subquartic algorithms for the well-studied 1-median problem in the edit metric, where given a set of n strings each of length n, the goal is to find a string in the set that minimizes the sum of the edit distances to the rest of the strings in the set

Pharmacokinetics of epinephrine in patients with septic shock: modelization and interaction with endogenous neurohormonal status

Introduction In septic patients, an unpredictable response to epinephrine may be due to pharmacodynamic factors or to non-linear pharmacokinetics. The purpose of this study was to investigate the pharmacokinetics of epinephrine and its determinants in patients with septic shock. Methods Thirty-eight consecutive adult patients with septic shock were prospectively recruited immediately before epinephrine infusion. A baseline blood sample (C0) was taken to assess endogenous epinephrine, norepinephrine, renin, aldosterone, and plasma cortisol levels before epinephrine infusion. At a fixed cumulative epinephrine dose adjusted to body weight and under steady-state infusion, a second blood sample (C1) was taken to assess epinephrine and norepinephrine concentrations. Data were analyzed using the nonlinear mixed effect modeling software program NONMEM. Results Plasma epinephrine concentrations ranged from 4.4 to 540 nmol/L at steady-state infusion (range 0.1 to 7 mg/hr; 0.026 to 1.67 μg/kg/min). A one-compartment model adequately described the data. Only body weight (BW) and New Simplified Acute Physiologic Score (SAPSII) at intensive care unit admission significantly influenced epinephrine clearance: CL (L/hr) = 127 × (BW/70)0.60 × (SAPS II/50)-0.67. The corresponding half-life was 3.5 minutes. Endogenous norepinephrine plasma concentration significantly decreased during epinephrine infusion (median (range) 8.8 (1 – 56.7) at C0 vs. 4.5 (0.3 – 38.9) nmol/L at C1, P &lt; 0.001). Conclusions Epinephrine pharmacokinetics is linear in septic shock patients, without any saturation at high doses. Basal neurohormonal status does not influence epinephrine pharmacokinetics. Exogenous epinephrine may alter the endogenous norepinephrine metabolism in septic patients