Initialization and Simulation of Three-Dimensional Aircraft Wake Vortices

This paper studies the effects of axial velocity profiles on vortex decay, in order to properly initialize and simulate three-dimensional wake vortex flow. Analytical relationships are obtained based on a single vortex model and computational simulations are performed for a rather practical vortex wake, which show that the single vortex analytical relations can still be applicable at certain streamwise sections of three-dimensional wake vortices

POTENTIAL MARKET IMPACTS OF SOYBEAN RUST

Crop Production/Industries,

Karhunen-Lo\`eve expansion for a generalization of Wiener bridge

We derive a Karhunen-Lo\`eve expansion of the Gauss process $B_t - g(t)\int_0^1 g'(u)\,d B_u$, $t\in[0,1]$, where $(B_t)_{t\in[0,1]}$ is a standard Wiener process and $g:[0,1]\to R$ is a twice continuously differentiable function with $g(0) = 0$ and $\int_0^1 (g'(u))^2\,d u =1$. This process is an important limit process in the theory of goodness-of-fit tests. We formulate two special cases with the function $g(t)=\frac{\sqrt{2}}{\pi}\sin(\pi t)$, $t\in[0,1]$, and $g(t)=t$, $t\in[0,1]$, respectively. The latter one corresponds to the Wiener bridge over $[0,1]$ from $0$ to $0$.Comment: 25 pages, 1 figure. The appendix is extende

Ventricular Tachyarrhythmia Detection by Implantable Loop Recording in Patients with Heart Failure and Preserved Ejection Fraction:The VIP-HF study

Aims: The primary aim of the VIP-HF study was to examine the incidence of sustained ventricular tachyarrhythmias (VTs) in heart failure (HF) with mid-range (HFmrEF) or preserved ejection fraction (HFpEF). Secondary aims were to examine the incidence of non-sustained VTs, bradyarrhythmias, HF hospitalizations and mortality. Methods and results: This was an investigator-initiated, prospective, multicentre, observational study of patients with HF and left ventricular ejection fraction (LVEF) >40%. Patients underwent extensive phenotyping, after which an implantable loop recorder was implanted. We enrolled 113 of the planned 250 patients [mean age 73 ± 8 years, 51% women, New York Heart Association class II/III 54%/46%, median N-terminal pro B-type natriuretic peptide 1367 (710–2452) pg/mL and mean LVEF 54 ± 6%; 75% had LVEF >50%]. Eighteen percent had non-sustained VTs and 37% had atrial fibrillation on Holter monitoring. During a median follow-up of 657 (219–748) days, the primary endpoint of sustained VT was observed in one patient. The incidence of the primary endpoint was 0.6 (95% confidence interval 0.2–3.5) per 100 person-years. The incidence of the secondary endpoint of non-sustained VT was 11.5 (7.1–18.7) per 100 person-years. Five patients developed bradyarrhythmias [3.2 (1.4–7.5) per 100 person-years], three were implanted with a pacemaker. In total, 23 patients (20%) were hospitalized for HF [16.3 (10.9–24.4) per 100 person-years]. Fourteen patients (12%) died [8.7 (5.2–14.7) per 100 person-years]; 10 due to cardiovascular causes, and four sudden deaths, one with implantable loop recorder-confirmed bradyarrhythmias as terminal event, three others undetermined. Conclusion: Despite the lower than expected number of included patients, the incidence of sustained VTs in HFmrEF/HFpEF was low. Clinically relevant bradyarrhythmias were more often observed than expected

Hypertension management in patients with diabetes. The need for more aggressive therapy

WSTĘP. W dużych badaniach klinicznych wykazano już potrzebę ścisłej kontroli ciśnienia tętniczego u chorych na cukrzycę. Jednak niewiele wiadomo o tym, jak w praktyce klinicznej realizowane są zasady leczenia nadciśnienia tętniczego współistniejącego z cukrzycą. W celu zbadania tego problemu postawiono pytania: 1) czy chorzy na cukrzycę osiągają niższe wartości ciśnienia tętniczego niż osoby bez współistniejącej cukrzycy; 2) czy istnieją różnice między intensywnością leczenia chorych na cukrzycę i chorych bez niej oraz 3) czy leczenie cukrzycy wpływa na podjęcie decyzji o bardziej intensywnym leczeniu nadciśnienia tętniczego. MATERIAŁ I METODY. W celu uzyskania szczegółów dotyczących postępowania w nadciśnieniu tętniczym zgromadzono dokumentację medyczną z 2-letniego okresu leczenia 800 mężczyzn, kombatantów, leczonych z powodu nadciśnienia tętniczego. Porównano intensywność leczenia i kontrolę ciśnienia tętniczego u chorych na cukrzycę i u osób bez niej. Intensywność leczenia oceniono na podstawie wcześniej stosowanej formuły opisującej prawdopodobieństwo wzrostu liczby stosowanych leków hipotensyjnych. Oceniano również, czy zwiększenie dawek leków przeciwnadciśnieniowych było mniej prawdopodobne w czasie wizyt, na których zmieniano leczenie hipoglikemizujące. WYNIKI. Z 247 chorych na nadciśnienie tętnicze i cukrzycę u 73% ciśnienie tętnicze przekraczało 140/90 mm Hg, w porównaniu z 66% osób z 526-osobowej grupy bez cukrzycy (p = 0,04). U osób chorych na cukrzycę stosowano również znamiennie (p = 0,05) mniej intensywne leczenie hipotensyjne niż u pacjentów bez tego schorzenia. Postępowania tego nie można tłumaczyć poświęceniem większej uwagi klinicystów leczeniu cukrzycy. WNIOSKI. Istnieje potrzeba szybkiej poprawy skuteczności leczenia i lepszej kontroli ciśnienia wśród chorych na cukrzycę z współistniejącym nadciśnieniem tętniczym. Konieczne są dodatkowe dane w celu zrozumienia mało agresywnej postawy klinicystów w leczeniu nadciśnienia tętniczego współistniejącego z cukrzycą.INTRODUCTION. Clinical trials have demonstrated the importance of tight blood pressure control among patients with diabetes. However, little is known regarding the management of hypertension in patients with coexisting diabetes. To examine this issue, we addressed 1) whether hypertensive patients with coexisting diabetes are achieving lower levels of blood pressure than patients without diabetes, 2) whether there are differences in the intensity of antihypertensive medication therapy provided to patients with and without diabetes, and 3) whether diabetes management affects decisions to increase antihypertensive medication therapy. MATERIAL AND METHODS. We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted. RESULTS. Of the 274 hypertensive patients with diabetes, 73% had a blood pressure 140/90 mm Hg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes. CONCLUSIONS. There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes

Energy minimization and AC demagnetization in a nanomagnet array

We study AC demagnetization in frustrated arrays of single-domain ferromagnetic islands, exhaustively resolving every (Ising-like) magnetic degree of freedom in the systems. Although the net moment of the arrays is brought near zero by a protocol with sufficiently small step size, the final magnetostatic energy of the demagnetized array continues to decrease for finer-stepped protocols and does not extrapolate to the ground state energy. The resulting complex disordered magnetic state can be described by a maximum-entropy ensemble constrained to satisfy just nearest-neighbor correlations.Comment: Published Versio

Identification of genes expressed by immune cells of the colon that are regulated by colorectal cancer-associated variants.

A locus on human chromosome 11q23 tagged by marker rs3802842 was associated with colorectal cancer (CRC) in a genome-wide association study; this finding has been replicated in case-control studies worldwide. In order to identify biologic factors at this locus that are related to the etiopathology of CRC, we used microarray-based target selection methods, coupled to next-generation sequencing, to study 103 kb at the 11q23 locus. We genotyped 369 putative variants from 1,030 patients with CRC (cases) and 1,061 individuals without CRC (controls) from the Ontario Familial Colorectal Cancer Registry. Two previously uncharacterized genes, COLCA1 and COLCA2, were found to be co-regulated genes that are transcribed from opposite strands. Expression levels of COLCA1 and COLCA2 transcripts correlate with rs3802842 genotypes. In colon tissues, COLCA1 co-localizes with crystalloid granules of eosinophils and granular organelles of mast cells, neutrophils, macrophages, dendritic cells and differentiated myeloid-derived cell lines. COLCA2 is present in the cytoplasm of normal epithelial, immune and other cell lineages, as well as tumor cells. Tissue microarray analysis demonstrates the association of rs3802842 with lymphocyte density in the lamina propria (p = 0.014) and levels of COLCA1 in the lamina propria (p = 0.00016) and COLCA2 (tumor cells, p = 0.0041 and lamina propria, p = 6 × 10(-5)). In conclusion, genetic, expression and immunohistochemical data implicate COLCA1 and COLCA2 in the pathogenesis of colon cancer. Histologic analyses indicate the involvement of immune pathways

In-hospital Depression Predicts Early Hospital Readmission after an Acute Coronary Syndrome: Preliminary Data from TRACE-CORE

Background: Hospital systems, patients and providers seek to avert rehospitalizations within 30 days for patients admitted with an acute coronary syndrome (ACS). Rehospitalizations within 30 days of discharge are often considered preventable and to reflect poor in-hospital management or discharge practices. However, independent associations of psychosocial factors with early rehospitalization in patients admitted with an ACS have not been examined. Methods: A multi-racial cohort of 1,540 patients admitted with an ACS reported psychosocial factors via standardized questionnaires in an in-hospital interview. One month following discharge, patients were interviewed via phone and reported hospital readmissions. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between in-hospital psychosocial characteristics (depression, anxiety, and perceived stress), health literacy and numeracy, and cognitive status, with self-reported readmission within 30 days. Results: Participants were 34% female and 17% non-white, with a mean age of 62 years and a mean length of stay of 4.1 days. Rehospitalization was reported for 14% (n=208) of participants, 77% of which were due to CVD. In univariate analyses, in-hospital severe depression, anxiety, and high stress were associated with higher odds of early readmission, whereas low health numeracy was associated with lower odds of early readmission. Severe depression remained associated with higher odds and low health numeracy remained associated with lower odds of early readmission in a multivariable model including covariates associated on univariate testing with rehospitalization. Conclusions: Early readmission after hospitalization for an ACS was common and associated with in-hospital depression and health numeracy. Notably, depression and health numeracy were the only predictors independently associated with readmission in multivariable analyses. We speculate that the lower likelihood of readmission for those with low numeracy may be related to less engagement with the healthcare system. In-hospital screening for depression and characterization of health numeracy may help stratify risk for early rehospitalization after an ACS

A Cluster Randomized Clinical Trial to Improve Prescribing Patterns in Ambulatory Pediatrics

Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.Cluster randomized controlled trial.A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.The proportion of prescriptions dispensed in accordance with evidence.The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices