Evidence for polar jets as precursors of polar plume formation

Observations from the Hinode/XRT telescope and STEREO/SECCHI/EUVI are utilized to study polar coronal jets and plumes. The study focuses on the temporal evolution of both structures and their relationship. The data sample, spanning April 7-8 2007, shows that over 90% of the 28 observed jet events are associated with polar plumes. EUV images (STEREO/SECCHI) show plume haze rising from the location of approximately 70% of the polar X-ray (Hinode/XRT) and EUV jets, with the plume haze appearing minutes to hours after the jet was observed. The remaining jets occurred in areas where plume material previously existed causing a brightness enhancement of the latter after the jet event. Short-lived, jet-like events and small transient bright points are seen (one at a time) at different locations within the base of pre-existing long-lived plumes. X-ray images also show instances (at least two events) of collimated-thin jets rapidly evolving into significantly wider plume-like structures that are followed by the delayed appearance of plume haze in the EUV. These observations provide evidence that X-ray jets are precursors of polar plumes, and in some cases cause brightenings of plumes. Possible mechanisms to explain the observed jet and plume relationship are discussed.Comment: 10 pages, 4 figures, accepted as APJ Lette

Auxiliary field diffusion Monte Carlo calculations of light and medium-mass nuclei with local chiral interactions

Quantum Monte Carlo methods have recently been employed to study properties of nuclei and infinite matter using local chiral effective field theory interactions. In this work, we present a detailed description of the auxiliary field diffusion Monte Carlo algorithm for nuclei in combination with local chiral two- and three-nucleon interactions up to next-to-next-to-leading order. We show results for the binding energy, charge radius, charge form factor, and Coulomb sum rule in nuclei with $3\le A\le16$. Particular attention is devoted to the effect of different operator structures in the three-body force for different cutoffs. The outcomes suggest that local chiral interactions fit to few-body observables give a very good description of the ground-state properties of nuclei up to $^{16}$O, with the exception of one fit for the softer cutoff which predicts overbinding in larger nuclei.Comment: 23 pages, 10 figure

Association is not causation: treatment effects cannot be estimated from observational data in heart failure

Aims: Treatment ‘effects’ are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). Methods and results: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the ‘effect’ of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. Conclusion: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients

Peripartum cardiomyopathy: diagnosis and management

No abstract available

Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system

OBJECTIVES: There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY). SETTING: We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention). PARTICIPANTS: Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system. RESULTS: Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1–2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50 000, cost per CPC 1–2 survivor was £65 000. Cost and length of stay of CPC 1–2 patients was considerably lower than CPC 3–4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1–2 survivor per QALY was £16 000. CONCLUSIONS: The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective

Down‐regulation of key genes involved in carbon metabolism in Medicago truncatula results in increased lipid accumulation in vegetative tissue

Alfalfa (Medicago sativa L.), is the most widely grown perennial forage crop, which is a close relative of the model diploid legume Medicago truncatula. However, use of alfalfa lead to substantial greenhouse gas emissions and economic losses related to inefficiencies in rumen fermentation. The provision of supplemental lipids has been used as a strategy to mitigate these issues, but it is a costly approach. The ability to enhance lipid content within the vegetative tissues of alfalfa would therefore be very advantageous. As such, our aim was to assess and select gene candidates to increase total shoot lipid content in M. truncatula using a virus‐induced gene silencing (VIGS) approach. We targeted gene homologs of the SUGAR‐DEPENDANT 1 (SDP1), ADP‐GLUCOSE‐PYROPHOSPHORYLASE SMALL SUBUNIT 1 (APS1), TRIGALACTOSYLDIACYLGLYCEROL 5 (TGD5) and PEROXISOMAL ABC TRANSPORTER 1 (PXA1) in M. truncatula for silencing. Reduced target transcript levels were confirmed and changes of shoot lipid content and fatty acid composition were measured. Silencing of SDP1, APS1 and PXA1 each resulted in significant increases in shoot total lipid content. Significantly increased proportions of α‐linolenic acid (18:3Δ9cis,12cis,15cis) were observed and stearic acid (18:0) levels significantly decreased in the total acyl lipids extracted from vegetative tissues of each of the M. truncatula silenced plants. In contrast, palmitic acid (16:0) levels were significantly decreased in only SDP1 and PXA1‐silenced plants. Genes of PXA1 and SDP1 would be ideal targets for mutation as a means of improving the quality of alfalfa for increasing feed efficiency and minimizing greenhouse gas emissions from livestock production in the future

Cardiovascular magnetic resonance activity in the United Kingdom: a survey on behalf of the british society of cardiovascular magnetic resonance

<p>Background: The indications, complexity and capabilities of cardiovascular magnetic resonance (CMR) have rapidly expanded. Whether actual service provision and training have developed in parallel is unknown.</p> <p>Methods: We undertook a systematic telephone and postal survey of all public hospitals on behalf of the British Society of Cardiovascular Magnetic Resonance to identify all CMR providers within the United Kingdom.</p> <p>Results: Of the 60 CMR centres identified, 88% responded to a detailed questionnaire. Services are led by cardiologists and radiologists in equal proportion, though the majority of current trainees are cardiologists. The mean number of CMR scans performed annually per centre increased by 44% over two years. This trend was consistent across centres of different scanning volumes. The commonest indication for CMR was assessment of heart failure and cardiomyopathy (39%), followed by coronary artery disease and congenital heart disease. There was striking geographical variation in CMR availability, numbers of scans performed, and distribution of trainees. Centres without on site scanning capability refer very few patients for CMR. Just over half of centres had a formal training programme, and few performed regular audit.</p> <p>Conclusion: The number of CMR scans performed in the UK has increased dramatically in just two years. Trainees are mainly located in large volume centres and enrolled in cardiology as opposed to radiology training programmes.</p&gt

The Long Period, Massive Binaries HD 37366 and HD 54662: Potential Targets for Long Baseline Optical Interferometry

We present the results from an optical spectroscopic analysis of the massive stars HD 37366 and HD 54662. We find that HD 37366 is a double-lined spectroscopic binary with a period of 31.8187 +/- 0.0004 days, and HD 54662 is also a double lined binary with a much longer period of 557.8 +/- 0.3 days. The primary of HD 37366 is classified as O9.5 V, and it contributes approximately two-thirds of the optical flux. The less luminous secondary is a broad-lined, early B-type main-sequence star. Tomographic reconstruction of the individual spectra of HD 37366 reveals absorption lines present in each component, enabling us to constrain the nature of the secondary and physical characteristics of both stars. Tomographic reconstruction was not possible for HD 54662; however, we do present mean spectra from our observations that show that the secondary component is approximately half as bright as the primary. The observed spectral energy distributions (SEDs) were fit with model SEDs and galactic reddening curves to determine the angular sizes of the stars. By assuming radii appropriate for their classifications, we determine distance ranges of 1.4 - 1.9 and 1.2 - 1.5 kpc for HD 37366 and HD 54662, respectively.Comment: 27 pages, 8 figures, Accepted for publication in Ap

Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design

Abstract Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF