4,815 research outputs found

    Increasing vertical mixing to reduce Southern Ocean deep convection in NEMO3.4

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    Most CMIP5 (Coupled Model Intercomparison Project Phase 5) models unrealistically form Antarctic Bottom Water by open ocean deep convection in the Weddell and Ross seas. To identify the mechanisms triggering Southern Ocean deep convection in models, we perform sensitivity experiments on the ocean model NEMO3.4 forced by prescribed atmospheric fluxes. We vary the vertical velocity scale of the Langmuir turbulence, the fraction of turbulent kinetic energy transferred below the mixed layer, and the background diffusivity and run short simulations from 1980. All experiments exhibit deep convection in the Riiser-Larsen Sea in 1987; the origin is a positive sea ice anomaly in 1985, causing a shallow anomaly in mixed layer depth, hence anomalously warm surface waters and subsequent polynya opening. Modifying the vertical mixing impacts both the climatological state and the associated surface anomalies. The experiments with enhanced mixing exhibit colder surface waters and reduced deep convection. The experiments with decreased mixing give warmer surface waters, open larger polynyas causing more saline surface waters and have deep convection across the Weddell Sea until the simulations end. Extended experiments reveal an increase in the Drake Passage transport of 4 Sv each year deep convection occurs, leading to an unrealistically large transport at the end of the simulation. North Atlantic deep convection is not significantly affected by the changes in mixing parameters. As new climate model overflow parameterisations are developed to form Antarctic Bottom Water more realistically, we argue that models would benefit from stopping Southern Ocean deep convection, for example by increasing their vertical mixing

    Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.

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    Oral anticoagulation prevents ischemic strokes in patients with atrial fibrillation (AF). Early detection of AF and subsequent initiation of oral anticoagulation help to prevent strokes in AF patients. Implanted cardiac pacemakers and defibrillators allow seamless detection of atrial high rate episodes (AHRE), but the best antithrombotic therapy in patients with AHRE is not known. RATIONALE: Stroke risk is higher in pacemaker patients with AHRE than in those without, but the available data also show that stroke risk in patients with AHRE is lower than in patients with AF. Furthermore, only a minority of patients with AHRE will develop AF, many strokes occur without a temporal relation to AHRE, and AHRE can reflect other arrhythmias than AF or artifacts. An adequately powered controlled trial of oral anticoagulation in patients with AHRE is needed. DESIGN: The Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6 ) trial tests whether oral anticoagulation with edoxaban is superior to prevent the primary efficacy outcome of stroke or cardiovascular death compared with aspirin or no antithrombotic therapy based on evidence-based indications. The primary safety outcome will be major bleeding. NOAH-AFNET 6 will randomize 3,400 patients with AHRE, but without documented AF, aged ≥65 years with at least 1 other stroke risk factor, to oral anticoagulation therapy (edoxaban) or no anticoagulation. All patients will be followed until the end of this investigator-driven, prospective, parallel-group, randomized, event-driven, double-blind, multicenter phase IIIb trial. Patients will be censored when they develop AF and offered open-label anticoagulation. The sponsor is the Atrial Fibrillation NETwork (AFNET). The trial is supported by the DZHK (German Centre for Cardiovascular Research), the BMBF (German Ministry of Education and Research), and Daiichi Sankyo Europe. CONCLUSION: NOAH-AFNET 6 will provide robust information on the effect of oral anticoagulation in patients with atrial high rate episodes detected by implanted devices

    Centre selection for clinical trials and the generalisability of results: a mixed methods study.

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    BACKGROUND: The rationale for centre selection in randomised controlled trials (RCTs) is often unclear but may have important implications for the generalisability of trial results. The aims of this study were to evaluate the factors which currently influence centre selection in RCTs and consider how generalisability considerations inform current and optimal practice. METHODS AND FINDINGS: Mixed methods approach consisting of a systematic review and meta-summary of centre selection criteria reported in RCT protocols funded by the UK National Institute of Health Research (NIHR) initiated between January 2005-January 2012; and an online survey on the topic of current and optimal centre selection, distributed to professionals in the 48 UK Clinical Trials Units and 10 NIHR Research Design Services. The survey design was informed by the systematic review and by two focus groups conducted with trialists at the Birmingham Centre for Clinical Trials. 129 trial protocols were included in the systematic review, with a total target sample size in excess of 317,000 participants. The meta-summary identified 53 unique centre selection criteria. 78 protocols (60%) provided at least one criterion for centre selection, but only 31 (24%) protocols explicitly acknowledged generalisability. This is consistent with the survey findings (n = 70), where less than a third of participants reported generalisability as a key driver of centre selection in current practice. This contrasts with trialists' views on optimal practice, where generalisability in terms of clinical practice, population characteristics and economic results were prime considerations for 60% (n = 42), 57% (n = 40) and 46% (n = 32) of respondents, respectively. CONCLUSIONS: Centres are rarely enrolled in RCTs with an explicit view to external validity, although trialists acknowledge that incorporating generalisability in centre selection should ideally be more prominent. There is a need to operationalize 'generalisability' and incorporate it at the design stage of RCTs so that results are readily transferable to 'real world' practice

    Effectiveness and cost-effectiveness of prognostic markers in prostate cancer

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    This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of 'monitoring' (observation), radical prostatectomy, or a selection-based management policy using DNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of pound 12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades -7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs

    Mechanisms of Manganese-Assisted Nonradiative Recombination in Cd(Mn)Se/Zn(Mn)Se Quantum Dots

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    Mechanisms of nonradiative recombination of electron-hole complexes in Cd(Mn)Se/Zn(Mn)Se quantum dots accompanied by interconfigurational excitations of Mn2+^{2+} ions are analyzed within the framework of single electron model of deep {\it 3d}-levels in semiconductors. In addition to the mechanisms caused by Coulomb and exchange interactions, which are related because of the Pauli principle, another mechanism due to {\it sp-d} mixing is considered. It is shown that the Coulomb mechanism reduces to long-range dipole-dipole energy transfer from photoexcited quantum dots to Mn2+^{2+} ions. The recombination due to the Coulomb mechanism is allowed for any states of Mn2+^{2+} ions and {\it e-h} complexes. In contrast, short-range exchange and spd{\it sp-d} recombinations are subject to spin selection rules, which are the result of strong {\it lh-hh} splitting of hole states in quantum dots. Estimates show that efficiency of the {\it sp-d} mechanism can considerably exceed that of the Coulomb mechanism. The phonon-assisted recombination and processes involving upper excited states of Mn2+^{2+} ions are studied. The increase in PL intensity of an ensemble of quantum dots in a magnetic field perpendicular to the sample growth plane observed earlier is analyzed as a possible manifestation of the spin-dependent recombination.Comment: 14 pages, 2 figure
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