Span, chainability and the continua H* and I_u

We show that the continua I_u and H* are non-chainable and have span nonzero. Under CH this can be strengthened to surjective symmetric span nonzero. We discuss the logical consequences of this.Comment: 2004-03-11: corrected some typos, some parts rewritte

Mass customization of teaching and learning in organizations

In search of methods that improve the efficiency of teaching and training in organizations, several authors point out that mass customization (MC) is a principle that covers individual needs of knowledge and skills and, at the same time, limits the development costs of customized training to those of mass training. MC is proven and established in the economic sector, and shows high potential for continuing education, too. The paper explores this potential and proposes a multidisciplinary, pragmatic approach to teaching and training in organizations. The first section of the paper formulates four design principles of MC deduced from an examination of economics literature. The second section presents amit™, a frame for mass customized training, designed according to the principles presented in the first section. The evaluation results encourage the further development and use of mass customized training in continuing education, and offer suggestions for future research

K022: Effect of combination therapy (ANG II antagonist, valsartan and a calcium channel blocker) in a hypertensive model of diabetic nephropathy

Recently, it has been suggested that in the context of diabetes and hypertension, more aggressive blood pressure targets should be considered. To achieve these levels of blood pressure control, it is likely that combination therapy will need to be used. The present study has explored the role of the addition of either a dihydropyridine or a non-dihydropyridine calcium channel blocker (CCB) to Ang II antagonist based treatment in an experimental model of hypertension and diabetes. The doses chosen for the combination therapy groups were lower than those used with monotherapy in order to achieve similar antihypertensive efficacy. Diabetic (streptozotocin induced) SHR were randomised to no treatment, valsartan (30 mg/kg/day), the non-dihydropyridine CCB verapamil (20 mg/kg/day), the dihydropyridine CCB amlodipine (6 mg/kg/day), a combination of valsartan and amlodipine (20 mg + 4 mg/kg/day respectively) or valsartan and verapamil (20 mg + 15 mg/kg/day respectively). Serial measurements of systolic blood pressure (BP) and albumin excretion rate (AER) were performed monthly (data are shown at week 16 for AER and mean of wk 20-28 for BP). This model was associated with hypertension (control, 217 ± 8, diabetic, 200 ± 5 mmHg) which was reduced by most treatments to a similar degree (valsartan 165 ± 3, amlodipine 164 ± 2, verapamil 182 ± 4, valsartan + amlodipine 151 ± 3 and valsartan + verapamil 169 ± 5 mmHg). Diabetes was associated with a progressive increase in AER (control 1.5 vs diabetic 17 mg/24 hr). Valsartan retarded the increase in AER (11 mg/24 hr). Similar efficacy was observed in the valsartan + amlodipine combination (9 mg/24 hr) but not with amlodipine alone (16 mg/24 hr) despite similar effects on blood pressure. No advantage of verapamil versus amlodipine either as monotherapy or in combination with valsartan was observed. The present study indicates that the combination of an Ang II antagonist and a dihydropyridine CCB is an effective regimen at reducing blood pressure and albuminuria in the context of diabetes and hypertensio

Metastable neon collisions: anisotropy and scattering length

In this paper we investigate the effective scattering length $a$ of spin-polarized Ne*. Due to its anisotropic electrostatic interaction, its scattering length is determined by five interaction potentials instead of one, even in the spin-polarized case, a unique property among the Bose condensed species and candidates. Because the interaction potentials of Ne* are not known accurately enough to predict the value of the scattering length, we investigate the behavior of $a$ as a function of the five phase integrals corresponding to the five interaction potentials. We find that the scattering length has five resonances instead of only one and cannot be described by a simple gas-kinetic approach or the DIS approximation. However, the probability for finding a positive or large value of the scattering length is not enhanced compared to the single potential case. The complex behavior of $a$ is studied by comparing a quantum mechanical five-channel numerical calculation to simpler two-channel models. We find that the induced dipole-dipole interaction is responsible for coupling between the different |\Omega> states, resulting in an inhomogeneous shift of the resonance positions and widths in the quantum mechanical calculation as compared to the DIS approach. The dependence of the resonance positions and widths on the input potentials turns out to be rather straightforward. The existence of two bosonic isotopes of Ne* enables us to choose the isotope with the most favorable scattering length for efficient evaporative cooling towards the Bose-Einstein Condensation transition, greatly enhancing the feasibility to reach this transition.Comment: 13pages, 8 eps figures, analytical model in section V has been remove

Different strategies for pharmacological thromboprophylaxis for lower-limb immobilisation after injury: systematic review and economic evaluation

Background Thromboprophylaxis can reduce the risk of venous thromboembolism (VTE) during lower-limb immobilisation, but it is unclear whether or not this translates into meaningful health benefit, justifies the risk of bleeding or is cost-effective. Risk assessment models (RAMs) could select higher-risk individuals for thromboprophylaxis. Objectives To determine the clinical effectiveness and cost-effectiveness of different strategies for providing thromboprophylaxis to people with lower-limb immobilisation caused by injury and to identify priorities for future research. Data sources Ten electronic databases and research registers (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, the Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluation Database, Science Citation Index Expanded, ClinicalTrials.gov and the International Clinical Trials Registry Platform) were searched from inception to May 2017, and this was supplemented by hand-searching reference lists and contacting experts in the field. Review methods Systematic reviews were undertaken to determine the effectiveness of pharmacological thromboprophylaxis in lower-limb immobilisation and to identify any study of risk factors or RAMs for VTE in lower-limb immobilisation. Study quality was assessed using appropriate tools. A network meta-analysis was undertaken for each outcome in the effectiveness review and the results of risk-prediction studies were presented descriptively. A modified Delphi survey was undertaken to identify risk predictors supported by expert consensus. Decision-analytic modelling was used to estimate the incremental cost per quality-adjusted life-year (QALY) gained of different thromboprophylaxis strategies from the perspectives of the NHS and Personal Social Services. Results Data from 6857 participants across 13 trials were included in the meta-analysis. Thromboprophylaxis with low-molecular-weight heparin reduced the risk of any VTE [odds ratio (OR) 0.52, 95% credible interval (CrI) 0.37 to 0.71], clinically detected deep-vein thrombosis (DVT) (OR 0.40, 95% CrI 0.12 to 0.99) and pulmonary embolism (PE) (OR 0.17, 95% CrI 0.01 to 0.88). Thromboprophylaxis with fondaparinux (Arixtra®, Aspen Pharma Trading Ltd, Dublin, Ireland) reduced the risk of any VTE (OR 0.13, 95% CrI 0.05 to 0.30) and clinically detected DVT (OR 0.10, 95% CrI 0.01 to 0.94), but the effect on PE was inconclusive (OR 0.47, 95% CrI 0.01 to 9.54). Estimates of the risk of major bleeding with thromboprophylaxis were inconclusive owing to the small numbers of events. Fifteen studies of risk factors were identified, but only age (ORs 1.05 to 3.48), and injury type were consistently associated with VTE. Six studies of RAMs were identified, but only two reported prognostic accuracy data for VTE, based on small numbers of patients. Expert consensus was achieved for 13 risk predictors in lower-limb immobilisation due to injury. Modelling showed that thromboprophylaxis for all is effective (0.015 QALY gain, 95% CrI 0.004 to 0.029 QALYs) with a cost-effectiveness of £13,524 per QALY, compared with thromboprophylaxis for none. If risk-based strategies are included, it is potentially more cost-effective to limit thromboprophylaxis to patients with a Leiden thrombosis risk in plaster (cast) [L-TRiP(cast)] score of ≥ 9 (£20,000 per QALY threshold) or ≥ 8 (£30,000 per QALY threshold). An optimal threshold on the L-TRiP(cast) receiver operating characteristic curve would have sensitivity of 84–89% and specificity of 46–55%. Limitations Estimates of RAM prognostic accuracy are based on weak evidence. People at risk of bleeding were excluded from trials and, by implication, from modelling. Conclusions Thromboprophylaxis for lower-limb immobilisation due to injury is clinically effective and cost-effective compared with no thromboprophylaxis. Risk-based thromboprophylaxis is potentially optimal but the prognostic accuracy of existing RAMs is uncertain. Future work Research is required to determine whether or not an appropriate RAM can accurately select higher-risk patients for thromboprophylaxis. Study registration This study is registered as PROSPERO CRD42017058688. Funding The National Institute for Health Research Health Technology Assessment programme

Constraints on diffuse neutrino background from primordial black holes

We calculated the energy spectra and the fluxes of electron neutrino emitted in the process of evaporation of primordial black holes (PBHs) in the early universe. It was assumed that PBHs are formed by a blue power-law spectrum of primordial density fluctuations. We obtained the bounds on the spectral index of density fluctuations assuming validity of the standard picture of gravitational collapse and using the available data of several experiments with atmospheric and solar neutrinos. The comparison of our results with the previous constraints (which had been obtained using diffuse photon background data) shows that such bounds are quite sensitive to an assumed form of the initial PBH mass function.Comment: 18 pages,(with 7 figures

CASSETTE—clindamycin adjunctive therapy for severe Staphylococcus aureus treatment evaluation: Study protocol for a randomised controlled trial

Background Exotoxins are important virulence factors in Staphylococcus aureus. Clindamycin, a protein synthesis inhibitor antibiotic, is thought to limit exotoxin production and improve outcomes in severe S. aureus infections. However, randomised prospective data to support this are lacking. Methods An open-label, multicentre, randomised controlled trial (RCT) will compare outcome differences in severe S. aureus infection between standard treatment (flucloxacillin/cefazolin in methicillin-susceptible S. aureus; and vancomycin/daptomycin in methicillin-resistant S. aureus) and standard treatment plus an additional clindamycin given for 7 days. We will include a minimum of 60 participants (both adult and children) in the pilot study. Participants will be enrolled within 72 h of an index culture. Severe infections will include septic shock, necrotising pneumonia, or multifocal and non-contiguous skin and soft tissue/osteoarticular infections. Individuals who are immunosuppressed, moribund, with current severe diarrhoea or Clostridiodes difficile infection, pregnant, and those with anaphylaxis to β-lactams or lincosamides will be excluded. The primary outcomes measure is the number of days alive and free (1 or 0) of systemic inflammatory response syndrome (SIRS) within the first 14 days post randomisation. The secondary outcomes measure will include all-cause mortality at 14, 42, and 90 days, time to resolution of SIRS, proportion with microbiological treatment failure, and rate of change of C-reactive protein over time. Impacts of inducible clindamycin resistance, strain types, methicillin susceptibility, and presence of various exotoxins will also be analysed. Discussion This study will assess the effect of adjunctive clindamycin on patient-centred outcomes in severe, toxin-mediated S. aureus infections. The pilot study will provide feasibility for a much larger RCT. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001416381p. Registered on 6 October 2017

Western oceanus procellarum as seen by c1xs on chandrayaan-1

We present the analysis of an X-ray fluorescence (XRF) observation of the western part of Oceanus Procellarum on the Moon’s nearside made by the Chandrayaan-1 X-ray Spectrometer on 10th February 2009. Through forward modelling of the X-ray spectra, we provide estimates of the MgO/SiO2 and Al2O3/SiO2 ratios for seven regions along the flare’s ground track. These results are combined with FeO and TiO2 contents derived from Clementine multispectral reflectance data in order to investigate the compositional diversity of this region of the Moon. The ground track observed consists mainly of low-Ti basaltic units, and the XRF data are largely consistent with this expectation. However, we obtain higher Al2O3/SiO2 ratios for these units than for most basalts in the Apollo sample collection. The widest compositional variation between the different lava flows is in wt% FeO content. A footprint that occurs in a predominantly highland region, immediately to the north of Oceanus Procellarum, has a composition that is consistent with mixing between low-Ti mare basaltic and more feldspathic regoliths. In contrast to some previous studies, we find no evidence for systematic differences in surface composition, as determined through X-ray and gamma-ray spectroscopy techniques