Trends in the medical management of patients with heart failure

BACKGROUND: Despite the availability of effective therapies, heart failure (HF) remains a highly prevalent disease and the leading cause of hospitalizations in the U.S. Few data are available, however, describing changing trends in the use of various cardiac medications to treat patients with HF and factors associated with treatment. The objectives of this population-based study were to examine decade-long trends (1995 - 2004) in the use of several cardiac medications in patients hospitalized with acute decompensated heart failure (ADHF) and factors associated with evidence-based treatment. METHODS: We reviewed the medical records of 9,748 residents of the Worcester, MA, metropolitan area who were hospitalized with ADHF at all 11 central Massachusetts medical centers in 1995, 2000, 2002, and 2004. RESULTS: Between 1995 and 2004, respectively, the prescription upon hospital discharge of beta-blockers (23%; 67%), angiotensin pathway inhibitors (47%; 55%), statins (5%; 43%), and aspirin (35%; 51%) increased markedly, while the use of digoxin (51%; 29%), nitrates (46%; 24%), and calcium channel blockers (33%; 22%) declined significantly; nearly all patients received diuretics. Patients in the earliest study year, those with a history of obstructive pulmonary disease or anemia, incident HF, non-specific symptoms, and women were less likely to receive beta blockers and angiotensin pathway inhibitors than respective comparison groups. In 2004, 82% of patients were discharged on at least one of these recommended agents; however, only 41% were discharged on medications from both recommended classes. CONCLUSIONS: Our data suggest that opportunities exist to further improve the use of HF therapeutics

The model of particle production by strong external sources

Using some knowledge of multiplicity disributions for high energy reactions, it is possible to propose a simple analytical model of particle production by strong external sources. The model describes qualitatively most peculiar properties of the distributions. The generating function of the distribution varies so drastically as it can happen at phase transitions.Comment: 7 pages, no Figures, LATEX; Eq. (10) corrected, Eqs (25), (26) added, ref [20] corrected; Pisma v Zhetf 84, n5 (2006

Search for MSSM Higgs bosons decaying to μ+μ-in proton-proton collisions at √s=13TeV

A search is performed for neutral non-standard-model Higgs bosons decaying to two muons in the context of the minimal supersymmetric standard model (MSSM). Proton-proton collision data recorded by the CMS experiment at the CERN Large Hadron Collider at a center-of-mass energy of 13TeVwere used, corresponding to an integrated luminosity of 35.9fb-1. The search is sensitive to neutral Higgs bosons produced via the gluon fusion process or in association with a bbquark pair. No significant deviations from the standard model expectation are observed. Upper limits at 95% confidence level are set in the context of the mmod+hand phenomenological MSSM scenarios on the parameter tanβas a function of the mass of the pseudoscalar Aboson, in the range from 130 to 600GeV. The results are also used to set a model-independent limit on the product of the branching fraction for the decay into a muon pair and the cross section for the production of a scalar neutral boson, either via gluon fusion, or in association with bquarks, in the mass range from 130 to 1000GeV

Modified Gravity on the Brane and Dark Energy

We analyze the dynamics of an AdS5 braneworld with matter fields when gravity is allowed to deviate from the Einstein form on the brane. We consider exact 5-dimensional warped solutions which are associated with conformal bulk fields of weight -4 and describe on the brane the following three dynamics: those of inhomogeneous dust, of generalized dark radiation, and of homogeneous polytropic dark energy. We show that, with modified gravity on the brane, the existence of such dynamical geometries requires the presence of non-conformal matter fields confined to the brane.Comment: Revised version published in Gen. Rel. Grav. Typos corrected, updated reference and some remarks added for clarity. 11 pages, latex, no figure

Feasibility and acceptance of electronic monitoring of symptoms and syndromes using a handheld computer in patients with advanced cancer in daily oncology practice

Purpose: We investigated the feasibility and acceptance of electronic monitoring of symptoms and syndromes in oncological outpatient clinics using a PALM (handheld computer). Methods: The assessment of a combination of symptoms and clinical benefit parameters grouped in four pairs was tested in a pilot phase in advanced cancer patients. Based on these experiences, the software E-MOSAIC was developed, consisting of patient-reported symptoms and nutritional intake and objective assessments (weight, weight loss, performance status and medication for pain, fatigue, and cachexia). E-MOSAIC was then tested in four Swiss oncology centers. In order to compare the methods, patients completed the E-MOSAIC as a paper and a PALM version. Preferences of version and completion times were collected. Assessments were compared using Wilcoxon signed-rank tests , and the test-retest reliability was evaluated. Results: The pilot phase was completed by 22 patients. Most patients and physicians perceived the assessment as useful. Sixty-two patients participated in the feasibility study. Twelve patients reported problems (understanding, optical, tactile), and five patients could not complete the assessment. The median time to complete the PALM-based assessment was 3min. Forty-nine percent of patients preferred the PALM, 23% preferred a paper version, and 28% of patients had no preference. Paper vs. PALM revealed no significant differences in symptoms, but in nutritional intake (p = 0.013). Test-retest (1h, n = 20) reliability was satisfactory (r = 073-98). Conclusion: Electronic symptom and clinical benefit monitoring is feasible in oncology outpatient clinics and perceived as useful by patients, oncology nurses, and oncologists. E-MOSAIC is tested in a prospective randomized trial

Organizational and dynamical aspects of a small network with two distinct communities : Neo creationists vs. Evolution Defenders

Social impacts and degrees of organization inherent to opinion formation for interacting agents on networks present interesting questions of general interest from physics to sociology. We present a quantitative analysis of a case implying an evolving small size network, i.e. that inherent to the ongoing debate between modern creationists (most are Intelligent Design (ID) proponents (IDP)) and Darwin's theory of Evolution Defenders (DED)). This study is carried out by analyzing the structural properties of the citation network unfolded in the recent decades by publishing works belonging to members of the two communities. With the aim of capturing the dynamical aspects of the interaction between the IDP and DED groups, we focus on $two$ key quantities, namely, the {\it degree of activity} of each group and the corresponding {\it degree of impact} on the intellectual community at large. A representative measure of the former is provided by the {\it rate of production of publications} (RPP), whilst the latter can be assimilated to the{\it rate of increase in citations} (RIC). These quantities are determined, respectively, by the slope of the time series obtained for the number of publications accumulated per year and by the slope of a similar time series obtained for the corresponding citations. The results indicate that in this case, the dynamics can be seen as geared by triggered or damped competition. The network is a specific example of marked heterogeneity in exchange of information activity in and between the communities, particularly demonstrated through the nodes having a high connectivity degree, i.e. opinion leaders.Comment: 10 pages, 4 figures, 2 tables, 52 reference

Brane World Dynamics and Conformal Bulk Fields

In the Randall-Sundrum scenario we investigate the dynamics of a spherically symmetric 3-brane world when matter fields are present in the bulk. To analyze the 5-dimensional Einstein equations we employ a global conformal transformation whose factor characterizes the $Z_2$ symmetric warp. We find a new set of exact dynamical collapse solutions which localize gravity in the vicinity of the brane for a stress-energy tensor of conformal weight -4 and a warp factor that depends only on the coordinate of the fifth dimension. Geometries which describe the dynamics of inhomogeneous dust and generalized dark radiation on the brane are shown to belong to this set. The conditions for singular or globally regular behavior and the static marginally bound limits are discussed for these examples. Also explicitly demonstrated is complete consistency with the effective point of view of a 4-dimensional observer who is confined to the brane and makes the same assumptions about the bulk degrees of freedom.Comment: 26 pages, latex, no figures. Minor revisions. Some references added. Revised version to appear in Phys. Rev.

Accessible opera : overcoming linguistic and sensorial barriers

The desire to make media available for all has been rapidly accepted and implemented by most European countries. Opera, as one of the many audiovisual representations, also falls under the category of production which needs to be made accessible and this article aims to analyse how opera has gone through a complete transformation to become a cultural event for all, overcoming not only linguistic but also sensorial barriers. The first part of the article analyses the various forms of translation associated with opera and the main challenges they entail. The second presents different systems used to make opera accessible to the sensorially challenged, highlighting their main difficulties. Examples from research carried out at the Barcelona's Liceu opera house are presented to illustrate various modalities, especially audio description. All in all, it is our aim to show how translated-related processes have made it possible to open opera to a wider audience despite some initial reluctance

Analysis of Charged-Particle/Photon Observables in Hadronic Multiparticle Production

In order to analyze data on joint charged-particle/photon distributions from an experimental search (T-864, MiniMax) for disoriented chiral condensate (DCC) at the Fermilab Tevatron collider, we have identified robust observables, ratios of normalized bivariate factorial moments, with many desirable properties. These include insensitivity to many efficiency corrections and the details of the modeling of the primary pion production, and sensitivity to the production of DCC, as opposed to the generic, binomial-distribution partition of pions into charged and neutral species. The relevant formalism is developed and tested in Monte-Carlo simulations of the MiniMax experimental conditions.Comment: Latex, 35 pages, no figures. Submitted to Physical Review D. PostScript file at http://fnmine.fnal.gov:80