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

A Color Mutation Model of Soft Interaction in High Energy Hadronic Collisions

A comprehensive model, called ECOMB, is proposed to describe multiparticle production by soft interaction. It incorporates the eikonal formalism, parton model, color mutation, branching and recombination. The physics is conceptually opposite to the dynamics that underlies the fragmentation of a string. The partons are present initially in a hadronic collision; they form a single, large, color-neutral cluster until color mutation of the quarks leads to a fission of the cluster into two color-neutral subclusters. The mutation and branching processes continue until only $q\bar q$ pairs are left in each small cluster. The model contains self-similar dynamics and exhibits scaling behavior in the factorial moments. It can satisfactorily reproduce the intermittency data that no other model has been able to fit.Comment: 24 pages including 11 figures in revtex epsf styl

Improving stamina and mobility with preop walking in surgical patients with frailty traits -OASIS IV: randomized clinical trial study protocol

BACKGROUND: Frail older surgical patients face more than a two-fold increase in postoperative complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, pneumonia, ileus, and others. Many of these complications occur because of postoperative loss of stamina and poor mobility. Preoperative exercise may better prepare these vulnerable patients for surgery. We present the protocol for our ongoing randomized trial to assess the impact of a preoperative walking intervention with remote coaching and pedometer on outcomes of stamina (six-minute walk distance- 6MWD) and mobility (postoperative steps) in older adults with frailty traits. METHODS: We will be conducting a randomized clinical trial with a total of 120 patients permitting up to a 33% rate of attrition, to reach a final sample size of 80 (with 40 patients for each study arm). We will include patients who are age 60 or higher, score 4 or greater on the Edmonton Frailty Scale assessment, and will be undergoing a surgical operation that requires a 2 or more night hospital stay to be eligible for our trial. Using block randomization stratified on baseline 6MWD, we will assign patients to wear a pedometer. At the end of three baseline days, an athletic trainer (AT) will provide a daily step count goal reflecting a 10-20% increase from baseline. Subsequently, the AT will call weekly to further titrate the goal or calls more frequently if the patient is not meeting the prescribed goal. Controls will receive general walking advice. Our main outcome is change in 6MWD on postoperative day (POD) 2/3 vs. baseline. We will also collect 6MWD approximately 4 weeks after surgery and daily in-hospital steps. CONCLUSION: If changes in a 6MWD and step counts are significantly higher for the intervention group, we believe this will confirm our hypothesis that the intervention leads to decreased loss of stamina and mobility. Once confirmed, we anticipate expanding to multiple centers to assess the interventional impact on clinical endpoints. TRIAL REGISTRATION: The randomized clinical trial was registered on clinicaltrials.gov under the identifier NCT03892187 on March 27, 2019

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

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

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