A keen eye for risk

No abstract available

Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need

The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease—INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term ‘stable coronary syndromes’ (SCS), which aligns with the well-established terminology for ‘acute coronary syndromes’. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation

Solution of a singular integral equation by a split-interval method

The article is available at http://www.math.ualberta.ca/ijnam/Volume-4-2007/No-1-07/2007-01-05.pdf. This article is not available through the Chester Digital RepositoryThis article discusses a new numerical method for the solution of a singular integral equation of Volterra type that has an infinite class of solutions. The split-interval method is discussed and examples demonstrate its effectiveness

How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients. Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgrounds Method: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26). Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services. Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care

Angina: contemporary diagnosis and management

No abstract available

General Characteristics of a Airspeed System using Fuselage Static Vents on a Swept-Wing Airplane

Studies have been made by the NACA wing-flow method of the use of fuselage static orifices between the wing and tail of a swept-wing airplane for possible application to service airspeed installations. The tests were made at zero angle of attack. The results indicate that, although the maximum errors are large, these locations are usable from the consideration that the local Mach numbers at the locations studied are sensitive to variation of the true Mach number within the test Mach number range of 0.7 to 1.2. The maximum errors in Mach number in the subsonic range varied from zero for the most forward location to -0.05 for the most rearward location (indicated Mach number less than true). At Mach numbers above 1.0, the maximum errors were from 0.14 for the most forward location to 0.04 for the most rearward location

Energy Density-Flux Correlations in an Unusual Quantum State and in the Vacuum

In this paper we consider the question of the degree to which negative and positive energy are intertwined. We examine in more detail a previously studied quantum state of the massless minimally coupled scalar field, which we call a ``Helfer state''. This is a state in which the energy density can be made arbitrarily negative over an arbitrarily large region of space, but only at one instant in time. In the Helfer state, the negative energy density is accompanied by rapidly time-varying energy fluxes. It is the latter feature which allows the quantum inequalities, bounds which restrict the magnitude and duration of negative energy, to hold for this class of states. An observer who initially passes through the negative energy region will quickly encounter fluxes of positive energy which subsequently enter the region. We examine in detail the correlation between the energy density and flux in the Helfer state in terms of their expectation values. We then study the correlation function between energy density and flux in the Minkowski vacuum state, for a massless minimally coupled scalar field in both two and four dimensions. In this latter analysis we examine correlation functions rather than expectation values. Remarkably, we see qualitatively similar behavior to that in the Helfer state. More specifically, an initial negative energy vacuum fluctuation in some region of space is correlated with a subsequent flux fluctuation of positive energy into the region. We speculate that the mechanism which ensures that the quantum inequalities hold in the Helfer state, as well as in other quantum states associated with negative energy, is, at least in some sense, already ``encoded'' in the fluctuations of the vacuum.Comment: 21 pages, 7 figures; published version with typos corrected and one added referenc

Metrics to Meet Security & Privacy Requirements with Agile Software Development Methods in a Regulated Environment

This work examines metrics that can be used to measure the ability of agile software development methods to meet security and privacy requirements of communications applications. Many implementations of communication protocols, including those in vehicular networks, occur within regulated environments where agile development methods are traditionally discouraged. We propose a framework and metrics to measure adherence to security, quality and software effectiveness regulations if developers desire the cost and schedule benefits of agile methods. After providing an overview of specific challenges that a regulated environment imposes on communications software development, we proceed to examine the 12 agile principles and how they relate to a regulatory environment. From this review we identify two metrics to measure performance of three key regulatory attributes of software for communications applications, and then recommend an approach of either tools, agile methods or DevOps that is best positioned to satisfy its regulated environment attributes. By considering the recommendations in this paper, managers of software-dominant communications programs in a regulated environment can gain insight into leveraging the benefits of agile methods