Risks and benefits of adding anti-platelet therapy to warfarin among patients with prosthetic heart valves: a meta-analysis

AbstractOBJECTIVESThe objective of this study was to compare the effectiveness and safety of adding dipyridamole or aspirin to warfarin among patients with prosthetic heart valves using meta-analytic techniques.BACKGROUNDPatients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism. Oral anticoagulation alone, or the addition of antiplatelet drugs, has been used to minimize this risk. An important issue is the effectiveness and safety of the latter strategy.METHODSA combined MEDLINE and manual search was made for relevant articles from 1966 to November 1999. Standard meta-analysis techniques were used.RESULTSTen studies involving 2,199 subjects met the inclusion criteria. Compared with anticoagulation alone, the addition of an antiplatelet agent reduced the risk of thromboembolic events (odds ratio [OR]: 0.41, p < 0.001) and total mortality (OR: 0.49, p < 0.001). The risk of major bleeding was increased when antiplatelet agents were added (OR: 1.50, p = 0.033). For major bleeding, the comparison of trials performed before and after 1990 (OR: 2.23 and 0.88, respectively) showed that the chi-square test for heterogeneity was significant (p = 0.025). The latter trials used low-dose aspirin, suggesting that the risk of bleeding may be lower with contemporary low-dose (100 mg daily) aspirin.CONCLUSIONSAdding antiplatelet therapy, especially low-dose aspirin, to warfarin decreases the risk of systemic embolism or death among patients with prosthetic heart valves. The risk of major bleeding is slightly increased with antiplatelet therapy. Nonetheless, the risk of bleeding appears to have diminished with the lower doses of aspirin used in the more recent trials, resulting in a favorable risk-to-benefit profile

Expansion dynamics in the one-dimensional Fermi-Hubbard model

Expansion dynamics of interacting fermions in a lattice are simulated within the one-dimensional (1D) Hubbard model, using the essentially exact time-evolving block decimation (TEBD) method. In particular, the expansion of an initial band-insulator state is considered. We analyze the simulation results based on the dynamics of a two-site two-particle system, the so-called Hubbard dimer. Our findings describe essential features of a recent experiment on the expansion of a Fermi gas in a two-dimensional lattice. We show that the Hubbard-dimer dynamics, combined with a two-fluid model for the paired and non-paired components of the gas, gives an efficient description of the full dynamics. This should be useful for describing dynamical phenomena of strongly interacting Fermions in a lattice in general.Comment: Fig. 9 changed, text + supplementary material revise

Hopping modulation in a one-dimensional Fermi-Hubbard Hamiltonian

We consider a strongly repulsive two-component Fermi gas in a one-dimensional (1D) optical lattice described in terms of a Hubbard Hamiltonian. We analyze the response of the system to a periodic modulation of the hopping amplitude in presence of large two body interaction. By (essentially) exact simulations of the time evolution, we find a non-trivial double occupancy frequency dependence. We show how the dependence relates to the spectral features of the system given by the Bethe ansatz. The discrete nature of the spectrum is clearly reflected in the double occupancy after long enough modulation time. We also discuss the implications of the 1D results to experiments in higher dimensional systems.Comment: 4 pages, 5 figures; minor changes in the text, updated references

Spectral up- and downshifting of Akhmediev breathers under wind forcing

We experimentally and numerically investigate the effect of wind forcing on the spectral dynamics of Akhmediev breathers, a wave-type known to model the modulation instability. We develop the wind model to the same order in steepness as the higher order modifcation of the nonlinear Schroedinger equation, also referred to as the Dysthe equation. This results in an asymmetric wind term in the higher order, in addition to the leading order wind forcing term. The derived model is in good agreement with laboratory experiments within the range of the facility's length. We show that the leading order forcing term amplifies all frequencies equally and therefore induces only a broadening of the spectrum while the asymmetric higher order term in the model enhances higher frequencies more than lower ones. Thus, the latter term induces a permanent upshift of the spectral mean. On the other hand, in contrast to the direct effect of wind forcing, wind can indirectly lead to frequency downshifts, due to dissipative effects such as wave breaking, or through amplification of the intrinsic spectral asymmetry of the Dysthe equation. Furthermore, the definitions of the up- and downshift in terms of peak- and mean frequencies, that are critical to relate our work to previous results, are highlighted and discussed.Comment: 30 pages, 11 figure

Assessing Readability of Online Patient Education Materials for Spine Surgery Procedures

Increased patient reliance on Internet-based health information has amplified the need for comprehensible online patient education articles. As suggested by the AMA and NIH, spine fusion articles should be between a 4th and 6th grade readability level to increase patient comprehension, which may contribute to improved postoperative outcomes. Objective: To determine the average readability level of online healthcare education information relating to anterior cervical discectomy and fusion (ACDF) and lumbar fusion procedures. Design: Online Health-Education Resource Qualitative Analysis. Setting: Rush University Medical Center - Department of Orthopaedic Surgery. Methods: Three popular search engines were utilized to access patient education articles for common cervical and lumbar spine procedures. Relevant articles were analyzed for readability using Readability Studio Professional Edition software (Oleander Software, Ltd). Articles were stratified by organization type as follows: General Medical Websites (GMW), Healthcare Network/Academic Institutions (HNAI), and Private Practices (PP). Thirteen common readability tests were performed with the mean grade level for each readability test compared between subgroups using ANOVA analysis. Results: 79 ACDF and 231 lumbar fusion articles were determined to have a mean readability level of 10.7 ± 1.5 and 11.3 ± 1.6, respectively. GMW, HNAI, and PP subgroups had mean readability levels of 10.9 ± 2.9, 10.7 ± 2.8, and 10.7 ± 2.5 for ACDF and 10.9 ± 3.0, 10.8 ± 2.9, and 11.6 ± 2.7 for lumbar fusion articles. Of 310 total articles, only 6 (3 ACDF and 3 lumbar fusion) were written below the 7th grade reading level. Conclusions: Current online literature from medical websites containing information regarding ACDF and lumbar fusion procedures are written at a grade level higher than the suggested guidelines. Therefore, current patient education articles should be revised to accommodate the average readability level in the United States and may result in improved patient comprehension and postoperative outcomes

Evolution of surface gravity waves over a submarine canyon

The effects of a submarine canyon on the propagation of ocean surface waves are examined with a three-dimensional coupled-mode model for wave propagation over steep topography. Whereas the classical geometrical optics approximation predicts an abrupt transition from complete transmission at small incidence angles to no transmission at large angles, the full model predicts a more gradual transition with partial reflection/transmission that is sensitive to the canyon geometry and controlled by evanescent modes for small incidence angles and relatively short waves. Model results for large incidence angles are compared with data from directional wave buoys deployed around the rim and over Scripps Canyon, near San Diego, California, during the Nearshore Canyon Experiment (NCEX). Wave heights are observed to decay across the canyon by about a factor 5 over a distance shorter than a wavelength. Yet, a spectral refraction model predicts an even larger reduction by about a factor 10, because low frequency components cannot cross the canyon in the geometrical optics approximation. The coupled-mode model yields accurate results over and behind the canyon. These results show that although most of the wave energy is refractively trapped on the offshore rim of the canyon, a small fraction of the wave energy 'tunnels' across the canyon. Simplifications of the model that reduce it to the standard and modified mild slope equations also yield good results, indicating that evanescent modes and high order bottom slope effects are of minor importance for the energy transformation of waves propagating across depth contours at large oblique angles

Generalized Hartree-Fock Theory for Interacting Fermions in Lattices: Numerical Methods

We present numerical methods to solve the Generalized Hartree-Fock theory for fermionic systems in lattices, both in thermal equilibrium and out of equilibrium. Specifically, we show how to determine the covariance matrix corresponding to the Fermionic Gaussian state that optimally approximates the quantum state of the fermions. The methods apply to relatively large systems, since their complexity only scales quadratically with the number of lattice sites. Moreover, they are specially suited to describe inhomogenous systems, as those typically found in recent experiments with atoms in optical lattices, at least in the weak interaction regime. As a benchmark, we have applied them to the two-dimensional Hubbard model on a 10x10 lattice with and without an external confinement.Comment: 16 pages, 22 figure

Slot-mode-coupled optomechanical crystals

We present a design methodology and analysis of a cavity optomechanical system in which a localized GHz frequency mechanical mode of a nanobeam resonator is evanescently coupled to a high quality factor (Q>10^6) optical mode of a separate nanobeam optical cavity. Using separate nanobeams provides flexibility, enabling the independent design and optimization of the optics and mechanics of the system. In addition, the small gap (approx. 25 nm) between the two resonators gives rise to a slot mode effect that enables a large zero-point optomechanical coupling strength to be achieved, with g/2pi > 300 kHz in a Si3N4 system at 980 nm and g/2pi approx. 900 kHz in a Si system at 1550 nm. The fact that large coupling strengths to GHz mechanical oscillators can be achieved in SiN is important, as this material has a broad optical transparency window, which allows operation throughout the visible and near-infrared. As an application of this platform, we consider wide-band optical frequency conversion between 1300 nm and 980 nm, using two optical nanobeam cavities coupled on either side to the breathing mode of a mechanical nanobeam resonator

The fidelity approach to the Hubbard model

We use the fidelity approach to quantum critical points to study the zero temperature phase diagram of the one-dimensional Hubbard model. Using a variety of analytical and numerical techniques, we analyze the fidelity metric in various regions of the phase diagram, with particular care to the critical points. Specifically we show that close to the Mott transition, taking place at on-site repulsion U=0 and electron density n=1, the fidelity metric satisfies an hyper-scaling form which we calculate. This implies that in general, as one approaches the critical point U=0, n=1, the fidelity metric tends to a limit which depends on the path of approach. At half filling, the fidelity metric is expected to diverge as U^{-4} when U is sent to zero.Comment: 8 pages, 4 figures, added results on the hyper-scaling form of the fidelity metri