Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

OBJECTIVES: Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice. DESIGN: Observational study. SETTING: 20 hospitals across the former Yorkshire region. PARTICIPANTS: All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months. MAIN OUTCOME MEASURES: Variable life­adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure. RESULTS: The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life­adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of - 4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice. CONCLUSIONS: Variable life­adjusted display has been integrated into surgical care as a graphical display of risk­adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction

Realistic interpretation of a superposition state does not imply a mixture

Contrary to previous claims, it is shown that, for an ensemble of either single-particle systems or multi-particle systems, the realistic interpretation of a superposition state that mathematically describes the ensemble does not imply that the ensemble is a mixture. Therefore it cannot be argued that the realistic interpretation is wrong on the basis that some predictions derived from the mixture are different from the corresponding predictions derived from the superposition state

R-parity Violation and General Soft Supersymmetry Breaking

We consider the most general class possible of soft supersymmetry breaking terms that can be added to the MSSM, with and without R-parity violation, consistent with the sole requirement that no quadratic divergences are induced. We renormalise the resulting theory through one loop and give an example of how a previously ignored term might affect the sparticle spectrum.Comment: 11 pages, 1 figure. Plain TeX, uses Harvmac (Big) and epsf. Added references and typo corrected (v2

Estimating the parameters of the Sgr A* black hole

The measurement of relativistic effects around the galactic center may allow in the near future to strongly constrain the parameters of the supermassive black hole likely present at the galactic center (Sgr A*). As a by-product of these measurements it would be possible to severely constrain, in addition, also the parameters of the mass-density distributions of both the innermost star cluster and the dark matter clump around the galactic center.Comment: Accepted for publication on General Relativity and Gravitation, 2010. 11 Pages, 1 Figur

Two-loop beta-functions and their effects for the R-parity Violating MSSM

We present the full two-loop beta-functions for the MSSM including R-parity violating couplings. We analyse the effect of two-loop running on the bounds on R-parity violating couplings, on the nature of the LSP and on the stop masses.Comment: 12 pages, including 2 figures. Plain TeX. Uses Harvmac and epsf. Revised version with corrected Table and Figure

Quark-Squark Alignment Revisited

We re-examine the possibility that the solution to the supersymmetric flavor problem is related to small mixing angles in gaugino couplings induced by approximate horizontal Abelian symmetries. We prove that, for a large class of models, there is a single viable structure for the down quark mass matrix with four holomorphic zeros. Consequently, we are able to obtain both lower and upper bounds on the supersymmetric mixing angles and predict the contributions to various flavor changing neutral current processes. We find that the most likely signals for alignment are $\Delta m_D$ close to the present bound, significant CP violation in $D^0-\bar{D^0}$ mixing, and shifts of order a few percent in various CP asymmetries in $B^0$ and $B_s$ decays. In contrast, the modifications to radiative B decays, to $\epsilon^\prime/\epsilon$ and to $K\to\pi\nu\bar\nu$ decays are small. We further investigate a new class of alignment models, where supersymmetric contributions to flavor changing processes are suppressed by both alignment and RGE-induced degeneracy.Comment: 20 pages, 3 figure

An Anglo-Saxon execution cemetery at Walkington Wold, Yorkshire

This paper presents a re-evaluation of a cemetery excavated over 30 years ago at Walkington Wold in east Yorkshire. The cemetery is characterized by careless burial on diverse alignments, and by the fact that most of the skeletons did not have associated crania. The cemetery has been variously described as being the result of an early post-Roman massacre, as providing evidence for a ‘Celtic’ head cult or as an Anglo-Saxon execution cemetery. In order to resolve the matter, radiocarbon dates were acquired and a re-examination of the skeletal remains was undertaken. It was confirmed that the cemetery was an Anglo-Saxon execution cemetery, the only known example from northern England, and the site is set into its wider context in the paper

MEK1 drives oncogenic signaling and interacts with PARP1 for genomic and metabolic homeostasis in malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a lethal malignancy etiologically caused by asbestos exposure, for which there are few effective treatment options. Although asbestos carcinogenesis is associated with reactive oxygen species (ROS), the bona fide oncogenic signaling pathways that regulate ROS homeostasis and bypass ROS-evoked apoptosis in MPM are poorly understood. In this study, we demonstrate that the mitogen-activated protein kinase (MAPK) pathway RAS-RAF-MEK-ERK is hyperactive and a molecular driver of MPM, independent of histological subtypes and genetic heterogeneity. Suppression of MAPK signaling by clinically approved MEK inhibitors (MEKi) elicits PARP1 to protect MPM cells from the cytotoxic effects of MAPK pathway blockage. Mechanistically, MEKi induces impairment of homologous recombination (HR) repair proficiency and mitochondrial metabolic activity, which is counterbalanced by pleiotropic PARP1. Consequently, the combination of MEK with PARP inhibitors enhances apoptotic cell death in vitro and in vivo that occurs through coordinated upregulation of cytotoxic ROS in MPM cells, suggesting a mechanism-based, readily translatable strategy to treat this daunting disease. Collectively, our studies uncover a previously unrecognized scenario that hyperactivation of the MAPK pathway is an essential feature of MPM and provide unprecedented evidence that MAPK signaling cooperates with PARP1 to homeostatically maintain ROS levels and escape ROS-mediated apoptosis

Exact solutions of the radial Schrodinger equation for some physical potentials

By using an ansatz for the eigenfunction, we have obtained the exact analytical solutions of the radial Schrodinger equation for the pseudoharmonic and Kratzer potentials in two dimensions. The energy levels of all the bound states are easily calculated from this eigenfunction ansatz. The normalized wavefunctions are also obtained.Comment: 13 page