Comment on "The black hole final state"

Horowitz and Maldacena have suggested that the unitarity of the black hole S-matrix can be reconciled with Hawking's semiclassical arguments if a final-state boundary condition is imposed at the spacelike singularity inside the black hole. We point out that, in this scenario, departures from unitarity can arise due to interactions between the collapsing body and the infalling Hawking radiation inside the event horizon. The amount of information lost when a black hole evaporates depends on the extent to which these interactions are entangling.Comment: 4 pages, REVTe

Relativistic Treatment of Hypernuclear Decay

We compute for the first time the decay width of lambda-hypernuclei in a relativistic mean-field approximation to the Walecka model. Due to the small mass difference between the lambda-hyperon and its decay products---a nucleon and a pion---the mesonic component of the decay is strongly Pauli blocked in the nuclear medium. Thus, the in-medium decay becomes dominated by the non-mesonic, or two-body, component of the decay. For this mode, the lambda-hyperon decays into a nucleon and a spacelike nuclear excitation. In this work we concentrate exclusively on the pion-like modes. By relying on the analytic structure of the nucleon and pion propagators, we express the non-mesonic component of the decay in terms of the spin-longitudinal response function. This response has been constrained from precise quasielastic (p,n) measurements done at LAMPF. We compute the spin-longitudinal response in a relativistic random-phase-approximation model that reproduces accurately the quasielastic data. By doing so, we obtain hypernuclear decay widths that are considerably smaller---by factors of two or three---relative to existing nonrelativistic calculations.Comment: Revtex: 18 pages and 4 postscript figure

Traversable Wormholes Construction in 2+1 Dimensions

We study traversable Lorentzian wormholes in the three-dimensional low energy string theory by adding some matter source involving a dilaton field. It will be shown that there are two-different types of wormhole solutions such as BTZ and black string wormholes depending on the dilaton backgrounds, respectively. We finally obtain the desirable solutions which confine exotic matter near the throat of wormhole by adjusting NS charge.Comment: 12 pages, 4 figures, JHEP style, one reference adde

4-Dimensional BF Theory as a Topological Quantum Field Theory

Starting from a Lie group G whose Lie algebra is equipped with an invariant nondegenerate symmetric bilinear form, we show that 4-dimensional BF theory with cosmological term gives rise to a TQFT satisfying a generalization of Atiyah's axioms to manifolds equipped with principal G-bundle. The case G = GL(4,R) is especially interesting because every 4-manifold is then naturally equipped with a principal G-bundle, namely its frame bundle. In this case, the partition function of a compact oriented 4-manifold is the exponential of its signature, and the resulting TQFT is isomorphic to that constructed by Crane and Yetter using a state sum model, or by Broda using a surgery presentation of 4-manifolds.Comment: 15 pages in LaTe

Acute myocardial uptake of digoxin in humans: Correlation with hemodynamic and electrocardiographic effects

Acute myocardial uptake of digoxin was measured at a constant paced heart rate (75 beats/min) for 30 min after an intravenous bolus injection of 500 µg of digoxin in 14 patients with ischemic heart disease. Myocardial digoxin content, determined by serial measurement of aortocoronary sinus digoxin concentration gradients and coronary sinus blood flow, was expressed relative to coronary sinus blood flow at rest and correlated with simultaneous hemodynamic and electrocardiographic changes.Myocardial digoxin uptake was extensive (4.1 ± 0.7% of total injected dose at 30 min) and prolonged, with rapid initial uptake (75.3 ± 6.6% of maximum at 3 min), followed by a variable phase of slower accumulation. Peak left ventricular positive first derivative of left ventricular pressure (dP/dt) increased progressively (p < 0.01), with a similar time course to that of myocardial digoxin accumu- lation; maximal change was 18.5 ± 4.7% at 27 min. The ratio of inotropic effect to myocardial digoxin content did not vary significantly over the period of the experiment. However, peak inotropic effects in individual patients were not significantly related to peak myocardial digoxin content. The spontaneous PR interval increased transiently, with a peak increase of 5.9 ± 1.8% (p < 0.05) 12 min after digoxin administration.It is concluded that after intravenous bolus administration, 1) peak effects of digoxin on atrioventricular (AV) conduction occur early, whereas positive inotropic effects increase progressively for ≥27 min; and 2) digoxin accumulation in the human myocardium is prolonged and is a determinant of inotropic effects, but not of prolongation of AV node conduction

A Review of the External Validity of Clinical Trials with Beta-Blockers in Heart Failure

This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.Background: Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions. Methods: We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities. Results: In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities. Conclusions: RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more global patient population

Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life

Takotsubo cardiomyopathy (TTC) has generally been regarded as a relatively transient disorder, characterized by reversible regional left ventricular systolic dysfunction. However, most patients with TTC experience prolonged lassitude or dyspnea after acute attacks. Although this might reflect continued emotional stress, myocardial inflammation and accentuated brain-type natriuretic peptide (BNP) release persist for at least 3 months. We therefore tested the hypotheses that this continued inflammation is associated with (1) persistent contractile dysfunction and (2) consequent impairment of quality of life. Echocardiographic parameters (global longitudinal strain [GLS], longitudinal strain rate [LSR], and peak apical twist [AT]) were compared acutely and after 3 months in 36 female patients with TTC and 19 age-matched female controls. Furthermore, correlations were sought between putative functional anomalies, inflammatory markers (T2 score on cardiovascular magnetic resonance, plasma NT-proBNP, and high-sensitivity C-reactive protein levels), and the physical composite component of SF36 score (SF36-PCS). In TTC cases, left ventricular ejection fraction returned to normal within 3 months. GLS, LSR, and AT improved significantly over 3-month recovery, but GLS remained reduced compared to controls even at follow-up (-17.9 ± 3.1% vs -20.0 ± 1.8%, p = 0.003). Impaired GLS at 3 months was associated with both persistent NT-proBNP elevation (p = 0.03) and reduced SF36-PCS at ≥3 months (p = 0.04). In conclusion, despite normalization of left ventricular ejection fraction, GLS remains impaired for at least 3 months, possibly as a result of residual myocardial inflammation. Furthermore, perception of impaired physical exercise capacity ≥3 months after TTC may be explained by persistent myocardial dysfunction

Contextualising evidence based medicine in determining the key root for translational effectiveness for chronic disease self-management and heart failure

Background: Congestive heart failure (CHF) management has proven devastating on morbidity, mortality, quality of life and also costly to health systems. Therapeutics for CHF have advanced and benefited greatly due to large multicentre randomised controlled trials and the evidence obtained from them. Management for chronic diseases and nonpharmaceutical therapies such as chronic disease self-management has lagged, and for CHF the evidence base has even been questioned. Methods: Perspective and non systematic mini review. Conclusions: Advancing translational research standards is important to achieve optimal cost effectiveness. Importantly is understanding evidence generation in medicine, identifying the primary roots for management and its translation

Electrical remodelling post cardiac resynchronization therapy in patients with ischemic and non-ischemic heart failure

Crown Copyright © 2018 Published by Elsevier Inc. This manuscript version is made available under the CC-BYNC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policyBackground The beneficial effects of cardiac resynchronization therapy (CRT) in heart failure are largely considered to be due to improved mechanical contractility. The contributory role of electrical remodelling is less clear. We sought to evaluate the impact of electrical remodelling in these patients. Methods 33 patients with conventional indications for CRT and with ischemic (ICM) (n = 17) and non-ischemic (NICM) (n = 16) aetiologies for heart failure were prospectively recruited. Functional parameters of peak exercise oxygen consumption (VO2max) and Minnesota quality of life (QOL) score, echocardiographic measures of LV functions and parameters of electrical remodelling, e.g. intrinsic QRS duration (iQRSD), intracardiac conduction times of LV pacing to RV electrocardiogram (LVp-RVegm), were measured at CRT implant and after 6 months. Results Only two electrical parameters predicted functional or symptomatic improvement. LVp-RVegm reduction significantly correlated with improvement in VO2max (r = −0.42, p = 0.03 while reduction in iQRSD significantly correlated with improvement in QOL score (r = 0.39, p = 0.04). The extent of changes in LVp-RVegm and iQRSD was significantly greater in NICM than in ICM patients (p = 0.017 and p = 0.042 for heterogeneity). There was also significant differential impact on QOL score in the NICM relative to the ICM group (p = 0.003) but none with VO2max. On multivariate analysis, only non-ischemic aetiology was a significant determinant of reduction in iQRSD. Conclusion CRT induces potentially beneficial reduction in LVp-RVegm and iQRSD, which are seen selectively in NICM rather than ICM patients. The extent of improvement in these markers is associated with some functional and symptomatic measures of CRT efficacy