A new fast-acting backup protection strategy for embedded MVDC links in future distribution networks

This paper presents a new fast-acting backup protection strategy for future hybrid ac-dc distribution networks. By examining the impedance measured by a distance protection relay measuring from the “ac-side” of the network, a unique characteristic is established for faults occurring on the “dc-side” of an embedded medium-voltage dc (MVDC) link, interconnecting two 33 kV distribution network sections. Based on the identified impedance characteristic, appropriate settings are developed and deployed on a verified software model of a commercially available distance protection relay. To remain stable for ac-side faults, it is found that the tripping logic of the device must be altered to provide correct time grading between standard, ac, protection zones and the fast-acting dc region, which can identify faults on the dc system within 40 ms. An additional confirmatory check is also employed to reduce the likelihood of mal-operation. Trials on a test system derived from an actual distribution network, which employs distance protection, are shown to provide stable operation for both ac-side and dc-side pole-pole and pole-pole-ground fault

Recent Advances in the Treatment of Opioid Use Disorder

PURPOSE OF REVIEW: Opioid use disorder (OUD) remains a national epidemic with an immense consequence to the United States\u27 healthcare system. Current therapeutic options are limited by adverse effects and limited efficacy. RECENT FINDINGS: Recent advances in therapeutic options for OUD have shown promise in the fight against this ongoing health crisis. Modifications to approved medication-assisted treatment (MAT) include office-based methadone maintenance, implantable and monthly injectable buprenorphine, and an extended-release injectable naltrexone. Therapies under investigation include various strategies such as heroin vaccines, gene-targeted therapy, and biased agonism at the G protein-coupled receptor (GPCR), but several pharmacologic, clinical, and practical barriers limit these treatments\u27 market viability. This manuscript provides a comprehensive review of the current literature regarding recent innovations in OUD treatment

Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease

Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95$303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590

Design and rationale of the high-sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial

BACKGROUND: Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful. METHODS: The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment. High-sensitivity troponin T (hsTnT) will be drawn at the time of enrollment and 3 hours after the initial draw. The initial hsTnT draw will be no more than 3 hours after initiation of therapy for AHF (vasodilator, loop diuretic, noninvasive ventilation). Treating clinicians will be blinded to hsTnT results. We will assess whether hsTnT, as a single measurement or in series, can accurately predict patients at low risk of short-term adverse events. CONCLUSION: TACIT will explore the value of hsTnT measurements in isolation, or in combination with other markers of disease severity, for the identification of ED patients with AHF who are at low risk of short-term adverse events

An in vivo demonstration of efficacy and acute safety of burst wave lithotripsy using a porcine model

Burst wave lithotripsy (BWL) is a new non-invasive method for stone comminution using bursts of sub-megahertz ultrasound. A porcine model of urolithiasis and techniques to implement BWL treatment has been developed to evaluate its effectiveness and acute safety. Six human calcium oxalate monohydrate stones (6–7 mm) were hydrated, weighed, and surgically implanted into the kidneys of three pigs. Transcutaneous stone treatments were performed with a BWL transducer coupled to the skin via an external water bath. Stone targeting and treatment monitoring were performed with a co-aligned ultrasound imaging probe. Treatment exposures were applied in three 10-minute intervals for each stone. If sustained cavitation in the parenchyma was observed by ultrasound imaging feedback, treatment was paused and the pressure amplitude was decreased for the remaining time. Peak negative focal pressures between 6.5 and 7 MPa were applied for all treatments. After treatment, stone fragments were removed from the kidneys. At least 50% of each stone was reduced to <2 mm fragments. 100% of four stones were reduced to <4 mm fragments. Magnetic resonance imaging showed minimal injury to the functional renal volume. This study demonstrated that BWL could be used to effectively fragment kidney stones with minimal injury

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)

CARMA Survey Toward Infrared-bright Nearby Galaxies (STING) II: Molecular Gas Star Formation Law and Depletion Time Across the Blue Sequence

We present an analysis of the relationship between molecular gas and current star formation rate surface density at sub-kpc and kpc scales in a sample of 14 nearby star-forming galaxies. Measuring the relationship in the bright, high molecular gas surface density (\Shtwo\gtrsim20 \msunpc) regions of the disks to minimize the contribution from diffuse extended emission, we find an approximately linear relation between molecular gas and star formation rate surface density, \nmol\sim0.96\pm0.16, with a molecular gas depletion time \tdep\sim2.30\pm1.32 Gyr. We show that, in the molecular regions of our galaxies there are no clear correlations between \tdep\ and the free-fall and effective Jeans dynamical times throughout the sample. We do not find strong trends in the power-law index of the spatially resolved molecular gas star formation law or the molecular gas depletion time across the range of galactic stellar masses sampled (\mstar $\sim$$10^{9.7}-10^{11.5}$ \msun). There is a trend, however, in global measurements that is particularly marked for low mass galaxies. We suggest this trend is probably due to the low surface brightness CO, and it is likely associated with changes in CO-to-H2 conversion factor.Comment: To appear in ApJ, December 2011; 17 pages; 8 figure

Star Formation in Dwarf Galaxies of the Nearby Centaurus A Group

We present Halpha narrow-band imaging of 17 dwarf irregular galaxies (dIs) in the nearby Centaurus A Group. Although all large galaxies of the group have a current or recent enhanced star formation episode, the dIs have normal star formation rates and do not contain a larger fraction of dwarf starbursts than other nearby groups. Relative distances between dIs and larger galaxies of the group can be computed in 3D since most of them have now fairly accurately known distances. We find that the dI star formation rates do not depend on local environment, and in particular they do not show any correlation with the distance of the dI to the nearest large galaxy of the group. There is a clear morphology-density relation in the Centaurus A Group, similarly to the Sculptor and Local Groups, in the sense that dEs/dSphs tend to be at small distances from the more massive galaxies of the group, while dIs are on average at larger distances. We find four transition dwarfs in the Group, dwarfs that show characteristics of both dE/dSphs and dIs, and which contain cold gas but no current star formation. Interestingly the transition dwarfs have an average distance to the more massive galaxies which is intermediate between those of the dEs/dSphs and dIs, and which is quite large: 0.54 +- 0.31 Mpc. This large distance poses some difficulty for the most popular scenarios proposed for transforming a dI into a dE/dSph (ram-pressure with tidal stripping or galaxy harassment). If the observed transition dwarfs are indeed missing links between dIs and dE/dSphs, their relative isolation makes it less likely to have been produced by these mechanisms. We propose that an inhomogeneous IGM containing higher density clumps would be able to ram-pressure stripped the dIs at such large distances.Comment: 57 pages, 10 fi5gure