Nodular Sarcoidosis Masquerading as Cancer.

Nodular lung disease is a rare pulmonary manifestation of sarcoidosis and resembles metastatic neoplasm disease. Nodular sarcoidosis is rare, varying from 1.6% to 4% of patients with sarcoidosis. Radiographic nodules measure from 1 to 5 cm in diameter that typically consist of coalescent granulomas. There is limited data on this form of sarcoidosis and its presentation can mimic primary or metastatic pulmonary neoplasms. Nodular sarcoidosis has a favorable prognosis, and resolution can be seen with oral corticosteroids. Herein, we present such a case of nodular pulmonary sarcoidosis with a lung nodule measured up to 6 cm

Addition of 24‐hour heart rate variability parameters to the Cardiovascular Health Study stroke risk score and prediction of incident stroke: The Cardiovascular Health Study

Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24‐hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS‐SCORE), previously developed at the baseline examination. Methods and Results N=884 stroke‐free CHS participants (age 75.3±4.6), with 24‐hour Holters adequate for HRV analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow‐up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding HRV to the CHS‐SCORE was assessed with stepwise Cox regression analysis. The CHS‐SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c‐statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher‐risk participants after adjustment for CHS‐SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <−1.4) maximally stratified higher‐risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c‐statistic for the model with the CHS‐SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS‐SCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8‐year follow‐up. These findings will require validation in separate, larger cohorts. Keywords: autonomic nervous system, clinical stroke risk model, heart rate variability, prediction, predictors, risk prediction, risk stratification, strok

Estimating changes in temperature extremes from millennial scale climate simulations using generalized extreme value (GEV) distributions

Changes in extreme weather may produce some of the largest societal impacts of anthropogenic climate change. However, it is intrinsically difficult to estimate changes in extreme events from the short observational record. In this work we use millennial runs from the CCSM3 in equilibrated pre-industrial and possible future conditions to examine both how extremes change in this model and how well these changes can be estimated as a function of run length. We estimate changes to distributions of future temperature extremes (annual minima and annual maxima) in the contiguous United States by fitting generalized extreme value (GEV) distributions. Using 1000-year pre-industrial and future time series, we show that the magnitude of warm extremes largely shifts in accordance with mean shifts in summertime temperatures. In contrast, cold extremes warm more than mean shifts in wintertime temperatures, but changes in GEV location parameters are largely explainable by mean shifts combined with reduced wintertime temperature variability. In addition, changes in the spread and shape of the GEV distributions of cold extremes at inland locations can lead to discernible changes in tail behavior. We then examine uncertainties that result from using shorter model runs. In principle, the GEV distribution provides theoretical justification to predict infrequent events using time series shorter than the recurrence frequency of those events. To investigate how well this approach works in practice, we estimate 20-, 50-, and 100-year extreme events using segments of varying lengths. We find that even using GEV distributions, time series that are of comparable or shorter length than the return period of interest can lead to very poor estimates. These results suggest caution when attempting to use short observational time series or model runs to infer infrequent extremes.Comment: 33 pages, 22 figures, 1 tabl

Noisy Classical Field Theories with Two Coupled Fields: Dependence of Escape Rates on Relative Field Stiffnesses

Exit times for stochastic Ginzburg-Landau classical field theories with two or more coupled classical fields depend on the interval length on which the fields are defined, the potential in which the fields deterministically evolve, and the relative stiffness of the fields themselves. The latter is of particular importance in that physical applications will generally require different relative stiffnesses, but the effect of varying field stiffnesses has not heretofore been studied. In this paper, we explore the complete phase diagram of escape times as they depend on the various problem parameters. In addition to finding a transition in escape rates as the relative stiffness varies, we also observe a critical slowing down of the string method algorithm as criticality is approached.Comment: 16 pages, 10 figure

Nontangential limits and Fatou-type theorems on post-critically finite self-similar sets

In this paper we study the boundary limit properties of harmonic functions on $\mathbb R_+\times K$, the solutions $u(t,x)$ to the Poisson equation $$\frac{\partial^2 u}{\partial t^2} + \Delta u = 0,$$ where $K$ is a p.c.f. set and $\Delta$ its Laplacian given by a regular harmonic structure. In particular, we prove the existence of nontangential limits of the corresponding Poisson integrals, and the analogous results of the classical Fatou theorems for bounded and nontangentially bounded harmonic functions.Comment: 22 page

Positron-inert gas differential elastic scattering

Measurements are being made in a crossed beam experiment of the relative elastic differential cross section (DCS) for 5 to 300 eV positrons scattering from inert gas atoms (He, Ne, Ar, Kr, and Xe) in the angular range from 30 to 134 deg. Results obtained at energies around the positronium (Ps) formation threshold provide evidence that Ps formation and possibly other inelastic channels have an effect on the elastic scattering channel

Walking side-by-side: Recovery Colleges revolutionising mental health care

© 2018 Emerald Publishing Limited. Purpose - The Recovery College model is an innovative approach to providing education to consumers, carers and mental health staff, with the potential to facilitate both personal recovery gains and organisational transformation towards recovery-focused service provision. The purpose of this paper is to explore the experiences of students who attended the South Eastern Sydney Recovery College (SESRC). Design/methodology/approach - An exploratory, descriptive qualitative design was employed with data collected through seven focus group interviews with consumers and mental health staff who had participated in courses run by the SESRC. Thematic analysis of the data was conducted using both deductive and inductive processes in order to interpret the data. Findings - All participants were positive about their involvement in the RC. Four themes emerged from the thematic analysis: Connection with others, hope for the future, the importance of the lived experience, and changing attitudes and systems. Originality/value - The outcomes of this study indicate that the SESRC is achieving its aims in relation to both personal recovery gains, and the potential to impact on service transformation. It highlights the centrality of co-production as a fundamental aspect of the Recovery College model. This paper contributes to the emerging evidence base for this model and provides evidence that this model is applicable to the Australian context

The Order of Phase Transitions in Barrier Crossing

A spatially extended classical system with metastable states subject to weak spatiotemporal noise can exhibit a transition in its activation behavior when one or more external parameters are varied. Depending on the potential, the transition can be first or second-order, but there exists no systematic theory of the relation between the order of the transition and the shape of the potential barrier. In this paper, we address that question in detail for a general class of systems whose order parameter is describable by a classical field that can vary both in space and time, and whose zero-noise dynamics are governed by a smooth polynomial potential. We show that a quartic potential barrier can only have second-order transitions, confirming an earlier conjecture [1]. We then derive, through a combination of analytical and numerical arguments, both necessary conditions and sufficient conditions to have a first-order vs. a second-order transition in noise-induced activation behavior, for a large class of systems with smooth polynomial potentials of arbitrary order. We find in particular that the order of the transition is especially sensitive to the potential behavior near the top of the barrier.Comment: 8 pages, 6 figures with extended introduction and discussion; version accepted for publication by Phys. Rev.

Photonic band mixing in linear chains of optically coupled micro-spheres

The paper deals with optical excitations arising in a one-dimensional chain of identical spheres due optical coupling of whispering gallery modes (WGM). The band structure of these excitations depends significantly on the inter-mixing between WGMs characterized by different values of angular quantum number, $l$. We develop a general theory of the photonic band structure of these excitations taking these effects into account and applied it to several cases of recent experimental interest. In the case of bands originating from WQMs with the angular quantum number of the same parity, the calculated dispersion laws are in good qualitative agreement with recent experiment results. Bands resulting from hybridization of excitations resulting from whispering gallery modes with different parity of $l$ exhibits anomalous dispersion properties characterized by a gap in the allowed values of \emph{wave numbers} and divergence of group velocity.Comment: RevTex, 28 pages, 7 Figure

Research review: young people leaving care

This paper reviews the international research on young people leaving care. Set in the context of a social exclusion framework, it explores young people's accelerated and compressed transitions to adulthood, and discusses the development and classification of leaving care services in responding to their needs. It then considers the evidence from outcome studies and argues that adopting a resilience framework suggests that young people leaving care may fall into three groups: young people 'moving on', 'survivors' and 'victims'. In concluding, it argues that these three pathways are associated with the quality of care young people receive, their transitions from care and the support they receive after care