Asymptomatic Pulmonary Hypertension in Systemic Lupus Erythematosus

Introduction Pulmonary arterial hypertension (PAH) is a serious and often fatal complication of systemic lupus erythematosus (SLE). Because the diagnosis of PAH often is made years after symptom onset, early diagnostic strategies are essential. Doppler echocardiography currently is considered the noninvasive screening test of choice for evaluating pulmonary hypertension. Aim Screening for asymptomatic pulmonary hypertension in systemic lupus erythematosus patients using Doppler echocardiography, and correlating it with inflammatory parameters of the disease. Patients and Methods Doppler echocardiography was performed in 74 patients with systemic lupus erythematosus over one year (66 adult and 8 juvenile), adult SLE included 57 patients with adult-onset and 9 patients with childhood-onset. Pulmonary hypertension was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 30 mmHg. All patients were subjected to full history taking, rheumatological examination, laboratory studies and chest x-ray. Results In seventy four SLE patients, the pulmonary hypertension was detected in 8 patients (10.8%), 7 adult-onset SLE patients (aged from 19 to 30 years) and 1 juvenile SLE (aged 12 years). The range of pulmonary artery systolic pressure was 34–61.2 mmHg (43.19 ± 9.28). No significant differences between patients with and those without pulmonary hypertension as regard clinical features. Significantly higher frequencies of rheumatoid factor and anti-cardiolipin antibodies were found in patients with pulmonary hypertension versus those without ( P = 0.02, P = 0.008 respectively). Positive rheumatoid factor and ACL were significantly associated with occurrence of PAH in SLE ( P = 0.007, P = 0.006 respectively). No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI), ESR, and anti-ds DNA. Conclusion Patients with SLE have an increased risk of pulmonary arterial hypertension. Echocardiography should be used as a screening tool in patients at high risk for development of pulmonary hypertension. Positive anti-cardiolipin antibodies and rheumatoid factor were significant predictors of pulmonary hypertension in our study

Pressure and linear heat capacity in the superconducting state of thoriated UBe13

Even well below Tc, the heavy-fermion superconductor (U,Th)Be13 has a large linear term in its specific heat. We show that under uniaxial pressure, the linear heat capacity increases in magnitude by more than a factor of two. The change is reversible and suggests that the linear term is an intrinsic property of the material. In addition, we find no evidence of hysteresis or of latent heat in the low-temperature and low-pressure portion of the phase diagram, showing that all transitions in this region are second order.Comment: 5 pages, 4 figure

A Step Beyond the Bounce: Bubble Dynamics in Quantum Phase Transitions

We study the dynamical evolution of a phase interface or bubble in the context of a \lambda \phi^4 + g \phi^6 scalar quantum field theory. We use a self-consistent mean-field approximation derived from a 2PI effective action to construct an initial value problem for the expectation value of the quantum field and two-point function. We solve the equations of motion numerically in (1+1)-dimensions and compare the results to the purely classical evolution. We find that the quantum fluctuations dress the classical profile, affecting both the early time expansion of the bubble and the behavior upon collision with a neighboring interface.Comment: 12 pages, multiple figure

Electron transport and energy relaxation in dilute magnetic alloys

We consider the effect of the RKKY interaction between magnetic impurities on the electron relaxation rates in a normal metal. The interplay between the RKKY interaction and the Kondo effect may result in a non-monotonic temperature dependence of the electron momentum relaxation rate, which determines the Drude conductivity. The electron phase relaxation rate, which determines the magnitude of the weak localization correction to the resistivity, is also a non-monotonic function of temperature. For this function, we find the dependence of the position of its maximum on the concentration of magnetic impurities. We also relate the electron energy relaxation rate to the excitation spectrum of the system of magnetic impurities. The energy relaxation determines the distribution function for the out-of-equilibrium electrons. Measurement of the electron distribution function thus may provide information about the excitations in the spin glass phase.Comment: 15 pages, 5 figure

Quantum Vacuum Experiments Using High Intensity Lasers

The quantum vacuum constitutes a fascinating medium of study, in particular since near-future laser facilities will be able to probe the nonlinear nature of this vacuum. There has been a large number of proposed tests of the low-energy, high intensity regime of quantum electrodynamics (QED) where the nonlinear aspects of the electromagnetic vacuum comes into play, and we will here give a short description of some of these. Such studies can shed light, not only on the validity of QED, but also on certain aspects of nonperturbative effects, and thus also give insights for quantum field theories in general.Comment: 9 pages, 8 figur

Additive and Multiplicative Noise Driven Systems in 1+1 Dimensions: Waiting Time Extraction of Nucleation Rates

We study the rate of true vacuum bubble nucleation numerically for a phi^4 field system coupled to a source of thermal noise. We compare in detail the cases of additive and multiplicative noise. We pay special attention to the choice of initial field configuration, showing the advantages of a version of the quenching technique. We advocate a new method of extracting the nucleation time scale that employs the full distribution of nucleation times. Large data samples are needed to study the initial state configuration choice and to extract nucleation times to good precision. The 1+1 dimensional models afford large statistics samples in reasonable running times. We find that for both additive and multiplicative models, nucleation time distributions are well fit by a waiting time, or gamma, distribution for all parameters studied. The nucleation rates are a factor three or more slower for the multiplicative compared to the additive models with the same dimensionless parameter choices. Both cases lead to high confidence level linear fits of ln(nucleation time) vs. 1/T plots, in agreement with semiclassical nucleation rate predictions.Comment: 38 pages, 20 figures, 6 table

Implementation of a pharmacogenomics consult service to support the INGENIOUS trial

Hospital systems increasingly utilize pharmacogenomic testing to inform clinical prescribing. Successful implementation efforts have been modeled at many academic centers. In contrast, this report provides insights into the formation of a pharmacogenomics consultation service at a safety-net hospital, which predominantly serves low-income, uninsured, and vulnerable populations. The report describes the INdiana GENomics Implementation: an Opportunity for the UnderServed (INGENIOUS) trial and addresses concerns of adjudication, credentialing, and funding

Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a social worker, over and above the federally mandated written information on HCPs) or comparison group (who received the written information only). Results: Logistic regression analysis indicates there is a statistically significantly higher probability that a patient would sign an HCP if assigned to the treatment group than if assigned to the comparison condition. Conclusion: Benefits of educating patients about HCPs as part of routine social work practice are outlined

Reduction of anti-K-mediated hemolytic disease of newborns after the introduction of a matched transfusion policy: a nation-wide policy change evaluation study in the Netherlands

Background: During pregnancy, maternal red blood cell (RBC) antibodies can lead to life-threatening fetal hemolysis and anemia. Women can become immunized by a pregnancy or an unmatched transfusion. Our aim was to quantify the effect of a nationwide K-matched transfusion policy for women of childbearing age potential to prevent K-immunization in pregnancy.Study Design and Methods: In this nation-wide policy change evaluation study we determined the occurrence of RBC antibodies before and after introduction of a K-matched transfusion policy and evaluated the cause K alloimmunization 10 years after introduction of this measure. K-matched transfusion for females under 45 years of age is advised in the Dutch transfusion guideline since 2004. We used laboratory data from pregnancies with RBC antibodies identified in the period 1999-2018 obtained as part of a population-based screening program in the Netherlands.Results: Tests of 36 286 pregnancies produced a positive antibody screening result which concerned anti-K in 1550 pregnancies. The occurrence of anti-K decreased from 67.9 to 20.2 per 100 000 pregnancies. The relative risk reduction was 0.70 which largely exceeded the relative risk reduction of 0.27 for antibodies against RBC antigens for which no preventive matching is required. The number of pregnancies at risk for anti-K-mediated disease decreased from 9.7 to 4.2 per 100 000 pregnancies.Conclusions: A K-matched transfusion policy is associated with a major decrease in a number of pregnant women with anti-K and pregnancies at risk for anti-K-mediated disease. A relatively simple measure is now shown to impact prevention of hemolytic disease in the fetus and newborn.Clinical epidemiolog

Measurement of the Atmospheric Muon Spectrum from 20 to 3000 GeV

The absolute muon flux between 20 GeV and 3000 GeV is measured with the L3 magnetic muon spectrometer for zenith angles ranging from 0 degree to 58 degree. Due to the large exposure of about 150 m2 sr d, and the excellent momentum resolution of the L3 muon chambers, a precision of 2.3 % at 150 GeV in the vertical direction is achieved. The ratio of positive to negative muons is studied between 20 GeV and 500 GeV, and the average vertical muon charge ratio is found to be 1.285 +- 0.003 (stat.) +- 0.019 (syst.).Comment: Total 32 pages, 9Figure