Method of moments solution of volume integral equations using parametric geometry modeling

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94709/1/rds4692.pd

UPDATING AND TESTING THE PASRR SCREEN IN KANSAS: REAL WORLD IMPLICATIONS

This work is licensed under a Creative Commons Attribution 4.0 International License.Kansas is updating the PASRR (Preadmission Screen and Resident Review) Level 1 screen per new guidance from the PASRR Technical Assistance Committee (PTAC), via a partnership between the State and university researchers. PTAC has directed states to screen for undiagnosed serious and persistent mental illness (SPMI) and also recommends screening for substance related disorders. Stakeholders were engaged through advisory workgroups and a content validity expert panel. These activities led to the creation of a revised PASRR Level-1 screen, but stakeholders also raised several concerns. PASRR law does not require Level-1 assessors to have professional training in mental health diagnoses or treatment, yet new guidelines asks them to screen for undiagnosed SPMI. Further, there are apparent discrepancies between these new guidelines and PASRR Level-2 criteria. Finally, current information management systems are not equipped to handle the higher security protocols associated substance use disorders. The draft instrument was tested with a sample of 103 nursing facility applicants by trained PASRR assessors and inter-rater reliability (IRR) was tested via a standardized vignette with 14 trained PASRR assessors. Only 3% of actual NF applicants were identified as possibly having an undiagnosed SPMI and only 43% of assessors correctly identified symptoms of a suspected SPMI in the standardized vignette, indicating poor validity and reliability in assessing for undiagnosed SPMI during the Level-1 screen. New PASRR guidelines may better ensure that nursing facility residents receive appropriate care for SPMI, however, there are many challenges to ensuring an accurate screen and supporting successful implementation

Evidence of a vertical kinematic oscillation beyond the Radcliffe Wave

The Radcliffe Wave (RW) is a recently discovered sinusoidal vertical feature of dense gas in the proximity of the Sun. In the disk plane, it is aligned with the Local Arm. However, the origin of its vertical undulation is still unknown. This study constrains the kinematics of the RW, using young stars and open clusters as tracers, and explores the possibility of this oscillation being part of a more extended vertical mode. We study the median vertical velocity trends of the young stars and clusters along with the RW and extend it further to the region beyond it. We discover a kinematic wave in the Galaxy, distinct from the warp, with the amplitude of oscillation depending on the age of the stellar population. We perform a similar analysis in the N-body simulation of a satellite as massive as the Sagittarius dwarf galaxy impacting the galactic disk. When projected in the plane, the spiral density wave induced by the satellite impact is aligned with the RW, suggesting that both may be the response of the disk to an external perturbation. However, the observed kinematic wave is misaligned. It appears as a kinematic wave travelling radially, winding up faster than the density wave matched by the RW, questioning its origin. If a satellite galaxy is responsible for this kinematic wave, we predict the existence of a vertical velocity dipole that should form across the disk and this may be measurable with the upcoming Gaia DR3 and DR4.Comment: Accepted for publication in Astronomy & Astrophysics Letter

Improved Determination of the Electroweak Penguin Contribution to epsilon'/epsilon in the Chiral Limit

We perform a finite energy sum rule analysis of the flavor ud two-point V-A current correlator, Delta Pi (Q^2). The analysis, which is performed using both the ALEPH and OPAL databases for the V-A spectral function, Delta rho, allows us to extract the dimension six V-A OPE coefficient, a_6, which is related to the matrix element of the electroweak penguin operator, Q_8, by chiral symmetry. The result for a_6 leads directly to the improved (chiral limit) determination epsilon'/epsilon = (- 15.0 +- 2.7) 10^{-4}. Determination of higher dimension OPE contributions also allows us to perform an independent test using a low-scale constrained dispersive analysis, which provides a highly nontrivial consistency check of the results.Comment: 17 pages, 4 figures, Revte

The Radcliffe Wave as the gas spine of the Orion Arm

The Radcliffe Wave is a $\sim3$ kpc long coherent gas structure containing most of the star-forming complexes near the Sun. In this Letter we aim to find a Galactic context for the Radcliffe Wave by looking into a possible relationship between the gas structure and the Orion (Local) Arm. We use catalogs of massive stars and young open clusters based on \textit{Gaia} EDR3 astrometry, in conjunction with kiloparsec-scale 3D dust maps, to investigate the Galactic \textit{XY} spatial distributions of gas and young stars. We find a quasi-parallel offset between the luminous blue stars and the Radcliffe Wave, in that massive stars and clusters are found essentially inside and downstream from the Radcliffe Wave. We examine this offset in the context of color gradients observed in the spiral arms of external galaxies, where the interplay between density wave theory, spiral shocks, and triggered star formation has been used to interpret this particular arrangement of gas/dust and OB stars, and outline other potential explanations as well. We hypothesize that the Radcliffe Wave constitutes the gas reservoir of the Orion (Local) Arm, and presents itself as a prime laboratory to study the interface between Galactic structure, the formation of molecular clouds in the Milky Way, and star formation.Comment: Published in A&A Letter

A New Panel-Estimated GFR, Including beta(2)-Microglobulin and beta-Trace Protein and Not Including Race, Developed in a Diverse Population

RATIONALE AND OBJECTIVE: GFR estimation based on creatinine and cystatin C (eGFR(cr-cys)) is more accurate than eGFR based on either creatinine or cystatin C alone (eGFR(cr) or eGFR(cys)), but the inclusion of creatinine in eGFR(cr-cys) requires specification of a person’s race. Beta-2-microglobulin (B2M) and beta-trace protein (BTP) are alternative filtration markers that appear to be less influenced by race than creatinine. STUDY DESIGN: Study of diagnostic test accuracy. SETTING AND PARTICIPANTS: Development in pooled population of seven studies with 5017 participants with and without chronic kidney disease. External validation in a pooled population of seven other studies with 2245 participants. TESTS COMPARED: Panel eGFR using B2M and BTP in addition to cystatin C (three-marker panel) or creatinine and cystatin C (four-marker panel) with and without age and sex or race. OUTCOMES: GFR measured as the urinary clearance of iothalamate, plasma clearance of iohexol, or plasma clearance of Cr-EDTA RESULTS: Mean measured GFR was 58.1 and 83.2 ml/min/1.73m(2) and the proportion of blacks was 38.6% and 24.0%, in the development and validation populations, respectively. In development, addition of age and sex improved the performance of all equations compared to equations without age and sex, but addition of race did not further improve the performance. In validation, the four-marker panels were more accurate than the three-marker panels (p<0.001). The three-marker panel without race was more accurate than eGFR(cys) [1- P(30) of 15.6 vs 17.4% (p=0.014)], and the four-marker panel without race was as accurate as eGFR(cr-cys) [1- P(30) of 8.6 vs 9.4% (p=0.17)]. Results were generally consistent across subgroups. LIMITATIONS: No representation of participants with severe comorbid illness and from geographic areas outside of North America and Europe. CONCLUSIONS: The four-marker panel eGFR is as accurate as eGFR(cr-cys), without requiring specification of race. A more accurate race-free eGFR could be an important advance

Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation

Background This assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF). Objectives To assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions. Data sources Electronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers’ submissions to the National Institute for Health and Care Excellence. Review methods Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon. Results A total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY. Limitations Limitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups. Conclusions In people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony. Study registration This study is registered as PROSPERO number CRD42012002062. Funding The National Institute for Health Research Health Technology Assessment programme

Use of AFLP and RAPD molecular genetic markers and cytogenetic analysis to explore relationships among taxa of the Patagonian Bromus setifolius complex

Bromus setifolius var. pictus (Hook) Skottsb., B. setifolius var. setifolius Presl. and B.setifolius var. brevifolius Ness are three native Patagonian taxa in the section Pnigma Dumort of the genus Bromus L. AFLP and RAPD analysis, in conjunction with genetic distance measurements and statistical techniques, revealed variation within this group and indicated that B. setifolius var. brevifolius was closely related to B. setifolius var. pictus, with both taxa being more distantly related to B. setifolius var. setifolius. Cytogenetic analysis confirmed the chromosomal number of B. setifolius var. pictus (2n = 70) and B. setifolius var. setifolius (2n = 28) and showed for the first time that B. setifolius var. brevifolius had 2n = 70. The combination of molecular genetic and cytogenetic evidence supported a species status for two of the three taxa and suggested hypotheses for the evolutionary origin of these complex taxa. Species status was also indicated for B. setifolius var. setifolius. Based on these findings, we suggest that B. setifolius var. pictus be referred to as B. pictus Hook var. pictus, and B. setifolius var brevifolius as B. pictus Hook var brevifolius. The correlation between AFLP diversity and variation in ecological parameters suggested that this marker system could be used to assess breeding progress and to monitor the domestication of Patagonian Bromus species for agronomic use