Right coronary artery—Pulmonary artery arteriovenous fistula secondary to open heart surgery

A patient is described who underwent atrial septal defect repair at age 12 and presented 16 years later with angina. Coronary angiography revealed a right coronary artery to pulmonary artery fistula that had developed at the site of the previous thoracotomy. This is the first report of an acquired fistula of this type developing secondary to trauma associated with open heart surgery. Diagnosis, shunt quantification and treatment are discussed

Semiclassical approach to discrete symmetries in quantum chaos

We use semiclassical methods to evaluate the spectral two-point correlation function of quantum chaotic systems with discrete geometrical symmetries. The energy spectra of these systems can be divided into subspectra that are associated to irreducible representations of the corresponding symmetry group. We show that for (spinless) time reversal invariant systems the statistics inside these subspectra depend on the type of irreducible representation. For real representations the spectral statistics agree with those of the Gaussian Orthogonal Ensemble (GOE) of Random Matrix Theory (RMT), whereas complex representations correspond to the Gaussian Unitary Ensemble (GUE). For systems without time reversal invariance all subspectra show GUE statistics. There are no correlations between non-degenerate subspectra. Our techniques generalize recent developments in the semiclassical approach to quantum chaos allowing one to obtain full agreement with the two-point correlation function predicted by RMT, including oscillatory contributions.Comment: 26 pages, 8 Figure

Chaotic maps and flows: Exact Riemann-Siegel lookalike for spectral fluctuations

To treat the spectral statistics of quantum maps and flows that are fully chaotic classically, we use the rigorous Riemann-Siegel lookalike available for the spectral determinant of unitary time evolution operators $F$. Concentrating on dynamics without time reversal invariance we get the exact two-point correlator of the spectral density for finite dimension $N$ of the matrix representative of $F$, as phenomenologically given by random matrix theory. In the limit $N\to\infty$ the correlator of the Gaussian unitary ensemble is recovered. Previously conjectured cancellations of contributions of pseudo-orbits with periods beyond half the Heisenberg time are shown to be implied by the Riemann-Siegel lookalike

Microwave Realization of the Gaussian Symplectic Ensemble

This work was funded by the Deutsche Forschungsgemeinschaft via the individual Grants No. STO 157/16-1 and No. KU 1525/3-1. C. H. J. acknowledges the Leverhulme Trust (Grant No. ECF-2014-448) for financial support

Recognizing Intimate Partner Violence in Primary Care: Western Cape, South Africa

Introduction: Interpersonal violence in South Africa is the second highest contributor to the burden of disease after HIV/ AIDS and 62 % is estimated to be from intimate partner violence (IPV). This study aimed to evaluate how women experiencing IPV present in primary care, how often IPV is recognized by health care practitioners and what other diagnoses are made. Methods: At two urban and three rural community health centres, health practitioners were trained to screen all women fo

Advanced Space Transportation Concepts and Propulsion Technologies for a New Delivery Paradigm

This paper describes Advanced Space Transportation Concepts and Propulsion Technologies for a New Delivery Paradigm. It builds on the work of the previous paper "Approach to an Affordable and Productive Space Transportation System". The scope includes both flight and ground system elements, and focuses on their compatibility and capability to achieve a technical solution that is operationally productive and also affordable. A clear and revolutionary approach, including advanced propulsion systems (advanced LOX rich booster engine concept having independent LOX and fuel cooling systems, thrust augmentation with LOX rich boost and fuel rich operation at altitude), improved vehicle concepts (autogeneous pressurization, turbo alternator for electric power during ascent, hot gases to purge system and keep moisture out), and ground delivery systems, was examined. Previous papers by the authors and other members of the Space Propulsion Synergy Team (SPST) focused on space flight system engineering methods, along with operationally efficient propulsion system concepts and technologies. This paper continues the previous work by exploring the propulsion technology aspects in more depth and how they may enable the vehicle designs from the previous paper. Subsequent papers will explore the vehicle design, the ground support system, and the operations aspects of the new delivery paradigm in greater detail

Finite pseudo orbit expansions for spectral quantities of quantum graphs

We investigate spectral quantities of quantum graphs by expanding them as sums over pseudo orbits, sets of periodic orbits. Only a finite collection of pseudo orbits which are irreducible and where the total number of bonds is less than or equal to the number of bonds of the graph appear, analogous to a cut off at half the Heisenberg time. The calculation simplifies previous approaches to pseudo orbit expansions on graphs. We formulate coefficients of the characteristic polynomial and derive a secular equation in terms of the irreducible pseudo orbits. From the secular equation, whose roots provide the graph spectrum, the zeta function is derived using the argument principle. The spectral zeta function enables quantities, such as the spectral determinant and vacuum energy, to be obtained directly as finite expansions over the set of short irreducible pseudo orbits.Comment: 23 pages, 4 figures, typos corrected, references added, vacuum energy calculation expande

Molecular crowding defines a common origin for the Warburg effect in proliferating cells and the lactate threshold in muscle physiology

Aerobic glycolysis is a seemingly wasteful mode of ATP production that is seen both in rapidly proliferating mammalian cells and highly active contracting muscles, but whether there is a common origin for its presence in these widely different systems is unknown. To study this issue, here we develop a model of human central metabolism that incorporates a solvent capacity constraint of metabolic enzymes and mitochondria, accounting for their occupied volume densities, while assuming glucose and/or fatty acid utilization. The model demonstrates that activation of aerobic glycolysis is favored above a threshold metabolic rate in both rapidly proliferating cells and heavily contracting muscles, because it provides higher ATP yield per volume density than mitochondrial oxidative phosphorylation. In the case of muscle physiology, the model also predicts that before the lactate switch, fatty acid oxidation increases, reaches a maximum, and then decreases to zero with concomitant increase in glucose utilization, in agreement with the empirical evidence. These results are further corroborated by a larger scale model, including biosynthesis of major cell biomass components. The larger scale model also predicts that in proliferating cells the lactate switch is accompanied by activation of glutaminolysis, another distinctive feature of the Warburg effect. In conclusion, intracellular molecular crowding is a fundamental constraint for cell metabolism in both rapidly proliferating- and non-proliferating cells with high metabolic demand. Addition of this constraint to metabolic flux balance models can explain several observations of mammalian cell metabolism under steady state conditions