972 research outputs found

    Asymptotic Expansions for Stationary Distributions of Perturbed Semi-Markov Processes

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    New algorithms for computing of asymptotic expansions for stationary distributions of nonlinearly perturbed semi-Markov processes are presented. The algorithms are based on special techniques of sequential phase space reduction, which can be applied to processes with asymptotically coupled and uncoupled finite phase spaces.Comment: 83 page

    Influence of piston position on the scavenging and swirling flow in two-stroke Diesel engines

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    We study the e ect of piston position on the in-cylinder swirling ow in a low speed large two-stroke marine diesel engine model. We are using Large Eddy Simulations in OpenFOAM, with three di erent models for the turbulent ow: a one equation model (OEM), a dynamic one equation model (DOEM) and Ta Phuoc Loc's model (TPLM). The simulated ows are grid-independent and they are computed in situations analogous to two di erent piston positions where the air intake ports are uncovered 100% and 50%, respectively. We nd that the average ow inside the cylinder changes qualitatively with port closure from a Burgers vortex pro le to a solid body rotation while the axial velocity changes from a wake-like pro le to a jet-like pro le. The numerical results are compared with measurements in a similar geometry [3] and we nd a good agreement between simulations and measurements. Furthermore, we consider the unsteady ow and identify a dominant frequency in a power spectrum based on velocity which we show is due to precession of the vortex core, and compare with measurements of the unsteady ow obtained with Laser Doppler Anemometry

    Comparative toxicity and effectiveness of trastuzumab-based chemotherapy regimens in older women with early-stage breast cancer

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    Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2-positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years. Propensity score matching was used to balance cohort characteristics between treatment arms. Outcomes included toxicity-related hospitalization, survival, and trastuzumab completion. Data from 1,077 patients receiving ACTH or TCH were analyzed, and the propensity-matched subsample included 416 women. Results There was a significant shift toward TCH over time, with 88% of patients receiving ACTH in 2005 compared with 15% by 2011. Among propensity score-matched patients, we found no difference between regimens in health care use overall or for chemotherapy-related adverse events (ACTH, 34% v TCH, 36.5%; P = .46). Patients receiving TCH were significantly more likely to complete trastuzumab (89% v 77%; P = .001). There was no difference in 5-year breast cancer-specific survival (ACTH, 92% v TCH, 96%; hazard ratio, 2.08; 95% CI, 0.90 to 4.82) or overall survival. Conclusion Among a matched sample of older patients, ACTH compared with TCH was not associated with a higher rate of serious adverse events or hospitalizations, but it was associated with less completion of adjuvant trastuzumab.Wedid not detect a difference in 5-year survival outcomes for ACTH compared with TCH. In the context of limited evidence in older patients, selection between these two regimens on the basis of concerns about differential toxicity or efficacy may not be appropriate

    Red cell ABO incompatibility and production of tumour necrosis factor-alpha

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    Tumour necrosis factor-alpha (TNF) is a major mediator of diverse pathophysiological events similar to those of haemolytic transfusion reactions (HTR), such as fever, intravascular coagulation and organ failure. However, the possible role of TNF in HTR has not been investigated. We have constructed an in vitro whole blood model of HTR to examine whether TNF may be produced in red cell ABO incompatibility. TNF was observed in plasma, in a dose dependent manner, when ABO incompatible red cells were added, but not with compatible (group O) cells. Plasma TNF levels were maximal at 2 h, and declined to control levels by 24 h. Haemolysis of incompatible red cells was accompanied by TNF production. Immune haemolysis induced TNF gene expression by buffy coat leucocytes, as determined by Northern blot analysis. Heat inactivation of plasma abolished TNF production, whereas prior treatment with interferongamma augmented the response. These results demonstrate that a major cytokine is produced in response to red cell incompatibility, and suggest that TNF may play a role in the pathogenesis of haemolytic transfusion reactions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75627/1/j.1365-2141.1991.tb04485.x.pd

    Microbial carbon use efficiency along an altitudinal gradient

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    Soil microbial carbon-use efficiency (CUE), described as the ratio of growth over total carbon (C) uptake, i.e. the sum of growth and respiration, is a key variable in all soil organic matter (SOM) models and critical to ecosystem C cycling. However, there is still a lack of consensus on microbial CUE when estimated using different methods. Furthermore, the significance of many fundamental drivers of CUE remains largely unknown and inconclusive, especially for tropical ecosystems. For these reasons, we determined CUE and microbial indicators of soil nutrient availability in seven tropical forest soils along an altitudinal gradient (circa 900-2200 m a.s.l) occurring at Taita Hills, Kenya. We used this gradient to study the soil nutrient (N and P) availability and its relation to microbial CUE estimates. For assessing the soil nutrient availability, we determined both the soil bulk stoichiometric nutrient ratios (soil C:N, C:P and N:P), as well as SOM degradation related enzyme activities. We estimated soil microbial CUE using two methods: substrate independent O-18-water tracing and C-13-glucose tracing method. Based on these two approaches, we estimated the microbial uptake efficiency of added glucose versus native SOM, with the latter defined by 18O-water tracing method. Based on the bulk soil C:N stoichiometry, the studied soils did not reveal N limitation. However, soil bulk P limitation increased slightly with elevation. Additionally, based on extracellular enzyme activities, the SOM nutrient availability decreased with elevation. The C-13-CUE did not change with altitude indicating that glucose was efficiently taken up and used by the microbes. On the other hand, 18O-CUE, which reflects the growth efficiency of microbes growing on native SOM, clearly declined with increasing altitude and was associated with SOM nutrient availability indicators. Based on our results, microbes at higher elevations invested more energy to scavenge for nutrients and energy from complex SOM whereas at lower elevations the soil nutrients may have been more readily available.Peer reviewe

    Influence of provider factors and race on uptake of breast cancer gene expression profiling

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    BACKGROUND: Gene expression profiling (GEP) has been rapidly adopted for early breast cancer and can aid in chemotherapy decision making. Study results regarding racial disparities in testing are conflicting, and may reflect different care settings. To the authors' knowledge, data regarding the influence of provider factors on testing are scarce. METHODS: The authors used a statewide, multipayer, insurance claims database linked to cancer registry records to examine the impact of race and provider characteristics on GEP uptake in a cohort of patients newly diagnosed with breast cancer between 2005 and 2012. Incidence proportion models were used to examine the adjusted likelihood of testing. Models were stratified by lymph node status (N0 vs N1). RESULTS: Among 11,958 eligible patients, 23% of black and 26% of non-Hispanic white patients received GEP. Among patients with N0 disease, black individuals were 16% less likely to receive testing after adjustment for clinical factors and the provider's specialty and volume of patients with breast cancer (95% confidence interval, 0.77-0.93). Adjustment for provider characteristics did not attenuate the effect of race on testing. Patients of middle-volume providers were more likely to be tested compared with those with either high-volume or low-volume providers, whereas patients seeing a medical oncologist were more likely to be tested compared with those whose only providers were from surgical specialties. CONCLUSIONS: Provider volume and specialty were found to be significant predictors of GEP use, but did not explain racial disparities in testing. Further research concerning the key contributors to lagging test use among black women is needed to optimize the equitable use of GEPs and support personalized treatment decision making for all patients

    Low-Luminosity Accretion in Black Hole X-ray Binaries and Active Galactic Nuclei

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    At luminosities below a few percent of Eddington, accreting black holes switch to a hard spectral state which is very different from the soft blackbody-like spectral state that is found at higher luminosities. The hard state is well-described by a two-temperature, optically thin, geometrically thick, advection-dominated accretion flow (ADAF) in which the ions are extremely hot (up to 101210^{12} K near the black hole), the electrons are also hot (∌109−10.5\sim10^{9-10.5} K), and thermal Comptonization dominates the X-ray emission. The radiative efficiency of an ADAF decreases rapidly with decreasing mass accretion rate, becoming extremely low when a source reaches quiescence. ADAFs are expected to have strong outflows, which may explain why relativistic jets are often inferred from the radio emission of these sources. It has been suggested that most of the X-ray emission also comes from a jet, but this is less well established.Comment: To appear in "From X-ray Binaries to Quasars: Black Hole Accretion on All Mass Scales" edited by T. Maccarone, R. Fender, L. Ho, to be published as a special edition of "Astrophysics and Space Science" by Kluwe
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