Opportunity for Regulating the Collective Effect of Random Expansion with Manifestations of Finite Size Effects in a Moderate Number of Finite Systems

One reports computational study revealing a set of general requirements, fulfilling of which would allow employing changes in ambient conditions to regulate accomplishing the collective outcome of emerging active network patterns in an ensemble of a moderate number of finite discrete systems. The patterns within all these component systems emerge out of random expansion process governed by certain local rule. The systems modeled are of the same type but different in details, finite discrete spatial domains of the expansion within the systems are equivalent regular hexagonal arrays. The way in which elements of a component system function in the local information transmission allows dividing them into two classes. One class is represented by zero-dimensional entities coupled into pairs identified at the array sites being nearest neighbors. The pairs preserve their orientation in the space while experiencing conditional hopping to positions close by and transferring certain information portions. Messenger particles hopping to signal the pairs for the conditional jumping constitute the other class. Contribution from the hopping pairs results in finite size effects being specific feature of accomplishing the mean expected network pattern representing the collective outcome. It is shown how manifestations of the finite size effects allow using changes in parameters of the model ambient conditions of the ensemble evolution to regulate accomplishing the collective outcome representation.Comment: 22 pages, 10 eps figures, corrected URL address placing in text, minor editorial correction in sec.2, author e-mail change

Can Countermovement Jump Neuromuscular Performance Qualities Differentiate Maximal Horizontal Deceleration Ability in Team Sport Athletes?

This investigation aimed to determine the countermovement jump (CMJ) neuromuscular performance (NMP) qualities that differentiate between athletes with high or low horizontal deceleration ability. Twenty-seven male university team sport athletes performed a CMJ on vertical axis force plates and a maximal horizontal deceleration following a 20 m maximal horizontal sprint acceleration. The instantaneous velocity throughout the maximal horizontal deceleration test was measured using a radar device. The deceleration ability was evaluated using the average deceleration (HDEC, m·s−2) and change in momentum—referred to as the horizontal braking impulse (HBI, N·s·kg−1). Participants were dichotomised into high and low HDEC and HBI according to a median-split analysis, and CMJ variables calculated for the overall eccentric, eccentric-deceleration and concentric phases. When horizontal deceleration ability was defined by HDEC, the CMJ concentric (effect size (ES) = 0.95) and eccentric (ES = 0.72) peak forces were the variables with the largest difference between groups. However, when defined using HBI, the largest difference was the concentric (ES = 1.15) and eccentric (ES = −1.00) peak velocities. Only the concentric mean power was significantly different between the high and low groups for both HDEC (ES = 0.85) and HBI (ES = 0.96). These findings show that specific eccentric and concentric NMP qualities may underpin the horizontal deceleration abilities characterised by HDEC and HBI. Specific NMP training interventions may be beneficial to target improvements in either of these measures of horizontal deceleration abilities

Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae

© 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. Methods: People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. Results: DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. Conclusion: Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.Peer reviewedFinal Published versio

Unique surgical approach to a twisted ileal-anal pouch

Total proctocolectomy with ileal pouch-anal anastomosis can restore gastrointestinal continuity in patients requiring colectomy for ulcerative colitis, however, it can be associated with high morbidity. Reoperation for pouch-related complications is technically challenging and often leads to deterioration of pouch function or need for permanent stoma. We report a case of acute on chronic small bowel obstruction secondary to a 360-degree twist in the small bowel introduced during creation of the ileal-anal pouch. Our novel approach at repair has not been reported in past literature which included resection and re-anastomosis of the small bowel proximal to the pouch allowing for pouch salvage with return to function

Big data-led cancer research, applications and insights

Insights distilled from integratingmultiple big-data or "omic" datasets have revealed functional hierarchies of molecular networks driving tumorigenesis and modifiers of treatment response. Identifying these novel key regulatory and dysregulated elements is now informing personalized medicine. Crucially, although there are many advantages to this approach, there are several key considerations to address. Here, we examine how this big data-led approach is impacting many diverse areas of cancer research, through review of the key presentations given at the Irish Association for Cancer Research Meeting and importantly how the results may be applied to positively affect patient outcomes

Acetarsol Suppositories: Effective Treatment for Refractory Proctitis in a Cohort of Patients with Inflammatory Bowel Disease.

BACKGROUND: Management of proctitis refractory to conventional therapies presents a common clinical problem. The use of acetarsol suppositories, which are derived from organic arsenic, was first described in 1965. Data concerning clinical efficacy and tolerability are very limited. AIM: To examine the efficacy of acetarsol suppositories for the treatment of refractory proctitis. METHODS: A retrospective analysis was performed on patients with inflammatory bowel disease treated with acetarsol suppositories between 2008 and 2014 at Addenbrooke's Hospital, Cambridge, United Kingdom. Clinical response was defined as resolution of symptoms back to baseline at the time of next clinic review. RESULTS: Thirty-nine patients were prescribed acetarsol suppositories between March 2008 and July 2014 (29 patients with ulcerative colitis, nine with Crohn's disease, and one with indeterminate colitis). Thirty-eight were included for analysis. The standard dose of acetarsol was 250 mg twice daily per rectum for 4 weeks. Clinical response was observed in 26 patients (68%). Of the 11 patients who had endoscopic assessment before and after treatment, nine (82%) showed endoscopic improvement and five (45%) were in complete remission (Wilcoxon signed-rank test p = 0.006). One patient developed a macular skin rash 1 week after commencing acetarsol, which resolved within 4 weeks of drug cessation. CONCLUSION: Acetarsol was effective for two out of every three patients with refractory proctitis. This cohort had failed a broad range of topical and systemic treatments, including anti-TNFα therapy. Clinical efficacy was reflected in significant endoscopic improvement. Adverse effects of acetarsol were rare

Deprivation and prognosis in patients with Pulmonary Arterial Hypertension: missing the effect of deprivation on a rare disease?

In this journal, Pellino et al presented survival analysis to assess how deprivation affects prognosis in patients with pulmonary arterial hypertension (PAH)1. Their conclusions were that social deprivation is not a significant referral barrier or prognostic factor for idiopathic (I)PAH or heritable (H)PAH in Scotland. This may appear surprising given the wider context of literature describing outcomes stratified by social deprivation. The authors were thorough on using both the address at time of diagnosis and at time of censoring to assign deprivation scores and compare the two, finding no significant differences between the two approaches. They also compared deprivation assigned to PAH cases to expected deprivation based on Scottish citizenry as a whole and found that PAH patients are more socially deprived than expected. Finally, they used the same survival univariate analysis adjusting for age and sex to assess how several clinical variables are associated with prognosis

Medieval Irish Chronicles Reveal Persistent Volcanic Forcing of Severe Winter Cold Events, 431–1649 CE

Explosive volcanism resulting in stratospheric injection of sulfate aerosol is a major driver of regional to global climatic variability on interannual and longer timescales. However, much of our knowledge of the climatic impact of volcanism derives from the limited number of eruptions that have occurred in the modern period during which meteorological instrumental records are available. We present a uniquely long historical record of severe short-term cold events from Irish chronicles, 431–1649 CE, and test the association between cold event occurrence and explosive volcanism. Thirty eight (79%) of 48 volcanic events identified in the sulfate deposition record of the Greenland Ice Sheet Project 2 ice-core correspond to 37 (54%) of 69 cold events in this 1219 year period. We show this association to be statistically significant at the 99.7% confidence level, revealing both the consistency of response to explosive volcanism for Ireland's climatically sensitive Northeast Atlantic location and the large proportional contribution of volcanism to historic cold event frequencies here. Our results expose, moreover, the extent to which volcanism has impacted winter-season climate for the region, and can help to further resolve the complex spatial patterns of Northern Hemisphere winter-season cooling versus warming after major eruptions.Earth and Planetary Science

Predictors of outcomes in mild pulmonary hypertension according to 2022 ESC/ERS Guidelines: the EVIDENCE-PAH UK study

BACKGROUND AND AIMS: Interventional studies in pulmonary arterial hypertension completed to date have shown to be effective in symptomatic patients with significantly elevated mean pulmonary artery pressure (mPAP) (≥25 mmHg) and pulmonary vascular resistance (PVR) > 3 Wood Unit (WU). However, in health the mPAP does not exceed 20 mmHg and PVR is 2 WU or lower, at rest. The ESC/ERS guidelines have recently been updated to reflect this. There is limited published data on the nature of these newly defined populations (mPAP 21-24 mmHg and PVR >2-≤3 WU) and the role of comorbidity in determining their natural history. With the change in guidelines, there is a need to understand this population and the impact of the ESC/ERS guidelines in greater detail. METHODS: A retrospective nationwide evaluation of the role of pulmonary haemodynamics and comorbidity in predicting survival among patients referred to the UK pulmonary hypertension (PH) centres between 2009 and 2017. In total, 2929 patients were included in the study. Patients were stratified by mPAP ( 2-≤3 WU, and >3 WU), with 968 (33.0%) in the mPAP 2-≤3WU) was lower than among those with normal pressures (mPAP <21 mmHg) and normal PVR (PVR ≤ 2WU) independent of comorbid lung and heart disease [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.14-1.61, P = .0004 for mPAP vs. HR 1.28, 95% CI 1.10-1.49, P = .0012 for PVR]. Among patients with mildly elevated mPAP, a mildly elevated PVR remained an independent predictor of survival when adjusted for comorbid lung and heart disease (HR 1.33, 95% CI 1.01-1.75, P = .042 vs. HR 1.4, 95% CI 1.06-1.86, P = .019). 68.2% of patients with a mPAP 21-24 mmHg had evidence of underlying heart or lung disease. Patients with mildly abnormal haemodynamics were not more symptomatic than patients with normal haemodynamics. Excluding patients with heart and lung disease, connective tissue disease was associated with a poorer survival among those with PH. In this subpopulation evaluating those with a mPAP of 21-24 mmHg, survival curves only diverged after 5 years. CONCLUSIONS: This study supports the change in diagnostic category of the ESC/ERS guidelines in a PH population. The newly included patients have an increased mortality independent of significant lung or heart disease. The majority of patients in this new category have underlying heart or lung disease rather than an isolated pulmonary vasculopathy. Mortality is higher if comorbidity is present. Rigorous phenotyping will be pivotal to determine which patients are at risk of progressive vasculopathic disease and in whom surveillance and recruitment to studies may be of benefit. This study provides an insight into the population defined by the new guidelines

Portfolio Management: The Holistic Data Lifecycle

21 pagesMachine learning provides many benefits to Portfolio Managers in analysing data and has the potential to provide much more. A concern with the approach to Machine Learning in Portfolio Management is that is caught between two domains: finance and information systems. In reality, to ensure its success, having these two separate and distinct domains are problematic. What is required is a holistic view, facilitating discussions, with data being the unifying concept and the one that is key to success. The data value map is a lens that allows all involved, in the use or adoption of Machine Learning in Portfolio Management, to form a shared understanding of the lifecycle of the data involved. Rather than being seen as a financial concept or a technical concept, this view of the data lifecycle provides a platform for all involved to determine what is required, and to identify and deal with any potential pitfalls along the way. A holistic view, and shared understanding, are required for the success of Machine Learning in Portfolio Management. Research on the intersection between Machine Learning and Portfolio Management is currently lacking. A focus on the different parts of the data lifecycle provides an opportunity for further research