Randomised controlled trial of specialist nurse intervention in heart failure

<p>Objectives. To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.</p> <p>Design. Randomised controlled trial.</p> <p>Setting. Acute medical admissions unit in a teaching hospital.</p> <p>Participants. 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.</p> <p>Main outcome measures. Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.</p> <p>Results. 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).</p> <p>Conclusions. Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.</p&gt

I=3/2 KπK \pi Scattering in the Nonrelativisitic Quark Potential Model

We study $I=3/2$ elastic $K\pi$ scattering to Born order using nonrelativistic quark wavefunctions in a constituent-exchange model. This channel is ideal for the study of nonresonant meson-meson scattering amplitudes since s-channel resonances do not contribute significantly. Standard quark model parameters yield good agreement with the measured S- and P-wave phase shifts and with PCAC calculations of the scattering length. The P-wave phase shift is especially interesting because it is nonzero solely due to $SU(3)_f$ symmetry breaking effects, and is found to be in good agreement with experiment given conventional values for the strange and nonstrange constituent quark masses.Comment: 12 pages + 2 postscript figures, Revtex, MIT-CTP-210

Mode-hop-free tuning over 135 GHz of external cavity diode lasers without anti-reflection coating

We report an external cavity diode laser (ECDL), using a diode whose front facet is not antireflection (AR) coated, that has a mode-hop-free (MHF) tuning range greater than 135 GHz. We achieved this using a short external cavity and by simultaneously tuning the internal and external modes of the laser. We find that the precise location of the pivot point of the grating in our laser is less critical than commonly believed. The general applicability of the method, combined with the compact portable mechanical and electronic design, makes it well suited for both research and industrial applications.Comment: 5 pages, 5 figure

Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation Electroanatomic characterization and treatment

ObjectivesThe purpose of this study was to evaluate the electroanatomic characteristics of left atrial tachycardia (AT) in a series of patients who underwent circumferential pulmonary vein ablation (CPVA) and to describe the ablation strategy and clinical outcome.BackgroundCircumferential pulmonary vein ablation is an effective treatment for atrial fibrillation. A potential midterm complication is the development of left AT. There are only isolated reports describing mapping and ablation of such arrhythmias.MethodsThirteen patients (age 57.4 ± 8.9 years, five female) underwent mapping and ablation of 14 left ATs via an electroanatomic mapping system a mean of 2.6 ± 1.6 months after CPVA.ResultsThree patients were characterized as having focal AT (cycle length: 266 ± 35.9 ms). Of 11 macro–re-entrant tachycardias studied in the remaining 10 patients (cycle length: 275 ± 75 ms), 5 showed single-loop and 6 dual-loop circuits. Re-entrant circuits used the mitral isthmus, the posterior wall, or gaps on previous encircling lines. Such gaps and all three foci occurred anterior to the left superior pulmonary vein or at the septal aspect of the right pulmonary veins. Thirteen of 14 tachycardias (93%) were successfully ablated.ConclusionsLeft AT after CPVA can be due to a macro–re-entrant or focal mechanism. Re-entry occurs most commonly across the mitral isthmus, the posterior wall, or gaps on previous ablation lines. Such gaps and foci occur most commonly at the anterior aspect of the left superior pulmonary vein and at the septal aspect of the right pulmonary veins. These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system

Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort

BACKGROUND:Understanding the health profile, service, and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population. AIMS:To examine the 2006-2015 trends in (1) co-morbidities and frailty of individuals accessing aged care and (2) health services, medicine use, and mortality after entry into long term care. METHODS:A cross-sectional and population-based trend analysis were conducted using the Registry of Senior Australians. RESULTS:From 2006-2015, 509,944 individuals accessed permanent residential care, 206,394 home care, 283,014 respite, and 124,943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7% to 49.7%), as did the proportion with 5-9 co-morbidities (46.4% to 54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6-12) to 10 (IQR 7-14), while remaining stable in home care (2006:9 IQR 5-12, 2015:9, IQR 6-13). Short-term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95%CI 15.2-16.0%) than 2015 (14.6%, 95%CI 14.3-14.9%), while longer term (101-1095 days, 2006: 44.3%, 95%CI 43.7-45.0%, 2015: 46.4%, 95%CI 45.8-46.9%) mortality was higher. Mortality in individuals accessing home care did not change. CONCLUSION:The health of older Australians accessing aged care programs has declined while frailty increased, with an increasing use of medicine and worse long-term mortality in some. Funding and care models need to adapt to this changing profile.Maria C. Inacio, Catherine Lang, Sarah C. E. Bray, Renuka Visvanathan, Craig Whitehead, Elizabeth C. Griffith, Keith Evans, Megan Corlis and Steve Wesseling

Physics basis and simulation of burning plasma physics for the fusion ignition research experiment (FIRE)

The FIRE [Fusion Ignition Research Experiment] design for a burning plasma experiment is described in terms of its physics basis and engineering features. Systems analysis indicates that the device has a wide operating space to accomplish its mission, both for the ELMing H-mode reference and the high bootstrap current/high beta advanced tokamak regimes. Simulations with 1.5D transport codes reported here both confirm and constrain the systems projections. Experimental and theoretical results are used to establish the basis for successful burning plasma experiments in FIRE

Pegasus IV: Discovery and Spectroscopic Confirmation of an Ultra-faint Dwarf Galaxy in the Constellation Pegasus

We report the discovery of Pegasus IV, an ultra-faint dwarf galaxy found in archival data from the Dark Energy Camera processed by the DECam Local Volume Exploration Survey. Pegasus IV is a compact, ultra-faint stellar system (r1 2 = 41-+68 pc; MV = −4.25 ± 0.2 mag) located at a heliocentric distance of 90-+64 kpc. Based on spectra of seven nonvariable member stars observed with Magellan/IMACS, we confidently resolve Pegasus IV’s velocity dispersion, measuring sv = 3.3-+1.11.7 km s−1 (after excluding three velocity outliers); this implies a mass-to-light ratio of M1 2 LV,1 2 = 167-+99224M☉ L☉ for the system. From the five stars with the highest signal-to-noise spectra, we also measure a systemic metallicity of [Fe/H] =-2.63-+0.300.26 dex, making Pegasus IV one of the most metal-poor ultra-faint dwarfs. We tentatively resolve a nonzero metallicity dispersion for the system. These measurements provide strong evidence that Pegasus IV is a dark-matter-dominated dwarf galaxy, rather than a star cluster. We measure Pegasus IV’s proper motion using data from Gaia Early Data Release 3, finding (μα*, μδ) = (0.33 ± 0.07, −0.21 ± 0.08) mas yr−1. When combined with our measured systemic velocity, this proper motion suggests that Pegasus IV is on an elliptical, retrograde orbit, and is currently near its orbital apocenter. Lastly, we identify three potential RR Lyrae variable stars within Pegasus IV, including one candidate member located more than 10 half-light radii away from the system’s centroid. The discovery of yet another ultra-faint dwarf galaxy strongly suggests that the census of Milky Way satellites is still incomplete, even within 100 kpc

Genome-wide association and Meta-analysis of age at onset in Parkinson Disease

Background and Objectives Considerable heterogeneity exists in the literature concerning genetic determinants of the age at onset (AAO) of Parkinson disease (PD), which could be attributed to a lack of well-powered replication cohorts. The previous largest genome-wide association studies (GWAS) identified SNCA and TMEM175 loci on chromosome (Chr) 4 with a significant influence on the AAO of PD; these have not been independently replicated. This study aims to conduct a meta-analysis of GWAS of PD AAO and validate previously observed findings in worldwide populations. Methods A meta-analysis was performed on PD AAO GWAS of 30 populations of predominantly European ancestry from the Comprehensive Unbiased Risk Factor Assessment for Genetics and Environment in Parkinson's Disease (COURAGE-PD) Consortium. This was followed by combining our study with the largest publicly available European ancestry dataset compiled by the International Parkinson Disease Genomics Consortium (IPDGC). Results The COURAGE-PD Consortium included a cohort of 8,535 patients with PD (91.9%: Europeans and 9.1%: East Asians). The average AAO in the COURAGE-PD dataset was 58.9 years (SD = 11.6), with an underrepresentation of females (40.2%). The heritability estimate for AAO in COURAGE-PD was 0.083 (SE = 0.057). None of the loci reached genome-wide significance (p < 5 × 10−8). Nevertheless, the COURAGE-PD dataset confirmed the role of the previously published TMEM175 variant as a genetic determinant of the AAO of PD with Bonferroni-corrected nominal levels of significance (p < 0.025): (rs34311866: β(SE)COURAGE = 0.477(0.203), pCOURAGE = 0.0185). The subsequent meta-analysis of COURAGE-PD and IPDGC datasets (Ntotal = 25,950) led to the identification of 2 genome-wide significant association signals on Chr 4, including the previously reported SNCA locus (rs983361: β(SE)COURAGE+IPDGC = 0.720(0.122), pCOURAGE+IPDGC = 3.13 × 10−9) and a novel BST1 locus (rs4698412: β(SE)COURAGE+IPDGC = −0.526(0.096), pCOURAGE+IPDGC = 4.41 × 10−8). Discussion Our study further refines the genetic architecture of Chr 4 underlying the AAO of the PD phenotype through the identification of BST1 as a novel AAO PD locus. These findings open a new direction for the development of treatments to delay the onset of PD