Erenumab in chronic migraine: Patient-reported outcomes in a randomized double-blind study.

OBJECTIVE: To determine the effect of erenumab, a human monoclonal antibody targeting the calcitonin gene-related peptide receptor, on health-related quality of life (HRQoL), headache impact, and disability in patients with chronic migraine (CM). METHODS: In this double-blind, placebo-controlled study, 667 adults with CM were randomized (3:2:2) to placebo or erenumab (70 or 140 mg monthly). Exploratory endpoints included migraine-specific HRQoL (Migraine-Specific Quality-of-Life Questionnaire [MSQ]), headache impact (Headache Impact Test-6 [HIT-6]), migraine-related disability (Migraine Disability Assessment [MIDAS] test), and pain interference (Patient-Reported Outcomes Measurement Information System [PROMIS] Pain Interference Scale short form 6b). RESULTS: Improvements were observed for all endpoints in both erenumab groups at month 3, with greater changes relative to placebo observed at month 1 for many outcomes. All 3 MSQ domains were improved from baseline with treatment differences for both doses exceeding minimally important differences established for MSQ-role function-restrictive (≥3.2) and MSQ-emotional functioning (≥7.5) and for MSQ-role function-preventive (≥4.5) for erenumab 140 mg. Changes from baseline in HIT-6 scores at month 3 were -5.6 for both doses vs -3.1 for placebo. MIDAS scores at month 3 improved by -19.4 days for 70 mg and -19.8 days for 140 mg vs -7.5 days for placebo. Individual-level minimally important difference was achieved by larger proportions of erenumab-treated participants than placebo for all MSQ domains and HIT-6. Lower proportions of erenumab-treated participants had MIDAS scores of severe (≥21) or very severe (≥41) or PROMIS scores ≥60 at month 3. CONCLUSIONS: Erenumab-treated patients with CM experienced clinically relevant improvements across a broad range of patient-reported outcomes. CLINICALTRIALSGOV IDENTIFIER: NCT02066415. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with CM, erenumab treatment improves HRQoL, headache impact, and disability

Network Friendly P2P-TV: The Napa-Wine Approach

DEMO Sessio

Experimental comparison of neighborhood filtering strategies in unstructured P2P-TV systems

P2P-TV systems performance are driven by the overlay topology that peers form. Several proposals have been made in the past to optimize it, yet little experimental studies have corroborated results. The aim of this work is to provide a comprehensive experimental comparison of different strategies for the construction and maintenance of the overlay topology in P2P-TV systems. To this goal, we have implemented different fully-distributed strategies in a P2P-TV application, called Peer- Streamer, that we use to run extensive experimental campaigns in a completely controlled set-up which involves thousands of peers, spanning very different networking scenarios. Results show that the topological properties of the overlay have a deep impact on both user quality of experience and network load. Strategies based solely on random peer selection are greatly outperformed by smart, yet simple strategies that can be implemented with negligible overhead. Even with different and complex scenarios, the neighborhood filtering strategy we devised as most perform- ing guarantees to deliver almost all chunks to all peers with a play-out delay as low as only 6s even with system loads close to 1.0. Results are confirmed by running experiments on PlanetLab. PeerStreamer is open-source to make results reproducible and allow further research by the communit

A delay-based aggregate rate control for P2P streaming systems

In this paper we consider mesh based P2P streaming systems focusing on the problem of regulating peer transmission rate to match the system demand while not overloading each peer upload link capacity. We propose Hose Rate Control (HRC), a novel scheme to control the speed at which peers offer chunks to other peers, ultimately controlling peer uplink capacity utilization. This is of critical importance for heterogeneous scenarios like the one faced in the Internet, where peer upload capacity is unknown and varies widely. HRC nicely adapts to the actual peer available upload bandwidth and system demand, so that Quality of Experience is greatly enhanced. To support our claims we present both simulations and actual experiments involving more than 1000 peers to assess performance in real scenarios. Results show that HRC consistently outperforms the Quality of Experience achieved by non-adaptive scheme

Lower bound on the blow-up rate of the axisymmetric Navier-Stokes equations

Consider axisymmetric strong solutions of the incompressible Navier-Stokes equations in $\R^3$ with non-trivial swirl. Such solutions are not known to be globally defined, but it is shown in \cite{MR673830} that they could only blow up on the axis of symmetry. Let $z$ denote the axis of symmetry and $r$ measure the distance to the z-axis. Suppose the solution satisfies the pointwise scale invariant bound $|v (x,t)| \le C_*{(r^2 -t)^{-1/2}}$ for $-T_0\le t < 0$ and $0<C_*<\infty$ allowed to be large, we then prove that $v$ is regular at time zero.Comment: 25 page

Cardiac Troponin After Percutaneous Coronary Intervention and 1-Year Mortality in Non–ST-Segment Elevation Acute Coronary Syndrome Using Systematic Evaluation of Biomarker Trends

ObjectivesThis study sought to review cardiac troponin (cTn) trends during non–ST-segment elevation acute coronary syndrome (NSTE ACS) in patients undergoing percutaneous coronary intervention (PCI) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Non–ST-Segment Elevation Acute Coronary Syndromes) and SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors) studies and to study the relationship between post-PCI cTn and mortality.BackgroundThe prognostic value of cTn post-PCI is controversial. In patients with NSTE ACS, it is especially difficult to distinguish between cTn elevations due to PCI or index myocardial infarction (MI).MethodsTime and cTn (indexed by upper limit of normal [ULN]) data pairs were plotted for 10,199 patients and independently reviewed by 2 physicians to identify patients in whom post-PCI cTn elevation could be distinguished from that of index MI. Post-PCI cTn peak was identified for each plot, and its relationship with 1-year mortality was evaluated using Cox modeling, correcting for 15 clinical variables from the EARLY ACS 1-year mortality model (including baseline cTn). We used an identical methodology to assess the association between creatine kinase-myocardial band and 1-year mortality.ResultsPatients with cTn (re-)elevation post-PCI not evaluable were identified and excluded from further analysis (4,198 [41%] with cTn rising prior to PCI; 229 [2%] with missing cTn). Among the remainder (n = 5,772 [57%]), in the multivariable model, peak cTn post-PCI was associated with a 7% increase in mortality (hazard ratio [HR] for 10× ULN increase: 1.07, 95% confidence interval [CI]: 1.02 to 1.11; p = 0.0038). Peak post-PCI creatine kinase-myocardial band was significantly associated with 1-year mortality (HR for 1× ULN increase: 1.13, 95% CI: 1.05 to 1.21; p = 0.0013).ConclusionsWe used a methodology that differentiated post-PCI cTn (re-)elevation from that of presenting MI in more than one-half of patients with NSTE ACS undergoing PCI. This identified a highly significant relationship between post-PCI cTn and 1-year mortality, with implications for both incorporating a cTn post-PCI MI definition and preventing PCI-related myonecrosis

Phase field approach to optimal packing problems and related Cheeger clusters

In a fixed domain of $\Bbb{R}^N$ we study the asymptotic behaviour of optimal clusters associated to $\alpha$-Cheeger constants and natural energies like the sum or maximum: we prove that, as the parameter $\alpha$ converges to the "critical" value $\Big (\frac{N-1}{N}\Big ) _+$, optimal Cheeger clusters converge to solutions of different packing problems for balls, depending on the energy under consideration. As well, we propose an efficient phase field approach based on a multiphase Gamma convergence result of Modica-Mortola type, in order to compute $\alpha$-Cheeger constants, optimal clusters and, as a consequence of the asymptotic result, optimal packings. Numerical experiments are carried over in two and three space dimensions