Most vital segment barriers

We study continuous analogues of "vitality" for discrete network flows/paths, and consider problems related to placing segment barriers that have highest impact on a flow/path in a polygonal domain. This extends the graph-theoretic notion of "most vital arcs" for flows/paths to geometric environments. We give hardness results and efficient algorithms for various versions of the problem, (almost) completely separating hard and polynomially-solvable cases

Goal-Oriented Adaptive Mesh Refinement for the Quasicontinuum Approximation of a Frenkel-Kontorova Model

The quasicontinuum approximation is a method to reduce the atomistic degrees of freedom of a crystalline solid by piecewise linear interpolation from representative atoms that are nodes for a finite element triangulation. In regions of the crystal with a highly nonuniform deformation such as around defects, every atom must be a representative atom to obtain sufficient accuracy, but the mesh can be coarsened away from such regions to remove atomistic degrees of freedom while retaining sufficient accuracy. We present an error estimator and a related adaptive mesh refinement algorithm for the quasicontinuum approximation of a generalized Frenkel-Kontorova model that enables a quantity of interest to be efficiently computed to a predetermined accuracy.Comment: 15 pages, 6 figures, 3 table

A Guidebook: navigating custody and access negotiation

guidelines for family negotiation: what to do in the interest of minors after a family breakup

MeV magnetosheath ions energized at the bow shock

A causal relationship between midlatitude magnetosheath energetic ions and bow shock magnetic geometry was previously established for ion energy up to 200 keV e−1 for the May 4, 1998, storm event. This study demonstrates that magnetosheath ions with energies above 200 keV up to 1 MeV simply extend the ion spectrum to form a power law tail. Results of cross-correlation analysis suggest that these ions also come directly from the quasi-parallel bow shock, not the magnetosphere. This is confirmed by a comparison of energetic ion fluxes simultaneously measured in the magnetosheath and at the quasi-parallel bow shock when both regions are likely connected by the magnetic field lines. We suggest that ions are accelerated at the quasi-parallel bow shock to energies as high as 1 MeV and subsequently transported into the magnetosheath during this event

Triggered Palliative Care for Late-stage Dementia: a Pilot Randomized Trial

Context Persons with late-stage dementia have limited access to palliative care. Objective To test dementia-specific specialty palliative care triggered by hospitalization. Methods This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus post-acute transitional care. Control dyads received usual care and educational information. The primary outcome was 60-day hospital or emergency department visits. Secondary patient and family-centered outcomes were patient comfort, family distress, palliative care domains addressed in the treatment plan, and access to hospice or community-based palliative care. Secondary decision-making outcomes were discussion of prognosis, goals of care, completion of Medical Orders for Scope of Treatment (MOST), and treatment decisions. Results Of 137 eligible dyads, 62 (45%) enrolled. The intervention proved feasible, with protocol completion ranging from 77% (family 2-week call) to 93% (initial consultation). Hospital and emergency department visits did not differ (intervention vs control, 0.68 vs 0.53 transfers per 60 days, p=0.415). Intervention patients had more palliative care domains addressed, and were more likely to receive hospice (25% vs 3%, p<0.019). Intervention families were more likely to discuss prognosis (90% vs 3%, p<0.001) and goals of care (90% vs 25%, p<0.001), and to have a MOST at 60-day follow-up (79% vs 30%, p<0.001). More intervention families made decisions to avoid re-hospitalization (13% vs 0%, p=0.033). Conclusion Specialty palliative care consultation for hospitalized patients with for late-stage dementia is feasible and promising to improve decision-making and some treatment outcomes

Patterns of stressful life events and polygenic scores for five mental disorders and neuroticism among adults with depression

The dominant (‘general’) version of the diathesis-stress theory of depression views stressors and genetic vulnerability as independent risks. In the Australian Genetics of Depression Study (N = 14,146; 75% female), we tested whether polygenic scores (PGS) for major depression, bipolar disorder, schizophrenia, anxiety, ADHD, and neuroticism were associated with reported exposure to 32 childhood, past-year, lifetime, and accumulated stressful life events (SLEs). In false discovery rate-corrected models, the clearest PGS-SLE relationships were for the ADHD- and depression-PGSs, and to a lesser extent, the anxiety- and schizophrenia-PGSs. We describe the associations for childhood and accumulated SLEs, and the 2–3 strongest past-year/lifetime SLE associations. Higher ADHD-PGS was associated with all childhood SLEs (emotional abuse, emotional neglect, physical neglect; ORs = 1.09–1.14; p’s < 1.3 × 10−5), more accumulated SLEs, and reported exposure to sudden violent death (OR = 1.23; p = 3.6 × 10−5), legal troubles (OR = 1.15; p = 0.003), and sudden accidental death (OR = 1.14; p = 0.006). Higher depression-PGS was associated with all childhood SLEs (ORs = 1.07–1.12; p’s < 0.013), more accumulated SLEs, and severe human suffering (OR = 1.17; p = 0.003), assault with a weapon (OR = 1.12; p = 0.003), and living in unpleasant surroundings (OR = 1.11; p = 0.001). Higher anxiety-PGS was associated with childhood emotional abuse (OR = 1.08; p = 1.6 × 10−4), more accumulated SLEs, and serious accident (OR = 1.23; p = 0.004), physical assault (OR = 1.08; p = 2.2 × 10−4), and transportation accident (OR = 1.07; p = 0.001). Higher schizophrenia-PGS was associated with all childhood SLEs (ORs = 1.12–1.19; p’s < 9.3−8), more accumulated SLEs, and severe human suffering (OR = 1.16; p = 0.003). Higher neuroticism-PGS was associated with living in unpleasant surroundings (OR = 1.09; p = 0.007) and major financial troubles (OR = 1.06; p = 0.014). A reversed pattern was seen for the bipolar-PGS, with lower odds of reported physical assault (OR = 0.95; p = 0.014), major financial troubles (OR = 0.93; p = 0.004), and living in unpleasant surroundings (OR = 0.92; p = 0.007). Genetic risk for several mental disorders influences reported exposure to SLEs among adults with moderately severe, recurrent depression. Our findings emphasise that stressors and diatheses are inter-dependent and challenge diagnosis and subtyping (e.g., reactive/endogenous) based on life events

Alterations in vascular function in primary aldosteronism - a cardiovascular magnetic resonance imaging study

Introduction: Excess aldosterone is associated with increased cardiovascular risk. Aldosterone has a permissive effect on vascular fibrosis. Cardiovascular magnetic resonance imaging (CMR) allows study of vascular function by measuring aortic distensibility. We compared aortic distensibility in primary aldosteronism (PA), essential hypertension (EH) and normal controls and explored the relationship between aortic distensibility and pulse wave velocity (PWV).&lt;p&gt;&lt;/p&gt; Methods: We studied PA (n=14) and EH (n=33) subjects and age-matched healthy controls (n=17) with CMR, including measurement of aortic distensibility, and measured PWV using applanation tonometry. At recruitment, PA and EH patients had similar blood pressure and left ventricular mass.&lt;p&gt;&lt;/p&gt; Results: Subjects with PA had significantly lower aortic distensibilty and higher PWV compared to EH and healthy controls. These changes were independent of other factors associated with reduced aortic distensibility, including aging. There was a significant relationship between increasing aortic stiffness and age in keeping with physical and vascular aging. As expected, aortic distensibility and PWV were closely correlated.&lt;p&gt;&lt;/p&gt; Conclusion: These results demonstrate that PA patients display increased arterial stiffness compared to EH, independent of vascular aging. The implication is that aldosterone invokes functional impairment of arterial function. The long-term implications of arterial stiffening in aldosterone excess require further study.&lt;p&gt;&lt;/p&gt