Movement and Fluctuations of the Vacuum

Quantum fields possess zero-point or vacuum fluctuations which induce mechanical effects, namely generalised Casimir forces, on any scatterer. Symmetries of vacuum therefore raise fundamental questions when confronted with the principle of relativity of motion in vacuum. The specific case of uniformly accelerated motion is particularly interesting, in connection with the much debated question of the appearance of vacuum in accelerated frames. The choice of Rindler representation, commonly used in General Relativity, transforms vacuum fluctuations into thermal fluctuations, raising difficulties of interpretation. In contrast, the conformal representation of uniformly accelerated frames fits the symmetry properties of field propagation and quantum vacuum and thus leads to extend the principle of relativity of motion to uniform accelerations. Mirrors moving in vacuum with a non uniform acceleration are known to radiate. The associated radiation reaction force is directly connected to fluctuating forces felt by motionless mirrors through fluctuation-dissipation relations. Scatterers in vacuum undergo a quantum Brownian motion which describes irreducible quantum fluctuations. Vacuum fluctuations impose ultimate limitations on measurements of position in space-time, and thus challenge the very concept of space-time localisation within a quantum framework. For test masses greater than Planck mass, the ultimate limit in localisation is determined by gravitational vacuum fluctuations. Not only positions in space-time, but also geodesic distances, behave as quantum variables, reflecting the necessary quantum nature of an underlying geometry.Comment: 17 pages, to appear in Reports on Progress in Physic

Organic Chemistry

XXX, 1439 tr.; 26 cm

Organic chemistry

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Organic Chemistry

xxxi, 1390 hal., index; 26c

Landscape and Consumer Culture in the Design Work of Humphry Repton and Gordon Cullen: A Methodological Framework

The practice of landscape and townscape or urban design is driven and shaped by consumer markets as much as it is by aesthetics and design values. Since the 1700s gardens and landscapes have performed like idealized lifestyle commodities via attractive images in mass media as landscape design and consumer markets became increasingly entangled. This essay is a methodological framework that locates landscape design studies in the context of visual consumer culture, using two examples of influential and media-savvy landscape designers: the renowned eighteenth-century English landscape gardener Humphry Repton and one of Britain’s top twentieth-century draftsmen and postwar townscape designers, Gordon Cullen. Rather than aesthetics and meaning, I focus on the designer’s motives, working modes, and visual marketing strategies for building audiences and markets. At the heart of these strategies is the performance of images in consumerist culture. Drawing on primary and secondary sources, I show that they persuasively fashioned, “packaged,” and “sold” their landscape commodity through attractive and marketable image-text products. The study highlights the specific role that each man assumed vis-à-vis his work environment and consumers, the pictorial sources that each used, and the media that broadcast and shaped each designer’s legacy. Despite the different historical contexts and the particular logics of the economy and mass media apparatuses of the time, this consumerist-focused study also reveals parallels between these men’s motives and image-making and marketing strategies. For instance, their drive for both professional and laypeople appeal led them to bridge theory and practice, use the “art of compromise,” and devise palatable and alluring images. By using consumerist arts perspectives in landscape and urban design studies, I offer a new interpretive path toward a historical knowledge that incorporates the landscape designer’s modus operandi and explains the role of mass media and marketing in the production and consumption of landscape

Association of Myocardial Fibrosis and Stroke Volume by Cardiovascular Magnetic Resonance in Patients With Severe Aortic Stenosis With Outcome After Valve Replacement: The British Society of Cardiovascular Magnetic Resonance AS700 Study

Importance: Low-flow severe aortic stenosis (AS) has higher mortality than severe AS with normal flow. The conventional definition of low-flow AS is an indexed stroke volume (SVi) by echocardiography less than 35 mL/m2. Cardiovascular magnetic resonance (CMR) is the reference standard for quantifying left ventricular volumes and function from which SVi by CMR can be derived. Objective: To determine the association of left ventricular SVi by CMR with myocardial remodeling and survival among patients with severe AS after valve replacement. Design, Setting, and Participants: This multicenter longitudinal cohort study was conducted between January 2003 and May 2015 across 6 UK cardiothoracic centers. Patients with severe AS listed for either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were included. Patients underwent preprocedural echocardiography and CMR. Patients were stratified by echocardiography-derived aortic valve mean and/or peak gradient and SVi by CMR into 4 AS endotypes: low-flow, low-gradient AS; low-flow, high-gradient AS; normal-flow, low-gradient AS; and normal-flow, high-gradient AS. Patients were observed for a median of 3.6 years. Data were analyzed from September to November 2021. Exposures SAVR or TAVR. Main Outcomes and Measures: All-cause and cardiovascular (CV) mortality after aortic valve intervention. Results: Of 674 included patients, 425 (63.1%) were male, and the median (IQR) age was 75 (66-80) years. The median (IQR) aortic valve area index was 0.4 (0.3-0.4) cm2/m2. Patients with low-flow AS endotypes (low gradient and high gradient) had lower left ventricular ejection fraction, mass, and wall thickness and increased all-cause and CV mortality than patients with normal-flow AS (all-cause mortality: hazard ratio [HR], 2.08; 95% CI, 1.37-3.14; P < .001; CV mortality: HR, 3.06; 95% CI, 1.79-5.25; P < .001). CV mortality was independently associated with lower SVi (HR, 1.64; 95% CI, 1.08-2.50; P = .04), age (HR, 2.54; 95% CI, 1.29-5.01; P = .001), and higher quantity of late gadolinium enhancement (HR, 2.93; 95% CI, 1.68-5.09; P < .001). CV mortality hazard increased more rapidly in those with an SVI less than 45 mL/m2. SVi by CMR was independently associated with age, atrial fibrillation, focal scar (by late gadolinium enhancement), and parameters of cardiac remodeling (left ventricular mass and left atrial volume). Conclusions and Relevance: In this cohort study, SVi by CMR was associated with CV mortality after aortic valve replacement, independent of age, focal scar, and ejection fraction. The unique capability of CMR to quantify myocardial scar, combined with other prognostically important imaging biomarkers, such as SVi by CMR, may enable comprehensive stratification of postoperative risk in patients with severe symptomatic AS

Association of myocardial fibrosis and stroke volume by cardiovascular magnetic resonance in patients with severe aortic stenosis with outcome after valve replacement:The British Society of Cardiovascular Magnetic Resonance AS700 Study

Importance: Low-flow severe aortic stenosis (AS) has higher mortality than severe AS with normal flow. The conventional definition of low-flow AS is an indexed stroke volume (SVi) by echocardiography less than 35 mL/m2. Cardiovascular magnetic resonance (CMR) is the reference standard for quantifying left ventricular volumes and function from which SVi by CMR can be derived. Objective To determine the association of left ventricular SVi by CMR with myocardial remodeling and survival among patients with severe AS after valve replacement. Design, Setting, and Participants: This multicenter longitudinal cohort study was conducted between January 2003 and May 2015 across 6 UK cardiothoracic centers. Patients with severe AS listed for either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were included. Patients underwent preprocedural echocardiography and CMR. Patients were stratified by echocardiography-derived aortic valve mean and/or peak gradient and SVi by CMR into 4 AS endotypes: low-flow, low-gradient AS; low-flow, high-gradient AS; normal-flow, low-gradient AS; and normal-flow, high-gradient AS. Patients were observed for a median of 3.6 years. Data were analyzed from September to November 2021. Exposures: SAVR or TAVR. Main Outcomes and Measures: All-cause and cardiovascular (CV) mortality after aortic valve intervention. Results: Of 674 included patients, 425 (63.1%) were male, and the median (IQR) age was 75 (66-80) years. The median (IQR) aortic valve area index was 0.4 (0.3-0.4) cm2/m2. Patients with low-flow AS endotypes (low gradient and high gradient) had lower left ventricular ejection fraction, mass, and wall thickness and increased all-cause and CV mortality than patients with normal-flow AS (all-cause mortality: hazard ratio [HR], 2.08; 95% CI, 1.37-3.14; P < .001; CV mortality: HR, 3.06; 95% CI, 1.79-5.25; P < .001). CV mortality was independently associated with lower SVi (HR, 1.64; 95% CI, 1.08-2.50; P = .04), age (HR, 2.54; 95% CI, 1.29-5.01; P = .001), and higher quantity of late gadolinium enhancement (HR, 2.93; 95% CI, 1.68-5.09; P < .001). CV mortality hazard increased more rapidly in those with an SVI less than 45 mL/m2. SVi by CMR was independently associated with age, atrial fibrillation, focal scar (by late gadolinium enhancement), and parameters of cardiac remodeling (left ventricular mass and left atrial volume). Conclusions and Relevance: In this cohort study, SVi by CMR was associated with CV mortality after aortic valve replacement, independent of age, focal scar, and ejection fraction. The unique capability of CMR to quantify myocardial scar, combined with other prognostically important imaging biomarkers, such as SVi by CMR, may enable comprehensive stratification of postoperative risk in patients with severe symptomatic AS

Myocardial scar and remodelling predict long-term mortality in severe aortic stenosis beyond 10 years

Aortic stenosis (AS) is characterized by the narrowing of the aortic valve and compensatory myocardial remodelling.1 However, ultimately the left ventricle decompensates, leading to heart failure and death, and intervention is advised for severe AS accompanied by either symptoms or left ventricular (LV) dysfunction.2 Yet, over half of patients receiving aortic valve replacement (AVR) have irreversible myocardial scarring.3 Our multi-centre UK consortium linked pre-operative myocardial scarring, detected by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) with increased all-cause and cardiovascular (CV) mortality, regardless of intervention type, after a median of 3.5 years.4 With the integration of machine learning for CMR analysis, we achieve 40% greater precision than human assessment, potentially uncovering patterns obscured by human variability.5 We now examine whether the association of myocardial scar with mortality persists over longer-term follow-up.</p