RF Breakdown in Drift Tube Linacs

The highest RF electric field in drift-tube linacs (DTLs) often occurs on the face of the first drift tube. Typically this drift tube contains a quadrupole focusing magnet whose fringing fields penetrate the face of the drift tube parallel to the RF electric fields in the accelerating gap. It has been shown that the threshold for RF breakdown in RF cavities may be reduced in the presence of a static magnetic field. This note offers a “rule of thumb” for picking the maximum “safe” surface electric field in DTLs based on these measurements

Sexual Orientation Differences in the Relationship Between Victimization and Hazardous Drinking Among Women in the National Alcohol Survey

This study examined relationships between past experiences of victimization (sexual abuse and physical abuse in childhood, sexual abuse and physical abuse in adulthood, and lifetime victimization) and hazardous drinking among sexual minority women compared to exclusively heterosexual women. Data were from 11,169 women responding to sexual identity and sexual behavior questions from three National Alcohol Survey waves: 2000 (n = 3,880), 2005 (n = 3,464), and 2010 (n = 3,825). A hazardous drinking index was constructed from five dichotomous variables (5+ drinking in the past year, drinking two or more drinks daily, drinking to intoxication in the past year, two or more lifetime dependence symptoms, and two or more lifetime drinking-related negative consequences). Exclusively heterosexual women were compared with three groups of sexual minority women: lesbian, bisexual, and women who identified as heterosexual but reported same-sex partners. Each of the sexual minority groups reported significantly higher rates of lifetime victimization (59.1% lesbians, 76% bisexuals, and 64.4% heterosexual women reporting same-sex partners) than exclusively heterosexual women (42.3%). Odds for hazardous drinking among sexual minority women were attenuated when measures of victimization were included in the regression models. Sexual minority groups had significantly higher odds of hazardous drinking, even after controlling for demographic and victimization variables: lesbian (OR [sub]adj[sub] = 2.0, CI = 1.1–3.9, p \u3c .01; bisexual (OR [sub]adj[sub] = 1.8, CI = 1.0–3.3, p \u3c .05; heterosexual with same-sex partners (ORadj = 2.7; CI = 1.7–4.3, p \u3c .001). Higher rates of victimization likely contribute to, but do not fully explain, higher rates of hazardous drinking among sexual minority women. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)

Mulberry extract to modULate Blood glucosE Responses in noRmoglYcaemic adults (MULBERRY): study protocol for a randomized controlled trial

Background: worldwide sugar consumption has tripled during the last fifty years. High sugar intake is associated with weight gain and increased incidence of diabetes and has been linked with increased cardiovascular mortality. Reducing the health impact of dietary sugar and poor quality carbohydrate intake is a public health priority. IminoNorm®, a proprietary mulberry leaf extract (ME), may reduce blood glucose responses following dietary sugar and carbohydrate intake by reducing absorption of glucose from the gut. Previous research has shown that ME can reduce blood glucose and improve insulin responses in healthy subjects and also in subjects with raised fasting blood glucose levels. Mulberry leaf has an excellent safety profile. This pilot study will test a novel, safe, water soluble product in normoglycaemic adults in the UK to determine if it can reduce glucose absorption without increasing plasma insulin concentration.Methods/design: the trial will be a double-blind, individually randomised, four-arm single-dose crossover design to test the effect of three doses of ME in order to determine efficacy, dose response relationship and gastrointestinal side effects with respect to placebo. A total of 40 subjects will participate in this study and attend for four visits receiving each of the four interventions in random order.Discussion: we aim to test the evidence that mulberry leaf extract can reduce blood glucose without a disproportionate increase in blood insulin responses in healthy individuals in a high-quality research study based in the UK. It is hoped that this will lead to further randomised controlled trials and an effective dietary supplement to lower blood glucose concentration

Feasibility of a placebo-controlled trial of antibiotics for possible urinary tract infection in care homes: a qualitative interview study

Background: Diagnosis of suspected urinary tract infection (UTI) in care and nursing home residents is commonly based on vague non-localising symptoms (for example, confusion), potentially leading to inappropriate antibiotic prescription. The safety of withholding antibiotics in such cases could be addressed by a randomised controlled trial (RCT); however, this would require close monitoring of residents, and support from care home staff, clinicians, residents, and families. Aim: To explore the views of residential care and nursing home staff (herein referred to as care home staff) and primary care clinicians on the feasibility and design of a potential RCT of antibiotics for suspected UTI in care home residents, with no localising urinary symptoms. Design & setting: A qualitative interview study with primary care clinicians and care home staff in the UK. Method: Semi-structured interviews with 16 care home staff and 11 primary care clinicians were thematically analysed. Results: Participants were broadly supportive of the proposed RCT. The safety of residents was a priority and there was strong support for using the RESTORE2 (Recognise Early Soft Signs, Take Observations, Respond, Escalate) assessment tool to monitor residents; however, there were concerns about associated training requirements, especially for night and temporary staff. Effective communication (with residents, families, and staff) was deemed essential, and carers were confident that residents and families would be supportive of the RCT if the rationale was clearly explained and safety systems were robust. There were mixed views on a placebo-controlled design. The perceived additional burden was seen as a potential barrier, and the use of temporary staff and the out-of-hours period were highlighted as potential risk areas. Conclusion: The support for this potential trial was encouraging. Future development will need to prioritise resident safety (especially in the out-of-hours period), effective communication, and minimising additional burden on staff to optimise recruitment

Flight Demonstration of Novel Atmospheric Satellite Concept

The major focus of the Phase II effort described herein is to develop and demonstrate an aircraft capable of autonomously sailing (i.e., to cruise without propulsion or external assistance), and thereby prove that the dual-aircraft platform (DAP) atmospheric satellite concept is potentially viable. This sailing mode of flight was identified as the number-1 enabling technology required for the stratospheric DAP concept (also known as Stratosat) in the NIAC (NASA Innovative Advanced Concept) Phase I effort. No scientific demonstration of this technology has ever been done or documented to our knowledge. This report describes efforts to take a major step towards the sailing mode of flight capability using a single aircraft connected by cable to a moving ground vehicle which uses sufficient crosswind to cruise without propulsion while "pulling" the ground vehicle forward (i.e., without external assistance). The development of a prototype aircraft is described in terms of novel and key hardware and software elements. A specialized prototype aircraft is described, including a novel cable release mechanism, novel "lateron" control surfaces, and a highly-accurate onboard wind measurement system. Additionally, a novel means to safely connect the aircraft to the moving ground vehicle is described involving a fishing rod/reel and integrated load cell. All of these devices were designed and developed in-house and validated in flight testing. Software is developed to provide look-up tables that give the flight condition targets (i.e., 3-D position relative to ground vehicle, forward speed, aircraft orientation, etc.), based on current wind speed and direction. These tables are successfully validated in flight simulation and used onboard the aircraft. High fidelity analysis of the aircraft aerodynamics are described - required to produce accurate target sailing flight conditions. A novel wind tunnel measurement technique is developed to accurately assess the aerodynamics of the ultra-thin cable. A new specialized flight simulator is described which is utilized to develop and verify the flight software required onboard the aircraft, and to support training of pilots for flying the aircraft while tethered to a ground vehicle. The DAP flight simulator was developed within the Matlab-Simulink framework and included detailed treatment of aircraft/cable aerodynamics, cable dynamics, experimentally-derived propeller-motor thrust curves, actuator responsiveness, and realistic air turbulence. The specialized formation flight controller algorithm, developed using this flight simulator, and onboard the aircraft is described. Finally, a novel auto-tuning software is described and verified within the flight simulator that is shown to refine the sailing flight condition targets during flight using an optimization technique involving doublet maneuvers. Virtual flights using the auto-tuning software indicate that the prototype aircraft should be able to reach and hold sailing conditions despite moderate levels of turbulence provided there is sufficient mean wind available. An overview of the flight testing program is provided. Hundreds of short flights were conducted, primarily using a dead short runway at Deland Municipal Airport which permitted use of a moving ground vehicle. Additional flight tests at Space Floridas Shuttle Landing Facility are also described. First year results from these tests in which the aircraft is controlled manually, demonstrated that excessive flight testing would be required for a pilot to learn to sail with visual cues. However, second year results from autonomous flight these tests included successful demonstration of the closed-loop autonomous formation flight capability (i.e., autonomously determine, reach, and hold the required 3-D location relative to the ground vehicle required for sailing). The next step of using the auto-tune software to autonomously refine the aircraft orientation targets to finally achieve sailing remains the primary goal of future work

Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis

BACKGROUND/OBJECTIVES: Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion and characteristics of patients eligible for hypertension trials conducted in older people. DESIGN: Cross‐sectional study. SETTING: A total of 24 general practices in England. PARTICIPANTS: Anonymized electronic health record data from all individuals aged 80 and older. MEASUREMENTS: Descriptive statistics were used to define the proportion and characteristics of patients eligible for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE). A logistic regression model was constructed to estimate predictors of eligibility for each trial. RESULTS: Of 15,376 patients identified, 268 (1.7%; 95% confidence interval [CI] = 1.5–2.0%), 5,290 (34.4%; 95%CI = 33.7–35.2%), and 3,940 (25.6%; 95%CI = 24.9–26.3%) were eligible for the HYVET, SPRINT, and OPTiMISE trials, respectively. Between 5.6% and 30.7% of exclusions from each trial were due to eligibility criteria excluding those with high or uncontrolled blood pressure. Frailty (odds ratio [OR] = .44; 95%CI = .36–.54 [OPTiMISE]), cardiovascular polypharmacy (OR = .61; 95%CI = .55–.68 [SPRINT]) and multimorbidity (OR = .72; 95%CI = .64–.82 [SPRINT]) were associated with a lower likelihood of being eligible for one or more of the trials. CONCLUSION: A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice. Caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity

RHYTHM-AF: design of an international registry on cardioversion of atrial fibrillation and characteristics of participating centers

BACKGROUND Atrial fibrillation is a serious public health problem posing a considerable burden to not only patients, but the healthcare environment due to high rates of morbidity, mortality, and medical resource utilization. There are limited data on the variation in treatment practice patterns across different countries, healthcare settings and the associated health outcomes. METHODS/DESIGN RHYTHM-AF was a prospective observational multinational study of management of recent onset atrial fibrillation patients considered for cardioversion designed to collect data on international treatment patterns and short term outcomes related to cardioversion. We present data collected in 10 countries between May 2010 and June 2011. Enrollment was ongoing in Italy and Brazil at the time of data analysis. Data were collected at the time of atrial fibrillation episode in all countries (Australia, Brazil, France, Germany, Italy, Netherlands, Poland, Spain, Sweden, United Kingdom), and cumulative follow-up data were collected at day 60 (±10) in all but Spain. Information on center characteristics, enrollment data, patient demographics, detail of atrial fibrillation episode, medical history, diagnostic procedures, acute treatment of atrial fibrillation, discharge information and the follow-up data on major events and rehospitalizations up to day 60 were collected. DISCUSSIN A total of 3940 patients were enrolled from 175 acute care centers. 70.5% of the centers were either academic (44%) or teaching (26%) hospitals with an overall median capacity of 510 beds. The sites were mostly specialized with anticoagulation clinics (65.9%), heart failure (75.1%) and hypertension clinics (60.1%) available. The RHYTHM-AF registry will provide insight into regional variability of antiarrhythmic and antithrombotic treatment of atrial fibrillation, the appropriateness of such treatments with respect to outcomes, and their cost-efficacy. Observations will help inform strategies to improve cardiovascular outcomes in patients with atrial fibrillation. TRIAL REGISTRATION Clinical trials NCT01119716Harry JGM Crijns, Lori D Bash, François Chazelle, Jean-Yves Le Heuzey, Thorsten Lewalter, Gregory YH Lip, Aldo P Maggioni, Alfonso Martín, Piotr Ponikowski, Mårten Rosenqvist, Prashanthan Sanders, Mauricio Scanavacca, Alexandra A Bernhardt, Sreevalsa Unniachan, Hemant M Phatak and Anselm K Git

Role of intestinal P‐glycoprotein ( mdr1 ) in interpatient variation in the oral bioavailability of cyclosporine

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110064/1/cptclpt1997116.pd

Mulberry-extract improves glucose tolerance and decreases insulin concentrations in normoglycaemic adults: results of a randomised double-blind placebo-controlled study

Background High sugar and refined carbohydrate intake is associated with weight gain, increased incidence of diabetes and is linked with increased cardiovascular mortality. Reducing the health impact of poor quality carbohydrate intake is a public health priority. Reducose, a proprietary mulberry leaf extract (ME), may reduce blood glucose responses following dietary carbohydrate intake by reducing absorption of glucose from the gut. Methods A double-blind, randomised, repeat measure, phase 2 crossover design was used to study the glycaemic and insulinaemic response to one reference product and three test products at the Functional Food Centre, Oxford Brooks University, UK. Participants; 37 adults aged 19–59 years with a BMI ≥ 20kg/m2 and ≤ 30kg/m2. The objective was to determine the effect of three doses of mulberry-extract (Reducose) versus placebo on blood glucose and insulin responses when co-administered with 50g maltodextrin in normoglycaemic healthy adults. We also report the gastrointestinal tolerability of the mulberry extract. Results Thirty-seven participants completed the study: The difference in the positive Incremental Area Under the Curve (pIAUC) (glucose (mmol / L x h)) for half, normal and double dose ME compared with placebo was -6.1% (-18.2%, 5.9%; p = 0.316), -14.0% (-26.0%, -2.0%; p = 0.022) and -22.0% (-33.9%, -10.0%; p<0.001) respectively. The difference in the pIAUC (insulin (mIU / L x h)) for half, normal and double dose ME compared with placebo was -9.7% (-25.8%, 6.3%; p = 0.234), -23.8% (-39.9%, -7.8%; p = 0.004) and -24.7% (-40.8%, -8.6%; p = 0.003) respectively. There were no statistically significant differences between any of the 4 groups in the odds of experiencing one or more gastrointestinal symptoms (nausea, abdominal cramping, distension or flatulence). Conclusions Mulberry leaf extract significantly reduces total blood glucose rise after ingestion of maltodextrin over 120 minutes. The pattern of effect demonstrates a classical dose response curve with significant effects over placebo. Importantly, total insulin rises were also significantly suppressed over the same time-period. There were no statistically significant differences between any of the treatment groups (including placebo) in the odds of experiencing one or more gastrointestinal symptoms. Mulberry extract may have multiple modes of action and further studies are necessary to evaluate ME as a potential target for the prevention of type 2 diabetes and the regulation of dysglycaemia