More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy-Current Data and Future Directions.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.Common to the pathogenesis of acute coronary syndromes (ACS) is the formation of arterial thrombus, which results from platelet activation and triggering of the coagulation cascade.1 To attenuate the risk of future thrombotic events, patients with ACS are treated with dual antiplatelet therapy (DAPT), namely, the combination of aspirin with a P2Y12 inhibitor, such as clopidogrel, ticagrelor, or prasugrel. Despite DAPT, some ≈10% of ACS patients experience recurrent major adverse cardiovascular events over the subsequent 30 days,2 driving the quest for more effective inhibition of thrombotic pathways. In this review, we provide an overview of studies to date and those ongoing that aim to deliver more effective combinations of antithrombotic agents to patients with recent ACS. We have chosen to confine the review to ACS patients without atrial fibrillation because those with atrial fibrillation have a clear indication for combination therapy that includes oral anticoagulation and should, we feel, be treated as a separate cohort. In this article, we discuss the limitations of the currently available clinical trial data and future directions, with suggestions for how practice might change to reduce the risk of coronary thrombosis in those at greatest risk, with minimal impact on bleeding.Peer reviewedFinal Published versio

It Could Not Be Seen Because It Could Not Be Believed on June 30, 2013

Nineteen Prescott Fire Department, Granite Mountain Hot Shot (GMHS) wildland firefighters (WF) perished in Arizona in June 2013 Yarnell Hill Fire, an inexplicable wildland fire disaster. In complex wildland fires, sudden, dynamic changes in human factors and fire conditions can occur, thus mistakes can be unfortunately fatal. Individual and organizational faults regarding the predictable, puzzling, human failures that will result in future WF deaths are addressed. The GMHS were individually, then collectively fixated with abandoning their Safety Zone to reengage, committing themselves at the worst possible time, to relocate to another Safety Zone - a form of collective tunnel vision. Our goal is to provoke meaningful discussion toward improved wildland firefighter safety with practical solutions derived from a long-established wildland firefighter expertise/performance in a fatality-prone profession. Wildfire fatalities are unavoidable, hence these proposals, applied to ongoing training, can significantly contribute to other well-thought-out and validated measures to reduce them

On the nonequilibrium entropy of large and small systems

Thermodynamics makes definite predictions about the thermal behavior of macroscopic systems in and out of equilibrium. Statistical mechanics aims to derive this behavior from the dynamics and statistics of the atoms and molecules making up these systems. A key element in this derivation is the large number of microscopic degrees of freedom of macroscopic systems. Therefore, the extension of thermodynamic concepts, such as entropy, to small (nano) systems raises many questions. Here we shall reexamine various definitions of entropy for nonequilibrium systems, large and small. These include thermodynamic (hydrodynamic), Boltzmann, and Gibbs-Shannon entropies. We shall argue that, despite its common use, the last is not an appropriate physical entropy for such systems, either isolated or in contact with thermal reservoirs: physical entropies should depend on the microstate of the system, not on a subjective probability distribution. To square this point of view with experimental results of Bechhoefer we shall argue that the Gibbs-Shannon entropy of a nano particle in a thermal fluid should be interpreted as the Boltzmann entropy of a dilute gas of Brownian particles in the fluid

A data preparation approach for cloud storage based on containerized parallel patterns

In this paper, we present the design, implementation, and evaluation of an efficient data preparation and retrieval approach for cloud storage. The approach includes a deduplication subsystem that indexes the hash of each content to identify duplicated data. As a consequence, avoiding duplicated content reduces reprocessing time during uploads and other costs related to outsource data management tasks. Our proposed data preparation scheme enables organizations to add properties such as security, reliability, and cost-efficiency to their contents before sending them to the cloud. It also creates recovery schemes for organizations to share preprocessed contents with partners and end-users. The approach also includes an engine that encapsulates preprocessing applications into virtual containers (VCs) to create parallel patterns that improve the efficiency of data preparation retrieval process. In a study case, real repositories of satellite images, and organizational files were prepared to be migrated to the cloud by using processes such as compression, encryption, encoding for fault tolerance, and access control. The experimental evaluation revealed the feasibility of using a data preparation approach for organizations to mitigate risks that still could arise in the cloud. It also revealed the efficiency of the deduplication process to reduce data preparation tasks and the efficacy of parallel patterns to improve the end-user service experience.This research was supported by "Fondo Sectorial de Investigación para la Educación";, SEP-CONACyT Mexico, through projects 281565 and 285276

Boundary operators in minimal Liouville gravity and matrix models

We interpret the matrix boundaries of the one matrix model (1MM) recently constructed by two of the authors as an outcome of a relation among FZZT branes. In the double scaling limit, the 1MM is described by the (2,2p+1) minimal Liouville gravity. These matrix operators are shown to create a boundary with matter boundary conditions given by the Cardy states. We also demonstrate a recursion relation among the matrix disc correlator with two different boundaries. This construction is then extended to the two matrix model and the disc correlator with two boundaries is compared with the Liouville boundary two point functions. In addition, the realization within the matrix model of several symmetries among FZZT branes is discussed.Comment: 26 page

Flavored Gauge-Mediation

The messengers of Gauge-Mediation Models can couple to standard-model matter fields through renormalizable superpotential couplings. These matter-messenger couplings generate generation-dependent sfermion masses and are therefore usually forbidden by discrete symmetries. However, the non-trivial structure of the standard-model Yukawa couplings hints at some underlying flavor theory, which would necessarily control the sizes of the matter-messenger couplings as well. Thus for example, if the doublet messenger and the Higgs have the same properties under the flavor theory, the resulting messenger-lepton couplings are parametrically of the same order as the lepton Yukawas, so that slepton mass-splittings are similar to those of minimally-flavor-violating models and therefore satisfy bounds on flavor-violation, with, however, slepton mixings that are potentially large. Assuming that fermion masses are explained by a flavor symmetry, we construct viable and natural models with messenger-lepton couplings controlled by the flavor symmetry. The resulting slepton spectra are unusual and interesting, with slepton mass-splittings and mixings that may be probed at the LHC. In particular, since the new contributions are typically negative, and since they are often larger for the first- and second-generation sleptons, some of these examples have the selectron or the smuon as the lightest slepton, with mass splittings of a few to tens of GeV.Comment: 16 pages v2: Explicit expressions (which are not needed in the analysis) for the pure Yukawa contributions removed. There was an error in some of these expressions in v1. References adde

Global Hopf bifurcation in the ZIP regulatory system

Regulation of zinc uptake in roots of Arabidopsis thaliana has recently been modeled by a system of ordinary differential equations based on the uptake of zinc, expression of a transporter protein and the interaction between an activator and inhibitor. For certain parameter choices the steady state of this model becomes unstable upon variation in the external zinc concentration. Numerical results show periodic orbits emerging between two critical values of the external zinc concentration. Here we show the existence of a global Hopf bifurcation with a continuous family of stable periodic orbits between two Hopf bifurcation points. The stability of the orbits in a neighborhood of the bifurcation points is analyzed by deriving the normal form, while the stability of the orbits in the global continuation is shown by calculation of the Floquet multipliers. From a biological point of view, stable periodic orbits lead to potentially toxic zinc peaks in plant cells. Buffering is believed to be an efficient way to deal with strong transient variations in zinc supply. We extend the model by a buffer reaction and analyze the stability of the steady state in dependence of the properties of this reaction. We find that a large enough equilibrium constant of the buffering reaction stabilizes the steady state and prevents the development of oscillations. Hence, our results suggest that buffering has a key role in the dynamics of zinc homeostasis in plant cells.Comment: 22 pages, 5 figures, uses svjour3.cl