Cardiac evaluation of young athletes: Time for a risk-based approach?

Pre-participation cardiovascular screening (PPCS) is recommended by several scientific and sporting organizations on the premise that early detection of cardiac disease provides a platform for individualized risk assessment and management; which has been proven to lower mortality rates for certain conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD). What constitutes the most effective strategy for PPCS of young athletes remains a topic of considerable debate. The addition of the electrocardiogram (ECG) to the medical history and physical examination undoubtedly enhances early detection of disease, which meets the primary objective of PPCS. The benefit of enhanced sensitivity must be carefully balanced against the risk of potential harm through increased false-positive findings, costly downstream investigations, and unnecessary restriction/disqualification from competitive sports. To mitigate this risk, it is essential that ECG-based PPCS programs are implemented by institutions with a strong infrastructure and by physicians appropriately trained in modern ECG standards with adequate cardiology resources to guide downstream investigations. While PPCS is compulsory for most competitive athletes, the current debate surrounding ECG-based programs exists in a binary form; whereby ECG screening is mandated for all competitive athletes or none at all. This polarized approach fails to consider individualized patient risk and the available sports cardiology resources. The limitations of a uniform approach are highlighted by evolving data, which suggest that athletes display a differential risk profile for SCA/SCD, which is influenced by age, sex, ethnicity, sporting discipline, and standard of play. Evaluation of the etiology of SCA/SCD within high-risk populations reveals a disproportionately higher prevalence of ECG-detectable conditions. Selective ECG screening using a risk-based approach may, therefore, offer a more cost-effective and feasible approach to PPCS in the setting of limited sports cardiology resources, although this approach is not without important ethical considerations

To Be Read At My Wake

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Simulation of transient energy distributions in sub-ns streamer formation

Breakdown and streamer formation is simulated in atmospheric pressure nitrogen for a 2D planar electrode system. A PIC code with multigrid potential solver is used to simulate the evolution of the non-equilibrium ionization front on sub-nanosecond timescales. The ion and electron energy distributions are computed, accounting for the inclusion of inelastic scattering of electrons, and collisionally excited metastable production and ionization. Of particular interest is the increased production of metastable and low-energy ions and electrons when the applied field is reversed during the progress of the ionization front, giving insight into the improved species yields in nanosecond pulsed systems

An Energy-Minimization Finite-Element Approach for the Frank-Oseen Model of Nematic Liquid Crystals: Continuum and Discrete Analysis

This paper outlines an energy-minimization finite-element approach to the computational modeling of equilibrium configurations for nematic liquid crystals under free elastic effects. The method targets minimization of the system free energy based on the Frank-Oseen free-energy model. Solutions to the intermediate discretized free elastic linearizations are shown to exist generally and are unique under certain assumptions. This requires proving continuity, coercivity, and weak coercivity for the accompanying appropriate bilinear forms within a mixed finite-element framework. Error analysis demonstrates that the method constitutes a convergent scheme. Numerical experiments are performed for problems with a range of physical parameters as well as simple and patterned boundary conditions. The resulting algorithm accurately handles heterogeneous constant coefficients and effectively resolves configurations resulting from complicated boundary conditions relevant in ongoing research.Comment: 31 pages, 3 figures, 3 table

The evolution of electron overdensities in magnetic fields

When a neutral gas impinges on a stationary magnetized plasma an enhancement in the ionization rate occurs when the neutrals exceed a threshold velocity. This is commonly known as the critical ionization velocity effect. This process has two distinct timescales: an ion–neutral collision time and electron acceleration time. We investigate the energization of an ensemble of electrons by their self-electric field in an applied magnetic field. The evolution of the electrons is simulated under different magnetic field and density conditions. It is found that electrons can be accelerated to speeds capable of electron impact ionization for certain conditions. In the magnetically dominated case the energy distribution of the excited electrons shows that typically 1% of the electron population can exceed the initial electrostatic potential associated with the unbalanced ensemble of electrons

Computing equilibrium states of cholesteric liquid crystals in elliptical channels with deflation algorithms

We study the problem of a cholesteric liquid crystal confined to an elliptical channel. The system is geometrically frustrated because the cholesteric prefers to adopt a uniform rate of twist deformation, but the elliptical domain precludes this. The frustration is resolved by deformation of the layers or introduction of defects, leading to a particularly rich family of equilibrium configurations. To identify the solution set, we adapt and apply a new family of algorithms, known as deflation methods, that iteratively modify the free energy extremisation problem by removing previously known solutions. A second algorithm, deflated continuation, is used to track solution branches as a function of the aspect ratio of the ellipse and preferred pitch of the cholesteric.Comment: 9 pages, 6 figure