Diagnostic challenge of artifactual electrocardiographic tachyarrhythmias

Electrocardiographic artifacts may generate recordings mimicking supraventricular and ventricular tachyarrhythmias. This report describes the diagnostic challenge presented by Holter or loop recordings in two patients, one with pseudo-atrial flutter and the other with pseudo- -polymorphic ventricular tachycardia

Lung volume reduction surgery since the National Emphysema Treatment Trial: Study of Society of Thoracic Surgeons Database

ObjectivesThe National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial.MethodsAggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests.ResultsIn 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P < .001), a larger proportion underwent the procedure thoracoscopically (P < .001), and forced expiratory volume in 1 second was 31% versus 28% of predicted (P < .001). When mortality was compared between subjects in the Society of Thoracic Surgeons Database and all subjects in the National Emphysema Treatment Trial randomized to surgery, there were no significant differences. However, mortality was 3% higher in subjects in the Society of Thoracic Surgeons Database when compared with the non–high-risk National Emphysema Treatment Trial subset (P = .005).ConclusionsThis study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema

Constraining the ISM Properties of the Cloverleaf Quasar Host Galaxy with Herschel Spectroscopy

We present Herschel observations of the far-infrared (FIR) fine-structure (FS) lines [C II]158 μm, [O I]63 μm, [O III]52 μm, and [Si II]35 μm in the z = 2.56 Cloverleaf quasar, and combine them with published data in an analysis of the dense interstellar medium (ISM) in this system. Observed [C II]158 μm, [O I]63 μm, and FIR continuum flux ratios are reproduced with photodissociation region (PDR) models characterized by moderate far-ultraviolet (FUV) radiation fields with G_0 = 0.3–1 × 10^3 and atomic gas densities n_H = 3–5 × 10^3 cm^(−3), depending on contributions to [C II]158 μm from ionized gas. We assess the contribution to the [C II]158 μm flux from an active galactic nucleus (AGN) narrow line region (NLR) using ground-based measurements of the [N II]122 μm transition, finding that the NLR can contribute at most 20%–30% of the observed [C II]158 μm flux. The PDR density and far-UV radiation fields inferred from the atomic lines are not consistent with the CO emission, indicating that the molecular gas excitation is not solely provided via UV heating from local star formation (SF), but requires an additional heating source. X-ray heating from the AGN is explored, and we find that X-ray-dominated region (XDR) models, in combination with PDR models, can match the CO cooling without overproducing the observed FS line emission. While this XDR/PDR solution is favored given the evidence for both X-rays and SF in the Cloverleaf, we also investigate alternatives for the warm molecular gas, finding that either mechanical heating via low-velocity shocks or an enhanced cosmic-ray ionization rate may also contribute. Finally, we include upper limits on two other measurements attempted in the Herschel program: [C II]158 μm in FSC 10214 and [O I]63 μm in APM 08279+5255

Tropical Intraseasonal Variability in Version 3 of the GFDL Atmosphere Model

Tropical intraseasonal variability is examined in version 3 of the Geophysical Fluid Dynamics Laboratory Atmosphere Model (AM3). In contrast to its predecessor AM2, AM3 uses a new treatment of deep and shallow cumulus convection and mesoscale clouds. The AM3 cumulus parameterization is a mass-flux-based scheme but also, unlike that in AM2, incorporates subgrid-scale vertical velocities; these play a key role in cumulus microphysical processes. The AM3 convection scheme allows multiphase water substance produced in deep cumuli to be transported directly into mesoscale clouds, which strongly influence large-scale moisture and radiation fields. The authors examine four AM3 simulations using a control model and three versions with different modifications to the deep convection scheme. In the control AM3, using a convective closure based on CAPE relaxation, both MJO and Kelvin waves are weak relative to those in observations. By modifying the convective closure and trigger assumptions to inhibit deep cumuli, AM3 produces reasonable intraseasonal variability but a degraded mean state. MJO-like disturbances in the modified AM3 propagate eastward at roughly the observed speed in the Indian Ocean but up to 2 times the observed speed in the west Pacific Ocean. Distinct differences in intraseasonal convective organization and propagation exist among the modified AM3 versions. Differences in vertical diabatic heating profiles associated with the MJO are also found. The two AM3 versions with the strongest intraseasonal signals have a more prominent “bottom heavy” heating profile leading the disturbance center and “top heavy” heating profile following the disturbance. The more realistic heating structures are associated with an improved depiction of moisture convergence and intraseasonal convective organization in AM3

Comparison of Patient Reported Outcomes using PROMIS in Patients with Shoulder Pain

Objectives: Compare a disease specific questionnaire (American Shoulder and Elbow Surgeons [ASES]) and a multidimensional global health scale (Patient reported outcome measurement system [PROMIS]) across a variety of shoulder condition

Monsoon Intraseasonal Oscillations as simulated by the Superparameterized Community Atmosphere Model

The relative success of the Community Atmosphere Model with superparameterized convection (SP-CAM) in simulating the space-time characteristics of the Madden Julian Oscillation encourages us to examine its simulation of the Indian summer monsoon and monsoon intraseasonal oscillations (MISOs). While the model simulates the onset and withdrawal of the Indian monsoon realistically, it has a significant wet bias in boreal summer precipitation over the Asian monsoon region. The space-time characteristics of the MISOs simulated by the SP-CAM are examined in detail and compared with those of the observed MISO to gain insight into the model's bias in simulating the seasonal mean. During northern summer, the model simulates a 20 day mode and a 60 day mode in place of the observed 15 and 45 day modes, respectively. The simulated 20 day mode appears to have no observed analog with a baroclinic vertical structure and strong northward propagation over Indian longitudes. The simulated 60 day mode seems to be a lower-frequency version of the observed 45 day mode with relatively slower northward propagation. The model's underestimation of light rain events and overestimation of heavy rain events are shown to be responsible for the wet bias of the model. More frequent occurrence of heavy rain events in the model is, in turn, related to the vertical structure of the higher-frequency modes. Northward propagation of the simulated 20 day mode is associated with a strong cyclonic vorticity at low levels north of the heating maximum associated with a smaller meridional scale of the simulated mode. The simulated vertical structure of heating indicates a strong maximum in the upper troposphere between 200 and 300 hPa. Such a heating profile seems to generate a higher-order baroclinic mode response with smaller meridional structure, stronger low-level cyclonic vorticity, enhanced low-level moisture convergence, and higher precipitation. Therefore, the vertical structure of heating simulated by the cloud-resolving model within SP-CAM may hold the key for improving the precipitation bias in the model

A Fluctuation Analysis of the Bolocam 1.1mm Lockman Hole Survey

We perform a fluctuation analysis of the 1.1mm Bolocam Lockman Hole Survey, which covers 324 square arcmin to a very uniform point source-filtered RMS noise level of 1.4 mJy/beam. The fluctuation analysis has the significant advantage of utilizing all of the available data. We constrain the number counts in the 1-10 mJy range, and derive significantly tighter constraints than in previous work: the power-law index is 2.7 (+0.18, -0.15), while the amplitude is equal to 1595 (+85,-238) sources per mJy per square degree, or N(>1 mJy) = 940 (+50,-140) sources/square degree (95% confidence). Our results agree extremely well with those derived from the extracted source number counts by Laurent et al (2005). Our derived normalization is about 2.5 times smaller than determined by MAMBO at 1.2mm by Greve et al (2004). However, the uncertainty in the normalization for both data sets is dominated by the systematic (i.e., absolute flux calibration) rather than statistical errors; within these uncertainties, our results are in agreement. We estimate that about 7% of the 1.1mm background has been resolved at 1 mJy.Comment: To appear in the Astrophysical Journal; 22 pages, 9 figure

Antitumor activity and safety of the PARP inhibitor rucaparib in patients with high grade ovarian carcinoma and a germline or somatic BRCA1 or BRCA2 mutation: integrated analysis of data from Study 10 and ARIEL2

Objective: An integrated analysis was undertaken to characterize the antitumor activity and safety profile of the oral poly(ADP-ribose) polymerase inhibitor rucaparib in patients with relapsed high-grade ovarian carcinoma (HGOC). Methods: Eligible patients from Study 10 (NCT01482715) and ARIEL2 (NCT01891344) who received a starting dose of oral rucaparib 600 mg twice daily (BID) with or without food were included in these analyses. The integrated efficacy population included patients with HGOC and a deleterious germline or somatic BRCA1 or BRCA2 (BRCA1/2) mutation who received at least two prior chemotherapies and were sensitive, resistant, or refractory to platinum-based chemotherapy. The primary endpoint was investigator-assessed confirmed objective response rate (ORR). Secondary endpoints included duration of response (DOR) and progression-free survival (PFS). The integrated safety population included patients with HGOC who received at least one dose of rucaparib 600 mg BID, irrespective of BRCA1/2 mutation status and prior treatments. Results: In the efficacy population (n = 106), ORR was 53.8% (95% confidence interval [CI], 43.8–63.5); 8.5% and 45.3% of patients achieved complete and partial responses, respectively. Median DOR was 9.2 months (95% CI, 6.6–11.6). In the safety population (n = 377), the most frequent treatment-emergent adverse events (AEs) were nausea, asthenia/fatigue, vomiting, and anemia/hemoglobin decreased. The most common grade ≥ 3 treatment-emergent AE was anemia/hemoglobin decreased. Treatment-emergent AEs led to treatment interruption, dose reduction, and treatment discontinuation in 58.6%, 45.9%, and 9.8% of patients, respectively. No treatment-related deaths occurred. Conclusions: Rucaparib has antitumor activity in advanced BRCA1/2-mutated HGOC and a manageable safety profile

Constraining the ISM Properties of the Cloverleaf Quasar Host Galaxy with Herschel Spectroscopy

We present Herschel observations of the far-infrared (FIR) fine-structure (FS) lines [C II]158 μm, [O I]63 μm, [O III]52 μm, and [Si II]35 μm in the z = 2.56 Cloverleaf quasar, and combine them with published data in an analysis of the dense interstellar medium (ISM) in this system. Observed [C II]158 μm, [O I]63 μm, and FIR continuum flux ratios are reproduced with photodissociation region (PDR) models characterized by moderate far-ultraviolet (FUV) radiation fields with G_0 = 0.3–1 × 10^3 and atomic gas densities n_H = 3–5 × 10^3 cm^(−3), depending on contributions to [C II]158 μm from ionized gas. We assess the contribution to the [C II]158 μm flux from an active galactic nucleus (AGN) narrow line region (NLR) using ground-based measurements of the [N II]122 μm transition, finding that the NLR can contribute at most 20%–30% of the observed [C II]158 μm flux. The PDR density and far-UV radiation fields inferred from the atomic lines are not consistent with the CO emission, indicating that the molecular gas excitation is not solely provided via UV heating from local star formation (SF), but requires an additional heating source. X-ray heating from the AGN is explored, and we find that X-ray-dominated region (XDR) models, in combination with PDR models, can match the CO cooling without overproducing the observed FS line emission. While this XDR/PDR solution is favored given the evidence for both X-rays and SF in the Cloverleaf, we also investigate alternatives for the warm molecular gas, finding that either mechanical heating via low-velocity shocks or an enhanced cosmic-ray ionization rate may also contribute. Finally, we include upper limits on two other measurements attempted in the Herschel program: [C II]158 μm in FSC 10214 and [O I]63 μm in APM 08279+5255