New Directions in Cloud Programming

Nearly twenty years after the launch of AWS, it remains difficult for most developers to harness the enormous potential of the cloud. In this paper we lay out an agenda for a new generation of cloud programming research aimed at bringing research ideas to programmers in an evolutionary fashion. Key to our approach is a separation of distributed programs into a PACT of four facets: Program semantics, Availablity, Consistency and Targets of optimization. We propose to migrate developers gradually to PACT programming by lifting familiar code into our more declarative level of abstraction. We then propose a multi-stage compiler that emits human-readable code at each stage that can be hand-tuned by developers seeking more control. Our agenda raises numerous research challenges across multiple areas including language design, query optimization, transactions, distributed consistency, compilers and program synthesis

Taxes and Investment in Annuities

dramatically with aggregate annuity purchases reaching $159.3 billion in 1995. While many annuities are job-related, by 1994 individual annuity purchases outside of job-related retirement plans had grown to$51 billion. This paper uses state-level data on annuity premiums for 1984-93 to explore the expansion of the annuity market and how taxes have affected this market. Annuities are tax-advantaged investments because income taxes are deferred. Higher tax rates can affect annuity purchases by affecting the overall level of saving, by inducing a switch towards tax-advantaged investments, or by encouraging investors to buy annuities at younger ages to increase the value of tax deferral. Both state-level variation in income tax rates and time-series variation in federal tax policy help identify differences in tax incentives to buy annuities. In our benchmark econometric specification using year and state fixed effects, a one percentage point increase in the marginal tax rate increases per capita individual annuity purchases by 4.3 percent. However, this result is somewhat sensitive to the econometric specification. Estimates controlling for year fixed effects but not state fixed effects suggest the overall effect of taxes on annuity purchases is negative and statistically significant. Furthermore, the effect of tax rates on annuity purchases depends on the age composition within the state. The effect of tax rates on annuity purchases increases with the fraction of the population between the ages 50 and 59.

Physical characteristics and non-keplerian orbital motion of "propeller" moons embedded in Saturn's rings

We report the discovery of several large "propeller" moons in the outer part of Saturn's A ring, objects large enough to be followed over the 5-year duration of the Cassini mission. These are the first objects ever discovered that can be tracked as individual moons, but do not orbit in empty space. We infer sizes up to 1--2 km for the unseen moonlets at the center of the propeller-shaped structures, though many structural and photometric properties of propeller structures remain unclear. Finally, we demonstrate that some propellers undergo sustained non-keplerian orbit motion. (Note: This arXiv version of the paper contains supplementary tables that were left out of the ApJL version due to lack of space).Comment: 9 pages, 4 figures; Published in ApJ

Natural history and clinical effect of aortic valve regurgitation after left ventricular assist device implantation

ObjectivesAortic valve regurgitation reduces left ventricular assist device mechanical efficiency. Evidence has also suggested that left ventricular assist device implantation can induce or exacerbate aortic valve regurgitation. However, this has not been compared with aortic valve regurgitation progression in a nonsurgical end-stage heart failure population. Furthermore, its clinical effect is unclear. We sought to characterize the development and progression of aortic valve regurgitation in left ventricular assist device recipients and to identify its clinical effect.MethodsA review of all consecutive patients who received an intracorporeal left ventricular assist device at Duke University Medical Center from January 2004 to January 2011 was conducted. Cases of previous or concomitant aortic valve surgery were excluded. Data from the remaining implants (n = 184) and a control group of contemporaneous nonsurgical patients with end-stage heart failure (n = 132) were analyzed. Serial transthoracic echocardiography was used to characterize aortic valve regurgitation as a function of time.ResultsLeft ventricular assist device implantation was associated with worsening aortic valve regurgitation, defined as an increase in aortic valve regurgitation grade, relative to the nonsurgical patients with end-stage heart failure (P < .0001). The recipients of continuous flow left ventricular assist devices were more likely than recipients of pulsatile left ventricular assist devices to develop worsening aortic valve regurgitation (P = .0348). Moderate or severe aortic valve regurgitation developed in 21 left ventricular assist device recipients; this was unrelated to the type of device implanted (continuous vs pulsatile; P = .754) or aortic valve regurgitation grade before left ventricular assist device implantation (P = .42). Five patients developed severe aortic valve regurgitation; all of whom underwent aortic valve procedures.ConclusionsNative aortic valve regurgitation developed and/or progressed after left ventricular assist device implantation, with this effect being more pronounced in continuous flow left ventricular assist device recipients. However, the preoperative aortic valve regurgitation grade failed to correlate with the development of substantial aortic valve regurgitation after left ventricular assist device implantation. After left ventricular assist device implantation, aortic valve regurgitation had a small, but discernible, clinical effect, with some patients developing severe aortic valve regurgitation and requiring aortic valve procedures. These data have implications for the long-term management of left ventricular assist device recipients, in particular as the durability of implantable continuous flow left ventricular assist device therapy improves

Hemodynamic Predictors of Heart Failure Morbidity and Mortality: Fluid or Flow?

BACKGROUND: Patients with advanced heart failure may persist for prolonged times with persistent hemodynamic abnormalities; intermediate and long-term outcomes of these patients are unknown. METHODS AND RESULTS: We used ESCAPE trial data to examine characteristics and outcomes of patients with invasive hemodynamic monitoring during an acute heart failure hospitalization. Patients were stratified by final measurement of cardiac index (CI; L/min/m2) and pulmonary capillary wedge pressure (PCWP; mmHg) before catheter removal. The study groups were CI ≥ 2/PCWP <20 (n = 74), CI ≥ 2/PCWP ≥ 20 (n = 37), CI < 2/PCWP < 20 (n = 23), and CI < 2/PCWP ≥ 20 (n = 17). Final CI was not associated with the combined risk of death, cardiovascular hospitalization, and transplantation (HR:1.03, 95% CI:0.96–1.11 per 0.2 L/min/m(2) decrease, p=0.39), but final PCWP ≥ 20mmHg was associated with increased risk of these events (HR:2.03, 95% CI:1.31–3.15, p<0.01), as was higher final right atrial pressure (RAP; HR:1.09, 95% CI:1.06–1.12 per mmHg increase, p<0.01). CONCLUSION: Final PCWP and final RAP were stronger predictors of post-discharge outcomes than CI in patients with advanced heart failure. The ability to lower filling pressures appears to be more prognostically important than improving CI in the management of patients with advanced heart failure. CLINICALTRIALS.GOV IDENTIFIER: NCT0000061

MicroRNA Expression Characterizes Oligometastasis(es)

Cancer staging and treatment presumes a division into localized or metastatic disease. We proposed an intermediate state defined by ≤ 5 cumulative metastasis(es), termed oligometastases. In contrast to widespread polymetastases, oligometastatic patients may benefit from metastasis-directed local treatments. However, many patients who initially present with oligometastases progress to polymetastases. Predictors of progression could improve patient selection for metastasis-directed therapy.Here, we identified patterns of microRNA expression of tumor samples from oligometastatic patients treated with high-dose radiotherapy.Patients who failed to develop polymetastases are characterized by unique prioritized features of a microRNA classifier that includes the microRNA-200 family. We created an oligometastatic-polymetastatic xenograft model in which the patient-derived microRNAs discriminated between the two metastatic outcomes. MicroRNA-200c enhancement in an oligometastatic cell line resulted in polymetastatic progression.These results demonstrate a biological basis for oligometastases and a potential for using microRNA expression to identify patients most likely to remain oligometastatic after metastasis-directed treatment