Optimal Alphabetic Ternary Trees

We give a new algorithm to construct optimal alphabetic ternary trees, where every internal node has at most three children. This algorithm generalizes the classic Hu-Tucker algorithm, though the overall computational complexity has yet to be determined

Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial

<p>Abstract</p> <p>Background:</p> <p>Lower respiratory tract infections like acute bronchitis, exacerbated chronic obstructive pulmonary disease and community-acquired pneumonia are often unnecessarily treated with antibiotics, mainly because of physicians' difficulties to distinguish viral from bacterial cause and to estimate disease-severity. The goal of this trial is to compare medical outcomes, use of antibiotics and hospital resources in a strategy based on enforced evidence-based guidelines versus procalcitonin guided antibiotic therapy in patients with lower respiratory tract infections.</p> <p>Methods and design:</p> <p>We describe a prospective randomized controlled non-inferiority trial with an open intervention. We aim to randomize over a fixed recruitment period of 18 months a minimal number of 1002 patients from 6 hospitals in Switzerland. Patients must be >18 years of age with a lower respiratory tract infections <28 days of duration. Patients with no informed consent, not fluent in German, a previous hospital stay within 14 days, severe immunosuppression or chronic infection, intravenous drug use or a terminal condition are excluded. Randomization to either guidelines-enforced management or procalcitonin-guided antibiotic therapy is stratified by centre and type of lower respiratory tract infections. During hospitalization, all patients are reassessed at days 3, 5, 7 and at the day of discharge. After 30 and 180 days, structured phone interviews by blinded medical students are conducted. Depending on the randomization allocation, initiation and discontinuation of antibiotics is encouraged or discouraged based on evidence-based guidelines or procalcitonin cut off ranges, respectively. The primary endpoint is the risk of combined disease-specific failure after 30 days. Secondary outcomes are antibiotic exposure, side effects from antibiotics, rate and duration of hospitalization, time to clinical stability, disease activity scores and cost effectiveness. The study hypothesis is that procalcitonin-guidance is non-inferior (i.e., at worst a 7.5% higher combined failure rate) to the management with enforced guidelines, but is associated with a reduced total antibiotic use and length of hospital stay.</p> <p>Discussion:</p> <p>Use of and prolonged exposure to antibiotics in lower respiratory tract infections is high. The proposed trial investigates whether procalcitonin-guidance may safely reduce antibiotic consumption along with reductions in hospitalization costs and antibiotic resistance. It will additionally generate insights for improved prognostic assessment of patients with lower respiratory tract infections.</p> <p>Trial registration:</p> <p>ISRCTN95122877</p

Integrated active and passive control design methodology for the LaRC CSI evolutionary model

A general design methodology to integrate active control with passive damping was demonstrated on the NASA LaRC CSI Evolutionary Model (CEM), a ground testbed for future large, flexible spacecraft. Vibration suppression controllers designed for Line-of Sight (LOS) minimization were successfully implemented on the CEM. A frequency-shaped H2 methodology was developed, allowing the designer to specify the roll-off of the MIMO compensator. A closed loop bandwidth of 4 Hz, including the six rigid body modes and the first three dominant elastic modes of the CEM was achieved. Good agreement was demonstrated between experimental data and analytical predictions for the closed loop frequency response and random tests. Using the Modal Strain Energy (MSE) method, a passive damping treatment consisting of 60 viscoelastically damped struts was designed, fabricated and implemented on the CEM. Damping levels for the targeted modes were more than an order of magnitude larger than for the undamped structure. Using measured loss and stiffness data for the individual damped struts, analytical predictions of the damping levels were very close to the experimental values in the (1-10) Hz frequency range where the open loop model matched the experimental data. An integrated active/passive controller was successfully implemented on the CEM and was evaluated against an active-only controller. A two-fold increase in the effective control bandwidth and further reductions of 30 percent to 50 percent in the LOS RMS outputs were achieved compared to an active-only controller. Superior performance was also obtained compared to a High-Authority/Low-Authority (HAC/LAC) controller

Comparison of the temporal release pattern of copeptin with conventional biomarkers in acute myocardial infarction

Background Early detection of acute myocardial infarction (AMI) using cardiac biomarkers of myocardial necrosis remains limited since these biomarkers do not rise within the first hours from onset of AMI. We aimed to compare the temporal release pattern of the C-terminal portion of provasopressin (copeptin) with conventional cardiac biomarkers, including creatine kinase isoenzyme (CK-MB), cardiac troponin T (cTnT), and high-sensitivity cTnT (hs-cTnT), in patients with ST-elevation AMI. Methods We included 145 patients undergoing successful primary percutaneous coronary intervention (PCI) for a first ST-elevation AMI presenting within 12 h of symptom onset. Blood samples were taken on admission and at four time points within the first 24 h after PCI. Results In contrast to all other markers, copeptin levels were already elevated on admission and were higher with a shorter time from symptom onset to reperfusion and lower systolic blood pressure. Copeptin levels peaked immediately after symptom onset at a maximum of 249 pmol/L and normalized within 10 h. In contrast, CK-MB, cTnT, and hs-cTnT peaked after 14 h from symptom onset at a maximum of 275 U/L, 5.75 lg/L, and 4.16 lg/L, respectively, and decreased more gradually. Conclusions Copeptin has a distinct release pattern in patients with ST-elevation AMI, peaking within the first hour after symptom onset before conventional cardiac biomarkers and falling to normal ranges within the first day. Further studies are required to determine the exact role of copeptin in AMI suspects presenting within the first hours after symptom onset

The rapid rotation and complex magnetic field geometry of Vega

The recent discovery of a weak surface magnetic field on the normal intermediate-mass star Vega raises the question of the origin of this magnetism in a class of stars that was not known to host magnetic fields. We aim to confirm the field detection and provide additional observational constraints about the field characteristics, by modelling the magnetic geometry of the star and by investigating the seasonal variability of the reconstructed field. We analyse a total of 799 circularly-polarized spectra collected with the NARVAL and ESPaDOnS spectropolarimeters during 2008 and 2009. We employ a cross-correlation procedure to compute, from each spectrum, a mean polarized line profile with a signal-to-noise ratio of about 20,000. The technique of Zeeman-Doppler Imaging is then used to determine the rotation period of the star and reconstruct the large-scale magnetic geometry of Vega at two different epochs. We confirm the detection of circularly polarized signatures in the mean line profiles. The amplitude of the signatures is larger when spectral lines of higher magnetic sensitivity are selected for the analysis, as expected for a signal of magnetic origin. The short-term evolution of polarized signatures is consistent with a rotational period of 0.732 \pm 0.008 d. The reconstructed magnetic topology unveils a magnetic region of radial field orientation, closely concentrated around the rotation pole. This polar feature is accompanied by a small number of magnetic patches at lower latitudes. No significant variability in the field structure is observed over a time span of one year. The repeated observation of a weak photospheric magnetic field on Vega suggests that a previously unknown type of magnetic stars exists in the intermediate-mass domain. Vega may well be the first confirmed member of a much larger, as yet unexplored, class of weakly-magnetic stars.Comment: Accepted by Astronomy & Astrophysics. Abstract shortened to respect the arXiv limit of 1920 character

A dominant magnetic dipole for the evolved Ap star candidate EK Eridani

EK Eri is one of the most slowly rotating active giants known, and has been proposed to be the descendant of a strongly magnetic Ap star. We have performed a spectropolarimetric study of EK Eri over 4 photometric periods with the aim of inferring the topology of its magnetic field. We used the NARVAL spectropolarimeter at the Bernard Lyot telescope at the Pic du Midi Observatory, along with the least-squares deconvolution method, to extract high signal-to-noise ratio Stokes V profiles from a timeseries of 28 polarisation spectra. We have derived the surface-averaged longitudinal magnetic field Bl. We fit the Stokes V profiles with a model of the large-scale magnetic field and obtained Zeeman Doppler images of the surface magnetic strength and geometry. Bl variations of up to about 80 G are observed without any reversal of its sign, and which are in phase with photometric ephemeris. The activity indicators are shown to vary smoothly on a timescale compatible with the rotational period inferred from photometry (308.8 d.), however large deviations can occur from one rotation to another. The surface magnetic field variations of EK Eri appear to be dominated by a strong magnetic spot (of negative polarity) which is phased with the dark (cool) photometric spot. Our modeling shows that the large-scale magnetic field of EK Eri is strongly poloidal. For a rotational axis inclination of i = 60{\deg}, we obtain a model that is almost purely dipolar. In the dipolar model, the strong magnetic/photometric spot corresponds to the negative pole of the dipole, which could be the remnant of that of an Ap star progenitor of EK Eri. Our observations and modeling conceptually support this hypothesis, suggesting an explanation of the outstanding magnetic properties of EK Eri as the result of interaction between deep convection and the remnant of an Ap star magnetic dipole.Comment: 8 pages, 6 figures, accepted for publication in Astronomy & Astrophysic