Long-Term Corticosteroid-Sparing Immunosuppression for Cardiac Sarcoidosis.

Background Long-term corticosteroid therapy is the standard of care for treatment of cardiac sarcoidosis (CS). The efficacy of long-term corticosteroid-sparing immunosuppression in CS is unknown. The goal of this study was to assess the efficacy of methotrexate with or without adalimumab for long-term disease suppression in CS, and to assess recurrence and adverse event rates after immunosuppression discontinuation. Methods and Results Retrospective chart review identified treatment-naive CS patients at a single academic medical center who received corticosteroid-sparing maintenance therapy. Demographics, cardiac uptake of 18-fluorodeoxyglucose, and adverse cardiac events were compared before and during treatment and between those with persistent or interrupted immunosuppression. Twenty-eight CS patients were followed for a mean 4.1 (SD 1.5) years. Twenty-five patients received 4 to 8 weeks of high-dose prednisone (>30 mg/day), followed by taper and maintenance therapy with methotrexate±low-dose prednisone (low-dose prednisone, <10 mg/day). Adalimumab was added in 19 patients with persistently active CS or in those with intolerance to methotrexate. Methotrexate±low-dose prednisone resulted in initial reduction (88%) or elimination (60%) of 18-fluorodeoxyglucose uptake, and patients receiving adalimumab-containing regimens experienced improved (84%) or resolved (63%) 18-fluorodeoxyglucose uptake. Radiologic relapse occurred in 8 of 9 patients after immunosuppression cessation, 4 patients on methotrexate-containing regimens, and in no patients on adalimumab-containing regimens. Conclusions Corticosteroid-sparing regimens containing methotrexate with or without adalimumab is an effective maintenance therapy in patients after an initial response is confirmed. Disease recurrence in patients on and off immunosuppression support need for ongoing radiologic surveillance regardless of immunosuppression regimen

Early marine growth in relation to marine-stage survival rates for Alaska sockeye salmon (Oncorhynchus nerka)

We tested the hypothesis that larger juvenile sockeye salmon (Oncorhynchus nerka) in Bristol Bay, Alaska, have higher marine-stage survival rates than smaller juvenile salmon. We used scales from returning adults (33 years of data) and trawl samples of juveniles (n= 3572) collected along the eastern Bering Sea shelf during August through September 2000−02. The size of juvenile sockeye salmon mirrored indices of their marine-stage survival rate (e.g., smaller fish had lower indices of marine-stage survival rate). However, there was no relationship between the size of sockeye salmon after their first year at sea, as estimated from archived scales, and brood-year survival size was relatively uniform over the time series, possibly indicating size-selective mortality on smaller individuals during their marine residence. Variation in size, relative abundance, and marine-stage survival rate of juvenile sockeye salmon is likely related to ocean conditions affecting their early marine migratory pathways along the eastern Bering Sea shelf

A CFTR Potentiator in Patients with Cystic Fibrosis and the G551D Mutation

BACKGROUND: Increasing the activity of defective cystic fibrosis transmembrane conductance regulator (CFTR) protein is a potential treatment for cystic fibrosis. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to evaluate ivacaftor (VX-770), a CFTR potentiator, in subjects 12 years of age or older with cystic fibrosis and at least one G551D-CFTR mutation. Subjects were randomly assigned to receive 150 mg of ivacaftor every 12 hours (84 subjects, of whom 83 received at least one dose) or placebo (83, of whom 78 received at least one dose) for 48 weeks. The primary end point was the estimated mean change from baseline through week 24 in the percent of predicted forced expiratory volume in 1 second (FEV(1)). RESULTS: The change from baseline through week 24 in the percent of predicted FEV(1) was greater by 10.6 percentage points in the ivacaftor group than in the placebo group (P<0.001). Effects on pulmonary function were noted by 2 weeks, and a significant treatment effect was maintained through week 48. Subjects receiving ivacaftor were 55% less likely to have a pulmonary exacerbation than were patients receiving placebo, through week 48 (P<0.001). In addition, through week 48, subjects in the ivacaftor group scored 8.6 points higher than did subjects in the placebo group on the respiratory-symptoms domain of the Cystic Fibrosis Questionnaire–revised instrument (a 100-point scale, with higher numbers indicating a lower effect of symptoms on the patient’s quality of life) (P<0.001). By 48 weeks, patients treated with ivacaftor had gained, on average, 2.7 kg more weight than had patients receiving placebo (P<0.001). The change from baseline through week 48 in the concentration of sweat chloride, a measure of CFTR activity, with ivacaftor as compared with placebo was −48.1 mmol per liter (P<0.001). The incidence of adverse events was similar with ivacaftor and placebo, with a lower proportion of serious adverse events with ivacaftor than with placebo (24% vs. 42%). CONCLUSIONS: Ivacaftor was associated with improvements in lung function at 2 weeks that were sustained through 48 weeks. Substantial improvements were also observed in the risk of pulmonary exacerbations, patient-reported respiratory symptoms, weight, and concentration of sweat chloride

Second Annual Seminar on Estate Planning

Schedule and materials from the Second Annual Seminar on Estate Planning held by UK/CLE on July 18-19, 1975

Quantum Cosmological Relational Model of Shape and Scale in 1-d

Relational particle models are useful toy models for quantum cosmology and the problem of time in quantum general relativity. This paper shows how to extend existing work on concrete examples of relational particle models in 1-d to include a notion of scale. This is useful as regards forming a tight analogy with quantum cosmology and the emergent semiclassical time and hidden time approaches to the problem of time. This paper shows furthermore that the correspondence between relational particle models and classical and quantum cosmology can be strengthened using judicious choices of the mechanical potential. This gives relational particle mechanics models with analogues of spatial curvature, cosmological constant, dust and radiation terms. A number of these models are then tractable at the quantum level. These models can be used to study important issues 1) in canonical quantum gravity: the problem of time, the semiclassical approach to it and timeless approaches to it (such as the naive Schrodinger interpretation and records theory). 2) In quantum cosmology, such as in the investigation of uniform states, robustness, and the qualitative understanding of the origin of structure formation.Comment: References and some more motivation adde

Approaching the Problem of Time with a Combined Semiclassical-Records-Histories Scheme

I approach the Problem of Time and other foundations of Quantum Cosmology using a combined histories, timeless and semiclassical approach. This approach is along the lines pursued by Halliwell. It involves the timeless probabilities for dynamical trajectories entering regions of configuration space, which are computed within the semiclassical regime. Moreover, the objects that Halliwell uses in this approach commute with the Hamiltonian constraint, H. This approach has not hitherto been considered for models that also possess nontrivial linear constraints, Lin. This paper carries this out for some concrete relational particle models (RPM's). If there is also commutation with Lin - the Kuchar observables condition - the constructed objects are Dirac observables. Moreover, this paper shows that the problem of Kuchar observables is explicitly resolved for 1- and 2-d RPM's. Then as a first route to Halliwell's approach for nontrivial linear constraints that is also a construction of Dirac observables, I consider theories for which Kuchar observables are formally known, giving the relational triangle as an example. As a second route, I apply an indirect method that generalizes both group-averaging and Barbour's best matching. For conceptual clarity, my study involves the simpler case of Halliwell 2003 sharp-edged window function. I leave the elsewise-improved softened case of Halliwell 2009 for a subsequent Paper II. Finally, I provide comments on Halliwell's approach and how well it fares as regards the various facets of the Problem of Time and as an implementation of QM propositions.Comment: An improved version of the text, and with various further references. 25 pages, 4 figure

Sandia capabilities for the measurement, characterization, and analysis of heliostats for CSP.

The Concentrating Solar Technologies Organization at Sandia National Laboratories has a long history of performing important research, development, and testing that has enabled the Concentrating Solar Power Industry to deploy full-scale power plants. Sandia continues to pursue innovative CSP concepts with the goal of reducing the cost of CSP while improving efficiency and performance. In this pursuit, Sandia has developed many tools for the analysis of CSP performance. The following capabilities document highlights Sandia's extensive experience in the design, construction, and utilization of large-scale testing facilities for CSP and the tools that Sandia has created for the full characterization of heliostats. Sandia has extensive experience in using these tools to evaluate the performance of novel heliostat designs

Communications Biophysics

Contains reports on four research projects.National Institutes of Health (Grant 5 P01 NS13126-02)National Institutes of Health (Grant 5 K04 NS00113-03)National Institutes of Health (Grant 2 ROI NS11153-02A1)National Science Foundation (Grant BNS77-16861)National Institutes of Health (Grant 5 RO1 NS10916-03)National Institutes of Health (Fellowship 1 F32 NS05327)National Institutes of Health (Grant 5 ROI NS12846-02)National Institutes of Health (Fellowship 1 F32 NS05266)Edith E. Sturgis FoundationNational Institutes of Health (Grant 1 R01 NS11680-01)National Institutes of Health (Grant 2 RO1 NS11080-04)National Institutes of Health (Grant 5 T32 GIM107301-03)National Institutes of Health (Grant 5 TOI GM01555-10