Elastic Scattering by Deterministic and Random Fractals: Self-Affinity of the Diffraction Spectrum

The diffraction spectrum of coherent waves scattered from fractal supports is calculated exactly. The fractals considered are of the class generated iteratively by successive dilations and translations, and include generalizations of the Cantor set and Sierpinski carpet as special cases. Also randomized versions of these fractals are treated. The general result is that the diffraction intensities obey a strict recursion relation, and become self-affine in the limit of large iteration number, with a self-affinity exponent related directly to the fractal dimension of the scattering object. Applications include neutron scattering, x-rays, optical diffraction, magnetic resonance imaging, electron diffraction, and He scattering, which all display the same universal scaling.Comment: 20 pages, 11 figures. Phys. Rev. E, in press. More info available at http://www.fh.huji.ac.il/~dani

Prognostic Variation Among Very High-Risk and High-Risk Individuals With Atherosclerotic Cardiovascular Disease

Given the availability of an effective but expensive lipid-lowering medication, proprotein convertase subtilisin/kexin type 9 inhibitors, the American Heart Association and the American College of Cardiology 2018 cholesterol guideline introduced a new classification of “very high-risk” (i.e., multiple major atherosclerotic cardiovascular diseases [ASCVDs] or a major ASCVD þ multiple high-risk conditions) versus “high-risk” for patients with prior ASCVD. A few recent studies reported risk variation within very high-risk ASCVD, with multiple ASCVDs conferring higher risk than 1 ASCVD þ $2 high-risk conditions. However, these studies did not evaluate whether the constellation of high-risk conditions in 1 ASCVD may equate to the risk of multiple ASCVDs or whether the new classification has implications for heart failure

Albuminuria and Prognosis Among Individuals With Atherosclerotic Cardiovascular Disease: The ARIC Study

The American College of Cardiology and the American Heart Association 2018 Cholesterol Guideline proposed the new classification of “very high-risk” atherosclerotic cardiovascular disease (ASCVD) (multiple ASCVDs or 1 ASCVD plus $2 high-risk conditions) to guide intensive secondary prevention. This guideline takes into account reduced glomerular filtration rate (GFR) as a high-risk condition, but not albuminuria, a measure of kidney damage, that is more strongly associated with cardiovascular outcomes than reduced GFR. Importantly, the assessment of albuminuria is already recommended in patients with diabetes and hypertension, and thus, data of albuminuria are readily available in many patients with ASCVD. We explored whether urine albumin-to-creatinine ratio (ACR) is independently associated with adverse outcomes and can improve risk prediction in persons with ASCVD beyond the high-risk conditions in the guideline

Altered Cognitive Function in Men Treated for Prostate Cancer with LHRH Analogues and Cyproterone Acetate: A Randomised Controlled Trial

Objective. Luteinising hormone releasing hormone (LHRH) analogues have been associated with memory impairments in women using these drugs for gynaecological conditions. This is the first systematic investigation of the cognitive effects of LHRH analogues in male patients. Methods. 82 men with non-localised prostate cancer were randomly assigned to receive continuous leuprorelin (LHRH analogue), goserelin (LHRH analogue), cyproterone acetate (steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before commencement of treatment (77) then 6 months later (65). Results. Compared with baseline assessments, men administered androgen suppression monotherapy performed worse in 2/12 tests of attention and memory. 24/50 men randomised to active treatment and assessed 6 months later demonstrated clinically significant decline in one or more cognitive tests but not one patient randomised to close monitoring showed a decline in any test performance. Conclusion. Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions

First record of Rhabdoceras suessi (Ammonoidea, Late Triassic) from the Transylvanian Triassic Series of the Eastern Carpathians (Romania) and a review of its biochronology, paleobiogeography and paleoecology

Abstract The occurrence of the heteromorphic ammonoid Rhabdoceras suessi Hauer, 1860, is recorded for the first time in the Upper Triassic limestone of the Timon-Ciungi olistolith in the Rarău Syncline, Eastern Carpathians. A single specimen of Rhabdoceras suessi co-occurs with Monotis (Monotis) salinaria that constrains its occurrence here to the Upper Norian (Sevatian 1). It is the only known heteromorphic ammonoid in the Upper Triassic of the Romanian Carpathians. Rhabdoceras suessi is a cosmopolitan species widely recorded in low and mid-paleolatitude faunas. It ranges from the Late Norian to the Rhaetian and is suitable for high-resolution worldwide correlations only when it co-occurs with shorter-ranging choristoceratids, monotid bivalves, or the hydrozoan Heterastridium. Formerly considered as the index fossil for the Upper Norian (Sevatian) Suessi Zone, by the latest 1970s this species lost its key biochronologic status among Late Triassic ammonoids, and it generated a controversy in the 1980s concerning the status of the Rhaetian stage. New stratigraphic data from North America and Europe in the subsequent decades resulted in a revised ammonoid biostratigraphy for the uppermost Triassic, the Rhaetian being reinstalled as the topmost stage in the current standard timescale of the Triassic. The geographic distribution of Rhabdoceras is compiled from published worldwide records, and its paleobiogeography and paleoecology are discussed

Randomized Pragmatic Trial of Stroke Transitional Care: The COMPASS Study

Background The objectives of this study were to develop and test in real-world clinical practice the effectiveness of a comprehensive postacute stroke transitional care (TC) management program. Methods and Results The COMPASS study (Comprehensive Post-Acute Stroke Services) was a pragmatic cluster-randomized trial where the hospital was the unit of randomization. The intervention (COMPASS-TC) was initiated at 20 hospitals, and 20 hospitals provided their usual care. Hospital staff enrolled 6024 adult stroke and transient ischemic attack patients discharged home between 2016 and 2018. COMPASS-TC was patient-centered and assessed social and functional determinates of health to inform individualized care plans. Ninety-day outcomes were evaluated by blinded telephone interviewers. The primary outcome was functional status (Stroke Impact Scale-16); secondary outcomes were mortality, disability, medication adherence, depression, cognition, self-rated health, fatigue, care satisfaction, home blood pressure monitoring, and falls. The primary analysis was intention to treat. Of intervention hospitals, 58% had uninterrupted intervention delivery. Thirty-five percent of patients at intervention hospitals attended a COMPASS clinic visit. The primary outcome was measured for 59% of patients and was not significantly influenced by the intervention. Mean Stroke Impact Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home blood pressure monitoring was self-reported by 72% of intervention patients versus 64% of usual care patients (adjusted odds ratio, 1.43 [95% CI, 1.21-1.70]). No other secondary outcomes differed. Conclusions Although designed according to the best available evidence with input from various stakeholders and consistent with Centers for Medicare and Medicaid Services TC policies, the COMPASS model of TC was not consistently incorporated into real-world health care. We found no significant effect of the intervention on functional status at 90 days post-discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664