Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey

Objective: To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function. Design: Cross sectional survey. Setting: Four centre general practice in Poole, Dorset. Subjects: 817 elderly patients aged 70-84 years. Main outcomes: Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction. Results: The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. Conclusions: Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown

The impact of the 1783-1784 AD Laki eruption on global aerosol formation processes and cloud condensation nuclei

The 1783–1784 AD Laki flood lava eruption commenced on 8 June 1783 and released 122 Tg of sulphur dioxide gas over the course of 8 months into the upper troposphere and lower stratosphere above Iceland. Previous studies have examined the impact of the Laki eruption on sulphate aerosol and climate using general circulation models. Here, we study the impact on aerosol microphysical processes, including the nucleation of new particles and their growth to cloud condensation nuclei (CCN) using a comprehensive Global Model of Aerosol Processes (GLOMAP). Total particle concentrations in the free troposphere increase by a factor ~16 over large parts of the Northern Hemisphere in the 3 months following the onset of the eruption. Particle concentrations in the boundary layer increase by a factor 2 to 5 in regions as far away as North America, the Middle East and Asia due to long-range transport of nucleated particles. CCN concentrations (at 0.22% supersaturation) increase by a factor 65 in the upper troposphere with maximum changes in 3-month zonal mean concentrations of ~1400 cm<sup>−3</sup> at high northern latitudes. 3-month zonal mean CCN concentrations in the boundary layer at the latitude of the eruption increase by up to a factor 26, and averaged over the Northern Hemisphere, the eruption caused a factor 4 increase in CCN concentrations at low-level cloud altitude. The simulations show that the Laki eruption would have completely dominated as a source of CCN in the pre-industrial atmosphere. The model also suggests an impact of the eruption in the Southern Hemisphere, where CCN concentrations are increased by up to a factor 1.4 at 20° S. Our model simulations suggest that the impact of an equivalent wintertime eruption on upper tropospheric CCN concentrations is only about one-third of that of a summertime eruption. The simulations show that the microphysical processes leading to the growth of particles to CCN sizes are fundamentally different after an eruption when compared to the unperturbed atmosphere, underlining the importance of using a fully coupled microphysics model when studying long-lasting, high-latitude eruptions

Lift-up, Kelvin-Helmholtz and Orr mechanisms in turbulent jets

Three amplification mechanisms present in turbulent jets, namely lift-up, Kelvin–Helmholtz and Orr, are characterized via global resolvent analysis and spectral proper orthogonal decomposition (SPOD) over a range of Mach numbers. The lift-up mechanism was recently identified in turbulent jets via local analysis by Nogueira et al. (J. Fluid Mech., vol. 873, 2019, pp. 211–237) at low Strouhal number ( St ) and non-zero azimuthal wavenumbers ( m ). In these limits, a global SPOD analysis of data from high-fidelity simulations reveals streamwise vortices and streaks similar to those found in turbulent wall-bounded flows. These structures are in qualitative agreement with the global resolvent analysis, which shows that they are a response to upstream forcing of streamwise vorticity near the nozzle exit. Analysis of mode shapes, component-wise amplitudes and sensitivity analysis distinguishes the three mechanisms and the regions of frequency–wavenumber space where each dominates, finding lift-up to be dominant as St/m→0 . Finally, SPOD and resolvent analyses of localized regions show that the lift-up mechanism is present throughout the jet, with a dominant azimuthal wavenumber inversely proportional to streamwise distance from the nozzle, with streaks of azimuthal wavenumber exceeding five near the nozzle, and wavenumbers one and two most energetic far downstream of the potential core

Divergence in Dialogue

Copyright: 2014 Healey et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This work was supported by the Economic and Social Research Council (ESRC; http://www.esrc.ac.uk/) through the DynDial project (Dynamics of Conversational Dialogue, RES-062-23-0962) and the Engineering and Physical Sciences Research Council (EPSRC; http://www.epsrc.ac.uk/) through the RISER project (Robust Incremental Semantic Resources for Dialogue, EP/J010383/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Measurement of nuclear effects in neutrino interactions with minimal dependence on neutrino energy

We present a phenomenological study of nuclear effects in neutrino charged-current interactions, using transverse kinematic imbalances in exclusive measurements. Novel observables with minimal dependence on neutrino energy are proposed to study quasielastic scattering, and especially resonance production. They should be able to provide direct constraints on nuclear effects in neutrino- and antineutrino-nucleus interactions.Comment: 7 pages, 9 figures, accepted version by PR

Energy Flow in Acoustic Black Holes

We present the results of an analysis of superradiant energy flow due to scalar fields incident on an acoustic black hole. In addition to providing independent confirmation of the recent results in [5], we determine in detail the profile of energy flow everywhere outside the horizon. We confirm explicitly that in a suitable frame the energy flow is inward at the horizon and outward at infinity, as expected on physical grounds.Comment: 8 pages, 9 figures, Comments added to discussion of energy flow and introductory section abbreviate

Spontaneous Symmetry Breaking for Scalar QED with Non-minimal Chern-Simons Coupling

We investigate the two-loop effective potential for both minimally and non-minimally coupled Maxwell-Chern-Simons theories. The non-minimal gauge interaction represents the magnetic moment interaction between a charged scalar and the electromagnetic field. In a previous paper we have shown that the two loop effective potential for this model is renormalizable with an appropriate choice of the non-minimal coupling constant. We carry out a detailed analysis of the spontaneous symmetry breaking induced by radiative corrections. As long as the renormalization point for all couplings is chosen to be the true minimum of the effective potential, both models predict the presence of spontaneous symmetry breaking. Two loop corrections are small compared to the one loop result, and thus the symmetry breaking is perturbatively stable.Comment: Revtex 25 pages, 9 figure

Automatic Methods of Gas Analysis Depending upon Thermal Conductivity

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