Patient factors associated with titration of medical therapy in patients with heart failure with reduced ejection fraction: data from the QUALIFY international registry

Aims Failure to prescribe key medicines at evidence-based doses is associated with increased mortality and hospitalization for patients with Heart Failure with reduced Ejection Fraction (HFrEF). We assessed titration patterns of guideline-recommended HFrEF medicines internationally and explored associations with patient characteristics in the global, prospective, observational, longitudinal registry. Methods and results Data were collected from September 2013 through December 2014, with 7095 patients from 36 countries [>18 years, previous HF hospitalization within 1–15 months, left ventricular ejection fraction (LVEF) ≤ 40%] enrolled, with dosage data at baseline and up to 18 months from 4368 patients. In 4368 patients (mean age 63 ± 17 years, 75% male) ≥ 100% target doses at baseline: 30.6% (ACEIs), 2.9% (ARBs), 13.9% (BBs), 53.8% (MRAs), 26.2% (ivabradine). At final follow-up, ≥100% target doses achieved in more patients for ACEI (34.8%), BB (18.0%), and ivabradine (30.5%) but unchanged for ARBs (3.2%) and MRAs (53.7%). Adjusting for baseline dosage, uptitration during follow-up was more likely with younger age, higher systolic blood pressure, and in absence of chronic kidney disease or diabetes for ACEIs/ARBs; younger age, higher body mass index, higher heart rate, lower LVEF, and absence of coronary artery disease for BBs. For ivabradine, uptitration was more likely with higher resting heart rate. Conclusions The international QUALIFY Registry suggests that few patients with HFrEF achieve target doses of disease-modifying medication, especially older patients and those with co-morbidity. Quality improvement initiatives are urgently required

Coulomb gap in a model with finite charge transfer energy

The Coulomb gap in a donor-acceptor model with finite charge transfer energy $\Delta$ describing the electronic system on the dielectric side of the metal-insulator transition is investigated by means of computer simulations on two- and three-dimensional finite samples with a random distribution of equal amounts of donor and acceptor sites. Rigorous relations reflecting the symmetry of the model presented with respect to the exchange of donors and acceptors are derived. In the immediate neighborhood of the Fermi energy $\mu$ the the density of one-electron excitations $g(\epsilon)$ is determined solely by finite size effects and $g(\epsilon)$ further away from $\mu$ is described by an asymmetric power law with a non-universal exponent, depending on the parameter $\Delta$.Comment: 10 pages, 6 figures, submitted to Phys. Rev.

Contextual and Granular Policy Enforcement in Database-backed Applications

Database-backed applications rely on inlined policy checks to process users' private and confidential data in a policy-compliant manner as traditional database access control mechanisms cannot enforce complex policies. However, application bugs due to missed checks are common in such applications, which result in data breaches. While separating policy from code is a natural solution, many data protection policies specify restrictions based on the context in which data is accessed and how the data is used. Enforcing these restrictions automatically presents significant challenges, as the information needed to determine context requires a tight coupling between policy enforcement and an application's implementation. We present Estrela, a framework for enforcing contextual and granular data access policies. Working from the observation that API endpoints can be associated with salient contextual information in most database-backed applications, Estrela allows developers to specify API-specific restrictions on data access and use. Estrela provides a clean separation between policy specification and the application's implementation, which facilitates easier auditing and maintenance of policies. Policies in Estrela consist of pre-evaluation and post-evaluation conditions, which provide the means to modulate database access before a query is issued, and to impose finer-grained constraints on information release after the evaluation of query, respectively. We build a prototype of Estrela and apply it to retrofit several real world applications (from 1000-80k LOC) to enforce different contextual policies. Our evaluation shows that Estrela can enforce policies with minimal overheads

Hysteresis, switching and anomalous behaviour of a quartz tuning fork in superfluid 4He

We have been studying the behaviour of commercial quartz tuning forks immersed in superfluid 4He and driven at resonance. For one of the forks we have observed hysteresis and switching between linear and non-linear damping regimes at temperatures below 10 mK. We associate linear damping with pure potential flow around the prongs of the fork, and non-linear damping with the production of vortex lines in a turbulent regime. At appropriate prong velocities, we have observed metastability of both the linear and the turbulent flow states, and a region of intermittency where the flow switched back and forth between each state. For the same fork, we have also observed anomalous behaviour in the linear regime, with large excursions in both damping, resonant frequency, and the tip velocity as a function of driving force

Focusing of Negative Ions by Vortices in Rotating 3He-A

Experiments with negative ions in rotating superfluid 3He-A show strong retardation and deformation of ion pulses drifting parallel to the angular velocity Ω. This is caused by the interaction between the ions and the l texture in the soft cores of A-phase vortices. The interaction is mediated by the anisotropic ion mobility: v=μ⊥E-Δμ(E·l)l. The (Ω,T) dependence of the retardation is explained by a model that assumes focusing of ions into the vortex cores, along which the mobility μc is lower than that in the bulk liquid, μ⊥. We find μc=μ⊥-0.6Δμ