684 research outputs found
The Viborg vascular (VIVA) screening trial of 65-74 year old men in the central region of Denmark: study protocol
<p>Abstract</p> <p>Background</p> <p>Screening for abdominal aortic aneurysm (AAA) of men aged 65-74 years reduces the AAA-related mortality and is generally considered cost effective. Despite of this only a few national health care services have implemented permanent programs.</p> <p>Around 10% of men in this group have peripheral arterial disease (PAD) defined by an ankle brachial systolic blood pressure index (ABI) below 0.9 resulting in an increased mortality-rate of 25-30%. In addition well-documented health benefits may be achieved through primary prophylaxis by initiating systematic cholesterol-lowering, smoking cessation, low-dose acetylsalicylic acid (aspirins), exercise, a healthy diet and blood-pressure control altogether reducing the increased risks for cardiovascular disease by at least 20-25%.</p> <p>The benefits of combining screening for AAA and PAD seem evident; yet they remain to be established. The objective of this study is to assess the efficacy and the cost-effectiveness of a combined screening program for AAA, PAD and hypertension.</p> <p>Methods</p> <p>The Viborg Vascular (VIVA) screening trial is a randomized, clinically controlled study designed to evaluate the benefits of vascular screening and modern vascular prophylaxis in a population of 50,000 men aged 65-74 years. Enrolment started October 2008 and is expected to stop in October 2010. The primary outcome is all-cause mortality. The secondary outcomes are cardiovascular mortality, AAA-related mortality, hospital services related to cardiovascular conditions, prevalence of AAA, PAD and potentially undiagnosed hypertension, health-related quality of life and cost effectiveness. Data analysis by intention to treat.</p> <p>Results</p> <p>Major follow-up will be performed at 3, 5 and 10 years and final study result after 15 years.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00662480</p
Experimental loophole-free violation of a Bell inequality using entangled electron spins separated by 1.3 km
For more than 80 years, the counterintuitive predictions of quantum theory
have stimulated debate about the nature of reality. In his seminal work, John
Bell proved that no theory of nature that obeys locality and realism can
reproduce all the predictions of quantum theory. Bell showed that in any local
realist theory the correlations between distant measurements satisfy an
inequality and, moreover, that this inequality can be violated according to
quantum theory. This provided a recipe for experimental tests of the
fundamental principles underlying the laws of nature. In the past decades,
numerous ingenious Bell inequality tests have been reported. However, because
of experimental limitations, all experiments to date required additional
assumptions to obtain a contradiction with local realism, resulting in
loopholes. Here we report on a Bell experiment that is free of any such
additional assumption and thus directly tests the principles underlying Bell's
inequality. We employ an event-ready scheme that enables the generation of
high-fidelity entanglement between distant electron spins. Efficient spin
readout avoids the fair sampling assumption (detection loophole), while the use
of fast random basis selection and readout combined with a spatial separation
of 1.3 km ensure the required locality conditions. We perform 245 trials
testing the CHSH-Bell inequality and find . A
null hypothesis test yields a probability of that a local-realist
model for space-like separated sites produces data with a violation at least as
large as observed, even when allowing for memory in the devices. This result
rules out large classes of local realist theories, and paves the way for
implementing device-independent quantum-secure communication and randomness
certification.Comment: Raw data will be made available after publicatio
Recent developments of the Hierarchical Reference Theory of Fluids and its relation to the Renormalization Group
The Hierarchical Reference Theory (HRT) of fluids is a general framework for
the description of phase transitions in microscopic models of classical and
quantum statistical physics. The foundations of HRT are briefly reviewed in a
self-consistent formulation which includes both the original sharp cut-off
procedure and the smooth cut-off implementation, which has been recently
investigated. The critical properties of HRT are summarized, together with the
behavior of the theory at first order phase transitions. However, the emphasis
of this presentation is on the close relationship between HRT and non
perturbative renormalization group methods, as well as on recent
generalizations of HRT to microscopic models of interest in soft matter and
quantum many body physics.Comment: 17 pages, 5 figures. Review paper to appear in Molecular Physic
Interactive Actor Analysis for Rural Water Management in The Netherlands
Recent developments in the policy sciences emphasize the social environment
in which decisions are made. The ‘network metaphor’ is often used to describe
the key role of interactions between interdependent actors involved in decision
making. These interactions take place in a policy arena drawn up by actors with an
interest in and control over decisions on the issues addressed. Interdependencies,
caused by the need for actors to increase their means of realizing objectives, are
the driving force behind these interactions. Dependency relations are of special
interest to water management and river basin management because of the fundamental
asymmetrical interdependencies that exist in river basins between upstream
and downstream stakeholders. Coleman’s linear system of action models decision
making process involving dependencies between multiple stakeholders as exchange
of control over issues, while interactions are required to negotiate exchanges of
control. We developed an interactive method for actor analysis based on Coleman’s
linear system of action and applied it to the national rural water management policy
domain in The Netherlands. The method is firmly rooted in mathematical sociology
and defies the criticism that methods for actor and stakeholder analysis do not specify
a theoretical basis explaining the causal relations between the variables analyzed and
policy change. With the application to the rural water management policy arena we
intended to increase our insight into the practical applicability of this analyticmethod
in an interactive workshop, the acceptability of the approach for the participating
actors, its contribution to the process of decision making and our understanding of
the rural water management policy arena in The Netherlands. We found that the
Association of Water Authorities, the Ministry of Public Works and the Ministry of
Agriculture are the most powerful actor in the policy domain, while governance and
cost and benefits of rural water management are the most salient issues. Progress
in policy development for rural water management is probably most promising for the issues governance, costs and benefits, safety and rural living conditions through
improved interaction between the Association of Water Authorities, the Ministry of
Agriculture and the Rural Credit Bank. Besides these analytic results the interactive
approach implemented increased the participants understanding of their dependency
on other actors in the rural water management policy domain and supported them
in developing a sound perspective on their dependency position. We concluded
that the method developed is acceptable to real-world policy decision makers, can
successfully be applied in an interactive setting, potentially contributes to the process
of decision making by increasing the participants understanding of their dependency
position, has the potential to delivers valuable advice for future decision-making and
increases our understanding of policy development for rural water management in
general
Archaeological collections from Long Hole (Gower, Swansea, UK) and their place in the British Palaeolithic
At the time of its excavation in 1861, the cave site of Long Hole (Gower peninsula, Swansea, UK) was recognized as important for establishing the antiquity of man in Wales. However, in comparison to its more illustrious neighbour Paviland Cave, it has received very little attention since. Long Hole has been host to three documented excavations: by Colonel Wood in the 1860s, by John Campbell in 1969 and most recently the small-scale work in 2012 described in this paper. Here we outline Long Hole’s excavations and the archaeological material from the cave. Although the site’s earliest collections suffer from the familiar problems of being significantly selected and lacking contextual information, several conclusions are possible. Previous suggestions of two late Neanderthal occupations are unconvincing. Lithic artefacts from Long Hole are instead reminiscent of Aurignacian material from Paviland Cave, suggesting that they were left by some of Britain’s very early modern human occupants, 37–35,000 cal BP. Because Campbell excavated an apparently well-stratified Late Pleistocene sequence his collections have the greatest potential for future work
Short- and long-term effects of a quality improvement collaborative on diabetes management
Introduction: This study examined the short- and long-term effects of a quality improvement collaborative on patient outcomes, professional performance, and structural aspects of chronic care management of type 2 diabetes in an integrated care setting.Methods: Controlled pre- and post-intervention study assessing patient outcomes (hemoglobin A1c, cholesterol, blood pressure, weight, blood lipid levels, and smoking status), professional performance (guideline adherence), and structural aspects of chronic care management from baseline up to 24 months. Analyses were based on 1,861 patients with diabetes in six intervention and nine control regions representing 37 general practices and 13 outpatient clinics.Results: Modest but significant improvement was seen in mean systolic blood pressure (decrease by 4.0 mm Hg versus 1.6 mm Hg) and mean high density lipoprotein levels (increase by 0.12 versus 0.03 points) at two-year follow up. Positive but insignificant differences were found in hemoglobin A1c (0.3%), cholesterol, and blood lipid levels. The intervention group showed significant improvement in the percentage of patients receiving advice and instruction to examine feet, and smaller reductions in the percentage of patients receiving instruction to monitor blood glucose and visiting a dietician annually. Structural aspects of self-management and decision support also improved significantly.Conclusions: At a time of heightened national attention toward diabetes care, our results demonstrate a modest benefit of participation in a multi-institutional quality improvement collaborative focusing on integrated, patient-centered care. The effects persisted for at least 12 months after the intervention was completed.Trial number: http://clinicaltrials.gov Identifier: NCT 00160017
Selected reactive oxygen species and antioxidant enzymes in common bean after Pseudomonas syringae pv. phaseolicola and Botrytis cinerea infection
Phaseolus vulgaris cv. Korona plants were
inoculated with the bacteria Pseudomonas syringae pv.
phaseolicola (Psp), necrotrophic fungus Botrytis cinerea
(Bc) or with both pathogens sequentially. The aim of the
experiment was to determine how plants cope with multiple
infection with pathogens having different attack strategy.
Possible suppression of the non-specific infection with
the necrotrophic fungus Bc by earlier Psp inoculation was
examined. Concentration of reactive oxygen species
(ROS), such as superoxide anion (O2
-) and H2O2 and
activities of antioxidant enzymes such as superoxide dismutase
(SOD), catalase (CAT) and peroxidase (POD) were
determined 6, 12, 24 and 48 h after inoculation. The
measurements were done for ROS cytosolic fraction and
enzymatic cytosolic or apoplastic fraction. Infection with
Psp caused significant increase in ROS levels since the
beginning of experiment. Activity of the apoplastic
enzymes also increased remarkably at the beginning of
experiment in contrast to the cytosolic ones. Cytosolic
SOD and guaiacol peroxidase (GPOD) activities achieved
the maximum values 48 h after treatment. Additional forms
of the examined enzymes after specific Psp infection were
identified; however, they were not present after single Bc
inoculation. Subsequent Bc infection resulted only in
changes of H2O2 and SOD that occurred to be especially
important during plant–pathogen interaction. Cultivar Korona
of common bean is considered to be resistant to Psp and mobilises its system upon infection with these bacteria.
We put forward a hypothesis that the extent of defence
reaction was so great that subsequent infection did not
trigger significant additional response
The significance of the Van Nuys prognostic index in the management of ductal carcinoma in situ
<p>Abstract</p> <p>Background</p> <p>Debate regarding the benefit of radiotherapy after local excision of ductal carcinoma <it>in situ </it>(DCIS) continues. The Van Nuys Prognostic Index (VNPI) is thought to be a useful aid in deciding which patients are at increased risk of local recurrence and who may benefit from adjuvant radiotherapy (RT). Recently published interim data from the Sloane project has showed that the VNPI score did significantly affect the chances of getting planned radiotherapy in the UK, suggesting that British clinicians may already be using this scoring system to assist in decision making. This paper independently assesses the prognostic validity of the VNPI in a British population.</p> <p>Patients and methods</p> <p>A retrospective review was conducted of all patients (n = 215) who underwent breast conserving surgery for DCIS at a single institution between 1997 – 2006. No patients included in the study received additional radiotherapy or hormonal treatment. Kaplan Meier survival curves were calculated, to determine disease free survival, for the total sample and a series of univariate analyses were performed to examine the value of various prognostic factors including the VNPI. The log-rank test was used to determine statistical significance of differential survival rates. Multivariate Cox regression analysis was performed to analyze the significance of the individual components of the VNPI. All analyses were conducted using SPSS software, version 14.5.</p> <p>Results</p> <p>The mean follow-up period was 53 months (range 12–97, SD19.9). Ninety five tumours were high grade (44%) and 84 tumours exhibited comedo necrosis (39%). The closest mean initial excision margin was 2.4 mm (range 0–22 mm, standard deviation 2.8) and a total of 72 tumours (33%) underwent further re-excision. The observed and the actuarial 8 year disease-free survival rates in this study were 91% and 83% respectively. The VNPI score and the presence of comedo necrosis were the only statistically significant prognostic indicators (P < 0.05).</p> <p>Conclusion</p> <p>This follow-up study of 215 patients with DCIS treated with local excision and observation alone is one of the largest series in which rates of recurrence are unaffected by radiation therapy, hormone manipulation or chemotherapy. It has afforded us the opportunity to assess the prognostic impact of patient and tumour characteristics free of any potentially confounding treatment related influences. The results suggest that the VNPI can be used to identify a subset of patients who are at risk of local recurrence and who may potentially benefit from RT.</p
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