Simulation of Ultra-High Energy Photon Propagation in the Geomagnetic Field

The identification of primary photons or specifying stringent limits on the photon flux is of major importance for understanding the origin of ultra-high energy (UHE) cosmic rays. We present a new Monte Carlo program allowing detailed studies of conversion and cascading of UHE photons in the geomagnetic field. The program named PRESHOWER can be used both as an independent tool or together with a shower simulation code. With the stand-alone version of the code it is possible to investigate various properties of the particle cascade induced by UHE photons interacting in the Earth's magnetic field before entering the Earth's atmosphere. Combining this program with an extensive air shower simulation code such as CORSIKA offers the possibility of investigating signatures of photon-initiated showers. In particular, features can be studied that help to discern such showers from the ones induced by hadrons. As an illustration, calculations for the conditions of the southern part of the Pierre Auger Observatory are presented.Comment: 41 pages, 9 figures, added references in introduction, corrected energy in row 1 of Table 3, extended caption of Table

Heterozygosity-fitness correlations in a wild mammal population: accounting for parental and environmental effects

HFCs (heterozygosity–fitness correlations) measure the direct relationship between an individual's genetic diversity and fitness. The effects of parental heterozygosity and the environment on HFCs are currently under-researched. We investigated these in a high-density U.K. population of European badgers (Meles meles), using a multimodel capture–mark–recapture framework and 35 microsatellite loci. We detected interannual variation in first-year, but not adult, survival probability. Adult females had higher annual survival probabilities than adult males. Cubs with more heterozygous fathers had higher first-year survival, but only in wetter summers; there was no relationship with individual or maternal heterozygosity. Moist soil conditions enhance badger food supply (earthworms), improving survival. In dryer years, higher indiscriminate mortality rates appear to mask differential heterozygosity-related survival effects. This paternal interaction was significant in the most supported model; however, the model-averaged estimate had a relative importance of 0.50 and overlapped zero slightly. First-year survival probabilities were not correlated with the inbreeding coefficient (f); however, small sample sizes limited the power to detect inbreeding depression. Correlations between individual heterozygosity and inbreeding were weak, in line with published meta-analyses showing that HFCs tend to be weak. We found support for general rather than local heterozygosity effects on first-year survival probability, and g2 indicated that our markers had power to detect inbreeding. We emphasize the importance of assessing how environmental stressors can influence the magnitude and direction of HFCs and of considering how parental genetic diversity can affect fitness-related traits, which could play an important role in the evolution of mate choice

Southeastern Pennsylvania (SEPA) Regional Enhancements Addressing Disconnects (READS) in Cardiovascular Health Communication

Seminar (39 PowerPoint slides) The objective of SEPA- READS is to enhance the capacity of health care systems and professionals to address health literacy needs of adults’ (aged 50+) to improve cardiovascular health outcomes by 1) identifying, implementing and evaluating educational/systems changes designed to improve written materials, navigation and provider communication skills, and 2) enhancing the ability of older adults to communicate effectively with healthcare providers. This is accomplished by: 1) creating a broad-based Cardiovascular Health Literacy Coalition (CHLC) 2) improving the ability of adults to communicate effectively with healthcare providers/staff at multiple points of care. The CHLC consists of a Coalition Steering Committee that provides overall guidance to the project and is composed of project leadership and representatives from two Advisory Working Groups. These Working Groups include: 1) a Professional Advisory Group (PAG) with representation from at least 10 hospitals and/or health systems, local literacy initiatives, and cultural groups dealing with non-English speakers such as the Nationalities Service Center and Southeast Asian Mutual Assistant Association’s Coalition, and 2) a Community Advisory Group (CAG) to ensure cultural and health literacy relevance for older adults. The CHLC utilizes a multi-pronged approach that includes: 1) assessing the quality and content of communication across multiple points of care; 2) integrating literacy improvement techniques and strategies, such as Teach Back, use of Plain Language, Creating a Shame Free Environment, into staff development programs 3) activating patients through training on Ask Me 3. Ultimately the impact of SEPA-READS includes: 1) Institutionalization of effective communication strategies into the culture of patient quality and safety protocols; 2) Creation of a centralized repository for culturally and linguistically forms and educational materials; 3) Improved cardiovascular health outcomes in adults aged 50+; 4) Reduced CVD related readmissions; 5) Reduced CVD medical errors; and 6) Improved CVD patient self-care behaviors. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to recruiting multiple hospital/health systems into a literacy initiative 2. Apply a methodology of engaging hospitals, community organizations and older adults to address health literacy 3. Identify the challenges in addressing cardiovascular health literacy at multiple level

The Role of Device Diagnostic Algorithms in the Assessment and Management of Patients with Systolic Heart Failure: A Review

Hospitalization due to heart failure (HF) exacerbation represents a major burden in health care and portends a poor long-term prognosis for patients. As a result, there is considerable interest to develop novel tools and strategies to better detect onset of volume overload, as HF hospitalizations may be reduced if appropriate interventions can be promptly delivered. One such innovation is the use of device-based diagnostic parameters in HF patients with implantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy (CRT) devices. These diagnostic algorithms can effectively monitor and detect changes in patients' HF status, as well as predict one's risk of HF hospitalization. This paper will review the role of these device diagnostics parameters in the assessment and management of HF patients in ambulatory settings. In addition, the integration of these novel algorithms in existing HF disease management models will be discussed

Defibrillator Shocks and Their Impact on Objective and Subjective Patient Outcomes: Results from the Painfree SST Clinical Trial

BACKGROUND: The impact of ICD shock on device-measured activity and patient reported outcomes is unknown. OBJECTIVE: The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data (i.e., device-based physical activity) and subjective patient reported outcomes (e.g., quality of life and shock anxiety). METHODS: The PainFree SST clinical trial included 2,770 patients with a single or dual-chamber ICD, or cardiac resynchronization defibrillator (CRT-D) who were followed for 22 ± 9 months. Participants completed measures of quality of life (EuroQol 5-D [EQ5D]) and shock anxiety (Florida Shock Anxiety Scale [FSAS]) at baseline, bi-annual visits, and monthly for 6 months following an ICD shock. Daily physical activity data were obtained from a built-in device accelerometer. RESULTS: Average daily activity was 185.3 ± 119.4 minutes/day. Activity was significantly reduced after an ICD shock (p<0.0001) and recovered to a normal level after approximately 90 days. ICD shock was also associated with decreased quality of life (EQ5D Health Score) and increased EQ5D anxiety scores, but it did not impact mobility, self-care, activity, or pain. Similarly, shock anxiety (FSAS) increased in shocked patients and remained significantly elevated at 24 months, regardless of appropriate or inappropriate shock delivery. CONCLUSIONS: ICD shocks have a long-lasting, adverse impact on both objective, device-measured physical activity and subjective patient reported outcomes of quality of life and shock anxiety. Successful management of ICD patients requires attention to clinically relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living

First Randomized, Multicenter, Placebo-Controlled Study of Self-Administered Intranasal Etripamil for Acute Conversion of Spontaneous Paroxysmal Supraventricular Tachycardia (NODE-301).

BACKGROUND: Pharmacologic termination of paroxysmal supraventricular tachycardia (PSVT) often requires medically supervised intervention. Intranasal etripamil, is an investigational fast-acting, nondihydropyridine, L-type calcium channel blocker, designed for unsupervised self-administration to terminate atrioventricular nodal-dependent PSVT. Phase 2 results showed potential safety and efficacy of etripamil in 104 patients with PSVT. METHODS: NODE-301, a phase 3, multicenter, double-blind, placebo-controlled study evaluated the efficacy and safety of etripamil nasal spray administered, unsupervised in patients with symptomatic sustained PSVT. After a medically supervised etripamil test dose while in sinus rhythm, patients were randomized 2:1 to receive etripamil 70 mg or placebo. When PSVT symptoms developed, patients applied a cardiac monitor and attempted a vagal maneuver; if symptoms persisted, they self-administered blinded treatment. An independent Adjudication Committee reviewed continuous electrocardiogram recordings. The primary efficacy endpoint was termination of adjudicated PSVT within 5 hours after study drug administration. RESULTS: NODE-301 accrued 156 positively adjudicated PSVT events treated with etripamil (n=107) or placebo (n=49). The hazard ratio for the primary endpoint, time-to-conversion to sinus rhythm during the 5-hour observation period, was 1.086 (95% CI, 0.726-1.623; P=0.12). In predefined sensitivity analyses, etripamil effects (compared with placebo) occurred at 3, 5, 10, 20, and 30 minutes (P<0.05). For example, at 30 minutes, there was a 53.7% of SVT conversion in the treatment arm compared to 34.7% in the placebo arm (hazard ratio, 1.87 [95% CI, 1.09-3.22]; P=0.02). Etripamil was well tolerated; adverse events were mainly related to transient nasal discomfort and congestion (19.6% and 8.0%, respectively, of randomized treatment-emergent adverse events. CONCLUSIONS: Although the primary 5-hour efficacy endpoint was not met, analyses at earlier time points indicated an etripamil treatment effect in terminating PSVT. Etripamil self-administration during PSVT was safe and well tolerated. These results support continued clinical development of etripamil nasal spray for self-administration during PSVT in a medically unsupervised setting. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03464019

Portraits of life: Patterns of events over the lifespan

This explorative content-analytic study completes earlier studies on the lifespan distributions of number and affect of past and future life-events, collected by means of the Life-line Interview Method (LIM), for three age groups of men and women (young, middle and late adulthood). LIM events were classified into 40 subcategories divided over 9 categories: Relations, School, Work, Health, Growth, Home, Birth, Death and Other. Compression of the full data set by age group, gender, affect, decade, and time perspective, disclosed various patterns of events underlying the human life-course, e.g., the ‘bump,’ ‘rosy view’ and ‘gender phase contrast’ patterns. The compressed data set provided detailed material for the composition of three written group portraits of life, reflecting the modal life story of young, middle-aged and older men and women. Patterns and portraits show a content shift of past memories and future expectations over the lifespan, supporting a more dynamic view on the human life-course

New technologies and firm organization : the case of electronic traceability systems in French agribusiness

This paper considers the relationship between the adoption of electronic traceability systems (ETSs) and the organization of firms. More precisely, it analyzes the respective roles of a firm's organizational structure, and organizational changes, in the process of ETS adoption in agribusiness. We use data from the French "Organizational Changes and Computerization" survey from 2006. We test a probit model to demonstrate the organizational structure and organizational changes underlying the firm's ETS adoption choice. Results show that ETS adoption is strongly favored by organizations with heavy hierarchical structures, standardized managerial practices and contractual mechanisms with external partners. This adoption process seems to coevolve with the organization: firms that implemented an ETS during the observed period (2003-2006) have experienced the most important organizational changes in terms of managerial practices, information systems and contractual relations, as well as the strengthening of the intermediate levels in the hierarchy

Hypnosis for hot flashes among postmenopausal women study: A study protocol of an ongoing randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Hot flashes are a highly prevalent problem associated with menopause and breast cancer treatments. The recent findings from the Women's Health Initiative have important implications for the significance of a non-hormonal, mind-body intervention for hot flashes in breast cancer survivors. Women who take hormone therapy long-term may have a 1.2 to 2.0 fold increased risk of developing breast cancer. In addition, it is now known that hormone therapy with estrogen and progestin is associated with increased risk of cardiovascular disease and stroke. Currently there are limited options to hormone replacement therapy as non-hormonal pharmacological agents are associated with only modest activity and many adverse side effects. Because of this there is a need for more alternative, non-hormonal therapies. Hypnosis is a mind-body intervention that has been shown to reduce self-reported hot flashes by up to 68% among breast cancer survivors, however, the use of hypnosis for hot flashes among post-menopausal women has not been adequately explored and the efficacy of hypnosis in reducing physiologically measured hot flashes has not yet been determined.</p> <p>Methods/design</p> <p>A sample of 180 post-menopausal women will be randomly assigned to either a 5-session Hypnosis Intervention or 5-session structured-attention control with 12 week follow-up. The present study will compare hypnosis to a structured-attention control in reducing hot flashes (perceived and physiologically monitored) in post-menopausal women in a randomized clinical trial. Outcomes will be hot flashes (self-report daily diaries; physiological monitoring; Hot Flash Related Daily Interference Scale), anxiety (State-Trait Anxiety Inventory; Hospital Anxiety and Depression Scale (HADS); anxiety visual analog scale (VAS rating); depression (Center for Epidemiologic Studies Depression Scale), sexual functioning (Sexual Activity Questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and cortisol.</p> <p>Discussion</p> <p>This study will be the first full scale test of hypnosis for hot flashes; one of the first studies to examine both perceived impact and physiologically measured impact of a mind-body intervention for hot flashes using state-of-the-art 24 hour ambulatory physiological monitoring; the first study to examine the effect of hypnosis for hot flashes on cortisol; and the first investigation of the role of cognitive expectancies in treatment of hot flashes in comparison to a Structured-Attention Control.</p> <p>Trial Registration</p> <p>This clinical trial has been registered with ClinicalTrials.gov, a service of the U.S. National Institutes of Health, ClinicalTrials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01293695">NCT01293695</a>.</p