Comparison of three methods for measuring psoriasis severity in clinical studies (Part 1 of 2): change during therapy in Psoriasis Area and Severity Index, Static Physician's Global Assessment and Lattice System Physician's Global Assessment

BackgroundAccurate and reliable assessment of changes in psoriasis severity is critical in clinical trials of therapies.ObjectiveTo compare Psoriasis Area and Severity Index (PASI), static Physician's Global Assessment (sPGA), and the Lattice System Physician's Global Assessment (LS‐PGA) in a trial of systemic treatments for plaque psoriasis vulgaris and to assess whether they measure change in psoriasis induced by therapy.MethodsPatients were randomized to voclosporin or cyclosporine for 24 weeks (the ‘24‐week‐treatment’ group, n = 366), or placebo for 12 weeks followed by voclosporin for 12 weeks (the ‘initial‐placebo’ group, n = 89).ResultsAll scoring systems changed in concert and were sensitive enough to detect reductions in severity during placebo therapy as well as with active therapy (P < 0.01 for each measurement). At study onset, there were poorer correlations of sPGA with PASI (r = 0.45) and LS‐PGA (r = 0.39) than between PASI and LS‐PGA (r = 0.68). After therapy, all correlations were stronger, but sPGA continued to be less well correlated (with PASI, r = 0.85; with LS‐PGA, r = 0.79) than LS‐PGA with PASI (r = 0.90). Two‐ or three‐step improvements in LS‐PGA showed very good to excellent accuracy in corresponding to PASI‐50 and PASI‐75, respectively, and were more accurate than comparable changes in sPGA.ConclusionPASI, sPGA and LS‐PGA are responsive to the varying degrees of improvement in psoriasis induced by either placebo or active therapy. While the three systems capture similar information, each has different reasons for use in a clinical trial.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111966/1/jdv13132.pd

Beyond Cervical Length: Association between Postcerclage Transvaginal Ultrasound Parameters and Preterm Birth

Objective To assess the value of transvaginal ultrasound parameters after cerclage placement in estimating the risk of spontaneous preterm birth. Study Design This is a retrospective cohort at a single tertiary care center from 2013 to 2016. Women carrying a singleton, nonanomalous fetus with cerclage in situ and at least one postcerclage transvaginal ultrasound from 16 0/7 to 25 6/7 weeks' gestation were included. In addition to abstracting maternal demographic and obstetric characteristics, two study investigators separately reviewed each of the images from the first transvaginal ultrasound after cerclage placement, masked to pregnancy outcomes. We measured the angle between the anterior uterine wall and cervical canal at the internal os and external os, closed canal length above and below the stitch, width of the anterior and posterior cervix at the level of the cerclage, and stitch distance from the cervical canal. The presence of additional ultrasound findings such as sludge and cervical funneling was also noted. The main outcomes were preterm birth &lt; 34 weeks and preterm birth &lt; 37 weeks. Transvaginal ultrasound parameters were compared between women with preterm birth and those without preterm birth using chi-square, Fisher's exact, and Wilcoxon's rank-sum tests, as appropriate. Log binomial regression was used to estimate the relative risk of preterm birth for all significant obstetric and ultrasound characteristics. Results A total of 102 women met inclusion criteria: 58% had history-indicated, 20% ultrasound-indicated, and 23% exam-indicated cerclages. Of these, 28 (27.5%) women delivered at &lt; 34 weeks' gestation, and 48 (47.0%) women delivered at &lt; 37 weeks' gestation. Preterm birth did not vary by race, maternal age, insurance, smoking, or gestational age of the earliest prior preterm birth (for multiparous women), but women who had preterm birth were more likely to have exam-indicated cerclage. There were several transvaginal ultrasound parameters associated with preterm birth &lt; 34 weeks and preterm birth &lt; 37 weeks. Of these, cervical length below the stitch, stitch distance from the cervical canal, straight cervical canal, funneling to or past the stitch, and presence of sludge had the greatest effect sizes. Conclusion Rates of preterm birth are high postcerclage. In addition to measuring cervical length, utilization of postcerclage transvaginal ultrasound to evaluate the location of the cerclage within the cervix, the curvature of the cervical canal, and the presence of funneling and sludge may help identify women who are at the highest risk for preterm birth

Field dynamics and kink-antikink production in rapidly expanding systems

Field dynamics in a rapidly expanding system is investigated by transforming from space-time to the rapidity - proper-time frame. The proper-time dependence of different contributions to the total energy is established. For systems characterized by a finite momentum cut-off, a freeze-out time can be defined after which the field propagation in rapidity space ends and the system decays into decoupled solitons, antisolitons and local vacuum fluctuations. Numerical simulations of field evolutions on a lattice for the (1+1)-dimensional $\Phi^4$ model illustrate the general results and show that the freeze-out time and average multiplicities of kinks (plus antikinks) produced in this 'phase transition' can be obtained from simple averages over the initial ensemble of field configurations. An extension to explicitly include additional dissipation is discussed. The validity of an adiabatic approximation for the case of an overdamped system is investigated. The (3+1)-dimensional generalization may serve as model for baryon-antibaryon production after heavy-ion collisions.Comment: 18 pages, 7 figures. Two references added. New subsection III.E added. Final version accepted for publication in PR

Superheavy Dark Matter with Discrete Gauge Symmetries

We show that there are discrete gauge symmetries protect naturally heavy X particles from decaying into the ordinary light particles in the supersymmetric standard model. This makes the proposal very attractive that the superheavy X particles constitute a part of the dark matter in the present universe. It is more interesting that there are a class of discrete gauge symmetries which naturally accommodate a long-lived unstable X particle. We find that in some discrete Z_{10} models, for example, a superheavy X particle has lifetime \tau_X \simeq 10^{11}-10^{26} years for its mass M_X \simeq 10^{13}-10^{14} GeV. This long lifetime is guaranteed by the absence of lower dimensional operators (of light particles) couple to the X. We briefly discuss a possible explanation for the recently observed ultra-high-energy cosmic ray events by the decay of this unstable X particle.Comment: 9 pages, Late

Fate of the first traversible wormhole: black-hole collapse or inflationary expansion

We study numerically the stability of Morris & Thorne's first traversible wormhole, shown previously by Ellis to be a solution for a massless ghost Klein-Gordon field. Our code uses a dual-null formulation for spherically symmetric space-time integration, and the numerical range covers both universes connected by the wormhole. We observe that the wormhole is unstable against Gaussian pulses in either exotic or normal massless Klein-Gordon fields. The wormhole throat suffers a bifurcation of horizons and either explodes to form an inflationary universe or collapses to a black hole, if the total input energy is respectively negative or positive. As the perturbations become small in total energy, there is evidence for critical solutions with a certain black-hole mass or Hubble constant. The collapse time is related to the initial energy with an apparently universal critical exponent. For normal matter, such as a traveller traversing the wormhole, collapse to a black hole always results. However, carefully balanced additional ghost radiation can maintain the wormhole for a limited time. The black-hole formation from a traversible wormhole confirms the recently proposed duality between them. The inflationary case provides a mechanism for inflating, to macroscopic size, a Planck-sized wormhole formed in space-time foam.Comment: 10 pages, RevTeX4, 11 figures, epsf.st

Lambda polarization and single-spin left-right asymmetry in diffractive hadron-hadron collisions

We discuss Lambda polarization and single-spin left-right asymmetry in diffractive hadron-hadron scattering at high energies. We show that the physical picture proposed in a recent Letter is consistent with the experimental observation that $\Lambda$ polarization in the diffractive process, $pp\to \Lambda K^+p$, is much higher than that in the inclusive reaction, $pp\to \Lambda X$. We make predictions for the left-right asymmetry, A_N, and for the spin transfer, $D_{NN}^\Lambda$, in the single-spin process $p(\uparrow)p\to \Lambda K^+p$ and suggest further experimental tests of the proposed picture.Comment: 14 pages, 3 ps-figures. Phys. Rev. D (in press

Evolving Lorentzian Wormholes

Evolving Lorentzian wormholes with the required matter satisfying the Energy conditions are discussed. Several different scale factors are used and the corresponding consequences derived. The effect of extra, decaying (in time) compact dimensions present in the wormhole metric is also explored and certain interesting conclusions are derived for the cases of exponential and Kaluza--Klein inflation.Comment: 10 pages( RevTex, Twocolumn format), Two figures available on request from the first author. transmission errors corrected

DCC Dynamics in (2+1)D-O(3) model

The dynamics of symmetry-breaking after a quench is numerically simulated on a lattice for the (2+1)-dimensional O(3) model. In addition to the standard sigma-model with temperature-dependent Phi^4-potential the energy functional includes a four-derivative current-current coupling to stabilize the size of the emerging extended topological textures. The total winding number can be conserved by constraint. As a model for the chiral phase transition during the cooling phase after a hadronic collision this allows to investigate the interference of 'baryon-antibaryon' production with the developing disoriented aligned domains. The growth of angular correlations, condensate, average orientation is studied in dependence of texture size, quench rate, symmetry breaking. The classical dissipative dynamics determines the rate of energy emitted from the relaxing source for each component of the 3-vector field which provides a possible signature for domains of Disoriented Chiral Condensate. We find that the 'pions' are emitted in two distinct pulses; for sufficiently small lattice size the second one carries the DCC signal, but it is strongly suppressed as compared to simultaneous 'sigma'-meson emission. We compare the resulting anomalies in the distributions of DCC pions with probabilities derived within the commonly used coherent state formalism.Comment: 27 pages, 17 figures; several minor insertions in the text; two references adde

Covariance of Antiproton Yield and Source Size in Nuclear Collisions

We confront for the first time the widely-held belief that combined event-by-event information from quark gluon plasma signals can reduce the ambiguity of the individual signals. We illustrate specifically how the measured antiproton yield combined with the information from pion-pion HBT correlations can be used to identify novel event classes.Comment: 8 pages, 5 figures, improved title, references and readability; results unchange

Formation of extended topological defects during symmetry breaking phase transitions in O(2) and O(3) models

The density of extended topological defects created during symmetry-breaking phase transitions depends on the ratio between the correlation length in the symmetric phase near $T_c$ and the winding length of the defects as determined by the momentaneous effective action after a typical relaxation time. Conservation of winding number in numerical simulations requires a suitable embedding of the field variables and the appropriate geometrical implementation of the winding density on the discrete lattice. We define a modified Kibble limit for the square lattice and obtain defect densities as functions of winding lengths in O(2) and O(3) models. The latter allows to observe formation of disoriented aligned domains within the easy plane. Their extent is severely limited by the momentaneous defect density during the course of the quench.Comment: 16 pages, 9 figure