An Analysis of the TRANSITION Study

Funding Information: This study was funded by Novartis . Funding Information: This study was funded by Novartis. The authors thank Tripti Sahu of Novartis Healthcare Pvt. Ltd. for providing medical writing support in accordance with Good Publication Practice (GPP 2022) guidelines (https://www.ismpp.org/gpp-2022). Publisher Copyright: © 2023 The AuthorsBackground: Treatment of patients with heart failure with reduced ejection fraction (HFrEF) and renal dysfunction (RD) is challenging owing to the risk of further deterioration in renal function, especially after acute decompensated HF (ADHF). Methods and Results: We assessed the effect of RD (estimated glomerular filtration rate of ≥30 to <60 mL/min/1.73 m2) on initiation, up-titration, and tolerability of sacubitril/valsartan in hemodynamically stabilized patients with HFrEF admitted for ADHF (RD, n = 476; non-RD, n = 483). At week 10, the target dose of sacubitril/valsartan (97/103 mg twice daily) was achieved by 42% patients in RD subgroup vs 54% in non-RD patients (P < .001). Sacubitril/valsartan was associated with greater estimated glomerular filtration rate improvements in RD subgroup than non-RD (change from baseline least squares mean 4.1 mL/min/1.73 m2, 95% confidence interval 2.2–6.1, P < .001). Cardiac biomarkers improved significantly in both subgroups; however, compared with the RD subgroup, the improvement was greater in those without RD (N-terminal pro-brain natriuretic peptide, −28.6% vs −44.8%, high-sensitivity troponin T −20.3% vs −33.9%) (P < .001). Patients in the RD subgroup compared with those without RD experienced higher rates of hyperkalemia (16.3% vs 6.5%, P < .001), investigator-reported cardiac failure (9.7% vs 5.6%, P = .029), and renal impairment (6.4% vs 2.1%, P = .002). Conclusions: Most patients with HFrEF and concomitant RD hospitalized for ADHF tolerated early initiation of sacubitril/valsartan and showed significant improvements in estimated glomerular filtration rate and cardiac biomarkers. Clinical Trial Registration: NCT02661217.proofepub_ahead_of_prin

Cost calculation and prediction in adult intensive care: A ground-up utilization study

Publisher's copy made available with the permission of the publisherThe ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were$6801 ($10311), with median costs of$2534, range $106 to$95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martinhttp://www.aaic.net.au/Article.asp?D=200403

Four-nucleon scattering with a correlated Gaussian basis method

Elastic-scattering phase shifts for four-nucleon systems are studied in an $ab$-$initio$ type cluster model in order to clarify the role of the tensor force and to investigate cluster distortions in low energy $d+d$ and $t+p$ scattering. In the present method, the description of the cluster wave function is extended from a simple (0$s$) harmonic-oscillator shell model to a few-body model with a realistic interaction, in which the wave function of the subsystems are determined with the Stochastic Variational Method. In order to calculate the matrix elements of the four-body system, we have developed a Triple Global Vector Representation method for the correlated Gaussian basis functions. To compare effects of the cluster distortion with realistic and effective interactions, we employ the AV8$^{\prime}$ potential as a realistic interaction and the Minnesota potential as an effective interaction. Especially for $^1S_0$, the calculated phase shifts show that the $t+p$ and $h+n$ channels are strongly coupled to the $d+d$ channel for the case of the realistic interaction. On the contrary, the coupling of these channels plays a relatively minor role for the case of the effective interaction. This difference between both potentials originates from the tensor term in the realistic interaction. Furthermore, the tensor interaction makes the energy splitting of the negative parity states of $^4$He consistent with experiments. No such splitting is however reproduced with the effective interaction

Advances in Global and Local Helioseismology: an Introductory Review

Helioseismology studies the structure and dynamics of the Sun's interior by observing oscillations on the surface. These studies provide information about the physical processes that control the evolution and magnetic activity of the Sun. In recent years, helioseismology has made substantial progress towards the understanding of the physics of solar oscillations and the physical processes inside the Sun, thanks to observational, theoretical and modeling efforts. In addition to the global seismology of the Sun based on measurements of global oscillation modes, a new field of local helioseismology, which studies oscillation travel times and local frequency shifts, has been developed. It is capable of providing 3D images of the subsurface structures and flows. The basic principles, recent advances and perspectives of global and local helioseismology are reviewed in this article.Comment: 86 pages, 46 figures; "Pulsation of the Sun and Stars", Lecture Notes in Physics, Vol. 832, Rozelot, Jean-Pierre; Neiner, Coralie (Eds.), 201

Perspectives in Global Helioseismology, and the Road Ahead

We review the impact of global helioseismology on key questions concerning the internal structure and dynamics of the Sun, and consider the exciting challenges the field faces as it enters a fourth decade of science exploitation. We do so with an eye on the past, looking at the perspectives global helioseismology offered in its earlier phases, in particular the mid-to-late 1970s and the 1980s. We look at how modern, higher-quality, longer datasets coupled with new developments in analysis, have altered, refined, and changed some of those perspectives, and opened others that were not previously available for study. We finish by discussing outstanding challenges and questions for the field.Comment: Invited review; to appear in Solar Physics (24 pages, 6 figures