Interventional cardiology : Cost-effectiveness of PCI guided by fractional flow reserve

Coronary revascularization strategies have been evaluated in numerous clinical trials. As coronary revascularization has become more common, concerns over financial costs have increased

CGRaBS: An All-Sky Survey of Gamma-Ray Blazar Candidates

We describe a uniform all-sky survey of bright blazars, selected primarily by their flat radio spectra, that is designed to provide a large catalog of likely gamma-ray AGN. The defined sample has 1625 targets with radio and X-ray properties similar to those of the EGRET blazars, spread uniformly across the |b| > 10 deg sky. We also report progress toward optical characterization of the sample; of objects with known R < 23, 85% have been classified and 81% have measured redshifts. One goal of this program is to focus attention on the most interesting (e.g., high redshift, high luminosity, ...) sources for intensive multiwavelength study during the observations by the Large Area Telescope (LAT) on GLAST.Comment: 18 pages, 6 figures, 1 machine-readable table available at http://astro.stanford.edu/CGRaBS/ ; accepted for publication in ApJ

CAN LINGUISTIC ANALYSIS BE USED TO IDENTIFY WHETHER ADOLESCENTS WITH A CHRONIC ILLNESS ARE DEPRESSED?

Comorbid depression is common in adolescents with chronic illness. We aimed to design and test a linguistic coding scheme for identifying depression in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), by exploring features of e-consultations within online cognitive behavioural therapy treatment. E-consultations of 16 adolescents (aged 11–17) receiving FITNET-NHS (Fatigue in teenagers on the interNET in the National Health Service) treatment in a national randomized controlled trial were examined. A theoretically driven linguistic coding scheme was developed and used to categorize comorbid depression in e-consultations using computerized content analysis. Linguistic coding scheme categorization was subsequently compared with classification of depression using the Revised Children's Anxiety and Depression Scale published cut-offs (t-scores ≥65, ≥70). Extra linguistic elements identified deductively and inductively were compared with self-reported depressive symptoms after unblinding. The linguistic coding scheme categorized three (19%) of our sample consistently with self-report assessment. Of all 12 identified linguistic features, differences in language use by categorization of self-report assessment were found for “past focus” words (mean rank frequencies: 1.50 for no depression, 5.50 for possible depression, and 10.70 for probable depression; p &lt;.05) and “discrepancy” words (mean rank frequencies: 16.00 for no depression, 11.20 for possible depression, and 6.40 for probable depression; p &lt;.05). The linguistic coding profile developed as a potential tool to support clinicians in identifying comorbid depression in e-consultations showed poor value in this sample of adolescents with CFS/ME. Some promising linguistic features were identified, warranting further research with larger samples.</p

Quiescent H2 Emission From Pre-Main Sequence Stars in Chamaeleon I

We report the discovery of quiescent emission from molecular hydrogen gas located in the circumstellar disks of six pre-main sequence stars, including two weak-line T Tauri stars (TTS), and one Herbig AeBe star, in the Chamaeleon I star forming region. For two of these stars, we also place upper limits on the 2->1 S(1)/1->0 S(1) line ratios of 0.4 and 0.5. Of the 11 pre-main sequence sources now known to be sources of quiescent near-infrared hydrogen emission, four possess transitional disks, which suggests that detectable levels of H$_2$ emission and the presence of inner disk holes are correlated. These H$_2$ detections demonstrate that these inner holes are not completely devoid of gas, in agreement with the presence of observable accretion signatures for all four of these stars and the recent detections of [Ne II] emission from three of them. The overlap in [Ne II] and H$_2$ detections hints at a possible correlation between these two features and suggests a shared excitation mechanism of high energy photons. Our models, combined with the kinematic information from the H$_2$ lines, locate the bulk of the emitting gas at a few tens of AU from the stars. We also find a correlation between H$_2$ detections and those targets which possess the largest H$\alpha$ equivalent widths, suggesting a link between accretion activity and quiescent H$_2$ emission. We conclude that quiescent H$_2$ emission from relatively hot gas within the disks of TTS is most likely related to on-going accretion activity, the production of UV photons and/or X-rays, and the evolutionary status of the dust grain populations in the inner disks.Comment: 12 pages, emulateapj, Accepted by Ap

Characteristics of EGRET Blazars in the VLBA Imaging and Polarimetry Survey (VIPS)

We examine the radio properties of EGRET-detected blazars observed as part of the VLBA Imaging and Polarimetry Survey (VIPS). VIPS has a flux limit roughly an order of magnitude below the MOJAVE survey and most other samples that have been used to study the properties of EGRET blazars. At lower flux levels, radio flux density does not directly correlate with gamma-ray flux density. We do find that the EGRET-detected blazars tend to have higher brightness temperatures, greater core fractions, and possibly larger than average jet opening angles. A weak correlation is also found with jet length and with polarization. All of the well-established trends can be explained by systematically larger Doppler factors in the gamma-ray loud blazars, consistent with the measurements of higher apparent velocities found in monitoring programs carried out at radio frequencies above 10 GHz.Comment: 20 pages, 7 figures, accepted to Ap

Pramipexole for the treatment of depressive symptoms in patients with Parkinson disease: a randomized, double blind, placebo controlled trial

Background: Depression is common in patients with Parkinson's disease, but evidence on the efficacy of antidepressants in this population is lacking. Because depression in patients with Parkinson's disease might be related to dopaminergic dysfunction, we aimed to assess the efficacy of the dopamine agonist pramipexole for treatment of depressive symptoms in patients with Parkinson's disease. METHODS: We did a 12-week randomised, double-blind, placebo-controlled (1:1 ratio) trial of pramipexole (0.125-1.0 mg three times per day) compared with placebo in patients with mild-to-moderate Parkinson's disease. Patients from 76 centres in 12 European countries and South Africa were included if they were on stable antiparkinsonian therapy without motor fluctuations and had depressive symptoms (15-item geriatric depression scale score > or =5 and unified Parkinson's disease rating scale [UPDRS] part 1 depression item score > or =2). Patients were randomly assigned by centre in blocks of four by use of a randomisation number generating system. Clinical monitors, the principal investigator, and patients were masked to treatment allocation. The primary endpoint was change in Beck depression inventory (BDI) score and all treated patients who had at least one post-baseline efficacy assessment were included in the primary analysis. We also did a pre-specified path analysis with regression models to assess the relation between BDI and UPDRS part 3 (motor score) changes. This trial is registered with ClinicalTrials.gov, number NCT00297778, and EudraCT, number 2005-003788-22. FINDINGS: Between March, 2006, and February, 2008, we enrolled 323 patients. Of 296 patients randomly assigned to pramipexole or placebo, 287 were included in the primary analysis: 139 in the pramipexole group and 148 in the placebo group. BDI scores decreased by an adjusted mean 5.9 (SE 0.5) points in the pramipexole group and 4.0 (0.5) points in the placebo group (difference 1.9, 95% CI 0.5-3.4; p=0.01, ANCOVA). The UPDRS motor score decreased by an adjusted mean 4.4 (0.6) points in the pramipexole group and 2.2 (0.5) points in the placebo group (difference 2.2, 95% CI 0.7-3.7; p=0.003, ANCOVA). Path analysis showed the direct effect of pramipexole on depressive symptoms accounted for 80% of total treatment effect (p=0.04). Adverse events were reported in 105 of 144 patients in the pramipexole group and 101 of 152 in the placebo group. Adverse events in the pramipexole group were consistent with the known safety profile of the drug. INTERPRETATION: Pramipexole improved depressive symptoms in patients with Parkinson's disease, mainly through a direct antidepressant effect. This effect should be considered in the clinical management of patients with Parkinson's disease

ROSAT X-ray Spectral Properties of Nearby Young Associations: TW Hydrae, Tucana-Horologium, and the beta Pic Moving Group

We present archival ROSAT data for three recently identified, nearby (D<70 pc), young (~10-40 Myr) stellar associations: the TW Hydrae Association, the Tucana-Horologium Association, and the beta Pic Moving Group. The distributions of ROSAT X-ray hardness ratios (HR1, HR2) for these three groups, whose membership is dominated by low-mass, weak-lined T Tauri stars, are tightly clustered and very similar to one another. The value of HR1 for TW Hya itself -- the only bona fide classical T Tauri star in any of the nearby groups -- is clearly anomalous among these nearby young stars. We compare the hardness ratio distributions of stars in the three nearby groups with those of T Tauri stars, the Hyades, and main sequence dwarfs in the field. This comparison demonstrates that the X-ray spectra of F through M stars soften with age, and that F and G stars evolve more rapidly in X-ray spectral hardness than do K and M stars. It is as yet unclear whether this trend can be attributed to age-dependent changes in the intrinsic X-ray spectra of stars of type F and later, to a decrease in the column density of circumstellar gas (e.g., in residual protoplanetary disks), or to the diminishing contributions of star-disk interactions to X-ray emission. Regardless, these results demonstrate that analysis of archival ROSAT X-ray spectral data can help both to identify nearby, young associations and to ascertain the X-ray emission properties of members of known associations.Comment: 17 pages, 4 figures; accepted by the Astrophysical Journa

Safety profile of statins alone or combined with ezetimibe : a pooled analysis of 27 studies including over 22,000 patients treated for 6-24 weeks

Aims:  The aim of this analysis was to assess the overall safety and tolerability profiles of various statins + ezetimibe vs. statin monotherapy and to explore tolerability in sub-populations grouped by age, race, and sex. Methods:  Study-level data were combined from 27 double-blind, placebo-controlled or active-comparator trials that randomized adult hypercholesterolemic patients to statin or statin + ezetimibe for 6-24 weeks. In the full cohort, % patients with AEs within treatment groups (statin: N = 10,517; statin + ezetimibe: N = 11,714) was assessed by logistic regression with terms for first-/second-line therapy (first line = drug-naïve or rendered drug-naïve by washout at study entry; second line = ongoing statin at study entry or statin run-in), trial within first-/second-line therapy, and treatment. The same model was fitted for age (< 65, ≥ 65 years), sex, race (white, black, other) and first-/second-line subgroups with additional terms for subgroup and subgroup-by-treatment interaction. Results:  In the full cohort, the only significant difference between treatments was consecutive AST or ALT elevations ≥ 3 × upper limit of normal (ULN) (statin: 0.35%, statin + ezetimibe: 0.56%; p = 0.017). Significantly more subjects reported ≥ 1 AE; drug-related, hepatitis-related and gastrointestinal-related AEs; and CK elevations ≥ 10 × ULN (all p ≤ 0.008) in first-line vs. second-line therapy studies with both treatments. AEs were generally similar between treatments in subgroups, and similar rates of AEs were reported within age and race subgroups; however, women reported generally higher AE rates. Conclusions:  In conclusion, in second-line studies, ongoing statin treatment at study entry likely screened out participants for previous statin-related AEs and tolerability issues. These results describe the safety profiles of widely used lipid-lowering therapies and encourage their appropriate and judicious use in certain subpopulations

An Innovative Interactive Modeling Tool to Analyze Scenario-Based Physician Workforce Supply and Demand

Effective physician workforce management requires that the various organizations comprising the House of Medicine be able to assess their current and future workforce supply. This information has direct relevance to funding of graduate medical education. We describe a dynamic modeling tool that examines how individual factors and practice variables can be used to measure and forecast the supply and demand for existing and new physician services. The system we describe, while built to analyze the pathologist workforce, is sufficiently broad and robust for use in any medical specialty. Our design provides a computer-based software model populated with data from surveys and best estimates by specialty experts about current and new activities in the scope of practice. The model describes the steps needed and data required for analysis of supply and demand. Our modeling tool allows educators and policy makers, in addition to physician specialty organizations, to assess how various factors may affect demand (and supply) of current and emerging services. Examples of factors evaluated include types of professional services (3 categories with 16 subcategories), service locations, elements related to the Patient Protection and Affordable Care Act, new technologies, aging population, and changing roles in capitated, value-based, and team-based systems of care. The model also helps identify where physicians in a given specialty will likely need to assume new roles, develop new expertise, and become more efficient in practice to accommodate new value-based payment models