Use of Statin Therapy to Reduce Cardiovascular Risk in Older Patients

Background. Cardiovascular disease is the principal cause of mortality in older individuals, and more than 80% of deaths due to coronary heart disease or stroke occur in patients over 65 years of age. Hyperlipidemia is one of the main modifiable risk factors for cardiovascular disease. Current guidelines recommend the use of statins to reduce low-density lipoprotein cholesterol to appropriate targets based on an individual's cardiovascular risk, and clearly state that older age should not be a barrier to treatment. Despite extensive evidence demonstrating clear benefit with statin therapy in older individuals, this population remains chronically undertreated. Scope. This paper provides an overview of the current evidence available regarding the efficacy and safety of statin therapy to reduce cardiovascular risk in older patients. We use hypothetical case studies to address some of the questions frequently posed by physicians responsible for the cardiovascular health of older patients. Conclusions. Various factors may account for the failure to provide appropriate treatment, including a lack of awareness of clinical benefits and perceived safety issues. However, if current guidelines are followed and older patients treated to appropriate LDL-C goals, the likelihood of cardiovascular events will be reduced in this high-risk population. Employing an evidence-based approach to the management of cardiovascular risk in older patients is likely to yield benefits in terms of overall cardiovascular burden

Excitation Enhancement of a Quantum Dot Coupled to a Plasmonic Antenna

Plasmonic antennas are key elements to control the luminescence of quantum emitters. However, the antenna's influence is often hidden by quenching losses. Here, the luminescence of a quantum dot coupled to a gold dimer antenna is investigated. Detailed analysis of the multiply excited states quantifies the antenna's influence on the excitation intensity and the luminescence quantum yield separately

Pulsed squeezed vacuum characterization without homodyning

Direct photon detection is experimentally implemented to measure the squeezing and purity of a single-mode squeezed vacuum state without an interferometric homodyne detection. Following a recent theoretical proposal [arXiv quant-ph/0311119], the setup only requires a tunable beamsplitter and a single-photon detector to fully characterize the generated Gaussian states. The experimental implementation of this procedure is discussed and compared with other reference methods.Comment: 8 pages, 7 figure

Intracule Functional Models I. Angle-corrected correlation kernels

We explore the merits of applying a simple angle-dependent correction to the correlation kernel within the framework of Hartree–Fock–Wigner theory. Based on numerical results for the first eighteen atoms, we conclude that such a correction offers a significant improvement over the action kernel that we and others have explored previously

Distributed leadership, trust and online communities

This paper analyses the role of distributed leadership and trust in online communities. The team-based informal ethos of online collaboration requires a different kind of leadership from that in formal positional hierarchies. Such leadership may be more flexible and sophisticated, capable of encompassing ambiguity and rapid change. Online leaders need to be partially invisible, delegating power and distributing tasks. Yet, simultaneously, online communities are facilitated by the high visibility and subtle control of expert leaders. This paradox: that leaders need to be both highly visible and invisible as appropriate, was derived from prior research and tested in the analysis of online community discussions using a pattern-matching process. It is argued that both leader visibility and invisibility are important for the facilitation of trusting collaboration via distributed leadership. Advanced leadership responses to complex situations in online communities foster positive group interaction and decision-making, facilitated through active distribution of specific tasks

Area minimizing discs in metric spaces

We solve the classical problem of Plateau in the setting of proper metric spaces. Precisely, we prove that among all disc-type surfaces with prescribed Jordan boundary in a proper metric space there exists an area minimizing disc which moreover has a quasi-conformal parametrization. If the space supports a local quadratic isoperimetric inequality for curves we prove that such a solution is locally Hölder continuous in the interior and continuous up to the boundary. Our results generalize corresponding results of Douglas Radò and Morrey from the setting of Euclidean space and Riemannian manifolds to that of proper metric spaces

Ensemble programme for early intervention in informal caregivers of psychiatric adult patients: a protocol for a randomised controlled trial.

Informal caregivers play a major role in the support and maintenance of community patients with severe psychiatric disorders. A pilot study showed that an individualised brief intervention such as the Ensemble programme leads to significant improvements in psychological health state and optimism. This randomised controlled trial aims to compare the efficacy of using Ensemble in improving informal caregivers' psychological health states and the ability to play an active role in their situations with that of support as usual. Improvements on the psychological health global index will be measured three times (T0-pre, T1-post and T3 2 months follow) with standardised questionnaires (the Global Severity Index of Brief Inventory Symptoms, the Life Orientation Test-Revised, the 36-item Medical Outcome Study Short-Form Health Survey and the French Zarit Burden Interview). Differences between groups in post-test and pretest values will be examined using an analysis of covariance for each outcome variable. The severity of illness measured by the Social and Occupational Functioning Assessment Scale will also be collected at T0 and T2 to compare eventual patient improvements. At the end of the programme, the experiences of the 20 patients participating in the Ensemble programme will be evaluated qualitatively. The research protocol received full authorisation from the Human Research Ethics Committee of the Vaud state, Switzerland. The principal paper will concern the results of the experimental design used to test the Ensemble programme. The research team will prioritise open access publications. NCT04020497

Making judgements about students making work : lecturers’ assessment practices in art and design.

This research study explores the assessment practices in two higher education art and design departments. The key aim of this research was to explore art and design studio assessment practices as lived by and experienced by art and design lecturers. This work draws on two bodies of pre existing research. Firstly this study adopted innovative methodological approaches that have been employed to good effect to explore assessment in text based subjects (think aloud) and moderation mark agreement (observation). Secondly the study builds on existing research into the assessment of creative practice. By applying thinking aloud methodologies into a creative practice assessment context the authors seek to illuminate the ‘in practice’ rather than espoused assessment approaches adopted. The analysis suggests that lecturers in the study employed three macro conceptions of quality to support the judgement process. These were; the demonstration of significant learning over time, the demonstration of effective studentship and the presentation of meaningful art/design work

High p_T Triggered Delta-eta,Delta-phi Correlations over a Broad Range in Delta-eta

The first measurement of pseudorapidity (Delta-eta) and azimuthal angle (Delta-phi) correlations between high transverse momentum charged hadrons (p_T > 2.5 GeV/c) and all associated particles is presented at both short- (small Delta-eta) and long-range (large Delta-eta) over a continuous pseudorapidity acceptance (-4<Delta-eta<2). In these proceedings, the various near- and away-side features of the correlation structure are discussed as a function of centrality in Au+Au collisions measured by PHOBOS at sqrt(s_NN)=200 GeV. In particular, this measurement allows a much more complete determination of the longitudinal extent of the ridge structure, first observed by the STAR collaboration over a limited eta range. In central collisions the ridge persists to at least Delta-eta=4, diminishing in magnitude as collisions become more peripheral until it disappears around Npart=80.Comment: 5 pages, 2 figures, presented at the 20th International Conference on Ultra-Relativistic Nucleus-Nucleus Collisions, "Quark Matter 2008", Jaipur, India, February 4-10, 2008. Full author list included and typo corrected in equation

The Spectral and Statistical Properties of Turbulence Generated by a Vortex/Blade-Tip Interaction

The perpendicular interaction of a streamwise vortex with the tip of a lifting blade was studied in incompressible flow to provide information useful to the accurate prediction of helicopter rotor noise and the understanding of vortex dominated turbulent flows. The vortex passed 0.3 chord lengths to the suction side of the blade tip, providing a weak interaction. Single and two-point turbulence measurements were made using sub-miniature four sensor hot-wire probes 15 chord lengths downstream of the blade trailing edge; revealing the mean velocity and Reynolds stress tensor distributions of the turbulence, as well as its spanwise length scales as a function of frequency. The single point measurements show the flow downstream of the blade to be dominated by the interaction of the original tip vortex and the vortex shed by the blade. These vortices rotate about each other under their mutual induction, winding up the turbulent wakes of the blades. This interaction between the vortices appears to be the source of new turbulence in their cores and in the region between them. This turbulence appears to be responsible for some decay in the core of the original vortex, not seen when the blade is removed. The region between the vortices is not only a region of comparatively large stresses, but also one of intense turbulence production. Velocity autospectra measured near its center suggests the presence quasi-periodic large eddies with axes roughly parallel to a line joining the vortex cores. Detailed two-point measurements were made on a series of spanwise cuts through the flow so as to reveal the turbulence scales as they would be seen along the span of an intersecting airfoil. The measurements were made over a range of probe separations that enabled them to be analyzed not only in terms of coherence and phase spectra but also in terms of wave-number frequency (kappa-omega) spectra, computed by transforming the measured cross-spectra with respect to the spanwise separation of the probes. These data clearly show the influence of the coherent eddies in the spiral wake and the turbulent region between the cores. These eddies produce distinct peaks in the upwash velocity kappa-omega spectra, and strong anisotropy manifested both in the decay of the kappa-omega spectrum at larger wave-numbers and in differences between the kappa-omega spectra of different components. None of these features are represented in the von Karman spectrum for isotropic turbulence that is often used in broadband noise computations. Wave-number frequency spectra measured in the cores appear to show some evidence that the turbulence outside sets tip core waves, as has previously been hypothesized. These spectra also provide for the first time a truly objective method for distinguishing velocity fluctuations produced by core wandering from other motions