Tracking icebergs with time-lapse photography and sparse optical flow, LeConte Bay, Alaska, 2016–2017

We present a workflow to track icebergs in proglacial fjords using oblique time-lapse photos and the Lucas-Kanade optical flow algorithm. We employ the workflow at LeConte Bay, Alaska, where we ran five time-lapse cameras between April 2016 and September 2017, capturing more than 400 000 photos at frame rates of 0.5–4.0 min−1. Hourly to daily average velocity fields in map coordinates illustrate dynamic currents in the bay, with dominant downfjord velocities (exceeding 0.5 m s−1 intermittently) and several eddies. Comparisons with simultaneous Acoustic Doppler Current Profiler (ADCP) measurements yield best agreement for the uppermost ADCP levels (∼ 12 m and above), in line with prevalent small icebergs that trace near-surface currents. Tracking results from multiple cameras compare favorably, although cameras with lower frame rates (0.5 min−1) tend to underestimate high flow speeds. Tests to determine requisite temporal and spatial image resolution confirm the importance of high image frame rates, while spatial resolution is of secondary importance. Application of our procedure to other fjords will be successful if iceberg concentrations are high enough and if the camera frame rates are sufficiently rapid (at least 1 min−1 for conditions similar to LeConte Bay).This work was funded by the U.S. National Science Foundation (OPP-1503910, OPP-1504288, OPP-1504521 and OPP-1504191).Ye

Chiral Dynamics and Heavy Quark Symmetry in a Toy Field Theoretic Model

We study a solvable QCD--like toy theory, a generalization of the Nambu--Jona-Lasinio model, which implements chiral symmetries of light quarks and heavy quark symmetry. The chiral symmetric and chiral broken phases can be dynamically tuned. This implies a parity doubled heavy--light meson system, corresponding to a $(0^-,1^-)$ multiplet and a $(0^+,1^+)$ heavy spin multiplet. Consequently the mass difference of the two multiplets is given by a Goldberger--Treiman relation and $g_A$ is found to be small. The Isgur--Wise function, $\xi(w)$, the decay constant, $f_B$, and other observables are studied.Comment: 42 pages, SSCL-PP-243; Fermi-Pub-93/059-

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

PS2-20: Racial Disparities in A1c Change and Medication Intensification

Introduction: While it is well documented that disparities exist across racial groups of diabetes patients relative to glucose control, the underlying causative factors are not well understood. The purpose of this study was to examine differences in physician orders for adjustments of glucose control medications in diabetes patients between African Americans and Caucasians

Evaluation of Provider Experience With an Electronic Health Record-Based Clinical Decision Support Tool

Background/Aims: Our goal was to evaluate provider experience with an electronic health record (EHR)-based clinical decision support (CDS) tool called CV Wizard implemented as part of a large randomized trial with 80% use rates for eligible patients. The tool included a quantitative “provider” form with prioritized treatment suggestions and a simpler visual companion “patient” form to efficiently elicit treatment preferences. Methods: Two focus groups were held outside of clinic hours with a meal and $250 compensation. Twelve providers participated and were asked to comment on open-ended questions including a) what goes into their decision to use the tool, b) the implementation process, c) how patients reacted to it, d) how it could be improved, and e) how effective it was. The discussions were audio-taped and transcribed verbatim and examined by the study team to identify themes. Results: Providers were enthusiastic about the tool and found it valuable. They were happy that the nurse printed it for them before visits, and commented that it helped set the visit agenda and organized cardiovascular (CV) risk information. They were more likely to discuss CV risk with patients, and indicated that they took additional time to use it with patients. There was general consensus that it was time well spent. They said the tool reinforced their treatment suggestions. Variability was noted with how nurses and providers were using the tools. For conversations with patients, some providers preferred to use the provider form over the patient form, and vice versa. The patient form was intended to be given to the patient while waiting to be seen by the provider, but this was often not happening. Providers had several suggestions for improving the use process, and asked for better documentation tools for results (smart phrases). Discussion: A clinical decision support tool designed to help providers and patients engage in shared decision-making for CV risk reduction was well received and perceived as time well spent with patients. Overcoming some problems associated with workflow and adding easier ways to document use of the tool for patient discussions would add to the existing value

C-B4-03: EMR-based Clinical Decision Support System Improved Glucose and Blood Pressure Control in Adults With Diabetes

Context: Medical groups have invested billions of dollars in outpatient Electronic Medical Records (EMR), but few studies demonstrate a positive impact of EMR-based clinical decision support on clinically important patient outcomes

Sustaining Use of a Clinical Decision Support Tool for Primary Care Providers

Background/Aims: Achieving and maintaining high rates of use of clinical decision support in primary care settings has been challenging. Our goal was to reach and maintain high use rates throughout the study period through ongoing feedback and incentives to clinics and consented providers. Methods: We conducted a clinic randomized trial of an electronic health record (EHR)-based point-of-care clinical decision support (CDS) tool (called CV Wizard) that provides prioritized treatment recommendations to optimize management of six reversible cardiovascular (CV) risk factors: lipids, blood pressure, glucose, tobacco use, aspirin use and weight. We assessed use (the number of times the tool was opened and printed) at targeted office visits for two groups of primary care providers (PCPs) at 11 intervention clinics: (a) those who provided informed consent to use and evaluate the tool (n=54), and (b) those who did not provide consent but still had access to the CDS (n=69). CDS use rate per provider was calculated in three postintervention months as the number of eligible visits at which the tool was used relative to the number of targeted outpatient visits that month. The use goal was 80% of targeted visits, and we reported monthly use rates to clinic leaders for all PCPs, with clinic compensation totaling $2,000 over the intervention period to achieve and maintain the goal. Generalized linear models tested whether PCP consent predicted use of the CDS system. Results: Among consented PCPs, average CDS use rates at 4, 8 and 12 months after full intervention implementation were 57.0%, 73.9% and 75%. Among PCPs at the same intervention clinics who did not provide consent, average use rates were 57.3%, 70.7%, and 58.9% (significant difference only at 12 months, P\u3c0.05). Discussion: We observed robust use of the CDS tool by PCPs and rooming nurses at targeted primary care visits, in the context of targeted use to high CV risk patients only, leadership support and PCP design input, implementation process measurement and feedback, and small financial incentives to clinics that achieved high use rates. Additional evaluation to explain why use rates declined at 12 months in the nonconsented PCPs is of interest