Mortality and quality of life in the five years after severe sepsis

Peer reviewedPublisher PD

Footprints of the Beyond in flavor physics: Possible role of the Top Two Higgs Doublet Model

The B-factories results provide an impressive confirmation of the Standard Model (SM) description of flavor and CP violation. Nevertheless, as more data were accumulated, deviations in the 2.5-3.5 sigma range have emerged pointing to the exciting possibility of new CP-odd phase(s) and flavor violating parameters in B-decays. Primarily this seems to be the case in the time dependent CP asymmetries in penguin dominated modes (e.g. B -> phi (eta') Ks). We discuss these and other deviations from the SM and, as an illustration of possible new physics scenarios, we examine the role of the Top Two Higgs Doublet Model. This is a simple extension of the SM obtained by adding second Higgs doublet in which the Yukawa interactions of the two Higgs doublets are assigned in order to naturally account for the large top-quark mass. Of course, many other extensions of the Standard Model could also account for these experimental deviations. Clearly if one takes these deviations seriously then some new particles in the 300 GeV to few TeV with associated new CP-odd phase(s) are needed.Comment: 40 pages, 17 figures (png format), uses pdflate

Moiré interferometry applied to fracture in titanium tubes

Despite there being a substantial body of evidence to the contrary, moiré interferometry is often regarded - even by some adherents - as a curiosity of the optics lab. The present work seeks to demonstrate still further that the method can be an effective tool for practical materials research and assessment, in this case, in a novel and challenging experimental application involving fracture testing of heat exchanger tube material, the work being conducted in a conventional materials test laboratory setting. The key to the utility of the present setup lies with the priority given to its optical efficiency. In standard fracture toughness tests, it is axiomatic that standard specimen geometries be used. A dilemma arises when a material's properties are transformed to a substantial degree by the final stages of its process of manufacture, and when the very nature of the finished form dictates that standard geometries cannot be produced. The focus of this investigation was to measure crack-tip opening displacements (CTODs) in thin-walled titanium tubes. Fringe patterns corresponding to in-plane displacement contours were obtained interferometrically and the method for extracting CTODs from these is described. Significant differences in yield, ultimate strength, elongation, and fracture behaviour were observed for different material orientations

GPs' willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a factorial randomised trial investigating factors influencing decisions.

BACKGROUND: The National Institute for Health and Care Excellence (NICE) 2020 guidelines recommends aspirin for colorectal cancer prevention for people with Lynch syndrome. Strategies to change practice should be informed by understanding the factors influencing prescribing. AIM: To investigate the optimal type and level of information to communicate with GPs to increase willingness to prescribe aspirin. DESIGN AND SETTING: GPs in England and Wales (n = 672) were recruited to participate in an online survey with a 23 factorial design. GPs were randomised to one of eight vignettes describing a hypothetical patient with Lynch syndrome recommended to take aspirin by a clinical geneticist. METHOD: Across the vignettes, the presence or absence of three types of information was manipulated: 1) existence of NICE guidance; 2) results from the CAPP2 trial; 3) information comparing risks/benefits of aspirin. The main effects and all interactions on the primary (willingness to prescribe) and secondary outcomes (comfort discussing aspirin) were estimated. RESULTS: There were no statistically significant main effects or interactions of the three information components on willingness to prescribe aspirin or comfort discussing harms and benefits. In total, 80.4% (540/672) of GPs were willing to prescribe, with 19.7% (132/672) unwilling. GPs with prior awareness of aspirin for preventive therapy were more comfortable discussing the medication than those unaware (P = 0.031). CONCLUSION: It is unlikely that providing information on clinical guidance, trial results, and information comparing benefits and harms will increase aspirin prescribing for Lynch syndrome in primary care. Alternative multilevel strategies to support informed prescribing may be warranted

Access to and use of clinical services and disease-modifying therapies by people with progressive multiple sclerosis in the United Kingdom

Background: According to current UK guidelines everyone with progressive MS should have access to an MS Specialist but levels of access and use of clinical services is unknown. Our objective was to investigate access to MS Specialists, use of clinical services and disease-modifying therapies (DMTs) by people with progressive MS in the United Kingdom. Methods: A UK wide, online survey was conducted via the UK MS Register. Inclusion criteria: age over 18 years, primary or secondary progressive MS and a member of the UK MS Register. Participants were asked about access to MS Specialists; recent clinical service use; receipt of regular review and current and previous DMT use. Participant demographics; quality of life and disease impact measures were supplied from the UK MS Register. Results: In total 1298 participants responded: 5% were currently taking DMT; 23% had previously taken DMT; and 95% reported access to an MS Specialist. Most utilised services were: MS Doctor/Nurse (50%), General Practitioner (45%), and Physiotherapist (40%). Seventy-four percent received a regular review although 37% received theirs less than annually. Current DMT use was associated with better quality of life but past DMT use was associated with poorer quality of life and higher impact of disease. Conclusions: Access to, and use of, MS Specialists was high. However a gap in service provision was highlighted in both receiving and frequency of regular reviews

Growing impact of restenosis on the surgical treatment of peripheral arterial disease

BACKGROUND: Patients with peripheral arterial disease often experience treatment failure from restenosis at the site of a prior peripheral endovascular intervention (PVI) or lower extremity bypass (LEB). The impact of these treatment failures on the utilization and outcomes of secondary interventions is poorly understood. METHODS AND RESULTS: In our regional vascular quality improvement collaborative, we compared 2350 patients undergoing primary infrainguinal LEB with 1154 patients undergoing secondary infrainguinal LEB (LEB performed after previous revascularization in the index limb) between 2003 and 2011. The proportion of patients undergoing secondary LEB increased by 72% during the study period (22% of all LEBs in 2003 to 38% in 2011, P\u3c0.001). In-hospital outcomes, such as myocardial infarction, death, and amputation, were similar between primary and secondary LEB groups. However, in both crude and propensity-weighted analyses, secondary LEB was associated with significantly inferior 1-year outcomes, including major adverse limb event-free survival (composite of death, new bypass graft, surgical bypass graft revision, thrombectomy/thrombolysis, or above-ankle amputation; Secondary LEB MALE-free survival = 61.6% vs primary LEB MALE-free survival = 67.5%, P=0.002) and reintervention or amputation-free survival (composite of death, reintervention, or above-ankle amputation; Secondary LEB RAO-free survival = 58.9% vs Primary LEB RAO-free survival 64.1%, P=0.003). Inferior outcomes for secondary LEB were observed regardless of the prior failed treatment type (PVI or LEB). CONCLUSIONS: In an era of increasing utilization of PVI, a growing proportion of patients undergo LEB in the setting of a prior failed PVI or surgical bypass. When caring for patients with peripheral arterial disease, physicians should recognize that first treatment failure (PVI or LEB) affects the success of subsequent revascularizations

Analytic Perturbation Theory for Practitioners and Upsilon Decay

Within the ghost-free Analytic Perturbation Theory (APT), devised in the last decade for low energy QCD, simple approximations are proposed for 3-loop analytic couplings and their effective powers, in both the space-like (Euclidean) and time-like (Minkowskian) regions, accurate enough in the large range (1--100 GeV) of current physical interest.\par Effectiveness of the new Model is illustrated by the example of $\Upsilon(1\mathrm{S})$ decay where the standard analysis gives $\alpha_s(M_{\Upsilon})=0.170\pm 0.004$ value that is inconsistent with the bulk of data for $\alpha_s$. Instead, we obtain $\alpha_s^{Mod}(M_{\Upsilon})=0.185\pm 0.005$ that corresponds to $\alpha_s^{Mod}(M_Z)=0.120\pm 0.002$ that is close to the world average.\par The issue of scale uncertainty for $\Upsilon$ decay is also discussed.Comment: 12 pages, 0 figures. Model slightly modified to increase its accuracy. Numerical results upgraded, references added. The issue of scale uncertainty is discusse

Multicentre, prospective, randomised, open-label, blinded end point trial of the efficacy of allopurinol therapy in improving cardiovascular outcomes in patients with ischaemic heart disease: protocol of the ALL-HEART study

Introduction Ischaemic heart disease (IHD) is one of the most common causes of death in the UK and treatment of patients with IHD costs the National Health System (NHS) billions of pounds each year. Allopurinol is a xanthine oxidase inhibitor used to prevent gout that also has several positive effects on the cardiovascular system. The ALL-HEART study aims to determine whether allopurinol improves cardiovascular outcomes in patients with IHD. Methods and Analysis The ALL-HEART study is a multicentre, controlled, prospective, randomised, open-label blinded end point (PROBE) trial of allopurinol (up to 600 mg daily) versus no treatment in a 1:1 ratio, added to usual care, in 5215 patients aged 60 years and over with IHD. Patients are followed up by electronic record linkage and annual questionnaires for an average of 4 years. The primary outcome is the composite of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. Secondary outcomes include all-cause mortality, quality of life and cost-effectiveness of allopurinol. The study will end when 631 adjudicated primary outcomes have occurred. The study is powered at 80% to detect a 20% reduction in the primary end point for the intervention. Patient recruitment to the ALL-HEART study started in February 2014. Ethics and Dissemination The study received ethical approval from the East of Scotland Research Ethics Service (EoSRES) REC 2 (13/ES/0104). The study is event-driven and results are expected after 2019. Results will be reported in peer-reviewed journals and at scientific meetings. Results will also be disseminated to guideline committees, NHS organisations and patient groups