Summary Bronchial asthma often remains uncontrolled despite treatment with inhaled corticosteroids (ICS), long-acting β2 -agonists (LABA) or both, necessitating additional treatment. Patients ≥18 ...years ( n = 1681) with mild-to-moderate asthma received oral montelukast 10 mg added to ICS or ICS + LABAs, and were followed for 6 months in a prospective, open-label observational study. The primary endpoint was change in Asthma Control Test (ACT) score. Secondary endpoints included mini-Asthma Quality-of-Life Questionnaire (mini-AQLQ) and FEV1 /PEF. Mean ACT scores improved from 14.6 ± 4.6 (baseline) to 19.4 ± 4.4 (month 6; p < 0.0001). Using ACT score categories, the percentage of patients with uncontrolled (57.5%) or poorly controlled (25.0%) asthma at baseline decreased at month 6 (17.6 and 21.7%, respectively); the percentage of patients with well controlled (13.9%) or completely controlled (1.2%) asthma at baseline increased at month 6 (47.5 and 11.4%, respectively). The mini-AQLQ score (mean ± SD) improved from 4.0 ± 1.1 to 5.3 ± 1.1 ( p < 0.0001); FEV1 increased from 2.46 ± 0.89 to 2.60 ± 0.92 L ( p < 0.0001). Treatment with montelukast was generally well tolerated. In patients insufficiently controlled with ICS or ICS + LABAs, daily add-on montelukast improved both asthma control and asthma-related quality of life. Clinicaltrials.gov registry number NCT00802789.
Radioisotope replacement with compact electron linear accelerators Kutsaev, Sergey V.; Agustsson, Ronald; Araujo-Martinez, Aurora ...
Nuclear instruments & methods in physics research. Section B, Beam interactions with materials and atoms,
04/2023, Letnik:
540
Journal Article
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The replacement of radioactive sources with alternative technologies has been identified as a priority by international authorities, due to the risk of accidents and diversion by terrorists for use ...in Radiological Dispersal Devices. Many of these sources can be replaced with the X-rays produced by electron beams accelerated to MeV energies. However, the size, weight and costs of electron linacs must be significantly reduced to be considered for radioisotope replacement. RadiaBeam Technologies, LLC is developing a series of inexpensive compact electron accelerators in the 1–10 MeV range for radioisotope replacement such as Ir-192, Cs-137 and Co-60 for various applications. The dramatic level of miniaturization and cost-reduction was achieved thanks to the implementation of such innovative technologies as high-frequency magnetrons, split accelerating structure fabrication technology and solid-state Marx modulators. Here, in this paper, we overview RadiaBeam's compact linac developments, discuss the enabling technologies, and report on the current progress.
Here, this work investigates the mechanical and forming behavior of pure niobium sheet, which has broad applications in low-temperature physics including the proposed International Linear Collider. ...An extensive suite of mechanical tests is performed on commercially-pure niobium (CP-Nb), including uniaxial tension, strain-rate-jump, biaxial tension and disc compression, which are used to characterize the plastic behavior of the CP-Nb sheet. The material is found to have significant plastic anisotropy, high R-values, significant ductility, and non-negligible rate-dependent behavior. Subsequently, two types of forming experiments, deep-drawing and stretch-forming, are conducted with CP-Nb blanks of different diameters. These two experiments subject the CP-Nb sheet to different modes of deformation and stress states, and are meant to highlight the strengths and deficiencies of constitutive models. To model the forming behavior of the CP-Nb sheet, the material hardening at large strains is extracted from the uniaxial tension test, including the strain-rate effect. The plastic anisotropy of the CP-Nb sheet is modeled with the Yld2000-2D and Yld2004-3D non-quadratic yield functions. The friction coefficient of 0.25 is inversely identified from the deep-drawing experiments, by matching the predicted and measured punch force–displacement responses. While the features of the deep-drawing experiment are captured well using the constitutive framework described above, those of the stretch-forming experiment are not. Agreement with the latter is accomplished only after a targeted recalibration of the anisotropic yield function. This underscores the general conclusion that successful modeling of plastic deformation processes requires an accurately calibrated yield function which captures the dominant, process-specific stress states.
From the mid-1980s to mid-1990s, the WHO MONICA Project monitored coronary events and classic risk factors for coronary heart disease (CHD) in 38 populations from 21 countries. We assessed the extent ...to which changes in these risk factors explain the variation in the trends in coronary-event rates across the populations.
In men and women aged 35–64 years, non-fatal myocardial infarction and coronary deaths were registered continuously to assess trends in rates of coronary events. We carried out population surveys to estimate trends in risk factors. Trends in event rates were regressed on trends in risk score and in individual risk factors.
Smoking rates decreased in most male populations but trends were mixed in women; mean blood pressures and cholesterol concentrations decreased, bodymass index increased, and overall risk scores and coronary-event rates decreased. The model of trends in 10-year coronary-event rates against risk scores and single risk factors showed a poor fit, but this was improved with a 4-year time lag for coronary events. The explanatory power of the analyses was limited by imprecision of the estimates and homogeneity of trends in the study populations.
Changes in the classic risk factors seem to partly explain the variation in population trends in CHD. Residual variance is attributable to difficulties in measurement and analysis, including time lag, and to factors that were not included, such as medical interventions. The results support prevention policies based on the classic risk factors but suggest potential for prevention beyond these.
Aims Degenerative aortic valve disease (DAVD), a common finding in the elderly, is associated with an increased risk of death due to cardiovascular causes. Taking advantage of its longitudinal ...design, this study evaluates the prevalence of DAVD and its temporal associations with long-term exposure to cardiovascular risk factors in the general population. Methods and results We studied 953 subjects (aged 25–74 years) from a random sample of German residents. Risk factors had been determined at a baseline investigation in 1994/95. At a follow-up investigation, 10 years later, standardized echocardiography determined aortic valve morphology and aortic valve area (AVA) as well as left ventricular geometry and function. At the follow-up study, the overall prevalence of DAVD was 28%. In logistic regression models adjusting for traditional cardiovascular risk factors at baseline age (OR 2.0 1.7–2.3 per 10 years, P < 0.001), active smoking (OR 1.7 1.1–2.4, P = 0.009) and elevated total cholesterol levels (OR 1.2 1.1–1.3 per increase of 20 mg/dL, P < 0.001) were significantly related to DAVD at follow-up. Furthermore, age, baseline status of smoking, and total cholesterol level were significant predictors of a smaller AVA at follow-up study. In contrast, hypertension and obesity had no detectable relationship with long-term changes of aortic valve structure. Conclusions In the general population we observed a high prevalence of DAVD that is associated with long-term exposure to elevated cholesterol levels and active smoking. These findings strengthen the notion that smoking cessation and cholesterol lowering are promising treatment targets for prevention of DAVD.
KORA-gen is a resource for genetic epidemiological research, based on the KORA platform (Cooperative Health Research in the Region of Augsburg). Biosamples and phenotypic characteristics as well as ...environmental parameters of 18,000 adults from Augsburg and the surrounding counties are available. The age range of the participants was 25 to 74 years of recruitment and is 30 to 90 years in 2005. KORA-gen can be used by external partners. Interested parties can inform themselves interactively via internet about the available data and the rules of access. The genotypic data base is a common resource of all partners.
To quantify the association between systolic blood pressure and season, indoor and outdoor temperature and short-term trends in outdoor temperature.
The study used data from the WHO MONICA Project ...risk factors surveys from 25 populations in 16 countries. Random samples of men and women aged 35-64 years were invited to participate. Systolic blood pressure measurements were available for 115 434 participants. Hierarchical models were used to quantify the association between blood pressure and temperature, and account for differences in the associations between populations.
Populations closer to the equator showed larger seasonal changes in blood pressure. A 1 degrees C increase in indoor temperature reduced systolic blood pressure by an average of 0.31 mmHg (95% posterior interval: -0.44, -0.19). A 1 degrees C increase in outdoor temperature reduced blood pressure by the smaller average of 0.19 mmHg (95% posterior interval: -0.26, -0.11). Increased outdoor, but not indoor, temperatures had a stronger effect in women than in men. The effect of outdoor temperature remained after controlling for indoor temperature. Short-term trends in temperature did not have a statistically signicant effect.
Indoor and outdoor temperature have independent effects on systolic blood pressure, and both should be controlled for in studies that measure blood pressure. Improved protection against cold temperatures could lead to a reduction in the winter excess of cardiovascular mortality.
As part of the Danish contribution to the World Health Organization (WHO) MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project, a register of patients with stroke was ...established in 1982. The purpose of the present study was to analyze long-term survival and causes of death after a first stroke and to compare them with those of the background population.
The study population comprised all subjects aged 25 years or older who were resident in a geographically defined region in Copenhagen County. All stroke events in the study population during 1982-1991 were ascertained and validated according to standardized criteria outlined for the WHO MONICA Project. After completion of the stroke registry at the end of 1991, all patients were followed up by record linkage to official registries. Standardized mortality ratios were calculated for various causes of death and periods after the stroke.
The estimated cumulative risks for death at 28 days, 1 year, and 5 years after onset were 28%, 41%, and 60%, respectively. Compared with the general population, nonfatal stroke was associated with an almost 5-fold increase in risk for death between 4 weeks and 1 year after a first stroke and a 2-fold increase in the risk for death subsequent to 1 year. The excess mortality rate in stroke patients was due mainly to cardiovascular diseases but also to cancer, other diseases, accidents, and suicide. The probability for long-term survival improved significantly during the observation period for patients with ischemic or ill-defined stroke.
Stroke is a medical emergency associated with a very high risk for death in the acute and subacute phases and with a continuous excess risk of death. Better prevention and management of strokes may improve the long-term survival rate.
Compact microwave electron linear accelerators must operate at high frequencies in order to maintain tight SWaP (size, weight, and power) requirements, set by modern applications. Currently, the ...frequencies are practically limited to X- and Ku-bands because of the availability of MW-class magnetrons, required to achieve beam energies of several MeV, and tight fabrication tolerances. The latter is associated with micron-level accuracy and further waveguide frequency tuning process, both increasing its costs dramatically. By implying a novel split structure fabrication approach, it is possible to relax these tolerances to the values of 10–20 μm and eliminate the tuning step, greatly reducing their total costs. This paper presents the results of microwave measurements of split X- and Ku-band accelerating structures of different types and discusses the benefits of our fabrication approach.
Abstract Background and aims The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting. Methods and results 27 populations from Europe, ...Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35–64 years ( n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m2 ), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m2 ) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk. Conclusion standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.
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