Cardiac-resynchronization therapy (CRT) benefits patients with left ventricular systolic dysfunction and a wide QRS complex. Most of these patients are candidates for an implantable ...cardioverter-defibrillator (ICD). We evaluated whether adding CRT to an ICD and optimal medical therapy might reduce mortality and morbidity among such patients.
We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD alone or an ICD plus CRT. The primary outcome was death from any cause or hospitalization for heart failure.
We followed 1798 patients for a mean of 40 months. The primary outcome occurred in 297 of 894 patients (33.2%) in the ICD-CRT group and 364 of 904 patients (40.3%) in the ICD group (hazard ratio in the ICD-CRT group, 0.75; 95% confidence interval CI, 0.64 to 0.87; P<0.001). In the ICD-CRT group, 186 patients died, as compared with 236 in the ICD group (hazard ratio, 0.75; 95% CI, 0.62 to 0.91; P = 0.003), and 174 patients were hospitalized for heart failure, as compared with 236 in the ICD group (hazard ratio, 0.68; 95% CI, 0.56 to 0.83; P<0.001). However, at 30 days after device implantation, adverse events had occurred in 124 patients in the ICD-CRT group, as compared with 58 in the ICD group (P<0.001).
Among patients with NYHA class II or III heart failure, a wide QRS complex, and left ventricular systolic dysfunction, the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure. This improvement was accompanied by more adverse events. (Funded by the Canadian Institutes of Health Research and Medtronic of Canada; ClinicalTrials.gov number, NCT00251251.).
Advocates bring unique and important viewpoints to the cancer research process, ensuring that scientific and medical advances are patient-centered and relevant. In this article, we discuss the ...benefits of engaging advocates in cancer research and underscore ways in which both the scientific and patient communities can facilitate this mutually beneficial collaboration. We discuss how to establish and nurture successful scientist-advocate relationships throughout the research process. We review opportunities that are available to advocates who want to obtain training in the evaluation of cancer research. We also suggest practical solutions that can strengthen communication between scientists and advocates, such as introducing scientist-advocate interactions at the trainee level. Finally, we highlight the essential role social media can play in disseminating patient-supported cancer research findings to the patient community and in raising awareness of the importance of promoting cancer research. Our perspective offers a model that Georgetown Breast Cancer Advocates have found effective and which could be one option for those interested in developing productive, successful, and sustainable collaborations between advocates and scientists in cancer research.
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Abstract
We report results from a systematic wide-area search for faint dwarf galaxies at heliocentric distances from 0.3 to 2 Mpc using the full 6 yr of data from the Dark Energy Survey (DES). ...Unlike previous searches over the DES data, this search specifically targeted a field population of faint galaxies located beyond the Milky Way virial radius. We derive our detection efficiency for faint, resolved dwarf galaxies in the Local Volume with a set of synthetic galaxies and expect our search to be complete to
M
V
∼ (−7, −10) mag for galaxies at
D
= (0.3, 2.0) Mpc. We find no new field dwarfs in the DES footprint, but we report the discovery of one high-significance candidate dwarf galaxy at a distance of
2.2
−
0.12
+
0.05
Mpc
, a potential satellite of the Local Volume galaxy NGC 55, separated by 47′ (physical separation as small as 30 kpc). We estimate this dwarf galaxy to have an absolute
V
-band magnitude of
−
8.0
−
0.3
+
0.5
mag
and an azimuthally averaged physical half-light radius of
2.2
−
0.4
+
0.5
kpc
, making this one of the lowest surface brightness galaxies ever found with
μ
=
32.3
mag
arcsec
−
2
. This is the largest, most diffuse galaxy known at this luminosity, suggesting possible tidal interactions with its host.
The process of the hydrogel broken down under the shear.
Combinations of microcrystalline cellulose (MCC) and sodium carboxymethyl cellulose (Na-CMC) are commonly used as stabilising agents and ...suspending agents in pharmaceutical formulations. This paper is based on a study of the interactions that take place during the process of hydrogel formation, break down, and recovery. Also considered is the binding that occurs between the MCC and the Na-CMC.
Avicel RC 591, a processed mixture of MCC and Na-CMC, is one of the more commonly used commercial suspending agents for aqueous compositions. Avicel RC 591 is used as an effective, blended stabilising agent. In this study, the contributions made by each of the components of Avicel RC 591 have been rationalised by monitoring the behaviour of the individual components in Avicel RC 591 suspensions or solutions. The hydrogels that are formed by Avicel RC 591 and by their laboratory formulated equivalent, which is spray dried (MCC
+
Na-CMC), have been characterised by confocal microscopy scanning electron microscopy and by dynamic light scattering. A 3D network structure that is formed by the MCC, in Avicel RC 591 is visualised. This network is supported by hydrogen bonding and by ionic interactions among and between the MCC, the Na-CMC and water. The strength of the network determines the physical properties of the hydrogel system, as seen in the rheological behaviour.
We present a methodology to quantify polarization and electron affinity changes at interfaces by combining scanning tunneling spectroscopy, off-axis electron holography in transmission electron ...microscopy (TEM), and self-consistent calculations of the electrostatic potential and electron phase change. We use a precisely known grown-in doping structure to calibrate the surface potential of the TEM lamella and thereby achieve a quantitative analysis of electron phase changes measured by off-axis electron holography. Using this calibration, we deduce quantitatively polarization and electron affinity changes for Al0.06Ga0.94N/GaN and In0.05 Ga0.95 N/ Al0.06 Ga0.94 N interfaces. The latter interface reveals, as expected, biaxial relaxation as well as polarization and electron affinity changes. However, at the Al0.06 Ga0.94 N / GaN interface anomalous lattice relaxations and vanishing polarization and electron affinity changes occur, whose underlying physical origin is anticipated to be total energy minimization by the minimization of Coulomb interactions between the polarization-induced interface charges.
As sediments carried by rivers enter coastal waters, fine particles can reduce the amount of light that reaches the reef through light attenuation. The Fitzroy Estuary - Keppel Bay (FE-KB), being the ...second-largest source of sediments to the Great Barrier Reef (GBR) poses a significant threat to the GBR ecosystem such as coral reefs and seagrass meadows, and biogeochemical cycles that influence water clarity. While monitoring and modelling capabilities for catchment and marine settings are now well-developed and operational, a remaining key gap is to better understand and model the transport, dynamics and fate of catchment derived material through tidally influenced sections of rivers that discharge into the GBR. This study aims to reveal sediment transport in the FE-KB estuary by continuously monitoring the seasonal variability over a year-long period and build a high-resolution model to predict sediment budgets under different scenarios of physical forcing and river conditions. Multiple data sources, including field surveys, historical data, and numerical modelling were used to obtain a detailed understanding of the sediment transport processes during wet (high river flow) and dry (low-to-no river flow) seasons. The use of high-resolution bathymetry and survey data for sediment model parameterization allowed for accurate mapping of the morphological changes, while numerical modeling provided insights into the hydrodynamic and sediment transport processes in the estuary. Observation and model data confirm the existence of a Turbidity Maximum Zone (TMZ) in the FE-KB (approximately 35 – 40 km from estuary head), where the topography plays a critical role in trapping sediments. By utilizing the model, a closed sediment budget was calculated under varying flow conditions and the results were used to determine the estuarine trapping coefficient that ranges from 28% (during extreme wet condition) to 100% (during dry condition) of the total catchment loads. Morphodynamic modelling demonstrated a persistent erosion pattern in the upper reach of the FE. The lower FE and southern tidal creeks serve as a large sediment storage basin during both wet and dry seasons, and sediment is exported and deposited offshore during high river flow conditions.
It remains unclear whether causal, rather than merely correlational, relationships in molecular networks can be inferred in complex biological settings. Here we describe the HPN-DREAM network ...inference challenge, which focused on learning causal influences in signaling networks. We used phosphoprotein data from cancer cell lines as well as in silico data from a nonlinear dynamical model. Using the phosphoprotein data, we scored more than 2,000 networks submitted by challenge participants. The networks spanned 32 biological contexts and were scored in terms of causal validity with respect to unseen interventional data. A number of approaches were effective, and incorporating known biology was generally advantageous. Additional sub-challenges considered time-course prediction and visualization. Our results suggest that learning causal relationships may be feasible in complex settings such as disease states. Furthermore, our scoring approach provides a practical way to empirically assess inferred molecular networks in a causal sense.
Measures of surgeons' skills have been associated with variations in short-term outcomes after laparoscopic gastric bypass. However, the effect of surgical skill on long-term outcomes after bariatric ...surgery is unknown.
To study the association between surgical skill and long-term outcomes of bariatric surgery.
In this retrospective observational study, 20 surgeons performing bariatric surgery submitted videos; surgeons were ranked on their skill level through blinded peer video review and sorted into quartiles of skill. Outcomes of bariatric surgery were then examined at the patient level across skill levels. The patients (N = 3631) undergoing surgery with these surgeons had 1-year postoperative follow-up data available between 2006 and 2012. The study was conducted using the Michigan Bariatric Surgery Collaborative, a prospective clinical registry of 40 hospitals performing bariatric surgery in the state of Michigan.
Surgeon skill level.
Excess body weight loss at 1 year; resolution of medical comorbidities (hypertension, sleep apnea, diabetes, and hyperlipidemia), functional status, and patient satisfaction.
Surgeons in the top and bottom quartiles had each been practicing for a mean of 11 years. Peer ratings of surgical skill varied from 2.6 to 4.8 on a 5-point scale. There was no difference between the best (top 25%) and worst (bottom 25%) performance quartiles when comparing excess body weight loss (67.2% vs 68.5%; P = .86) at 1 year. There were no differences in resolution of sleep apnea (62.6% vs 62.0%; P = .77), hypertension (47.1% vs 45.4%; P = .73), or hyperlipidemia (52.3% vs 63.4%; P = .45). Surgeons with the lowest skill rating had patients with higher rates of diabetes resolution (78.8%) when compared with the high-skill group (72.8%) (P = .01).
In contrast to its effect on early complications, surgical skill did not affect postoperative weight loss or resolution of medical comorbidities at 1 year after laparoscopic gastric bypass. These findings suggest that long-term outcomes after bariatric surgery may be less dependent on a surgeon's operative skill and instead be driven by other factors. Operative technique was not assessed in this analysis and should be considered in future studies.
It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in ...independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence.
We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs.
By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate).
In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.
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In California, severe precipitation events (SPEs) are often associated with winter season atmospheric rivers. These SPEs can generate hurricane-scale precipitation, creating a variety of natural ...hazards such as floods and landslides. For California, the most complete SPE-flood record yet generated is a 9000-year paleoflood reconstruction from the Santa Barbara Basin (Du et al. in Mar Geol 397:29–42, 2018). Finding terrestrial counterparts to compare to the Santa Barbara Basin is a challenge in Southern California where lake basins are rare and the terrestrial spatiotemporal signature of SPE floods remains largely unconstrained. Here, we present five 1–2 m sediment cores from a sag pond along the San Andreas Fault in the southern Carrizo Plain. The most complete record (core CLPC21-4) was selected for a variety of chronological, sedimentological, and biological analyses. Principal Component Analysis on these data reveals two end member sediment unit types:
event
versus
ambient
sedimentation. We focus on the two thickest sediment units likely generated by SPEs. These two units (EU 1 and EU 2) are especially distinct within CLPC21-4, characterized by erosive bases, above average sand content, normal grading, low magnetic susceptibility, and low total organic matter. Moreover, they are visually apparent across all five cores within the sag pond and thin from source to sink. Age control for the two units is constrained by AMS
14
C dates on discrete organic materials and supported by the identification of
Erodium’s
first appearance ca. 1750–1765 CE in the Santa Barbara region. Using these age constraints, we infer the maximum limiting age range for Event Unit 1 from 1470 to 1640 CE and Event Unit 2 from 1740 to 1800 CE. Within the limits of dating, site-specific proxy sensitivities, and inherent meteorological heterogeneity, we propose a probable correlation to Santa Barbara Basin flood events at 1525 CE and 1760 CE. Our results suggest that sag ponds may represent a viable and untapped paleoclimatic archive for California. Future work will focus on a latitudinal series of sag ponds to determine the spatiotemporal sequence and correlativity of SPEs in the sediment record.
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