Brownian thermal noise associated with highly reflective mirror coatings is a fundamental limit for several precision experiments, including gravitational-wave detectors. Recently, there has been a ...worldwide effort to find mirror coatings with improved thermal noise properties that also fulfill strict optical requirements such as low absorption and scatter. We report on the optical and mechanical properties of ion-beam-sputtered niobia and titania-niobia thin films, and we discuss application of such coatings in current and future gravitational-wave detectors. We also report an updated direct coating thermal noise measurement of the HR coatings used in Advanced LIGO and Advanced Virgo, and the observation of a discrepancy between ring-down measurements and thermal-noise estimations of mechanical loss in highly reflective mirror coatings. This discrepancy might be ascribed either to a dissipation of the silica layers considerably higher than expected or to an unexplained excess loss of stacked layers.
Introduction
Dementia-related psychosis (DRP) is characterized by hallucinations and delusions, which may increase the debilitating effects of underlying dementia. This network meta-analysis (NMA) ...evaluated the comparative efficacy, safety, and acceptability of atypical antipsychotics (AAPs) commonly used off label to treat DRP.
Methods
We included 22 eligible studies from a systematic literature review of AAPs (quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole) used off label to treat DRP. Study outcomes were: (1) efficacy—neuropsychiatric inventory-nursing home (NPI-NH psychosis subscale), (2) safety—mortality, cerebrovascular events (CVAEs), and others (somnolence, falls, fractures, injuries, etc.), and (3) acceptability—discontinuations due to all causes, lack of efficacy, and adverse events (AEs). We used random-effects modeling to estimate pooled standardized mean differences (SMDs) for NPI-NH psychosis subscale scores and odds ratios (OR) for other dichotomous outcomes, with their respective 95% confidence intervals (CIs).
Results
Compared with placebo, aripiprazole (SMD − 0.12; 95% CI − 0.31, 0.06), and olanzapine (SMD − 0.17; 95% CI − 0.04; 0.02) demonstrated small, non-significant numerical improvements in NPI-NH psychosis scores (5 studies;
n
= 1891), while quetiapine (SMD 0.04; 95% CI − 0.23, 0.32) did not improve symptoms. The odds of mortality (15 studies,
n
= 4989) were higher for aripiprazole (OR 1.58; 95% CI 0.62, 4.04), brexpiprazole (OR 2.22; 95% CI 0.30, 16.56), olanzapine (OR 2.21; 95% CI 0.84, 5.85), quetiapine (OR 1.68; 95% CI 0.70, 4.03), and risperidone (OR 1.63; 95% CI 0.93, 2.85) than for placebo. Risperidone (OR 3.68; 95% CI 1.68, 8.95) and olanzapine (OR 4.47; 95% CI 1.36, 14.69) demonstrated significantly greater odds of CVAEs compared to placebo. Compared with placebo, odds of all-cause discontinuation were significantly lower for aripiprazole (OR 0.71; 95% CI 0.51, 0.98; 20 studies; 5744 patients) and higher for other AAPs. Aripiprazole (OR 0.5; 95% CI 0.31, 0.82) and olanzapine (OR 0.48; 95% CI 0.31, 0.74) had significantly lower odds of discontinuation due to lack of efficacy (OR 12 studies;
n
= 4382) compared to placebo, while results for quetiapine and risperidone were not significant. Compared with placebo, the odds of discontinuation due to AEs (19 studies,
n
= 5445) were higher for olanzapine (OR 2.62; 95% CI 1.75, 3.92), brexpiprazole (OR 1.80; 95% CI 0.80, 4.07), quetiapine (OR 1.25; 95% CI 0.82, 1.91), aripiprazole (OR 1.38; 95% CI 0.90, 2.13), and risperidone (OR 1.41; 95% CI 1.02, 1.94).
Conclusions
Overall results demonstrate that, compared with placebo, quetiapine is not associated with improvement in psychosis in patients with dementia, while olanzapine and aripiprazole have non-significant small numerical improvements. These off-label AAPs (quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole) are associated with greater odds of mortality, CVAEs, and discontinuations due to AEs than placebo. These results underscore the ongoing unmet need for newer pharmacological options with a more favorable benefit-risk profile for the treatment of DRP.
A case report is presented of spontaneous chylothorax successfullytreated by conservative means. The helpful role of the inhibitorypeptide, octreotide, is discussed.
We present and assess a Bayesian method to interpret gravitational wave signals from binary black holes. Our method directly compares gravitational wave data to numerical relativity (NR) simulations. ...In this study, we present a detailed investigation of the systematic and statistical parameter estimation errors of this method. This procedure bypasses approximations used in semianalytical models for compact binary coalescence. In this work, we use the full posterior parameter distribution for only generic nonprecessing binaries, drawing inferences away from the set of NR simulations used, via interpolation of a single scalar quantity (the marginalized log likelihood, lnL) evaluated by comparing data to nonprecessing binary black hole simulations. We also compare the data to generic simulations, and discuss the effectiveness of this procedure for generic sources. We specifically assess the impact of higher order modes, repeating our interpretation with both l≤2 as well as l≤3 harmonic modes. Using the l≤3 higher modes, we gain more information from the signal and can better constrain the parameters of the gravitational wave signal. We assess and quantify several sources of systematic error that our procedure could introduce, including simulation resolution and duration; most are negligible. We show through examples that our method can recover the parameters for equal mass, zero spin, GW150914-like, and unequal mass, precessing spin sources. Our study of this new parameter estimation method demonstrates that we can quantify and understand the systematic and statistical error. This method allows us to use higher order modes from numerical relativity simulations to better constrain the black hole binary parameters.
There is increasing evidence that the combination of epinephrine (adrenaline) with vasopressin may be superior to either epinephrine or vasopressin alone for treatment of cardiac arrest. However, the ...optimal combination, and dosage of cardiovascular drugs to minimize side effects, and to improve outcome has yet to be found. We therefore evaluated whether the combination of vasopressin plus epinephrine plus nitroglycerin (EVN), would improve vital organ blood flow during cardiopulmonary resuscitation (CPR) when compared with epinephrine (EPI) alone. After 4 min of ventricular fibrillation (VF) and 4 min of standard CPR, pigs were randomized to the combination of epinephrine (45 microg/kg) plus vasopressin (0.4 U/kg) plus nitroglycerin (7.5 microg/kg; n=12), or epinephrine (40 microg/kg; n=12) alone. Cerebral and myocardial blood flow was measured with radiolabeled microspheres. Defibrillation was attempted after 19 min of VF including 15 min of CPR. Mean+/-SEM coronary perfusion pressures were significantly (P < 0.01) higher 5 min after EVN vs. EPI alone (34+/-3 vs. 24+/-3 mmHg, respectively). At the same time, mean+/-SEM left ventricular, and global cerebral blood flow was also significantly (P < 0.05) higher after EVN vs. EPI alone (0.78+/-0.11 vs. 0.48+/-0.08 ml/min/g; and 0.37+/-0.05 vs. 0.22+/-0.0 3 ml/min/g, respectively). Spontaneous circulation was restored in 11 of 12 animals in the EVN group vs. 6 of 12 swine after EPI alone (P = N.S.). In conclusion, the combination of EVN significantly improved vital organ blood flow during CPR compared with EPI alone. Addition of nitroglycerin to the combination of low dose epinephrine with vasopressin during cardiac arrest may be beneficial.
This talk will describe the author's recent research into pulsed Electro-Magnetic Field stimulation (pEMF). It will include the history of pEMF for the treatment of physiological disorders as well as ...recent developments in the application of pEMF for brain disorders. Participants will be introduced to the fundamentals of both pulsing electro-magnetic fields as wells as pulsing photic stimulation. Case studies will demonstrate the efficacy of these therapeutic interventions, especially when they are combined with neurofeedback training. Users will learn the advantage of using z-score statistics to guide protocol selection and more specifically frequency output. Participants with MicroTesla equipment installed on BrainMaster as well as Dz-Caps to hold pEMF coils will be able to add this new modality to their practice after the workshop. Keywords * Pulsed electromagnetic field stimulation * Pulsing photic stimulation * BrainMaster
A simple, tension‐free, in situ gastroplasty was devised in the late 1960s and early 1970s to avoid the recurrences and complications of the Collis and Nissen hiatal hernioplasties. Long‐term ...follow‐up has now been completed on 153 patients.
For this procedure, the anterior gastric wall is stapled, not cut, and the fundoplication is performed on the cardia and the neoesophagus created by the stapling and is sutured under the diaphragm. A total of 161 patients underwent the stapled, uncut gastroplasty and were followed for up to 24 years. Conditions included reflux in 145, organic stricture in 23, giant hiatal hernia in 14 (with or without obstruction) and collagen esophagus in six. Post‐operative tests included subjective symptom evaluation by questionnaire, esophageal manometry and 24‐h pH monitoring.
Of the total 161 patients, 89 were followed up for 2–10 years and 64 for 1–24 years; seven were lost to follow‐up and one died soon after the operation. The stapled, uncut gastroplasty and fundoplication produced 95% excellent and good results (Matthews classification grade I and II). After the procedure, the esophagus was significantly lengthened (from 2.55 ± 0.96 to 3.2 ± 0.32 cm; p < 0.001) and sphincter pressure was significantly increased (from 6.35 ± 3.5 to 27.3 ± 6.82 mmHg; p < 0.0001). No leakage, bleeding, or ‘slipped’ recurrence was observed. Only one patient experienced dissolution of the wrap and recurrent symptoms. Aspiration, scleroderma, stricture and short esophagi, post‐gastrectomy gastric remnants and hiccups were treated with excellent and good long‐term results.
The stapled, uncut gastroplasty has universal application with excellent results, not only in typical cases of gastroesophageal reflux, but also in complicated situations such as short esophagus, strictures, or dysperistaltic and aperistaltic esophagus.
Hypertrophic obstructive cardiomyopathy Demos, Nicholas J.
The Journal of thoracic and cardiovascular surgery,
06/1997, Letnik:
113, Številka:
6
Journal Article
A total of 82 patients with gastroesophageal reflux were consecutively treated with stapled, uncut gastroplasty and complete fundoplication over a 12-year period. The conditions treated included ...symptomatic reflux; esophageal stricture; massive hernia; collagen esophagus; short esophagus; Barrett's esophagus; recurrent, massive bleeding or anemia; small gastric remnant after gastrectomy; and acute volvulus. The transthoracic approach of stapled, uncut gastroplasty gives superb exposure. Outstanding features of the procedure are the safety and versatility resulting from the small amount of fundus required, no need either to ligate short gastric vessels or to suture the esophagus itself, and preservation of anatomical continuity between the wrapping fundus and the wrapped gastric tubular segment. There have been no deaths and no cases of anatomical or symptomatic recurrence in the series. Complications included some nondebilitating and mainly self-limiting symptoms.
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