Working in the context of a proposal for collisional dark matter, we derive bounds on the Higgs boson coupling g′ to a stable light scalar particle, which we refer to as phion (φ), required to solve ...problems with small scale structure formation which arise in collisionless dark matter models. We discuss the behaviour of the phion in the early universe for different ranges of its mass. We find that a phion in the mass range of 100 MeV is excluded and that a phion in the mass range of 1 GeV requires a large coupling constant, g′≳2, and mh≲130 GeV in order to avoid overabundance, in which case the invisible decay mode of the Higgs boson would be dominant.
In patients with heart failure and reduced ejection fraction, sleep-disordered breathing, comprising obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is associated with increased ...morbidity, mortality, and sleep disruption. We hypothesised that treating sleep-disordered breathing with a peak-flow triggered adaptive servo-ventilation (ASV) device would improve cardiovascular outcomes in patients with heart failure and reduced ejection fraction.
We conducted a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial of peak-flow triggered ASV in patients aged 18 years or older with heart failure and reduced ejection fraction (left ventricular ejection fraction ≤45%) who were stabilised on optimal medical therapy with co-existing sleep-disordered breathing (apnoea-hypopnoea index AHI ≥15 events/h of sleep), with concealed allocation and blinded outcome assessments. The trial was carried out at 49 hospitals in nine countries. Sleep-disordered breathing was stratified into predominantly OSA with an Epworth Sleepiness Scale score of 10 or lower or predominantly CSA. Participants were randomly assigned to standard optimal treatment alone or standard optimal treatment with the addition of ASV (1:1), stratified by study site and sleep apnoea type (ie, CSA or OSA), with permuted blocks of sizes 4 and 6 in random order. Clinical evaluations were performed and Minnesota Living with Heart Failure Questionnaire, Epworth Sleepiness Scale, and New York Heart Association class were assessed at months 1, 3, and 6 following randomisation and every 6 months thereafter to a maximum of 5 years. The primary endpoint was the cumulative incidence of the composite of all-cause mortality, first admission to hospital for a cardiovascular reason, new onset atrial fibrillation or flutter, and delivery of an appropriate cardioverter-defibrillator shock. All-cause mortality was a secondary endpoint. Analysis for the primary outcome was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT01128816) and the International Standard Randomised Controlled Trial Number Register (ISRCTN67500535), and the trial is complete.
The first and last enrolments were Sept 22, 2010, and March 20, 2021. Enrolments terminated prematurely due to COVID-19-related restrictions. 1127 patients were screened, of whom 731 (65%) patients were randomly assigned to receive standard care (n=375; mean AHI 42·8 events per h of sleep SD 20·9) or standard care plus ASV (n=356; 43·3 events per h of sleep 20·5). Follow-up of all patients ended at the latest on June 15, 2021, when the trial was terminated prematurely due to a recall of the ASV device due to potential disintegration of the motor sound-abatement material. Over the course of the trial, 41 (6%) of participants withdrew consent and 34 (5%) were lost to follow-up. In the ASV group, the mean AHI decreased to 2·8-3·7 events per h over the course of the trial, with associated improvements in sleep quality assessed 1 month following randomisation. Over a mean follow-up period of 3·6 years (SD 1·6), ASV had no effect on the primary composite outcome (180 events in the control group vs 166 in the ASV group; hazard ratio HR 0·95, 95% CI 0·77-1·18; p=0·67) or the secondary endpoint of all-cause mortality (88 deaths in the control group vs. 76 in the ASV group; 0·89, 0·66-1·21; p=0·47). For patients with OSA, the HR for all-cause mortality was 1·00 (0·68-1·46; p=0·98) and for CSA was 0·74 (0·44-1·23; p=0·25). No safety issue related to ASV use was identified.
In patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely.
Canadian Institutes of Health Research and Philips RS North America.
Planetary nebulae represent a potential late stage of stellar evolution, however, their central stars (CSPNe) are relatively faint and, therefore, pertinent information is available for merely < 20% ...of the Galactic sample. Consequently, the literature was surveyed to construct a new catalogue of 620 CSPNe featuring important spectral classifications and information. The catalogue supersedes the existing iteration by 25% and includes physical parameters such as luminosity, surface gravity, temperature, magnitude estimates, and references for published spectra. The marked statistical improvement enabled the following pertinent conclusions to be determined: the H-rich/H-poor ratio is 2:1, there is a deficiency of CSPNe with types WC 5-6, and nearly 80% of binary central stars belong to the H-rich group. The last finding suggests that evolutionary scenarios leading to the formation of binary central stars interfere with the conditions required for the formation of H-poor CSPN. Approximately 50% of the sample with derived values of log L⋆, log Teff, and log g, exhibit masses and ages consistent with single stellar evolutionary models. The implication is that single stars are indeed able to form planetary nebulae. Moreover, it is shown that H-poor CSPNe are formed by higher mass progenitors. The catalogue is available through the Vizier database.
We argue that NSV 11749, an eruption observed in the early twentieth century, was a rare event known as 'very late thermal pulse' (VLTP). To support our argument we compare the light curve of NSV ...11749 with those of the two bona fide VLTP objects known to date, V4334 Sgr and V605 Aql, and with those predicted by state-of-the-art stellar evolution models. Next, we explore the INT Photometric H-Alpha Survey (IPHAS) and Two Micron All Sky Survey (2MASS) catalogs for possible counterparts of the eruption. Our analysis shows that the VLTP scenario outperforms all other proposed scenarios as an explanation of NSV 11749. We identify an IPHAS/2MASS source at the eruption location of NSV 11749. The derived colors suggest that the object is not enshrouded in a thick dust shell as V605 Aql and V4334 Sgr. Also, the absence of an apparent planetary nebula at the eruption location suggests differences with known VLTP objects which might be linked to the intensity of the eruption and the mass of the object. Further exploration of this source and scenario seems desirable. If NSV 11749 was a born-again star, it would be the third event of its kind to have been observed and will strongly help us to increase our understanding of the later stages of stellar evolution and violent reactive convective burning.
Aims. Motivated by the recent detection of single and binary He-core white dwarfs in metal-rich clusters, we present a full set of evolutionary calculations and colors appropriate to the study of ...these white dwarfs. The paper is also aimed at investigating whether stable hydrogen burning may constitute a major source of energy for massive He-core white dwarfs resulting from high-metallicity progenitors. Methods. White dwarf sequences are derived by considering the evolutionary history of progenitor stars with supersolar metallicities. We also incorporate a self-consistent, time-dependent treatment of gravitational settling and chemical diffusion, as well as of the residual nuclear burning. Results. We find that the influence of residual nuclear burning during the late stages of white dwarf evolution is strongly dependent on the chemical diffusion at the base of the hydrogen-rich envelope. When no diffusion is considered, residual hydrogen burning strongly influences the advanced stages of white dwarf cooling, introducing evolutionary delays of several Gyr. By contrast, when diffusion is taken into account, the role of residual nuclear burning is strongly mitigated, and the evolution is only dictated by the thermal content stored in the ions. In addition, for all of our sequences, we provide accurate color and magnitudes on the basis of new and improved non-gray model atmospheres that explicitly include Lyα quasi-molecular opacity.
Abstract
Background/Introduction
With increasing evidence of LDL-cholesterol (LDL-c) lowering and a subsequent reduction in cardiovascular events, guidelines of different parts of the world aim for ...lower LDL-c goals by risk stratification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition has been able to reduce up to 60% LDL-c levels, with further reduction in cardiovascular outcomes.
Purpose
Our aim was to evaluate the proportion of very high risk patients in a tertiary cardiology center that met LDL-c goal of less than 50mg/dL proposed by the Brazilian Society of Cardiology (BSC) guidelines. Furthermore, we assessed the number of patients that were receiving adequate statin intensity therapy and could benefit from PCSK9 inhibition by the FOURIER/ODYSSEY and by the National Institute for Health and Care Excellence (NICE) criteria.
Methods
We screened 2180 consecutive patients from March, 2018 to February, 2019 for cardiovascular risk factors, cholesterol and glycemic levels, and current medical therapy at use. Patients were stratified by level of risk, and compliance to recommended statin therapy was evaluated. We then analyzed how many of the very high risk patients, that were in use of high intensity statin therapy, met the inclusion LDL-c levels of the FOURIER/ODYSSEY trials (≥70mg/dL) and the NICE recommendations (≥140mg/dL) for the introduction of PCSK9 inhibitors.
Results
Of the 2180 patients enrolled to our study, 1225 (56.2%) patients were at very high cardiovascular risk level. Of these patients, 136 (11.1%) met LDL-c BSC guideline levels. Using the LDL-c target of 70mg/dL, an additional 320 (26.1%) patients were below target range. When analyzing statin therapy at use, 913 (74,5%) were receiving adequate statin therapy. Of the very high risk patients in adequate statin treatment, 617 (65.9%) by the FOURIER/ODYSSEY criteria and 88 (9.4%) patients by the NICE criteria would benefit from PCSK9 inhibitors.
Conclusions
With lower LDL-c goals, achievement of optimal LDL-c levels is now a challenge for current clinical practice. Even though many patients are receiving adequate guideline-based statin therapy, difficulty remains in achieving optimal treatment, especially in the higher risk stratum. These patients would benefit from PCSK9 inhibition, being the NICE criteria, a more cost-effective strategy, still applicable in a substantial portion of our patients.
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