Parkinson's disease (PD) is a progressive neurological disorder characterized by a large number of motor and non‐motor features. Fatigue is one of the most common and most disabling symptoms among ...patients with PD, and it has a significant impact on their quality of life. Although fatigue has been recognized for a long time, its pathophysiology remains poorly understood, and there is no evidence to support any therapeutic approach in PD patients. Expert consensus on case definition and diagnostic criteria for PD‐related fatigue have been recently published, and although they still need to be adequately validated, they provide a great step forward in the study of fatigue. The goal of this article is to provide relevant information for the identification and management of patients with fatigue.
Although studies consistently show that beta-blockers reduce morbidity and mortality in patients with reduced ejection fraction (EF), data are inconsistent in patients with heart failure with mildly ...reduced ejection fraction (HFmrEF) and suggest potential negative effects in heart failure with preserved ejection fraction (HFpEF).
The purpose of this study was to examine the association of beta-blockers with heart failure (HF) hospitalization and death in patients with HF and EF ≥40%
Beta-blocker use was assessed at first encounter in outpatients ≥65 years of age with HFmrEF and HFpEF in the U.S. PINNACLE Registry (2013-2017). The associations of beta-blockers with HF hospitalization, death, and the composite of HF hospitalization/death were assessed using propensity-score adjusted multivariable Cox regression models, including interactions of EF × beta-blocker use.
Among 435,897 patients with HF and EF ≥40% (HFmrEF, n = 75,674; HFpEF = 360,223), 289,377 (66.4%) were using a beta-blocker at first encounter; more commonly in patients with HFmrEF vs HFpEF (77.7% vs 64.0%; P < 0.001). There were significant interactions between EF × beta-blocker use for HF hospitalization, death, and composite of HF hospitalization/death (P < 0.001 for all), with higher risk with beta-blocker use as EF increased. Beta-blockers were associated with decreased risk of HF hospitalization and death in patients with HFmrEF but a lack of survival benefit and a higher risk of HF hospitalization in patients with HFpEF, particularly when EF was >60%.
In a large, real-world, propensity score-adjusted cohort of older outpatients with HF and EF ≥40%, beta-blocker use was associated with a higher risk of HF hospitalization as EF increased, with potential benefit in patients with HFmrEF and potential risk in patients with higher EF (particularly >60%). Further studies are needed to understand the appropriateness of beta-blocker use in patients with HFpEF in the absence of compelling indications.
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Residual straw affects the physical, chemical, and biological attributes of soil and can influence plant transpiration and the evaporation of water from the soil. Therefore, in this study, we ...evaluated the effect of straw on evaporation and transpiration of sugarcane. The experiment was conducted in a 2.5 ha area irrigated via a central pivot. The experiment consisted of two treatments, namely, with and without straw removal of soil. Evaporation was determined by means of equations and transpiration with sap flow sensors using the heat balance method. Evapotranspiration of the crop was measured using the Bowen ratio method and compared with the sum of the collected soil evaporation and transpiration data. On the basis of relationship analysis between the evapotranspiration of the crop measured using the Bowen ratio method and the sum of the sap flow combined with estimates of the evaporation of soil water, we obtained coefficient of determination values of 0.65 and 0.69, and angular coefficients of 1.01 and 0.96 for treatments with and without straw, respectively. We accordingly found that the use of straw on the soil reduces the evaporation of soil water and increases the transpiration and evapotranspiration of the crop.
Highly scaled technologies at and beyond the 22-nm node exhibit increased sensitivity to various scaling-related problems that conspire to reduce the overall reliability of integrated circuits and ...systems. In prior technology nodes, the assumption was that manufacturing technology was responsible for ensuring device reliability. This basic assumption is no longer tenable. Trying to contain reliability problems purely at the technology level would cause prohibitive increases in power consumption. Thus, a cross-layer approach is required, which spreads the burden of ensuring resilience across multiple levels of the design hierarchy. This article illustrates a methodology for dealing with scaling-related problems via two case studies that link models of low-level technology-related problems to system behavior.
Residual straw affects the physical, chemical, and biological attributes of soil and can influence plant transpiration and the evaporation of water from the soil. Therefore, in this study, we ...evaluated the effect of straw on evaporation and transpiration of sugarcane. The experiment was conducted in a 2.5 ha area irrigated via a central pivot. The experiment consisted of two treatments, namely, with and without straw removal of soil. Evaporation was determined by means of equations and transpiration with sap flow sensors using the heat balance method. Evapotranspiration of the crop was measured using the Bowen ratio method and compared with the sum of the collected soil evaporation and transpiration data. On the basis of relationship analysis between the evapotranspiration of the crop measured using the Bowen ratio method and the sum of the sap flow combined with estimates of the evaporation of soil water, we obtained coefficient of determination values of 0.65 and 0.69, and angular coefficients of 1.01 and 0.96 for treatments with and without straw, respectively. We accordingly found that the use of straw on the soil reduces the evaporation of soil water and increases the transpiration and evapotranspiration of the crop.
This article addresses the role of programmed cell death (apoptosis) during embryonic head development of Drosophila. Previous studies showed that reaper (rpr) is expressed in and required by cells ...undergoing apoptosis. We have analyzed the correlation between the pattern of expression of rpr and morphogenetic movements affecting head development. Furthermore, we have investigated the defects in head development resulting from the absence of apoptosis in embryos deficient for rpr. Our results show that, in the head, domains of high incidence of cell death as marked by expression of rpr correlate with regions where most morphogenetic movements occur; these regions are involved in formation of mouth structures, the internalization of neural progenitors, and head involution. Cellular events driving these movements are delamination, invagination, and intercalation as well as disruption and reformation of contacts among epithelial cells. The analysis of rpr-deficient embryos demonstrates that, despite of the widespread occurrence of apoptosis during normal head morphogenesis, many aspects of this process proceed in an apparently unperturbed manner even when cell death is blocked. In particular, movements that happen early during embryonic development and that are evolutionarily more ancient (e.g., formation of the dorsal ridge and the pharynx) take place almost normally in rpr-deficient embryos. Later events which are mostly associated with head involution (e.g., retraction of the clypeolabrum, formation of the dorsal pouch, fusion of lateral gnathal lobes) are evolutionarily more recent and fail to occur normally in rpr-deficient embryos.
Optimization is commonly employed to determine the content of web pages, such as to maximize conversions on landing pages or click-through rates on search engine result pages. Often the layout of ...these pages can be decoupled into several separate decisions. For example, the composition of a landing page may involve deciding which image to show, which wording to use, what color background to display, etc. Such optimization is a combinatorial problem over an exponentially large decision space. Randomized experiments do not scale well to this setting, and therefore, in practice, one is typically limited to optimizing a single aspect of a web page at a time. This represents a missed opportunity in both the speed of experimentation and the exploitation of possible interactions between layout decisions. Here we focus on multivariate optimization of interactive web pages. We formulate an approach where the possible interactions between different components of the page are modeled explicitly. We apply bandit methodology to explore the layout space efficiently and use hill-climbing to select optimal content in realtime. Our algorithm also extends to contextualization and personalization of layout selection. Simulation results show the suitability of our approach to large decision spaces with strong interactions between content. We further apply our algorithm to optimize a message that promotes adoption of an Amazon service. After only a single week of online optimization, we saw a 21% conversion increase compared to the median layout. Our technique is currently being deployed to optimize content across several locations at Amazon.com.
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