The main obstacle that gravitational lensing has in determining accurate masses of deflectors, or in determining precise estimates for the Hubble constant, is the degeneracy of lensing observables ...with respect to the mass-sheet transformation (MST). The MST is a global modification of the mass distribution which leaves all image positions, shapes, and flux ratios invariant, but which changes the time delay. Here we show that another global transformation of lensing mass distributions exists which leaves image positions and flux ratios almost invariant, and of which the MST is a special case. As is the case for the MST, this new transformation only applies if one considers only those source components that are at the same distance from us. Whereas for axi-symmetric lenses this source position transformation exactly reproduces all strong lensing observables, it does so only approximately for more general lens situations. We provide crude estimates for the accuracy with which the transformed mass distribution can reproduce the same image positions as the original lens model, and present an illustrative example of its performance. This new invariance transformation is most likely the reason why the same strong lensing information can be accounted for with rather different mass models.
The light travel time differences in strong gravitational lensing systems allows an independent determination of the Hubble constant. This method has been successfully applied to several lens ...systems. The formally most precise measurements are, however, in tension with the recent determination of H0 from the Planck satellite for a spatially flat six-parameters ΛCDM cosmology. We reconsider the uncertainties of the method, concerning the mass profile of the lens galaxies, and show that the formal precision relies on the assumption that the mass profile is a perfect power law. Simple analytical arguments and numerical experiments reveal that mass-sheet like transformations yield significant freedom in choosing the mass profile, even when exquisite Einstein rings are observed. Furthermore, the characterization of the environment of the lens does not break that degeneracy which is not physically linked to extrinsic convergence. We present an illustrative example where the multiple imaging properties of a composite (baryons + dark matter) lens can be extremely well reproduced by a power-law model having the same velocity dispersion, but with predictions for the Hubble constant that deviate by ~20%. Hence we conclude that the impact of degeneracies between parametrized models have been underestimated in current H0 measurements from lensing, and need to be carefully reconsidered.
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or ...limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.
Persons whose identifying DNA profile (STR profile) is not yet known to the ingvestigating authorities cannot be identified by standard forensic DNA analysis (STR profiling) as it is now practiced. ...In view of the current public debate, particularly in Germany, on the legalization of so-called forensic DNA phenotyping, we present its scientific basis, societal aspects, and forensic applications and describe the analytic techniques that are now available.
This review is based on pertinent publications that were retrieved by a selective search in PubMed and in public media, and on the authors' own research.
Forensically validated DNA test systems are available for the categorization of eye, hair, and skin color and the inference of continental biogeographic ancestry. As for statistical measures of test accuracy, the AUC (area under the curve) values lie in the range 0.74-0.99 for eye color, 0.64-0.94 for hair color, and 0.72-0.99 for skin color, depending on the predictive model and color category used.The corre- sponding positive predictive values (PPV) are lower. Empirical social-scientific research on forensic DNA phenotyping has shown that preserving privacy and protecting against discrimination are major ethical and regulatory considerations.
All three methods of forensic DNA phenotyping-the predition of exter- nally visible characteristics, biogeographic ancestry, and the estimation of age from crime scene DNA-require a proper regulatory framework and should be used in conjunction with each other. Before forensic DNA phenotyping can be implemented in forensic practice, steps must be taken to minimize the risks of violation of privacy scrimination and to ensure that these methods are used transpar- ently and proportionately.
Reversible Destinytraces the history of the Sicilian mafia to its nineteenth-century roots and examines its late twentieth-century involvement in urban real estate and construction as well as drugs. ...Based on research in the regional capital of Palermo, this book suggests lessons regarding secretive organized crime: its capacity to reproduce a subculture of violence through time, its acquisition of a dense connective web of political and financial protectors during the Cold War era, and the sad reality that repressing it easily risks harming vulnerable people and communities. Charting the efforts of both the judiciary and a citizen's social movement to reverse the mafia's economic, political, and cultural power, the authors establish a framework for understanding both the difficulties and the accomplishments of Sicily's multifaceted antimafia efforts.
An important facet in caring for patients with claudication is the development of a plan for managing the technology available for superficial femoral artery (SFA) and popliteal artery interventions. ...Although this is a field in evolution, clinical experience and data are emerging that assist the clinician in making informed choices as to the best method of endovascular treatment. Algorithms for SFA and popliteal artery interventions are developing. Methods for assessing a wide range of technologies are discussed. This article reviews the evolution of technology for SFA and popliteal artery interventions, describes the recent developments in data and clinical experiences, and discusses some potential methods of device assessment and incorporation into clinical practice.
The goal of the current review is to examine the hazards and benefits of carotid interventions in women and to provide recommendations for the indications for carotid intervention in female patients. ...Stroke and cerebrovascular disease are prevalent in women. There are inherent biological and other differences in men and women, which affect the manifestations and outcome of stroke, with women experiencing worse disability and higher mortality following ischemic stroke than men. Due to the underrepresentation of female patients in most clinical trials, the ability to make firm but alternative recommendations for women specifically on the management of carotid stenosis is challenging. Although some data suggest that women might have worse periprocedural outcomes as compared to men following all carotid revascularization procedures, there is also an abundance of data to support a similar risk for carotid procedures in men and women, especially with carotid endarterectomy and transcarotid artery revascularization. Therefore, the indications for carotid revascularization are the same in women as they are in men. The choice of a carotid revascularization procedure in women is based upon the same factors as in men and requires careful evaluation of a particular patient's risk profile, anatomic criteria, plaque morphology, and medical comorbidities that might favor one technique over the other. When performing carotid revascularization procedures in women, tailored techniques and procedures to address the small diameter of the female artery are warranted.
Five years of prospective clinical trials confirm that the paclitaxel drug-coated balloon (DCB) (IN.PACT Admiral, Medtronic, Dublin, Ireland) is safe and effective to treat femoropopliteal artery ...disease. A recent meta-analysis of heterogeneous trials of paclitaxel-based balloons and stents reported that they are associated with increased mortality and that higher doses are linked to higher mortality from 2 to 5 years.
The purpose of this study was to determine if there is a correlation between paclitaxel exposure and mortality by conducting an independent patient-level meta-analysis of 1,980 patients with up to 5-year follow-up.
Data from 2 single-arm and 2 randomized independently adjudicated prospective studies of a paclitaxel DCB (n = 1,837) and uncoated percutaneous transluminal angioplasty (PTA) (n = 143) were included. Analyses of baseline, procedure, and follow-up data of individual patients were performed to explore correlations of paclitaxel dose with long-term mortality. Survival time by paclitaxel dose tercile was analyzed with adjustment of inverse probability weighting to correct baseline imbalances and study as random effect. A standard cohort was defined to compare DCB- and PTA-treated patients with similar characteristics by applying criteria from pivotal studies (n = 712 DCB, n = 143 PTA).
A survival analysis stratified nominal paclitaxel dose by low, mid, and upper terciles; mean doses were 5,019.0, 10,007.5, and 19,978.2 μg, respectively. Rates of freedom from all-cause mortality between the 3 groups through 5 years were 85.8%, 84.2%, and 88.2%, respectively (p = 0.731). There was no significant difference in all-cause mortality between DCB and PTA through 5 years comparing all patients (unadjusted p = 0.092) or patients with similar characteristics (adjusted p = 0.188).
This independent patient-level meta-analysis demonstrates that this paclitaxel DCB is safe. Within DCB patients, there was no correlation between level of paclitaxel exposure and mortality. (Randomized Trial of IN.PACT Admiral® Drug Coated Balloon vs Standard PTA for the Treatment of SFA and Proximal Popliteal Arterial Disease INPACT SFA I, NCT01175850; IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery SFA and Proximal Popliteal Artery PPA INPACT SFA II, NCT01566461; MDT-2113 Drug-Eluting Balloon vs. Standard PTA for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery and/or Proximal Popliteal Artery MDT-2113 SFA, NCT01947478; The IN.PACT SFA Clinical Study for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery and/or Proximal Popliteal Artery Using the IN.PACT Admiral™ Drug-Eluting Balloon in a Chinese Patient Population, NCT02118532; and IN.PACT Global Clinical Study, NCT01609296).
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