Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization.

Background: Ratings by an expert panel of the appropriateness of treatments may offer better guidance for clinical practice than the variable decisions of individual clinicians, yet there have been no prospective studies of clinical outcomes. We compared the clinical outcomes of patients treated medically after angiography with those of patients who underwent revascularization, within groups defined by ratings of the degree of appropriateness of revascularization in varying clinical circumstances.Methods: This was a prospective study of consecutive patients undergoing coronary angiography at three London hospitals. Before patients were recruited, a nine-member expert panel rated the appropriateness of percutaneous transluminal coronary angioplasty (PTCA) and coronary-artery bypass grafting (CABG) on a nine-point scale (with 1 denoting highly inappropriate and 9 denoting highly appropriate) for specific clinical indications. These ratings were then applied to a population of patients with coronary artery disease. However, the patients were treated without regard to the ratings. A total of 2552 patients were followed for a median of 30 months after angiography.Results: Of 908 patients with indications for which PTCA was rated appropriate (score, 7 to 9), 34 percent were treated medically; these patients were more likely to have angina at follow-up than those who underwent PTCA (odds ratio, 1.97; 95 percent confidence interval, 1.29 to 3.00). Of 1353 patients with indications for which CABG was considered appropriate, 26 percent were treated medically; they were more likely than those who underwent CABG to die or have a nonfatal myocardial infarction - the composite primary outcome (hazard ratio, 4.08; 95 percent confidence interval, 2.82 to 5.93) - and to have angina (odds ratio, 3.03; 95 percent confidence interval, 2.08 to 4.42). Furthermore, there was a graded relation between rating and outcome over the entire scale of appropriateness (P for linear trend = 0.002).Conclusions: On the basis of the ratings of the expert panel, we identified substantial underuse of coronary revascularization among patients who were considered appropriate candidates for these procedures. Underuse was associated with adverse clinical outcomes. (N Engl J Med 2001;344:645-54.) Copyright (C) 2001 Massachusetts Medical Society

Negative discriminant states in N=4 supersymmetric string theories

Single centered BPS black hole solutions exist only when the charge carried by the black hole has positive discriminant. On the other hand the exact dyon spectrum in heterotic string theory compactified on T^6 is known to contain states with negative discriminant. We show that all of these negative discriminant states can be accounted for as two centered black holes. Thus after the contribution to the index from the two centered black holes is subtracted from the total microscopic index, the index for states with negative discriminant vanishes even for finite values of charges, in agreement with the results from the black hole side. Bound state metamorphosis -- which requires us to identify certain apparently different two centered configurations according to a specific set of rules -- plays a crucial role in this analysis. We also generalize these results to a class of CHL string theories.Comment: LaTeX file, 32 pages; v2: reference added; v3: added new section 3.

Perturbative tests of non-perturbative counting

We observe that a class of quarter-BPS dyons in N=4 theories with charge vector (Q, P) and with nontrivial values of the arithmetic duality invariant I := gcd (Q wedge P) are nonperturbative in one frame but perturbative in another frame. This observation suggests a test of the recently computed nonperturbative partition functions for dyons with nontrivial values of the arithmetic invariant. For all values of I, we show that the nonperturbative counting yields vanishing indexed degeneracy for this class of states everywhere in the moduli space in precise agreement with the perturbative result.Comment: 10 pages, 0 figure

Complex magnetism of lanthanide intermetallics unravelled

We explain a profound complexity of magnetic interactions of some technologically relevant gadolinium intermetallics using an ab-initio electronic structure theory which includes disordered local moments and strong $f$-electron correlations. The theory correctly finds GdZn and GdCd to be simple ferromagnets and predicts a remarkably large increase of Curie temperature with pressure of +1.5 K kbar$^{-1}$ for GdCd confirmed by our experimental measurements of +1.6 K kbar$^{-1}$. Moreover we find the origin of a ferromagnetic-antiferromagnetic competition in GdMg manifested by non-collinear, canted magnetic order at low temperatures. Replacing 35\% of the Mg atoms with Zn removes this transition in excellent agreement with longstanding experimental data.Comment: 11 pages, 4 figure

Intestinal colonization due to Escherichia coli ST131: Risk factors and prevalence

Background Escherichia coli sequence type 131 (ST131) is a successful clonal group that has dramatically spread during the last decades and is considered an important driver for the rapid increase of quinolone resistance in E. coli. Methods Risk factors for rectal colonization by ST131 Escherichia coli (irrespective of ESBL production) were investigated in 64 household members (18 were colonized) and 54 hospital contacts (HC; 10 colonized) of 34 and 30 index patients with community and nosocomial infection due to these organisms, respectively, using multilevel analysis with a p limit of < 0.1. Result Colonization among household members was associated with the use of proton-pump inhibitors (PPI) by the household member (OR = 3.08; 95% CI: 0.88–10.8) and higher age of index patients (OR = 1.05; 95% CI; 1.01–1.10), and among HC, with being bed-ridden (OR = 21.1; 95% CI: 3.61–160.0) and having a urinary catheter (OR = 8.4; 95% CI: 0.87–76.9). Conclusion Use of PPI and variables associated with higher need of person-to-person contact are associated with increased risk of rectal colonization by ST131. These results should be considered for infection control purposes.Plan Nacional de I + D + i 2013-2016Ministerio de Economía y Competitividad (España)European Development Regional Fund REIPI RD12/0015/0010 REIPI RD16/0016/0001Instituto de Salud Carlos III 070190 AC16/000076-MODERN AC16/AC16/00072-ST131TSJunta de Andalucía CTS5259 CTS21

Local cosmic string in generalised scalar tensor theory

A recent investigation shows that a local gauge string with a phenomenological energy momentum tensor, as prescribed by Vilenkin, is inconsistent in Brans-Dicke theory. In this work it has been shown that such a string is consistent in a more general scalar tensor theory where $\omega$ is function of the scalar field.A set of solutions of full nonlinear Einstein's equations for interior region of such a string are presented.Comment: 7 pages, latex format, minor changes according to referee's suggestions, revised version submitted in Phys.Rev.

Logarithmic Corrections to Extremal Black Hole Entropy from Quantum Entropy Function

We evaluate the one loop determinant of matter multiplet fields of N=4 supergravity in the near horizon geometry of quarter BPS black holes, and use it to calculate logarithmic corrections to the entropy of these black holes using the quantum entropy function formalism. We show that even though individual fields give non-vanishing logarithmic contribution to the entropy, the net contribution from all the fields in the matter multiplet vanishes. Thus logarithmic corrections to the entropy of quarter BPS black holes, if present, must be independent of the number of matter multiplet fields in the theory. This is consistent with the microscopic results. During our analysis we also determine the complete spectrum of small fluctuations of matter multiplet fields in the near horizon geometry.Comment: LaTeX file, 52 pages; v2: minor corrections, references adde

Evaluation of Phage Display Discovered Peptides as Ligands for Prostate-Specific Membrane Antigen (PSMA)

The aim of this study was to identify potential ligands of PSMA suitable for further development as novel PSMA-targeted peptides using phage display technology. The human PSMA protein was immobilized as a target followed by incubation with a 15-mer phage display random peptide library. After one round of prescreening and two rounds of screening, high-stringency screening at the third round of panning was performed to identify the highest affinity binders. Phages which had a specific binding activity to PSMA in human prostate cancer cells were isolated and the DNA corresponding to the 15-mers were sequenced to provide three consensus sequences: GDHSPFT, SHFSVGS and EVPRLSLLAVFL as well as other sequences that did not display consensus. Two of the peptide sequences deduced from DNA sequencing of binding phages, SHSFSVGSGDHSPFT and GRFLTGGTGRLLRIS were labeled with 5-carboxyfluorescein and shown to bind and co-internalize with PSMA on human prostate cancer cells by fluorescence microscopy. The high stringency requirements yielded peptides with affinities KD∼1 μM or greater which are suitable starting points for affinity maturation. While these values were less than anticipated, the high stringency did yield peptide sequences that apparently bound to different surfaces on PSMA. These peptide sequences could be the basis for further development of peptides for prostate cancer tumor imaging and therapy. © 2013 Shen et al

Discrete Information from CHL Black Holes

AdS_2/CFT_1 correspondence predicts that the logarithm of a Z_N twisted index over states carrying a fixed set of charges grows as 1/N times the entropy of the black hole carrying the same set of charges. In this paper we verify this explicitly by calculating the microscopic Z_N twisted index for a class of states in the CHL models. This demonstrates that black holes carry more information about the microstates than just the total degeneracy.Comment: LaTeX file, 24 pages; v2: references adde