Equivalent Cutoff Research Articles

Alcohol Withdrawal Severity Measures for Identifying Patients Requiring High-Intensity Care.

Alcohol withdrawal syndrome (AWS) may progress to require high-intensity care. Approaches to identify hospitalized patients with AWS who received higher level of care have not been previously examined. This study aimed to examine the utility of Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) for alcohol scale scores and medication doses for alcohol withdrawal management in identifying patients who received high-intensity care. A multicenter observational cohort study of hospitalized adults with alcohol withdrawal. University of Chicago Medical Center and University of Wisconsin Hospital. Inpatient encounters between November 2008 and February 2022 with a CIWA-Ar score greater than 0 and benzodiazepine or barbiturate administered within the first 24 hours. The primary composite outcome was patients who progressed to high-intensity care (intermediate care or ICU). None. Among the 8742 patients included in the study, 37.5% (n = 3280) progressed to high-intensity care. The odds ratio for the composite outcome increased above 1.0 when the CIWA-Ar score was 24. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at this threshold were 0.12 (95% CI, 0.11-0.13), 0.95 (95% CI, 0.94-0.95), 0.58 (95% CI, 0.54-0.61), and 0.64 (95% CI, 0.63-0.65), respectively. The OR increased above 1.0 at a 24-hour lorazepam milligram equivalent dose cutoff of 15 mg. The sensitivity, specificity, PPV, and NPV at this threshold were 0.16 (95% CI, 0.14-0.17), 0.96 (95% CI, 0.95-0.96), 0.68 (95% CI, 0.65-0.72), and 0.65 (95% CI, 0.64-0.66), respectively. Neither CIWA-Ar scores nor medication dose cutoff points were effective measures for identifying patients with alcohol withdrawal who received high-intensity care. Research studies for examining outcomes in patients who deteriorate with AWS will require better methods for cohort identification.

Validation and usability of modified palmoplantar psoriasis area and severity index in patients with palmoplantar psoriasis: A prospective longitudinal cohort study.

Background Palmoplantar psoriasis (PPP), a troublesome variant, does not have any validated scoring system to assess disease severity. Objective To validate modified Palmoplantar Psoriasis Area and Severity Index (m-PPPASI) in patients affected with PPP and to categorise it based on Dermatology Life Quality Index (DLQI). Methods In this prospective study, patients with PPP aged > 18 years visiting the psoriasis clinic at a tertiary care centre were included and requested to complete DLQI during each visit at baseline, 2nd week, 6th and 12th week. m-PPPASI was used by the raters to determine the disease severity. Results Overall, 73 patients were included. m-PPPASI demonstrated high internal consistency (α = 0.99), test-retest reliability of all three raters, that is, Adithya Nagendran (AN) (r = 0.99, p < 0.0001), Tarun Narang (TN) (r = 1.0, p < 0.0001) and Sunil Dogra (SD) (r = 1.0, p < 0.0001) and inter-rater agreement (intra-class correlation coefficient = 0.83). Face and content validity index for items I-CVI = 0.845 were robust, and the instrument was uniformly rated as easy to use (Likert scale 2) by all three raters. It was found to be responsive to change (r = 0.92, p < 0.0001). Minimal clinically important differences (MCID)-1 and MCID-2 calculated by receiver operating characteristic curve using DLQI as anchor were 2 and 35%, respectively. DLQI equivalent cutoff points for m-PPPASI were 0-5 for mild, 6-9 for moderate, 10-19 for severe, and 20-72 for very severe disease. Limitation Small sample size and single-center validation were the major limitations. m-PPPASI doesn't objectively measure all characteristics of PPP such as "fissuring" and "scaling" which could also be taken into consideration. Conclusion m-PPPASI is validated in PPP and can be readily utilized by physicians. However, further large-scale studies are needed.

Atrial substrate characterization based on bipolar voltage electrograms acquired with multipolar, focal and mini-electrode catheters.

Bipolar voltage (BV) electrograms for left atrial (LA) substrate characterization depend on catheter design and electrode configuration. The aim of the study was to investigate the relationship between the BV amplitude (BVA) using four catheters with different electrode design and to identify their specific LA cutoffs for scar and healthy tissue. Consecutive high-resolution electroanatomic mapping was performed using a multipolar-minielectrode Orion catheter (Orion-map), a duo-decapolar circular mapping catheter (Lasso-map), and an irrigated focal ablation catheter with minielectrodes (Mifi-map). Virtual remapping using the Mifi-map was performed with a 4.5 mm tip-size electrode configuration (Nav-map). BVAs were compared in voxels of 3 × 3 × 3 mm3. The equivalent BVA cutoff for every catheter was calculated for established reference cutoff values of 0.1, 0.2, 0.5, 1.0, and 1.5 mV. We analyzed 25 patients (72% men, age 68 ± 15 years). For scar tissue, a 0.5 mV cutoff using the Nav corresponds to a lower cutoff of 0.35 mV for the Orion and of 0.48 mV for the Lasso. Accordingly, a 0.2 mV cutoff corresponds to a cutoff of 0.09 mV for the Orion and of 0.14 mV for the Lasso. For healthy tissue cutoff at 1.5 mV, a larger BVA cutoff for the small electrodes of the Orion and the Lasso was determined of 1.68 and 2.21 mV, respectively. When measuring LA BVA, significant differences were seen between focal, multielectrode, and minielectrode catheters. Adapted cutoffs for scar and healthy tissue are required for different catheters.

Seismometer Orientation Correction via Teleseismic Receiver Function Measurements in West Africa and Adjacent Islands

AbstractTo establish a robust method of determining and correcting the misorientation of seismometers with radial and tangential components of the teleseismic receiver function (RF), we assess the measurement of the amplitude of P-wave phase arrivals at zero seconds (PRFamp method) and the energy of the width of the time window around the P-wave phase arrival (PRFenergy method) using varying Gaussian factors, ranging from 0.5 to 5.0 with equivalent cutoff frequencies. To understand the efficacy and discrepancies in these methods, and their results across different geological terrains, we conduct an assessment of their performance on 26 permanent seismic stations located in West Africa and adjacent islands. We conduct several tests to examine the effect of varying Gaussian factors on the estimates of misorientation. These effects are more noticeable in results from stations for which RFs are indicative of 3D or complex structures and islandic stations. Statistical analyses reveal good correlation between the results obtained from both the methods, although results from PRFamp method proves to be more stable due to their proximity to the statistical mean and standard deviation results. In comparison with the PRFenergy results, there is a smaller error difference and uncertainty, a higher correlation coefficient, a relatively lower standard deviation, and better convergence around the mean misorientation obtained using PRFamp. From both the methods, estimates from continental stations reveal similar trends, results from coastal stations tend to be consistent, whereas some island stations show a reverse trend in sensor misorientation classification. We propose that the PRFamp yields more consistent results and is less sensitive to subsurface heterogeneities. Gaussian filtering with an alpha value (α) of 1.5 is recommended as a trade-off between oversimplification and complications due to subsurface structures. However, we suggest that multiple approaches be adopted to provide robust bases for the estimation and comparison of sensor orientation correction calculations.

Properties of Harmonic and Composite Half-Waves, Determination of the Uniform Time Sampling Interval of Digital Signal Processors

When building autonomous real-time systems (RTS), it is necessary to solve the problem of optimal multitasking loading of a number of parallel functioning digital signal processors. One of the reserves for achieving the desired result is the implementation of samples from the sensor signals of information about the magnitude of the signal most rarely in time. In this case, it is necessary to provide a linear or stepwise approximation of the signal by samples with an acceptable reconstruction error. One of the system tasks of these processors is filtering signals or limiting the spectrum to the cutoff frequency. A distinctive feature of the approach proposed in the article is the fulfillment of the condition: if the measurement of this frequency is difficult (for example, in the electromechanical means of the RTS), then for such signals it is proposed to match the maximum values of the harmonic half-wave parameters: approximation error, speed and acceleration. The study opens up the prospect of applying new approaches to sampling the time of signals in the amplitude-time domain and determining the equivalent cutoff frequency of the signal spectrum for such signals. In this article, the dependences of the value of the unit of system time for input-output of data on the degree of agreement between the maximum values of the signal parameters are obtained. A mathematical model of the extreme behavior of a signal between two adjacent samples is given in the form of a harmonic half-wave. The study is also extended to convex composite harmonic functions, according to which the signal can deviate from the results of a linear or stepwise approximation of the signal for these samples. The comparison of the models by the value of the relative time sampling intervals, depending on the degree of matching of the maximum parameters of the harmonic half-wave, is carried out. When comparing, in addition to these maximum parameters, the relationship of the maximum signal speed with the error of approximating the samples by steps and the relationship of the maximum acceleration of the signal with the maximum error of the linear approximation was taken into account. The results make it possible to determine the duration of the intervals of uniform sampling of the signal time based on the results of the inspection of the control object, substantiate a significant increase in the sampling interval of time or a similar increase in the number of tasks to be solved per unit of system time.

Energy Partitioning Control in the PITM Hybrid RANS/LES Method for the Simulation of Turbulent Flows

The partially integrated transport modeling (PITM) method first introduced in Refs. Schiestel and Dejoan (Theor Comput Fluid Dyn 18:443, 2005) and in Chaouat and Schiestel (Phys Fluids 17:065106, 2005) provides a continuous approach for hybrid RANS-LES simulations. Inspired from the multiple scale approach, the basis of the development of the method is the spectral space in quasi-homogeneous turbulence. The PITM method embodies a partitioning control function that monitors the ratio of subfilter energy to total turbulent energy by reference to the cutoff wavenumber location. How this procedure behaves in inhomogeneous flows is an important question. The present paper demonstrates that the same control function can be used both in homogeneous and in non-homogeneous flows as well. Further on, an analysis of the effect of anisotropic filters generally used for wall flows is conducted for computing the equivalent cutoff wavenumber suitable for determining the subfilter energy of the spectrum and see how it interferes with control function. Illustrations in the turbulent plane channel flow are given that confirm the efficiency of the procedure and DNS data have been used to support and supplement the discussion.

External validation and comparison of the Brock model and Lung-RADS for the baseline lung cancer CT screening using data from the Korean Lung Cancer Screening Project.

To validate and compare the performance of the Brock model and Lung CT Screening Reporting and Data System (Lung-RADS) on nodules detected by baseline CT screening. We performed a secondary analysis of the Korean Lung Cancer Screening Project (K-LUCAS; ClinicalTrials.gov , NCT03394703), a nationwide, multicenter, prospective cohort study. From April 2017 to December 2018, low-dose CT screening was performed on high-risk subjects. Discrimination and calibration of Brock models 2a and 2b (i.e., full model without and with spiculation, respectively) were assessed, and discrimination was compared with that of Lung-RADS, which utilized subjective assessment categories 2b (b stands for benign) and 4X. Of the 13,150 subjects, 4578 were eligible (median age 62 years; 4458 men; 9929 nodules including 40 lung cancers). Areas under the receiver operating characteristic curve were 0.96 (IQR 0.92-0.99) for Brock model 2a, 0.96 (IQR 0.92-0.99) for Brock model 2b, and 0.95 (IQR 0.91-0.99) for Lung-RADS (p = 0.32 and p = 0.34, respectively). At an equivalent cutoff of 5%, Brock model 2b (sensitivity 87.5% [35/40]; specificity 93.6% [9259/9889]; positive predictive value [PPV] 5.3% [35/665]; negative predictive value [NPV] 99.9% [9259/9264]) and Lung-RADS (sensitivity 87.5% [35/40]; specificity 93.3% [9222/9889]; PPV 5.0% [35/702]; NPV 99.9% [9222/9227]) performed similarly well (all p > 0.05). The calibration performance of both Brock models 2a and 2b was poor (both p < 0.001). Lung-RADS, when reinforced with visual assessment-based categories, has a similar diagnostic performance to the Brock model for baseline CT scans. • Brock model 2b and Lung CT Screening Reporting and Data System (Lung-RADS) demonstrated a similar discrimination performance for lung cancer in the baseline CT screening (areas under the receiver operating characteristic curve 0.96 vs. 0.95; p = 0.34). • When visual assessment-based categories were removed from Lung-RADS, specificity and positive predictive value were lower than those of Brock model 2b (p = 0.001 and p = 0.02, respectively). • The Brock model showed poor calibration (p < 0.001).

Agronomic traits of einkorn and emmer under different seeding rates and topdressing with organic fertilizers

The goal of this research carried out at the experimental facility of the Faculty of Agriculture of the University of Zagreb in 2015/2016, 2016/2017 and 2017/2018 was to determine the influence of seeding rate and topdressing with organic fertilizers on yield and yield components in einkorn (Triticum monococcum subsp. monococcum) and emmer (Triticum dicoccon) populations collected in the Croatian region of Slavonia. The research comprised four seeding rates: 100, 150, 200, and 250 grains per m2; topdressing with organic fertilizers (Fertil Supernova 12.5 N and Ilsamin N90); and a control (no topdressing). Einkorn populations achieved a higher yield of hulled grain relative to the emmer population as a result of their higher coefficient of productive tillering. Conversely, the emmer population showed superiority in a greater number of yield components. On average, for both cereals, yield increased with increasing seeding rates; however, increased yields for seeding rates above 150 grains per m2 were not statistically significant. Einkorn populations showed a yield increase up to the seeding rate of 200 grains per m2, while in emmer the equivalent cutoff value amounted to 250 grains per m2. Topdressing with organic fertilizers positively influenced yield and yield components in both einkorn and emmer populations, except for the year marked by inclement weather conditions in June. Topdressing with organic fertilizers increased the number of spikelets and grains per ear, as well as the grain weight per ear, except in the year with lower precipitation.

Prevalence and risk factors for nonalcoholic fatty liver disease in obese children in rural Punjab, India.

BACKGROUND:Pediatric nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, hypertension, metabolic syndrome, cardiovascular problems, and increased risk of chronic liver disease and Type II diabetes mellitus. The aim of the study was to assess the metabolic profiles and associated risk factors of NAFLD in obese children.MATERIALS AND METHODS:Children with a body mass index (BMI) of >27 kg/m2 an adult equivalent cutoff (Indian Academy of Paediatrics, 2015 guidelines) aged 5–18 years presenting to the pediatric outpatient unit of PGIMER Satellite Centre, Sangrur, India, were retrospectively recruited over a 1-year period. Anthropometry, lipid profile, thyroid levels, liver function test, fasting blood sugar, and blood pressure were measured. Ultrasonography was used to diagnose NAFLD. Logistic regression was used to assess the risk factors.RESULTS:A total of 100 children participated in the study. The mean age was 10.6 ± 2.6 years and the mean BMI-Z score was 2.6 ± 0.5. The prevalence of NAFLD was 62%. Alanine transaminase (ALT) was significantly elevated in all the children with NAFLD. Lipid levels and BMI Z-score were similar in both groups. Unadjusted odds ratio shows statistically significant association of ALT (2.058 [1.11–1.01]) and waist circumference (1.089 [1.19–0.99]) with NAFLD. With adjusted odds ratio only, ALT (1.12 [1.24–1.01]) was found to be significantly associated with NAFLD.CONCLUSION:There is quite a high prevalence of nonalcoholic fatty liver in obese Indian children. All children with raised liver enzymes should undergo sonography to rule out NAFLD.

A Compact Wideband SIW Bandpass Filter with Wide Stopband and High Selectivity

A novel method to design a wideband substrate integrated waveguide (SIW) bandpass filter (BPF) with compact size, wide stopband and high selectivity is presented. In this method some unique electromagnetic band-gap (EBG) cells are periodically etched on the top layer of SIW to realize a wide passband propagating below the equivalent waveguide cutoff frequency. By changing the configuration of EBG cells, undesired harmonics in upper stopband can be suppressed and a wideband BPF with wide stopband can be obtained. By symmetrically loading two complementary split ring resonators (CSRRs) on the tapered gradient lines of the input/output ports, a transmission zero near the passband can be introduced, and it makes the frequency selectivity of upper sideband improve significantly. As a verification, a wideband SIW BPF with a 3.02 GHz absolute bandwidth (ABW) and a 64.7% fractional bandwidth (FBW) centered at 4.67 GHz is designed, simulated, manufactured, and measured. The results of the experiment and simulation are in good agreement.

Application of the Korean version of the Modified Barthel Index: Development of a keyform for use in clinical practice

ObjectiveTo demonstrate the clinical application of the Korean version of the Modified Barthel Index (K-MBI) using Rasch analysis.MethodsA total of 276 patients with neurological disorders were assessed with the K-MBI in outpatient clinics. The Rasch partial-credit model was used to generate a keyform based on investigating the psychometric properties of the K-MBI, including dimensionality, precision (person strata and reliability), and hierarchical item difficulty. The Minimal Detectable Change (MDC) in item difficulty was used to establish right-challenging treatment goals and long-term treatment plans.ResultsThe findings demonstrated that the Korean version of the MBI satisfied the assumption of unidimensionality. It also showed a hierarchical structure in terms of item difficulty, good reliability (Cronbach alpha, 0.92), and approximately five distinct person strata (4.6). The MDC (raw score, 20.1) of the item difficulty of the test items demonstrated equivalent cutoff scores for targeted short-term treatment goals on the keyform, a Rasch-derived display of patient responses. Long-term treatment goals were identified based on the test items of the keyform.ConclusionsThe findings suggest that a Rasch keyform can be applied to clinical practice in Korean settings by identifying clinically and statistically meaningful test items and their step thresholds as short- and long-term goals.

Low-pass plasmonic filter and its miniaturization based on spoof surface plasmon polaritons

In this work, a low-pass plasmonic filter based on spoof surface plasmon polaritons (SSPPs) is reported by etching the two grounds of coplanar waveguide with periodic grooves. The cutoff frequency of the filter coincides with the asymptotic frequency of the SSPPs that are supported by the periodic grooves, which can be tuned by the depth of the grooves at will. In addition, a T-shaped groove is designed to increase the equivalent depth of the groove so as to realize the miniaturization of the proposed filter by decreasing the equivalent cutoff frequency of the SSPPs. Measured S-parameters of the two proposed low-pass plasmonic filters agree well with the simulated ones, which validates our ideas and designs. This simple low-pass plasmonic filter can find potential applications in plasmonic circuits and systems.

The impact of high-sensitivity troponin implementation on hospital operations and patient outcomes in 3 tertiary care centers

ObjectiveHigh-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI. MethodsThis control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days. ResultsData were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score. ConclusionsThis hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.

Estimation of Equivalent Cutoff Thresholds in Blood and Oral Fluid for Drug Prevalence Studies

Oral fluid is an easily available specimen for studying drug use in a cohort or population. The prevalence of drugs in samples of oral fluid is the same as the prevalence in blood if using equivalent cutoff concentrations. The cutoffs in oral fluid may be higher or lower than that in blood in accordance with the median oral fluid-to-blood (OF/B) concentration ratio, but it is also influenced by the skewness of the distribution of OF/B ratios. The aim of this study was to determine formulae for the estimation of equivalent cutoff concentrations in oral fluid and blood for 12 commonly used illegal and medicinal psychoactive drugs when oral fluid was collected with Statsure Saliva·Sampler™. Paired samples from 4,080 persons were collected and analyzed with chromatographic methods and mass spectroscopic detection. Regression formulae for the concentrations corresponding to selected percentiles in oral fluid versus the same concentration percentiles in blood were determined. The accuracy when multiplying the cutoff thresholds in blood with the average and median OF/B ratios to estimate equivalent cutoffs in oral fluid was also investigated. Prevalence regression gave the most accurate results. The regression formulae can be used to estimate equivalent cutoff concentrations in oral fluid and blood.

Assessment of apoB dyslipoproteinemia in Korean population

ObjectivesThere is sparse data on apoB dyslipoproteinemia in Asian population. The purpose of this study was to assess apoB dyslipoproteinemia and to compare the LDL-C, non-HDL and apoB for risk assessment with percentile equivalent cut off in Korean population. MethodsWith 1193 Korean adult subjects, the prevalence and characteristics of different types of dyslipoproteinemias were analyzed in each age and gender group. The percentile values of direct LDL-C, calculated LDL-C, non HDL-C, HDL-C, apoAI, apoB and apoB/apoAI ratio were estimated. ResultsThe prevalences of normoapoB–hyperTG, hyperapoB–normoTG and hyperapoB–hyperTG dyslipoproteinemia were 6.9, 8.9 and 10.9% in men and 3.7, 6.4 and 2.8% in women. The 40th percentile of direct LDL-C, calculated LDL-C, non-HDL-C and apo B were 108, 104.2, 126 and 85mg/dl, respectively. The individual above optimal cut off was significantly underestimated with LDL-C than with non-HDL and apoB, in groups with adverse risk factors. ConclusionsThis study firstly shows the prevalence of various types of dyslipoproteinemias in Asian population. The percentile values of Korean population were similar to those of NHANES. Integration of lipid markers is needed for making clinical decisions and further research involving various populations and methodologies should be performed.

Lessons From the Mixed-Meal Tolerance Test

OBJECTIVEMixed-meal tolerance test (MMTT) area under the curve C-peptide (AUC CP) is the gold-standard measure of endogenous insulin secretion in type 1 diabetes but is intensive and invasive to perform. The 90-min MMTT-stimulated CP ≥0.2 nmol/L (90CP) is related to improved clinical outcomes, and CP ≥0.1 nmol/L is the equivalent fasting measure (FCP). We assessed whether 90CP or FCP are alternatives to a full MMTT.RESEARCH DESIGN AND METHODSCP was measured during 1,334 MMTTs in 421 type 1 diabetes patients aged <18 years at 3, 9, 18, 48, and 72 months duration. We assessed: 1) correlation between mean AUC CP and 90CP or FCP; 2) sensitivity and specificity of 90CP ≥0.2 nmol/L and FCP ≥ 0.1 nmol/L to detect peak CP ≥0.2 nmol/L and the equivalent AUC CP; and 3) how the time taken to reach the CP peak varied with age of diagnosis and diabetes duration.RESULTSAUC CP was highly correlated to 90CP (rs = 0.96; P < 0.0001) and strongly correlated to FCP (rs = 0.84; P < 0.0001). AUC CP ≥23 nmol/L/150 min was the equivalent cutoff for peak CP ≥0.2 nmol/L (98% sensitivity/97% specificity). A 90CP ≥0.2 nmol/L correctly classified 96% patients using AUC or peak CP, whereas FCP ≥0.1 nmol/L classified 83 and 85% patients, respectively. There was only a small difference seen between peak and 90CP (median 0.02 nmol/L). The CP peak occurred earlier in patients with longer diabetes duration (6.1 min each 1-year increase in duration) and younger age (2.5 min each 1-year increase).CONCLUSIONS90CP is a highly sensitive and specific measure of AUC and peak CP in children and adolescents with type 1 diabetes and offers a practical alternative to a full MMTT.

Deep Sea Mining of Submarine Hydrothermal Deposits and its Possible Environmental Impact in Manus Basin, Papua New Guinea

The Manus back-arc basin host three distinct well known submarine hydrothermal deposits of Vienna Wood, Pacmanus and Onsen sites. The Vienna Wood site is a typical Cu-Zn type of mineralization consisting predominantly of pyrite, marcasite, sphalerite, wurtzite and chalcopyrite. The Pacmanus site is a polymetallic type of mineral deposit consisting of sphalerite, chalcopyrite, bornite, wurtzite, pyrite, marcasite, enargite, tennantite, galena, Pb-As-Sulphosalt, gold, covellite, digenite and chalcocite. The Onsen site is the first deep sea acid sulfate type of mineralisationconsisting ofenargite, covellite, chalcopyrite, pyrite and marcasite.The Papua New Guinea (PNG) Government has granted exploration license to Nautilus Mineral Cooperation to explore for submarin e hydrothermal deposit in the Manus Basin. It has done extensive exploration around the existing hydrothermal depos its of Vienna Wood, Pacmanus and Onsen site. This has resulted in the discoveries of well over twenty hydrothermal deposits (Solwara 1 to Solwara 20). Nautilus Minerals has done resource drilling on Solwara 1 and Solwara 12 deposit due to its polymetallic type of mineralization and its geochemicalsimilarities to the Pacmanus site. From resources drilling, Nautilus Minerals reported an indicated and inferred mineral resource of 1030 kt and 1540 kt respectively for the Solwara 1 project at 2.6% Cu equivalent cut off grade. The PNG government has granted mining lease (ML154) to Nautilus Minerals to mine the Solwara 1 deposit in January 2012. If mining activity commences at the Solwara 1 site then Nautilus needs to address possible environmental impacts of water usage and discharge, water quality, sedimentation and dewatering and preservation of hydrothermal vent communities.

Differences Between Men and Women in Ambulatory Blood Pressure Thresholds for Diagnosis of Hypertension Based on Cardiovascular Outcomes

Previous studies have reported sex differences in the pathophysiology of hypertension and responses to blood pressure (BP)-lowering medications. Moreover, men exhibit typically higher BP than women, the differences being greater for systolic (SBP) than diastolic (DBP) BP. These differences become apparent during adolescence and remain significant at least until 55–60 yrs of age. Despite such significant sex-related differences in BP regulation, the current recommended ambulatory BP monitoring (ABPM) thresholds for diagnosis of hypertension do not differentiate between men and women. We aimed to derive separate male and female diagnostic thresholds for the awake and asleep SBP and DBP means based upon cardiovascular disease (CVD) outcome. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 yrs of age, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every minute by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Cox regression analysis was used to derive outcome-based reference thresholds for ABPM in men and women. Men exhibited greater event rates than women of CVD death, myocardial infarction, angina pectoris, coronary revascularization, and heart failure; however, event rates of non-CVD death and cerebrovascular events were comparable. The relationship between progressively higher ambulatory BP and CVD risk increased more rapidly in women than men for awake SBP/DBP means ≥125/75 mm Hg and asleep means ≥110/70 mm Hg. The derived outcome-based reference thresholds for men were 135/85 mm Hg for the awake and 120/70 mm Hg for the asleep SBP/DBP means. In terms of CVD outcome, the equivalent cutoff threshold values for women were 125/80 mm Hg for the awake and 110/65 mm Hg for the asleep SBP/DBP means. Outcome-based reference thresholds for the diagnosis of hypertension were 10/5 mm Hg lower for ambulatory SBP/DBP in women than men. This marked sex difference indicates the need for revision of current guidelines that propose diagnostic thresholds for ambulatory BP without differentiation between men and women. (Author correspondence: rhermida@uvigo.es)

Ambulatory Blood Pressure Thresholds for Diagnosis of Hypertension in Patients With and Without Type 2 Diabetes Based on Cardiovascular Outcomes

Currently recommended ambulatory blood pressure (BP) monitoring (ABPM) thresholds for diagnosis of hypertension do not differentiate, as international guidelines do for clinic BP, uncomplicated persons at low risk from those at higher risk, e.g., patients with diabetes, for target injury and cardiovascular disease (CVD) risk. We aimed to derive diagnostic thresholds for the awake and asleep systolic (SBP) and diastolic (DBP) BP means based upon CVD outcomes (death from all causes, myocardial infarction, angina pectoris, coronary revascularization, heart failure, acute arterial occlusion of the lower extremities, thrombotic occlusion of the retinal artery, hemorrhagic stroke, ischemic stroke, and transient ischemic attack) for patients with and without diabetes. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 (mean ± SD) yrs of age, 607 with type 2 diabetes, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every minute by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Cox regression analysis was used to derive outcome-based reference thresholds for ABPM in subjects with and without diabetes. CVD risk was consistently greater in patients with than without diabetes for awake SBP/DBP means ≥130/75 mm Hg and asleep means ≥110/65 mm Hg. Derived outcome-based reference thresholds for persons without diabetes were 135/85 mm Hg for the awake and 120/70 mm Hg for the asleep SBP/DBP means. In terms of CVD outcome, the equivalent cutoff threshold values for patients with diabetes were 120/75 mm Hg for the awake and 105/60 mm Hg for the asleep SBP/DBP means. Outcome-based reference thresholds for the diagnosis of hypertension were 15/10 mm Hg lower for ambulatory SBP/DBP in patients with than without diabetes. This marked difference indicates the need for revision of current guidelines that propose diagnostic thresholds for ambulatory BP without differentiation between the presence/absence of diabetes. (Author correspondence: rhermida@uvigo.es)

New local duals in eternal inflation

Global-local duality is the equivalence of seemingly different regulators in eternal inflation. For example, the light-cone time cutoff (a global measure, which regulates time) makes the same predictions as the causal patch (a local measure that cuts off space). We show that global-local duality is far more general. It rests on a redundancy inherent in any global cutoff: at late times, an attractor regime is reached, characterized by the unlimited exponential self-reproduction of a certain fundamental region of spacetime. An equivalent local cutoff can be obtained by restricting to this fundamental region. We derive local duals to several global cutoffs of interest. The New Scale Factor Cutoff is dual to the Short Fat Geodesic, a geodesic of fixed infinitesimal proper width. Vilenkin's CAH Cutoff is equivalent to the Hubbletube, whose width is proportional to the local Hubble volume. The famous youngness problem of the Proper Time Cutoff can be readily understood by considering its local dual, the Incredible Shrinking Geodesic.