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Extensive air showers, induced by high energy cosmic rays impinging on the Earth's atmosphere, produce radio emission that is measured with the LOFAR radio telescope. As the emission comes from a finite distance of a few kilometers, the incident wavefront is non-planar. A spherical, conical or hyperbolic shape of the wavefront has been proposed, but measurements of individual air showers have been inconclusive so far. For a selected high-quality sample of 161 measured extensive air showers, we have reconstructed the wavefront by measuring pulse arrival times to sub-nanosecond precision in 200 to 350 individual antennas. For each measured air shower, we have fitted a conical, spherical, and hyperboloid shape to the arrival times. The fit quality and a likelihood analysis show that a hyperboloid is the best parametrization. Using a non-planar wavefront shape gives an improved angular resolution, when reconstructing the shower arrival direction. Furthermore, a dependence of the wavefront shape on the shower geometry can be seen. This suggests that it will be possible to use a wavefront shape analysis to get an additional handle on the atmospheric depth of the shower maximum, which is sensitive to the mass of the primary particle., Accepted for publication in Astroparticle Physics

This study compared the presence of pain in recreational and competitive road cyclists and body position on the bicycle between cyclists with and without pain. Seventy-one cyclists completed a survey reporting existing cycling-related sites of pain and comfort. Static sagittal and frontal plane images were taken to analyse body position on the bicycle. Participants were separated into recreational and competitive road cycling groups, and further into cyclists reporting pain in the upper body, low back, buttocks/hips and knees for comparison with cyclists without pain. A logistic regression model investigated possible predictors of pain whilst cycling. Pain was present in 67% of recreational and 70% of competitive cyclists whilst comfort was reported by 81% of recreational and 75% of competitive cyclists. Trivial to moderate non-significant differences were observed for body position on the bicycle between cyclists with and without pain, and between cyclists with and without pain in the upper body, low back, buttocks/hips and knees. The predictive logistic model was not significant (p = 0.07) with a model fit predicted by McFadden R

PURPOSE OF STUDY The purpose of this study was to evaluate the impact of a quality improvement multidisciplinary care coordination program designed to reduce frequent emergency department (ED) utilization and hospital admissions. PRIMARY PRACTICE SETTING The single hospital ED is part of a large, integrated, managed care delivery system in Northern California serving the city of Oakland, California. METHODOLOGY AND SAMPLE A retrospective cohort study design was used to analyze a multidisciplinary care coordination program on 58 patients during January 2015 and August 2018. Patients were identified from a high-utilization report when they had 10 or more ED visits in a 6-month period, were 18 years of age or older, and members of the integrated delivery system's health plan. Data were collected at initiation and 6 months postintervention. The pre-/postanalysis consisted of descriptive statistics, Wilcoxon signed ranks test, and binary logistic regression. RESULTS There was a statistically significant pre-/postdifference of 7.7 ED visits (95% confidence interval [CI] = 4.44-10.97, p < .001). The program did not result in statistically significant reduced hospital admissions (95% CI =-1.24 to 1.45, p = .875). Prior frequent use, number of pre-ED visits, age, sex, complex medical history, and mental health disorder had a significant effect on frequent ED use (χ[6] =17.62, p = .007, McFadden R = .32]. Sex (odds ratio [OR] = 5.13, p = .070), prior frequent use (OR = 2.87, p = .252), and complex medical history (OR = 2.52, p = .412) had the greatest odds of ongoing frequent ED use. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE We demonstrated reductions in ED use among frequent users with a low-cost care management intervention. Our multidisciplinary care coordination program confirms the positive impact case management has on utilization and health outcomes. We established that a care coordination program can optimize the overall quality of care and control hospital costs incurred by this vulnerable population. The effectiveness of this program contributes to the advancement of case management efforts in undertaking the challenging health care issue of reducing repeated visits by frequent users, a practice that strains emergency medical services.

Summary Titanium and its alloys have emerged as excellent candidates for use as orthopedic biomaterials. Nevertheless, there are often complications arising after implantation of orthopedic devices, most notably prosthetic joint infection and aseptic loosening. To ensure that implanted devices remain functional in situ, innovation in surface modification has attracted much attention in the effort to develop orthopedic materials with optimal characteristics at the biomaterial-tissue interface. This review will draw together metallurgy, surface engineering, biofilm microbiology, and biomaterial science. It will serve to appreciate why titanium and its alloys are frequently used orthopedic biomaterials and address some of the challenges facing these biomaterials currently, including the significant problem of device-associated infection. Finally, the authors shall consolidate and evaluate surface modification techniques employed to overcome some of these issues by offering a unique perspective as to the direction in which research is headed from a broad, interdisciplinary point of view., Orthopedics; Microbiofilms; Biomaterials; Surface Science

The objective of this research is to prove, analyze the influence of tax and exchange rate on transfer pricing decision in multinational manufacturing companies. Tax is measured using a proxy ETR (Effective Tax Rate), Exchange Rate is measured using a proxy keutungan or loss transactions of companies using foreign currency, and transfer pricing was measured using dummy variables to determine the companies that conduct transactions with related parties. The analysis technique used in this research is regression analysis with the use of categorical variables logit model (Logistic Regression / Binary Choice) or also called logistic regression using EViews 9.5 program for Windows. Based on the results of logistic regression analyzes tested, testing the first hypothesis (H1) of positive influence Tax on transfer pricing decisions of companies, the result is precisely the opposite direction to that predicted, namely tax significant negative effect on the company transfer pricing decisions. While testing the second hypothesis (H2) on the effect of Exchange Rate on transfer pricing decisions the company showed a positive direction but not significant. The results of this study indicate that the tax and exchange rate does not significantly influence transfer pricing indications. The determination coefficient (McFadden R-squared) is 0.023610. This result show that 2.3% transfer pricing is affected by tax, and exchange rate. While the rest 97.7% is explained by other variable that means many other variables in outside of tax, and exchange rate that can explain transfer pricing. Transfer pricing happen on the company with high profit purpose and using tax avoidance become the a to fulfil it, but the higher the tax rate used by the company will lower the company's transfer pricing decisions. The amount of the exchange rate (exchange rate) affects the judgment of the company, whether the company will choose to conduct transfer pricing decisions, or choose not to take a decision of transfer pricing. Keywords: tax, exchange rate, transfer pricing, multinational corporations

A new two-channel digital receiver-spectrometer whose parameters and functional capabilities are optimized to provide its effective use in decameter telescopes, as well as in other systems where high precision and synchronization of measurements are required, is described. The receiver has a low level of noise floor, a high dynamic range and sensitivity. The implemented features of the receiver are continuous writing of raw data waveform mode) for the two channels simultaneously at ADC sampling rate up to 160 MHz (the maximum regulated relative inter-channel delay is 8 μs and increment 8 ps. The receiver offers flexible selection of a segment size of the fast Fourier transform ( N FFT = 2 10+k , k =1, ..., 5) and resulting frequency range selection (spectrometer mode) with increment of 1024 spectral samples, an ability of inter-channel cross-spectrograms real-time calculation. 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Washout on delayed phase (or equilibrium phase) imaging of an arterially hyperenhancing lesion is an excellent predictor of hepatocellular carcinoma (HCC). The purpose of our study was to quantitatively define washout in pathologically proven HCC. A quantitative definition of HCC may minimize interobserver variability and facilitate more accurate diagnosis.We identified 47 liver lesions that were hyperenhancing in the arterial phase from 24 patients who underwent triphasic MDCT as part of preoperative evaluation for liver transplantation. All HCCs were pathologically proven. Regions of interest were obtained of lesions and areas of adjacent liver on arterial, portal venous, and delayed phase images. Enhancement profiles were assessed by three radiologists.Of the 47 hypervascular lesions, 14 HCCs were identified. There was a statistically significant difference in percentage attenuation ratio (defined as 100 × ratio of attenuation of adjacent liver to that of the lesion) between lesions that were HCC (median percentage attenuation ratio, 121) and those that were not (median percentage attenuation ratio, 101) on delayed phase. Percentage attenuation ratio ≥ 107 on delayed phase imaging achieved maximal sensitivity (100%) with good specificity (75.8%), positive predictive value (PPV) (63.6%), and negative predictive value (NPV) (100%) in HCC detection. Percentage attenuation ratio also correlated well with radiologists' assessments of enhancement profiles of lesions (multinomial logistic regression McFadden R(2), 0.72; chi-square p,0.01).Our analysis of simple CT attenuation measurements indicates that percentage attenuation ratio offers excellent sensitivity, specificity, PPV, and NPV for HCC detection and very good correlation with radiologists' assessments of washout.

Altres ajuts: Fundació La Marató de TV3 (no.201502-30), Sociedad Española de Cardiología, Societat Catalana de Cardiologia Despite advances in pharmacologic therapy and devices, patients with heart failure (HF) continue to have significant rehospitalization rates and risk prediction remains challenging. We sought to explore the value of a multi-biomarker panel [including NT-proBNP, high-sensitivity cardiac troponin T (hs-TnT), and ST2] on top of clinical assessment for long-term prediction of recurrent hospitalizations in HF. NT-proBNP, hs-TnT, and ST2 (suppression of tumorigenicity-2) levels were measured in 891 consecutive ambulatory HF patients. The independent association between the multi-biomarker panel and recurrent hospitalizations was assessed through a multivariable negative binomial regression and expressed as incidence rates ratios. McFadden pseudo- R 2 and goodness-of-fit measures were also used. The total number of unplanned hospitalizations [all-cause, cardiovascular (CV)-, and HF-related] were selected as the primary endpoints. At a mean follow-up of 4.2 ± 2.1 years, 1623 all-cause hospitalizations in 498 patients (55.9%), 710 CV-related hospitalizations in 331 patients (37.2%), and 444 HF-related hospitalizations in 214 patients (24.1%) were registered. The crude incidence of all-cause, CV-, and HF-related recurrent hospitalizations was significantly higher for patients with the multi-biomarker panel above the cut-point (hs-TnT > 14 ng/L, NT-proBNP > 1000 ng/L, and ST2 > 35 ng/mL) (all P < 0.001). For all-cause, CV-, and HF-related recurrent hospitalizations, the McFadden R 2, Akaike information criterion, and Bayesian information criterion supported the superiority of incorporating the multi-biomarker panel into a clinical predictive model. A multi-biomarker approach based on NT-proBNP, hs-TnT, and ST2 better identifies HF patients at risk for recurrent hospitalizations as compared to approaches entailing just one or two of these biomarkers. Elucidation of new biophysiological predictors for recurrent hospitalizations may identify patient profiles for focused intervention.

Background and Purpose— Poststroke pneumonia is a potentially preventable complication after stroke associated with poor outcome. We developed and externally validated a prognostic score for predicting risk of pneumonia after ischemic stroke. Methods— The prognostic score was developed based on clinical data routinely collected after admission from the Berlin Stroke Register, Germany. The association of demographics, comorbidities, and clinical characteristics with poststroke pneumonia was investigated using multivariable logistic regression analyses. Independent predictors of poststroke pneumonia were translated into a point scoring system based on the corresponding regression coefficients. The predictive properties of the developed prognostic score were externally validated using an independent data set from the Stroke Register Northwest-Germany. Results— Between 2007 and 2009, 15 335 patients with ischemic stroke were registered within the Berlin Stroke Register. The observed rate of pneumonia in hospital was 7.2%. A 10-point score was derived for prediction of poststroke pneumonia (Age ≥75 years=1, Atrial fibrillation=1, Dysphagia=2, male Sex=1, stroke Severity, National Institutes of Health Stroke Scale 0–4=0, 5–15=3, ≥16=5; A 2 DS 2 ). The proportion of pneumonia varied between 0.3% in patients with a score of 0 point to 39.4% in patients with a score of 10 points. The score demonstrated excellent discrimination (C-statistic 0.84; 95% CI, 0.83–0.85) and calibration (McFadden R 2 =0.21). Prediction, discrimination, and calibration properties were reproduced in the validation cohort consisting of 45 085 patients with ischemic stroke. Conclusions— The A 2 DS 2 score is a valid tool for predicting poststroke pneumonia based on routinely available data. A 2 DS 2 might be useful for guiding monitoring of high-risk patients or prophylactic pneumonia management in clinical routine.

Background and objectives B-cell activating factor of the TNF family (BAFF) plays a role in (auto)antibody production. Elevated serum levels (sBAFF) were found in patients with myositis. Associations of elevated sBAFF with a SNP in the 5´regulatory region of the BAFF genewere reported in patients with autoimmune diseases, together with TTTT haplotype of the four SNPs located upstream of the BAFF gene. TTTT was associated with myositis in Czech patients, independently from the HLA-DRB1*03 allele. Here we evaluate associations of sBAFF with particular SNPs, anti-Jo-1-autoantibodies, HLA-DRB1*03, ILD and disease activity in myositis. Materials and methods The SNPs (rs9514828:871C>T, rs9514827:-2841T>C, rs3759467:-2704T>C and rs1041569:-2701T >A) were analysed by direct DNA sequencing in 311 patients with myositis (age:58.0 ± 14.5(years), females = 74%) and 113 healthy controls (age:40.6 ± 14.3, females = 70%). Levels of sBAFF were measured by ELISA. Autoantibodies were detected by immunoprecipitation. Multivariable logistic regression model for presence of anti-Jo-1-autoantibodies and nonparametric tests for group comparisons and correlation analysis were used. Results Analysed patients cohort included 150 DM, 139 PM, 51% ILD and 24% anti-Jo-1-positive patients. HLA-DRB1*03 was present in 45% of patients and 16% of controls. Higher s-BAFF levels were detected in: patients compared to healthy controls (p Logistic regression model explaining 49% (McFadden R 2 =0.49) of the data variability included, besides ILD (OR = 27.24;p 2 = 0.38). However, the additive effect of -871T allele to sBAFF levels in anti-Jo-1-positive patients compared to autoantibody-negative (higher in -871TT:p = 0.023 and -871CT:p = 0.043) and the opposite association in -2841TT genotype (higher in -2841CC: p = 0.033 and -2841CT:p = 0.068)were seen. Conclusion In addition to ILD and HLA-DRB1*03 allele, SNPs of the promotor region of the BAFF gene, -871C >T and -2841T >C, increase the risk of having anti-Jo-1-autoantibodies and high sBAFF levels in patients with myositis. Acknowledgements MZCR-Institutional support of research organisation-00023728.