Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study.

INTRODUCTION: Anti-cholinergic medications have been associated with increased risks of cognitive impairment, premature mortality and increased risk of hospitalisation. Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer, yet little is known about associated adverse outcomes in this setting. METHODS: A substudy of 112 participants in a randomised control trial who had cancer and an Australia modified Karnofsky Performance Scale (AKPS) score (AKPS) of 60 or above, explored survival and health service utilisation; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale (modified version) longitudinally to death. A standardised starting point for prospectively calculating survival was an AKPS of 60 or above. RESULTS: Baseline entry to the sub-study was a mean 62 +/- 81 days (median 37, range 1-588) days before death (survival), with mean of 4.8 (median 3, SD 4.18, range 1 - 24) study assessments in this time period. Participants spent 22% of time as an inpatient. There was no significant association between anti-cholinergic score and time spent as an inpatient (adjusted for survival time) (p = 0.94); or survival time. DISCUSSION: No association between anti-cholinergic load and survival or time spent as an inpatient was seen. Future studies need to include cognitively impaired populations where the risks of symptomatic deterioration may be more substantial.

Flow stabilization with active hydrodynamic cloaks

We demonstrate that fluid flow cloaking solutions, based on active hydrodynamic metamaterials, exist for two-dimensional flows past a cylinder in a wide range of Reynolds numbers (Re's), up to approximately 200. Within the framework of the classical Brinkman equation for homogenized porous flow, we demonstrate using two different methods that such cloaked flows can be dynamically stable for Re's in the range of 5-119. The first highly efficient method is based on a linearization of the Brinkman-Navier-Stokes equation and finding the eigenfrequencies of the least stable eigenperturbations; the second method is a direct numerical integration in the time domain. We show that, by suppressing the von Kármán vortex street in the weakly turbulent wake, porous flow cloaks can raise the critical Reynolds number up to about 120 or five times greater than for a bare uncloaked cylinder. © 2012 American Physical Society.