A comparison of Diamond Forrester and coronary calcium scores as gatekeepers for investigations of stable chest pain

To determine if calcium scores (CS) could act as a more effective gatekeeper than Diamond Forrester (DF) in the assessment of patients with suspected coronary artery disease (CAD). A sub-study of the Cardiac CT for the Assessment of Chest Pain and Plaque (CAPP) study, a randomised control trial evaluating the cost-effectiveness of cardiac CT in symptomatic patients with stable chest pain. Stable pain was defined as troponin negative pain without symptoms of unstable angina. 250 patients undergoing cardiac CT had both DF scores and CS calculated, with the accuracy of both evaluated against CT coronary angiogram. Criteria given in UK national guidelines were compared. Of the 250 patients, 4 withdrew. 140 (57 %) patients were male. The mean DF was 47.8 and mean CS 172.5. Of the 144 patients with non-anginal pain 19.4 % had significant disease (>50 % stenosis). In general the DF over estimated the presence of CAD whereas the CS reclassified patients to lower risk groups, with 91 in the high risk DF category compared to 26 in the CS. Both receiver operating curve and McNemar Bowker test analysis suggested the DF was less accurate in the prediction of CAD compared to CS [Formula: see text] Projected downstream investigations were also calculated, with the cost per number of significant stenoses identified cheaper with the CS criteria. Patients with suspected stable CAD are more accurately risk stratified by CS compared to the traditional DF. CS was more successful in the prediction of significant stenosis and appears to be more effective at targeting clinical resources to those patients that are in need of them.

Generation of hemispherical fast electron waves in the presence of preplasma in ultraintense laser-matter interaction

Hemispherical electron plasma waves generated from ultraintense laser interacting with a solid target having a subcritical preplasma is studied using particle-in-cell simulation. As the laser pulse propagates inside the preplasma, it becomes self-focused due to the response of the plasma electrons to the ponderomotive force. The electrons are mainly heated via betatron resonance absorption and their thermal energy can become higher than the ponderomotive energy. The hot electrons easily penetrate through the thin solid target and appear behind it as periodic hemispherical shell-like layers separated by the laser wavelength.

Observations of ubiquitous compressive waves in the Sun's chromosphere

The details of the mechanism(s) responsible for the observed heating and dynamics of the solar atmosphere still remain a mystery. Magnetohydrodynamic waves are thought to have a vital role in this process. Although it has been shown that incompressible waves are ubiquitous in off-limb solar atmospheric observations, their energy cannot be readily dissipated. Here we provide, for the first time, on-disk observation and identification of concurrent magnetohydrodynamic wave modes, both compressible and incompressible, in the solar chromosphere. The observed ubiquity and estimated energy flux associated with the detected magnetohydrodynamic waves suggest the chromosphere is a vast reservoir of wave energy with the potential to meet chromospheric and coronal heating requirements. We are also able to propose an upper bound on the flux of the observed wave energy that is able to reach the corona based on observational constraints, which has important implications for the suggested mechanism(s) for quiescent coronal heating. © 2012 Macmillan Publishers Limited. All rights reserved.

Semiclassical relativistic fluid theory for electrostatic envelope modes in dense electron-positron-ion plasmas:Modulational instability and rogue waves

A fluid model is used to describe the propagation of envelope structures in an ion plasma under the influence of the action of weakly relativistic electrons and positrons. A multiscale perturbative method is used to derive a nonlinear Schrödinger equation for the envelope amplitude. Criteria for modulational instability, which occurs for small values of the carrier wavenumber (long carrier wavelengths), are derived. The occurrence of rogue waves is briefly discussed. © Cambridge University Press 2013.

Freak waves and electrostatic wavepacket modulation in a quantum electron-positron-ion plasma

The occurrence of rogue waves (freak waves) associated with electrostatic wavepacket propagation in a quantum electron-positron-ion plasma is investigated from first principles. Electrons and positrons follow a Fermi-Dirac distribution, while the ions are subject to a quantum (Fermi) pressure. A fluid model is proposed and analyzed via a multiscale technique. The evolution of the wave envelope is shown to be described by a nonlinear Schrödinger equation (NLSE). Criteria for modulational instability are obtained in terms of the intrinsic plasma parameters. Analytical solutions of the NLSE in the form of envelope solitons (of the bright or dark type) and localized breathers are reviewed. The characteristics of exact solutions in the form of the Peregrine soliton, the Akhmediev breather and the Kuznetsov-Ma breather are proposed as candidate functions for rogue waves (freak waves) within the model. The characteristics of the latter and their dependence on relevant parameters (positron concentration and temperature) are investigated. © 2014 IOP Publishing Ltd.