Luzerne County Community College

Cardiac amyloidosis is frequently overlooked, leading to delayed diagnosis and underestimation of its true impact on cardiac mortality. Using CDC WONDER (1999-2020), we identified U.S. decedents aged ≥ 25 years with amyloidosis (ICD-10 E85) as the underlying cause of death and at least one cardiac-related condition as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and trends were analyzed using Joinpoint regression and autoregressive integrated moving average (ARIMA) forecasting through 2040. Among 16,673 deaths, the AAMR rose from 0.261 in 1999 to 0.608 in 2020, with inflection points in 2012 and 2017 and an overall annual increase of 3.96%. Mortality was higher in men (0.537 vs. 0.210) and Black individuals (0.83 vs. 0.32), with a sharp post-2017 rise, especially among Black decedents. Geographic disparities were also observed, with the highest rates in the Northeast and urban areas. Most deaths occurred in hospitals (43.2%) or at home (31.4%), and mortality rates peaked in those aged 85 and older. Forecasting models project continued increases in AAMR through 2040, reaching approximately 2.0 overall, with especially elevated rates among Black (≈ 5.9) and male (≈ 3.8) decedents. Cardiac mortality in amyloidosis has risen sharply since 2017, likely driven by improved ATTR-CM detection through non-biopsy imaging and guideline adoption. Disparities by sex, race, and geography persist, reflecting uneven diagnostic capacity concentrated in urban and Northeastern centers. Forecasts project continued increases, particularly among Black and male individuals, underscoring the need for more equitable access to diagnosis and treatment.

This article shows that for pressure‐dependent demand (PDD) modeling, as pressures become very low, not only does the decrease in pressure affect outflow from orifices (faucets, showers, leaks), but it can leave some orifices above the hydraulic grade. The orifices above the hydraulic grade line would not have flowed at all. This has implications for the PDD function used in some hydraulic models in that a simple orifice equation cannot accurately describe such nodal demands. This article presents the results of lab experiments that measure the effect of very low pressures on demands. An equation that accounts for the influence of very low pressure and orifice elevation is proposed and verified. The impact of this equation on modeling low‐pressure situations is presented.

SummaryIn this article, we describe clever arguments by Torricelli and Roberval that employ indivisibles to find the volume of Gabriel's trumpet and the area under the cycloid. We detail 17th-century objections to these non-rigorous but highly intuitive techniques, as well as the controversy surrounding indivisibles. After reviewing the fundamentals of infinitesimal calculus and its rigorous footing provided by Robinson in the 1960s, we are able to revisit the 17th-century solutions. In changing from indivisible to infinitesimal-based arguments, we salvage the beautiful intuition found in these works.

Calculus and Its Origins is primarily a collection of results that show how calculus came to be, beginning in ancient Greece and climaxing with the discovery of calculus. Other books have traveled these paths, but they presuppose knowledge of calculus. This book requires only a basic knowledge of high school geometry and algebra. Exercises introduce further historical figures and their results, and make it possible for a professor to use this book in class.

Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multi-institutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique. Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions. The mean time from mesh implantation to reoperation was 420 days (range, 2-1 739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91 %) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis. In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91 % of cases, and no severe cohesive adhesions were found. Comparative analyses of newer materials based on clinical reoperative findings are warranted to assess the safety of intraabdominally placed meshes.