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- Bhatt, A. S., et al.
(författare)
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Achieving a Maximally Tolerated beta-Blocker Dose in Heart Failure Patients Is There Room for Improvement?
- 2017
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 69:20, s. 2542-2550
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Tidskriftsartikel (refereegranskat)abstract
- Heart failure (HF) is associated with significant morbidity and mortality. Although initially thought to be harmful in HF, beta-adrenergic blockers (beta-blockers) have consistently been shown to reduce mortality and HF hospitalization in chronic HF with reduced ejection fraction. Proposed mechanisms include neurohormonal blockade and heart rate reduction. A new therapeutic agent now exists to target further heart rate lowering in patients who have been stable on a "maximally tolerated b-blocker dose," but this definition and how to achieve it are incompletely understood. In this review, the authors summarize published reports on the mechanisms by which beta-blockers improve clinical outcomes. The authors describe differences in doses achieved in landmark clinical trials and those observed in routine clinical practice. They further discuss reasons for intolerance and the evidence behind using b-blocker dose and heart rate as therapeutic targets. Finally, the authors offer recommendations for clinicians actively initiating and up-titrating b-blockers that may aid in achieving maximally tolerated doses. (C) 2017 by the American College of Cardiology Foundation.
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- Lynch, Benjamin J., et al.
(författare)
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Modeling a Carrington-scale Stellar Superflare and Coronal Mass Ejection from κ1Cet
- 2019
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Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 880:2
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Tidskriftsartikel (refereegranskat)abstract
- Observations from the Kepler mission have revealed frequent superflares on young and active solar-like stars. Superflares result from the large-scale restructuring of stellar magnetic fields, and are associated with the eruption of coronal material (a coronal mass ejection, or CME) and energy release that can be orders of magnitude greater than those observed in the largest solar flares. These catastrophic events, if frequent, can significantly impact the potential habitability of terrestrial exoplanets through atmospheric erosion or intense radiation exposure at the surface. We present results from numerical modeling designed to understand how an eruptive superflare from a young solar-type star, kappa(1)Cet, could occur and would impact its astrospheric environment. Our data-inspired, three-dimensional magnetohydrodynamic modeling shows that global-scale shear concentrated near the radial-field polarity inversion line can energize the closed-field stellar corona sufficiently to power a global, eruptive superflare that releases approximately the same energy as the extreme 1859 Carrington event from the Sun. We examine proxy measures of synthetic emission during the flare and estimate the observational signatures of our CME-driven shock, both of which could have extreme space-weather impacts on the habitability of any Earth-like exoplanets. We also speculate that the observed 1986 Robinson-Bopp superflare from. kappa(1)Cet was perhaps as extreme for that star as the Carrington flare was for the Sun.
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