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Objective To evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards. Design Randomised controlled, adaptive, open label clinical trial. Setting 28 hospitals in Brazil, Canada, Ireland, Saudi Arabia, United Arab Emirates, and US. Participants 465 adults admitted to hospital wards with covid-19 and increased D-dimer levels were recruited between 29 May 2020 and 12 April 2021 and were randomly assigned to therapeutic dose heparin (n=228) or prophylactic dose heparin (n=237). Interventions Therapeutic dose or prophylactic dose heparin (low molecular weight or unfractionated heparin), to be continued until hospital discharge, day 28, or death. Main outcome measures The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an intensive care unit, assessed up to 28 days. The secondary outcomes included all cause death, the composite of all cause death or any mechanical ventilation, and venous thromboembolism. Safety outcomes included major bleeding. Outcomes were blindly adjudicated. Results The mean age of participants was 60 years; 264 (56.8%) were men and the mean body mass index was 30.3 kg/m 2 . At 28 days, the primary composite outcome had occurred in 37/228 patients (16.2%) assigned to therapeutic heparin and 52/237 (21.9%) assigned to prophylactic heparin (odds ratio 0.69, 95% confidence interval 0.43 to 1.10; P=0.12). Deaths occurred in four patients (1.8%) assigned to therapeutic heparin and 18 patients (7.6%) assigned to prophylactic heparin (0.22, 0.07 to 0.65; P=0.006). The composite of all cause death or any mechanical ventilation occurred in 23 patients (10.1%) assigned to therapeutic heparin and 38 (16.0%) assigned to prophylactic heparin (0.59, 0.34 to 1.02; P=0.06). Venous thromboembolism occurred in two patients (0.9%) assigned to therapeutic heparin and six (2.5%) assigned to prophylactic heparin (0.34, 0.07 to 1.71; P=0.19). Major bleeding occurred in two patients (0.9%) assigned to therapeutic heparin and four (1.7%) assigned to prophylactic heparin (0.52, 0.09 to 2.85; P=0.69). Conclusions In moderately ill patients with covid-19 and increased D-dimer levels admitted to hospital wards, therapeutic heparin was not significantly associated with a reduction in the primary outcome but the odds of death at 28 days was decreased. The risk of major bleeding appeared low in this trial. Trial registration ClinicalTrials.gov NCT04362085 .

The research and development work on the Advanced Light Source (ALS) upgrade to a diffraction limited storage ring light source, ALS-U, has brought to focus the need for near-perfect x-ray optics, capable of delivering light to experiments without significant degradation of brightness and coherence. The desired surface quality is characterized with residual (after subtraction of an ideal shape) surface slope and height errors of

In the article authors present the concept of the surgical manipulator delivering laser radiation to the target area. For the implementation of Doppler-controlled treatment of hemorrhoids by laser coagulation, an important circumstance is the necessity to realize by means of the dopplerograph the possibility of controlling the efficiency of coagulation of the pathological vessel immediately after the impact, which will create the prerequisites for the formation of a program cycle with the inclusion of control elements by feedback. In this regard, the structure of the laser medical apparatus is developed, which allows determining the location, size and flow of arterial and venous vessels, performing laser coagulation of pathologically damaged sites under constant Doppler control. The developed adaptive power management system includes several functional units for the processing of the data from ultrasound scanner and the Doppler. Medical apparatus for minimally invasive treatment of hemorrhoids based on the laser coagulator and ultrasound Doppler will allow performing surgeries in automated and half-automated modes. The suggested medical apparatus helps to determine pathological vessels, choose the required radiation mode and provides vessel obliteration. Successful realization of constructive combination of real-time diagnostics and surgical manipulation with a laser can result in a unique minimally invasive solution to treat hemorrhoids that currently doesn’t have analogues.

Time-domain Brillouin scattering technique, also known as picosecond ultrasonic interferometry, which provides opportunity to monitor propagation of nanometers to sub-micrometers length coherent acoustic pulses in the samples of sub-micrometers to tens of micrometers dimensions, was applied to depth-profiling of polycrystalline aggregate of ice compressed in a diamond anvil cell to Megabar pressures. The technique allowed examination of characteristic dimensions of elastic inhomogeneities and texturing of polycrystalline ice in the direction normal to the diamond anvil surfaces with sub-micrometer spatial resolution via time-resolved measurements of variations in the propagation velocity of the acoustic pulse traveling in the compressed sample. The achieved two-dimensional imaging of the polycrystalline ice aggregate in-depth and in one of the lateral directions indicates the feasibility of three-dimensional imaging and quantitative characterization of acoustical, optical and acousto-optical properties of transparent polycrystalline aggregates in diamond anvil cell with tens of nanometers in-depth resolution and lateral spatial resolution controlled by pump laser pulses focusing., 32 pages, 5 figures

The paper proposes a new algorithm for solving global univariate optimization problems. The algorithm does not require convexity of the target function. For a broad variety of target functions after performing (if necessary) several evolutionary leaps the algorithm naturally becomes the standard descent (or ascent) procedure near the global extremum. Moreover, it leads us to an efficient numerical method for calculating the global extrema of univariate real analytic functions., Comment: 24 pages, 10 figures

It is well known that a three dimensional (closed, connected and compact) manifold is obtained by identifying boundary faces from a polyhedron P. The study of (\partial P)/~, the boundary \partial P with the polygonal faces identified in pairs leads us to the following conclusion: either a three dimensional manifold is homeomorphic to a sphere or to a polyhedron P with its boundary faces identified in pairs so that (\partial P)/~ is a finite number of internally flat complexes attached to each other along the edges of a finite graph that contains at least one closed circuit. Each of those internally flat complexes is obtained from a polygon where each side may be identified with more than one different sides. Moreover, Euler characteristic of (\partial P)/~ is equal to one and the fundamental group of (\partial P)/~ is not trivial.

It is well known that a compact two dimensional surface is homeomorphic to a polygon with the edges identified in pairs. This paper not only presents a new proof of this statement but also generalizes it for any connected n-dimensional stellar manifold with a finite number of vertices.