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Sample records for suboptimal pci technique

  1. High dose adenosine for suboptimal myocardial reperfusion after primary PCI : A randomized placebo-controlled pilot study

    NARCIS (Netherlands)

    Stoel, Martin G.; Marques, Koen M. J.; de Cock, Carel C.; Bronzwaer, Jean G. F.; von Birgelen, Clemens; Zijlstra, Felix

    2008-01-01

    Objectives: This study was designed to investigate the influence of high dose intracoronary adenosine on persistent ST-segment elevation after primary percutaneous coronary intervention (PCI). Background: After successful PCI for acute myocardial infarction 40-50% of patients show persistent

  2. Suboptimal inhaler medication adherence and incorrect technique are common among chronic obstructive pulmonary disease patients.

    Science.gov (United States)

    Sriram, Krishna B; Percival, Matthew

    2016-02-01

    Patients with chronic obstructive pulmonary disease (COPD) are routinely prescribed one or more inhaled medications. Adherence to inhaler medications and correct inhaler device technique are crucial to successful COPD management. The goals of this study were to estimate adherence and inhaler technique in a cohort of COPD patients. This was an observational study conducted on a sample of 150 COPD patients. Medication adherence was assessed using the Medication Adherence Report Scale (MARS). Inhaler technique was assessed using standardized checklists. Clinical data were collected using a proforma. Of the 150 patients (mean age 70.3 years, 52% male), 58% reported suboptimal adherence (MARS ≤ 24). High adherence to therapy (MARS = 25) was associated with older age (p = 0.001), but not any of the other studied variables. Medication non-adherence was not associated with COPD exacerbations. Errors (≥ 1) in inhaler technique were common across all of the types of inhaler devices reportedly used by patients, with the highest proportion of errors among Turbuhaler users (83%) and the least proportion of errors among Handihaler users (50%). No clinical variables were associated with errors in inhaler technique. Suboptimal adherence and errors in inhaler technique are common among COPD patients. No clinical variables to assist in the prediction of medication non-adherence and poor inhaler technique were identifiable. Consequently, regular assessment of medication adherence and inhaler technique should be incorporated into routine clinical practice to facilitate improved health outcomes among patients with COPD. © The Author(s) 2015.

  3. PCI bus demystified

    CERN Document Server

    Abbott, Doug

    2004-01-01

    The peripheral component interconnect (PCI) bus is the dominant bus system used to connect the different elements making up today''s high-performance computer systems. Different PCI implementations have also been developed for such applications as telecommunications and embedded computing. If an application calls for high speed, high reliability, flexible configuration, and bus mastering, then PCI is the only logical bus choice. This book is an applications-oriented introduction to the PCI bus, with an emphasis on implementing PCI in a variety of computer architectures. Special attention is given to industrial and mission-critical applications of PCI bus.·Fully describes PCI electrical specifications, mechanical requirements, and signal types·Covers advanced topics through numerous design examples to increase the readers understanding of the subject ·Includes updated coverage of PCI-X 2.0

  4. TRP0033 - PCI Coal Combustion Behavior and Residual Coal Char Carryover in the Blast Furnace of 3 American Steel Companies during Pulverized Coal Injection (PCI) at High Rates

    Energy Technology Data Exchange (ETDEWEB)

    Veena Sahajwalla; Sushil Gupta

    2005-04-15

    Combustion behavior of pulverized coals (PC), gasification and thermal annealing of cokes were investigated under controlled environments. Physical and chemical properties of PCI, coke and carbon residues of blast furnace dust/sludge samples were characterized. The strong influence of carbon structure and minerals on PCI reactivity was demonstrated. A technique to characterize char carryover in off gas emissions was established.

  5. PCI-SS: MISO dynamic nonlinear protein secondary structure prediction

    Directory of Open Access Journals (Sweden)

    Aboul-Magd Mohammed O

    2009-07-01

    Full Text Available Abstract Background Since the function of a protein is largely dictated by its three dimensional configuration, determining a protein's structure is of fundamental importance to biology. Here we report on a novel approach to determining the one dimensional secondary structure of proteins (distinguishing α-helices, β-strands, and non-regular structures from primary sequence data which makes use of Parallel Cascade Identification (PCI, a powerful technique from the field of nonlinear system identification. Results Using PSI-BLAST divergent evolutionary profiles as input data, dynamic nonlinear systems are built through a black-box approach to model the process of protein folding. Genetic algorithms (GAs are applied in order to optimize the architectural parameters of the PCI models. The three-state prediction problem is broken down into a combination of three binary sub-problems and protein structure classifiers are built using 2 layers of PCI classifiers. Careful construction of the optimization, training, and test datasets ensures that no homology exists between any training and testing data. A detailed comparison between PCI and 9 contemporary methods is provided over a set of 125 new protein chains guaranteed to be dissimilar to all training data. Unlike other secondary structure prediction methods, here a web service is developed to provide both human- and machine-readable interfaces to PCI-based protein secondary structure prediction. This server, called PCI-SS, is available at http://bioinf.sce.carleton.ca/PCISS. In addition to a dynamic PHP-generated web interface for humans, a Simple Object Access Protocol (SOAP interface is added to permit invocation of the PCI-SS service remotely. This machine-readable interface facilitates incorporation of PCI-SS into multi-faceted systems biology analysis pipelines requiring protein secondary structure information, and greatly simplifies high-throughput analyses. XML is used to represent the input

  6. PCI of CTOs: hope or hype?

    Science.gov (United States)

    Trivax, Justin E; Safian, Robert D

    2015-04-01

    Compared with successful PCI, failed PCI of CTOs is associated with higher rates of in-hospital death, MI, CABG, perforation, and cardiac tamponade, but the absolute risk difference is small. Since 1991, the overall rates of in-hospital complications are declining, due to significant improvements in CTO technology and operator expertise. Outcomes after CTO-PCI may be enhanced by proper patient selection (resistant angina; large areas of ischemia; and anatomic suitability for antegrade, retrograde, and/or subintimal recanalization) and by reliance on expert operators using a flexible incremental approach to recanalization. © 2015 Wiley Periodicals, Inc.

  7. PCI compliance understand and implement effective PCI data security standard compliance

    CERN Document Server

    Williams, Branden R

    2012-01-01

    The credit card industry established the PCI Data Security Standards to provide a minimum standard for how vendors should protect data to ensure it is not stolen by fraudsters. PCI Compliance, 3e, provides the information readers need to understand the current PCI Data Security standards, which have recently been updated to version 2.0, and how to effectively implement security within your company to be compliant with the credit card industry guidelines and protect sensitive and personally identifiable information. Security breaches continue to occur on a regular basis, affecting millions of

  8. Intravenous platelet blockade with cangrelor during PCI

    NARCIS (Netherlands)

    Bhatt, Deepak L.; Lincoff, A. Michael; Gibson, C. Michael; Stone, Gregg W.; McNulty, Steven; Montalescot, Gilles; Kleiman, Neal S.; Goodman, Shaun G.; White, Harvey D.; Mahaffey, Kenneth W.; Pollack, Charles V.; Manoukian, Steven V.; Widimsky, Petr; Chew, Derek P.; Cura, Fernando; Manukov, Ivan; Tousek, Frantisek; Jafar, M. Zubair; Arneja, Jaspal; Skerjanec, Simona; Harrington, Robert A.; Bhatt, D. L.; Harrington, R. A.; Lincoff, A. M.; Pollack, C. V.; Gibson, C. M.; Stone, G. W.; Mahaffey, K. W.; Kleiman, N. S.; Montalescot, G.; White, H. D.; Goodman, S. G.; Greenbaum, A.; Simon, D.; Lee, D.; Feit, F.; Dauerman, H.; Gurbel, P.; Berger, P.; Makkar, R.; Becker, R. C.; Manoukian, S.; Jorgova, J.; Chew, D. P.; Storey, R.; Desmet, W.; Cura, F.; Herrmann, H.; Rizik, D.; DeServi, S.; Huber, K.; Jukema, W. J.; Knopf, W.; Steg, P. G.; Schunkert, H.; Widimsky, P.; Betriu, A.; Aylward, P.; Polonestsky, L.; Lima, V.; Kobulia, B.; Navickas, R.; Gasior, Z.; Vasilieva, E.; Bennett, J. M.; Kraiz, I.; Van de Werf, F.; Faxon, D.; Ohman, E. M.; Tijssen, J. G. P.; Verheugt, F.; Weaver, W. D.; Califf, R. M.; Mehta, C.; Hamm, C. W.; Pepine, C. J.; Ware, J.; Wilson, M.; Gorham, C.; Maran, A.; McNulty, S.; Fasteson, D.; Ryan, G.; Bradsher, J.; Connolly, P.; Mehta, R.; Leonardi, S.; Brennan, M.; Patel, M.; Petersen, J.; Bushnel, C.; Jolicoeur, M.; Chan, M.; Dowd, L.; Skinner, P.; Lawrence, G.; Jordon, M.; Dickerson, S.; Meyer, M.; Hartford, S.; Garcia Escudero, Alejandro; Poy, Carlos; Miceli, Miguel; Pocovi, Antonio; Londero, Hugo; Baccaro, Jorge; Polonetsky, Leonid; Karotkin, Aliaksey; Shubau, Leanid; Maffini, Eduardo; Machado, Bruno; Airton, José; Lima, Valter; Martinez Filho, Eulogio; Herdy, Arthur; Tumelero, Rogerio; Precoma, Dalton; Botelho, Roberto; Saad, Jamil; Jatene, Jose; Vilas-Boas, Fabio; Godinho, Antonio; Perin, Marco; Caramori, Paulo; Castro, Iran; Grigorov, Mladen; Milkov, Plamen; Jorgova, Julia; Georgiev, Svetoslav; Rifai, Nizar; Doganov, Alexander; Petrov, Ivo; Hui, William; Lazzam, Charles; Reeves, Francois; Tanguay, Jean-Francois; Richter, Marek; Klimsa, Zdenek; Padour, Michal; Mrozek, Jan; Branny, Marian; Coufal, Zdenek; Simek, Stanislav; Rozsival, Vladimir; Pleva, Leos; Stasek, Josef; Kala, Petr; Groch, Ladislav; Kocka, Viktor; Shaburishvili, Tamaz; Khintibidze, Irakli; Chapidze, Gulnara; Mamatsashvili, Merab; Mohanan, Padinhare; Jain, Rajesh; Parikh, Keyur; Patel, Tejas; Kumar, Sampath; Mehta, Ashwani; Banker, Darshan; Krishna, Lanka; Gadkari, Milind; Joshi, Hasit; Hiremath, Shirish; Grinius, Virgilijus; Norkiene, Sigute; Petrauskiene, Birute; Michels, Rolf; Tjon, Melvin; de Swart, Hans; de Winter, Robbert; White, Harvey; Devlin, Gerard; Abernethey, Malcolm; Osiev, Alexander; Linev, Kirill; Kalinina, Svetlana; Baum, Svetlana; Kosmachova, Elena; Shogenov, Zaur; Markov, Valentin; Boldueva, Svetlana; Barbarash, Olga; Kostenko, Victor; Vasilieva, Elena; Gruzdev, Aleksey; Lusov, Victor; Dovgalevsky, Pavel; Azarin, Oleg; Chernov, Sergey; Smolenskaya, Olga; Duda, Alexey; Fridrich, Viliam; Hranai, Marian; Studencan, Martin; Kurray, Peter; Bennett, John; Blomerus, Pieter; Disler, Laurence; Engelbrecht, Johannes; Klug, Eric; Routier, Robert; Venter, Tjaart; van der Merwe, Nico; Becker, Anthony; Cha, Kwang-Soo; Lee, Seung-Hwan; Han, Sang-Jin; Youn, Tae Jin; Hur, Seung-Ho; Seo, Hong Seog; Park, Hun-Sik; Rhim, Chong-Yun; Pyun, Wook-Bum; Choe, Hyunmin; Jeong, Myung-Ho; Park, Jong-Seon; Shin, Eak-Kyun; Hernández, Felipe; Figueras, Jaume; Hernández, Rosana; López-Minguez, José Ramón; González Juanatey, José Ramón; Palop, Ramón López; Galeote, Guillermo; Chamnarnphol, Noppadol; Buddhari, Wacin; Sansanayudh, Nakarin; Kuanprasert, Srun; Penny, William; Lui, Charles; Grimmett, Garfield; Srinivasan, Venkatraman; Ariani, Kevin; Khan, Waqor; Blankenship, James; Cannon, Louis; Eisenberg, Steven; McLaurin, Brent; Mahoney, Paul; Greenberg, Jerry; Breall, Jeffrey; Chandna, Harish; Hockstad, Eric; Tolerico, Paul; Kao, John; Shroff, Adhir; Nseir, Georges; Greenbaum, Adam; Cohn, Joel; Gogia, Harinder; Nahhas, Ahed; Istfan, Pierre; Orlow, Steve; Spriggs, Douglas; Sklar, Joel; Paulus, Richard; Cochran, David; Smith, Robert; Ferrier, L. Norman; Scott, J. Christopher; Xenopoulos, Nicholaos; Mulumudi, Mahesh; Hoback, James; Ginete, Wilson; Ballard, William; Stella, Joseph; Voeltz, Michele; Staniloae, Cezar; Eaton, Gregory; Griffin, John; Kumar, Krishna; Ebrahimi, Ramin; O'Shaughnessy, Charles; Lundstrom, Lundstrom; Temizer, Dogan; Tam, Kenneth; Suarez, Jose; Raval, Amish; Kaufman, Jay; Brilakis, Emmanouil; Stillabower, Michael; Quealy, Kathleen; Nunez, Boris; Pow, Thomas; Samuels, Bruce; Argenal, Agustin; Srinivas, Vankeepuram; Rosenthal, Andrew; Tummala, Pradyumna; Myers, Paul; LaMarche, Nelson; Chan, Michael; Bach, Richard; Simon, Daniel; Kettelkamp, Richard; Helmy, Tarek; Schaer, Gary; Kosinski, Edward; Buchbinder, Maurice; Sharma, Mukesh; Goodwin, Mark; Horwitz, Phillip; Mann, J. Tift; Holmes, David; Angiolillo, Dominick; Rao, Sunil; Azrin, Michael; Gammon, Roger; Mavromatis, Kreton; Ahmed, Abdel; Kent, Kenneth; Zughaib, Marcel; Westcott, R. Jeffrey; Jain, Ash; Gruberg, Luis; LeGalley, Thomas

    2009-01-01

    BACKGROUND: Intravenous cangrelor, a rapid-acting, reversible adenosine diphosphate (ADP) receptor antagonist, might reduce ischemic events during percutaneous coronary intervention (PCI). METHODS: In this double-blind, placebo-controlled study, we randomly assigned 5362 patients who had not been

  9. PCI Compliance Understand and Implement Effective PCI Data Security Standard Compliance

    CERN Document Server

    Chuvakin, Anton

    2010-01-01

    Identity theft and other confidential information theft have now topped the charts as the #1 cybercrime. In particular, credit card data is preferred by cybercriminals. Is your payment processing secure and compliant?. Now in its second edition, PCI Compliance has been revised to follow the new PCI DSS standard 1.2.1. Also new to this edition: Each chapter has how-to guidance to walk you through implementing concepts, and real-world scenarios to help you relate to the information and better grasp how it impacts your data. This book provides the information that you need to understand the curre

  10. The feasibility of using Patients Concerns Inventory (PCI) in managing Malaysian oral cancer patients.

    Science.gov (United States)

    Hatta, J M M; Doss, J G; Rogers, S N

    2014-02-01

    The feasibility of using the Patients Concerns Inventory (PCI) to identify oral cancer patient concerns during consultation in oral and maxillofacial specialist clinics in Malaysia was assessed. A cross-sectional study was conducted using a consecutive clinical sampling technique of all new and follow-up oral cancer patients. Surgeons and counter staff were also recruited. Two-thirds of patients were elderly, 63.9% female, 55.6% Indian, 63.9% of lower-level education, and half had the lowest level household income. Patient status was mostly post-treatment (87.5%) and most were at cancer stage III/IV (63.9%); 59.7% had surgery. Patients took an average 5.9 min (95% CI 5.1-6.7 min) to complete the PCI. Physical domain appeared highest (94.4%); social/family relationship issues (4.2%) were lowest. Significant associations included patient age-personal function (P=0.02); patient education level-emotional status (P=0.05) and social/family relationship issues (P=0.04), and patient TNM staging-personal function (P=0.03). The patients' mean feasibility score for the PCI was 5.3 (95% CI 5.1-5.5) out of 6. Patients (93.1%) and surgeons (90%) found the PCI to be feasible. Only 57.1% of counter staff agreed on the use of the PCI during patient registration. Overall, the PCI was considered feasible, thus favouring its future use in routine oral cancer patient management. Copyright © 2013. Published by Elsevier Ltd.

  11. A shooting approach to suboptimal control

    Science.gov (United States)

    Hull, David G.; Sheen, Jyh-Jong

    1991-01-01

    The shooting method is used to solve the suboptimal control problem where the control history is assumed to be piecewise linear. Suboptimal solutions can be obtained without difficulty and can lead to accurate approximate controls and good starting multipliers for the regular shooting method by increasing the number of nodes. Optimal planar launch trajectories are presented for the advanced launch system.

  12. Bivalirudin started during emergency transport for primary PCI

    DEFF Research Database (Denmark)

    Steg, Philippe Gabriel; van 't Hof, Arnoud; Hamm, Christian W

    2013-01-01

    Bivalirudin, as compared with heparin and glycoprotein IIb/IIIa inhibitors, has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary intervention (PCI). Whether these benefits persist in contemporary practice characterized by prehospital initiation...... of treatment, optional use of glycoprotein IIb/IIIa inhibitors and novel P2Y12 inhibitors, and radial-artery PCI access use is unknown....

  13. Suboptimal glycemic control in type 2 diabetes

    DEFF Research Database (Denmark)

    Nefs, Giesje; Pouwer, F; Denollet, J

    2012-01-01

    , clinical, lifestyle and psychological factors between 2005 and 2009. The Edinburgh Depression Scale was used to assess symptoms of depressed mood, anhedonia and anxiety. Suboptimal glycemic control was defined as HbA(1c) values ≥7%, with 29.8% of the sample (n=1718) scoring above this cut......-off. In univariate logistic regression analyses, anhedonia was significantly associated with suboptimal glycemic control (OR 1.29, 95% CI 1.09-1.52), while both depressed mood (OR 1.04, 0.88-1.22) and anxiety (OR 0.99, 0.83-1.19) were not. The association between anhedonia and glycemic control remained after...

  14. Prognostic relevance of PCI-related myocardial infarction

    NARCIS (Netherlands)

    Woudstra, Pier; Grundeken, Maik J.; van de Hoef, Tim P.; Wallentin, Lars; Fox, Keith A.; de Winter, Robbert J.; Damman, Peter

    2013-01-01

    Procedure-related myocardial infarction (pMI) is directly associated with a coronary revascularization procedure, such as percutaneous coronary intervention (PCI) or CABG surgery. In contrast to spontaneous myocardial infarction (MI), the prognostic relevance of pMI is the subject of ongoing debate.

  15. Optimal catchment area and primary PCI centre volume revisited

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene

    2015-01-01

    AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres....... The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care....... stable at 32 minutes. Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon volume...

  16. Assessment of VME-PCI Interfaces with Linux Drivers

    CERN Document Server

    Schossmater, K; CERN. Geneva

    2000-01-01

    Abstract This report summarises the performance measurements and experiences recorded by testing three commercial VME-PCI interfaces with their Linux drivers. These interfaces are manufactured by Wiener, National Instruments and SBS Bit 3. The developed C programs are reading/writing a VME memory in different transfer modes via these interfaces. A dual processor HP Kayak XA-s workstation was used with the CERN certified Red Hat Linux 6.1 running on it.

  17. Implementing the Payment Card Industry (PCI Data Security Standard (DSS

    Directory of Open Access Journals (Sweden)

    John O' Raw

    2011-08-01

    Full Text Available Underpinned by the rise in online criminality, the payment card industry (PCI data security standards (DSS were introduced which outlines a subset of the core principals and requirements that must be followed, including precautions relating to the software that processes credit card data. The necessity to implement these requirements in existing software applications can present software owners and developers with a range of issues. We present here a generic solution to the sensitive issue of PCI compliance where aspect orientated programming (AOP can be applied to meet the requirement of masking the primary account number (PAN. Our architecture allows a definite amount of code to be added which intercepts all the methods specified in the aspect, regardless of future additions to the system thus reducing the amount of work required to the maintain aspect. We believe that the concepts here will provide an insight into how to approach the PCI requirements to undertake the task. The software artefact should also serve as a guide to developers attempting to implement new applications, where security and design are fundamental elements that should be considered through each phase of the software development lifecycle and not as an afterthought.

  18. Efficacy and safety of transradial percutaneous coronary intervention using sheathless guide catheter technique

    Directory of Open Access Journals (Sweden)

    Mohamed Aboel-Kassem F. Abdelmegid

    2014-03-01

    Conclusions: TR PCI via standard and sheathless hydrophilic-coated GC techniques are effective and safe with high rate of procedural success and low rate of asymptomatic radial artery occlusion. Moreover, TR PCI using sheathless GC technique has the advantage of performing complex intervention requiring large bore catheters that can not be performed via standard TR PCI using 6F GC.

  19. On Suboptimal Solution of Antagonistic Matrix Games

    Directory of Open Access Journals (Sweden)

    Goryashko Alexander

    2017-01-01

    Full Text Available The paper examines resource allocation games such as Colonel Blotto and Colonel Lotto games with the goal to develop tractable method for building suboptimal solution in mixed strategies of these games without solving the relevant optimization problem. The foundation of proposed method lies in the specific combinatorial properties of the partition games. It turned out that as far as distribution of resource along battlefield is concerned that pure strategies participating in ε-optimal solution possessed specific structure. Numerical experiments showed that these specific structural peculiarities can be easily reproduced utilizing previously found combinatorial properties of partition. As a result, we get ε-optimal solution of partition games and support set mixed strategies can be computed in polynomial time.

  20. 100 Gbps PCI-Express Readout for the LHCb Upgrade

    CERN Document Server

    Durante, Paolo; Schwemmer, Rainer; Marconi, Umberto; Balbi, Gabriele; Lax, Ignazio

    2015-01-01

    We present a new data acquisition system under development for the next upgrade of the LHCb experiment at CERN. We focus in particular on the design of a new common readout board, the PCIe40, and on the viability of PCI-Express as an interconnect technology for high speed readout. We describe a new high-performance DMA controller for data acquisition, implemented on an FPGA, coupled with a custom software module for the Linux kernel. Lastly, we describe how these components can be leveraged to achieve a throughput of 100 Gbit/s per readout board.

  1. Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

    Science.gov (United States)

    Polk, James D.; Parazynski, Scott; Kelly, Scott; Hurst, Victor, IV; Doerr, Harold K.

    2007-01-01

    Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present

  2. PCI coals: quality parameters for an efficient usage; Carvoes para PCI: parametros de qualidade para uma utilizacao eficiente

    Energy Technology Data Exchange (ETDEWEB)

    Holcombe, D.; Coin, C.D.A. [Australian Coal Industry Research Labs., Riverview, QLD (Australia); Caldeira Filho, J.G [P.D.C.A. Consultoria Empresarial, Volta Redonda, RJ (Brazil)

    1996-12-31

    The technology of chemical reduction in blast furnaces has been presenting an increase in coke injection rates during the last five years. Even though the blast furnaces have been achieving excellent production rates, there is still a discussion in the community concerning which types of coke are more appropriate to the operation as well as the limits of coke injection through the blasts. This work discusses the role of PCI in metallurgy as well as its limitations giving special emphasis to the several quality parameters in the process 16 refs., 2 tabs.

  3. Macrophage mediated PCI enhanced gene-directed enzyme prodrug therapy

    Science.gov (United States)

    Christie, Catherine E.; Zamora, Genesis; Kwon, Young J.; Berg, Kristian; Madsen, Steen J.; Hirschberg, Henry

    2015-03-01

    Photochemical internalization (PCI) is a photodynamic therapy-based approach for improving the delivery of macromolecules and genes into the cell cytosol. Prodrug activating gene therapy (suicide gene therapy) employing the transduction of the E. coli cytosine deaminase (CD) gene into tumor cells, is a promising method. Expression of this gene within the target cell produces an enzyme that converts the nontoxic prodrug, 5-FC, to the toxic metabolite, 5-fluorouracil (5-FU). 5-FC may be particularly suitable for brain tumors, because it can readily cross the bloodbrain barrier (BBB). In addition the bystander effect, where activated drug is exported from the transfected cancer cells into the tumor microenvironment, plays an important role by inhibiting growth of adjacent tumor cells. Tumor-associated macrophages (TAMs) are frequently found in and around glioblastomas. Monocytes or macrophages (Ma) loaded with drugs, nanoparticles or photosensitizers could therefore be used to target tumors by local synthesis of chemo attractive factors. The basic concept is to combine PCI, to enhance the ex vivo transfection of a suicide gene into Ma, employing specially designed core/shell NP as gene carrier.

  4. Outcome of the sub-optimal dialysis starter on peritoneal dialysis. Report from the French Language Peritoneal Dialysis Registry (RDPLF).

    Science.gov (United States)

    Lobbedez, Thierry; Verger, Christian; Ryckelynck, Jean-Philippe; Fabre, Emmanuel; Evans, David

    2013-05-01

    This study was carried out to examine the association of sub-optimal dialysis initiation of peritoneal dialysis (PD) with all the possible outcomes on PD using survival analysis in the presence of competing risks. This was a retrospective cohort study based on the data of the French Language Peritoneal Dialysis Registry. We analysed 8527 incident patients starting PD between January 2002 and December 2010. The end of the observation period was 01 June 2011. Times from the start of PD to death, transplantation, transfer to haemodialysis (HD) and first peritonitis episode were calculated. The sub-optimal dialysis initiation was defined by a period of <30 days on HD before PD initiation. Among 8527 patients, there were 568 patients who started PD after <30 days on HD. There were 6562 events: 3078 deaths, 2136 transfers to HD, 1348 renal transplantations. When using a Fine and Gray model, sub-optimal dialysis start, early peritonitis and transplant failure were associated with a higher sub-distribution relative hazard of technique failure. There was no association between the sub-optimal dialysis start and the sub-distribution hazard of death or transplantation. In the multivariate analysis using a Fine and Gray regression model, the sub-optimal dialysis start was not associated with a higher sub distribution relative hazard of peritonitis. Sub-optimal dialysis initiation is neither associated with a higher risk of death nor with a lower risk of renal transplantation. Sub-optimal PD patients had a higher risk of transfer to HD.

  5. Robotic PCI – Has It Come of Age?

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2016-07-01

    Full Text Available Last issue of the Journal contained an article on the benefits of robotic telesurgery. Now we would like to examine another aspect of robotics in medicine - Robotic enhanced percutaneous coronary intervention (PCI. The first-in-humans pilot clinical trial involving 18 patients was published in 2006. In this study angioplasty guidewire, balloon and stents were navigated by a computerized system. The guidewire could cross the lesion successfully in 17 cases and 15 of these cases could be successfully completed by remote navigation. The remaining 3 cases were completed manually. The proposed advantages of the system was a significantly lower radiation exposure to the operator and possibly more precise positioning of the coronary stent. There was no increase in fluoroscopy time.

  6. Effect of platelet inhibition with cangrelor during PCI on ischemic events

    NARCIS (Netherlands)

    Bhatt, Deepak L.; Stone, Gregg W.; Mahaffey, Kenneth W.; Gibson, C. Michael; Steg, P. Gabriel; Hamm, Christian W.; Price, Matthew J.; Leonardi, Sergio; Gallup, Dianne; Bramucci, Ezio; Radke, Peter W.; Widimský, Petr; Tousek, Frantisek; Tauth, Jeffrey; Spriggs, Douglas; McLaurin, Brent T.; Angiolillo, Dominick J.; Généreux, Philippe; Liu, Tiepu; Prats, Jayne; Todd, Meredith; Skerjanec, Simona; White, Harvey D.; Harrington, Robert A.; Steg, Gabriel; Huber, Kurt; Lima, Valter C.; Jorgova-Makedonska, Julia B.; Kobulia, Bondo; Witkowski, Adam; Shlyakhto, Evgeny; van de Werf, Frans; Faxon, David P.; Ohman, E. Magnus; Verheugt, Freek W. A.; Weaver, W. Douglas; Tijssen, Jan G. P.; Wilson, Matthew; Mangum, Stacey; Lopes, Renato D.; Melloni, Chiara; Brennan, Matthew J.; Tricoci, Pierluigi; Harrison, Robert; Barros, Pedro; Armaganijan, Luciana; Anderson, Monique; Bagai, Akshay; Brener, Sorin J.; LaSalle, Laura; Benzer, Werner; Delle-Karth, Georg; Leisch, Franz; Abdalla Saad, Jamil; Abizaid, Alexandre; Formiga Areas, Carlos Augusto; Ribeiro, Expedito E.; Rossi Dos Santos, Fabio; Tadeu Tumelero, Rogerio; Vieira Botelho, Roberto; Atzev, Borislav; Boichev, Boicho; Grigorov, Georgi; Penkov, Nikolay; Petrov, Ivo; Zehirov, Boris; Cervinka, Pavel; Coufal, Zdenek; Hajek, Petr; Horak, David; Kala, Petr; Kmonicek, Petr; Kocka, Viktor; Mrozek, Jan; Simek, Stanislav; Sitar, Jan; Stasek, Josef; Chapidze, Gulnara; Emukhvari, Nodar; Khabeishvili, George; Mamatsashvili, Merab; Shaburishvili, Tamaz; Behrens, Steffen; Darius, Harald; Dissmann, Martin; Fichtlscherer, Stephan; Franz, Wolfgang; Geisler, Tobias; Genth-Zotz, Sabine; Goldmann, Britta; Heuer, Hubertus; Hoffmann, Stefan; Mugge, Andreas; Poerner, Tudor; Radke, Peter; Richardt, Gert; Stellbrink, Christoph; Werner, Nikos; de Servi, Stefano; Galasso, Gennaro; Menozzi, Alberto; Musumeci, Giuseppe; Picchi, Andrea; Presbitero, Patrizia; Devlin, Gerard; Sasse, Alexander; Scott, Douglas; Stewart, Ralph; Andrzej, Szyszka; Dubaniewicz, Witold; Gasior, Zbigniew; Kasprzak, Jaroslaw; Kleinrok, Andrzej; Kornacewicz-Jach, Zdzislawa; Rynkiewicz, Andrzej; Sosnowski, Cezary; Targonski, Radoslaw; Trebacz, Jaroslaw; Zinka, Elzbieta; Barbarash, Olga; Dovgalevsky, Yakov; Gordeev, Ivan; Kalinina, Svetlana; Kosmachova, Elena; Linev, Kirill; Markov, Valentin; Pavlov, Prokhor; Shalaev, Sergey; Shogenov, Zaur; Sukmanova, Irina; Vasilieva, Elena; Yakovlev, Alexey; Boonbaichaiyapruck, Sarana; Chamnarnphol, Noppadol; Kaewsuwanna, Pinij; Kuanprasert, Srun; Piyayotai, Dilok; Amine, Maged; Angiolillo, Dominick; Arif, Imran; Blankenship, James; Brilakis, Emmanouil; Chan, Michael; Cinderella, Joseph; Davis, Brent; Devireddy, Chandanreddy; Dorogy, Mark; Douglas, John; Ferrier, Norman; Fisher, Daniel; Foster, Robert; French, William; Galla, John; Gimple, Lawrence; Gogia, Harinder; Gogo, Prospero; Gollapudi, Raghava; Gruberg, Luis; Hermiller, James; Heuser, Richard; Iwaoka, Robert; Jafar, Zubair; Kimmelstiel, Carey; Kinlay, Scott; Leggett, James; Leimgruber, Pierre; Letts, Dustin; Lipsitt, Michael; Low, Reginald; Martinez-Arraras, Joaquin; Mayhew, Marc; McLaurin, Brent; McWhirter, Paul; Mirza, Ayoub; Negus, Brian; Nygaard, Thomas; O'Riordan, William; Paulus, Richard; Petersen, John; Picon, Hector; Picone, Mark; Price, Matthew; Rivera, Ernesto; Rizik, David; Rodriguez, Arsenio; Saucedo, Jorge; Scott, J. Christopher; Sethi, Virender; Shroff, Adhir; Siegel, Craig; Steinberg, Daniel; Stillabower, Michael; Stuckey, Thomas; Suarez, Jose; Temizer, Dogan; Vidovich, Mladen; Voeltz, Michele; Waltman, Jonathan; Wilensky, Michael

    2013-01-01

    The intensity of antiplatelet therapy during percutaneous coronary intervention (PCI) is an important determinant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that acts rapidly and has quickly reversible effects. In a

  7. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Tebbe, Ulrich; Wöhrle, Jochen; Pachinger, Otmar; Busch, Clemens; Pfeiffer, Nathalie; Neumer, Alexander; Ouarrak, Taoufik; Reimer, Thomas; Lober, Christiane; Clemmensen, Peter; Follath, Ferenc; Wegscheider, Karl; Zeitouni, M.; Overtchouk, P.; Guedeney, P.; Hage, G.; Hauguel-Moreau, N. N.; Eitel, Ingo; Weinschenk, Sabrina; Borggrefe, Martin; Neumann, Franz-Josef; Ferenc, Miroslaw; Olbrich, Hans-Gerd; Hopf, Hans-Bernd; Kastrati, Adnan; de Waha, Antoinette; Schunkert, Heribert; Richardt, Gert; Schwarz, Bettina; Abdel-Wahab, Mohamed; Toelg, Ralph; Geist, Volker; Bahnsen-Maaß, Monika; Hennersdorf, Marcus; Graf, Jochen; Riemann, Urs; Scharpf, Dominik; Empen, Klaus; Busch, Mathias C.; Werdan, Karl; Nuding, Sebastian; Hambrecht, Rainer; Fiehn, Eduard; Gitt, Anselm K.; Mark, Bernd; Winkler, Ralph; Lauer, Bernward; Möbius-Winkler, Sven; Schulze, Christian; Minden, Hans-Heinrich; Braun-Dullaeus, Rüdiger C.; Schmeißer, Alexander; Strasser, Ruth H.; Ebner, Bernd; Ertl, Georg; Mudra, Harald; Hug, Martin; Endemann, Dierk; Hamm, Christian; Walther, Claudia; Liebetrau, Christoph; Menck, Niels; Mehilli, Julinda; Orban, Martin; Hausleiter, Jörg; Massberg, Steffen; Prondzinsky, Roland; Gielen, Stephan; Gawaz, Meinrad; Pauschinger, Matthias; Ademaj, Fadil; Bode, Christoph; Nickenig, Georg; Fichtlscherer, Stephan; Zeiher, Andreas; Viertel, Achim; Kelm, Malte; Jung, Christian; Sydow, Carsten; Karakas, Mahir; Rudolph, Volker; Baldus, Stephan; Jacobshagen, Claudius; Hasenfuß, Gerd; Pfeiffer, Dietrich; Buchter, Björn; Hügl, Burkhard; Nef, Holger; Dörr, Oliver; Reinig, Karsten; Kuck, Karl Heinz; Ghanem, Alexander; Katus, Hugo; Gori, Tommaso; Münzel, Thomas; Schnupp, Steffen; Brachmann, Johannes; Ferrari, Markus; Achenbach, Stephan; Carrié, Didier; Henry, Patrick; Manzo-Silberman, Stephane; Ledermann, Bertrand; Cayla, Guillaume; Bonnet, Jean-Louis; Windecker, Stefan; Frenk, André; Jeger, Raban; Eeckhout, Eric; Henriques, Jose P.; van Geuns, Robert-Jan; Voskuil, Michiel; Bax, M.; van der Harst, Pim; Serpytis, Rokas; Jarasuniene, Dalia; Lang, Irene Marthe; Pichler, Philipp; Weidinger, Franz; Zaruba, Marc-Michael; Dudek, Darius; Depukat, Rafal; Witkowski, Adam; Milewski, Krzysztof; Prokopczuk, Janusz; Gąsior, Mariusz; Gorycki, Bogdan; Ochała, Andrzej; Piatti, Luigi; Galvani, Marcello; Bossi, Irene; Emilia, Reggio; Pignatelli, Gianluca; Greenwood, John; Lockie, Tim; Mamas, Mamas

    2017-01-01

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be

  8. Success Rate of Szabo Technique in Ostial Coronary Pci. Techniques, Angiographic and IVUS Findings

    Directory of Open Access Journals (Sweden)

    MJ Zibaeenezhad

    2009-09-01

    Full Text Available Background: The purpose of this prospective study is to quantify the risk of lower limb deep venous thrombosis (DVT in patients requiring temporary transvenous femoral pacing and to evaluate the use of different enoxaparin dosages (prophylactic or therapeutic for thrombus prevention. Transvenous temporary cardiac pacemaker, with catheters frequently used along the femoral vein is useful to relieve difficult bradyarrythmias and some tachyarrythmias. Up to one-third of patients receiving transfemoral pacing develop asymptomatic DVT. At present, there are no recommendations for thrombus prophylaxis in these patients. Besides, the efficacy in this specific condition has not been studied.Methods: Sixty consecutive patients who underwent transvenous femoral pacing and had no contraindication to low molecular weight heparin (LMWH therapy were divided into 3 groups each group consisted of 20 patients. Group I received prophylactic enoxaparin (1mg/kg/day; subcutaneously, group II received therapeutic enoxaparin (1 mg/kg/day every 12 hours; subcutaneously, and group III consisting of patients who were not treated with enoxaparin was considered as control group. Patients were evaluated daily for clinical features of DVT. Color Doppler sonography imaging was performed on both lower limbs of all patients within 24 hours after removal of the temporary pacemakers.Results: Of the sixty patients, two who belonged to group III, had definitive evidence of right lower limb DVT by color Doppler sonography. These two cases of DVT were asymptomatic and had thrombosis of femoral vein. No evidence of thrombus was detected in contra lateral lower limb. No DVT was detected among patients who received prophylactic or therapeutic doses of enoxaparin. No heparin related complications were detected in this study. There were no significant difference in the clinical characteristics among 2 groups (I, II and control group. Correlations of age and gender with occurrence of DVT were not significant (P= 0.512, 0.737.Conclusions: This study showed that DVT is a common complication of femoral pacing, and that its incidence can be reduced with the use of prophylaxis and therapeutic intravenous enoxaparin.

  9. Lack of consensus in biomarker measurement to diagnose PCI-related myocardial infarction

    DEFF Research Database (Denmark)

    Al-Dakhiel, Zaid; Rune Larsen, Søren; Svenstrup Poulsen, Tina

    2008-01-01

    the questionnaire. In none of six centres the proposed 3-sample testing of biomarkers had been followed. A pre-PCI sample was taken in one centre. In approximately half of the centres biomarkers were only measured on clinical indication. Conclusion. Biomarker sampling for procedure-related MI according to the 2 000......Objective. To evaluate if biomarker sampling in PCI has adhered to the 2 000 consensus document for the diagnosis of procedure-related myocardial infarction (MI). Design. Firstly, a review of relevant papers from 2000 to September 2007 was done. Secondly, in October 2007, a questionnaire addressing...... biomarker sampling in routine PCI was sent to Danish PCI centres. Results. Fourteen papers fulfilled the selection criteria. In six studies serial sampling according to the consensus document had been done. Biomarker measuring before PCI was not performed in four studies. All centres answered...

  10. Potential of Pseudomonas putida PCI2 for the Protection of Tomato Plants Against Fungal Pathogens.

    Science.gov (United States)

    Pastor, Nicolás; Masciarelli, Oscar; Fischer, Sonia; Luna, Virginia; Rovera, Marisa

    2016-09-01

    Tomato is one of the most economically attractive vegetable crops due to its high yields. Diseases cause significant losses in tomato production worldwide. We carried out Polymerase Chain Reaction studies to detect the presence of genes encoding antifungal compounds in the DNA of Pseudomonas putida strain PCI2. We also used liquid chromatography-electrospray tandem mass spectrometry to detect and quantify the production of compounds that increase the resistance of plants to diseases from culture supernatants of PCI2. In addition, we investigated the presence of 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase in PCI2. Finally, PCI2 was used for inoculation of tomato seeds to study its potential biocontrol activity against Fusarium oxysporum MR193. The obtained results showed that no fragments for the encoding genes of hydrogen cyanide, pyoluteorin, 2,4-diacetylphloroglucinol, pyrrolnitrin, or phenazine-1-carboxylic acid were amplified from the DNA of PCI2. On the other hand, PCI2 produced salicylic acid and jasmonic acid in Luria-Bertani medium and grew in a culture medium containing ACC as the sole nitrogen source. We observed a reduction in disease incidence from 53.33 % in the pathogen control to 30 % in tomato plants pre-inoculated with PCI2 as well as increases in shoot and root dry weights in inoculated plants, as compared to the pathogenicity control. This study suggests that inoculation of tomato seeds with P. putida PCI2 increases the resistance of plants to root rot caused by F. oxysporum and that PCI2 produces compounds that may be involved at different levels in increasing such resistance. Thus, PCI2 could represent a non-contaminating management strategy potentially applicable in vegetable crops such as tomato.

  11. Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).

    Science.gov (United States)

    Mazzei, Maria Antonietta; Khader, Leila; Cirigliano, Alfredo; Cioffi Squitieri, Nevada; Guerrini, Susanna; Forzoni, Beatrice; Marrelli, Daniele; Roviello, Franco; Mazzei, Francesco Giuseppe; Volterrani, Luca

    2013-12-01

    To evaluate the accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction surgery. Pre-HIPEC CT examinations of 43 patients with advanced ovarian cancer after neoadjuvant chemotherapy were analyzed by two radiologists. The PCI was scored according to the Sugarbaker classification, based on lesion size and distribution. The results were compared with macroscopic and histologic data after peritonectomy and HIPEC. To evaluate the accuracy of MDCT to detect and localize peritoneal carcinomatosis, both patient-level and regional-level analyses were conducted. A correlation between PCI CT and histologic values for each patient was searched according to the PCI grading. Considering the patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV, and an accuracy in detecting the peritoneal carcinomatosis of 100 %, 40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the correlation between CT and histology. Our results encourage the use of MDCT as the only technique sufficient to select patients with peritoneal carcinomatosis for cytoreductive surgery and HIPEC on the condition that a CT examination will be performed using a dedicated protocol optimized to detect minimal peritoneal disease and CT images will be analyzed by an experienced reader.

  12. A convex programming framework for optimal and bounded suboptimal well field management

    DEFF Research Database (Denmark)

    Dorini, Gianluca Fabio; Thordarson, Fannar Ørn; Bauer-Gottwein, Peter

    2012-01-01

    are often convex, hence global optimality can be attained by a wealth of algorithms. Among these, the Interior Point methods are extensively employed for practical applications, as they are capable of efficiently solving large-scale problems. Despite this, management models explicitly embedding both systems...... without simplifications are rare, and they usually involve heuristic techniques. The main limitation with heuristics is that neither optimality nor suboptimality bounds can be guarantee. This paper extends the proof of convexity to mixed management models, enabling the use of Interior Point techniques...... to compute globally optimal management solutions. If convexity is not achieved, it is shown how suboptimal solutions can be computed, and how to bind their deviation from the optimality. Experimental results obtained by testing the methodology in a well field located nearby Copenhagen (DK), show...

  13. Suboptimal light conditions influence source-sink metabolism during flowering

    Directory of Open Access Journals (Sweden)

    Annelies eChristiaens

    2016-03-01

    Full Text Available Reliance on carbohydrates during flower forcing was investigated in one early and one late flowering cultivar of azalea (Rhododendron simsii hybrids. Carbohydrate accumulation, invertase activity, and expression of a purported sucrose synthase gene (RsSUS was monitored during flower forcing under suboptimal (natural and optimal (supplemental light light conditions, after a cold treatment (7°C + dark to break flower bud dormancy. Post-production sucrose metabolism and flowering quality was also assessed. Glucose and fructose concentrations and invertase activity increased in petals during flowering, while sucrose decreased. In suboptimal light conditions RsSUS expression in leaves increased as compared to optimal light conditions, indicating that plants in suboptimal light conditions have a strong demand for carbohydrates. However, carbohydrates in leaves were markedly lower in suboptimal light conditions compared to optimal light conditions. This resulted in poor flowering of plants in suboptimal light conditions. Post-production flowering relied on the stored leaf carbon, which could be accumulated under optimal light conditions in the greenhouse. These results show that flower opening in azalea relies on carbohydrates imported from leaves and is source-limiting under suboptimal light conditions.

  14. Uma interface PCI para periféricos de alta velocidade

    OpenAIRE

    de Lima Pereira, Adilson

    2003-01-01

    Peripheral Component Interconnect (PCI) é um protocolo de comunicação para dispositivos de alta velocidade que requerem uma alta vazão de dados (throughput), tais como, controladores de vídeo e de rede de computadores. O protocolo PCI é um protocolo síncrono e possui várias versões com diferentes larguras de barramento e freqüência. Esta dissertação, em particular, trata da implementação do protocolo PCI para dispositivos do tipo escravos targets, versão 2.2, com 32 bits de dad...

  15. Fractional flow reserve-guided PCI for stable coronary artery disease

    DEFF Research Database (Denmark)

    De Bruyne, Bernard; Fearon, William F; Pijls, Nico H J

    2014-01-01

    BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we...... years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P=0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved...

  16. Predictors of subjective health status 10 years post-PCI

    Directory of Open Access Journals (Sweden)

    Jan C. van den Berge

    2016-06-01

    Conclusions: SF-36 scores at baseline, age, and previous PCI were significant predictors of subjective health status 10 years post-PCI. Specifically, the SF-36 score at baseline was an important predictor. Thus assessment of subjective health status at baseline is useful as an indicator to predict long-term subjective health status. Subjective health status becomes better by optimal medical treatment, cardiac rehabilitation and psychosocial support. This is the first study determining predictors of subjective health status 10 years post-PCI.

  17. Computational Fluid Dynamics (CFD) Modeling for High Rate Pulverized Coal Injection (PCI) into the Blast Furnace

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Chenn Zhou

    2008-10-15

    Pulverized coal injection (PCI) into the blast furnace (BF) has been recognized as an effective way to decrease the coke and total energy consumption along with minimization of environmental impacts. However, increasing the amount of coal injected into the BF is currently limited by the lack of knowledge of some issues related to the process. It is therefore important to understand the complex physical and chemical phenomena in the PCI process. Due to the difficulty in attaining trus BF measurements, Computational fluid dynamics (CFD) modeling has been identified as a useful technology to provide such knowledge. CFD simulation is powerful for providing detailed information on flow properties and performing parametric studies for process design and optimization. In this project, comprehensive 3-D CFD models have been developed to simulate the PCI process under actual furnace conditions. These models provide raceway size and flow property distributions. The results have provided guidance for optimizing the PCI process.

  18. Optical coherence tomography guided PCI – Initial experience at Apollo Health City, Jubilee Hills, Hyderabad

    Directory of Open Access Journals (Sweden)

    Pratap Chandra Rath

    2014-01-01

    Conclusion: OCT makes better visualization of plaque, thrombus, stent malapposition, dissection, plaque prolapse and helps in optimization of PCI results. More extensive, long-term studies will be needed to assess the prognostic implications of these findings.

  19. An Implement of FPGA Based PCI Controller Device and Improvement of DDA Arc Interpolation

    Directory of Open Access Journals (Sweden)

    Zhengjie Zhang

    2014-01-01

    Full Text Available The main purpose of this paper is to develop a new kind of PCI slave device serving as a motion controller for a biaxial motion control system. This kind of controller device is a new realization scheme of PCI devices, which is embedded with a deeply customized PCI interface block instead of traditional PCI interface chips, which will greatly promote the comprehensive performance of the device. Besides, we improved the popular and widely used DDA arc interpolation algorithm, promoting its performance in both accuracy and stability, and integrated it into our device, allowing the ability of the moving parts to move along nonlinear curve paths. Currently, this kind of controller device has been successfully applied on a surface mount machine which is also developed by our lab. As a result, the controller device performs well and is able to satisfy the requirement of accuracy and velocity of the surface mount machine. And its reliability and stability are also remarkable.

  20. Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time

    DEFF Research Database (Denmark)

    Terkelsen, C J; Christiansen, E H; Sørensen, J T

    2009-01-01

    There is a continuing controversy about the acceptable time-window for primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Recent American and European guidelines recommend PPCI if the delay in performing PPCI instead of administering...... fibrinolysis (PCI-related delay) is literature, this viewpoint recommends a revision of the guidelines. The evidence supports an acceptable PCI-related delay of 80-120 min and PPCI as the better reperfusion strategy also in the early...

  1. Suboptimal palliative sedation in primary care: an exploration.

    Science.gov (United States)

    Pype, Peter; Teuwen, Inge; Mertens, Fien; Sercu, Marij; De Sutter, An

    2017-06-05

    Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/ or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.

  2. Suboptimal Rate Adaptive Resource Allocation for Downlink OFDMA Systems

    Directory of Open Access Journals (Sweden)

    Sanam Sadr

    2009-01-01

    Full Text Available This paper aims to study the performance of low complexity adaptive resource allocation in the downlink of OFDMA systems with fixed or variable rate requirements (with fairness consideration. Two suboptimal resource allocation algorithms are proposed using the simplifying assumption of transmit power over the entire bandwidth. The objective of the first algorithm is to maximize the total throughput while maintaining rate proportionality among the users. The proposed suboptimal algorithm prioritizes the user with the highest sensitivity to the subcarrier allocation, and the variance over the subchannel gains is used to define the sensitivity of each user. The second algorithm concerns rate adaptive resource allocation in multiuser systems with fixed rate constraints. We propose a suboptimal joint subchannel and power allocation algorithm which prioritizes the users with the highest required data rates. The main feature of this algorithm is its low complexity while achieving the rate requirements.

  3. Administration of eptifibatide during transfer for primary PCI in patients with STEMI: effect on Pre-PCI TIMI flow and its correlation with pain-to-therapy time.

    Science.gov (United States)

    Aquilina, Matteo; Varani, Elisabetta; Balducelli, Marco; Vecchi, Giuseppe; Frassineti, Valeria; Maresta, Aleardo

    2009-03-01

    Facilitation therapy in ST-elevation myocardial infarction (STEMI) is still controversial and no relationship between timing of treatment and efficacy has been reported to date. In order to evaluate the effect of pre-catheterization laboratory (cath lab) administration of eptifibatide on pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow and its correlation with ischemia duration, we studied all 438 STEMI patients treated with primary PCI from January 2006 to December 2007: 310 patients were pretreated with eptifibatide (Group P), while 128 patients received either no glycoprotein IIb/IIIa inhibitors or were only given them in the cath lab (Group C). All ischemia times (chest pain onset, diagnostic electrocardiogram, eptifibatide administration, cath lab arrival, first balloon inflation) were recorded. Group P was divided into early (E:159 patients with symptoms duration eptifibatide administration. Pretreatment with eptifibatide and symptom duration of or= 2 flow on multivariable analysis. Thirtyday mortality was 1.9% in Group P and 9.5% in Group C (p eptifibatide therapy prior to primary PCI achieves a higher rate of pre-PCI TIMI flow >or= 2 with respect to late administration.

  4. Suboptimal care in stillbirths - a retrospective audit study.

    Science.gov (United States)

    Saastad, Eli; Vangen, Siri; Frøen, J Frederik

    2007-01-01

    Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub-optimal factors in stillbirths were more frequent among non-western than western women. Population-based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998-2003 (4.2 per 1,000 deliveries); of these 31% were born to non-western women. By audit, the stillbirths were attributed to optimal or sub-optimal care factors. Multivariate methods were used to analyse the data. Sub-optimal factors were identified in 37% of the deaths. When compared to western women, non-western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3-3.8), and an increased risk of sub-optimal care (OR: 2.4; 95% CI: 1.5-3.9). More often, non-western women received sub-optimal obstetric care (plabour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non-western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non-western mothers; an interpreter was used in 29% of these cases. Non-western women constituted a risk group for sub-optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non-western women.

  5. Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen

    2010-01-01

    Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

  6. Optimal and Suboptimal Noises Enhancing Mutual Information in Threshold System

    Science.gov (United States)

    Zhai, Qiqing; Wang, Youguo

    2016-05-01

    In this paper, we investigate the efficacy of noise enhancing information transmission in a threshold system. At first, in the frame of stochastic resonance (SR), optimal noise (Opt N) is derived to maximize mutual information (MI) of this nonlinear system. When input signal is discrete (binary), the optimal SR noise is found to have a finite distribution. In contrast, when input signal is continuous, the optimal SR noise is a constant one. In addition, suboptimal SR noises are explored as well with optimization methods when the types of noise added into the system are predetermined. We find that for small thresholds, suboptimal noises do not exist. Only when thresholds reach some level, do suboptimal noises come into effect. Meanwhile, we have discussed the impact of tails in noise distribution on SR effect. Finally, this paper extends the single-threshold system to an array of multi-threshold devices and presents the corresponding efficacy of information transmission produced by optimal and suboptimal SR noises. These results may be beneficial to quantization and coding.

  7. Suboptimal Utilisation of Resources in Sub-Saharan African Higher ...

    African Journals Online (AJOL)

    Suboptimal Utilisation of Resources in Sub-Saharan African Higher Education Institutions: the Case of Teaching Space at Makerere University. ... This means that the institutions need to evaluate their utilization of these resources—to pinpoint their need for the resources and potential for quality assurance. This paper reports ...

  8. When animals misbehave: analogs of human biases and suboptimal choice.

    Science.gov (United States)

    Zentall, Thomas R

    2015-03-01

    Humans tend to value rewards more if they have had to work hard to obtain them (justification of effort). Similarly they tend to persist in a task even when they would be better off beginning a new one (sunk cost). Humans also often give greater value to objects of good quality than the same objects together with objects of lesser quality (the less is more effect). Commercial gambling (lotteries and slot machines) is another example of suboptimal choice by humans because on average the rewards are less than the investment. In another example of a systematic bias, when humans try to estimate the probability of the occurrence of a low probability event, they often give too much weight to the results of a test, in spite of the fact that the known probability of a false alarm reduces the predictive value of the test (base rate neglect). In each of these examples, we have found that pigeons show a similar tendency to choose suboptimally. When one can show comparable findings of suboptimal choice in animals it suggests that whereas culture may reinforce certain suboptimal behavior, the behavior is likely to result from the overgeneralization of basic behavioral processes or predisposed heuristics that may have been appropriate in natural environments. This article is part of a Special Issue entitled: "Tribute to Tom Zentall." Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Prevalence and predictors of sub-optimal medication adherence ...

    African Journals Online (AJOL)

    In this study, the levels of adherence, prevalence and the predictors of suboptimal adherence were assessed in a sub-Saharan African setting. Methods: Three hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the ...

  10. PCI Outcomes in U.S. Hospitals with Varying Structural Characteristics: Analysis of the NCDR® CathPCI Registry®

    Science.gov (United States)

    Cram, Peter; House, John A.; Messenger, John; Piana, Robert N.; Horwitz, Phillip A; Spertus, John A.

    2011-01-01

    Background In the U.S. there continues to be debate about whether certain types of hospitals deliver improved patient outcomes. We sought to assess the association between hospital organizational characteristics and in-hospital outcomes for percutaneous coronary intervention (PCI). Methods Retrospective analysis of 2004-2007 data for 694 U.S. hospitals participating in the American College of Cardiology NCDR® CathPCI Registry®. Our analysis focused on 1,113,554 patients who underwent PCI in 471 not-for-profit (NFP) hospitals, 131 major teaching hospitals, 79 for-profit (FP) hospitals, and 13 physician-owned specialty hospitals. Outcomes included in-hospital mortality, stroke, bleeding, vascular injury and a composite representing one or more of the individual complications. We used the current NCDR mortality risk model to calculate risk standardized mortality ratios (RSMR) for each category of hospital and compared hospital groupings for all patients in aggregate and in subgroups stratified by patients' indications for PCI. Results Patients treated in major teaching hospitals were younger, while FP hospitals performed greater proportion of PCI for patients with ST-elevation myocardial infarction (STEMI)(P<.0001). Specialty hospitals treated patients with less acuity including a lower proportion of patients with STEMI. In unadjusted analyses, specialty hospitals had significantly lower rates of all adverse outcomes compared to NFP, teaching, and FP hospitals including in-hospital mortality (0.7%, 1.2%, 1.4%, and 1.4% respectively; P<.001) and the composite endpoint (2.4%, 4.1%, 4.6%, 4.3%; P<.001). In adjusted analyses, RSMR was significantly lower for specialty hospitals when compared to the other three groups for all patients in-aggregate (RSMR 1.05%, 1.30%, 1.38%, 1.39%; P<.001); these differences remained clinically significant but were no longer statistically significant for all subgroup analyses. Conclusions Specialty hospitals appear to have lower rates of

  11. Management of adjunctive antithrombotic therapy in STEMI patients treated with fibrinolysis undergoing rescue or delayed PCI.

    Science.gov (United States)

    Capodanno, Davide; Angiolillo, Dominick J

    2015-11-01

    Although primary percutaneous coronary intervention (PCI) is the recommended method of reperfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI), fibrinolysis remains a beneficial alternative in patients who cannot be reperfused timely with primary PCI, and is still the preferred revascularisation strategy in many parts of the world where PCI facilities are unavailable. Because fibrinolysis is known to activate platelets and promote thrombin activity, concomitant administration of antiplatelet and anticoagulant therapies is needed to lower the risk for re-occlusion and to support mechanical interventions in patients undergoing rescue or delayed PCI. However, the addition of oral antiplatelet and parenteral anticoagulant drugs on top of fibrinolysis may come at the price of an increased risk of bleeding. The current availability of several antiplatelet and anticoagulant therapies often leads to questions about the optimal selection in STEMI patients treated with fibrinolytics. This article appraises current evidences for the management of adjunctive antiplatelet and anticoagulant therapies in patients with STEMI undergoing fibrinolysis followed by rescue or delayed PCI.

  12. Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

    Directory of Open Access Journals (Sweden)

    Xiao-Gang Zhu

    2016-10-01

    Full Text Available Objective: To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI. Methods: A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared. Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05; 99mTc-MIBI and 18F-FDG intake of observation group after PCI were more than those of control group (P<0.05; serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05. Conclusions: Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

  13. Step-by-step manual for planning and performing bifurcation PCI: a resource-tailored approach.

    Science.gov (United States)

    Milasinovic, Dejan; Wijns, William; Ntsekhe, Mpiko; Hellig, Farrel; Mohamed, Awad; Stankovic, Goran

    2017-11-28

    As bifurcation PCI can often be resource demanding due to the use of multiple guidewires, balloons and stents, different technical options are sometimes being explored, in different local settings, to meet the need of optimally treating a patient with a bifurcation lesion, while being confronted with limited material resources. Thereby, it seems important to keep a proper balance between what is recognized as the contemporary state-of-the-art, and, what is known as potentially harmful, and to be discouraged. Ultimately, the resource-tailored approach to bifurcation PCI may be characterized by the notion of minimum technical requirements for each step of a successful procedure. Hence, this paper describes the logical sequence of steps when performing bifurcation PCI with provisional SB stenting, starting with basic anatomy assessment and ending with the optimization of MB stenting and the evaluation of the potential need to stent the SB, suggesting, for each step, the minimum technical requirement of a successful intervention.

  14. Charcoal injection in blast furnaces (Bio-PCI: CO2 reduction potential and economic prospects

    Directory of Open Access Journals (Sweden)

    Cristobal Feliciano-Bruzual

    2014-07-01

    Full Text Available The steel industry is under pressure to reduce its CO2 emissions, which arise from the use of coal. In the long-term, the injection of pulverized particles of charcoal from biomass through blast furnace tuyeres, in this case called Bio-PCI, is an attractive method from both an environmental and metallurgical viewpoint. The potential of Bio-PCI has been assessed in terms of its CO2 abatement potential and economic viewpoint. A cost objective function has been used to measure the impact of biochar substitution in highly fuel-efficient BF among the top nine hot metal producers; estimations are based on the relevant cost determinants of ironmaking. This contribution aims to shed light on two strategic questions: Under what conditions is the implementation of Bio-PCI economically attractive? Additionally, where is such a techno-economic innovation likely to be taken up the earliest? The results indicate the potential for an 18–40% mitigation of CO2. Findings from the economic assessment show that biochar cannot compete with fossil coal on price alone; therefore, a lower cost of biochar or the introduction of carbon taxes will be necessary to increase the competitiveness of Bio-PCI. Based on the current prices of raw materials, electricity and carbon taxes, biochar should be between 130.1 and 236.4 USD/t and carbon taxes should be between 47.1 and 198.7 USD/t CO2 to facilitate the substitution of Bio-PCI in the examined countries. In regard to implementation, Brazil, followed by India, China and the USA appeared to be in a better position to deploy Bio-PCI.

  15. Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion.

    Science.gov (United States)

    Vichova, Teodora; Maly, Marek; Ulman, Jaroslav; Motovska, Zuzana

    2016-03-01

    Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion. Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion. A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction 65 years (P 2 (P <0.001), female gender (P = 0.019), and creatinine clearance < 30 mL/min (P < 0.001). Time delay to reperfusion is significantly related to 1-year mortality of patients with STEMI/BBB-MI and complete restoration of epicardial blood flow in culprit vessel after PCI.

  16. Visually suboptimal bananas: How ripeness affects consumer expectation and perception.

    Science.gov (United States)

    Symmank, Claudia; Zahn, Susann; Rohm, Harald

    2017-10-07

    One reason for the significant amount of food that is wasted in developed countries is that consumers often expect visually suboptimal food as being less palatable. Using bananas as example, the objective of this study was to determine how appearance affects consumer overall liking, the rating of sensory attributes, purchase intention, and the intended use of bananas. The ripeness degree (RD) of the samples was adjusted to RD 5 (control) and RD 7 (more ripened, visually suboptimal). After preliminary experiments, a total of 233 participants were asked to judge their satisfaction with the intensity of sensory attributes that referred to flavor, taste, and texture using just-about-right scales. Subjects who received peeled samples were asked after tasting, whereas subjects who received unpeeled bananas judged expectation and, after peeling and tasting, perception. Expected overall liking and purchase intention were significantly lower for RD 7 bananas. Purchase intention was still significantly different between RD 5 and RD 7 after tasting, whereas no difference in overall liking was observed. Significant differences between RD 5 and RD 7 were observed when asking participants for their intended use of the bananas. Concerning the sensory attributes, penalty analysis revealed that only the firmness of the RD 7 bananas was still not just-about-right after tasting. The importance that consumers attribute to the shelf-life of food had a pronounced impact on purchase intention of bananas with different ripeness degree. In the case of suboptimal bananas, the results demonstrate a positive relationship between the sensory perception and overall liking and purchase intention. Convincing consumers that visually suboptimal food is still tasty is of high relevance for recommending different ways of communication. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Prehospital diagnosis in STEMI patients treated by primary PCI : the key to rapid reperfusion

    NARCIS (Netherlands)

    Vermeulen, R. P.; Jaarsma, T.; Hanenburg, F. G. A.; Nannenberg, J. W.; Jessurun, G. A. J.; Zijlstra, F.

    Background. Primary coronary intervention (PCI) for acute myocardial infarction should be performed as quickly as possible, with a door-to-balloon time of less then 90 minutes. However, in daily practice this cannot always be achieved. Prehospital diagnosis of ST-elevation myocardial infarction

  18. Condition Assessment of PCI Bridge Girder a Result of The Reduction Prestressing Force

    Directory of Open Access Journals (Sweden)

    Suangga Made

    2014-03-01

    Full Text Available PCI bridge girders is known and widely used for many construction e.g.: bridge, wharf, flyover, and other application. PC Bridge girders have two types: Pre - tensioned girders and post - tensioned girders. In pre tensioned girders, prestressing in carried out first then after that the fresh concrete poured. The prestressing process in only carried off after the concrete has sufficient strength. In this study, analysis was conducted for PCI bridge girder with span is 40 meters. Based on the data geometry bridge dimension girder, material girder, and material strands cable, it will be analyzed to calculate the natural frequencies and moment capacity using finite element program (Midas/Civil program. So it can be estimated how much the percentage reduction prestress force on the bridge until PCI bridge structure collapses. From the calculation, it found that the pattern comparison between reduction prestressing force and natural frequency are linear. These results are also similar for natural frequency versus moment capacity.PCI bridge will collapse when the reduction prestreesing force of 45 % to 50 % from the total loss of prestressing.

  19. Insights into the Proton Transfer Mechanism of a Bilin Reductase PcyA Following Neutron Crystallography.

    Science.gov (United States)

    Unno, Masaki; Ishikawa-Suto, Kumiko; Kusaka, Katsuhiro; Tamada, Taro; Hagiwara, Yoshinori; Sugishima, Masakazu; Wada, Kei; Yamada, Taro; Tomoyori, Katsuaki; Hosoya, Takaaki; Tanaka, Ichiro; Niimura, Nobuo; Kuroki, Ryota; Inaka, Koji; Ishihara, Makiko; Fukuyama, Keiichi

    2015-04-29

    Phycocyanobilin, a light-harvesting and photoreceptor pigment in higher plants, algae, and cyanobacteria, is synthesized from biliverdin IXα (BV) by phycocyanobilin:ferredoxin oxidoreductase (PcyA) via two steps of two-proton-coupled two-electron reduction. We determined the neutron structure of PcyA from cyanobacteria complexed with BV, revealing the exact location of the hydrogen atoms involved in catalysis. Notably, approximately half of the BV bound to PcyA was BVH(+), a state in which all four pyrrole nitrogen atoms were protonated. The protonation states of BV complemented the protonation of adjacent Asp105. The "axial" water molecule that interacts with the neutral pyrrole nitrogen of the A-ring was identified. His88 Nδ was protonated to form a hydrogen bond with the lactam O atom of the BV A-ring. His88 and His74 were linked by hydrogen bonds via H3O(+). These results imply that Asp105, His88, and the axial water molecule contribute to proton transfer during PcyA catalysis.

  20. The association between type D personality, and depression and anxiety ten years after PCI

    NARCIS (Netherlands)

    M.N.A. Al-Qezweny (Mustafa N.A.); E.M.W.J. Utens (Elisabeth); K. Dulfer (Karolijn); B.A.F. Hazemeijer; R.J.M. van Geuns (Robert Jan); J. Daemen (Joost); R.T. van Domburg (Ron)

    2016-01-01

    markdownabstract_Objective_ There are indications that type D personality and depression are associated in patients treated with percutaneous coronary intervention (PCI). However, at present it is unclear whether this relationship holds in the long term. This study’s aim was to investigate the

  1. Impaired health status in Type D patients following PCI in the drug-eluting stent era

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Denollet, Johan; Ong, Andrew T L

    2007-01-01

    Drug-eluting stenting reduces restenosis post-percutaneous coronary intervention (PCI), but subgroups of patients may not benefit optimally from this procedure. We examined the impact of Type D personality on health status over time and the clinical relevance of Type D as a predictor of impaired ...

  2. PCI Based Read-out Receiver Card in the ALICE DAQ System

    CERN Document Server

    Carena, W; Dénes, E; Divià, R; Schossmaier, K; Soós, C; Sulyán, J; Vascotto, Alessandro; Van de Vyvre, P

    2001-01-01

    The Detector Data Link (DDL) is the high-speed optical link for the ALICE experiment. This link shall transfer the data coming from the detectors at 100 MB/s rate. The main components of the link have been developed: the destination Interface Unit (DIU), the Source Interface Unit (SIU) and the Read-out Receiver Card (RORC). The first RORC version is based on the VME bus. The performance tests show that the maximum VME bandwidth could be reached. Meanwhile the PCI bus became very popular and is used in many platforms. The development of a PCI-based version has been started. The document describes the prototype version in three sections. An overview explains the main purpose of the card: to provide an interface between the DDL and the PCI bus. Acting as a 32bit/33MHz PCI master the card is able to write or read directly to or from the system memory from or to the DDL, respectively. Beside these functions the card can also be used as an autonomous data generator. The card has been designed to be well adapted to ...

  3. Condition Assessment of PCI Bridge Girder a Result of The Reduction Prestressing Force

    Science.gov (United States)

    Suangga, Made; Hidayat, Irpan; Lutter, Bobby

    2014-03-01

    PCI bridge girders is known and widely used for many construction e.g.: bridge, wharf, flyover, and other application. PC Bridge girders have two types: Pre - tensioned girders and post - tensioned girders. In pre tensioned girders, prestressing in carried out first then after that the fresh concrete poured. The prestressing process in only carried off after the concrete has sufficient strength. In this study, analysis was conducted for PCI bridge girder with span is 40 meters. Based on the data geometry bridge dimension girder, material girder, and material strands cable, it will be analyzed to calculate the natural frequencies and moment capacity using finite element program (Midas/Civil program). So it can be estimated how much the percentage reduction prestress force on the bridge until PCI bridge structure collapses. From the calculation, it found that the pattern comparison between reduction prestressing force and natural frequency are linear. These results are also similar for natural frequency versus moment capacity.PCI bridge will collapse when the reduction prestreesing force of 45 % to 50 % from the total loss of prestressing.

  4. Real-time fusion of coronary CT angiography with X-ray fluoroscopy during chronic total occlusion PCI

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Takx, Richard A.P. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Boston, MA (United States); Stone, Luke L.; Yeh, Robert W.; Jaffer, Farouc A. [Harvard Medical School, Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA (United States); Girard, Erin E. [Siemens Healthcare, Princeton, NJ (United States); Brilakis, Emmanouil S. [Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX (United States); Lombardi, William L. [University of Washington, Cardiology Division, Seattle, WA (United States)

    2017-06-15

    The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with X-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. (orig.)

  5. BIO-PCI, Charcoal injection in Blast Furnaces: State of the art and economic perspectives

    Directory of Open Access Journals (Sweden)

    Feliciano-Bruzual, C.

    2013-12-01

    Full Text Available The injection of grinded particles of charcoal through the tuyeres in Blast Furnaces, here coined Bio-PCI, presents as an attractive and plausible alternative to significantly reduce the CO2 emissions generated during hot metal production. In this contribution a summary of the technological fundaments, benefits and limitations of the incorporation of Bio-PCI is presented. Additionally the principal economic challenges of renewables fuel in ironmaking are exposed, with especial interest in the main productions costs of charcoal making. In this sense, a strategic question arises: can the residual biomass drive the emergence of Bio-PCI?, our analysis leads to conclude that the use of residual biomass (e.g. agricultural and forestry residues may significantly reduce the production cost in 120-180 USD/t in comparison to primary woods sources, this naturally increment the economical attractiveness of Bio-PCI substitution.La inyección de carbón vegetal por toberas en Altos Hornos, aqui denominada Bio-PCI, se presenta como una forma atractiva y realista de reducir significativamente las emisiones de CO2 generadas durante la producción de arrabio. En esta contribución se presenta un resumen de los fundamentos tecnológicos, los beneficios y las limitaciones de la incorporación de la tecnología del Bio-PCI. Adicionalmente se exponen los retos económicos que enfrentan los combustibles renovables a los fósiles, con especial interés en los principales costos de producción del carbón vegetal. En este sentido se plantea una pregunta estratégica: ¿puede la biomasa residual impulsar el desarrollo de la Bio-PCI?. Nuestro análisis conlleva a concluir que la utilización de biomasa residual (residuos forestales y agrícolas puede reducir sensiblemente el costo del carbón vegetal entre 120-180 USD/t en comparación con biomasa primaria, incrementando su competitividad frente al carbón mineral.

  6. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, MSE; Schmand, B; Wekking, EM; Hageman, G; Deelman, BG

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  7. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, Moniek S. E.; Schmand, Ben; Wekking, Ellie M.; Hageman, Gerard; Deelman, Betto G.

    2003-01-01

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  8. Effect of preoperative small dose of tirofiban on PCI treatment in patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Li Wang

    2016-06-01

    Full Text Available Objective: To analyze the effect of preoperative small dose of tirofiban on PCI treatment prognosis in patients with acute coronary syndrome. Methods: A total of 108 cases with acute coronary syndrome who received PCI treatment in our hospital from August 2011 to May 2014 were included for study and randomly divided into observation group and control group by half according to different treatment methods. Control group received PCI treatment alone, observation group received small dose of tirofiban combined with PCI treatment, and then differences in hemorheology indicators, platelet function, left ventricular systolic function and left ventricular diastolic function parameters, serum indicators and so on were compared between two groups after treatment. Results: Whole blood high shear viscosity, whole blood low shear viscosity, reduced high shear viscosity, reduced low shear viscosity, plasma ratio viscosity, erythrocyte aggregation index and erythrocyte deformability index of observation group after treatment were all less than those of control group (P<0.05; PAdT, PAgT, CD62p, CD40L and P-selectin values of observation group after treatment were all lower than those of control group (P<0.05; LPER and LPFR values of observation group 1 week after treatment were higher than those of control group while LTPER and LTPFR values were lower than those of control group (P<0.05; serum GA, MCP-1, PAI-1, NT-proBNP, PAC-1, VCAM-1 and ICAM-1 values of observation group after treatment were all lower than those of control group (P<0.05. Conclusions: Small dose of tirofiban combined with PCI treatment for patients with acute coronary syndrome can effectively enhance therapeutic effect, inhibit platelet activity while protect heart function and optimize long-term treatment outcome.

  9. Interventions via Social Influence for Emergent Suboptimal Restraint Use

    Directory of Open Access Journals (Sweden)

    Ziad KOBTI

    2013-08-01

    Full Text Available Although restraint use has increased primarily in developed countries, vehicle accident-related injuries and deaths continue to be a problem. Alongside lack of restraint use, studies involving suboptimal restraint use have gained recent popularity. In this study we investigate the use of social influence forinterventions to counter emerging suboptimal restraint use in groups of agents.A multi-agent simulation model is provided where dominant individuals use randomly assigned influence rates to repeatedly alter the knowledge of lessinfluential group members. Cultural influence is implemented via a cultural algorithm and used to simulate individuals affected by beliefs in the community. Objectives include investigating the emergence of patterns of restraint selection and use as well as interventions targeted at more influential agents. Results demonstrate that prominent patterns of behaviour similar to the influentialmembers of the groups do emerge. Furthermore, interventions targeted at influential group members outperform interventions targeted at a percentage of the population at large. Interventions succeed at some level both in the presence and absence of cultural influence.

  10. Optimal inference with suboptimal models: addiction and active Bayesian inference.

    Science.gov (United States)

    Schwartenbeck, Philipp; FitzGerald, Thomas H B; Mathys, Christoph; Dolan, Ray; Wurst, Friedrich; Kronbichler, Martin; Friston, Karl

    2015-02-01

    When casting behaviour as active (Bayesian) inference, optimal inference is defined with respect to an agent's beliefs - based on its generative model of the world. This contrasts with normative accounts of choice behaviour, in which optimal actions are considered in relation to the true structure of the environment - as opposed to the agent's beliefs about worldly states (or the task). This distinction shifts an understanding of suboptimal or pathological behaviour away from aberrant inference as such, to understanding the prior beliefs of a subject that cause them to behave less 'optimally' than our prior beliefs suggest they should behave. Put simply, suboptimal or pathological behaviour does not speak against understanding behaviour in terms of (Bayes optimal) inference, but rather calls for a more refined understanding of the subject's generative model upon which their (optimal) Bayesian inference is based. Here, we discuss this fundamental distinction and its implications for understanding optimality, bounded rationality and pathological (choice) behaviour. We illustrate our argument using addictive choice behaviour in a recently described 'limited offer' task. Our simulations of pathological choices and addictive behaviour also generate some clear hypotheses, which we hope to pursue in ongoing empirical work. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders

    Directory of Open Access Journals (Sweden)

    Adam M. Nagy

    2016-10-01

    Full Text Available Deep brain stimulation (DBS is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in “deep” structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS’s efficacy has been well established for its movement disorder indications (Parkinson’s disease, essential tremor, and dystonia. However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson’s disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate.

  12. Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

    DEFF Research Database (Denmark)

    Pedersen, Frants; Butrymovich, Vitalij; Kelbæk, Henning

    2014-01-01

    ,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI. RESULTS: Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after...... cardiac arrest. Age, culprit vessel size and flow, and the presence of heart failure and diabetes were independent predictors of mortality. After 30 days, the annual cardiac mortality rate was death beyond 30 days were noncardiac in 65% of cases (mainly malignancies and pulmonary diseases......BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study...

  13. CMS Tracker Readout Prototype Front-End Driver PCI Mezzanine Card (Mk1) (connector side)

    CERN Multimedia

    J.Coughlan

    1998-01-01

    The tracking system of the CMS detector at the LHC employs Front End Driver (FED) cards to digitise, buffer and sparsify analogue data arriving via optical links from on detector pipeline chips. This paper describes a prototype version of the FED based upon the popular commercial PCI bus Mezzanine Card (PMC) form factor. The FED-PMC consists of an 8 channel, 9 bit ADC, card, providing a 1 MByte data buffer and operating at the LHC design frequency of 40 MHz. The core of the card is a re-programmable FPGA which allows the functionality of the card to be conveniently modified. The card is supplied with a comprehensive library of C routines.The PMC form factor allows the card to be plugged onto a wide variety of processor carrier boards and even directly into PCI based PCs. The flexibility of the FPGA based design permits the card to be used in a variety of ADC based applications.

  14. Heparin or bivalirudin for non-primary PCI: Beware of neat and simple answers….

    Science.gov (United States)

    Deliargyris, Efthymios N; Kimmelstiel, Carey

    2017-09-01

    The debate regarding the choice of heparin or bivalirudin as the preferred anticoagulant in PCI is still ongoing Nonrandomized registry data are severely limited for comparative analyses and should therefore always be interpreted with caution Clinicians should resist simplistic data interpretations or populist cries relating to cost, but rather focus on valid benefit:risk analyses for their clinical decision making. © 2017 Wiley Periodicals, Inc.

  15. High intensity interval training reduces systemic inflammation in post-PCI patients.

    Science.gov (United States)

    Munk, Peter Scott; Breland, Unni Mathilde; Aukrust, Pål; Ueland, Thor; Kvaløy, Jan Terje; Larsen, Alf Inge

    2011-12-01

    Increased plasma levels of inflammatory markers and markers of endothelial cell activation have been associated with increased risk for cardiovascular events. Exercise training may lower the risk for coronary heart disease by attenuating inflammation and improving endothelial function. The objective of this study was to evaluate effects of regular high-intensity exercise training on a wide range of markers of inflammation and endothelial cell activation. Consecutively, 40 patients were prospectively randomized to a 6 months supervised high-intensity interval training programme or to a control group following successful percutaneous coronary intervention (PCI). Blood samples of 36 patients with stable angina, drawn at baseline (before PCI) and at 6 months, were analysed. Late luminal loss was measured at 6 months using quantitative coronary angiography. At 6 months, levels of the inflammatory markers interleukin (IL)-6 and IL-8 were reduced and levels of the anti-inflammatory cytokine IL-10 increased in the training group only. The decrease in IL-6 and C-reactive protein levels were significantly correlated with the decrease in luminal loss following PCI. In contrast to these anti-inflammatory effects, training had no effect on markers of platelet-mediated inflammation, and the effect of training on markers on endothelial cell activation were rather complex showing attenuating (von Willebrand factor) and enhancing (E-selectin and vascular cell adhesion molecule 1) effects. Regular exercise training in stable angina patients following PCI may attenuate some, but not all, inflammatory pathways, potentially contributing to the beneficial effects of exercise training on restenosis.

  16. China suboptimal health cohort study: rationale, design and baseline characteristics.

    Science.gov (United States)

    Wang, Youxin; Ge, Siqi; Yan, Yuxiang; Wang, Anxin; Zhao, Zhongyao; Yu, Xinwei; Qiu, Jing; Alzain, Mohamed Ali; Wang, Hao; Fang, Honghong; Gao, Qing; Song, Manshu; Zhang, Jie; Zhou, Yong; Wang, Wei

    2016-10-13

    Suboptimal health status (SHS) is a physical state between health and disease, characterized by the perception of health complaints, general weakness, chronic fatigue and low energy levels. SHS is proposed by the ancient concept of traditional Chinese medicine (TCM) from the perspective of preservative, predictive and personalized (precision) medicine. We previously created the suboptimal health status questionnaire 25 (SHSQ-25), a novel instrument to measure SHS, validated in various populations. SHSQ-25 thus affords a window of opportunity for early detection and intervention, contributing to the reduction of chronic disease burdens. To investigate the causative effect of SHS in non-communicable chronic diseases (NCD), we initiated the China suboptimal health cohort study (COACS), a longitudinal study starting from 2013. Phase I of the study involved a cross-sectional survey aimed at identifying the risk/protective factors associated with SHS; and Phase II: a longitudinal yearly follow-up study investigating how SHS contributes to the incidence and pattern of NCD. (1) Cross-sectional survey: in total, 4313 participants (53.8 % women) aged from 18 to 65 years were included in the cohort. The prevalence of SHS was 9.0 % using SHS score of 35 as threshold. Women showed a significantly higher prevalence of SHS (10.6 % in the female vs. 7.2 % in the male, P differed significantly between subjects of SHS (SHS score ≥35) and those of ideal health (SHS score difference in prevalence of SHS might partly explain the gender difference of incidence of certain chronic diseases. The COACS will enable a thorough characterization of SHS and establish a cohort that will be used for longitudinal analyses of the interaction between the genetic, lifestyle and environmental factors that contribute to the onset and etiology of targeted chronic diseases. The study together with the designed prospective cohort provides a chance to characterize and evaluate the effect of SHS

  17. Design and Performance of a PCI Interface with four 2 Gbit/s Serial Optical Links

    CERN Document Server

    Haas, S; Iwanski, W; 10th Workshop on Electronics for LHC and Future Experiments

    2004-01-01

    A reconfigurable PCI interface card (FILAR) with four on-board high-speed serial optical links has been developed for application in DAQ and test systems. FILAR cards, installed in low cost PCs, are currently being used in the combined test-beam of the ATLAS experiment at CERN as well as in several laboratory set-ups. The hardware and firmware design of the module and results from performance measurements are presented. The four on-board 2 Gbit/s serial optical links conform to the S-LINK specification and are compatible with the Readout Link (ROL) implementation for the ATLAS experiment. The board design is largely based on FPGAs and the firmware uses a commercial 64-bit/66 MHz PCI IP core for the bus interface. Different firmware versions were developed which can be used to configure the hardware as either a data source or a destination card. Design optimizations have been made during the development cycle of the firmware to maximize the data throughput and reduce the PCI bus overhead as well as the CPU loa...

  18. Determine Operating Reactor to Use for the 2016 PCI Level 1 Milestone

    Energy Technology Data Exchange (ETDEWEB)

    Clarno, Kevin T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-01-30

    The Consortium for Advanced Simulation of Light Water Reactors (LWRs) (CASL) Level 1 milestone to “Assess the analysis capability for core-wide [pressurized water reactor] PWR Pellet- Clad Interaction (PCI) screening and demonstrate detailed 3-D analysis on selected sub-region” (L1:CASL.P13.03) requires a particular type of nuclear power plant for the assessment. This report documents the operating reactor and cycles chosen for this assessment in completion of the physics integration (PHI) milestone to “Determine Operating Reactor to use for PCI L1 Milestone” (L3:PHI.CMD.P12.02). Watts Bar Unit 1 experienced (at least) one fuel rod failure in each of cycles 6 and 7, and at least one was deemed to be duty related rather than being primarily related to a manufacturing defect or grid effects. This brief report documents that the data required to model cycles 1–12 of Watts Bar Unit 1 using VERA-CS contains sufficient data to model the PHI portion of the PCI challenge problem. A list of additional data needs is also provided that will be important for verification and validation of the BISON results.

  19. Feature-preserving surface mesh smoothing via suboptimal Delaunay triangulation.

    Science.gov (United States)

    Gao, Zhanheng; Yu, Zeyun; Holst, Michael

    2013-01-01

    A method of triangular surface mesh smoothing is presented to improve angle quality by extending the original optimal Delaunay triangulation (ODT) to surface meshes. The mesh quality is improved by solving a quadratic optimization problem that minimizes the approximated interpolation error between a parabolic function and its piecewise linear interpolation defined on the mesh. A suboptimal problem is derived to guarantee a unique, analytic solution that is significantly faster with little loss in accuracy as compared to the optimal one. In addition to the quality-improving capability, the proposed method has been adapted to remove noise while faithfully preserving sharp features such as edges and corners of a mesh. Numerous experiments are included to demonstrate the performance of the method.

  20. Risk of Suboptimal Iodine Intake in Pregnant Norwegian Women

    Directory of Open Access Journals (Sweden)

    Helle Margrete Meltzer

    2013-02-01

    Full Text Available Pregnant women and infants are exceptionally vulnerable to iodine deficiency. The aims of the present study were to estimate iodine intake, to investigate sources of iodine, to identify predictors of low or suboptimal iodine intake (defined as intakes below 100 μg/day and 150 μg/day in a large population of pregnant Norwegian women and to evaluate iodine status in a sub-population. Iodine intake was calculated based on a validated Food Frequency Questionnaire in the Norwegian Mother and Child Cohort. The median iodine intake was 141 μg/day from food and 166 μg/day from food and supplements. Use of iodine-containing supplements was reported by 31.6%. The main source of iodine from food was dairy products, contributing 67% and 43% in non-supplement and iodine-supplement users, respectively. Of 61,904 women, 16.1% had iodine intake below 100 μg/day, 42.0% had iodine intake below 150 μg/day and only 21.7% reached the WHO/UNICEF/ICCIDD recommendation of 250 μg/day. Dietary behaviors associated with increased risk of low and suboptimal iodine intake were: no use of iodine-containing supplements and low intake of milk/yogurt, seafood and eggs. The median urinary iodine concentration measured in 119 participants (69 μg/L confirmed insufficient iodine intake. Public health strategies are needed to improve and secure the iodine status of pregnant women in Norway.

  1. Suboptimal Criterion Learning in Static and Dynamic Environments.

    Directory of Open Access Journals (Sweden)

    Elyse H Norton

    2017-01-01

    Full Text Available Humans often make decisions based on uncertain sensory information. Signal detection theory (SDT describes detection and discrimination decisions as a comparison of stimulus "strength" to a fixed decision criterion. However, recent research suggests that current responses depend on the recent history of stimuli and previous responses, suggesting that the decision criterion is updated trial-by-trial. The mechanisms underpinning criterion setting remain unknown. Here, we examine how observers learn to set a decision criterion in an orientation-discrimination task under both static and dynamic conditions. To investigate mechanisms underlying trial-by-trial criterion placement, we introduce a novel task in which participants explicitly set the criterion, and compare it to a more traditional discrimination task, allowing us to model this explicit indication of criterion dynamics. In each task, stimuli were ellipses with principal orientations drawn from two categories: Gaussian distributions with different means and equal variance. In the covert-criterion task, observers categorized a displayed ellipse. In the overt-criterion task, observers adjusted the orientation of a line that served as the discrimination criterion for a subsequently presented ellipse. We compared performance to the ideal Bayesian learner and several suboptimal models that varied in both computational and memory demands. Under static and dynamic conditions, we found that, in both tasks, observers used suboptimal learning rules. In most conditions, a model in which the recent history of past samples determines a belief about category means fit the data best for most observers and on average. Our results reveal dynamic adjustment of discrimination criterion, even after prolonged training, and indicate how decision criteria are updated over time.

  2. 42. The effect of ticagrelor on coronary blood after primary PCI when compared with clopidogril

    Directory of Open Access Journals (Sweden)

    W. Kadro

    2016-07-01

    Full Text Available Primary PCI (PPCI has been established as the best treatment for acute MI when it is used appropriately. It is known to give better TIMI III flow and better frame count when compared with thrombolytics. Loading with P2Y12 inhibitors in the ER prior to primary PCI is an important step in antiplatelet therapy for acute myocardial infarction. In this study We report the effect of loading with two different P2Y12 inhibitors (ticagrelor and clopidogril on the TIMI frame count in the culprit artery after successful PPCI. Ticagrelor may affect coronary microcirculation and coronary blood flow through faster and stronger platelet inhibition. We randomized 44 patient who presented to our center with acute MI into two groups. The first group received a loading with 180mg of ticagrelor and the second group received a loading with 600 mg of clopidogril. The mean door to balloon time was 98 ± 12 min. All patients in both groups received a loading with 162 mg of aspirin. GP IIb/IIIa inhibitors were used in all cases together with adjusted dose heparin. Stent usage was 100%. No thrombectomy or thrombus aspiration device was used in any of these cases. TIMI III flow after stenting was achieved in all culprit arteries. Then we calculated the TIMI frame count in the culprit artery after successful primary PCI. The mean corrected TIMI frame count in the culprit artery post PCI was 18.34 ± 3.16 frames in group 1 (Ticagrelor group and 28.73 ± 3.92 in group 2 (clopidogril group (p = 0.02. Loading with ticagrelor gives faster flow after successful primary PCI in the culprit artery of acute MI when compared with clopidogril. This can be explained by the fact that ticagrelor therapy give faster P2Y12 inhibition thus faster antiplatelet therapy causing less platelet aggregation resulting in less distal embolization and reduced production of inflammatory mediators and adhesion molecules which may result in faster restoration of normal endothelial function

  3. The ASDEX upgrade UTDC and DIO cards-a family of PCI/cPCI devices for real-time DAQ under Solaris

    Energy Technology Data Exchange (ETDEWEB)

    Lohs, A. [Max-Planck-Institut fuer Plasmaphysik, EURATOM Association, Boltzmannstr. 2, 85748 Garching (Germany); Behler, K. [Max-Planck-Institut fuer Plasmaphysik, EURATOM Association, Boltzmannstr. 2, 85748 Garching (Germany)]. E-mail: karl.behler@ipp.mpg.de; Lueddecke, K. [Unlimited Computer Systems GmbH, Seeshaupter Strasse 15, 82393 Iffeldorf (Germany); Raupp, G. [Max-Planck-Institut fuer Plasmaphysik, EURATOM Association, Boltzmannstr. 2, 85748 Garching (Germany)

    2006-07-15

    A universal time to digital converter (UTDC) and a digital I/O (DIO) card have been purpose-built for the new ASDEX Upgrade control system, the Thomson scattering diagnostic, a renovation of the magnetic measurements, and a couple of other diagnostics requiring renewed timing or real-time features. The principal features of these cards are presented and it is shown how synergy in hardware and software development was achieved. Examples of actual usage in diagnostics are given. Measurements of the real-time behaviour of cPCI-based diagnostics show low jitter of the Solaris operating system and highly reliable operation under moderate real-time conditions. Future applications of this family of cards are foreseen.

  4. Analysis of Payment Card Industry Data Security Standard [PCI DSS] Compliance by Confluence of COBIT 5 Framework

    OpenAIRE

    Ashish Ukidve; Ds S SMantha; Milind Tadvalkar

    2017-01-01

    The Payment Card Industry Data Security Standard (PCI DSS) aims to enhance the security of cardholder data and is required when cardholder data or authentication data are stored, processed or transmitted. The implementation of enabling processes from COBIT 5 can complement compliance to PCI DSS. COBIT 5 assists enterprises in governance and management of enterprise IT and, at the same time, supports the need to meet security requirements with supporting processes and management activities. Th...

  5. A single center experience with same-day transradial-PCI patients: a contrast with published guidelines.

    Science.gov (United States)

    Gilchrist, Ian C; Rhodes, Denise A; Zimmerman, Helen E

    2012-03-01

    Our goal was to compare recently published Consensus Statement from the SCAI/ACC on appropriateness for same-day PCI with patient characteristics from a real-world same-day PCI experience in the United States. Recent practice statement published by the SCAI /ACC in 2009 describes patients suitable for outpatient PCI procedures. Whether this practice statement reflects actual real-world practice in the setting of advances in transradial catheterization needs further exploration. Pre-existing, deidentified, quality assurance data from 100 sequential patients undergoing transradial PCI, and same-day discharge were compared with criteria in SCAI/ACC statement on outpatient PCI. Each had been identified post-PCI as uncomplicated and therefore eligible for same day discharged. Specific attention was placed on whether the patients carried any exclusion to same-day discharge. One hundred six procedures were recorded in 100 patients including 11 women and 89 men, median age 62 (55,71) years all with stable ischemia. Early follow up was done for medication compliance. None were readmitted nor had post-PCI complications. Only 15% met appropriateness criteria for same-day discharge. Older age, distance from the hospital, greater than simple PCI, and the need for specific antiplatelet therapy represented the dominant contraindications to discharge. Using transradial approaches and structured early follow up by advance practice nurses, same-day discharge can be accomplished successfully in a broad range of patients outside of those suggested by the SCAI/ACC 2009 Consensus Document. Confirmation of these results could result in shorter hospitalizations for US patients and align advances in catheterization technology to optimize heath care delivery. Copyright © 2011 Wiley Periodicals, Inc.

  6. Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI.

    Science.gov (United States)

    Dehghani, Payam; Lavoie, Andrea; Lavi, Shahar; Crawford, Jennifer J; Harenberg, Sebastian; Zimmermann, Rodney H; Booker, Jeff; Kelly, Sheila; Cantor, Warren J; Mehta, Shamir R; Bagai, Akshay; Goodman, Shaun G; Cheema, Asim N

    2017-10-01

    Patients undergoing PCI early after fibrinolytic therapy are at high risk for both thrombotic and bleeding complications. We sought to assess the pharmacodynamic effects of ticagrelor versus clopidogrel in the fibrinolytic-treated STEMI patients undergoing early PCI. Patients undergoing PCI within 24 hours of tenecteplase (TNK), aspirin, and clopidogrel for STEMI were randomized to receive additional clopidogrel 300 mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline) at 4 and 24 hours post-PCI. The primary end point was PRU ≤208 at 4 hours. A total of 140 patients (74 in ticagrelor and 66 in clopidogrel group) were enrolled. The mean PRU values at baseline were similar for the 2 groups (257.8±52.9 vs 259.5±56.7, P=.85, respectively). Post-PCI, patients on ticagrelor, compared to those on clopidogrel, had significantly lower PRU at 4 hours (78.7±88 vs 193.6±86.5, respectively, Pclopidogrel-treated patients, Pclopidogrel and aspirin at the time of fibrinolysis and were undergoing early PCI frequently had PRU >208. In this high-risk population, ticagrelor provides more prompt and potent platelet inhibition compared with clopidogrel (Funded by Astra Zeneca; NCT01930591, https://clinicaltrials.gov/ct2/show/NCT01930591). Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Energy expenditures & physical activity in rats with chronic suboptimal nutrition

    Directory of Open Access Journals (Sweden)

    Lifshitz Fima

    2006-01-01

    Full Text Available Abstract Background Sub-optimally nourished rats show reduced growth, biochemical and physiological changes. However, no one has assessed metabolic rate adaptations in rats subjected to chronic suboptimal nutrition (CSN. In this study energy expenditure (EE; kcal/100 g body weight and physical activity (PA; oscillations in weight/min/kg body weight were assessed in rats subjected to three levels of CSN. Results Body weight gain was diminished (76.7 ± 12.0 and 61.6 ± 11.0 g in rats fed 70 and 60% of the ad-libitum fed controls which gained more weight (148.5 ± 32.3 g. The rats fed 80% gained weight similarly to controls (136.3 ± 10.5 g. Percent Fat-free body mass was reduced (143.8 ± 8.7 and 142.0 ± 7.6 g in rats fed 70 and 60% of ad-libitum, but not in those fed 80% (200.8 ± 17.5 g as compared with controls (201.6 ± 33.4 g. Body fat (g decreased in rats fed 80% (19.7 ± 5.3, 70% (15.3 ± 3.5 and 60% (9.6 ± 2.7 of ad-libitum in comparison to controls (26.0 ± 6.7. EE and PA were also altered by CSN. The control rats increased their EE and PA during the dark periods by 1.4 ± 0.8 and 1.7 ± 1.1 respectively, as compared with light the period; whereas CSN rats fed 80 and 70% of ad-libitum energy intake had reduced EE and PA during the dark periods as compared with the light period EE(7.5 ± 1.4 and 7.8 ± 0.6 vs. 9.0 ± 1.2 and 9.7 ± 0.8; p Conclusion CSN rats adapt to mild energy restriction by reducing body fat, EE and PA mainly during the dark period while growth proceeds and lean body mass is preserved. At higher levels of energy restrictions there is decreased growth, body fat and lean mass. Moreover EE and PA are also reduced during both light and dark periods.

  8. Treatment of KPC-producing Enterobacteriaceae: suboptimal efficacy of polymyxins.

    Science.gov (United States)

    de Oliveira, M S; de Assis, D B; Freire, M P; Boas do Prado, G V; Machado, A S; Abdala, E; Pierrotti, L C; Mangini, C; Campos, L; Caiaffa Filho, H H; Levin, A S

    2015-02-01

    Treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) remains a challenge. Combined therapy has been proposed as the best choice, but there are no clear data showing which combination therapy is superior. Our aim was to evaluate the effectiveness of antimicrobial regimens for treating KPC-EI. This was a retrospective cohort study of KPC-EI nosocomial infections (based on CDC criteria) between October 2009 and June 2013 at three tertiary Brazilian hospitals. The primary outcomes were the 30-day mortality for all infections and the 30-day mortality for patients with bacteraemia. Risk factors for mortality were evaluated by comparing clinical variables of survivors and nonsurvivors. In this study, 118 patients were included, of whom 78 had bacteraemia. Catheter-related bloodstream infections were the most frequent (43%), followed by urinary tract infections (n = 27, 23%). Monotherapy was used in 57 patients and combined treatment in 61 patients. The most common therapeutic combination was polymyxin plus carbapenem 20 (33%). Multivariate analysis for all infections (n = 118) and for bacteremic infections (n = 78) revealed that renal failure at the end of treatment, use of polymyxin and older age were prognostic factors for mortality. In conclusion, polymyxins showed suboptimal efficacy and combination therapy was not superior to monotherapy. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  9. Robust Adaptive LCMV Beamformer Based On An Iterative Suboptimal Solution

    Directory of Open Access Journals (Sweden)

    Xiansheng Guo

    2015-06-01

    Full Text Available The main drawback of closed-form solution of linearly constrained minimum variance (CF-LCMV beamformer is the dilemma of acquiring long observation time for stable covariance matrix estimates and short observation time to track dynamic behavior of targets, leading to poor performance including low signal-noise-ratio (SNR, low jammer-to-noise ratios (JNRs and small number of snapshots. Additionally, CF-LCMV suffers from heavy computational burden which mainly comes from two matrix inverse operations for computing the optimal weight vector. In this paper, we derive a low-complexity Robust Adaptive LCMV beamformer based on an Iterative Suboptimal solution (RAIS-LCMV using conjugate gradient (CG optimization method. The merit of our proposed method is threefold. Firstly, RAIS-LCMV beamformer can reduce the complexity of CF-LCMV remarkably. Secondly, RAIS-LCMV beamformer can adjust output adaptively based on measurement and its convergence speed is comparable. Finally, RAIS-LCMV algorithm has robust performance against low SNR, JNRs, and small number of snapshots. Simulation results demonstrate the superiority of our proposed algorithms.

  10. Predictors of Suboptimal Follow-up in Pediatric Cancer Survivors.

    Science.gov (United States)

    May, Leana; Schwartz, David D; Frugé, Ernest; Laufman, Larry; Holm, Suzanne; Kamdar, Kala; Harris, Lynnette; Brackett, Julienne; Unal, Sule; Tanyildiz, Gulsah; Bryant, Rosalind; Suzawa, Hilary; Dreyer, Zoann; Okcu, M Fatih

    2017-04-01

    Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.

  11. Adaptive suboptimal second-order sliding mode control for microgrids

    Science.gov (United States)

    Incremona, Gian Paolo; Cucuzzella, Michele; Ferrara, Antonella

    2016-09-01

    This paper deals with the design of adaptive suboptimal second-order sliding mode (ASSOSM) control laws for grid-connected microgrids. Due to the presence of the inverter, of unpredicted load changes, of switching among different renewable energy sources, and of electrical parameters variations, the microgrid model is usually affected by uncertain terms which are bounded, but with unknown upper bounds. To theoretically frame the control problem, the class of second-order systems in Brunovsky canonical form, characterised by the presence of matched uncertain terms with unknown bounds, is first considered. Four adaptive strategies are designed, analysed and compared to select the most effective ones to be applied to the microgrid case study. In the first two strategies, the control amplitude is continuously adjusted, so as to arrive at dominating the effect of the uncertainty on the controlled system. When a suitable control amplitude is attained, the origin of the state space of the auxiliary system becomes attractive. In the other two strategies, a suitable blend between two components, one mainly working during the reaching phase, the other being the predominant one in a vicinity of the sliding manifold, is generated, so as to reduce the control amplitude in steady state. The microgrid system in a grid-connected operation mode, controlled via the selected ASSOSM control strategies, exhibits appreciable stability properties, as proved theoretically and shown in simulation.

  12. A Specified Procedure for Distress Identification and Assessment for Urban Road Surfaces Based on PCI

    Directory of Open Access Journals (Sweden)

    Giuseppe Loprencipe

    2017-04-01

    Full Text Available In this paper, a simplified procedure for the assessment of pavement structural integrity and the level of service for urban road surfaces is presented. A sample of 109 Asphalt Concrete (AC urban pavements of an Italian road network was considered to validate the methodology. As part of this research, the most recurrent defects, those never encountered and those not defined with respect to the list collected in the ASTM D6433 have been determined by statistical analysis. The goal of this research is the improvement of the ASTM D6433 Distress Identification Catalogue to be adapted to urban road surfaces. The presented methodology includes the implementation of a Visual Basic for Application (VBA language-based program for the computerization of Pavement Condition Index (PCI calculation with interpolation by the parametric cubic spline of all of the density/deduct value curves of ASTM D6433 distress types. Also, two new distress definitions (for manholes and for tree roots and new density/deduct curve values were proposed to achieve a new distress identification manual for urban road pavements. To validate the presented methodology, for the 109 urban pavements considered, the PCI was calculated using the new distress catalogue and using the ASTM D6433 implemented on PAVERTM. The results of the linear regression between them and their statistical parameters are presented in this paper. The comparison of the results shows that the proposed method is suitable for the identification and assessment of observed distress in urban pavement surfaces at the PCI-based scale.

  13. Determinants of suboptimal breast-feeding practices in Pakistan.

    Science.gov (United States)

    Hazir, Tabish; Akram, Dure-Samin; Nisar, Yasir Bin; Kazmi, Narjis; Agho, Kingsley E; Abbasi, Saleem; Khan, Amira M; Dibley, Michael J

    2013-04-01

    Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan. A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007. A nationally representative sample of households. Last-born alive children aged 0-23 months (total weighted sample size 3103). The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.

  14. Genotypic Variation in the Response to Suboptimal Temperature at Different Plant Densities in Cut Chrysanthemum

    NARCIS (Netherlands)

    Ploeg, van der A.; Carvalho, S.M.P.; Heuvelink, E.

    2009-01-01

    Energy efficiency of greenhouse cut chrysanthemum (Chrysanthemum morifolium Ramat.) may be increased by breeding. In addition to breeding for cultivars with a shorter reaction time at suboptimal temperatures, an alternative approach would be to develop cultivars that are heavier at suboptimal

  15. LabVIEW Interface for PCI-SpaceWire Interface Card

    Science.gov (United States)

    Lux, James; Loya, Frank; Bachmann, Alex

    2005-01-01

    This software provides a LabView interface to the NT drivers for the PCISpaceWire card, which is a peripheral component interface (PCI) bus interface that conforms to the IEEE-1355/ SpaceWire standard. As SpaceWire grows in popularity, the ability to use SpaceWire links within LabVIEW will be important to electronic ground support equipment vendors. In addition, there is a need for a high-level LabVIEW interface to the low-level device- driver software supplied with the card. The LabVIEW virtual instrument (VI) provides graphical interfaces to support all (1) SpaceWire link functions, including message handling and routing; (2) monitoring as a passive tap using specialized hardware; and (3) low-level access to satellite mission-control subsystem functions. The software is supplied in a zip file that contains LabVIEW VI files, which provide various functions of the PCI-SpaceWire card, as well as higher-link-level functions. The VIs are suitably named according to the matching function names in the driver manual. A number of test programs also are provided to exercise various functions.

  16. Il PCI, Autonomia Operaia e l'emergenza terrorismo: il caso 7 aprile 1979

    Directory of Open Access Journals (Sweden)

    Giulia Pacifici

    2017-03-01

    Full Text Available The article analyzes the positions of the Italian Communist Party towards the large political movement that took action on its left, especially “Autonomia Operaia”, in the late seventies, during the terrorism emergency and the crisis of national solidarity governments. The debate, internal to the PCI and between the left parliamentary forces, is analyzed through the documents, the newspaper articles and the declarations about a specific counter-terrorism trial, known as the “7th April case". This trial caused a large and heated public debate on terrorism, democracy and public order that saw two main political positions in opposition to one another. On one side the so called guarantee position represented by the “Partito Radicale”, some intellectuals, journalist and magistrates and on the other those who endorsed the firmness position, especially the PCI. At the same time, within the same communist party, the firmness front wasn't completely unanimous. On 7th April 1979 the deputy public prosecutor of Padua, Pietro Calogero, issued an arrest warrant that led to prison more than a dozen militants from the extra-parliamentary leftist area, “Potere Operaio” and “Autonomia Operaia”, including among others Oreste Scalzone, Franco Piperno, Nanni Balestrini, Emilio Vesce and Antonio Negri.

  17. Characterising the blast furnace cohesive zone as high PCI: final report

    Energy Technology Data Exchange (ETDEWEB)

    Danloy, G.; Mignon, J.; Oury, L.; Bolignano, G.; Pisteeli, M.I.; Gelli, I.; Hahlin, P. [CRM, Leige (Belgium)

    2002-07-01

    The research aimed to characterise the permeability to gas of the blast furnace burden during softening and melting, to develop an improved model of the blast furnace cohesive zone, and to introduce this model into a general model of the blast furnace in order to assess ways to increase PCI rates. Softening and melting experimental tests were carried out on five types of materials: olivine pellets, acid pellets, and sinters of three different basicities. The conclusion of the test is that the two main factors controlling the reduction of the burden material, and with that the meltdown properties, are the hydrogen content, resulting from the PCI rate, and the temperature increase rate, resulting from the rate of descent in the blast furnace. Based on these experimental results, a model of the cohesive zone was developed, which compares very well with the observations made on dissected blast furnaces. Finally, the blast furnace model has been used to study the influence on the cohesive zone and on some blast furnace performances of the variables affecting the cohesive zone permeability, essentially burned composition and chemistry. The influence of the layers thickness has also been assessed.

  18. Scale-space for empty catheter segmentation in PCI fluoroscopic images.

    Science.gov (United States)

    Bacchuwar, Ketan; Cousty, Jean; Vaillant, Régis; Najman, Laurent

    2017-07-01

    In this article, we present a method for empty guiding catheter segmentation in fluoroscopic X-ray images. The guiding catheter, being a commonly visible landmark, its segmentation is an important and a difficult brick for Percutaneous Coronary Intervention (PCI) procedure modeling. In number of clinical situations, the catheter is empty and appears as a low contrasted structure with two parallel and partially disconnected edges. To segment it, we work on the level-set scale-space of image, the min tree, to extract curve blobs. We then propose a novel structural scale-space, a hierarchy built on these curve blobs. The deep connected component, i.e. the cluster of curve blobs on this hierarchy, that maximizes the likelihood to be an empty catheter is retained as final segmentation. We evaluate the performance of the algorithm on a database of 1250 fluoroscopic images from 6 patients. As a result, we obtain very good qualitative and quantitative segmentation performance, with mean precision and recall of 80.48 and 63.04% respectively. We develop a novel structural scale-space to segment a structured object, the empty catheter, in challenging situations where the information content is very sparse in the images. Fully-automatic empty catheter segmentation in X-ray fluoroscopic images is an important and preliminary step in PCI procedure modeling, as it aids in tagging the arrival and removal location of other interventional tools.

  19. A validation study of the Brazilian version of the pornography consumption inventory (PCI) in a sample of female university students.

    Science.gov (United States)

    Baltieri, Danilo Antonio; Luísa de Souza Gatti, Ana; Henrique de Oliveira, Vitor; Junqueira Aguiar, Ana Saito; Almeida de Souza Aranha e Silva, Renata

    2016-02-01

    Although men constitute the widest consumer group of pornography, the Internet has facilitated both the production of and access to pornographic material by women as well. However, few measures are available to examine pornography-use constructs, which can compromise the reliability of statements regarding the harmful use of pornography. Our study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory (PCI) in a sample of female university students in Brazil. The PCI is a four-factor, 15-item, five-point Likert-type scale. After translation and back-translation of the PCI, it was administered to 105 female medical students. Exploratory and confirmatory factor analyses were conducted to examine the construct validity. The results supported the four-factor model of the PCI. The model showed adequate internal reliability and good fit indices (comparative fit index (CFI) = 0.95, Tucker-Lewis index (TLI) = 0.94, root mean square error of approximation (RMSEA) = 0.07 (95% confidence interval (CI) = 0.04-0.09), and standardized root mean square residual (SRMR) = 0.08). Overall, the findings from this study support the use of the PCI in Portuguese-speaking women. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  20. Suboptimal evolutionary novel environments promote singular altered gravity responses of transcriptome during Drosophila metamorphosis.

    Science.gov (United States)

    Herranz, Raul; Larkin, Oliver J; Hill, Richard J A; Lopez-Vidriero, Irene; van Loon, Jack J W A; Medina, F Javier

    2013-06-27

    Previous experiments have shown that the reduced gravity aboard the International Space Station (ISS) causes important alterations in Drosophila gene expression. These changes were shown to be intimately linked to environmental space-flight related constraints. Here, we use an array of different techniques for ground-based simulation of microgravity effects to assess the effect of suboptimal environmental conditions on the gene expression of Drosophila in reduced gravity. A global and integrative analysis, using "gene expression dynamics inspector" (GEDI) self-organizing maps, reveals different degrees in the responses of the transcriptome when using different environmental conditions or microgravity/hypergravity simulation devices. Although the genes that are affected are different in each simulation technique, we find that the same gene ontology groups, including at least one large multigene family related with behavior, stress response or organogenesis, are over represented in each case. These results suggest that the transcriptome as a whole can be finely tuned to gravity force. In optimum environmental conditions, the alteration of gravity has only mild effects on gene expression but when environmental conditions are far from optimal, the gene expression must be tuned greatly and effects become more robust, probably linked to the lack of experience of organisms exposed to evolutionary novel environments such as a gravitational free one.

  1. Factors associated with suboptimal adherence to antiretroviral therapy in Asia

    Directory of Open Access Journals (Sweden)

    Awachana Jiamsakul

    2014-05-01

    Full Text Available Introduction: Adherence to antiretroviral therapy (ART plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh in the first 24 months of ART in an Asian HIV cohort. Methods: As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results: Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR=0.7 (95% confidence interval (CI (0.55 to 0.90, p=0.006, compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs (OR=1.92, 95% CI (1.23 to 3.00, p=0.004 and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71, p<0.001. Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67, p=0.001 compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI combination. SubAdh decreased with increasing time on ART (all p<0.001. Similar associations were found with adherence <95% as the outcome. Conclusions: We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

  2. Over-the-counter suboptimal dispensing of antibiotics in Uganda

    Directory of Open Access Journals (Sweden)

    Mukonzo JK

    2013-08-01

    : In Uganda, at least four in every ten individuals that visit a health-care facility are treated with an antibiotic. Antibiotics are largely given as over-the-counter drugs at community pharmacies. The number of antibiotic prescribed daily doses/1,000 antibiotic clients does not significantly differ between categories of health-care facilities except at community pharmacies, where lower doses are dispensed compared to other health-care facilities. Keywords: antibiotic, over-the-counter dispensing, suboptimal dosing, Uganda

  3. A system analysis of a suboptimal surgical experience

    Directory of Open Access Journals (Sweden)

    Richards Michael

    2009-01-01

    Full Text Available Abstract Background System analyses of incidents that occur in the process of health care delivery are rare. A case study of a series of incidents that one of the authors experienced after routine urologic surgery is presented. We interpret the sequence of events as a case of cascading incidents that resulted in outcomes that were suboptimal, although fortunately not fatal. Methods A system dynamics approach was employed to develop illustrative models (flow diagrams of the dynamics of the patient's interaction with surgery and emergency departments. The flow diagrams were constructed based upon the experience of the patient, chart review, discussion with the involved physicians as well as several physician colleagues, comparison of our diagrams with those developed by the hospital of interest for internal planning purposes, and an iterative process with one of the co-authors who is a system dynamics expert. A dynamic hypothesis was developed using insights gained by building the flow diagrams. Results The incidents originated in design flaws and many small innocuous system changes that have occurred incrementally over time, which by themselves may have no consequence but in conjunction with some system randomness can have serious consequences. In the patient's case, the incidents that occurred in preoperative assessment and surgery originated in communication and procedural failures. System delays, communication failures, and capacity issues contributed largely to the subsequent incidents. Some of these issues were controllable by the physicians and staff of the institution, whereas others were less controllable. To the system's credit, some of the more controllable issues were addressed, but systemic problems like overcrowding are unlikely to be addressed in the near future. Conclusion This is first instance that we are aware of in the literature where a system dynamics approach has been used to analyze a patient safety experience. The

  4. A system analysis of a suboptimal surgical experience.

    Science.gov (United States)

    Lee, Robert C; Cooke, David L; Richards, Michael

    2009-01-06

    System analyses of incidents that occur in the process of health care delivery are rare. A case study of a series of incidents that one of the authors experienced after routine urologic surgery is presented. We interpret the sequence of events as a case of cascading incidents that resulted in outcomes that were suboptimal, although fortunately not fatal. A system dynamics approach was employed to develop illustrative models (flow diagrams) of the dynamics of the patient's interaction with surgery and emergency departments. The flow diagrams were constructed based upon the experience of the patient, chart review, discussion with the involved physicians as well as several physician colleagues, comparison of our diagrams with those developed by the hospital of interest for internal planning purposes, and an iterative process with one of the co-authors who is a system dynamics expert. A dynamic hypothesis was developed using insights gained by building the flow diagrams. The incidents originated in design flaws and many small innocuous system changes that have occurred incrementally over time, which by themselves may have no consequence but in conjunction with some system randomness can have serious consequences. In the patient's case, the incidents that occurred in preoperative assessment and surgery originated in communication and procedural failures. System delays, communication failures, and capacity issues contributed largely to the subsequent incidents. Some of these issues were controllable by the physicians and staff of the institution, whereas others were less controllable. To the system's credit, some of the more controllable issues were addressed, but systemic problems like overcrowding are unlikely to be addressed in the near future. This is first instance that we are aware of in the literature where a system dynamics approach has been used to analyze a patient safety experience. The qualitative system dynamics analysis was useful in understanding the

  5. Factors associated with suboptimal adherence to antiretroviral therapy in Asia

    Science.gov (United States)

    Jiamsakul, Awachana; Kumarasamy, Nagalingeswaran; Ditangco, Rossana; Li, Patrick CK; Phanuphak, Praphan; Sirisanthana, Thira; Sungkanuparph, Somnuek; Kantipong, Pacharee; Lee, Christopher KC; Mustafa, Mahiran; Merati, Tuti; Kamarulzaman, Adeeba; Singtoroj, Thida; Law, Matthew

    2014-01-01

    Introduction Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. Methods As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. Conclusions We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

  6. Research on carbonaceous substance of blast furnace dust under different PCI rates at Shouqin's No.1 blast furnace

    Energy Technology Data Exchange (ETDEWEB)

    Ding, R.; Wu, K.; Wu, W.; Fei, S.; Zhang, J.; Ni, B. [Shouqin Metal Company Ltd., Qinhuangdao (China). Ironmaking Dept.

    2008-11-15

    The microstructure of blast furnace (BF) dust (gravitational dust and bag dust of hop pocket) under increased pulverized coal injection (PCI) rate at Shouqin's No. 1 BF was investigated by means of microscopic analysis. The percentage of surface area of unconsumed coal and coke particles was determined under different PCI rates. The effect of increased PCI rate on the carbon mass fraction in BF dust and consequently on the unburnt coal and coke particles as well as the utilisation factor of pulverised coal are given for different PCI rates at Shouqin's No. 1 BF. 5 refs., 2 figs., 4 tabs.

  7. Switching from Clopidogrel to Prasugrel in patients undergoing PCI: A meta-analytic overview.

    Science.gov (United States)

    Verdoia, Monica; Barbieri, Lucia; Suryapranata, Harry; De Luca, Giuseppe

    2016-01-01

    Despite the demonstrated benefits of Prasugrel, a new generation thienopyridine, in the prevention of thrombotic complications after percutaneous coronary interventions (PCI) for Acute Coronary Syndromes (ACS), its use is still precluded to those many patients arriving to the cath lab pre-treated with Clopidogrel. Conclusive data on the strategy of switching from Clopidogrel to Prasugrel are still missing, therefore we aimed to perform a meta-analysis of current studies evaluating the safety and efficacy of switching from Clopidogrel to Prasugrel (PS) as compared to a standard thienopyridine therapy with Clopidogrel or Prasugrel in patients undergoing PCI. Literature archives and main scientific sessions' abstracts were scanned for studies comparing a switching strategy from Clopidogrel to Prasugrel vs. Prasugrel or Clopidogrel. Primary efficacy endpoint was overall mortality. Secondary endpoints were: non-fatal myocardial infarction and definite/probable stent thrombosis. Safety endpoint was the rate of major bleedings according to a per-protocol definition. A total of 12 studies, involving 3956 patients, were included. Among them, 1396 patients (35.3%), received Prasugrel after a Clopidogrel treatment (PS), while 2560 (64.7%) received either Prasugrel or Clopidogrel. The switch from Clopidogrel to Prasugrel was in the majority of the studies periprocedural. The mortality was numerically lower, but not statistically significant, in the PS group as compared with patients who did not switch (1.7% vs. 3.8%, OR [95% CI] = 0.68 [0.40,1.15], p = 0.15, phet = 0.61), without any relationship with patients' risk profile (r = -0.68 [-2.09, 0.73], p = 0.35). Similar results were obtained for secondary efficacy endpoints and at sensitivity analysis in the majority of subgroups evaluated. Moreover, the PS strategy did not increase major bleedings as compared with standard therapy (1.4% vs. 2.5%, OR [95% CI = 0.70 [0.39, 1.25], p = 0.23, phet = 0.6). The present meta

  8. Suboptimal cytoreduction in ovarian carcinoma is associated with molecular pathways characteristic of increased stromal activation.

    Science.gov (United States)

    Liu, Zhenqiu; Beach, Jessica A; Agadjanian, Hasmik; Jia, Dongyu; Aspuria, Paul-Joseph; Karlan, Beth Y; Orsulic, Sandra

    2015-12-01

    Suboptimal cytoreductive surgery in advanced epithelial ovarian cancer (EOC) is associated with poor survival but it is unknown if poor outcome is due to the intrinsic biology of unresectable tumors or insufficient surgical effort resulting in residual tumor-sustaining clones. Our objective was to identify the potential molecular pathway(s) and cell type(s) that may be responsible for suboptimal surgical resection. By comparing gene expression in optimally and suboptimally cytoreduced patients, we identified a gene network associated with suboptimal cytoreduction and explored the biological processes and cell types associated with this gene network. We show that primary tumors from suboptimally cytoreduced patients express molecular signatures that are typically present in a distinct molecular subtype of EOC characterized by increased stromal activation and lymphovascular invasion. Similar molecular pathways are present in EOC metastases, suggesting that primary tumors in suboptimally cytoreduced patients are biologically similar to metastatic tumors. We demonstrate that the suboptimal cytoreduction network genes are enriched in reactive tumor stroma cells rather than malignant tumor cells. Our data suggest that the success of cytoreductive surgery is dictated by tumor biology, such as extensive stromal reaction and increased invasiveness, which may hinder surgical resection and ultimately lead to poor survival. Copyright © 2015. Published by Elsevier Inc.

  9. Suboptimal care and maternal mortality among foreign-born women in Sweden

    DEFF Research Database (Denmark)

    Esscher, Annika; Binder-Finnema, Pauline; Bødker, Birgit

    2014-01-01

    BACKGROUND: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths...... language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. CONCLUSIONS: Suboptimal care factors, major...

  10. Universal LabVIEW-powered Moessbauer spectrometer based on USB, PCI or PXI devices

    Energy Technology Data Exchange (ETDEWEB)

    Pechousek, J; Prochazka, R; Jancik, D; Frydrych, J; Mashlan, M, E-mail: pechous@prfnw.upol.c [Centre for Nanomaterial Research, Palacky University, Slechtitelu 11, 783 71, Olomouc (Czech Republic)

    2010-03-01

    A new design of the universal Moessbauer spectrometer is presented. Hardware solution is based on commercial-available data acquisition devices working on the USB, PCI or PXI platform controlled by the main application running on the personal computer. Final application allows, in addition to Moessbauer spectra accumulation, the detailed analysis of the acquired detector signal in energy and time domains, and also to tune the velocity driving system separately. The experimental results show a high flexibility in various detectors and velocity transducers usage. It is easy to change the way of operation according to the different experimental requirements. This concept can be used with all common spectrometric benches with different velocity transducers, radioactive sources and gamma-ray detectors. This is a new approach in the Moessbauer spectrometer construction.

  11. Introduzione al carteggio Benelli-Gozzini, ovvero sulla militanza dei credenti nel Pci

    Directory of Open Access Journals (Sweden)

    Giambattista Scirè

    2014-04-01

    Full Text Available Questo contributo propone lo scambio epistolare tra il cardinale di Firenze Giovanni Benelli e l’intellettuale fiorentino Mario Gozzini, con una introduzione che, alla luce delle carte conservate nel Fondo Gozzini, permette di capire il contesto in cui avvenne il significativo carteggio. Il tema affrontato è il rapporto tra cristianesimo e marxismo, tra credenti e Partito comunista italiano. La vicenda va collocata tra la fine degli anni Settanta e gli inizi degli anni Ottanta, quando un intenso dibattito sul declino della politica e della cultura cattolica nella società contemporanea animava il mondo cattolico italiano (intellettuali, politici e sacerdoti e, in particolare, quello della città di Firenze. In questo contesto di crisi del partito cattolico, le proposte di ‘riaggregazione’ dell’area cattolica si scontrano con la nascita del gruppo parlamentare della Sinistra indipendente, eletto nelle file del Pci.

  12. Optimal and Suboptimal Finger Selection Algorithms for MMSE Rake Receivers in Impulse Radio Ultra-Wideband Systems

    Directory of Open Access Journals (Sweden)

    Chiang Mung

    2006-01-01

    Full Text Available The problem of choosing the optimal multipath components to be employed at a minimum mean square error (MMSE selective Rake receiver is considered for an impulse radio ultra-wideband system. First, the optimal finger selection problem is formulated as an integer programming problem with a nonconvex objective function. Then, the objective function is approximated by a convex function and the integer programming problem is solved by means of constraint relaxation techniques. The proposed algorithms are suboptimal due to the approximate objective function and the constraint relaxation steps. However, they perform better than the conventional finger selection algorithm, which is suboptimal since it ignores the correlation between multipath components, and they can get quite close to the optimal scheme that cannot be implemented in practice due to its complexity. In addition to the convex relaxation techniques, a genetic-algorithm- (GA- based approach is proposed, which does not need any approximations or integer relaxations. This iterative algorithm is based on the direct evaluation of the objective function, and can achieve near-optimal performance with a reasonable number of iterations. Simulation results are presented to compare the performance of the proposed finger selection algorithms with that of the conventional and the optimal schemes.

  13. Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana

    Directory of Open Access Journals (Sweden)

    James Tsai

    2017-06-01

    In conclusion, among adult ever users of marijuana, current tobacco use is high and strongly associated with suboptimal SRH; regular marijuana smoking with or without current tobacco use is significantly associated with suboptimal SRH.

  14. Cost-effectiveness of clopidogrel treatment in percutaneous coronary intervention: a European model based on a meta-analysis of the PCI-CURE, CREDO and PCI-CLARITY trials.

    Science.gov (United States)

    Berg, Jenny; Fidan, Dogan; Lindgren, Peter

    2008-07-01

    Our objective was to conduct a comprehensive cost-effectiveness analysis of pre-treatment and long-term treatment with clopidogrel in percutaneous coronary intervention (PCI) in three European countries based on a meta-analysis of the PCI-Clopidogrel in Unstable angina to prevent Recurrent Events (CURE), Clopidogrel for the Reduction of Events During Observation (CREDO) and PCI-Clopidogrel as Adjunctive Therapy (CLARITY) trials. This analysis adds to existing knowledge by providing further data on the cost-effectiveness of clopidogrel in PCI across a wide spectrum of patients. A combined decision tree and Markov model was created. The relative risks of myocardial infarction, cardiovascular death and of major bleedings with clopidogrel were based on a fixed-effects meta-analysis. The risk of ischaemic events in untreated patients and long-term survival were taken from the Swedish hospital and death registers. A societal perspective was used in Sweden and a payer perspective in Germany and France. Costs are stated in euro2006 and effectiveness measured in quality-adjusted life-years (QALYs). The pooled effects of clopidogrel on the combined endpoint showed a relative risk of 0.711 (p=0.003) at 30 days and 0.745 (p=0.002) at end of follow-up (up to 1 year). Pre-treatment with clopidogrel compared with aspirin alone is a dominant strategy. Long-term treatment with clopidogrel compared with 1-month treatment leads to approximately 0.09 QALYs at an incremental cost of euro393 in Sweden, euro709 in Germany and euro494 in France. The corresponding incremental cost-effectiveness ratios range from euro4225/QALY to euro7871/QALY. The results of this modelling analysis suggest that pre-treatment and long-term treatment in PCI with clopidogrel for up to 1 year are cost-effective in a range of patient groups and settings given commonly accepted thresholds.

  15. Caracterização e Beneficiamento Primário de Placas de Circuito Impresso (PCI de Telefones Celulares

    Directory of Open Access Journals (Sweden)

    Theo Antonio de Jesus

    2015-12-01

    Full Text Available Devido ao constante avanço tecnológico, uma grande quantidade de aparelhos é descartada por obsolescência tecnológica ou defeitos. Isto acarreta a contaminação do solo e do lençol freático, além de representar perda econômica pois as PCI (placas de circuito impresso dos telefones celulares são ricas em metais pesados e alguns metais valiosos. Com o objetivo de conhecer melhor a composição e concentração destas PCI de modo a otimizar os processos de reciclagem, foi realizada a caracterização das PCI através da digestão em água régia e da utilização das técnicas de DRx (difração de raios x e FRx (espectrometria de fluorescência de raios x. Os resultados proporcionaram conhecimento suficiente a respeito da composição e concentração dos principais metais das PCI. A presença de ouro, prata e cobre chama a atenção para o potencial econômico destes resíduos. Estudos são necessários para desenvolver os processos mais adequados com vistas a concentrar estes metais e viabilizar sua reciclagem.

  16. Long-term outcome of FFR-guided PCI for stable coronary artery disease in daily clinical practice

    DEFF Research Database (Denmark)

    De Backer, Ole; Biasco, Luigi; Lønborg, Jacob

    2016-01-01

    AIMS: Our aim was to investigate the strength of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) in daily practice. METHODS AND RESULTS: For this study, 3,512 patients with stable CAD and at least one 50-89% coronary stenosis...

  17. Smokers with ST-segment elevation myocardial infarction and short time to treatment have equal effects of PCI and fibrinolysis

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Kelbæk, Henning; Madsen, Jan Kyst

    2012-01-01

    The purpose of this study was to examine the effect of primary percutaneous coronary intervention (PCI) compared to fibrinolysis in smokers and non-smokers with ST-segment elevation myocardial infarction (STEMI). Smokers seem to have less atherosclerosis but are more prone to thrombotic disease...

  18. Impact of Timing of Eptifibatide Administration on Preprocedural Infarct-Related Artery Patency in Acute STEMI Patients Undergoing Primary PCI.

    Science.gov (United States)

    Dharma, Surya; Firdaus, Isman; Danny, Siska Suridanda; Juzar, Dafsah A; Wardeh, Alexander J; Jukema, J Wouter; van der Laarse, Arnoud

    2014-09-01

    The appropriate timing of eptifibatide initiation for acute ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. This study aimed to analyze the impact of timing of eptifibatide administration on infarct-related artery (IRA) patency in STEMI patients undergoing primary PCI. Acute STEMI patients who underwent primary PCI (n = 324) were enrolled in this retrospective study; 164 patients received eptifibatide bolus ≤ 30 minutes after emergency department (ED) admission (group A) and 160 patients received eptifibatide bolus > 30 minutes after ED admission (group B). The primary endpoint was preprocedural IRA patency. Most patients in group A (90%) and group B (89%) were late presenters (> 2 hours after symptom onset). The two groups had similar preprocedural thrombolysis in myocardial infarction 2 or 3 flow of the IRA (26 vs. 24%, p = not significant [NS]), similar creatine kinase-MB (CK-MB) levels at 8 hours after admission (339 vs. 281 U/L, p = NS), similar left ventricular ejection fraction (LVEF) (52 vs. 50%, p = NS), and similar 30-day mortality (2 vs. 7%, p = NS). Compared with group B, patients in group A had shorter door-to-device time (p eptifibatide before primary PCI did not improve preprocedural IRA patency, CK-MB level at 8 hours after admission, LVEF and 30-day mortality compared with patients who received intravenous eptifibatide that was administered later.

  19. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study

    NARCIS (Netherlands)

    Mehta, S. R.; Yusuf, S.; Peters, R. J.; Bertrand, M. E.; Lewis, B. S.; Natarajan, M. K.; Malmberg, K.; Rupprecht, H.; Zhao, F.; Chrolavicius, S.; Copland, I.; Fox, K. A.

    2001-01-01

    Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and

  20. Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG

    Directory of Open Access Journals (Sweden)

    Sandra Eifert

    2010-06-01

    Full Text Available Sandra Eifert1, Helmut Mair1, Anne-Laure Boulesteix2, Eckehard Kilian1, Martin Adamczak1, Bruno Reichart1, Peter Lamm11Department of Cardiac Surgery, 2Department of Medical Informatics, Biometry and Epidemiology (IBE, Ludwig Maximilians University, Munich, GermanyAbstract: The number of percutaneous coronary interventions (PCI prior to coronary artery bypass grafting (CABG increased drastically during the last decade. Patients are referred for CABG with more severe coronary pathology, which may influence postoperative outcome. Outcomes of 200 CABG patients, collected consecutively in an observational study, were compared (mean follow-up: 5 years. Group A (n = 100, mean age 63 years, 20 women had prior PCI before CABG, and group B (n = 100, mean age 66, 20 women underwent primary CABG. In group A, the mean number of administered stents was 2. Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 54 vs 34 (P = 0.007, distribution of CAD (P < 0.0001, unstable angina: 27 vs 5 (P < 0.0001. For intraoperative data, the total number of established bypasses was 2.43 ± 1.08 vs 2.08 ± 1.08 (P = 0.017, with the number of arterial bypass grafts being: 1.26 ± 0.82 vs 1.07 ± 0.54 (P = 0.006. Regarding the postoperative course, significant results could be demonstrated for: adrenaline dosage (0.83 vs 0.41 mg/h; [p is not significant (ns] administered in 67 group A vs 47 group B patients (P = 0.006, and noradrenaline dosage (0.82 vs 0.87 mg/h; ns administered in 46 group A vs 63 group B patients (P = 0.023, CK/troponine I (P = 0.002; P < 0.001, postoperative resuscitation (6 vs 0; P = 0.029, intra aortic balloon pump 12 vs 1 (P = 0.003, and 30-day mortality (9% in group A vs 1% in group B; P = 0.018. Clopidogrel was administered in 35% of patients with prior PCI and in 19% of patients without prior PCI (P = 0.016. Patients with prior PCI presented for CABG with more severe CAD. Morbidity

  1. Effect of Using Suboptimal Alignments in Template-Based Protein Structure Prediction

    Science.gov (United States)

    Chen, Hao; Kihara, Daisuke

    2010-01-01

    Computational protein structure prediction remains a challenging task in protein bioinformatics. In the recent years, the importance of template-based structure prediction is increasing due to the growing number of protein structures solved by the structural genomics projects. To capitalize the significant efforts and investments paid on the structural genomics projects, it is urgent to establish effective ways to use the solved structures as templates by developing methods for exploiting remotely related proteins that cannot be simply identified by homology. In this work, we examine the effect of employing suboptimal alignments in template-based protein structure prediction. We showed that suboptimal alignments are often more accurate than the optimal one, and such accurate suboptimal alignments can occur even at a very low rank of the alignment score. Suboptimal alignments contain a significant number of correct amino acid residue contacts. Moreover, suboptimal alignments can improve template-based models when used as input to Modeller. Finally, we employ suboptimal alignments for handling a contact potential in a probabilistic way in a threading program, SUPRB. The probabilistic contacts strategy outperforms the partly thawed approach which only uses the optimal alignment in defining residue contacts and also the reranking strategy, which uses the contact potential in reranking alignments. The comparison with existing methods in the template-recognition test shows that SUPRB is very competitive and outperform existing methods. PMID:21058297

  2. PCI-24781, a Novel Hydroxamic Acid HDAC Inhibitor, Exerts Cytotoxicity and Histone Alterations via Caspase-8 and FADD in Leukemia Cells

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    Nilsa Rivera-Del Valle

    2010-01-01

    Full Text Available Histone deacetylase inhibitors (HDACi have become a promising new avenue for cancer therapy, and many are currently in Phase I/II clinical trials for various tumor types. In the present study, we show that apoptosis induction and histone alterations by PCI-24781, a novel hydroxamic acid-based HDAC inhibitor, require caspase-8 and the adaptor molecule, Fas-associated death domain (FADD, in acute leukemia cells. PCI-24781 treatment also causes an increase in superoxide levels, which has been reported for other HDACi. However, an antioxidant does not reverse histone alterations caused by PCI-24781, indicating that ROS generation is likely downstream of the effects that PCI-24781 exerts on histone H3. Taken together, these results provide insight into the mechanism of apoptosis induction by PCI-24781 in leukemia by highlighting the roles of caspase-8, FADD and increased superoxide levels.

  3. Left ventricular thrombi after STEMI in the primary PCI era: A systematic review and meta-analysis.

    Science.gov (United States)

    Robinson, Austin A; Jain, Amit; Gentry, Mark; McNamara, Robert L

    2016-10-15

    Left ventricular (LV) thrombus formation following myocardial infarction (MI) has not been well characterized since the advent of primary percutaneous coronary intervention (pPCI). Ascertainment of the utility of prophylactic anticoagulation is hindered by the lack of reliable information on its modern incidence. We sought to provide an estimate of the rate of LV thrombus formation in patients treated with pPCI for ST segment elevation MI (STEMI) by means of a systematic review and meta-analysis. We searched Ovid MEDLINE and Ovid EMBASE databases for studies between 1990 and 2015 documenting LV thrombi after STEMI treated with pPCI. We estimated the rate of echocardiographically-diagnosed LV thrombi within 90days of pPCI, calculating the rate of LV thrombi after STEMI in any infarct territory as well as only anterior infarcts. From an initial yield of 1144 studies, inclusion criteria were met by 19 studies, including 10,076 patients across 27 centers in 9 countries. Rate of LV thrombi after all STEMI was 2.7% (95% CI 1.9%-3.5%) and 9.1% (95% CI 6.6%-11.6%) after anterior STEMI. Among anterior STEMI, there was an inverse relationship between size of study and rate of LV thrombi. LV thrombi persist as an important part of the management of STEMI after pPCI, particularly among anterior infarcts. Estimating risk of thrombus formation and embolization as well as utility of treatment remains critical. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Effect of nicorandil on the myocardial tissue perfusion and myocardial cell injury in patients with diabetes after PCI

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    Xue-Li Ren1

    2017-04-01

    Full Text Available Objective: To study the effect of nicorandil on the myocardial tissue perfusion and myocardial cell damage in patients with diabetes after percutaneous coronary intervention (PCI. Methods: 68 patients with coronary heart disease and type 2 diabetes mellitus who received PCI in our hospital between May 2011 and September 2015 were collected and then divided into observation group and control group (n=34 according to the single-blind randomized control method. Control group of patients received PCI alone, and the observation group of patients received nicorandil therapy after PCI. After treatment, real-time myocardial ultrasound contrast was used to evaluate the myocardial perfusion of two groups of patients; blood biochemical analyzer was used to detect the contents of peripheral blood myocardial enzyme spectrum indexes; the ELISA method was used to detect the contents of serum oxidative stress indicators; RIA method was used to detect the contents of serum apoptosis molecules. Results: After treatment, the myocardial tissue perfusion parameters plateau peak intensity (A, slope rate of curve (β and myocardial blood flow (A×β levels of observation group were significantly higher than those of control group (P<0.05; peripheral blood myocardial enzyme spectrum indexes creatine kinase (CK, lactate dehydrogenase (LDH, troponin I (cTnI and glutamic oxalacetic transaminase (GOT contents of observation group were significantly lower than those of control group (P<0.05; serum vitamin E (VitE and vitamin C (VitC contents of observation group were significantly higher than those of control group while malondialdehyde (MDA, advanced oxidation protein products (AOPPs, soluble apoptosis-associated factor (sFas and soluble apoptosis-associated factor ligand (sFasL contents were lower than those of control group (P<0.05. Conclusion: Adjuvant nicorandil therapy can improve the myocardial perfusion and reduce the myocardial cell injury in patients with coronary

  5. Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.

    Science.gov (United States)

    Lupi, Alessandro; Schaffer, Alon; Lazzero, Maurizio; Tessitori, Massimo; De Martino, Leonardo; Rognoni, Andrea; Bongo, Angelo S; Porto, Italo

    2016-12-01

    Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion. We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint. The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups. In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Suboptimal asthma care for immigrant children: results of an audit study

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    Klazinga Niek S

    2008-01-01

    Full Text Available Abstract Background Little is known on the scope and nature of ethnic inequalities in suboptimal asthma care for children. This study aimed to assess (1 ethnic differences in suboptimal asthma care for children with an asthma exacerbation who consulted a physician, and (2 ethnic differences in the nature of suboptimal care. Methods All children aged 6–16 years who during a period of six months consulted the paediatric department of the Academic Medical Centre-University of Amsterdam or one of the six regional primary care centres with an asthma exacerbation were included. Clinical guidelines were systematically converted to review criteria following the strategy as proposed by the Agency for Health Care Policy and Research. Based upon these review criteria and their experience experts of two multidisciplinary panels retrospectively assessed the quality of care and its (possible failure to prevent the occurrence of asthma exacerbation. Results Only a small number of children (n = 35 were included in the analysis as a result of which the ethnic differences in suboptimal care were not significant. However, the results do indicate immigrant children, in particular 'other non-Western' children (n = 11, more frequently to receive suboptimal care related to the asthma exacerbation when compared to ethnic Dutch children. Furthermore, we found the nature of suboptimal care to differ with under-prescribing in the 'other non-Western' group (n = 11, lack of information exchange between physicians in the Surinamese/Antillean group (n = 12 and lack of education, and counselling of patients and parents in the ethnic Dutch (n = 12 as the most relevant factor. Conclusion Ethnic inequalities in the scope and nature of suboptimal asthma care for children in the Netherlands seem to exist. For the non-western immigrant groups the results indicate the importance of the prescription behaviour of the medical doctor, as well as the supervision by one health care

  7. Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI.

    Science.gov (United States)

    Bonzel, Tassilo; Schächinger, Volker; Dörge, Hilmar

    2016-05-01

    We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p approach is an effective tool for ad hoc and conference

  8. Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: results from the ASSENT-4 PCI study.

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    Zeymer, Uwe; Huber, Kurt; Fu, Yuling; Ross, Allan; Granger, Christopher; Goldstein, Patrick; van de Werf, Frans; Armstrong, Paul

    2012-06-01

    Early restoration of blood flow of the infarct-related artery is associated with an improved outcome in patients with ST-elevation myocardial infarction (STEMI). Previous studies have shown a low mortality in patients with TIMI 3 flow before primary percutaneous coronary intervention (PCI). Most likely these patients had spontaneous recanalization of the infarct vessel and might constitute a low-risk subgroup. The purpose of the present analysis was to investigate whether TIMI 3 flow obtained with fibrinolysis before PCI is associated with a clinical outcome comparable to that in patients with spontaneous TIMI 3 flow. Patients with STEMI TIMI flow of the infarct vessel before PCI: TIMI 0/1, TIMI 2, and TIMI 3. From a total of 1617 patients, 861 had TIMI 0/1, 279 had TIMI 2, and 477 TIMI 3 flow. The rates of TIMI 3 flow after PCI were 84.6, 89.7, and 95.6%, respectively. Complete ST resolution was observed most often in the TIMI 3 flow group (47.5, 53.6, and 58.6%). The incidence of cardiogenic shock (6.2, 5.5, and 3.6%) and 90-day mortality (6.1, 4.7, and 4.0%) were lowest in the group with TIMI 3 patency before PCI, respectively. The rate of TIMI 3 flow before PCI was higher in the facilitated PCI group than in the primary PCI group (43.9 vs. 15.2%). The 90-day mortality in patients with TIMI 3 before PCI was identical in the facilitated and the primary PCI groups (14/353, 4.0% vs. 5/124, 4.0%). In this post-hoc analysis of ASSENT-4 PCI, TIMI grade 3 flow in the infarct-related artery before PCI, occurring either spontaneously or obtained by fibrinolysis, is associated with a higher TIMI patency after PCI, better improved ST resolution and a trend towards a favourable clinical outcome after 90 days.

  9. UNSUCCESSFUL PRIMARY PCI FOR POSTPARTAL DISSECTION OF ALL THREE MAJOR CORONARY ARTERIES

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    Svetlana Apostolović

    2014-03-01

    Full Text Available Coronary artery dissection is rare but very dangerous condition which can result in myocardial infarction. It mostly occurs in young postpartum women. The left anterior descending artery is affected in 75% of cases and in some extremely rare cases dissection may include all three coronary arteries. Treatment guides are still not consistent. While some authors recommend medical treatment other recommend surgical one. Case report. We present a 36-year-old female patient who was admitted to our hospital with intermittent chest pain and dyspnea that occurred two hours before admission. After premedication with Aspirin 300 mg per os, Clopidogrel 300 mg per os and Enoxaparin 30 mg iv, the pain disappeared. Chest pain was repeated after five days. Coronary angiography revealed spiral dissection in medial segment of LAD. After PCI attempt, dissection progressed and ended fatal. Pathological finding was intimal dissection of the coronary arteries with loss of some parts of internal elastic lamina. It is interesting that in the literature there is no consistent opinion about therapeutic approach to SDCA and we hope that this case report will contribute to elucidating the problem.

  10. Cultura politica di partito e cultura politica nazionale: il caso del Pci nella Prima Repubblica

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    Andrea Millefiorini

    2016-01-01

    Full Text Available In the paper we are explaining those aspects of the Italian Communist Party, that, thanks to the particular organized structure, contributed, in a meaningful way, to outline some characteristic features of the Italian political culture. There are four aspects of them: the first one was represented by a strong level of ideologism that for reaction and contamination passed from its main centre of diffusion (which was just the P.C.I to the other actors of the Italian party system, whose high level of ideologization produced models of interpretation of problems and of decisions, elaboration and planning, about not so much pragmatic plans; on the contrary, concerning rhetoric or propagandistic approaches.A second, relevant effect to which contributed in this case not only the political communist culture, we are analyzing above all from this point of view: it was constituted by the leadership exerced by the political parties that acquired in the symbolic values of the Italians universe as regards the other components of the Political system; the consequences of this situation we are going to analyze in the paper.A third element was the strong statalism which constituted the political culture of the country at least till the end of seventies.The fourth factor spread by the political communist culture was given by the egualitarianism. It assumed a relevant role at the organizing and structural level concerning the burocratic machinery; the values connected to it not always produced good results in efficiency, in resources optimization and productivity.

  11. Suboptimal maternal and paternal mental health are associated with child bullying perpetration.

    Science.gov (United States)

    Shetgiri, Rashmi; Lin, Hua; Flores, Glenn

    2015-06-01

    This study examines associations between maternal and paternal mental health and child bullying perpetration among school-age children, and whether having one or both parents with suboptimal mental health is associated with bullying. The 2007 National Survey of Children's Health, a nationally-representative, random-digit-dial survey, was analyzed, using a parent-reported bullying measure. Suboptimal mental health was defined as fair/poor (vs. good/very good/excellent) parental self-reported mental and emotional health. Of the 61,613 parents surveyed, more than half were parents of boys and were white, 20% were Latino, 15% African American, and 7% other race/ethnicity. Suboptimal maternal (OR 1.4; 95% CI 1.1-1.8) and paternal (OR 1.5; 95% CI 1.1-2.2) mental health are associated with bullying. Compared with children with no parents with suboptimal mental health, children with only one or both parents with suboptimal mental health have higher bullying odds. Addressing the mental health of both parents may prove beneficial in preventing bullying.

  12. Adapting smartphone-based photoplethysmograpy to suboptimal scenarios.

    Science.gov (United States)

    Garcia-Agundez, Augusto; Dutz, Tim; Goebel, Stefan

    2017-02-01

    Photoplethysmography (PPG) is an optical technique used to measure the heart rate (HR) and other cardiovascular variables by analyzing volume changes in the microvascular bed of tissue. At the moment, smartphone users can already measure their HR using PPG applications that use the smartphone's built-in camera. However, available applications are unreliable when artifacts are present, such as those caused by movement, finger pressure, or ambient light changes. This contribution aims to analyze the limitations of a smartphone-based PPG algorithm capable of measuring N-N intervals when such artifacts are present by comparing it to a 2-lead electrocardiography (ECG). By using a Bandpass filter and a zero-crossing detection algorithm on a PPG signal captured at 800  ×  600 pixels and 30 Hz, we have designed an approach capable of assessing N-N intervals when movement artifacts are present. An evaluation performed on n  =  31 users shows our algorithm is capable of measuring N-N intervals with an average relative error of 9.23 ms, when compared to a 2-lead ECG. Our approach proves the reliability of smartphone-based photoplethysmography to measure N-N intervals, even under the presence of movement artifacts, and opens the door for its future use in remote diagnosis scenarios.

  13. Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes

    DEFF Research Database (Denmark)

    Sirker, Alex; Kwok, Chun Shing; Kontopantelis, Evangelos

    2018-01-01

    with the use of potent P2Y12 blocking drugs, Prasugrel and Ticagrelor, in SVG PCI are unknown. METHODS: Patients included in the study underwent SVG PCI in the United Kingdom between 2007 and 2014 for acute coronary syndrome and were grouped by P2Y12 antiplatelet use. In-hospital major adverse cardiac events......-day mortality compared with Clopidogrel. The odds ratios reported from the multivariable analysis were 1.22 (95% CI: 0.60-2.51) for Prasugrel vs. Clopidogrel and 0.48 (95% CI: 0.20-1.16) for Ticagrelor vs. Clopidogrel. No significant differences were seen for in-hospital ischemic or bleeding events...

  14. The catalytic performance of Ru–NHC alkylidene complexes: PCy3 versus pyridine as the dissociating ligand

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    Stefan Krehl

    2010-12-01

    Full Text Available The catalytic performance of NHC-ligated Ru-indenylidene or benzylidene complexes bearing a tricyclohexylphosphine or a pyridine ligand in ring closing metathesis (RCM, cross metathesis, and ring closing enyne metathesis (RCEYM reactions is compared. While the PCy3 complexes perform significantly better in RCM and RCEYM reactions than the pyridine complex, all catalysts show similar activity in cross metathesis reactions.

  15. Smokers with ST-segment elevation myocardial infarction and short time to treatment have equal effects of PCI and fibrinolysis

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Kelbæk, Henning; Madsen, Jan Kyst

    2012-01-01

    The purpose of this study was to examine the effect of primary percutaneous coronary intervention (PCI) compared to fibrinolysis in smokers and non-smokers with ST-segment elevation myocardial infarction (STEMI). Smokers seem to have less atherosclerosis but are more prone to thrombotic disease....... Compared to non-smokers, they have higher rates of early, complete reperfusion when treated with fibrinolysis for MI....

  16. Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients.

    Science.gov (United States)

    Schaaf, Mathieu Julien; Mewton, Nathan; Rioufol, Gilles; Angoulvant, Denis; Cayla, Guillaume; Delarche, Nicolas; Jouve, Bernard; Guerin, Patrice; Vanzetto, Gerald; Coste, Pierre; Morel, Olivier; Roubille, François; Elbaz, Meyer; Roth, Olivier; Prunier, Fabrice; Cung, Thien Tri; Piot, Christophe; Sanchez, Ingrid; Bonnefoy-Cudraz, Eric; Revel, Didier; Giraud, Céline; Croisille, Pierre; Ovize, Michel

    2016-03-01

    The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size. Copyright © 2015. Published by Elsevier Ltd.

  17. Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of PCI Followed by Minimally Invasive Valve Surgery.

    Science.gov (United States)

    Pineda, Andrés M; Gowani, Saqib A; Mihos, Christos G; Chandra, Ramesh; Santana, Orlando; Lamelas, Joseph; Beohar, Nirat

    A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the combined coronary artery bypass graft and valve surgery for patients with concomitant coronary artery (CAD) and valvular heart disease. We sought to evaluate the impact of the complexity of CAD, as assessed by the Syntax score, on the outcomes of the staged approach. We retrospectively evaluated 138 patients who underwent PCI and MIVS at our institution between January 2009 and June 2013. The baseline Syntax score was calculated, and the patients were divided into two groups: low risk (Syntax scores, 0-22) or intermediate-high risk (>22). There were 125 patients with low (mean ± standard deviation, 8 ± 5) and 13 with intermediate-high (mean ± standard deviation, 26 ± 4) Syntax scores. Baseline, PCI, and operative characteristics were similar between the groups, except for an observed higher incidence of peripheral arterial disease, multivessel coronary disease, mitral valve replacement, and a higher predicted The Society of Thoracic Surgeons mortality risk score in the intermediate-high Syntax group. The short-term postoperative complications, 30-day mortality, and 3-year survival (84% vs 77%) were similar between the groups. Patients in the intermediate-high-risk group had a higher incidence of repeat target vessel revascularization during follow-up (0.8% vs 16.7%). A staged approach of PCI followed by MIVS is a safe and feasible alternative for patients with valvular heart disease and concomitant CAD. However, it may confer an increased incidence of repeat target vessel revascularization in patients with intermediate- to high-complexity CAD.

  18. The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI.

    Science.gov (United States)

    Turkmen, S; Dogdu, O; Tekin, K; Kucukdurmaz, Z; Cagliyan, C E; Sarikaya, S; Yucel, H; Karapinar, H; Ozkan, B; Uysal, O K; Basara, A; Sancaktar, E; Yilmaz, A

    2013-08-01

    ST segment elevation myocardial infarction (STEMI) is an important cause of the morbidity and mortality in coronary artery disease. The aim of this study is to investigate the relationship between hematologic parameters and post primary PCI coronary no-reflow. A total of 145 consecutive STEMI patients (mean age=58.2±12.3 years) and healthy volunteer admitted within 6 hours from symptom onset were enrolled to the study in the cardiology clinics. The STEMI patients were divided into 2 groups based on the Thrombolysis In Myocardial Infarction (TIMI) flow grade. No-reflow was defined as post-PCI TIMI Flow Grade 0, 1 or 2 and angiographic success was defined as TIMI Grade 3 Flow. Diabetes mellitus hypertension and smoking status were similar between groups. With respect to baseline laboratory status, fasting glucose, blood urea nitrogen, creatinine levels were not significantly different between groups. The neutrophil/lymphocyte (N/L) ratio was also significantly higher in STEMI group (7.1±4.6 vs. 2.3±1.7, p TIMI Flow Grade 0, 1 or 2) group (13.1±4.5 vs. 5.3±2.7, p < 0.001). The N/L ratio, which is cheaply and easily measurable laboratory data is independently associated with post primary PCI coronary no-reflow.

  19. Not Noisy, Just Wrong: The Role of Suboptimal Inference in Behavioral Variability

    Science.gov (United States)

    Beck, Jeffrey M.; Ma, Wei Ji; Pitkow, Xaq; Latham, Peter E.; Pouget, Alexandre

    2015-01-01

    Behavior varies from trial to trial even when the stimulus is maintained as constant as possible. In many models, this variability is attributed to noise in the brain. Here, we propose that there is another major source of variability: suboptimal inference. Importantly, we argue that in most tasks of interest, and particularly complex ones, suboptimal inference is likely to be the dominant component of behavioral variability. This perspective explains a variety of intriguing observations, including why variability appears to be larger on the sensory than on the motor side, and why our sensors are sometimes surprisingly unreliable. PMID:22500627

  20. Frequency and predictors of suboptimal glycemic control in an African diabetic population

    Directory of Open Access Journals (Sweden)

    Kibirige D

    2017-02-01

    Full Text Available Davis Kibirige,1 George Patrick Akabwai,2 Leaticia Kampiire,3 Daniel Ssekikubo Kiggundu,4 William Lumu5 1Department of Medicine/Diabetic and Hypertension Clinics, Our Lady of Consolota Hospital, Kisubi, 2Baylor College of Medicine, Children’s Foundation, 3Infectious Diseases Research Collaboration, Kampala, 4Nephrology Unit, Mulago National Referral and Teaching Hospital, Kampala, 5Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital, Mengo, Uganda Background: Persistent suboptimal glycemic control is invariably associated with onset and progression of acute and chronic diabetic complications in diabetic patients. In Uganda, studies documenting the magnitude and predictors of suboptimal glycemic control in adult ambulatory diabetic patients are limited. This study aimed at determining the frequency and predictors of suboptimal glycemic control in adult diabetic patients attending three urban outpatient diabetic clinics in Uganda. Methods: In this hospital-based cross-sectional study, eligible ambulatory adult diabetic patients attending outpatient diabetic clinics of three urban hospitals were consecutively enrolled over 11 months. Suboptimal glycemic control was defined as glycated hemoglobin (HbA1c level ≥7%. Multivariable analysis was applied to determine the predictors. Results: The mean age of the study participants was 52.2±14.4 years, and the majority of them were females (283, 66.9%. The median (interquartile range HbA1c level was 9% (6.8%–12.4%. Suboptimal glycemic control was noted in 311 study participants, accounting for 73.52% of the participants. HbA1c levels of 7%–8%, 8.1%–9.9%, and ≥10% were noted in 56 (13.24%, 76 (17.97%, and 179 (42.32% study participants, respectively. The documented predictors of suboptimal glycemic control were metformin monotherapy (odds ratio: 0.36, 95% confidence interval: 0.21–0.63, p<0.005 and insulin therapy (odds ratio: 2.41, 95% confidence interval: 1.41–4.12, p=0

  1. Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial.

    NARCIS (Netherlands)

    Pechoux, C. Le; Dunant, A.; Senan, S.; Wolfson, A.; Quoix, E.; Faivre-Finn, C.; Ciuleanu, T.; Arriagada, R.; Jones, R.; Wanders, R.; Lerouge, D.; Laplanche, A.; Bussink, J.

    2009-01-01

    BACKGROUND: The optimum dose of prophylactic cranial irradiation (PCI) for limited-stage small-cell lung cancer (SCLC) is unknown. A meta-analysis suggested that the incidence of brain metastases might be reduced with higher PCI doses. This randomised clinical trial compared the effect of standard

  2. Radial PCI and the obesity paradox: Insights from Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

    Science.gov (United States)

    McDonagh, Jonathan R; Seth, Milan; LaLonde, Thomas A; Khandewal, Akshay K; Wohns, David H; Dixon, Simon R; Gurm, Hitinder S

    2016-02-01

    To examine if transradial approach (TRA) negates the increased risk associated with femoral access in lean and morbidly obese patients undergoing percutaneous coronary intervention (PCI). Patients at extremes of body mass are at increased risk of bleeding after PCI. TRA has been associated with lower overall rates of bleeding compared to femoral approach. We studied patients undergoing emergent and elective PCI from 2010 to 2012 across 47 hospitals in Michigan who participate in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry. The primary outcomes were the incidences of bleeding and postprocedure transfusion. Propensity matching (PM) was used to adjust for nonrandomized use of TRA. TRA was used in 10,235 procedures. In PM analyses, use of TRA was associated with a reduction in bleeding (0.80 vs. 1.9%, odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.32-0.54, P obesity (BMI ≥ 40 kg/m(2)): Lean patients undergoing TRA had a rate of bleeding of 1.2 versus 2.8% for femoral access (OR = 0.43, 95% CI = 0.24-0.77, P = 0.002); and rate of transfusion of 2.4 versus 3.9% (OR = 0.61, 95% CI = 0.40-0.94, P = 0.019). The morbidly obese had a rate of bleeding of 0.8% for TRA versus 2.4% for femoral access (OR = 0.33, 95% CI = 0.44-0.72, P = 0.004); and rate of transfusion of 1.7 versus 3.0%, (OR = 0.55, 95% CI = 0.30-1.0, P = 0.051). Compared with the femoral approach, TRA is associated with a reduction in bleeding across all patients undergoing PCI and the absolute benefit was greatest in those with extremely low or high BMI. © 2015 Wiley Periodicals, Inc.

  3. Are theoretical perspectives useful to explain nurses' tolerance of suboptimal care?

    Science.gov (United States)

    Price, Lesley; Duffy, Kathleen; McCallum, Jacqueline; Ness, Valerie

    2015-10-01

    This paper explores two theoretical perspectives that may help nurse managers understand why staff tolerate suboptimal standards of care. Standards of care have been questioned in relation to adverse events and errors for some years in health care across the western world. More recently, the focus has shifted to inadequate nursing standards with regard to care and compassion, and a culture of tolerance by staff to these inadequate standards. The theories of conformity and cognitive dissonance are analysed to investigate their potential for helping nurse managers to understand why staff tolerate suboptimal standards of care. The literature suggests that nurses appear to adopt behaviours consistent with the theory of conformity and that they may accept suboptimal care to reduce their cognitive dissonance. Nurses may conform to be accepted by the team. This may be confounded by nurses rationalising their care to reduce the cognitive dissonance they feel. The investigation into the Mid Staffordshire National Health Service called for a change in culture towards transparency, candidness and openness. Providing insights as to why some nursing staff tolerate suboptimal care may provide a springboard to allow nurse managers to consider the complexities surrounding this required transformation. © 2014 John Wiley & Sons Ltd.

  4. Influence of sub-optimal temperature on tomato growth and yield : a review

    NARCIS (Netherlands)

    Ploeg, van der A.; Heuvelink, E.

    2005-01-01

    The effects of temperature on growth, development and yield of tomato (Lycopersicon esculentum) are reviewed with special emphasis on cultivar differences. The focus is on sub-optimal temperatures, above the level where chilling injury occurs. Temperature has a large effect on all aspects of

  5. Suboptimal decision making by children with ADHD in the face of risk

    DEFF Research Database (Denmark)

    Sørensen, Lin; Sonuga-Barke, Edmund; Eichele, Heike

    2017-01-01

    Objective: Suboptimal decision making in the face of risk (DMR) in children with attention-deficit hyperactivity disorder (ADHD) may be mediated by deficits in a number of different neuropsychological processes. We investigated DMR in children with ADHD using the Cambridge Gambling Task (CGT...

  6. High Current CD4+ T Cell Count Predicts Suboptimal Adherence to Antiretroviral Therapy

    NARCIS (Netherlands)

    Pasternak, Alexander O.; de Bruin, Marijn; Bakker, Margreet; Berkhout, Ben; Prins, Jan M.

    2015-01-01

    High levels of adherence to antiretroviral therapy (ART) are necessary for achieving and maintaining optimal virological suppression, as suboptimal adherence leads to therapy failure and disease progression. It is well known that adherence to ART predicts therapy response, but it is unclear whether

  7. Indicators of suboptimal performance embedded in the Wechsler Memory Scale : Fourth Edition (WMS-IV)

    NARCIS (Netherlands)

    Bouman, Z.; Hendriks, M.P.H.; Schmand, B.A.; Kessels, R.P.C.; Aldenkamp, A.P.

    2016-01-01

    INTRODUCTION: Recognition and visual working memory tasks from the Wechsler Memory Scale-Fourth Edition (WMS-IV) have previously been documented as useful indicators for suboptimal performance. The present study examined the clinical utility of the Dutch version of the WMS-IV (WMS-IV-NL) for the

  8. High current CD4+ T cell count predicts suboptimal adherence to antiretroviral therapy

    NARCIS (Netherlands)

    Pasternak, A.O.; de Bruin, M.; Bakker, M.; Berkhout, B.; Prins, J.M.

    2015-01-01

    High levels of adherence to antiretroviral therapy (ART) are necessary for achieving and maintaining optimal virological suppression, as suboptimal adherence leads to therapy failure and disease progression. It is well known that adherence to ART predicts therapy response, but it is unclear whether

  9. State Space Formulas for a Solution of the Suboptimal Nehari Problem on the Unit Disc

    NARCIS (Netherlands)

    Curtain, Ruth F.; Opmeer, Mark R.

    We give state space formulas for a ("central") solution of the suboptimal Nehari problem for functions defined on the unit disc and taking values in the space of bounded operators in separable Hilbert spaces. Instead of assuming exponential stability, we assume a weaker stability concept (the

  10. Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization: Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial.

    Science.gov (United States)

    Alexander, Karen P; Weisz, Giora; Prather, Kristi; James, Stefan; Mark, Daniel B; Anstrom, Kevin J; Davidson-Ray, Linda; Witkowski, Adam; Mulkay, Angel J; Osmukhina, Anna; Farzaneh-Far, Ramin; Ben-Yehuda, Ori; Stone, Gregg W; Ohman, E Magnus

    2016-01-05

    Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients. In RIVER-PCI, 2604 patients with a history of chronic angina who had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo; QOL analyses included 2389 randomized subjects. Angina and QOL questionnaires were collected at baseline and months 1, 6, and 12. Ranolazine patients were more likely than placebo to discontinue study drug by month 6 (20.4% versus 14.1%, Pdiabetics (mean difference 3.3; 95% CI 0.6, 6.1; P=0.02) and those with more angina (baseline SAQ angina frequency ≤60; mean difference 3.4; 95% CI 0.6, 6.2; P=0.02), but was not maintained at month 12. Despite ICR following PCI, there was no incremental benefit in angina or QOL measures by adding ranolazine in this angiographically-identified population. These measures markedly improved within 1 month of PCI and persisted up to 1 year in both treatment arms. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442038. © 2015 American Heart Association, Inc.

  11. Sub-optimal birth weight in newborns of a high socioeconomic status population

    Directory of Open Access Journals (Sweden)

    Conceição Aparecida de Mattos Segre

    2008-09-01

    Full Text Available Objective: To compare sub-optimal birth weight (2,500 to 2,999 g term newborns to appropriate for gestational age (birth weight ≥ 3,000 g term newborns, regarding maternal data and newborn morbidity and mortality. Methods: Single term newborns, appropriate for gestational age from a high socioeconomic population (n = 1,242 with birth weight ranging from 2,500 to 2,999 g (Group I were compared to 4,907 newborns with birth weight ≥ than 3,000 g (Group II. Maternal and newborn characteristics were compared between the groups. The Mann-Whitney test, χ2 test and multivariate analysis were used. The significance level adopted was p < 0.05. Rresults: The frequency of sub-optimal birth weight newborns in the population studied was 20.2%. There was a significant association between sub-optimal birth weight and maternal weight before pregnancy and body mass index, maternal weight gain, height, smoking habit and hypertension. Newborns’ 1-minute Apgar score, neonatal hypoglycemia, jaundice, transient tachypnea, congenital pneumonia and hospital stay were significantly different between the groups (p < 0.05. A significant relationship could not be established with the 5-minute Apgar score and pulmonary hypertension in both groups. Neonatal mortality did not differ between the groups. Cconclusions: Socioeconomic status was not a risk factor for sub-optimal birth weight in the studied population. Genetic and environmental factors were associated to sub-optimal weight and neonatal diseases. According to these data, this group of newborns should receive special attention from the health team.

  12. 50. Primary PCI for STEMI patients at KACC: Has patient’s access and hospital outcome improved over the last 5 years?

    Directory of Open Access Journals (Sweden)

    B.T. Saeed

    2016-07-01

    Full Text Available Primary PCI (pPCI is Class1 indication to treat patients (pts with S-T elevation Myocardial Infarction (STEMI. In 2010, 56% of STEMI pts presented to KACC were treated with pPCI with hospital mortality of 2.3% compared to 11.3% for those who did not qualify mainly due to late presentation. We aim to compare pts access, reason for no access to pPCI and hospital outcome 5 yrs on. Data from 2010 at KACC showed relatively low access to pPCI for STEMI pts primarily due to late presentation and initial thrombolysis. We believe that pts access to pPCI would have improved over the last 5 years due to improved public awareness and expanding evidenced-based health provision. This is a retrospective study to analyze and compare data for STEMI pts during 2010 (G1 = 223 pts and those treated between August 2014 and August 2015 (G2 = 288 pts. We compared demographic and baseline characteristics, pts access, reason for no access and hospital mortality for the two groups. We used student-t test to compare continuous variables and Chi-square test to compare categorical onesOf the 288 pts in G2, 247 pts (85% were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57% only had access to pPCI compared to 56% in G1 (p = 0.536-NS. In G2, the main reasons for no pPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 (p = 0.11NS. Hospital mortality in G2 was 4% in those treated with pPCI compared to 2.3% in G1 (P = 0.522-NS. Mortality In pts who did not receive pPCI in G2 was 8% compared to 11.3% in G1 (p = 0.49-NS. Females in G2 has about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access

  13. A risk prediction score model for predicting occurrence of post-PCI vasovagal reflex syndrome: a single center study in Chinese population.

    Science.gov (United States)

    Li, Hai-Yan; Guo, Yu-Tao; Tian, Cui; Song, Chao-Qun; Mu, Yang; Li, Yang; Chen, Yun-Dai

    2017-08-01

    The vasovagal reflex syndrome (VVRS) is common in the patients undergoing percutaneous coronary intervention (PCI). However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. From the hospital electronic medical database, we identified 3550 patients who received PCI (78.0% males, mean age 60 years) in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic (ROC) analysis were performed. The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation (all P< 0.001). The rate of VVRS [95% confidence interval (CI)] in patients receiving PCI was 4.5% (4.1%-5.6%). Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stents implantation in the left anterior descending (LAD), and the femoral puncture site. The multivariate analysis suggested that they were independent risk factors for predicting the incidence of VVRS (all P < 0.001). We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI (c-statistic 0.76, 95% CI: 0.72-0.79, P < 0.001). There were decreased events of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute (AUC: 0.84, 95% CI: 0.81-0.87, P < 0.001). The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be involved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.

  14. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2013-01-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  15. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2015-04-15

    We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to 2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95% CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between diabetic status and the effect of PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary

  16. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2015-09-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  17. A non-destructive selection method for faster growth at suboptimal temperature in common bean (Phaseolus vulgaris)

    NARCIS (Netherlands)

    Drijfhout, E.; Oeveren, J.C. van; Jansen, R.C.

    1991-01-01

    A non-destructive method has been developed to select common bean (Phaseolus vulgaris L.) plants whose growth is less effected at a suboptimal temperature. Shoot weight was determined at a suboptimal (14°C) and optimal temperature (20°C), 38 days after sowing and accessions identified with a

  18. Shexiang Tongxin Dropping Pill combined with thrombus aspiration improves myocardial perfusion after PCI in patients with STEMI: the clinical research

    Directory of Open Access Journals (Sweden)

    Shan-Shan Xiao

    2017-04-01

    Full Text Available Objective: To study the effect of Shexiang Tongxin Dropping Pill combined with thrombus aspiration on improving myocardial perfusion after PCI in patients with STEMI. Methods: A total of 104 patients with STEMI who received emergency PCI combined with thrombus aspiration in our hospital between May 2013 and October 2015 were selected as the research subjects and randomly divided into two groups: observation group received perioperative antiplatelet combined with Shexiang Tongxin Dropping Pill therapy, and the control group received perioperative antiplatelet therapy alone. Before treatment and 3 days after treatment, serum myocardial injury indexes, endothelial injury indexes and RAS system indexes were determined; 4 weeks after treatment, serum ventricular remodeling indexes were determined. Results: 3 d after treatment, serum CK, CK-MB, cTnI, cTnT, ET-1, vWF, PRA, AngII and ALD levels of both groups were significantly lower than those before treatment while NO level was significantly higher than that before treatment; serum CK, CK-MB, cTnI, cTnT, ET-1, vWF, PRA, AngII and ALD levels of observation group 3 d after treatment were significantly lower than those of control group while NO level was significantly higher than that of control group; 4 weeks after treatment, serum PICP, ICTP, PIIINP, HSP47 and GDF-15 levels of observation group were significantly lower than those of control group. Conclusion: Shexiang Tongxin Dropping Pill application during perioperative period of PCI combined with thrombus aspiration can reduce myocardial cell damage and endothelial function injury as well as inhibit RAS system activation and ventricular remodeling.

  19. Predictive value study of serum STIM1 and Adropin contents in cardiovascular events and restenosis after PCI operation

    Directory of Open Access Journals (Sweden)

    Qiu-Wei Lin

    2016-02-01

    Full Text Available Objective: To study the predictive value of serum STIM1 and Adropin contents in cardiovascular events and restenosis after PCI operation. Methods: Single coronary artery lesion patients receiving percutaneous coronary intervention in our hospital from May 2014 to January 2015 were selected for study, 45 cases of patients with in-stent restenosis 6 months after PCI operation more than 50% were enrolled in ISR group, 85 cases of patients with instent restenosis no more than 50% were enrolled in NISR group, and then serum STIM1, Adropin and NO contents as well as endothelial progenitor cell content and endothelial microparticle number in peripheral blood of two groups were detected. Results: Serum STIM1 content of ISR group was significantly higher than that of NISR group and STIM1 content was positively correlated with lumen stenosis degree, and serum Adropin content of ISR group was significantly lower than that of NISR group and Adropin content was negatively correlated with lumen stenosis degree; endothelial progenitor cell content in peripheral blood and serum NO content of ISR group were less than those of NISR group, and endothelial microparticle number in peripheral blood was more than that of NISR group; serum STIM1 content was positively correlated with endothelial microparticle number in peripheral blood and negatively correlated with endothelial progenitor cell content in peripheral blood, and serum Adropin content was negatively correlated with endothelial microparticle number in peripheral blood and positively correlated with serum NO content. Conclusion: Serum STIM1 content increase and Adropin content decrease are related to the occurrence of cardiovascular events and restenosis after PCI operation, and the two molecules mainly affect endothelial cell function and endothelial progenitor cell homing.

  20. Previous hypertensive hemorrhage increases the risk for bleeding and ischemia for PCI patients on dual antiplatelet therapy.

    Science.gov (United States)

    Qiao, Manli; Bi, Qi; Fu, Paul; Wang, Yixin; Song, Zhe; Guo, Fang

    2017-06-01

    The use of antiplatelet therapy after intracerebral hemorrhage remains controversial, while the use of dual antiplatelet therapy (DAPT) is required after cardiac stenting. In this study, we examine the risk of bleeding and ischemic events for PCI patients with a history of hypertensive hemorrhage on DAPT. A total of 128 cases and 153 controls were selected from Chinese patients with cardiac stenting on dual anti-platelet therapy for a single-center retrospective case-control study. Patients with a history of hypertensive hemorrhage were selected for the case group, while patients with a history of hypertension were chosen as control. All patients were on aspirin 100 mg and clopidogrel 75 mg after cardiac stenting, and were followed for a duration of 12-48 months. The primary outcomes were intracerebral hemorrhage, major bleeding, and major adverse cardiovascular and cerebrovascular events. A history of previous hypertensive hemorrhage was not found to be a risk factor for intracerebral hemorrhage and major bleeding while on dual anti-platelet therapy. However, a history of either hypertensive hemorrhage or coronary artery disease was independently found to be risk factors for major adverse cardiovascular and cerebrovascular events. On sub-group analysis, patients with a history of hypertensive hemorrhage within 12 months were found to be at higher risk for bleeding on dual anti-platelet therapy, while patients with history of hypertensive hemorrhage outside of 12 months on dual anti-platelet therapy did not have the same increased risk. A history of hypertensive hemorrhage and coronary heart disease were two independent risk factors for major adverse cardiovascular and cerebrovascular events in PCI patients taking DAPT. A history of hypertensive hemorrhage less than 12 months had an increased risk for recurrent intracerebral hemorrhage and major bleeding in PCI patients taking DAPT.

  1. Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up.

    Science.gov (United States)

    van Dijk, Milan R; Utens, Elisabeth M W J; Dulfer, Karolijn; Al-Qezweny, Mustafa N A; van Geuns, Robert-Jan; Daemen, Joost; van Domburg, Ron T

    2016-03-01

    Depression has been shown to be an independent risk factor for short-term mortality in patients with coronary artery disease (CAD). There are studies suggesting that depression might also be associated with long-term mortality. Anxiety has also been associated with mortality. This study aimed to further investigate the predictive value of depression and anxiety symptoms on all-cause mortality, 10 years after percutaneous coronary intervention (PCI). The study population comprised a consecutive series of CAD patients (n = 1411) treated with PCI between September 2001 and October 2002 at the Erasmus Medical Centre, Rotterdam. The Hospital Anxiety and Depression Scale (HADS) was completed by 1112 patients at baseline to assess levels of depression and anxiety. The endpoint was defined as all-cause mortality. The prevalence of depression and anxiety was 24.8% and 27.7%, respectively. The cumulative all-cause mortality rate in depressed patients was 37% versus 20% in non-depressed patients (log-rank p depression remained a predictor of all-cause mortality (hazard ratio (HR) 1.77; 95% confidence interval (CI) 1.36-2.29). Cumulative survival rates did not differ for anxious versus non-anxious patients (log-rank p = .79). However, after adjustment, anxiety was associated with an increased risk for all-cause mortality (HR 1.50; 95% CI 1.14-1.98). A sub-analysis showed that cumulative survival rates did not differ for depressed and anxious patients versus depressed but non-anxious patients (log-rank p = 0.46). Depression is associated with an increased risk of 77% for all-cause mortality, 10 years post-PCI, independently of anxiety. Although anxiety was associated with all-cause mortality, it has no additional value in the case of co-occurring depression. © The European Society of Cardiology 2015.

  2. Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy.

    Science.gov (United States)

    Di Vito, Luca; Cattabiani, Maria Alberta; Paoletti, Giulia; Yoon, Joo Heung; Chisari, Alberto; Gramegna, Mario; Versaci, Francesco; Castriota, Fausto; Prati, Francesco

    2016-05-01

    We compared optical coherence tomography (OCT) features of intermediate and severe coronary stenoses in patients with stable angina and acute coronary syndrome (ACS), and tested the clinical impact of an OCT-based strategy for treating intermediate stenoses. The study enrolled 135 consecutive patients with either ACS or stable angina and a single de-novo coronary stenosis. Patients were divided into two groups: intermediate stenosis defined as quantitative coronary angiography percentage narrowing less than 70%, or presence of angiographic vessel haziness and severe stenosis with percentage narrowing more than 70%. OCT was performed to assess features of plaque vulnerability and to measure the minimal lumen area. We also appraised the 12-month rate of major adverse event (MACE) of an OCT-guided strategy of percutaneous coronary intervention (PCI) based on the presence of thrombus and/or minimal lumen area less than 3.0 mm. Fifty-six patients had intermediate stenoses, whilst 79 had severe stenoses. In the 'intermediate stenosis group', patients with stable angina had a lower asymmetric index (P = 0.02) and a greater calcific arc (P = 0.0001). In the 'severe stenosis group', intermediate lesions of patients with ACS exhibited a greater lipid arc as compared with patients with stable angina (P = 0.03). A higher prevalence of thin cap fibroatheroma was seen in patients with ACS of both groups. The incidence of MACE was not significantly different between patients with an intermediate stenosis who received PCI vs. optimal medical therapy on the basis of OCT findings (P = 0.26). Intermediate coronary stenoses showed distinctive OCT-based features according to the initial clinical presentation. The adoption of an OCT-guided PCI strategy, based on the presence of coronary thrombus and significant vessel narrowing, led to encouraging results.

  3. Statin therapy reduces the likelihood of suboptimal blood pressure control among Ugandan adult diabetic patients

    Directory of Open Access Journals (Sweden)

    Lumu W

    2017-02-01

    Full Text Available William Lumu,1 Leaticia Kampiire,2 George Patrick Akabwai,3 Daniel Ssekikubo Kiggundu,4 Davis Kibirige5 1Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital, 2Infectious Disease Research Collaboration, 3Baylor College of Medicine Children’s Foundation, 4Nephrology Unit, Mulago National Referral and Teaching Hospital, 5Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda Background: Hypertension is one of the recognized risk factors of cardiovascular diseases in adult diabetic patients. High prevalence of suboptimal blood pressure (BP control has been well documented in the majority of studies assessing BP control in diabetic patients in sub-Saharan Africa. In Uganda, there is a dearth of similar studies. This study evaluated the prevalence and correlates of suboptimal BP control in an adult diabetic population in Uganda.Patients and methods: This was a cross-sectional study that enrolled 425 eligible ambulatory adult diabetic patients attending three urban diabetic outpatient clinics over 11 months. Data about their sociodemographic characteristics and clinical history were collected using pre-tested questionnaires. Suboptimal BP control was defined according to the 2015 American Diabetes Association standards of diabetes care guideline as BP levels ≥140/90 mmHg.Results: The mean age of the study participants was 52.2±14.4 years, with the majority being females (283, 66.9%. Suboptimal BP control was documented in 192 (45.3% study participants and was independently associated with the study site (private hospitals; odds ratio 2.01, 95% confidence interval 1.18–3.43, P=0.01 and use of statin therapy (odds ratio 0.5, 95% confidence interval 0.26–0.96, P=0.037.Conclusion: Suboptimal BP control was highly prevalent in this study population. Strategies to improve optimal BP control, especially in the private hospitals, and the use of statin therapy should be encouraged in adult diabetic patients

  4. Long-term mortality after primary PCI for STEMI in patients with insulin-dependent diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Zlatanović Petar

    2015-01-01

    Full Text Available Introduction: Primary PCI (pPCI is the gold standard in the treatment of patients with acute myocardial infarction (AMI with ST elevation (STEMI. Aim: The purpose of this study is to evaluate the influence of diabetic status upon arrival at five year survival in patients with STEMI that were treated with pPCI. Material and methods: Consecutive data for 2087 patients admitted in the period from 1st of January 2009. to 31st of December 2010. with diagnosis of acute STEMI were collected from catheterisation laboratory cardiology clinic CCS electronic database. Patients were divided into 3 groups: those without diabetes mellitus (DM, IDDM (insulin dependent diabetes mellitus, NIDDM (non-insulin dependent diabetes mellitus. Results: 1664 patients (79.7% did not have DM, 98 (4.7% had IDDM and 325 (15.6% had NIDDM. There was a statistically significant difference in mortality rate among three groups after 30 days, one year and five years after intervention, and the highest rates were recorded at the IDDM patients, then at the NIDDM and the lowest in patients without DM (15.3% vs 8.3% vs 5.9 %, p < 0.001 after 30 days; 21.4% vs 15.4% vs 10.9%, p < 0.001 after one year and 32.7% vs 24.3% vs 18%, p < 0.001 after 5 years. Also, there was a highly statistically significant difference in five-year mortality rate between patients with and without DM (26.2 % vs 17.6%, p < 0.001. IDDM was a independent factor when it comes to predicting five-year mortality (HR = 1.58, 95% CI 1.07-2.32, p = 0.02 whereas NIDDM was not (HR = 1.24, 95% CI 0.95-1.63, p = 0.12. Conclusion: Diabetic patients had an increased risk of mortality in the short and long-term follow-up after pPCI. Insulin-dependent was a single predicting factor after five year follow-up.

  5. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome.

    Science.gov (United States)

    Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

    2017-12-31

    To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.

  6. PCI-24781 down-regulates EZH2 expression and then promotes glioma apoptosis by suppressing the PIK3K/Akt/mTOR pathway

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    2014-12-01

    Full Text Available PCI-24781 is a novel histone deacetylase inhibitor that inhibits tumor proliferation and promotes cell apoptosis. However, it is unclear whether PCI-24781 inhibits Enhancer of Zeste 2 (EZH2 expression in malignant gliomas. In this work, three glioma cell lines were incubated with various concentrations of PCI-24781 (0, 0.25, 0.5, 1, 2.5 and 5 M and analyzed for cell proliferation by the MTS 3-(4,5-dimethylthiazol-2-yl-5-(3-carboxymethoxyphenyl-2-(4-sulfophenyl-2H-tetrazolium assay and colony formation, and cell cycle and apoptosis were assessed by flow cytometry. The expression of EZH2 and apoptosis-related proteins was assessed by western blotting. Malignant glioma cells were also transfected with EZH2 siRNA to examine how PCI-24781 suppresses tumor cells. EZH2 was highly expressed in the three glioma cell lines. Incubation with PCI-24781 reduced cell proliferation and increased cell apoptosis by down-regulating EZH2 in a concentration-dependent manner. These effects were simulated by EZH2 siRNA. In addition, PCI-24781 or EZH2 siRNA accelerated cell apoptosis by down-regulating the expression of AKT, mTOR, p70 ribosomal protein S6 kinase (p70s6k, glycogen synthase kinase 3A and B (GSK3a/b and eukaryotic initiation factor 4E binding protein 1 (4E-BP1. These data suggest that PCI-24781 may be a promising therapeutic agent for treating gliomas by down-regulating EZH2 which promotes cell apoptosis by suppressing the phosphatidylinositol 3-kinase (PI3K/Akt/mammalian target of the rapamycin (mTOR pathway.

  7. Peptide Suboptimal Conformation Sampling for the Prediction of Protein-Peptide Interactions.

    Science.gov (United States)

    Lamiable, Alexis; Thévenet, Pierre; Eustache, Stephanie; Saladin, Adrien; Moroy, Gautier; Tuffery, Pierre

    2017-01-01

    The blind identification of candidate patches of interaction on the protein surface is a difficult task that can hardly be accomplished without a heuristic or the use of simplified representations to speed up the search. The PEP-SiteFinder protocol performs a systematic blind search on the protein surface using a rigid docking procedure applied to a limited set of peptide suboptimal conformations expected to approximate satisfactorily the conformation of the peptide in interaction. All steps rely on a coarse-grained representation of the protein and the peptide. While simple, such a protocol can help to infer useful information, assuming a critical analysis of the results. Moreover, such a protocol can be extended to a semi-flexible protocol where the suboptimal conformations are directly folded in the vicinity of the receptor.

  8. Suboptimal investments and M&A deals in emerging capital markets

    Directory of Open Access Journals (Sweden)

    Cherkasova Victoria

    2016-01-01

    Full Text Available This paper focuses on the efficiency of target-company investment decisions before and after Merger & Acquisition deals. We study whether M&A deals help to solve the problem of suboptimal investment after the acquisition. Using a sample of 145 target companies from BRICS countries that were acquired during the period 2004-2014, we outline those that had over- or underinvested before the deal and show that more than half the companies managed to optimize the investment level after the deal. We determine the key factors that improve the inefficiency of investment decisions and demonstrate that the industry and country have an impact on the degree of suboptimal investment.

  9. Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control.

    Science.gov (United States)

    Tan, Ming Yeong; Magarey, Judy

    2008-08-01

    To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG). Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = practices among the majority of diabetic patients with sub-optimal glycaemic control. This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.

  10. Comparative Performance Analysis of G-RAKE Receivers with Suboptimal Finger Placement

    Directory of Open Access Journals (Sweden)

    K. B. Baltzis

    2014-07-01

    Full Text Available Generalized RAKE (G-RAKE reception reduces the total amount of interference and provides enhanced diversity by comprising extra fingers to collect information about interference and further using channel and impairment correlation estimates for fingers allocation. However, the hardware complexity and the excessive computational requirements of GRAKE receivers may restrict their application in real systems; thus, suboptimal solutions are commonly used. In this paper, we propose and evaluate three maximum likelihood G-RAKE structures for colored noise with suboptimal finger placement. In all implementations, the fingers are optimally distributed within a time window that spans from several chip periods before the first arriving multipath to several chip periods after the latest one. The first receiver has its fingers at integer multiples of the chip period while in the rest two structures the search window is segmented in halves and tenths of the chip duration. This work also extends earlier studies by thoroughly investigating the impact of fractionally spaced finger placement on system performance. Our analysis shows that a suboptimal finger allocation reduces hardware complexity with negligible performance loss. The impact of channel delay spread and processing gain on system performance is also investigated and gives interesting results.

  11. Weighted Implementation of Suboptimal Paths (WISP): An Optimized Algorithm and Tool for Dynamical Network Analysis.

    Science.gov (United States)

    Van Wart, Adam T; Durrant, Jacob; Votapka, Lane; Amaro, Rommie E

    2014-02-11

    Allostery can occur by way of subtle cooperation among protein residues (e.g., amino acids) even in the absence of large conformational shifts. Dynamical network analysis has been used to model this cooperation, helping to computationally explain how binding to an allosteric site can impact the behavior of a primary site many ångstroms away. Traditionally, computational efforts have focused on the most optimal path of correlated motions leading from the allosteric to the primary active site. We present a program called Weighted Implementation of Suboptimal Paths (WISP) capable of rapidly identifying additional suboptimal pathways that may also play important roles in the transmission of allosteric signals. Aside from providing signal redundancy, suboptimal paths traverse residues that, if disrupted through pharmacological or mutational means, could modulate the allosteric regulation of important drug targets. To demonstrate the utility of our program, we present a case study describing the allostery of HisH-HisF, an amidotransferase from T. maritima thermotiga. WISP and its VMD-based graphical user interface (GUI) can be downloaded from http://nbcr.ucsd.edu/wisp.

  12. Sub-optimal MCV Cover Based Method for Measuring Fractal Dimension

    Energy Technology Data Exchange (ETDEWEB)

    Tolle, Charles Robert; McJunkin, Timothy R; Gorsich, D. I.

    2003-01-01

    A new method for calculating fractal dimension is developed in this paper. The method is based on the box dimension concept; however, it involves direct estimation of a suboptimal covering of the data set of interest. By finding a suboptimal cover, this method is better able to estimate the required number of covering elements for a given cover size than is the standard box counting algorithm. Moreover, any decrease in the error of the covering element count directly increases the accuracy of the fractal dimension estimation. In general, our method represents a mathematical dual to the standard box counting algorithm by not solving for the number of boxes used to cover a data set given the size of the box. Instead, the method chooses the number of covering elements and then proceeds to find the placement of smallest hyperellipsoids that fully covers the data set. This method involves a variant of the Fuzzy-C Means clustering algorithm, as well as the use of the Minimum Cluster Volume clustering algorithm. A variety of fractal dimension estimators using this suboptimal covering method are discussed. Finally, these methods are compared to the standard box counting algorithm and wavelet-decomposition methods for calculating fractal dimension by using one-dimensional cantor dust sets and a set of standard Brownian random fractal images.

  13. When the learning environment is suboptimal: exploring medical students' perceptions of "mistreatment".

    Science.gov (United States)

    Gan, Runye; Snell, Linda

    2014-04-01

    Despite widespread implementation of policies to address mistreatment, high rates of mistreatment during clinical training are reported, prompting the question of whether "mistreatment" means more to students than delineated in official codes of conduct. Understanding "mistreatment" from students' perspective and as it relates to the learning environment is needed before effective interventions can be implemented. The authors conducted focus groups with final-year medical students at McGill University Faculty of Medicine in 2012. Participants were asked to characterize "suboptimal learning experience" and "mistreatment." Transcripts were analyzed via inductive thematic analysis. Forty-one of 174 eligible students participated in six focus groups. Students described "mistreatment" as lack of respect or attack directed toward the person, and "suboptimal learning experience" as that which compromised their learning. Differing perceptions emerged as students debated whether "mistreatment" can be applied to negative learning environments as well as isolated incidents of mistreatment even though some experiences fell outside of the "official" label as per institutional policies. Whether students perceived "mistreatment" versus a "suboptimal learning experience" in negative environments appeared to be influenced by several key factors. A concept map integrating these ideas is presented. How students perceived negative situations during training appears to be a complex process. When medical students say "mistreatment," they may be referring to a spectrum, with incident-based mistreatment on one end and learning-environment-based mistreatment on the other. Multiple factors influenced how students perceived an environment-based negative situation and may provide strategies to improving the learning environment.

  14. Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial.

    Science.gov (United States)

    Elias, Joëlle; van Dongen, Ivo M; Hoebers, Loes P; Ouweneel, Dagmar M; Claessen, Bimmer E P M; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; van der Schaaf, René J; Ioanes, Dan; Nijveldt, Robin; Tijssen, Jan G; Hirsch, Alexander; Henriques, José P S

    2017-07-19

    The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment. In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2-3 collaterals compared to grade 0-1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04). CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.

  15. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME)

    DEFF Research Database (Denmark)

    van Nunen, Lokien X; Zimmermann, Frederik M; Tonino, Pim A L

    2015-01-01

    BACKGROUND: In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study...... is registered with ClinicalTrials.gov, number NCT00267774. FINDINGS: After 5 years, major adverse cardiac events occurred in 31% of patients (154 of 496) in the angiography-guided group versus 28% (143 of 509 patients) in the FFR-guided group (relative risk 0·91, 95% CI 0·75-1·10; p=0·31). The number of stents...... in a significant decrease of major adverse cardiac events for up to 2 years after the index procedure. From 2 years to 5 years, the risks for both groups developed similarly. This clinical outcome in the FFR-guided group was achieved with a lower number of stented arteries and less resource use. These results...

  16. PCI-GC-MS-MS approach for identification of non-amino organic acid and amino acid profiles.

    Science.gov (United States)

    Luan, Hemi; Yang, Lin; Ji, Fenfen; Cai, Zongwei

    2017-03-15

    Alkyl chloroformate have been wildly used for the fast derivatization of metabolites with amino and/or carboxyl groups, coupling of powerful separation and detection systems, such as GC-MS, which allows the comprehensive analysis of non-amino organic acids and amino acids. The reagents involving n-alkyl chloroformate and n-alcohol are generally employed for providing symmetric labeling terminal alkyl chain with the same length. Here, we developed an asymmetric labeling strategy and positive chemical ionization gas chromatography-tandem mass spectrometry (PCI-GC-MS-MS) approach for determination of non-amino organic acids and amino acids, as well as the short chain fatty acids. Carboxylic and amino groups could be selectively labelled by propyl and ethyl groups, respectively. The specific neutral loss of C3H8O (60Da), C3H5O2 (74Da) and C4H8O2 (88Da) were useful in the selective identification for qualitative analysis of organic acids and amino acid derivatives. PCI-GC-MS-MS using multiple reaction monitoring (MRM) was applied for semi-quantification of typical non-amino organic acids and amino acids. This method exhibited a wide range of linear range, good regression coefficient (R2) and repeatability. The relative standard deviation (RSD) of targeted metabolites showed excellent intra- and inter-day precision (GC-MS-MS, coupled with alkyl chloroformate derivatization. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic Patients: Choosing Wisely Between PCI and Surgery.

    Science.gov (United States)

    Razzouk, Louai; Feit, Frederick; Farkouh, Michael E

    2017-05-01

    Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of systemic atherosclerosis and advanced coronary artery disease (CAD). Herein, we review clinical trials comparing surgical to percutaneous revascularization in the context of the unique pathophysiology in this patient population, and seek to answer the question of optimal strategy of revascularization. Early studies showed a signal towards benefit of surgical revascularization over percutaneous revascularization in this group, but there was a paucity of randomized clinical trials (RCT) to directly support this finding. The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM), a large-scale international RCT, was then undertaken and established the benefit of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in terms of mortality, myocardial infarction and repeat revascularization; CABG was inferior to PCI with regards to stroke. The quality of life and cost effectiveness also demonstrated a long-term benefit for surgery. The decision as to choice of mode of revascularization in patients with T2DM and advanced CAD depends upon a multitude of factors, including the coronary anatomy, co-morbidities and the patient's surgical risk. These factors influence the recommendation of the cardiovascular team, which should result in a balanced presentation of the short and long-term risks and benefits of either mode of revascularization to the patient and his/her family.

  18. Intravenous enoxaparin versus unfractionated heparin in unselected patients undergoing percutaneous coronary interventions: the Zurich enoxaparin versus unfractionated heparin in PCI study (ZEUS).

    Science.gov (United States)

    Bertel, Osmund; Ramsay, David; Wettstein, Tobias; Kurz, David J; Stettler, Irene; Straumann, Edwin; Frielingsdorf, Juergen; Maurer, Dominik; Naegeli, Barbara

    2010-08-01

    To evaluate the efficacy and safety of intravenous enoxaparin as an alternative to unfractionated heparin (UFH) as antithrombotic therapy in unselected patients undergoing percutaneous coronary intervention (PCI). Eight hundred and seventy-six (876) consecutive eligible patients undergoing PCI were prospectively randomised to either intravenous enoxaparin 0.75 mg/kg or dose-adjusted UFH in this open-label study that was prematurely stopped due to slow recruitment. Randomisation was stratified on elective PCI or PCI for acute coronary syndrome (ACS). The primary endpoint was a combination of death, myocardial infarction, unplanned target vessel revascularisation and major bleeding at 30 days. Secondary endpoint was a composite of major and minor bleeding and thrombocytopenia < 50x109. The primary endpoint of intravenous enoxaparin did not differ from those of UFH (5.5% vs. 7.0%, p=ns) whereas safety endpoints were reduced with enoxaparin compared to UFH (9.9% vs. 20.0%, p<0.001). Among 229 (26%) patients presenting with ACS, the incidence of both, the primary and secondary endpoints, was lower with enoxaparin as compared to UFH (1.8% vs. 12.9% and 14.2% vs. 31%, p<0.001 and p=0.003, respectively). Due to the premature halting of the study and the low event rate, these data are observational only, and no definite conclusion could be made concerning efficacy and safety of intravenous enoxaparin as an alternative to UFH in unselected patients undergoing PCI.

  19. Protocol for an economic evaluation of the randomised controlled trial of culprit lesion only PCI versus immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: CULPRIT-SHOCK trial.

    Science.gov (United States)

    Quayyum, Zahidul; Briggs, Andrew; Robles-Zurita, Jose; Oldroyd, Keith; Zeymer, Uwe; Desch, Steffen; Waha, Suzanne de; Thiele, Holger

    2017-08-18

    Emergency percutaneous coronary intervention (PCI) of the culprit lesion for patients with acute myocardial infarctions is an accepted practice. A majority of patients present with multivessel disease with additional relevant stenoses apart from the culprit lesion. In haemodynamically stable patients, there is increasing evidence from randomised trials to support the practice of immediate complete revascularisation. However, in the presence of cardiogenic shock, the optimal management strategy for additional non-culprit lesions is unknown. A multicentre randomised controlled trial, CULPRIT-SHOCK, is examining whether culprit vessel only PCI with potentially subsequent staged revascularisation is more effective than immediate multivessel PCI. This paper describes the intended economic evaluation of the trial. The economic evaluation will be conducted using a pre-trial decision model and within-trial analysis. The modelling-based analysis will provide expected costs and health outcomes, and incremental cost-effectiveness ratio over the lifetime for the cohort of patients included in the trial. The within-trial analysis will provide estimates of cost per life saved at 30 days and in 1 year, and estimates of health-related quality of life. Bootstrapping and cost-effectiveness acceptability curves will be used to address any uncertainty around these estimates. Different types of regression models within a generalised estimating equation framework will be used to examine how the total cost and quality-adjusted life years are explained by patients' characteristics, revascularisation strategy, country and centre. The cost-effectiveness analysis will be from the perspective of each country's national health services, where costs will be expressed in euros adjusted for purchasing power parity. Ethical approval for the study was granted by the local Ethics Committee at each recruiting centre. The economic evaluation analyses will be published in peer-reviewed journals of

  20. A propósito de un caso: terapia oro-facial como tratamiento complementario de la espasticidad en niños con PCI

    OpenAIRE

    González Alberdi, Miriam

    2014-01-01

    Introducción: Debido a la prevalencia de niños con PCI espástica y buscando el avance en esta patología, siempre será de utilidad la búsqueda de otras alternativas de tratamiento, en este caso en fisioterapia, para poder valernos de un mayor número de herramientas. En este caso, se valorará la eficacia del tratamiento fisioterápico oro-facial en la espasticidad. Objetivo: Evaluar la eficacia de la terapia oro-facial en la disminución de la espasticidad en un paciente con PCI. Metodo...

  1. Characteristics influencing therapy switch behavior after suboptimal response to first-line treatment in patients with multiple sclerosis.

    Science.gov (United States)

    Teter, Barbara; Agashivala, Neetu; Kavak, Katelyn; Chouhfeh, Lynn; Hashmonay, Ron; Weinstock-Guttman, Bianca

    2014-06-01

    Factors driving disease-modifying therapy (DMT) switch behavior are not well understood. The objective of this paper is to identify patient characteristics and clinical events predictive of therapy switching in patients with suboptimal response to DMT. This retrospective study analyzed patients with relapsing-remitting multiple sclerosis (MS) and a suboptimal response to initial therapy with either interferon β or glatiramer acetate. Suboptimal responders were defined as patients with ≥1 MS event (clinical relapse, worsening disability, or MRI worsening) while on DMT. Switchers were defined as those who changed DMT within six to 12 months after the MS event. Of 606 suboptimal responders, 214 (35.3%) switched therapy. Switchers were younger at symptom onset (p = 0.012), MS diagnosis (p = 0.004), DMT initiation (p therapy switched sooner than patients who are older at the time of MS diagnosis and DMT initiation. © The Author(s) 2013.

  2. [Effects of chlorophyllin-iron on osmotic adjustment and activities of antioxidantive enzymes in cucumber seedlings under suboptimal temperature].

    Science.gov (United States)

    Zhang, Meng; Wang, Xiu-feng; Zhang, Fan-yang; Wei, Min; Shi, Qing-hua; Yang, Feng-juan; Li, Yan

    2014-12-01

    Cucumber cultivar 'Jinyan 4' was subjected to suboptimal temperature treatment of 18/12 degrees C (day/night) in the growth chambers. A solution culture experiment was conducted to study the effect of exogenously spraying 5 mg x L(-1) chlorophyllin-iron solution on plant growth, the content of proline, soluble sugar, MDA and activity of peroxidase in the leaves of cucumber seedling under suboptimal temperature. Application of chlorophyllin-iron showed prominent effects on mitigating the stress of suboptimal temperature on growth of the cucumber seedlings, significantly increasing the plant height, leaf area, shoot dry mass, the contents of soluble sugar and proline and the activities of SOD, POD, CAT and APX. Exogenously spraying chlorophyllin-iron could promote the accumulation of proline and soluble sugar, raise the activities of antioxidant enzymes, decrease the membrane lipid peroxidation and improve the adaptability of cucumber seedlings under suboptimal temperature.

  3. When the Learning Environment Is Suboptimal: Exploring Medical Students’ Perceptions of “Mistreatment”

    Science.gov (United States)

    Snell, Linda

    2014-01-01

    Purpose Despite widespread implementation of policies to address mistreatment, high rates of mistreatment during clinical training are reported, prompting the question of whether “mistreatment” means more to students than delineated in official codes of conduct. Understanding “mistreatment” from students’ perspective and as it relates to the learning environment is needed before effective interventions can be implemented. Method The authors conducted focus groups with final-year medical students at McGill University Faculty of Medicine in 2012. Participants were asked to characterize “suboptimal learning experience” and “mistreatment.” Transcripts were analyzed via inductive thematic analysis. Results Forty-one of 174 eligible students participated in six focus groups. Students described “mistreatment” as lack of respect or attack directed toward the person, and “suboptimal learning experience” as that which compromised their learning. Differing perceptions emerged as students debated whether “mistreatment” can be applied to negative learning environments as well as isolated incidents of mistreatment even though some experiences fell outside of the “official” label as per institutional policies. Whether students perceived “mistreatment” versus a “suboptimal learning experience” in negative environments appeared to be influenced by several key factors. A concept map integrating these ideas is presented. Conclusions How students perceived negative situations during training appears to be a complex process. When medical students say “mistreatment,” they may be referring to a spectrum, with incident-based mistreatment on one end and learning-environment-based mistreatment on the other. Multiple factors influenced how students perceived an environment-based negative situation and may provide strategies to improving the learning environment. PMID:24556767

  4. Real time magnetic field and flux measurements for tokamak control using a multi-core PCI Express system

    Energy Technology Data Exchange (ETDEWEB)

    Giannone, L. [Max-Planck-Institut fuer Plasmaphysik, IPP-EURATOM Association, 85748 Garching (Germany)], E-mail: Louis.Giannone@ipp.mpg.de; Schneider, W.; McCarthy, P.J.; Sips, A.C.C.; Treutterer, W.; Behler, K.; Eich, T.; Fuchs, J.C.; Hicks, N.; Kallenbach, A.; Maraschek, M.; Mlynek, A.; Neu, G.; Pautasso, G.; Raupp, G.; Reich, M.; Schuhbeck, K.H.; Stober, J.; Volpe, F.; Zehetbauer, T. [Max-Planck-Institut fuer Plasmaphysik, IPP-EURATOM Association, 85748 Garching (Germany)] (and others)

    2009-06-15

    The existing real time system for the position and shape control in ASDEX Upgrade has been extended to calculate magnetic flux surfaces in real time using a multi-core PCI Express system running LabVIEW RT. The availability of reflective memory for LabVIEW RT will allow this system to be connected to the control system and other diagnostics in a multi-platform real time network. The measured response of each magnetic probe to the individual poloidal field coil currents in the absence of plasma current is compared to the calculated value. Prior to a tokamak discharge this comparison can be used to check for failure of the magnetic probe, flux loop or integrator.

  5. A Suboptimal Scheme for Multi-User Scheduling in Gaussian Broadcast Channels

    KAUST Repository

    Zafar, Ammar

    2014-05-28

    This work proposes a suboptimal multi-user scheduling scheme for Gaussian broadcast channels which improves upon the classical single user selection, while considerably reducing complexity as compared to the optimal superposition coding with successful interference cancellation. The proposed scheme combines the two users with the maximum weighted instantaneous rate using superposition coding. The instantaneous rate and power allocation are derived in closed-form, while the long term rate of each user is derived in integral form for all channel distributions. Numerical results are then provided to characterize the prospected gains of the proposed scheme.

  6. Suboptimal Larval Habitats Modulate Oviposition of the Malaria Vector Mosquito Anopheles coluzzii.

    Directory of Open Access Journals (Sweden)

    Eunho Suh

    Full Text Available Selection of oviposition sites by gravid females is a critical behavioral step in the reproductive cycle of Anopheles coluzzii, which is one of the principal Afrotropical malaria vector mosquitoes. Several studies suggest this decision is mediated by semiochemicals associated with potential oviposition sites. To better understand the chemosensory basis of this behavior and identify compounds that can modulate oviposition, we examined the generally held hypothesis that suboptimal larval habitats give rise to semiochemicals that negatively influence the oviposition preference of gravid females. Dual-choice bioassays indicated that oviposition sites conditioned in this manner do indeed foster significant and concentration dependent aversive effects on the oviposition site selection of gravid females. Headspace analyses derived from aversive habitats consistently noted the presence of dimethyl disulfide (DMDS, dimethyl trisulfide (DMTS and 6-methyl-5-hepten-2-one (sulcatone each of which unitarily affected An. coluzzii oviposition preference. Electrophysiological assays across the antennae, maxillary palp, and labellum of gravid An. coluzzii revealed differential responses to these semiochemicals. Taken together, these findings validate the hypothesis in question and suggest that suboptimal environments for An. coluzzii larval development results in the release of DMDS, DMTS and sulcatone that impact the response valence of gravid females.

  7. An Approach to Streaming Video Segmentation With Sub-Optimal Low-Rank Decomposition.

    Science.gov (United States)

    Li, Chenglong; Lin, Liang; Zuo, Wangmeng; Wang, Wenzhong; Tang, Jin

    2016-05-01

    This paper investigates how to perform robust and efficient video segmentation while suppressing the effects of data noises and/or corruptions, and an effective approach is introduced to this end. First, a general algorithm, called sub-optimal low-rank decomposition (SOLD), is proposed to pursue the low-rank representation for video segmentation. Given the data matrix formed by supervoxel features of an observed video sequence, SOLD seeks a sub-optimal solution by making the matrix rank explicitly determined. In particular, the representation coefficient matrix with the fixed rank can be decomposed into two sub-matrices of low rank, and then we iteratively optimize them with closed-form solutions. Moreover, we incorporate a discriminative replication prior into SOLD based on the observation that small-size video patterns tend to recur frequently within the same object. Second, based on SOLD, we present an efficient inference algorithm to perform streaming video segmentation in both unsupervised and interactive scenarios. More specifically, the constrained normalized-cut algorithm is adopted by incorporating the low-rank representation with other low level cues and temporal consistent constraints for spatio-temporal segmentation. Extensive experiments on two public challenging data sets VSB100 and SegTrack suggest that our approach outperforms other video segmentation approaches in both accuracy and efficiency.

  8. Suboptimal and optimal order policies for fixed and varying replenishment interval with declining market

    Science.gov (United States)

    Yu, Jonas C. P.; Wee, H. M.; Yang, P. C.; Wu, Simon

    2016-06-01

    One of the supply chain risks for hi-tech products is the result of rapid technological innovation; it results in a significant decline in the selling price and demand after the initial launch period. Hi-tech products include computers and communication consumer's products. From a practical standpoint, a more realistic replenishment policy is needed to consider the impact of risks; especially when some portions of shortages are lost. In this paper, suboptimal and optimal order policies with partial backordering are developed for a buyer when the component cost, the selling price, and the demand rate decline at a continuous rate. Two mathematical models are derived and discussed: one model has the suboptimal solution with the fixed replenishment interval and a simpler computational process; the other one has the optimal solution with the varying replenishment interval and a more complicated computational process. The second model results in more profit. Numerical examples are provided to illustrate the two replenishment models. Sensitivity analysis is carried out to investigate the relationship between the parameters and the net profit.

  9. Sub-optimal parenting is associated with schizotypic and anxiety personality traits in adulthood.

    Science.gov (United States)

    Giakoumaki, S G; Roussos, P; Zouraraki, C; Spanoudakis, E; Mavrikaki, M; Tsapakis, E M; Bitsios, P

    2013-05-01

    Part of the variation in personality characteristics has been attributed to the child-parent interaction and sub-optimal parenting has been associated with psychiatric morbidity. In the present study, an extensive battery of personality scales (Trait Anxiety Inventory, Behavioural Inhibition/Activation System questionnaire, Eysenck Personality Questionnaire-Revised, Temperament and Character Inventory, Schizotypal Traits Questionnaire, Toronto Alexithymia Scale) and the Parental Bonding Instrument (PBI) were administered in 324 adult healthy males to elucidate the effects of parenting on personality configuration. Personality variables were analysed using Principal Component Analysis (PCA) and the factors "Schizotypy", "Anxiety", "Behavioural activation", "Novelty seeking" and "Reward dependence" were extracted. Associations between personality factors with PBI "care" and "overprotection" scores were examined with regression analyses. Subjects were divided into "parental style" groups and personality factors were subjected to categorical analyses. "Schizotypy" and "Anxiety" were significantly predicted by high maternal overprotection and low paternal care. In addition, the Affectionless control group (low care/high overprotection) had higher "Schizotypy" and "Anxiety" compared with the Optimal Parenting group (high care/low overprotection). These results further validate sub-optimal parenting as an important environmental exposure and extend our understanding on the mechanisms by which it increases risk for psychiatric morbidity. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  10. Design Of Real-Time Implementable Distributed Suboptimal Control: An LQR Perspective

    KAUST Repository

    Jaleel, Hassan

    2017-09-29

    We propose a framework for multiagent systems in which the agents compute their control actions in real time, based on local information only. The novelty of the proposed framework is that the process of computing a suboptimal control action is divided into two phases: an offline phase and an online phase. In the offline phase, an approximate problem is formulated with a cost function that is close to the optimal cost in some sense and is distributed, i.e., the costs of non-neighboring nodes are not coupled. This phase is centralized and is completed before the deployment of the system. In the online phase, the approximate problem is solved in real time by implementing any efficient distributed optimization algorithm. To quantify the performance loss, we derive upper bounds for the maximum error between the optimal performance and the performance under the proposed framework. Finally, the proposed framework is applied to an example setup in which a team of mobile nodes is assigned the task of establishing a communication link between two base stations with minimum energy consumption. We show through simulations that the performance under the proposed framework is close to the optimal performance and the suboptimal policy can be efficiently implemented online.

  11. Quality of reporting randomised controlled trials in major dental journals suboptimal.

    Science.gov (United States)

    Hurst, Dominic

    2011-01-01

    Hand searching of the most recent 24 issues of six high impact dental journals. RCTs involving only humans, from 24 issues of six leading specialty journals, covering a period up to July 2009 were included, including cluster randomised trials. Each article included in the study was assessed and scored independently by two observers, with any discrepancies being resolved by a third observer. In this study the modified CONSORT checklist was used to score each applicable item of data. The sum of the scores was converted to a percentage value for each trial. The data were analysed using descriptive statistics. Data regarding the publishing journal, country of origin of the trial, number of authors, involvement of statistician/epidemiologist, number of centres involved, ethics committee approval were subject to quantitative analysis. Ninety-five RCTs were identified with, according to the authors, generally suboptimal scores on quality reporting on key CONSORT areas. Significant differences in scores were found among the journals covering the named specialties. Overall there was a positive association between the quality score in studies with more authors, multicentre studies and studies in which a statistician/epidemiologist was involved. The overall quality of reporting RCTs in major dental journals was considered suboptimal in key CONSORT areas. This is very important as the reported results of RCTs can have an impact on future patient care.

  12. Discovery, screening and evaluation of a plasma biomarker panel for subjects with psychological suboptimal health state using (1)H-NMR-based metabolomics profiles.

    Science.gov (United States)

    Tian, Jun-Sheng; Xia, Xiao-Tao; Wu, Yan-Fei; Zhao, Lei; Xiang, Huan; Du, Guan-Hua; Zhang, Xiang; Qin, Xue-Mei

    2016-09-21

    Individuals in the state of psychological suboptimal health keep increasing, only scales and questionnaires were used to diagnose in clinic under current conditions, and symptoms of high reliability and accuracy are destitute. Therefore, the noninvasive and precise laboratory diagnostic methods are needed. This study aimed to develop an objective method through screen potential biomarkers or a biomarker panel to facilitate the diagnosis in clinic using plasma metabolomics. Profiles were based on H-nuclear magnetic resonance ((1)H-NMR) metabolomics techniques combing with multivariate statistical analysis. Furthermore, methods of correlation analysis with Metaboanalyst 3.0 for selecting a biomarker panel, traditional Chinese medicine (TCM) drug intervention for validating the close relations between the biomarker panel and the state and the receiver operating characteristic curves (ROC curves) analysis for evaluation of clinical diagnosis ability were carried out. 9 endogenous metabolites containing trimethylamine oxide (TMAO), glutamine, N-acetyl-glycoproteins, citrate, tyrosine, phenylalanine, isoleucine, valine and glucose were identified and considered as potential biomarkers. Then a biomarker panel consisting of phenylalanine, glutamine, tyrosine, citrate, N-acetyl-glycoproteins and TMAO was selected, which exhibited the highest area under the curve (AUC = 0.971). This study provided critical insight into the pathological mechanism of psychological suboptimal health and would supply a novel and valuable diagnostic method.

  13. The cost-effectiveness of a new percutaneous ventricular assist device for high-risk PCI patients: mid-stage evaluation from the European perspective

    NARCIS (Netherlands)

    Roos, Johanna B.; Doshi, Sagar N.; Konorza, Thomas; Palacios, Igor; Schreiber, Ted; Borisenko, Oleg V.; Henriques, Jose P. S.

    2013-01-01

    A new and smaller percutaneous ventricular assist device (pVAD, Impella, Abiomed, Danvers, MA) has been developed to provide circulatory support in hemodynamically unstable patients and to prevent hemodynamic collapse during high-risk percutaneous coronary interventions (PCI). The objective of the

  14. A firmware implementation of a Quad HOLA S-LINK to PCI Express interface for use in the ATLAS Trigger DAQ system

    CERN Document Server

    Slenders, Daniel

    2014-01-01

    The firmware for a PCI Express interface card with four on-board high-speed optical S-LINKS (FILAREXPRESS) has been developed. This was done for an Altera Stratix II GX FPGA. Furthermore, detection of the available channels through a pull-up resistor and a readout of the on-board temperature sensor were implemented.

  15. Abbreviated infusion of eptifibatide after successful coronary intervention The BRIEF-PCI (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention) randomized trial.

    Science.gov (United States)

    Fung, Anthony Y; Saw, Jacqueline; Starovoytov, Andrew; Densem, Cameron; Jokhi, Percy; Walsh, Simon J; Fox, Rebecca S; Humphries, Karin H; Aymong, Eve; Ricci, Donald R; Webb, John G; Hamburger, Jaap N; Carere, Ronald G; Buller, Christopher E

    2009-03-10

    The purpose of this study was to assess whether the early discontinuation of eptifibatide infusion in nonemergent percutaneous coronary intervention (PCI) is associated with a higher frequency of periprocedural ischemic myonecrosis. The recommended regimen for eptifibatide is a double bolus followed by an infusion for 18 h. It is not known whether the infusion can be shortened if the PCI is uncomplicated. We enrolled 624 patients with stable angina, acute coronary syndrome, or recent ST-segment elevation myocardial infarction (>48 h) who underwent successful coronary stenting and received eptifibatide. Patients were randomly assigned to receive either an 18-h infusion or an abbreviated infusion of 0.26 microg/l. Secondary end points included death, myocardial infarction, urgent target vessel revascularization at 30 days, and in-hospital major bleeding using the REPLACE-2 (Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events) trial criteria. The incidence of periprocedural myonecrosis was 30.1% in the eptifibatide infusion can be abbreviated safely to Eptifibatide Following Percutaneous Coronary Intervention [BRIEF PCI]; NCT00111566).

  16. Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing PCI for non-ST-segment elevation acute coronary syndromes: impact of clinical status and procedural characteristics

    NARCIS (Netherlands)

    T. Bauer (Timm); H. Möllmann (Helge); F. Weidinger (Franz); U. Zeymer (Uwe); R. Seabra-Gomes (Ricardo); F.R. Eberli (Franz Robert); P.W.J.C. Serruys (Patrick); A. Vahanian (Alec); S. Silber (Sigmund); W. Wijns (William); M. Hochadel (Matthias); H.M. Nef (Holger); C.W. Hamm (Christian); J. Marco (Jean); A.K. Gitt (Anselm)

    2010-01-01

    textabstractBackground: The most recent ESC guidelines for percutaneous coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa inhibitors (GPI) in high risk patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known about

  17. Characteristics of Patients Undergoing Cardiac Catheterization Before Noncardiac Surgery: A Report From the National Cardiovascular Data Registry CathPCI Registry.

    Science.gov (United States)

    Schulman-Marcus, Joshua; Feldman, Dmitriy N; Rao, Sunil V; Prasad, Abhiram; McCoy, Lisa; Garratt, Kirk; Kim, Luke K; Minutello, Robert M; Wong, Shing-Chiu; Vora, Amit N; Singh, Harsimran S; Wojdyla, Daniel; Mohsen, Amr; Bergman, Geoffrey; Swaminathan, Rajesh V

    2016-05-01

    Many patients undergo cardiac catheterization and/or percutaneous coronary intervention (PCI) before noncardiac surgery even though these procedures are not routinely indicated. Data on this cohort of patients are limited. To describe the characteristics, angiographic findings, and treatment patterns of clinically stable patients undergoing cardiac catheterization and/or PCI before noncardiac surgery in a large national registry. This study is a retrospective, descriptive analysis of National Cardiac Data Registry CathPCI Registry diagnostic catheterization and PCI data from July 1, 2009, through December 31, 2014. Data analysis was performed from April 21, 2015, to January 4, 2016. The study included 194 444 patients from 1046 sites who underwent coronary angiography before noncardiac surgery. Patients with acute coronary syndrome, cardiogenic shock, cardiac arrest, or emergency catheterization were excluded. Demographic characteristics, preprocedure noninvasive testing results, angiographic findings, and treatment recommendations are summarized. Among the 27 838 patients who underwent PCI, procedural details, inpatient outcomes, and discharge medications are reported. Of the 194 444 included patients, 113 590 (58.4%) were male, the median age was 65 years (interquartile range, 57-73 years), and 162 532 (83.6%) were white. Most were overweight or obese (152 849 [78.6%]), and 78 847 (40.6%) had diabetes mellitus. Most patients were asymptomatic (117 821 [60.6%]), although 112 302 (57.8%) had been taking antianginal medications within 2 weeks of the procedure. Prior noninvasive stress testing was reported in 126 766 (65.2%), and results were positive in 109 458 (86.3%) of those with stress data. Obstructive disease was present in 93 447 (48.1%). After diagnostic angiography, revascularization with PCI or bypass surgery was recommended in 46 380 patients (23.8%) in the overall cohort, 27 191 asymptomatic patients (23.1%), and 45 083 patients with obstructive

  18. Predictors of suboptimal TIMI flow after primary angioplasty for acute myocardial infarction: results from the HORIZONS-AMI trial.

    Science.gov (United States)

    Caixeta, Adriano; Lansky, Alexandra J; Mehran, Roxana; Brener, Sorin J; Claessen, Bimmer; Généreux, Philippe; Palmerini, Tullio; Witzenbichler, Bernhard; Guagliumi, Giulio; Brodie, Bruce R; Dudek, Dariusz; Fahy, Martin; Dangas, George D; Stone, Gregg W

    2013-06-22

    The predictors of TIMI flow TIMI 3 flow, while 407 (12.9%) had TIMI flow TIMI flow TIMI flow grade 0/1 (OR 2.79; 95% CI: 2.14 to 3.62; pTIMI 3 flow was achieved was significantly lower than that of patients in whom TIMI 3 flow was not achieved (5.5% vs. 10.5%; pTIMI flow after primary PCI in STEMI occurred in 12.9% of patients, and was associated with patient-related factors (age), anatomical factors (anterior MI location), and angiographic factors (baseline TIMI 0/1 flow and lesion length). Failure to achieve TIMI 3 flow continues to be a powerful predictor of mortality after primary PCI in the contemporary era. http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

  19. Information Needs in Relation to Physical Activity among Angina Patients before Percutaneous Coronary Intervention (PCI at a Private Hospital in Penang, Malaysia

    Directory of Open Access Journals (Sweden)

    Ho Siew Eng

    2016-10-01

    Full Text Available Background: Episodes experienced by angina patients are potentially frightening and life threatening. Angina patients lack awareness regarding Percutaneous Coronary Intervention (PCI as a prognostic benefit. Aim and Objectives: To identify the information needs in relation to physical activity among angina patients before PCI at a private hospital in Penang, Malaysia. Material and Methods: A cross-sectional study was conducted from April to July 2016; 150 respondents who fulfilled the inclusion criteria were recruited. A 16-item questionnaire related to physical limitations was adapted and modified from Seattle Angina Questionnaire (SAQ. Results: The findings reported that majority of respondents (103; 69% possessed more than one co-morbidity, while 47respondents (31% single co-morbidity. Those with secondary level education showed (M=15.98, SD±6.14 while tertiary level education reported (M=16.61, SD±6.11, with no significant difference (t= -0.623, p= 0.534 between respondents' education level and physical activity. In terms of occupation, employed (M=15.58, SD±6.42 and unemployed (M=17.31, SD±5.52 also reported significant difference with (t= -1.70, p= 0.04. There was likewise a significant difference between respondents with single co-morbidity (M=18.09, SD±6.88 and multiple co-morbidity (M=15.46, SD± 5.58 with (t= 2.475, p= 0.01.However, there was no significant difference between respondents with previous admission and physical activity (t= 0.868, p= 0.387, as well as respondents' age group with physical activity (t=-0.675, p= 0.501.Conclusion: In conclusion, respondents' information needs regarding PCI are significantly associated with occupation and co-morbidity towards physical activity before PCI. Age, educational level and previous admission did not have any effect on respondents' physical activity before PCI.

  20. Balloon-Assisted Tracking Use Reduces Radial Artery Access Failure in an Experienced Radial Center and is Feasible During Primary PCI for STEMI.

    Science.gov (United States)

    Obaid, Daniel; Hailan, Ahmed; Chase, Alexander; Dorman, Stephen; Jenkins, Geraint; Raybould, Adrian; Ramsey, Mark; Thomas, Phillip; Smith, David; Ionescu, Adrian

    2017-07-01

    This prospective study assesses balloon-assisted tracking (BAT) in reducing radial access failure during percutaneous coronary intervention (PCI). Arterial spasm prevents PCI from the radial artery in a small percentage of cases. A total of 2223 consecutive patients undergoing PCI from the radial approach were analyzed. Radial access failure mode and requirement for crossover to femoral access during a 12-month run-in period were compared with the following 14-month period with routine BAT usage. During the 14-month study period, 1334 radial PCIs were attempted. Twenty-six patients switched to femoral at an early stage, while 76 encountered radial spasm and underwent successful BAT in 69 cases (91%), giving a total crossover rate to femoral of 33/1334 (2.5%). Utilizing BAT rather than a femoral puncture reduced our institution's radial-femoral crossover rate from 7.6% to 2.5% (P<.01), which is also significantly lower than the radial-femoral crossover rate in the 12 months before BAT implementation (6.1%; P<.01). Mean procedure times were similar for those requiring BAT compared with conventional radial access (51.3 ± 21.3 min vs 47.9 ± 23.7 min; P=.23), and those crossing straight to femoral (BAT not attempted) (60.7 ± 31.9 min; P=.10). Mean first device/balloon time for the BAT-assisted primary PCI cases (22.6 ± 9.4 min) was similar to cases that had radial difficulties and converted to femoral without attempting BAT (25.8 ± 13.4 min; P=.54). BAT allowed catheter passage despite radial spasm in 91% of cases, significantly reducing the institution's rate of femoral crossover. During radial spasm in primary PCI, using BAT did not delay reperfusion compared with femoral crossover.

  1. OCT guidance during stent implantation in primary PCI: A randomized multicenter study with nine months of optical coherence tomography follow-up.

    Science.gov (United States)

    Kala, Petr; Cervinka, Pavel; Jakl, Martin; Kanovsky, Jan; Kupec, Andrej; Spacek, Radim; Kvasnak, Martin; Poloczek, Martin; Cervinkova, Michaela; Bezerra, Hiram; Valenta, Zdenek; Attizzani, Guilherme F; Schnell, Audrey; Hong, Lu; Costa, Marco A

    2018-01-01

    To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the OCT study. OCT analysis at nine months showed significantly less in-segment area of stenosis (6% [-11, 19] versus 18% [3, 33]; p=0.0002) in favor of the OCT-guided group. The rate major adverse cardiovascular events were comparable at nine months in both groups (3% in the OCT group versus 2% in the angio-guided group; p=0.87). This study demonstrates the safety of OCT guidance during pPCI. The use of OCT optimized stent deployment in 1/3 of patients in this clinical scenario and significantly reduced in-segment area of stenosis at nine months of follow-up. Whether such improvements in OCT endpoints will have a positive impact on late clinical outcomes, they demand both a larger and longer-term follow-up study. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

    Energy Technology Data Exchange (ETDEWEB)

    Becher, Tobias, E-mail: Tobias.Becher@umm.de [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Mashayekhi, Kambis [Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen (Germany); Borggrefe, Martin; Akin, Ibrahim [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)

    2016-12-15

    Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use.

  3. Associations between P2RY12 gene polymorphisms and risks of clopidogrel resistance and adverse cardiovascular events after PCI in patients with acute coronary syndrome.

    Science.gov (United States)

    Li, Miaonan; Wang, Hongju; Xuan, Ling; Shi, Xiaojun; Zhou, Tong; Zhang, Ningru; Huang, Yuli

    2017-04-01

    Clopidogrel resistance in patients with acute coronary syndrome (ACS) is one of the key causes of recurrent cardiovascular disease (CVD) events after percutaneous coronary intervention (PCI). Clopidogrel targets the platelet membrane receptor P2RY12 to inhibit platelet aggregation via adenosine diphosphate (ADP). This study aimed to investigate the relationships between P2RY12 polymorphisms and the risk of clopidogrel resistance and adverse CVD events after PCI. From January 2015 to December 2014, patients who had been diagnosed with ACS undergoing PCI and treated with clopidogrel were recruited for this prospective cohort study (N = 498). Data regarding demographics, medication intake, and ACS lesion were recorded, and whole blood samples were collected for biochemical tests, ADP-induced platelet aggregation ratio detection, and P2RY12 genotyping. P2RY12 genotyping was performed by polymerase chain reaction. The left ventricular ejection fraction was calculated by echocardiography. After 3 to 12 months of follow-up, data regarding any adverse CVD event or death were recorded. The allele frequencies for the T variation alleles in C34T and G52T of P2RY12 were 20.3% and 11.6%, respectively. Patients with T variations at C34T or G52T of P2RY12 had a significantly higher risk of clopidogrel resistance (C34T: P clopidogrel resistance. Also, the T variations in C34T (OR: 2.68 [95% CI: 1.07-6.73], P = 0.035) and G52T (OR: 5.64 [95% CI: 1.52-20.88], P = 0.010) significantly increased the risk of post-PCI CVD events after accounting for confounding factors. The P2RY12 gene polymorphisms C34T and G52T were significantly associated with a higher risk of clopidogrel resistance and sequential cardiovascular events in Chinese ACS patients after PCI.

  4. Feature-preserving surface mesh smoothing via suboptimal Delaunay triangulation ☆

    Science.gov (United States)

    Gao, Zhanheng; Yu, Zeyun; Holst, Michael

    2012-01-01

    A method of triangular surface mesh smoothing is presented to improve angle quality by extending the original optimal Delaunay triangulation (ODT) to surface meshes. The mesh quality is improved by solving a quadratic optimization problem that minimizes the approximated interpolation error between a parabolic function and its piecewise linear interpolation defined on the mesh. A suboptimal problem is derived to guarantee a unique, analytic solution that is significantly faster with little loss in accuracy as compared to the optimal one. In addition to the quality-improving capability, the proposed method has been adapted to remove noise while faithfully preserving sharp features such as edges and corners of a mesh. Numerous experiments are included to demonstrate the performance of the method. PMID:23580890

  5. Suboptimal Rayleigh damping coefficients in seismic analysis of viscously-damped structures

    Science.gov (United States)

    Pan, Danguang; Chen, Genda; Wang, Zuocai

    2014-12-01

    An optimization method for the consistent evaluation of two Rayleigh damping coefficients is proposed. By minimizing an objective function such as an error term of the peak displacement of a structure, the two coefficients can be determined with response spectral analysis. The optimization method degenerates into the conventional method used in current practices when only two modes of vibration are included in the objective function. Therefore, the proposed method with all significant modes included for simplicity in practical applications results in suboptimal damping coefficients. The effects of both spatial distribution and frequency content of excitations as well as structural dynamic characteristics on the evaluation of Rayleigh damping coefficients were investigated with a five-story building structure. Two application examples with a 62-story high-rise building and a 840 m long cable-stayed bridge under ten earthquake excitations demonstrated the accuracy and effectiveness of the proposed method to account for all of the above effects.

  6. A similar correction mechanism in slow and fluent readers after suboptimal landing positions.

    Directory of Open Access Journals (Sweden)

    Benjamin eGagl

    2014-06-01

    Full Text Available The present eye movements study investigated the optimal viewing position (OVP and inverted-optimal viewing position (I-OVP effects in slow readers. The basis of these effects is a phenomenon called corrective re-fixations, which describes a short saccade from a suboptimal landing position (word beginning or end to the center of the word. The present study found corrective re-fixations in slow readers, which was evident from the I-OVP effects in first fixation durations, the OVP effect in number of fixations and the OVP effect in re-fixation probability. The main result is that slow readers, despite being characterized by a fragmented eye movement pattern during reading, nevertheless share an intact mechanism for performing corrective re-fixations. This correction mechanism is not linked to linguistic processing, but to visual and oculomotor processes, which suggests the integrity of oculomotor and visual processes in slow readers.

  7. Sub-optimal asthma control in teenagers in the midland region of Ireland.

    Science.gov (United States)

    Kelly, I; Fitzpatrick, P

    2011-12-01

    Internationally, many children with asthma are not attaining achievable asthma control. To examine the prevalence of asthma in teenagers in four midland counties, their asthma control and the barriers, if any, to gaining control of asthma. International Study of Asthma and Allergies in Children (ISAAC) methodology was used in a survey of Junior Cycle Year 2 second-level students. The prevalence of "wheeze ever" was 49.8%, "wheeze in the last 12 months" was 32.6% and "asthma ever" was 23.5%. Of teenagers with current asthma, 96% had evidence of sub-optimal asthma control during the previous year. For the majority of the teenagers with asthma, treatment was not guideline concordant; infrequent lung function testing, insufficient review after acute care and poor use of written asthma action plans. Barriers included lack of awareness of need for treatment. If asthma guidelines are implemented fully, these children may experience better health.

  8. Subtypes of type I IFN differentially enhance cytokine expression by suboptimally stimulated CD4(+) T cells.

    Science.gov (United States)

    Hillyer, Philippa; Raviv, Nataly; Gold, Doria M; Dougherty, Danielle; Liu, Jie; Johnson, Teresa R; Graham, Barney S; Rabin, Ronald L

    2013-12-01

    Human type I interferons (IFNs) include IFN-β and 12 subtypes of IFN-α. During viral infection, infiltrating memory CD4(+) T cells are exposed to IFNs, but their impact on memory T-cell function is poorly understood. To address this, we pretreated PBMCs with different IFNs for 16 h before stimulation with Staphylococcus aureus enterotoxin B and measured cytokine expression by flow cytometry. IFN-α8 and -α10 most potently enhanced expression of IFN-γ, IL-2, and IL-4. Potency among the subtypes differed most at doses between 10 and 100 U/mL. While enhancement of IL-2 and IL-4 correlated with the time of preincubation with type I IFN, IFN-γ production was enhanced best when IFN-α was added immediately preceding or simultaneously with T-cell stimulation. Comparison of T-cell responses to multiple doses of Staphylococcus aureus enterotoxin B and to peptide libraries from RSV or CMV demonstrated that IFN-α best enhanced cytokine expression when CD4(+) T cells were suboptimally stimulated. We conclude that type I IFNs enhance Th1 and Th2 function with dose dependency and subtype specificity, and best when T-cell stimulation is suboptimal. While type I IFNs may beneficially enhance CD4(+) T-cell memory responses to vaccines or viral pathogens, they may also enhance the function of resident Th2 cells and exacerbate allergic inflammation. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  9. Improvement of Suboptimal Land Productivity Approach by Land and Plant Management

    Directory of Open Access Journals (Sweden)

    Marthen Pasang Sirappa

    2014-06-01

    Full Text Available Assessment for increasing productivity of suboptimal land with using three kinds of organic fertilizer and six rice varieties had been conducted in the Debowae village, Waeapo district, Buru regency at 2011. Purpose of the assessment were to determine the effect of three types organic fertilizer and the use of six Inpara varieties to growth and productivity of rice in sub-optimal land. Study used a split plot design with three replications (farmers as replicates, where the main plot was three types of organic fertilizers (livestock manure, granular organic, and petroganic, while the subplot was 6 varieties Inpara (Inpara 1, Inpara 2, Inpara 3, Inpara 4, Inpara 5, and Indragiri. The soil types at the study site based on soil classification were Endoaquepts with soil fertility status was low. The study results showed that the use of organic manure combined with inorganic fertilizers, both from livestock manure, while granular organic and petrogranic, gave an average crop growth and yield better than the results obtained by farmers outside of the study. Average petroganic fertilizer had a better growth and higher crop yields compared to other organic fertilizers. The six varieties of rice swamps that were examined (Inpara 1, Inpara 2, Inpara 3, Inpara 4, Inpara 5, and Indragiri had the average growth and better yields than rice varieties used by farmers outside of the study (2.75 Mg ha-1. Varieties Inpara 4, Indragiri, Inpara 1 and Inpara 2 had average yield above 7 Mg ha-1, while Inpara 3 and Inpara 5 average above 4 Mg ha-1. Combination of granular organic fertilizer with Inpara 4 variety and petroganic with Indragiri variety had the best results (8.37 and 8.02 Mg ha-1, while the lowest yield (4.48 Mg ha-1 was reached at combination of livestock manure with Inpara 5 variety.

  10. A PROCEDURE FOR DETERMINING OPTIMAL FACILITY LOCATION AND SUB-OPTIMAL POSITIONS

    Directory of Open Access Journals (Sweden)

    P.K. Dan

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: This research presents a methodology for determining the optimal location of a new facility, having physical flow interaction of various degrees with other existing facilities in the presence of barriers impeding the shortest flow-path as well as the sub-optimal iso-cost positions. It also determines sub-optimal iso-cost positions with additional cost or penalty for not being able to site it at the computed optimal point. The proposed methodology considers all types of quadrilateral barrier or forbidden region configurations to generalize and by-pass such impenetrable obstacles, and adopts a scheme of searching through the vertices of the quadrilaterals to determine the alternative shortest flow-path. This procedure of obstacle avoidance is novel. Software has been developed to facilitate computations for the search algorithm to determine the optimal and iso-cost co-ordinates. The test results are presented.

    AFRIKAANSE OPSOMMING: Die navorsing behandel ‘n procedure vir die bepaling van optimum stigtingsposisie vir ‘n onderneming met vloei vanaf ander bestaande fasiliteite in die teenwoordigheid van ‘n verskeidenheid van randvoorwaardes. Die prodedure lewer as resultaat suboptimale isokoste-stigtingsplekke met bekendmaking van die koste wat onstaan a.g.v. afwyking van die randvoorwaardlose optimum oplossingskoste, die prosedure maak gebruik van ‘n vindingryke soekmetode wat toegepas word op niersydige meerkundige voorstellings vir die bepaling van korste roetes wat versperring omseil. Die prosedure word onderskei deur programmatuur. Toetsresultate word voorgehou.

  11. Clopidogrel-Proton Pump Inhibitor Drug-Drug Interaction and Risk of Adverse Clinical Outcomes Among PCI-Treated ACS Patients: A Meta-analysis.

    Science.gov (United States)

    Serbin, Michael A; Guzauskas, Gregory F; Veenstra, David L

    2016-08-01

    Uncertainty regarding clopidogrel effectiveness attenuation because of a drug-drug interaction with proton pump inhibitors (PPI) has led to conflicting guidelines on concomitant therapy. In particular, the effect of this interaction in patients who undergo a percutaneous coronary intervention (PCI), a population known to have increased risk of adverse cardiovascular events, has not been systematically evaluated. To synthesize the evidence of the effect of clopidogrel-PPI drug interaction on adverse cardiovascular outcomes in a PCI patient population. We conducted a systematic literature review for studies reporting clinical outcomes in patients who underwent a PCI and were initiated on clopidogrel with or without a PPI. Studies were included in the analysis if they reported at least 1 of the clinical outcomes of interest (major adverse cardiovascular event [MACE], cardiovascular death, all-cause death, myocardial infarction, stroke, stent thrombosis, and bleed events). We excluded studies that were not exclusive to PCI patients or had no PCI subgroup analysis and/or did not report at least a 6-month follow-up. Statistical and clinical heterogeneity were evaluated and HRs and 95% CIs for adverse clinical events were pooled using the DerSimonian and Laird random-effects meta-analysis method. We identified 12 studies comprising 50,277 PCI patients that met our inclusion and exclusion criteria. Our analysis included retrospective analyses of randomized controlled trials (2), health registries (3), claims databases (2), and institutional records (5); no prospective studies of PCI patients were identified. On average, patients were in their mid-60s, male, and had an array of comorbidities, including hyperlipidemia, diabetes, hypertension, and smoking history. Concomitant therapy following PCI resulted in statistically significant increases in composite MACE (HR = 1.28; 95% CI = 1.24-1.32), myocardial infarction (HR = 1.51; 95% CI = 1.40-1.62), and stroke (HR = 1.46; 95

  12. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with end-stage renal disease requiring dialysis (5-year outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2014-08-15

    Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p <0.001) and left main disease (10% vs 34%, p <0.001). Preprocedural Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score in the CABG group was significantly higher than that in the PCI group (23.5 ± 8.7 vs 29.4 ± 11.0, p <0.001). Unadjusted 30-day mortality was 2.7% for PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (HR 2.10, 95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83, 95% CI 1.01 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p <0.001). Among the 201 patients who died during the follow-up, 94 patients (47%) died from noncardiac morbidities such as stroke, respiratory failure, and renal failure. In patients with multivessel and/or left main disease undergoing dialysis, 5-year

  13. Assessments of whole body scan images (PCI) obtained in patients undergoing treatment of radioiodine (pre and post-treatment); Avaliacoes das imagens de pesquisa de corpo inteiro (PCI) obtidas em pacientes submetidos ao tratamento de radioiodoterapia (pre e pos-tratamento)

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Fernanda Karolina Mendonca da; Lopes Filho, Ferdinand de Jesus; Vieira, Jose Wilson; Souza, Milena Thays Barbosa de, E-mail: fernanda.radiologia8@gmail.com, E-mail: milena_thays@hotmail.com, E-mail: jose.wilson59@uol.com.br, E-mail: ferdinand.lopes@oi.com.br [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil)

    2014-07-01

    Nuclear medicine is a medical specialty used for diagnosis and therapy of some diseases. For the treatment of differentiated thyroid carcinoma (papillary and follicular) Radioiodine therapy is employed, in order to eliminate the rest of thyroid tissue after removal of the thyroid (thyroidectomy). In radioiodine therapy is used radioisotope iodine-131 ({sup 131}I) as Sodium Iodide (NaI). The amount of the activity (dose) of {sup 131}I administered is generally the responsibility of nuclear medicine, which is based on an image Research Length of the patient (pre-dose therapy PCI). PCI is also used after treatment (post-PCI therapeutic dose) to evaluate possible metastasis. The purpose of this study was to investigate the distribution of biokinetic {sup 131}I at length and in some organs of the patient, in order to note any similarity. Exams PCI pre-dose and post-dose were analyzed, the anterior and posterior projections of ten patients. Contours in these images (ROI - Region Of Interest) were made in the whole body and in areas with high uptake of {sup 131}I. The total score was used in the calculation to obtain the percentage distribution of {sup 13I} in the organs of the patient. The results showed that there similarity on the biodistribution of {sup 131}I between pre-dose and post-dose PCI. Therefore, it was found that it is valuable images of PCI pre-dose therapy as a way to assist the nuclear medicine physician in choosing the best activity to be administered to the patient in order to minimize the dose to adjacent organs. (author)

  14. A high-throughput readout architecture based on PCI-Express Gen3 and DirectGMA technology

    Science.gov (United States)

    Rota, L.; Vogelgesang, M.; Ardila Perez, L. E.; Caselle, M.; Chilingaryan, S.; Dritschler, T.; Zilio, N.; Kopmann, A.; Balzer, M.; Weber, M.

    2016-02-01

    Modern physics experiments produce multi-GB/s data rates. Fast data links and high performance computing stages are required for continuous data acquisition and processing. Because of their intrinsic parallelism and computational power, GPUs emerged as an ideal solution to process this data in high performance computing applications. In this paper we present a high-throughput platform based on direct FPGA-GPU communication. The architecture consists of a Direct Memory Access (DMA) engine compatible with the Xilinx PCI-Express core, a Linux driver for register access, and high- level software to manage direct memory transfers using AMD's DirectGMA technology. Measurements with a Gen3 x8 link show a throughput of 6.4 GB/s for transfers to GPU memory and 6.6 GB/s to system memory. We also assess the possibility of using the architecture in low latency systems: preliminary measurements show a round-trip latency as low as 1 μs for data transfers to system memory, while the additional latency introduced by OpenCL scheduling is the current limitation for GPU based systems. Our implementation is suitable for real-time DAQ system applications ranging from photon science and medical imaging to High Energy Physics (HEP) systems.

  15. Study of Fluctuations with the PCI Diagnostic During the Search for an I-Mode on DIII-D

    Science.gov (United States)

    Marinoni, A.; Rost, J. C.; Porkolab, M.; Hubbard, A. E.; White, A. E.; Whyte, D. G.; Burrell, K. H.; Osborne, T. H.

    2013-10-01

    Recent experiments on DIII-D explored the operational space required to achieve the I-mode regime observed on Alcator C-Mod. This regime features an edge energy transport barrier without an accompanying particle barrier, and broadband instabilities known as WCM. Although none of the DIII-D plasmas exhibited all those characteristics, preceding the H-mode transition, the edge electron temperature slowly and intermittently evolved towards a pedestal-like profile 0.4 keV high while maintaining a typical L-mode edge density profile. During this prelude phase, edge density fluctuations measured with the recently upgraded Phase Contrast Interferometer (PCI) are observed to be qualitatively similar to those seen in H-mode: the intensity of fluctuations is reduced, and the frequency spectrum is broadened in the range of 300 kHz and is non-monotonic. The 2D k-f spectra also approach those typical of an H-mode, showing broad fluctuations in k-space and group velocities increasing to 10 km/s. Several branches are observed in 2D spectra, possibly indicating multiple instabilities at play. Work supported by the US DOE under DE-FG02-04ER54235 and DE-FC02-04ER54698.

  16. Penyusunan Panduan Pengelolaan Keamanan Informasi Untuk Firewall Configuration Berdasarkan Kerangka Kerja PCI DSS v.3.1 dan COBIT 5

    Directory of Open Access Journals (Sweden)

    Bagus Puji Santoso

    2016-10-01

    Full Text Available Information security systems must be protected from all attacks and interuptions by an unauthorized user. Firewall is a mechanism that can be applied to improve the security information which done by filtering data packets that enter and exit the network. IT governance is needed to manage good information security. IT governance can use to make the arrangement of guidelines for the management of information security. This research aims to create a reference guide to information security such as an information security management guide for firewall configuration that refers to the framework of PCI DSS v.3.1 and COBIT 5 by taking a case study at the DSIK Universitas Airlangga.Arrangement of guidelines for information security management for firewall configuration will be done in three stages. The first stage was the arrangement of information security management procedures for firewall configuration which consists of mapping analysis stage process, arrangement procedure’s stage and determining roles and job description’s stage. In the second stage was the verification of the information security management guidance using a questionnaire. The third stage was improvement of the information security management guidance. These improvements was done to correct deficiencies that were produced when verification. The verification results show that 42.86% of respondents said that management guidelines are operationally very easy to be implemented.

  17. Developing primary PCI as a national reperfusion strategy for patients with ST-elevation myocardial infarction: the UK experience.

    Science.gov (United States)

    McLenachan, James M; Gray, Huon H; de Belder, Mark A; Ludman, Peter F; Cunningham, David; Birkhead, John

    2012-08-01

    In 2004 in the United Kingdom (UK), the infrastructural and organisational changes required for implementation of primary PCI for treatment of STEMI were unclear, and the cost-effectiveness and sustainability of a changed reperfusion strategy had not been tested. In addition, any proposed change was to be made against the background of a previously successful in-hospital thrombolysis strategy, with plans for greater use of pre-hospital administration. A prospective study (the "National Infarct Angioplasty Project - NIAP") was set up to collect information on all patients presenting with STEMI in selected regions in the UK over a one year period (April 2005 - March 2006). The key findings from the NIAP project included that PPCI could be delivered within acceptable treatment times in a variety of geographical settings and that the shortest treatment times were achieved with direct admission to a PPCI-capable cardiac catheter laboratory. The transformation from a dominant lytic strategy to one of PPCI across the UK was achieved both swiftly and consistently with the help of 28 cardiac networks. By the second quarter of 2011, 94% of those STEMI patients in England who received reperfusion treatment were being treated by PPCI compared with 46% during the third quarter of 2008.

  18. Implement of Digital Moire technique on DSP for alignment of partial compensation interferometer

    Science.gov (United States)

    Tian, Yuhan; QunHao; YaoHu; Wang, Shaopu; Li, Tengfei; Wang, Jingxian

    2016-01-01

    Digital Moiré technique is adopted in partial compensation interferometer (PCI) for high-precision testing of figure error of the aspheric surfaces. The figure error of the measured aspheric is obtained by a series of calculation with the real interferogram and ideal interferograms generated by computer. The dense interference fringes at the exit pupil make it difficult to align the PCI. On the contrary, digital Moire fringes composed from real and ideal interferograms are sparse and corresponding to the figure error of the measured aspheric, making it easier to align the PCI. Generally, digital Moire technique is processed on the computer, resulting in slow processing speed and difficult display in real time. Digital Signal Processor (DSP) can be used to implement digital Moire technique and display digital Moire fringes in real time with its powerful processing capacity. In this paper, digital Moire technique is implemented on the TMS320C6455 DSP. The hardware system consists of a DSP module, a CCD camera and a monitor. Finally we experimentally obtain the digital Moire image, and further analyze how to align the PCI theoretically.

  19. Gender differences in therapeutic recommendation after diagnostic coronary angiography: insights from the Coronary Angiography and PCI Registry of the German Society of Cardiology.

    Science.gov (United States)

    Heer, Tobias; Hochadel, Matthias; Schmidt, Karin; Mehilli, Julinda; Zahn, Ralf; Kuck, Karl-Heinz; Hamm, Christian; Böhm, Michael; Ertl, Georg; Andresen, Dietrich; Massberg, Steffen; Senges, Jochen; Pilz, Günter; Gitt, Anselm K; Zeymer, Uwe

    2015-06-01

    There is information suggesting differences and underuse of invasive coronary diagnostic and therapeutic procedures in women compared to men. Data from consecutive patients (pts) which were enrolled in the Coronary Angiography and PCI Registry of the German Society of Cardiology were analyzed. We compared gender-related differences in diagnosis and therapeutic recommendation of pts undergoing coronary angiography (XA) for stable coronary artery disease (CAD), non-ST elevation acute coronary syndromes (NSTE-ACS) and ST elevation myocardial infarction (STEMI). From 2004 until the end of 2009, data of 1,060,542 invasive procedures in 1,014,996 pts were prospectively registered. One-third (34.6%) of them were female. Women less often had significant CAD, irrespective of the indication for XA. In pts with relevant CAD, percutaneous coronary interventions (PCI) were recommended in 87.1% of women versus 89.1% of men with STEMI [age-adjusted OR (aOR) 0.98, 95% CI 0.93-1.04], in 67.1 vs. 66.8% in NSTE-ACS (aOR 1.10, 1.07-1.12), and in 50.3 vs 49.4% in stable CAD (aOR 1.07, 1.05-1.09). In pts with significant CAD, there was no difference in recommendation for PCI between the genders in stable CAD, whereas in STEMI and NSTE-ACS women were treated even more often with PCI. There were only minor differences in referral for CABG between women and men. Hence, our data provide strong evidence against a gender bias in use of invasive therapeutic procedures once the diagnosis of significant CAD has been confirmed.

  20. Impact of PCI Appropriateness in the Long-Term Outcomes of Consecutive Patients Treated With Second-Generation Drug-Eluting Stents.

    Science.gov (United States)

    Seixas, Ana Cristina; Sousa, Amanda; de Ribamar Costa, Jose; Costa Moreira, Adriana; Costa, Ricardo; Damiani, Lucas; Campos Neto, Cantídio; Maldonado, Galo; Cano, Manuel; Sousa, J Eduardo

    2017-09-01

    Appropriate use criteria (AUC) for coronary revascularization were developed to deliver high-quality care; however, the prognostic impact of these criteria remains unclear. We sought to assess the outcomes of patients treated with second-generation drug-eluting stent (DES) classified according to the updated American College of Cardiology Foundation/American Heart Association/Society for Cardiac Angiography and Intervention AUC for percutaneous coronary intervention (PCI). Between January 2012 and December 2013, a total of 1108 consecutive patients treated only with second-generation DES were categorized according to the AUC in three groups, using the new proposed terminology: appropriate ("A"); uncertain ("U"); and inappropriate ("I"). Major adverse cardiac event (MACE, defined as cardiac death, non-fatal myocardial infarction, and ischemia-driven target-lesion revascularization) and stent thrombosis up to 3 years were compared. PCI was categorized as A in 33.8%, U in 46.8%, and I in 19.4% of all cases. PCI-A patients had a higher prevalence of acute coronary syndromes, while PCI-I involved the treatment of more diabetics and patients with stable coronary disease. There were no differences in procedural complications among the three groups, with comparable rates of in-hospital MACE (9.3% for A vs 9.0% for U vs 7.0% for I; P=.70) and 2-year MACE (13.9% for A vs 9.0% for U vs 8.6% for I; P=.40). In the multivariable analysis, AUC classification was not associated with adverse outcomes. In this contemporary cohort of patients treated with second-generation DES implantation, AUC did not impact 3-year clinical follow-up.

  1. Effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Yang Ji

    2016-06-01

    Full Text Available Objective: To analyze the effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction. Methods: A total of 70 cases with acute anterior myocardial infarction who received emergency rescue in our hospital from February 2012 to September 2014 were included for study, and all included patients were divided into control group 38 cases who received emergency PCI treatment alone and observation group 32 cases who received emergency PCI combined with rh-BNP therapy. Differences in the values of neuroendocrine indicators, ventricular collagen remodeling-related indicators, cardiac function indicators, myocardial injury-related indicators and so on were compared between two groups after treatment. Results: Serum ET, PRA, ALD, AngII, NE and E values of observation group after treatment were significantly lower than those of control group (P<0.05; serum PⅠCP and PCⅢ values of observation group after treatment were lower than those of control group, and PⅠCP/ PCⅢ and TIMP-1 values were significantly higher than those of control group (P<0.05; examination of cardiac function by color Doppler ultrasound showed that LAD, LVEDD, LVESD, LVESV and LVEDV values of observation group were lower than those of control group, and LVEF and LVFS values were significantly higher than those of control group (P<0.05; serum CD14++CD2L+, hs-cTnT, HBDH and H-FABP values of observation group after treatment were significantly lower than those of control group, and CD14+CD2L- value was significantly higher than that of control group (P<0.05. Conclusions: Emergency PCI combined with rh-BNP therapy for patients with acute anterior myocardial infarction can significantly improve cardiac function and inhibit ventricular remodeling, and it has positive clinical significance.

  2. Bone marrow concentrate promotes bone regeneration with a suboptimal-dose of rhBMP-2.

    Directory of Open Access Journals (Sweden)

    Kazuhiro Egashira

    Full Text Available Bone marrow concentrate (BMC, which is enriched in mononuclear cells (MNCs and platelets, has recently attracted the attention of clinicians as a new optional means for bone engineering. We previously reported that the osteoinductive effect of bone morphogenetic protein-2 (BMP-2 could be enhanced synergistically by co-transplantation of peripheral blood (PB-derived platelet-rich plasma (PRP. This study aims to investigate whether BMC can effectively promote bone formation induced by low-dose BMP-2, thereby reducing the undesirable side-effects of BMP-2, compared to PRP. Human BMC was obtained from bone marrow aspirates using an automated blood separator. The BMC was then seeded onto β-TCP granules pre-adsorbed with a suboptimal-dose (minimum concentration to induce bone formation at 2 weeks in mice of recombinant human (rh BMP-2. These specimens were transplanted subcutaneously to the dorsal skin of immunodeficient-mice and the induction of ectopic bone formation was assessed 2 and 4 weeks post-transplantation. Transplantations of five other groups [PB, PRP, platelet-poor plasma (PPP, bone marrow aspirate (BM, and BM-PPP] were employed as experimental controls. Then, to clarify the effects on vertical bone augmentation, specimens from the six groups were transplanted for on-lay placement on the craniums of mice. The results indicated that BMC, which contained an approximately 2.5-fold increase in the number of MNCs compared to PRP, could accelerate ectopic bone formation until 2 weeks post-transplantation. On the cranium, the BMC group promoted bone augmentation with a suboptimal-dose of rhBMP-2 compared to other groups. Particularly in the BMC specimens harvested at 4 weeks, we observed newly formed bone surrounding the TCP granules at sites far from the calvarial bone. In conclusion, the addition of BMC could reduce the amount of rhBMP-2 by one-half via its synergistic effect on early-phase osteoinduction. We propose here that BMC

  3. PAPP-A and IGFBP-4 fragment levels in patients with ST-elevation myocardial infarction treated with heparin and PCI

    DEFF Research Database (Denmark)

    Hjortebjerg, Rikke; Lindberg, Søren; Hoffmann, Søren

    2015-01-01

    OBJECTIVES: Circulating levels of pregnancy-associated plasma protein-A (PAPP-A) predict outcome in patients with acute coronary syndrome (ACS). Unfortunately, administration of heparin to patients with ACS increases circulating PAPP-A, probably by a detachment of PAPP-A from cell surfaces......, inducing a considerable bias when using PAPP-A as a biomarker. It remains unknown whether PAPP-A-derived N- and C-terminal fragments of insulin-like growth factor binding protein-4 (NT-IGFBP-4/CT-IGFBP-4) are acutely affected by the increase in PAPP-A. METHODS: We prospectively included 78 patients with ST....... Plasma IGFBP-4, CT-IGFBP-4 and NT-IGFBP-4 levels were determined by specific, novel immunoassays, and PAPP-A and IGF-I by commercial immunoassays. RESULTS: Plasma PAPP-A was strongly elevated upon STEMI, UFH-administration and PCI with mean concentrations (95%-confidence interval) pre-PCI, post-PCI, day...

  4. Effects of home-based exercise rehabilitation on quality of life after coronary artery bypass graft and PCI early post-discharge

    Directory of Open Access Journals (Sweden)

    Shadi Moafi

    2011-11-01

    Full Text Available Background: The barriers to participation in cardiac rehabilitation programs are individual and economic problems and limited availability and access of rehabilitation services. Because of the important role of rehabilitation, home based exercise rehabilitation is a new approach to participate in such programs. The purpose of this study was to evaluate the effects of home-based rehabilitation on quality of life (QoL in patients with coronary artery disease after coronary artery bypass graft (CABG and PCI.Materials and Method: Participants included 18 CABG (3 women, 15 men and 40 PCI (12 women, 28 men low to moderate risk patients. Finally 17 patients in the exercise group and 16 patients in the control group remained. The SF-36 was used to evaluate changes in QoL before and after the program.Result: forty-three percent was dropped out from the program. Before and after program, the exercise group was better in all domains of QoL (p<0.05. After 8 weeks of cardiac rehabilitation, significant improvements were observed in quality of life in both groups (p<0.05 but the exercise group showed more improvements in three domains.Conclusion: Home-based exercise rehabilitation after CABG and PCI may improve QoL and provide an efficient low-cost approach to cardiac rehabilitation. It may be helpful due to limited availability and resources in Iran. Nevertheless, for increasing participation and decreasing drop out it needs more training

  5. GC-PCI-MS/MS and LC-ESI-MS/MS databases for the detection of 104 psychotropic compounds (synthetic cannabinoids, synthetic cathinones, phenethylamine derivatives).

    Science.gov (United States)

    Waters, Brian; Ikematsu, Natsuki; Hara, Kenji; Fujii, Hiroshi; Tokuyasu, Tomoko; Takayama, Mio; Matsusue, Aya; Kashiwagi, Masayuki; Kubo, Shin-Ichi

    2016-05-01

    Designer psychotropic compounds continue to be a major problem in Japan and all around the world. Electron impact mass spectrometry (GC-EI-MS) and liquid chromatography with electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) data on these compounds have been widely reported. In this report, we present a detection method that has been rarely utilized to analyze these types of compounds, gas chromatography with positive chemical ionization and tandem mass spectrometry (GC-PCI-MS/MS). We report on the development of GC-PCI-MS/MS and LC-ESI-MS/MS databases of 104 psychotropic compounds, including 32 cannabinoid derivatives, 29 cathinone derivatives, 34 phenethylamine derivatives, and several other designer compounds. Using this database, we were able to detect 5 psychotropic compounds in an actual forensic autopsy case. If GC-PCI-MS/MS is used together with the more established methods of GC-EI-MS and LC-ESI-MS/MS, we believe the forensic toxicology community could be better prepared to deal with the challenges of these ever-changing compounds. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Does Serum Bilirubin level on admission predict TIMI flow grade and in-hospital MACE in patients with STEMI undergoing primary PCI.

    Science.gov (United States)

    Celik, Turgay; Kaya, Mehmet G; Akpek, Mahmut; Yarlioglues, Mikail; Sarli, Bahadir; Topsakal, Ramazan; Gibson, Charles Michael

    2014-03-01

    We evaluated the association of total bilirubin with post-percutaneous coronary intervention (PCI) coronary blood flow and in-hospital major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. A total of 536 consecutive patients with STEMI (male 79%, mean age = 59.9 ± 12.6 years) admitted within 6 hours from symptom onset were enrolled. Patients were divided into 2 groups based on the thrombolysis in myocardial infarction (MI) flow grade. In-stent thrombosis, nonfatal MI, and in-hospital mortality were significantly higher in no-reflow group (P = .007, P = .002, and P < .001, respectively). On multivariate regression, the total bilirubin levels remained independent predictors of no-reflow (odds ratio [OR] 1.586, 95% confidence interval [CI] 1.02-2.47; P = .042) and in-hospital MACE (OR 1.399, 95% CI 1.053-1.857; P = .020). Serum bilirubin levels were independently associated with no-reflow and in-hospital MACE in patients with STEMI undergoing primary PCI.

  7. COMPARISON OF MAIZE INBRED LINES DIFFERING IN LOW-TEMPERATURE TOLERANCE - EFFECT OF ACCLIMATION AT SUBOPTIMAL TEMPERATURE ON CHLOROPLAST FUNCTIONING

    NARCIS (Netherlands)

    VERHEUL, MJ; VANHASSEL, PR; STAMP, P

    Acclimation to optimal or suboptimal temperature may influence photosynthetic properties of different maize genotypes in distinct ways. In this study, leaf growth and chloroplast functioning of the second leaves of Penjalinan, an inbred line used in warm tropical regions (CS) and Z7, an inbred line

  8. Physician, organizational, and patient factors associated with suboptimal blood pressure management in type 2 diabetic patients in primary care

    NARCIS (Netherlands)

    Schaars, Carel F; Denig, Petra; Kasje, Willeke N; Stewart, Roy E; Wolffenbuttel, Bruce H R; Haaijer-Ruskamp, Flora M

    OBJECTIVE: To assess the quality of hypertension care in patients with type 2 diabetes in general practice and identify physician, organizational, and patient factors associated with suboptimal care. RESEARCH DESIGN AND METHODS: Data from 895 randomly selected diabetic patients were extracted from

  9. TECHNOLOGICAL INNOVATION AND BUSINESS DIVERSIFICATION: SUSTAINABILITY LIVELIHOODS IMPROVEMENT SCENARIO OF RICE FARMER HOUSEHOLD IN SUB-OPTIMAL LAND

    Directory of Open Access Journals (Sweden)

    Adriani D.

    2017-09-01

    Full Text Available The increased role of the sub-optimal land to support food security continue to be encouraged in Indonesia, given the more limited expansion for potential land. But until recently, development of sub-optimal land becomes not an easy thing. Ecological and technical barriers became the main issue. A series of these issues resulted in a high number of underemproleymeny and poverty in agriculture region. Technological inovation of agriculture and the business diversification can be seen be the solution to those issues. This research aims to analyze the impact of the technological innovation and business diversification on underemployment, working time, household income and also sustainable livelihoods of farmers on the sub-optimal land. The research was carried out in Pemulutan District, Ogan Ilir Regency, South Sumatra Province, Indonesia. The objects of research are farmers which adopter and non adopter technological innovation, and also work outside of paddy farming (business diversification. The research method is the survey. Method of sampling is stratified random sampling. Data obtained in the field analyses using descriptive statistics and inferesia. The results showed there are positive impact of technological innovation on the allocation of working time farmer households, the numbers underemployment, household income and livelihood sustainability. Determinant factors for farmers in applying technology and business diversification are paddy farming income, off-farm income, and age. The use of technology and business diversification proves to be one of the positive scenarios for sustainable livelihood of farmers in sub-optimal land.

  10. Two Liters a Day Keep the Doctor Away? Considerations on the Pathophysiology of Suboptimal Fluid Intake in the Common Population

    OpenAIRE

    Florian Lang; Isabelle Guelinckx; Guillaume Lemetais; Olle Melander

    2017-01-01

    Suboptimal fluid intake may require enhanced release of antidiuretic hormone (ADH) or vasopressin for the maintenance of adequate hydration. Enhanced copeptin levels (reflecting enhanced vasopressin levels) in 25% of the common population are associated with enhanced risk of metabolic syndrome with abdominal obesity, type 2 diabetes, hypertension, coronary artery disease, heart failure, vascular dementia, cognitive impairment, microalbuminuria, chronic kidney disease, inflammatory bowel disea...

  11. Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study.

    OpenAIRE

    de Lusignan, S; Belsey, J; Hague, N.; Dhoul, N; van Vlymen, J

    2006-01-01

    Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention.

  12. Spotlight on unmet needs in stroke prevention: The PIONEER AF-PCI, NAVIGATE ESUS and GALILEO trials.

    Science.gov (United States)

    Hemmrich, Melanie; Peterson, Eric D; Thomitzek, Karen; Weitz, Jeffrey I

    2016-09-28

    Atrial fibrillation (AF) is a major healthcare concern, being associated with an estimated five-fold risk of ischaemic stroke. In patients with AF, anticoagulants reduce stroke risk to a greater extent than acetylsalicylic acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel. Non-vitamin K antagonist oral anticoagulants (NOACs) are now a widely-accepted therapeutic option for stroke prevention in non-valvular AF (NVAF). There are particular patient types with NVAF for whom treatment challenges remain, owing to sparse clinical data, their high-risk nature or a need to harmonise anticoagulant and antiplatelet regimens if co-administered. This article focuses on three randomised controlled trials (RCTs) that are investigating the utility of rivaroxaban, a direct, oral, factor Xa inhibitor, in additional areas of stroke prevention where data for anticoagulants are lacking: oPen-label, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment (PIONEER AF-PCI); New Approach riVaroxoban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS); and Global study comparing a rivAroxaban-based antithrombotic strategy to an antipLatelet-based strategy after transcatheter aortIc vaLve rEplacement to Optimize clinical outcomes (GALILEO). Data from these studies present collaborative efforts to build upon existing registrational Phase III data for rivaroxaban, driving the need for effective and safe treatment of a wider range of patients for stroke prevention.

  13. Extension of suboptimal control theory for flow around a square cylinder

    Science.gov (United States)

    Fujita, Yosuke; Fukagata, Koji

    2017-11-01

    We extend the suboptimal control theory to control of flow around a square cylinder, which has no point symmetry on the impulse response from the wall in contrast to circular cylinders and spheres previously studied. The cost functions examined are the pressure drag (J1), the friction drag (J2), the squared difference between target pressure and wall pressure (J3) and the time-averaged dissipation (J4). The control input is assumed to be continuous blowing and suction on the cylinder wall and the feedback sensors are assumued on the entire wall surface. The control law is derived so as to minimize the cost function under the constraint of linearized Navier-Stokes equation, and the impulse response field to be convolved with the instantaneous flow quanties are numerically obtained. The amplitide of control input is fixed so that the maximum blowing/suction velocity is 40% of the freestream velocity. When J2 is used as the cost function, the friction drag is reduced as expected but the mean drag is found to increase. In constast, when J1, J3, and J4 were used, the mean drag was found to decrease by 21%, 12%, and 22%, respectively; in addition, vortex shedding is suppressed, which leads to reduction of lift fluctuations.

  14. Suboptimal HIV Testing Uptake Among Men Who Engage in Commercial Sex Work with Men in Asia.

    Science.gov (United States)

    Jin, Harry; Friedman, Mackey Reuel; Lim, Sin How; Guadamuz, Thomas E; Wei, Chongyi

    2016-12-01

    Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia. The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year. About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested. While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

  15. Suboptimal Nutritional Characteristics in Male and Female Soldiers Compared to Sports Nutrition Guidelines.

    Science.gov (United States)

    Beals, Kim; Darnell, Matthew E; Lovalekar, Mita; Baker, Rachel A; Nagai, Takashi; San-Adams, Thida; Wirt, Michael D

    2015-12-01

    The purpose of this study was to evaluate the nutrient intake of male and female Soldiers in the 101 st Airborne Division (Air Assault) compared to sports nutrition standards for athletes, and to identify suboptimal eating characteristics that may impair physical performance and jeopardize military readiness. Male and female Soldiers from the 101 st Airborne Division (Air Assault) completed a 24-hour dietary recall and nutrition history questionnaire before anthropometric and body composition measurements were taken. Compared to sports nutrition guidelines, Soldiers of the 101 st under consume carbohydrates (males: 3.9 ± 2.0 vs. 5.0 g/kg, p < 0.001; females: 4.0 ± 2.1 vs. 5.0 g/kg, p = 0.001), male Soldiers eat too much fat (32.4% of kcal vs. <30% of kcal, p = 0.000) and saturated fat (males: 10.5 ± 3.9% of kcal vs. 10.0% of kcal, p = 0.044), and both males and females follow a meal pattern that may not optimize energy availability throughout the day. Eating too much fat and under fueling carbohydrate may negatively impact the adaptations to physical training and compromise overall health. Although Soldiers continue to participate in arduous training programs, future research should be aimed at determining the energy and macronutrient needs to fuel and recover from specific types of military training. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  16. Daily menus can result in suboptimal nutrient intakes, especially calcium, of adolescents living in dormitories.

    Science.gov (United States)

    Kresić, Greta; Simundić, Borislav; Mandić, Milena L; Kendel, Gordana; Zezelj, Sandra Pavicić

    2008-03-01

    The aims of this study were to evaluate daily menus in Croatian dormitories and to assess the overall intake of dairy products among resident adolescents. For this purpose, 168 daily menus were chosen for nutritional evaluation by random sampling. In addition, 227 adolescents (133 girls and 94 boys) participated in a questionnaire focused on food intake in addition to the meals supplied in dormitories with the aim to assess the amount and the type of dairy products consumed. The results showed that only 35% of the daily menus were nutritionally balanced. Most of the menus provided an excess of energy, protein, carbohydrate, saturated fat, phosphorus, riboflavin, and vitamin A. The levels of calcium and magnesium in the menus were suboptimal. The menus offered to adolescents provided approximately 2 servings of dairy products per day. Milk was the most often supplied dairy product (1.1 servings per day), whereas yogurt had the lowest frequency of serving (0.2 servings per day). The most preferred dairy-based snack for both sexes was milk. Dairy-based snacks provided about 1 serving per day for both sexes and contributed to about 30% of the recommended dietary allowances for calcium. Adolescents who regularly consumed dairy-based snacks meet the recommendations (3.2 servings of dairy products per day and about 98% recommended dietary allowances for calcium). We conclude that the institutional menu planning should be improved because the intake of dairy snacks will continue to be a problem for achieving a healthy diet in adolescences.

  17. Parasitological and transcriptomic comparison of Strongyloides ratti infections in natural and in suboptimal permissive hosts.

    Science.gov (United States)

    Jaleta, Tegegn G; Rödelsperger, Christian; Streit, Adrian

    2017-09-01

    The nematode genus Strongyloides consists of fairly species-specific small intestinal parasites of various vertebrates, among them the human pathogen S. stercoralis. Between the parthenogenetic parasitic generations these worms can also form single facultative sexual free-living generations. In addition to their primary hosts, several species can also live more or less well in other permissive hosts, which are sometimes not very closely related with the normal host. For example, S. stercoralis can also infect dogs and non-human primates. Here we compare the infection and reproductive success over time and the gene expression profiles as determined by quantitative sequencing of S. ratti parasitizing in its natural host rat and in the permissive host gerbil. We show that in gerbils fewer infective larvae successfully establish in the host, but those that do accomplish this survive and reproduce for longer and produced a higher proportion of males during the first two month of infection. Globally, the gene expression profiles in the two hosts are very similar. Among the relatively few differentially expressed genes, astacin-like and acetylcholinesterase genes are prominently represented. In the future it will be interesting to see if these changes in the suboptimal host are indeed ecologically sensible responses to the different host. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Development and evaluation of a questionnaire for measuring suboptimal health status in urban Chinese.

    Science.gov (United States)

    Yan, Yu-Xiang; Liu, You-Qin; Li, Man; Hu, Pei-Feng; Guo, Ai-Min; Yang, Xing-Hua; Qiu, Jing-Jun; Yang, Shan-Shan; Shen, Jian; Zhang, Li-Ping; Wang, Wei

    2009-01-01

    Suboptimal health status (SHS) is characterized by ambiguous health complaints, general weakness, and lack of vitality, and has become a new public health challenge in China. It is believed to be a subclinical, reversible stage of chronic disease. Studies of intervention and prognosis for SHS are expected to become increasingly important. Consequently, a reliable and valid instrument to assess SHS is essential. We developed and evaluated a questionnaire for measuring SHS in urban Chinese. Focus group discussions and a literature review provided the basis for the development of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and in a larger cross-sectional study of 3000 individuals. Analyses included tests for reliability and internal consistency, exploratory and confirmatory factor analysis, and tests for discriminative ability and convergent validity. The final questionnaire included 25 items on SHS (SHSQ-25), and encompassed 5 subscales: fatigue, the cardiovascular system, the digestive tract, the immune system, and mental status. Overall, 2799 of 3000 participants completed the questionnaire (93.3%). Test-retest reliability coefficients of individual items ranged from 0.89 to 0.98. Item-subscale correlations ranged from 0.51 to 0.72, and Cronbach's alpha was 0.70 or higher for all subscales. Factor analysis established 5 distinct domains, as conceptualized in our model. One-way ANOVA showed statistically significant differences in scale scores between 3 occupation groups; these included total scores and subscores (Purban Chinese.

  19. Motor planning under temporal uncertainty is suboptimal when the gain function is asymmetric.

    Science.gov (United States)

    Ota, Keiji; Shinya, Masahiro; Kudo, Kazutoshi

    2015-01-01

    For optimal action planning, the gain/loss associated with actions and the variability in motor output should both be considered. A number of studies make conflicting claims about the optimality of human action planning but cannot be reconciled due to their use of different movements and gain/loss functions. The disagreement is possibly because of differences in the experimental design and differences in the energetic cost of participant motor effort. We used a coincident timing task, which requires decision making with constant energetic cost, to test the optimality of participant's timing strategies under four configurations of the gain function. We compared participant strategies to an optimal timing strategy calculated from a Bayesian model that maximizes the expected gain. We found suboptimal timing strategies under two configurations of the gain function characterized by asymmetry, in which higher gain is associated with higher risk of zero gain. Participants showed a risk-seeking strategy by responding closer than optimal to the time of onset/offset of zero gain. Meanwhile, there was good agreement of the model with actual performance under two configurations of the gain function characterized by symmetry. Our findings show that human ability to make decisions that must reflect uncertainty in one's own motor output has limits that depend on the configuration of the gain function.

  20. Altered Innate Immune Responses in Neutrophils from Patients with Well- and Suboptimally Controlled Asthma

    Directory of Open Access Journals (Sweden)

    Francesca S. M. Tang

    2015-01-01

    Full Text Available Background. Respiratory infections are a major cause of asthma exacerbations where neutrophilic inflammation dominates and is associated with steroid refractory asthma. Structural airway cells in asthma differ from nonasthmatics; however it is unknown if neutrophils differ. We investigated neutrophil immune responses in patients who have good (AGood and suboptimal (ASubopt asthma symptom control. Methods. Peripheral blood neutrophils from AGood (ACQ 0.75, n=7, and healthy controls (HC (n=9 were stimulated with bacterial (LPS (1 μg/mL, fMLF (100 nM, and viral (imiquimod (3 μg/mL, R848 (1.5 μg/mL, and poly I:C (10 μg/mL surrogates or live rhinovirus (RV 16 (MOI1. Cell-free supernatant was collected after 1 h for neutrophil elastase (NE and matrix metalloproteinase- (MMP- 9 measurements or after 24 h for CXCL8 release. Results. Constitutive NE was enhanced in AGood neutrophils compared to HC. fMLF stimulated neutrophils from ASubopt but not AGood produced 50% of HC levels. fMLF induced MMP-9 was impaired in ASubopt and AGood compared to HC. fMLF stimulated CXCL8 but not MMP-9 was positively correlated with FEV1 and FEV1/FVC. ASubopt and AGood responded similarly to other stimuli. Conclusions. Circulating neutrophils are different in asthma; however, this is likely to be related to airflow limitation rather than asthma control.

  1. Sub-optimal wavelet denoising of coaveraged spectra employing statistics from individual scans.

    Science.gov (United States)

    Galvão, Roberto Kawakami Harrop; Filho, Heronides Adonias Dantas; Martins, Marcelo Nascimento; Araújo, Mário César Ugulino; Pasquini, Celio

    2007-01-02

    This paper proposes a novel wavelet denoising method, which exploits the statistics of individual scans acquired in the course of a coaveraging process. The proposed method consists of shrinking the wavelet coefficients of the noisy signal by a factor that minimizes the expected square error with respect to the true signal. Since the true signal is not known, a sub-optimal estimate of the shrinking factor is calculated by using the sample statistics of the acquired scans. It is shown that such an estimate can be generated as the limit value of a recursive formulation. In a simulated example, the performance of the proposed method is seen to be equivalent to the best choice between hard and soft thresholding for different signal-to-noise ratios. Such a conclusion is also supported by an experimental investigation involving near-infrared (NIR) scans of a diesel sample. It is worth emphasizing that this experimental example concerns the removal of actual instrumental noise, in contrast to other case studies in the denoising literature, which usually present simulations with artificial noise. The simulated and experimental cases indicate that, in classic denoising based on wavelet coefficient thresholding, choosing between the hard and soft options is not straightforward and may lead to considerably different outcomes. By resorting to the proposed method, the analyst is not required to make such a critical decision in order to achieve appropriate results.

  2. Metabonomics-Based Study of Clinical Urine Samples in Suboptimal Health with Different Syndromes

    Directory of Open Access Journals (Sweden)

    Hai-Zhen Cui

    2013-01-01

    Full Text Available Objective. To explore the urinary biochemistry features of syndromes of traditional Chinese medicine (TCM such as syndrome of stagnation of liver Qi, spleen deficiency, liver Qi stagnation, and spleen deficiency (LSSDS in sub-optimal health status (SHS. Methods. 12 cases for each syndrome group in SHS were selected, 12 subjects were used as a normal control group, and 1H NMR detection was, respectively, carried out, and the data was corrected by the orthogonal signal correction (OSC and then adopted a partial least squares (PLS method for discriminate analysis. Results. The OSC-PLS (ctr analysis results of the nuclear overhauser enhancement spectroscopy (NOESY detection indicated that the syndromes in SHS could be differentiated, and there were significant differences in the levels of metabolites of the urine samples of the four groups; the biomarkers of LSSDS in SHS were found out. The contents of citric acid (2.54 and 2.66, trimethylamineoxide (3.26, and hippuric acid (3.98, 7.54, 7.58, 7.62, 7.66, 7.82, and 7.86 in the urine samples of LSSDS group were lower than that of the normal control group. Conclusion. There are differences in the 1H-NMR metabolic spectrum of the urine samples of the four groups, and the specific metabolic products of the LSSDS in SHS can be identified from metabonomics analysis.

  3. Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurers.

    Science.gov (United States)

    Herring, Bradley

    2010-04-01

    Many preventive healthcare procedures are widely recognized as cost-effective but have relatively low utilization rates in the US. Because preventive care is a present-period investment with a future-period expected financial return, enrollee turnover among private insurers lowers the expected return of this investment. In this paper, I present a simple theoretical model to illustrate the suboptimal provision of preventive healthcare that results from insurers 'free riding' off of the provision from others. I also provide an empirical test of this hypothesis using data from the Community Tracking Study's Household Survey. I use lagged market-level measures of employment-induced insurer turnover to identify variation in insurers' expectations and test for the effect of turnover on several different measures of medical utilization. As expected, I find that turnover has a significantly negative effect on the utilization of preventive services and has no effect on the utilization of acute services used as a control. Copyright (c) 2009 John Wiley & Sons, Ltd.

  4. Economic and disease burden of breast cancer associated with suboptimal breastfeeding practices in Mexico.

    Science.gov (United States)

    Unar-Munguía, Mishel; Meza, Rafael; Colchero, M Arantxa; Torres-Mejía, Gabriela; de Cosío, Teresita Gonzalez

    2017-10-05

    Exclusive breastfeeding and longer breastfeeding reduce women's breast cancer risk but Mexico has one of the lowest breastfeeding rates worldwide. We estimated the lifetime economic and disease burden of breast cancer in Mexico if 95% of parous women breastfeed each child exclusively for 6 months and continue breastfeeding for over a year. We used a static microsimulation model with a cost-of-illness approach to simulate a cohort of Mexican women. We estimated breast cancer incidence, premature mortality, disability-adjusted life years (DALYs), medical costs, and income losses due to breast cancer and extrapolated the results to 1.116 million Mexican women of age 15 in 2012. Costs were expressed in 2015 US dollars and discounted at a 3% annual rate. We estimated that 2,186 premature deaths (95% CI 2,123-2,248), 9,936 breast cancer cases (95% CI 9,651-10,220), 45,109 DALYs (95% CI 43,000-47,217), and $245 million USD (95% CI 234-256) in medical costs and income losses owing to breast cancer could be saved over a cohort's lifetime. Medical costs account for 80% of the economic burden; income losses and opportunity costs for caregivers account for 15 and 5%, respectively. In Mexico, the burden of breast cancer due to suboptimal breastfeeding in women is high in terms of morbidity, premature mortality, and the economic costs for the health sector and society.

  5. Effects of Suboptimally Presented Erotic Pictures on Moral Judgments: A Cross-Cultural Comparison

    Science.gov (United States)

    Martí-Vilar, Manuel; Arango, Olber Eduardo

    2016-01-01

    Previous research has identified a set of core factors that influence moral judgments. The present study addresses the interplay between moral judgments and four factors: (a) incidental affects, (b) sociocultural context, (c) type of dilemma, and (d) participant’s sex. We asked participants in two different countries (Colombia and Spain) to judge the acceptability of actions in response to personal and impersonal moral dilemmas. Before each dilemma an affective prime (erotic, pleasant or neutral pictures) was presented suboptimally. Our results show that: a) relative to neutral priming, erotic primes increase the acceptance of harm for a greater good (i.e., more utilitarian judgments), b) relative to Colombians, Spanish participants rated causing harm as less acceptable, c) relative to impersonal dilemmas, personal dilemmas reduced the acceptance of harm, and d) relative to men, women were less likely to consider harm acceptable. Our results are congruent with findings showing that sex is a crucial factor in moral cognition, and they extend previous research by showing the interaction between culture and incidental factors in the making of moral judgments. PMID:27367795

  6. Effects of Suboptimally Presented Erotic Pictures on Moral Judgments: A Cross-Cultural Comparison.

    Directory of Open Access Journals (Sweden)

    Antonio Olivera-La Rosa

    Full Text Available Previous research has identified a set of core factors that influence moral judgments. The present study addresses the interplay between moral judgments and four factors: (a incidental affects, (b sociocultural context, (c type of dilemma, and (d participant's sex. We asked participants in two different countries (Colombia and Spain to judge the acceptability of actions in response to personal and impersonal moral dilemmas. Before each dilemma an affective prime (erotic, pleasant or neutral pictures was presented suboptimally. Our results show that: a relative to neutral priming, erotic primes increase the acceptance of harm for a greater good (i.e., more utilitarian judgments, b relative to Colombians, Spanish participants rated causing harm as less acceptable, c relative to impersonal dilemmas, personal dilemmas reduced the acceptance of harm, and d relative to men, women were less likely to consider harm acceptable. Our results are congruent with findings showing that sex is a crucial factor in moral cognition, and they extend previous research by showing the interaction between culture and incidental factors in the making of moral judgments.

  7. Motor planning under temporal uncertainty is suboptimal when the gain function is asymmetric

    Directory of Open Access Journals (Sweden)

    Keiji eOta

    2015-07-01

    Full Text Available For optimal action planning, the gain/loss associated with actions and the variability in motor output should both be considered. A number of studies make conflicting claims about the optimality of human action planning but cannot be reconciled due to their use of different movements and gain/loss functions. The disagreement is possibly because of differences in the experimental design and differences in the energetic cost of participant motor effort. We used a coincident timing task, which requires decision making with constant energetic cost, to test the optimality of participant’s timing strategies under four configurations of the gain function. We compared participant strategies to an optimal timing strategy calculated from a Bayesian model that maximizes the expected gain. We found suboptimal timing strategies under two configurations of the gain function characterized by asymmetry, in which higher gain is associated with higher risk of zero gain. Participants showed a risk-seeking strategy by responding closer than optimal to the time of onset/offset of zero gain. Meanwhile, there was good agreement of the model with actual performance under two configurations of the gain function characterized by symmetry. Our findings show that human ability to make decisions that must reflect uncertainty in one’s own motor output has limits that depend on the configuration of the gain function.

  8. Suboptimal maximum likelihood detection of on-off keying for a wireless optical communication system.

    Science.gov (United States)

    Li, Ruijie; Ding, Shengli; Dang, Anhong

    2017-05-01

    This paper investigates a detection scheme without channel state information for wireless optical communication systems. Employing conventional on-off keying signals, we supposed that conditional probability density function P(r|0) is much bigger than P(r|1) when r<0. Under this assumption, the suboptimal maximum likelihood scheme is obtained by utilizing the probability density function without channel information. Theoretical analysis shows the performance of the proposed scheme is close to the maximum likelihood symbol-by-symbol detection. Compared with the maximum likelihood symbol by symbol detection, Monte Carlo simulations show that the performance of the proposed scheme is about 0.62 dB loss for a gamma-gamma channel with a Rytov variance of 1 at the signal-to-noise ratio of 2 dB, but the efficient algorithm makes the real-time implementation of detection based on maximum likelihood feasible. Besides, the experiment is set up under 2 Gbps, and the experimental results match well with that of the theory and simulation.

  9. Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome.

    Science.gov (United States)

    Turner, Richard M; Yin, Peng; Hanson, Anita; FitzGerald, Richard; Morris, Andrew P; Stables, Rod H; Jorgensen, Andrea L; Pirmohamed, Munir

    High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice. To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM). A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months. There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14-2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30-14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25-3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38-4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence. Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  10. Gender, TIMI risk score and in-hospital mortality in STEMI patients undergoing primary PCI: results from the Belgian STEMI registry.

    Science.gov (United States)

    Gevaert, Sofie A; De Bacquer, Dirk; Evrard, Patrick; Convens, Carl; Dubois, Philippe; Boland, Jean; Renard, Marc; Beauloye, Christophe; Coussement, Patrick; De Raedt, Herbert; de Meester, Antoine; Vandecasteele, Els; Vranckx, Pascal; Sinnaeve, Peter R; Claeys, Marc J

    2014-01-22

    The relationship between the predictive performance of the TIMI risk score for STEMI and gender has not been evaluated in the setting of primary PCI (pPCI). Here, we compared in-hospital mortality and predictive performance of the TIMI risk score between Belgian women and men undergoing pPCI. In-hospital mortality was analysed in 8,073 (1,920 [23.8%] female and 6,153 [76.2%] male patients) consecutive pPCI-treated STEMI patients, included in the prospective, observational Belgian STEMI registry (January 2007 to February 2011). A multivariable logistic regression model, including TIMI risk score variables and gender, evaluated differences in in-hospital mortality between men and women. The predictive performance of the TIMI risk score according to gender was evaluated in terms of discrimination and calibration. Mortality rates for TIMI scores in women and men were compared. Female patients were older, had more comorbidities and longer ischaemic times. Crude in-hospital mortality was 10.1% in women vs. 4.9% in men (OR 2.2; 95% CI: 1.82-2.66, pTIMI risk score variables, mortality remained higher in women (OR 1.47, 95% CI: 1.15-1.87, p=0.002). The TIMI risk score provided a good predictive discrimination and calibration in women as well as in men (c-statistic=0.84 [95% CI: 0.809-0.866], goodness-of-fit p=0.53 and c-statistic=0.89 [95% CI: 0.873-0.907], goodness-of-fit p=0.13, respectively), but mortality prediction for TIMI scores was better in men (p=0.02 for TIMI score x gender interaction). In the Belgian STEMI registry, pPCI-treated women had a higher in-hospital mortality rate even after correcting for TIMI risk score variables. The TIMI risk score was effective in predicting in-hospital mortality but performed slightly better in men. The database was registered with clinicaltrials.gov (NCT00727623).

  11. Three-year outcome after percutaneous coronary intervention and coronary artery bypass grafting in patients with triple-vessel coronary artery disease: observations from the CREDO-Kyoto PCI/CABG registry cohort-2.

    Science.gov (United States)

    Tazaki, Junichi; Shiomi, Hiroki; Morimoto, Takeshi; Imai, Masao; Yamaji, Kyohei; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

    2013-08-22

    We sought to investigate medium-term outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with triple-vessel coronary artery disease (TVD). We identified 2,981 patients with TVD (PCI: N=1,825, CABG: N=1,156) among 15,939 patients with first coronary revascularisation enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. Excess adjusted three-year risk of the PCI group relative to the CABG group for death/myocardial infarction (MI)/stroke was significant (HR 1.47 [95% CI: 1.13-1.92, p=0.004]). Adjusted risk for all-cause death was also significantly higher with PCI as compared with CABG (HR 1.62 [95% CI: 1.16-2.27, p=0.005]), while risk for cardiac death was neutral between the two groups (HR 1.3 [95% CI: 0.81-2.07, p=0.28]). PCI was also associated with a markedly higher risk for any coronary revascularisation. Regarding the analysis stratified by the SYNTAX score, the adjusted HR of PCI relative to CABG for death/MI/stroke was 1.66 (95% CI: 1.04-2.65, p=0.03) in the low-score (<23: N=874, and N=257), 1.24 (95% CI: 0.83-1.85, p=0.29) in the intermediate-score (23-32: N=638, and N=388), and 1.59 (95% CI: 0.998-2.54, p=0.051) in the high-score (≥ 33: N=280, and N=375) tertiles, respectively. PCI as compared with CABG was associated with significantly higher risk for serious adverse events in TVD patients.

  12. The importance of inhaler devices: the choice of inhaler device may lead to suboptimal adherence in COPD patients

    Directory of Open Access Journals (Sweden)

    Darbà J

    2015-10-01

    Full Text Available Josep Darbà,1 Gabriela Ramírez,2 Antoni Sicras,3 Pablo Francoli,4 Saku Torvinen,5 Rainel Sánchez-de la Rosa4 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics and Outcomes Research SL, 3Dirección de Planificación, Badalona Serveis Assistencials, SA, Barcelona, 4Medical Department, TEVA Pharmaceutical, Madrid, Spain; 5Market Access Department, TEVA Pharmaceutical Europe BV, Amsterdam, the Netherlands Objective: This study aims to identify factors associated with poor adherence to COPD treatment in patients receiving a fixed-dose combination (FDC of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA, focusing on the importance of inhaler devices.Methods: We conducted a retrospective and multicenter study based on a review of medical registries between 2007 and 2012 of COPD patients (n=1,263 treated with ICS/LABA FDC, whose medical devices were either dry powder inhalers (DPIs or pressurized metered-dose inhalers (pMDI. Medication adherence included persistence outcomes through 18 months and medication possession ratios. Data on exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also included as confounders of adherence.Results: The analyses revealed that COPD patients whose medication was delivered through a DPI were less likely to have medication adherence compared to patients with pMDI, after adjusting for confounding factors, especially active ingredients. Younger groups of patients were less likely to be adherent compared to the oldest group. Smoker men were less likely to be adherent compared to women and non-smokers. Comorbidities decreased the probability of treatment adherence. Those patients that visited their doctor once a month were more likely to adhere to their medication regimen; however, suboptimal adherence was more likely to occur among those patients who visited more than three times per month their doctor. We also found that worsening of

  13. [The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial].

    Science.gov (United States)

    Lee, Jueun; Lee, Haejung

    2017-12-01

    To identify the effects of a smart program for the patients who underwent percutaneous coronary intervention (SP-PCI) on coronary disease-related knowledge, health behaviors, and quality of life. A nonequivalent control group with a non-synchronized design was utilized and 48 participants (experimental=22, control=26) were recruited from a university hospital in Gyeongsang area from May to December, 2016. The 12-week SP-PCI consisted of self-study of health information using smart phone applications (1/week), walking exercise (>5/week) using smart band, feedback using Kakao talk (2/week), and telephone counseling (1/week). Patients in the control group received usual care from their primary health care providers and a brief health education with basic self-management brochure after the PCI. Data were analyzed using the SPSS 21.0 program through descriptive statistics, χ² test, and t-test. After the 12-week SP-PCI, the experimental group showed higher levels of coronary disease-related knowledge (t=2.43, p=.019), heart-related health behaviors (t=5.96, phealth behaviors, and quality of life. Further study with a wider population is needed to evaluate the effects of SP-PCI on disease recurrence and quality of life for patients after PCI.

  14. Suboptimal herd performance amplifies the spread of infectious disease in the cattle industry.

    Directory of Open Access Journals (Sweden)

    M Carolyn Gates

    Full Text Available Farms that purchase replacement breeding cattle are at increased risk of introducing many economically important diseases. The objectives of this analysis were to determine whether the total number of replacement breeding cattle purchased by individual farms could be reduced by improving herd performance and to quantify the effects of such reductions on the industry-level transmission dynamics of infectious cattle diseases. Detailed information on the performance and contact patterns of British cattle herds was extracted from the national cattle movement database as a case example. Approximately 69% of beef herds and 59% of dairy herds with an average of at least 20 recorded calvings per year purchased at least one replacement breeding animal. Results from zero-inflated negative binomial regression models revealed that herds with high average ages at first calving, prolonged calving intervals, abnormally high or low culling rates, and high calf mortality rates were generally more likely to be open herds and to purchase greater numbers of replacement breeding cattle. If all herds achieved the same level of performance as the top 20% of herds, the total number of replacement beef and dairy cattle purchased could be reduced by an estimated 34% and 51%, respectively. Although these purchases accounted for only 13% of between-herd contacts in the industry trade network, they were found to have a disproportionately strong influence on disease transmission dynamics. These findings suggest that targeting extension services at herds with suboptimal performance may be an effective strategy for controlling endemic cattle diseases while simultaneously improving industry productivity.

  15. Suboptimal management of central nervous system infections in children: a multi-centre retrospective study

    Directory of Open Access Journals (Sweden)

    Kelly Christine

    2012-09-01

    Full Text Available Abstract Objective We aimed to audit the regional management of central nervous system (CNS infection in children. Methods The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines. Results Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years. Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV type 1]. A lumbar puncture (LP was attempted in 50 (77% cases but only 43 had cerebrospinal fluid (CSF available for analysis. Of these 24 (57% had a complete standard set of tests performed. Fifty eight (89% received a third generation cephalosporin. Seventeen (26% also received aciclovir with no obvious indication in 9 (53%. Only 11 (65% of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days. Conclusions The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.

  16. Suboptimal vitamin K status despite supplementation in children and young adults with cystic fibrosis.

    Science.gov (United States)

    Dougherty, Kelly A; Schall, Joan I; Stallings, Virginia A

    2010-09-01

    For children and adolescents with cystic fibrosis (CF) and pancreatic insufficiency, the efficacy of routine vitamin K supplementation to normalize vitamin K status remains unclear. This study examined and determined predictors of vitamin K status in subjects aged 8-25 y with CF and pancreatic insufficiency taking various vitamin K supplements. In 97 subjects, serum 25-hydroxyvitamin D [25(OH)D], dietary intake, vitamin K supplement intake, and vitamin K statusmdashdetermined on the basis of the percentage of serum undercarboxylated osteocalcin (%ucOC; sufficient: lt 20%) and plasma proteins induced by vitamin K absence-factor II (PIVKA-II; n = 60; sufficient: le 2 microg/L)mdashwere assessed. The vitamin K supplementation groups were as follows: lt 150 microg/d (low; multivitamins or no supplement), 150-999 microg/d (middle; CF-specific vitamins), and ge 1000 microg/d (high; mephyton). %ucOC values were compared with 140 healthy subjects aged 6-21 y. In subjects with CF, the median (range) %ucOC was 35% (3%, 76%) and the median (range) for PIVKA-II was 2 (0, 42) micro g/L. Subjects with CF had a higher %ucOC with low [45% (10%, 76%)] and medium [41% (3%, 66%)] supplement intakes but not with a high supplement intake [16% (4%, 72%)] compared with healthy subjects [23% (0%, 43%); both P lt 0.05]. Supplementation group for males and females and 25(OH)D and age for males were significant predictors of vitamin K status. Vitamin K status was often suboptimal despite routine supplementation. Only subjects taking high-dose vitamin K achieved a status similar to healthy subjects, and only the vitamin K supplementation dose predicted vitamin K status for males and females. These data suggest that higher doses of vitamin K are required.

  17. Suboptimal vitamin K status and its risk factors in a population of Chinese chronic haemodialysis patients.

    Science.gov (United States)

    Feng, Yunlin; Ruan, Yizhe; He, Qiang; Zhang, Wensong; Wang, Li

    2015-09-01

    Vitamin K deficiency is known to be common in haemodialysis patients and associates with adverse outcomes in this population, particularly vascular calcification. We aimed to investigate the vitamin K status in a population of Chinese haemodialysis (HD) patients. We collected demographic and biochemical data from a population of maintenance HD (MHD) patients in our unit and a control group composed of healthy subjects from our outpatient clinic. Fasting serum samples from all subjects were collected for the measurement of known vitamin K-dependent proteins i.e. matrix Gla protein (MGP), osteocalcin (OC) and uncarboxylated osteocalcin (ucOC). We also quantified the fraction of ucOC to total OC (%ucOC). Differences of these parameters between groups were analyzed and risk factors of vitamin K deficiency based on the definition as per %ucOC were investigated. We enrolled 93 MHD patients as a test group and 93 healthy subjects as a control group. There was no significant difference in MGP between groups (4.0 ± 2.8 pg/mL in MHD vs 4.2 ± 1.2 pg/mL in control; P = 0.676). Mean %ucOC was significantly greater in the MHD patients as compared to control subjects (76.4 ± 20.0% in MHD vs 48.56 ± 15.5%; P vitamin K deficiency, with the former being an independent risk factor. Defining Vitamin K deficiency by %ucOC, suboptimal vitamin K levels appear common in Chinese MHD patients. Time on dialysis and LDL cholesterol level predict vitamin K deficiency. © 2015 Asian Pacific Society of Nephrology.

  18. Suboptimal porcine endogenous retrovirus infection in non-human primate cells: implication for preclinical xenotransplantation.

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    Giada Mattiuzzo

    Full Text Available BACKGROUND: Porcine endogenous retrovirus (PERV poses a potential risk of zoonotic infection in xenotransplantation. Preclinical transplantation trials using non-human primates (NHP as recipients of porcine xenografts present the opportunity to assess the zoonosis risk in vivo. However, PERV poorly infects NHP cells for unclear reasons and therefore NHP may represent a suboptimal animal model to assess the risk of PERV zoonoses. We investigated the mechanism responsible for the low efficiency of PERV-A infection in NHP cells. PRINCIPAL FINDINGS: Two steps, cell entry and exit, were inefficient for the replication of high-titer, human-tropic A/C recombinant PERV. A restriction factor, tetherin, is likely to be responsible for the block to matured virion release, supported by the correlation between the levels of inhibition and tetherin expression. In rhesus macaque, cynomolgus macaque and baboon the main receptor for PERV entry, PERV-A receptor 1 (PAR-1, was found to be genetically deficient: PAR-1 genes in these species encode serine at amino acid 109 in place of the leucine in human PAR-1. This genetic defect inevitably impacts in vivo sensitivity to PERV infection of these species. In contrast, African green monkey (AGM PAR-1 is functional, but PERV infection is still poor. Although the mechanism is unclear, tunicamycin treatment, which removes N-glycosylated sugar chains, increases PERV infection, suggesting a possible role for the glycosylation of the receptors. CONCLUSIONS: Since cynomolgus macaque and baboon, species often used in pig-to-NHP xenotransplantation experiments, have a defective PAR-1, they hardly represent an ideal animal model to assess the risk of PERV transmission in xenotransplantation. Alternatively, NHP species, like AGM, whose both PARs are functional may represent a better model than baboon and cynomolgus macaque for PERV zoonosis in vivo studies.

  19. Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type 1 diabetes; a randomized controlled trial

    DEFF Research Database (Denmark)

    Hermanides, J; Nørgaard, K; Bruttomesso, D

    2011-01-01

    To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes.......To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes....

  20. Real-time discrete suboptimal control for systems with input and state delays: Experimental tests on a dehydration process.

    Science.gov (United States)

    Rodríguez-Guerrero, Liliam; Santos-Sánchez, Omar-Jacobo; Cervantes-Escorcia, Nicolás; Romero, Hugo

    2017-11-01

    This article presents a suboptimal control strategy with finite horizon for affine nonlinear discrete systems with both state and input delays. The Dynamic Programming Approach is used to obtain the suboptimal control sequence, but in order to avoid the computation of the Bellman functional, a numerical approximation of this function is proposed in every step. The feasibility of our proposal is demonstrated via an experimental test on a dehydration process and the obtained results show a good performance and behavior of this process. Then in order to demonstrate the benefits of using this kind of control strategy, the results are compared with a non optimal control strategy, particularly with respect to results produced by an industrial Proportional Integral Derivative (PID) Honeywell controller, which is tuned using the Ziegler-Nichols method. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  1. Consumer behaviour towards price-reduced suboptimal foods in the supermarket and the relation to food waste in households.

    Science.gov (United States)

    Aschemann-Witzel, Jessica; Jensen, Jacob Haagen; Jensen, Mette Hyldetoft; Kulikovskaja, Viktorija

    2017-09-01

    To combat food waste, supermarkets offer food items at a reduced price in-store when they are close to the expiration date or perceived as suboptimal. It is yet unknown, however, which considerations consumers engage in when deciding about the offer, and whether focusing particularly on the price during food purchase might be related to greater food waste at home. Knowledge about both the consumers' food purchase process for these price-reduced foods and the potential wastage of price-focused consumers can contribute to the assessment of whether or not offering suboptimal food at reduced prices in-store actually reduces food waste across the supply chain. We explore these questions in a mixed-method study including 16 qualitative accompanied shopping interviews and a quantitative online experimental survey with 848 consumers in Denmark. The interviews reveal that the consumers interviewed assess their ability to consume the price-reduced suboptimal food at home already while in the store. Consumers consider the relation between product-related factors of package unit, expiration date, and product quality, in interaction with household-related factors of freezing/storing, household size/demand, and possible meal/cooking. The survey shows that consumers who are more price-focused report lower food waste levels and lower tendency to choose the optimal food item first at home, than those who are not emphasizing the price-quality relation or do not search for price offers to the same extent. Higher age and high education also played a role, and the price-focus is lower in high-income groups and among single households. The findings allow deriving recommendations for retailers and policy makers to support both the marketability and the subsequent actual consumption of price-reduced suboptimal food, but they also raise questions for further research of this underexplored area. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Suboptimal inhibition of platelet cyclo-oxygenase-1 (COX-1) by aspirin in lupus erythematosus: Association with metabolic syndrome

    Science.gov (United States)

    Kawai, Vivian K.; Avalos, Ingrid; Oeser, Annette; Oates, John A.; Milne, Ginger L.; Solus, Joseph F.; Chung, Cecilia P.; Stein, C. Michael

    2013-01-01

    Objectives Low-dose aspirin prevents platelet aggregation by suppressing thromboxane A2 synthesis. However, in some individuals thromboxane A2 suppression by aspirin is impaired, indicating suboptimal inhibition of platelet COX-1 by aspirin. Because patients with systemic lupus erythematosus (SLE) have increased risk of thrombotic events, many receive aspirin; however, the efficacy of aspirin in SLE has not been determined. We examined the hypothesis that aspirin response is impaired in SLE. Methods We assessed the effect of aspirin by measuring concentrations of the stable metabolite of thromboxane A2 - serum thromboxane B2 (sTxB2), before and after treatment with 81 mg daily aspirin for 7 days in 34 patients with SLE and 36 control subjects. The inability to suppress sTxB2 synthesis to aspirin. Results Aspirin almost completely suppressed sTXB2 in control subjects to 1.5, [0.8–2.7] ng/ml (median and interquartile ranges [IQR]), but had less effect in patients with SLE (3.1, [2.2–5.3] ng/ml) (P=0.002). A suboptimal effect of aspirin was present in 15% (5/34) of the patients with SLE but not in control subjects (0/36) (P=0.023). Incomplete responders were more likely to have metabolic syndrome (P=0.048), obesity (P=0.048) and higher concentrations of CRP (P=0.018). Conclusion The pharmacologic effect of aspirin is suboptimal in 15% of patients with SLE but in none of the control subjects, and the suboptimal response was associated with metabolic syndrome, obesity, and higher CRP concentrations. PMID:24022862

  3. Dyslipidemia is not associated with cardiovascular disease risk in an animal model of mild chronic suboptimal nutrition.

    Science.gov (United States)

    Lifshitz, Fima; Pintos, Patricia M; Lezón, Christian E; Macri, Elisa V; Friedman, Silvia M; Boyer, Patricia M

    2012-01-01

    Previous studies performed in an experimental model of nutritional growth retardation (NGR) have observed metabolic adaptation. We hypothesized that changes in lipid-lipoprotein profile, glucose, and insulin levels occur, whereas overall body growth is reduced.The aim of this study was to assess serum lipid-lipoprotein profile, hepatogram, insulinemia and glycemia, and CVD risk markers in rats fed a suboptimal diet. Weanling male rats were assigned either to control (C) or NGR group. In this 4-week study, C rats were fed ad libitum a standard diet, and NGR rats received 80% of the amount of food consumed by C. Zoometric parameters, body fat content, serum lipid-lipoprotein profile, hepatogram, insulinemia, and glycemia were determined, and the cardiovascular disease (CVD) risk markers homeostasis model assessment-insulin resistance and homeostasis model assessment and β-cell function were calculated. Suboptimal food intake induced a significant decrease in body weight and length, which were accompanied by a reduction of 50% in body fat mass. Serum lipoproteins were significantly higher in NGR rats, with the exception of high-density lipoprotein cholesterol, which remained unchanged. Nutritional growth retardation rats had decreased triglycerides compared with C rats. No significant differences were detected in liver function parameters. The CVD risk markers homeostasis model assessment (HOMA)-insulin resistance and homeostasis model assessment and β-cell function were significantly lower in NGR rats. Mild chronic suboptimal nutrition in weanling male rats led to growth retardation and changes in the lipid-lipoprotein profile, glucose, and insulin levels while preserving the integrity of liver function. These data suggest a metabolic adaptation during suboptimal food intake, which ensures substrates flux to tissues that require constant energy-in detriment to body growth. The CVD risk markers suggested that mild chronic food restriction of approximately 20% could

  4. In-Hospital and One-Year Clinical Outcome of Percutaneous Coronary Intervention in a Tertiary Hospital in Oman: Oman PCI Registry

    Directory of Open Access Journals (Sweden)

    Prashanth Panduranga

    2017-01-01

    Full Text Available Objectives: The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI in a tertiary hospital in Oman. Methods: We conducted a retrospective, single-center, observational study looking at patients > 18 years old who underwent a PCI from 1 January to 31 December 2013. The primary end point was the occurrence of a major adverse cardiovascular event (MACE, defined as death, any myocardial infarction (MI, cerebrovascular accident (CVA, and target vessel revascularization (TVR with either repeat PCI or coronary artery bypass surgery (CABG. Secondary end-points included procedural success rate, angina status, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. Results: A total of 1 045 consecutive patients were analyzed. The mean age of the cohort was 58.2±11.2 years. Hyperlipidemia (66.8%, hypertension (55.1%, and diabetes mellitus (45.9% were the predominant risk factors. Stable angina, ST-elevation MI, non-ST-elevation MI, and post-acute coronary syndrome (ACS were common indications (approximately 20.0% each. The angiographic and procedural success rate was 95.0%. Forty-six percent of patients had single-vessel disease, 34.4% had double vessel disease, and triple vessel disease was seen in 19.1% of patients. Ninety-eight percent had balloon angioplasty with stenting, and only 1.9% of patients had balloon angioplasty without stenting. The majority of patients had single-vessel stenting (81.3%. A drug-eluting stent was used in 88.4% of patients, and a bare-metal stent in 11.6%. In-hospital MACE was 3.6%. There were 19 in-hospital deaths (1.8%, and four patients (0.4% had CVA/MI. Out of 1 026 patients discharged, 100 patients were lost to follow-up. Among the 926 patients followed-up, 673 patients (72.7% were asymptomatic. One-year MACE was 17.0%, including 5.0% death and 6.0% MI. Repeat revascularization was performed in 53 patients (5

  5. Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

    Science.gov (United States)

    Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

    2014-06-01

    The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  6. Guideline recommended door-to-balloon time can be achieved in transradial primary PCI — the usefulness of a dedicated radial guide catheter

    Energy Technology Data Exchange (ETDEWEB)

    Malaiapan, Yuvaraj, E-mail: yuvim@y7mail.com; Leung, Michael; Ahmar, Walid; Hutchison, Adam W.; Prasad, Sandhir; Katticaran, Therma; Cameron, James D.; Harper, Richard W.; Meredith, Ian T.

    2013-01-15

    Background: Radial access for primary percutaneous coronary intervention (PPCI) is well established in terms of safety and efficacy. However, there are limited data on the impact of the use of a single dedicated radial guide catheter in primary PCI using radial access. Aims: To determine the overall cardiac catheterisation laboratory to balloon time (CCL2BT) and door to balloon (D2BT) time in transradial PPCI. To determine the impact of a single dedicated radial guide catheter on CCLD2BT and D2BT in transradial PPCI compared to conventional transfemoral PPCI. Methods: The procedural and clinical outcomes of consecutive patients who had transradial primary PCI between 2005 and 2009 were included in this study and compared with a matched cohort who underwent transfemoral primary PCI. Results: Overall D2BT and inpatient MACE were similar between the radial (n = 53) and femoral (n = 53) groups (85 and 82 min, P = 0.889; 0% and 1.8% P = 0.317 respectively). An increase in the CCL2BT and procedural times was noted in the radial compared to the femoral group (34 min versus 29 min P = 0.028; 15.8 min versus 11.6 min P = 0.001). When a single radial guide catheter was used for the entire procedure, there was no difference in CCL2BT, D2BT and procedural times between the radial and femoral groups (31 min versus 29 min P = 0.599; 74 min versus 82 min P = 0.418; 50 min versus 47 min P = 0.086). Conclusion: The radial approach is safe and results in guideline recommended D2BT in STEMI. The use of a dedicated radial guide catheter reduces treatment time, demonstrating equivalent times to a femoral approach.

  7. CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Sá, Michel Pompeu Barros Oliveira; Soares, Artur Freire; Miranda, Rodrigo Gusmão Albuquerque; Araújo, Mayara Lopes; Menezes, Alexandre Motta; Silva, Frederico Pires Vasconcelos; Lima, Ricardo Carvalho

    2017-01-01

    Objective To compare the safety and efficacy of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with unprotected left main coronary artery (ULMCA) disease. Methods MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 1-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies fulfilled our eligibility criteria and they included a total of 4.595 patients (2.298 for CABG and 2.297 for PCI with DES). Results At 1-year follow-up, there was no significant difference between CABG and DES groups concerning the risk for death (risk ratio [RR] 0.973, P=0.830), myocardial infarction (RR 0.694, P=0.148), stroke (RR 1.224, P=0.598), and major adverse cerebrovascular and cardiovascular events (RR 0.948, P=0.680). The risk for target vessel revascularization (TVR) was significantly lower in the CABG group compared to the DES group (RR 0.583, P<0.001). It was observed no publication bias regarding the outcomes, but only the outcome TVR was free from substantial statistical heterogeneity of the effects. In the meta-regression, there was evidence that the factor "female gender" modulated the effect regarding myocardial infarction rates, favoring the CABG strategy. Conclusion CABG surgery remains the best option of treatment for patients with ULMCA disease, with lower TVR rates. PMID:29211222

  8. Measuring change in perceived well-being of family caregivers: validation of the Spanish version of the Perceived Change Index (PCI-S) in Chilean dementia caregivers.

    Science.gov (United States)

    Aravena, José M; Albala, Cecilia; Gitlin, Laura N

    2017-05-16

    Few instruments evaluate family caregiver perceptions of challenges caring for persons with dementia and improvement or worsening in these areas. To address this measurement gap, we examine psychometric properties of a Spanish version of the 13-item Perceived Change Index (PCI-S), originally validated with English-speaking caregivers. Cross-sectional study with 94 caregivers of persons with mild to moderate dementia in Chile. Interviews included caregiver demographics, burden, health perception, distress with behaviours, dementia severity, behavioural symptoms and functionality. Caregiver mean age was 55.9 (SD ± 14.14) years and mean years caregiving was 3 (SD ± 2.60). The scale had strong internal consistency (Cronbach α = 0.94), and inter-observer consistency (CCI = 0.99; 95% CI = 0.95-0.99). Two factors were identified: Management skills (α = 0.89), and somatic well-being and affects (α = 0.92), explaining 63% of scale variance. Significant associations supporting convergent validity were observed for PCI-S and subscales with caregiver burden (p caregiver burden (OR = 1.48; 95% CI = 1.18-1.86); whereas perceived improvement was associated with higher physical functioning (OR = 0.95; 95% CI = 0.91-0.99) in persons with dementia. PCI-S scores were not associated with socio-demographic characteristics reflecting divergent validity. Spanish version of the 13-item Perceived Change Index and its two-factor solution is a valid and reliable measure with clinical utility to detect improvement or worsening in caregivers concerning daily care challenges. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Kevin L., E-mail: kevinmoore@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Schmidt, Rachel [Department of Physics, Fort Hays State University, Hays, Kansas (United States); Moiseenko, Vitali [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Olsen, Lindsey A.; Tan, Jun [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri (United States); Xiao, Ying; Galvin, James [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Pugh, Stephanie [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Seider, Michael J. [Akron City Hospital, Akron, Ohio (United States); Dicker, Adam P. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Bosch, Walter; Michalski, Jeff; Mutic, Sasa [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri (United States)

    2015-06-01

    Purpose: The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. Methods and Materials: A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH{sub 0126,top10%}). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed “high-quality,” “low-quality,” and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Results: Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH{sub 0126,top10%} to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the

  10. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study

    Science.gov (United States)

    Kuo, Chang-Fu; Grainge, Matthew J; Mallen, Christian; Zhang, Weiya; Doherty, Michael

    2015-01-01

    Objectives To describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012. Methods We used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients. Results In 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012. Conclusions In recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor. PMID:24431399

  11. Synthesis of high-purity phthalocyanines (pc): High intrinsic conductivities in the molecular conductors H[sub 2](pc)I and Ni(pc)I

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, J.A.; Murata, K.; Miller, D.C.; Stanton, J.L.; Broderick, W.E.; Hoffman, B.M.; Ibers, J.A. (Northwestern Univ., Evanston, IL (United States))

    1993-08-04

    The authors show that one can prepare M(pc)I crystals, M = [open quotes]H[sub 2][close quotes] and Ni, with remarkably improved charge-transport properties by carefully avoiding impurities in the preparation of the M(pc) precursors. The purest H[sub 2](pc) (<60 ppm free-radical impurities) was prepared by a melt method in quartz and Teflon vessels while very pure Ni(pc) (170-250 pm) could only be obtained by metalation of the pure H[sub 2](pc). Template syntheses of Ni(pc) result in impure material and are to be discouraged for applications requiring very pure M(pc) materials. H[sub 2](pc)I and Ni(pc)I synthesized from the high-purity precursors remain metallic down to ca. 3 K, a far lower temperature than ever before observed. At this temperature the conductivities exhibit maximum values that are ca. 30-fold greater than at room temperature, not 5-7-fold as seen before, with absolute values of [sigma] [approximately] (1-2) [times] 10[sup 4] [Omega][sup [minus]1] cm[sup [minus]1]. The study of a series of Ni(pc)I compounds prepared from Ni(pc) parent materials exhibiting a range of purity levels further shows a strong correlation between the charge-transport properties and the level of paramagnetic impurities in the macrocycle precursor. However, the maximum conductivity appears to saturate at the lowest impurity concentrations, which suggests that the behavior exhibited by the best materials prepared are representative for the first time of the limiting, intrinsic charge-transport properties of H[sub 2](pc)I and Ni(pc)I. A full structure report for H[sub 2](pc)I-1 is presented also. The structure consists of metal-over-metal stacks of partially oxidized H[sub 2](pc) groups surrounded by linear chains of triiodide anions. H[sub 2](pc)I crystallizes with two formula units in the tetragonal space group D[sub 4h][sup 2]-P4/mcc with a = 13.931 [angstrom], c = 6.411 [angstrom], and V = 1244.2 [angstrom][sup 3] (T = 108 K).

  12. [Clopidogrel before and after percutaneous coronary intervention: the PCI-CURE and CREDO studies do not support long-term therapy. Shorter treatment saves millions].

    Science.gov (United States)

    Eriksson, Peter

    2003-10-09

    The ideal time to start treatment with clopidogrel prior to a percutaneous coronary intervention, the most efficacious loading-dose and the optimal duration of treatment following the procedure are not known in detail. PCI-CURE and CREDO both support pre-treatment with clopidogrel. Extended treatment beyond the first few months after the procedure is not, however, supported by the data. Accordingly, 300 mg clopidogrel should be given at least 6 hours and ideally 12 hours before the procedure. If the intervention must be undertaken sooner, a doubling of the loading-dose is recommended. After the procedure, clopidogrel 75 mg once daily should be continued for one to three months.

  13. Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Shiomi, Hiroki; Morimoto, Takeshi; Hayano, Mamoru; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Imai, Masao; Yamaji, Kyohei; Tada, Tomohisa; Natsuaki, Masahiro; Saijo, Sayaka; Funakoshi, Shunsuke; Nagao, Kazuya; Hanazawa, Koji; Ehara, Natsuhiko; Kadota, Kazushige; Iwabuchi, Masashi; Shizuta, Satoshi; Abe, Mitsuru; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Yamazaki, Fumio; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Imoto, Yutaka; Komiya, Tatsuhiko; Horie, Minoru; Fujiwara, Hisayoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi

    2012-10-01

    The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Predictors of mortality in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI): Insights from National Cardiovascular Disease Database (NCVD), Malaysia.

    Science.gov (United States)

    Ponniah, J P S; Shamsul, A S; Adam, B M

    2012-12-01

    The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary intervention. Estimation of post operative mortality risk factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data extracted from the National Cardiovascular Disease Database (NCVD-ACS and NCVD PCI). Both these registries were interlinked and was further matched to JPN (Jabatan Pendaftaran Negara/National registration Department) to assess mortality among the patients who underwent PCI and all death which occurred in between 2007, 2008 and 2009. There were 630 patients in this studied. Age, history of diabetes mellitus, peripheral vascular, renal failure and previous percutaneous coronary intervention were univariately associated with mortality. However based on logistics stepwise method, only age and history of renal failure had showed statistically significant and sizeable odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.

  15. Dual antiplatelet response during PCI: VerifyNow P2Y12 predicts myocardial necrosis and thromboxane B2 generation confirms wide variation in aspirin response.

    Science.gov (United States)

    Good, Richard I S; McGarrity, Anne; James, Tina E; Miller, Helen; McConnachie, Alex; Goodall, Alison H; Oldroyd, Keith G

    2015-06-01

    There remains concern that the antiplatelet effects of aspirin and clopidogrel vary between patients and poor responders may be at increased risk of adverse events. However, the optimal method of measuring aspirin and/or clopidogrel response remains unresolved. We compared three methods of measuring clopidogrel response recommended by a recent consensus statement for the European Society of Cardiology, and investigated a novel approach to measuring aspirin response in patients established on both aspirin and clopidogrel. In addition, we investigated whether any of these assays predict peri-procedural myocardial necrosis following percutaneous coronary intervention (PCI). A cross-section of 323 patients attending for PCI was tested for clopidogrel response using VerifyNow P2Y12, VASP Platelet Reactivity Index (VASP-PRI) and whole blood impedance aggregometry (WBPA). Aspirin response was assessed by measuring the residual ability of platelets to generate thromboxane, calculated as the difference between thromboxane B2 levels in serum and plasma, [TxB2]S-P. Peri-procedural myocardial necrosis was determined by a change in troponin I >0.2 μmol/l. Patients demonstrated wide variation in response to both aspirin and clopidogrel. Correlation between VerifyNow P2Y12 and VASP-PRI was good (r=0.702, paspirin response in patients taking dual antiplatelet therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Diseño de un módulo IP para controlar dispositivos DDS utilizando un núcleo de interfaz PCI

    Directory of Open Access Journals (Sweden)

    Abdel Martínez Alonso

    2011-03-01

    Full Text Available Normal 0 21 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} El presente trabajo constituye una etapa del proyecto de integración y desarrollo nacional de dispositivos basados en tecnología de Síntesis Digital Directa (SDD que se lleva a cabo en LACETEL®. Se logra un diseño en lenguaje de descripción de hardware (VHDL, capaz de conectar estos dispositivos al bus PCI, para intercambiar información a través de la PC. Se explican los bloques funcionales del diseño, y su relación con el núcleo de interfaz con el bus PCI generado con herramientas del fabricante Xilinx. Finalmente, se valida el diseño mediante simulación.

  17. The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry

    Directory of Open Access Journals (Sweden)

    Moo-Sik Lee

    2014-07-01

    Full Text Available Objectives: This study aims to investigate trends of cardiovascular disease (CVD risk factor profiles over 17 years in percutaneous coronary intervention (PCI patients at the Mayo Clinic. Methods: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Results: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

  18. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry.

    Science.gov (United States)

    Peiyuan, He; Jingang, Yang; Haiyan, Xu; Xiaojin, Gao; Ying, Xian; Yuan, Wu; Wei, Li; Yang, Wang; Xinran, Tang; Ruohua, Yan; Chen, Jin; Lei, Song; Xuan, Zhang; Rui, Fu; Yunqing, Ye; Qiuting, Dong; Hui, Sun; Xinxin, Yan; Runlin, Gao; Yuejin, Yang

    2016-01-01

    Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P fibrinolysis and no reperfusion (P fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

  19. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

    Science.gov (United States)

    Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

    2017-03-17

    Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Pilot study on the additive effects of berberine and oral type 2 diabetes agents for patients with suboptimal glycemic control

    Directory of Open Access Journals (Sweden)

    Di Pierro F

    2012-07-01

    Full Text Available Francesco Di Pierro,1 Nicola Villanova,2 Federica Agostini,2 Rebecca Marzocchi,2 Valentina Soverini,2 Giulio Marchesini21Scientific Department, Velleja Research, Milano, 2Diseases of Metabolism, S Orsola Malpighi Hospital, Bologna, ItalyBackground: Suboptimal glycemic control is a common situation in diabetes, regardless of the wide range of drugs available to reach glycemic targets. Basic research in diabetes is endeavoring to identify new actives working as insulin savers, use of which could delay the introduction of injectable insulin or reduce the insulin dose needed. Commonly available as a nutraceutical, berberine is a potential candidate.Methods and results: Because its low oral bioavailability can be overcome by P-glycoprotein inhibitors like herbal polyphenols, we have tested the nutraceutical combination of Berberis aristata extract and Silybum marianum extract (Berberol® in type 2 diabetes in terms of its additive effect when combined with a conventional oral regimen for patients with suboptimal glycemic control. After 90 days of treatment, the nutraceutical association had a positive effect on glycemic and lipid parameters, significantly reducing glycosylated hemoglobin, basal insulin, homeostatic model assessment of insulin resistance, total and low-density lipoprotein cholesterol, and triglycerides. A relevant effect was also observed in terms of liver function by measuring aspartate transaminase and alanine transaminase. The product had a good safety profile, with distinctive gastrointestinal side effects likely due to its acarbose-like action.Conclusion: Although further studies should be carried out to confirm our data, Berberol could be considered a good candidate as an adjunctive treatment option in diabetes, especially in patients with suboptimal glycemic control.Keywords: berberine, silymarin, glycosylated hemoglobin, diabetes

  1. Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana

    OpenAIRE

    Tsai, James; Rolle, Italia V.; Singh, Tushar; Sheree L. Boulet; McAfee, Timothy A.; Grant, Althea M.

    2017-01-01

    The purpose of this study was to examine the patterns of marijuana and tobacco use and their associations with suboptimal self-rated health (SRH) among US adults who reported ?ever, even once, using marijuana or hashish.? Data came from the 2009?2012 National Health and Nutrition Examination Survey, restricting to respondents aged 20 years and older who reported using marijuana at least once in their lifetime (n?=?3,210). We assessed the age-adjusted prevalence of mutually exclusive groups of...

  2. LAM add-on ADV combination therapy or ETV monotherapy for CHB patients with suboptimal response to ADV.

    Science.gov (United States)

    Jia, Hongyu; Ding, Feng; Chen, Jianyang; Zhang, Yimin; Xiang, Dairong; Lian, Jiangshan; Zeng, Linyan; Yu, Liang; Hu, Jianhua; Li, Yongtao; Lu, Yingfeng; Liu, Yuanchun; Zheng, Lin; Li, Lanjuan; Yang, Yida

    2015-01-01

    Among the available nucleos(t)ide analogues adefovir dipivoxil (ADV) is relatively cheap and widely used in rural area in China. However, there are insufficient data on recommendation for patients with suboptimal response to ADV after 48 weeks of treatment in order to reduce the resistance rate in the long term. The aim of this study was to compare the efficacy and safety of LAM add-on combination therapy versus ETV monotherapy for patients with suboptimal response to ADV. 136 patients with suboptimal response to ADV were randomly assigned to the add-on LAM with ADV combination therapy (68 patients) group and the ETV monotherapy (68 patients) group. Patients in the add-on group were prescribed 100 mg LAM and 10 mg ADV per day, while the monotherapy group received 0.5 mg ETV per day for 48 weeks. Tests for liver and kidney function, HBV serum markers, HBV DNA load, were performed every 3 months. The mean patient age in LAM add-on group and ETV monotherapy was 38.59 ± 7.65 and 37.56 ± 8.67 years respectively. The HBV DNA undetectable rate in the LAM add-on group and the ETV group were not significant difference at week 4, 12 and 24 (P > 0.05). However, the HBV undetectable rate in the ETV group was higher than that in the LAM add-on group at week 36 and 48 (P = 0.043 for week 36 and P = 0.038 for week 48). There was no significant difference both for HBeAg loss and HBeAg seroconversion between two groups (P > 0.05) at 48 weeks. Meanwhile, our study also demonstrated that the mean eGFR levels in LAM add-on group was decreased from 99.6 ± 8.71 at baseline to 86.4 ± 9.83 at the end of 48 weeks, which was significantly higher than that in the ETV monotherapy group (P add-on group experienced eGFR reduction by 20-30% from baseline at 48 weeks. No patients developed hyposphosphatemia in our study. Our study clearly showed that switch to ETV monotherapy was the more effective and more safe than that of LAM add-on combination therapy for patients with suboptimal response

  3. Rootstock Sub-Optimal Temperature Tolerance Determines Transcriptomic Responses after Long-Term Root Cooling in Rootstocks and Scions of Grafted Tomato Plants

    OpenAIRE

    Georgia Ntatsi; Dimitrios Savvas; Vassilis Papasotiropoulos; Anastasios Katsileros; Zrenner, Rita M.; Hincha, Dirk K.; Ellen Zuther; Dietmar Schwarz

    2017-01-01

    Grafting of elite cultivars onto tolerant rootstocks is an advanced strategy to increase tomato tolerance to sub-optimal temperature. However, a detailed understanding of adaptive mechanisms to sub-optimal temperature in rootstocks and scions of grafting combinations on a physiological and molecular level is lacking. Here, the commercial cultivar Kommeet was grafted either onto ‘Moneymaker’ (sensitive) or onto the line accession LA 1777 of Solanum habrochaites (tolerant). Grafted plants were ...

  4. Risk factors and morbidity associated with suboptimal instrument placement at instrumental delivery: observational study nested within the Instrumental Delivery & Ultrasound randomised controlled trial ISRCTN 72230496.

    Science.gov (United States)

    Ramphul, M; Kennelly, M M; Burke, G; Murphy, D J

    2015-03-01

    To identify risk factors and morbidity associated with suboptimal instrument placement at instrumental delivery. Observational study, nested within a randomised controlled trial. Two university-affiliated maternity hospitals. A cohort of 478 nulliparous women at term (≥37 weeks of gestation) undergoing instrumental delivery. Univariable and multivariable logistic regression analyses were performed. Risk factors for suboptimal application of vacuum or forceps, maternal and neonatal morbidity, and the sequential use of instruments, second operator, and caesarean section following failed instrumental delivery. Instrument placement was suboptimal in 138 of 478 (28.8%) deliveries. Factors associated with suboptimal instrument placement included fetal malposition (OR 2.44, 95% CI 1.62-3.66), mid-cavity station (OR 1.68, 95% CI 1.02-2.78), and forceps as the primary instrument (OR 2.01, 95% CI 1.33-3.04). Compared with optimal instrument placement, suboptimal placement was associated with prolonged hospital stay (adjusted OR 2.28, 95% CI 1.30-4.02) and neonatal trauma (adjusted OR 4.25, 95% CI 1.85-9.72). Suboptimal placement was associated with a greater use of sequential instruments (adjusted OR 3.99, 95% CI 1.94-8.23) and caesarean section for failed instrumental delivery (adjusted OR 3.81, 95% CI 1.10-13.16). The mean decision to delivery interval (DDI) was 4 minutes longer in the suboptimal group (95% CI 2.1-5.9 minutes). Suboptimal instrument placement is associated with increased maternal and neonatal morbidity and procedural complications. Greater attention should be focused on instrument placement when training obstetricians for instrumental delivery. © 2014 Royal College of Obstetricians and Gynaecologists.

  5. A Reduced Dantzig-Wolfe Decomposition for a Suboptimal Linear MPC

    DEFF Research Database (Denmark)

    Standardi, Laura; Poulsen, Niels Kjølstad; Jørgensen, John Bagterp

    2014-01-01

    Linear Model Predictive Control (MPC) is an efficient control technique that repeatedly solves online constrained linear programs. In this work we propose an economic linear MPC strategy for operation of energy systems consisting of multiple and independent power units. These systems cooperate to...

  6. The Bruton tyrosine kinase (BTK) inhibitor PCI-32765 synergistically increases proteasome inhibitor activity in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells sensitive or resistant to bortezomib.

    Science.gov (United States)

    Dasmahapatra, Girija; Patel, Hiral; Dent, Paul; Fisher, Richard I; Friedberg, Jonathan; Grant, Steven

    2013-04-01

    Interactions between the Bruton tyrosine kinase (BTK) inhibitor PCI-32765 and the proteasome inhibitor (bortezomib) were examined in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells, including those highly resistant to bortezomib. Co-administration of PCI-32765/bortezomib synergistically increased mitochondrial injury and apoptosis in germinal centre- or activated B-cell-like-DLBCL cells and in MCL cells. These events were accompanied by marked AKT and nuclear factor (NF)-κB (NFKB1) inactivation, down-regulation of Mcl-1 (MCL1), Bcl-xL (BCL2L1), and XIAP, and enhanced DNA damage (e.g., γH2A.X formation) and endoplasmic reticulum (ER) stress. Similar interactions were observed in highly bortezomib-resistant DLBCL and MCL cells, and in primary DLBCL cells. In contrast, PCI-32765/bortezomib regimens displayed minimal toxicity toward normal CD34(+) bone marrow cells. Transfection of DLBCL cells with a constitutively active AKT construct attenuated AKT inactivation and significantly diminished cell death, whereas expression of an NF-κB "super-repressor" (IκBαser34/36 ) increased both PCI-32765 and bortezomib lethality. Moreover, cells in which the ER stress response was disabled by a dominant-negative eIF2α construct were resistant to this regimen. Finally, combined exposure to PCI-32765 and bortezomib resulted in more pronounced and sustained reactive oxygen species (ROS) generation, and ROS scavengers significantly diminished lethality. Given promising early clinical results for PCI-32765 in DLBCL and MCL, a strategy combining BTK/proteasome inhibitor warrants attention in these malignancies. © 2013 Blackwell Publishing Ltd.

  7. Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease - 5-Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort-2 - .

    Science.gov (United States)

    Shiomi, Hiroki; Morimoto, Takeshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

    2015-01-01

    Studies evaluating long-term (≥5 years) outcome of percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD) are still limited, despite concerns for late adverse events after drug-eluting stents implantation. We identified 1,004 patients with ULMCAD (PCI: n=364, CABG: n=640) among 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG registry cohort-2. The primary outcome measure in the current analysis was a composite of death, myocardial infarction, and stroke (death/MI/stroke). The cumulative 5-year incidence of and the adjusted risk for death/MI/stroke were significantly higher in the PCI group than in the CABG group (34.5% vs. 24.1%, log-rank P<0.001, adjusted hazard ratio (HR): 1.48 [95% confidence interval (CI): 1.07-2.05, P=0.02]). The adjusted risks for all-cause death was not significantly different between the 2 groups. Regarding the stratified analysis by the SYNTAX score, the adjusted risk for death/MI/stroke was not significantly different between the 2 groups in patients with low (<23) or intermediate (23-33) SYNTAX score, whereas it was significantly higher in the PCI group than in the CABG group in patients with high (≤33) SYNTAX score. CABG as compared with PCI was associated with better long-term outcome in patients with ULMCAD, especially those with high anatomical complexity.

  8. Implementación de la norma de seguridad PCI-DSS versión 3.0 sobre aplicación web ASP.NET desplegada en Azure

    OpenAIRE

    PÉREZ GÓMEZ, ISRAEL

    2016-01-01

    [ES] El almacenamiento de datos bancarios requiere de un estricto control y seguimiento para asegurar en lo posible la integridad e inaccesibilidad de los datos sensibles. Estos requisitos se detallan en el Estándar de seguridad de datos para la industria de tarjeta de pago (PCI-DSS). El objetivo del TFG es implementar una serie de medidas que permitan superar las auditorías que certifiquen el cumplimiento de la norma PCI-DSS para la aplicación web y móvil "Pay[in]", cuyo despl...

  9. Comparison of five-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with left ventricular ejection fractions≤50% versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    Science.gov (United States)

    Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

    2014-10-01

    Coronary heart disease is a major risk factor for left ventricular (LV) systolic dysfunction. However, limited data are available regarding long-term benefits of percutaneous coronary intervention (PCI) in the era of drug-eluting stent or coronary artery bypass grafting (CABG) in patients with LV systolic dysfunction with severe coronary artery disease. We identified 3,584 patients with 3-vessel and/or left main disease of 15,939 patients undergoing first myocardial revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Of them, 2,676 patients had preserved LV systolic function, defined as an LV ejection fraction (LVEF) of >50% and 908 had impaired LV systolic function (LVEF≤50%). In patients with preserved LV function, 5-year outcomes were not different between PCI and CABG regarding propensity score-adjusted risk of all-cause and cardiac deaths. In contrast, in patients with impaired LV systolic function, the risks of all-cause and cardiac deaths after PCI were significantly greater than those after CABG (hazard ratio 1.49, 95% confidence interval 1.04 to 2.14, p=0.03 and hazard ratio 2.39, 95% confidence interval 1.43 to 3.98, p<0.01). In both patients with moderate (35%PCI was significantly greater than that after CABG (hazard ratio 2.25, 95% confidence interval 1.15 to 4.40, p=0.02 and hazard ratio 4.42, 95% confidence interval 1.48 to 13.24, p=0.01). Similarly, the risk of all-cause death tended to be greater after PCI than after CABG in both patients with moderate and severe LV systolic dysfunction without significant interaction (hazard ratio 1.57, 95% confidence interval 0.96 to 2.56, p=0.07 and hazard ratio 1.42, 95% confidence interval 0.71 to 2.82, p=0.32; interaction p=0.91). CABG was associated with better 5-year survival outcomes than PCI in patients with impaired LV systolic function (LVEF≤50%) with complex coronary disease in the era

  10. Conformity does not perpetuate suboptimal traditions in a wild population of songbirds.

    Science.gov (United States)

    Aplin, Lucy M; Sheldon, Ben C; McElreath, Richard

    2017-07-24

    Social learning is important to the life history of many animals, helping individuals to acquire new adaptive behavior. However despite long-running debate, it remains an open question whether a reliance on social learning can also lead to mismatched or maladaptive behavior. In a previous study, we experimentally induced traditions for opening a bidirectional door puzzle box in replicate subpopulations of the great tit Parus major Individuals were conformist social learners, resulting in stable cultural behaviors. Here, we vary the rewards gained by these techniques to ask to what extent established behaviors are flexible to changing conditions. When subpopulations with established foraging traditions for one technique were subjected to a reduced foraging payoff, 49% of birds switched their behavior to a higher-payoff foraging technique after only 14 days, with younger individuals showing a faster rate of change. We elucidated the decision-making process for each individual, using a mechanistic learning model to demonstrate that, perhaps surprisingly, this population-level change was achieved without significant asocial exploration and without any evidence for payoff-biased copying. Rather, by combining conformist social learning with payoff-sensitive individual reinforcement (updating of experience), individuals and populations could both acquire adaptive behavior and track environmental change.

  11. Treatment of advanced colorectal cancer in a patient with cardiotoxic reactions to 5-fluorouracil and capecitabine using suboptimal doses.

    Science.gov (United States)

    Cioffi, Joseph H; Estes, Derek J; Florou, Vaia; Ardalan, Bach

    2017-11-27

    A 32-year-old female with stage IV colorectal cancer and metastasis to the liver experienced cardiotoxic reactions after treatment with 5-fluorouracil and its oral prodrug capecitabine even at two-thirds the recommended dose. After careful considerations, the decision was made to attempt capecitabine retrial at a further suboptimal dose with combination chemotherapy where she no longer experienced cardiac events. As a result, the liver tumour shrank and rectal mass stabilised, tumour markers dropped and she underwent surgical resection of both masses. Later there was local recurrence of disease near the previous liver tumour, so the suboptimal capecitabine therapy was restarted without complaint. The patient became a candidate for a NanoKnife procedure, offering a potentially curative therapy. This case report summarises a novel treatment strategy for those patients with advanced colorectal cancer who experience cardiotoxic reactions to fluoropyrimidines, the active agent of gold standard treatment. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Application of the tuning algorithm with the least squares approximation to the suboptimal control algorithm for integrating objects

    Science.gov (United States)

    Kuzishchin, V. F.; Merzlikina, E. I.; Van Va, Hoang

    2017-11-01

    The problem of PID and PI-algorithms tuning by means of the approximation by the least square method of the frequency response of a linear algorithm to the sub-optimal algorithm is considered. The advantage of the method is that the parameter values are obtained through one cycle of calculation. Recommendations how to choose the parameters of the least square method taking into consideration the plant dynamics are given. The parameters mentioned are the time constant of the filter, the approximation frequency range and the correction coefficient for the time delay parameter. The problem is considered for integrating plants for some practical cases (the level control system in a boiler drum). The transfer function of the suboptimal algorithm is determined relating to the disturbance that acts in the point of the control impact input, it is typical for thermal plants. In the recommendations it is taken into consideration that the overregulation for the transient process when the setpoint is changed is also limited. In order to compare the results the systems under consideration are also calculated by the classical method with the limited frequency oscillation index. The results given in the paper can be used by specialists dealing with tuning systems with the integrating plants.

  13. Tuber melanosporum spread within sub-optimal climatic zones is controlled by fruiting triggers and not mycorrhiza survival

    Directory of Open Access Journals (Sweden)

    Paul W. Thomas

    2014-07-01

    Full Text Available Tuber melanosporum is the most valuable of all cultivatable truffle species. Farming of this species spans every continent with the exception of Antarctica. Tuber aestivum (syn. T. uncinatum and Tuber brumale are truffle species that have similar host plant preference and a similar affinity for calcareous soils as T. melanosporum, but occur over a broader geographic zone. The geographic limit of T. melanosporum is thought to be climatically dictated but it is not known whether this is due to an impact on mycorrhizal survival or climatically-derived fruiting triggers. Here, data is compiled from five cultivated research sites in the climatically sub-optimal conditions of the UK in order to address this question. Here we show: (iTuber melanosporum mycorrhiza can survive and grow in sub-optimal climatic conditions. (iiIt is climatically-derived fruiting triggers and not ectomycorrhiza survival that dictate the climatic preferences and geographic spread of T. melanosporum. (iiiImportant climatic parameters for potential fruiting triggers are sunshine hours, summer rainfall and summer temperatures.   The data presented here not only aid our understanding of the ecological parameters of T. melanosporum but also have a practical application for truffle cultivators in choosing suitable locations for a plantation.

  14. Comparative assessment of platelet GpIIb/IIIa receptor occupancy ratio with Eptifibatide/Tirofiban in patients presenting with ACS and undergoing PCI

    Science.gov (United States)

    Puri, Aniket; Bansal, A.; Narain, V.S.; Sethi, R.; Dwivedi, S.K.; Puri, V.K.; Saran, R.K.

    2013-01-01

    Background The level of platelet inhibition by a Glycoprotein IIb/IIIa (GpIIb/IIIa) antagonist therapy necessary to minimize thrombotic complications in patients undergoing percutaneous coronary intervention (PCI) is a subject of debate. The degree of platelet inhibition obtained 10 min after start of GpIIb/IIIa antagonist therapy predicts adverse events after PCI. The aim of this study was to look at platelet inhibition and to compare platelet GpIIb/IIIa receptors occupancy ratio (GpRO) with Eptifibatide and Tirofiban using various dose regimens and correlate with 30-day clinical outcomes in patients presenting with high-risk acute coronary syndromes (ACS) and undergoing PCI. Methods The patients were divided into four sub groups: (1) Eptifibatide two intracoronary bolus (180 μg/kg) alone (EB); or (2) two intravenous bolus (180 μg/kg) followed by infusion at 2 μg/kg/min for 24 h (EB + Inf); and (3) Tirofiban standard bolus dose (0.4 μg/kg) over 30 min followed by infusion at 0.1 μg/kg/min (TStd); or (4) at ADVANCE dose bolus (25 μg/kg) over 3 min, followed by infusion at 0.1 μg/kg/min (TAdv). Number of GpIIb/IIIa receptors was assessed by flow cytometry at baseline and 10 min after the bolus and percentage of free receptors was determined to calculate the GpRO. Patients were followed for 30 days for any major adverse cardiac events (MACE). Results 200 consecutive patients (including 74% with ST-elevation ACS) were enrolled. GpRO in groups EB (n = 48) and EB + Inf (n = 44) were 62.7% ± 27.2% and 61.4% ± 6.1% respectively while in the groups TStd (n = 96) and TAdv (n = 12) groups were 35.1% ± 17.74% and 68.8% ± 27.3% respectively. The GpRO was similar in EB, EB + Inf and TAdv groups and was significantly higher than TStd group (p < 0.0001). The 30-day MACE rates in EB (4.2%), EB + Inf (4.5%) and TAdv (4.2%) were significantly lower than TStd group (12.5%) (p < 0.01). Conclusions Standard dose Tirofiban results in

  15. Prognosis of STEMI Patients with Multi-Vessel Disease Undergoing Culprit-Only PCI without Significant Residual Ischemia on Non-Invasive Stress Testing.

    Directory of Open Access Journals (Sweden)

    Adaya Weissler-Snir

    Full Text Available In about 50-80% of ST-segment elevation myocardial infarction (STEMI patients there is significant atherosclerotic disease in other coronary arteries in addition to the culprit vessel. There is substantial controversy as to the optimal revascularization approach in these patients. We sought to compare the outcomes of STEMI patients with multi-vessel disease (MVD treated with culprit-only primary percutaneous coronary intervention (PPCI without significant ischemia on subsequent non-invasive testing, to those of STEMI patients with single-vessel disease (SVD.Between 2001-2010, 1,540 consecutive patients treated with primary PCI for STEMI were prospectively observed and entered into a comprehensive clinical database. The primary end point was a composite of major adverse cardiac events (MACE, consisting of mortality, re-infarction and revascularization within 1 and 3 years following PPCI (excluding events occurring during the first 30 days. Patients with cardiogenic shock were excluded. The study included 720 patients with SVD and 185 patients with MVD who underwent culprit-only PPCI and had no residual ischemia on subsequent non-invasive stress testing. Patients with MVD were older, more likely to have hypertension or previous MI and less likely to be smokers and present with anterior MI than patients with SVD. One and 3-year MACE rates were similar between the groups. On cox proportional-hazards regression MVD without residual ischemia was not independently associated with MACE and its components.STEMI patients with MVD treated with culprit only-PCI without significant residual ischemia on non-invasive stress testing appear to have similar prognosis to STEMI patients with SVD.

  16. Prognosis of STEMI Patients with Multi-Vessel Disease Undergoing Culprit-Only PCI without Significant Residual Ischemia on Non-Invasive Stress Testing.

    Science.gov (United States)

    Weissler-Snir, Adaya; Gurevitz, Chen; Assali, Abid; Vaknin-Assa, Hana; Bental, Tamir; Lador, Adi; Yavin, Hagai; Perl, Leor; Kornowski, Ran; Lev, Eli

    2015-01-01

    In about 50-80% of ST-segment elevation myocardial infarction (STEMI) patients there is significant atherosclerotic disease in other coronary arteries in addition to the culprit vessel. There is substantial controversy as to the optimal revascularization approach in these patients. We sought to compare the outcomes of STEMI patients with multi-vessel disease (MVD) treated with culprit-only primary percutaneous coronary intervention (PPCI) without significant ischemia on subsequent non-invasive testing, to those of STEMI patients with single-vessel disease (SVD). Between 2001-2010, 1,540 consecutive patients treated with primary PCI for STEMI were prospectively observed and entered into a comprehensive clinical database. The primary end point was a composite of major adverse cardiac events (MACE), consisting of mortality, re-infarction and revascularization within 1 and 3 years following PPCI (excluding events occurring during the first 30 days). Patients with cardiogenic shock were excluded. The study included 720 patients with SVD and 185 patients with MVD who underwent culprit-only PPCI and had no residual ischemia on subsequent non-invasive stress testing. Patients with MVD were older, more likely to have hypertension or previous MI and less likely to be smokers and present with anterior MI than patients with SVD. One and 3-year MACE rates were similar between the groups. On cox proportional-hazards regression MVD without residual ischemia was not independently associated with MACE and its components. STEMI patients with MVD treated with culprit only-PCI without significant residual ischemia on non-invasive stress testing appear to have similar prognosis to STEMI patients with SVD.

  17. Traditional Chinese medicine and new concepts of predictive, preventive and personalized medicine in diagnosis and treatment of suboptimal health.

    Science.gov (United States)

    Wang, Wei; Russell, Alyce; Yan, Yuxiang

    2014-02-13

    The premise of disease-related phenotypes is the definition of the counterpart normality in medical sciences. Contrary to clinical practices that can be carefully planned according to clinical needs, heterogeneity and uncontrollability is the essence of humans in carrying out health studies. Full characterization of consistent phenotypes that define the general population is the basis to individual difference normalization in personalized medicine. Self-claimed normal status may not represent health because asymptomatic subjects may carry chronic diseases at their early stage, such as cancer, diabetes mellitus and atherosclerosis. Currently, treatments for non-communicable chronic diseases (NCD) are implemented after disease onset, which is a very much delayed approach from the perspective of predictive, preventive and personalized medicine (PPPM). A NCD pandemic will develop and be accompanied by increased global economic burden for healthcare systems throughout both developed and developing countries. This paper examples the characterization of the suboptimal health status (SHS) which represents a new PPPM challenge in a population with ambiguous health complaints such as general weakness, unexplained medical syndrome (UMS), chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) and chronic fatigue immune dysfunction syndrome (CFIDS). We applied clinical informatic approaches and developed a questionnaire-suboptimal health status questionnaire-25 (SHSQ-25) for measuring SHS. The validity and reliability of this approach were evaluated in a small pilot study and then in a cross-sectional study of 3,405 participants in China. We found a correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol and high-density lipoprotein (HDL) cholesterol among men, and a correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides

  18. Suboptimal feedback control of TCP flows in computer network using random early discard (RED mechanism

    Directory of Open Access Journals (Sweden)

    Ahmed N. U.

    2005-01-01

    Full Text Available We consider a dynamic model that simulates the interaction of TCP sources with active queue management system (AQM. We propose a modified version of an earlier dynamic model called RED. This is governed by a system of stochastic differential equations driven by a doubly stochastic point process with intensity as the control. The feedback control law proposed observes the router (queue status and controls the intensity by sending congestion signals (warnings to the sources for adjustment of their transmission rates. The (feedback control laws used are of polynomial type (including linear with adjustable coefficients. They are optimized by use of genetic algorithm (GA and random recursive search (RRS technique. The numerical results demonstrate that the proposed model and the method can improve the system performance significantly.

  19. Suboptimal RED Feedback Control for Buffered TCP Flow Dynamics in Computer Network

    Directory of Open Access Journals (Sweden)

    N. U. Ahmed

    2007-01-01

    Full Text Available We present an improved dynamic system that simulates the behavior of TCP flows and active queue management (AQM system. This system can be modeled by a set of stochastic differential equations driven by a doubly stochastic point process with intensities being the controls. The feedback laws proposed monitor the status of buffers and multiplexor of the router, detect incipient congestion by sending warning signals to the sources. The simulation results show that the optimal feedback control law from the class of linear as well as quadratic polynomials can improve the system performance significantly in terms of maximizing the link utilization, minimizing congestion, packet losses, as well as global synchronization. The optimization process used is based on random recursive search technique known as RRS.

  20. An Efficient Sub-optimal Motion Planning Method for Attitude Manoeuvres

    Science.gov (United States)

    Caubet, Albert; Biggs, James D.

    A motion planning technique for efficiently generating smooth spacecraft attitude slew manoeuvres is presented. The attitude trajectory (using quaternions) is shaped by a polynomial, determined by matching prescribed boundary conditions and the manoeuvre time. This method allows constraints such as limits on velocity, acceleration, jerk, and torque to be evaluated via inverse dynamics. Pointing constraints are also considered. A spin-to-spin case is presented whereby an axis-azimuth parameterisation is used. The problem of time minimization (within the set of trajectories defined by the given polynomials) is addressed, and a method for analytically estimating the minimum time of a manoeuvre is proposed. The method requires low computational capacity, and a comparison with optimal control solutions shows its relative performance.

  1. A brief mindfulness based intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (PCI) patients : The MindfulHeart randomized controlled trial

    NARCIS (Netherlands)

    Nyklicek, I.; Dijksman, S.C.; Lenders, P.J.; Fonteijn, W.A.; Koolen, J.J.

    2014-01-01

    In this study effects of a brief mindfulness-based stress reduction intervention were examined in cardiac patients who had a percutaneous coronary intervention (PCI). One-hundred-and-fourteen patients (mean age 55 ± 7 years, 18 % women) were randomly assigned to a 4-session mindfulness group

  2. Immediate and midterm outcomes following primary PCI with bioresorbable vascular scaffold implantation in patients with ST-segment myocardial infarction: insights from the multicentre "Registro ABSORB Italiano" (RAI registry).

    Science.gov (United States)

    Ielasi, Alfonso; Cortese, Bernardo; Varricchio, Attilio; Tespili, Maurizio; Sesana, Marco; Pisano, Francesco; Loi, Bruno; Granata, Francesco; Moscarella, Elisabetta; Silva Orrego, Pedro; La Vecchia, Luigi; Steffenino, Giuseppe

    2015-06-01

    In this multicentre prospective registry we sought to evaluate the immediate and midterm clinical outcomes following single or multiple overlapping bioresorbable vascular scaffold (BVS) implantation in the STEMI setting. A prospective cohort analysis was performed on all STEMI patients who underwent primary PCI with BVS implantation. Between December 2012 and February 2014, 1,232 STEMI patients underwent primary PCI at the participating centres. Of these, 74 (6.0%) received a BVS, 18 (24.3%) of them were multiple and overlapping. Procedural success was obtained in 72 (97.3%) cases without differences between the groups (overlapping BVS 100% vs. single BVS 96.4%, p=0.5). One patient experienced a reinfarction due to subacute BVS thrombosis which was successfully managed with balloon-only PCI while the other patient had a "slow-flow" phenomenon (final TIMI flow 2). At six-month follow-up, two non-fatal MI (2.7%), three target lesion revascularisations (4.1%), and one subacute BVS thrombosis were reported in three patients (one [5.6%] overlapping BVS and two [3.6%] in the single BVS group, p=0.5). All the events were successfully managed with re-PCI. BVS implantation in STEMI patients can be successfully performed with a high procedural success rate and encouraging midterm outcomes. Larger randomised trials and longer follow-up are needed to assess the potential clinical benefit of BVS versus new-generation DES in this setting.

  3. Clinical neurological outcome and quality of life among patients with limited small-cell cancer treated with two different doses of prophylactic cranial irradiation in the intergroup phase III trial (PCI99-01, EORTC 22003-08004, RTOG 0212 and IFCT 99-01)

    NARCIS (Netherlands)

    Pechoux, C. Le; Laplanche, A.; Faivre-Finn, C.; Ciuleanu, T.; Wanders, R.; Lerouge, D.; Keus, R.; Hatton, M.; Videtic, G.M.; Senan, S.; Wolfson, A.; Jones, R.; Arriagada, R.; Quoix, E.; Dunant, A.; Bussink, J.

    2011-01-01

    BACKGROUND: We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a

  4. Impact of Bleeding on Mortality After Percutaneous Coronary Intervention Results From a Patient-Level Pooled Analysis of the REPLACE-2 (Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trials

    NARCIS (Netherlands)

    Mehran, Roxana; Pocock, Stuart; Nikolsky, Eugenia; Dangas, George D.; Clayton, Tim; Claessen, Bimmer E.; Caixeta, Adriano; Feit, Frederick; Manoukian, Steven V.; White, Harvey; Bertrand, Michel; Ohman, E. Magnus; Parise, Helen; Lansky, Alexandra J.; Lincoff, A. Michael; Stone, Gregg W.

    2011-01-01

    This study sought to develop a risk score predictive of bleeding in patients undergoing percutaneous coronary intervention (PCI) and to investigate the impact of bleeding on subsequent mortality. Bleeding complications after PCI have been independently associated with early and late mortality. This

  5. Consumer perception and preference for suboptimal food under the emerging practice of expiration date based pricing in supermarkets

    DEFF Research Database (Denmark)

    Aschemann-Witzel, Jessica

    2017-01-01

    Consumers have been found to majorly prefer ‘optimal’ food over ‘suboptimal’ when purchasing food. To provide an incentive for consumers to select suboptimal food and thus decrease food waste in the supply chain, expiration date based pricing is suggested and increasingly applied. However......, individual preferences, and product-related factors. An online survey experiment among 842 Danish consumers realistically mimicked the current market context. Findings reveal that neither communicating budget saving or food waste avoidance nor the product being organic has an influence. However......, there is a gender effect when the practice is communicated as a food waste avoidance action. Consumer’s familiarity with the practice has a significant influence, as has the individual giving importance to the price criterion, age, and education. Food category differences are explored, showing that familiarity...

  6. Adjustment of Eculizumab Dosage Pattern in Patients with Atypical Hemolytic Uremic Syndrome with Suboptimal Response to Standard Treatment Pattern

    Directory of Open Access Journals (Sweden)

    Camino García Monteavaro

    2016-01-01

    Full Text Available In patients with atypical hemolytic uremic syndrome (aHUS, complement blocking by eculizumab rapidly halts the process of thrombotic microangiopathy and it is associated with clear long-term hematologic and renal improvements. Eculizumab treatment consists of a 4-week initial phase with weekly IV administration of 900 mg doses, followed by a maintenance phase with a 1,200 mg dose in the fifth week and every 14±2 days thereafter. We present three patients with aHUS and suboptimal response to eculizumab treatment at the usual administration dosage who showed hematologic and renal improvements after an adjustment in the eculizumab treatment protocol.

  7. Two Liters a Day Keep the Doctor Away? Considerations on the Pathophysiology of Suboptimal Fluid Intake in the Common Population.

    Science.gov (United States)

    Lang, Florian; Guelinckx, Isabelle; Lemetais, Guillaume; Melander, Olle

    2017-01-01

    Suboptimal fluid intake may require enhanced release of antidiuretic hormone (ADH) or vasopressin for the maintenance of adequate hydration. Enhanced copeptin levels (reflecting enhanced vasopressin levels) in 25% of the common population are associated with enhanced risk of metabolic syndrome with abdominal obesity, type 2 diabetes, hypertension, coronary artery disease, heart failure, vascular dementia, cognitive impairment, microalbuminuria, chronic kidney disease, inflammatory bowel disease, cancer, and premature mortality. Vasopressin stimulates the release of glucocorticoids which in turn up-regulate the serum- and glucocorticoid-inducible kinase 1 (SGK1). Moreover, dehydration upregulates the transcription factor NFAT5, which in turn stimulates SGK1 expression. SGK1 is activated by insulin, growth factors and oxidative stress via phosphatidylinositide-3-kinase, 3-phosphoinositide-dependent kinase PDK1 and mTOR. SGK1 is a powerful stimulator of Na+/K+-ATPase, carriers (e.g. the Na+,K+,2Cl- cotransporter NKCC, the NaCl cotransporter NCC, the Na+/H+ exchanger NHE3, and the Na+ coupled glucose transporter SGLT1), and ion channels (e.g. the epithelial Na+ channel ENaC, the Ca2+ release activated Ca2+ channel Orai1 with its stimulator STIM1, and diverse K+ channels). SGK1 further participates in the regulation of the transcription factors nuclear factor kappa-B NFκB, p53, cAMP responsive element binding protein (CREB), activator protein-1, and forkhead transcription factor FKHR-L1 (FOXO3a). Enhanced SGK1 activity fosters the development of hypertension, obesity, diabetes, thrombosis, stroke, inflammation including inflammatory bowel disease and autoimmune disease, cardiac fibrosis, proteinuria, renal failure as well as tumor growth. The present brief review makes the case that suboptimal fluid intake in the common population may enhance vasopressin and glucocorticoid levels thus up-regulating SGK1 expression and favouring the development of SGK1 related

  8. Hyperplastic obesity and liver steatosis as long-term consequences of suboptimal in vitro culture of mouse embryos.

    Science.gov (United States)

    Serrano, Antonia; Decara, Juan M; Fernández-González, Raúl; López-Cardona, Angela P; Pavón, Francisco J; Orio, Laura; Alen, Francisco; Gutiérrez-Adán, Alfonso; de Fonseca, Fernando Rodríguez

    2014-08-01

    In the present study, we identify and describe an obese phenotype in mice as a long-term consequence of a suboptimal in vitro culture that resulted from the addition of fetal calf serum (FCS) into the culture medium. Mice produced with FCS displayed a high mortality rate (approximately 55% versus 15% in control mice within 20 mo) and increased sensitivity to the development of obesity in adulthood when fed either a standard or a high-fat diet. These mice developed hyperplastic obesity that was characterized by a significant expansion of the fat pads (approximately 25% and 32% higher body weight in male and female mice over controls, respectively) with unchanged adipocyte size. We observed a sexual dimorphism in the development of obesity in the mice produced with FCS. Whereas the female mice displayed hypertension, hyperleptinemia, and fatty liver, the male mice only displayed glucose intolerance. The mRNA expression of metabolically relevant genes in the adipose tissue was also affected. The males produced with FCS expressed higher mRNA levels of the genes that activate fatty acid oxidation (peroxisome proliferator-activated receptor alpha [Ppara, PPARalpha] and acyl-CoA oxidase 1 [Acox1, ACOX1]) and thermogenesis (uncoupling protein 1 [Ucp1, UCP1]), which may counteract the metabolic phenotype. Conversely, the females produced with FCS generally expressed lower levels of these metabolic genes. In the females, the obese phenotype was associated with inhibition of the lipogenic pathway (peroxisome proliferator-activated receptor gamma [Pparg, PPARgamma] and fatty acid synthase [Fasn, FAS]), indicating a saturation of the storage capacity of the adipose tissue. Overall, our data indicate that the exposure to suboptimal in vitro culture conditions can lead to the sexually dimorphic development of obesity in adulthood. © 2014 by the Society for the Study of Reproduction, Inc.

  9. Sickness presenteeism predicts suboptimal self-rated health and sickness absence: a nationally representative study of the Swedish working population.

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    Marina Taloyan

    Full Text Available BACKGROUND: Earlier studies have suggested that sickness presenteeism (SP may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers. METHODS: Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR with 95% confidence intervals (CI were calculated using logistic regression. RESULTS: Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12, also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06. Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health. CONCLUSION: The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.

  10. Sickness Presenteeism Predicts Suboptimal Self-Rated Health and Sickness Absence: A Nationally Representative Study of the Swedish Working Population

    Science.gov (United States)

    Taloyan, Marina; Aronsson, Gunnar; Leineweber, Constanze; Magnusson Hanson, Linda; Alexanderson, Kristina; Westerlund, Hugo

    2012-01-01

    Background Earlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers. Methods Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression. Results Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98–7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30–2.06). Those who reported 1–7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health. Conclusion The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health. PMID:22984547

  11. Two Liters a Day Keep the Doctor Away? Considerations on the Pathophysiology of Suboptimal Fluid Intake in the Common Population

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    Florian Lang

    2017-08-01

    Full Text Available Suboptimal fluid intake may require enhanced release of antidiuretic hormone (ADH or vasopressin for the maintenance of adequate hydration. Enhanced copeptin levels (reflecting enhanced vasopressin levels in 25% of the common population are associated with enhanced risk of metabolic syndrome with abdominal obesity, type 2 diabetes, hypertension, coronary artery disease, heart failure, vascular dementia, cognitive impairment, microalbuminuria, chronic kidney disease, inflammatory bowel disease, cancer, and premature mortality. Vasopressin stimulates the release of glucocorticoids which in turn up-regulate the serum- and glucocorticoid-inducible kinase 1 (SGK1. Moreover, dehydration upregulates the transcription factor NFAT5, which in turn stimulates SGK1 expression. SGK1 is activated by insulin, growth factors and oxidative stress via phosphatidylinositide-3-kinase, 3-phosphoinositide-dependent kinase PDK1 and mTOR. SGK1 is a powerful stimulator of Na+/K+-ATPase, carriers (e.g. the Na+,K+,2Cl- cotransporter NKCC, the NaCl cotransporter NCC, the Na+/H+ exchanger NHE3, and the Na+ coupled glucose transporter SGLT1, and ion channels (e.g. the epithelial Na+ channel ENaC, the Ca2+ release activated Ca2+ channel Orai1 with its stimulator STIM1, and diverse K+ channels. SGK1 further participates in the regulation of the transcription factors nuclear factor kappa-B NFκB, p53, cAMP responsive element binding protein (CREB, activator protein-1, and forkhead transcription factor FKHR-L1 (FOXO3a. Enhanced SGK1 activity fosters the development of hypertension, obesity, diabetes, thrombosis, stroke, inflammation including inflammatory bowel disease and autoimmune disease, cardiac fibrosis, proteinuria, renal failure as well as tumor growth. The present brief review makes the case that suboptimal fluid intake in the common population may enhance vasopressin and glucocorticoid levels thus up-regulating SGK1 expression and favouring the development of SGK1

  12. High Prevalence of Suboptimal Vitamin D Status and Bone Loss in Adult Short Bowel Syndrome Even After Weaning Off Parenteral Nutrition.

    Science.gov (United States)

    Fan, Shengxian; Ni, Xiaodong; Wang, Jian; Zhang, Yongliang; Tao, Shen; Kong, Wencheng; Li, Yousheng; Li, Jieshou

    2017-04-01

    Previous studies have noticed the high incidence of suboptimal vitamin D (VtD) status and bone loss in short bowel syndrome (SBS) with parenteral nutrition (PN) dependence. However, limited data have focused on adult SBS without PN dependence. Therefore, our objective was to investigate the incidence and risk factors of suboptimal VtD status and bone loss in adult SBS even after weaning off PN. We performed a prospective study of 60 adult patients with SBS. Serum 25-hydroxyvitamin D (25-OHD) was measured by radioimmunoassay. Bone mineral density (BMD) was measured using dual-energy x-ray absorptiometry (DEXA). Medical records and various laboratory parameters were collected in all participants. Suboptimal VtD status was identified in all individuals, including 3 (5.0%) with VtD insufficiency and 57 (95.0%) with VtD deficiency. Residual small bowel length (B, 0.072, P = .001) and duration of SBS (B, -0.066, P = .020) were both significantly correlated with suboptimal VtD levels. Overall, only 2 patients presented a normal BMD; osteopenia and osteoporosis were noted in 41 (68.3%) and 17 (28.3%) individuals, respectively. Low 25-OHD concentration was associated with a decreased BMD (B, 0.065, P = .029). There were no other demographic characteristics or clinical examinations associated with suboptimal VtD levels and bone loss. Suboptimal VtD status and bone loss were common in adult SBS even after weaning off PN. Despite routine oral VtD supplementation, most patients did not achieve satisfactory status. This emphasizes the critical importance of routine surveillance of 25-OHD and BMD, as well as consideration of alternative methods of supplementation after weaning off PN.

  13. High T-cell immune activation and immune exhaustion among individuals with suboptimal CD4 recovery after 4 years of antiretroviral therapy in an African cohort

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    Colebunders Robert

    2011-02-01

    Full Text Available Abstract Background Antiretroviral therapy (ART partially corrects immune dysfunction associated with HIV infection. The levels of T-cell immune activation and exhaustion after long-term, suppressive ART and their correlation with CD4 T-cell count reconstitution among ART-treated patients in African cohorts have not been extensively evaluated. Methods T-cell activation (CD38+HLA-DR+ and immune exhaustion (PD-1+ were measured in a prospective cohort of patients initiated on ART; 128 patient samples were evaluated and subcategorized by CD4 reconstitution after long-term suppressive treatment: Suboptimal [median CD4 count increase 129 (-43-199 cells/μl], N = 34 ], optimal [282 (200-415 cells/μl, N = 64] and super-optimal [528 (416-878 cells/μl, N = 30]. Results Both CD4+ and CD8 T-cell activation was significantly higher among suboptimal CD4 T-cell responders compared to super-optimal responders. In a multivariate model, CD4+CD38+HLADR+ T-cells were associated with suboptimal CD4 reconstitution [AOR, 5.7 (95% CI, 1.4-23, P = 0.014]. T-cell exhaustion (CD4+PD1+ and CD8+PD1+ was higher among suboptimal relative to optimal (P P = 0.022]. Conclusion T-cell activation and exhaustion persist among HIV-infected patients despite long-term, sustained HIV-RNA viral suppression. These immune abnormalities were associated with suboptimal CD4 reconstitution and their regulation may modify immune recovery among suboptimal responders to ART.

  14. Rootstock Sub-Optimal Temperature Tolerance Determines Transcriptomic Responses after Long-Term Root Cooling in Rootstocks and Scions of Grafted Tomato Plants.

    Science.gov (United States)

    Ntatsi, Georgia; Savvas, Dimitrios; Papasotiropoulos, Vassilis; Katsileros, Anastasios; Zrenner, Rita M; Hincha, Dirk K; Zuther, Ellen; Schwarz, Dietmar

    2017-01-01

    Grafting of elite cultivars onto tolerant rootstocks is an advanced strategy to increase tomato tolerance to sub-optimal temperature. However, a detailed understanding of adaptive mechanisms to sub-optimal temperature in rootstocks and scions of grafting combinations on a physiological and molecular level is lacking. Here, the commercial cultivar Kommeet was grafted either onto 'Moneymaker' (sensitive) or onto the line accession LA 1777 of Solanum habrochaites (tolerant). Grafted plants were grown in NFT-system at either optimal (25°C) or sub-optimal (15°C) temperatures in the root environment with optimal air temperature (25°C) for 22 days. Grafting onto the differently tolerant rootstocks caused differences in shoot fresh and dry weight, total leaf area and dry matter content of roots, in stomatal conductance and intercellular CO2 and guaiacol peroxidase activity but not in net photosynthesis, sugar, starch and amino acid content, lipid peroxidation and antioxidant enzyme activity. In leaves, comparative transcriptome analysis identified 361 differentially expressed genes (DEG) responding to sub-optimal root temperature when 'Kommeet' was grafted onto the sensitive but no when grafted onto the tolerant rootstock. 1509 and 2036 DEG responding to sub-optimal temperature were identified in LA 1777 and 'Moneymaker' rootstocks, respectively. In tolerant rootstocks down-regulated genes were enriched in main stress-responsive functional categories and up-regulated genes in cellulose synthesis suggesting that cellulose synthesis may be one of the main adaptation mechanisms to long-term sub-optimal temperature. Down-regulated genes of the sensitive rootstock showed a similar response, but functional categories of up-regulated genes pointed to induced stress responses. Rootstocks of the sensitive cultivar Moneymaker showed in addition an enrichment of up-regulated genes in the functional categories fatty acid desaturation, phenylpropanoids, biotic stress, cytochrome P

  15. Rootstock Sub-Optimal Temperature Tolerance Determines Transcriptomic Responses after Long-Term Root Cooling in Rootstocks and Scions of Grafted Tomato Plants

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    Georgia Ntatsi

    2017-06-01

    Full Text Available Grafting of elite cultivars onto tolerant rootstocks is an advanced strategy to increase tomato tolerance to sub-optimal temperature. However, a detailed understanding of adaptive mechanisms to sub-optimal temperature in rootstocks and scions of grafting combinations on a physiological and molecular level is lacking. Here, the commercial cultivar Kommeet was grafted either onto ‘Moneymaker’ (sensitive or onto the line accession LA 1777 of Solanum habrochaites (tolerant. Grafted plants were grown in NFT-system at either optimal (25°C or sub-optimal (15°C temperatures in the root environment with optimal air temperature (25°C for 22 days. Grafting onto the differently tolerant rootstocks caused differences in shoot fresh and dry weight, total leaf area and dry matter content of roots, in stomatal conductance and intercellular CO2 and guaiacol peroxidase activity but not in net photosynthesis, sugar, starch and amino acid content, lipid peroxidation and antioxidant enzyme activity. In leaves, comparative transcriptome analysis identified 361 differentially expressed genes (DEG responding to sub-optimal root temperature when ‘Kommeet’ was grafted onto the sensitive but no when grafted onto the tolerant rootstock. 1509 and 2036 DEG responding to sub-optimal temperature were identified in LA 1777 and ‘Moneymaker’ rootstocks, respectively. In tolerant rootstocks down-regulated genes were enriched in main stress-responsive functional categories and up-regulated genes in cellulose synthesis suggesting that cellulose synthesis may be one of the main adaptation mechanisms to long-term sub-optimal temperature. Down-regulated genes of the sensitive rootstock showed a similar response, but functional categories of up-regulated genes pointed to induced stress responses. Rootstocks of the sensitive cultivar Moneymaker showed in addition an enrichment of up-regulated genes in the functional categories fatty acid desaturation, phenylpropanoids

  16. Suboptimal enhancer sequences are required for efficient bovine leukemia virus propagation in vivo: implications for viral latency.

    Science.gov (United States)

    Merezak, C; Pierreux, C; Adam, E; Lemaigre, F; Rousseau, G G; Calomme, C; Van Lint, C; Christophe, D; Kerkhofs, P; Burny, A; Kettmann, R; Willems, L

    2001-08-01

    Repression of viral expression is a major strategy developed by retroviruses to escape from the host immune response. The absence of viral proteins (or derived peptides) at the surface of an infected cell does not permit the establishment of an efficient immune attack. Such a strategy appears to have been adopted by animal oncoviruses such as bovine leukemia virus (BLV) and human T-cell leukemia virus (HTLV). In BLV-infected animals, only a small fraction of the infected lymphocytes (between 1 in 5,000 and 1 in 50,000) express large amounts of viral proteins; the vast majority of the proviruses are repressed at the transcriptional level. Induction of BLV transcription involves the interaction of the virus-encoded Tax protein with the CREB/ATF factors; the resulting complex is able to interact with three 21-bp Tax-responsive elements (TxRE) located in the 5' long terminal repeat (5' LTR). These TxRE contain cyclic AMP-responsive elements (CRE), but, remarkably, the "TGACGTCA" consensus is never strictly conserved in any viral strain (e.g.,AGACGTCA, TGACGGCA, TGACCTCA). To assess the role of these suboptimal CREs, we introduced a perfect consensus sequence within the TxRE and showed by gel retardation assays that the binding efficiency of the CREB/ATF proteins was increased. However, trans-activation of a luciferase-based reporter by Tax was not affected in transient transfection assays. Still, in the absence of Tax, the basal promoter activity of the mutated LTR was increased as much as 20-fold. In contrast, mutation of other regulatory elements within the LTR (the E box, NF-kappa B, and glucocorticoid- or interferon-responsive sites [GRE or IRF]) did not induce a similar alteration of the basal transcription levels. To evaluate the biological relevance of these observations made in vitro, the mutations were introduced into an infectious BLV molecular clone. After injection into sheep, it appeared that all the recombinants were infectious in vivo and did not revert

  17. A novel tool to assess available hydrological information and the occurrence of sub-optimal water allocation decisions in large irrigation districts

    NARCIS (Netherlands)

    Kaune, Alexander; Werner, Micha; Rodríguez, Erasmo; Karimi, Poolad; Fraiture, de Charlotte

    2017-01-01

    Hydrological information on water availability and demand is vital for sound water allocation decisions in irrigation districts, particularly in times of water scarcity. However, water allocation decisions are often taken based on uncertain hydrological information, which may lead to sub-optimal

  18. Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type 1 diabetes; a randomized controlled trial

    NARCIS (Netherlands)

    Hermanides, J.; Nørgaard, K.; Bruttomesso, D.; Mathieu, C.; Frid, A.; Dayan, C. M.; Diem, P.; Fermon, C.; Wentholt, I. M. E.; Hoekstra, J. B. L.; DeVries, J. H.

    2011-01-01

    To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes. In this investigator-initiated multi-centre trial (the Eurythmics Trial) in eight outpatient centres in Europe, we randomized 83 patients with

  19. The effect of plant-based diet and suboptimal environmental conditions on digestive function and diet-induced enteropathy in rainbow trout (Oncorhynchus mykiss)

    NARCIS (Netherlands)

    Mosberian-Tanha, P.; Schrama, J.W.; Landsverk, T.; Mydland, L.T.; Øverland, M.

    2017-01-01

    This experiment investigated intestinal enteropathy and digestive function of rainbow trout challenged with soybean meal-based diet (SBM) at optimal or suboptimal environments created by normal or reduced water flow, respectively. Oxygen level remained above 7 mg L-1 for optimal environment and

  20. Physician, organizational, and patient factors associated with suboptimal blood pressure mManagement in Type 2 diabetic patients in primary care

    NARCIS (Netherlands)

    Schaars, CF; Denig, P; Kasje, WN; Stewart, RE; Wolffenbuttel, BHR; Haaijer-Ruskamp, FM

    OBJECTIVE - To assess the quality of hypertension care in patients with type 2 diabetes in general practice and identify physician, organizational, and patient factors associated with suboptimal care. RESEARCH DESIGN AND METHODS - Data from 895 randomly selected diabetic patients were extracted from

  1. Effects of feeding frequency on apparent energy and nutrient digestibility/availability of channel catfish, Ictalurus punctatus, reared at optimal and suboptimal temperatures

    Science.gov (United States)

    This study examined the effects of feeding frequency (daily versus every other day [EOD]) on nutrient digestibility/availability of channel catfish, Ictalurus punctatus, reared at optimal (30 C) and suboptimal (24 C) temperatures. A 28% protein practical diet was used as the test diet, and chromic o...

  2. Sub-optimal vitamin B-12 levels among ART-naive HIV-positive individuals in an urban cohort in Uganda.

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    Aggrey S Semeere

    Full Text Available Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART naïve adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals' Joint AIDS Program (MJAP or the Infectious Diseases Institute (IDI clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200-900. Sub-optimal vitamin B-12 levels (<300 pg/ml were found in 75/204 (36.8%. Twenty-one of 204 (10.3% had vitamin B-12 deficiency (<200 pg/ml while 54/204 (26.5% had marginal depletion (200-300 pg/ml. Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1-5.6, P=0.03. Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (± 5.1 vs. 83 fl (± 8.4 vs. 82 fl (± 8.4 for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P=0.017. Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (± 27.1 vs. 29.4 months (± 23.8; P=0.02. Participants eligible for ART (CD4<350 cells/µl with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (± 145 vs. 22 (± 115 cells/µl/year, P=0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal

  3. Effects of mannan oligosaccharide and virginiamycin on the cecal microbial community and intestinal morphology of chickens raised under suboptimal conditions.

    Science.gov (United States)

    Pourabedin, Mohsen; Xu, Zhengxin; Baurhoo, Bushansingh; Chevaux, Eric; Zhao, Xin

    2014-05-01

    There is an increasing movement against use of antibiotic growth promoters in animal feed. Prebiotic supplementation is a potential alternative to enhance the host's natural defense through modulation of gut microbiota. In the present study, the effect of mannan oligosaccharide (MOS) and virginiamycin (VIRG) on cecal microbial ecology and intestinal morphology of broiler chickens raised under suboptimal conditions was evaluated. MOS and VIRG induced different bacterial community structures, as revealed by denaturing gradient gel electrophoresis of 16S rDNA. The antibiotic treatment reduced cecal microbial diversity while the community equitability increased. A higher bacterial diversity was observed in the cecum of MOS-supplemented birds. Quantitative polymerase chain reaction results indicated that MOS changed the cecal microbiota in favor of the Firmicutes population but not the Bacteroidetes population. No difference was observed in total bacterial counts among treatments. MOS promoted the growth of Lactobacillus spp. and Bifidobacterium spp. in the cecum and increased villus height and goblet cell numbers in the ileum and jejunum. These results provide a deeper insight into the microbial ecological changes after supplementation of MOS prebiotic in poultry diets.

  4. Plasticity of Tiller Dynamics in Wild Rice Oryza rufipogon Griff.: A Strategy for Resilience in Suboptimal Environments

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    Pravat K. Mohapatra

    2011-01-01

    Full Text Available Rice cultivation in tropical Asia is susceptible to drought and flood and the need is high for stress resistant genes. Wild rice Oryza rufipogon Griff., grows in close sympatric association with cultivated rice in various habitats across the globe and possesses traits for survival under challenging environments. The species adapts according to the level of soil moisture available and modifies phenology, biomass production and grain yield. Variation in tiller dynamics of the species between contrasting environments gives an estimate of the adaptation. The species possesses AA genome, which permits genetic compatibility for cross breeding with cultivated rice. Utility of the species as possible repository of stress resistant genes is evaluated in this review by examining variation in assimilate partitioning between different classes of tillers of ecotypes growing across a gradation of habitats against background knowledge available for cultivated rice. Models have been constructed to explain mechanisms of tillering and tiller dynamics, and reveal the genotypic permissibility for resilience in sub-optimal environments. It is concluded that environmentally cued alteration in assimilate production and partitioning mask genetic potential for tiller production and survival. Tiller number in excess of resource capacity is corrected by senescence of late-tillers possibly through an ethylene-mediated signal.

  5. Cost-effectiveness of extended-release methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder sub-optimally treated with immediate release methylphenidate.

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    Jurjen van der Schans

    Full Text Available Attention-Deficit/Hyperactivity Disorder (ADHD is a common psychiatric disorder in children and adolescents. Immediate-release methylphenidate (IR-MPH is the medical treatment of first choice. The necessity to use several IR-MPH tablets per day and associated potential social stigma at school often leads to reduced compliance, sub-optimal treatment, and therefore economic loss. Replacement of IR-MPH with a single-dose extended release (ER-MPH formulation may improve drug response and economic efficiency.To evaluate the cost-effectiveness from a societal perspective of a switch from IR-MPH to ER-MPH in patients who are sub-optimally treated.A daily Markov-cycle model covering a time-span of 10 years was developed including four different health states: (1 optimal response, (2 sub-optimal response, (3 discontinued treatment, and (4 natural remission. ER-MPH options included methylphenidate osmotic release oral system (MPH-OROS and Equasym XL/Medikinet CR. Both direct costs and indirect costs were included in the analysis, and effects were expressed as quality-adjusted life years (QALYs. Univariate, multivariate as well as probabilistic sensitivity analysis were conducted and the main outcomes were incremental cost-effectiveness ratios.Switching sub-optimally treated patients from IR-MPH to MPH-OROS or Equasym XL/Medikinet CR led to per-patient cost-savings of €4200 and €5400, respectively, over a 10-year treatment span. Sensitivity analysis with plausible variations of input parameters resulted in cost-savings in the vast majority of estimations.This study lends economic support to switching patients with ADHD with suboptimal response to short-acting IR-MPH to long-acting ER-MPH regimens.

  6. Cost-effectiveness of extended-release methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder sub-optimally treated with immediate release methylphenidate.

    Science.gov (United States)

    van der Schans, Jurjen; Kotsopoulos, Nikos; Hoekstra, Pieter J; Hak, Eelko; Postma, Maarten J

    2015-01-01

    Attention-Deficit/Hyperactivity Disorder (ADHD) is a common psychiatric disorder in children and adolescents. Immediate-release methylphenidate (IR-MPH) is the medical treatment of first choice. The necessity to use several IR-MPH tablets per day and associated potential social stigma at school often leads to reduced compliance, sub-optimal treatment, and therefore economic loss. Replacement of IR-MPH with a single-dose extended release (ER-MPH) formulation may improve drug response and economic efficiency. To evaluate the cost-effectiveness from a societal perspective of a switch from IR-MPH to ER-MPH in patients who are sub-optimally treated. A daily Markov-cycle model covering a time-span of 10 years was developed including four different health states: (1) optimal response, (2) sub-optimal response, (3) discontinued treatment, and (4) natural remission. ER-MPH options included methylphenidate osmotic release oral system (MPH-OROS) and Equasym XL/Medikinet CR. Both direct costs and indirect costs were included in the analysis, and effects were expressed as quality-adjusted life years (QALYs). Univariate, multivariate as well as probabilistic sensitivity analysis were conducted and the main outcomes were incremental cost-effectiveness ratios. Switching sub-optimally treated patients from IR-MPH to MPH-OROS or Equasym XL/Medikinet CR led to per-patient cost-savings of €4200 and €5400, respectively, over a 10-year treatment span. Sensitivity analysis with plausible variations of input parameters resulted in cost-savings in the vast majority of estimations. This study lends economic support to switching patients with ADHD with suboptimal response to short-acting IR-MPH to long-acting ER-MPH regimens.

  7. CA 19-9 to peritoneal carcinomatosis index (PCI) ratio is prognostic in patients with epithelial appendiceal mucinous neoplasms and peritoneal dissemination undergoing cytoreduction surgery and intraperitoneal chemotherapy: A retrospective cohort study.

    Science.gov (United States)

    Kozman, Mathew A; Fisher, Oliver M; Rebolledo, Bree-Anne J; Valle, Sarah J; Alzahrani, Nayef; Liauw, Winston; Morris, David L

    2017-12-01

    Serum tumour levels have been shown to be prognostic in patients with epithelial appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei (PMP)). A singular index which incorporates both tumour activity (as depicted by serum tumour marker levels) and tumour volume (as depicted by peritoneal carcinomatosis index (PCI)), may give a more precise surrogate of tumour biological behaviour. The prognostic implication of this index has not yet been reported. A retrospective cohort study of all patients with PMP managed from 1996 to 2016 with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) was performed by analysing the survival effect of the ratio of preoperative serum CEA, CA19.9 and CA125 to PCI. Three hundred and eighty-six patients were included. In patients with low-grade PMP, elevated CA19-9/PCI ratio resulted in poorer median overall survival times (104 months vs NR, 95%CI 83 - NR, log-rank p < 0.001) and was an independent predictor of reduced overall survival on multivariable analysis (adjusted HR 5.60, 95%CI 1.60-19.68, p = 0.007). In patients with high-grade PMP, no statistically significant difference in survival was recognised. CA19-9/PCI ratio is an independent prognostic factor for overall survival in patients with low-grade PMP undergoing CRS and IPC. By accounting for both tumour activity and tumour volume simultaneously, this novel index behaves as a surrogate of tumour biology and provides a useful adjunct for decisions regarding treatment allocation in this patient group. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  8. Pharmacokinetic and pharmacodynamic effects of elinogrel: results of the platelet function substudy from the intravenous and oral administration of elinogrel to evaluate tolerability and efficacy in nonurgent percutaneous coronary intervention patients (INNOVATE-PCI) trial.

    Science.gov (United States)

    Angiolillo, Dominick J; Welsh, Robert C; Trenk, Dietmar; Neumann, Franz-Josef; Conley, Pamela B; McClure, Matthew W; Stephens, Gillian; Kochman, Janusz; Jennings, Lisa K; Gurbel, Paul A; Wójcik, Jarosław; Dabrowski, Marek; Saucedo, Jorge F; Stumpf, Juergen; Buerke, Michael; Broderick, Samuel; Harrington, Robert A; Rao, Sunil V

    2012-06-01

    Elinogrel is the only selective, competitive and reversible platelet P2Y(12) inhibitor available in both intravenous (IV) and oral formulations. This substudy of the Intravenous and Oral Administration of Elinogrel to Evaluate Tolerability and Efficacy in Nonurgent Percutaneous Coronary Intervention patients (INNOVATE-PCI) trial evaluated the pharmacokinetic and pharmacodynamic effects of two dosing regimens of IV followed by oral elinogrel (120 mg IV plus 100 mg oral twice daily; 120 mg IV plus 150 mg oral twice daily) versus standard clopidogrel therapy (300-600 mg oral loading dose plus 75 mg oral maintenance dose) in 56 patients undergoing nonurgent PCI. At time of randomization, 71.4% (40/56) of patients were using maintenance clopidogrel therapy. In the acute phase, an IV bolus of elinogrel achieved more rapid and potent antiplatelet effects compared with clopidogrel, which were sustained during the transition from the IV to the oral formulation in the first 24 hours of the peri-PCI period. During chronic therapy, elinogrel achieved similar levels of platelet reactivity compared with clopidogrel before the next oral dose and, although platelet reactivity was lower with elinogrel up to 6 hours after daily oral maintenance dosing, these differences were not statistically significant. These pharmacodynamic effects matched the pharmacokinetic profile of elinogrel. There were no differences in pharmacodynamic and pharmacokinetic effects between the two elinogrel dosing regimens. Compared with clopidogrel, the combination of IV and oral elinogrel achieves more rapid and enhanced antiplatelet effects that were sustained through the transition to oral elinogrel in the peri-PCI period, but these were not significant during chronic dosing in this pilot investigation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00751231.

  9. Randomized comparison of new dual-antiplatelet therapy (aspirin, prasugrel) and triple-antiplatelet therapy (aspirin, clopidogrel, cilostazol) using P2Y12 point-of-care assay in patients with STEMI undergoing primary PCI.

    Science.gov (United States)

    Yang, Tae-Hyun; Jin, Han-Young; Choi, Kyu-Nam; Do, Ungjeong; Kim, Hyung Jun; Chung, Sang-Ryul; Seo, Jeong-Sook; Jang, Jae-Sik; Kim, Dae-Kyeong; Kim, Dong-Soo

    2013-09-20

    Both new dual antiplatelet therapy (DAT; aspirin and prasugrel) and triple antiplatelet therapy (TAT; aspirin, clopidogrel and cilostazol) are more potent than classic DAT (aspirin and clopidogrel). We compared the antiplatelet efficacy between new DAT and TAT in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary percutaneous coronary intervention (PCI). Forty patients who were eligible for primary PCI were prospectively randomized to DAT group (n=20) or TAT group (n=20) immediately after hospital arrival. The primary end point was P2Y12 reaction unit (PRU) determined with the VerifyNow P2Y12 point-of-care assay at the time of discharge. PRU value at discharge was significantly lower in patients receiving DAT compared with that of TAT (84.5 ± 44.7 vs. 128.4 ± 74.9, p=0.032). Percent platelet inhibition was significantly higher for DAT compared with TAT at discharge (72.1 ± 12.2 vs. 57.5 ± 23.5, p=0.020). Inter-patient variability of PRU values at discharge was significantly smaller in patient taking DAT compared with TAT (p=0.026). A new DAT is more potent antiplatelet therapy than TAT in patients with STEMI undergoing primary PCI. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Triple Antithrombotic Therapy after Percutaneous Coronary Intervention (PCI in Patients with Indication for Oral Anticoagulation: Data from a Single Center Registry.

    Directory of Open Access Journals (Sweden)

    Dawid L Staudacher

    Full Text Available Antithrombotic therapy consisting of a dual anti-platelet therapy (DAPT and oral anti-coagulation (OAC with a vitamin k antagonist is often referred to as triple therapy. This combined anticoagulation is applied in patients undergoing coronary artery stent implantation while also having an indication for OAC. Triple therapy increases the risk for bleeding events compared to either DAPT or OAC alone and thereby might be associated with adverse outcomes. Clinical data on the frequency of bleeding events in patients on triple therapy from clinical trials derives from pre-selected patients and may differ from the real world patients. We report data on patient characteristics and bleeding incidence of patients dismissed on triple therapy from a single university hospital. Within the time span from January 2000 to December 2012, we identified a total of 213 patients undergoing PCI who were prescribed a triple therapy for at least 4 weeks (representing 0.86% of all patients treated. The usage of triple therapy significantly increased over the observed time period. The average CHA2DS2-VASc Score was 3.1 ± 1.1 with an average HAS-BLED score of 2.5 ± 0.86 representing a high-risk group for thromboembolic events as well as considerable risk for bleeding events. An on-treatment bleeding incidence of 9.4% was detected, with gastrointestinal and airway bleeding being the most frequent (5.1% and 1.4%, respectively. This is consistent with data from clinical trials and confirms the high risk of bleeding in patients on DAPT plus OAC. 29.0% of all patients receiving triple therapy had an indication for OAC other than non-valvular atrial fibrillation. This substantial patient group is underrepresented by clinical trials and needs further attention.

  11. Defining predictive values using three different platelet function tests for CYP2C19 phenotype status on maintenance dual antiplatelet therapy after PCI.

    Science.gov (United States)

    Zhang, Hong-Zhe; Kim, Moo Hyun; Han, Jin-Yeong; Jeong, Young-Hoon

    2014-01-01

    Published data suggests that the presence of CYP2C19*2 or *3 loss of function (LOF) alleles is indicative of increased platelet aggregation and a higher risk of adverse cardiovascular events after clopidogrel administration. We sought to determine cut-off values using three different assays for prediction of the CYP2C19 phenotype in Korean percutaneous coronary intervention (PCI) patients. We enrolled 244 patients with drug-eluting stent implantation who were receiving clopidogrel and aspirin maintenance therapy for one month or more. Platelet reactivity was assessed with light transmittance aggregometry (LTA), multiple electrode aggregometry (MEA) and the VerifyNow P2Y12 assay (VN). The CYP2C19 genotype was analyzed by polymerase chain reaction (PCR) and snapshot method. The frequency of CYP2C19 LOF allele carriers was 58.6%. The cut-off values from LTA, MEA and VerifyNow for the identification of LOF allele carriers were as follows: 10 µM ADP-induced LTA ≥ 48 %, VN>242 PRU and MEA ≥ 37 U. Between the three tests, correlation was higher between LTA vs. VN assays (r=0.69) and LTA vs. MEA (r=0.56), with moderate agreement (κ=0.46 and κ=0.46), but between VN assay and MEA, both devices using whole blood showed a lower correlation (r=0.42) and agreement (κ=0.3). Our results provide guidance regarding cut-off levels for LTA, VerifyNow and MEA assays to detect the CYP2C19 LOF allele in patients during dual antiplatelet maintenance therapy.

  12. Experimental techniques; Techniques experimentales

    Energy Technology Data Exchange (ETDEWEB)

    Roussel-Chomaz, P. [GANIL CNRS/IN2P3, CEA/DSM, 14 - Caen (France)

    2007-07-01

    This lecture presents the experimental techniques, developed in the last 10 or 15 years, in order to perform a new class of experiments with exotic nuclei, where the reactions induced by these nuclei allow to get information on their structure. A brief review of the secondary beams production methods will be given, with some examples of facilities in operation or under project. The important developments performed recently on cryogenic targets will be presented. The different detection systems will be reviewed, both the beam detectors before the targets, and the many kind of detectors necessary to detect all outgoing particles after the reaction: magnetic spectrometer for the heavy fragment, detection systems for the target recoil nucleus, {gamma} detectors. Finally, several typical examples of experiments will be detailed, in order to illustrate the use of each detector either alone, or in coincidence with others. (author)

  13. Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Bermúdez-Millán, Angela; Pérez-Escamilla, Rafael; Segura-Pérez, Sofia; Damio, Grace; Chhabra, Jyoti; Osborn, Chandra Y; Wagner, Julie

    2016-10-01

    Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus. We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus. Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation. Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P sleep quality with and without adjustment for age, education, income, marital status, and employment status. Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management

  14. Effects of TCMC on Transformation of Good Health Status to Suboptimal Health Status: A Nested Case-Control Study

    Directory of Open Access Journals (Sweden)

    Tian Wang

    2015-01-01

    Full Text Available To explore the effects of traditional Chinese medicine constitution (TCMC on transformation of good health status to suboptimal health status (SHS, we conducted a nested case-control study among college students in China. During the 18-month mean follow-up time, 543 cases of SHS (42.7% occurred in 1273 healthy students. There was a significant (P=0.000 and marked reduction in SHMS V1.0 total score in the case group at the 18-month follow-up (69.32 ± 5.45 compared with baseline (78.60 ± 4.70, but there was no significant change in the control group. Conditional logistic regression analysis showed that respondents reporting Yin-deficiency and Qi-deficiency were, respectively, 2.247 and 2.198 times more likely to develop SHS, while tendency to Yin-deficiency and tendency to Damp-heat were, respectively, 1.642 and 1.506 times more likely to develop SHS. However, the Balanced Constitution was a significant protective factor (OR 0.649; P<0.05. Altogether, these findings demonstrate that Yin-deficiency, Qi-deficiency, tendency to Yin-deficiency, and tendency to Damp-heat appeared to induce a change in health status to SHS, while the Balanced Constitution seemed to restrain this change. We conclude that regulating the unbalanced TCMC (such as Yin-deficiency and Qi-deficiency may prevent a healthy status developing into SHS or lead to the regression of SHS.

  15. Educational intervention to reduce disease related to sub-optimal basic hygiene in Rwanda: initial evaluation and feasibility study.

    Science.gov (United States)

    Stone, Margaret A; Ndagijimana, Hormisdas

    2018-01-01

    Despite a global reduction in morbidity related to sub-optimal water, sanitation and hygiene, the incidence of such diseases remains a significant problem in sub-Saharan Africa. This study aimed to initially assess the potential effectiveness (primarily in terms of impact on morbidity) of a simple educational intervention delivered in Rwanda. Additionally, we sought to explore feasibility relating to the practicality of evaluating and implementing this type of intervention in a low- and middle-income country. Two districts in Northern Province were purposively selected; one was randomly allocated to receive the intervention, with the other acting as control. The intervention was based on an interactive DVD about basic hygiene. Baseline and follow-up data for incident cases of relevant morbidities were collected from health centre records. Changes were compared between the two districts using descriptive statistics and chi-squared tests. Qualitative data were obtained through observations, discussions and feedback and were analysed thematically. Cases of infection with intestinal worms and parasites were frequently recorded in both districts. For these morbidities, there was a 39% decrease in cases between baseline and follow-up in the intervention district (4995 reduced to 3069), compared to 13% (5002 reduced to 4356) in the control district (p evaluation and implementation, whilst also highlighting problems encountered and possible solutions, in particular, the potential advantages of training local personnel to deliver this type of intervention. This small-scale study has a number of acknowledged limitations which would need to be addressed in a larger study in order to confidently confirm the effectiveness of the intervention. It nevertheless provides evidence suggesting that the educational intervention is promising in terms of a potential impact on health and feasible to deliver and evaluate. These findings indicate that further evaluation and possibly early

  16. Comparison of dry powder versus nebulized beta-agonist in patients with COPD who have suboptimal peak inspiratory flow rate.

    Science.gov (United States)

    Mahler, Donald A; Waterman, Laurie A; Ward, Joseph; Gifford, Alex H

    2014-04-01

    A peak inspiratory flow rate (PIFR) of powder inhaler (DPI) may limit the ability of a patient with chronic obstructive pulmonary disease (COPD) to achieve bronchodilation. The hypothesis was that lung function would be higher with a beta-agonist inhaled via nebulization compared with dry powder in patients with COPD who exhibit a PIFRresist of powder (50 μg) via Diskus. The primary outcome was the change in lung function from baseline at 2 hr as these two inhaled beta-agonists have the similar peak bronchodilator effect as measured by forced expiratory volume in 1 sec (FEV1). Twenty patients (15 females/5 males) with postalbuterol FEV1 of 0.83±0.31 L (38±12% predicted) and PIFRresist of 53±5 L/min completed the study. At 15 min, improvements in FEV1, forced vital capacity (FVC), and IC were significantly higher with arformoterol than with salmeterol. At 2 hr, changes in FVC and IC, but not FEV1, were significantly higher with arformoterol. At visit 3, patient preference was similar for salmeterol Diskus (n=8) and arformoterol solution (n=7), whereas five patients reported no preference. At peak effect (2 hr), volume responses were greater with arfomoterol via nebulizer compared with dry powder salmeterol in patients with COPD who had a PIFRresist of <60 L/min. Bronchodilator therapy via nebulization should be considered in patients with COPD who have a suboptimal PIFRresist against a particular DPI.

  17. Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study.

    Science.gov (United States)

    de Lusignan, S; Belsey, J; Hague, N; Dhoul, N; van Vlymen, J

    2006-12-01

    Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention. To report the PCDQ programme's effect on the cholesterol management in cardiovascular disease. Subjects and methods Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses. Mean cholesterol fell from 4.75 to 4.64 mmol l(-1); patients achieving cholesterol target (< 5 mmol l(-1)) rose from 45.3 to 53.2%. Coronary heart disease patients achieved better control (mean 4.57 mmol l(-1)) than those with stroke (4.87 mmol l(-1)) or peripheral vascular disease (4.93 mmol l(-1)). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91-2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80-2.07), revascularization (OR 1.52, 95% CI 1.33-1.73) and smokers (OR 1.31, 95% CI 1.23-1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45-0.50), females (OR 0.90, 95% CI 0.86-0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34-0.38) were less likely. Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins.

  18. Emotional Freedom Techniques dan Tingkat Kecemasan Pasien yang akan Menjalani Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Weni Widya Shari

    2017-09-01

    Full Text Available Kecemasan yang terjadi pada pasien yang akan dilakukan Percutaneous Coronary Intervention (PCI dapat memperparah kondisi penyakit, memengaruhi status hemodinamik, gangguan imunitas dan gangguan metabolisme yang mengakibatkan suplai oksigen dan perfusi jaringan semakin terganggu. Emotional Freedom Techniques (EFT merupakan salah satu intervensi pilihan, karena berdasarkan beberapa literatur, EFT dapat menurunkan kecemasan, mengatasi kecemasan langsung di bagian korteks serebri serta mengatasi kecemasan berdasarkan akar permasalahannya. Tujuan penelitian untuk mengidentifikasi pengaruh intervensi EFT terhadap tingkat kecemasan pasien yang akan menjalani PCI di RS. X. Peneliti menggunakan metode quasi experimentaldengan rancangan one group pretest dan postest. Jumlah sampel 30 orang dibagi menjadi kelompok intervensi dan kontrol dengan menggunakan teknik concecutive sampling. Kelompok intervensi diberikan EFT selama 15 menit. Sebelum dan sesudah intervensi diukur tingkat kecemasannya dengan menggunakan kuesioner state trait anxiety inventory (STAI-S. Data dianalisis dengan uji t. Hasil menunjukkan terdapat perbedaan yang bermakna antara tingkat kecemasan sebelum dan sesudah intervensi EFT (p<0.05 dan terdapat perbedaan yang bermakna intensitas kecemasan sesudah intervensi antara kelompok intervensi dan kontrol (p<0.05 . Kesimpulan penelitian yaitu EFT dapat menurunkan tingkat kecemasan pada pasien yang akan menjalani PCI. Penggunaan EFT dalam mengatasi kecemasan pasien di ranah kritis merupakan sesuatu yang perlu dipertimbangkan karena berdasarkan bukti empiris, memberikan manfaat, menggunakan teknik yang sederhana, mudah digunakan oleh siapapun, serta tanpa efek samping.

  19. Recanalization strategy for chronic total occlusions with tapered and stiff-tip guidewire. The results of CTO new techniQUE for STandard procedure (CONQUEST) trial.

    Science.gov (United States)

    Mitsudo, Kazuaki; Yamashita, Takehiro; Asakura, Yasushi; Muramatsu, Toshiya; Doi, Osamu; Shibata, Yoshisato; Morino, Yoshihiro

    2008-11-01

    The success rate of percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) lesions varies depending on the guidewire manipulation skills of the operator. The standardization of guidewire technique is very important. A new technique with a new tapered wire (Conquest, Confianza Pro) was tested to verify effectiveness for higher initial success rates and standardization of PCI for CTO. A prospective, multicenter registry was conducted at 6 investigational sites. In the CONQUEST trial, The CTO lesions were treated by using an intermediate guidewire to cross the lesion. If it did not cross, the guidewire was changed to the Conquest guidewire. If it did not cross, "seesaw-wiring" or the "parallel-wire technique" was performed. The primary endpoint was the initial procedural success rate. A total of 110 patients representing 116 CTO lesions were treated from July 2003 through March 2004. The procedural success rate was 86.2% on the first try, and 88.8% on the second try, respectively. The guidewire success rate on the second try was 90.5% during the hospital stay; no deaths, or acute myocardial infarctions were confirmed. Two patients deteriorated into tamponade, and surgical or percutaneous drainage was performed in each patient without any sequelae. A guidewire technique in PCI for CTOs that starts with the intermediate guidewire and moves to the Confianza Pro tapered guidewire, either alone or by performing a see-saw or parallel-wire technique, can achieve a high initial success rate with an acceptably low major complication rate.

  20. Healing of the goat anterior cruciate ligament after a new suture repair technique and bioscaffold treatment

    NARCIS (Netherlands)

    Nguyen, D. Tan; Geel, Jurre; Schulze, Martin; Raschke, Michael J.; Woo, Savio L.-Y.; van Dijk, C. Niek; Blankevoort, Leendert

    2013-01-01

    Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining

  1. Coadministration of Hedera helix L. Extract Enabled Mice to Overcome Insufficient Protection against Influenza A/PR/8 Virus Infection under Suboptimal Treatment with Oseltamivir.

    Directory of Open Access Journals (Sweden)

    Eun-Hye Hong

    Full Text Available Several anti-influenza drugs that reduce disease manifestation exist, and although these drugs provide clinical benefits in infected patients, their efficacy is limited by the emergence of drug-resistant influenza viruses. In the current study, we assessed the therapeutic strategy of enhancing the antiviral efficacy of an existing neuraminidase inhibitor, oseltamivir, by coadministering with the leaf extract from Hedera helix L, commonly known as ivy. Ivy extract has anti-inflammatory, antibacterial, antifungal, and antihelminthic properties. In the present study, we investigated its potential antiviral properties against influenza A/PR/8 (PR8 virus in a mouse model with suboptimal oseltamivir that mimics a poor clinical response to antiviral drug treatment. Suboptimal oseltamivir resulted in insufficient protection against PR8 infection. Oral administration of ivy extract with suboptimal oseltamivir increased the antiviral activity of oseltamivir. Ivy extract and its compounds, particularly hedrasaponin F, significantly reduced the cytopathic effect in PR8-infected A549 cells in the presence of oseltamivir. Compared with oseltamivir treatment alone, coadministration of the fraction of ivy extract that contained the highest proportion of hedrasaponin F with oseltamivir decreased pulmonary inflammation in PR8-infected mice. Inflammatory cytokines and chemokines, including tumor necrosis factor-alpha and chemokine (C-C motif ligand 2, were reduced by treatment with oseltamivir and the fraction of ivy extract. Analysis of inflammatory cell infiltration in the bronchial alveolar of PR8-infected mice revealed that CD11b+Ly6G+ and CD11b+Ly6Cint cells were recruited after virus infection; coadministration of the ivy extract fraction with oseltamivir reduced infiltration of these inflammatory cells. In a model of suboptimal oseltamivir treatment, coadministration of ivy extract fraction that includes hedrasaponin F increased protection against PR8

  2. Coadministration of Hedera helix L. Extract Enabled Mice to Overcome Insufficient Protection against Influenza A/PR/8 Virus Infection under Suboptimal Treatment with Oseltamivir.

    Science.gov (United States)

    Hong, Eun-Hye; Song, Jae-Hyoung; Shim, Aeri; Lee, Bo-Ra; Kwon, Bo-Eun; Song, Hyuk-Hwan; Kim, Yeon-Jeong; Chang, Sun-Young; Jeong, Hyeon Gun; Kim, Jong Geal; Seo, Sang-Uk; Kim, HyunPyo; Kwon, YongSoo; Ko, Hyun-Jeong

    2015-01-01

    Several anti-influenza drugs that reduce disease manifestation exist, and although these drugs provide clinical benefits in infected patients, their efficacy is limited by the emergence of drug-resistant influenza viruses. In the current study, we assessed the therapeutic strategy of enhancing the antiviral efficacy of an existing neuraminidase inhibitor, oseltamivir, by coadministering with the leaf extract from Hedera helix L, commonly known as ivy. Ivy extract has anti-inflammatory, antibacterial, antifungal, and antihelminthic properties. In the present study, we investigated its potential antiviral properties against influenza A/PR/8 (PR8) virus in a mouse model with suboptimal oseltamivir that mimics a poor clinical response to antiviral drug treatment. Suboptimal oseltamivir resulted in insufficient protection against PR8 infection. Oral administration of ivy extract with suboptimal oseltamivir increased the antiviral activity of oseltamivir. Ivy extract and its compounds, particularly hedrasaponin F, significantly reduced the cytopathic effect in PR8-infected A549 cells in the presence of oseltamivir. Compared with oseltamivir treatment alone, coadministration of the fraction of ivy extract that contained the highest proportion of hedrasaponin F with oseltamivir decreased pulmonary inflammation in PR8-infected mice. Inflammatory cytokines and chemokines, including tumor necrosis factor-alpha and chemokine (C-C motif) ligand 2, were reduced by treatment with oseltamivir and the fraction of ivy extract. Analysis of inflammatory cell infiltration in the bronchial alveolar of PR8-infected mice revealed that CD11b+Ly6G+ and CD11b+Ly6Cint cells were recruited after virus infection; coadministration of the ivy extract fraction with oseltamivir reduced infiltration of these inflammatory cells. In a model of suboptimal oseltamivir treatment, coadministration of ivy extract fraction that includes hedrasaponin F increased protection against PR8 infection that could be

  3. Identifying abnormalities in symbiotic development between Trifolium spp. and Rhizobium leguminosarum bv. trifolii leading to sub-optimal and ineffective nodule phenotypes

    Science.gov (United States)

    Melino, V. J.; Drew, E. A.; Ballard, R. A.; Reeve, W. G.; Thomson, G.; White, R. G.; O'Hara, G. W.

    2012-01-01

    Background and Aims Legumes overcome nitrogen limitations by entering into a mutualistic symbiosis with N2-fixing bacteria (rhizobia). Fully compatible associations (effective) between Trifolium spp. and Rhizobium leguminosarum bv. trifolii result from successful recognition of symbiotic partners in the rhizosphere, root hair infection and the formation of nodules where N2-fixing bacteroids reside. Poorly compatible associations can result in root nodule formation with minimal (sub-optimal) or no (ineffective) N2-fixation. Despite the abundance and persistence of strains in agricultural soils which are poorly compatible with the commercially grown clover species, little is known of how and why they fail symbiotically. The aims of this research were to determine the morphological aberrations occurring in sub-optimal and ineffective clover nodules and to determine whether reduced bacteroid numbers or reduced N2-fixing activity is the main cause for the Sub-optimal phenotype. Methods Symbiotic effectiveness of four Trifolium hosts with each of four R. leguminosarum bv. trifolii strains was assessed by analysis of plant yields and nitrogen content; nodule yields, abundance, morphology and internal structure; and bacteroid cytology, quantity and activity. Key Results Effective nodules (Nodule Function 83–100 %) contained four developmental zones and N2-fixing bacteroids. In contrast, Sub-optimal nodules of the same age (Nodule Function 24–57 %) carried prematurely senescing bacteroids and a small bacteroid pool resulting in reduced shoot N. Ineffective-differentiated nodules carried bacteroids aborted at stage 2 or 3 in differentiation. In contrast, bacteroids were not observed in Ineffective-vegetative nodules despite the presence of bacteria within infection threads. Conclusions Three major responses to N2-fixation incompatibility between Trifolium spp. and R. l. trifolii strains were found: failed bacterial endocytosis from infection threads into plant cortical

  4. Discovery, screening and evaluation of a plasma biomarker panel for subjects with psychological suboptimal health state using 1H-NMR-based metabolomics profiles

    OpenAIRE

    Jun-sheng Tian; Xiao-tao Xia; Yan-fei Wu; Lei Zhao; Huan Xiang; Guan-hua Du; Xiang Zhang; Xue-mei Qin

    2016-01-01

    Individuals in the state of psychological suboptimal health keep increasing, only scales and questionnaires were used to diagnose in clinic under current conditions, and symptoms of high reliability and accuracy are destitute. Therefore, the noninvasive and precise laboratory diagnostic methods are needed. This study aimed to develop an objective method through screen potential biomarkers or a biomarker panel to facilitate the diagnosis in clinic using plasma metabolomics. Profiles were based...

  5. Deep anterior lamellar keratoplasty: indications, surgical techniques and complications.

    Science.gov (United States)

    Karimian, Farid; Feizi, Sepehr

    2010-01-01

    The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to conventional PK. This review article describes the indications, different techniques, clinical outcomes and complications of deep anterior LK.

  6. Time-trend analysis on the Framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over the last 17 years: a study from the Mayo Clinic PCI registry.

    Science.gov (United States)

    Lee, Moo-Sik; Flammer, Andreas J; Li, Jing; Lennon, Ryan J; Singh, Mandeep; Holmes, David R; Rihal, Charanjit S; Lerman, Amir

    2014-07-01

    There is a paucity of data on the temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated the secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). CVD risk factors are changed over time. This time-trend analysis from 1994 to 2010 was performed within the Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including the Framingham risk score (FRS), at the time of admission for PCI. During this period, 12,055 patients without a history of CVD (mean age, 65.0 ± 12.4 years, 67% male) underwent PCI at the Mayo Clinic. Age distribution slightly shifted toward older age (P for trend trend trend trend trend <0.001), whereas smoking prevalence did not change. The current study demonstrates that although traditional FRS and its associated predicted 10-year cardiovascular risk declined over time, the prevalence of risk factors increased in patients undergoing PCI. The study suggests the need for a new risk-factor assessment in this patient population. © 2014 Wiley Periodicals, Inc.

  7. No improvement in suboptimal vitamin A status with a randomized, double-blind, placebo-controlled trial of vitamin A supplementation in children with sickle cell disease.

    Science.gov (United States)

    Dougherty, Kelly A; Schall, Joan I; Kawchak, Deborah A; Green, Michael H; Ohene-Frempong, Kwaku; Zemel, Babette S; Stallings, Virginia A

    2012-10-01

    Suboptimal vitamin A status is prevalent in children with type SS sickle cell disease (SCD-SS) and is associated with hospitalizations and poor growth and hematologic status. The supplemental vitamin A dose that optimizes suboptimal vitamin A status in this population is unknown. The efficacy of Recommended Dietary Allowance (RDA) doses (based on age and sex) of vitamin A (300, 400, or 600 μg retinyl palmitate/d) or vitamin A + zinc (10 or 20 mg zinc sulfate/d) compared with placebo to optimize vitamin A status was assessed in children aged 2.0-12.9 y with SCD-SS and a suboptimal baseline serum retinol concentration (children (based on age and sex) failed to improve serum retinol values in either group (vitamin A: n = 23; vitamin A + zinc: n = 18) compared with placebo (n = 21). By 12 mo, the increase (±SD) in serum retinol (3.6 ± 2.8 μg/dL) in those taking 600 μg vitamin A/d was significantly different from the decrease (±SD; -2.8 ± 2.4 μg/dL) in those taking 300 μg/d, which possibly suggests a dose-response relation (P children did not improve serum retinol values in children with SCD-SS, which possibly suggests that higher doses are needed. However, the existence of alternative conclusions emphasizes the need for future research.

  8. Maraviroc Intensification of cART in Patients with Suboptimal Immunological Recovery: A 48-Week, Placebo-Controlled Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Steven F L van Lelyveld

    Full Text Available The immunomodulatory effects of the CCR5-antagonist maraviroc might be beneficial in patients with a suboptimal immunological response, but results of different cART (combination antiretroviral therapy intensification studies are conflicting. Therefore, we performed a 48-week placebo-controlled trial to determine the effect of maraviroc intensification on CD4+ T-cell counts and immune activation in these patients.Double-blind, placebo-controlled, randomized trial.Major inclusion criteria were 1. CD4+ T-cell count <350 cells/μL while at least two years on cART or CD4+ T-cell count <200 cells/μL while at least one year on cART, and 2. viral suppression for at least the previous 6 months. HIV-infected patients were randomized to add maraviroc (41 patients or placebo (44 patients to their cART regimen for 48 weeks. Changes in CD4+ T-cell counts (primary endpoint and other immunological parameters were modeled using linear mixed effects models.No significant differences for the modelled increase in CD4+ T-cell count (placebo 15.3 CD4+ T cells/μL (95% confidence interval (CI [1.0, 29.5] versus maraviroc arm 22.9 CD4+ T cells/μL (95% CI [7.4, 38.5] p = 0.51 or alterations in the expression of markers for T-cell activation, proliferation and microbial translocation were found between the arms. However, maraviroc intensification did increase the percentage of CCR5 expressing CD4+ and CD8+ T-cells, and the plasma levels of the CCR5 ligand MIP-1β. In contrast, the percentage of ex-vivo apoptotic CD8+ and CD4+ T-cells decreased in the maraviroc arm.Maraviroc intensification of cART did not increase CD4+ T-cell restoration or decrease immune activation as compared to placebo. However, ex-vivo T-cell apoptosis was decreased in the maraviroc arm.ClinicalTrials.gov NCT00875368.

  9. Initial Accuracy of HIV Rapid Test Kits Stored in Suboptimal Conditions and Validity of Delayed Reading of Oral Fluid Tests.

    Science.gov (United States)

    Choko, Augustine T; Taegtmeyer, Miriam; MacPherson, Peter; Cocker, Derek; Khundi, McEwen; Thindwa, Deus; Sambakunsi, Rodrick S; Kumwenda, Moses K; Chiumya, Kondwani; Malema, Owen; Makombe, Simon D; Webb, Emily L; Corbett, Elizabeth L

    2016-01-01

    To evaluate the effect of storing commonly used rapid diagnostic tests above manufacturer-recommended temperature (at 37°C), and the accuracy of delayed reading of oral fluid kits with relevance to HIV self-testing programmes. A quality assurance study of OraQuick (OraSure), Determine HIV 1/2™ (Alere) and Uni-Gold™ (Recombigen®). Consecutive adults (≥18y) attending Ndirande Health Centre in urban Blantyre, Malawi in January to April 2012 underwent HIV testing with two of each of the three rapid diagnostic test kits stored for 28 days at either 18°C (optimally-stored) or at 37°C (pre-incubated). Used OraQuick test kits were stored in a laboratory for delayed day 1 and subsequent monthly re-reading was undertaken for one year. Of 378 individuals who underwent parallel testing, 5 (1.3%) were dropped from the final analysis due to discordant or missing reference standard results (optimally-stored Determine and Uni-Gold). Compared to the diagnostic reference standard, OraQuick had a sensitivity of 97.2% (95% CI: 93.6-99.6). There were 7 false negative results among all test kits stored at 37°C and three false negatives among optimally stored kits. Excellent agreement between pre-incubated tests and optimally-stored tests with Kappa values of 1.00 for Determine and Uni-Gold; and 0.97 (95% CI: 0.95; 1.00) for OraQuick were observed. There was high visual stability on re-reading of OraQuick, with only 1/375 pre-incubated and 1/371 optimally-stored OraQuick kits changing from the initial result over 12 months. Erroneous results observed during HIV testing in low income settings are likely to be due to factors other than suboptimal storage conditions. Re-reading returned OraQuick kits may offer a convenient and accurate quality assurance approach, including in HIV self-testing programmes.

  10. Work-Recreation Balance, Health-Promoting Lifestyles and Suboptimal Health Status in Southern China: A Cross-Sectional Study.

    Science.gov (United States)

    Wu, Shengwei; Xuan, Zhengzheng; Li, Fei; Xiao, Wei; Fu, Xiuqiong; Jiang, Pingping; Chen, Jieyu; Xiang, Lei; Liu, Yanyan; Nie, Xiaoli; Luo, Ren; Sun, Xiaomin; Kwan, Hiuyee; Zhao, Xiaoshan

    2016-03-19

    Suboptimal health status (SHS)-an intermediate state between health and illness--refers to functional somatic symptoms that are medically undiagnosed. Although- SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part of work-life balance, and is related to stress which greatly influences health status. We therefore carried out a cross-sectional investigation between 2012 and 2013 within a clustered sample of 24,475 individuals aged 15-60 years from a population in southern China. In so doing, we hoped to illuminate the associations between work-recreation balance conditions, healthy lifestyles, and SHS. Work-recreation balance conditions were categorically defined by frequency ("rarely, sometimes, or always"). Health-Promoting Lifestyle Profile (HPLP-II) was used to evaluate the level of healthy lifestyles, and the medical examination report and Sub-Health Measurement Scale V1.0 (SHMS V1.0) were both used to evaluate health status. The ratio of SHS (46.3%) is higher than health status (18.4%) or disease status (35.3%). Overall, 4.9% of respondents reported the lowest level of work-recreation balance, and they scored lower on both the HPLP-II and SHMS V1.0 compared with those who frequently maintained a work-recreation balance. Significant association was found between work-recreation balance behaviors and healthy lifestyles (p work-recreation balance, individuals whose work-recreation balance was categorically "rare" were 1.69 times as likely to develop SHS (odds ratio (OR): 1.69, 95% confidence interval (CI): 1.49-1.92), and those with infrequent work-recreation balance ("sometimes") were 1.71 times more likely to develop SHS (OR: 1.71, 95% CI: 1.62-1.81). These findings suggest that work-recreation balance conditions are significantly associated with, and seem to be accurate behavioral indicia of a healthy lifestyle. Poor work-recreation balance is associated with

  11. Work-Recreation Balance, Health-Promoting Lifestyles and Suboptimal Health Status in Southern China: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Shengwei Wu

    2016-03-01

    Full Text Available Suboptimal health status (SHS—an intermediate state between health and illness—refers to functional somatic symptoms that are medically undiagnosed. Although SHS has become a great challenge for global public health, very little about its etiology and mechanisms are known. Work-recreation balance is a part of work−life balance, and is related to stress which greatly influences health status. We therefore carried out a cross-sectional investigation between 2012 and 2013 within a clustered sample of 24,475 individuals aged 15−60 years from a population in southern China. In so doing, we hoped to illuminate the associations between work-recreation balance conditions, healthy lifestyles, and SHS. Work-recreation balance conditions were categorically defined by frequency (“rarely, sometimes, or always”. Health-Promoting Lifestyle Profile (HPLP-II was used to evaluate the level of healthy lifestyles, and the medical examination report and Sub-Health Measurement Scale V1.0 (SHMS V1.0 were both used to evaluate health status. The ratio of SHS (46.3% is higher than health status (18.4% or disease status (35.3%. Overall, 4.9% of respondents reported the lowest level of work-recreation balance, and they scored lower on both the HPLP-II and SHMS V1.0 compared with those who frequently maintained a work-recreation balance. Significant association was found between work-recreation balance behaviors and healthy lifestyles (p < 0.001 after demographic adjustment. In comparison with those reporting a frequent work-recreation balance, individuals whose work-recreation balance was categorically “rare” were 1.69 times as likely to develop SHS (odds ratio (OR: 1.69, 95% confidence interval (CI: 1.49–1.92, and those with infrequent work-recreation balance (“sometimes” were 1.71 times more likely to develop SHS (OR: 1.71, 95% CI: 1.62–1.81. These findings suggest that work-recreation balance conditions are significantly associated with, and

  12. Udder infections with Staphylococcus aureus, Streptococcus dysgalactiae, and Streptococcus uberis at calving in dairy herds with suboptimal udder health.

    Science.gov (United States)

    Lundberg, Å; Nyman, A-K; Aspán, A; Börjesson, S; Unnerstad, H Ericsson; Waller, K Persson

    2016-03-01

    Udder infections with Staphylococcus aureus, Streptococcus dysgalactiae, and Streptococcus uberis are common causes of bovine mastitis. To study these pathogens in early lactation, a 12-mo longitudinal, observational study was carried out in 13 herds with suboptimal udder health. The aims of the study were to investigate the occurrence of these pathogens and to identify if presence of the 3 pathogens, and of genotypes within the pathogens, differed with respect to herd, season, and parity. Quarter milk samples, collected at calving and 4 d in milk (DIM), were cultured for the 3 pathogens. Genotyping of staphylococcal and streptococcal isolates was performed using spa typing and pulsed-field gel electrophoresis, respectively. For each of the 3 pathogens, cows with an udder infection at calving or 4 DIM were allocated to 1 of 4 infection types: cleared (pathogen present only at calving), persistent (pathogen present in the same quarter at calving and 4 DIM), new (pathogen present only at 4 DIM), or cleared/new (pathogen present in 1 quarter at calving and in another quarter at 4 DIM). Associations between season or parity and overall occurrence of pathogens or infection types were determined using univariable mixed-effect logistic-regression models and the Fisher's exact test, respectively. The most commonly occurring pathogen was Staph. aureus, followed by Strep. dysgalactiae and Strep. uberis. Persistent infections were the most common infection type among Staph. aureus-infected cows, whereas cleared infections were the most common among Strep. dysgalactiae- and Strep. uberis-positive cows. The proportion of cows with persistent Staph. aureus infections and the proportion of cows having a Strep. uberis infection at calving or 4 DIM were higher in the multiparous cows than in primiparous cows. Infections with Strep. dysgalactiae were less common during the early housing season than during the late housing or pasture seasons, whereas persistent Strep. uberis

  13. Prematriculation variables associated with suboptimal outcomes for the 1994-1999 cohort of US medical school matriculants.

    Science.gov (United States)

    Andriole, Dorothy A; Jeffe, Donna B

    2010-09-15

    The relationship between increasing numbers and diversity of medical school enrollees and the US physician workforce size and composition has not been described. To identify demographic and prematriculation factors associated with medical school matriculants' outcomes. Retrospective study using deidentified data for the 1994-1999 national cohort of 97,445 matriculants who were followed up through March 2, 2009, and had graduated, had withdrawn, or were dismissed. Data were analyzed using multivariable logistic regression to identify factors associated with suboptimal outcomes. Academic withdrawal or dismissal, nonacademic withdrawal or dismissal, and graduation without first-attempt passing scores on the US Medical Licensing Examination Step 1 and/or Step 2 Clinical Knowledge (CK) compared with graduation with first-attempt passing scores on both of the examinations. Of 84,018 matriculants (86.2%), 74,494 graduated and had first-attempt passing scores on both the Step 1 and Step 2 CK (88.7%), 6743 graduated and did not have first-attempt passing scores on the Step 1 and/or Step 2 CK (8.0%), 1049 withdrew or were dismissed for academic reasons (1.2%), and 1732 withdrew or were dismissed for nonacademic reasons (2.1%). Variables associated with greater likelihood of graduation without first-attempt passing scores on the Step 1 and/or Step 2 CK and of academic withdrawal or dismissal, respectively, were (1) Medical College Admission Test scores (scores of 18-20 [2.9% of sample] vs > 29: adjusted odds ratio [AOR], 13.06 [95% confidence interval {CI}, 11.56-14.76] and AOR, 11.08 [95% CI, 8.50-14.45]; scores of 21-23 [5.6% of sample] vs > 29: AOR, 7.52 [95% CI, 6.79-8.33] and AOR, 5.97 [95% CI, 4.68-7.62]; and scores of 24-26 [13.9% of sample] vs > 29: AOR, 4.27 [95% CI, 3.92-4.65] and AOR, 3.56 [95% CI, 2.88-4.40]), (2) race/ethnicity (Asian or Pacific Islander [18.2% of sample] vs white: AOR, 2.15 [95% CI, 2.00-2.32] and AOR, 1.69 [95% CI, 1.37-2.09]; underrepresented

  14. How common and what are the determinants of sub-optimal care for Parkinson's disease patients: the Milton Keynes community study.

    Science.gov (United States)

    Hu, Michele T M; Butterworth, Richard; Kumar, Vasantha; Cooper, Jonathan; Jones, Emma; Catterall, Lesley; Ben-Shlomo, Yoav

    2011-03-01

    Limited data currently exists within the UK addressing the level of Parkinson's disease (PD) healthcare provision. We investigated whether care for PD patients in a UK community met national guidelines, and the determinants of sub-optimal care for this patient group. 340 PD patients were identified from a population of 242,606 (crude prevalence 140 per 100,000 (95% CI 126-156 per 100,000), age-adjusted prevalence 199 per 100,000 (95% CI 178-221 per 100,000)). 248 out of 340 (73%) PD patients identified took part, completing rating scales assessing cognitive, non-motor and sociodemographic variables. 9% of patients had never seen a neurologist for their PD and 18.5% were sub-optimally managed; defined as (a) delay between initial diagnosis and first consultation by a specialist >1 year and (b) patients who had not had specialist PD review for >1 year. Older age, poor cognition and worse mobility were major factors in determining sub-optimal care whilst lower education level and tremor as initial symptom were more modest predictors. 20% of patients had been started on dopaminergic therapies including ergot-derived agonists by their GP prior to referral and less than a third had seen allied health professionals throughout their illness. Further work is required to test whether these findings are generalizable across the country and identify what can be done to ensure equal access to specialist care so that all PD patients have access to best practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Assesment on the performance of electrode arrays using image processing technique

    Science.gov (United States)

    Usman, N.; Khiruddin, A.; Nawawi, Mohd

    2017-08-01

    Interpreting inverted resistivity section is time consuming, tedious and requires other sources of information to be relevant geologically. Image processing technique was used in order to perform post inversion processing which make geophysical data interpretation easier. The inverted data sets were imported into the PCI Geomatica 9.0.1 for further processing. The data sets were clipped and merged together in order to match the coordinates of the three layers and permit pixel to pixel analysis. Dipole-dipole array is more sensitive to resistivity variation with depth in comparison with Werner-Schlumberger and pole-dipole. Image processing serves as good post-inversion tool in geophysical data processing.

  16. Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adults.

    Science.gov (United States)

    Stringham, Nicole Tressa; Holmes, Philip V; Stringham, James M

    2017-02-15

    Oxidative stress and systemic inflammation are the root cause of several deleterious effects of chronic psychological stress. We hypothesize that the antioxidant and anti-inflammatory capabilities of the macular carotenoids (MCs) lutein, zeaxanthin, and meso-zeaxanthin could, via daily supplementation, provide a dietary means of benefit. A total of 59 young healthy subjects participated in a 12-month, double-blind, placebo-controlled trial to evaluate the effects of MC supplementation on blood cortisol, psychological stress ratings, behavioural measures of mood, and symptoms of sub-optimal health. Subjects were randomly assigned to one of three groups: placebo, 13 mg, or 27 mg / day total MCs. All parameters were assessed at baseline, 6 months, and 12 months. Serum MCs were determined via HPLC, serum cortisol via ELISA, and macular pigment optical density (MPOD) via customized heterochromatic flicker photometry. Behavioural data were obtained via questionnaire. Significant baseline correlations were found between MPOD and Beck anxiety scores (r = -0.28; P = 0.032), MPOD and Brief Symptom Inventory scores (r = 0.27; P = 0.037), and serum cortisol and psychological stress scores (r = 0.46; P stress, serum cortisol, and measures of emotional and physical health (P stress, cortisol, and symptoms of sub-optimal emotional and physical health. Determining the basis for these effects, whether systemic or a more central (i.e. brain) is a question that warrants further study.

  17. Quantitative effect of suboptimal codon usage on translational efficiency of mRNA encoding HIV-1 gag in intact T cells.

    Directory of Open Access Journals (Sweden)

    Kholiswa C Ngumbela

    Full Text Available BACKGROUND: The sequences of wild-isolate strains of Human Immunodeficiency Virus-1 (HIV-1 are characterized by low GC content and suboptimal codon usage. Codon optimization of DNA vectors can enhance protein expression both by enhancing translational efficiency, and by altering RNA stability and export. Although gag codon optimization is widely used in DNA vectors and experimental vaccines, the actual effect of altered codon usage on gag translational efficiency has not been quantified. METHODOLOGY AND PRINCIPAL FINDINGS: To quantify translational efficiency of gag mRNA in live T cells, we transfected Jurkat cells with increasing doses of capped, polyadenylated synthetic mRNA corresponding to wildtype or codon-optimized gag sequences, measured Gag production by quantitative ELISA and flow cytometry, and estimated the translational efficiency of each transcript as pg of Gag antigen produced per microg of input mRNA. We found that codon optimization yielded a small increase in gag translational efficiency (approximately 1.6 fold. In contrast when cells were transfected with DNA vectors requiring nuclear transcription and processing of gag mRNA, codon optimization resulted in a very large enhancement of Gag production. CONCLUSIONS: We conclude that suboptimal codon usage by HIV-1 results in only a slight loss of gag translational efficiency per se, with the vast majority of enhancement in protein expression from DNA vectors due to altered processing and export of nuclear RNA.

  18. Quantitative effect of suboptimal codon usage on translational efficiency of mRNA encoding HIV-1 gag in intact T cells.

    Science.gov (United States)

    Ngumbela, Kholiswa C; Ryan, Kieran P; Sivamurthy, Rohini; Brockman, Mark A; Gandhi, Rajesh T; Bhardwaj, Nina; Kavanagh, Daniel G

    2008-06-04

    The sequences of wild-isolate strains of Human Immunodeficiency Virus-1 (HIV-1) are characterized by low GC content and suboptimal codon usage. Codon optimization of DNA vectors can enhance protein expression both by enhancing translational efficiency, and by altering RNA stability and export. Although gag codon optimization is widely used in DNA vectors and experimental vaccines, the actual effect of altered codon usage on gag translational efficiency has not been quantified. To quantify translational efficiency of gag mRNA in live T cells, we transfected Jurkat cells with increasing doses of capped, polyadenylated synthetic mRNA corresponding to wildtype or codon-optimized gag sequences, measured Gag production by quantitative ELISA and flow cytometry, and estimated the translational efficiency of each transcript as pg of Gag antigen produced per microg of input mRNA. We found that codon optimization yielded a small increase in gag translational efficiency (approximately 1.6 fold). In contrast when cells were transfected with DNA vectors requiring nuclear transcription and processing of gag mRNA, codon optimization resulted in a very large enhancement of Gag production. We conclude that suboptimal codon usage by HIV-1 results in only a slight loss of gag translational efficiency per se, with the vast majority of enhancement in protein expression from DNA vectors due to altered processing and export of nuclear RNA.

  19. Suboptimal vitamin D status in a population-based study of Asian children: prevalence and relation to allergic diseases and atopy.

    Directory of Open Access Journals (Sweden)

    Tsung-Chieh Yao

    Full Text Available BACKGROUND: New evidence shows high prevalence of vitamin D deficiency in many countries and some studies suggest a possible link between vitamin D status and allergic diseases. The objectives of this study were to determine the prevalence of suboptimal vitamin D status in a population sample of Asian children and to investigate the relationship of vitamin D status with allergic diseases and atopy. METHODS: Children aged 5-18 years (N = 1315 in the Prediction of Allergies in Taiwanese CHildren (PATCH study were evaluated using questionnaires, anthropometric measurements, and serum levels of 25-hydroxyvitamin D [25(OHD] and total and specific immunoglobulin E (IgE. RESULTS: The mean concentration of serum 25(OHD was 20.4 ng/mL (SD: 7.1 ng/mL. Vitamin D deficiency (defined as serum 25(OHD0.05. CONCLUSIONS: Low serum 25(OHD levels are remarkably common in this population sample of Asian children, suggesting that millions of children living in Taiwan may have suboptimal levels of vitamin D, which should be a matter of public health concern. Our results provides epidemiological evidence against the association of vitamin D status with various allergic diseases and atopy in Asian children.

  20. Acquired Techniques

    DEFF Research Database (Denmark)

    Lunde Nielsen, Espen; Halse, Karianne

    2013-01-01

    Acquired Techniques - a Leap into the Archive, at Aarhus School of Architecture. In collaboration with Karianne Halse, James Martin and Mika K. Friis. Following the footsteps of past travelers this is a journey into tools and techniques of the architectural process. The workshop will focus upon...

  1. Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study

    Directory of Open Access Journals (Sweden)

    Ndiaye M

    2013-09-01

    Full Text Available Maimouna Ndiaye,1,2 Peter Nyasulu,1 Hoang Nguyen,6,7 Elizabeth D Lowenthal,8,9 Robert Gross,10 Edward J Mills,3 Jean B Nachega4–6 1School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Central Medical Stores, Ministry of Health, Gaborone, Botswana; 3Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; 4Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 5Department of Epidemiology, Infectious Disease Epidemiology Research Program, Pittsburgh University Graduate School of Public Health, Pittsburgh, PA, USA; 6Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 7Tay Ho Clinics, Department of Medicine, Hanoi Health Services, Hanoi, Vietnam; 8Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 9Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 10Departments of Medicine and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Objective: Little is known about factors associated with suboptimal antiretroviral treatment (ART adherence among adolescents in Sub-Saharan Africa. Our objective was to determine the level of ART adherence and predictors of non-adherence among human immunodeficiency virus (HIV-infected adolescents at the Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana. Methods: In a cross-sectional study, 82 HIV-infected adolescents receiving ART and their caregivers were administered a structured questionnaire. The patient's clinical information was retrieved from medical records. Outcome measures included excellent pill count ART adherence (>95% and virologic suppression

  2. Balloon-Assisted Microdissection "BAM" Technique for Balloon-Uncrossable Chronic Total Occlusions.

    Science.gov (United States)

    Vo, Minh N; Christopoulos, Georgios; Karmpaliotis, Dimitri; Lombardi, William L; Grantham, J Aaron; Brilakis, Emmanouil S

    2016-04-01

    After successful guidewire passage, failure to cross the occluded segment with a balloon is the most common cause of procedural failure in coronary chronic total occlusion (CTO) intervention. We evaluated the safety and efficacy of the balloon-assisted microdissection (BAM) technique for treating these complex balloon-uncrossable lesions. We identified consecutive cases treated with BAM for balloon-uncrossable CTOs between January 2012 and February 2015 at two experienced CTO percutaneous coronary intervention (PCI) centers and reviewed their clinical and angiographic characteristics and procedural outcomes. During the study period, a total of 17 patients had BAM performed for balloon-uncrossable CTOs. Mean age was 65.5 ± 8.7 years and 94% of patients were males who often had prior myocardial infarction, PCI, and coronary artery bypass graft surgery. The most common CTO target vessel was the right coronary artery. Mean J-CTO score was 2.6 ± 1.1. Despite high lesion complexity, overall procedural success was 94% and BAM facilitated success in approximately one-half of these cases. All BAM failure cases except 1 were successfully recanalized utilizing additional techniques. No patient experienced a major complication. BAM is a simple, inexpensive, and safe technique that can facilitate crossing of balloon-uncrossable CTOs and can be considered as first-line treatment for these complex lesions.

  3. Deadlock Prevention Policy with Behavioral Optimality or Suboptimality Achieved by the Redundancy Identification of Constraints and the Rearrangement of Monitors

    Directory of Open Access Journals (Sweden)

    Liang Hong

    2015-01-01

    Full Text Available This work develops an iterative deadlock prevention method for a special class of Petri nets that can well model a variety of flexible manufacturing systems. A deadlock detection technique, called mixed integer programming (MIP, is used to find a strict minimal siphon (SMS in a plant model without a complete enumeration of siphons. The policy consists of two phases. At the first phase, SMSs are obtained by MIP technique iteratively and monitors are added to the complementary sets of the SMSs. For the possible existence of new siphons generated after the first phase, we add monitors with their output arcs first pointed to source transitions at the second phase to avoid new siphons generating and then rearrange the output arcs step by step on condition that liveness is preserved. In addition, an algorithm is proposed to remove the redundant constraints of the MIP problem in this paper. The policy improves the behavioral permissiveness of the resulting net and greatly enhances the structural simplicity of the supervisor. Theoretical analysis and experimental results verify the effectiveness of the proposed method.

  4. Dating Techniques

    Indian Academy of Sciences (India)

    Absolute dating technique (such as stylistic affiliation, association with datable deposits, amino acid study of protein in pigments, and direct radiocarbon dating of the organic fraction of pigments or desert varnish).

  5. Intensity techniques

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2008-01-01

    The Handbook of Signal Processing in Acoustics will compile the techniques and applications of signal processing as they are used in the many varied areas of Acoustics. The Handbook will emphasize the interdisciplinary nature of signal processing in acoustics. Each Section of the Handbook...... from different areas, will find the self-contained chapters accessible and will be interested in the similarities and differences between the approaches and techniques used in different areas of acoustics....

  6. Decomposition techniques

    Science.gov (United States)

    Chao, T.T.; Sanzolone, R.F.

    1992-01-01

    Sample decomposition is a fundamental and integral step in the procedure of geochemical analysis. It is often the limiting factor to sample throughput, especially with the recent application of the fast and modern multi-element measurement instrumentation. The complexity of geological materials makes it necessary to choose the sample decomposition technique that is compatible with the specific objective of the analysis. When selecting a decomposition technique, consideration should be given to the chemical and mineralogical characteristics of the sample, elements to be determined, precision and accuracy requirements, sample throughput, technical capability of personnel, and time constraints. This paper addresses these concerns and discusses the attributes and limitations of many techniques of sample decomposition along with examples of their application to geochemical analysis. The chemical properties of reagents as to their function as decomposition agents are also reviewed. The section on acid dissolution techniques addresses the various inorganic acids that are used individually or in combination in both open and closed systems. Fluxes used in sample fusion are discussed. The promising microwave-oven technology and the emerging field of automation are also examined. A section on applications highlights the use of decomposition techniques for the determination of Au, platinum group elements (PGEs), Hg, U, hydride-forming elements, rare earth elements (REEs), and multi-elements in geological materials. Partial dissolution techniques used for geochemical exploration which have been treated in detail elsewhere are not discussed here; nor are fire-assaying for noble metals and decomposition techniques for X-ray fluorescence or nuclear methods be discussed. ?? 1992.

  7. Semiautomated head-and-neck IMRT planning using dose warping and scaling to robustly adapt plans in a knowledge database containing potentially suboptimal plans

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Matthew, E-mail: matthew.schmidt@varian.com; Grzetic, Shelby [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27708 (United States); Lo, Joseph Y. [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27708 (United States); Department of Radiology, Duke University Medical Center, Durham, North Carolina 27708 (United States); Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Lutzky, Carly [Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Brizel, David M. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27708 (United States); Das, Shiva K. [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27708 and Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27708 (United States)

    2015-08-15

    Purpose: Prior work by the authors and other groups has studied the creation of automated intensity modulated radiotherapy (IMRT) plans of equivalent quality to those in a patient database of manually created clinical plans; those database plans provided guidance on the achievable sparing to organs-at-risk (OARs). However, in certain sites, such as head-and-neck, the clinical plans may not be sufficiently optimized because of anatomical complexity and clinical time constraints. This could lead to automated plans that suboptimally exploit OAR sparing. This work investigates a novel dose warping and scaling scheme that attempts to reduce effects of suboptimal sparing in clinical database plans, thus improving the quality of semiautomated head-and-neck cancer (HNC) plans. Methods: Knowledge-based radiotherapy (KBRT) plans for each of ten “query” patients were semiautomatically generated by identifying the most similar “match” patient in a database of 103 clinical manually created patient plans. The match patient’s plans were adapted to the query case by: (1) deforming the match beam fluences to suit the query target volume and (2) warping the match primary/boost dose distribution to suit the query geometry and using the warped distribution to generate query primary/boost optimization dose-volume constraints. Item (2) included a distance scaling factor to improve query OAR dose sparing with respect to the possibly suboptimal clinical match plan. To further compensate for a component plan of the match case (primary/boost) not optimally sparing OARs, the query dose volume constraints were reduced using a dose scaling factor to be the minimum from either (a) the warped component plan (primary or boost) dose distribution or (b) the warped total plan dose distribution (primary + boost) scaled in proportion to the ratio of component prescription dose to total prescription dose. The dose-volume constraints were used to plan the query case with no human intervention

  8. Routine use of microarray-based gene expression profiling to identify patients with low cytogenetic risk acute myeloid leukemia: accurate results can be obtained even with suboptimal samples

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    de la Blétière Diane Raingeard

    2012-01-01

    Full Text Available Abstract Background Gene expression profiling has shown its ability to identify with high accuracy low cytogenetic risk acute myeloid leukemia such as acute promyelocytic leukemia and leukemias with t(8;21 or inv(16. The aim of this gene expression profiling study was to evaluate to what extent suboptimal samples with low leukemic blast load (range, 2-59% and/or poor quality control criteria could also be correctly identified. Methods Specific signatures were first defined so that all 71 acute promyelocytic leukemia, leukemia with t(8;21 or inv(16-AML as well as cytogenetically normal acute myeloid leukemia samples with at least 60% blasts and good quality control criteria were correctly classified (training set. The classifiers were then evaluated for their ability to assign to the expected class 111 samples considered as suboptimal because of a low leukemic blast load (n = 101 and/or poor quality control criteria (n = 10 (test set. Results With 10-marker classifiers, all training set samples as well as 97 of the 101 test samples with a low blast load, and all 10 samples with poor quality control criteria were correctly classified. Regarding test set samples, the overall error rate of the class prediction was below 4 percent, even though the leukemic blast load was as low as 2%. Sensitivity, specificity, negative and positive predictive values of the class assignments ranged from 91% to 100%. Of note, for acute promyelocytic leukemia and leukemias with t(8;21 or inv(16, the confidence level of the class assignment was influenced by the leukemic blast load. Conclusion Gene expression profiling and a supervised method requiring 10-marker classifiers enable the identification of favorable cytogenetic risk acute myeloid leukemia even when samples contain low leukemic blast loads or display poor quality control criterion.

  9. Burden of Disease Attributable to Suboptimal Breastfeeding in Iran during 1990-2010; Findings from the Global Burden of Disease Study 2010

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    Roya Kelishadi

    2016-09-01

    Full Text Available Background: This study uses data of the global burden of diseases (GBD study 2010 to report death, disability-adjusted life year (DALYs, years of life lived with disability (YLDs and years of life lost due to premature mortality (YLLs, attributed to suboptimal breastfeeding by age and gender during 1990 to 2010 in Iran. Materials and Methods:The GBD assessments were used, together with estimates of death and DALYs due to specific risk factors to calculate the attributed burden of each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of mortality attributable and burden and were presented as 95 % uncertainty interval (UI. Results:In both genders, the age standardized DALYs rates and the age standardized death rate [(from 5 (95% UI: 2-8 to 1 (95% UI: 0-2 per 100,000 populations], attributed to breastfeeding, had a decreasing trends. The age standardized YLD rate increased from 7 (95% UI: 2-15 to 10 (95% UI: 3-23 per 100,000 populations in boys and, from 7(95% UI: 2-16 to 11(95% UI: 3-26 per 100,000 populations in girls. The YLD changes showed some variation according to age categories. For both genders, the age standardizes YLL rate decreased from 395 (95% UI: 185-681 per 100,000 populations to 111(95% UI: 42-213 per 100,000 populations. Conclusion: The burden attributed to suboptimal breastfeeding had a considerable reduction rate from 1990 to 2010. Additional studies on burden of exclusive breastfeeding with more accurate data are recommended for policies make decision.

  10. Clinical and hemodynamic improvements after adding ambrisentan to background PDE5i therapy in patients with pulmonary arterial hypertension exhibiting a suboptimal therapeutic response (ATHENA-1).

    Science.gov (United States)

    Shapiro, Shelley; Torres, Fernando; Feldman, Jeremy; Keogh, Anne; Allard, Martine; Blair, Christiana; Gillies, Hunter; Tislow, James; Oudiz, Ronald J

    2017-05-01

    Pulmonary arterial hypertension (PAH) is a condition which may lead to right ventricular failure and premature death. While recent data supports the initial combination of ambrisentan (a selective ERA) and tadalafil (a PDE5i) in functional class II or III patients, there is no published data describing the safety and efficacy of ambrisentan when added to patients currently receiving a PDE5i and exhibiting a suboptimal response. The ATHENA-1 study describes the safety and efficacy of the addition of ambrisentan in this patient population. PAH patients with a suboptimal response to current PDE5i monotherapy were assigned ambrisentan in an open-label fashion and evaluated for up to 48 weeks. Cardiopulmonary hemodynamics (change in PVR as primary endpoint) were evaluated at week 24 and functional parameters and biomarkers were measured through week 48. Time to clinical worsening (TTCW) and survival are also described. Thirty-three subjects were included in the analysis. At week 24, statistically significant improvements in PVR (-32%), mPAP (-11%), and CI (+25%) were observed. Hemodynamic improvements at week 24 were further supported by improvements in the secondary endpoints: 6-min walk distance (+18 m), NT-proBNP (-31%), and maintenance or improvement in WHO FC in 97% of patients. Adverse events were consistent with known effects of ambrisentan. The hemodynamic, functional, and biomarker improvements observed in the ATHENA-1 study suggests that the sequential addition of ambrisentan to patients not having a satisfactory response to established PDE5i monotherapy is a reasonable option. Published by Elsevier Ltd.

  11. Miscellaneous Techniques

    Science.gov (United States)

    Jha, Shyam N.

    Nondestructive way of determining the food quality is the need of the hour. Till now major methods such as colour measurements and their modeling; machine vision systems; X-ray, CT and MRI; NIR spectroscopy; electronic nose and tongue; and ultrasonic technology have been discussed in detail. These techniques, in general, are considered to be sophisticated and costly, and therefore probably are not being adopted as fast as it should be. I am however of the reverse opinion. While going through these techniques, it has been seen that majority of quality parameters have been measured and correlated with the signals obtained using different equipment.

  12. Pediatric brain MRI. Pt. 1. Basic techniques

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Mai-Lan; Campeau, Norbert G.; Welker, Kirk M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Ngo, Thang D. [Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Udayasankar, Unni K. [University of Arizona, Department of Radiology, Tucson, AZ (United States)

    2017-05-15

    Pediatric neuroimaging is a complex and specialized field that uses magnetic resonance (MR) imaging as the workhorse for diagnosis. Standard MR techniques used in adult neuroimaging are suboptimal for imaging in pediatrics because there are significant differences in the child's developing brain. These differences include size, myelination and sulcation. MR protocols need to be tailored to the specific indication and reviewed by the supervising radiologist in real time, and the specialized needs of this population require careful consideration of issues such as scan timing, sequence order, sedation, anesthesia and gadolinium administration. In part 1 of this review, we focus on basic protocol development and anatomical characterization. We provide multiple imaging examples optimized for evaluation of supratentorial and infratentorial brain, midline structures, head and neck, and intracranial vasculature. (orig.)

  13. Electrochemical Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Gang; Lin, Yuehe

    2008-07-20

    Sensitive and selective detection techniques are of crucial importance for capillary electrophoresis (CE), microfluidic chips, and other microfluidic systems. Electrochemical detectors have attracted considerable interest for microfluidic systems with features that include high sensitivity, inherent miniaturization of both the detection and control instrumentation, low cost and power demands, and high compatibility with microfabrication technology. The commonly used electrochemical detectors can be classified into three general modes: conductimetry, potentiometry, and amperometry.

  14. Experimental Techniques

    DEFF Research Database (Denmark)

    Wyer, Jean

    2013-01-01

    Gas-phase ion spectroscopy requires specialised apparatus, both when it comes to measuring photon absorption and light emission (fluorescence). The reason is much lower ion densities compared to solution-phase spectroscopy. In this chapter different setups are described, all based on mass spectro...... in data interpretation, and the advantages and disadvantages of the different techniques are clarified. New instrumental developments involving cryo-cooled storage rings, which show great promise for the future, are briefly touched upon....

  15. Astrophysical techniques

    CERN Document Server

    Kitchin, CR

    2013-01-01

    DetectorsOptical DetectionRadio and Microwave DetectionX-Ray and Gamma-Ray DetectionCosmic Ray DetectorsNeutrino DetectorsGravitational Radiation Dark Matter and Dark Energy Detection ImagingThe Inverse ProblemPhotographyElectronic ImagingScanningInterferometrySpeckle InterferometryOccultationsRadarElectronic ImagesPhotometryPhotometryPhotometersSpectroscopySpectroscopy SpectroscopesOther TechniquesAstrometryPolarimetrySolar StudiesMagnetometryComputers and The Internet.

  16. Terahertz Techniques

    CERN Document Server

    Bründermann, Erik; Kimmitt, Maurice FitzGerald

    2012-01-01

    Research and development in the terahertz portion of the electromagnetic spectrum has expanded very rapidly during the past fifteen years due to major advances in sources, detectors and instrumentation. Many scientists and engineers are entering the field and this volume offers a comprehensive and integrated treatment of all aspects of terahertz technology. The three authors, who have been active researchers in this region over a number of years, have designed Terahertz Techniques to be both a general introduction to the subject and a definitive reference resource for all those involved in this exciting research area.

  17. Detecting suboptimal cognitive effort: classification accuracy of the Conner's Continuous Performance Test-II, Brief Test Of Attention, and Trail Making Test.

    Science.gov (United States)

    Busse, Michelle; Whiteside, Douglas

    2012-01-01

    Many cognitive measures have been studied for their ability to detect suboptimal cognitive effort; however, attention measures have not been extensively researched. The current study evaluated the classification accuracy of commonly used attention/concentration measures, the Brief Test of Attention (BTA), Trail Making Test (TMT), and the Conners' Continuous Performance Test (CPT-II). Participants included 413 consecutive patients who completed a comprehensive neuropsychological evaluation. Participants were separated into two groups, identified as either unbiased responders or biased responders as determined by performance on the TOMM. Based on Mann-Whitney U results, the two groups differed significantly on all attentional measures. Classification accuracy of the BTA (.83), CPT-II omission errors (OE; .76) and TMT B (.75) were acceptable; however, classification accuracy of CPT-II commission errors (CE; .64) and TMT A (.62) were poor. When variables were combined in different combinations, sensitivity did not significantly increase. Results indicated for optimal cut-off scores, sensitivity ranged from 48% to 64% when specificity was at least 85%. Given that sensitivity rates were not adequate, there remains a need to utilize highly sensitive measures in addition to these embedded measures. Results were discussed within the context of research promoting the need for multiple measures of cognitive effort.

  18. Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal.

    Science.gov (United States)

    Batista, G; Buvé, A; Ngom Gueye, N F; Manga, N M; Diop, M N; Ndiaye, K; Thiam, A; Ly, F; Diallo, A; Ndour, C T; Seydi, M

    2015-06-01

    We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50 cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load ( 40 years (aOR = 1.74, 95% CI = 1.10-2.75), baseline CD4 ≥ 100 cells/μL (aOR = 2.06, 95% CI = 1.24-3.42), ARVT including AZT (aOR = 4.57, 95% CI=1.06-19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR = 2.38 95% CI= 1.49-3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate= 9.78/100 person-years) compared to 168 with a normal recovery (rate = 7.75/100 person-years) but the difference was not statistically significant (aHR = 1.22, 95% CI = 0.85 to 1.74). SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Food Insecurity, Poor Diet Quality, and Suboptimal Intakes of Folate and Iron Are Independently Associated with Perceived Mental Health in Canadian Adults.

    Science.gov (United States)

    Davison, Karen M; Gondara, Lovedeep; Kaplan, Bonnie J

    2017-03-14

    To address nutrition-related population mental health data gaps, we examined relationships among food insecurity, diet quality, and perceived mental health. Stratified and logistic regression analyses of respondents aged 19-70 years from the Canadian Community Health Survey, Cycle 2.2 were conducted ( n = 15,546). Measures included the Household Food Security Survey Module, diet quality (i.e., comparisons to the Dietary Reference Intakes , Healthy Eating Index), perceived mental health (poor versus good), sociodemographics, and smoking. In this sample, 6.9% were food insecure and 4.5% reported poor mental health. Stratified analysis of food security and mental health status by age/gender found associations for poor diet quality, protein, fat, fibre, and several micronutrients ( p -values mental health emerged for food insecurity (OR = 1.60, 95% CI 1.45-1.71), poor diet quality (1.61, 95% CI 1.34-1.81), and suboptimal intakes of folate (OR = 1.58, 95% CI 1.17-1.90) and iron (OR = 1.45, 95% CI 1.23-1.88). Population approaches that improve food security and intakes of high quality diets may protect people from poor mental health.

  20. Association of suboptimal health status with psychosocial stress, plasma cortisol and mRNA expression of glucocorticoid receptor α/β in lymphocyte.

    Science.gov (United States)

    Yan, Yu-Xiang; Dong, Jing; Liu, You-Qin; Zhang, Jie; Song, Man-Shu; He, Yan; Wang, Wei

    2015-01-01

    Suboptimal health status (SHS) has become a new public health challenge in China. This study investigated whether high SHS is associated with psychosocial stress, changes in cortisol level and/or glucocorticoid receptor (GR) isoform expression. Three-hundred eighty-six workers employed in three companies in Beijing were recruited. The SHS score was derived from data collection in the SHS questionnaire (SHSQ-25). The short standard version of the Copenhagen Psychosocial Questionnaire (COPSOQ) was used to assess job-related psychosocial stress. The mean value of the five scales of COPSOQ and distribution of plasma cortisol and mRNA expression of GRα/GRβ between the high level of SHS group and the low level of SHS group were compared using a general linear model procedure. Multiple linear regression analysis was used to analyze the effect of psychosocial stress on SHS. We identified three factors that were predictive of SHS, including "demands at work", "interpersonal relations and leadership" and "insecurity at work". Significantly higher levels of plasma cortisol and GRβ/GRα mRNA ratio were observed among the high SHS group. High level of SHS is associated with decreased mRNA expression of GRα. This study confirmed the association between chronic psychosocial stress and SHS, indicating that improving the psychosocial work environment may reduce SHS and then prevent chronic diseases effectively.

  1. Rotavirus-specific IgA Responses Are Impaired and Serve as a Sub-Optimal Correlate of Protection among Infants in Bangladesh.

    Science.gov (United States)

    Lee, Benjamin; Carmolli, Marya; Dickson, Dorothy M; Colgate, E Ross; Diehl, Sean A; Uddin, Muhammad Ikhtear; Islam, Shahidul; Hossain, Motaher; Rafique, Tanzeem Ahmed; Bhuiyan, Taufiqur Rahman; Alam, Masud; Nayak, Uma; Mychaleckyj, Josyf C; McNeal, Monica M; Petri, William A; Qadri, Firdausi; Haque, Rashidul; Kirkpatrick, Beth D

    2018-01-31

    Rotavirus-specific IgA (RV-IgA) responses following oral RV vaccination are impaired in low-income countries, where the utility of RV-IgA as a correlate of protection (CoP) remains unclear. In a monovalent oral RV (Rotarix™) vaccine efficacy trial among infants in Dhaka, Bangladesh, we identified factors associated with poor RV-IgA responses and explored the utility of RV-IgA as a CoP. Infants were randomized to receive Rotarix™ or no Rotarix™ at 10 and 17 weeks of life and followed with active diarrheal surveillance. RV-IgA concentration, seroconversion, and seropositivity were determined at 18 weeks of life and analyzed for correlation(s) with rotavirus diarrhea (RVD) and for contribution to Rotarix™ vaccine effect. Among vaccinated infants, overall RV-IgA geometric mean concentration was 21 U/mL; only 27% seroconverted and 32% were seropositive after vaccination. Increased RV-specific maternal antibodies significantly impaired immunogenicity. Seroconversion was associated with reduced risk of RVD through one year of life, but RV-IgA seropositivity only explained 7.8% of the vaccine effect demonstrated by the clinical endpoint (RVD). RV-IgA responses were low among infants in Bangladesh and were significantly impaired by maternal antibodies. RV-IgA is a sub-optimal CoP in this setting; an improved CoP for RV in low-income countries is needed. NCT01375647.

  2. Combinatorial techniques

    CERN Document Server

    Sane, Sharad S

    2013-01-01

    This is a basic text on combinatorics that deals with all the three aspects of the discipline: tricks, techniques and theory, and attempts to blend them. The book has several distinctive features. Probability and random variables with their interconnections to permutations are discussed. The theme of parity has been specially included and it covers applications ranging from solving the Nim game to the quadratic reciprocity law. Chapters related to geometry include triangulations and Sperner's theorem, classification of regular polytopes, tilings and an introduction to the Eulcidean Ramsey theory. Material on group actions covers Sylow theory, automorphism groups and a classification of finite subgroups of orthogonal groups. All chapters have a large number of exercises with varying degrees of difficulty, ranging from material suitable for Mathematical Olympiads to research.

  3. A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates.

    Directory of Open Access Journals (Sweden)

    Sam C Hankins

    Full Text Available Low-volume polyethylene glycol (PEG bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation, procedure times, adenoma detection rate (ADR, and advanced adenoma detection rate (AADR.This is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841 or high-volume Colyte® (n = 1337 was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate, procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.MoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06-1.76, but it was not associated with differences in insertion (p = 0.43, withdrawal (p = 0.22, or total procedure times (p = 0.10. The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78-1.11, AADR (OR 1.18; 95% CI: 0.87-1.62, or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72-1.88.MoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

  4. Emergency medicine techniques and the forensic autopsy.

    Science.gov (United States)

    Buschmann, Claas; Schulz, Thomas; Tsokos, Michael; Kleber, Christian

    2013-03-01

    Emergency medicine measures often have to be carried out under suboptimal conditions in emergency situations and require invasive patient treatment. In the case of a fatal outcome these measures have to be evaluated at autopsy, regarding indications, correct implementation and possible complications. As well, alongside the more familiar procedures--such as endotracheal intubation, insertion of chest drains, external cardiac massage and cannulation of central and peripheral veins--there are alternative techniques being increasingly applied, that include new tools for the management of hemorrhagic shock, drug delivery and alternative airway management devices. On the one hand, all of these measures are essential for the survival and appropriate treatment of the injured and/or sick patient, but on the other hand they can damage the patient and thus contain a significant risk of both medical and forensic relevance for the patient and the physician. In the following review we provide an overview of established, new and alternative techniques for emergency airway management, administration of drugs and management of hemorrhagic shock. The aim is to facilitate the understanding and autopsy evaluation of current emergency medicine techniques.

  5. Reactivity of the phosphinito bridged Pt(I) complex [(PHCy2)Pt(μ-PCy2){κ2P,O-μ-P(O)Cy2}Pt(PHCy2)](Pt-Pt) towards Au(I) and Ag(I) electrophiles.

    Science.gov (United States)

    Latronico, Mario; Sánchez, Sergio; Rizzuti, Antonino; Gallo, Vito; Polini, Flavia; Lalinde, Elena; Mastrorilli, Piero

    2013-02-21

    The reactivity of the phosphinito bridged Pt(I) complex [(PHCy(2))Pt(1)(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(2)(PHCy(2))](Pt-Pt) (1) towards Au(I) and Ag(I) electrophiles was explored. Treatment of 1 with AuCl yielded the dichloro Pt(II) complex [(Cl)(PHCy(2))Pt(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(Cl)(PHCy(2))] (4), while [Au(PPh(3))Cl] in thf (or toluene) caused ligand exchange resulting in the formation of [(PPh(3))Pt(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(PHCy(2))](Pt-Pt) (7) and [(PPh(3))Pt(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(PPh(3))](Pt-Pt) (8). With [Au(PPh(3))OTf] (independently from the solvent) or with [Au(PPh(3))Cl] (only in dichloromethane), reaction with 1 gave [(PHCy(2))Pt(1)(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(2){μ-Au(PPh(3))}(PHCy(2))]X(Pt-Pt) ([6]X, X = OTf, Cl) clusters in which the [Au(PPh(3))] moiety bridges the μP-Pt(2) bond. The [Ag(PPh(3))](+) electrophile attacks complex 1 selectively at the Pt(2)-μP bond to afford, at low T, the cationic cluster [(PHCy(2))Pt(1)(μ-PCy(2)){κ(2)P,O-μ-P(O)Cy(2)}Pt(2){μ-Ag(PPh(3))}(PHCy(2))](+)(Pt-Pt) (10(+)) in which the [Ag(PPh(3))](+) moiety bridges the μP-Pt(2) bond. Clusters analogous to 10(+), but without PPh(3) bonded to Ag, are obtained from reactions of 1 with AgOTf, AgBF(4), AgClO(4) and AgCl.

  6. Techniques de combustion Combustin Techniques

    Directory of Open Access Journals (Sweden)

    Perthuis E.

    2006-11-01

    Full Text Available L'efficacité d'un processus de chauffage par flamme est étroitement liée à la maîtrise des techniques de combustion. Le brûleur, organe essentiel de l'équipement de chauffe, doit d'une part assurer une combustion complète pour utiliser au mieux l'énergie potentielle du combustible et, d'autre part, provoquer dans le foyer les conditions aérodynamiques les plus propices oux transferts de chaleur. En s'appuyant sur les études expérimentales effectuées à la Fondation de Recherches Internationales sur les Flammes (FRIF, au Groupe d'Étude des Flammes de Gaz Naturel (GEFGN et à l'Institut Français du Pétrole (IFP et sur des réalisations industrielles, on présente les propriétés essentielles des flammes de diffusion aux combustibles liquides et gazeux obtenues avec ou sans mise en rotation des fluides, et leurs répercussions sur les transferts thermiques. La recherche des températures de combustion élevées conduit à envisager la marche à excès d'air réduit, le réchauffage de l'air ou son enrichissement à l'oxygène. Par quelques exemples, on évoque l'influence de ces paramètres d'exploitation sur l'économie possible en combustible. The efficiency of a flame heating process is closely linked ta the mastery of, combustion techniques. The burner, an essential element in any heating equipment, must provide complete combustion sa as to make optimum use of the potential energy in the fuel while, at the same time, creating the most suitable conditions for heat transfers in the combustion chamber. On the basis of experimental research performed by FRIF, GEFGN and IFP and of industrial achievements, this article describesthe essential properties of diffusion flames fed by liquid and gaseous fuels and produced with or without fluid swirling, and the effects of such flames on heat transfers. The search for high combustion temperatures means that consideration must be given to operating with reduced excess air, heating the air or

  7. Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study.

    Science.gov (United States)

    Hsu, Yueh-Han; Cheng, Jur-Shan; Ouyang, Wen-Chen; Lin, Chen-Li; Huang, Chi-Ting; Hsu, Chih-Cheng

    2015-01-01

    Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.

  8. Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study.

    Directory of Open Access Journals (Sweden)

    Yueh-Han Hsu

    Full Text Available Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD. However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort. We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3 to compare quality of renal care before dialysis and outcomes (the dialysis cohort. Cox proportional hazard models were used to estimate the hazard ratio (HR for dialysis and death. Odds ratio (OR derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8, but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3. Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8 and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9. But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P < .05. Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.

  9. The Role of Healthy Lifestyle in the Implementation of Regressing Suboptimal Health Status among College Students in China: A Nested Case-Control Study.

    Science.gov (United States)

    Chen, Jieyu; Xiang, Hongjie; Jiang, Pingping; Yu, Lin; Jing, Yuan; Li, Fei; Wu, Shengwei; Fu, Xiuqiong; Liu, Yanyan; Kwan, Hiuyee; Luo, Ren; Zhao, Xiaoshan; Sun, Xiaomin

    2017-02-28

    Suboptimal health status (SHS) is the intermediate health state between health and disease, it is medically undiagnosed and is also termed functional somatic syndrome. Although its clinical manifestations are complicated and various, SHS has not reached the disease status. Unhealthy lifestyle is associated with many chronic diseases and mortality. In accordance with the impact of lifestyle on health, it is intriguing to determine the association between unhealthy lifestyle and SHS risk. We conducted a nested case-control study among healthy Chinese college students from March 2012 to September 2013, which was nested in a prospective cohort of 5676 students. We performed 1:1 incidence density sampling with matched controls for birth year, sex, grade, specialty and individual character. SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Exposure was defined as an unhealthy lifestyle per the frequency of six behavioral dimensions from the Health-promoting Lifestyle Profile (HPLP-II). We matched 543 cases of SHS (42.66%) in a cohort of 1273 students during the 1.5 years mean follow-up time with controls. A significant difference (t = 9.79, p lifestyle behavior with respect to behavioral dimensions significantly affected SHS likelihood. Further analyses revealed a marked increase (average increased 14.73 points) in lifestyle level among those SHS regression to health after 1.5 years, with respect to the HPLP-II behavioral dimensions, in addition to the total score (t = -15.34, p lifestyles, and the Int. J. Environ. Res. Public Health 2017, 14, 240 2 of 17 mitigation of modifiable lifestyle risk factors may lead to SHS regression. Increased efforts to modify unhealthy lifestyles are necessary to prevent SHS.

  10. Sub-optimal Testing and Awareness of HCV and HBV Among High Risk Individuals at an Underserved Safety-Net Hospital.

    Science.gov (United States)

    Wong, Robert J; Campbell, Brendan; Liu, Benny; Baden, Rachel; Bhuket, Taft

    2017-06-24

    Sub-optimal screening for chronic hepatitis C virus (HCV) and chronic hepatitis B virus (HBV) among high risk groups delays diagnosis and treatment. We aimed to evaluate overall rates of HCV and HBV screening and patient knowledge of their testing result. Adults age ≥18 years undergoing elective outpatient endoscopy at a large, urban safety-net hospital from July 2015 to July 2016 were prospectively evaluated to determine rates of HCV and HBV testing, the results of those completed tests, and patient knowledge of test results among high risk individuals (as determined by U.S. Preventative Services Task Force). Among 1125 patients (52.3% male, 70.4% foreign-born), 66.5% were high risk for chronic HCV; only 30.9% received prior testing. 14.7% had positive chronic HCV infection. Patients born in the 1945-1965 cohort were more likely to have received prior HCV testing compared to those born outside of this cohort (32.7 vs. 16.9%, p = 0.01). Among patients who received HCV screening, 29.3% were aware of test results. Overall, 61.6% were high risk for chronic HBV; only 25.1% received prior testing. 4.1% were positive for chronic HBV. Compared to Caucasians, Asians (19.0 vs. 44.4%, p HBV testing. Among patients who received prior HBV screening, 18.4% were aware of test results. Less than one-third of high risk patients received HCV and HBV screening among an ethnically diverse safety-net population. Equally low rates of patient knowledge of testing results were observed.

  11. An efficient method for the prediction of deleterious multiple-point mutations in the secondary structure of RNAs using suboptimal folding solutions

    Directory of Open Access Journals (Sweden)

    Barash Danny

    2008-04-01

    Full Text Available Abstract Background RNAmute is an interactive Java application which, given an RNA sequence, calculates the secondary structure of all single point mutations and organizes them into categories according to their similarity to the predicted structure of the wild type. The secondary structure predictions are performed using the Vienna RNA package. A more efficient implementation of RNAmute is needed, however, to extend from the case of single point mutations to the general case of multiple point mutations, which may often be desired for computational predictions alongside mutagenesis experiments. But analyzing multiple point mutations, a process that requires traversing all possible mutations, becomes highly expensive since the running time is O(nm for a sequence of length n with m-point mutations. Using Vienna's RNAsubopt, we present a method that selects only those mutations, based on stability considerations, which are likely to be conformational rearranging. The approach is best examined using the dot plot representation for RNA secondary structure. Results Using RNAsubopt, the suboptimal solutions for a given wild-type sequence are calculated once. Then, specific mutations are selected that are most likely to cause a conformational rearrangement. For an RNA sequence of about 100 nts and 3-point mutations (n = 100, m = 3, for example, the proposed method reduces the running time from several hours or even days to several minutes, thus enabling the practical application of RNAmute to the analysis of multiple-point mutations. Conclusion A highly efficient addition to RNAmute that is as user friendly as the original application but that facilitates the practical analysis of multiple-point mutations is presented. Such an extension can now be exploited prior to site-directed mutagenesis experiments by virologists, for example, who investigate the change of function in an RNA virus via mutations that disrupt important motifs in its secondary

  12. Atorvastatin reduces T-cell activation and exhaustion among HIV-infected cART-treated suboptimal immune responders in Uganda: a randomised crossover placebo-controlled trial.

    Science.gov (United States)

    Nakanjako, Damalie; Ssinabulya, Isaac; Nabatanzi, Rose; Bayigga, Lois; Kiragga, Agnes; Joloba, Moses; Kaleebu, Pontiano; Kambugu, Andrew D; Kamya, Moses R; Sekaly, Rafick; Elliott, Alison; Mayanja-Kizza, Harriet

    2015-03-01

    T-cell activation independently predicts mortality, poor immune recovery and non-AIDS illnesses during combination antiretroviral therapy (cART). Atorvastatin showed anti-immune activation effects among HIV-infected cART-naïve individuals. We investigated whether adjunct atorvastatin therapy reduces T-cell activation among cART-treated adults with suboptimal immune recovery. A randomised double-blind placebo-controlled crossover trial, of atorvastatin 80 mg daily vs. placebo for 12 weeks, was conducted among individuals with CD4 increase <295 cells/μl after seven years of suppressive cART. Change in T-cell activation (CD3 + CD4 + /CD8 + CD38 + HLADR+) and in T-cell exhaustion (CD3 + CD4 + /CD8 + PD1 + ) was measured using flow cytometry. Thirty patients were randomised, 15 to each arm. Atorvastatin resulted in a 28% greater reduction in CD4 T-cell activation (60% reduction) than placebo (32% reduction); P = 0.001. Atorvastatin also resulted in a 35% greater reduction in CD8-T-cell activation than placebo (49% vs. 14%, P = 0.0009), CD4 T-cell exhaustion (27% vs. 17% in placebo), P = 0.001 and CD8 T-cell exhaustion (27% vs. 16%), P = 0.004. There was no carry-over/period effect. Expected adverse events were comparable in both groups, and no serious adverse events were reported. Atorvastatin reduced T-cell immune activation and exhaustion among cART-treated adults in a Ugandan cohort. Atorvastatin adjunct therapy should be explored as a strategy to improve HIV treatment outcomes among people living with HIV in sub-Saharan Africa. © 2014 John Wiley & Sons Ltd.

  13. Suboptimal Weight Loss and Weight Regain after Gastric Bypass Surgery-Postoperative Status of Energy Intake, Eating Behavior, Physical Activity, and Psychometrics.

    Science.gov (United States)

    Amundsen, Tina; Strømmen, Magnus; Martins, Catia

    2017-05-01

    Suboptimal weight loss (SWL) and weight regain (WR) after gastric bypass surgery (GB) remains poorly understood. This study aims to compare GB patients experiencing SWL or significant WR (SigWR) with successful controls, regarding postoperative food intake, eating behavior, physical activity (PA), and psychometrics. Forty-nine patients with >1 year post-surgery were classified as either experiencing SWL (excess body weight loss, EWL, weight regain ≥15%, n = 38), with respective control groups. Energy intake (EI) was measured with a Food Frequency Questionnaire, eating behavior using the Dutch Eating Behavior Questionnaire and the Three-Factor Eating Questionnaire, and PA using both SenseWear Armbands and the International Physical Activity Questionnaire. Eating disorders, depression, and quality of life (QoL) were measured using the Eating Disorder Examination Questionnaire, Beck Depression Inventory II, and Impact of Weight on Quality of Life, respectively. EI, macronutrient distribution, and meal frequency were similar among groups. However, disinhibited eating behavior score was higher, while most subcategories from IWQOL were significantly lower in both SWL and SigWR groups compared with their respective controls. PA was significantly lower in the SWL and SigWR groups compared with the respective controls. There were no differences between groups regarding depression. Lower PA levels, disordered eating behavior and lower QoL are associated with unsuccessful weigh loss outcome after GB surgery. Longitudinal studies are needed to clarify the potential causal relationship between the previously described variables and SWL/SigWR after GB.

  14. Associations between breakfast eating habits and health-promoting lifestyle, suboptimal health status in Southern China: a population based, cross sectional study.

    Science.gov (United States)

    Chen, Jieyu; Cheng, Jingru; Liu, Yanyan; Tang, Yang; Sun, Xiaomin; Wang, Tian; Xiao, Ya; Li, Fei; Xiang, Lei; Jiang, Pingping; Wu, Shengwei; Wu, Liuguo; Luo, Ren; Zhao, Xiaoshan

    2014-12-11

    Suboptimal health status (SHS) is the intermediate health state between health and disease, refers to medically undiagnosed or functional somatic syndromes, and has been a major global public health challenge. However, both the etiology and mechanisms associated with SHS are still unclear. Breakfast eating behavior is a dietary pattern marker and previous studies have presented evidence of associations between failure to consume breakfast and increased diseases. Accordingly, in view of the significance of breakfast eating behaviors with respect to health status, the associations between breakfast eating habits and healthy lifestyle, SHS require further elucidation. A cross-sectional survey was conducted within a clustered sample of 24,159 individuals aged 12-80 years in 2012-13 within the population of Southern China. Breakfast eating habits were categorically defined by consumption frequency ('scarcely, sometimes or always'). Health-promoting lifestyle was assessed via the health-promoting lifestyle profile (HPLP-II). SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Of the 24,159 participants, the prevalence rates for the 'health' , 'SHS' , and 'disease' were 18.8%, 46.0%, and 35.2%, respectively. Overall, 19.6% of participants reported 'scarce' breakfast eating habits, with frequent breakfast eaters scoring higher on both HPLP-II and SHMS V1.0. After demographic adjustment, regression analyses revealed a significant association between breakfast eating habits and healthy lifestyle (p eating habits are significantly associated with a healthy lifestyle, and appear to be a useful predictor of a healthy lifestyle. Irregular breakfast eating habits are related to an increased risk of SHS; increased breakfast eating frequency may contribute to lowering the prevalence of SHS in Southern China.

  15. Assessing the Accuracy of High Resolution Digital Surface Models Computed by PhotoScan® and MicMac® in Sub-Optimal Survey Conditions

    Directory of Open Access Journals (Sweden)

    Marion Jaud

    2016-06-01

    Full Text Available For monitoring purposes and in the context of geomorphological research, Unmanned Aerial Vehicles (UAV appear to be a promising solution to provide multi-temporal Digital Surface Models (DSMs and orthophotographs. There are a variety of photogrammetric software tools available for UAV-based data. The objective of this study is to investigate the level of accuracy that can be achieved using two of these software tools: Agisoft PhotoScan® Pro and an open-source alternative, IGN© MicMac®, in sub-optimal survey conditions (rugged terrain, with a large variety of morphological features covering a range of roughness sizes, poor GPS reception. A set of UAV images has been taken by a hexacopter drone above the Rivière des Remparts, a river on Reunion Island. This site was chosen for its challenging survey conditions: the topography of the study area (i involved constraints on the flight plan; (ii implied errors on some GPS measurements; (iii prevented an optimal distribution of the Ground Control Points (GCPs and; (iv was very complex to reconstruct. Several image processing tests are performed with different scenarios in order to analyze the sensitivity of each software package to different parameters (image quality, numbers of GCPs, etc.. When computing the horizontal and vertical errors within a control region on a set of ground reference targets, both methods provide rather similar results. A precision up to 3–4 cm is achievable with these software packages. The DSM quality is also assessed over the entire study area comparing PhotoScan DSM and MicMac DSM with a Terrestrial Laser Scanner (TLS point cloud. PhotoScan and MicMac DSM are also compared at the scale of particular features. Both software packages provide satisfying results: PhotoScan is more straightforward to use but its source code is not open; MicMac is recommended for experimented users as it is more flexible.

  16. Initiation of insulin glargine in patients with Type 2 diabetes in suboptimal glycaemic control positively impacts health-related quality of life. A prospective cohort study in primary care

    DEFF Research Database (Denmark)

    Hajós, Tibor R S; Pouwer, F; de Grooth, R

    2011-01-01

    AIMS: To study prospectively the impact of initiating insulin glargine in suboptimally controlled insulin-naïve patients with Type 2 diabetes on health-related quality of life in relation to glycaemic control. METHODS: Insulin-naïve Dutch patients with Type 2 diabetes in suboptimal glycaemic...... completed self-report health-related quality of life measures, including emotional well-being (World Health Organization-5 well-being index), fear of hypoglycaemia (Hypoglycaemia Fear Survey) and diabetes symptom distress (Diabetes Symptom Checklist-revised). Data were analysed using generalized estimating...... of this observational study demonstrate combined glycaemic and health-related quality of life benefits of initiating insulin glargine in patients with Type 2 diabetes in routine primary care....

  17. Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long-Term Outcome.

    Science.gov (United States)

    Ciccarelli, Giovanni; Barbato, Emanuele; Golino, Marco; Cimmino, Giovanni; Bartunek, Jozef; Di Serafino, Luigi; Di Girolamo, Domenico; De Bruyne, Bernard; Wijns, William; Golino, Paolo

    2017-02-01

    Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients. Seven-hundred and thirteen consecutive STEMI patients undergoing PPCI, admitted to the S. Anna and S. Sebastiano Hospital (Caserta, Italy) and to the OLV Clinic (Aalst, Belgium), between March 2009 and December 2011, were retrospectively enrolled. Rescue PCI was the only exclusion criterion. Primary end-point was the combination of death for all causes, re-infarction, stroke, and target lesion revascularization (TLR). Patients already on DAPT at admission (26.4%) showed a significant increase in the event rate at univariate analysis (HR 2.34, CI 1.62-3.75, P smoking patients already on DAPT at admission, a lower event rate was observed than in non-smoking patients on DAPT. Although, patients already on DAPT had a higher-risk profile (renal impairment, ongoing statin treatment, ST resolution 1 were more frequently present than in patients not on DAPT), Cox regression analysis confirmed that both DAPT (HR 1.74, 95%CI 1.20-2.53, P smoking status (HR 0.69, 95%CI 0.48-1.00, P < 0.05) retained their statistical significance, as they and were significantly associated with a worse and a better outcome, respectively, underlying their role as independent prognostic factors. Not being a current smoker and ongoing DAPT at admission, in patients with STEMI undergoing PPCI, represent independent negative prognostic value. © 2016, Wiley Periodicals, Inc.

  18. Influence of initial acute myocardial infarction presentation on the outcome of surgical procedures after coronary stent implantation: a report from the CREDO-Kyoto PCI/CABG Registry Cohort-2.

    Science.gov (United States)

    Tokushige, Akihiro; Shiomi, Hiroki; Morimoto, Takeshi; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Iwabuchi, Masashi; Shizuta, Satoshi; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Hamasaki, Shuichi; Tei, Chuwa; Nakashima, Hitoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi

    2013-01-01

    Several previous publications have consistently reported that surgical procedures performed early after coronary stenting were associated with significantly higher risk for ischemic events than those performed late. In the current post hoc analysis of the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting Registry Cohort-2, we compared the outcomes of early (within 42 days) versus late surgery (beyond 42 days) after coronary stenting stratified by the initial clinical presentations [acute myocardial infarction (AMI) [early N = 153, and late N = 586] and non-AMI (early N = 202, and late N = 1457)]. Cumulative incidence of death/myocardial infarction/stent thrombosis at 30 days after surgery was significantly higher in the early group than in the late group in the AMI stratum [18.4 vs. 2.6 %, P presentation and the timing of surgery (P interaction = 0.03). Deaths in patients with early surgery in the AMI stratum were mostly related to preoperative complications of AMI (76 %), but not related to perioperative stent-related complications (4.0 %). In conclusion, significantly higher risk of early versus late surgery for perioperative ischemic events was seen only in patients with initial AMI presentation, but not in patients with non-AMI presentation. Previous observations suggesting higher risk in early surgery might not be related to the timing after stent implantation per se, but related to more morbid preoperative conditions in patients who underwent early surgery.

  19. Late Thrombosis of Sirolimus-Eluting Stent: A Multifactorial Problem

    Directory of Open Access Journals (Sweden)

    Igor Kranjec

    2009-01-01

    Full Text Available We report a case of a young patient in whom a sirolimus-eluting stent was implanted on the culprit left anterior descending coronary artery at primary percutaneous coronary intervention (PCI for acute myocardial infarction. Nine months later she suffered from a reinfarction due to the late stent thrombosis despite a continuous antiplatelet therapy with aspirin and clopidogrel. A cluster of factors that might have contributed to the development of the stent thrombosis were identified: suboptimal PCI technique, complete stent fracture, and clopidogrel resistance. The obstructed stent was successfully reopened by repeat PCI, while the clopidogrel maintenance dosage was doubled to 150 mg daily for the following year. The further long-term clinical course was uneventful.

  20. Sub-optimal CD4 reconstitution despite viral suppression in an urban cohort on Antiretroviral Therapy (ART in sub-Saharan Africa: Frequency and clinical significance

    Directory of Open Access Journals (Sweden)

    Kamya Moses R

    2008-10-01

    Full Text Available Abstract Background A proportion of individuals who start antiretroviral therapy (ART fail to achieve adequate CD4 cell reconstitution despite sustained viral suppression. We determined the frequency and clinical significance of suboptimal CD4 reconstitution despite viral suppression (SO-CD4 in an urban HIV research cohort in Kampala, Uganda Methods We analyzed data from a prospective research cohort of 559 patients initiating ART between 04/04–04/05. We described the patterns of SO-CD4 both in terms of:- I magnitude of CD4 cell increase (a CD4 count increase Results Of 559 patients initiating ART, 386 (69% were female. Median (IQR age and baseline CD4 counts were 38 yrs (33–44 and 98 cells/μl (21–163 respectively; 414 (74% started a d4T-based regimen (D4T+3TC+NVP and 145 (26% a ZDV-based regimen (ZDV+3TC+EFV. After 6, 12 and 24 months of ART, 380 (68%, 339 (61% and 309 (55% had attained and sustained HIV-RNA viral suppression. Of these, 78 (21%, 151 (45% and 166 (54% respectively had SO-CD4 based on criteria I, and 165(43%, 143(42% and 58(19% respectively based on criteria II. With both criteria combined, 56 (15% and 129 (38% had SO-CD4 at 6 and 12 months respectively. A high proportion (82% and 58% of those that had SO-CD4 at 6 months (using criteria I maintained SO-CD4 at 12 and 24 months respectively. There were no statistically significant differences in the incidence of clinical events among patients with [19/100PYO (12–29] and without SO-CD4 [23/100PYO (19–28]. Conclusion Using criteria I, the frequency of SO-CD4 was 21% at 6 months. Majority of patients with SO-CD4 at 6 months maintained SO-CD4 up to 2 years. We recommend studies of CD4 T-cell functional recovery among patients with SO-CD4.

  1. Addition of neutral protamine lispro insulin or insulin glargine to oral type 2 diabetes regimens for patients with suboptimal glycemic control: a randomized trial.

    Science.gov (United States)

    Esposito, Katherine; Ciotola, Miryam; Maiorino, Maria Ida; Gualdiero, Roberto; Schisano, Bruno; Ceriello, Antonio; Beneduce, Flora; Feola, Giovanni; Giugliano, Dario

    2008-10-21

    Injection of long-acting insulin at bedtime is a common therapeutic approach for patients with type 2 diabetes that is poorly controlled with oral regimens. Neutral protamine lispro (NPL) insulin has demonstrated better glycemic control and similar incidence of hypoglycemic events than that of neutral protamine Hagedorn insulin. To compare the clinical efficacy and safety of bedtime NPL insulin or insulin glargine in patients with type 2 diabetes who had suboptimal glycemic control while receiving stable doses of metformin and sulfonylurea. Open-label, randomized trial. Teaching hospital (Azienda Ospedaliera Universitaria, Second University of Naples), Naples, Italy. 116 adults receiving stable doses of metformin plus sulfonylurea for longer than 90 days with hemoglobin A(1c) (HbA(1c)) levels of 7.5% to 10% and fasting plasma glucose levels of 6.7 mmol/L or greater (> or =120 mg/dL). 10 IU of NPL insulin or insulin glargine injected subcutaneously at bedtime with weekly dose titrations to target fasting glucose levels less than 5.6 mmol/L (weight. Twenty patients in each group had continuous glucose monitoring for 3 consecutive days before adding insulin and at week 36. Improvement in HbA(1c) levels was similar in both groups (1.83% and 1.89% for NPL and glargine, respectively). The difference between the groups was 0.06 percentage point (95% CI, -0.1 to 0.15 percentage points). Secondary outcomes did not differ between groups. Hemoglobin A(1c) levels less than 7% occurred in 62% of patients receiving NPL and 64% of patients receiving glargine (difference, 2.0 percentage points [CI, -1.1 to 5.0 percentage points]). Fasting plasma glucose levels less than 5.6 mmol/L (<100 mg/dL) occurred in 40% of patients receiving NPL and 41% of patients receiving glargine (difference, 1.0 percentage point [CI, -0.9 to 3.0 percentage points]). Any hypoglycemic event occurred in 74% of patients receiving NPL and 67% of patients receiving glargine (difference, 7 percentage points

  2. The framing of research questions using the PICOT format in randomized controlled trials of venous ulcer disease is suboptimal: A systematic survey.

    Science.gov (United States)

    Abbade, Luciana P F; Wang, Mei; Sriganesh, Kamath; Jin, Yanling; Mbuagbaw, Lawrence; Thabane, Lehana

    2017-09-01

    Despite several publications on venous ulcers, there is still a lack of evidence from randomized controlled trials (RCTs) to support certain treatments for patients with this disorder. Well-designed research questions using the PICOT (Population; Intervention; Comparator; Outcome; Time-frame) format in RCTs can improve the quality of research. The objectives of this study were to assess how the PICOT format is used to frame research questions in RCTs published on venous ulcer disease and to determine the factors associated with better adherence to the PICOT format. We conducted a systematic survey of RCTs on venous ulcers published in the PubMed database between January 2009 and May 2016. All RCTs published in English addressing therapeutic interventions for venous ulcer disease in human subjects were included. We examined whether the five elements of the PICOT format were used in formulating the research question and scored them between 0 and 5. The primary outcome of this systematic survey was the percentage of studies that adequately reported all five PICOT elements. Eighty-five (85) RCTs were included with median PICOT score of 3 (IQR = 1.5). Four elements of PICOT were present in 28 reports (32.9%) and only 2 RCTS (2.3%) reported all the PICOT elements. Population and intervention were often appropriately described, in (70/85) 82.4% and (83/85) 97.6% of the studies, respectively; however, comparison intervention and outcome were presented in only (53/85) 62.3% and (48/85) 56.5% of studies, respectively. Very few RCTs (7.1%; 6/85) reported the study time frame. No journal or RCT characteristics were found to be significantly associated with better reporting. Use of the PICOT format to frame research questions in RCTs published on venous ulcers is suboptimal, and our study reinforces the importance of framing a good research question to improve the design of trials and quality of evidence in venous ulcer disease. © 2017 by the Wound Healing Society.

  3. The Role of Healthy Lifestyle in the Implementation of Regressing Suboptimal Health Status among College Students in China: A Nested Case-Control Study

    Science.gov (United States)

    Chen, Jieyu; Xiang, Hongjie; Jiang, Pingping; Yu, Lin; Jing, Yuan; Li, Fei; Wu, Shengwei; Fu, Xiuqiong; Liu, Yanyan; Kwan, Hiuyee; Luo, Ren; Zhao, Xiaoshan; Sun, Xiaomin

    2017-01-01

    Background: Suboptimal health status (SHS) is the intermediate health state between health and disease, it is medically undiagnosed and is also termed functional somatic syndrome. Although its clinical manifestations are complicated and various, SHS has not reached the disease status. Unhealthy lifestyle is associated with many chronic diseases and mortality. In accordance with the impact of lifestyle on health, it is intriguing to determine the association between unhealthy lifestyle and SHS risk. Methods: We conducted a nested case-control study among healthy Chinese college students from March 2012 to September 2013, which was nested in a prospective cohort of 5676 students. We performed 1:1 incidence density sampling with matched controls for birth year, sex, grade, specialty and individual character. SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Exposure was defined as an unhealthy lifestyle per the frequency of six behavioral dimensions from the Health-promoting Lifestyle Profile (HPLP-II). Results: We matched 543 cases of SHS (42.66%) in a cohort of 1273 students during the 1.5 years mean follow-up time with controls. A significant difference (t = 9.79, p < 0.001) and a reduction in HPLP-II total score was present at 1.5 years follow-up (135.93 ± 17.65) compared to baseline (144.48 ± 18.66). A level-response effect was recorded with an increase of the total HPLP-II (every dimension was correlated with a decreased SHS risk). Compared to respondents with the least exposure (excellent level), those reporting a general HPLP-II level were approximately 2.3 times more likely to develop SHS (odd ratio = 2.333, 95% CI = 1.471 to 3.700); and those with less HPLP-II level (good level) were approximately 1.6 times more likely (1.644, 1.119–2.414) to develop SHS (p < 0.05). Our data indicated that unhealthy lifestyle behavior with respect to behavioral dimensions significantly affected SHS likelihood

  4. A dietary dairy/yeast prebiotic and flaxseed oil enhance growth, hematological and immunological parameters in channel catfish at a suboptimal temperature (15°C).

    Science.gov (United States)

    Thompson, M; Lochmann, R; Phillips, H; Sink, T D

    2015-07-01

    Channel catfish raised in the southern United States require two growing seasons to reach market size. Growing seasons are separated by a cool period of about 3 months when feed intake and growth are greatly reduced. A cool-weather feeding strategy to improve feed intake, growth or health of catfish might improve survival and reduce the time needed to achieve market size. We conducted a feeding trial with channel catfish at a suboptimal temperature (15°C) to determine the effects of supplementing diets with either a dairy/yeast prebiotic or flaxseed oil (high in 18:3n-3) compared with a control with soybean oil (high in 18:2n-6). The trial was conducted in recirculating systems with 1140-l tanks containing 100 fish each (mean initial weight 61.4 g±0.43 s.e.m.). A 28%-protein basal diet was supplemented with 20 g/kg cellulose and 20 g/kg soybean oil (SBO, control), 20 g/kg cellulose and 20 g/kg flaxseed oil (FLAX) or 20 g/kg of a dairy/yeast prebiotic and 20 g/kg soybean oil (PREB). Fish were fed once daily to satiation and weighed every 3 weeks to track growth. Hematology, non-specific immune responses, proximate and fatty acid composition of muscle were determined to assess diet effects. Catfish-fed FLAX or PREB had higher weight gain, feed consumption and lysozyme activity than fish fed SBO. Total n-3 fatty acids in muscle were higher in fish fed SBO or FLAX than those fed PREB. Total n-6 long-chain polyunsaturated acids were higher in muscle of fish fed PREB than those fed SBO. Fatty acids in the PREB and SBO diets were similar, so the PREB appeared to increase elongation and desaturation of n-6 fatty acids in muscle. Flaxseed oil and the dairy/yeast prebiotic both have potential to increase catfish performance at a low temperature.

  5. Doses estimations of a comparative study between radial and femoral access during coronary angiograms and percutaneous coronary interventions; Estimations des doses dans le cadre d'une etude comparative des voies radiales et femorales droites dans la technique radiologique coronarographique

    Energy Technology Data Exchange (ETDEWEB)

    Blanpain, T.; Brasselet, C.; Tassan-mangina, S.; Deschildre, A.; Metz, D. [Hopital Robert Debre, Lab. de Catheterisme Cardiaque, Dept. de cardiologie, 51 - Reims (France); Blanpain, T.; Clement, J.P.; Gaillot-petit, N.; Tourneux, C. [Hopital Robert Debre, Unite de Radio Physique Medicale et de Radioprotection, 51 - Reims (France)

    2008-07-15

    Irradiation of operators and patients during coronary angiograms (CA) and percutaneous coronary interventions (PCI) are legitimate matter of concern of modern interventional cardiology. Femoral and right radial approaches are privileged accesses for the CA and PCI. However, few registers compare these 2 accesses in term of operators and patients irradiation. The purpose of this register is to establish a comparative evaluation between these 2 techniques. 423 consecutive patients having benefited in our center either one or the other of these techniques performed between October, 2005 and March, 2006 were included. The retained parameters are: Left operator arm dose, patient surface dose, global procedure time and scopy time. The results are significantly higher in radial CA and PCI ad hoc than in femoral access for the four studied parameters: (1) scopy time: 4 min versus 1.8 min, and 9.6 min versus 6.3 min; (2) procedure time: 15 min versus 9.5, and 41 min versus 35.25 min; (3) patient dose: 59 Gy cm{sup 2} versus 37.5 Gy cm{sup 2}, and 123 Gy cm{sup 2} versus 102 Gy cm{sup 2}; (4) operator dose: 29 {mu}Sv versus 13 {mu}Sv, and 69 {mu}Sv versus 40 {mu}Sv. In spite of its interest with less post-operative vascular complications, the right radial access is significantly more irradiating for the operators and the patients than the femoral access. (author)

  6. ‘Mother-in-child’ thrombectomy technique: a novel and effective approach to decrease intracoronary thrombus burden in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Dauvergne, Christian; Araya, Mario [Department of Cardiology, Clinica Alemana, Santiago (Chile); Uriarte, Polentzi [Department of Cardiology, Instituto Nacional del Torax, Santiago (Chile); Novoa, Oscar; Novoa, Lilian [Department of Cardiology, Clinica Alemana, Santiago (Chile); Maluenda, Gabriel, E-mail: gabrielmaluenda@gmail.com [Department of Cardiology, Clinica Alemana, Santiago (Chile)

    2013-01-15

    Background: The presence of large thrombus burden in patients presenting with acute myocardial infarction (AMI) is common and associated with poor prognosis. This study aimed to describe the feasibility and safety of the novel ‘mother-in-child’ thrombectomy (MCT) technique in patients presenting with AMI and large thrombus burden undergoing percutaneous coronary intervention (PCI). Methods: We studied 13 patients presenting with AMI who underwent PCI with persistent large intracoronary thrombus after standard thrombectomy. The procedure was performed using a 5 F ‘Heartrail II-ST01’ catheter (Terumo Medical) into a 6 F guiding system. Angiographic assessment of thrombus burden and coronary flow was obtained at baseline, immediately after thrombectomy and at the end of the procedure. Results: The mean age was 55.9 ± 13.0 years and involved mostly males (76.9%). All patients underwent PCI via radial approach. Following MCT Thrombolysis In Myocardial Infarction (TIMI) flow improved by 2 or more degrees in 11 patients (84.5%), while visible angiographic thrombus was reduced in 11 patients (84.5%). In the final angiogram, normal TIMI flow was restored in 11 patients (84.5%), with normal myocardial ‘blush’ in 7 patients (53.8%) and total clearance of a visible thrombus in 7 patients (53.8%). Overall, 6 patients received thrombectomy as ‘stand-alone’ procedure. All patients were discharged alive after a mean of 5.6 ± 2 days. Conclusion: This initial report suggests that significant reduction in thrombus burden and improvement of the coronary flow can be safely achieved in patients presenting with AMI and large thrombus burden by using the novel MCT technique.

  7. Single or dual antiplatelet therapy after PCI

    NARCIS (Netherlands)

    Miyazaki, Yosuke; Suwannasom, Pannipa; Sotomi, Yohei; Abdelghani, Mohammad; Tummala, Karthik; Katagiri, Yuki; Asano, Taku; Tenekecioglu, Erhan; Zeng, Yaping; Cavalcante, Rafael; Collet, Carlos; Onuma, Yoshinobu; Serruys, Patrick W.

    2017-01-01

    The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. At the time of the first-in-man implantation of the sirolimus DES in 1999, the protocol-defined dual antiplatelet therapy (DAPT) duration was only 2 months. Subsequently, DAPT

  8. Applying PCI in Combination Swivel Head Wrench

    Science.gov (United States)

    Chen, Tsang-Chiang; Yang, Chun-Ming; Hsu, Chang-Hsien; Hung, Hsiang-Wen

    2017-09-01

    Taiwan’s traditional industries are subject to competition in the era of globalization and environmental change, the industry is facing economic pressure and shock, and now sustainable business can only continue to improve production efficiency and quality of technology, in order to stabilize the market, to obtain high occupancy. The use of process capability indices to monitor the quality of the ratchet wrench to find the key function of the dual-use ratchet wrench, the actual measurement data, The use of process capability Cpk index analysis, and draw Process Capability Analysis Chart model. Finally, this study explores the current situation of this case and proposes a lack of improvement and improvement methods to improve the overall quality and thereby enhance the overall industry.

  9. Effectiveness of NEM® brand eggshell membrane in the treatment of suboptimal joint function in dogs: a multicenter, randomized, double-blind, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Ruff KJ

    2016-08-01

    Full Text Available Kevin J Ruff,1 Kenneth J Kopp,2 Pamela Von Behrens,3 Mark Lux,4 Matthew Mahn,5 Matthew Back1 1ESM Technologies LLC, Carthage, 2Kopp Veterinary Consulting, St Louis, 3Clarkson-Wilson Veterinary Clinic, Chesterfield, 4Mackenzie Pointe Animal Hospital, St Louis, 5Midwest Veterinary Referral Center, Chesterfield, MO, USA Introduction: Sub-optimal joint function is extremely prevalent in dogs. Therefore, a 6-week, prospective, randomized, double-blind, placebo-controlled study was conducted at eight different veterinary clinics to evaluate the efficacy, safety, and tolerability of NEM® brand eggshell membrane (EM, a novel dietary supplement shown in other species to help maintain healthy joints and connective tissues. Subjects and methods: Fifty-one dogs received oral EM ~13.5 mg/kg (6 mg/lb or placebo (excipients once daily for six weeks. The primary outcome measure of this study was to evaluate the change in mean joint function following 1 week and 6 weeks of supplementation as determined via the Canine Brief Pain Inventory (CBPI questionnaire (Q#5-10 in the treatment group versus the placebo group. Secondary outcome measures were for changes in mean CBPI pain and CBPI quality of life, and mean joint pain, mobility and lameness via Veterinary Canine Scoring Assessments (VCSA. A final secondary outcome measure was for a change in serum levels of the cartilage degradation biomarker, c-terminal cross-linked telopeptide of type-II collagen (CTX-II. Results: Supplementation with EM produced a significant treatment response versus placebo at 1 week (20.5% improvement, P=0.028, but fell shy of significance at 6 weeks post-treatment (22.5% improvement for the primary outcome measure (CBPI Function, despite a sizeable treatment effect. Similarly, there was also a significant treatment response versus placebo at 1 week for CBPI Pain (19.4% improvement, P=0.010, but fell just shy of significance at 6 weeks (22.5% improvement, again despite a sizeable

  10. The Role of Healthy Lifestyle in the Implementation of Regressing Suboptimal Health Status among College Students in China: A Nested Case-Control Study

    Directory of Open Access Journals (Sweden)

    Jieyu Chen

    2017-02-01

    Full Text Available Background: Suboptimal health status (SHS is the intermediate health state between health and disease, it is medically undiagnosed and is also termed functional somatic syndrome. Although its clinical manifestations are complicated and various, SHS has not reached the disease status. Unhealthy lifestyle is associated with many chronic diseases and mortality. In accordance with the impact of lifestyle on health, it is intriguing to determine the association between unhealthy lifestyle and SHS risk. Methods: We conducted a nested case-control study among healthy Chinese college students from March 2012 to September 2013, which was nested in a prospective cohort of 5676 students. We performed 1:1 incidence density sampling with matched controls for birth year, sex, grade, specialty and individual character. SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0. Exposure was defined as an unhealthy lifestyle per the frequency of six behavioral dimensions from the Health-promoting Lifestyle Profile (HPLP-II. Results: We matched 543 cases of SHS (42.66% in a cohort of 1273 students during the 1.5 years mean follow-up time with controls. A significant difference (t = 9.79, p < 0.001 and a reduction in HPLP-II total score was present at 1.5 years follow-up (135.93 ± 17.65 compared to baseline (144.48 ± 18.66. A level-response effect was recorded with an increase of the total HPLP-II (every dimension was correlated with a decreased SHS risk. Compared to respondents with the least exposure (excellent level, those reporting a general HPLP-II level were approximately 2.3 times more likely to develop SHS (odd ratio = 2.333, 95% CI = 1.471 to 3.700; and those with less HPLP-II level (good level were approximately 1.6 times more likely (1.644, 1.119–2.414 to develop SHS (p < 0.05. Our data indicated that unhealthy lifestyle behavior with respect to behavioral dimensions significantly affected SHS likelihood

  11. Arthroscopic techniques in minimally invasive spine surgery: closure of the lumbar fascia: surgical technique.

    Science.gov (United States)

    Tumialán, Luis M; Ponton, Ryan; Riccio, Anthony I

    2011-04-01

    The constrained working area in minimally invasive exposures of the spine may limit the capacity to effectively close the lumbar fascia, especially in patients with elevated body mass indexes. The working channel in these cases may have a diameter as narrow as 14 mm and a length up to 9 cm. Under these circumstances, the use of a conventional needle driver and a curved needle becomes suboptimal for closures of the fascia. To demonstrate the utility of an arthroscopic suture passer for closure of the lumbar fascia in such approaches. A flexible suture passer, typically used in arthroscopic rotator cuff repair surgery, was used through a minimally invasive portal for fascial closure after minimally invasive lumbar spine procedures. The use of an arthroscopic suture passer precludes the need for rotation of a curved needle in a constrained working area. Deploying a nitinol needle through an arc delivers the suture through the fascia, thereby facilitating closure. Satisfactory lumbar fascia closures were achieved in 18 patients with elevated body mass indexes. Application of existing technology in other surgical specialties may address the shortcomings of current techniques in minimally invasive approaches to the spine. The use of a flexible arthroscopic suture passer is one example in which current technology in one discipline may be applied to minimally invasive approaches. Increasing the awareness of techniques and instruments in other surgical disciplines may expand the armamentarium of the minimally invasive spine surgeon.

  12. Persistent type I endoleak after endovascular treatment with Chimney technique

    Directory of Open Access Journals (Sweden)

    Ana Isabel Azevedo

    2016-09-01

    Full Text Available Thoracic endovascular aortic repair (TEVAR is increasingly used in the treatment of acute type B aortic dissection. Type Ia endoleaks are a common complication of the procedure, but its clinical significance as well as the best treatment strategy remain poorly defined. We present a case of a type Ia endoleak following TEVAR in the treatment of acute type B aortic dissection. Chimney technique approach was used in an attempt to seal the endoleak. Although technical success was suboptimal, the patient remained clinically stable and event free. Data regarding the natural course and management of type Ia endoleaks following TEVAR for aortic dissection are sparse. Future research is required to establish the clinical and technical determinants of the need to treat these endoleaks as well as the best treatment strategy.

  13. MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Sanjay P.; Mahmood, Soran; Sena, Laureen [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Lee, Edward Y. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Children' s Hospital Boston and Harvard Medical School, Department of Medicine, Pulmonary Division, Boston, MA (United States)

    2009-09-15

    Pulmonary embolism (PE) is a life-threatening thromboembolic complication in patients who have undergone a Fontan procedure for augmenting pulmonary blood flow in the setting of single-ventricle physiology. In patients following a Fontan procedure, lack of proper contrast agent mixing in the right atrium and sluggish, low-velocity blood flow within the Fontan circulation often results in suboptimal contrast enhancement within the pulmonary artery for evaluating PE. Unfortunately, there is a paucity of information describing the optimal contrast-enhancement technique with multidetector CT (MDCT) for evaluating PE in children and young adults following a Fontan procedure. We illustrate the MDCT imaging findings of suboptimal contrast enhancement within the pulmonary artery, which can be mistaken for PE, in patients following a lateral Fontan procedure, and we discuss MDCT techniques to optimize contrast enhancement within the pulmonary artery in these patients for evaluating PE. The MDCT imaging findings in pediatric and young adult patients following a lateral Fontan procedure and with clinically suspected PE are illustrated. We describe intravenous contrast agent injection techniques that can be used to optimize the contrast enhancement in the pulmonary artery in patients following a lateral Fontan procedure. The use of a suboptimal contrast-enhancement technique led to initial misdiagnosis and incomplete evaluation of PE in the three patients following a lateral Fontan procedure. Imaging in two patients showed that optimal evaluation of thrombosis in the Fontan pathway and PE in the pulmonary arteries can be successfully achieved with simultaneous upper- and lower-limb injections of contrast agent. This series demonstrates that suboptimal contrast enhancement can result in misdiagnosis or incomplete evaluation of PE in children and young adults following a lateral Fontan procedure. Careful attention to optimizing contrast enhancement during MDCT examination for

  14. Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol versus Standard Dual Anti-platelet in Patients with High Post-Treatment Platelet Reactivity: Results of the CREATIVE Trial (Clopidogrel Response Evaluation and AnTi-platelet InterVEntion in High Thrombotic Risk PCI Patients).

    Science.gov (United States)

    Tang, Yi-Da; Wang, Wenyao; Yang, Min; Zhang, Kuo; Chen, Jing; Qiao, Shubin; Yan, Hongbing; Wu, Yongjian; Huang, Xiaohong; Xu, Bo; Gao, Runlin; Yang, Yuejin

    2018-02-02

    Background -Patients undergoing percutaneous coronary intervention (PCI) react differently to antiplatelet drugs. Those with low responsiveness to clopidogrel have a higher risk of cardiac ischemic events. The goal of this study is to conduct a head-to-head comparison of the safety and effectiveness of intensified antiplatelet therapies (either double-dose clopidogrel [DOUBLE] or adjunctive cilostazol [TRIPLE]) and conventional strategy (STANDARD) in post-PCI patients. Methods -In this single-center, randomized, controlled trial, we used thromboelastography (TEG), a platelet function test, to select 1078 PCI patients at high thrombotic risk and compared the intensified antiplatelet therapies with standard antiplatelet therapy. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events at 18 months post-PCI, defined as a composite of all-cause death, myocardial infarction, target vessel revascularization or stroke. Bleeding Academic Research Consortium (BARC) defined bleeding complications (types 1, 2, 3, or 5) were the safety endpoints. Results -The primary endpoint occurred in 52 patients (14.4%) in STANDARD group, 38 patients (10.6%) in DOUBLE group and 30 patients (8.5%) in TRIPLE group (HR: 0.720, 95%CI: 0.474-1.094, DOUBLE vs. STANDARD; HR: 0.550, 95%CI: 0.349-0.866, TRIPLE vs. STANDARD). No significant difference in the rates of major bleeding (BARC grade≥3) was found in DOUBLE group (3.34% vs. 1.93% in STANDARD, P=0.133) and TRIPLE group (2.53% vs 1.93% in STANDARD, P=0.240). The rate of BARC-defined minor bleeding increased in DOUBLE group (27.4% vs. 20.3% in STANDARD, P=0.031), but not in TRIPLE group (23.6% vs. 20.3% in STANDARD, P=0.146). Conclusions -In patients with low responsiveness to clopidogrel, as measured by thromboelastography, the intensified antiplatelet strategies with adjunctive use of cilostazol significantly improved the clinical outcomes without increasing the risk of major bleeding. Decreased trend of

  15. Cogeneration techniques; Les techniques de cogeneration

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-10-01

    This dossier about cogeneration techniques comprises 12 parts dealing successively with: the advantages of cogeneration (examples of installations, electrical and thermal efficiency); the combustion turbine (principle, performances, types); the alternative internal combustion engines (principle, types, rotation speed, comparative performances); the different configurations of cogeneration installations based on alternative engines and based on steam turbines (coal, heavy fuel and natural gas-fueled turbines); the environmental constraints of combustion turbines (pollutants, techniques of reduction of pollutant emissions); the environmental constraints of alternative internal combustion engines (gas and diesel engines); cogeneration and energy saving; the techniques of reduction of pollutant emissions (pollutants, unburnt hydrocarbons, primary and secondary (catalytic) techniques, post-combustion); the most-advanced configurations of cogeneration installations for enhanced performances (counter-pressure turbines, massive steam injection cycles, turbo-chargers); comparison between the performances of the different cogeneration techniques; the tri-generation technique (compression and absorption cycles). (J.S.)

  16. Applications of sub-optimality in dynamic programming to location and construction of nuclear fuel processing plant; Application de la sous-optimalite en programmation dynamique a la localisation et la cadence optimales de construction des equipements

    Energy Technology Data Exchange (ETDEWEB)

    Thiriet, L.; Deledicq, A. [Commissariat a l' Energie Atomique, 92 - Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires, section des etudes economiques generales

    1968-09-01

    First, the point of applying Dynamic Programming to optimization and Operational Research problems in chemical industries are recalled, as well as the conditions in which a dynamic program is illustrated by a sequential graph. A new algorithm for the determination of sub-optimal politics in a sequential graph is then developed. Finally, the applications of sub-optimality concept is shown when taking into account the indirect effects related to possible strategies, or in the case of stochastic choices and of problems of the siting of plants... application examples are given. (authors) [French] On rappelle d'abord l'interet de la Programmation Dynamique dans les problemes d'optimisation et de Recherche Operationnelle dans les industries chimiques, et les conditions de representation d'un programme dynamique par un graphe sequentiel. On expose ensuite un nouvel algorithme de determination de politiques sous-optimales dans un graphe sequentiel. On montre enfin les applications du concept de sous-optimalite a la prise en compte d'effets indirects lies aux politiques possibles, aux choix dans l'aleatoire, a des problemes de localisation optimale d'usines... et on donne des exemples d'utilisation. (auteurs)

  17. Hypotonic MR duodenography with water ingestion alone: feasibility and technique.

    Science.gov (United States)

    Cronin, Carmel G; Dowd, Geraldine; Mhuircheartaigh, Jennifer Ni; DeLappe, Eithne; Allen, Ruaridh H; Roche, Clare; Murphy, Joseph M

    2009-07-01

    To date, cross-sectional imaging of the duodenum has a number of inadequacies, most likely a reflection of its tortuous and complex anatomical course, resulting in somewhat suboptimal imaging. The purpose of this study was to describe and assess the feasibility of performing a 'tubeless', per-oral, single contrast, hypotonic magnetic resonance (MR) duodenography technique. Secondly, to assess the efficacy of intravenous Buscopan in facilitating duodenal distension at cross-sectional MR imaging. Ten healthy volunteers prospectively underwent MR imaging of the duodenum pre- and post-Buscopan immediately after consuming 1,000 ml of water. Images were qualitatively (using a visual assessment grading scale of 1-3) and quantitatively evaluated with regard to degree of small bowel distension by two observers. The contrast medium was successfully ingested and MR examination was completed in all participants. Quantitatively and qualitatively, the per-oral, hypotonic duodenography technique yielded superior distension scores and was significantly greater in diameter in comparison with the per-oral non-hypotonic duodenography technique (p hypotonic MR duodenography is a feasible, simple, fast mode of investigation of the duodenum, which does not involve radiation and represents a useful technique in the armamentarium of the radiologist.

  18. Submillisievert chest CT with filtered back projection and iterative reconstruction techniques.

    Science.gov (United States)

    Padole, Atul; Singh, Sarabjeet; Ackman, Jeanne B; Wu, Carol; Do, Synho; Pourjabbar, Sarvenaz; Khawaja, Ranish Deedar Ali; Otrakji, Alexi; Digumarthy, Subba; Shepard, Jo-Anne; Kalra, Mannudeep

    2014-10-01

    The purpose of this study was to compare submillisievert chest CT images reconstructed with filtered back projection (FBP), SafeCT, adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR) with standard of care FBP images. Fifty patients (33 men and 17 women; mean age [± SD], 62 ± 10 years) undergoing routine chest CT gave written informed consent for acquisition of an additional submillisievert chest CT series with reduced tube current but identical scanning length as standard of care chest CT. Sinogram data of the submillisievert series were reconstructed with FBP, SafeCT, ASIR, and MBIR and compared with FBP images at standard-dose chest CT (n = 8 × 50 = 400 series). Two thoracic radiologists performed independent comparison for visualization of lesion margin, visibility of small structures, and diagnostic acceptability. Objective noise measurements and noise spectral density were obtained. Of 287 detected lesions, 162 were less than 1-cm noncalcified nodules. Lesion margins were well seen on all submillisievert reconstruction images except MBIR, on which they were poorly visualized. Likewise, only submillisievert MBIR images were suboptimal for visibility of normal structures, such as pulmonary vessels in the outer 2 cm of the lung, interlobular fissures, and subsegmental bronchial walls. MBIR had the lowest image noise compared with other techniques. FBP, SafeCT, ASIR, and MBIR can enable optimal lesion evaluation on chest CT acquired at a volume CT dose index of 2 mGy. However, all submillisievert reconstruction techniques were suboptimal for visualization of mediastinal structures. Submillisievert MBIR images were suboptimal for visibility of normal lung structures despite showing lower image noise.

  19. Subjection and subjectification / technique and techniques

    Directory of Open Access Journals (Sweden)

    Emanuele Clarizio

    2013-03-01

    Full Text Available The Course on The Hermeneutic of the Subject problematizes a theme that goes through the whole Foucault’s thought, that of technique. The article, through a dialogue among Foucault, Heidegger and Simondon, aims to trace the development of this theme, also asking the way the technique works when related to processes of subjection and subjectification.

  20. Five-year outcomes following PCI with DES versus CABG for unprotected LM coronary lesions: meta-analysis and meta-regression of 2914 patients Desfechos de 5 anos do tratamento de lesões de TCE por stents farmacológicos versus CRM: metaanálise e meta-regressão de 2914 pacientes

    Directory of Open Access Journals (Sweden)

    Michel Pompeu Barros de Oliveira Sá

    2013-03-01

    Full Text Available OBJECTIVE: To compare the safety and efficacy at long-term follow-up of coronary artery bypass grafting (CABG with percutaneous coronary intervention (PCI using drug-eluting stents (DES in patients with unprotected left main coronary artery (ULMCA disease. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for clinical studies that reported outcomes at 5-year follow-up after PCI with DES and CABG for the treatment of ULMCA stenosis. Five studies (1 randomized controlled trial and 4 observational studies were identified and included a total of 2914 patients (1300 for CABG and 1614 for PCI with DES. RESULTS: At 5-year follow-up, there was no significant difference between the CABG and PCI-DES groups in the risk for death (odds ratio [OR] 1.159, P=0.168 for random effect or the composite endpoint of death, myocardial infarction, or stroke (OR 1.214, P=0.083. The risk for target vessel revascularization (TVR was significantly lower in the CABG group compared to the PCI-DES group (OR 0.212, POBJETIVO: Comparar segurança e eficácia do seguimento a longo prazo da cirurgia de revascularização miocárdica (CRM com intervenção coronária percutânea (ICP, utilizando stents farmacológicos (SF em pacientes com lesão de tronco de coronária esquerda não-protegida (TCE. MÉTODOS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar e listas de referências artigos relevantes foram escaneados para estudos clínicos que relataram resultados em 5 anos de seguimento após ICP-SF eCRM para o tratamento de lesão de TCE. Cinco estudos (um de ensaio clínico randomizado e quatro estudos observacionais foram identificados e incluíram um total de 2914 pacientes (1300 para CRM e 1614 para ICP-SF. RESULTADOS: Aos 5 anos de seguimento, não houve diferença significativa entre os grupos CRM e ICP-SF no risco de morte (odds ratio [OR] 1,159, P=0,168 ou desfecho composto de morte

  1. Surface science techniques

    CERN Document Server

    Bracco, Gianangelo

    2013-01-01

    The book describes the experimental techniques employed to study surfaces and interfaces. The emphasis is on the experimental method. Therefore all chapters start with an introduction of the scientific problem, the theory necessary to understand how the technique works and how to understand the results. Descriptions of real experimental setups, experimental results at different systems are given to show both the strength and the limits of the technique. In a final part the new developments and possible extensions of the techniques are presented. The included techniques provide microscopic as well as macroscopic information. They cover most of the techniques used in surface science.

  2. A review of metaheuristic scheduling techniques in cloud computing

    Directory of Open Access Journals (Sweden)

    Mala Kalra

    2015-11-01

    Full Text Available Cloud computing has become a buzzword in the area of high performance distributed computing as it provides on-demand access to shared pool of resources over Internet in a self-service, dynamically scalable and metered manner. Cloud computing is still in its infancy, so to reap its full benefits, much research is required across a broad array of topics. One of the important research issues which need to be focused for its efficient performance is scheduling. The goal of scheduling is to map tasks to appropriate resources that optimize one or more objectives. Scheduling in cloud computing belongs to a category of problems known as NP-hard problem due to large solution space and thus it takes a long time to find an optimal solution. There are no algorithms which may produce optimal solution within polynomial time to solve these problems. In cloud environment, it is preferable to find suboptimal solution, but in short period of time. Metaheuristic based techniques have been proved to achieve near optimal solutions within reasonable time for such problems. In this paper, we provide an extensive survey and comparative analysis of various scheduling algorithms for cloud and grid environments based on three popular metaheuristic techniques: Ant Colony Optimization (ACO, Genetic Algorithm (GA and Particle Swarm Optimization (PSO, and two novel techniques: League Championship Algorithm (LCA and BAT algorithm.

  3. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... decisions about your health care. CF Genetics: The Basics CF Mutations Video Series CFTR2 Personalized Medicine Types ... of Breathing Technique Airway Clearance Techniques Autogenic Drainage Basics of Lung Care Chest Physical Therapy Coughing and ...

  4. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... of treatment options. Airway Clearance Active Cycle of Breathing Technique Airway Clearance Techniques Autogenic Drainage Basics of ... Pulmonary Exacerbations Clinical Care Guidelines SCREENING & TREATING DEPRESSION & ANXIETY GUIDELINES Clinician Resources As a clinician, you’re ...

  5. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... CF Treatments and Therapies Airway Clearance Airway Clearance Techniques (ACTs) There are different ways to clear your ... for fitting ACTs into daily life Airway Clearance Techniques | Webcast To learn more about how you can ...

  6. Healthy Cooking Techniques

    Science.gov (United States)

    Healthy Lifestyle Nutrition and healthy eating Healthy-cooking techniques capture the flavor and nutrients of food without ... in expensive cookware. You can use basic cooking techniques to prepare food in healthy ways. By using ...

  7. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... many challenges, including medical, social, and financial. By learning more about how you can manage your disease every day, you can ... Clearance Active Cycle of Breathing Technique (ACBT) Airway Clearance Techniques ( ...

  8. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Airway Clearance Airway Clearance Techniques (ACTs) There are different ways to clear your airways. Most are easy ... to loosen mucus from airway walls. See how different airway clearance techniques work to help you clear ...

  9. Combination therapy with sulfasalazine and methotrexate is more effective than either drug alone in patients with rheumatoid arthritis with a suboptimal response to sulfasalazine: results from the double‐blind placebo‐controlled MASCOT study

    Science.gov (United States)

    Capell, Hilary A; Madhok, Rajan; Porter, Duncan R; Munro, Robin A L; McInnes, Iain B; Hunter, John A; Steven, Malcolm; Zoma, Asad; Morrison, Elaine; Sambrook, Martin; Poon, Fat Wui; Hampson, Rosemary; McDonald, Fiona; Tierney, Ann; Henderson, Neil; Ford, Ian

    2007-01-01

    Background Optimal use of disease‐modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis is vital if progression of disease is to be reduced. Methotrexate (MTX) and sulfasalazine (SASP) are widely used inexpensive DMARDs, recently often combined despite no firm evidence of benefit from previous studies. Aim To establish whether a combination of SASP and MTX is superior to either drug alone in patients with rheumatoid arthritis with a suboptimal response to 6 months of SASP. Methods A randomised controlled study of step‐up DMARD treatment in early rheumatoid arthritis. In phase I, 687 patients received SASP for 6 months. Those with a disease activity score (DAS) ⩾2.4 were offered additional treatment in phase II (SASP alone, MTX alone or a combination of the two). The primary outcome measure was change in DAS. Results At 6 months, 191 (28%) patients had a DAS <2.4, 123 (18%) were eligible but did not wish to enter phase II, 130 (19%) stopped SASP because of reversible adverse events and 165 (24%) entered phase II. DAS at 18 months was significantly lower in those who received combination treatment compared with those who received either SASP or MTX: monotherapy arms did not differ. Improvement in European League Against Rheumatism and American College of Rheumatology 20, 50 and 70 scores favoured combination therapy. Conclusions In this “true‐to‐life” study, an inexpensive combination of DMARDs proved more effective than monotherapy in patients with rheumatoid arthritis with a suboptimal response to SASP. There was no increase in toxicity. These results provide an evidence base for the use of this combination as a component of tight control strategies. PMID:16926184

  10. Efficacy of switching from adefovir to tenofovir in chronic hepatitis B patients who exhibit suboptimal responses to adefovir-based combination rescue therapy due to resistance to nucleoside analogues (SATIS study

    Directory of Open Access Journals (Sweden)

    Hye Won Lee

    2016-12-01

    Full Text Available Background/Aims It remains to be determined whether switching from adefovir (ADV to tenofovir (TDF provides better virological outcomes in patients exhibiting suboptimal responses to ADV plus nucleoside analogue (ADV+NA therapy for NA-resistant chronic hepatitis B (CHB. Methods In this prospective trial, patients who showed partial responses (defined as serum hepatitis B virus [HBV] DNA >60 IU/mL to ADV+NA therapy for NA resistance were randomly allocated to receive TDF plus NA (TDF+NA group, n=16 or to continue their current therapy (ADV+NA group, n=16. The primary end point was the proportion of patients with complete virological response (CVR, defined as serum HBV DNA 2log10 IU/mL was more likely in the TDF+NA group at both 24 and 48 weeks (68.8% vs. 56.3%, P=0.014 vs. 81.3% vs. 56.3%, P=0.001, respectively. During the follow-up, the rate of HBeAg seroconversion was higher in the TDF+NA group than the ADV+NA group (12.5% vs. 6.25%, P=0.640, as was that for the hepatitis B surface antigen (6.25% vs. 0%, P=0.080. No serious adverse events due to antiviral agents occurred. Conclusion In patients exhibiting suboptimal responses to ADV+NA therapy for NA-resistant CHB, switching from ADV to TDF might provide better virological outcomes.

  11. Semiconductor Research Experimental Techniques

    CERN Document Server

    Balkan, Naci

    2012-01-01

    The book describes the fundamentals, latest developments and use of key experimental techniques for semiconductor research. It explains the application potential of various analytical methods and discusses the opportunities to apply particular analytical techniques to study novel semiconductor compounds, such as dilute nitride alloys. The emphasis is on the technique rather than on the particular system studied.

  12. Techniques for characterizing lignin

    Science.gov (United States)

    Nicole M. Stark; Daniel J. Yelle; Umesh P. Agarwal

    2016-01-01

    Many techniques are available to characterize lignin. The techniques presented in this chapter are considered nondegradative, which are commonly applied to lignin. A brief discussion of lignin structure is included with this chapter to aid the reader in understanding why the discussed characterization techniques are appropriate for the study of lignin. Because the...

  13. The backcross sterility technique

    Science.gov (United States)

    V. C. Mastro; A. Pellegrini-Toole

    1991-01-01

    The sterile insect technique (SIT) and the induced inherited (F1) sterility technique have been investigated for a number of lepidopterous pests, including the gypsy moths. Another technique, backcross sterility, which could potentially prove as or more useful for control of pest species has been developed for the control of only one lepidopteran...

  14. Growth of Leuconostoc mesenteroides NRRL-B523 in an alkaline medium: suboptimal pH growth inhibition of a lactic acid bacterium.

    Science.gov (United States)

    Wolf, Barry F; Fogler, H Scott

    2005-01-05

    Bacterial profile modification (BPM), a form of tertiary oil recovery, diverts water from the water-flooded high-permeability zone into the oil-bearing low-permeability zone. During field use, exopolymer-producing bacteria plug the high-permeability zone only in the immediate vicinity of the injection point (the near-well bore region). For effective BPM the plug must penetrate far into the formation. Slowing the specific growth rate, lengthening the lag phase, and slowing the polymerization rate are techniques that can prolong the onset of biopolymer gelation and extend the depth of the biological plug. In batch experiments, the growth of Leuconostoc mesenteroides NRRL-B523 was inhibited by the synergistic effects of high substrate loading and an alkaline pH. Exponential growth was delayed up to 190 h. It was observed that cell division was significantly retarded until the medium pH, reduced by the acid byproducts of fermentation, reached a critical value of 6.79 +/- 0.06. A mathematical model was developed to describe the relationship between specific growth rate, lag time, and medium pH. (c) 2004 Wiley Periodicals, Inc.

  15. Low current beam techniques

    Energy Technology Data Exchange (ETDEWEB)

    Saint, A.; Laird, J.S.; Bardos, R.A.; Legge, G.J.F. [Melbourne Univ., Parkville, VIC (Australia). School of Physics; Nishijima, T.; Sekiguchi, H. [Electrotechnical Laboratory, Tsukuba (Japan).

    1993-12-31

    Since the development of Scanning Transmission Microscopy (STIM) imaging in 1983 many low current beam techniques have been developed for the scanning (ion) microprobe. These include STIM tomography, Ion Beam Induced Current, Ion Beam Micromachining and Microlithography and Ionoluminense. Most of these techniques utilise beam currents of 10{sup -15} A down to single ions controlled by beam switching techniques This paper will discuss some of the low beam current techniques mentioned above, and indicate, some of their recent applications at MARC. A new STIM technique will be introduced that can be used to obtain Z-contrast with STIM resolution. 4 refs., 3 figs.

  16. Quantitative Doppler in musculoskeletal ultrasonography - suboptimal performance of both experienced and in-training sonographers in selection of the highest Doppler signal image from cine-loops.

    Science.gov (United States)

    Berghea, Florian; Vlad, Violeta; Palanciuc, Lavinia; Micu, Mihaela; Bojinca, Violeta; Vreju, Florentin; Enache, Luminita; Copotoiu, Monica; Kosevoi, Alexandra; Serban, Teodora; Stanciu, Denisa; Abobului, Mihai; Borangiu, Andreea; Berghea, Camelia Elena; Balanescu, Andra Rodica; Ionescu, Ruxandra

    2017-05-10

    Doppler ultrasonography assessment is mandatory nowadays for the complete description of rheumatic disease activity. Initially it was performed in semi quantitative way but recently the (fully) quantitative assessment is gaining more interest. In quantitative assessment, the ratio between total colorized and total pixels (CTR) is computed for the whole image or just for the region of interest (ROI). The frame with the highest amount of Doppler signal (also called worst case scenario image - WCSI) is usually the only one analyzed. The technique requires a very precise identification of WCSI from a certain number of consecutive frames, captured from the same position of the US probe, (and in most cases this is done manually). Our study examined the ability of both experienced and in-training sonographers to identify WCSI using a computerized analytical system as the gold standard. The study analyzed 480 frame selections done in two distinct exercises. The WCSI and other 3 images with a 5%, 10% and respectively 20% lower level of CTR compared with WCSI were packed in one selection. All frames emerging from the same video clip were randomly presented to six experienced and six in training sonographers; the request was to select the frame with the highest CTR (WCSI) from each package (twenty packages in total). A similar exercise was performed with CTRs decreasing in steps of 2%. In the first exercise the WCSI was correctly identified in 79.1% cases and in 67% of cases in the 2nd exercise. The interobserver agreement between experienced and in-trainer evaluators for the 1st exercise was 0.78 and 0.4 in the 2nd exercise. Using computerized analysis as the gold standard, we demonstrated a large heterogeneity across sonographers regarding their ability to identify the best Doppler image even from a small group of frames.

  17. [Evaluation of myocardial viability with 201Tl/18F-FDG DISA-SPECT technique in patients with acute myocardial infarction after emergent intracoronary autologous bone marrow mononuclear cells transplantation].

    Science.gov (United States)

    Huang, Rong-chong; Yao, Kang; Qian, Ju-ying; Niu, Yu-hong; Ge, Lei; Chen, Shu-guang; Shi, Hong-cheng; Zhang, Yi-Qi; Sun, Ai-jun; Wang, Ke-qiang; Zou, Yun-zeng; Ge, Jun-bo

    2007-06-01

    To evaluate the myocardial viability with (201)Tl/(18)F-FDG DISA-SPECT technique in patients with acute myocardial infarction underwent emergent intracoronary autologous bone marrow mononuclear cells (BM-MNC) transplantation. Patients with first acute myocardial infarction underwent emergent percutaneous coronary intervention (PCI) were randomized in a 1:1 ratio to either intracoronary transplantation of autologous BM-MNC (n = 20) or to sodium chloride concluding heparin (control, n = 20) via a micro infusion catheter group immediately after PCI. Change in global left ventricular function (LVEF measured by echocardiography) and the myocardial viability detected by (201)Tl/(18)F-FDG DISA-SPECT from baseline and 6-months post transplantation were analyzed. Left ventricular ejection fraction (LVEF) was improved in both groups and the absolute increase (DeltaLVEF) in BM-MNC group was significantly higher than that in control group (7.6% +/- 2.8% vs. 3.0% +/- 2.8%, P DISA-SPECT technique.

  18. L'elaboració del poder i la qüestió de les minories dins la política del PCY l'últim any de la guerra, amb especial atenció als hongaresos de Voivodina (1944-1945)

    OpenAIRE

    Hornyák, Árpad

    2015-01-01

    En aquest article s'analitza la reorganització política dels territoris del nord de Iugoslàvia els últims anys de la Segona Guerra Mundial, amb atenció preferent a la reconstrucció de l'estructura ètnica de Voivodina. El centre d'interès rau en la qüestió de les minories en la política del PCI l'últim any de la guerra, amb un respecte especial als hongaresos de la Vojvodina.La reconstrucció de l'estructura ètnica i l'obtenció del poder polític i econòmic es van aconseguir de diverses maneres:...

  19. Principles of fluorescence techniques

    CERN Document Server

    2016-01-01

    Fluorescence techniques are being used and applied increasingly in academics and industry. The Principles of Fluorescence Techniques course will outline the basic concepts of fluorescence techniques and the successful utilization of the currently available commercial instrumentation. The course is designed for students who utilize fluorescence techniques and instrumentation and for researchers and industrial scientists who wish to deepen their knowledge of fluorescence applications. Key scientists in the field will deliver theoretical lectures. The lectures will be complemented by the direct utilization of steady-state and lifetime fluorescence instrumentation and confocal microscopy for FLIM and FRET applications provided by leading companies.

  20. Persian fencing techniques

    Directory of Open Access Journals (Sweden)

    Manouchehr Moshtagh Khorasani

    2012-07-01

    Full Text Available There are numerous manuscripts, poems and stories that describe, specifically and in detail, the different techniques used in Persian swordsmanship. The present article explains the origins and the techniques of Persian swordsmanship. The article also describes the traditional code of conduct for Persian warriors. Additionally, it describes an array of techniques that were deployed in actual combat in Iran’s history. Some of these techniques are represented via the miniatures that are reproduced herein. This is the first article on Persian swordsmanship published in any periodical.

  1. Materials characterization techniques

    National Research Council Canada - National Science Library

    Zhang, Sam; Li, L; Kumar, Ashok

    2009-01-01

    "With an emphasis on practical applications and real-world case studies, Materials Characterization Techniques presents the principles of widely used advanced surface and structural characterization...

  2. Systematic evaluation of the quality of clinical practice guidelines on the use of assisted reproductive techniques.

    Science.gov (United States)

    Gutarra-Vilchez, Rosa Bertha; Barajas-Nava, Leticia; Aleman, Alicia; Solà, Ivan; Gich, Ignasi; Bonfill, Xavier; Alonso-Coello, Pablo

    2014-03-01

    To conduct a systematic evaluation of clinical practice guidelines (CPGs) on the use of assisted reproductive technologies. We searched Medline, the Turning Research into Practice database, and guidelines-specific databases from December 2006 to November 2011. Three reviewers independently assessed each Guideline using the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument. A standardized score was calculated separately for each of the six domains. Fourteen Guidelines were included. Overall, the quality of these was suboptimal. The scores for each AGREE II domain ranged between 37% and 80%. Three (22%) were deemed "Recommended"; nine (64%),"Recommended with modifications"; and two (14%), "Not recommended". Agreement among reviewers was very good (Intraclass Correlation Coefficient: 0.915 [95% CI 0.807-0.970]). The overall quality of the CPGs on Assisted Reproduction Techniques published during the last 5 years is suboptimal. Most Guidelines present significant shortcomings in important domains such as "stakeholder involvement", "rigor of development", and "applicability". Instruments such as the AGREE II and "the Grading of Recommendation Assessment Development and Evaluation" system could prove useful to improve CPGs in this field. Guideline users could benefit from the present results when choosing which guidelines to implement.

  3. Emerging optical nanoscopy techniques

    Directory of Open Access Journals (Sweden)

    Montgomery PC

    2015-09-01

    Full Text Available Paul C Montgomery, Audrey Leong-Hoi Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie (ICube, Unistra-CNRS, Strasbourg, France Abstract: To face the challenges of modern health care, new imaging techniques with subcellular resolution or detection over wide fields are required. Far field optical nanoscopy presents many new solutions, providing high resolution or detection at high speed. We present a new classification scheme to help appreciate the growing number of optical nanoscopy techniques. We underline an important distinction between superresolution techniques that provide improved resolving power and nanodetection techniques for characterizing unresolved nanostructures. Some of the emerging techniques within these two categories are highlighted with applications in biophysics and medicine. Recent techniques employing wider angle imaging by digital holography and scattering lens microscopy allow superresolution to be achieved for subcellular and even in vivo, imaging without labeling. Nanodetection techniques are divided into four subcategories using contrast, phase, deconvolution, and nanomarkers. Contrast enhancement is illustrated by means of a polarized light-based technique and with strobed phase-contrast microscopy to reveal nanostructures. Very high sensitivity phase measurement using interference microscopy is shown to provide nanometric surface roughness measurement or to reveal internal nanometric structures. Finally, the use of nanomarkers is illustrated with stochastic fluorescence microscopy for mapping intracellular structures. We also present some of the future perspectives of optical nanoscopy. Keywords: microscopy, imaging, superresolution, nanodetection, biophysics, medical imaging

  4. Analog signal isolation techniques

    Energy Technology Data Exchange (ETDEWEB)

    Beadle, E.R.

    1992-12-31

    This paper discusses several techniques for isolating analog signals in an accelerator environment. The techniques presented here encompass isolation amplifiers, voltage-to-frequency converters (VIFCs), transformers, optocouplers, discrete fiber optics, and commercial fiber optic links. Included within the presentation of each method are the design issues that must be considered when selecting the isolation method for a specific application.

  5. Analog signal isolation techniques

    Energy Technology Data Exchange (ETDEWEB)

    Beadle, E.R.

    1992-01-01

    This paper discusses several techniques for isolating analog signals in an accelerator environment. The techniques presented here encompass isolation amplifiers, voltage-to-frequency converters (VIFCs), transformers, optocouplers, discrete fiber optics, and commercial fiber optic links. Included within the presentation of each method are the design issues that must be considered when selecting the isolation method for a specific application.

  6. Techniques of Wastewater Treatment

    Indian Academy of Sciences (India)

    In the first part of this article, we have learned about the need and importance of wastewater treatment and conven- tional methods of treatment. Currently the need is to develop low power consuming and yet effective techniques to handle complex wastes. As a result, new and advanced techniques are being studied and in ...

  7. A Technique: Exposure Therapy

    Directory of Open Access Journals (Sweden)

    Serkan AKKOYUNLU

    2013-08-01

    Conclusion: Exposure with response prevention is a basic and effective technique. Every cognitive behavior therapist must be able to implement this technique and be cognizant of pearls of this procedure. (Journal of Cognitive Behavioral Psychotherapy and Research 2013, 2: 121-128 [JCBPR 2013; 2(2.000: 121-128

  8. Point of Technique

    African Journals Online (AJOL)

    .

    Minimally invasive techniques are becoming popular choice for the recent times. These techniques are lowering the cost ... Through a skin incision which extends 2 cm medially from the left anterior-superior iliac Spine ... very invasive surgical procedure , less invasive procedures are becoming the first treatment options and ...

  9. Contamination Control Techniques

    Energy Technology Data Exchange (ETDEWEB)

    EBY, J.L.

    2000-05-16

    Welcome to a workshop on contamination Control techniques. This work shop is designed for about two hours. Attendee participation is encouraged during the workshop. We will address different topics within contamination control techniques; present processes, products and equipment used here at Hanford and then open the floor to you, the attendees for your input on the topics.

  10. Emerging optical nanoscopy techniques

    Science.gov (United States)

    Montgomery, Paul C; Leong-Hoi, Audrey

    2015-01-01

    To face the challenges of modern health care, new imaging techniques with subcellular resolution or detection over wide fields are required. Far field optical nanoscopy presents many new solutions, providing high resolution or detection at high speed. We present a new classification scheme to help appreciate the growing number of optical nanoscopy techniques. We underline an important distinction between superresolution techniques that provide improved resolving power and nanodetection techniques for characterizing unresolved nanostructures. Some of the emerging techniques within these two categories are highlighted with applications in biophysics and medicine. Recent techniques employing wider angle imaging by digital holography and scattering lens microscopy allow superresolution to be achieved for subcellular and even in vivo, imaging without labeling. Nanodetection techniques are divided into four subcategories using contrast, phase, deconvolution, and nanomarkers. Contrast enhancement is illustrated by means of a polarized light-based technique and with strobed phase-contrast microscopy to reveal nanostructures. Very high sensitivity phase measurement using interference microscopy is shown to provide nanometric surface roughness measurement or to reveal internal nanometric structures. Finally, the use of nanomarkers is illustrated with stochastic fluorescence microscopy for mapping intracellular structures. We also present some of the future perspectives of optical nanoscopy. PMID:26491270

  11. Microscopic techniques in biotechnology

    National Research Council Canada - National Science Library

    Hoppert, M

    2003-01-01

    ... techniques. Over the past 50 years, electron microscopy has opened new pathways for biologists to understand structure-function interrelations at the subcellular level. New lightbased optical techniques involving the detection of fluorescent molecules have introduced a new dimension of imaging into light microscopy, enabling cellular events to be studied in vivo d...

  12. Spectrometric techniques 4

    CERN Document Server

    Vanasse, George A

    2013-01-01

    Spectrometric Techniques, Volume IV discusses three widely diversified areas of spectrometric techniques. The book focuses on three spectrometric methods. Chapter 1 discusses the phenomenology and applications of Coherent Anti-Stokes Raman Spectroscopy (CARS), the most commonly used optical technique that exploit the Raman effect. The second chapter is concerned with diffraction gratings and mountings for the Vacuum Ultraviolet Spectral Region. Chapter 3 accounts the uses of mass spectrometry, detectors, types of spectrometers, and ion sources. Physicists and chemists will find the book a go

  13. Computer techniques for electromagnetics

    CERN Document Server

    Mittra, R

    1973-01-01

    Computer Techniques for Electromagnetics discusses the ways in which computer techniques solve practical problems in electromagnetics. It discusses the impact of the emergence of high-speed computers in the study of electromagnetics. This text provides a brief background on the approaches used by mathematical analysts in solving integral equations. It also demonstrates how to use computer techniques in computing current distribution, radar scattering, and waveguide discontinuities, and inverse scattering. This book will be useful for students looking for a comprehensive text on computer techni

  14. Separation techniques: Chromatography

    Science.gov (United States)

    Coskun, Ozlem

    2016-01-01

    Chromatography is an important biophysical technique that enables the separation, identification, and purification of the components of a mixture for qualitative and quantitative analysis. Proteins can be purified based on characteristics such as size and shape, total charge, hydrophobic groups present on the surface, and binding capacity with the stationary phase. Four separation techniques based on molecular characteristics and interaction type use mechanisms of ion exchange, surface adsorption, partition, and size exclusion. Other chromatography techniques are based on the stationary bed, including column, thin layer, and paper chromatography. Column chromatography is one of the most common methods of protein purification. PMID:28058406

  15. TECHNIQUE IN TEACHING LITERATURE

    Directory of Open Access Journals (Sweden)

    Jaftiyatur Rohaniyah

    2012-05-01

    Full Text Available This article tries to explore a particular technique in literature classroom. Literature is a content subject and compulsory subject, such as: poetry, prose, drama, etc. which give for the college students who take course in English language education. The paper focuses on using small group discussion technique included pre-discussion activities, whilst-discussion activities, and postdiscussion activities and how to implement them in teaching English poetry for the EFL/ESL students of English language education program. This technique is intended to help students in improving their poetry comprehension and motivating them to learn literary subject especially poetry.

  16. Spectrometric techniques 2

    CERN Document Server

    Vanasse, George A

    2013-01-01

    Spectrometric Techniques, Volume II provides information pertinent to vacuum ultraviolet techniques to complete the demonstration of the diversity of methods available to the spectroscopist interested in the ultraviolet visible and infrared spectral regions. This book discusses the specific aspects of the technique of Fourier transform spectroscopy.Organized into five chapters, this volume begins with an overview of the large number of systematic effects in the recording of an interferogram. This text then examines the design approach for a Fourier transform spectrometer with focus on optics.

  17. Electrical termination techniques

    Science.gov (United States)

    Oakey, W. E.; Schleicher, R. R.

    1976-01-01

    A technical review of high reliability electrical terminations for electronic equipment was made. Seven techniques were selected from this review for further investigation, experimental work, and preliminary testing. From the preliminary test results, four techniques were selected for final testing and evaluation. These four were: (1) induction soldering, (2) wire wrap, (3) percussive arc welding, and (4) resistance welding. Of these four, induction soldering was selected as the best technique in terms of minimizing operator errors, controlling temperature and time, minimizing joint contamination, and ultimately producing a reliable, uniform, and reusable electrical termination.

  18. Spectrometric techniques 3

    CERN Document Server

    Vanasse, George A

    2013-01-01

    Spectrometric Techniques, Volume III presents the applications of spectrometric techniques to atmospheric and space studies. This book reviews the spectral data processing and analysis techniques that are of broad applicability.Organized into five chapters, this volume begins with an overview of the instrumentation used for obtaining field data. This text then reviews the contribution that space-borne spectroscopy in the thermal IR has made to the understanding of the planets. Other chapters consider the instruments that have recorded the planetary emission spectra. This book discusses as well

  19. Clinical techniques of invertebrates.

    Science.gov (United States)

    Braun, Matthew E; Heatley, J Jill; Chitty, John

    2006-05-01

    This article highlights techniques and equipment needed to successfully restrain, diagnose, and treat gastropods (including snails and slugs) and arthropods (including spiders, scorpions, honey-bees, cockroaches, silkworms, phasmids, centipedes, and millipedes). A review of current clinical techniques for invertebrates kept as pets and those kept for agricultural use is provided. The specific techniques of restraint, assessment of hydration, fluid therapy, diagnostic sampling, imaging, exoskeleton repair, ectoparasite control and removal, euthanasia, and postmortem examination are reviewed for use in the invertebrate patient. The authors intend this article to stimulate further research and reporting on appropriate and humane techniques for use in these species and to increase the ability of the veterinary practitioner to successfully attend to these animals.

  20. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... CYSTIC FIBROSIS Learn about cystic fibrosis, a genetic lung disorder that affects the pancreas and other organs, ... Clearance Techniques (ACTs) Autogenic Drainage (AD) Basics of Lung Care Chest Physical Therapy Coughing and Huffing High- ...

  1. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... a Family Parenting as an Adult With CF Treatments & Therapies People with cystic fibrosis are living longer ... to specialized CF care and a range of treatment options. Airway Clearance Active Cycle of Breathing Technique ...

  2. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Team Your cystic fibrosis care team includes a group of CF health care professionals who partner with ... Airway Clearance Airway Clearance Techniques (ACTs) There are different ways to clear your airways. Most are easy ...

  3. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Treatments and Therapies Airway Clearance Airway Clearance Techniques (ACTs) There are different ways to clear your airways. ... or caregiver. Older kids and adults can choose ACTs that they can do on their own. Share ...

  4. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... a Family Parenting as an Adult With CF Treatments & Therapies People with cystic fibrosis are living longer and ... to specialized CF care and a range of treatment options. Airway Clearance Active Cycle of Breathing Technique ( ...

  5. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Twitter YouTube Instagram Email DONATE Breadcrumb Navigation Home Life With CF Treatments and Therapies Airway Clearance Airway Clearance Techniques (ACTs) There are different ways to clear your airways. Most are easy to ...

  6. RFCM Techniques Chamber Facility

    Data.gov (United States)

    Federal Laboratory Consortium — FUNCTION: Provides the capability to develop radio-frequency countermeasure (RFCM) techniques in a controlled environment from 2.0 to 40.0 GHz. The configuration of...

  7. Microwave Breast Imaging Techniques

    DEFF Research Database (Denmark)

    Zhurbenko, Vitaliy; Rubæk, Tonny

    2010-01-01

    This paper outlines the applicability of microwave radiation for breast cancer detection. Microwave imaging systems are categorized based on their hardware architecture. The advantages and disadvantages of various imaging techniques are discussed. The fundamental tradeoffs are indicated between...

  8. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Techniques Autogenic Drainage Basics of Lung Care Chest Physical Therapy Coughing and Huffing High-Frequency Chest Wall ... Clinical Care Guidelines Chronic Medications to Maintain Lung Health Clinical Care Guidelines Lung Transplants Clinical Care Guidelines ...

  9. Plant tissue culture techniques

    Directory of Open Access Journals (Sweden)

    Rolf Dieter Illg

    1991-01-01

    Full Text Available Plant cell and tissue culture in a simple fashion refers to techniques which utilize either single plant cells, groups of unorganized cells (callus or organized tissues or organs put in culture, under controlled sterile conditions.

  10. The MST Radar Technique

    Science.gov (United States)

    Balsley, B. B.

    1985-01-01

    The past ten year have witnessed the development of a new radar technique to examine the structure and dynamics of the atmosphere between roughly 1 to 100 km on a continuous basis. The technique is known as the MST (for Mesosphere-Stratosphere-Troposphere) technique and is usable in all weather conditions, being unaffected by precipitation or cloud cover. MST radars make use of scattering from small scale structure in the atmospheric refractive index, with scales of the order of one-half the radar wavelength. Pertinent scale sizes for middle atmospheric studies typically range between a fraction of a meter and a few meters. The structure itself arises primarily from atmospheric turbulence. The technique is briefly described along with the meteorological parameters it measures.

  11. Airway Clearance Techniques (ACTs)

    Medline Plus

    Full Text Available ... Make a Charitable Gift Our Corporate Supporters Workplace Engagement DONATE YOUR PROPERTY eCards for a Cure About ... airway walls. See how different airway clearance techniques work to help you clear the thick, sticky mucus ...

  12. Efficient Vocabulary Testing Techniques

    Directory of Open Access Journals (Sweden)

    L. V. Mykhailiuk

    2016-12-01

    Full Text Available The article deals with the problem of teaching vocabulary. Different aspects of vocabulary (pronunciation, spelling, grammar, collocation, meaning, word formation are considered alongside with efficient vocabulary testing techniques.

  13. Assisted reproductive techniques.

    Science.gov (United States)

    Huang, Jack Yu Jen; Rosenwaks, Zev

    2014-01-01

    Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.

  14. TECHNIQUE OF JEJUNOSTOMY

    OpenAIRE

    E. Tarcoveanu

    2005-01-01

    Feeding difficulties is an important problem of some patients (postoperative feeding in major interventions, acute pancreatitis etc.). Many of these patients are managed by jejunostomy. This paper presents the surgical technique for temporary or permanent jejunostomy by laparoscopic and open approach. Standard technique is Witzel jejunostomy but in some cases it is indicated other types of interventions: Stamm, Liffmann, Albert or Roux jejunostomy. It is also presented postoperative complic...

  15. Optimization techniques in statistics

    CERN Document Server

    Rustagi, Jagdish S

    1994-01-01

    Statistics help guide us to optimal decisions under uncertainty. A large variety of statistical problems are essentially solutions to optimization problems. The mathematical techniques of optimization are fundamentalto statistical theory and practice. In this book, Jagdish Rustagi provides full-spectrum coverage of these methods, ranging from classical optimization and Lagrange multipliers, to numerical techniques using gradients or direct search, to linear, nonlinear, and dynamic programming using the Kuhn-Tucker conditions or the Pontryagin maximal principle. Variational methods and optimiza

  16. Sub-Optimal Treatment of Bacterial Biofilms

    Directory of Open Access Journals (Sweden)

    Tianyan Song

    2016-06-01

    Full Text Available Bacterial biofilm is an emerging clinical problem recognized in the treatment of infectious diseases within the last two decades. The appearance of microbial biofilm in clinical settings is steadily increasing due to several reasons including the increased use of quality of life-improving artificial devices. In contrast to infections caused by planktonic bacteria that respond relatively well to standard antibiotic therapy, biofilm-forming bacteria tend to cause chronic infections whereby infections persist despite seemingly adequate antibiotic therapy. This review briefly describes the responses of biofilm matrix components and biofilm-associated bacteria towards sub-lethal concentrations of antimicrobial agents, which may include the generation of genetic and phenotypic variabilities. Clinical implications of bacterial biofilms in relation to antibiotic treatments are also discussed.

  17. How suboptimal are linear sharing rules?

    DEFF Research Database (Denmark)

    Jensen, Bjarne Astrup; Nielsen, Jørgen Aase

    2016-01-01

    The objective of this paper is to analyze criteria for portfolio choice when two investors are forced to invest in a common portfolio and share the proceeds by a linear sharing rule. A similar situation with many investors is typical for defined contribution pension schemes. The restriction impli...

  18. Reasons for Suboptimal Learning in Medical Microbiology

    Science.gov (United States)

    Struwig, Magdalena C.; Beylefeld, Adriana A.; Joubert, Georgina

    2016-01-01

    Medical microbiology presents a challenge to undergraduate students, mostly due to its extensive content and complexity of unfamiliar terminology. In addition to a narrative review of the literature, we report findings on students' motivation for and approach to learning in the Infections module of an undergraduate medical curriculum, and their…

  19. Dependent Interviewing and Sub-Optimal Responding

    Directory of Open Access Journals (Sweden)

    Johannes Eggs

    2015-02-01

    Full Text Available With proactive dependent interviewing (PDI respondents are reminded of the answer they gave in the previous interview, before being asked about their current status. PDI is used in panel surveys to assist respondent recall and reduce spurious changes in responses over time. PDI may however provide scope for new errors if respondents falsely accept the previous information as still being an accurate description of their current situation. In this paper we use data from the German Labour Market and Social Security panel study, in which an error was made with the preload data for a PDI question about receipt of welfare benefit. The survey data were linked to individual administrative records on receipt of welfare benefit. A large proportion of respondents accepted the false preload. This behaviour seems mainly driven by the difficulty of the response task: respondents with a more complex history of receipt according to the records were more likely to confirm the false preload. Personality also seemed related to the probability of confirming. Predictors of satisficing, indicators of satisficing on other items in the survey, and characteristics of the survey and interviewer were not predictive of confirming the false preload.

  20. Effects of Suboptimal Bidding in Combinatorial Auctions

    Science.gov (United States)

    Schneider, Stefan; Shabalin, Pasha; Bichler, Martin

    Though the VCG auction assumes a central place in the mechanism design literature, there are a number of reasons for favoring iterative combinatorial auction designs. Several promising ascending auction formats have been developed throughout the past few years based on primal-dual and subgradient algorithms and linear programming theory. Prices are interpreted as a feasible dual solution and the provisional allocation is interpreted as a feasible primal solution. iBundle( 3) (Parkes and Ungar 2000), dVSV (de Vries et al. 2007) and the Ascending Proxy auction (Ausubel and Milgrom 2002) result in VCG payoffs when the coalitional value function satisfies the buyer submodularity condition and bidders bid straightforward, which is an expost Nash equilibrium in that case. iBEA and CreditDebit auctions (Mishra and Parkes 2007) do not even require the buyer submodularity condition and achieve the same properties for general valuations. In many situations, however, one cannot assume bidders to bid straightforward and it is not clear from the theory how these non-linear personalized price auctions (NLPPAs) perform in this case. Robustness of auctions with respect to different bidding behavior is therefore a critical issue for any application. We have conducted a large number of computational experiments to analyze the performance of NLPPA designs with respect to different bidding strategies and different valuation models. We compare the results of NLPPAs to those of the VCG auction and those of iterative combinatorial auctions with approximate linear prices, such as ALPS (Bichler et al. 2009) and the Combinatorial Clock auction (Porter et al. 2003).

  1. ADAPTIVE SUBOPTIMAL CONTROL OF INPUT CONSTRAINED PLANTS

    Directory of Open Access Journals (Sweden)

    Valerii Azarskov

    2011-03-01

    Full Text Available Abstract. This paper deals with adaptive regulation of a discrete-time linear time-invariant plant witharbitrary bounded disturbances whose control input is constrained to lie within certain limits. The adaptivecontrol algorithm exploits the one-step-ahead control strategy and the gradient projection type estimationprocedure using the modified dead zone. The convergence property of the estimation algorithm is shown tobe ensured. The sufficient conditions guaranteeing the global asymptotical stability and simultaneously thesuboptimality of the closed-loop systems are derived. Numerical examples and simulations are presented tosupport the theoretical results.

  2. Suboptimal Micronutrient Intake among Children in Europe

    Directory of Open Access Journals (Sweden)

    Boris Kaganov

    2015-05-01

    Full Text Available Adequate dietary intake of micronutrients is not necessarily achieved even in resource-rich areas of the world wherein overeating is a public health concern. In Europe, population-based data suggests substantial variability in micronutrient intake among children. Two independent surveys of micronutrient consumption among European children were evaluated. Stratified by age, the data regarding micronutrient intake were evaluated in the context of daily requirements, which are typically estimated in the absence of reliable absolute values derived from prospective studies. The proportion of children living in Europe whose intake of at least some vitamins and trace elements are at or below the estimated average requirements is substantial. The most common deficiencies across age groups included vitamin D, vitamin E, and iodine. Specific deficiencies were not uniform across countries or by age or gender.  Micronutrient intake appears to be more strongly influenced by factors other than access to food. Substantial portions of European children may be at risk of reversible health risks from inadequate intake of micronutrients. Despite the growing health threat posed by excess intake of calories, adequate exposure to vitamins, trace elements, and other micronutrients may deserve attention in public health initiatives to optimize growth and development in the European pediatric population.

  3. On the Suboptimality of Linear Lossy Codes

    Science.gov (United States)

    Kuzuoka, Shigeaki

    This letter reveals that linear lossy codes cannot attain the rate-distortion function in general, even if the source is binary i. i. d. and the distortion is measured by the Hamming distortion measure.

  4. Laser prostate enucleation techniques.

    Science.gov (United States)

    Lerner, Lori B; Rajender, Archana

    2015-10-01

    Laser treatment of benign prostatic hyperplasia (BPH) through enucleation techniques has become increasingly more utilized in the field of urology. Laser enucleation of the prostate (LEP) is a transurethral procedure that employs several different types of lasers to dissect the adenoma from the surgical capsule in a retrograde fashion. We review basic laser physics and current laser prostate enucleation techniques. Holmium-LEP (HoLEP), Thulium-LEP (ThuLEP), Greenlight-LEP (GreenLEP) and Diode-LEP (DiLEP) applications are discussed. We summarize the current literature with respect to functional outcomes and complications. Although each laser device used for prostate enucleation has the same goal of removal of the adenoma from the surgical capsule, each has unique characteristics (i.e. wavelength, absorption rates) that must be understood by the practicing surgeon. Mastery of one LEP technique does not necessarily translate into facile use of an alternative enucleation energy source and/or approach. The various LEP techniques have demonstrated similar, if not superior, postoperative results to transurethral resection of the prostate (TURP), the current gold standard in the treatment of BPH. This article outlines the current LEP techniques and should serve as a quick reference for the practicing urologist.

  5. Radiation techniques for acromegaly

    Directory of Open Access Journals (Sweden)

    Minniti Giuseppe

    2011-12-01

    Full Text Available Abstract Radiotherapy (RT remains an effective treatment in patients with acromegaly refractory to medical and/or surgical interventions, with durable tumor control and biochemical remission; however, there are still concerns about delayed biochemical effect and potential late toxicity of radiation treatment, especially high rates of hypopituitarism. Stereotactic radiotherapy has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. Radiation can be delivered in a single fraction by stereotactic radiosurgery (SRS or as fractionated stereotactic radiotherapy (FSRT in which smaller doses are delivered over 5-6 weeks in 25-30 treatments. A review of the recent literature suggests that pituitary irradiation is an effective treatment for acromegaly. Stereotactic techniques for GH-secreting pituitary tumors are discussed with the aim to define the efficacy and potential adverse effects of each of these techniques.

  6. Telescopes and Techniques

    CERN Document Server

    Kitchin, C R

    2013-01-01

    Telescopes and Techniques has proved itself in its first two editions, having become probably one of the most widely used astronomy texts, both for amateur astronomers and astronomy and astrophysics undergraduates. Both earlier editions of the book were widely used for introductory practical astronomy courses in many universities. In this Third Edition the author guides the reader through the mathematics, physics and practical techniques needed to use today's telescopes (from the smaller models to the larger instruments installed in many colleges) and how to find objects in the sky. Most of the physics and engineering involved is described fully and requires little prior knowledge or experience. Both visual and electronic imaging techniques are covered, together with an introduction to how data (measurements) should be processed and analyzed. A simple introduction to radio telescopes is also included. Brief coverage of the more advanced topics of photometry and spectroscopy are included, but mainly to enable ...

  7. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  8. Novel food processing techniques

    Directory of Open Access Journals (Sweden)

    Vesna Lelas

    2006-12-01

    Full Text Available Recently, a lot of investigations have been focused on development of the novel mild food processing techniques with the aim to obtain the high quality food products. It is presumed also that they could substitute some of the traditional processes in the food industry. The investigations are primarily directed to usage of high hydrostatic pressure, ultrasound, tribomechanical micronization, microwaves, pulsed electrical fields. The results of the scientific researches refer to the fact that application of some of these processes in particular food industry can result in lots of benefits. A significant energy savings, shortening of process duration, mild thermal conditions, food products with better sensory characteristics and with higher nutritional values can be achieved. As some of these techniques act also on the molecular level changing the conformation, structure and electrical potential of organic as well as inorganic materials, the improvement of some functional properties of these components may occur. Common characteristics of all of these techniques are treatment at ambient or insignificant higher temperatures and short time of processing (1 to 10 minutes. High hydrostatic pressure applied to various foodstuffs can destroy some microorganisms, successfully modify molecule conformation and consequently improve functional properties of foods. At the same time it acts positively on the food products intend for freezing. Tribomechanical treatment causes micronization of various solid materials that results in nanoparticles and changes in structure and electrical potential of molecules. Therefore, the significant improvement of some rheological and functional properties of materials occurred. Ultrasound treatment proved to be potentially very successful technique of food processing. It can be used as a pretreatment to drying (decreases drying time and improves functional properties of food, as extraction process of various components

  9. Reactivity to CO{sub 2} of chars prepared in O{sub 2}/N{sub 2} and O{sub 2}/CO{sub 2} mixtures for pulverized coal injection (PCI) in blast furnace in relation to char petrographic characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Pohlmann, Juliana G.; Osorio, Eduardo; Vilela, Antonio C.F. [Iron and Steelmaking Laboratory, UFRGS, Porto Alegre (Brazil); Borrego, Angeles G. [Instituto Nacional del Carbon, CSIC, Oviedo (Spain)

    2010-12-01

    Pulverized coal injection (PCI) is employed in blast furnace tuyeres in order to increase the injection rate without increasing the amount of unburned char inside the stack. When coal is injected with air in the region of tuyeres, the resolidified char will burn in an atmosphere with progressively lower oxygen content and higher CO{sub 2} concentration. In this study, an experimental approach comprising refiring has been followed to separate the combustion process into two distinct devolatilization and combustion steps. A drop tube furnace (DTF) operating at 1300 C in an atmosphere with low oxygen concentration was used to simulate devolatilization and then the char was refired into DTF at the same temperature under two different atmospheres O{sub 2}/N{sub 2} (typical combustion) and O{sub 2}/CO{sub 2} (oxy-combustion) with the same oxygen concentration. Coal injection was also performed under a higher oxygen concentration in both typical combustion and oxy-combustion atmospheres. The fuels tested comprised a petroleum coke and coals ranging in rank from high to low volatile bituminous, currently used for PCI injection. Specific surface areas, reactivity to CO{sub 2} and char petrography have been used to chars characterization. The morphology and appearance of the chars generated under oxy-fuel (O{sub 2}/CO{sub 2}) and conventional combustion (O{sub 2}/N{sub 2}) conditions with similar amount of oxygen were similar for each parent coal. Vitrinite-rich particles generated cenospheres with anisotropic optical texture increasing in size with increasing coal rank, whereas inertinite yielded a variety of morphologies and optical textures. The apparent reactivity to CO{sub 2} measured at high temperature (1000 C) tended to increase with burnout reflecting the operation under a regime controlled by internal diffusion in which surface area also increased. This may have a significant effect in the reactivity to CO{sub 2} of the chars inside the stack of the blast furnace

  10. Millimicrosecond pulse techniques

    CERN Document Server

    Lewis, Ian A D

    1959-01-01

    Millimicrosecond Pulse Techniques, Second Edition focuses on millimicrosecond pulse techniques and the development of devices of large bandwidth, extending down to comparatively low frequencies (1 Mc/s). Emphasis is on basic circuit elements and pieces of equipment of universal application. Specific applications, mostly in the field of nuclear physics instrumentation, are considered. This book consists of eight chapters and opens with an introduction to some of the terminology employed by circuit engineers as well as theoretical concepts, including the laws of circuit analysis, Fourier analysi

  11. Dermal exposure assessment techniques.

    Science.gov (United States)

    Fenske, R A

    1993-12-01

    Exposure of the skin to chemical substances can contribute significantly to total dose in many workplace situations, and its relative importance will increase when airborne occupational exposure limits are reduced, unless steps to reduce skin exposure are undertaken simultaneously. Its assessment employs personal sampling techniques to measure skin loading rates, and combines these measurements with models of percutaneous absorption to estimate absorbed dose. Knowledge of dermal exposure pathways is in many cases fundamental to hazard evaluation and control. When the skin is the primary contributor to absorbed dose, dermal exposure measurements and biological monitoring play complementary roles in defining occupational exposures. Exposure normally occurs by one of three pathways: (i) immersion