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Sample records for achieved stable disease

  1. Stable Ischemic Heart Disease.

    PubMed

    Kones, Richard; Rumana, Umme

    2016-01-01

    Classical angina refers to typical substernal discomfort triggered by effort or emotions, relieved with rest or nitroglycerin. The well-accepted pathogenesis is an imbalance between oxygen supply and demand. Goals in therapy are improvement in quality of life by limiting the number and severity of attacks, protection against future lethal events, and measures to lower the burden of risk factors to slow disease progression. New pathophysiological data, drugs, as well as conceptual and technological advances have improved patient care over the past decade. Behavioral changes to improve diets, increase physical activity, and encourage adherence to cardiac rehabilitation programs, are difficult to achieve but are effective. PMID:26567972

  2. Inducing stable reversion to achieve cancer control.

    PubMed

    Powers, Scott; Pollack, Robert E

    2016-04-01

    How can we stop cancer progression? Current strategies depend on modelling progression as the balanced outcome of mutations in, and expression of, tumour suppressor genes and oncogenes. New treatments emerge from successful attempts to tip that balance, but secondary mutational escape from those treatments has become a major impediment because it leads to resistance. In this Opinion article, we argue for a return to an earlier stratagem: tumour cell reversion. Treatments based on selection and analysis of stable revertants could create more durable remissions by reducing the selective pressure that leads to rapid drug resistance. PMID:27458638

  3. Low high-density lipoprotein cholesterol is a residual risk factor associated with long-term clinical outcomes in diabetic patients with stable coronary artery disease who achieve optimal control of low-density lipoprotein cholesterol.

    PubMed

    Ogita, Manabu; Miyauchi, Katsumi; Miyazaki, Tadashi; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Dohi, Tomotaka; Kasai, Takatoshi; Yokoyama, Takayuki; Okazaki, Shinya; Kurata, Takeshi; Daida, Hiroyuki

    2014-01-01

    Diabetes mellitus is recognized an independent risk factor for coronary artery disease (CAD) and mortality. Clinical trials have shown that statins significantly reduce cardiovascular events in diabetic patients. However, residual cardiovascular risk persists despite the achievement of target low-density lipoprotein cholesterol (LDL-C) levels with statin. High-density lipoprotein cholesterol (HDL-C) is an established coronary risk factor that is independent of LDL-C levels. We evaluated the impact of HDL-C on long-term mortality in diabetic patients with stable CAD who achieved optimal LDL-C. We enrolled 438 consecutive diabetic patients who were scheduled for percutaneous coronary intervention between 2004 and 2007 at our institution. We identified 165 patients who achieved target LDL-C <100 mg/dl. Patients were stratified into two groups according to HDL-C levels (low HDL-C group, baseline HDL-C <40 mg/dl; high HDL-C group, ≥40 mg/dl). Major adverse cardiac events (MACE) that included all-cause death, acute coronary syndrome, and target lesion revascularization were evaluated between the two groups. The median follow-up period was 946 days. The rate of MACE was significantly higher in diabetic patients with low-HDL-C who achieved optimal LDL-C (6.9 vs 17.9 %, log-rank P = 0.030). Multivariate Cox regression analysis showed that HDL-C is significantly associated with clinical outcomes (adjusted hazard ratio for MACE 1.33, 95 % confidence interval 1.01-1.75, P = 0.042). Low HDL-C is a residual risk factor that is significantly associated with long-term clinical outcomes among diabetic patients with stable CAD who achieve optimal LDL-C levels.

  4. An evolutionary method to achieve stable superpixel tracking

    NASA Astrophysics Data System (ADS)

    Xi, Wenxing; Tang, Xinyi

    2014-11-01

    Object tracking is a hot and hard problem in the computer vision study area.We deal with large objects,which are challenged in many aspects,such as the factors of lighting, size, posture, disturbance, occlusion, and so on.The superpixel tracking method has been proposed to deal with this problem. Unlike many other approaches, it is robust in all the mentioned aspects to some extent. It is very flexible to deal with non-rigid objects just like the meanshift of color histogram does,but can be more advanced, since it takes advantage of the segmented local color histogram. Here we first introduce the adaptive superpixel tracking algorithm, which is comprised by two parts, modeling and confidence mapping using the color features of superpixels.We model them by clustering, just like the "bags of words" method does, and build the cluster confidence.The model is adaptive since it just learns from some latest tracked frames, which can accumulate errors and lead to drift easily. So we propose a refined model, which incorporates the kalman filter's ideas to this problem, by integrating the current model and the new model as an evolutionary one, to better adapt to the object variation and disturbance in subsequent frames, thus achieve more stable tracking. The evolutionary model is achieved by reclustering the cluster centers of the two models, to make new cluster centers and new cluster confidences. We allocate different weight to them, if the current model gets more weight, then the evolutionary model will be more stable, otherwise it will be more adaptive. Finally we give some experiment comparisons between the evolutionary model and the adaptive one. For most cases, when the scene of the object is stable, namely there is no big sudden light change or color change, the evolutionary model outperforms the adaptive one. The reason is that the adaptive one easily learns from other objects. But when the scene suffers big sudden change, the evolutionary model can't quickly adapt

  5. Achieving Operational Hydrologic Monitoring of Mosquitoborne Disease

    PubMed Central

    Day, Jonathan F.

    2005-01-01

    Mosquitoes and mosquitoborne disease transmission are sensitive to hydrologic variability. If local hydrologic conditions can be monitored or modeled at the scales at which these conditions affect the population dynamics of vector mosquitoes and the diseases they transmit, a means for monitoring or modeling mosquito populations and mosquitoborne disease transmission may be realized. We review how hydrologic conditions have been associated with mosquito abundances and mosquitoborne disease transmission and discuss the advantages of different measures of hydrologic variability. We propose that the useful application of any measure of hydrologic conditions requires additional consideration of the scales for both the hydrologic measurement and the vector control interventions that will be used to mitigate an outbreak of vectorborne disease. Our efforts to establish operational monitoring of St. Louis encephalitis virus and West Nile virus transmission in Florida are also reviewed. PMID:16229760

  6. Use a linear model to achieve stable composition control in a naphtha splitter

    SciTech Connect

    Karpe, P.

    1997-01-01

    The following two points using dual composition control in a naphtha splitter are emphasized: while literature provides general guidelines for design of control systems for distillation columns, each column is unique in terms of dynamic and steady state behavior. Multivariable control analytical tools, such as RGA and SVD, coupled with rigorous steady state simulations, can be effectively employed to achieve stable control in columns beset with severe loop interactions, and often in the absence of on-line analyzers, linear models representing the first order approximations of distillation columns can yield significant benefits. Such models are simple to understand, readily acceptable to operators, do not require special expertise to maintain, and therefore, offer high degree of reliability.

  7. Stable Same-Sex Friendships with Higher Achieving Partners Promote Mathematical Reasoning in Lower Achieving Primary School Children

    PubMed Central

    DeLay, Dawn; Laursen, Brett; Kiuru, Noona; Poikkeus, Anna-Maija; Aunola, Kaisa; Nurmi, Jari-Erik

    2015-01-01

    This study is designed to investigate friend influence over mathematical reasoning in a sample of 374 children in 187 same-sex friend dyads (184 girls in 92 friendships; 190 boys in 95 friendships). Participants completed surveys that measured mathematical reasoning in the 3rd grade (approximately 9 years old) and one year later in the 4th grade (approximately 10 years old). Analyses designed for dyadic data (i.e., longitudinal Actor-Partner Interdependence Models) indicated that higher achieving friends influenced the mathematical reasoning of lower achieving friends, but not the reverse. Specifically, greater initial levels of mathematical reasoning among higher achieving partners in the 3rd grade predicted greater increases in mathematical reasoning from 3rd grade to 4th grade among lower achieving partners. These effects held after controlling for peer acceptance and rejection, task avoidance, interest in mathematics, maternal support for homework, parental education, length of the friendship, and friendship group norms on mathematical reasoning. PMID:26402901

  8. Achieving Highly Efficient, Selective, and Stable CO2 Reduction on Nitrogen-Doped Carbon Nanotubes.

    PubMed

    Wu, Jingjie; Yadav, Ram Manohar; Liu, Mingjie; Sharma, Pranav P; Tiwary, Chandra Sekhar; Ma, Lulu; Zou, Xiaolong; Zhou, Xiao-Dong; Yakobson, Boris I; Lou, Jun; Ajayan, Pulickel M

    2015-05-26

    The challenge in the electrosynthesis of fuels from CO2 is to achieve durable and active performance with cost-effective catalysts. Here, we report that carbon nanotubes (CNTs), doped with nitrogen to form resident electron-rich defects, can act as highly efficient and, more importantly, stable catalysts for the conversion of CO2 to CO. The unprecedented overpotential (-0.18 V) and selectivity (80%) observed on nitrogen-doped CNTs (NCNTs) are attributed to their unique features to facilitate the reaction, including (i) high electrical conductivity, (ii) preferable catalytic sites (pyridinic N defects), and (iii) low free energy for CO2 activation and high barrier for hydrogen evolution. Indeed, DFT calculations show a low free energy barrier for the potential-limiting step to form key intermediate COOH as well as strong binding energy of adsorbed COOH and weak binding energy for the adsorbed CO. The highest selective site toward CO production is pyridinic N, and the NCNT-based electrodes exhibit no degradation over 10 h of continuous operation, suggesting the structural stability of the electrode.

  9. Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease

    PubMed Central

    2008-01-01

    BACKGROUND Angiotensin-converting-enzyme (ACE) inhibitors are effective in reducing the risk of heart failure, myocardial infarction, and death from cardiovascular causes in patients with left ventricular systolic dysfunction or heart failure. ACE inhibitors have also been shown to reduce atherosclerotic complications in patients who have vascular disease without heart failure. METHODS In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, we tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to modern conventional therapy. The trial was a double-blind, placebo-controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg per day (4158 patients) or matching placebo (4132 patients). RESULTS The mean (±SD) age of the patients was 64±8 years, the mean blood pressure 133±17/78±10 mm Hg, and the mean left ventricular ejection fraction 58±9 percent. The patients received intensive treatment, with 72 percent having previously undergone coronary revascularization and 70 percent receiving lipid-lowering drugs. The incidence of the primary end point — death from cardiovascular causes, myocardial infarction, or coronary revascularization — was 21.9 percent in the trandolapril group, as compared with 22.5 percent in the placebo group (hazard ratio in the trandolapril group, 0.96; 95 percent confidence interval, 0.88 to 1.06; P=0.43) over a median follow-up period of 4.8 years. CONCLUSIONS In patients with stable coronary heart disease and preserved left ventricular function who are receiving “current standard” therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in

  10. Stable same-sex friendships with higher achieving partners promote mathematical reasoning in lower achieving primary school children.

    PubMed

    DeLay, Dawn; Laursen, Brett; Kiuru, Noona; Poikkeus, Anna-Maija; Aunola, Kaisa; Nurmi, Jari-Erik

    2015-11-01

    This study was designed to investigate friend influence over mathematical reasoning in a sample of 374 children in 187 same-sex friend dyads (184 girls in 92 friendships; 190 boys in 95 friendships). Participants completed surveys that measured mathematical reasoning in the 3rd grade (approximately 9 years old) and 1 year later in the 4th grade (approximately 10 years old). Analyses designed for dyadic data (i.e., longitudinal actor-partner interdependence model) indicated that higher achieving friends influenced the mathematical reasoning of lower achieving friends, but not the reverse. Specifically, greater initial levels of mathematical reasoning among higher achieving partners in the 3rd grade predicted greater increases in mathematical reasoning from 3rd grade to 4th grade among lower achieving partners. These effects held after controlling for peer acceptance and rejection, task avoidance, interest in mathematics, maternal support for homework, parental education, length of the friendship, and friendship group norms on mathematical reasoning. PMID:26402901

  11. Mind the bubbles: achieving stable measurements of maximum hydraulic conductivity through woody plant samples

    PubMed Central

    Espino, Susana; Schenk, H. Jochen

    2011-01-01

    The maximum specific hydraulic conductivity (kmax) of a plant sample is a measure of the ability of a plants’ vascular system to transport water and dissolved nutrients under optimum conditions. Precise measurements of kmax are needed in comparative studies of hydraulic conductivity, as well as for measuring the formation and repair of xylem embolisms. Unstable measurements of kmax are a common problem when measuring woody plant samples and it is commonly observed that kmax declines from initially high values, especially when positive water pressure is used to flush out embolisms. This study was designed to test five hypotheses that could potentially explain declines in kmax under positive pressure: (i) non-steady-state flow; (ii) swelling of pectin hydrogels in inter-vessel pit membranes; (iii) nucleation and coalescence of bubbles at constrictions in the xylem; (iv) physiological wounding responses; and (v) passive wounding responses, such as clogging of the xylem by debris. Prehydrated woody stems from Laurus nobilis (Lauraceae) and Encelia farinosa (Asteraceae) collected from plants grown in the Fullerton Arboretum in Southern California, were used to test these hypotheses using a xylem embolism meter (XYL'EM). Treatments included simultaneous measurements of stem inflow and outflow, enzyme inhibitors, stem-debarking, low water temperatures, different water degassing techniques, and varied concentrations of calcium, potassium, magnesium, and copper salts in aqueous measurement solutions. Stable measurements of kmax were observed at concentrations of calcium, potassium, and magnesium salts high enough to suppress bubble coalescence, as well as with deionized water that was degassed using a membrane contactor under strong vacuum. Bubble formation and coalescence under positive pressure in the xylem therefore appear to be the main cause for declining kmax values. Our findings suggest that degassing of water is essential for achieving stable and precise

  12. Mind the bubbles: achieving stable measurements of maximum hydraulic conductivity through woody plant samples.

    PubMed

    Espino, Susana; Schenk, H Jochen

    2011-01-01

    The maximum specific hydraulic conductivity (k(max)) of a plant sample is a measure of the ability of a plants' vascular system to transport water and dissolved nutrients under optimum conditions. Precise measurements of k(max) are needed in comparative studies of hydraulic conductivity, as well as for measuring the formation and repair of xylem embolisms. Unstable measurements of k(max) are a common problem when measuring woody plant samples and it is commonly observed that k(max) declines from initially high values, especially when positive water pressure is used to flush out embolisms. This study was designed to test five hypotheses that could potentially explain declines in k(max) under positive pressure: (i) non-steady-state flow; (ii) swelling of pectin hydrogels in inter-vessel pit membranes; (iii) nucleation and coalescence of bubbles at constrictions in the xylem; (iv) physiological wounding responses; and (v) passive wounding responses, such as clogging of the xylem by debris. Prehydrated woody stems from Laurus nobilis (Lauraceae) and Encelia farinosa (Asteraceae) collected from plants grown in the Fullerton Arboretum in Southern California, were used to test these hypotheses using a xylem embolism meter (XYL'EM). Treatments included simultaneous measurements of stem inflow and outflow, enzyme inhibitors, stem-debarking, low water temperatures, different water degassing techniques, and varied concentrations of calcium, potassium, magnesium, and copper salts in aqueous measurement solutions. Stable measurements of k(max) were observed at concentrations of calcium, potassium, and magnesium salts high enough to suppress bubble coalescence, as well as with deionized water that was degassed using a membrane contactor under strong vacuum. Bubble formation and coalescence under positive pressure in the xylem therefore appear to be the main cause for declining k(max) values. Our findings suggest that degassing of water is essential for achieving stable and

  13. Gout: optimizing treatment to achieve a disease cure

    PubMed Central

    Bernal, José Antonio; Quilis, Neus; Andrés, Mariano; Sivera, Francisca; Pascual, Eliseo

    2016-01-01

    Gout is one of the most common inflammatory arthritides. The disease is due to the deposition of monosodium urate crystals. These deposits are reversible with proper treatment, suggesting that gout is a curable disease. The main aim in gout is to lower serum uric acid levels to a pre-established target; there are different urate-lowering drugs (xanthine oxidase inhibitors, uricosurics and uricases) through which this can be achieved. Proper treatment of gout also involves correct management of acute flares and their prevention. To ensure treatment adherence it is necessary to explain to the patient what the objectives are. PMID:26977282

  14. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments

    PubMed Central

    Berry, Colin; Corcoran, David; Hennigan, Barry; Watkins, Stuart; Layland, Jamie; Oldroyd, Keith G.

    2015-01-01

    Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, and improvements in the diagnosis and treatment of CAD can reduce the health and economic burden of this condition. Fractional flow reserve (FFR) is an evidence-based diagnostic test of the physiological significance of a coronary artery stenosis. Fractional flow reserve is a pressure-derived index of the maximal achievable myocardial blood flow in the presence of an epicardial coronary stenosis as a ratio to maximum achievable flow if that artery were normal. When compared with standard angiography-guided management, FFR disclosure is impactful on the decision for revascularization and clinical outcomes. In this article, we review recent developments with FFR in patients with stable CAD and recent myocardial infarction. Specifically, we review novel developments in our understanding of CAD pathophysiology, diagnostic applications, prognostic studies, clinical trials, and clinical guidelines. PMID:26038588

  15. Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

    PubMed Central

    KAMPITS, Cassio; MONTENEGRO, Marlon M.; RIBEIRO, Ingrid W. J.; FURTADO, Mariana V.; POLANCZYK, Carisi A.; RÖSING, Cassiano K.; HAAS, Alex. N

    2016-01-01

    ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients. PMID:27556206

  16. Predictors and Outcomes of Routine Versus Optimal Medical Therapy in Stable Coronary Heart Disease.

    PubMed

    Chun, Soohun; Qiu, Feng; Austin, Peter C; Ko, Dennis T; Mamdani, Muhammad; Wijeysundera, Duminda N; Czarnecki, Andrew; Bennell, Maria C; Wijeysundera, Harindra C

    2015-09-01

    Although randomized studies have shown optimal medical therapy (OMT) to be as efficacious as revascularization in stable coronary heart disease (CHD), the application of OMT in routine practice is suboptimal. We sought to understand the predictors of receiving OMT in stable CHD and its impact on clinical outcomes. All patients with stable CHD based on coronary angiography from October 2008 to September 2011 were identified in Ontario, Canada. OMT was defined as concurrent use of β blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin. Aspirin use was not part of the OMT definition because of database limitations. Multivariable hierarchical logistic models identified predictors of OMT in the 12 months after angiography. Cox proportional hazard models with time-varying covariates for OMT and revascularization status examined differences in death and nonfatal myocardial infarction (MI). In these models, patients transitioned among 4 mutually exclusive treatment groups: no OMT and no revascularization, no OMT and revascularization, OMT and no revascularization, OMT and revascularization. Our cohort had 20,663 patients. Over a mean period of 2.5 years, 8.7% had died. Only 61% received OMT within 12 months. The strongest predictor of receiving OMT at 12 months was OMT before the angiogram (odds ratio 14.40, 95% confidence interval [CI] 13.17 to 15.75, p <0.001). Relative to no OMT and nonrevascularized patients, patients on OMT and revascularized had the greatest reduction in mortality (hazard ratio 0.52, 95% CI 0.45 to 0.60, p <0.001) and nonfatal MI (hazard ratio 0.74, 95% CI 0.64 to 0.84, p <0.001). In conclusion, our study highlights the low rate of OMT in stable CHD. Patients who received both OMT and revascularization achieved the greatest reduction in mortality and nonfatal MI. PMID:26119653

  17. Achieving a stable time response in polymeric radiation sensors under charge injection by X-rays.

    PubMed

    Intaniwet, Akarin; Mills, Christopher A; Sellin, Paul J; Shkunov, Maxim; Keddie, Joseph L

    2010-06-01

    Existing inorganic materials for radiation sensors suffer from several drawbacks, including their inability to cover large curved areas, lack of tissue-equivalence, toxicity, and mechanical inflexibility. As an alternative to inorganics, poly(triarylamine) (PTAA) diodes have been evaluated for their suitability for detecting radiation via the direct creation of X-ray induced photocurrents. A single layer of PTAA is deposited on indium tin oxide (ITO) substrates, with top electrodes selected from Al, Au, Ni, and Pd. The choice of metal electrode has a pronounced effect on the performance of the device; there is a direct correlation between the diode rectification factor and the metal-PTAA barrier height. A diode with an Al contact shows the highest quality of rectifying junction, and it produces a high X-ray photocurrent (several nA) that is stable during continuous exposure to 50 kV Mo Kalpha X-radiation over long time scales, combined with a high signal-to-noise ratio with fast response times of less than 0.25 s. Diodes with a low band gap, 'Ohmic' contact, such as ITO/PTAA/Au, show a slow transient response. This result can be explained by the build-up of space charge at the metal-PTAA interface, caused by a high level of charge injection due to X-ray-induced carriers. These data provide new insights into the optimum selection of metals for Schottky contacts on organic materials, with wider applications in light sensors and photovoltaic devices.

  18. Carboxylate-based molecular magnet: One path toward achieving stable quantum correlations at room temperature

    NASA Astrophysics Data System (ADS)

    Cruz, C.; Soares-Pinto, D. O.; Brandão, P.; dos Santos, A. M.; Reis, M. S.

    2016-02-01

    The control of quantum correlations in solid-state systems by means of material engineering is a broad avenue to be explored, since it makes possible steps toward the limits of quantum mechanics and the design of novel materials with applications on emerging quantum technologies. In this context, this letter explores the potential of molecular magnets to be prototypes of materials for quantum information technology. More precisely, we engineered a material and from its geometric quantum discord we found significant quantum correlations up to 9540 K (even without entanglement); and, in addition, a pure singlet state occupied up to around 80 K (above liquid nitrogen temperature). These results could only be achieved due to the carboxylate group promoting a metal-to-metal huge magnetic interaction.

  19. Natural foci diseases as a stable biological threat.

    PubMed

    Vynograd, Nataliya

    2014-12-01

    The key aspects of the natural foci of especially dangerous diseases as a type of biological threats are presented. Approaches to epidemiological surveillance and control to the spread of the agents of especially dangerous diseases on endemic areas are described for zoonosis that has a medical value. The knowledge of specific design of tools for the implementation of epidemiological surveillance, monitoring and evaluation of natural foci diseases in developing countries is low; accordingly, little is known on the ecology and transmission dynamics for the agents of especially dangerous diseases. Important is to know the effectiveness of serological monitoring of the indigenous population to determine the activity of natural foci of hemorrhagic fever with renal syndrome, tick-borne encephalitis, tularemia, Q-fever, Lyme disease and West Nile disease. The main species of reservoirs and vectors for these agents have been determined in different regions of Ukraine. New tick-borne agents that were unknown for certain regions have been detected. These data indicate the spreading of different pathogens in combination with natural foci. PMID:25326726

  20. Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease: Anatomy, Physiology, or Morphology?

    PubMed

    Ahmadi, Amir; Stone, Gregg W; Leipsic, Jonathon; Shaw, Leslee J; Villines, Todd C; Kern, Morton J; Hecht, Harvey; Erlinge, David; Ben-Yehuda, Ori; Maehara, Akiko; Arbustini, Eloisa; Serruys, Patrick; Garcia-Garcia, Hector M; Narula, Jagat

    2016-07-01

    Risk stratification in patients with stable ischemic heart disease is essential to guide treatment decisions. In this regard, whether coronary anatomy, physiology, or plaque morphology is the best determinant of prognosis (and driver an effective therapeutic risk reduction) remains one of the greatest ongoing debates in cardiology. In the present report, we review the evidence for each of these characteristics and explore potential algorithms that may enable a practical diagnostic and therapeutic strategy for the management of patients with stable ischemic heart disease.

  1. Achieving sustainable plant disease management through evolutionary principles.

    PubMed

    Zhan, Jiasui; Thrall, Peter H; Burdon, Jeremy J

    2014-09-01

    Plants and their pathogens are engaged in continuous evolutionary battles and sustainable disease management requires novel systems to create environments conducive for short-term and long-term disease control. In this opinion article, we argue that knowledge of the fundamental factors that drive host-pathogen coevolution in wild systems can provide new insights into disease development in agriculture. Such evolutionary principles can be used to guide the formulation of sustainable disease management strategies which can minimize disease epidemics while simultaneously reducing pressure on pathogens to evolve increased infectivity and aggressiveness. To ensure agricultural sustainability, disease management programs that reflect the dynamism of pathogen population structure are essential and evolutionary biologists should play an increasing role in their design.

  2. Recent achievements in restorative neurology: Progressive neuromuscular diseases

    SciTech Connect

    Dimitrijevic, M.R.; Kakulas, B.A.; Vrbova, G.

    1986-01-01

    This book contains 27 chapters. Some of the chapter titles are: Computed Tomography of Muscles in Neuromuscular Disease; Mapping the Genes for Muscular Dystrophy; Trophic Factors and Motor Neuron Development; Size of Motor Units and Firing Rate in Muscular Dystrophy; Restorative Possibilities in Relation to the Pathology of Progressive Neuromuscular Disease; and An Approach to the Pathogenesis of some Congenital Myopathies.

  3. Control of invasive meningococcal disease: is it achievable?

    PubMed

    Marshall, Helen; Wang, Bing; Wesselingh, Steve; Snape, Matthew; Pollard, Andrew J

    2016-03-01

    Neisseria meningitidis still leads to deaths and severe disability in children, adolescents and adults. Six different capsular groups of N. meningitidis cause invasive meningococcal disease in the form of meningitis and septicaemia in humans. Although conjugate meningococcal vaccines have been developed to provide protection against four of the capsular groups causing most diseases in humans, vaccines against capsular group B, which causes 85% of cases in Australia and the United Kingdom, have only recently been developed. A capsular group B meningococcal vaccine - 4CMenB (Bexsero) - has recently been licensed in the European Union, Canada and Australia. In Australia, a submission for inclusion of 4CMenB in the funded national immunization programme has recently been rejected. The vaccine will now be introduced into the national immunization programme in the United Kingdom following negotiation of a cost-effective price. With the current low incidence of invasive meningococcal disease in many regions, cost-effectiveness of a new capsular group B meningococcal vaccine is borderline in both the United Kingdom and Australia. Cost-effectiveness of an infant programme is determined largely by the direct protection of those vaccinated and is driven by the higher rate of disease in this age group. However, for an adolescent programme to be cost-effective, it must provide both long-term protection against both disease and carriage. The potential of vaccination to reduce the rate of severe invasive disease is a real possibility. A dual approach using both an infant and adolescent immunization programme to provide direct protection to those age groups at highest risk of meningococcal disease and to optimize the potential herd immunity effects is likely to be the most effective means of reducing invasive meningococcal disease. This commentary aims to describe the known disease burden and consequences of meningococcal disease, and the development and potential effectiveness of

  4. Achieving Stable Nitritation for Mainstream Deammonification by Combining Free Nitrous Acid-Based Sludge Treatment and Oxygen Limitation

    PubMed Central

    Wang, Dongbo; Wang, Qilin; Laloo, Andrew; Xu, Yifeng; Bond, Philip L.; Yuan, Zhiguo

    2016-01-01

    Stable nitritation is a critical bottleneck for achieving autotrophic nitrogen removal using the energy-saving mainstream deammonification process. Herein we report a new strategy to wash out both the Nitrospira sp. and Nitrobacter sp. from the treatment of domestic-strength wastewater. The strategy combines sludge treatment using free nitrous acid (FNA) with dissolved oxygen (DO) control in the nitritation reactor. Initially, the nitrifying reactor achieved full conversion of NH4+ to NO3−. Then, nitrite accumulation at ~60% was achieved in the reactor when 1/4 of the sludge was treated daily with FNA at 1.82 mg N/L in a side-stream unit for 24 h. Fluorescence in-situ hybridization (FISH) revealed FNA treatment substantially reduced the abundance of nitrite oxidizing bacteria (NOB) (from 23.0 ± 4.3 to 5.3 ± 1.9%), especially that of Nitrospira sp. (from 15.7 ± 3.9 to 0.4 ± 0.1%). Nitrite accumulation increased to ~80% when the DO concentration in the mainstream reactor was reduced from 2.5–3.0 to 0.3–0.8 mg/L. FISH revealed the DO limitation further reduced the abundance of NOB (to 2.1 ± 1.0%), especially that of Nitrobacter sp. (from 4.9 ± 1.2 to 1.8 ± 0.8%). The strategy developed removes a major barrier for deammonification in low-strength domestic wastewater. PMID:27151247

  5. Achieving Stable Nitritation for Mainstream Deammonification by Combining Free Nitrous Acid-Based Sludge Treatment and Oxygen Limitation.

    PubMed

    Wang, Dongbo; Wang, Qilin; Laloo, Andrew; Xu, Yifeng; Bond, Philip L; Yuan, Zhiguo

    2016-01-01

    Stable nitritation is a critical bottleneck for achieving autotrophic nitrogen removal using the energy-saving mainstream deammonification process. Herein we report a new strategy to wash out both the Nitrospira sp. and Nitrobacter sp. from the treatment of domestic-strength wastewater. The strategy combines sludge treatment using free nitrous acid (FNA) with dissolved oxygen (DO) control in the nitritation reactor. Initially, the nitrifying reactor achieved full conversion of NH4(+) to NO3(-). Then, nitrite accumulation at ~60% was achieved in the reactor when 1/4 of the sludge was treated daily with FNA at 1.82 mg N/L in a side-stream unit for 24 h. Fluorescence in-situ hybridization (FISH) revealed FNA treatment substantially reduced the abundance of nitrite oxidizing bacteria (NOB) (from 23.0 ± 4.3 to 5.3 ± 1.9%), especially that of Nitrospira sp. (from 15.7 ± 3.9 to 0.4 ± 0.1%). Nitrite accumulation increased to ~80% when the DO concentration in the mainstream reactor was reduced from 2.5-3.0 to 0.3-0.8 mg/L. FISH revealed the DO limitation further reduced the abundance of NOB (to 2.1 ± 1.0%), especially that of Nitrobacter sp. (from 4.9 ± 1.2 to 1.8 ± 0.8%). The strategy developed removes a major barrier for deammonification in low-strength domestic wastewater. PMID:27151247

  6. Achieving Stable Nitritation for Mainstream Deammonification by Combining Free Nitrous Acid-Based Sludge Treatment and Oxygen Limitation

    NASA Astrophysics Data System (ADS)

    Wang, Dongbo; Wang, Qilin; Laloo, Andrew; Xu, Yifeng; Bond, Philip L.; Yuan, Zhiguo

    2016-05-01

    Stable nitritation is a critical bottleneck for achieving autotrophic nitrogen removal using the energy-saving mainstream deammonification process. Herein we report a new strategy to wash out both the Nitrospira sp. and Nitrobacter sp. from the treatment of domestic-strength wastewater. The strategy combines sludge treatment using free nitrous acid (FNA) with dissolved oxygen (DO) control in the nitritation reactor. Initially, the nitrifying reactor achieved full conversion of NH4+ to NO3‑. Then, nitrite accumulation at ~60% was achieved in the reactor when 1/4 of the sludge was treated daily with FNA at 1.82 mg N/L in a side-stream unit for 24 h. Fluorescence in-situ hybridization (FISH) revealed FNA treatment substantially reduced the abundance of nitrite oxidizing bacteria (NOB) (from 23.0 ± 4.3 to 5.3 ± 1.9%), especially that of Nitrospira sp. (from 15.7 ± 3.9 to 0.4 ± 0.1%). Nitrite accumulation increased to ~80% when the DO concentration in the mainstream reactor was reduced from 2.5–3.0 to 0.3–0.8 mg/L. FISH revealed the DO limitation further reduced the abundance of NOB (to 2.1 ± 1.0%), especially that of Nitrobacter sp. (from 4.9 ± 1.2 to 1.8 ± 0.8%). The strategy developed removes a major barrier for deammonification in low-strength domestic wastewater.

  7. Patients with chronic obstructive pulmonary disease and chronically colonized with Haemophilus influenzae during stable disease phase have increased airway inflammation

    PubMed Central

    Tufvesson, Ellen; Bjermer, Leif; Ekberg, Marie

    2015-01-01

    Background Some patients with chronic obstructive pulmonary disease (COPD) show increased airway inflammation and bacterial colonization during stable phase. The aim of this study was to follow COPD patients and investigate chronic colonization with pathogenic bacteria during stable disease phase, and relate these findings to clinical parameters, inflammatory pattern, lung function, and exacerbations. Methods Forty-three patients with COPD were included while in a stable state and followed up monthly until exacerbation or for a maximum of 6 months. The patients completed the Clinical COPD Questionnaire and Medical Research Council dyspnea scale questionnaires, and exhaled breath condensate was collected, followed by spirometry, impulse oscillometry, and sputum induction. Results Ten patients were chronically colonized (ie, colonized at all visits) with Haemophilus influenzae during stable phase. These patients had higher sputum levels of leukotriene B4 (P<0.001), 8-isoprostane (P=0.002), myeloperoxidase activity (P=0.028), and interleukin-8 (P=0.02) during stable phase when compared with other patients. In addition, they had lower forced vital capacity (P=0.035) and reactance at 5 Hz (P=0.034), but there was no difference in forced expiratory volume in 1 second (FEV1), FEV1 % predicted, forced vital capacity % predicted, exhaled breath condensate biomarkers, C-reactive protein, or Clinical COPD Questionnaire and Medical Research Council dyspnea scale results. Three patients had intermittent colonization (colonized at only some visits) of H. influenzae during stable phase, and had lower levels of inflammatory biomarkers in sputum when compared with the chronically colonized patients. The difference in airway inflammation seen during stable phase in patients chronically colonized with H. influenzae was not observed during exacerbations. Conclusion Some COPD patients who were chronically colonized with H. influenzae during stable phase showed increased airway

  8. Reexamining the Efficacy and Value of Percutaneous Coronary Intervention for Patients With Stable Ischemic Heart Disease.

    PubMed

    Weintraub, William S; Boden, William E

    2016-08-01

    Percutaneous coronary intervention (PCI) continues to be performed frequently for patients with stable ischemic heart disease, despite uncertain efficacy. Individual randomized trial data and meta-analyses have not demonstrated that PCI in addition to optimal medical therapy reduces the incidence of death or myocardial infarction in patients with stable disease. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial did not show benefit for cardiovascular outcomes or mortality but did find a modest improvement in quality of life that did not persist at 3 years. Long-term follow-up from COURAGE (up to 15 years) found no differences in mortality, consistent with other published literature. How PCI could reduce long-term mortality or prevent myocardial infarction is not clear because sites of future plaque rupture leading to myocardial infarction are unpredictable and PCI can only treat localized anatomic segments of obstructive atherosclerosis. In addition, PCI is expensive, and the value to society of PCI for stable disease has not been demonstrated. The ISCHEMIA trial will assess the role of PCI for stable ischemic heart disease using newer technology and in patients with greater ischemic burden than in COURAGE. After nearly a decade, the COURAGE trial and other studies have given us pause to critically reexamine the role of PCI for patients with stable ischemic heart disease. Until further research can show that PCI can reduce cardiovascular events in these patients, a first-line strategy of optimal medical therapy is known to be safe, effective, and noninferior to PCI, and our practice should more closely follow this strategy.

  9. Predictors of Academic Achievement for School-Age Children with Sickle Cell Disease

    ERIC Educational Resources Information Center

    Smith, Kelsey E.; Patterson, Chavis A.; Szabo, Margo M.; Tarazi, Reem A.; Barakat, Lamia P.

    2013-01-01

    Children with sickle cell disease (SCD) are at risk for neurocognitive impairment and poor academic achievement, although there is limited research on factors predicting academic achievement in this population. This study explores the relative contribution to academic achievement of a comprehensive set of factors, such as environmental…

  10. Using electronic health records to predict costs and outcomes in stable coronary artery disease

    PubMed Central

    Asaria, Miqdad; Walker, Simon; Palmer, Stephen; Gale, Chris P; Shah, Anoop D; Abrams, Keith R; Crowther, Michael; Manca, Andrea; Timmis, Adam; Hemingway, Harry; Sculpher, Mark

    2016-01-01

    Objectives To use electronic health records (EHR) to predict lifetime costs and health outcomes of patients with stable coronary artery disease (stable-CAD) stratified by their risk of future cardiovascular events, and to evaluate the cost-effectiveness of treatments targeted at these populations. Methods The analysis was based on 94 966 patients with stable-CAD in England between 2001 and 2010, identified in four prospectively collected, linked EHR sources. Markov modelling was used to estimate lifetime costs and quality-adjusted life years (QALYs) stratified by baseline cardiovascular risk. Results For the lowest risk tenth of patients with stable-CAD, predicted discounted remaining lifetime healthcare costs and QALYs were £62 210 (95% CI £33 724 to £90 043) and 12.0 (95% CI 11.5 to 12.5) years, respectively. For the highest risk tenth of the population, the equivalent costs and QALYs were £35 549 (95% CI £31 679 to £39 615) and 2.9 (95% CI 2.6 to 3.1) years, respectively. A new treatment with a hazard reduction of 20% for myocardial infarction, stroke and cardiovascular disease death and no side-effects would be cost-effective if priced below £72 per year for the lowest risk patients and £646 per year for the highest risk patients. Conclusions Existing EHRs may be used to estimate lifetime healthcare costs and outcomes of patients with stable-CAD. The stable-CAD model developed in this study lends itself to informing decisions about commissioning, pricing and reimbursement. At current prices, to be cost-effective some established as well as future stable-CAD treatments may require stratification by patient risk. PMID:26864674

  11. Effects of Trimetazidine on T Wave Alternans in Stable Coronary Artery Disease

    PubMed Central

    Yaman, Mehmet; Gümrükçüoğlu, Hasan Ali; Şahin, Musa; Şimşek, Hakkı; Akdağ, Serkan

    2016-01-01

    Background and Objectives Studies reveal that the microvolt T wave alternans (MTWA) test has a high negative predictive value for arrhythmic mortality among patients with ischemic or non-ischemic cardiomyopathy. In this study, we investigate the effects of trimetazidine treatment on MTWA and several echocardiographic parameters in patients with stable coronary artery disease. Subjects and Methods One hundred patients (23 females, mean age 55.6±9.2 years) with stable ischemic heart disease were included in the study group. Twenty-five age- and sex-matched patients with stable coronary artery disease formed the control group. All patients were stable with medical treatment, and had no active complaints. Trimetazidine, 60 mg/day, was added to their current treatment for a minimum three months in the study group and the control group received no additional treatment. Pre- and post-treatment MTWA values were measured by 24 hour Holter testing. Left ventricular systolic and diastolic functions were assessed by echocardiography. Results After trimetazidine treatment, several echocardiographic parameters related with diastolic dysfunction significantly improved. MTWA has been found to be significantly improved after trimethazidine treatment (63±8 μV vs. 53±7 μV, p<0.001). Abnormal MTWA was present in 29 and 11 patients pre- and post-treatment, respectively (p< 0.001). Conclusion Trimetazidine improves MTWA, a non-invasive determinant of electrical instability. Moreover, several echocardiographic parameters related with left ventricular functions also improved. Thus, we can conclude that trimetazidine may be an effective agent to prevent arrhythmic complications and improve myocardial functions in patients with stable coronary artery disease. PMID:27275171

  12. Diagnosis of Coronary Heart Diseases Using Gene Expression Profiling; Stable Coronary Artery Disease, Cardiac Ischemia with and without Myocardial Necrosis.

    PubMed

    Kazmi, Nabila; Gaunt, Tom R

    2016-01-01

    Cardiovascular disease (including coronary artery disease and myocardial infarction) is one of the leading causes of death in Europe, and is influenced by both environmental and genetic factors. With the recent advances in genomic tools and technologies there is potential to predict and diagnose heart disease using molecular data from analysis of blood cells. We analyzed gene expression data from blood samples taken from normal people (n = 21), non-significant coronary artery disease (n = 93), patients with unstable angina (n = 16), stable coronary artery disease (n = 14) and myocardial infarction (MI; n = 207). We used a feature selection approach to identify a set of gene expression variables which successfully differentiate different cardiovascular diseases. The initial features were discovered by fitting a linear model for each probe set across all arrays of normal individuals and patients with myocardial infarction. Three different feature optimisation algorithms were devised which identified two discriminating sets of genes, one using MI and normal controls (total genes = 6) and another one using MI and unstable angina patients (total genes = 7). In all our classification approaches we used a non-parametric k-nearest neighbour (KNN) classification method (k = 3). The results proved the diagnostic robustness of the final feature sets in discriminating patients with myocardial infarction from healthy controls. Interestingly it also showed efficacy in discriminating myocardial infarction patients from patients with clinical symptoms of cardiac ischemia but no myocardial necrosis or stable coronary artery disease, despite the influence of batch effects and different microarray gene chips and platforms.

  13. Diagnosis of Coronary Heart Diseases Using Gene Expression Profiling; Stable Coronary Artery Disease, Cardiac Ischemia with and without Myocardial Necrosis

    PubMed Central

    Kazmi, Nabila; Gaunt, Tom R.

    2016-01-01

    Cardiovascular disease (including coronary artery disease and myocardial infarction) is one of the leading causes of death in Europe, and is influenced by both environmental and genetic factors. With the recent advances in genomic tools and technologies there is potential to predict and diagnose heart disease using molecular data from analysis of blood cells. We analyzed gene expression data from blood samples taken from normal people (n = 21), non-significant coronary artery disease (n = 93), patients with unstable angina (n = 16), stable coronary artery disease (n = 14) and myocardial infarction (MI; n = 207). We used a feature selection approach to identify a set of gene expression variables which successfully differentiate different cardiovascular diseases. The initial features were discovered by fitting a linear model for each probe set across all arrays of normal individuals and patients with myocardial infarction. Three different feature optimisation algorithms were devised which identified two discriminating sets of genes, one using MI and normal controls (total genes = 6) and another one using MI and unstable angina patients (total genes = 7). In all our classification approaches we used a non-parametric k-nearest neighbour (KNN) classification method (k = 3). The results proved the diagnostic robustness of the final feature sets in discriminating patients with myocardial infarction from healthy controls. Interestingly it also showed efficacy in discriminating myocardial infarction patients from patients with clinical symptoms of cardiac ischemia but no myocardial necrosis or stable coronary artery disease, despite the influence of batch effects and different microarray gene chips and platforms. PMID:26930047

  14. Tailored therapy of ACE inhibitors in stable coronary artery disease: pharmacogenetic profiling of treatment benefit.

    PubMed

    Brugts, Jasper J; Boersma, Eric; Simoons, Maarten L

    2010-08-01

    Angiotensin-converting enzyme (ACE) inhibitors are among the most commonly used drugs in stable coronary artery disease as these agents have been proven to be effective for reducing the risk of cardiovascular morbidity and mortality. As with other drugs, individual variation in treatment benefit is likely. Such heterogeneity could be used to target ACE-inhibitor therapy to those patients most likely to benefit from treatment. However, prior attempts to target ACE-inhibitor therapy to those patients who are most likely to benefit of such prophylactic treatment in secondary prevention using clinical characteristics or the level of baseline risk appeared not to be useful. A new approach of 'tailored therapy' could be to integrate more patient-specific characteristics, such as the genetic information of patients. Pharmacogenetic research of ACE inhibitors in coronary artery disease patients is at a formative stage, and studies are limited. The Perindopril Genetic association (PERGENE) study is a large pharmacogenetic substudy of the randomized placebo-controlled European trial On Reduction of Cardiac Events with Perindopril in Patients with Stable Coronary Artery disease (EUROPA) trial, aimed to assess the feasibility of pharmacogenetic profiling of ACE-inhibitor therapy by perindopril. This article summarizes the recent findings of the PERGENE study and pharmacogenetic research of the treatment benefit of perindopril in stable coronary artery disease. PMID:20712529

  15. Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation

    PubMed Central

    Baños-González, Manuel Alfonso; Peña-Duque, Marco Antonio; Martínez-Ríos, Marco Antonio; Quintanar-Trejo, Leslie; Aptilon-Duque, Gad; Flores-García, Mirthala; Cruz-Robles, David; Cardoso-Saldaña, Guillermo

    2016-01-01

    Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 μg/L versus 20.81 μg/L, p = 0.002) and homocysteine (11.36 μmol/L versus 8.81 μmol/L, p < 0.01) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 μg/L in the patients with bivascular obstruction and 42.77 ± 31.81 μg/L in trivascular coronary obstruction, p = 0.002. Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients.

  16. Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation

    PubMed Central

    Baños-González, Manuel Alfonso; Peña-Duque, Marco Antonio; Martínez-Ríos, Marco Antonio; Quintanar-Trejo, Leslie; Aptilon-Duque, Gad; Flores-García, Mirthala; Cruz-Robles, David; Cardoso-Saldaña, Guillermo

    2016-01-01

    Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 μg/L versus 20.81 μg/L, p = 0.002) and homocysteine (11.36 μmol/L versus 8.81 μmol/L, p < 0.01) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 μg/L in the patients with bivascular obstruction and 42.77 ± 31.81 μg/L in trivascular coronary obstruction, p = 0.002. Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients. PMID:27597926

  17. Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation.

    PubMed

    Valente-Acosta, Benjamin; Baños-González, Manuel Alfonso; Peña-Duque, Marco Antonio; Martínez-Ríos, Marco Antonio; Quintanar-Trejo, Leslie; Aptilon-Duque, Gad; Flores-García, Mirthala; Cruz-Robles, David; Cardoso-Saldaña, Guillermo; de la Peña-Díaz, Aurora

    2016-01-01

    Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 μg/L versus 20.81 μg/L, p = 0.002) and homocysteine (11.36 μmol/L versus 8.81 μmol/L, p < 0.01) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 μg/L in the patients with bivascular obstruction and 42.77 ± 31.81 μg/L in trivascular coronary obstruction, p = 0.002. Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients. PMID:27597926

  18. Explaining the Substantial Inter-Domain and Over-Time Correlations in Student Achievement: The Importance of Stable Student Attributes

    ERIC Educational Resources Information Center

    Marks, Gary N.

    2016-01-01

    Multi-domain and longitudinal studies of student achievement routinely find moderate to strong correlations across achievement domains and even stronger within-domain correlations over time. The purpose of this study is to examine the sources of these patterns analysing student achievement in 5 domains across Years 3, 5 and 7. The analysis is of…

  19. Use of a stable copper isotope (65Cu) in the differential diagnosis of Wilson's disease.

    PubMed

    Lyon, T D; Fell, G S; Gaffney, D; McGaw, B A; Russell, R I; Park, R H; Beattie, A D; Curry, G; Crofton, R J; Gunn, I

    1995-06-01

    1. 65Cu/63Cu stable-isotope ratios have been measured in blood serum after oral administration of the stable isotope 65Cu. The incorporation of the isotope into the plasma protein pool was followed at various times for up to 3 days. The resulting patterns of enrichment in healthy control subjects, in Wilson's disease patients and in heterozygotes for the Wilson's disease gene, were similar in appearance to those found by others using copper radioactive isotopes. After an initially high enrichment at 2 h after dosage, the Wilson's disease cases, in contrast to the control subjects, did not show a secondary rise in isotope enrichment of the plasma pool after 72 h, demonstrating a failure to incorporate copper into caeruloplasmin. The Wilson's disease heterozygotes had variable degrees of impairment of isotope incorporation, not always distinguished from those of control subjects. 2. The stability of the isotope also permits the copper tracer to be followed for a longer period. Ten healthy subjects were studied for over 40 days, allowing the biological half-time of an oral dose of copper to be determined (median 18.5 days, 95% confidence interval 14-26 days). Known heterozygotes for the Wilson's disease gene were found to have a significantly increased biological half-time for removal of copper from the plasma pool (median 43 days, 95% confidence interval 32-77 days). 3. The incorporation of 65 Cu in patients with diseases of the liver (other than Wilson's disease) was found to be similar to that in control subjects, aiding differential diagnosis.

  20. Achievement Gaps for Students with Disabilities: Stable, Widening, or Narrowing on a State-Wide Reading Comprehension Test?

    ERIC Educational Resources Information Center

    Schulte, Ann C.; Stevens, Joseph J.; Elliott, Stephen N.; Tindal, Gerald; Nese, Joseph F. T.

    2016-01-01

    Reading comprehension growth trajectories from 3rd to 7th grade were estimated for 99,919 students on a state reading comprehension assessment. We examined whether differences between students in general education (GE) and groups of students identified as exceptional learners were best characterized as stable, widening, or narrowing. The groups…

  1. Neonatal Respiratory Diseases in the Newborn Infant: Novel Insights from Stable Isotope Tracer Studies.

    PubMed

    Carnielli, Virgilio P; Giorgetti, Chiara; Simonato, Manuela; Vedovelli, Luca; Cogo, Paola

    2016-01-01

    Respiratory distress syndrome is a common problem in preterm infants and the etiology is multifactorial. Lung underdevelopment, lung hypoplasia, abnormal lung water metabolism, inflammation, and pulmonary surfactant deficiency or disfunction play a variable role in the pathogenesis of respiratory distress syndrome. High-quality exogenous surfactant replacement studies and studies on surfactant metabolism are available; however, the contribution of surfactant deficiency, alteration or dysfunction in selected neonatal lung conditions is not fully understood. In this article, we describe a series of studies made by applying stable isotope tracers to the study of surfactant metabolism and lung water. In a first set of studies, which we call 'endogenous studies', using stable isotope-labelled intravenous surfactant precursors, we showed the feasibility of measuring surfactant synthesis and kinetics in infants using several metabolic precursors including plasma glucose, plasma fatty acids and body water. In a second set of studies, named 'exogenous studies', using stable isotope-labelled phosphatidylcholine tracer given endotracheally, we could estimate surfactant disaturated phosphatidylcholine pool size and half-life. Very recent studies are focusing on lung water and on the endogenous biosynthesis of the surfactant-specific proteins. Information obtained from these studies in infants will help to better tailor exogenous surfactant treatment in neonatal lung diseases.

  2. Neonatal Respiratory Diseases in the Newborn Infant: Novel Insights from Stable Isotope Tracer Studies.

    PubMed

    Carnielli, Virgilio P; Giorgetti, Chiara; Simonato, Manuela; Vedovelli, Luca; Cogo, Paola

    2016-01-01

    Respiratory distress syndrome is a common problem in preterm infants and the etiology is multifactorial. Lung underdevelopment, lung hypoplasia, abnormal lung water metabolism, inflammation, and pulmonary surfactant deficiency or disfunction play a variable role in the pathogenesis of respiratory distress syndrome. High-quality exogenous surfactant replacement studies and studies on surfactant metabolism are available; however, the contribution of surfactant deficiency, alteration or dysfunction in selected neonatal lung conditions is not fully understood. In this article, we describe a series of studies made by applying stable isotope tracers to the study of surfactant metabolism and lung water. In a first set of studies, which we call 'endogenous studies', using stable isotope-labelled intravenous surfactant precursors, we showed the feasibility of measuring surfactant synthesis and kinetics in infants using several metabolic precursors including plasma glucose, plasma fatty acids and body water. In a second set of studies, named 'exogenous studies', using stable isotope-labelled phosphatidylcholine tracer given endotracheally, we could estimate surfactant disaturated phosphatidylcholine pool size and half-life. Very recent studies are focusing on lung water and on the endogenous biosynthesis of the surfactant-specific proteins. Information obtained from these studies in infants will help to better tailor exogenous surfactant treatment in neonatal lung diseases. PMID:27251153

  3. Paraoxonase-1 and Simvastatin Treatment in Patients with Stable Coronary Artery Disease

    PubMed Central

    2016-01-01

    Background. Paraoxonase-1 (PON1) is the crucial antioxidant marker of high-density lipoproteins. The present study is aimed at assessing the effect of simvastatin treatment on PON1 activity and its relationship to Q192R and M55L polymorphisms in subjects with stable coronary artery disease (CAD). Methods. The patient group was composed of 53 individuals with stable CAD, and the control group included 53 sex-matched police officers without CAD. CAD patients were treated with simvastatin 40mg/day for 12 months. Respectively, flow mediated dilatation (FMD), serum hs-CRP and TNF-α levels, urinary 8-iso-PGF2α concentrations, and PON1 activity were evaluated in definitive intervals. Results. There was no effect of simvastatin treatment on urinary 8-iso-PGF2α. Simvastatin treatment significantly increased FMD value, decreased CRP and TNF-α concentration. After adjusting for PON1 genotypes, significantly higher PON1 activity was noted in the 192R allele carriers, in both groups. Regardless of genotype, PON1 activity remained stable after simvastatin treatment. Conclusions. The present study confirms a positive effect of simvastatin therapy on endothelial function and inflammatory markers in secondary prevention. Simvastatin treatment shows no effects on PON1 activity and 8-isoprostanes level. The effect of simvastatin therapy on PON1 activity is not modulated by Q192R and M55L polymorphisms. PMID:27213056

  4. Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

    PubMed Central

    Beresniak, Ariel; Caruba, Thibaut; Sabatier, Brigitte; Juillière, Yves; Dubourg, Olivier; Danchin, Nicolas

    2015-01-01

    The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available. PMID:26516413

  5. The Relationship between P & QT Dispersions and Presence & Severity of Stable Coronary Artery Disease

    PubMed Central

    Yıldırım, Erkan; Ipek, Emrah; Cengiz, Mahir; Aslan, Kursat; Poyraz, Esra; Demirelli, Selami; Bayantemur, Murat; Ermis, Emrah; Ciftci, Cavlan

    2016-01-01

    Background and Objectives The study aimed to evaluate the correlation between electrocardiographic (ECG) parameters and presence and extent of coronary artery disease (CAD) to indicate the usefulness of these parameters as predictors of severity in patients with stable CAD. Subjects and Methods Two hundred fifty patients, without a history of any cardiovascular event were included in the study. The ECG parameters were measured manually by a cardiologist before coronary angiography. The patients were allocated into five groups: those with normal coronary arteries (Group 1), non-critical coronary lesions (Group 2), one, two and three vessel disease (Group 3, Group 4 and Group 5, respectively. Results Group 1 had the lowest P wave dispersion (PWD) and P wave (Pmax), QT interval (QTmax), QT dispersion (QTd), corrected QT dispersion (QTcd) and QT dispersion ratio (QTdR), while the patients in group 5 had the highest values of these parameters. Gensini score and QTmax, QTd, QTcmax, QTcd, QTdR, Pmax, and PWD were positively correlated. QTdR was the best ECG parameter to differentiate group 1 and 2 from groups with significant stenosis (groups 3, 4, and 5) (area under curve [AUC] 0.846). QTdR was the best ECG parameter to detect coronary arterial narrowing lesser than 50% and greater than 50%, respectively (AUC 0.858). Conclusion Presence and severity of CAD can be determined by using ECG in patients with stable CAD and normal left ventricular function. PMID:27482261

  6. Disrupted Network Topology in Patients with Stable and Progressive Mild Cognitive Impairment and Alzheimer's Disease

    PubMed Central

    Pereira, Joana B.; Mijalkov, Mite; Kakaei, Ehsan; Mecocci, Patricia; Vellas, Bruno; Tsolaki, Magda; Kłoszewska, Iwona; Soininen, Hilka; Spenger, Christian; Lovestone, Simmon; Simmons, Andrew; Wahlund, Lars-Olof; Volpe, Giovanni; Westman, Eric

    2016-01-01

    Recent findings suggest that Alzheimer's disease (AD) is a disconnection syndrome characterized by abnormalities in large-scale networks. However, the alterations that occur in network topology during the prodromal stages of AD, particularly in patients with stable mild cognitive impairment (MCI) and those that show a slow or faster progression to dementia, are still poorly understood. In this study, we used graph theory to assess the organization of structural MRI networks in stable MCI (sMCI) subjects, late MCI converters (lMCIc), early MCI converters (eMCIc), and AD patients from 2 large multicenter cohorts: ADNI and AddNeuroMed. Our findings showed an abnormal global network organization in all patient groups, as reflected by an increased path length, reduced transitivity, and increased modularity compared with controls. In addition, lMCIc, eMCIc, and AD patients showed a decreased path length and mean clustering compared with the sMCI group. At the local level, there were nodal clustering decreases mostly in AD patients, while the nodal closeness centrality detected abnormalities across all patient groups, showing overlapping changes in the hippocampi and amygdala and nonoverlapping changes in parietal, entorhinal, and orbitofrontal regions. These findings suggest that the prodromal and clinical stages of AD are associated with an abnormal network topology. PMID:27178195

  7. Inferring host-parasite relationships using stable isotopes: implications for disease transmission and host specificity.

    PubMed

    Stapp, Paul; Salkeld, Daniel J

    2009-11-01

    Identifying the roles of different hosts and vectors is a major challenge in the study of the ecology of diseases caused by multi-host pathogens. Intensive field studies suggested that grasshopper mice (Onychomys leucogaster) help spread the bacterium that causes plague (Yersinia pestis) in prairie dog colonies by sharing fleas with prairie dogs (Cynomys ludovicianus); yet conclusive evidence that prairie dog fleas (Oropsylla hirsuta) feed on grasshopper mice is lacking. Using stable nitrogen isotope analysis, we determined that many blood-engorged O. hirsuta collected from wild grasshopper mice apparently contained blood meals of prairie dogs. These results suggest that grasshopper mice may be infected with Y. pestis via mechanisms other than flea feeding, e.g., early phase or mechanical transmission or scavenging carcasses, and raise questions about the ability of grasshopper mice to maintain Y. pestis in prairie dog colonies during years between plague outbreaks. They also indicate that caution may be warranted when inferring feeding relationships based purely on the occurrence of fleas or other haematophagous ectoparasites on hosts. Stable-isotope analysis may complement or provide a useful alternative to immunological or molecular techniques for identifying hosts of cryptically feeding ectoparasites, and for clarifying feeding relationships in studies of host-parasite interactions. PMID:19967881

  8. Myocardial ischemia is a key factor in the management of stable coronary artery disease

    PubMed Central

    Iwasaki, Kohichiro

    2014-01-01

    Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality. Studies using fractional flow reserve (FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI, and the presence of ischemia is the key to decision-making for PCI. Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method’s limitations. Recent studies of appropriateness criteria showed that, although PCI in the acute setting and coronary bypass surgery are properly performed in most patients, PCI in the non-acute setting is often inappropriate, and stress testing to identify myocardial ischemia is performed in less than half of patients. Also, some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis. Taken together, the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease, and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis. PMID:24772253

  9. Antianginal Agents for the Management of Stable Ischemic Heart Disease: A Review.

    PubMed

    Mody, Purav; Sidhu, Mandeep S; Brilakis, Emmanouil S; Sacco, Joseph D; Banerjee, Subhash; Boden, William E

    2016-01-01

    Antianginal medications are an important aspect of optimal medical therapy for the management of angina in patients with stable ischemic heart disease. The lack of a standardized definition of effective antianginal therapy and the lack of clear understanding of the underlying evidence have often been cited as reasons for the large variations in the use of these particular classes of pharmacologic agents in contemporary clinical practice. Hence, we performed a search of the PubMed database and identified published manuscripts examining the effect of common antianginal agents on improving anginal parameters and on important clinical outcomes such as mortality, myocardial infarction, and repeat revascularization from multiple large randomized, controlled trials, systematic reviews, meta-analyses, and outcomes data from observational studies in patients with stable ischemic heart disease. The most commonly used antianginal agents (beta-blockers, nitrates, calcium channel blockers, and ranolazine) demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial in the setting of depressed left ventricular systolic function. In contrast, recent evidence points toward the lack of similar benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction. No survival benefit has been identified with the use of calcium channel blockers, nitrates, or ranolazine. Currently, guidance regarding objective measurement and up titration of antianginal therapy is missing. There is an unmet need for development of potentially novel and clinically relevant methodology to assess the intensity and/or efficacy of antianginal therapy. PMID:26274534

  10. Extramammary Paget disease of the perianal region: the potential role of imiquimod in achieving disease control

    PubMed Central

    Knight, Stephen R.; Proby, Charlotte; Ziyaie, Dorin; Carey, Frank; Koch, Sacha

    2016-01-01

    Extramammary Paget disease (EMPD) is a rare perineal neoplasia associated with a high rate of local recurrence. Surgical excision is the standard treatment; however, this has high rates of post-operative morbidity in combination with potentially mutilating results. Previous literature has demonstrated good response with imiquimod 5% cream in patients with vulval EMPD, yet its effectiveness in primary perianal disease is unknown. We describe the case of a 40-year-old woman presenting with EMPD of the perianal region, providing detailed histological and pictoral evidence of its response to topical imiquimod 5% cream over a 16-week period, which initially resulted in remission prior to metastatic lymph node recurrence. This case demonstrates the potential for topical imiquimod cream to avoid major surgery and its associated complications in patients presenting with EMPD of the perianal region. We discuss the current evidence for treating this rare condition with medical therapy, how this case adds to current literature and possible future directions. PMID:27511910

  11. Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize.

    PubMed

    Torosoff, Mikhail T; Sidhu, Mandeep S; Desai, Karan P; Fein, Steven A; Boden, William E

    2015-09-01

    Patients with acute coronary syndromes and severe multivessel or left main coronary artery disease have better outcomes when prompt revascularization is performed in addition to optimal medical therapy (OMT). However, in patients with stable ischemic heart disease, randomized strategy trials have revealed equipoise between initial strategies of OMT alone and OMT plus revascularization. Conducted in diverse stable ischemic heart disease patient populations and throughout the spectrum of atherosclerotic and ischemic burden, the RITA-2, MASS II, COURAGE, BARI 2D and FAME 2 trials demonstrate that OMT alone and OMT plus revascularization yield similar outcomes with respect to mortality and myocardial infarction. What remains unclear is whether there may be one or more subsets of patients with stable ischemic heart disease in whom revascularization may be associated with a reduction in mortality or myocardial infarction, which is to be addressed in the ongoing ISCHEMIA trial.

  12. Biochemical and clinical effects of aspartame in patients with chronic, stable alcoholic liver disease.

    PubMed

    Hertelendy, Z I; Mendenhall, C L; Rouster, S D; Marshall, L; Weesner, R

    1993-05-01

    Aspartame is an artificial sweetener completely metabolized in the gut and absorbed as aspartate, phenylalanine, and methanol. Phenylalanine is thought to mediate or exacerbate hepatic encephalopathy, and an impaired liver may not be able to cope with the ammoniagenic properties of the amino acid constituents, or adequately metabolize methanol. Thus, we compared the clinical and biochemical effects of a single ingestion of aspartame (15 mg/kg) to skim milk (phenylalanine content equimolar to aspartame) and placebo in patients with chronic, alcoholic liver disease in a randomized, crossover study. Aspartame produced an elevation of plasma phenylalanine significantly greater than milk and placebo (Cmax 14.55 +/- 7.38, 10.95 +/- 4.95, 8.84 +/- 4.55 mumol/dl, respectively; p < 0.01). However, quantified encephalopathic changes were observed only with milk (p < 0.05). Plasma aspartate, methanol, formate, and ammonia levels remained unchanged after all treatments. The lack of clinical derangements in encephalopathic indices, methanol accumulation, or biochemical changes in liver status suggests that a single large dose of aspartame (representing 5 times the average daily intake of adults) may be used safely by patients with chronic, stable liver disease.

  13. Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases.

    PubMed

    Hollingsworth, T Déirdre; Adams, Emily R; Anderson, Roy M; Atkins, Katherine; Bartsch, Sarah; Basáñez, María-Gloria; Behrend, Matthew; Blok, David J; Chapman, Lloyd A C; Coffeng, Luc; Courtenay, Orin; Crump, Ron E; de Vlas, Sake J; Dobson, Andy; Dyson, Louise; Farkas, Hajnal; Galvani, Alison P; Gambhir, Manoj; Gurarie, David; Irvine, Michael A; Jervis, Sarah; Keeling, Matt J; Kelly-Hope, Louise; King, Charles; Lee, Bruce Y; Le Rutte, Epke A; Lietman, Thomas M; Ndeffo-Mbah, Martial; Medley, Graham F; Michael, Edwin; Pandey, Abhishek; Peterson, Jennifer K; Pinsent, Amy; Porco, Travis C; Richardus, Jan Hendrik; Reimer, Lisa; Rock, Kat S; Singh, Brajendra K; Stolk, Wilma; Swaminathan, Subramanian; Torr, Steve J; Townsend, Jeffrey; Truscott, James; Walker, Martin; Zoueva, Alexandra

    2015-01-01

    Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminate disease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals for neglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyses which aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease, visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: the importance of epidemiological setting on the success of interventions; targeting groups who are at highest risk of infection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoir for infection,. The results also highlight the challenge of maintaining elimination 'as a public health problem' when true elimination is not reached. The models elucidate the factors that may be contributing most to persistence of disease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall this collection presents new analyses to inform current control initiatives. These papers form a base from which further development of the models and more rigorous validation against a variety of datasets can help to give more detailed advice. At the moment, the models' predictions are being considered as the world prepares for a final push towards control or elimination of neglected tropical diseases by 2020. PMID:26652272

  14. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery

    PubMed Central

    Manisco, Gianfranco; Potì’, Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-01-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well. PMID:26034591

  15. Revascularization in stable coronary artery disease: a combined perspective from an interventional cardiologist and a cardiac surgeon.

    PubMed

    Holmes, David R; Taggart, David P

    2016-06-21

    It is now half a century since the start of coronary bypass graft surgery (CABG) with the first percutaneous coronary intervention (PCI) following just over a decade later. The relative merits of PCI vs. CABG for stable coronary artery disease (stable-CAD) have continued to be debated ever since and have been the focus of around 20 randomized trials and numerous registry studies, systematic reviews, and meta-analyses. The aim of this review is to identify areas of agreement, disagreement, and uncertainties in the role of PCI and CABG in patients with stable-CAD. PMID:26994152

  16. Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease.

    PubMed

    Rimoldi, Stefano F; Messerli, Franz H; Cerny, David; Gloekler, Steffen; Traupe, Tobias; Laurent, Stéphane; Seiler, Christian

    2016-06-01

    Heart rate (HR) lowering by β-blockade was shown to be beneficial after myocardial infarction. In contrast, HR lowering with ivabradine was found to confer no benefits in 2 prospective randomized trials in patients with coronary artery disease. We hypothesized that this inefficacy could be in part related to ivabradine's effect on central (aortic) pressure. Our study included 46 patients with chronic stable coronary artery disease who were randomly allocated to placebo (n=23) or ivabradine (n=23) in a single-blinded fashion for 6 months. Concomitant baseline medication was continued unchanged throughout the study except for β-blockers, which were stopped during the study period. Central blood pressure and stroke volume were measured directly by left heart catheterization at baseline and after 6 months. For the determination of resting HR at baseline and at follow-up, 24-hour ECG monitoring was performed. Patients on ivabradine showed an increase of 11 mm Hg in central systolic pressure from 129±22 mm Hg to 140±26 mm Hg (P=0.02) and in stroke volume by 86±21.8 to 107.2±30.0 mL (P=0.002). In the placebo group, central systolic pressure and stroke volume remained unchanged. Estimates of myocardial oxygen consumption (HR×systolic pressure and time-tension index) remained unchanged with ivabradine.The decrease in HR from baseline to follow-up correlated with the concomitant increase in central systolic pressure (r=-0.41, P=0.009) and in stroke volume (r=-0.61, P<0.001). In conclusion, the decrease in HR with ivabradine was associated with an increase in central systolic pressure, which may have antagonized possible benefits of HR lowering in coronary artery disease patients. CLINICAL TRIALSURL: http://www.clinicaltrials.gov. Unique identifier NCT01039389. PMID:27091900

  17. Endogenous nitric oxide in patients with stable COPD: correlates with severity of disease

    PubMed Central

    Clini, E.; Bianchi, L.; Pagani, M.; Ambrosino, N.

    1998-01-01

    BACKGROUND—Increased levels of exhaled nitric oxide (eNO) have been reported in asthmatic subjects but little information is available on eNO in patients with advanced chronic obstructive pulmonary disease (COPD). A study was undertaken to evaluate the levels of eNO in patients with stable COPD of different degrees of severity.
METHODS—Peak and plateau values of eNO (PNO and PLNO, respectively) were evaluated in 53 patients with COPD and analysed according to the level of forced expiratory volume in one second (FEV1) and the presence of cor pulmonale (CP) (group 1, FEV1 <35% predicted with CP, n = 15; group 2, FEV1 <35% predicted without CP, n =15; group 3, FEV1 >35% predicted, n = 23). Seventeen normal subjects served as controls.
RESULTS—All the patients with COPD had reduced levels of PLNO compared with the controls (mean (SD) 6.3 (3.0) and 9.4 (2.8) ppb, respectively). In groups 1 and 2 PLNO levels were significantly lower than in subjects in group 3 (5.5 (2.9), 5.7 (3.5), and 7.1 (2.7) ppb, respectively; p<0.01 ANOVA). In all subjects % predicted FEV1 correlated slightly with PLNO but not with PNO.
CONCLUSION—Patients with severe stable COPD have reduced levels of eNO compared with normal subjects. eNO levels are slightly related to the severity of airflow obstruction.

 PMID:10193378

  18. Prognostic Utility of Secretory Phospholipase A2 in Patients with Stable Coronary Artery Disease

    PubMed Central

    O’Donoghue, Michelle; Mallat, Ziad; Morrow, David A; Benessiano, Joelle; Sloan, Sarah; Omland, Torbjørn; Solomon, Scott D.; Braunwald, Eugene; Tedgui, Alain; Sabatine, Marc S

    2011-01-01

    Background Secretory phospholipase A2 (sPLA2) may contribute to atherogenesis. To date, few prospective studies have examined the utility of sPLA2 for risk stratification in coronary artery disease (CAD). Methods Plasma sPLA2 activity was measured at baseline in 3708 subjects in the PEACE randomized trial of trandolapril versus placebo in stable CAD. Median follow-up was 4.8 years. Cox regression was used to adjust for demographics, clinical risk factors, apolipoprotein B, apolipoprotein A1, and medications. Results After multivariable adjustment, sPLA2 was associated with an increased risk of cardiovascular death, myocardial infarction or stroke (adjusted hazard ratio quartile 4:quartile 1 1.55, 95% CI 1.13–2.14) and cardiovascular death or heart failure (adjusted hazard ratio quartile 4:quartile 1 1.91, 95% CI 1.20–3.03). In further multivariable assessment, increased activities of sPLA2 were associated with the risk of cardiovascular death, myocardial infarction or stroke (adjusted hazard ratio 1.47, 95% CI 1.06–2.04) independent of lipoprotein-associated phospholipase A2 mass and C-reactive protein, and modestly improved the area under the curve (AUC) beyond established clinical risk factors (AUC 0.668 to 0.675, P=0.01). sPLA2, NT-pro B-type natriuretic peptide and high-sensitivity cardiac troponin T were all independently associated with cardiovascular death or heart failure and each improved risk discrimination (P=0.02, P<0.001, P<0.001, respectively). Conclusion sPLA2 activity provides independent prognostic information beyond established risk markers in patients with stable CAD. These data are encouraging for studies designed to evaluate the role of sPLA2 as a therapeutic target. PMID:21784767

  19. Chagas disease: an impediment in achieving the Millennium Development Goals in Latin America

    PubMed Central

    Franco-Paredes, Carlos; Von, Anna; Hidron, Alicia; Rodríguez-Morales, Alfonso J; Tellez, Ildefonso; Barragán, Maribel; Jones, Danielle; Náquira, Cesar G; Mendez, Jorge

    2007-01-01

    Background Achieving sustainable economic and social growth through advances in health is crucial in Latin America within the framework of the United Nations Millennium Development Goals. Discussion Health-related Millennium Development Goals need to incorporate a multidimensional approach addressing the specific epidemiologic profile for each region of the globe. In this regard, addressing the cycle of destitution and suffering associated with infection with Trypanosoma cruzi, the causal agent of Chagas disease of American trypanosomiasis, will play a key role to enable the most impoverished populations in Latin America the opportunity to achieve their full potential. Most cases of Chagas disease occur among forgotten populations because these diseases persist exclusively in the poorest and the most marginalized communities in Latin America. Summary Addressing the cycle of destitution and suffering associated with T. cruzi infection will contribute to improve the health of the most impoverished populations in Latin America and will ultimately grant them with the opportunity to achieve their full economic potential. PMID:17725836

  20. [EFFICIENCY OF CONCOMITANT USE OF POLICOSANOL AND ROSUVASTATIN IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND MODERATE HEPATIC DYSFUNCTION].

    PubMed

    Solomenchuk, T M; Vosukh, V; Bedzay, A; Koval, V G; Chepka, I M; Trotsko, V V

    2015-01-01

    The article presents the results for the study of lipid correction capacity and safety of concomitant use of policosanol and rosuvastatin compared with rosuvastatin monotherapy in patients with stable coronary artery disease and moderate hepatic dysfunction. Fifty-seven subjects aged 37 to 72 years (mean age 54.4 years +/- 6.5 years) have been enrolled into the study with the following inclusion criteria: therapy with statins for more than 8 weeks, failure to achieve target LDL cholesterol levels and moderately elevated liver enzymes. The following laboratory tests were performed at baseline and after 12 weeks of follow-up: blood lipid profile (total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG), lipid peroxidation (ma- Ionic dialdehyde (MDA), glycosylated hemoglobin HbAlc (%) and liver function tests (gamma-glutamyl transpeptidase-gamma-GTP) and alanine aminotransferase (ALT). Concomitant use of policosanol with rosuvastatin was superior to rosuvastatin monotherapy in terms of reduction of pro-aterogenicity of lipid metabolism by decreasing serum TC, LDL-C and TG, increasing serum HDL-C and decreasing the pro-oxidative activity (MDA) with simultaneous substantial improvement of hepatic function. Concomitant use of policosanol at the dose of 20 mg/day and rosuvastatin at 10-20 mg/day was favorably tolerated. None of the subjects had any discontinuations of therapy due to adverse events. PMID:27491147

  1. Impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease. Lessons from the COURAGE and FAME 2 trials.

    PubMed

    Torosoff, M T; Sidhu, M S; Boden, W E

    2013-06-01

    In patients with stable ischemic heart disease (SIHD), myocardial revascularization should be performed to either improve survival or improve symptoms and functional status among patients who are not well controlled with optimal medical therapy (OMT). A general consensus exists on the core elements of OMT, which include both lifestyle intervention and intensive secondary prevention with proven pharmacotherapies. By contrast, however, there is less general agreement as to what constitutes the optimal approach to revascularization in SIHD patients. The COURAGE and FAME 2 randomized trials form the foundation of the current clinical evidence base and raise the important question: "What is the impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease?"

  2. Plasma proteomic analysis of stable coronary artery disease indicates impairment of reverse cholesterol pathway

    PubMed Central

    Basak, Trayambak; Tanwar, Vinay Singh; Bhardwaj, Gourav; Bhardwaj, Nitin; Ahmad, Shadab; Garg, Gaurav; V, Sreenivas; Karthikeyan, Ganesan; Seth, Sandeep; Sengupta, Shantanu

    2016-01-01

    Coronary artery disease (CAD) is one of the largest causes of death worldwide yet the traditional risk factors, although useful in identifying people at high risk, lack the desired predictive accuracy. Techniques like quantitative plasma proteomics holds immense potential to identify newer markers and this study (conducted in three phases) was aimed to identify differentially expressed proteins in stable CAD patients. In the first (discovery) phase, plasma from CAD cases (angiographically proven) and controls were subjected to iTRAQ based proteomic analysis. Proteins found to be differentially expressed were then validated in the second and third (verification and validation) phases in larger number of (n = 546) samples. After multivariate logistic regression adjusting for confounding factors (age, diet, etc.), four proteins involved in the reverse cholesterol pathway (Apo A1, ApoA4, Apo C1 and albumin) along with diabetes and hypertension were found to be significantly associated with CAD and could account for approximately 88% of the cases as revealed by ROC analysis. The maximum odds ratio was found to be 6.70 for albumin (p < 0.0001), followed by Apo AI (5.07, p < 0.0001), Apo CI (4.03, p = 0.001), and Apo AIV (2.63, p = 0.003). Down-regulation of apolipoproteins and albumin implicates the impairment of reverse cholesterol pathway in CAD. PMID:27350024

  3. Usefulness of Beta blockade in contemporary management of patients with stable coronary heart disease.

    PubMed

    Winchester, David E; Pepine, Carl J

    2014-11-15

    Considerable progress has been made over the last few decades in the management of clinically stable coronary heart disease (SCHD), including improvements in interventions (e.g., percutaneous revascularization), pharmacological management, and risk factor control (e.g., smoking, diet, activity level, hypercholesterolemia, hypertension). Although β blockers have long been used for the treatment of SCHD, their efficacy was established in the era before widespread use of reperfusion interventions, modern medical therapy (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers), or preventive treatments (e.g., aspirin, statins). On the basis of these older data, β blockers are assumed beneficial, and their use has been extrapolated beyond patients with heart failure and previous myocardial infarction, which provided the best evidence for efficacy. However, there are no randomized clinical trials demonstrating that β blockers decrease clinical events in patients with SCHD in the modern era. Furthermore, these agents are associated with weight gain, problems with glycemic control, fatigue, and bronchospasm, underscoring the fact that their use is not without risk. In conclusion, data are currently lacking to support the widespread use of β blockers for all SCHD patients, but contemporary data suggest that they be reserved for a well-defined high-risk group of patients with evidence of ongoing ischemia, left ventricular dysfunction, heart failure, and perhaps some arrhythmias.

  4. Harnessing collaborative technology to accelerate achievement of chronic disease management objectives for Canada.

    PubMed

    Thompson, Leslee J; Healey, Lindsay; Falk, Will

    2007-01-01

    Morgan and colleagues put forth a call to action for the transformation of the Canadian healthcare system through the adoption of a national chronic disease prevention and management (CDPM) strategy. They offer examples of best practices and national solutions including investment in clinical information technologies to help support improved care and outcomes. Although we acknowledge that the authors propose CDPM solutions that are headed in the right direction, more rapid deployment of solutions that harness the potential of advanced collaborative technologies is required. We provide examples of how technologies that exist today can help to accelerate the achievement of some key CDPM objectives.

  5. Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence

    PubMed Central

    García, María Luisa Gutiérrez; Blasco-Algora, Sara; Fernández-Rodríguez, Conrado M

    2015-01-01

    Harmful alcohol drinking may lead to significant damage on any organ or system of the body. Alcoholic liver disease (ALD) is the most prevalent cause of advanced liver disease in Europe. In ALD, only alcohol abstinence was associated with a better long-term survival. Therefore, current effective therapeutic strategy should be oriented towards achieving alcohol abstinence or a significant reduction in alcohol consumption. Screening all primary care patients to detect those cases with alcohol abuse has been proposed as population-wide preventive intervention in primary care. It has been suggested that in patients with mild alcohol use disorder the best approach is brief intervention in the primary care setting with the ultimate goal being abstinence, whereas patients with moderate-to-severe alcohol use disorder must be referred to specialized care where detoxification and medical treatment of alcohol dependence must be undertaken. PMID:26229395

  6. A Randomized Controlled Trial of Acupuncture in Stable Ischemic Heart Disease Patients

    PubMed Central

    Mehta, Puja K.; Polk, Donna M.; Zhang, Xiao; Li, Ning; Painovich, Jeannette; Kothawade, Kamlesh; Kirschner, Joan; Qiao, Yi; Ma, Xiuling; Chen, Yii-Der Ida; Brantman, Anna; Shufelt, Chrisandra; Minissian, Margo; Bairey Merz, C. Noel

    2014-01-01

    Background Heart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients. Methods We conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting control (WC) in 151 SIHD subjects. TA group received needle insertion at acupuncture sites, SA group received a sham at non-acupuncture sites, while WC received nothing. TA and SA received 3 treatments/week for 12 wks. 24-hour, mental arithmetic stress, and cold pressor (COP) HRV was collected at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol, peripheral endothelial function by tonometry(PAT), and psychosocial variables. Results Mean age was 63±10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated differences consistent with the unblinded WC status; therefore by design, the control groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers of parasympathetic tone (p≤0.025), including a 17% higher vagal activity (p=0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables. Conclusions TA results in intermediate effects on autonomic function in SIHD patients. TA effect on HRV may be clinically relevant and should be explored further. These data document feasibility and provide sample size estimation for a clinical trial of TA in SIHD patients for prevention of SCD. PMID:25103909

  7. G-CSF Predicts Cardiovascular Events in Patients with Stable Coronary Artery Disease

    PubMed Central

    Katsaros, Katharina M.; Speidl, Walter S; Demyanets, Svitlana; Kastl, Stefan P.; Krychtiuk, Konstantin A.; Wonnerth, Anna; Zorn, Gerlinde; Tentzeris, Ioannis; Farhan, Serdar; Maurer, Gerald; Wojta, Johann; Huber, Kurt

    2015-01-01

    Granulocyte-colony-stimulating-factor (G-CSF) induces mobilization of progenitor cells but may also exert pro-inflammatory and pro-thrombotic effects. Treatment with recombinant G-CSF after acute myocardial infarction is currently under examination and has been associated with in-stent restenosis. However, it is not known whether plasma levels of endogenous G-CSF are also associated with an increased cardiovascular risk. Therefore we included 280 patients with angiographically proven stable coronary artery disease. G-CSF was measured by specific ELISA and patients were followed for a median of 30 months for the occurrence of major adverse cardiovascular events (MACE: death, myocardial infarction, re-hospitalization). Those with cardiac events during follow-up showed significant higher G-CSF levels (32.3 pg/mL IQR 21.4–40.5 pg/mL vs. 24.6 pg/mL IQR 16.4–34.9 pg/mL; p<0.05) at baseline. Patients with G-CSF plasma levels above the median had a 2-fold increased risk for MACE (p<0.05). This was independent from established cardiovascular risk factors. In addition, G-CSF above the median was a predictor of clinical in-stent restenosis after implantation of bare-metal stents (6.6% vs. 19.4%; p<0.05) but not of drug-eluting stents (7.7% vs. 7.6%; p = 0.98). This data suggests that endogenous plasma levels of G-CSF predict cardiovascular events independently from established cardiac risk factors and are associated with increased in-stent restenosis rates after implantation of bare metal stents. PMID:26555480

  8. Association of Small Dense LDL Serum Levels and Circulating Monocyte Subsets in Stable Coronary Artery Disease

    PubMed Central

    Krychtiuk, Konstantin A.; Kastl, Stefan P.; Pfaffenberger, Stefan; Lenz, Max; Hofbauer, Sebastian L.; Wonnerth, Anna; Koller, Lorenz; Katsaros, Katharina M.; Pongratz, Thomas; Goliasch, Georg; Niessner, Alexander; Gaspar, Ludovit; Huber, Kurt; Maurer, Gerald; Dostal, Elisabeth; Wojta, Johann; Oravec, Stanislav; Speidl, Walter S.

    2015-01-01

    Objective Atherosclerosis is considered to be an inflammatory disease in which monocytes and monocyte-derived macrophages play a key role. Circulating monocytes can be divided into three distinct subtypes, namely in classical monocytes (CM; CD14++CD16-), intermediate monocytes (IM; CD14++CD16+) and non-classical monocytes (NCM; CD14+CD16++). Low density lipoprotein particles are heterogeneous in size and density, with small, dense LDL (sdLDL) crucially implicated in atherogenesis. The aim of this study was to examine whether monocyte subsets are associated with sdLDL serum levels. Methods We included 90 patients with angiographically documented stable coronary artery disease and determined monocyte subtypes by flow cytometry. sdLDL was measured by an electrophoresis method on polyacrylamide gel. Results Patients with sdLDL levels in the highest tertile (sdLDL≥4mg/dL;T3) showed the highest levels of pro-inflammatory NCM (15.2±7% vs. 11.4±6% and 10.9±4%, respectively; p<0.01) when compared with patients in the middle (sdLDL=2-3mg/dL;T2) and lowest tertile (sdLDL=0-1mg/dL;T1). Furthermore, patients in the highest sdLDL tertile showed lower CM levels than patients in the middle and lowest tertile (79.2±8% vs. 83.9±7% and 82.7±5%; p<0.01 for T3 vs. T2+T1). Levels of IM were not related to sdLDL levels (5.6±4% vs. 4.6±3% vs. 6.4±3% for T3, T2 and T1, respectively). In contrast to monocyte subset distribution, levels of circulating pro- and anti-inflammatory markers were not associated with sdLDL levels. Conclusion The atherogenic lipoprotein fraction sdLDL is associated with an increase of NCM and a decrease of CM. This could be a new link between lipid metabolism dysregulation, innate immunity and atherosclerosis. PMID:25849089

  9. Nutrition Prescription to Achieve Positive Outcomes in Chronic Kidney Disease: A Systematic Review

    PubMed Central

    Ash, Susan; Campbell, Katrina L.; Bogard, Jessica; Millichamp, Anna

    2014-01-01

    In Chronic Kidney Disease (CKD), management of diet is important in prevention of disease progression and symptom management, however evidence on nutrition prescription is limited. Recent international CKD guidelines and literature was reviewed to address the following question “What is the appropriate nutrition prescription to achieve positive outcomes in adult patients with chronic kidney disease?” Databases included in the search were Medline and CINAHL using EBSCOhost search engine, Embase and the Cochrane Database of Systematic Reviews published from 2000 to 2009. International guidelines pertaining to nutrition prescription in CKD were also reviewed from 2000 to 2013. Three hundred and eleven papers and eight guidelines were reviewed by three reviewers. Evidence was graded as per the National Health and Medical Research Council of Australia criteria. The evidence from thirty six papers was tabulated under the following headings: protein, weight loss, enteral support, vitamin D, sodium, fat, fibre, oral nutrition supplements, nutrition counselling, including protein and phosphate, nutrients in peritoneal dialysis solution and intradialytic parenteral nutrition, and was compared to international guidelines. While more evidence based studies are warranted, the customary nutrition prescription remains satisfactory with the exception of Vitamin D and phosphate. In these two areas, additional research is urgently needed given the potential of adverse outcomes for the CKD patient. PMID:24451311

  10. [ANMCO/GICR-IACPR/SICI-GISE Consensus document: Clinical management of patients with stable coronary artery disease].

    PubMed

    Riccio, Carmine; Gulizia, Michele Massimo; Colivicchi, Furio; Di Lenarda, Andrea; Musumeci, Giuseppe; Faggiano, Pompilio Massimo; Abrignani, Maurizio Giuseppe; Rossini, Roberta; Fattirolli, Francesco; Valente, Serafina; Mureddu, Gian Francesco; Temporelli, Pier Luigi; Olivari, Zoran; Amico, Antonio Francesco; Casolo, Giancarlo; Fresco, Claudio; Menozzi, Alberto; Nardi, Federico

    2016-01-01

    Stable coronary artery disease is of epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions.Stable coronary artery disease encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow-charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity and diet. Adherence to therapy as an emerging risk factor is also discussed.

  11. [ANMCO/GICR-IACPR/SICI-GISE Consensus document: Clinical management of patients with stable coronary artery disease].

    PubMed

    Riccio, Carmine; Gulizia, Michele Massimo; Colivicchi, Furio; Di Lenarda, Andrea; Musumeci, Giuseppe; Faggiano, Pompilio Massimo; Abrignani, Maurizio Giuseppe; Rossini, Roberta; Fattirolli, Francesco; Valente, Serafina; Mureddu, Gian Francesco; Temporelli, Pier Luigi; Olivari, Zoran; Amico, Antonio Francesco; Casolo, Giancarlo; Fresco, Claudio; Menozzi, Alberto; Nardi, Federico

    2016-01-01

    Stable coronary artery disease is of epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions.Stable coronary artery disease encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow-charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity and diet. Adherence to therapy as an emerging risk factor is also discussed. PMID:27571333

  12. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

    PubMed Central

    Fauchier, Laurent; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M.; Tardif, Jean-Claude; Tendera, Michal; Steg, Ph. Gabriel

    2015-01-01

    Background Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. Methods and Findings CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use. Conclusions In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients. Trial Registration ISRCTN registry of clinical trials: ISRCTN43070564. PMID:25915904

  13. Diagnosis and risk stratification of women with stable ischemic heart disease.

    PubMed

    Isiadinso, Ijeoma; Shaw, Leslee J

    2016-10-01

    Although mortality rates for cardiovascular disease are on the decline, it remains the leading cause of death among men and women in the United States. Until recently, more women died of heart disease every year than men. Significant effort has been focused on increasing the awareness of cardiovascular disease among women, but ethnic disparities in awareness still exist. Early symptom recognition, risk assessment, and diagnosis of CAD are paramount in reducing cardiovascular morbidity and mortality in women. This review will highlight the unique risk factors for CAD in women, variability in clinical presentation for ischemic heart disease, and risk stratification for CAD in symptomatic women. PMID:27473217

  14. Characterization of stable RNAs from the resected intestinal tissues of individuals with either Crohn’s disease or ulcerative colitis

    PubMed Central

    Roy, Guylaine; Mercure, Stéphane; Beuvon, Frédéric; Perreault, Jean-Pierre

    2010-01-01

    Circular RNAs reminiscent of viroids and the human hepatitis delta virus have been proposed as possible nonconventional pathogens responsible for Crohn’s disease and ulcerative colitis, two inflammatory bowel diseases. Consequently, RNA was extracted from various areas of intestinal tissues from individuals with either Crohn’s disease or ulcerative colitis as well as several appropriate control diseases, and analyzed by two-dimensional gel electrophoresis. No circular viroid-like RNAs (<1500 nucleotides) were detected, confirming a previous report that was limited to the investigation of small RNAs (<300 nucleotides). However, three small, unusually stable, linear RNAs were shown to be associated to both Crohn’s disease and ulcerative colitis tissues: a specific 28S ribosomal RNA cleavage product characterized previously; a 5.8S ribosomal RNA conformer; and a fragment homologous to transcripts from DNA CpG islands. The two last RNAs were detected prior to visible morphological tissue alterations, suggesting that they are produced early during the inflammation and that they have value as molecular diagnostic tools for the inflammatory bowel diseases. The potential cellular mechanisms producing these RNAs and their involvement in inflammatory bowel disease are discussed. PMID:9599669

  15. Stable isotope probing with 15N achieved by disentangling the effects of genome G+C content and isotope enrichment on DNA density.

    PubMed

    Buckley, Daniel H; Huangyutitham, Varisa; Hsu, Shi-Fang; Nelson, Tyrrell A

    2007-05-01

    Stable isotope probing (SIP) of nucleic acids is a powerful tool that can identify the functional capabilities of noncultivated microorganisms as they occur in microbial communities. While it has been suggested previously that nucleic acid SIP can be performed with 15N, nearly all applications of this technique to date have used 13C. Successful application of SIP using 15N-DNA (15N-DNA-SIP) has been limited, because the maximum shift in buoyant density that can be achieved in CsCl gradients is approximately 0.016 g ml-1 for 15N-labeled DNA, relative to 0.036 g ml-1 for 13C-labeled DNA. In contrast, variation in genome G+C content between microorganisms can result in DNA samples that vary in buoyant density by as much as 0.05 g ml-1. Thus, natural variation in genome G+C content in complex communities prevents the effective separation of 15N-labeled DNA from unlabeled DNA. We describe a method which disentangles the effects of isotope incorporation and genome G+C content on DNA buoyant density and makes it possible to isolate 15N-labeled DNA from heterogeneous mixtures of DNA. This method relies on recovery of "heavy" DNA from primary CsCl density gradients followed by purification of 15N-labeled DNA from unlabeled high-G+C-content DNA in secondary CsCl density gradients containing bis-benzimide. This technique, by providing a means to enhance separation of isotopically labeled DNA from unlabeled DNA, makes it possible to use 15N-labeled compounds effectively in DNA-SIP experiments and also will be effective for removing unlabeled DNA from isotopically labeled DNA in 13C-DNA-SIP applications.

  16. Stable Isotope Probing with 15N Achieved by Disentangling the Effects of Genome G+C Content and Isotope Enrichment on DNA Density▿ †

    PubMed Central

    Buckley, Daniel H.; Huangyutitham, Varisa; Hsu, Shi-Fang; Nelson, Tyrrell A.

    2007-01-01

    Stable isotope probing (SIP) of nucleic acids is a powerful tool that can identify the functional capabilities of noncultivated microorganisms as they occur in microbial communities. While it has been suggested previously that nucleic acid SIP can be performed with 15N, nearly all applications of this technique to date have used 13C. Successful application of SIP using 15N-DNA (15N-DNA-SIP) has been limited, because the maximum shift in buoyant density that can be achieved in CsCl gradients is approximately 0.016 g ml−1 for 15N-labeled DNA, relative to 0.036 g ml−1 for 13C-labeled DNA. In contrast, variation in genome G+C content between microorganisms can result in DNA samples that vary in buoyant density by as much as 0.05 g ml−1. Thus, natural variation in genome G+C content in complex communities prevents the effective separation of 15N-labeled DNA from unlabeled DNA. We describe a method which disentangles the effects of isotope incorporation and genome G+C content on DNA buoyant density and makes it possible to isolate 15N-labeled DNA from heterogeneous mixtures of DNA. This method relies on recovery of “heavy” DNA from primary CsCl density gradients followed by purification of 15N-labeled DNA from unlabeled high-G+C-content DNA in secondary CsCl density gradients containing bis-benzimide. This technique, by providing a means to enhance separation of isotopically labeled DNA from unlabeled DNA, makes it possible to use 15N-labeled compounds effectively in DNA-SIP experiments and also will be effective for removing unlabeled DNA from isotopically labeled DNA in 13C-DNA-SIP applications. PMID:17369331

  17. HDAC4 as a potential therapeutic target in neurodegenerative diseases: a summary of recent achievements

    PubMed Central

    Mielcarek, Michal; Zielonka, Daniel; Carnemolla, Alisia; Marcinkowski, Jerzy T.; Guidez, Fabien

    2015-01-01

    For the past decade protein acetylation has been shown to be a crucial post-transcriptional modification involved in the regulation of protein functions. Histone acetyltransferases (HATs) mediate acetylation of histones which results in the nucleosomal relaxation associated with gene expression. The reverse reaction, histone deacetylation, is mediated by histone deacetylases (HDACs) leading to chromatin condensation followed by transcriptional repression. HDACs are divided into distinct classes: I, IIa, IIb, III, and IV, on the basis of size and sequence homology, as well as formation of distinct repressor complexes. Implications of HDACs in many diseases, such as cancer, heart failure, and neurodegeneration, have identified these molecules as unique and attractive therapeutic targets. The emergence of HDAC4 among the members of class IIa family as a major player in synaptic plasticity raises important questions about its functions in the brain. The characterization of HDAC4 specific substrates and molecular partners in the brain will not only provide a better understanding of HDAC4 biological functions but also might help to develop new therapeutic strategies to target numerous malignancies. In this review we highlight and summarize recent achievements in understanding the biological role of HDAC4 in neurodegenerative processes. PMID:25759639

  18. Practice Patterns for Outpatients With Stable Coronary Artery Disease: A Case Vignette-based Survey Among French Cardiologists

    PubMed Central

    Bauters, Christophe; Lemesle, Gilles; Lamblin, Nicolas; Danchin, Nicolas

    2015-01-01

    Background Although medical management of patients with coronary artery disease (CAD) is often based on scientific guidelines, a number of everyday clinical situations are not specifically covered by recommendations or the level of evidence is low. The aim of this study was to assess practice patterns regarding routine management of patients with stable CAD. Methods A survey comprising six questions on two clinical scenarios regarding stable CAD management was sent to 345 cardiologists from the Nord-Pas-de-Calais Region (France). We first assessed practice patterns globally and then searched for associations with physician characteristics (age, gender, sub-specialty, and type of practice). Findings The response rate was 92%. Regarding management of asymptomatic CAD, 86% of the cardiologists performed routine exercise testing, before which, 69% withdrew β-blockers. After a positive exercise test, 26% immediately performed coronary angiography and 67%, further imaging tests. In the absence of left ventricular dysfunction or history of myocardial infarction, routine β-blocker prescription for stable CAD was selected by 43%. When anticoagulation was needed for atrial fibrillation, 41% initiated direct oral anticoagulants rather than vitamin-K antagonists and 50% combined aspirin with anticoagulants. For recurrent stable angina in patients with known CAD, 24% performed coronary angiography directly, 49% requested a stress test, and 27% opted for medical therapy without further diagnostic testing. Age, gender of the cardiologist, academic environment, and practice of interventional cardiology were associated with certain management patterns. Interpretation When not guided by high-level recommendations, practice patterns for routine clinical situations in stable CAD vary considerably. Future clinical trials should address these clinical interrogations. PMID:26870792

  19. Oral Huangqi Formulae for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Wu, Lei; Chen, Yuanbin; Xu, Yinji; Guo, Xinfeng; Li, Xiaoyan; Zhang, Anthony Lin; May, Brian H.; Xue, Charlie Changli; Wen, Zehuai; Lin, Lin

    2013-01-01

    Objective. To evaluate the efficacy and safety of oral Huangqi formulae for the treatment of stable COPD. Methods. The major databases were searched until September 2010 and supplemented with a manual search. Randomized controlled trials (RCTs) of oral Huangqi formulae that reported on lung function, St. George's Respiratory Questionnaire, symptom improvement and/or frequency of exacerbations were extracted by two reviewers. The Cochrane tool was used for the assessment of risk of bias in the included trials. Data were analyzed with RevMan 5.1.2 software. Results. 25 RCTs (1,661 participants) were included. Compared with conventional therapy (CT) alone, oral Huangqi formulae plus CT increased FEV1, and a similar result was found comparing Huangqi formulae with no treatment. Improvements in SGRQ total score, COPD-related symptoms and reduction of frequency of exacerbations were found in patients receiving Huangqi formulae plus CT compared to those receiving CT alone or CT plus placebo. No serious adverse events were reported. However, there were some methodological inadequacies in the included studies. Conclusions. The benefits of Huangqi formulae for stable COPD were promising, but its efficacy and safety have not been established due to methodological weakness and possible bias in the reported results. Further rigorously designed studies are warranted. PMID:23606889

  20. Current Role of Ivabradine in Stable Coronary Artery Disease Without Heart Failure.

    PubMed

    Porres-Aguilar, Mateo; Muñoz, Oscar C; Abbas, Aamer

    2016-02-01

    Increase in heart rate represents a significant contribution in the pathophysiology of coronary artery disease and heart failure, by promoting atherosclerotic process and endothelial dysfunction. Thus, it negatively influences cardiovascular risk in the general population. The aim of this review is to analyze the current, controversial, and future role of ivabradine as an anti-anginal agent in the setting of coronary artery disease without heart failure. Ivabradine represents a selective heart rate-lowering agent that increased diastolic perfusion time and improving energetics in the ischemic myocardium.

  1. Optimising diagnostic accuracy with the exercise ECG: opportunities for women and men with stable ischaemic heart disease

    PubMed Central

    Shaw, Leslee J; Xie, Joe X; Phillips, Lawrence M; Goyal, Abhinav; Reynolds, Harmony R; Berman, Daniel S; Picard, Michael H; Bhargava, Balram; Devlin, Gerard; Chaitman, Bernard R

    2016-01-01

    The exercise ECG is an integral part within the evaluation algorithm for diagnosis and risk stratification of patients with stable ischaemic heart disease (SIHD). There is evidence, both older and new, that the exercise ECG can be an effective and cost-efficient option for patients capable of performing at maximal levels of exercise with suitable resting ECG findings. In this review, we will highlight the major dilemmas in interpreting suspected coronary artery disease symptoms in women and identify optimal strategies for employing exercise ECG as a first-line diagnostic test in the SIHD evaluation algorithm. We will highlight current evidence as well as recent guideline statements on this subject. Trial registration number NCT01471522; Pre-results. PMID:27326241

  2. Vitamin D-mediated calcium absorption in patients with clinically stable Crohn's disease: a pilot study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin D is the critical hormone for intestinal absorption of calcium. Optimal calcium absorption is important for proper mineralization of bone in the prevention of osteoporosis and osteoporotic fractures, among other important functions. Diseases associated with gut inflammation, such as Crohn's ...

  3. Asymmetric Dimethylarginine versus Proton Pump Inhibitors Usage in Patients with Stable Coronary Artery Disease: A Cross-Sectional Study.

    PubMed

    Kruszelnicka, Olga; Świerszcz, Jolanta; Bednarek, Jacek; Chyrchel, Bernadeta; Surdacki, Andrzej; Nessler, Jadwiga

    2016-01-01

    A recent experimental study suggested that proton pump inhibitors (PPI), widely used to prevent gastroduodenal complications of dual antiplatelet therapy, may increase the accumulation of the endogenous nitric oxide synthesis antagonist asymmetric dimethylarginine (ADMA), an adverse outcome predictor. Our aim was to assess the effect of PPI usage on circulating ADMA in coronary artery disease (CAD). Plasma ADMA levels were compared according to PPI use for ≥1 month prior to admission in 128 previously described non-diabetic men with stable CAD who were free of heart failure or other coexistent diseases. Patients on PPI tended to be older and with insignificantly lower estimated glomerular filtration rate (GFR). PPI use was not associated with any effect on plasma ADMA (0.51 ± 0.11 (SD) vs. 0.50 ± 0.10 µmol/L for those with PPI (n = 53) and without PPI (n = 75), respectively; p = 0.7). Additionally, plasma ADMA did not differ between PPI users and non-users stratified by a history of current smoking, CAD severity or extent. The adjustment for patients' age and GFR did not substantially change the results. Thus, PPI usage does not appear to affect circulating ADMA in non-diabetic men with stable CAD. Whether novel mechanisms of adverse PPI effects on the vasculature can be translated into clinical conditions, requires further studies. PMID:27092494

  4. Asymmetric Dimethylarginine versus Proton Pump Inhibitors Usage in Patients with Stable Coronary Artery Disease: A Cross-Sectional Study

    PubMed Central

    Kruszelnicka, Olga; Świerszcz, Jolanta; Bednarek, Jacek; Chyrchel, Bernadeta; Surdacki, Andrzej; Nessler, Jadwiga

    2016-01-01

    A recent experimental study suggested that proton pump inhibitors (PPI), widely used to prevent gastroduodenal complications of dual antiplatelet therapy, may increase the accumulation of the endogenous nitric oxide synthesis antagonist asymmetric dimethylarginine (ADMA), an adverse outcome predictor. Our aim was to assess the effect of PPI usage on circulating ADMA in coronary artery disease (CAD). Plasma ADMA levels were compared according to PPI use for ≥1 month prior to admission in 128 previously described non-diabetic men with stable CAD who were free of heart failure or other coexistent diseases. Patients on PPI tended to be older and with insignificantly lower estimated glomerular filtration rate (GFR). PPI use was not associated with any effect on plasma ADMA (0.51 ± 0.11 (SD) vs. 0.50 ± 0.10 µmol/L for those with PPI (n = 53) and without PPI (n = 75), respectively; p = 0.7). Additionally, plasma ADMA did not differ between PPI users and non-users stratified by a history of current smoking, CAD severity or extent. The adjustment for patients’ age and GFR did not substantially change the results. Thus, PPI usage does not appear to affect circulating ADMA in non-diabetic men with stable CAD. Whether novel mechanisms of adverse PPI effects on the vasculature can be translated into clinical conditions, requires further studies. PMID:27092494

  5. Comparison of cytokine expressions in acute myocardial infarction and stable angina stages of coronary artery disease

    PubMed Central

    Yan, Wenwen; Wen, Siwan; Wang, Lemin; Duan, Qianglin; Ding, Lin

    2015-01-01

    Objective: To investigate the differential gene expression of cytokines and compare their impacts on the immune functions among the acute myocardial infarction patients (AMI), the stable angina patients (SA) and the controls. Methods: 20 patients with AMI, 20 patients with SA and 20 healthy volunteers were recruited into the study. Whole human genome microarray analysis was used to detect the gene expression differences in interferons, interleukins, chemokines, tumor necrosis factors and associated receptors in peripheral blood mononuclear cells (PBMCs) among three groups. Results: Compared with SA patients and the controls respectively, in AMI patients, IFNα2, IFNαR1, IFNαR2, IFNγR1, IFNγR2, L1β, IL16, IL18, Cxcl1, Cxcl2, Cxcl6, CxcR2, CxcR4, LIGHT, TNFR1, LT-βR, CD137, TRAILR, and TWEAKR mRNA expressions were significantly up-regulated (P<0.05), while Ccl5, Ccl24, Ccl28, CcR5, TWEAK, CD40, CD27, and BAFFR mRNA expressions were significantly down-regulated (P<0.05). But, there was no significant difference in cytokine expression between the SA patients and the controls. Conclusion: In AMI patients, mRNA expression levels of cytokines were imbalanced, indicating the dysfunction of the immune system. Together with no significant change of cytokines was observed between the SA and controls, showing the different cytokine related immune activity in the AMI and SA patients. PMID:26770404

  6. How Stable Is Stable?

    ERIC Educational Resources Information Center

    Baehr, Marie

    1994-01-01

    Provides a problem where students are asked to find the point at which a soda can floating in some liquid changes its equilibrium between stable and unstable as the soda is removed from the can. Requires use of Newton's first law, center of mass, Archimedes' principle, stable and unstable equilibrium, and buoyant force position. (MVL)

  7. Conformational energetics of stable and metastable states formed by DNA triplet repeat oligonucleotides: Implications for triplet expansion diseases

    PubMed Central

    Völker, J.; Makube, N.; Plum, G. E.; Klump, H. H.; Breslauer, K. J.

    2002-01-01

    We have embedded the hexameric triplet repeats (CAG)6 and (CTG)6 between two (GC)3 domains to produce two 30-mer hairpins with the sequences d[(GC)3(CAG)6(GC)3] and d[(GC)3(CTG)6(GC)3]. This construct reduces the conformational space available to these repetitive DNA sequences. We find that the (CAG)6 and (CTG)6 repeats form stable, ordered, single-stranded structures. These structures are stabilized at 62°C by an average enthalpy per base of 1.38 kcal·mol−1 for the CAG triplet and 2.87 kcal·mol−1 for the CTG triplet, while being entropically destabilized by 3.50 cal·K−1·mol−1 for the CAG triplet and 7.6 cal·K−1·mol−1 for the CTG triplet. Remarkably, these values correspond, respectively, to 1/3 (for CAG) and 2/3 (for CTG) of the enthalpy and entropy per base values associated with Watson–Crick base pairs. We show that the presence of the loop structure kinetically inhibits duplex formation from the two complementary 30-mer hairpins, even though the duplex is the thermodynamically more stable state. Duplex formation, however, does occur at elevated temperatures. We propose that this thermally induced formation of a more stable duplex results from thermal disruption of the single-stranded order, thereby allowing the complementary domains to associate (perhaps via “kissing hairpins”). Our melting profiles show that, once duplex formation has occurred, the hairpin intermediate state cannot be reformed, consistent with our interpretation of kinetically trapped hairpin structures. The duplex formed by the two complementary oligonucleotides does not have any unusual optical or thermodynamic properties. By contrast, the very stable structures formed by the individual single-stranded triplet repeat sequences are thermally and thermodynamically unusual. We discuss this stable, triplet repeat, single-stranded structure and its interconversion with duplex in terms of triplet expansion diseases. PMID:12417759

  8. Functionally stable plasminogen activator inhibitor-1 in a family with cardiovascular disease and vitiligo.

    PubMed

    Agirbasli, Mehmet; Eren, Mesut; Yasar, Songul; Delil, Kenan; Goktay, Fatih; Oner, Ebru Toksoy; Vaughan, Douglas E

    2014-07-01

    Vitiligo is a common skin condition with a complex pathophysiology characterized by the lack of pigmentation due to melanocyte degeneration. In this study, we investigated PAI-1 antigen (Ag) and activity levels in a 34 year old male with extensive vascular disease, alopecia areata and vitiligo. Fasting PAI-1 Ag and activity levels were measured at 9 a.m. in the subject and family members. Both PAI-1 Ag (67 ± 38 vs. 18.6 ± 6.5 ng/ml, P < 0.001) and specific activity (15.8 ± 10.0 vs. 7.6 ± 6.0 IU/pmol, P < 0.04) levels of PAI-1 were moderately elevated in subjects compared to the controls. PAI-1 kinetic studies demonstrated a markedly enhanced stability of plasma PAI-1 activity in the family members. Specific activity at 16 h was significantly higher than expected activity levels (0.078 ± 0.072 vs. 0.001 ± 0.001 IU/ng/ml, P < 0.001). While the exact mechanism of increased stability of PAI-1 activity in vitiligo is not known, it is likely due to post-translational modifications or increased binding affinity for a stabilizing cofactor. In conclusion, enhanced stability of PAI-1 may contribute to the pathophysiology of vascular disease and associated melanocyte degeneration. Systemic or local treatment with PAI-1 inhibitors may offer a potential treatment alternative to the near orphan status for vitiligo drug development. PMID:24197654

  9. Achievement of therapeutic goals with low-dose imiglucerase in Gaucher disease: a single-center experience.

    PubMed

    Tukan, Irina; Hadas-Halpern, Irith; Altarescu, Gheona; Abrahamov, Ayala; Elstein, Deborah; Zimran, Ari

    2013-01-01

    Gaucher disease, a lysosomal storage disorder, is a multisystem disorder with variable and unpredictable onset and severity. Disease-specific enzyme replacement therapy (ERT) has been shown to reverse or ameliorate disease-specific hepatosplenomegaly and anemia and thrombocytopenia. ERT also impacts bone manifestations, including bone crises, bone pain, and appearance of new osteonecrosis, and improves bone mineral density to varying degrees. The objective of this study was to assess achievement of predefined therapeutic goals based on international registry outcomes for Israeli patients with Gaucher disease receiving imiglucerase for four consecutive years on a low-dose regimen followed in a single center. All data were taken from patient files. The therapeutic goals were taken from standards published in the literature for disease-specific clinical parameters. Among 164 patients at baseline, values for spleen and liver volumes, hemoglobin and platelet counts, and Z-scores for lumbar spine and femoral were significantly different from the goal. After four years ERT, there was a significant improvement (P = 0.000) in each of the therapeutic goal parameters from baseline. 15.2% of these patients achieved all hematology-visceral goals. In children, there was achievement of linear growth and puberty. This survey highlights the good overall response in symptomatic patients receiving low-dose ERT with imiglucerase in Israel. PMID:24285960

  10. Frequency of angina pectoris and secondary events in patients with stable coronary heart disease (from the Heart and Soul Study).

    PubMed

    Beatty, Alexis L; Spertus, John A; Whooley, Mary A

    2014-10-01

    The extent to which angina pectoris (AP) predicts secondary cardiovascular events beyond independent of measures of disease severity is unknown. We evaluated the association between AP frequency and secondary events in patients with stable coronary heart disease (CHD). We administered the Seattle Angina Questionnaire to 1,023 participants with stable CHD enrolled from September 2000 to December 2002 and followed for a median of 8.9 years. We used Cox proportional hazards to evaluate the association of AP frequency with death and subsequent hospitalization for AP, revascularization, myocardial infarction (MI), or heart failure. At enrollment, 633 (62%) participants reported no AP, 279 (27%) reported monthly AP, and 111 (11%) reported daily or weekly AP. During follow-up, 396 participants died, 204 were hospitalized for AP, 194 for revascularization, 140 for MI, and 188 for heart failure. Compared with participants without AP, participants with daily or weekly AP were more likely to be hospitalized for AP (hazard ratio [HR] 3.3; 95% confidence interval [CI] 2.3 to 4.7; p<0.001), revascularization (HR 2.0; 95% CI 1.3 to 2.9; p=0.001), or heart failure (HR 1.6; 95% CI 1.0 to 2.5; p=0.03) and more likely to die (HR 1.5; 95% CI 1.1 to 2.0; p=0.01). AP was not independently associated with MI (HR 1.3; 95% CI 0.8 to 2.3; p=0.29). After adjusting for demographics, co-morbidities, treadmill exercise capacity, ejection fraction, and inducible ischemia, frequency of AP remained independently associated with hospitalization for AP (HR 2.4; 95% CI 1.6 to 3.6; p<0.001), revascularization (HR 1.7; 95% CI 1.1 to 2.7; p=0.02), and death (HR 1.4; 95% CI 1.0 to 2.0; p=0.045). In conclusion, in outpatients with stable CHD, AP frequency predicts higher rates of secondary cardiovascular events and death, independent of objective measures of disease severity.

  11. Human Tissue Kallikrein Activity in Angiographically Documented Chronic Stable Coronary Artery Disease

    PubMed Central

    Figueiredo, Estêvão Lanna; Magalhães, Carolina Antunes; Belli, Karlyse Claudino; Mandil, Ari; Garcia, José Carlos Faria; Araújo, Rosanã Aparecida; Figueiredo, Amintas Fabiano de Souza; Pellanda, Lucia Campos

    2015-01-01

    Background Human tissue kallikrein (hK1) is a key enzyme in the kallikrein–kinin system (KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary artery disease (CAD) remains unclear. Objective To evaluate hK1-specific amidase activity in the urine of CAD patients Methods Sixty-five individuals (18–75 years) who underwent cardiac catheterism (CATH) were included. Random midstream urine samples were collected immediately before CATH. Patients were classified in two groups according to the presence of coronary lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was determined using Jaffé’s method. Urinary hK1-specific amidase activity was expressed as µM/(min · mg creatinine) to correct for differences in urine flow rates. Results Urinary hK1-specific amidase activity levels were similar between CAD [0.146 µM/(min ·mg creatinine)] and non-CAD [0.189 µM/(min . mg creatinine)] patients (p = 0.803) and remained similar to values previously reported for hypertensive patients [0.210 µM/(min . mg creatinine)] and HF patients [0.104 µM/(min . mg creatinine)]. CAD severity and hypertension were not observed to significantly affect urinary hK1-specific amidase activity. Conclusion CAD patients had low levels of urinary hK1-specific amidase activity, suggesting that renal KKS activity may be reduced in patients with this disease. PMID:26351984

  12. Establishment and evaluation of stable cell lines inhibiting foot-and-mouth disease virus by RNA interference.

    PubMed

    Gu, Yuan-Xing; Gao, Zong-Liang; Zhou, Jian-Hua; Zhang, Jie; Liu, Yong-Sheng

    2014-01-01

    RNA interference (RNAi) has been proved to be a powerful tool for foot-and-mouth disease virus FMDV inhibition in vitro and in vivo. We established five stable baby hamster kidney 21 cell lines (BHK-21) containing five short hairpin RNAs (shRNAs) expression plasmids (p3D1shRNA, p3D2shRNA, p3D3shRNA, p3D4shRNA, and p3D5shRNA) targeting 3D gene of FMDV. Immunofluorescent assay, virus titration, and real-time quantitative reverse transcription polymerase chain reaction (Q-RT-PCR) were conducted to detect the effect of shRNAs on FMDV replication. After challenged with FMDV of O/CHA/99, two cell lines (p3D1shRNA and p3D4shRNA) showed a significant reduction in the synthesis of viral protein and RNA, accompanied by a sharp decrease in viral yield, and the inhibition could last for at least thirty passages. We developed an efficient procedure for the establishment and evaluation of stable cell lines for anti-FMDV research based on RNAi technology, which can be a candidate method for anti-FMDV research.

  13. Conservative versus invasive stable ischemic heart disease management strategies: what do we plan to learn from the ISCHEMIA trial?

    PubMed

    Cheng-Torres, Kathleen A; Desai, Karan P; Sidhu, Mandeep S; Maron, David J; Boden, William E

    2016-01-01

    Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.

  14. Potent, metabolically stable benzopyrimido-pyrrolo-oxazine-dione (BPO) CFTR inhibitors for polycystic kidney disease.

    PubMed

    Snyder, David S; Tradtrantip, Lukmanee; Yao, Chenjuan; Kurth, Mark J; Verkman, A S

    2011-08-11

    We previously reported the discovery of pyrimido-pyrrolo-quinoxalinedione (PPQ) inhibitors of the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel and showed their efficacy in an organ culture model of polycystic kidney disease (PKD) (J. Med. Chem. 2009, 52, 6447-6455). Here, we report related benzopyrimido-pyrrolo-oxazinedione (BPO) CFTR inhibitors. To establish structure-activity relationships and select lead compound(s) with improved potency, metabolic stability, and aqueous solubility compared to the most potent prior compound 8 (PPQ-102, IC(50) ∼ 90 nM), we synthesized 16 PPQ analogues and 11 BPO analogues. The analogues were efficiently synthesized in 5-6 steps and 11-61% overall yield. Modification of 8 by bromine substitution at the 5-position of the furan ring, replacement of the secondary amine with an ether bridge, and carboxylation, gave 6-(5-bromofuran-2-yl)-7,9-dimethyl-8,10-dioxo-11-phenyl-7,8,9,10-tetrahydro-6H-benzo[b]pyrimido [4',5':3,4]pyrrolo [1,2-d][1,4]oxazine-2-carboxylic acid 42 (BPO-27), which fully inhibited CFTR with IC(50) ∼ 8 nM and, compared to 8, had >10-fold greater metabolic stability and much greater polarity/aqueous solubility. In an embryonic kidney culture model of PKD, 42 prevented cyst growth with IC(50) ∼ 100 nM. Benzopyrimido-pyrrolo-oxazinediones such as 42 are potential development candidates for antisecretory therapy of PKD.

  15. Antioxidative Activity after Rosuvastatin Treatment in Patients with Stable Ischemic Heart Disease and Decreased High Density Lipoprotein Cholesterol

    PubMed Central

    Park, Do-Sim; Park, Hyun Young; Rhee, Sang Jae; Kim, Nam-Ho; Oh, Seok Kyu; Jeong, Jin-Won

    2016-01-01

    Background and Objectives The clinical significance of statin-induced high-density lipoprotein cholesterol (HDL-C) changes is not well known. We investigated whether rosuvastatin-induced HDL-C changes can influence the anti-oxidative action of high-density lipoprotein particle. Subjects and Methods A total of 240 patients with stable ischemic heart disease were studied. Anti-oxidative property was assessed by paraoxonase 1 (PON1) activity. We compared the lipid profile and PON1 activity at baseline and at 8 weeks after rosuvastatin 10 mg treatment. Results Rosuvastatin treatment increased the mean HDL-C concentration by 1.9±9.2 mg/dL (6.4±21.4%). HDL-C increased in 138 patients (57.5%), but decreased in 102 patients (42.5%) after statin treatment. PON1 activity increased to 19.1% in all patients. In both, the patients with increased HDL-C and with decreased HDL-C, PON1 activity significantly increased after rosuvastatin treatment (+19.3% in increased HDL-C responder; p=0.018, +18.8% in decreased HDL-C responder; p=0.045 by paired t-test). Baseline PON1 activity modestly correlated with HDL-C levels (r=0.248, p=0.009); however, the PON1 activity evaluated during the course of the treatment did not correlate with HDL-C levels (r=0.153, p=0.075). Conclusion Rosuvastatin treatment improved the anti-oxidative properties as assessed by PON1 activity, regardless of on-treatment HDL-C levels, in patients with stable ischemic heart disease. PMID:27275167

  16. Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol

    PubMed Central

    Laaksonen, Reijo; Ekroos, Kim; Sysi-Aho, Marko; Hilvo, Mika; Vihervaara, Terhi; Kauhanen, Dimple; Suoniemi, Matti; Hurme, Reini; März, Winfried; Scharnagl, Hubert; Stojakovic, Tatjana; Vlachopoulou, Efthymia; Lokki, Marja-Liisa; Nieminen, Markku S.; Klingenberg, Roland; Matter, Christian M.; Hornemann, Thorsten; Jüni, Peter; Rodondi, Nicolas; Räber, Lorenz; Windecker, Stephan; Gencer, Baris; Pedersen, Eva Ringdal; Tell, Grethe S.; Nygård, Ottar; Mach, Francois; Sinisalo, Juha; Lüscher, Thomas F.

    2016-01-01

    Aims The aim was to study the prognostic value of plasma ceramides (Cer) as cardiovascular death (CV death) markers in three independent coronary artery disease (CAD) cohorts. Methods and results Corogene study is a prospective Finnish cohort including stable CAD patients (n = 160). Multiple lipid biomarkers and C-reactive protein were measured in addition to plasma Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0), and Cer(d18:1/24:1). Subsequently, the association between high-risk ceramides and CV mortality was investigated in the prospective Special Program University Medicine—Inflammation in Acute Coronary Syndromes (SPUM-ACS) cohort (n = 1637), conducted in four Swiss university hospitals. Finally, the results were validated in Bergen Coronary Angiography Cohort (BECAC), a prospective Norwegian cohort study of stable CAD patients. Ceramides, especially when used in ratios, were significantly associated with CV death in all studies, independent of other lipid markers and C-reactive protein. Adjusted odds ratios per standard deviation for the Cer(d18:1/16:0)/Cer(d18:1/24:0) ratio were 4.49 (95% CI, 2.24–8.98), 1.64 (1.29–2.08), and 1.77 (1.41–2.23) in the Corogene, SPUM-ACS, and BECAC studies, respectively. The Cer(d18:1/16:0)/Cer(d18:1/24:0) ratio improved the predictive value of the GRACE score (net reclassification improvement, NRI = 0.17 and ΔAUC = 0.09) in ACS and the predictive value of the Marschner score in stable CAD (NRI = 0.15 and ΔAUC = 0.02). Conclusions Distinct plasma ceramide ratios are significant predictors of CV death both in patients with stable CAD and ACS, over and above currently used lipid markers. This may improve the identification of high-risk patients in need of more aggressive therapeutic interventions. PMID:27125947

  17. Change in Leukocyte Telomere Length Predicts Mortality in Patients with Stable Coronary Heart Disease from the Heart and Soul Study

    PubMed Central

    Goglin, Sarah E.; Farzaneh-Far, Ramin; Epel, Elissa S.; Lin, Jue; Blackburn, Elizabeth H.

    2016-01-01

    Background Short telomere length independently predicts mortality in patients with coronary heart disease. Whether 5-year change in telomere length predicts subsequent mortality in patients with coronary heart disease has not been evaluated. Methods In a prospective cohort study of 608 individuals with stable coronary artery disease, we measured leukocyte telomere length at baseline and after five years of follow-up. We divided the sample into tertiles of telomere change: shortened, maintained or lengthened. We used Cox survival models to evaluate 5-year change in telomere length as a predictor of mortality. Results During an average of 4.2 years follow-up, there were 149 deaths. Change in telomere length was inversely predictive of all-cause mortality. Using the continuous variable of telomere length change, each standard deviation (325 base pair) greater increase in telomere length was associated with a 24% reduction in mortality (HR 0.76, 95% CI 0.61–0.94; p = 0.01), adjusted for age, sex, waist to hip ratio, exercise capacity, LV ejection fraction, serum creatinine, and year 5 telomere length. Mortality occurred in 39% (79/203) of patients who experienced telomere shortening, 22% (45/203) of patients whose telomere length was maintained, and 12% (25/202) of patients who experienced telomere lengthening (p<0.001). As compared with patients whose telomere length was maintained, those who experienced telomere lengthening were 56% less likely to die (HR 0.44, 95% CI, 0.23–0.87). Conclusions In patients with coronary heart disease, an increase in leukocyte telomere length over 5 years is associated with decreased mortality. PMID:27783614

  18. Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

    PubMed Central

    Escobedo, Jorge; Rana, Jamal S.; Lombardero, Manuel S.; Albert, Stewart G.; Davis, Andrew M.; Kennedy, Frank P.; Mooradian, Arshag D.; Robertson, David G.; Srinivas, V. S.; Gebhart, Suzanne S. P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. PATIENTS AND METHODS: We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. RESULTS: Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. CONCLUSION: Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD. PMID:20042560

  19. Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients.

    PubMed

    Satake, Masahiro; Shioya, Takanobu; Uemura, Sachiko; Takahashi, Hitomi; Sugawara, Keiyu; Kasai, Chikage; Kiyokawa, Noritaka; Watanabe, Toru; Sato, Sayaka; Kawagoshi, Atsuyoshi

    2015-01-01

    The purpose of this study was to investigate the relationship between dynamic hyperinflation and dyspnea and to clarify the characteristics of dyspnea during the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease patients. Twenty-three subjects with stable moderate chronic obstructive pulmonary disease (age 73.8±5.8 years, all male) took part in this study. During the 6MWT, ventilatory and gas exchange parameters were measured using a portable respiratory gas analysis system. Dyspnea and oxygen saturation were recorded at the end of every 2 minute period during the test. There was a significant decrease in inspiratory capacity during the 6MWT. This suggested that dynamic hyperinflation had occurred. Dyspnea showed a significant linear increase, and there was a significant negative correlation with inspiratory capacity. It was suggested that one of the reasons that dyspnea developed during the 6MWT was the dynamic hyperinflation. Even though the tidal volume increased little after 2 minutes, dyspnea increased linearly to the end of the 6MWT. These results suggest that the mechanisms generating dyspnea during the 6MWT were the sense of respiratory effort at an early stage and then the mismatch between central motor command output and respiratory system movement.

  20. Stable Isotopes Suggest Low Site Fidelity in Bar-headed Geese (Anser indicus) in Mongolia: Implications for Disease Transmission

    PubMed Central

    Bridge, Eli S.; Kelly, Jeffrey F.; Xiao, Xiangming; Batbayar, Nyambayar; Natsagdorj, Tseveenmyadag; Hill, Nichola J.; Takekawa, John Y.; Hawkes, Lucy A.; Bishop, Charles M.; Butler, Patrick J.; Newman, Scott H.

    2016-01-01

    Population connectivity is an important consideration in studies of disease transmission and biological conservation, especially with regard to migratory species. Determining how and when different subpopulations intermingle during different phases of the annual cycle can help identify important geographical regions or features as targets for conservation efforts and can help inform our understanding of continental-scale disease transmission. In this study, stable isotopes of hydrogen and carbon in contour feathers were used to assess the degree of molt-site fidelity among Bar-headed Geese (Anser indicus) captured in north-central Mongolia. Samples were collected from actively molting Bar-headed Geese (n = 61), and some individual samples included both a newly grown feather (still in sheath) and an old, worn feather from the bird’s previous molt (n = 21). Although there was no difference in mean hydrogen isotope ratios for the old and new feathers, the isotopic variance in old feathers was approximately three times higher than that of the new feathers, which suggests that these birds use different and geographically distant molting locations from year to year. To further test this conclusion, online data and modeling tools from the isoMAP website were used to generate probability landscapes for the origin of each feather. Likely molting locations were much more widespread for old feathers than for new feathers, which supports the prospect of low molt-site fidelity. This finding indicates that population connectivity would be greater than expected based on data from a single annual cycle, and that disease spread can be rapid even in areas like Mongolia where Bar-headed Geese generally breed in small isolated groups.

  1. Stable isotopes suggest low site fidelity in Bar-Headed Geese (Anser indicus) in Mongolia: Implications for disease transmission

    USGS Publications Warehouse

    Bridge, Eli S.; Kelly, Jeffrey F.; Xiangming Xiao,; Batbayar, Nyambayar; Natsagdorj, Tseveenmyadag; Hill, Nichola J.; Takekawa, John Y.; Hawkes, Lucy A.; Bishop, Charles M.; Butler, Patrick J.; Newman, Scott H.

    2015-01-01

    Population connectivity is an important consideration in studies of disease transmission and biological conservation, especially with regard to migratory species. Determining how and when different subpopulations intermingle during different phases of the annual cycle can help identify important geographical regions or features as targets for conservation efforts and can help inform our understanding of continental-scale disease transmission. In this study, stable isotopes of hydrogen and carbon in contour feathers were used to assess the degree of molt-site fidelity among Bar-headed Geese (Anser indicus) captured in north-central Mongolia. Samples were collected from actively molting Bar-headed Geese (n = 61), and some individual samples included both a newly grown feather (still in sheath) and an old, worn feather from the bird's previous molt (n = 21). Although there was no difference in mean hydrogen isotope ratios for the old and new feathers, the isotopic variance in old feathers was approximately three times higher than that of the new feathers, which suggests that these birds use different and geographically distant molting locations from year to year. To further test this conclusion, online data and modeling tools from the isoMAP website were used to generate probability landscapes for the origin of each feather. Likely molting locations were much more widespread for old feathers than for new feathers, which supports the prospect of low molt-site fidelity. This finding indicates that population connectivity would be greater than expected based on data from a single annual cycle, and that disease spread can be rapid even in areas like Mongolia where Bar-headed Geese generally breed in small isolated groups.

  2. Stable Isotopes Suggest Low Site Fidelity in Bar-headed Geese (Anser indicus) in Mongolia: Implications for Disease Transmission

    PubMed Central

    Bridge, Eli S.; Kelly, Jeffrey F.; Xiao, Xiangming; Batbayar, Nyambayar; Natsagdorj, Tseveenmyadag; Hill, Nichola J.; Takekawa, John Y.; Hawkes, Lucy A.; Bishop, Charles M.; Butler, Patrick J.; Newman, Scott H.

    2016-01-01

    Population connectivity is an important consideration in studies of disease transmission and biological conservation, especially with regard to migratory species. Determining how and when different subpopulations intermingle during different phases of the annual cycle can help identify important geographical regions or features as targets for conservation efforts and can help inform our understanding of continental-scale disease transmission. In this study, stable isotopes of hydrogen and carbon in contour feathers were used to assess the degree of molt-site fidelity among Bar-headed Geese (Anser indicus) captured in north-central Mongolia. Samples were collected from actively molting Bar-headed Geese (n = 61), and some individual samples included both a newly grown feather (still in sheath) and an old, worn feather from the bird’s previous molt (n = 21). Although there was no difference in mean hydrogen isotope ratios for the old and new feathers, the isotopic variance in old feathers was approximately three times higher than that of the new feathers, which suggests that these birds use different and geographically distant molting locations from year to year. To further test this conclusion, online data and modeling tools from the isoMAP website were used to generate probability landscapes for the origin of each feather. Likely molting locations were much more widespread for old feathers than for new feathers, which supports the prospect of low molt-site fidelity. This finding indicates that population connectivity would be greater than expected based on data from a single annual cycle, and that disease spread can be rapid even in areas like Mongolia where Bar-headed Geese generally breed in small isolated groups. PMID:27695389

  3. Efficacy and safety of ezetimibe co-administered with ongoing atorvastatin therapy in achieving low-density lipoprotein goal in patients with hypercholesterolemia and coronary heart disease.

    PubMed

    Cruz-Fernández, J M; Bedarida, G V; Adgey, J; Allen, C; Johnson-Levonas, A O; Massaad, R

    2005-06-01

    This randomised, double-blind, placebo (PBO)-controlled study evaluated the efficacy and safety of ezetimibe (EZE) co-administered with ongoing atorvastatin (ATV) therapy in 450 hypercholesterolemic patients with coronary heart disease (CHD) who had not achieved their low-density lipoprotein cholesterol (LDL-C) goal < or =2.60 mmol/l while on a stable dose of ATV 10 or 20 mg/day for > or =6 weeks. After a 4-week diet/baseline active run-in period, patients with LDL-C >2.60 mmol/l and < or =4.20 mmol/l were stratified by ATV dose and randomised (1 : 1) to EZE 10 mg or PBO for 6 weeks while continuing open-label ATV. Significantly more patients achieved an LDL-C goal < or =2.6 mmol/l with EZE than PBO (81.3 vs. 21.8%; p < or = 0.001). Compared to PBO, co-administration of EZE with ongoing ATV led to significantly (p < or = 0.001) greater reductions in LDL-C, total cholesterol, triglycerides, non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B; HDL-C was significantly (p < or = 0.05) increased. Co-administration of EZE and ATV was well tolerated, with an overall safety profile similar to ATV alone.

  4. Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

    PubMed Central

    Teo, Boon Wee; Chua, Horng Ruey; Wong, Weng Kin; Haroon, Sabrina; Subramanian, Srinivas; Loh, Ping Tyug; Sethi, Sunil; Lau, Titus

    2016-01-01

    INTRODUCTION Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD. METHODS Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses. RESULTS 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m2. At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020). CONCLUSION Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients. PMID:27212015

  5. Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region.

    PubMed

    Hennessey, Karen; Schluter, W William; Wang, Xiaojun; Boualam, Liliane; Jee, Youngmee; Mendoza-Aldana, Jorge; Roesel, Sigrun; Diorditsa, Sergey; Ehrenberg, John

    2014-07-23

    Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals. Given the long history and experience with VPD initiatives in the Western Pacific Region, this manuscript focuses on the Region's following initiatives: (1) smallpox eradication, (2) polio eradication, (3) measles elimination, (4) maternal and neonatal tetanus elimination (MNTE), and (5) hepatitis B control. There is good consistency across the Region's VPD initiatives yet a pattern of more robust and representative data requirements, stricter evaluation criteria, and more formal evaluation bodies are linked to the intensity of the goal - with eradication being the peak. On the other end of this spectrum, the Regional hepatitis B control initiative has established efficient and low-cost approaches for measuring impact and evaluating if the goals have been met. Even within the confines of VPD initiatives there are some deviations in use of terminology and comparisons across other disease control initiatives in the Region are provided.

  6. Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region.

    PubMed

    Hennessey, Karen; Schluter, W William; Wang, Xiaojun; Boualam, Liliane; Jee, Youngmee; Mendoza-Aldana, Jorge; Roesel, Sigrun; Diorditsa, Sergey; Ehrenberg, John

    2014-07-23

    Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals. Given the long history and experience with VPD initiatives in the Western Pacific Region, this manuscript focuses on the Region's following initiatives: (1) smallpox eradication, (2) polio eradication, (3) measles elimination, (4) maternal and neonatal tetanus elimination (MNTE), and (5) hepatitis B control. There is good consistency across the Region's VPD initiatives yet a pattern of more robust and representative data requirements, stricter evaluation criteria, and more formal evaluation bodies are linked to the intensity of the goal - with eradication being the peak. On the other end of this spectrum, the Regional hepatitis B control initiative has established efficient and low-cost approaches for measuring impact and evaluating if the goals have been met. Even within the confines of VPD initiatives there are some deviations in use of terminology and comparisons across other disease control initiatives in the Region are provided. PMID:24947995

  7. Franz Volhard and Theodor Fahr: achievements and controversies in their research in renal disease and hypertension.

    PubMed

    Heidland, A; Gerabek, W; Sebekova, K

    2001-01-01

    The clinician, Franz Volhard, and the pathologist, Theodor Fahr, worked closely together in Mannheim from 1909 until 1915 and introduced a novel classification of renal diseases. In the monograph entitled 'Die Bright'sche Nierenkrankheit, Klinik, Pathologie und Atlas' (1914) they differentiated between degenerative (nephroses), inflammatory (nephritides) and arteriosclerotic (scleroses) diseases. Nephrosclerosis was divided into the benign and malignant form, of which the latter stood the test of time as a new disease entity. Fahr further divided benign nephrosclerosis into the compensated and decompensated form--depending on the presence or absence of glomerular injury. In the pathogenesis of malignant nephrosclerosis, Volhard stressed the decisive role of severe blood pressure elevation, while Fahr postulated an inflammatory mechanism, a concept later confirmed by Adalbert Bohle for at least a minority of patients. A very far reaching concept of Franz Volhard was his idea that pale (renal) hypertension results from a pressor substance released from ischaemic kidney(s) contributing--via a vicious circle--to a further rise in blood pressure with subsequent renovascular injury and aggravation of hypertension. This hypothesis was supported in 1930 by initial experiments of his collaborator, Hartwich (demonstrating in dogs a mild rise in blood pressure after ligation of branches of the renal artery) and definitively proven by Goldblatt (1934) in dogs by induction of severe and persistent hypertension after clamping of both renal arteries. The consequent detection of the renin angiotensin system was the final confirmation of Volhard's postulated renal pressor substance. In the pathogenesis of red (essential) hypertension, Volhard stressed the role of hereditary factors, age, obesity and potentially of severe alcoholism. He emphasised a premature reduction of vascular distensibility (due to elastosis of the prearterioles), a high cardiac output as well as a dampening of

  8. Foodborne Diseases Active Surveillance Network—2 Decades of Achievements, 1996–2015

    PubMed Central

    Jones, Timothy F.; Vugia, Duc J.; Griffin, Patricia M.

    2015-01-01

    The Foodborne Diseases Active Surveillance Network (FoodNet) provides a foundation for food safety policy and illness prevention in the United States. FoodNet conducts active, population-based surveillance at 10 US sites for laboratory-confirmed infections of 9 bacterial and parasitic pathogens transmitted commonly through food and for hemolytic uremic syndrome. Through FoodNet, state and federal scientists collaborate to monitor trends in enteric illnesses, identify their sources, and implement special studies. FoodNet’s major contributions include establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for sporadic enteric infections; population and laboratory surveys that describe the features of gastrointestinal illnesses, medical care–seeking behavior, frequency of eating various foods, and laboratory practices; and development of a surveillance and research platform that can be adapted to address emerging issues. The importance of FoodNet’s ongoing contributions probably will grow as clinical, laboratory, and informatics technologies continue changing rapidly. PMID:26292181

  9. Individualised therapy of angiotensin converting enzyme (ACE) inhibitors in stable coronary artery disease: overview of the primary results of the PERindopril GENEtic association (PERGENE) study.

    PubMed

    Brugts, J J; de Maat, M P M; Danser, A H J; Boersma, E; Simoons, M L

    2012-01-01

    In patients with stable coronary artery disease (CAD) without overt heart failure, ACE inhibitors are among the most commonly used drugs as these agents have been proven effective in reducing the risk of cardiovascular events. Considerable individual variations in the blood pressure response to ACE inhibitors are observed and as such heterogeneity in clinical treatment effect would be likely as well. Assessing the consistency of treatment benefit is essential for the rational and cost-effective prescription of ACE inhibitors. Information on heterogeneities in treatment effect between subgroups of patients could be used to develop an evidence-based guidance for the installation of ACE-inhibitor therapy. Obviously, therapy should only be applied in those patients who most likely will benefit. Attempts to develop such treatment guidance by using clinical characteristics have been unsuccessful. No heterogeneity in risk reduction by ACE inhibitors has been observed in relation to relevant clinical characteristics. A new approach to such 'guided-therapy' could be to integrate more patient-specific characteristics such as the patients' genetic information. If proven feasible, pharmacogenetic profiling could optimise patients' benefit of treatment and reduce unnecessary treatment of patients. Cardiovascular pharmacogenetic research of ACE inhibitors in coronary artery disease patients is in a formative stage and studies are limited. The PERGENE study is a large pharmacogenetic substudy of the EUROPA trial, aimed to assess the achievability of pharmacogenetic profiling. We provide an overview of the main results of the PERGENE study in terms of the genetic determinants of treatment benefit and blood pressure response. The main results of the PERGENE study show a pharmacogenetic profile related to the treatment benefit of perindopril identifying responders and non-responders to treatment. PMID:21688035

  10. Is FFR-CT a "game changer" in the diagnostic management of stable coronary artery disease?

    PubMed

    Leber, W A

    2016-08-01

    The introduction of fractional flow reserve computed tomography (FFR-CT) that is performed from static coronary CT angiography datasets may open new horizons in the diagnostic management of patients with suspected coronary artery disease. FFR-CT has a high sensitivity and moderate specificity in identifying ischemia in intermediate coronary stenoses. It has been demonstrated that this technology has the potential to significantly reduce the number of invasive coronary angiograms and the rate of normal coronary angiograms that are not followed by an intervention. Furthermore, initial data indicate that FFR-CT may predict the hemodynamic effect of stenting and even of bypass surgery. Thus, FFR-CT, with its capacity to serve as an effective gatekeeper before invasive angiography and the option to virtually predict the success of revascularization, constitutes a completely new concept in managing patients with stable angina pectoris. Before this exciting technology can enter clinical practice, however, some evident limitations need to be overcome and significantly more data concerning accuracy and influence on clinical and economic outcome parameters need to be generated. PMID:27393032

  11. Application of stable isotopic techniques in the prevention of degenerative diseases like obesity and NIDDM in developing societies.

    PubMed

    Shetty, Prakash; Iyengar, Venkatesh; Sawaya, Ana; Diaz, Erik; Ma, Guansheng; Hernandez-Triana, Manuel; Yajnik, Chittaranjan; Forrester, Terrence; Valencia, Mauro; Rush, Elaine; Adeyemo, Adebowale; Jahoor, Farook; Roberts, Susan

    2002-09-01

    Economic development in developing societies characterized by industrialization, urbanization, and globalization has seen the emergence of an epidemic of diet- and life-style-related chronic degenerative diseases. A research project was initiated under the aegis of the International Atomic Energy Agency (IAEA), Vienna, Austria under its Coordinated Research Programme (CRP) to promote the use of stable isotopic techniques to document the extent of the problem and to understand the determinants of this epidemic. The principal objectives of this CRP involving countries both in the North and the South are to define the magnitude of the problem of obesity and non-insulin dependent diabetes mellitus (NIDDM) in developing countries, to identify the vulnerable groups at increased risk, and to attempt to describe the metabolic and physiological mechanisms underlying this phenomenon. These comparative international studies of obesity and NIDDM are looking at the effects of childhood malnutrition (Brazil) and socioeconomic differentials (Mexico) on adult risk factors; the composition of the daily diet on obesity (Chile); levels of patterns of physical activity of older adults (China) as well as their influence on weight gain and obesity (Cuba, Nigeria); the impact of body composition and energy expenditure on the evolution frank diabetes from impaired glucose tolerance (Jamaica), and of body compositional changes and the role of inflammatory cytokines on impaired glucose tolerance (India). The last study conducted in New Zealand was aimed at comparing the energy expenditures of Maori (Pacific Island) with New Zealanders of European descent.

  12. Confluence of Depression and Acute Psychological Stress Among Patients With Stable Coronary Heart Disease: Effects on Myocardial Perfusion

    PubMed Central

    Burg, Matthew M.; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W.; Schwartz, Joseph E.; Soufer, Robert

    2014-01-01

    Background Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Methods and Results Patients (N=146) completed the Beck Depression Inventory‐I (BDI‐I), a measure of depression linked to recurrent ACS and post‐ACS mortality, and underwent single‐photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI‐I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI‐I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Conclusions Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression‐associated risk for ACS recurrence and mortality. PMID:25359402

  13. Impact of anaemia on lung function and exercise capacity in patients with stable severe chronic obstructive pulmonary disease

    PubMed Central

    Guo, Jian; Zheng, Cong; Xiao, Qiang; Gong, Sugang; Zhao, Qinhua; Wang, Lan; He, Jing; Yang, Wenlan; Shi, Xue; Sun, Xingguo; Liu, Jinming

    2015-01-01

    Objective This study intended to search for potential correlations between anaemia in patients with severe chronic obstructive pulmonary disease (COPD; GOLD stage III) and pulmonary function at rest, exercise capacity as well as ventilatory efficiency, using pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET). Setting The study was undertaken at Shanghai Pulmonary Hospital, a tertiary-level centre affiliated to Tongji University. It caters to a large population base within Shanghai and referrals from centres in other cities as well. Participants 157 Chinese patients with stable severe COPD were divided into 2 groups: the anaemia group (haemoglobin (Hb) <12.0 g/dL for males, and <11 g/dL for females (n=48)) and the non-anaemia group (n=109). Primary and secondary outcome measures Arterial blood gas, PFT and CPET were tested in all patients. Results (1) Diffusing capacity for carbon monoxide (DLCO) corrected by Hb was significantly lower in the anaemia group ((15.3±1.9) mL/min/mm Hg) than in the non-anaemia group ((17.1±2.1) mL/min/mm Hg) (p<0.05). A significant difference did not exist in the level of forced expiratory volume in 1 s (FEV1), FEV1%pred, FEV1/forced vital capacity (FVC), inspiratory capacity (IC), residual volume (RV), total lung capacity (TLC) and RV/TLC (p>0.05). (2) Peak Load, Peak oxygen uptake (), Peak %pred, Peak , Peak pulse and the ratio of increase to WR increase () were significantly lower in the anaemia group (p<0.05); however, Peak minute ventilation (VE), Lowest /carbon dioxide output () and Peak dead space/tidal volume ratio (VD/VT) were similar between the 2 groups (p>0.05). (3) A strong positive correlation was found between Hb concentration and Peak in patients with anaemia (r=0.702, p<0.01). Conclusions Anaemia has a negative impact on gas exchange and exercise tolerance during exercise in patients with severe COPD. The decrease in amplitude of Hb levels is related to the quantity of oxygen uptake

  14. [Evaluation test of cadmium concentration influence on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG)].

    PubMed

    Kleszczewska, Ewa; Lisowski, Piotr; Kleszczewski, Tomasz; Adamczuk, Anna; Trzciński, Robert

    2005-01-01

    The influence of cadium from cigarette intoxication on selected lipid metabolism parameters in smokers with stable coronary artery disease scheduled for coronary artery bypass grafting (CABG) was studied. It has been shown that concentration of cadmium leads to an increase in the lipid peroxidation and changes in the lipid metabolism. In our study, there was a significant higher cadmium concentration in smokers with stable angina pectoris (20.90+/-0.18) compared to stable angina pectoris non-smokers (7.71 +/-0,45), p<0.0001. We have not found correlations between cadmium concentration in smokers and non-smokers with stable angina pectoris patients and total cholesterol, LDL, HDL, and triglicerydes concentrations. Total cholesterol, LDL, HDL and TG concentrations in smokers scheduled for CABG were respectively: 221.60+/-10.26 mg/dl; 148.40+/-8.71 mg/dl; 41.16+/-2.12 mg/dl, 159.10+/-14.49 mg/dl. All of these lipid parameters in stable angina pectoris smokers did not differ significantly from non-smokers.

  15. Population pharmacokinetics and pharmacodynamics of prasugrel and clopidogrel in aspirin-treated patients with stable coronary artery disease.

    PubMed

    Ernest, C Steven; Small, David S; Rohatagi, Shashank; Salazar, Daniel E; Wallentin, Lars; Winters, Kenneth J; Wrishko, Rebecca E

    2008-12-01

    The aim of the current analysis was to characterize the population PK of prasugrel and clopidogrel metabolites, the resulting PD response, and identification of covariates for key PK/PD parameters. Aspirin-treated subjects with coronary artery disease were randomized to double-blind treatment with clopidogrel 600 mg loading dose (LD) followed by daily 75 mg maintenance dose (MD) or prasugrel 60 mg LD and daily 10 mg MD for 28 days. Plasma concentrations of prasugrel active metabolite (Pras-AM) and prasugrel's inactive thiolactone metabolite (Pras-thiolactone) were simultaneously fit to a multicompartmental model; a similar model adequately described clopidogrel's active metabolite (Clop-AM) PK. By linking to the PK model through the active metabolite concentrations, the PK/PD model characterized the irreversible inhibition of platelet aggregation through a sigmoidal Emax model. Although dose, sex, and weight were identified as significant covariates in the prasugrel PK model, only the effect of body weight produced significant changes in Pras-AM exposure. Generally, these factors resulted in only minor changes in Pras-AM exposures such that, overall, the change in the resulting maximal platelet aggregation (MPA) was predicted to be < or =10% points on average. The clopidogrel PK model included dose as a covariate indicating that a significantly less-than-proportional increase in Clop-AM exposure is expected over the dose range of 75-600 mg, thus, the model-predicted PD response is lower than might be anticipated given an 8-fold difference in dose and lower than that typically achieved following prasugrel 60 mg LD. The greater PD response with prasugrel compared with clopidogrel was accounted for by greater conversion of dose to active metabolite. PMID:19023649

  16. The impact of concomitant diffuse idiopathic skeletal hyperostosis on the achievement of minimal disease activity in subjects with psoriatic arthritis.

    PubMed

    Pappone, Nicola; Di Minno, Matteo Nicola Dario; Iervolino, Salvatore; Lupoli, Roberta; Mader, Reuven; Zincarelli, Carmela; Peluso, Rosario

    2015-12-01

    Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of different entheses. Psoriatic arthritis (PsA) is a seronegative spondyloarthritis associated with psoriasis. Given the possible overlap of the two diseases, we assessed whether DISH presence may affect PsA clinical outcomes. Also, predictors of DISH presence in the cohort were investigated. Consecutive PsA patients from two Italian Rheumatology Research Units were enrolled. Subjects were splitted into two groups, according to the current treatment (TNF-α blockers or traditional DMARDs). All patients underwent a rheumatologic examination, blood sample collections and spine radiographs. Information about traditional vascular risk factors was recorded. In each patient, the presence of minimal disease activity was evaluated and the presence of DISH was established according to the Resnick and Niwayama criteria. Among the 80 enrolled subjects (57.5 % men, mean age 56.5 ± 11.1 years), the overall prevalence of DISH was 30.0 %. Patients with DISH were older, with higher BMI and waist circumference. DISH subjects showed worsen BASMI, HAQ and ESR. In a multivariate regression model, BASMI was a significant predictor of DISH presence (OR 3.027, 95 % CI 1.449-6.325, p = 0.003). The prevalence of MDA was lower in DISH patients than in no-DISH (16.7 vs 41.1 %, p = 0.041), and the presence of DISH was a predictor of not achieving MDA (OR 3.485, 95 % CI 1.051-11.550, p = 0.041). PsA subjects with DISH showed worsen indices of spine mobility and articular function and lower prevalence of minimal disease activity than no-DISH patients.

  17. Relation between initial treatment strategy in stable coronary artery disease and 1-year costs in Ontario: a population-based cohort study

    PubMed Central

    Kang, Jaskaran S.; Bennell, Maria C.; Qiu, Feng; Knudtson, Merril L.; Austin, Peter C.; Ko, Dennis T.; Wijeysundera, Harindra C.

    2016-01-01

    Background: Cardiovascular disease is costly, and annual expenditures are projected to increase. Our objective was to examine the variation in patient-level costs and identify drivers of cost in patients with stable coronary artery disease. Methods: In this retrospective cohort study using administrative databases in Ontario, Canada, we identified all patients with stable coronary artery disease after index angiography between Oct. 1, 2008, and Sept. 30, 2011. We excluded patients with a myocardial infarction within 90 days before the index, with normal coronaries, or with mild coronary disease. We categorized hospitals into low, medium or high revascularization ratio centres. The primary outcome was cumulative 1-year health care costs. A hierarchical generalized linear model identified patient, physician and hospital characteristics associated with patient costs, with 2 main covariates of interest: treatment allocation (medical v. percutaneous coronary intervention v. coronary artery bypass grafting) and hospital revascularization ratio. Results: A total of 183 630 angiography procedures were performed in Ontario during the study period. The final cohort included 39 126 patients with stable coronary artery disease, of which 15 138 received medical treatment and 23 988 received revascularization. The mean 1-year cost was $24 026 (interquartile range $8235-$30 511). The mean costs for medical management and revascularization were $18 069 and $27 786, respectively. The strongest predictor of costs was revascularization (percutaneous coronary intervention: cost ratio 1.27, 95% CI [confidence interval] 1.24-1.31; coronary artery bypass grafting: cost ratio 2.62, 95% CI 2.53-2.71). Hospital revascularization ratio did not significantly affect costs. There was no significant interaction between treatment and revascularization ratio. Interpretation: Most health care costs were due to acute care hospital admissions, and costs were higher for patients undergoing

  18. Palaeodiet reconstruction in a woman with probable celiac disease: a stable isotope analysis of bone remains from the archaeological site of Cosa (Italy).

    PubMed

    Scorrano, Gabriele; Brilli, Mauro; Martínez-Labarga, Cristina; Giustini, Francesca; Pacciani, Elsa; Chilleri, Filberto; Scaldaferri, Franco; Gasbarrini, Antonio; Gasbarrini, Giovanni; Rickards, Olga

    2014-07-01

    Stable isotope analysis in the reconstruction of human palaeodiets can yield clues to early human subsistence strategies, origins and history of farming and pastoralist societies, and intra- and intergroup social differentiation. In the last 10 years, the method has been extended to the pathological investigation. Stable isotope analysis to better understand a diet-related disease: celiac disease in ancient human bones was carried out. To do this, we analyzed the nitrogen and carbon isotopic composition of human (n = 37) and faunal (n = 8) bone remains from the archaeological site of Cosa at Ansedonia, on the Tyrrhenian coast near Orbetello (Tuscany), including the skeletal remains of a young woman (late 1st century-early 2nd century Common Era [CE]) with morphological and genetic features suggestive of celiac disease. We compared the young woman's isotopic data with those of other individuals recovered at the same site but from two later time periods (6th century CE; 11-12th century CE) and with literature data from other Italian archaeological sites dating to the same period. Her collagen δ(13) C and δ(15) N values differed from those of the samples at the same site, and from most but not all of the contemporary sites. Although the woman's diet appears distinct, chronic malnutrition resulting from severe malabsorption of essential nutrients due to celiac disease may have affected the isotopic composition of her bone collagen. PMID:24706415

  19. Palaeodiet reconstruction in a woman with probable celiac disease: a stable isotope analysis of bone remains from the archaeological site of Cosa (Italy).

    PubMed

    Scorrano, Gabriele; Brilli, Mauro; Martínez-Labarga, Cristina; Giustini, Francesca; Pacciani, Elsa; Chilleri, Filberto; Scaldaferri, Franco; Gasbarrini, Antonio; Gasbarrini, Giovanni; Rickards, Olga

    2014-07-01

    Stable isotope analysis in the reconstruction of human palaeodiets can yield clues to early human subsistence strategies, origins and history of farming and pastoralist societies, and intra- and intergroup social differentiation. In the last 10 years, the method has been extended to the pathological investigation. Stable isotope analysis to better understand a diet-related disease: celiac disease in ancient human bones was carried out. To do this, we analyzed the nitrogen and carbon isotopic composition of human (n = 37) and faunal (n = 8) bone remains from the archaeological site of Cosa at Ansedonia, on the Tyrrhenian coast near Orbetello (Tuscany), including the skeletal remains of a young woman (late 1st century-early 2nd century Common Era [CE]) with morphological and genetic features suggestive of celiac disease. We compared the young woman's isotopic data with those of other individuals recovered at the same site but from two later time periods (6th century CE; 11-12th century CE) and with literature data from other Italian archaeological sites dating to the same period. Her collagen δ(13) C and δ(15) N values differed from those of the samples at the same site, and from most but not all of the contemporary sites. Although the woman's diet appears distinct, chronic malnutrition resulting from severe malabsorption of essential nutrients due to celiac disease may have affected the isotopic composition of her bone collagen.

  20. Non-haemodynamic anti-anginal agents in the management of patients with stable coronary artery disease and diabetes: A review of the evidence.

    PubMed

    Ambrosio, Giuseppe; Tamargo, Juan; Grant, Peter J

    2016-03-01

    Patients with coronary artery disease and concomitant diabetes mellitus tend to have more extensive vessel disease than non-diabetes mellitus coronary artery disease patients, are at high risk of adverse cardiovascular events and suffer from a great anginal burden. Very few trials have specifically addressed the issue of optimal anti-anginal therapy in coronary artery disease patients who also have diabetes mellitus. Among 'classical' anti-anginal agents, recent guidelines do not specifically recommend any molecule over others; however, European Society of Cardiology guidelines acknowledge that favourable data in patients with concomitant diabetes mellitus and coronary artery disease are available for trimetazidine and ranolazine, two anti-anginal agents with a non-haemodynamic mechanism of action. The aim of this article is to review available evidence supporting the anti-anginal efficacy of these two drugs in the difficult-to-treat population of diabetes mellitus patients, including their effects on glycated haemoglobin (HbA1c), a measure of medium-term glycaemic control. Although direct head-to-head comparisons have not been performed, available evidence favours ranolazine as an effective anti-anginal agent over trimetazidine in this population. In addition, ranolazine lowers HbA1c, indicating that it may improve glycaemic control in patients with diabetes mellitus. Conversely, scanty data are available on the metabolic effects of trimetazidine in this cohort of patients. Thus, ranolazine may represent a valuable therapeutic option in stable coronary artery disease patients with diabetes mellitus. PMID:26873904

  1. Clinical characteristics and one year outcomes in Chinese atrial fibrillation patients with stable coronary artery disease: a population-based study

    PubMed Central

    Bai, Ying; Zhu, Jun; Yang, Yan-Min; Liang, Yan; Tan, Hui-Qiong; Wang, Juan; Huang, Bi; Zhang, Han; Shao, Xing-Hui

    2016-01-01

    Background Atrial fibrillation (AF) and coronary artery disease (CAD) often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well understood. Methods Consecutive AF patients in 20 hospitals in China from November 2008 to October 2011 were enrolled. The primary endpoints included 1-year all-cause mortality, stroke, non-central nervous system (non-CNS) embolism, and major bleeding. Results A total of 1947 AF patients were analyzed, of whom 40.5% had stable CAD. The mean CHADS2 scores in CAD patients were significantly higher than that of non-CAD patients (2.4 ± 1.4 vs. 1.4 ± 1.2, P < 0.001). During follow-up period, warfarin use is low in both groups, with relatively higher proportion in non-CAD patients compared with CAD patients (22.3% vs. 10.7%, P < 0.001). Compared with non-CAD patients, CAD patients had higher one-year all-cause mortality (16.8% vs. 12.9%, P = 0.017) and incidence of stroke (9.0% vs. 6.4%, P = 0.030), while the non-CNS embolism and major bleeding rates were comparable between the two groups. After multivariate adjustment, stable CAD was independently associated with increased risk of 1-year all-cause mortality (HR = 1.35, 95% CI: 1.01−1 .80, P = 0.040), but not associated with stroke (HR = 1.07, 95% CI: 0.72–1.58, P = 0.736). Conclusions Stable CAD was prevalent in Chinese AF patients and was independently associated with increased risk of 1-year all-cause mortality. Chinese AF patients with stable CAD received inadequate antithrombotic therapy and this grim status of antithrombotic therapy needed to be improved urgently. PMID:27781056

  2. Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER)

    PubMed Central

    Walker, Simon; Asaria, Miqdad; Manca, Andrea; Palmer, Stephen; Gale, Chris P.; Shah, Anoop Dinesh; Abrams, Keith R.; Crowther, Michael; Timmis, Adam; Hemingway, Harry; Sculpher, Mark

    2016-01-01

    Aims To examine long-term healthcare utilization and costs of patients with stable coronary artery disease (SCAD). Methods and results Linked cohort study of 94 966 patients with SCAD in England, 1 January 2001 to 31 March 2010, identified from primary care, secondary care, disease, and death registries. Resource use and costs, and cost predictors by time and 5-year cardiovascular disease (CVD) risk profile were estimated using generalized linear models. Coronary heart disease hospitalizations were 20.5% in the first year and 66% in the year following a non-fatal (myocardial infarction, ischaemic or haemorrhagic stroke) event. Mean healthcare costs were £3133 per patient in the first year and £10 377 in the year following a non-fatal event. First-year predictors of cost included sex (mean cost £549 lower in females), SCAD diagnosis (non-ST-elevation myocardial infarction cost £656 more than stable angina), and co-morbidities (heart failure cost £657 more per patient). Compared with lower risk patients (5-year CVD risk 3.5%), those of higher risk (5-year CVD risk 44.2%) had higher 5-year costs (£23 393 vs. £9335) and lower lifetime costs (£43 020 vs. £116 888). Conclusion Patients with SCAD incur substantial healthcare utilization and costs, which varies and may be predicted by 5-year CVD risk profile. Higher risk patients have higher initial but lower lifetime costs than lower risk patients as a result of shorter life expectancy. Improved cardiovascular survivorship among an ageing CVD population is likely to require stratified care in anticipation of the burgeoning demand. PMID:27042338

  3. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease.

    PubMed

    Kato, Shingo; Saito, Naka; Kirigaya, Hidekuni; Gyotoku, Daiki; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Nakachi, Tatsuya; Fukui, Kazuki; Futaki, Masaaki; Iwasawa, Tae; Taguri, Masataka; Kimura, Kazuo; Umemura, Satoshi

    2016-06-01

    The prognostic significance of the SYNTAX (Synergy between PCI with Taxus and cardiac surgery) score has recently been demonstrated in patients with stable multivessel or left main coronary artery disease (CAD). The present study determines whether adding the SYNTAX score to Framingham risk score (FRS), left ventricular ejection fraction (LVEF) and presence of myocardial infarction (MI) by late gadolinium enhancement (LGE) magnetic resonance imaging can improve the risk stratification in patients with stable CAD. We calculated the SYNTAX score in 161 patients with stable CAD (mean age: 66 ± 10 years old). During a mean follow-up of 2.3 years, 56 (35 %) of 161 patients developed cardiovascular events defined as cardiovascular death, non-fatal MI, cerebral infarction, unstable angina pectoris, hospitalization due to heart failure and revascularization. Multivariate Cox regression analysis selected triglycerides [hazard ratio (HR): 1.005 (95 % confidence interval (CI): 1.001-1.008), p < 0.008], presence of LGE [HR: 6.329 (95 % CI: 2.662-15.05), p < 0.001] and the SYNTAX score [HR: 1.085 (95 % CI: 1.044-1.127), p < 0.001] as risk factors for future cardiovascular events. Adding the SYNTAX score to FRS, EF and LGE significantly improved the net reclassification index (NRI) [40.4 % (95 % CI: 18.1-54.8 %), p < 0.05] with an increase in C-statistics of 0.089 (from 0.707 to 0.796). An increase in C-statistics and significant improvement of NRI showed that adding the SYNTAX score to the FRS, LVEF and LGE incrementally improved risk stratification in patient with stable CAD.

  4. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.

    PubMed

    Josephs, Lynn K; Coker, Robina K; Thomas, Mike

    2013-06-01

    Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey. PMID:23732637

  5. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.

    PubMed

    Josephs, Lynn K; Coker, Robina K; Thomas, Mike

    2013-06-01

    Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey.

  6. Comparison of routes for achieving parenteral access with a focus on the management of patients with Ebola virus disease

    PubMed Central

    Ker, Katharine; Tansley, Gavin; Beecher, Deirdre; Perner, Anders; Shakur, Haleema; Harris, Tim; Roberts, Ian

    2015-01-01

    Background Dehydration is an important cause of death in patients with Ebola virus disease (EVD). Parenteral fluids are often required in patients with fluid requirements in excess of their oral intake. The peripheral intravenous route is the most commonly used method of parenteral access, but inserting and maintaining an intravenous line can be challenging in the context of EVD. Therefore it is important to consider the advantages and disadvantages of different routes for achieving parenteral access (e.g. intravenous, intraosseous, subcutaneous and intraperitoneal). Objectives To compare the reliability, ease of use and speed of insertion of different parenteral access methods. Search methods We ran the search on 17 November 2014. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE(R) and Ovid OLDMEDLINE(R), Embase Classic + Embase (OvidSP), CINAHL (EBSCOhost), clinicaltrials.gov and screened reference lists. Selection criteria Randomised controlled trials comparing different parenteral routes for the infusion of fluids or medication. Data collection and analysis Two review authors examined the titles and abstracts of records obtained by searching the electronic databases to determine eligibility. Two review authors extracted data from the included trials and assessed the risk of bias. Outcome measures of interest were success of insertion; time required for insertion; number of insertion attempts; number of dislodgements; time period with functional access; local site reactions; clinicians' perception of ease of administration; needlestick injury to healthcare workers; patients' discomfort; and mortality. For trials involving the administration of fluids we also collected data on the volume of fluid infused, changes in serum electrolytes and markers of renal function. We rated the

  7. Relation of obesity to heart failure hospitalization and cardiovascular events in persons with stable coronary heart disease (from the Heart and Soul Study).

    PubMed

    Spies, Christian; Farzaneh-Far, Ramin; Na, Beeya; Kanaya, Alka; Schiller, Nelson B; Whooley, Mary A

    2009-10-01

    Obesity is an independent risk factor for recurrent events among patients with established coronary heart disease (CHD). The goal of the present study was to identify potential mechanisms underlying this association. We measured the waist-to-hip ratio and body mass index in 979 outpatients with stable CHD and followed them for a mean of 4.9 years. We used proportional hazards models to evaluate the extent to which the association of obesity with subsequent heart failure (HF) hospitalization or cardiovascular (CV) events (myocardial infarction, stroke, or CHD death) was explained by baseline co-morbidities, cardiac disease severity, inflammation, insulin resistance, neurohormones and adipokines. Of the 979 participants, 128 (13%) were hospitalized for HF and 152 (16%) developed a CV event. Each standard deviation (SD) increase in the waist-to-hip ratio was associated with a 30% increased risk of HF hospitalization (unadjusted hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1 to 1.6). This association was not attenuated after adjustment for potential mediators (HR 1.6, 95% CI 1.2 to 2.1). Likewise, each SD increase in the waist-to-hip ratio was associated with a 20% greater risk of CV events (unadjusted HR 1.2, 95% CI 1.0 to 1.4), and this remained unchanged after adjustment for potential mediators (adjusted HR 1.3, 95% CI 1.0 to 1.5). The body mass index was not associated with the risk of HF or CV events. In conclusion, abdominal obesity is an independent predictor of HF hospitalization and recurrent CV events in patients with stable CHD. This association does not appear to be mediated by co-morbid conditions, cardiac disease severity, insulin resistance, inflammation, neurohormones, or adipokines.

  8. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease

    PubMed Central

    Stewart, Ralph A. H.; Wallentin, Lars; Benatar, Jocelyne; Danchin, Nicolas; Hagström, Emil; Held, Claes; Husted, Steen; Lonn, Eva; Stebbins, Amanda; Chiswell, Karen; Vedin, Ola; Watson, David; White, Harvey D.

    2016-01-01

    Objectives To determine whether dietary pattern assessed by a simple self-administered food frequency questionnaire is associated with major adverse cardiovascular events (MACE) in high-risk patients with stable coronary artery disease. Background A Mediterranean dietary pattern has been associated with lower cardiovascular (CV) mortality. It is less certain whether foods common in western diets are associated with CV risk. Methods At baseline, 15 482 (97.8%) patients (mean age 67 ± 9 years) with stable coronary heart disease from 39 countries who participated in the Stabilisation of atherosclerotic plaque by initiation of darapladib therapy (STABILITY) trial completed a life style questionnaire which included questions on common foods. A Mediterranean diet score (MDS) was calculated for increasing consumption of whole grains, fruits, vegetables, legumes, fish, and alcohol, and for less meat, and a ‘Western diet score’ (WDS) for increasing consumption of refined grains, sweets and deserts, sugared drinks, and deep fried foods. A multi-variable Cox proportional hazards models assessed associations between MDS or WDS and MACE, defined as CV death, non-fatal myocardial infarction, or non-fatal stroke. Results After a median follow-up of 3.7 years MACE occurred in 7.3% of 2885 subjects with an MDS ≥15, 10.5% of 4018 subjects with an MDS of 13–14, and 10.8% of 8579 subjects with an MDS ≤12. A one unit increase in MDS >12 was associated with lower MACE after adjusting for all covariates (+1 category HR 0.95, 95% CI 0.91, 0.98, P = 0.002). There was no association between WDS (adjusted model +1 category HR 0.99, 95% CI 0.97, 1.01) and MACE. Conclusion Greater consumption of healthy foods may be more important for secondary prevention of coronary artery disease than avoidance of less healthy foods typical of Western diets. PMID:27109584

  9. Clinically significant responses achieved with romidepsin across disease compartments in patients with cutaneous T-cell lymphoma

    PubMed Central

    Kim, Ellen J.; Kim, Youn H.; Rook, Alain H.; Lerner, Adam; Duvic, Madeleine; Reddy, Sunil; Robak, Tadeusz; Becker, Jürgen C.; Samtsov, Alexey; McCulloch, William; Waksman, Joel; Whittaker, Sean

    2015-01-01

    Cutaneous T-cell lymphoma (CTCL) is a rare heterogeneous group of non-Hodgkin lymphomas that arises in the skin but can progress to systemic disease (lymph nodes, blood, viscera). Historically, in clinical trials of CTCL there has been little consistency in how responses were defined in each disease “compartment”; some studies only assessed responses in the skin. The histone deacetylase inhibitor romidepsin is approved by the US Food and Drug Administration for the treatment of CTCL in patients who have received at least one prior systemic therapy. Phase II studies that led to approval used rigorous composite end points that incorporated disease assessments in all compartments. The objective of this analysis was to thoroughly examine the activity of romidepsin within each disease compartment in patients with CTCL. Romidepsin was shown to have clinical activity across disease compartments and is suitable for use in patients with CTCL having skin involvement only, erythroderma, lymphadenopathy and/or blood involvement. PMID:25791237

  10. Clinically significant responses achieved with romidepsin across disease compartments in patients with cutaneous T-cell lymphoma.

    PubMed

    Kim, Ellen J; Kim, Youn H; Rook, Alain H; Lerner, Adam; Duvic, Madeleine; Reddy, Sunil; Robak, Tadeusz; Becker, Jürgen C; Samtsov, Alexey; McCulloch, William; Waksman, Joel; Whittaker, Sean

    2015-01-01

    Cutaneous T-cell lymphoma (CTCL) is a rare heterogeneous group of non-Hodgkin lymphomas that arises in the skin but can progress to systemic disease (lymph nodes, blood, viscera). Historically, in clinical trials of CTCL there has been little consistency in how responses were defined in each disease "compartment"; some studies only assessed responses in the skin. The histone deacetylase inhibitor romidepsin is approved by the US Food and Drug Administration for the treatment of CTCL in patients who have received at least one prior systemic therapy. Phase II studies that led to approval used rigorous composite end points that incorporated disease assessments in all compartments. The objective of this analysis was to thoroughly examine the activity of romidepsin within each disease compartment in patients with CTCL. Romidepsin was shown to have clinical activity across disease compartments and is suitable for use in patients with CTCL having skin involvement only, erythroderma, lymphadenopathy and/or blood involvement.

  11. Stable angina

    MedlinePlus

    ... Angina pectoris; Chest pain - angina; CAD - angina; Coronary artery disease - angina; Heart disease - angina ... needs a constant supply of oxygen. The coronary arteries carry blood containing oxygen to the heart. When ...

  12. Randomized, double-blind, placebo-controlled superiority trial of the Yiqigubiao pill for the treatment of patients with chronic obstructive pulmonary disease at a stable stage

    PubMed Central

    Li, Feng-Sen; Zhang, Yan-Li; Li, Zheng; Xu, Dan; Liao, Chun-Yan; Ma, Huan; Gong, Li; Su, Jun; Sun, Qi; Xu, Qian; Gao, Zhen; Wang, Ling; Jing, Jing; Wang, Jing; Jiang, Min; Tian, Ge; Hasan, Bilal

    2016-01-01

    In traditional Chinese medicine (TCM), the Yiqigubiao pill is commonly used to enhance physical fitness. The current clinical trial was designed to evaluate the efficacy and safety of the Yiqigubiao pill as an adjuvant therapy for patients with stable chronic obstructive pulmonary disease (COPD). The current trial was a randomized, double-blind, placebo-controlled superiority trial. The participants were recruited from outpatients at the Traditional Chinese Medicine Hospital affiliated with Xinjiang Medical University (Ürümqi, China) between February and September 2012. All participants were patients with stable COPD that were randomized to the Yiqigubiao pill (YQGB; n=84) or placebo (Pb; n=87) groups. The occurrences of acute exacerbation (AE) of COPD during the trial were recorded. Lung function value assessments, scoring of life quality and exercise endurance, arterial blood gas analysis and serum inflammatory cytokines level determination were performed prior to and throughout the study. A total of 139 participants completed the intervention and 132 participants completed the study. The interval between the initial intervention and the first AECOPD was greater in the YQGB group compared with the Pb group (P<0.01). The incidence rate of AECOPD was lower in the YQGB group than in the Pb group (P<0.01). Subsequent to the intervention or at the end of the study, the 6-min walking distance difference was longer in the YQGB group compared with the Pb group (P<0.01). The scores reflecting life quality decline became lower in the YQGB group (P<0.01). The serum levels of proinflammatory factors were downregulated to a greater extent in the YQGB group compared with the Pb group. Thus, the Yiqigubiao pill is an efficient and safe adjuvant therapy for the treatment of stable patients with COPD.

  13. Randomized, double-blind, placebo-controlled superiority trial of the Yiqigubiao pill for the treatment of patients with chronic obstructive pulmonary disease at a stable stage

    PubMed Central

    Li, Feng-Sen; Zhang, Yan-Li; Li, Zheng; Xu, Dan; Liao, Chun-Yan; Ma, Huan; Gong, Li; Su, Jun; Sun, Qi; Xu, Qian; Gao, Zhen; Wang, Ling; Jing, Jing; Wang, Jing; Jiang, Min; Tian, Ge; Hasan, Bilal

    2016-01-01

    In traditional Chinese medicine (TCM), the Yiqigubiao pill is commonly used to enhance physical fitness. The current clinical trial was designed to evaluate the efficacy and safety of the Yiqigubiao pill as an adjuvant therapy for patients with stable chronic obstructive pulmonary disease (COPD). The current trial was a randomized, double-blind, placebo-controlled superiority trial. The participants were recruited from outpatients at the Traditional Chinese Medicine Hospital affiliated with Xinjiang Medical University (Ürümqi, China) between February and September 2012. All participants were patients with stable COPD that were randomized to the Yiqigubiao pill (YQGB; n=84) or placebo (Pb; n=87) groups. The occurrences of acute exacerbation (AE) of COPD during the trial were recorded. Lung function value assessments, scoring of life quality and exercise endurance, arterial blood gas analysis and serum inflammatory cytokines level determination were performed prior to and throughout the study. A total of 139 participants completed the intervention and 132 participants completed the study. The interval between the initial intervention and the first AECOPD was greater in the YQGB group compared with the Pb group (P<0.01). The incidence rate of AECOPD was lower in the YQGB group than in the Pb group (P<0.01). Subsequent to the intervention or at the end of the study, the 6-min walking distance difference was longer in the YQGB group compared with the Pb group (P<0.01). The scores reflecting life quality decline became lower in the YQGB group (P<0.01). The serum levels of proinflammatory factors were downregulated to a greater extent in the YQGB group compared with the Pb group. Thus, the Yiqigubiao pill is an efficient and safe adjuvant therapy for the treatment of stable patients with COPD. PMID:27698749

  14. Use of Lipid-Lowering Medications and the Likelihood of Achieving Optimal LDL-Cholesterol Goals in Coronary Artery Disease Patients.

    PubMed

    Karalis, Dean G; Victor, Brett; Ahedor, Lilian; Liu, Longjian

    2012-01-01

    Background. In clinical practice, most coronary artery disease patients are not achieving their recommend LDL-cholesterol goal of <70 mg/dL. Methods. We conducted a retrospective analysis of outpatient electronic health records and the most recent lipid profile, lipid-lowering medications and doses were collected. Results. We identified 9950 coronary artery disease patients. Only 37% on a statin alone achieved an LDL-cholesterol of <70 mg/dL, and most were on moderate-to-high-potency statins. The intensity of statin therapy did not improve LDL-cholesterol goal attainment. Among patients on combination therapy, 41% on statin plus ezetimibe and 46% on statin plus niacin achieved an LDL-cholesterol of <70 mg/dL (P = 0.01 and <0.0001 versus statin alone). If patients were switched to a high-potency statin LDL-cholesterol goal attainment of <70 mg/dL would increase to 46% and would increase up to 72% with combination therapy. Conclusions. Most coronary artery disease patients in clinical practice do not attain an LDL-cholesterol of <70 mg/dL, even among patients on high potency statins. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL-cholesterol of <70 mg/dL, however, these drug combinations are used infrequently in clinical practice.

  15. Inhibitory effect of procaterol on exercise dynamic lung hyperinflation during the 6-min walk test in stable patients with chronic obstructive pulmonary disease.

    PubMed

    Satake, Masahiro; Takahashi, Hitomi; Sugawara, Keiyu; Kawagoshi, Atsuoshi; Tamaki, Akira; Homma, Mitsunobu; Morita, Ryou; Sato, Kazuhiro; Sano, Masaaki; Shioya, Takanobu

    2011-01-01

    The purpose of this study was to evaluate the inhibitory effect of procaterol (procaterol hydrochloride, CAS 62929-91-3) on exercise dynamic lung hyperinflation during the 6-min walk test (6MWT) in stable chronic obstructive disease (COPD) patients. Fourteen patients with stable COPD who were referred to our clinic between July 2008 and October 2009 were evaluated in this study. After the inhalation of procaterol, values for the lung function test, including vital capacity, inspiratory capacity, forced vital capacity, and FEV1/FEV1pred showed a significant improvement. Compared to the baseline assessment, the 6-min walk distance increased by a mean of 20.5 m when measured after inhalation of procaterol (512.4 +/- 90.7 m vs. 532.9 +/- 79.8 m, p < 0.05). During the 6MWT, inspiratory capacity decreased significantly with time. The inspiratory capacity after inhalation of procaterol was improved significantly compared with placebo. The Borg scale increased significantly during the 6MWT and was attenuated after inhaling procaterol hydrochloride, though the difference between the two groups was not statistically significant. In the present study, there was a significant attenuation in exercise dynamic lung hyperinflation, suggesting the important role of the beta2-receptor agonist procaterol in the treatment of COPD. It is therefore likely that most patients with COPD may derive considerable benefit from bronchodilator therapy with procaterol.

  16. [Connection of endothelial dysfunction and level of blood leukocytes with clinical course of stable angina pectoris in patients with ischemic heart disease].

    PubMed

    Lyzohub, V H; Savchenko, O V; Bondarchuk, O M; Dykukha, I S; Voloshyna, O O; Bohdan, T V; Koval'chuk, S M; Moshkovs'ka, Iu O

    2008-01-01

    The authors presents in the article information on influence of endothelial dysfunction and level of blood leukocytes with clinical course of stable angina pectoris in patients with ischemic heart disease (IHD). 104 male patients aged from 36 to 69 (on average 54.9+/-2.1 years) with IHD and stage I-III stable angina pectoris have been observed. The level of leukocytes, ECG daily monitoring, endotelial function with the help of Celermaera-Sorensena test and plasma concentration of endothelin I have been studied in patients. It was established that there is no significant different (P>0.05) in the level of leukocytes between health persons and patients with IHD independently of functional class of angina pectoris. Patients with IHD had higher level of endothelin I in their blood serum than those in a control group. Patients with IHD have a complicated endothelial-non-dependent vasodilation and an increased thickness of the complex intima-media, there is a negative correlation bond between these characteristics. Patients III functional class of angina pectoris has also reliably decreased endothelial-dependent vasodilation by 37%. Frequency of ventricular extrasystoles in patients with IHD and endothelial dysfunction increases by 12 times.

  17. Sensitive cardiac troponins and N-terminal pro-B-type natriuretic peptide in stable coronary artery disease: correlation with left ventricular function as assessed by myocardial strain.

    PubMed

    Smedsrud, Marit Kristine; Gravning, Jørgen; Omland, Torbjørn; Eek, Christian; Mørkrid, Lars; Skulstad, Helge; Aaberge, Lars; Bendz, Bjørn; Kjekshus, John; Edvardsen, Thor

    2015-06-01

    N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponins (cTns) measured with sensitive assays provide strong prognostic information in patients with stable coronary artery disease. However, the relationship between these biomarkers and myocardial contractile function, as well as infarct size, in this patient group, remains to be defined. The study population consisted of 160 patients referred to a follow-up echocardiography scheduled 1 year after coronary revascularization. Concentrations of NT-proBNP, high-sensitive cTnT (hs-cTnT) and sensitive cTnI assays were assessed. Left ventricular function was measured as global peak systolic longitudinal strain by speckle tracking echocardiography and infarct size was assessed by late-enhancement MRI. NT-proBNP and sensitive cTnI levels were significantly associated with left ventricular function by peak systolic strain (R-values 0.243 and 0.228, p = 0.002 and 0.004) as well as infarct size (R-values 0.343 and 0.366, p = 0.014 and p = 0.008). In contrast, hs-cTnT did not correlate with left ventricular function (R = 0.095, p = 0.231) and only marginally with infarct size (R = 0.237, p = 0.094). NT-proBNP and sensitive cTnI levels correlate with left ventricular function and infarct size in patients with stable coronary artery disease after revascularization. As opposed to hs-cTnT, NT-proBNP and cTnI seem to be indicators of incipient myocardial dysfunction and the extent of myocardial necrosis.

  18. Prognostic factors for brain metastases from non-small cell lung cancer with EGFR mutation: influence of stable extracranial disease and erlotinib therapy.

    PubMed

    Sekine, Akimasa; Satoh, Hiroaki; Iwasawa, Tae; Tamura, Katsumi; Hayashihara, Kenji; Saito, Takefumi; Kato, Terufumi; Arai, Mito; Okudela, Koji; Ohashi, Kenichi; Ogura, Takashi

    2014-10-01

    The aim of this study was to explore prognostic factors for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) on the basis of EGFR mutation status. Among 779 consecutive NSCLC patients who underwent EGFR mutation screening, all 197 patients with BM were divided according to the EGFR mutation status. The prognostic factors, including patient characteristics at the time of BM diagnosis, treatment history, and radiologic features, were analyzed. Of 197 patients with BM, 108 had wild-type EGFR and 89 had EGFR mutation. The patients with EGFR mutation presented longer overall survival after BM diagnosis (OS) than those with wild-type EGFR, regardless of whether BM was synchronous or metachronous. For the patients with EGFR mutation, favorable prognostic factors in multivariate analysis were age<65 (p=0.037), good performance status (PS) (p<0.0001), cranial radiotherapy (p=0.020), previous chemotherapy≤1 regimen (p=0.009), stable extracranial disease at BM diagnosis (p=0.022), and erlotinib therapy after BM diagnosis (p=0.0015). On the other hand, favorable prognostic factors for the patients with wild-type EGFR were only good PS (p=0.0037) and cranial radiotherapy (p=0.0005). Among patients treated with erlotinib after BM diagnosis, the patients with exon 19 deletion showed longer OS than those with exon 21 point mutation (p=0.019). The prognostic factors for NSCLC patients with BM were different according to the EGFR mutation status. Particularly in NSCLC patients with EGFR mutation and stable extracranial disease, regular cranial evaluation for detecting asymptomatic BM would lead to good prognosis. In addition, erlotinib therapy would be preferable in NSCLC patients with BM and EGFR mutation, especially those with exon 19 deletion.

  19. Development of a proteolytically stable retro-inverso peptide inhibitor of beta-amyloid oligomerization as a potential novel treatment for Alzheimer's disease.

    PubMed

    Taylor, Mark; Moore, Susan; Mayes, Jennifer; Parkin, Edward; Beeg, Marten; Canovi, Mara; Gobbi, Marco; Mann, David M A; Allsop, David

    2010-04-20

    The formation of beta-amyloid (Abeta) deposits in the brain is likely to be a seminal step in the development of Alzheimer's disease. Recent studies support the hypothesis that Abeta soluble oligomers are toxic to cells and have potent effects on memory and learning. Inhibiting the early stages of Abeta aggregation could, therefore, provide a novel approach to treating the underlying cause of AD. We have designed a retro-inverso peptide (RI-OR2, H(2)N-r<--G<--k<--l<--v<--f<--f<--G<--r-Ac), based on a previously described inhibitor of Abeta oligomer formation (OR2, H(2)N-R-G-K-L-V-F-F-G-R-NH(2)). Unlike OR2, RI-OR2 was highly stable to proteolysis and completely resisted breakdown in human plasma and brain extracts. RI-OR2 blocked the formation of Abeta oligomers and fibrils from extensively deseeded preparations of Abeta(1-40) and Abeta(1-42), as assessed by thioflavin T binding, an immunoassay method for Abeta oligomers, SDS-PAGE separation of stable oligomers, and atomic force microscopy, and was more effective against Abeta(1-42) than Abeta(1-40). In surface plasmon resonance experiments, RI-OR2 was shown to bind to immobilized Abeta(1-42) monomers and fibrils, with an apparent K(d) of 9-12 muM, and also acted as an inhibitor of Abeta(1-42) fibril extension. In two different cell toxicity assays, RI-OR2 significantly reversed the toxicity of Abeta(1-42) toward cultured SH-SY5Y neuroblastoma cells. Thus, RI-OR2 represents a strong candidate for further development as a novel treatment for Alzheimer's disease. PMID:20230062

  20. High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda.

    PubMed

    Muyanja, Daniel; Muzoora, Conrad; Muyingo, Anthony; Muyindike, Winnie; Siedner, Mark J

    2016-01-01

    The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). Outcomes of interest were (1) presence of metabolic syndrome (at least two of the following: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and (2) a Framingham score correlating to >5% 10-year CVD risk. Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.

  1. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

    PubMed Central

    Korosoglou, Grigorios; Giusca, Sorin; Gitsioudis, Gitsios; Erbel, Christian; Katus, Hugo A.

    2014-01-01

    Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein. PMID:25147526

  2. Prediction of Flow-Limiting Fractional Flow Reserve in Patients With Stable Coronary Artery Disease Based on Quantitative Myocardial Perfusion Imaging.

    PubMed

    Tanaka, Haruki; Takahashi, Teruyuki; Kozono, Nami; Tanakamaru, Yoshiki; Ohashi, Norihiko; Yasunobu, Yuji; Tanaka, Koichi; Okada, Takenori; Kaseda, Shunichi; Nakanishi, Toshio; Kihara, Yasuki

    2016-05-01

    Although fractional flow reserve (FFR) and myocardial perfusion imaging (MPI) findings fundamentally differ, several cohort studies have revealed that these findings correlate. Here, we investigated whether flow-limiting FFR could be predicted from adenosine stress thallium-201 MPI with single-photon emission computed tomography (SPECT) findings derived from 84 consecutive, prospectively identified patients with stable coronary artery disease and 212 diseased vessels. Among them, FFR was measured in 136 diseased vessels (64%). The findings were compared with regional perfusion abnormalities including stress total perfusion defect (TPD) - rest TPD determined using quantitative perfusion single-photon emission computed tomography software. The FFR inversely correlated the most accurately with stress TPD - rest TPD (r = -0.552, p <0.001). Predictors of major vessels of interest comprising FFR <0.80, included stress TPD - rest TPD, the transient ischemic dilation ratio, left ventricular ejection fraction at rest and beta blockers for left anterior descending artery (LAD) regions, and stress TPD - rest TPD, left ventricular mass, left ventricular ejection fraction at rest, right coronary artery lesions, the transient ischemic dilation ratio, and age for non-LAD regions. The diagnostic accuracy of formulas to predict major vessels of interest with FFR <0.80 was high (sensitivity, specificity and accuracy for LAD and non-LAD: 84%, 87% and 86%, and 75%, 93% and 87%, respectively). In conclusion, although somewhat limited by a sample size and a single-center design, flow-limiting FFR could be predicted from MPI findings with a defined probability. A cohort study might validate our results and provide a novel adjunctive tool with which to diagnose functionally significant coronary artery disease from MPI findings. PMID:26970815

  3. Evaluation of miglustat as maintenance therapy after enzyme therapy in adults with stable type 1 Gaucher disease: a prospective, open-label non-inferiority study

    PubMed Central

    2012-01-01

    Background Previous studies have provided equivocal data on the use of miglustat as maintenance therapy in Gaucher disease type 1. We report findings from a clinical trial evaluating the effects of miglustat treatment in patients with stable type 1 Gaucher disease after enzyme therapy. Methods Adult type 1 Gaucher disease patients stabilized during at least 3 years of previous enzyme therapy were included in this 2-year, prospective, open-label non-inferiority study. The primary endpoint was percent change from baseline in liver volume. Secondary endpoints included changes in spleen volume, hemoglobin concentration and platelet count. Results Forty-two patients were enrolled (mean±SD age, 45.1±12.7 years; previous enzyme therapy duration 9.5±4.0 years). Median (range) exposure to miglustat 100 mg t.i.d. was 658 (3–765) days. Twenty-one patients discontinued treatment prematurely; 13 due to adverse events, principally gastrointestinal. The upper 95% confidence limit of mean percent change in liver volume from baseline to end of treatment was below the non-inferiority margin of 10% (–1.1%; 95%CI −6.0, 3.9%). Mean (95%CI) changes in spleen volume, hemoglobin concentration and platelet count were 102 (24,180) mL, –0.95 (−1.38, –0.53) g/dL and −44.1 (–57.6, –30.7) ×109/L, respectively. Conclusions The primary efficacy endpoint was met; overall there was no change in liver volume during 24 months of miglustat therapy. Several patients showed a gradual deterioration in some disease manifestations, suggesting that miglustat could maintain clinical stability, but not in all patients. Miglustat demonstrated a predictable profile of safety and tolerability that was consistent with that reported in previous clinical trials and experience in clinical practice. Trial registration Clinicaltrials.gov identifier NCT00319046 PMID:23270487

  4. Clarithromycin for 2 Weeks for Stable Coronary Heart Disease: 6-Year Follow-Up of the CLARICOR Randomized Trial and Updated Meta-Analysis of Antibiotics for Coronary Heart Disease

    PubMed Central

    Gluud, Christian; Als-Nielsen, Bodil; Damgaard, Morten; Fischer Hansen, Jørgen; Hansen, Stig; Helø, Olav H.; Hildebrandt, Per; Hilden, Jørgen; Jensen, Gorm Boje; Kastrup, Jens; Kolmos, Hans Jørn; Kjøller, Erik; Lind, Inga; Nielsen, Henrik; Petersen, Lars; Jespersen, Christian M.

    2008-01-01

    Objectives We have reported increased 2.6-year mortality in clarithromycin- versus placebo-exposed stable coronary heart disease patients, but meta-analysis of randomized trials in coronary heart disease patients showed no significant effect of antibiotics on mortality. Here we report the 6-year mortality of clarithromycin- versus placebo-exposed patients and updated meta-analyses. Methods Centrally randomized, placebo controlled multicenter trial. All parties were blinded. Analyses were by intention to treat. Meta-analyses followed the Cochrane Collaboration methodology. Results We randomized 4,372 patients with stable coronary heart disease to clarithromycin 500 mg (n = 2,172) or placebo (n = 2,200) once daily for 2 weeks. Mortality was followed through public register. Nine hundred and twenty-three patients (21.1%) died. Six-year mortality was significantly higher in the clarithromycin group (hazard ratio 1.21, 95% confidence interval 1.06–1.38). Adjustment for entry characteristics (sex, age, prior myocardial infarction, center, and smoking) did not change the results (1.18, 1.04–1.35). Addition of our data to that of other randomized trials on antibiotics for patients with coronary heart disease versus placebo/no intervention (17 trials, 25,271 patients, 1,877 deaths) showed a significantly increased relative risk of death from antibiotics of 1.10 (1.01–1.20) without heterogeneity. Conclusions Our results stress the necessity to consider carefully the strength of the indication before administering antibiotics to patients with coronary heart disease. PMID:18451646

  5. Radiographic Progression of Patients With Psoriatic Arthritis Who Achieve Minimal Disease Activity in Response to Golimumab Therapy: Results Through 5 Years of a Randomized, Placebo‐Controlled Study

    PubMed Central

    van der Heijde, Désirée; Beutler, Anna; Gladman, Dafna; Mease, Philip; Krueger, Gerald G.; McInnes, Iain B.; Helliwell, Philip; Coates, Laura C.; Xu, Stephen

    2016-01-01

    Objective To evaluate long‐term outcomes in psoriatic arthritis (PsA) patients who achieved or did not achieve minimal disease activity (MDA) through 5 years of golimumab treatment in the GO‐REVEAL trial. Methods The GO‐REVEAL trial was a phase III, randomized, double‐blind trial with placebo‐control through week 24 followed by an open‐label extension of golimumab 50/100 mg treatment up to 5 years. In these post‐hoc analyses, MDA was defined by the presence of ≥5 of 7 PsA outcome measures (≤1 swollen joint, ≤1 tender joint, Psoriasis Area and Severity Index [PASI] ≤1, patient pain score ≤15, patient global disease activity score ≤20 [range 0–100], Health Assessment Questionnaire disability index [HAQ DI] ≤0.5, and ≤1 tender enthesis point). Results Treatment with golimumab yielded significantly higher MDA response rates versus patients randomized to placebo at week 14 (23.5% versus 1.0%; P < 0.0001), week 24 (28.1% versus 7.7%; P < 0.0001), and week 52 (42.4% versus 30.2%; P = 0.037). MDA was achieved at least once by ∼50% of golimumab‐treated patients overall. Irrespective of treatment randomization, achievement of MDA at ≥3 and ≥4 consecutive visits was associated with significantly less radiographic progression and more improvement in MDA components allowing specific assessment of physical function (HAQ DI) and overall disease activity (patient global assessment of disease activity) at week 256 versus patients not achieving MDA. Logistic regression analyses indicated that a 1‐unit higher baseline HAQ DI score yielded a significantly lower likelihood of achieving MDA at ≥3 (odds ratio 0.514 [95% confidence interval 0.321–0.824]; P = 0.006) and ≥4 (odds ratio 0.480 [95% confidence interval 0.290–0.795]; P = 0.004) consecutive visits. Conclusion Among golimumab‐treated PsA patients, better long‐term functional improvement, patient global assessment, and radiographic outcomes were observed when

  6. Social marketing sexually transmitted disease and HIV prevention: a consumer-centered approach to achieving behaviour change.

    PubMed

    Lamptey, P R; Price, J E

    1998-01-01

    This paper proposes that international sexually transmitted disease (STD)/HIV prevention efforts might be enhanced by the application of social marketing principles. It first outlines the conceptual basis of social marketing approaches to health behaviour change generally and then explores key issues and opportunities for using these principles to improve current STD/HIV prevention efforts. PMID:9792356

  7. Social marketing sexually transmitted disease and HIV prevention: a consumer-centered approach to achieving behaviour change.

    PubMed

    Lamptey, P R; Price, J E

    1998-01-01

    This paper proposes that international sexually transmitted disease (STD)/HIV prevention efforts might be enhanced by the application of social marketing principles. It first outlines the conceptual basis of social marketing approaches to health behaviour change generally and then explores key issues and opportunities for using these principles to improve current STD/HIV prevention efforts.

  8. An integrative analysis of foot-and-mouth disease virus carriers in Vietnam achieved through targeted surveillance and molecular epidemiology

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A multidisciplinary, molecular and conventional epidemiological approach was applied to an investigation of endemic foot-and-mouth disease in Vietnam. Within the study space, it was found that 22.3 percent of sampled ruminants had previously been infected with FMD virus (FMDV) and that 2.4 percent w...

  9. A randomised trial of the pharmacodynamic and pharmacokinetic effects of ticagrelor compared with clopidogrel in Hispanic patients with stable coronary artery disease.

    PubMed

    Price, Matthew J; Clavijo, Leonardo; Angiolillo, Dominick J; Carlson, Glenn; Caplan, Richard; Teng, Renli; Maya, Juan

    2015-01-01

    The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic subjects with stable coronary artery disease (CAD). Subjects were allocated to either ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) followed by clopidogrel 600 mg LD/75 mg once-daily MD with an intervening washout period, or vice versa. The primary endpoint was on-treatment reactivity (OTR) at 2 h post-LD according to the VerifyNow P2Y12 test. OTR was significantly lower at 2 h post-LD with ticagrelor compared with clopidogrel (34 PRU vs. 201 PRU, least square means difference = -167 PRU [95 % CI, -197, -137], P < 0.001). OTR was also lower with ticagrelor at 30 min and 8 h post-LD (P < 0.001). The greater magnitude of antiplatelet effect with ticagrelor persisted after 7 days of MD (52 PRU [95 % CI, 30, 73] vs. 182 PRU [95 % CI, 160, 205], P < 0.001). Mean plasma concentration of ticagrelor and its active metabolite were greatest at 2 h post-LD, with similar levels at 2 h post-MD after 7 days of MD. Among Hispanic subjects with stable CAD, ticagrelor provides a more rapid onset of platelet inhibition and a significantly greater antiplatelet effect compared with clopidogrel during both the loading and maintenance phases of treatment. PMID:25305090

  10. Exercise capacity and heart rate responses to exercise as predictors of short-term outcome among patients with stable coronary artery disease.

    PubMed

    Kiviniemi, Antti M; Lepojärvi, Samuli; Kenttä, Tuomas V; Junttila, M Juhani; Perkiömäki, Juha S; Piira, Olli-Pekka; Ukkola, Olavi; Hautala, Arto J; Tulppo, Mikko P; Huikuri, Heikki V

    2015-11-15

    Although exercise capacity (EC) and autonomic responses to exercise predict clinical outcomes in various populations, they are not routinely applied in patients with coronary artery disease (CAD). We hypothesized that the composite index of EC and exercise heart rate responses would be a powerful determinant of short-term risk in CAD. Patients with angiographically documented stable CAD and treated with β blockers (n = 1,531) underwent exercise testing to allow the calculation of age- and gender-adjusted EC, maximal chronotropic response index (CRI), and 2-minute postexercise heart rate recovery (HRR, percentage of maximal heart rate). Cardiovascular deaths and hospitalization due to heart failure, registered during a 2-year follow-up (n = 39, 2.5%), were defined as the composite primary end point. An exercise test risk score was calculated as the sum of hazard ratios related to abnormal (lowest tertile) EC, CRI, and HRR. Abnormal EC, CRI, and HRR predicted the primary end point, involving 4.5-, 2.2-, and 6.2-fold risk, respectively, independently of each other. The patients with intermediate and high exercise test risk score had 11.1-fold (95% confidence interval 2.4 to 51.1, p = 0.002) and 25.4-fold (95% confidence interval 5.5 to 116.8, p <0.001) adjusted risk for the primary end point in comparison with the low-risk group, respectively. The addition of this risk score to the established risk model enhanced discrimination by integrated discrimination index and reclassification by categorical and continuous net reclassification index (p <0.001 for all). In conclusion, the composite index of EC and heart rate responses to exercise and recovery is a powerful predictor of short-term outcome in patients with stable CAD.

  11. Risk of Stroke in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention versus Optimal Medical Therapy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Taglieri, Nevio; Bacchi Reggiani, Maria Letizia; Ghetti, Gabriele; Saia, Francesco; Dall’Ara, Gianni; Gallo, Pamela; Moretti, Carolina; Palmerini, Tullio; Marrozzini, Cinzia; Marzocchi, Antonio; Rapezzi, Claudio

    2016-01-01

    Background Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. Methods We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. Results Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85–1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. Conclusions In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone. PMID:27391212

  12. A randomised trial of the pharmacodynamic and pharmacokinetic effects of ticagrelor compared with clopidogrel in Hispanic patients with stable coronary artery disease.

    PubMed

    Price, Matthew J; Clavijo, Leonardo; Angiolillo, Dominick J; Carlson, Glenn; Caplan, Richard; Teng, Renli; Maya, Juan

    2015-01-01

    The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic subjects with stable coronary artery disease (CAD). Subjects were allocated to either ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) followed by clopidogrel 600 mg LD/75 mg once-daily MD with an intervening washout period, or vice versa. The primary endpoint was on-treatment reactivity (OTR) at 2 h post-LD according to the VerifyNow P2Y12 test. OTR was significantly lower at 2 h post-LD with ticagrelor compared with clopidogrel (34 PRU vs. 201 PRU, least square means difference = -167 PRU [95 % CI, -197, -137], P < 0.001). OTR was also lower with ticagrelor at 30 min and 8 h post-LD (P < 0.001). The greater magnitude of antiplatelet effect with ticagrelor persisted after 7 days of MD (52 PRU [95 % CI, 30, 73] vs. 182 PRU [95 % CI, 160, 205], P < 0.001). Mean plasma concentration of ticagrelor and its active metabolite were greatest at 2 h post-LD, with similar levels at 2 h post-MD after 7 days of MD. Among Hispanic subjects with stable CAD, ticagrelor provides a more rapid onset of platelet inhibition and a significantly greater antiplatelet effect compared with clopidogrel during both the loading and maintenance phases of treatment.

  13. Achievement of early complete donor chimerism in CD25+-activated leukocytes is a strong predictor of the development of graft-versus-host-disease after stem cell transplantation.

    PubMed

    Martínez-Laperche, Carolina; Noriega, Víctor; Kwon, Mi; Balsalobre, Pascual; González-Rivera, Milagros; Serrano, David; Anguita, Javier; Gayoso, Jorge; Díez-Martín, José Luis; Buño, Ismael

    2015-01-01

    Chimerism dynamics in bone marrow, peripheral blood (PB), and T lymphocytes (TL) has been associated with the development of various complications after allogeneic stem-cell transplantation (allo-SCT). In the present study, the usefulness of chimerism monitoring in CD25(+)-activated leukocytes (AL), together with that in bone marrow, PB, and TL, for the anticipation of complications after allo-SCT, has been analyzed in 68 patients. In AL, we observed a slower dynamics toward complete chimerism (CC) than in PB (p = 0.042), while no significant differences were found between TL and PB (p = 0.12). Complete chimerism achievement in AL at day +30 has shown to be an independent risk factor for the development of grade II-IV acute graft-versus-host disease (aGvHD; hazard ratio [95% confidence interval]: 11.9 [1.5-91.7]; p = 0.017). Moreover, among patients achieving CC in TL and AL at different time-points after SCT (n = 17/68), the incidence of grade II-IV aGvHD was significantly higher in patients who achieved CC earlier in AL (5/5) than in those who achieved CC earlier in TL (1/11; p = 0.001). Therefore, achievement of early complete donor chimerism in CD25(+) AL is a strong predictor for the development of aGvHD. Prospective analysis of chimerism in AL could improve the post-SCT management of immunosuppressive therapy in transplanted patients.

  14. Nonlinear speech analysis algorithms mapped to a standard metric achieve clinically useful quantification of average Parkinson's disease symptom severity

    PubMed Central

    Tsanas, Athanasios; Little, Max A.; McSharry, Patrick E.; Ramig, Lorraine O.

    2011-01-01

    The standard reference clinical score quantifying average Parkinson's disease (PD) symptom severity is the Unified Parkinson's Disease Rating Scale (UPDRS). At present, UPDRS is determined by the subjective clinical evaluation of the patient's ability to adequately cope with a range of tasks. In this study, we extend recent findings that UPDRS can be objectively assessed to clinically useful accuracy using simple, self-administered speech tests, without requiring the patient's physical presence in the clinic. We apply a wide range of known speech signal processing algorithms to a large database (approx. 6000 recordings from 42 PD patients, recruited to a six-month, multi-centre trial) and propose a number of novel, nonlinear signal processing algorithms which reveal pathological characteristics in PD more accurately than existing approaches. Robust feature selection algorithms select the optimal subset of these algorithms, which is fed into non-parametric regression and classification algorithms, mapping the signal processing algorithm outputs to UPDRS. We demonstrate rapid, accurate replication of the UPDRS assessment with clinically useful accuracy (about 2 UPDRS points difference from the clinicians' estimates, p < 0.001). This study supports the viability of frequent, remote, cost-effective, objective, accurate UPDRS telemonitoring based on self-administered speech tests. This technology could facilitate large-scale clinical trials into novel PD treatments. PMID:21084338

  15. High On-Aspirin Platelet Reactivity and Clinical Outcome in Patients With Stable Coronary Artery Disease: Results From ASCET (Aspirin Nonresponsiveness and Clopidogrel Endpoint Trial)

    PubMed Central

    Pettersen, Alf-Åge R.; Seljeflot, Ingebjørg; Abdelnoor, Michael; Arnesen, Harald

    2012-01-01

    Background Patients with stable coronary artery disease on single-antiplatelet therapy with aspirin are still at risk for atherothrombotic events, and high on-aspirin residual platelet reactivity (RPR) has been suggested as a risk factor. Methods and Results In this randomized trial, the association between platelet function determined by the PFA100 platelet function analyzer system (Siemens Healthcare Diagnostics, Germany) and clinical outcome in 1001 patients, all on single-antiplatelet therapy with aspirin (160 mg/d) was studied. Patients were randomized to continue with aspirin 160 mg/d or change to clopidogrel 75 mg/d. A composite end point of death, myocardial infarction, ischemic stroke, and unstable angina was used. At 2-year follow-up, 106 primary end points were registered. The prevalence of high RPR was 25.9%. High on-aspirin RPR did not significantly influence the primary end point in the aspirin group (13.3% versus 9.9%, P=0.31). However, in post hoc analysis, patients with von Willebrand factor levels or platelet count below median values and high on-aspirin RPR had a statistically significant higher end point rate than that of patients with low RPR (20% versus 7.5%, P=0.014, and 18.2% versus 10.8%, P=0.039, respectively). The composite end point rate in patients with high on-aspirin RPR treated with clopidogrel was not different from that of patients treated with aspirin (7.6% versus 13.3%, P=0.16). Conclusions In stable, aspirin-treated patients with coronary artery disease, high on-aspirin RPR did not relate to clinical outcome and did not identify a group responsive to clopidogrel. Post hoc subgroup analysis raised the possibility that high on-aspirin RPR might be predictive in patients with low von Willebrand factor or platelet count, but these findings will require confirmation in future studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT00222261. (J Am Heart Assoc. 2012;1:e000703 doi: 10.1161/JAHA.112

  16. Engaging the Entire Care Cascade in Western Kenya: A Model to Achieve the Cardiovascular Disease Secondary Prevention Roadmap Goals.

    PubMed

    Vedanthan, Rajesh; Kamano, Jemima H; Bloomfield, Gerald S; Manji, Imran; Pastakia, Sonak; Kimaiyo, Sylvester N

    2015-12-01

    Cardiovascular disease (CVD) is the leading cause of death in the world, with a substantial health and economic burden confronted by low- and middle-income countries. In low-income countries such as Kenya, there exists a double burden of communicable and noncommunicable diseases, and the CVD profile includes many nonatherosclerotic entities. Socio-politico-economic realities present challenges to CVD prevention in Kenya, including poverty, low national spending on health, significant out-of-pocket health expenditures, and limited outpatient health insurance. In addition, the health infrastructure is characterized by insufficient human resources for health, medication stock-outs, and lack of facilities and equipment. Within this socio-politico-economic reality, contextually appropriate programs for CVD prevention need to be developed. We describe our experience from western Kenya, where we have engaged the entire care cascade across all levels of the health system, in order to improve access to high-quality, comprehensive, coordinated, and sustainable care for CVD and CVD risk factors. We report on several initiatives: 1) population-wide screening for hypertension and diabetes; 2) engagement of community resources and governance structures; 3) geographic decentralization of care services; 4) task redistribution to more efficiently use of available human resources for health; 5) ensuring a consistent supply of essential medicines; 6) improving physical infrastructure of rural health facilities; 7) developing an integrated health record; and 8) mobile health (mHealth) initiatives to provide clinical decision support and record-keeping functions. Although several challenges remain, there currently exists a critical window of opportunity to establish systems of care and prevention that can alter the trajectory of CVD in low-resource settings. PMID:26704963

  17. Engaging the Entire Care Cascade in Western Kenya: A Model to Achieve the Cardiovascular Disease Secondary Prevention Roadmap Goals.

    PubMed

    Vedanthan, Rajesh; Kamano, Jemima H; Bloomfield, Gerald S; Manji, Imran; Pastakia, Sonak; Kimaiyo, Sylvester N

    2015-12-01

    Cardiovascular disease (CVD) is the leading cause of death in the world, with a substantial health and economic burden confronted by low- and middle-income countries. In low-income countries such as Kenya, there exists a double burden of communicable and noncommunicable diseases, and the CVD profile includes many nonatherosclerotic entities. Socio-politico-economic realities present challenges to CVD prevention in Kenya, including poverty, low national spending on health, significant out-of-pocket health expenditures, and limited outpatient health insurance. In addition, the health infrastructure is characterized by insufficient human resources for health, medication stock-outs, and lack of facilities and equipment. Within this socio-politico-economic reality, contextually appropriate programs for CVD prevention need to be developed. We describe our experience from western Kenya, where we have engaged the entire care cascade across all levels of the health system, in order to improve access to high-quality, comprehensive, coordinated, and sustainable care for CVD and CVD risk factors. We report on several initiatives: 1) population-wide screening for hypertension and diabetes; 2) engagement of community resources and governance structures; 3) geographic decentralization of care services; 4) task redistribution to more efficiently use of available human resources for health; 5) ensuring a consistent supply of essential medicines; 6) improving physical infrastructure of rural health facilities; 7) developing an integrated health record; and 8) mobile health (mHealth) initiatives to provide clinical decision support and record-keeping functions. Although several challenges remain, there currently exists a critical window of opportunity to establish systems of care and prevention that can alter the trajectory of CVD in low-resource settings.

  18. Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease.

    PubMed

    Bade, Geetanjali; Khan, Meraj Alam; Srivastava, Akhilesh Kumar; Khare, Parul; Solaiappan, Krishna Kumar; Guleria, Randeep; Palaniyar, Nades; Talwar, Anjana

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a major global health problem. It results from chronic inflammation and causes irreversible airway damage. Levels of different serum cytokines could be surrogate biomarkers for inflammation and lung function in COPD. We aimed to determine the serum levels of different biomarkers in COPD patients, the association between cytokine levels and various prognostic parameters, and the key pathways/networks involved in stable COPD. In this study, serum levels of 48 cytokines were examined by multiplex assays in 30 subjects (control, n=9; COPD, n=21). Relationships between serum biomarkers and forced expiratory volume in 1 second, peak oxygen uptake, body mass index, dyspnea score, and smoking were assessed. Enrichment pathways and network analyses were implemented, using a list of cytokines showing differential expression between healthy controls and patients with COPD by Cytoscape and GeneGo Metacore™ software (Thomson-Reuters Corporation, New York, NY, USA). Concentrations of cutaneous T-cell attracting chemokine, eotaxin, hepatocyte growth factor, interleukin 6 (IL-6), IL-16, and stem cell factor are significantly higher in COPD patients compared with in control patients. Notably, this study identifies stem cell factor as a biomarker for COPD. Multiple regression analysis predicts that cutaneous T-cell-attracting chemokine, eotaxin, IL-6, and stem cell factor are inversely associated with forced expiratory volume in 1 second and peak oxygen uptake change, whereas smoking is related to eotaxin and hepatocyte growth factor changes. Enrichment pathways and network analyses reveal the potential involvement of specific inflammatory and immune process pathways in COPD. Identified network interaction and regulation of different cytokines would pave the way for deeper insight into mechanisms of the disease process.

  19. Psychodynamic Motivation and Training program (PMT) for the secondary prevention in patients with stable coronary heart disease: study protocol for a randomized controlled trial of feasibility and effects

    PubMed Central

    2013-01-01

    Background Nonpharmacological secondary prevention of coronary heart disease is considered a safe and effective measure to substantially reduce mortality. Despite the effectiveness of lifestyle changes, the compliance rate of patients is very low mainly due to psychosocial barriers. Psychotherapeutic approaches that address how persons think about themselves and their behaviors appear to have a significant potential for improving health behavior. Methods/design Against this background, our study aims to examine the feasibility and effects of a Psychodynamic Motivation and Training program (PMT) as compared to one session of advice in exercise training (EX) and treatment as usual (TAU). For that purpose, 90 patients with stable coronary heart disease and a physically inactive lifestyle will be randomly assigned to the three groups (each with n = 30). The primary outcome is the change in the individual anaerobic threshold as determined by spiroergometry from baseline to six month follow-up. Secondary endpoints include change in endothelial function, biomarkers of inflammation and oxidative stress, quality of life, symptoms of fatigue, illness perception and feasibility of the treatment approach. We hypothesize that physical fitness will improve more in PMT than in EX and TAU, with PMT and EX more than TAU, and that the effects will be more pronounced for participants with current mental or psychosocial distress. Discussion The results of the study will help to determine the effectiveness of a psychodynamic lifestyle change approach and to identify measures for designing specifically tailored interventions to improve compliance with cardiovascular prevention. Trial registration ClinicalTrials.gov Identifier: NCT01445808 PMID:24066805

  20. Blood pressure reverse dipping may associate with stable coronary artery disease in patients with essential hypertension: a cross-sectional study.

    PubMed

    Yan, Bin; Sun, Lu; Gao, Ya; Guo, Qi; Guo, Litao; Wang, Xue; Wang, Gang

    2016-01-01

    The dipping variations of circadian blood pressure (BP) correlate closely with target-organ damages and cardiovascular events. The aim of this study was to investigate the relationship between BP reverse dipping and the prevalence of stable coronary artery disease (sCAD) in hypertensive patients. Clinical data and the results of 24-hour ambulatory BP monitoring (ABPM) were obtained from 718 hypertensive patients (390 males, mean age 59.6 ± 13.8 years) in a single centre in Northern China. Reverse dipping pattern was defined as nocturnal systolic BP (SBP) was higher than daytime SBP. A logistic regression model was applied to explore the independent risk factors of sCAD. The patients with BP reverse dipping accounted for 31.5% in sCAD group and 19.5% in control group (P < 0.05). In multivariate analysis, BP reverse dipping remained significantly associated with the prevalence of sCAD (Odds ratio [OR], 1.772; p = 0.027). Furthermore, the circadian decline rate of SBP was independently associated with sCAD (OR, 0.975; p = 0.043). The hypertensive patients with reverse BP dipping were found to be more frequently suffering from sCAD. BP reverse dipping examined with 24-hour ABPM may indicate sCAD. PMID:27139821

  1. Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA.

    PubMed

    Phillips, Lawrence M; Hachamovitch, Rory; Berman, Daniel S; Iskandrian, Ami E; Min, James K; Picard, Michael H; Kwong, Raymond Y; Friedrich, Matthias G; Scherrer-Crosbie, Marielle; Hayes, Sean W; Sharir, Tali; Gosselin, Gilbert; Mazzanti, Marco; Senior, Roxy; Beanlands, Rob; Smanio, Paola; Goyal, Abhi; Al-Mallah, Mouaz; Reynolds, Harmony; Stone, Gregg W; Maron, David J; Shaw, Leslee J

    2013-12-01

    There is a preponderance of evidence that, in the setting of an acute coronary syndrome, an invasive approach using coronary revascularization has a morbidity and mortality benefit. However, recent stable ischemic heart disease (SIHD) randomized clinical trials testing whether the addition of coronary revascularization to guideline-directed medical therapy (GDMT) reduces death or major cardiovascular events have been negative. Based on the evidence from these trials, the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline; the role of prompt revascularization is less precisely defined. Based on data from observational studies, it has been hypothesized that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events. However, eligibility for recent negative trials in SIHD has mandated at most minimal standards for ischemia. An ongoing randomized trial evaluating the effectiveness of randomization of patients to coronary angiography and revascularization as compared to no coronary angiography and GDMT in patients with moderate-severe ischemia will formally test this hypothesis. The current review will highlight the available evidence including a review of the published and ongoing SIHD trials.

  2. Blood pressure reverse dipping may associate with stable coronary artery disease in patients with essential hypertension: a cross-sectional study

    PubMed Central

    Yan, Bin; Sun, Lu; Gao, Ya; Guo, Qi; Guo, Litao; Wang, Xue; Wang, Gang

    2016-01-01

    The dipping variations of circadian blood pressure (BP) correlate closely with target-organ damages and cardiovascular events. The aim of this study was to investigate the relationship between BP reverse dipping and the prevalence of stable coronary artery disease (sCAD) in hypertensive patients. Clinical data and the results of 24-hour ambulatory BP monitoring (ABPM) were obtained from 718 hypertensive patients (390 males, mean age 59.6 ± 13.8 years) in a single centre in Northern China. Reverse dipping pattern was defined as nocturnal systolic BP (SBP) was higher than daytime SBP. A logistic regression model was applied to explore the independent risk factors of sCAD. The patients with BP reverse dipping accounted for 31.5% in sCAD group and 19.5% in control group (P < 0.05). In multivariate analysis, BP reverse dipping remained significantly associated with the prevalence of sCAD (Odds ratio [OR], 1.772; p = 0.027). Furthermore, the circadian decline rate of SBP was independently associated with sCAD (OR, 0.975; p = 0.043). The hypertensive patients with reverse BP dipping were found to be more frequently suffering from sCAD. BP reverse dipping examined with 24-hour ABPM may indicate sCAD. PMID:27139821

  3. Invasive fungal diseases during first induction chemotherapy affect complete remission achievement and long-term survival of patients with acute myeloid leukemia.

    PubMed

    Girmenia, Corrado; Micozzi, Alessandra; Piciocchi, Alfonso; Gentile, Giuseppe; Di Caprio, Luigi; Nasso, Daniela; Minotti, Clara; Capria, Saveria; Cartoni, Claudio; Alimena, Giuliana; Meloni, Giovanna; Amadori, Sergio; Foà, Robin; Venditti, Adriano

    2014-04-01

    We retrospectively evaluated, in a logistic-regression-model, the role of proven/probable invasive fungal diseases (PP-IFD), occurring during first induction chemotherapy, on the achievement of complete remission (CR) and overall survival (OS) in 198 acute myeloid leukemia (AML) patients. A PP-IFD was documented in 34 (17.2%) patients. Younger age, good performance status at AML diagnosis and no development of a PP-IFD (OR 4.09, 95% CI 1.71-9.81, p<0.0001) were independent factors associated to CR achievement. Younger age, good performance status, favorable genetic risk and no development of PP-IFD (HR 1.86, 95% CI 1.20-2.88, p=0.005) were independent factors associated to OS at 3 years.

  4. Multiple-factor analysis of the first radioactive iodine therapy in post-operative patients with differentiated thyroid cancer for achieving a disease-free status

    PubMed Central

    Liu, Na; Meng, Zhaowei; Jia, Qiang; Tan, Jian; Zhang, Guizhi; Zheng, Wei; Wang, Renfei; Li, Xue; Hu, Tianpeng; Upadhyaya, Arun; Zhou, Pingping; Wang, Sen

    2016-01-01

    131I treatment is an important management method for patients with differentiated thyroid cancer (DTC). Unsuccessful 131I ablation drastically affects the prognosis of the patients. This study aimed to analyze potential predictive factors influencing the achievement of a disease-free status following the first 131I therapy. This retrospective review included 315 DTC patients, and multiple factors were analyzed. Tumor size, pathological tumor stage, lymph node (LN) metastasis, distant metastasis, American Thyroid Association recommended risks, pre-ablation thyroglobulin (Tg), and thyroid stimulating hormone (TSH) displayed significant differences between unsuccessful and successful group. Cutoff values of Tg and TSH to predict a successful outcome were 3.525 ng/mL and 99.700 uIU/ml by receiver operating characteristic curves analysis. Binary logistic regression analysis showed that tumor stage T3 or T4, LN metastasis to N1b station, intermediate and high risks, pre-ablation Tg ≥ 3.525 ng/ml and TSH <99.700 μIU/mL were significantly associated with unsuccessful outcomes. Logistic regression equation for achieving a disease-free status could be rendered as: y (successful treatment) = −0.270–0.503 X1 (LN metastasis) −0.236 X2 (Tg) + 0.015 X3 (TSH). This study demonstrated LN metastasis, pre-ablation Tg and TSH were the most powerful predictors for achieving a disease-free status by the first 131I therapy. PMID:27721492

  5. The benefit of consolidation radiotherapy to initial disease bulk in patients with advanced Hodgkin’s disease who achieved complete remission after standard chemotherapy

    PubMed Central

    Bayoumi, Yasser; Al-Homaidi, Abdulaziz; Zaidi, Syed; Tailor, Imran; Motiabi, Ibrahiem; Alshehri, Nawal; Al-Ghazali, Assem; Almudaibigh, Samer

    2015-01-01

    Background/purpose The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-stage Hodgkin’s disease (HD) with initial bulky sites after radiological complete remission (CR) or partial response (PR) with positron emission tomography-negative (metabolic CR) following standard chemotherapy (ABVD [Adriamycin, bleomycin, vinblastine, and dacarbazine]) six to eight cycles. Patients and methods Adult patients with advanced-stage HD treated at our institute during the period 2006 to 2012 were retrospectively evaluated. One hundred and ninety-two patients with initial bulky disease size (>7 cm) who attained radiological CR/PR and metabolic CR were included in the analysis. One hundred and thirteen patients who received radiotherapy (RT) as consolidation postchemotherapy (RT group) were compared to 79 patients who did not receive RT (non-RT group). Disease-free (DFS) and overall survival (OS) rates were estimated using the Kaplan–Meier method and were compared according to treatment group by the log-rank tests at P ≤0.05 significance level. Results The mean age of the cohort was 33 (range: 14 to 81) years. Eighty-four patients received involved-field radiation and 29 patients received involved-site RT. The RT group had worse prognostic factors compared to the non-RT group. Thirteen (12%) relapses occurred in the RT group, and 19 (24%) relapses occurred in the non-RT group. Nine patients (8%) in the RT group died, compared to eleven patients (14%) in the non-RT group. Second malignancies were seen in only five patients: three patients in the RT group compared to two patients in the non-RT group. At 5 years, overall DFS was 79%±9% and OS was 85%±9%. There was significant statistical difference between the RT group and the non-RT group regarding 5-year DFS: 86%±7% and 74%±9%, respectively (P ≤0.02). However, the 5-year OS was 90%±5% for the RT group and 83%±8% for the non-RT group, with no statistical difference (P ≤0

  6. Stable isotopes in obesity research.

    PubMed

    Dolnikowski, Gregory G; Marsh, Julian B; Das, Sai Krupa; Welty, Francine K

    2005-01-01

    Obesity is recognized as a major public health problem. Obesity is a multifactorial disease and is often associated with a wide range of comorbidities including hypertension, non-insulin dependent (Type II) diabetes mellitus, and cardiovascular disease, all of which contribute to morbidity and mortality. This review deals with stable isotope mass spectrometric methods and the application of stable isotopes to metabolic studies of obesity. Body composition and total energy expenditure (TEE) can be measured by mass spectrometry using stable isotope labeled water, and the metabolism of protein, lipid, and carbohydrate can be measured using appropriate labeled tracer molecules.

  7. Achieving Synergy: Linking an Internet-Based Inflammatory Bowel Disease Cohort to a Community-Based Inception Cohort and Multicentered Cohort in Inflammatory Bowel Disease

    PubMed Central

    Aldridge, Molly; Cook, Suzanne Follan; Bright, Renee; Mallette, Meaghan; Moniz, Heather; Shah, Samir A; LeLeiko, Neal S; Shapiro, Jason; Sands, Bruce E; Chen, Wenli; Jaeger, Elizabeth; Galanko, Joseph; Long, Millie D; Martin, Christopher F; Sandler, Robert S; Kappelman, Michael D

    2016-01-01

    Background Traditional cohort studies are important contributors to our understanding of inflammatory bowel diseases, but they are labor intensive and often do not focus on patient-reported outcomes. Internet-based studies provide new opportunities to study patient-reported outcomes and can be efficiently implemented and scaled. If a traditional cohort study was linked to an Internet-based study, both studies could benefit from added synergy. Existing cohort studies provide an opportunity to develop and test processes for cohort linkage. The Crohn’s and Colitis Foundation of America’s (CCFA) Partners study is an Internet-based cohort of more than 14,000 participants. The Ocean State Crohn’s and Colitis Area Registry (OSCCAR) is an inception cohort. The Sinai-Helmsley Alliance for Research Excellence (SHARE) is a multicentered cohort of inflammatory bowel disease patients. Both the later cohorts include medical record abstraction, patient surveys, and biospecimen collection. Objective Given the complementary nature of these existing cohorts, we sought to corecruit and link data. Methods Eligible OSCCAR and SHARE participants were invited to join the CCFA Partners study and provide consent for data sharing between the 2 cohorts. After informed consent, participants were directed to the CCFA Partners website to complete enrollment and a baseline Web-based survey. Participants were linked across the 2 cohorts by the matching of an email address. We compared demographic and clinical characteristics between OSCCAR and SHARE participants who did and did not enroll in CCFA Partners and the data linkage. Results Of 408 participants in the OSCCAR cohort, 320 were eligible for participation in the CCFA Partners cohort. Of these participants, 243 consented to participation; however, only 44 enrolled in CCFA Partners and completed the linkage. OSCCAR participants who enrolled in CCFA Partners were better educated (17% with doctoral degrees) than those who did not (3% with

  8. Ethiopia and its steps to mobilize resources to achieve 2020 elimination and control goals for neglected tropical diseases webs joined can tie a lion.

    PubMed

    Mengitsu, Belete; Shafi, Oumer; Kebede, Biruck; Kebede, Fikreab; Worku, Dagemlidet T; Herero, Merce; French, Michael; Kebede, Biruk; Mackenzie, Charles; Martindale, Sarah; Kebede, Zeyede; Hirpa, Tigist; Frawley, Hannah; Crowley, Kathryn; O'Neil, Maggie; McPherson, Scott

    2016-03-01

    In June 2013, at the launch of its National Neglected Tropical Disease (NTD) Master Plan, the Ethiopian government pledged to achieve WHO NTD elimination and control targets by 2020. With an estimated 80 million people living in areas where one or more NTDs are endemic, this goal presented an enormous challenge for the Federal Ministry of Health. However, as of September 2015, the Federal Ministry of Health has managed to mobilize support to implement mass drug administration in 84% of the trachoma endemic districts and 100% of the endemic districts for onchocerciasis, lymphatic filariasis, soil-transmitted helminthes and schistosomiasis. The national program still is facing large gaps in its podoconiosis and leishmaniasis programs, and it faces significant other challenges to stay on track for 2020 targets. However, this unprecedented scale-up in support was achieved through significant government investment in NTD interventions and creative coordination between donors and implementing partners, which may provide valuable lessons for other national NTD programs trying to achieve nationwide coverage. PMID:26940308

  9. Ethiopia and its steps to mobilize resources to achieve 2020 elimination and control goals for neglected tropical diseases webs joined can tie a lion.

    PubMed

    Mengitsu, Belete; Shafi, Oumer; Kebede, Biruck; Kebede, Fikreab; Worku, Dagemlidet T; Herero, Merce; French, Michael; Kebede, Biruk; Mackenzie, Charles; Martindale, Sarah; Kebede, Zeyede; Hirpa, Tigist; Frawley, Hannah; Crowley, Kathryn; O'Neil, Maggie; McPherson, Scott

    2016-03-01

    In June 2013, at the launch of its National Neglected Tropical Disease (NTD) Master Plan, the Ethiopian government pledged to achieve WHO NTD elimination and control targets by 2020. With an estimated 80 million people living in areas where one or more NTDs are endemic, this goal presented an enormous challenge for the Federal Ministry of Health. However, as of September 2015, the Federal Ministry of Health has managed to mobilize support to implement mass drug administration in 84% of the trachoma endemic districts and 100% of the endemic districts for onchocerciasis, lymphatic filariasis, soil-transmitted helminthes and schistosomiasis. The national program still is facing large gaps in its podoconiosis and leishmaniasis programs, and it faces significant other challenges to stay on track for 2020 targets. However, this unprecedented scale-up in support was achieved through significant government investment in NTD interventions and creative coordination between donors and implementing partners, which may provide valuable lessons for other national NTD programs trying to achieve nationwide coverage.

  10. Meta-analysis of trials on mortality after percutaneous coronary intervention compared with medical therapy in patients with stable coronary heart disease and objective evidence of myocardial ischemia.

    PubMed

    Gada, Hemal; Kirtane, Ajay J; Kereiakes, Dean J; Bangalore, Sripal; Moses, Jeffrey W; Généreux, Philippe; Mehran, Roxana; Dangas, George D; Leon, Martin B; Stone, Gregg W

    2015-05-01

    Outcomes of percutaneous coronary intervention (PCI) versus medical therapy (MT) in the management of stable ischemic heart disease (SIHD) remain controversial, with some but not all studies showing improved results in patients with ischemia. We sought to elucidate whether PCI improves mortality compared to MT in patients with objective evidence of ischemia (assessed using noninvasive imaging or its invasive equivalent). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PCI to MT in patients with SIHD. To maintain a high degree of specificity for ischemia, studies were only included if ischemia was defined on the basis of noninvasive stress imaging or abnormal fractional flow reserve. The primary outcome was all-cause mortality. We identified 3 RCTs (Effects of Percutaneous Coronary Interventions in Silent Ischemia After Myocardial Infarction II, Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2, and a substudy of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial) enrolling a total of 1,557 patients followed for an average of 3.0 years. When compared with MT in this population of patients with objective ischemia, PCI was associated with lower mortality (hazard ratio 0.52, 95% confidence interval 0.30 to 0.92, p=0.02). There was no evidence of study heterogeneity or bias among included trials. In this meta-analysis of published RCTs, PCI was shown to have a mortality benefit over MT in patients with SIHD and objective assessment of ischemia using noninvasive imaging or its invasive equivalent. In conclusion, this study provides insight into the management of a higher-risk SIHD population that is the focus of the ongoing International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial.

  11. Novel BAC mouse model of Huntington’s disease with 225 CAG repeats exhibits an early widespread and stable degenerative phenotype

    PubMed Central

    Wegrzynowicz, Michal; Bichell, Terry Jo; Soares, Barbara D.; Loth, Meredith K.; McGlothan, Jennifer L.; Alikhan, Fatima S.; Hua, Kegang; Coughlin, Jennifer M.; Holt, Hunter K.; Jetter, Christopher S.; Mori, Susumu; Pomper, Martin G.; Osmand, Alexander P.; Guilarte, Tomás R.; Bowman, Aaron B.

    2015-01-01

    BACKGROUND Unusually large CAG repeat expansions (>60) in exon one of Huntingtin (HTT) are invariably associated with a juvenile-onset form of Huntington’s disease (HD), characterized by a more extensive and rapidly progressing neuropathology than the more prevalent adult-onset form. However, existing mouse models of HD that express the full-length Htt gene with CAG repeat lengths associated with juvenile HD (ranging between ~75 to ~150 repeats in published models) exhibit selective neurodegenerative phenotypes more consistent with adult-onset HD. OBJECTIVE To determine if a very large CAG repeat (>200) in full-length Htt elicits neurodegenerative phenotypes consistent with juvenile HD. METHODS Using a bacterial artificial chromosome (BAC) system, we generated mice expressing full-length mouse Htt with ~225 CAG repeats under control of the mouse Htt promoter. Mice were characterized using behavioral, neuropathological, biochemical and brain imaging methods. RESULTS BAC-225Q mice exhibit phenotypes consistent with a subset of features seen in juvenile-onset HD: very early motor behavior abnormalities, reduced body weight, widespread and progressive increase in Htt aggregates, gliosis, and neurodegeneration. Early striatal pathology was observed, including reactive gliosis and loss of dopamine receptors, prior to detectable volume loss. HD-related blood markers of impaired energy metabolism and systemic inflammation were also increased. Aside from an age-dependent progression of diffuse nuclear aggregates at 6 months of age to abundant neuropil aggregates at 12 months of age, other pathological and motor phenotypes showed little to no progression. CONCLUSIONS The HD phenotypes present in animals 3 to 12 months of age make the BAC-225Q mice a unique and stable model of full-length mutant Htt associated phenotypes, including body weight loss, behavioral impairment and HD-like neurodegenerative phenotypes characteristic of juvenile-onset HD and/or late-stage adult

  12. Long-Term Stable Mixed Chimerism after Hematopoietic Stem Cell Transplantation in Patients with Non-Malignant Disease, Shall We Be Tolerant?

    PubMed Central

    Stikvoort, Arwen; Sundin, Mikael; Uzunel, Mehmet; Gertow, Jens; Sundberg, Berit; Schaffer, Marie; Mattsson, Jonas; Uhlin, Michael

    2016-01-01

    Long-term stable mixed chimerism is a rare and poorly understood phenomenon post hematopoietic stem cell transplantation. This study aims to shed light on whether the two hematopoietic systems in patients with mixed chimerism remain functional. Additionally, we investigate possible immunologic differences in these individuals compared to patients with only donor derived immune cells. Patients with donor and mixed chimerism, at median 10 (5–16) years post-HSCT for non-malignant diseases, were assessed regarding clinical situation and immune system (phenotypical and functional). No difference in long-term outcome was seen in terms of general wellbeing, central phenotypic immune system features (e.g., differentiation status, CD4/CD8 ratio, B and NK-cell frequency) and antibody responses to immunizations. At a median of 10 years post transplantation, patients with mixed chimerism had significantly higher IgG3 and platelet levels. Additionally, these patients had higher NKT-cell levels (CD94+CD8+ and CD56+CD8+) than patients with donor chimerism. In depth phenotypic analysis of patients with mixed chimerism demonstrated recipient-derived fractions in most immune cell lineages (e.g., T-cell, B-cell and NK-cell subsets). Recipient cells were also capable of responding to mitogenic stimulation with production of several cytokines. In conclusion, long-term mixed chimerism did not negatively affect patient wellbeing and long-term outcome. Moreover, recipient-derived immunity may still be functional in these patients, suggesting an active state of tolerance and immunologic dependence on both hematopoietic systems. PMID:27152621

  13. Susceptibility to viral infection is enhanced by stable expression of 3A or 3AB proteins from foot-and-mouth disease virus

    SciTech Connect

    Rosas, Maria F.; Vieira, Yuri A.; Postigo, Raul; Martin-Acebes, Miguel A.; Armas-Portela, Rosario; Martinez-Salas, Encarnacion; Sobrino, Francisco

    2008-10-10

    The foot-and-mouth disease virus (FMDV) 3A protein is involved in virulence and host range. A distinguishing feature of FMDV 3B among picornaviruses is that three non-identical copies are encoded in the viral RNA and required for optimal replication in cell culture. Here, we have studied the involvement of the 3AB region on viral infection using constitutive and transient expression systems. BHK-21 stably transformed clones expressed low levels of FMDV 3A or 3A(B) proteins in the cell cytoplasm. Transformed cells stably expressing these proteins did not exhibit inner cellular rearrangements detectable by electron microscope analysis. Upon FMDV infection, clones expressing either 3A alone or 3A(B) proteins showed a significant increase in the percentage of infected cells, the number of plaque forming units and the virus yield. The 3A-enhancing effect was specific for FMDV as no increase in viral multiplication was observed in transformed clones infected with another picornavirus, encephalomyocarditis virus, or the negative-strand RNA virus vesicular stomatitis virus. A potential role of 3A protein in viral RNA translation was discarded by the lack of effect on FMDV IRES-dependent translation. Increased viral susceptibility was not caused by a released factor; neither the supernatant of transformed clones nor the addition of purified 3A protein to the infection medium was responsible for this effect. Unlike stable expression, high levels of 3A or 3A(B) protein transient expression led to unspecific inhibition of viral infection. Therefore, the effect observed on viral yield, which inversely correlated with the intracellular levels of 3A protein, suggests a transacting role operating on the FMDV multiplication cycle.

  14. Increased expression of CD4+IL-17+ cells in the lung tissue of patients with stable chronic obstructive pulmonary disease (COPD) and smokers.

    PubMed

    Zhang, Jianquan; Chu, Shuyuan; Zhong, Xiaoning; Lao, Qifang; He, Zhiyi; Liang, Yi

    2013-01-01

    CD4(+)IL-17(+) cells have an important role in controlling immune and inflammatory reactions. The authors of the present study hypothesize that these cells may be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). To characterize the frequency of CD4(+)IL-17(+) cells in the lung alveolar walls, small airways and muscular pulmonary arteries of nonsmokers, smokers with normal lung function and COPD patients, CD4(+)IL-17(+) cell number was assessed using double immunofluorescence staining, and IL-17 and IL-21 expression were measured using real-time quantitative PCR in the peripheral lung tissues of 10 nonsmokers, 10 smokers with normal lung function and 10 smokers with stable COPD. In the lung alveolar walls, the number of CD4(+)IL-17(+) cells was increased in COPD patients compared with nonsmokers and in normal smokers compared with nonsmokers. In the small airways, the CD4(+)IL-17(+) cell numbers were higher in COPD patients than in normal smokers and nonsmokers. A positive correlation was observed between CD4(+)IL-17(+) cell expression and pathological changes in the lung tissue. In the small airways, the number of CD4(+)IL-17(+) cells was positively correlated with airflow limitations. The IL-17 mRNA levels in lung tissues were increased in COPD patients and normal smokers compared with nonsmokers. Increased CD4(+)IL-17(+) cell number in lung tissue is involved in chronic inflammation of the lungs and parallels lung injury aggravation in COPD patients and in smokers without airway limitations. These findings contribute to a better understanding of CD4(+) cell-related pathogenesis in COPD.

  15. Diagnosing coronary artery disease by sound analysis from coronary stenosis induced turbulent blood flow: diagnostic performance in patients with stable angina pectoris.

    PubMed

    Winther, Simon; Schmidt, Samuel Emil; Holm, Niels Ramsing; Toft, Egon; Struijk, Johannes Jan; Bøtker, Hans Erik; Bøttcher, Morten

    2016-02-01

    Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond-Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond-Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond-Forrester score (p < 0.05). Addition of the CAD-score to the Diamond-Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation. PMID:26335368

  16. Molecular analysis of a male breast cancer patient with prolonged stable disease under mTOR/PI3K inhibitors BEZ235/everolimus

    PubMed Central

    Brannon, A. Rose; Frizziero, Melissa; Chen, David; Hummel, Jennifer; Gallo, Jorge; Riester, Markus; Patel, Parul; Cheung, Wing; Morrissey, Michael; Carbone, Carmine; Cottini, Silvia; Tortora, Giampaolo; Melisi, Davide

    2016-01-01

    The mTORC1 inhibitor everolimus (Afinitor/RAD001) has been approved for multiple cancer indications, including ER+/HER2− metastatic breast cancer. However, the combination of everolimus with the dual PI3K/mTOR inhibitor BEZ235 was shown to be more efficacious than either everolimus or BEZ235 alone in preclinical models. Herein, we describe a male breast cancer (MBC) patient who was diagnosed with hormone receptor-positive (HR+)/HER2− stage IIIA invasive ductal carcinoma and sequentially treated with chemoradiotherapy and hormonal therapy. Upon the development of metastases, the patient began a 200 mg twice-daily BEZ235 and 2.5 mg weekly everolimus combination regimen. The patient sustained a prolonged stable disease of 18 mo while undergoing the therapy, before his tumor progressed again. Therefore, we sought to both better understand MBC and investigate the underlying molecular mechanisms of the patient's sensitivity and subsequent resistance to the BEZ235/everolimus combination therapy. Genomic and immunohistochemical analyses were performed on samples collected from the initial invasive ductal carcinoma pretreatment and a metastasis postprogression on the BEZ235/everolimus combination treatment. Both tumors were relatively quiet genomically with no overlap to recurrent MBC alterations in the literature. Markers of PI3K/mTOR pathway hyperactivation were not identified in the pretreatment sample, which complements previous reports of HR+ female breast cancers being responsive to mTOR inhibition without this activation. The postprogression sample, however, demonstrated greater than fivefold increased estrogen receptor and pathogenesis-related protein expression, which could have constrained the PI3K/mTOR pathway inhibition by BEZ235/everolimus. Overall, these analyses have augmented the limited episteme on MBC genetics and treatment. PMID:27148582

  17. Long-Term Stable Mixed Chimerism after Hematopoietic Stem Cell Transplantation in Patients with Non-Malignant Disease, Shall We Be Tolerant?

    PubMed

    Stikvoort, Arwen; Sundin, Mikael; Uzunel, Mehmet; Gertow, Jens; Sundberg, Berit; Schaffer, Marie; Mattsson, Jonas; Uhlin, Michael

    2016-01-01

    Long-term stable mixed chimerism is a rare and poorly understood phenomenon post hematopoietic stem cell transplantation. This study aims to shed light on whether the two hematopoietic systems in patients with mixed chimerism remain functional. Additionally, we investigate possible immunologic differences in these individuals compared to patients with only donor derived immune cells. Patients with donor and mixed chimerism, at median 10 (5-16) years post-HSCT for non-malignant diseases, were assessed regarding clinical situation and immune system (phenotypical and functional). No difference in long-term outcome was seen in terms of general wellbeing, central phenotypic immune system features (e.g., differentiation status, CD4/CD8 ratio, B and NK-cell frequency) and antibody responses to immunizations. At a median of 10 years post transplantation, patients with mixed chimerism had significantly higher IgG3 and platelet levels. Additionally, these patients had higher NKT-cell levels (CD94+CD8+ and CD56+CD8+) than patients with donor chimerism. In depth phenotypic analysis of patients with mixed chimerism demonstrated recipient-derived fractions in most immune cell lineages (e.g., T-cell, B-cell and NK-cell subsets). Recipient cells were also capable of responding to mitogenic stimulation with production of several cytokines. In conclusion, long-term mixed chimerism did not negatively affect patient wellbeing and long-term outcome. Moreover, recipient-derived immunity may still be functional in these patients, suggesting an active state of tolerance and immunologic dependence on both hematopoietic systems.

  18. Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease

    PubMed Central

    Zhou, Jia; Yang, Jun-Jie; Yang, Xia; Chen, Zhi-Ye; He, Bai; Du, Luo-Shan; Chen, Yun-Dai

    2016-01-01

    Background: Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice. Methods: A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA. Results: Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982–1.021; P = 0.8678). Conclusions: These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent. PMID:26830982

  19. Long-Term Stable Mixed Chimerism after Hematopoietic Stem Cell Transplantation in Patients with Non-Malignant Disease, Shall We Be Tolerant?

    PubMed

    Stikvoort, Arwen; Sundin, Mikael; Uzunel, Mehmet; Gertow, Jens; Sundberg, Berit; Schaffer, Marie; Mattsson, Jonas; Uhlin, Michael

    2016-01-01

    Long-term stable mixed chimerism is a rare and poorly understood phenomenon post hematopoietic stem cell transplantation. This study aims to shed light on whether the two hematopoietic systems in patients with mixed chimerism remain functional. Additionally, we investigate possible immunologic differences in these individuals compared to patients with only donor derived immune cells. Patients with donor and mixed chimerism, at median 10 (5-16) years post-HSCT for non-malignant diseases, were assessed regarding clinical situation and immune system (phenotypical and functional). No difference in long-term outcome was seen in terms of general wellbeing, central phenotypic immune system features (e.g., differentiation status, CD4/CD8 ratio, B and NK-cell frequency) and antibody responses to immunizations. At a median of 10 years post transplantation, patients with mixed chimerism had significantly higher IgG3 and platelet levels. Additionally, these patients had higher NKT-cell levels (CD94+CD8+ and CD56+CD8+) than patients with donor chimerism. In depth phenotypic analysis of patients with mixed chimerism demonstrated recipient-derived fractions in most immune cell lineages (e.g., T-cell, B-cell and NK-cell subsets). Recipient cells were also capable of responding to mitogenic stimulation with production of several cytokines. In conclusion, long-term mixed chimerism did not negatively affect patient wellbeing and long-term outcome. Moreover, recipient-derived immunity may still be functional in these patients, suggesting an active state of tolerance and immunologic dependence on both hematopoietic systems. PMID:27152621

  20. Oral Chinese Herbal Medicine for Improvement of Quality of Life in Patients with Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

    PubMed Central

    An, Xuedong; Zhang, Anthony Lin; May, Brian H.; Lin, Lin; Xu, Yinji

    2012-01-01

    Abstract Purpose This study evaluates published clinical trials of Chinese herbal medicine (CHM) for chronic obstructive pulmonary disease (COPD) that employ a health-related quality of life (HRQoL) outcome measure. Methods Searches were conducted in April 2011 on MEDLINE®, Embase, the Cochrane Controlled Trials Register, CINAHL, Scopus, and Chinese databases (CNKI, CQVIP, WANFANG). Randomized controlled trials involving oral administration of CHM formulae or single herb, with or without blinding, compared to placebo, no treatment, routine pharmacotherapy control, or CHM plus routine pharmacotherapy versus routine pharmacotherapy, with a HRQoL questionnaire as an outcome measure were identified. The methodological quality was assessed using the Cochrane risk of bias assessment. Results A total of 27 studies involving 1966 patients were identified. St. George Respiratory Questionnaire (SGRQ) or Cai's QoLQ were used in 13 and 14 studies, respectively. Assessment of the Cochrane risk of bias revealed adequate sequence of generation in 10 studies and adequate allocation concealment in 1 study; double blinding was not described adequately in any studies. Seventeen (17) studies addressed incomplete outcome data, and 17 studies were free of selective reporting. The main results of meta-analysis showed improvement of total HRQoL scores (SGRQ and Cai's QoLQ) when CHM was compared to no treatment (−6.07 [−9.21, −2.93] and −0.20 [−32, −0.07], respectively) and for CHM plus routine pharmacotherapy versus routine pharmacotherapy (−5.15 [−7.26, −3.05]) and (−0.25 [−0.37, −0.13]). Conclusions While the results of CHM on HRQoL for stable COPD sufferers were promising, they need to be interpreted with caution due to methodological problems, which should be addressed in future trials. PMID:22803654

  1. Molecular analysis of a male breast cancer patient with prolonged stable disease under mTOR/PI3K inhibitors BEZ235/everolimus.

    PubMed

    Brannon, A Rose; Frizziero, Melissa; Chen, David; Hummel, Jennifer; Gallo, Jorge; Riester, Markus; Patel, Parul; Cheung, Wing; Morrissey, Michael; Carbone, Carmine; Cottini, Silvia; Tortora, Giampaolo; Melisi, Davide

    2016-03-01

    The mTORC1 inhibitor everolimus (Afinitor/RAD001) has been approved for multiple cancer indications, including ER(+)/HER2(-) metastatic breast cancer. However, the combination of everolimus with the dual PI3K/mTOR inhibitor BEZ235 was shown to be more efficacious than either everolimus or BEZ235 alone in preclinical models. Herein, we describe a male breast cancer (MBC) patient who was diagnosed with hormone receptor-positive (HR(+))/HER2(-) stage IIIA invasive ductal carcinoma and sequentially treated with chemoradiotherapy and hormonal therapy. Upon the development of metastases, the patient began a 200 mg twice-daily BEZ235 and 2.5 mg weekly everolimus combination regimen. The patient sustained a prolonged stable disease of 18 mo while undergoing the therapy, before his tumor progressed again. Therefore, we sought to both better understand MBC and investigate the underlying molecular mechanisms of the patient's sensitivity and subsequent resistance to the BEZ235/everolimus combination therapy. Genomic and immunohistochemical analyses were performed on samples collected from the initial invasive ductal carcinoma pretreatment and a metastasis postprogression on the BEZ235/everolimus combination treatment. Both tumors were relatively quiet genomically with no overlap to recurrent MBC alterations in the literature. Markers of PI3K/mTOR pathway hyperactivation were not identified in the pretreatment sample, which complements previous reports of HR(+) female breast cancers being responsive to mTOR inhibition without this activation. The postprogression sample, however, demonstrated greater than fivefold increased estrogen receptor and pathogenesis-related protein expression, which could have constrained the PI3K/mTOR pathway inhibition by BEZ235/everolimus. Overall, these analyses have augmented the limited episteme on MBC genetics and treatment.

  2. Th17/Treg-related cytokine imbalance in sulfur mustard exposed and stable chronic obstructive pulmonary (COPD) patients: correlation with disease activity.

    PubMed

    Imani, Saber; Salimian, Jafar; Fu, Junjiang; Ghanei, Mostafa; Panahi, Yunes

    2016-08-01

    In this study, we investigated expression changes of Th17/Treg-related cytokine in transbronchial lung biopsy (TBLBs) of sulfur mustard (SM) exposure, stable chronic obstructive pulmonary disease (COPD) patients and also compared it with a healthy control (HC) group. Here, ROR-γt, FoxP3, and Treg/Th17-related cytokines (IL-10, IL-17A, IL-6, and TGF-β1) were assessed using a combination of RT-QPCR and ELISA in 11 SM-exposed cases, 9 patients with GOLD stage II COPD diagnosed, and 8 HC. Our results showed that the levels of Foxp3 expression were lower and ROR-γt expression was higher in SM and COPD patients when compared with HC (all p values were less than 0.001). The relative Foxp3 expressions and Foxp3/ROR-γt ratio were positively correlated with FEV1 (%) pred (R = 0.682 and R = 0.602, respectively; p ≤ 0.001). However, the relative ROR-γt expressions were inversely correlated with FEV1 (%) pred (R= -0.75, p = 0.003) and relative Foxp3 expression (R= -0.704, p = 0.003). The mRNA and protein expression of IL-10 were significantly decreased in SM and COPD patients compared with HC (p < 0.001). An increase of IL-17A (∼7.2 fold) and TGF-β1 (∼5.6 fold) are involved in the lung exacerbation of SM and COPD patients. The expression of IL-6 was variable between three groups (p ≥ 0.05). In addition, an inverse correlation were observed between FEV1 (%) pred and expressions of IL-17A (R= -0.741), IL-6 (R= -0.673) and TGF-β1 (R= -0.632) (p ≤ 0.001). Instead, positive correlation was found between IL-10 ratios and FEV1 (%) pred (R = 0.777, p = 0.001). These findings suggest that Treg/Th17-mediated distributions are involved in the progression of chronic lung injury of SM and COPD patients.

  3. Usefulness of an Echocardiographic Composite Cardiac Calcium Score to Predict Death in Patients With Stable Coronary Artery Disease (from the Heart and Soul Study).

    PubMed

    Saha, Sandeep A; Beatty, Alexis L; Mishra, Rakesh K; Whooley, Mary A; Schiller, Nelson B

    2015-07-01

    Mitral annular calcium and aortic valve sclerosis on transthoracic echocardiography (TTE) are independently associated with cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic value of calcific deposits at multiple sites is unknown. We performed TTEs in a prospective cohort of 595 outpatients with stable CAD and graded the severity of calcific deposition at 6 sites: mitral annulus, aortic valve, aortic ring, sinotubular junction, papillary muscle tip, and left main coronary artery. For each site with moderate calcific deposition or greater, 1 point was given to generate a composite cardiac calcium score (maximum of 6). The primary end point was the occurrence of CV events-a composite of death, myocardial infarction, stroke, transient ischemic attack, and heart failure. The association of the composite calcium score with CV events was evaluated using multivariate Cox proportional hazards models. Over a median follow-up of 4.2 years, 205 CV events occurred. Participants with a composite calcium score ≥2 had a higher risk of CV events (11.1 events/100 person-years) than those with a score of 0 (5.5 events/100 person-years, unadjusted hazard ratio [HR] 2.01, p <0.001), but this association was not significant after multivariate adjustment. The risk of death was higher in participants with a composite calcium score of ≥2 (8.9 events/100 person-years) versus those with a score of 0 (3.6 events/100 person-years, unadjusted HR 2.51, p <0.001). After adjustment for age, diabetes mellitus, previous coronary revascularization, diastolic blood pressure, estimated glomerular filtration rate, and serum phosphorus level, the risk of death remained higher in participants with a composite calcium score of ≥2 compared with those with a score of 0 (adjusted HR 1.76, 95% confidence interval 1.10 to 2.81, p = 0.02). In conclusion, a simple TTE-derived composite cardiac calcium score was independently predictive of death in patients

  4. Comparison of serum levels of inflammatory markers in patients with coronary vasospasm without significant fixed coronary artery disease versus patients with stable angina pectoris and acute coronary syndromes with significant fixed coronary artery disease.

    PubMed

    Hung, Ming-Jui; Cherng, Wen-Jin; Cheng, Chi-Wen; Li, Li-Fu

    2006-05-15

    Serum levels of inflammatory markers (interleukin-6, monocyte chemoattractant protein-1, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, and C-reactive protein) were measured at baseline in serum samples from 189 patients who were admitted for coronary angiography because of suspected ischemic heart disease. Median duration of follow-up was 28 months. Patients in our sample were enrolled in 4 diagnostic groups: no hemodynamically significant coronary artery disease (CAD) and no coronary vasospasm (control group, n = 32), hemodynamically significant CAD and stable angina pectoris (SAP group, n = 34), coronary vasospastic angina pectoris without hemodynamically significant CAD (vasospasm group, n = 31), and acute coronary syndrome (ACS) and hemodynamically significant CAD (ACS group, n = 92). Overall, the level of serum inflammatory markers was highest in the ACS group and lowest in the control group, with intermediate values observed in the SAP and vasospasm groups, with the exception of soluble intercellular adhesion molecule-1, the level of which was highest in the vasospasm group. Multivariate analysis showed that log (interleukin-6) was independently associated with a diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD (odds ratio 8.48, p = 0.027). Patients in the ACS group had a significantly lower survival rate compared with the other 3 groups but without an independent predictor that could be identified in this patient cohort. Recurrent angina pectoris occurred with similar rates in the SAP, vasospasm, and ACS groups. The independent predictor for recurrent angina pectoris was treatment that did not include clopidogrel (odds ratio 3.88, p = 0.007). In conclusion, the results of this study suggest that inflammation can exist in coronary vasospasm without hemodynamically significant CAD.

  5. Comparison of the effects of combination atorvastatin (40 mg) + ezetimibe (10 mg) versus atorvastatin (40 mg) alone on secretory phospholipase A2 activity in patients with stable coronary artery disease or coronary artery disease equivalent.

    PubMed

    Azar, Mireille; Valentin, Emmanuel; Badaoui, Georges; Kassab, Roland; Sarkis, Antoine; Azar, Rabih R

    2011-06-01

    Secretory phospholipase A2 (sPLA2) is an enzyme that plays an important role in the pathogenesis of atherosclerosis and of adverse cardiovascular events. It is currently the target of emerging therapeutic agents. Our study was designed to investigate the effect of aggressive lowering of low-density lipoprotein (LDL) cholesterol with ezetimibe and atorvastatin on sPLA2 activity. We randomized 100 patients with stable coronary artery disease (CAD) or CAD equivalent (diabetes, stroke, or peripheral vascular disease) to receive ezetimibe 10 mg/day in association with atorvastatin 40 mg/day (combination therapy group) versus atorvastatin 40 mg/day and placebo (monotherapy group). Patients on statin therapy before inclusion were allowed to enter the study as long as the potency of the statin was lower than atorvastatin 40 mg/day. Lipid profile, high-sensitivity C-reactive protein (hs-CRP), and sPLA activity were measured at baseline and after 8 weeks of therapy. The decrease in LDL cholesterol was more significant in the combination therapy group, but the decrease in hs-CRP was similar. sPLA2 activity significantly decreased in the ezetimibe/atorvastatin group from 29 U/ml (interquartile range 23 to 35) to 26 U/ml (23 to 29, p = 0.001) but remained similar in the placebo/atorvastatin group (23 U/ml, 19 to 32, vs 22 U/ml, 19 to 28, p = NS). In a multivariate stepwise linear regression model, change in sPLA2 correlated with change in hs-CRP (p <0.001), baseline LDL cholesterol level (p = 0.001), body mass index (p = 0.003), diabetes mellitus (p = 0.04) and combination therapy with ezetimibe/atorvastatin (p = 0.05). In conclusion, this study demonstrates that coadministration of ezetimibe and atorvastatin decreases sPLA2 activity.

  6. Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy).

    PubMed

    Dong, Liang; Mintz, Gary S; Witzenbichler, Bernhard; Metzger, D Christopher; Rinaldi, Michael J; Duffy, Peter L; Weisz, Giora; Stuckey, Thomas D; Brodie, Bruce R; Yun, Kyeong Ho; Xu, Ke; Kirtane, Ajay J; Stone, Gregg W; Maehara, Akiko

    2015-04-01

    Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter registry of 8,582 consecutive stable and unstable patients who underwent percutaneous coronary intervention using a drug-eluting stent. We sought to identify key morphologic features leading to ST-segment elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI) or unstable angina pectoris (UA) versus stable coronary artery disease (CAD) presentation. In the prespecified grayscale and virtual histology (VH) substudy of ADAPT-DES, preintervention imaging identified 676 patients with a single culprit lesion. The relation between lesion morphology and clinical presentation was compared among patients with (1) STEMI, (2) NSTEMI or UA, and (3) stable CAD. Intravascular ultrasound identified more plaque rupture and VH thin-cap fibroatheroma (TCFA) in STEMI lesions compared with NSTEMI/UA or stable CAD lesions; conversely, fibroatheromas appeared more often calcified with a thick fibrous cap in stable CAD. Minimum lumen cross-sectional area (MLA) was smaller with larger plaque burden and positive remodeling in STEMI lesions. Lesions with plaque rupture versus those without plaque rupture showed higher prevalence of VH-TCFA and larger plaque burden with positive remodeling, especially in patients with STEMI. Multivariate analysis showed that in the lesions with plaque rupture, plaque burden at the MLA site was the only independent predictor for STEMI (cutoff of plaque burden = 85%) and in lesions without plaque rupture, MLA was the only independent predictor for STEMI (cutoff of MLA = 2.3 mm(2)). In conclusion, culprit lesions causing STEMI have smaller lumen areas, greater plaque burden, and more plaque rupture or VH-TCFA compared with NSTEMI/UA or stable CAD; in lesions with plaque rupture, only plaque burden predicted STEMI, and in lesions without plaque rupture, only MLA area predicted STEMI.

  7. Achieving cholesterol targets by individualizing starting doses of statin according to baseline low-density lipoprotein cholesterol and coronary artery disease risk category: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) study

    PubMed Central

    Ur, Ehud; Langer, Anatoly; Rabkin, Simon W; Calciu, Cristina-Dana; Leiter, Lawrence A

    2010-01-01

    BACKGROUND: Despite an increasing body of evidence on the benefit of lowering elevated levels of low-density lipoprotein cholesterol (LDL-C), there is still considerable concern that patients are not achieving target LDL-C levels. OBJECTIVE: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) trial tested whether an algorithm-based statin dosing approach would enable patients to achieve LDL-C and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio targets quickly. METHODS: Subjects requiring statin therapy, but with an LDL-C level of 5.7 mmol/L or lower, and triglycerides of 6.8 mmol/L or lower at screening participated in the 12-week study, which had two open-label, six-week phases: a treatment period during which patients received 10 mg, 20 mg, 40 mg or 80 mg of atorvastatin based on an algorithm incorporating baseline LDL-C value and cardiovascular risk; and patients who achieved both LDL-C and TC/HDL-C ratio targets at six weeks continued on the same atorvastatin dose. Patients who did not achieve both targets received dose uptitration using a single-step titration regimen. The primary efficacy outcome was the proportion of patients achieving target LDL-C levels after 12 weeks. RESULTS: Of 2016 subjects screened at 88 Canadian sites, 1258 were assigned to a study drug (1101 were statin-free and 157 were statin-treated at baseline). The proportion of subjects who achieved LDL-C targets after 12 weeks of treatment was 86% (95% CI 84% to 88%) for statin-free patients and 54% (95% CI 46% to 61%) for statin-treated patients. Overall, 1003 subjects (80%; 95% CI 78% to 82%) achieved both lipid targets. CONCLUSIONS: Algorithm-based statin dosing enables patients to achieve LDL-C and TC/HDL-C ratio targets quickly, with either no titration or a single titration. PMID:20151053

  8. Statin Discontinuation after Achieving a Target Low Density Lipoprotein Cholesterol Level in Type 2 Diabetic Patients without Cardiovascular Disease: A Randomized Controlled Study

    PubMed Central

    Lee, Seung-Hwan; Kwon, Hyuk-Sang; Park, Yong-Moon; Ko, Seung-Hyun; Choi, Yoon-Hee; Yoon, Kun-Ho

    2014-01-01

    Background This study investigated the rate of relapse of dyslipidemia and the factors which could predict relapse following a short-term statin discontinuation after achieving a target low density lipoprotein cholesterol (LDL-C) level in type 2 diabetic patients without cardiovascular disease (CVD). Methods Ninety-nine subjects on rosuvastatin treatment and whose LDL-C level was lower than 100 mg/dL were randomly assigned to discontinue or maintain statin treatment at a 2:1 ratio. The subjects were followed-up after 10 weeks. A relapse of dyslipidemia was defined as a reascent of LDL-C level to greater than 100 mg/dL. Results The statin discontinuation group had a significant rate of relapse compared to the maintenance group (79% vs. 3%, respectively). Pretreatment and baseline lipid levels, their ratios, and hemoglobin A1c level were significantly different between the relapse and nonrelapse groups. The pretreatment and baseline lipid profiles and their ratios were independently associated with relapse. The pretreatment LDL-C level was the most useful parameter for predicting a relapse, with a cutoff of 123 mg/dL. During the follow-up period, no CVD event was noted. Conclusion The relapse rate of dyslipidemia was high when statins were discontinued in type 2 diabetic patients without CVD. Statin discontinuation should be considered carefully based on the pretreatment lipid profiles of patients. PMID:24627830

  9. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

    PubMed Central

    Barbero, Umberto; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; Biondi-Zoccai, Giuseppe; Mennuni, Marco; Capodanno, Davide; Lococo, Marco; Lipinski, Michael J.; Gaita, Fiorenzo

    2016-01-01

    Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease. PMID:27239372

  10. Minimal Residual Disease at First Achievement of Complete Remission Predicts Outcome in Adult Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia

    PubMed Central

    Lai, Xiaoyu; Tan, Yamin; Zheng, Weiyan; Shi, Jimin; Zhao, Yanmin; Lin, Maofang; He, Jingsong; Cai, Zhen; Luo, Yi; Huang, He

    2016-01-01

    We evaluated the prognostic effect of minimal residual disease at first achievement of complete remission (MRD at CR1) in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL). A total of 97 patients received treatment in our center between 2007 and 2012 were retrospectively reviewed in this study. Patients were divided into two arms according to the post-remission therapy (chemotherapy alone or allogeneic hematopoietic stem cell transplantation (allo-HSCT)) they received. MRD was detected by four-color flow cytometry. We chose 0.02% and 0.2% as the cut-off points of MRD at CR1 for risk stratification using receiver operating characteristic analysis. The 3-year overall survival (OS) and leukemia free survival (LFS) rates for the whole cohort were 46.2% and 40.5%. MRD at CR1 had a significantly negative correlation with survival in both arms. Three-year OS rates in the chemotherapy arm were 70.0%, 25.2%, 0% (P = 0.003) for low, intermediate, and high levels of MRD at CR1, respectively. Three-year OS rates in the transplant arm were 81.8%, 64.3%, 27.3% (P = 0.005) for low, intermediate, and high levels of MRD at CR1, respectively. Multivariate analysis confirmed that higher level of MRD at CR1 was a significant adverse factor for OS and LFS. Compared with chemotherapy alone, allo-HSCT significantly improved LFS rates in patients with intermediate (P = 0.005) and high (P = 0.022) levels of MRD at CR1, but not patients with low level of MRD at CR1 (P = 0.851). These results suggested that MRD at CR1 could strongly predict the outcome of adult ALL. Patients with intermediate and high levels of MRD at CR1 would benefit from allo-HSCT. PMID:27695097

  11. Multi-stable cylindrical lattices

    NASA Astrophysics Data System (ADS)

    Pirrera, Alberto; Lachenal, Xavier; Daynes, Stephen; Weaver, Paul M.; Chenchiah, Isaac V.

    2013-11-01

    We present a cylindrical lattice structure that mimics the behaviour of the virus bacteriophage T4 in having two (or more) stable states which differ in their radii and length. While the virus achieves bistability through molecular mechanisms we use composite materials to exploit the interplay between pre-stress, material properties and structural geometry. We demonstrate (computationally) that multi-stability is a robust phenomenon. We also show (analytically) that it is possible to choose the design variables so that the energy is independent of the radius, thus resulting in every state of the structure being stable.

  12. Stable topological insulators achieved using high energy electron beams

    PubMed Central

    Zhao, Lukas; Konczykowski, Marcin; Deng, Haiming; Korzhovska, Inna; Begliarbekov, Milan; Chen, Zhiyi; Papalazarou, Evangelos; Marsi, Marino; Perfetti, Luca; Hruban, Andrzej; Wołoś, Agnieszka; Krusin-Elbaum, Lia

    2016-01-01

    Topological insulators are potentially transformative quantum solids with metallic surface states which have Dirac band structure and are immune to disorder. Ubiquitous charged bulk defects, however, pull the Fermi energy into the bulk bands, denying access to surface charge transport. Here we demonstrate that irradiation with swift (∼2.5 MeV energy) electron beams allows to compensate these defects, bring the Fermi level back into the bulk gap and reach the charge neutrality point (CNP). Controlling the beam fluence, we tune bulk conductivity from p- (hole-like) to n-type (electron-like), crossing the Dirac point and back, while preserving the Dirac energy dispersion. The CNP conductance has a two-dimensional character on the order of ten conductance quanta and reveals, both in Bi2Te3 and Bi2Se3, the presence of only two quantum channels corresponding to two topological surfaces. The intrinsic quantum transport of the topological states is accessible disregarding the bulk size. PMID:26961901

  13. Achieving fast and stable failure detection in WDM Networks

    NASA Astrophysics Data System (ADS)

    Gao, Donghui; Zhou, Zhiyu; Zhang, Hanyi

    2005-02-01

    In dynamic networks, the failure detection time takes a major part of the convergence time, which is an important network performance index. To detect a node or link failure in the network, traditional protocols, like Hello protocol in OSPF or RSVP, exchanges keep-alive messages between neighboring nodes to keep track of the link/node state. But by default settings, it can get a minimum detection time in the measure of dozens of seconds, which can not meet the demands of fast network convergence and failure recovery. When configuring the related parameters to reduce the detection time, there will be notable instability problems. In this paper, we analyzed the problem and designed a new failure detection algorithm to reduce the network overhead of detection signaling. Through our experiment we found it is effective to enhance the stability by implicitly acknowledge other signaling messages as keep-alive messages. We conducted our proposal and the previous approaches on the ASON test-bed. The experimental results show that our algorithm gives better performances than previous schemes in about an order magnitude reduction of both false failure alarms and queuing delay to other messages, especially under light traffic load.

  14. Subpopulations of bovine T lymphocytes collected during foot-and-mouth disease virus infection are affected by freezing, but are subsequently stable in frozen samples

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Immunophenotyping of peripheral-blood lymphocytes by flow cytometry is an important tool for infectious disease research. In many live-animal experiments and other longitudinal studies, the processing, prompt staining, and analysis of fresh samples is a logistical challenge and daily variation can c...

  15. Foot-and-mouth disease virus (FMDV) with a stable FLAG epitope in the VP1 G-H loop as a new tool for studying FMDV pathogenesis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In this study, we generated a recombinant foot-and-mouth disease virus (FMDV) particle derived from A24 Cruzeiro with a FLAG tag (DYKDDDDK) substitution in the hypervariable antigenic site of the G-H loop of the VP1 capsid protein in an effort to expand the immunogenicity of the virus particle and t...

  16. The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation.

    PubMed

    Sacco, Ralph L; Roth, Gregory A; Reddy, K Srinath; Arnett, Donna K; Bonita, Ruth; Gaziano, Thomas A; Heidenreich, Paul A; Huffman, Mark D; Mayosi, Bongani M; Mendis, Shanthi; Murray, Christopher J L; Perel, Pablo; Piñeiro, Daniel J; Smith, Sidney C; Taubert, Kathryn A; Wood, David A; Zhao, Dong; Zoghbi, William A

    2016-06-01

    In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities

  17. The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation.

    PubMed

    Sacco, Ralph L; Roth, Gregory A; Reddy, K Srinath; Arnett, Donna K; Bonita, Ruth; Gaziano, Thomas A; Heidenreich, Paul A; Huffman, Mark D; Mayosi, Bongani M; Mendis, Shanthi; Murray, Christopher J L; Perel, Pablo; Piñeiro, Daniel J; Smith, Sidney C; Taubert, Kathryn A; Wood, David A; Zhao, Dong; Zoghbi, William A

    2016-06-01

    In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities

  18. The effect of increasing age on the prognosis of non-dialysis patients with chronic kidney disease receiving stable nephrology care.

    PubMed

    De Nicola, Luca; Minutolo, Roberto; Chiodini, Paolo; Borrelli, Silvio; Zoccali, Carmine; Postorino, Maurizio; Iodice, Carmela; Nappi, Felice; Fuiano, Giorgio; Gallo, Ciro; Conte, Giuseppe

    2012-08-01

    To define whether age modifies the prognosis of patients with chronic kidney disease (CKD) on nephrology care, we prospectively followed patients with CKD who have been receiving nephrology care in a clinic for 1 year or more. The incidence of end-stage renal disease (ESRD), defined by the occurrence of dialysis or transplant, or death without ESRD was estimated by a competing-risk approach, and interactions between age and risk factors tested in Cox models over a median follow-up period of 62.4 months. Of 1248 patients with stage III–V CKD, 481 were younger than 65, 410 were between 65 and 75, and 357 were over 75 years old. Within each age class, the mean estimated glomerular filtration rate(eGFR) was 31, 32, and 29 ml/min per 1.73 m2, respectively. There were 394 ESRD events and 353 deaths. The risk of ESRD was higher than the risk of death without ESRD for ages <60 years, and independent of eGFR. The ESRD risk diminished with aging but still prevailed for eGFRs of 25–35 in patients between 65 and 75 years and with an eGFR below 15 in those up to 85 years old. Proteinuria significantly increased the risk of ESRD with advancing age. Surprisingly, the unfavorable effects of cardiovascular disease on ESRD and of diabetes on survival significantly decreased with increasing age. Male gender, higher phosphate, lower body mass index, and hemoglobin were age-independent predictors for ESRD, while cardiovascular disease, lower hemoglobin, higher proteinuria and uric acid, and ESRD also predicted death. Thus, in older patients on nephrology care, the risk of ESRD prevailed overmortality even when eGFR was not severely impaired. Proteinuria increases ESRD risk, while the predictive role of other modifiable risk factors was unchanged compared with younger patients.

  19. Evaluating the Quality of Research into a Single Prognostic Biomarker: A Systematic Review and Meta-analysis of 83 Studies of C-Reactive Protein in Stable Coronary Artery Disease

    PubMed Central

    Hemingway, Harry; Philipson, Peter; Chen, Ruoling; Fitzpatrick, Natalie K.; Damant, Jacqueline; Shipley, Martin; Abrams, Keith R.; Moreno, Santiago; McAllister, Kate S. L.; Palmer, Stephen; Kaski, Juan Carlos; Timmis, Adam D.; Hingorani, Aroon D.

    2010-01-01

    Background Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease. Methods and Findings We searched MEDLINE (1966 to 2009) and EMBASE (1980 to 2009) and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years) between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17) from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78–2.17), with substantial heterogeneity (I2 = 79.5). Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol) and these had a relative risk of 1.65 (95% CI 1.39–1.96), I2 = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p<0.001) using a validated method reduced the relative risk to 1.19 (95% CI 1.13–1.25). Only two studies reported a measure of discrimination (c-statistic). In 20 studies the detection rate for subsequent events could be calculated and was 31% for a 10% false positive rate, and the calculated pooled c-statistic was 0.61 (0.57–0.66). Conclusion Multiple types of reporting bias, and publication bias, make the magnitude of any

  20. Angina Pectoris (Stable Angina)

    MedlinePlus

    ... Pressure High Blood Pressure Tools & Resources Stroke More Angina Pectoris (Stable Angina) Updated:Aug 24,2016 You may have heard the term “angina pectoris” or “stable angina” in your doctor’s office, but ...

  1. Stable electroosmotically driven actuators

    NASA Astrophysics Data System (ADS)

    Sritharan, Deepa; Motsebo, Mylene; Tumbic, Julia; Smela, Elisabeth

    2013-04-01

    We have previously presented "nastic" actuators based on electroosmotic (EO) pumping of fluid in microchannels using high electric fields for potential application in soft robotics. In this work we address two challenges facing this technology: applying EO to meso-scale devices and the stability of the pumping fluid. The hydraulic pressure achieved by EO increases with as 1/d2, where d is the depth of the microchannel, but the flow rate (which determines the stroke and the speed) is proportional to nd, where n is the number of channels. Therefore to get high force and high stroke the device requires a large number of narrow channels, which is not readily achievable using standard microfabrication techniques. Furthermore, for soft robotics the structure must be soft. In this work we present a method of fabricating a three-dimensional porous elastomer to serve as the array of channels based on a sacrificial sugar scaffold. We demonstrate the concept by fabricating small pumps. The flexible devices were made from polydimethylsiloxane (PDMS) and comprise the 3D porous elastomer flanked on either side by reservoirs containing electrodes. The second issue addressed here involves the pumping fluid. Typically, water is used for EO, but water undergoes electrolysis even at low voltages. Since EO takes place at kV, these systems must be open to release the gases. We have recently reported that propylene carbonate (PC) is pumped at a comparable rate as water and is also stable for over 30 min at 8 kV. Here we show that PC is, however, degraded by moisture, so future EO systems must prevent water from reaching the PC.

  2. Stable isotope analysis of breath using the optogalvanic effect

    NASA Astrophysics Data System (ADS)

    Murnick, Daniel E.; Colgan, M. J.; Lie, H. P.; Stoneback, D.

    1996-05-01

    A new technique based on the optogalvanic effect has been developed for the measurement of stable isotope ratios in the carbon dioxide of exhaled breath. Data obtained before and after ingestion of harmless stable isotope labeled compounds, metabolized to carbon dioxide, can be used for sensitive noninvasive diagnostics of various disease conditions. The technique uses the specificity of laser resonance spectroscopy and achieves sensitivity and accuracy typical of sophisticated isotope ratio mass spectrometers. Using fixed frequency carbon dioxide lasers, 13C/12C ratios can be determined with a precision of 2 ppm with 100 second averaging times. Multiple samples can be analyzed simultaneously providing real time continuous calibration. In a first application, analysis of 13C/12C ratios in exhaled human breath after ingestion of 13C labeled urea is being developed as a diagnostic for the bacterium H-pylori, known to be the causative agent for most peptic and duodenal ulcers.

  3. Assessment of disease activity in treated acromegalic patients using a sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure?

    PubMed

    Costa, Augusto C F; Rossi, Adriana; Martinelli, Carlos E; Machado, Hélio R; Moreira, Ayrton C

    2002-07-01

    acromegaly, we reviewed our results obtained with a sensitive GH assay. Twenty-five patients (78%) had oGTT nadir GH < 2 microg/liter. Nineteen subjects had normal age-related IGF-I levels. When the GH nadir cut-off was reduced to 1 microg/liter or less, there was a cure rate of 59.4%. IGF-I and IGFBP-3 levels were normal in 16 and 15 of these 19 patients, respectively. Furthermore, 59.4% of these 32 patients were in remission when age-normalized IGF-I levels were used as a criterion for inactive disease. All but three had GH nadir of 1 microg/liter or less. Finally, the definition of cure may be contradictory in a subgroup (9.4%) of patients with a GH nadir less than 1 microg/liter despite high-for-age IGF-I levels. In conclusion, using a sensitive GH assay it can be seen that the strictly normal postglucose GH values less than 0.25 microg/liter required for biochemical control of acromegaly are not often achieved. Furthermore, the cut-off of GH nadir 1 microg/liter or less is more closely related to normal for age serum IGF-I levels in treated acromegalic patients than 0.25 microg/liter or 2 microg/liter cut-offs. According to previous epidemiological reports, a GH level less than 2.5 microg/liter, determined by RIA, is associated with a reduction of morbidity and mortality. Therefore, our data lead us to postulate that the biochemical criterion of oGTT GH levels 1 microg/liter or less, determined by immunofluorometric assay, is a useful and accurate marker of safe GH secretion in treated acromegaly. PMID:12107214

  4. Diagnostic performance and comparative cost-effectiveness of non-invasive imaging tests in patients presenting with chronic stable chest pain with suspected coronary artery disease: a systematic overview.

    PubMed

    van Waardhuizen, Claudia N; Langhout, Marieke; Ly, Felisia; Braun, Loes; Genders, Tessa S S; Petersen, Steffen E; Fleischmann, Kirsten E; Nieman, Koen; Hunink, M G Myriam

    2014-01-01

    Several non-invasive imaging techniques are currently in use for the diagnostic workup of adult patients with stable chest pain suspected of having coronary artery disease (CAD). In this paper, we present a systematic overview of the evidence on diagnostic performance and comparative cost-effectiveness of new modalities in comparison to established technologies. A literature search for English language studies from 2009 to 2013 was performed, and two investigators independently extracted data on patient and study characteristics. The reviewed published evidence on diagnostic performance and cost-effectiveness support a strategy of CTCA as a rule out (gatekeeper) test of CAD in low- to intermediate-risk patients since it has excellent diagnostic performance and as initial imaging test is cost-effective under different willingness-to-pay thresholds. More cost-effectiveness research is needed in order to define the role and choice of cardiac stress imaging tests. PMID:25301401

  5. Three Huntington’s Disease Specific Mutation-Carrying Human Embryonic Stem Cell Lines Have Stable Number of CAG Repeats upon In Vitro Differentiation into Cardiomyocytes

    PubMed Central

    Jacquet, Laureen; Neueder, Andreas; Földes, Gabor; Karagiannis, Panagiotis; Hobbs, Carl; Jolinon, Nelly; Mioulane, Maxime; Sakai, Takao; Harding, Sian E.; Ilic, Dusko

    2015-01-01

    Huntington disease (HD; OMIM 143100), a progressive neurodegenerative disorder, is caused by an expanded trinucleotide CAG (polyQ) motif in the HTT gene. Cardiovascular symptoms, often present in early stage HD patients, are, in general, ascribed to dysautonomia. However, cardio-specific expression of polyQ peptides caused pathological response in murine models, suggesting the presence of a nervous system-independent heart phenotype in HD patients. A positive correlation between the CAG repeat size and severity of symptoms observed in HD patients has also been observed in in vitro HD cellular models. Here, we test the suitability of human embryonic stem cell (hESC) lines carrying HD-specific mutation as in vitro models for understanding molecular mechanisms of cardiac pathology seen in HD patients. We have differentiated three HD-hESC lines into cardiomyocytes and investigated CAG stability up to 60 days after starting differentiation. To assess CAG stability in other tissues, the lines were also subjected to in vivo differentiation into teratomas for 10 weeks. Neither directed differentiation into cardiomyocytes in vitro nor in vivo differentiation into teratomas, rich in immature neuronal tissue, led to an increase in the number of CAG repeats. Although the CAG stability might be cell line-dependent, induced pluripotent stem cells generated from patients with larger numbers of CAG repeats could have an advantage as a research tool for understanding cardiac symptoms of HD patients. PMID:25993131

  6. Tailoring mass drug administration to context: implementation research is critical in achieving equitable progress in the control and elimination of helminth neglected tropical diseases in sub-Saharan Africa.

    PubMed

    Dean, Laura; Page, Samantha; Hawkins, Kate; Stothard, Russell; Thomson, Rachael; Wanji, Samuel; Gyapong, Margaret; Anagbogu, Ifeoma; Molyneux, David; Theobald, Sally

    2016-07-01

    The concept of a technological quick fix or 'magic-bullet' for control and elimination of Neglected Tropical Diseases (NTDs) is flawed. NTDs are embedded within complex biological and social systems that are shaped by ecological and political contexts. This commentary emphasises the need for implementation research to address implementation gaps in the control of NTDs. With a specific focus on sub-Saharan Africa and helminth diseases amenable to preventive chemotherapy through mass drug administration, we explore the important role of context, programme partnerships and community in achieving equitable and effective NTD control. PMID:27481833

  7. Stable gastric pentadecapeptide BPC 157 in trials for inflammatory bowel disease (PL-10, PLD-116, PL 14736, Pliva, Croatia). Full and distended stomach, and vascular response.

    PubMed

    Sikiric, P; Seiwerth, S; Brcic, L; Blagaic, A B; Zoricic, I; Sever, M; Klicek, R; Radic, B; Keller, N; Sipos, K; Jakir, A; Udovicic, M; Tonkic, A; Kokic, N; Turkovic, B; Mise, S; Anic, T

    2006-12-01

    Gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419, safe in clinical trials for inflammatory bowel disease (PL 10, PLD 116, PLD 14736, Pliva, Croatia)) has a particular cytoprotective/adaptive cytoprotective activity. The cytoprotective/adaptive cytoprotection researches largely neglect that stomach distension could per se jeopardize the mucosal integrity, with constantly stretched mucosa and blood vessels, and sphincters more prone for reflux induction. After absolute alcohol instillation in fully distended rat stomach, gastric, esophageal and duodenal lesions occur. Throughout next 3 min, left gastric artery blood vessels clearly disappear at the serosal site, indicative for loss of vessels both integrity and function. Contrary, constant vessels presentation could predict the beneficial effect of applied agent. After pentadecapeptide BPC 157 instillation into the stomach the vessels presentation remains constant, and lesions of stomach, esophagus, and duodenum are inhibited. Standards (atropine, ranitidine, omeprazole) could only slightly improve the vessels presentation compared to control values, and they have only a partial effect on the lesions. In this review we emphasize BPC 157 unusual stability, and some of its important effects: effectiveness against various lesions in gastrointestinal tract, on nitric oxide (NO)-system, and NO-agents effects, on somatosensory neurons, salivary glands function, recovery of AMP-ADP-ATP system, endothelium protection, effect on endothelin, and on angiogenesis promotion. It also antagonizes other alcohol effects, including acute and chronic intoxication. Given peripherally, it counteracts the consequence of central dopamine system disturbances (receptor blockade), and induces serotonin release in substantia nigra. Therapeutic potential of BPC 157 as a cytoprotective agent is also seen in its capability to heal various wounds. Given directly into the stomach, BPC 157 instantly recovers disturbed lower esophageal

  8. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system.

    PubMed

    Jiang, Lixin; Krumholz, Harlan M; Li, Xi; Li, Jing; Hu, Shengshou

    2015-10-10

    China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.

  9. Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system.

    PubMed

    Jiang, Lixin; Krumholz, Harlan M; Li, Xi; Li, Jing; Hu, Shengshou

    2015-10-10

    China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies. PMID:26466053

  10. Low grade inflammation as a common pathogenetic denominator in age-related diseases: novel drug targets for anti-ageing strategies and successful ageing achievement.

    PubMed

    Candore, G; Caruso, C; Jirillo, E; Magrone, T; Vasto, S

    2010-01-01

    Nowadays, people are living much longer than they used to do, however they are not free from ageing. Ageing, an inexorable intrinsic process that affects all cells, tissues, organs and individuals, is a post-maturational process that, due to a diminished homeostasis and increased organism frailty, causes a reduction of the response to environmental stimuli and, in general, is associated to an increased predisposition to illness and death. However, the high incidence of death due to infectious, cardiovascular and cancer diseases underlies a common feature in these pathologies that is represented by dysregulation of both instructive and innate immunity. Several studies show that a low-grade systemic inflammation characterizes ageing and that inflammatory markers are significant predictors of mortality in old humans. This pro-inflammatory status of the elderly underlies biological mechanisms responsible for physical function decline and age-related diseases such as Alzheimer's disease and atherosclerosis are initiated or worsened by systemic inflammation. Understanding of the ageing process should have a prominent role in new strategies for extending the health old population. Accordingly, as extensively discussed in the review and in the accompanying related papers, investigating ageing pathophysiology, particularly disentangling age-related low grade inflammation, is likely to provide important clues about how to develop drugs that can slow or delay ageing.

  11. Achieving universal access for human immunodeficiency virus and tuberculosis: potential prevention impact of an integrated multi-disease prevention campaign in kenya.

    PubMed

    Granich, Reuben; Muraguri, Nicolas; Doyen, Alexandre; Garg, Navneet; Williams, Brian G

    2012-01-01

    In 2009, Government of Kenya with key stakeholders implemented an integrated multi-disease prevention campaign for water-borne diseases, malaria and HIV in Kisii District, Nyanza Province. The three day campaign, targeting 5000 people, included testing and counseling (HTC), condoms, long-lasting insecticide-treated bednets, and water filters. People with HIV were offered on-site CD4 cell counts, condoms, co-trimoxazole, and HIV clinic referral. We analysed the CD4 distributions from a district hospital cohort, campaign participants and from the 2007 Kenya Aids Indicator Survey (KAIS). Of the 5198 individuals participating in the campaign, all received HTC, 329 (6.3%) tested positive, and 255 (5%) were newly diagnosed (median CD4 cell count 536 cells/μL). The hospital cohort and KAIS results included 1,284 initial CD4 counts (median 348/L) and 306 initial CD4 counts (median 550/μL), respectively (campaign and KAIS CD4 distributions P = 0.346; hospital cohort distribution was lower P < 0.001 and P < 0.001). A Nyanza Province campaign strategy including ART <350 CD4 cell count could avert approximately 35,000 HIV infections and 1,240 TB cases annually. Community-based integrated public health campaigns could be a potential solution to reach universal access and Millennium Development Goals.

  12. Effects of Atorvastatin Dose and Concomitant Use of Angiotensin-Converting Enzyme Inhibitors on Renal Function Changes over Time in Patients with Stable Coronary Artery Disease: A Prospective Observational Study.

    PubMed

    Wieczorek-Surdacka, Ewa; Świerszcz, Jolanta; Surdacki, Andrzej

    2016-01-01

    Angiotensin-converting enzyme inhibitors (ACEI) and statins are widely used in patients with coronary artery disease (CAD). Our aim was to compare changes in glomerular filtration rate (GFR) over time in subjects with stable CAD according to atorvastatin dose and concomitant use of ACEI. We studied 78 men with stable CAD referred for an elective coronary angiography who attained the then-current guideline-recommended target level of low-density lipoproteins (LDL) cholesterol below 2.5 mmol/L in a routine fasting lipid panel on admission and were receiving atorvastatin at a daily dose of 10-40 mg for ≥3 months preceding the index hospitalization. Due to an observational study design, atorvastatin dosage was not intentionally modified for other reasons. GFR was estimated during index hospitalization and at about one year after discharge from our center. Irrespective of ACEI use, a prevention of kidney function loss was observed only in those treated with the highest atorvastatin dose. In 38 subjects on ACEI, both of the higher atorvastatin doses were associated with increasing beneficial effects on GFR changes (mean ± SEM: -4.2 ± 2.4, 1.1 ± 1.6, 5.2 ± 2.4 mL/min per 1.73 m² for the 10-mg, 20-mg and 40-mg atorvastatin group, respectively, p = 0.02 by ANOVA; Spearman's rho = 0.50, p = 0.001 for trend). In sharp contrast, in 40 patients without ACEI, no significant trend effect was observed across increasing atorvastatin dosage (respective GFR changes: -1.3 ± 1.0, -4.7 ± 2.1, 4.8 ± 3.6 mL/min per 1.73 m², p = 0.02 by ANOVA; rho = 0.08, p = 0.6 for trend). The results were substantially unchanged after adjustment for baseline GFR or time-dependent variations of LDL cholesterol. Thus, concomitant ACEI use appears to facilitate the ability of increasing atorvastatin doses to beneficially modulate time-dependent changes in GFR in men with stable CAD. PMID:26848655

  13. Effects of Atorvastatin Dose and Concomitant Use of Angiotensin-Converting Enzyme Inhibitors on Renal Function Changes over Time in Patients with Stable Coronary Artery Disease: A Prospective Observational Study.

    PubMed

    Wieczorek-Surdacka, Ewa; Świerszcz, Jolanta; Surdacki, Andrzej

    2016-02-02

    Angiotensin-converting enzyme inhibitors (ACEI) and statins are widely used in patients with coronary artery disease (CAD). Our aim was to compare changes in glomerular filtration rate (GFR) over time in subjects with stable CAD according to atorvastatin dose and concomitant use of ACEI. We studied 78 men with stable CAD referred for an elective coronary angiography who attained the then-current guideline-recommended target level of low-density lipoproteins (LDL) cholesterol below 2.5 mmol/L in a routine fasting lipid panel on admission and were receiving atorvastatin at a daily dose of 10-40 mg for ≥3 months preceding the index hospitalization. Due to an observational study design, atorvastatin dosage was not intentionally modified for other reasons. GFR was estimated during index hospitalization and at about one year after discharge from our center. Irrespective of ACEI use, a prevention of kidney function loss was observed only in those treated with the highest atorvastatin dose. In 38 subjects on ACEI, both of the higher atorvastatin doses were associated with increasing beneficial effects on GFR changes (mean ± SEM: -4.2 ± 2.4, 1.1 ± 1.6, 5.2 ± 2.4 mL/min per 1.73 m² for the 10-mg, 20-mg and 40-mg atorvastatin group, respectively, p = 0.02 by ANOVA; Spearman's rho = 0.50, p = 0.001 for trend). In sharp contrast, in 40 patients without ACEI, no significant trend effect was observed across increasing atorvastatin dosage (respective GFR changes: -1.3 ± 1.0, -4.7 ± 2.1, 4.8 ± 3.6 mL/min per 1.73 m², p = 0.02 by ANOVA; rho = 0.08, p = 0.6 for trend). The results were substantially unchanged after adjustment for baseline GFR or time-dependent variations of LDL cholesterol. Thus, concomitant ACEI use appears to facilitate the ability of increasing atorvastatin doses to beneficially modulate time-dependent changes in GFR in men with stable CAD.

  14. The Promise of Observational Studies (ECLIPSE, SPIROMICS, and COPDGene) in Achieving the Goal of Personalized Treatment of Chronic Obstructive Pulmonary Disease.

    PubMed

    Rennard, Stephen I

    2015-08-01

    Personalized medicine is based on the concept that individuals differ from one another. Chronic obstructive pulmonary disease (COPD) is particularly in need of a personalized medicine strategy. However, while the COPD population is characterized by a marked degree of heterogeneity at the etiologic, mechanistic, physiologic, and clinical levels, efforts to cluster COPD patients into meaningful groups that can guide therapy have been limited. Three large observational studies-the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE), the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS), and COPDGene-are underway and/or being analyzed. These studies have accumulated a uniquely rich set of clinical and biological data on relatively large cohorts of patients who have already influenced the way in which COPD is viewed. These studies have great potential to advance understanding of COPD so that the goal of personalized treatment can be pursued.

  15. Graded Achievement, Tested Achievement, and Validity

    ERIC Educational Resources Information Center

    Brookhart, Susan M.

    2015-01-01

    Twenty-eight studies of grades, over a century, were reviewed using the argument-based approach to validity suggested by Kane as a theoretical framework. The review draws conclusions about the meaning of graded achievement, its relation to tested achievement, and changes in the construct of graded achievement over time. "Graded…

  16. Effects of Low-Dose and Long-Term Treatment with Erythromycin on Interleukin-17 and Interleukin-23 in Peripheral Blood and Induced Sputum in Patients with Stable Chronic Obstructive Pulmonary Disease

    PubMed Central

    Tan, Caimei; Huang, Huijuan; Zhang, Jianquan; He, Zhiyi; Zhong, Xiaoning; Bai, Jing

    2016-01-01

    Objective. To study the effects of low-dose and long-term treatment with erythromycin on IL-17 and IL-23, in peripheral blood and induced sputum, in patients with stable chronic obstructive pulmonary disease (COPD). Methods. Patients were randomly divided into placebo-treated group, group A (12 months of additive treatment with erythromycin, N = 18), and group B (6 months of additive treatment with erythromycin followed by 6 months of follow-up, N = 18). Inflammatory cells in induced sputum, pulmonary function, and the 6-minute walk distance (6MWD) were analyzed. Concentrations of IL-17 and IL-23 in peripheral blood and sputum were measured using enzyme-linked immunosorbent assays. Results. After treatment, sputum and peripheral blood concentrations of IL-17 and IL-23 significantly decreased in groups A and B compared with placebo-treated group. There were no significant differences after erythromycin withdrawal at months 9 and 12 in group B compared with placebo-treated group. An increase in 6MWD was observed after treatment. Conclusions. Erythromycin was beneficial and reduced airway inflammation in COPD patients. Underlying mechanisms may involve inhibition of IL-17 and IL-23 mediated airway inflammation. COPD patients treated with erythromycin for 6 months experienced improved exercise capacity. Finally, treatment for 12 months may be more effective than treatment for 6 months. PMID:27127346

  17. Addition of hydrochlorothiazide to angiotensin receptor blocker therapy can achieve a lower sodium balance with no acceleration of intrarenal renin angiotensin system in patients with chronic kidney disease

    PubMed Central

    Fuwa, Daisuke; Fukuda, Michio; Ogiyama, Yoshiaki; Sato, Ryo; Mizuno, Masashi; Miura, Toshiyuki; Abe-Dohmae, Sumiko; Michikawa, Makoto; Kobori, Hiroyuki; Ohte, Nobuyuki

    2016-01-01

    Objective Angiotensin receptor blockers (ARBs) produce a lower sodium (Na) balance, and the natriuretic effect is enhanced under Na deprivation, despite falls in blood pressure (BP) and glomerular filtration rate (GFR). Methods The effect of additional hydrochlorothiazide (HCTZ; 12.5 mg/day) to ARB treatment (valsartan; 80 mg/day) on glomerulotubular Na balance was evaluated in 23 patients with chronic kidney disease. Results Add-on HCTZ decreased GFR, tubular Na load, and tubular Na reabsorption (tNa), although 24-hour urinary Na excretion (UNaV) remained constant. Daily urinary angiotensinogen excretion (UAGTV, 152±10→82±17 μg/g Cre) reduced (p=0.02). Changes in tubular Na load (r2=0.26) and tNa (r2=0.25) correlated with baseline 24-hour UAGTV. Changes in filtered Na load correlated with changes in nighttime systolic BP (r2=0.17), but not with changes in daytime systolic BP. The change in the tNa to filtered Na load ratio was influenced by the change in daytime UNaV (β=−0.67, F=16.8), rather than the change in nighttime UNaV. Conclusions Lower Na balance was produced by add-on HCTZ to ARB treatment without an increase of intra-renal renin-angiotensin system activity, leading to restoration of nocturnal hypertension. A further study is needed to demonstrate that the reduction of UAGTV by additional diuretics to ARBs prevents the progression of nephropathy or cardiovascular events. PMID:27283968

  18. How stable are the 'stable ancient shields'?

    NASA Astrophysics Data System (ADS)

    Viola, Giulio; Mattila, Jussi

    2014-05-01

    "Archean cratons are relatively flat, stable regions of the crust that have remained undeformed since the Precambrian, forming the ancient cores of the continents" (King, EPSL, 2005). While this type of statement is supported by a wealth of constraints in the case of episodes of thoroughgoing ductile deformation affecting shield regions of Archean and also Peleoproterozoic age, a growing amount of research indicates that shields are not nearly as structurally stable within the broad field of environmental conditions leading to brittle deformation. In fact, old crystalline basements usually present compelling evidence of long brittle deformation histories, often very complex and challenging to unfold. Recent structural and geochronological studies point to a significant mechanical instability of the shield areas, wherein large volumes of 'stable' rocks actually can become saturated with fractures and brittle faults soon after regional cooling exhumes them to below c. 300-350° C. How cold, rigid and therefore strong shields respond to applied stresses remains, however, still poorly investigated and understood. This in turn precludes a better definition of the shallow rheological properties of large, old crystalline blocks. In particular, we do not yet have good constraints on the mechanisms of mechanical reactivation that control the partial (if not total) accommodation of new deformational episodes by preexisting structures, which remains a key to untangle brittle histories lasting several hundred Myr. In our analysis, we use the Svecofennian Shield (SS) as an example of a supposedly 'stable' region with Archean nucleii and Paleoproterozoic cratonic areas to show how it is possible to unravel the details of brittle histories spanning more than 1.5 Gyr. New structural and geochronological results from Finland are integrated with a review of existing data from Sweden to explore how the effects of far-field stresses are partitioned within a shield, which was growing

  19. The Stable Pairing Problem

    ERIC Educational Resources Information Center

    Greenwell, Raymond N.; Seabold, Daniel E.

    2014-01-01

    The Gale-Shapley stable marriage theorem is a fascinating piece of twentieth-century mathematics that has many practical applications--from labor markets to school admissions--yet is accessible to secondary school mathematics students. David Gale and Lloyd Shapley were both mathematicians and economists who published their work on the Stable…

  20. Stable Ejection Seat

    NASA Technical Reports Server (NTRS)

    Hirsch, R. S.

    1986-01-01

    Drogue chute for ejection seat slows down seat in more stable fashion than conventional parachutes and thus improves chances for survival. Square drogue linked to seat from its corners suppresses tendency of seat to rotate in pitch and yaw. New parachute expected to reduce dynamic forces on ejected person and extend maximum possible ejection altitude by 50 percent. Used at high or low speeds.

  1. Stable Unhappy Marriages.

    ERIC Educational Resources Information Center

    Heaton, Tim B.; Albrecht, Stan L.

    1991-01-01

    Examined prevalence and determinants of stable unhappy marriage using data from national survey. Results indicated age, lack of prior marital experience, commitment to marriage as an institution, low social activity, lack of control over one's life, and belief that divorce would detract from happiness were all predictive of stability in unhappy…

  2. Stable isotope studies

    SciTech Connect

    Ishida, T.

    1992-01-01

    The research has been in four general areas: (1) correlation of isotope effects with molecular forces and molecular structures, (2) correlation of zero-point energy and its isotope effects with molecular structure and molecular forces, (3) vapor pressure isotope effects, and (4) fractionation of stable isotopes. 73 refs, 38 figs, 29 tabs.

  3. Large HDL Subfraction But Not HDL-C Is Closely Linked With Risk Factors, Coronary Severity and Outcomes in a Cohort of Nontreated Patients With Stable Coronary Artery Disease: A Prospective Observational Study.

    PubMed

    Li, Jian-Jun; Zhang, Yan; Li, Sha; Cui, Chuan-Jue; Zhu, Cheng-Gang; Guo, Yuan-Lin; Wu, Na-Qiong; Xu, Rui-Xia; Liu, Geng; Dong, Qian; Sun, Jing

    2016-01-01

    High-density lipoprotein (HDL) is highly heterogeneous in its size and composition. Till now, the link of HDL subfractions to coronary risk is less clear. We aimed to investigate the associations of HDL subfractions with traditional risk factors (RFs), coronary severity, and outcomes in a cohort of nontreated patients with stable coronary artery disease (CAD). We prospectively enrolled 591 eligible patients. Baseline HDL subfractions were separated by Lipoprint system. HDL subfractions (large, medium, and small) and HDL-cholesterol (HDL-C) levels were dichotomized into low and high group according to the 50 percentile. Coronary severity was evaluated by SYNTAX, Gensini, and Jeopardy scoring systems. Patients were followed up annually for major adverse cardiovascular events (MACEs). Cox proportional hazards' models were used to evaluate the risk of HDL subfractions on MACEs. Patients with high large HDL-C levels had a decreased number of RFs. Significantly, large HDL-C levels were negatively associated with coronary severity assessed by SYNTAX and Gensini score (both P < 0.05). New MACEs occurred in 67 (11.6%) patients during a median 17.0 months follow-up. Moreover, the log-rank test revealed that there was a significant difference between high and low large HDL-C groups in event-free survival analysis (P = 0.013), but no differences were observed in total HDL-C groups and medium or small HDL-C groups (both P > 0.05). In particular, the multivariate Cox-proportional hazards model revealed that high large HDL-C was associated with lower MACEs risk (hazard ratio [95% confidence interval] 0.531 [0.295-0.959]) independent of potential confounders. Higher large HDL-C but not medium, small, or total HDL-C is associated with lower cardiovascular risk, highlighting the potential beneficial of HDL subfractionation.

  4. Handbook of stable strontium

    SciTech Connect

    Skoryna, S.C.

    1981-01-01

    This book presents information on the following topics: chemistry of strontium; biogeochemistry of strontium; uptake of stable strontium by plants and effects on plant growth; divalent cation-dependent deposits in paramecium; effects of strontium ion on the hydrolysis of ATP; stronium ions and membranes - screening versus binding at charged surfaces; mitochondrial granules in the liver of rats kept on stable strontium supplementation; divalent cations and regulation of cyclic nucleotides in nervous systems; strontium as the substitute for calcium in the excitation-contraction coupling of crayfish muscle fibers; hemodynamic effects of strontium in the dog; some mechanical characteristics of strontium-mediated contractions in heart muscle; effects of calcium, magnesium, and strontium on drug-receptor interactions; strontium and histamine secretion; and effects of strontium in human dental enamel.

  5. Stable glow discharge detector

    DOEpatents

    Koo, Jackson C.; Yu, Conrad M.

    2004-05-18

    A highly sensitive electronic ion cell for the measurement of trace elements in He carrier gas which involves glow discharge. A constant wave (CW) stable glow discharge detector which is controlled through a biased resistor, can detect the change of electron density caused by impurities in the He carrier gas by many orders of magnitude larger than that caused by direct ionization or electron capture. The stable glow discharge detector utilizes a floating pseudo-electrode to form a probe in or near the plasma and a solid rod electrode. By using this probe, the large variation of electron density due to trace amounts of impurities can be directly measured. The solid rod electrode provides greater stability and thus easier alignment.

  6. Stable isotopes in mineralogy

    USGS Publications Warehouse

    O'Neil, J.R.

    1977-01-01

    Stable isotope fractionations between minerals are functions of the fundamental vibrational frequencies of the minerals and therefore bear on several topics of mineralogical interest. Isotopic compositions of the elements H, C, O, Si, and S can now be determined routinely in almost any mineral. A summary has been made of both published and new results of laboratory investigations, analyses of natural materials, and theoretical considerations which bear on the importance of temperature, pressure, chemical composition and crystal structure to the isotopic properties of minerals. It is shown that stable isotope studies can sometimes provide evidence for elucidating details of crystal structure and can be a powerful tool for use in tracing the reaction paths of mineralogical reactions. ?? 1977 Springer-Verlag.

  7. Stable local oscillator module.

    SciTech Connect

    Brocato, Robert Wesley

    2007-11-01

    This report gives a description of the development of a Stable Local Oscillator (StaLO) multi-chip module (MCM). It is a follow-on report to SAND2006-6414, Stable Local Oscillator Microcircuit. The StaLO accepts a 100MHz input signal and produces output signals at 1.2, 3.3, and 3.6 GHz. The circuit is built as a multi-chip module (MCM), since it makes use of integrated circuit technologies in silicon and lithium niobate as well as discrete passive components. This report describes the development of an MCM-based version of the complete StaLO, fabricated on an alumina thick film hybrid substrate.

  8. Stable Charged Cosmic Strings

    SciTech Connect

    Weigel, H.; Quandt, M.; Graham, N.

    2011-03-11

    We study the quantum stabilization of a cosmic string by a heavy fermion doublet in a reduced version of the standard model. We show that charged strings, obtained by populating fermionic bound state levels, become stable if the electroweak bosons are coupled to a fermion that is less than twice as heavy as the top quark. This result suggests that extraordinarily large fermion masses or unrealistic couplings are not required to bind a cosmic string in the standard model. Numerically we find the most favorable string profile to be a simple trough in the Higgs vacuum expectation value of radius {approx_equal}10{sup -18} m. The vacuum remains stable in our model, because neutral strings are not energetically favored.

  9. Stable charged cosmic strings.

    PubMed

    Weigel, H; Quandt, M; Graham, N

    2011-03-11

    We study the quantum stabilization of a cosmic string by a heavy fermion doublet in a reduced version of the standard model. We show that charged strings, obtained by populating fermionic bound state levels, become stable if the electroweak bosons are coupled to a fermion that is less than twice as heavy as the top quark. This result suggests that extraordinarily large fermion masses or unrealistic couplings are not required to bind a cosmic string in the standard model. Numerically we find the most favorable string profile to be a simple trough in the Higgs vacuum expectation value of radius ≈10(-18)  m. The vacuum remains stable in our model, because neutral strings are not energetically favored. PMID:21469786

  10. Thermally stable laminating resins

    NASA Technical Reports Server (NTRS)

    Jones, R. J.; Vaughan, R. W.; Burns, E. A.

    1972-01-01

    Improved thermally stable laminating resins were developed based on the addition-type pyrolytic polymerization. Detailed monomer and polymer synthesis and characterization studies identified formulations which facilitate press molding processing and autoclave fabrication of glass and graphite fiber reinforced composites. A specific resin formulation, termed P10P was utilized to prepare a Courtaulds HMS reinforced simulated airfoil demonstration part by an autoclave molding process.

  11. Forensic Stable Isotope Biogeochemistry

    NASA Astrophysics Data System (ADS)

    Cerling, Thure E.; Barnette, Janet E.; Bowen, Gabriel J.; Chesson, Lesley A.; Ehleringer, James R.; Remien, Christopher H.; Shea, Patrick; Tipple, Brett J.; West, Jason B.

    2016-06-01

    Stable isotopes are being used for forensic science studies, with applications to both natural and manufactured products. In this review we discuss how scientific evidence can be used in the legal context and where the scientific progress of hypothesis revisions can be in tension with the legal expectations of widely used methods for measurements. Although this review is written in the context of US law, many of the considerations of scientific reproducibility and acceptance of relevant scientific data span other legal systems that might apply different legal principles and therefore reach different conclusions. Stable isotopes are used in legal situations for comparing samples for authenticity or evidentiary considerations, in understanding trade patterns of illegal materials, and in understanding the origins of unknown decedents. Isotope evidence is particularly useful when considered in the broad framework of physiochemical processes and in recognizing regional to global patterns found in many materials, including foods and food products, drugs, and humans. Stable isotopes considered in the larger spatial context add an important dimension to forensic science.

  12. Dynamically stable magnetic suspension/bearing system

    DOEpatents

    Post, R.F.

    1996-02-27

    A magnetic bearing system contains magnetic subsystems which act together to support a rotating element in a state of dynamic equilibrium. However, owing to the limitations imposed by Earnshaw`s Theorem, the magnetic bearing systems to be described do not possess a stable equilibrium at zero rotational speed. Therefore, mechanical stabilizers are provided, in each case, to hold the suspended system in equilibrium until its speed has exceeded a low critical speed where dynamic effects take over, permitting the achievement of a stable equilibrium for the rotating object. A state of stable equilibrium is achieved above a critical speed by use of a collection of passive elements using permanent magnets to provide their magnetomotive excitation. The magnetic forces exerted by these elements, when taken together, levitate the rotating object in equilibrium against external forces, such as the force of gravity or forces arising from accelerations. At the same time, this equilibrium is made stable against displacements of the rotating object from its equilibrium position by using combinations of elements that possess force derivatives of such magnitudes and signs that they can satisfy the conditions required for a rotating body to be stably supported by a magnetic bearing system over a finite range of those displacements. 32 figs.

  13. Dynamically stable magnetic suspension/bearing system

    DOEpatents

    Post, Richard F.

    1996-01-01

    A magnetic bearing system contains magnetic subsystems which act together to support a rotating element in a state of dynamic equilibrium. However, owing to the limitations imposed by Earnshaw's Theorem, the magnetic bearing systems to be described do not possess a stable equilibrium at zero rotational speed. Therefore, mechanical stabilizers are provided, in each case, to hold the suspended system in equilibrium until its speed has exceeded a low critical speed where dynamic effects take over, permitting the achievement of a stable equilibrium for the rotating object. A state of stable equilibrium is achieved above a critical speed by use of a collection of passive elements using permanent magnets to provide their magnetomotive excitation. The magnetic forces exerted by these elements, when taken together, levitate the rotating object in equilibrium against external forces, such as the force of gravity or forces arising from accelerations. At the same time, this equilibrium is made stable against displacements of the rotating object from its equilibrium position by using combinations of elements that possess force derivatives of such magnitudes and signs that they can satisfy the conditions required for a rotating body to be stably supported by a magnetic bearing system over a finite range of those displacements.

  14. Modeling the dynamics of stable isotope tissue-diet enrichment.

    PubMed

    Remien, Christopher H

    2015-02-21

    Reconstructions of dietary composition and trophic level from stable isotope measurements of animal tissue rely on predictable offsets of stable isotope ratios from diet to tissue. Physiological processes associated with metabolism shape tissue stable isotope ratios, and as such the spacing between stable isotope ratios of diet and tissue may be influenced by processes such as growth, nutritional stress, and disease. Here, we develop a model of incorporation stable isotopes in diet to tissues by coupling stable isotope dynamics to a model of macronutrient energy metabolism. We use the model to explore the effect of changes in dietary intake, both composition and amount, and in energy expenditure, on body mass and carbon and nitrogen stable isotope ratios of tissue.

  15. Comparing Science Achievement Constructs: Targeted and Achieved

    ERIC Educational Resources Information Center

    Ferrara, Steve; Duncan, Teresa

    2011-01-01

    This article illustrates how test specifications based solely on academic content standards, without attention to other cognitive skills and item response demands, can fall short of their targeted constructs. First, the authors inductively describe the science achievement construct represented by a statewide sixth-grade science proficiency test.…

  16. Stable predictive control horizons

    NASA Astrophysics Data System (ADS)

    Estrada, Raúl; Favela, Antonio; Raimondi, Angelo; Nevado, Antonio; Requena, Ricardo; Beltrán-Carbajal, Francisco

    2012-04-01

    The stability theory of predictive and adaptive predictive control for processes of linear and stable nature is based on the hypothesis of a physically realisable driving desired trajectory (DDT). The formal theoretical verification of this hypothesis is trivial for processes with a stable inverse, but it is not for processes with an unstable inverse. The extended strategy of predictive control was developed with the purpose of overcoming methodologically this stability problem and it has delivered excellent performance and stability in its industrial applications given a suitable choice of the prediction horizon. From a theoretical point of view, the existence of a prediction horizon capable of ensuring stability for processes with an unstable inverse was proven in the literature. However, no analytical solution has been found for the determination of the prediction horizon values which guarantee stability, in spite of the theoretical and practical interest of this matter. This article presents a new method able to determine the set of prediction horizon values which ensure stability under the extended predictive control strategy formulation and a particular performance criterion for the design of the DDT generically used in many industrial applications. The practical application of this method is illustrated by means of simulation examples.

  17. Focus on ulcerative colitis: stable gastric pentadecapeptide BPC 157.

    PubMed

    Sikiric, P; Seiwerth, S; Rucman, R; Turkovic, B; Rokotov, D S; Brcic, L; Sever, M; Klicek, R; Radic, B; Drmic, D; Ilic, S; Kolenc, D; Stambolija, V; Zoricic, Z; Vrcic, H; Sebecic, B

    2012-01-01

    Stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419) may be the new drug stable in human gastric juice, effective both in the upper and lower GI tract, and free of side effects. BPC 157, in addition to an antiulcer effect efficient in therapy of inflammatory bowel disease (IBD) (PL 14736) so far only tested in clinical phase II, has a very safe profile, and exhibited a particular wound healing effect. It also has shown to interact with the NO-system, providing endothelium protection and angiogenic effect, even in severely impaired conditions (i.e., it stimulated expression of early growth response 1 gene responsible for cytokine and growth factor generation and early extracellular matrix (collagen) formation (but also its repressor nerve growth factor 1-A binding protein-2)), important to counteract severe complications of advanced and poorly controlled IBD. Hopefully, the lessons from animal studies, particularly advanced intestinal anastomosis healing, reversed short bowel syndrome and fistula healing indicate BPC 157's high significance in further IBD therapy. Also, this supportive evidence (i.e., no toxic effect, limit test negative, LD1 not achieved, no side effect in trials) may counteract the problems commonly exercised in the use of peptidergic agents, particularly those used on a long-term basis. PMID:22300085

  18. Mobility and Reading Achievement.

    ERIC Educational Resources Information Center

    Waters, Theresa Z.

    A study examined the effect of geographic mobility on elementary school students' achievement. Although such mobility, which requires students to make multiple moves among schools, can have a negative impact on academic achievement, the hypothesis for the study was that it was not a determining factor in reading achievement test scores. Subjects…

  19. Stable lepton mass matrices

    NASA Astrophysics Data System (ADS)

    Domcke, Valerie; Romanino, Andrea

    2016-06-01

    We study natural lepton mass matrices, obtained assuming the stability of physical flavour observables with respect to the variations of individual matrix elements. We identify all four possible stable neutrino textures from algebraic conditions on their entries. Two of them turn out to be uniquely associated to specific neutrino mass patterns. We then concentrate on the semi-degenerate pattern, corresponding to an overall neutrino mass scale within the reach of future experiments. In this context we show that i) the neutrino and charged lepton mixings and mass matrices are largely constrained by the requirement of stability, ii) naturalness considerations give a mild preference for the Majorana phase most relevant for neutrinoless double- β decay, α ˜ π/2, and iii) SU(5) unification allows to extend the implications of stability to the down quark sector. The above considerations would benefit from an experimental determination of the PMNS ratio | U 32 /U 31|, i.e. of the Dirac phase δ.

  20. Stable local oscillator microcircuit.

    SciTech Connect

    Brocato, Robert Wesley

    2006-10-01

    This report gives a description of the development of a Stable Local Oscillator (StaLO) Microcircuit. The StaLO accepts a 100MHz input signal and produces output signals at 1.2, 3.3, and 3.6 GHz. The circuit is built as a multi-chip module (MCM), since it makes use of integrated circuit technologies in silicon and lithium niobate as well as discrete passive components. The StaLO uses a comb generator followed by surface acoustic wave (SAW) filters. The comb generator creates a set of harmonic components of the 100MHz input signal. The SAW filters are narrow bandpass filters that are used to select the desired component and reject all others. The resulting circuit has very low sideband power levels and low phase noise (both less than -40dBc) that is limited primarily by the phase noise level of the input signal.

  1. Bi-stable optical actuator

    DOEpatents

    Holdener, Fred R.; Boyd, Robert D.

    2000-01-01

    The present invention is a bi-stable optical actuator device that is depowered in both stable positions. A bearing is used to transfer motion and smoothly transition from one state to another. The optical actuator device may be maintained in a stable position either by gravity or a restraining device.

  2. Production of highly concentrated, heat stable hepatitis B surface antigen in maize

    PubMed Central

    Hayden, Celine A.; Egelkrout, Erin M.; Moscoso, Alessa M.; Enrique, Cristina; Keener, Todd K.; Jimenez-Flores, Rafael; Wong, Jeffrey C.; Howard, John A.

    2012-01-01

    Summary Plant-based oral vaccines are a promising emergent technology that could help alleviate disease burden worldwide by providing a low-cost, heat stable, oral alternative to parenterally administered commercial vaccines. Here we describe high-level accumulation of the hepatitis B surface antigen (HBsAg) at a mean concentration of 0.51%TSP in maize T1 seeds using an improved version of the globulin1 promoter. This concentration is more than four-fold higher than any previously reported lines. HBsAg expressed in maize seeds was extremely heat stable, tolerating temperatures up to 55°C for one month without degradation. Optimal heat stability was achieved after oil extraction of ground maize material, either by supercritical fluid extraction or hexane treatment. The contributions of this material towards the development of a practical oral vaccine delivery system are discussed. PMID:22816734

  3. Construct validity of Stable-2000 and Stable-2007 scores.

    PubMed

    Nunes, Kevin L; Babchishin, Kelly M

    2012-02-01

    We addressed the construct validity of Stable-2000 and Stable-2007 scores by examining correlations between selected items and validated independent measures of relevant constructs in samples of convicted sex offenders. In Study 1, the Child Molester Attitudes item of the Stable-2000 shared 23% of the variance with a self-report measure of beliefs supportive of child molestation, r(19) = .48. The Deviant Sexual Interests items of the Stable-2000 and Stable-2007 shared 7% to 66% of the variance, respectively, with an offense-history-based measure of pedophilic interests, r(18) = .27 for the Stable-2000 and r(11) = .81 for the Stable-2007. In Study 2, the Lovers/Intimate Partners, General Social Rejection/Loneliness, Rapist Attitudes, and Child Molester Attitudes items of the Stable-2000 shared 4% to 19% of the variance with self-report measures of, respectively, intimacy, r(90) = -.44; loneliness, r(88) = .34; beliefs supportive of rape, r(72) = .21; and beliefs supportive of child molestation, r(78) = .36. The results generally suggest that the Stable items examined are associated with measures of similar constructs; however, the degree of convergence was lower than expected. More systematic and comprehensive research is needed to examine convergence of the Stable items with other relevant measures and additional aspects of construct validity. Such efforts will provide a clearer understanding of dynamic risk factors, appropriate areas of focus for treatment efforts, and, more generally, why some sex offenders recidivate.

  4. Highly stable aerosol generator

    SciTech Connect

    DeFord, Henry S.; Clark, Mark L.

    1981-01-01

    An improved compressed air nebulizer has been developed such that a uniform aerosol particle size and concentration may be produced over long time periods. This result is achieved by applying a vacuum pressure to the makeup assembly and by use of a vent tube between the atmosphere and the makeup solution. By applying appropriate vacuum pressures to the makeup solution container and by proper positioning of the vent tube, a constant level of aspirating solution may be maintained within the aspirating assembly with aspirating solution continuously replaced from the makeup solution supply. This device may also be adapted to have a plurality of aerosol generators and only one central makeup assembly.

  5. Highly stable aerosol generator

    DOEpatents

    DeFord, H.S.; Clark, M.L.

    1981-11-03

    An improved compressed air nebulizer has been developed such that a uniform aerosol particle size and concentration may be produced over long time periods. This result is achieved by applying a vacuum pressure to the makeup assembly and by use of a vent tube between the atmosphere and the makeup solution. By applying appropriate vacuum pressures to the makeup solution container and by proper positioning of the vent tube, a constant level of aspirating solution may be maintained within the aspirating assembly with aspirating solution continuously replaced from the makeup solution supply. This device may also be adapted to have a plurality of aerosol generators and only one central makeup assembly. 2 figs.

  6. Stable face representations

    PubMed Central

    Jenkins, Rob; Burton, A. Mike

    2011-01-01

    Photographs are often used to establish the identity of an individual or to verify that they are who they claim to be. Yet, recent research shows that it is surprisingly difficult to match a photo to a face. Neither humans nor machines can perform this task reliably. Although human perceivers are good at matching familiar faces, performance with unfamiliar faces is strikingly poor. The situation is no better for automatic face recognition systems. In practical settings, automatic systems have been consistently disappointing. In this review, we suggest that failure to distinguish between familiar and unfamiliar face processing has led to unrealistic expectations about face identification in applied settings. We also argue that a photograph is not necessarily a reliable indicator of facial appearance, and develop our proposal that summary statistics can provide more stable face representations. In particular, we show that image averaging stabilizes facial appearance by diluting aspects of the image that vary between snapshots of the same person. We review evidence that the resulting images can outperform photographs in both behavioural experiments and computer simulations, and outline promising directions for future research. PMID:21536553

  7. General Achievement Trends: Oklahoma

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  8. General Achievement Trends: Georgia

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  9. General Achievement Trends: Nebraska

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  10. General Achievement Trends: Arkansas

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  11. General Achievement Trends: Maryland

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  12. General Achievement Trends: Maine

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  13. General Achievement Trends: Iowa

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  14. General Achievement Trends: Texas

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  15. General Achievement Trends: Hawaii

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  16. General Achievement Trends: Kansas

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  17. General Achievement Trends: Florida

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  18. General Achievement Trends: Massachusetts

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  19. General Achievement Trends: Tennessee

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  20. General Achievement Trends: Alabama

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  1. General Achievement Trends: Virginia

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  2. General Achievement Trends: Michigan

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  3. General Achievement Trends: Colorado

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  4. Inverting the Achievement Pyramid

    ERIC Educational Resources Information Center

    White-Hood, Marian; Shindel, Melissa

    2006-01-01

    Attempting to invert the pyramid to improve student achievement and increase all students' chances for success is not a new endeavor. For decades, educators have strategized, formed think tanks, and developed school improvement teams to find better ways to improve the achievement of all students. Currently, the No Child Left Behind Act (NCLB) is…

  5. Achievement Test Program.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

    The Ohio Trade and Industrial Education Achievement Test battery is comprised of seven basic achievement tests: Machine Trades, Automotive Mechanics, Basic Electricity, Basic Electronics, Mechanical Drafting, Printing, and Sheet Metal. The tests were developed by subject matter committees and specialists in testing and research. The Ohio Trade and…

  6. School Effects on Achievement.

    ERIC Educational Resources Information Center

    Nichols, Robert C.

    The New York State Education Department conducts a Pupil Evaluation Program (PEP) in which each year all third, sixth, and ninth grade students in the state are given a series of achievement tests in reading and mathematics. The data accumulated by the department includes achievement test scores, teacher characteristics, building and curriculum…

  7. Heritability of Creative Achievement

    ERIC Educational Resources Information Center

    Piffer, Davide; Hur, Yoon-Mi

    2014-01-01

    Although creative achievement is a subject of much attention to lay people, the origin of individual differences in creative accomplishments remain poorly understood. This study examined genetic and environmental influences on creative achievement in an adult sample of 338 twins (mean age = 26.3 years; SD = 6.6 years). Twins completed the Creative…

  8. Confronting the Achievement Gap

    ERIC Educational Resources Information Center

    Gardner, David

    2007-01-01

    This article talks about the large achievement gap between children of color and their white peers. The reasons for the achievement gap are varied. First, many urban minorities come from a background of poverty. One of the detrimental effects of growing up in poverty is receiving inadequate nourishment at a time when bodies and brains are rapidly…

  9. Achieving Public Schools

    ERIC Educational Resources Information Center

    Abowitz, Kathleen Knight

    2011-01-01

    Public schools are functionally provided through structural arrangements such as government funding, but public schools are achieved in substance, in part, through local governance. In this essay, Kathleen Knight Abowitz explains the bifocal nature of achieving public schools; that is, that schools are both subject to the unitary Public compact of…

  10. Strategies for stable composite structural design

    NASA Astrophysics Data System (ADS)

    Brand, Richard A.

    1992-12-01

    Advanced composites have been effectively used in space applications such as telescopes, optical benches, and metering structures. As the sophistication of optics and instrumentation increases, the need for near-zero outgassing and extremely dimensionally stable composites becomes of paramount importance. Continuing improvements in resin and reinforcing fiber technology have resulted in a wider selection of materials for the composite designer of dimensionally stable structures. Additional improvements in metal sealing techniques promise unprecedented long-term environmental stability. These new options allow the designer to develop a dimensional stability strategy which conforms to design requirements and yields an optimum, cost-effective composite design approach. This paper addresses the major stability issues in composites and how stability can be predicted for long-term applications, along with design options to achieve program goals. Low-moisture-absorbing composites based on cyanate esters, metal sealing techniques, and long-range stability are also addressed.

  11. Aspirin and heart disease

    MedlinePlus

    ... the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology ... NE, et al. Antithrombotic and thrombolytic therapy for ischemic ... of coronary heart disease. In: Mann DL, Zipes DP, Libby P, et ...

  12. Student Achievement and Motivation

    ERIC Educational Resources Information Center

    Flammer, Gordon H.; Mecham, Robert C.

    1974-01-01

    Compares the lecture and self-paced methods of instruction on the basis of student motivation and achieveme nt, comparing motivating and demotivating factors in each, and their potential for motivation and achievement. (Authors/JR)

  13. Stable, Electroinactive Wetting Agent For Fuel Cells

    NASA Technical Reports Server (NTRS)

    Prakash, Surya G.; Olah, George A.; Narayanan, Sekharipuram R.; Surampudi, Subbarao; Halpert, Gerald

    1994-01-01

    Straight-chain perfluorooctanesulfonic acid (C8 acid) identified as innocuous and stable wetting agent for use with polytetrafluoroethylene-containing electrodes in liquid-feed direct-oxidation fuel cells suggested for use in vehicles and portable power supplies. C8 acid in small concentrations in aqueous liquid solutions of methanol, trimethoxymethane, dimethoxymethane, and trioxane enables oxidation of these substances by use of commercially available electrodes of type designed originally for use with gases. This function specific to C8 acid molecule and not achieved by other related perfluorolkanesulfonic acids.

  14. Tempered stable Lévy motion driven by stable subordinator

    NASA Astrophysics Data System (ADS)

    Gajda, Janusz; Wyłomańska, Agnieszka

    2013-08-01

    In this article we propose a new model for financial data description. Combining two independent mechanisms, namely the tempered stable process and inverse stable subordinator, we obtain a new model which captures not only the tempered stable character of the underlying data but also such a property as periods in which the values of an asset stay on the same level. Moreover, we classify our system to the family of subdiffusive processes and investigate its tail behavior. We describe in detail testing and estimation procedures for the proposed model. In the last step we calibrate our model to the real data.

  15. Documenting Reading Achievement and Growth for Students Taking Alternate Assessments

    ERIC Educational Resources Information Center

    Tindal, Gerald; Nese, Joseph F. T.; Farley, Dan; Saven, Jessica L.; Elliott, Stephen N.

    2016-01-01

    Students with disabilities have been included in state accountability systems for more than a decade; however, only in the past few years have alternate assessments of alternate achievement standards (AA-AAS) become stable enough to allow examination of these students' achievement growth. Using data from Oregon's AA-AAS in Reading during the…

  16. Gender Differences, Especially on Fifty College Board Achievement Tests.

    ERIC Educational Resources Information Center

    Stanley, Julian C.; Stumpf, Heinrich

    In a follow-up to findings published by H. Stumpf and J. Stanley (1996), the gender-related differences in enrollment in and scores on the College Board Achievement (SAT II) and Advanced Placement (AP) tests were studied. Differences in scores turned out to be rather stable from 1982 (for the Achievement tests) and 1984 (for the AP tests) through…

  17. Iowa Women of Achievement.

    ERIC Educational Resources Information Center

    Ohrn, Deborah Gore, Ed.

    1993-01-01

    This issue of the Goldfinch highlights some of Iowa's 20th century women of achievement. These women have devoted their lives to working for human rights, education, equality, and individual rights. They come from the worlds of politics, art, music, education, sports, business, entertainment, and social work. They represent Native Americans,…

  18. Achieving Peace through Education.

    ERIC Educational Resources Information Center

    Clarken, Rodney H.

    While it is generally agreed that peace is desirable, there are barriers to achieving a peaceful world. These barriers are classified into three major areas: (1) an erroneous view of human nature; (2) injustice; and (3) fear of world unity. In a discussion of these barriers, it is noted that although the consciousness and conscience of the world…

  19. Increasing Male Academic Achievement

    ERIC Educational Resources Information Center

    Jackson, Barbara Talbert

    2008-01-01

    The No Child Left Behind legislation has brought greater attention to the academic performance of American youth. Its emphasis on student achievement requires a closer analysis of assessment data by school districts. To address the findings, educators must seek strategies to remedy failing results. In a mid-Atlantic district of the Unites States,…

  20. Leadership Issues: Raising Achievement.

    ERIC Educational Resources Information Center

    Horsfall, Chris, Ed.

    This document contains five papers examining the meaning and operation of leadership as a variable affecting student achievement in further education colleges in the United Kingdom. "Introduction" (Chris Horsfall) discusses school effectiveness studies' findings regarding the relationship between leadership and effective schools, distinguishes…

  1. Achievements or Disasters?

    ERIC Educational Resources Information Center

    Goodwin, MacArthur

    2000-01-01

    Focuses on policy issues that have affected arts education in the twentieth century, such as: interest in discipline-based arts education, influence of national arts associations, and national standards and coordinated assessment. States that whether the policy decisions are viewed as achievements or disasters are for future determination. (CMK)

  2. Achieving True Consensus.

    ERIC Educational Resources Information Center

    Napier, Rod; Sanaghan, Patrick

    2002-01-01

    Uses the example of Vermont's Middlebury College to explore the challenges and possibilities of achieving consensus about institutional change. Discusses why, unlike in this example, consensus usually fails, and presents four demands of an effective consensus process. Includes a list of "test" questions on successful collaboration. (EV)

  3. School Students' Science Achievement

    ERIC Educational Resources Information Center

    Shymansky, James; Wang, Tzu-Ling; Annetta, Leonard; Everett, Susan; Yore, Larry D.

    2013-01-01

    This paper is a report of the impact of an externally funded, multiyear systemic reform project on students' science achievement on a modified version of the Third International Mathematics and Science Study (TIMSS) test in 33 small, rural school districts in two Midwest states. The systemic reform effort utilized a cascading leadership strategy…

  4. Essays on Educational Achievement

    ERIC Educational Resources Information Center

    Ampaabeng, Samuel Kofi

    2013-01-01

    This dissertation examines the determinants of student outcomes--achievement, attainment, occupational choices and earnings--in three different contexts. The first two chapters focus on Ghana while the final chapter focuses on the US state of Massachusetts. In the first chapter, I exploit the incidence of famine and malnutrition that resulted to…

  5. Assessing Handwriting Achievement.

    ERIC Educational Resources Information Center

    Ediger, Marlow

    Teachers in the school setting need to emphasize quality handwriting across the curriculum. Quality handwriting means that the written content is easy to read in either manuscript or cursive form. Handwriting achievement can be assessed, but not compared to the precision of assessing basic addition, subtraction, multiplication, and division facts.…

  6. Intelligence and Educational Achievement

    ERIC Educational Resources Information Center

    Deary, Ian J.; Strand, Steve; Smith, Pauline; Fernandes, Cres

    2007-01-01

    This 5-year prospective longitudinal study of 70,000+ English children examined the association between psychometric intelligence at age 11 years and educational achievement in national examinations in 25 academic subjects at age 16. The correlation between a latent intelligence trait (Spearman's "g"from CAT2E) and a latent trait of educational…

  7. Explorations in achievement motivation

    NASA Technical Reports Server (NTRS)

    Helmreich, Robert L.

    1982-01-01

    Recent research on the nature of achievement motivation is reviewed. A three-factor model of intrinsic motives is presented and related to various criteria of performance, job satisfaction and leisure activities. The relationships between intrinsic and extrinsic motives are discussed. Needed areas for future research are described.

  8. NCLB: Achievement Robin Hood?

    ERIC Educational Resources Information Center

    Bracey, Gerald W.

    2008-01-01

    In his "Wall Street Journal" op-ed on the 25th of anniversary of "A Nation At Risk", former assistant secretary of education Chester E. Finn Jr. applauded the report for turning U.S. education away from equality and toward achievement. It was not surprising, then, that in mid-2008, Finn arranged a conference to examine the potential "Robin Hood…

  9. Achieving All Our Ambitions

    ERIC Educational Resources Information Center

    Hartley, Tricia

    2009-01-01

    National learning and skills policy aims both to build economic prosperity and to achieve social justice. Participation in higher education (HE) has the potential to contribute substantially to both aims. That is why the Campaign for Learning has supported the ambition to increase the proportion of the working-age population with a Level 4…

  10. INTELLIGENCE, PERSONALITY AND ACHIEVEMENT.

    ERIC Educational Resources Information Center

    MUIR, R.C.; AND OTHERS

    A LONGITUDINAL DEVELOPMENTAL STUDY OF A GROUP OF MIDDLE CLASS CHILDREN IS DESCRIBED, WITH EMPHASIS ON A SEGMENT OF THE RESEARCH INVESTIGATING THE RELATIONSHIP OF ACHIEVEMENT, INTELLIGENCE, AND EMOTIONAL DISTURBANCE. THE SUBJECTS WERE 105 CHILDREN AGED FIVE TO 6.3 ATTENDING TWO SCHOOLS IN MONTREAL. EACH CHILD WAS ASSESSED IN THE AREAS OF…

  11. SALT and Spelling Achievement.

    ERIC Educational Resources Information Center

    Nelson, Joan

    A study investigated the effects of suggestopedic accelerative learning and teaching (SALT) on the spelling achievement, attitudes toward school, and memory skills of fourth-grade students. Subjects were 20 male and 28 female students from two self-contained classrooms at Kennedy Elementary School in Rexburg, Idaho. The control classroom and the…

  12. Appraising Reading Achievement.

    ERIC Educational Resources Information Center

    Ediger, Marlow

    To determine quality sequence in pupil progress, evaluation approaches need to be used which guide the teacher to assist learners to attain optimally. Teachers must use a variety of procedures to appraise student achievement in reading, because no one approach is adequate. Appraisal approaches might include: (1) observation and subsequent…

  13. Stable gastric pentadecapeptide BPC 157: novel therapy in gastrointestinal tract.

    PubMed

    Sikiric, Predrag; Seiwerth, Sven; Rucman, Rudolf; Turkovic, Branko; Rokotov, Dinko Stancic; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Drmic, Domagoj; Ilic, Spomenko; Kolenc, Danijela; Vrcic, Hrvoje; Sebecic, Bozidar

    2011-01-01

    Stable gastric pentadecapeptide BPC 157 is an anti-ulcer peptidergic agent, safe in inflammatory bowel disease clinical trials (GEPPPGKPADDAGLV, M.W. 1419, PL 14736) and wound healing, stable in human gastric juice and has no reported toxicity. We focused on BPC 157 as a therapy in peridontitis, esophagus, stomach, duodenum, intestine, liver and pancreas lesions. Particularly, it has a prominent effect on alcohol-lesions (i.e., acute, chronic) and NSAIDs-lesions (interestingly, BPC 157 both prevents and reverses adjuvant arthritis). In rat esophagitis and failed function of both lower esophageal sphincter (LES) and pyloric sphincters (PS), BPC 157 increased pressure in both sphincters till normal and reduced esophagitis. However, in healthy rats, it may decrease (PS) or increase (LES) the pressure in sphincters. It has strong angiogenic potential, it acts protectively on endothelium, prevents and reverses thrombus formation after abdominal aorta anastomosis, affects many central disturbances (i.e., dopamine and 5-HT system), the NO-system (either L-arginine and L-NAME effects), endothelin, acts as a free radical scavenger (counteracting CCl4-, paracetamol-, diclofenac-injuries) and exhibits neuroprotective properties. BPC 157 successfully heals the intestinal anastomosis, gastrocutaneous, duodenocutaneous and colocutaneous fistulas in rats, as well as interacting with the NO-system. Interestingly, the fistula closure was achieved even when the BPC 157 therapy was postponed for one month. In short-bowel syndrome escalating throughout 4 weeks, the constant weight gain above preoperative values started immediately with peroral and parental BPC 157 therapy and the villus height, crypth depth and muscle thickness (inner (circular) muscular layer) additionally increased. Thus, BPC 157 may improve gastrointestinal tract therapy. PMID:21548867

  14. Toxicity by NSAIDs. Counteraction by stable gastric pentadecapeptide BPC 157.

    PubMed

    Sikiric, Predrag; Seiwerth, Sven; Rucman, Rudolf; Turkovic, Branko; Rokotov, Dinko Stancic; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Drmic, Domagoj; Ilic, Spomenko; Kolenc, Danijela; Aralica, Gorana; Safic, Hana; Suran, Jelena; Rak, Davor; Dzidic, Senka; Vrcic, Hrvoje; Sebecic, Bozidar

    2013-01-01

    Stable gastric pentadecapeptide BPC 157 is an anti-ulcer peptidergic agent, proven in clinical trials to be both safe in inflammatory bowel disease (PL-10, PLD-116, PL 14736) and wound healing, stable in human gastric juice, with no toxicity being reported. Recently, we claim that BPC 157 may be used as an antidote against NSAIDs. We focused on BPC 157 beneficial effects on stomach, duodenum, intestine, liver and brain injuries, adjuvant arthritis, pain, hyper/hypothermia, obstructive thrombus formation and thrombolysis, blood vessel function, counteraction of prolonged bleeding and thrombocytopenia after application of various anticoagulants and antiplatelet agents and wound healing improvement. The arguments for BPC 157 antidote activity (i.e., the role of BPC 157 in cytoprotection, being a novel mediator of Robert's cytoprotection and BPC 157 beneficial effects on NSAIDs mediated lesions in the gastrointestinal tract, liver and brain and finally, counteraction of aspirin-induced prolonged bleeding and thrombocytopenia) obviously have a counteracting effect on several established side-effects of NSAIDs use. The mentioned variety of the beneficial effects portrayed by BPC 157 may well be a foundation for establishing BPC 157 as a NSAIDs antidote since no other single agent has portrayed a similar array of effects. Unlike NSAIDs, a very high safety (no reported toxicity (LD1 could be not achieved)) profile is reported for BPC 157. Also, unlike the different dosage levels of aspirin, as a NSAIDs prototype, which differ by a factor of about ten, all these beneficial and counteracting effects of BPC 157 were obtained using the equipotent dosage (μg, ng/kg) in parenteral or peroral regimens. PMID:22950504

  15. Hygrothermally stable laminated composites with optimal coupling

    NASA Astrophysics Data System (ADS)

    Haynes, Robert Andrew

    This work begins by establishing the necessary and sufficient conditions for hygrothermal stability of composite laminates. An investigation is performed into the range of coupling achievable from within all hygrothermally stable families. The minimum number of plies required to create an asymmetric hygrothermally stable stacking sequence is found to be five. Next, a rigorous and general approach for determining designs corresponding to optimal levels of coupling is established through the use of a constrained optimization procedure. Couplings investigated include extension-twist, bend-twist, extension-bend, shear-twist, and anticlastic. For extension-twist and bend-twist coupling, specimens from five- through ten-ply laminates are manufactured and tested to demonstrate hygrothermal stability and achievable levels of coupling. Nonlinear models and finite element analysis are developed, and predictions are verified through comparison with test results. Sensitivity analyses are performed to demonstrate the robustness of the hygrothermal stability and couplings to deviations in ply angle, typical of manufacturing tolerances. Comparisons are made with current state-of-the-art suboptimal layups, and significant increases in coupling over previously known levels are demonstrated.

  16. Improvements in Cd stable isotope analysis achieved through use of liquid–liquid extraction to remove organic residues from Cd separates obtained by extraction chromatography† †Electronic supplementary information (ESI) available. See DOI: 10.1039/c5ja00115c Click here for additional data file.

    PubMed Central

    Rehkämper, Mark; Kreissig, Katharina; Coles, Barry; van de Flierdt, Tina

    2016-01-01

    Organic compounds released from resins that are commonly employed for trace element separations are known to have a detrimental impact on the quality of isotopic analyses by MC-ICP-MS. A recent study highlighted that such effects can be particularly problematic for Cd stable isotope measurements (M. Gault-Ringold and C. H. Stirling, J. Anal. At. Spectrom., 2012, 27, 449–459). In this case, the final stage of sample purification commonly applies extraction chromatography with Eichrom TRU resin, which employs particles coated with octylphenyl-N,N-di-isobutyl carbamoylphosphine oxide (CMPO) dissolved in tri-n-butyl phosphate (TBP). During chromatography, it appears that some of these compounds are eluted alongside Cd and cannot be removed by evaporation due to their high boiling points. When aliquots of the zero-ε reference material were processed through the purification procedure, refluxed in concentrated HNO3 and analyzed at minimum dilution (in 1 ml 0.1 M HNO3), they yielded Cd isotopic compositions (ε114/110Cd = 4.6 ± 3.4, 2SD, n = 4) that differed significantly from the expected value, despite the use of a double spike technique to correct for instrumental mass fractionation. This result was accompanied by a 35% reduction in instrumental sensitivity for Cd. With increasing dilution of the organic resin residue, both of these effects are reduced and they are insignificant when the eluted Cd is dissolved in ≥3 ml 0.1 M HNO3. Our results, furthermore, indicate that the isotopic artefacts are most likely related to anomalous mass bias behavior. Previous studies have shown that perchloric acid can be effective at avoiding such effects (Gault-Ringold and Stirling, 2012; K. C. Crocket, M. Lambelet, T. van de Flierdt, M. Rehkämper and L. F. Robinson, Chem. Geol., 2014, 374–375, 128–140), presumably by oxidizing the resin-derived organics, but there are numerous disadvantages to its use. Here we show that liquid–liquid extraction with n-heptane removes the

  17. Earthquakes in Stable Continental Crust.

    ERIC Educational Resources Information Center

    Johnston, Arch C.; Kanter, Lisa R.

    1990-01-01

    Discussed are some of the reasons for earthquakes which occur in stable crust away from familiar zones at the ends of tectonic plates. Crust stability and the reactivation of old faults are described using examples from India and Australia. (CW)

  18. Shelf-Stable Food Safety

    MedlinePlus

    ... process of packing meat and poultry in glass bottles, corking them, and submerging them in boiling water. ... fsis.usda.gov. [ Top of Page ] Are any egg products shelf stable? Pasteurized, dried egg products can ...

  19. Stable Multibubble Sonoluminescence Bubble Patterns

    SciTech Connect

    Posakony, Gerald J.; Greenwood, Lawrence R.; Ahmed, Salahuddin

    2006-06-30

    Multibubble standing wave patterns can be generated from a flat piezoceramic transducer element propagating into water. By adding a second transducer positioned at 90 degrees from the transducer generating the standing wave, a 3-dimensional volume of stable single bubbles can be established. Further, the addition of the second transducer stabilizes the bubble pattern so that individual bubbles may be studied. The size of the bubbles and the separation of the standing waves depend on the frequency of operation. Two transducers, operating at frequencies above 500 kHz, provided the most graphic results for the configuration used in this study. At these frequencies stable bubbles exhibit a bright sonoluminescence pattern. Whereas stable SBSL is well-known, stable MBSL has not been previously reported. This paper includes discussions of the acoustic responses, standing wave patterns, and pictorial results of the separation of individual bubble of sonoluminescence in a multibubble sonoluminescence environment.

  20. Distributed Weighted Stable Marriage Problem

    NASA Astrophysics Data System (ADS)

    Amira, Nir; Giladi, Ran; Lotker, Zvi

    The Stable Matching problem was introduced by Gale and Shapley in 1962. The input for the stable matching problem is a complete bipartite K n,n graph together with a ranking for each node. Its output is a matching that does not contain a blocking pair, where a blocking pair is a pair of elements that are not matched together but rank each other higher than they rank their current mates. In this work we study the Distributed Weighted Stable Matching problem. The input to the Weighted Stable Matching problem is a complete bipartite K n,n graph and a weight function W. The ranking of each node is determined by W, i.e. node v prefers node u 1 over node u 2 if W((v,u 1)) > W((v, u 2)). Using this ranking we can solve the original Stable Matching problem. We consider two different communication models: the billboard model and the full distributed model. In the billboard model, we assume that there is a public billboard and each participant can write one message on it in each time step. In the distributed model, we assume that each node can send O(logn) bits on each edge of the K n,n . In the billboard model we prove a somewhat surprising tight bound: any algorithm that solves the Stable Matching problem requires at least n - 1 rounds. We provide an algorithm that meets this bound. In the distributed communication model we provide an algorithm named intermediation agencies algorithm, in short (IAA), that solves the Distributed Weighted Stable Marriage problem in O(sqrt{n}) rounds. This is the first sub-linear distributed algorithm that solves some subcase of the general Stable Marriage problem.

  1. Project ACHIEVE final report

    SciTech Connect

    1997-06-13

    Project ACHIEVE was a math/science academic enhancement program aimed at first year high school Hispanic American students. Four high schools -- two in El Paso, Texas and two in Bakersfield, California -- participated in this Department of Energy-funded program during the spring and summer of 1996. Over 50 students, many of whom felt they were facing a nightmare future, were given the opportunity to work closely with personal computers and software, sophisticated calculators, and computer-based laboratories -- an experience which their regular academic curriculum did not provide. Math and science projects, exercises, and experiments were completed that emphasized independent and creative applications of scientific and mathematical theories to real world problems. The most important outcome was the exposure Project ACHIEVE provided to students concerning the college and technical-field career possibilities available to them.

  2. Hadamard Factorization of Stable Polynomials

    NASA Astrophysics Data System (ADS)

    Loredo-Villalobos, Carlos Arturo; Aguirre-Hernández, Baltazar

    2011-11-01

    The stable (Hurwitz) polynomials are important in the study of differential equations systems and control theory (see [7] and [19]). A property of these polynomials is related to Hadamard product. Consider two polynomials p,q ∈ R[x]:p(x) = anxn+an-1xn-1+...+a1x+a0q(x) = bmx m+bm-1xm-1+...+b1x+b0the Hadamard product (p × q) is defined as (p×q)(x) = akbkxk+ak-1bk-1xk-1+...+a1b1x+a0b0where k = min(m,n). Some results (see [16]) shows that if p,q ∈R[x] are stable polynomials then (p×q) is stable, also, i.e. the Hadamard product is closed; however, the reciprocal is not always true, that is, not all stable polynomial has a factorization into two stable polynomials the same degree n, if n> 4 (see [15]).In this work we will give some conditions to Hadamard factorization existence for stable polynomials.

  3. [Rapid cycling--finally stable but obese--target acquired?].

    PubMed

    Reininghaus, B; Bengesser, S A; Reininghaus, E; Lackner, N; Kapfhammer, H P; Birner, A

    2014-12-01

    Overweight and obesity are common in patients with bipolar disorder. Rates of up to 70% are described in scientific publications. There is sufficient evidence that these conditions are associated with a worse course of the disease (more episodes, higher suicide and hospitality rates, worse response to lithium, somatic comorbidities). Most of the mood stabilisers lead to weight gain. This is also true for clozapine, which can be effective in therapy-refractory courses of bipolar disorder. This case report demonstrates the complexity of the treatment of bipolar disorder. A young patient in depressive stupor following a severe suicide attempt after 5 months of hospital treatment was sent to our department to perform ECT. This was not possible because of the severity of his injuries. We were able to cure the acute condition and interrupt the course of rapid cycling with a combination of clomipramine, lithium and clozapine. A stable course of four years under this medication and psychoeducation has been achieved. In this period the patient was able to lower his body mass index from 38 to 26 because of a consequent lifestyle modification.

  4. Does achievement motivation mediate the semantic achievement priming effect?

    PubMed

    Engeser, Stefan; Baumann, Nicola

    2014-10-01

    The aim of our research was to understand the processes of the prime-to-behavior effects with semantic achievement primes. We extended existing models with a perspective from achievement motivation theory and additionally used achievement primes embedded in the running text of excerpts of school textbooks to simulate a more natural priming condition. Specifically, we proposed that achievement primes affect implicit achievement motivation and conducted pilot experiments and 3 main experiments to explore this proposition. We found no reliable positive effect of achievement primes on implicit achievement motivation. In light of these findings, we tested whether explicit (instead of implicit) achievement motivation is affected by achievement primes and found this to be the case. In the final experiment, we found support for the assumption that higher explicit achievement motivation implies that achievement priming affects the outcome expectations. The implications of the results are discussed, and we conclude that primes affect achievement behavior by heightening explicit achievement motivation and outcome expectancies. PMID:24820250

  5. [Home oxygen therapy and noninvasive ventilation for stable COPD].

    PubMed

    Tachikawa, Ryo; Chin, Kazuo

    2016-05-01

    Chronic obstructive pulmonary disease (COPD) is the most common underlying disease of home oxygen therapy (HOT) and long-term noninvasive ventilation (NIV) in Japan. Although both have been increasingly used for stable COPD in clinical practice, there are numerous questions to be resolved with regard to the indication of these therapies. Here we briefly reviewed current indication and available evidence of HOT and long-term NIV for stable COPD. We also outline research agenda that should be investigated in future studies. PMID:27254949

  6. A single infusion of MDCO-216 (ApoA-1 Milano/POPC) increases ABCA1-mediated cholesterol efflux and pre-beta 1 HDL in healthy volunteers and patients with stable coronary artery disease

    PubMed Central

    Kallend, D.G.; Reijers, J.A.A.; Bellibas, S.E.; Bobillier, A.; Kempen, H.; Burggraaf, J.; Moerland, M.; Wijngaard, P.L.J.

    2016-01-01

    Aims Apolipoprotein A-1 (ApoA-1), based on epidemiology, is inversely associated with cardiovascular (CV) events. Human carriers of the ApoA-1 Milano variant have a reduced incidence of CV disease. Regression of atherosclerotic plaque burden was previously observed on intravascular ultrasound (IVUS) with ETC-216, a predecessor of MDCO-216. MDCO-216, a complex of dimeric ApoA-1 Milano and 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine, is being developed to reduce atherosclerotic plaque burden and CV events. We investigated the efficacy and safety of a single infusion of MDCO-216 in healthy volunteers and in patients with coronary artery disease (CAD). Methods and results Twenty-four healthy volunteers and 24 patients with documented CAD received a 2-h infusion of MDCO-216 in a randomized, placebo controlled, single ascending dose study. Five cohorts of healthy volunteers and four cohorts of CAD patients received ApoA-1 Milano doses ranging from 5 to 40 mg/kg. Subjects were followed for 30 days. Dose-dependent increases in ApoA-1, phospholipid, and pre-beta 1 HDL and decreases in ApoE were observed. Prominent and sustained increases in triglyceride, and decreases in HDL-C, endogenous ApoA-1 and ApoA-II occurred at doses >20 mg/kg and profound increases in ABCA1-mediated cholesterol efflux were observed. Other lipid and lipoprotein parameters were generally unchanged. MDCO-216 was well tolerated. Conclusions MDCO-216-modulated lipid parameters profoundly increased ABCA1-mediated cholesterol efflux and was well tolerated. These single-dose data support further development of this agent for reducing atherosclerotic disease and subsequent CV events. PMID:27418968

  7. Highly Stable Silver Nanoplates for Surface Plasmon Resonance Biosensing

    SciTech Connect

    Gao, Chuanbo; Lu, Zhenda; Chi, Miaofang; Liu, ying; Cheng, Quan; Yin, Yadong

    2012-01-01

    An SPR biosensor was developed by employing highly stable Au-protected Ag nanoplates (NP) as enhancers (see picture). Superior performance was achieved by depositing a thin and uniform coating of Au on the Ag surface while minimizing disruptive galvanic replacement and retaining the strong surface plasmon resonance (SPR) of the silver nanoplates.

  8. Stable Degeneracies for Ising Models

    NASA Astrophysics Data System (ADS)

    Knauf, Andreas

    2016-10-01

    We introduce and consider the notion of stable degeneracies of translation invariant energy functions, taken at spin configurations of a finite Ising model. By this term we mean the lack of injectivity that cannot be lifted by changing the interaction. We show that besides the symmetry-induced degeneracies, related to spin flip, translation and reflection, there exist additional stable degeneracies, due to more subtle symmetries. One such symmetry is the one of the Singer group of a finite projective plane. Others are described by combinatorial relations akin to trace identities. Our results resemble traits of the length spectrum for closed geodesics on a Riemannian surface of constant negative curvature. There, stable degeneracy is defined w.r.t. Teichmüller space as parameter space.

  9. Metal Stable Isotopes in Paleoceanography

    NASA Astrophysics Data System (ADS)

    Anbar, Ariel D.; Rouxel, Olivier

    2007-05-01

    Considered esoteric only a few years ago, research into the stable isotope geochemistry of transition metals is moving into the geoscience mainstream. Although initial attention focused on the potential use of some of these nontraditional isotope systems as biosignatures, they are now emerging as powerful paleoceanographic proxies. In particular, the Fe and Mo isotope systems are providing information about changes in oxygenation and metal cycling in ancient oceans. Zn, Cu, Tl, and a number of other metals and metalloids also show promise. Here we review the basis of stable isotope fractionation as it applies to these elements, analytical considerations, and the current status and future prospects of this rapidly developing research area.

  10. Achieving closure at Fernald

    SciTech Connect

    Bradburne, John; Patton, Tisha C.

    2001-02-25

    When Fluor Fernald took over the management of the Fernald Environmental Management Project in 1992, the estimated closure date of the site was more than 25 years into the future. Fluor Fernald, in conjunction with DOE-Fernald, introduced the Accelerated Cleanup Plan, which was designed to substantially shorten that schedule and save taxpayers more than $3 billion. The management of Fluor Fernald believes there are three fundamental concerns that must be addressed by any contractor hoping to achieve closure of a site within the DOE complex. They are relationship management, resource management and contract management. Relationship management refers to the interaction between the site and local residents, regulators, union leadership, the workforce at large, the media, and any other interested stakeholder groups. Resource management is of course related to the effective administration of the site knowledge base and the skills of the workforce, the attraction and retention of qualified a nd competent technical personnel, and the best recognition and use of appropriate new technologies. Perhaps most importantly, resource management must also include a plan for survival in a flat-funding environment. Lastly, creative and disciplined contract management will be essential to effecting the closure of any DOE site. Fluor Fernald, together with DOE-Fernald, is breaking new ground in the closure arena, and ''business as usual'' has become a thing of the past. How Fluor Fernald has managed its work at the site over the last eight years, and how it will manage the new site closure contract in the future, will be an integral part of achieving successful closure at Fernald.

  11. Achievement Goals and Achievement Emotions: A Meta-Analysis

    ERIC Educational Resources Information Center

    Huang, Chiungjung

    2011-01-01

    This meta-analysis synthesized 93 independent samples (N = 30,003) in 77 studies that reported in 78 articles examining correlations between achievement goals and achievement emotions. Achievement goals were meaningfully associated with different achievement emotions. The correlations of mastery and mastery approach goals with positive achievement…

  12. Bayesian stable isotope mixing models

    EPA Science Inventory

    In this paper we review recent advances in Stable Isotope Mixing Models (SIMMs) and place them into an over-arching Bayesian statistical framework which allows for several useful extensions. SIMMs are used to quantify the proportional contributions of various sources to a mixtur...

  13. Stable Black Families. Final Report.

    ERIC Educational Resources Information Center

    Gary, Lawrence E.; And Others

    This document is the final report of a study conducted to determine what factors contribute to strong Black family life and how these strong families solve problems, in order to add to the knowledge base on stable families so as to enhance practical intervention with families in need, and to identify models of self-help strategies used by stable…

  14. Synthesis of thermally stable polymers

    NASA Technical Reports Server (NTRS)

    Butler, G. B.

    1978-01-01

    The reaction of bis triazo linediones with divinyl esters and substituted styrenes was investigated. Twenty new polymers were derived via reaction of two previously synthesized bis triazol linediones and four new bis atriazol linediones with eight styrenes. The structure and polymer properties of these thermally stable polymers was examined. The reaction of triazo linediones with enol esters was also considered.

  15. Ultra-stable oscillator with complementary transistors

    NASA Technical Reports Server (NTRS)

    Kleinberg, L. L. (Inventor)

    1974-01-01

    A high frequency oscillator, having both good short and long term stability, is formed by including a piezoelectric crystal in the base circuit of a first bi-polar transistor circuit, the bi-polar transistor itself operated below its transitional frequency and having its emitter load chosen so that the input impedance, looking into the base thereof, exhibits a negative resistance in parallel with a capacitive reactance. Combined with this basic circuit is an auxiliary, complementary, second bi-polar transistor circuit of the same form with the piezoelectric crystal being common to both circuits. By this configuration small changes in quiescent current are substantially cancelled by opposite variations in the second bi-polar transistor circuit, thereby achieving from the oscillator a signal having its frequency of oscillation stable over long time periods as well as short time periods.

  16. Entrepreneur achievement. Liaoning province.

    PubMed

    Zhao, R

    1994-03-01

    This paper reports the successful entrepreneurial endeavors of members of a 20-person women's group in Liaoning Province, China. Jing Yuhong, a member of the Family Planning Association at Shileizi Village, Dalian City, provided the basis for their achievements by first building an entertainment/study room in her home to encourage married women to learn family planning. Once stocked with books, magazines, pamphlets, and other materials on family planning and agricultural technology, dozens of married women in the neighborhood flocked voluntarily to the room. Yuhong also set out to give these women a way to earn their own income as a means of helping then gain greater equality with their husbands and exert greater control over their personal reproductive and social lives. She gave a section of her farming land to the women's group, loaned approximately US$5200 to group members to help them generate income from small business initiatives, built a livestock shed in her garden for the group to raise marmots, and erected an awning behind her house under which mushrooms could be grown. The investment yielded $12,000 in the first year, allowing each woman to keep more than $520 in dividends. Members then soon began going to fairs in the capital and other places to learn about the outside world, and have successfully ventured out on their own to generate individual incomes. Ten out of twenty women engaged in these income-generating activities asked for and got the one-child certificate.

  17. Thermally Stable, Latent Olefin Metathesis Catalysts

    PubMed Central

    Thomas, Renee M.; Fedorov, Alexey; Keitz, Benjamin K.

    2011-01-01

    Highly thermally stable N-aryl,N-alkyl N-heterocyclic carbene (NHC) ruthenium catalysts were designed and synthesized for latent olefin metathesis. These catalysts showed excellent latent behavior toward metathesis reactions, whereby the complexes were inactive at ambient temperature and initiated at elevated temperatures, a challenging property to achieve with second generation catalysts. A sterically hindered N-tert-butyl substituent on the NHC ligand of the ruthenium complex was found to induce latent behavior toward cross-metathesis reactions, and exchange of the chloride ligands for iodide ligands was necessary to attain latent behavior during ring-opening metathesis polymerization (ROMP). Iodide-based catalysts showed no reactivity toward ROMP of norbornene-derived monomers at 25 °C, and upon heating to 85 °C gave complete conversion of monomer to polymer in less than 2 hours. All of the complexes were very stable to air, moisture, and elevated temperatures up to at least 90 °C, and exhibited a long catalyst lifetime in solution at elevated temperatures. PMID:22282652

  18. Dynamic analysis of bi-stable composite plates

    NASA Astrophysics Data System (ADS)

    Diaconu, Cezar G.; Weaver, Paul M.; Arrieta, Andres F.

    2009-05-01

    The static and dynamic transitions between stable states for rectangular bi-stable laminated composite plates are considered. The laminated composite plates have nonsymmetric laminate configurations and are subjected to thermal curing in order to introduce residual stresses and to achieve bi-stability. As geometrically nonlinear effects occur, after curing, the plates are able to take multiple stable shapes at service or room temperature. A simple model for dynamic analysis of the snap-through phenomena is proposed based on strain field approximations for the plates. Hamilton's principle is applied in conjunction with the Rayleigh-Ritz method in order to achieve fast results. The model is used to evaluate the initial displacements for the stable states and also to investigate the static and dynamic transitions from one stable state to another. Parametric studies are carried out for various aspect ratios, laminate configurations and actuation loads and the results are compared with those obtained with finite element analysis in order to evaluate the accuracy of the model.

  19. Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

    PubMed Central

    Roth, Christian; Gangl, Clemens; Dalos, Daniel; Krenn, Lisa; Scherzer, Sabine; Gerken, Anna; Reinwein, Martin; Zhang, Chao; Hagmann, Michael; Wrba, Thomas; Delle-Karth, Georg; Neunteufl, Thomas; Maurer, Gerald; Vock, Paul; Mayr, Harald

    2016-01-01

    Background Age is a strong predictor of survival in patients with coronary artery disease. In elder patients with increasing co-morbidities percutaneous coronary intervention (PCI) is associated with more complications and worse outcome. The calculation of relative survival rates adjusts for the “background” mortality in the general population by correcting for age and gender. We analyzed if elder patients after elective PCI have a worse relative survival compared to younger patient groups. Methods A total of 8,342 patients who underwent elective PCI at two high volume centers between 1998 and 2009 were analyzed. Results The survival of our patients after PCI (observed survival) was slightly lower compared to the general population (expected survival) resulting in a slightly decreasing relative survival curve. In a multivariate Cox regression model age amongst others was a strong predictor of survival. Stratifying patients according to their age the relative survival curves of younger patients (Quartile 1: <58 years; 2,046 patients), elder patients (Quartile 3: 66–73 years; 2,090 patients) and very old patients (Quartile 4: >73 years; 2,307 patients) were similar. The relative survival of mid-aged patients (Quartile 2: 58–65 years; 1,899 patients) was better than that of all other patient groups. The profile of cardiovascular risk factors differs between the various groups resulting in different composition and burden of coronary plaques in an optical coherence tomography sub-study. Conclusion Patients after elective PCI have a slightly worse long-term survival compared to the age- and sex-matched general population. This is also true for different groups of age except for mid-aged patients between 58 and 63 years. Elder patients between 66 and 73 years and above 73 years have a similar relative survival compared to younger patients below 58 years, and might therefore have similar benefit from elective PCI. PMID:27105207

  20. Stable continuous-time autoregressive process driven by stable subordinator

    NASA Astrophysics Data System (ADS)

    Wyłomańska, Agnieszka; Gajda, Janusz

    2016-02-01

    In this paper we examine the continuous-time autoregressive moving average process driven by α-stable Lévy motion delayed by inverse stable subordinator. This process can be applied to high-frequency data with visible jumps and so-called "trapping-events". Those properties are often visible in financial time series but also in amorphous semiconductors, technical data describing the rotational speed of a machine working under various load regimes or data related to indoor air quality. We concentrate on the main characteristics of the examined subordinated process expressed in the language of the measures of dependence which are main tools used in statistical investigation of real data. However, because the analyzed system is based on the α-stable distribution therefore we cannot consider here the correlation (or covariance) as a main measure which indicates at the dependence inside the process. In the paper we examine the codifference, the more general measure of dependence defined for wide class of processes. Moreover we present the simulation procedure of the considered system and indicate how to estimate its parameters. The theoretical results we illustrate by the simulated data analysis.

  1. HEPEX - achievements and challenges!

    NASA Astrophysics Data System (ADS)

    Pappenberger, Florian; Ramos, Maria-Helena; Thielen, Jutta; Wood, Andy; Wang, Qj; Duan, Qingyun; Collischonn, Walter; Verkade, Jan; Voisin, Nathalie; Wetterhall, Fredrik; Vuillaume, Jean-Francois Emmanuel; Lucatero Villasenor, Diana; Cloke, Hannah L.; Schaake, John; van Andel, Schalk-Jan

    2014-05-01

    HEPEX is an international initiative bringing together hydrologists, meteorologists, researchers and end-users to develop advanced probabilistic hydrological forecast techniques for improved flood, drought and water management. HEPEX was launched in 2004 as an independent, cooperative international scientific activity. During the first meeting, the overarching goal was defined as: "to develop and test procedures to produce reliable hydrological ensemble forecasts, and to demonstrate their utility in decision making related to the water, environmental and emergency management sectors." The applications of hydrological ensemble predictions span across large spatio-temporal scales, ranging from short-term and localized predictions to global climate change and regional modeling. Within the HEPEX community, information is shared through its blog (www.hepex.org), meetings, testbeds and intercompaison experiments, as well as project reportings. Key questions of HEPEX are: * What adaptations are required for meteorological ensemble systems to be coupled with hydrological ensemble systems? * How should the existing hydrological ensemble prediction systems be modified to account for all sources of uncertainty within a forecast? * What is the best way for the user community to take advantage of ensemble forecasts and to make better decisions based on them? This year HEPEX celebrates its 10th year anniversary and this poster will present a review of the main operational and research achievements and challenges prepared by Hepex contributors on data assimilation, post-processing of hydrologic predictions, forecast verification, communication and use of probabilistic forecasts in decision-making. Additionally, we will present the most recent activities implemented by Hepex and illustrate how everyone can join the community and participate to the development of new approaches in hydrologic ensemble prediction.

  2. The Homogeneity of School Achievement.

    ERIC Educational Resources Information Center

    Cahan, Sorel

    Since the measurement of school achievement involves the administration of achievement tests to various grades on various subjects, both grade level and subject matter contribute to within-school achievement variations. To determine whether achievement test scores vary most among different fields within a grade level, or within fields among…

  3. Structure of the thermally stable Zika virus.

    PubMed

    Kostyuchenko, Victor A; Lim, Elisa X Y; Zhang, Shuijun; Fibriansah, Guntur; Ng, Thiam-Seng; Ooi, Justin S G; Shi, Jian; Lok, Shee-Mei

    2016-05-19

    Zika virus (ZIKV), formerly a neglected pathogen, has recently been associated with microcephaly in fetuses, and with Guillian-Barré syndrome in adults. Here we present the 3.7 Å resolution cryo-electron microscopy structure of ZIKV, and show that the overall architecture of the virus is similar to that of other flaviviruses. Sequence and structural comparisons of the ZIKV envelope (E) protein with other flaviviruses show that parts of the E protein closely resemble the neurovirulent West Nile and Japanese encephalitis viruses, while others are similar to dengue virus (DENV). However, the contribution of the E protein to flavivirus pathobiology is currently not understood. The virus particle was observed to be structurally stable even when incubated at 40 °C, in sharp contrast to the less thermally stable DENV. This is also reflected in the infectivity of ZIKV compared to DENV serotypes 2 and 4 (DENV2 and DENV4) at different temperatures. The cryo-electron microscopy structure shows a virus with a more compact surface. This structural stability of the virus may help it to survive in the harsh conditions of semen, saliva and urine. Antibodies or drugs that destabilize the structure may help to reduce the disease outcome or limit the spread of the virus.

  4. Remarks on search methods for stable, massive, elementary particles

    NASA Astrophysics Data System (ADS)

    Perl, Martin L.

    2001-11-01

    This paper was presented at the 69th birthday celebration of Professor Eugene Commins, honoring his research achievements. These remarks are about the experimental techniques used in the search for new stable, massive particles, particles at least as massive as the electron. A variety of experimental methods such as accelerator experiments, cosmic ray studies, searches for halo particles in the galaxy and searches for exotic particles in bulk matter are described. A summary is presented of the measured limits on the existence of new stable, massive particle. .

  5. Phase stable RF transport system

    DOEpatents

    Curtin, Michael T.; Natter, Eckard F.; Denney, Peter M.

    1992-01-01

    An RF transport system delivers a phase-stable RF signal to a load, such as an RF cavity of a charged particle accelerator. A circuit generates a calibration signal at an odd multiple frequency of the RF signal where the calibration signal is superimposed with the RF signal on a common cable that connects the RF signal with the load. Signal isolating diplexers are located at both the RF signal source end and load end of the common cable to enable the calibration to be inserted and extracted from the cable signals without any affect on the RF signal. Any phase shift in the calibration signal during traverse of the common cable is then functionally related to the phase shift in the RF signal. The calibration phase shift is used to control a phase shifter for the RF signal to maintain a stable RF signal at the load.

  6. Stable maps and Quot schemes

    NASA Astrophysics Data System (ADS)

    Popa, Mihnea; Roth, Mike

    2003-06-01

    In this paper we study the relationship between two different compactifications of the space of vector bundle quotients of an arbitrary vector bundle on a curve. One is Grothendieck's Quot scheme, while the other is a moduli space of stable maps to the relative Grassmannian. We establish an essentially optimal upper bound on the dimension of the two compactifications. Based on that, we prove that for an arbitrary vector bundle, the Quot schemes of quotients of large degree are irreducible and generically smooth. We precisely describe all the vector bundles for which the same thing holds in the case of the moduli spaces of stable maps. We show that there are in general no natural morphisms between the two compactifications. Finally, as an application, we obtain new cases of a conjecture on effective base point freeness for pluritheta linear series on moduli spaces of vector bundles.

  7. Combination of molecular, morphological, and interfacial engineering to achieve highly efficient and stable plastic solar cells.

    PubMed

    Chang, Chih-Yu; Cheng, Yen-Ju; Hung, Shih-Hsiu; Wu, Jhong-Sian; Kao, Wei-Shun; Lee, Chia-Hao; Hsu, Chain-Shu

    2012-01-24

    A flexible solar device showing exceptional air and mechanical stability is produced by simultaneously optimizing molecular structure, active layer morphology, and interface characteristics. The PFDCTBT-C8-based devices with inverted architecture exhibited excellent power conversion efficiencies of 7.0% and 6.0% on glass and flexible substrates, respectively.

  8. Advanced Thermally Stable Jet Fuels

    SciTech Connect

    A. Boehman; C. Song; H. H. Schobert; M. M. Coleman; P. G. Hatcher; S. Eser

    1998-01-01

    The Penn State program in advanced thermally stable jet fuels has five components: 1) development of mechanisms of degradation and solids formation; 2) quantitative measurement of growth of sub-micrometer and micrometer-sized particles during thermal stressing; 3) characterization of carbonaceous deposits by various instrumental and microscopic methods; 4) elucidation of the role of additives in retarding the formation of carbonaceous solids; and 5) assessment of the potential of producing high yields of cycloalkanes and hydroaromatics from coal.

  9. LP based approach to optimal stable matchings

    SciTech Connect

    Teo, Chung-Piaw; Sethuraman, J.

    1997-06-01

    We study the classical stable marriage and stable roommates problems using a polyhedral approach. We propose a new LP formulation for the stable roommates problem. This formulation is non-empty if and only if the underlying roommates problem has a stable matching. Furthermore, for certain special weight functions on the edges, we construct a 2-approximation algorithm for the optimal stable roommates problem. Our technique uses a crucial geometry of the fractional solutions in this formulation. For the stable marriage problem, we show that a related geometry allows us to express any fractional solution in the stable marriage polytope as convex combination of stable marriage solutions. This leads to a genuinely simple proof of the integrality of the stable marriage polytope. Based on these ideas, we devise a heuristic to solve the optimal stable roommates problem. The heuristic combines the power of rounding and cutting-plane methods. We present some computational results based on preliminary implementations of this heuristic.

  10. How Stable Is Stable? Function versus Community Composition

    PubMed Central

    Fernández, Ana; Huang, Suiying; Seston, Sherry; Xing, Jian; Hickey, Robert; Criddle, Craig; Tiedje, James

    1999-01-01

    The microbial community dynamics of a functionally stable, well-mixed, methanogenic reactor fed with glucose were analyzed over a 605-day period. The reactor maintained constant pH and chemical oxygen demand removal during this period. Thirty-six rrn clones from each of seven sampling events were analyzed by amplified ribosomal DNA restriction analysis (ARDRA) for the Bacteria and Archaea domains and by sequence analysis of dominant members of the community. Operational taxonomic units (OTUs), distinguished as unique ARDRA patterns, showed reproducible distribution for three sample replicates. The highest diversity was observed in the Bacteria domain. The 16S ribosomal DNA Bacteria clone library contained 75 OTUs, with the dominant OTU accounting for 13% of the total clones, but just 21 Archaea OTUs were found, and the most prominent OTU represented 50% of the clones from the respective library. Succession in methanogenic populations was observed, and two periods were distinguished: in the first, Methanobacterium formicicum was dominant, and in the second, Methanosarcina mazei and a Methanobacterium bryantii-related organism were dominant. Higher variability in Bacteria populations was detected, and the temporal OTU distribution suggested a chaotic pattern. Although dominant OTUs were constantly replaced from one sampling point to the next, phylogenetic analysis indicated that inferred physiologic changes in the community were not as dramatic as were genetic changes. Seven of eight dominant OTUs during the first period clustered with the spirochete group, although a cyclic pattern of substitution occurred among members within this order. A more flexible community structure characterized the second period, since a sequential replacement of a Eubacterium-related organism by an unrelated deep-branched organism and finally by a Propionibacterium-like species was observed. Metabolic differences among the dominant fermenters detected suggest that changes in carbon and

  11. Attitude Towards Physics and Additional Mathematics Achievement Towards Physics Achievement

    ERIC Educational Resources Information Center

    Veloo, Arsaythamby; Nor, Rahimah; Khalid, Rozalina

    2015-01-01

    The purpose of this research is to identify the difference in students' attitude towards Physics and Additional Mathematics achievement based on gender and relationship between attitudinal variables towards Physics and Additional Mathematics achievement with achievement in Physics. This research focused on six variables, which is attitude towards…

  12. The Impact of Reading Achievement on Overall Academic Achievement

    ERIC Educational Resources Information Center

    Churchwell, Dawn Earheart

    2009-01-01

    This study examined the relationship between reading achievement and achievement in other subject areas. The purpose of this study was to determine if there was a correlation between reading scores as measured by the Standardized Test for the Assessment of Reading (STAR) and academic achievement in language arts, math, science, and social studies…

  13. Circadian Activity Rhythms, Time Urgency, and Achievement Concerns.

    ERIC Educational Resources Information Center

    Watts, Barbara L.

    Many physiological and psychological processes fluctuate throughout the day in fairly stable, rhythmic patterns. The relationship between individual differences in circadian activity rhythms and a sense of time urgency were explored as well as a number of achievement-related variables. Undergraduates (N=308), whose circadian activity rhythms were…

  14. Pre-transplant achievement of negativity in minimal residual disease and French-American-British L1 morphology predict superior outcome after allogeneic transplant for Philadelphia chromosome positive acute lymphoblastic leukemia: an analysis of Southeast Asian patients.

    PubMed

    Ma, Liyuan; Hao, Siguo; Diong, Colin; Goh, Yeow-Tee; Gopalakrishnan, Sathish; Ho, Aloysius; Hwang, William; Koh, Liang-Piu; Koh, Mickey; Lim, Zi-Yi; Loh, Yvonne; Poon, Michelle; Tan, Lip-Kun; Tan, Patrick; Linn, Yeh-Ching

    2015-05-01

    To better understand predictive factors and improve the clinical outcome of allogeneic transplant for patients with Philadelphia positive acute lymphoblastic leukemia, we analyzed 67 Southeast Asian patients transplanted in our institutions. Multivariate analysis showed that disease status before transplant, year of transplant and, interestingly, French-American-British (FAB) subtype had a significant impact on overall survival (OS) and non-relapse mortality. Patients who were minimal residual disease (MRD) negative at transplant had a 3-year OS of 73% compared to those who were MRD positive (45%) and refractory (0%). The 3-year cumulative incidence of relapse was 18% and 36% for the MRD negative and positive groups, respectively. FAB L1 subtype had a significantly superior 3-year OS of 63% vs. 29% for L2 subtype. Pre-transplant use of a tyrosine kinase inhibitor significantly improved outcomes in univariate but not multivariate analysis, as it served to induce more patients into MRD negativity, which was the factor that directly improved transplant outcome.

  15. Approximated Stable Inversion for Nonlinear Systems with Nonhyperbolic Internal Dynamics. Revised

    NASA Technical Reports Server (NTRS)

    Devasia, Santosh

    1999-01-01

    A technique to achieve output tracking for nonminimum phase nonlinear systems with non- hyperbolic internal dynamics is presented. The present paper integrates stable inversion techniques (that achieve exact-tracking) with approximation techniques (that modify the internal dynamics) to circumvent the nonhyperbolicity of the internal dynamics - this nonhyperbolicity is an obstruction to applying presently available stable inversion techniques. The theory is developed for nonlinear systems and the method is applied to a two-cart with inverted-pendulum example.

  16. Cherokee Culture and School Achievement.

    ERIC Educational Resources Information Center

    Brown, Anthony D.

    1980-01-01

    Compares the effect of cooperative and competitive behaviors of Cherokee and Anglo American elementary school students on academic achievement. Suggests changes in teaching techniques and lesson organization that might raise academic achievement while taking into consideration tribal traditions that limit scholastic achievement in an…

  17. Stable vices and trailer problems.

    PubMed

    Houpt, K A

    1986-12-01

    Stable vices include oral vices such as cribbing, wood chewing, and coprophagia, as well as stall walking, weaving, pawing, and stall kicking. Some of these behaviors are escape behaviors; others are forms of self-stimulation. Most can be eliminated by pasturing rather than stall confinement. Trailering problems include failure to load, scrambling in the moving trailer, struggling in the stationary trailer, and refusal to unload. Gradual habituation to entering the trailer, the presence of another horse, or a change in trailer type can be used to treat these problems. PMID:3492249

  18. Stable Hemiaminals: 2-Aminopyrimidine Derivatives.

    PubMed

    Kwiecień, Anna; Ciunik, Zbigniew

    2015-01-01

    Stable hemiaminals can be obtained in the one-pot reaction between 2-aminopyrimidine and nitrobenzaldehyde derivatives. Ten new hemiaminals have been obtained, six of them in crystal state. The molecular stability of these intermediates results from the presence of both electron-withdrawing nitro groups as substituents on the phenyl ring and pyrimidine ring, so no further stabilisation by intramolecular interaction is required. Hemiaminal molecules possess a tetrahedral carbon atom constituting a stereogenic centre. As the result of crystallisation in centrosymmetric space groups both enantiomers are present in the crystal structure. PMID:26258772

  19. Students’ Achievement Goals, Learning-Related Emotions and Academic Achievement

    PubMed Central

    Lüftenegger, Marko; Klug, Julia; Harrer, Katharina; Langer, Marie; Spiel, Christiane; Schober, Barbara

    2016-01-01

    In the present research, the recently proposed 3 × 2 model of achievement goals is tested and associations with achievement emotions and their joint influence on academic achievement are investigated. The study was conducted with 388 students using the 3 × 2 Achievement Goal Questionnaire including the six proposed goal constructs (task-approach, task-avoidance, self-approach, self-avoidance, other-approach, other-avoidance) and the enjoyment and boredom scales from the Achievement Emotion Questionnaire. Exam grades were used as an indicator of academic achievement. Findings from CFAs provided strong support for the proposed structure of the 3 × 2 achievement goal model. Self-based goals, other-based goals and task-approach goals predicted enjoyment. Task-approach goals negatively predicted boredom. Task-approach and other-approach predicted achievement. The indirect effects of achievement goals through emotion variables on achievement were assessed using bias-corrected bootstrapping. No mediation effects were found. Implications for educational practice are discussed. PMID:27199836

  20. Persistence Length of Stable Microtubules

    NASA Astrophysics Data System (ADS)

    Hawkins, Taviare; Mirigian, Matthew; Yasar, M. Selcuk; Ross, Jennifer

    2011-03-01

    Microtubules are a vital component of the cytoskeleton. As the most rigid of the cytoskeleton filaments, they give shape and support to the cell. They are also essential for intracellular traffic by providing the roadways onto which organelles are transported, and they are required to reorganize during cellular division. To perform its function in the cell, the microtubule must be rigid yet dynamic. We are interested in how the mechanical properties of stable microtubules change over time. Some ``stable'' microtubules of the cell are recycled after days, such as in the axons of neurons or the cilia and flagella. We measured the persistence length of freely fluctuating taxol-stabilized microtubules over the span of a week and analyzed them via Fourier decomposition. As measured on a daily basis, the persistence length is independent of the contour length. Although measured over the span of the week, the accuracy of the measurement and the persistence length varies. We also studied how fluorescently-labeling the microtubule affects the persistence length and observed that a higher labeling ratio corresponded to greater flexibility. National Science Foundation Grant No: 0928540 to JLR.

  1. Stable Imaging for Astronomy (SIA)

    NASA Astrophysics Data System (ADS)

    Beaulieu, Mathilde; Ottogalli, Sebastien; Preis, Olivier; Bresson, Yves; Rivet, Jean-Pierre; Abe, Lyu; Vakili, Farrokh

    2014-07-01

    One of the most challenging fields of astronomical instrumentation is probably high-contrast imaging since it ultimately combines ultra-high sensitivity at low flux and the ability to cope with photon flux contrasts of several hundreds of millions or even more. These two aspects implicitly require that high-contrast instruments should be highly stable in the sense of the reproducibility of their measurements at different times, but also, continuously stable over time. In most high contrast instruments or experiments, their sensitivity is broken after at most tens of minutes of operation due to uncontrolled and unknown behaviour of the whole experiment regarding the environmental conditions. In this paper, we introduce a general approach of an exhaustive stability study for high-contrast imaging that has been initiated at Lagrange Laboratory, Observatoire de la Côte d'Azur (OCA). On a practical ground, one of the fundamental issues of this study is the metrology, which is the basis of all reproducible measurements. We describe a small experiment designed to understand the behaviour of one of our ultra-precise metrology tools (a commercial sub-nanometric 3-way interferometer) and derive the conditions under which its operation delivers reliable results. The approach will apply to the high-contrast imaging test-bench SPEED, under development at OCA.

  2. Paleoproxies: Heavy Stable Isotope Perspectives

    NASA Astrophysics Data System (ADS)

    Nagler, T. F.; Hippler, D.; Siebert, C.; Kramers, J. D.

    2002-12-01

    Recent advances in isotope ratio mass spectrometry, namely multiple collector ICP-MS and refined TIMS techniques, will significantly enhance the ability to measure heavy stable isotope fractionation, which will lead to the development of a wide array of process-identifying (bio)-geochemical tools. Thus far research in this area is not easily assessable to scientists outside the isotope field. This is due to the fact that analyzing heavy stable isotopes does not provide routine numbers which are per se true (the preciser the truer) but is still a highly experimental field. On the other hand resolving earth science problems requires specialists familiar with the environment being studied. So what is in there for paleoceanographers? In a first order approach, relating isotope variations to physical processes is straightforward. A prominent example are oxygen isotope variations with temperature. The total geological signal is of course far more complicated. At low temperatures, heavy stable isotopes variations have been reported for e.g. Ca, Cr, Fe, Cu, Zn, Mo and Tl. Fractionation mechanisms and physical parameters responsible for the observed variations are not yet resolved for most elements. Significant equilibrium isotope fractionation is expected from redox reactions of transition metals. However a difference in coordination number between two coexisting speciations of an element in the same oxidation state can also cause fractionation. Protonation of dissolved Mo is one case currently discussed. For paleoceanography studies, a principal distinction between transition metals essential for life (V to Zn plus Mo) or not will be helpful. In case of the former group, distinction between biogenic and abiogenic isotope fractionation will remain an important issue. For example, abiotic Fe redox reactions result in isotope fractionations indistinguishable in direction and magnitude from microbial effects. Only a combination of different stable isotope systems bears the

  3. Supraventricular tachycardia presenting in labour: A case report achieving vaginal birth and review of the literature.

    PubMed

    Bircher, C W; Farrakh, S; Gada, R

    2016-06-01

    Arrhythmias are one of the most common forms of cardiac disease presenting in pregnancy. Women with underlying arrhythmias may only present to health care professionals when they are pregnant. The most common type of sustained arrhythmia presenting in pregnancy is a supraventricular tachycardia (SVT). This can be difficult to diagnose, as symptoms such as palpitations, dizziness and shortness of breath are also common symptoms of pregnancy. We present the management of a woman who developed intrapartum SVT. Her case highlights the importance of considering the diagnosis in the antenatal period, the use of antiarrhythmic drugs, as well as the fact that achieving vaginal delivery is possible in correctly selected cases while the mother and baby remain stable. PMID:27512502

  4. Stable Isotope Ratios as Biomarkers of Diet for Health Research.

    PubMed

    O'Brien, Diane M

    2015-01-01

    Diet is a leading modifiable risk factor for chronic disease, but it remains difficult to measure accurately due to the error and bias inherent in self-reported methods of diet assessment. Consequently, there is a pressing need for more objective biomarkers of diet for use in health research. The stable isotope ratios of light elements are a promising set of candidate biomarkers because they vary naturally and reproducibly among foods, and those variations are captured in molecules and tissues with high fidelity. Recent studies have identified valid isotopic measures of short- and long-term sugar intake, meat intake, and fish intake in specific populations. These studies provide a strong foundation for validating stable isotopic biomarkers in the general US population. Approaches to improve specificity for specific foods are needed; for example, by modeling intake using multiple stable isotope ratios or by isolating and measuring specific molecules linked to foods of interest. PMID:26048703

  5. Stable Isotope Ratios as Biomarkers of Diet for Health Research.

    PubMed

    O'Brien, Diane M

    2015-01-01

    Diet is a leading modifiable risk factor for chronic disease, but it remains difficult to measure accurately due to the error and bias inherent in self-reported methods of diet assessment. Consequently, there is a pressing need for more objective biomarkers of diet for use in health research. The stable isotope ratios of light elements are a promising set of candidate biomarkers because they vary naturally and reproducibly among foods, and those variations are captured in molecules and tissues with high fidelity. Recent studies have identified valid isotopic measures of short- and long-term sugar intake, meat intake, and fish intake in specific populations. These studies provide a strong foundation for validating stable isotopic biomarkers in the general US population. Approaches to improve specificity for specific foods are needed; for example, by modeling intake using multiple stable isotope ratios or by isolating and measuring specific molecules linked to foods of interest.

  6. Stable Isotope Ratios as Biomarkers of Diet for Health Research

    PubMed Central

    O’Brien, Diane M.

    2016-01-01

    Diet is a leading modifiable risk factor for chronic disease, but it remains difficult to measure accurately due to the error and bias inherent in self-reported methods of diet assessment. Consequently there is a pressing need for more objective biomarkers of diet for use in health research. The stable isotope ratios of light elements are a promising set of candidate biomarkers because they vary naturally and reproducibly among foods, and those variations are captured in molecules and tissues with high fidelity. Recent studies have identified valid isotopic measures of short and long-term sugar intake, meat intake, and fish intake in specific populations. These studies provide a strong foundation for validating stable isotopic biomarkers in the general United States population. Approaches to improve specificity for specific foods are needed, for example, by modeling intake using multiple stable isotope ratios, or by isolating and measuring specific molecules linked to foods of interest. PMID:26048703

  7. Achievement as Resistance: The Development of a Critical Race Achievement Ideology among Black Achievers

    ERIC Educational Resources Information Center

    Carter, Dorinda J.

    2008-01-01

    In this article, Dorinda Carter examines the embodiment of a critical race achievement ideology in high-achieving black students. She conducted a yearlong qualitative investigation of the adaptive behaviors that nine high-achieving black students developed and employed to navigate the process of schooling at an upper-class, predominantly white,…

  8. Stable nuclear transformation of Eudorina elegans

    PubMed Central

    2013-01-01

    Background A fundamental step in evolution was the transition from unicellular to differentiated, multicellular organisms. Volvocine algae have been used for several decades as a model lineage to investigate the evolutionary aspects of multicellularity and cellular differentiation. There are two well-studied volvocine species, a unicellular alga (Chlamydomonas reinhardtii) and a multicellular alga with differentiated cell types (Volvox carteri). Species with intermediate characteristics also exist, which blur the boundaries between unicellularity and differentiated multicellularity. These species include the globular alga Eudorina elegans, which is composed of 16–32 cells. However, detailed molecular analyses of E. elegans require genetic manipulation. Unfortunately, genetic engineering has not yet been established for Eudorina, and only limited DNA and/or protein sequence information is available. Results Here, we describe the stable nuclear transformation of E. elegans by particle bombardment using both a chimeric selectable marker and reporter genes from different heterologous sources. Transgenic algae resistant to paromomycin were achieved using the aminoglycoside 3′-phosphotransferase VIII (aphVIII) gene of Streptomyces rimosus, an actinobacterium, under the control of an artificial promoter consisting of two V. carteri promoters in tandem. Transformants exhibited an increase in resistance to paromomycin by up to 333-fold. Co-transformation with non-selectable plasmids was achieved with a rate of 50 - 100%. The luciferase (gluc) gene from the marine copepod Gaussia princeps, which previously was engineered to match the codon usage of C. reinhardtii, was used as a reporter gene. The expression of gluc was mediated by promoters from C. reinhardtii and V. carteri. Heterologous heat shock promoters induced an increase in luciferase activity (up to 600-fold) at elevated temperatures. Long-term stability and both constitutive and inducible expression of the co

  9. Mixture of Skewed α-Stable Distributions

    NASA Astrophysics Data System (ADS)

    Shojaei, S. R. Hosseini; Nassiri, V.; Mohammadian, Gh. R.; Mohammadpour, A.

    2011-03-01

    Expectation maximization (EM) algorithm and the Bayesian techniques are two approaches for statistical inference of mixture models [3, 4]. By noting the advantages of the Bayesian methods, practitioners prefer them. However, implementing Markov chain Monte Carlo algorithms can be very complicated for stable distributions, due to the non-analytic density or distribution function formulas. In this paper, we introduce a new class of mixture of heavy-tailed distributions, called mixture of skewed stable distributions. Skewed stable distributions belongs to the exponential family and they have analytic density representation. It is shown that skewed stable distributions dominate skew stable distribution functions and they can be used to model heavy-tailed data. The class of skewed stable distributions has an analytic representation for its density function and the Bayesian inference can be done similar to the exponential family of distributions. Finally, mixture of skewed stable distributions are compared to the mixture of stable distributions through a simulations study.

  10. The significance of early, major and stable molecular responses in chronic myeloid leukemia in the imatinib era.

    PubMed

    Breccia, Massimo; Alimena, Giuliana

    2011-08-01

    Tyrosine kinase inhibitors (TKI) have dramatically changed the management and the outcome of chronic myeloid leukemia (CML) patients. Imatinib is recognized as gold standard first-line therapy and impressive clinical and cytogenetic responses are obtained in the majority of chronic phase patients treated with this drug. Quantitative polymerase chain reaction (RQ-PCR) tool is used to monitor molecular residual disease, but practical issues are associated to measurement of molecular responses. Several evidences have now proved that molecular responses have prognostic significance: patients who achieve early molecular response are more likely to obtain durable cytogenetic response and to present less rate of disease progression. While some reports indicated that achieving major molecular response (MMR) represents the most important endpoint associated to best outcome, some other reports indicated that achievement of MMR does not improve the greatest clinical benefit brought by complete cytogenetic response. In this review, we discuss on the role of molecular monitoring, the significance of early response and its correlation with outcome, the significance of major and complete molecular response, the emphasized value of a stable molecular response, the early identification of resistance presenting with increased molecular level.

  11. Brentuximab vedotin administered to platinum-refractory, transplant-naïve Hodgkin lymphoma patients can increase the proportion achieving FDG PET negative status.

    PubMed

    Onishi, Maika; Graf, Solomon A; Holmberg, Leona; Behnia, Sanaz; Shustov, Andrei R; Schiavo, Karen; Philip, Mary; Libby, Edward N; Cassaday, Ryan D; Pagel, John M; Roden, Jennifer E; Maloney, David G; Green, Damian J; Till, Brian G; Press, Oliver W; Smith, Stephen D; Gopal, Ajay K

    2015-12-01

    Normalization of fluorodeoxyglucose positron emission tomography (FDG PET) imaging prior to high-dose therapy and autologous stem cell transplantation (ASCT) improves outcomes in relapsed and refractory (RR) Hodgkin lymphoma (HL), but many patients refractory to platinum-based salvage regimens are unable to achieve this goal. We therefore investigated whether brentuximab vedotin (BV) could normalize FDG PET in platinum-refractory HL prior to ASCT. Fifteen consecutive patients with RR HL and FDG PET positive disease after platinum-based salvage therapy were treated with a median of 4 cycles of BV. Normalization of FDG PET (Deauville ≤2) occurred in 8/15 (53%) patients but was only observed in patients that had achieved partial remission or stable disease after platinum-based salvage therapy. All patients eventually proceeded to ASCT, regardless of FDG PET status. Our data suggest that BV can normalize FDG PET in a subset of patients with platinum-refractory HL prior to ASCT.

  12. Super-stable Poissonian structures

    NASA Astrophysics Data System (ADS)

    Eliazar, Iddo

    2012-10-01

    In this paper we characterize classes of Poisson processes whose statistical structures are super-stable. We consider a flow generated by a one-dimensional ordinary differential equation, and an ensemble of particles ‘surfing’ the flow. The particles start from random initial positions, and are propagated along the flow by stochastic ‘wave processes’ with general statistics and general cross correlations. Setting the initial positions to be Poisson processes, we characterize the classes of Poisson processes that render the particles’ positions—at all times, and invariantly with respect to the wave processes—statistically identical to their initial positions. These Poisson processes are termed ‘super-stable’ and facilitate the generalization of the notion of stationary distributions far beyond the realm of Markov dynamics.

  13. Stable density stratification solar pond

    NASA Technical Reports Server (NTRS)

    Lansing, F. L. (Inventor)

    1985-01-01

    A stable density-stratification solar pond for use in the collection and storage of solar thermal energy including a container having a first section characterized by an internal wall of a substantially cylindrical configuration and a second section having an internal wall of a substantially truncated conical configuration surmounting the first section in coaxial alignment therewith, the second section of said container being characterized by a base of a diameter substantially equal to the diameter of the first section and a truncated apex defining a solar energy acceptance opening is discussed. A body of immiscible liquids is disposed within the container and comprises a lower portion substantially filling the first section of the container and an upper portion substantially filling the second section of the container, said lower portion being an aqueous based liquid of a darker color than the upper portion and of a greater density. A protective cover plate is removably provided for covering the acceptance opening.

  14. A stable perfluorochemical blood substitute.

    PubMed

    Mukherji, B; Sloviter, H A

    1991-05-01

    A stable emulsion of perfluorodecalin, made up of 34 percent (vol/vol) perfluorodecalin dispersed by sonication in isotonic Tyrode's buffer (pH 7.4) containing egg yolk lecithin, has been developed. The viscosity of the emulsion is the same as that of human blood, and the particle size is 0.2 microns in diameter. On storage at 5 degrees C, there was no change in viscosity for up to 60 weeks. At 21 degrees C, viscosity increased after 20 weeks of storage; this increase was considerably diminished by the presence of tocopherol in the emulsion. The accumulation of malondialdehyde indicated that there was continuous slow oxidation of the lecithin on storage of the emulsion at either 5 or 21 degrees C; this oxidation was markedly reduced by the presence of tocopherol. PMID:2020995

  15. Dimensionally stable metallic hydride composition

    DOEpatents

    Heung, Leung K.

    1994-01-01

    A stable, metallic hydride composition and a process for making such a composition. The composition comprises a uniformly blended mixture of a metal hydride, kieselguhr, and a ballast metal, all in the form of particles. The composition is made by subjecting a metal hydride to one or more hydrogen absorption/desorption cycles to disintegrate the hydride particles to less than approximately 100 microns in size. The particles are partly oxidized, then blended with the ballast metal and the kieselguhr to form a uniform mixture. The mixture is compressed into pellets and calcined. Preferably, the mixture includes approximately 10 vol. % or more kieselguhr and approximately 50 vol. % or more ballast. Metal hydrides that can be used in the composition include Zr, Ti, V, Nb, Pd, as well as binary, tertiary, and more complex alloys of La, Al, Cu, Ti, Co, Ni, Fe, Zr, Mg, Ca, Mn, and mixtures and other combinations thereof. Ballast metals include Al, Cu and Ni.

  16. Stable line defects in silicene

    NASA Astrophysics Data System (ADS)

    Ghosh, Dibyajyoti; Parida, Prakash; Pati, Swapan K.

    2015-11-01

    Line defects in two-dimensional (2D) materials greatly modulate various properties of their pristine form. Using ab initio molecular dynamics (AIMD) simulations, we investigate the structural reconstructions of different kinds of grain boundaries in the silicene sheets. It is evident that depending upon the presence of silicon adatoms and edge shape of grain boundaries (i.e., armchair or zigzag), stable extended line defects (ELDs) can be introduced in a controlled way. Further studies show the stability of these line-defects in silicene, grown on Ag(111) surface at room-temperature. Importantly, unlike most of the 2D sheet materials such as graphene and hexagonal boron nitride, 5-5-8 line defects modify the nonmagnetic semimetallic pristine silicene sheet to spin-polarized metal. As ferromagnetically ordered magnetic moments remain strongly localized at the line defect, a one-dimensional spin channel gets created in silicene. Interestingly, these spin channels are quite stable because, unlike the edge of nanoribbons, structural reconstruction or contamination cannot destroy the ordering of magnetic moments here. Zigzag silicene nanoribbons with a 5-5-8 line defect also exhibit various interesting electronic and magnetic properties depending upon their width as well as the nature of the magnetic coupling between edge and defect spin states. Upon incorporation of other ELDs, such as 4-4-4 and 4-8 defects, 2D sheets and nanoribbons of silicene show a nonmagnetic metallic or semiconducting ground state. Highlighting the controlled formation of ELDs and consequent emergence of technologically important properties in silicene, we propose new routes to realize silicene-based nanoelectronic and spintronic devices.

  17. The Mechanics of Human Achievement

    PubMed Central

    Duckworth, Angela L.; Eichstaedt, Johannes C.; Ungar, Lyle H.

    2015-01-01

    Countless studies have addressed why some individuals achieve more than others. Nevertheless, the psychology of achievement lacks a unifying conceptual framework for synthesizing these empirical insights. We propose organizing achievement-related traits by two possible mechanisms of action: Traits that determine the rate at which an individual learns a skill are talent variables and can be distinguished conceptually from traits that determine the effort an individual puts forth. This approach takes inspiration from Newtonian mechanics: achievement is akin to distance traveled, effort to time, skill to speed, and talent to acceleration. A novel prediction from this model is that individual differences in effort (but not talent) influence achievement (but not skill) more substantially over longer (rather than shorter) time intervals. Conceptualizing skill as the multiplicative product of talent and effort, and achievement as the multiplicative product of skill and effort, advances similar, but less formal, propositions by several important earlier thinkers. PMID:26236393

  18. Uses of stable isotopes in fish ecology

    EPA Science Inventory

    Analyses of fish tissues (other than otoliths) for stable isotope ratios can provide substantial information on fish ecology, including physiological ecology. Stable isotopes of nitrogen and carbon frequently are used to determine the mix of diet sources for consumers. Stable i...

  19. Stable bound orbits around black rings

    SciTech Connect

    Igata, Takahisa; Ishihara, Hideki; Takamori, Yohsuke

    2010-11-15

    We examine bound orbits of particles around singly rotating black rings. We show that there exist stable bound orbits in toroidal spiral shape near the 'axis' of the ring, and also stable circular orbits on the axis as special cases. The stable bound orbits can have arbitrary large size if the thickness of the ring is less than a critical value.

  20. Mathematics Achievement in High- and Low-Achieving Secondary Schools

    ERIC Educational Resources Information Center

    Mohammadpour, Ebrahim; Shekarchizadeh, Ahmadreza

    2015-01-01

    This paper identifies the amount of variance in mathematics achievement in high- and low-achieving schools that can be explained by school-level factors, while controlling for student-level factors. The data were obtained from 2679 Iranian eighth graders who participated in the 2007 Trends in International Mathematics and Science Study. Of the…

  1. Achieving a Strongly Temperature-Dependent Casimir Effect

    SciTech Connect

    Rodriguez, Alejandro W.; Woolf, David; Capasso, Federico; McCauley, Alexander P.; Joannopoulos, John D.; Johnson, Steven G.

    2010-08-06

    We propose a method of achieving large temperature T sensitivity in the Casimir force that involves measuring the stable separation between dielectric objects immersed in a fluid. We study the Casimir force between slabs and spheres using realistic material models, and find large >2 nm/K variations in their stable separations (hundreds of nanometers) near room temperature. In addition, we analyze the effects of Brownian motion on suspended objects, and show that the average separation is also sensitive to changes in T. Finally, this approach also leads to rich qualitative phenomena, such as irreversible transitions, from suspension to stiction, as T is varied.

  2. Magneto-hydrodynamically stable axisymmetric mirrors

    NASA Astrophysics Data System (ADS)

    Ryutov, Dmitri

    2010-11-01

    The achievement of high beta (60%) plasma with near classical confinement in a linear axisymmetric magnetic configuration has sparked interest in the Gas Dynamic Trap concept. The significance of these results is that they can be projected directly to a neutron source for materials testing. The possibility of axisymmetric mirrors (AM) being magneto-hydrodynamically (MHD) stable is also of interest from a general physics standpoint (as it seemingly contradicts to well-established criteria of curvature-driven instabilities). The axial symmetry allows for much simpler and more reliable designs of mirror-based fusion facilities than the well-known quadrupole mirror configurations. In this tutorial, after a brief summary of classical results (in particular of the Rosenbluth-Longmire theory and of the energy principle as applied to AM) several approaches towards achieving MHD stabilization of the AM will be considered: 1) Employing the favorable field-line curvature in the end tanks; 2) Using the line-tying effect; 3) Setting the plasma in a slow or fast differential rotation; 4) Imposing a divertor configuration on the solenoidal magnetic field; 5) Controlling the plasma dynamics by the ponderomotive force; 6) Other techniques. Several of these approaches go beyond pure MHD and require accounting for finite Larmor radius effects and trapped particle modes. Some illuminative theoretical approaches for understanding axisymmetric mirror stability will be described. Wherever possible comparison of theoretical and experimental results on AM will be provided. The applicability of the various stabilization techniques to axisymmetric mirrors as neutron sources, hybrids, and pure-fusion reactors will be discussed and the constraints on the plasma parameters will be formulated. Prepared by LLNL under Contract DE-AC52-07NA27344.

  3. Attribution theory in science achievement

    NASA Astrophysics Data System (ADS)

    Craig, Martin

    Recent research reveals consistent lags in American students' science achievement scores. Not only are the scores lower in the United States compared to other developed nations, but even within the United States, too many students are well below science proficiency scores for their grade levels. The current research addresses this problem by examining potential malleable factors that may predict science achievement in twelfth graders using 2009 data from the National Assessment of Educational Progress (NAEP). Principle component factor analysis was conducted to determine the specific items that contribute to each overall factor. A series of multiple regressions were then analyzed and formed the predictive value of each of these factors for science achievement. All significant factors were ultimately examined together (also using multiple regression) to determine the most powerful predictors of science achievement, identifying factors that predict science achievement, the results of which suggested interventions to strengthen students' science achievement scores and encourage persistence in the sciences at the college level and beyond. Although there is a variety of research highlighting how students in the US are falling behind other developing nations in science and math achievement, as yet, little research has addressed ways of intervening to address this gap. The current research is a starting point, seeking to identify malleable factors that contribute to science achievement. More specifically, this research examined the types of attributions that predict science achievement in twelfth grade students.

  4. Magneto-hydrodynamically stable axisymmetric mirrors

    SciTech Connect

    Ryutov, D. D.; Cohen, B. I.; Molvik, A. W.; Berk, H. L.; Simonen, T. C.

    2011-09-15

    Making axisymmetric mirrors magnetohydrodynamically (MHD) stable opens up exciting opportunities for using mirror devices as neutron sources, fusion-fission hybrids, and pure-fusion reactors. This is also of interest from a general physics standpoint (as it seemingly contradicts well-established criteria of curvature-driven instabilities). The axial symmetry allows for much simpler and more reliable designs of mirror-based fusion facilities than the well-known quadrupole mirror configurations. In this tutorial, after a summary of classical results, several techniques for achieving MHD stabilization of the axisymmetric mirrors are considered, in particular: (1) employing the favorable field-line curvature in the end tanks; (2) using the line-tying effect; (3) controlling the radial potential distribution; (4) imposing a divertor configuration on the solenoidal magnetic field; and (5) affecting the plasma dynamics by the ponderomotive force. Some illuminative theoretical approaches for understanding axisymmetric mirror stability are described. The applicability of the various stabilization techniques to axisymmetric mirrors as neutron sources, hybrids, and pure-fusion reactors are discussed; and the constraints on the plasma parameters are formulated.

  5. Low energy stable plasma calibration facility.

    PubMed

    Frederick-Frost, K M; Lynch, K A

    2007-07-01

    We have designed and fabricated a low energy plasma calibration facility for testing and calibration of rocket-borne charged-particle detectors and for the investigation of plasma sheath formation in an environment with ionospheric plasma energies, densities, and Debye lengths. We describe the vacuum system and associated plasma source, which was modified from a Naval Research Laboratory design [Bowles et al. Rev. Sci. Instrum. 67, 455 (1996)]. Mechanical and electrical modifications to this cylindrical microwave resonant source are outlined together with a different method of operating the magnetron that achieves a stable discharge. This facility produces unmagnetized plasmas with densities from 1x10(3)/cm(3) to 6x10(5)/cm(3), electron temperatures from 0.1 to 1.7 eV, and plasma potentials from 0.5 to 8 V depending on varying input microwave power and neutral gas flow. For the range of input microwave power explored (350-600 W), the energy density of the plasma remains constant because of an inverse relationship between density and temperature. This relationship allows a wide range of Debye lengths (0.3-8.4 cm) to be investigated, which is ideal for simulating the ionospheric plasma sheaths we explore.

  6. Management of Stable Angina - Current Guidelines: A Critical Appraisal.

    PubMed

    Thadani, Udho

    2016-08-01

    Guidelines provide recommendations to improve patient outcomes, but many of the recommendations made for treating patients with stable angina are opinion based rather than evidence based. Risk stratification to predict patients at an increased risk of myocardial infarction (MI) and sudden ischemic death, and selection of patients for possible revascularization, is based on expert opinion. Randomized trials have compared optimal medical therapy to revascularization, after the coronary anatomy was known, and yet routine coronary angiography to exclude left main disease is not recommended. What exactly is optimal antianginal treatment varies considerably from one country's guideline recommendations to another. None of the antianginal drugs reduce mortality or MI and these drugs are equally effective in treating angina pectoris; and yet beta-blockers and calcium channel blockers are recommended as first line therapy. Double and triple therapy with different classes of antianginal drugs is also expert opinion based rather than evidence based. Recommendations to reduce the incidence of MI and sudden death are appropriate; however the use of a potent, high dose statin, is recommended by AHA/ACC and NICE guidelines for all patients with ischemic heart disease, while the European guidelines recommend a target LDL goal in patients with coronary artery disease (CAD). Management of patients with stable angina pectoris with normal coronary arteries remains ambiguous. This short review critically appraises the recommendations for managing patients with stable angina pectoris. PMID:27638354

  7. Perils of Standardized Achievement Testing

    ERIC Educational Resources Information Center

    Haladyna, Thomas M.

    2006-01-01

    This article argues that the validity of standardized achievement test-score interpretation and use is problematic; consequently, confidence and trust in such test scores may often be unwarranted. The problem is particularly severe in high-stakes situations. This essay provides a context for understanding standardized achievement testing, then…

  8. Poor Results for High Achievers

    ERIC Educational Resources Information Center

    Bui, Sa; Imberman, Scott; Craig, Steven

    2012-01-01

    Three million students in the United States are classified as gifted, yet little is known about the effectiveness of traditional gifted and talented (G&T) programs. In theory, G&T programs might help high-achieving students because they group them with other high achievers and typically offer specially trained teachers and a more advanced…

  9. Parental Involvement and Academic Achievement

    ERIC Educational Resources Information Center

    Goodwin, Sarah Christine

    2015-01-01

    This research study examined the correlation between student achievement and parent's perceptions of their involvement in their child's schooling. Parent participants completed the Parent Involvement Project Parent Questionnaire. Results slightly indicated parents of students with higher level of achievement perceived less demand or invitations…

  10. Examination Regimes and Student Achievement

    ERIC Educational Resources Information Center

    Cosentino de Cohen, Clemencia

    2010-01-01

    Examination regimes at the end of secondary school vary greatly intra- and cross-nationally, and in recent years have undergone important reforms often geared towards increasing student achievement. This research presents a comparative analysis of the relationship between examination regimes and student achievement in the OECD. Using a micro…

  11. General Achievement Trends: New Jersey

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  12. Teaching the Low Level Achiever.

    ERIC Educational Resources Information Center

    Salomone, Ronald E., Ed.

    1986-01-01

    Intended for teachers of the English language arts, the articles in this issue offer suggestions and techniques for teaching the low level achiever. Titles and authors of the articles are as follows: (1) "A Point to Ponder" (Rachel Martin); (2) "Tracking: A Self-Fulfilling Prophecy of Failure for the Low Level Achiever" (James Christopher Davis);…

  13. Family Status and School Achievement.

    ERIC Educational Resources Information Center

    Chalker, Rhoda N.; Horns, Virginia

    This study tested the hypothesis that there is no significant difference in reading achievement among children in grades 2 through 5 related to family structure. Researchers administered the Stanford Achievement Test to 119 students in an Alabama city suburban school system. Of the sample, 69 children lived in intact families and 50 lived in…

  14. General Achievement Trends: North Carolina

    ERIC Educational Resources Information Center

    Center on Education Policy, 2009

    2009-01-01

    This general achievement trends profile includes information that the Center on Education Policy (CEP) and the Human Resources Research Organization (HumRRO) obtained from states from fall 2008 through April 2009. Included herein are: (1) Bullet points summarizing key findings about achievement trends in that state at three performance…

  15. Classroom Composition and Achievement Gains.

    ERIC Educational Resources Information Center

    Leiter, Jeffrey

    1983-01-01

    Third-grade students in high ability groups in mathematics achieved greater gains than students in low ability groups. The opposite results occurred in reading achievement. Possible reasons for this difference include different instructional techniques for reading and math and the effect of home environment on learning. (IS)

  16. Raising Boys' Achievement in Schools.

    ERIC Educational Resources Information Center

    Bleach, Kevan, Ed.

    This book offers insights into the range of strategies and good practice being used to raise the achievement of boys. Case studies by school-based practitioners suggest ideas and measures to address the issue of achievement by boys. The contributions are: (1) "Why the Likely Lads Lag Behind" (Kevan Bleach); (2) "Helping Boys Do Better in Their…

  17. School Size and Student Achievement

    ERIC Educational Resources Information Center

    Riggen, Vicki

    2013-01-01

    This study examined whether a relationship between high school size and student achievement exists in Illinois public high schools in reading and math, as measured by the Prairie State Achievement Exam (PSAE), which is administered to all Illinois 11th-grade students. This study also examined whether the factors of socioeconomic status, English…

  18. Stress Correlates and Academic Achievement.

    ERIC Educational Resources Information Center

    Bentley, Donna Anderson; And Others

    An ongoing concern for educators is the identification of factors that contribute to or are associated with academic achievement; one such group of variables that has received little attention are those involving stress. The relationship between perceived sources of stress and academic achievement was examined to determine if reactions to stress…

  19. On nonstable and stable population momentum.

    PubMed

    Espenshade, Thomas J; Olgiati, Analia S; Levin, Simon A

    2011-11-01

    This article decomposes total population momentum into two constituent and multiplicative parts: "nonstable" momentum and "stable" momentum. Nonstable momentum depends on deviations between a population's current age distribution and its implied stable age distribution. Stable momentum is a function of deviations between a population's implied stable and stationary age distributions. In general, the factorization of total momentum into the product of nonstable and stable momentum is a very good approximation. The factorization is exact, however, when the current age distribution is stable or when observed fertility is already at replacement. We provide numerical illustrations by calculating nonstable, stable, and total momentum for 176 countries, the world, and its major regions. In short, the article brings together disparate strands of the population momentum literature and shows how the various kinds of momentum fit together into a single unifying framework.

  20. A stable monomeric nickel borohydride.

    PubMed

    Desrochers, Patrick J; LeLievre, Stacey; Johnson, Rosemary J; Lamb, Brian T; Phelps, Andrea L; Cordes, A W; Gu, Weiwei; Cramer, Stephen P

    2003-12-01

    A stable discrete nickel borohydride complex (Tp*NiBH(4) or Tp*NiBD(4)) was prepared using the nitrogen-donor ligand hydrotris(3,5-dimethylpyrazolyl)borate (Tp*-). This complex represents one of the best characterized nickel(II) borohydrides to date. Tp*NiBH(4) and Tp*NiBD(4) are stable toward air, boiling water, and high temperatures (mp > 230 degrees C dec). X-ray crystallographic measurements for Tp*NiBH(4) showed a six-coordinate geometry for the complex, with the nickel(II) center facially coordinated by three bridging hydrogen atoms from borohydride and a tridentate Tp(-) ligand. For Tp*NiBH(4), the empirical formula is C(15)H(26)B(2)N(6)Ni, a = 13.469(9) A, b = 7.740(1) A, c = 18.851(2) A, beta = 107.605(9) degrees, the space group is monoclinic P2(1)/c, and Z = 4. Infrared measurements confirmed the presence of bridging hydrogen atoms; both nu(B[bond]H)(terminal) and nu(B[bond]H)(bridging) are assignable and shifted relative to nu(B-D) of Tp*NiBD(4) by amounts in agreement with theory. Despite their hydrolytic stability, Tp*NiBH(4) and Tp*NiBD(4) readily reduce halocarbon substrates, leading to the complete series of Tp*NiX complexes (X = Cl, Br, I). These reactions showed a pronounced hydrogen/deuterium rate dependence (k(H)/k(D) approximately 3) and sharp isosbestic points in progressive electronic spectra. Nickel K-edge X-ray absorption spectroscopy (XAS) measurements of a hydride-rich nickel center were obtained for Tp*NiBH(4), Tp*NiBD(4), and Tp*NiCl. X-ray absorption near-edge spectroscopy results confirmed the similar six-coordinate geometries for Tp*NiBH(4) and Tp*NiBD(4). These contrasted with XAS results for the crystallographically characterized pseudotetrahedral Tp*NiCl complex. The stability of Tp*Ni-coordinated borohydride is significant given this ion's accelerated decomposition and hydrolysis in the presence of transition metals and simple metal salts. PMID:14632512

  1. Evolutionary routes to stable ownership.

    PubMed

    Hare, D; Reeve, H K; Blossey, B

    2016-06-01

    Ownership can evolve in potentially any species. Drawing on insights from across disciplines, we distinguish between possession and ownership and present species-neutral criteria for ownership, defined as respect for possession. We use a variant of the tug-of-war evolutionary game to demonstrate how ownership can evolve in the form of a new, biologically realistic strategy, Restraint With Retaliation (RWR). In our game, resource holding potential (RHP) is assumed to be equal between interactants, and resource holding asymmetry determines whether ownership is adaptive. RWR will be evolutionarily stable when the ratio of resource holdings between interactants is relatively low, but not when this ratio is sufficiently high. We offer RWR as one evolutionary route to ownership among many, and discuss how ownership unites previously described behavioural phenomena across taxa. We propose that some but not all mechanisms of territory formation and maintenance can be considered ownership, and show that territories are not the only resources that can be owned. We argue that ownership can be a powerful cooperative solution to tragedies of the commons and problems of collective action throughout the biological world. We advance recent scholarship that has begun to investigate the biological importance of ownership, and we call for a comprehensive account of its evolutionary logic and taxonomic distribution. We propose that ownership should be considered a fundamental, unifying biological phenomenon. PMID:26991035

  2. Evolutionary routes to stable ownership.

    PubMed

    Hare, D; Reeve, H K; Blossey, B

    2016-06-01

    Ownership can evolve in potentially any species. Drawing on insights from across disciplines, we distinguish between possession and ownership and present species-neutral criteria for ownership, defined as respect for possession. We use a variant of the tug-of-war evolutionary game to demonstrate how ownership can evolve in the form of a new, biologically realistic strategy, Restraint With Retaliation (RWR). In our game, resource holding potential (RHP) is assumed to be equal between interactants, and resource holding asymmetry determines whether ownership is adaptive. RWR will be evolutionarily stable when the ratio of resource holdings between interactants is relatively low, but not when this ratio is sufficiently high. We offer RWR as one evolutionary route to ownership among many, and discuss how ownership unites previously described behavioural phenomena across taxa. We propose that some but not all mechanisms of territory formation and maintenance can be considered ownership, and show that territories are not the only resources that can be owned. We argue that ownership can be a powerful cooperative solution to tragedies of the commons and problems of collective action throughout the biological world. We advance recent scholarship that has begun to investigate the biological importance of ownership, and we call for a comprehensive account of its evolutionary logic and taxonomic distribution. We propose that ownership should be considered a fundamental, unifying biological phenomenon.

  3. High Frequency Stable Oscillate boiling

    NASA Astrophysics Data System (ADS)

    Li, Fenfang; Gonzalez-Avila, Silvestre Roberto; Ohl, Claus Dieter

    2015-11-01

    We present an unexpected regime of resonant bubble oscillations on a thin metal film submerged in water, which is continuously heated with a focused CW laser. The oscillatory bubble dynamics reveals a remarkably stable frequency of several 100 kHz and is resolved from the side using video recordings at 1 million frames per second. The emitted sound is measured simultaneously and shows higher harmonics. Once the laser is switched on the water in contact with the metal layer is superheated and an explosively expanding cavitation bubble is generated. However, after the collapse a microbubble is nucleated from the bubble remains which displays long lasting oscillations. Generally, pinch-off from of the upper part of the microbubble is observed generating a continuous stream of small gas bubbles rising upwards. The cavitation expansion, collapse, and the jetting of gas bubbles are detected by the hydrophone and are correlated to the high speed video. We find the bubble oscillation frequency is dependent on the bubble size and surface tension. A preliminary model based on Marangoni flow and heat transfer can explain the high flow velocities observed, yet the origin of bubble oscillation is currently not well understood.

  4. Mathematics anxiety and mathematics achievement

    NASA Astrophysics Data System (ADS)

    Sherman, Brian F.; Wither (Post.), David P.

    2003-09-01

    This paper is a distillation of the major result from the 1998 Ph.D. thesis of the late David Wither. It details a longitudinal study over five years of the relationship between mathematics anxiety and mathematics achievement. It starts from the already well documented negative correlation between the two, and seeks to establish one of the three hypotheses—that mathematics anxiety causes an impairment of mathematics achievement; that lack of mathematics achievement causes mathematics anxiety; or that there is a third underlying cause of the two.

  5. Telerobotic surgery: stable force feedback with time delay

    NASA Astrophysics Data System (ADS)

    Hu, Jianjuen; Ren, Jie; Sheridan, Thomas B.

    1996-12-01

    A master-slave telerobotic surgery system has been developed in Human Machine Systems Lab at MIT. This system is composed of a master-slave telerobotic system, a two-way video/audio transmission link, a control data link, and a laparoscopic surgery simulation platform. With video, audio and force feedback, a surgeon can conduct telelaparoscopic surgery for a remote 'patient' by means of the master-slave telerobotic system. However, the force feedback can go unstable when the communication time delay of the control data link is larger than roughly 0.2 seconds. Therefore designing a stable force feedback control becomes an important issue for a telerobotic surgery system. This paper proposes a new approach to achieve stable force reflecting teleoperation control under time delay -- fuzzy sliding control (FSC). FSC is based on the conventional fuzzy control and sliding mode control both of which have been proven robust and stable. The design methodology of FSC includes the following major parts: a fuzzy sliding control law, rule tuning in the phase plane, and soft boundary layer tuning. FSC can easily be modified and applied to deal with the uncertainties and human interactions in teleoperation. In our research, a novel control structure which consists of FSC and a fuzzy supervisor has been implemented in our high bandwidth master-slave telerobotic system. It has been shown that this approach has stable force reflection and good tracking accuracy for loop delays up to 2 seconds. Experiment results are described in the paper.

  6. Advanced thermally stable jet fuels

    SciTech Connect

    Schobert, H.H.

    1999-01-31

    The Pennsylvania State University program in advanced thermally stable coal-based jet fuels has five broad objectives: (1) Development of mechanisms of degradation and solids formation; (2) Quantitative measurement of growth of sub-micrometer and micrometer-sized particles suspended in fuels during thermal stressing; (3) Characterization of carbonaceous deposits by various instrumental and microscopic methods; (4) Elucidation of the role of additives in retarding the formation of carbonaceous solids; (5) Assessment of the potential of production of high yields of cycloalkanes by direct liquefaction of coal. Future high-Mach aircraft will place severe thermal demands on jet fuels, requiring the development of novel, hybrid fuel mixtures capable of withstanding temperatures in the range of 400--500 C. In the new aircraft, jet fuel will serve as both an energy source and a heat sink for cooling the airframe, engine, and system components. The ultimate development of such advanced fuels requires a thorough understanding of the thermal decomposition behavior of jet fuels under supercritical conditions. Considering that jet fuels consist of hundreds of compounds, this task must begin with a study of the thermal degradation behavior of select model compounds under supercritical conditions. The research performed by The Pennsylvania State University was focused on five major tasks that reflect the objectives stated above: Task 1: Investigation of the Quantitative Degradation of Fuels; Task 2: Investigation of Incipient Deposition; Task 3: Characterization of Solid Gums, Sediments, and Carbonaceous Deposits; Task 4: Coal-Based Fuel Stabilization Studies; and Task 5: Exploratory Studies on the Direct Conversion of Coal to High Quality Jet Fuels. The major findings of each of these tasks are presented in this executive summary. A description of the sub-tasks performed under each of these tasks and the findings of those studies are provided in the remainder of this volume

  7. Using Design To Achieve Sustainability

    EPA Science Inventory

    Sustainability is defined as meeting the needs of this generation without compromising the ability of future generations to meet their needs. This is a conditional statement that places the responsibility for achieving sustainability squarely in hands of designers and planners....

  8. Childhood Obesity and Cognitive Achievement.

    PubMed

    Black, Nicole; Johnston, David W; Peeters, Anna

    2015-09-01

    Obese children tend to perform worse academically than normal-weight children. If poor cognitive achievement is truly a consequence of childhood obesity, this relationship has significant policy implications. Therefore, an important question is to what extent can this correlation be explained by other factors that jointly determine obesity and cognitive achievement in childhood? To answer this question, we exploit a rich longitudinal dataset of Australian children, which is linked to national assessments in math and literacy. Using a range of estimators, we find that obesity and body mass index are negatively related to cognitive achievement for boys but not girls. This effect cannot be explained by sociodemographic factors, past cognitive achievement or unobserved time-invariant characteristics and is robust to different measures of adiposity. Given the enormous importance of early human capital development for future well-being and prosperity, this negative effect for boys is concerning and warrants further investigation. PMID:26123250

  9. Mastery Achievement of Intellectual Skills.

    ERIC Educational Resources Information Center

    Trembath, Richard J.; White, Richard T.

    1979-01-01

    Mastery learning techniques were improved through mathematics instruction based on a validated learning hierarchy, presenting tasks in a sequence consistent with the requirements of the hierarchy, and requiring learners to demonstrate achievement before being allowed to proceed. (Author/GDC)

  10. Achieving Standards through Environmental Education.

    ERIC Educational Resources Information Center

    Kaspar, Mike

    1999-01-01

    Most states do not have the time or resources to develop environmental education standards from scratch. Highlights the role that environmental education and its interdisciplinary nature can play in helping students achieve. (DDR)

  11. Childhood Obesity and Cognitive Achievement.

    PubMed

    Black, Nicole; Johnston, David W; Peeters, Anna

    2015-09-01

    Obese children tend to perform worse academically than normal-weight children. If poor cognitive achievement is truly a consequence of childhood obesity, this relationship has significant policy implications. Therefore, an important question is to what extent can this correlation be explained by other factors that jointly determine obesity and cognitive achievement in childhood? To answer this question, we exploit a rich longitudinal dataset of Australian children, which is linked to national assessments in math and literacy. Using a range of estimators, we find that obesity and body mass index are negatively related to cognitive achievement for boys but not girls. This effect cannot be explained by sociodemographic factors, past cognitive achievement or unobserved time-invariant characteristics and is robust to different measures of adiposity. Given the enormous importance of early human capital development for future well-being and prosperity, this negative effect for boys is concerning and warrants further investigation.

  12. On Nonstable and Stable Population Momentum

    PubMed Central

    Olgiati, Analia S.; Levin, Simon A.

    2014-01-01

    This article decomposes total population momentum into two constituent and multiplicative parts: “nonstable” momentum and “stable” momentum. Nonstable momentum depends on deviations between a population’s current age distribution and its implied stable age distribution. Stable momentum is a function of deviations between a population’s implied stable and stationary age distributions. In general, the factorization of total momentum into the product of nonstable and stable momentum is a very good approximation. The factorization is exact, however, when the current age distribution is stable or when observed fertility is already at replacement. We provide numerical illustrations by calculating nonstable, stable, and total momentum for 176 countries, the world, and its major regions. In short, the article brings together disparate strands of the population momentum literature and shows how the various kinds of momentum fit together into a single unifying framework. PMID:21948106

  13. Stable doping of carbon nanotubes via molecular self assembly

    SciTech Connect

    Lee, B.; Chen, Y.; Podzorov, V.; Cook, A.; Zakhidov, A.

    2014-10-14

    We report a novel method for stable doping of carbon nanotubes (CNT) based on methods of molecular self assembly. A conformal growth of a self-assembled monolayer of fluoroalkyl trichloro-silane (FTS) at CNT surfaces results in a strong increase of the sheet conductivity of CNT electrodes by 60–300%, depending on the CNT chirality and composition. The charge carrier mobility of undoped partially aligned CNT films was independently estimated in a field-effect transistor geometry (~100 cm²V⁻¹s⁻¹). The hole density induced by the FTS monolayer in CNT sheets is estimated to be ~1.8 ×10¹⁴cm⁻². We also show that FTS doping of CNT anodes greatly improves the performance of organic solar cells. This large and stable doping effect, easily achieved in large-area samples, makes this approach very attractive for applications of CNTs in transparent and flexible electronics.

  14. Recombinant protein production from stable mammalian cell lines and pools.

    PubMed

    Hacker, David L; Balasubramanian, Sowmya

    2016-06-01

    We highlight recent developments for the production of recombinant proteins from suspension-adapted mammalian cell lines. We discuss the generation of stable cell lines using transposons and lentivirus vectors (non-targeted transgene integration) and site-specific recombinases (targeted transgene integration). Each of these methods results in the generation of cell lines with protein yields that are generally superior to those achievable through classical plasmid transfection that depends on the integration of the transfected DNA by non-homologous DNA end-joining. This is the main reason why these techniques can also be used for the generation of stable cell pools, heterogenous populations of recombinant cells generated by gene delivery and genetic selection without resorting to single cell cloning. This allows the time line from gene transfer to protein production to be reduced.

  15. Recombinant protein production from stable mammalian cell lines and pools.

    PubMed

    Hacker, David L; Balasubramanian, Sowmya

    2016-06-01

    We highlight recent developments for the production of recombinant proteins from suspension-adapted mammalian cell lines. We discuss the generation of stable cell lines using transposons and lentivirus vectors (non-targeted transgene integration) and site-specific recombinases (targeted transgene integration). Each of these methods results in the generation of cell lines with protein yields that are generally superior to those achievable through classical plasmid transfection that depends on the integration of the transfected DNA by non-homologous DNA end-joining. This is the main reason why these techniques can also be used for the generation of stable cell pools, heterogenous populations of recombinant cells generated by gene delivery and genetic selection without resorting to single cell cloning. This allows the time line from gene transfer to protein production to be reduced. PMID:27322762

  16. Pharmacological Management of Chronic Stable Angina: Focus on Ranolazine.

    PubMed

    Rosano, Giuseppe M C; Vitale, Cristiana; Volterrani, Maurizio

    2016-08-01

    Percutaneous coronary intervention and anti-anginal medications have similar prognostic effectiveness in patients with chronic stable angina. The choice of optimal medical therapy for the management of chronic angina is of pivotal importance in patients with stable ischemic heart disease. The most commonly used anti-anginal agents have demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial only in the setting of depressed left ventricular systolic function after a recent myocardial infarction. Recent evidence suggests the lack of any benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction.Ranolazine is a non-haemodynamic anti-anginal agent. It is effective as adjunctive therapy in patients with chronic stable angina whose symptoms are un-adequately controlled by conventional treatment. The clinical development program of ranolazine has shown that the drug improves exercise performance, decreases angina and use of sublingual nitrates, compared to placebo. Ranolazine is well tolerated with neutral effect on haemodynamics. Besides its role in chronic stable angina, ranolazine has the potential for development in a number of other cardiovascular and non-cardiovascular conditions in the future.

  17. The inflammasome pathway in stable COPD and acute exacerbations

    PubMed Central

    Faner, Rosa; Sobradillo, Patricia; Noguera, Aina; Gomez, Cristina; Cruz, Tamara; López-Giraldo, Alejandra; Ballester, Eugeni; Soler, Nestor; Arostegui, Juan I.; Pelegrín, Pablo; Rodriguez-Roisin, Roberto; Yagüe, Jordi; Cosio, Borja G.; Juan, Manel

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is characterised by pulmonary and systemic inflammation that bursts during exacerbations of the disease (ECOPD). The NLRP3 inflammasome is a key regulatory molecule of the inflammatory response. Its role in COPD is unclear. We investigated the NLRP3 inflammasome status in: 1) lung tissue samples from 38 patients with stable COPD, 15 smokers with normal spirometry and 14 never-smokers; and 2) sputum and plasma samples from 56 ECOPD patients, of whom 41 could be reassessed at clinical recovery. We observed that: 1) in lung tissue samples of stable COPD patients, NLRP3 and interleukin (IL)-1β mRNA were upregulated, but both caspase-1 and ASC were mostly in inactive form, and 2) during infectious ECOPD, caspase-1, oligomeric ASC and associated cytokines (IL-1β, IL-18) were significantly increased in sputum compared with clinical recovery. The NLRP3 inflammasome is primed, but not activated, in the lungs of clinically stable COPD patients. Inflammasome activation occurs during infectious ECOPD. The results of this study suggest that the inflammasome participates in the inflammatory burst of infectious ECOPD. PMID:27730204

  18. Stable isotope-resolved metabolomics and applications for drug development

    PubMed Central

    Fan, Teresa W-M.; Lorkiewicz, Pawel; Sellers, Katherine; Moseley, Hunter N.B.; Higashi, Richard M.; Lane, Andrew N.

    2012-01-01

    Advances in analytical methodologies, principally nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS), during the last decade have made large-scale analysis of the human metabolome a reality. This is leading to the reawakening of the importance of metabolism in human diseases, particularly cancer. The metabolome is the functional readout of the genome, functional genome, and proteome; it is also an integral partner in molecular regulations for homeostasis. The interrogation of the metabolome, or metabolomics, is now being applied to numerous diseases, largely by metabolite profiling for biomarker discovery, but also in pharmacology and therapeutics. Recent advances in stable isotope tracer-based metabolomic approaches enable unambiguous tracking of individual atoms through compartmentalized metabolic networks directly in human subjects, which promises to decipher the complexity of the human metabolome at an unprecedented pace. This knowledge will revolutionize our understanding of complex human diseases, clinical diagnostics, as well as individualized therapeutics and drug response. In this review, we focus on the use of stable isotope tracers with metabolomics technologies for understanding metabolic network dynamics in both model systems and in clinical applications. Atom-resolved isotope tracing via the two major analytical platforms, NMR and MS, has the power to determine novel metabolic reprogramming in diseases, discover new drug targets, and facilitates ADME studies. We also illustrate new metabolic tracer-based imaging technologies, which enable direct visualization of metabolic processes in vivo. We further outline current practices and future requirements for biochemoinformatics development, which is an integral part of translating stable isotope-resolved metabolomics into clinical reality. PMID:22212615

  19. Are Reductions in Population Sodium Intake Achievable?

    PubMed Central

    Levings, Jessica L.; Cogswell, Mary E.; Gunn, Janelle Peralez

    2014-01-01

    The vast majority of Americans consume too much sodium, primarily from packaged and restaurant foods. The evidence linking sodium intake with direct health outcomes indicates a positive relationship between higher levels of sodium intake and cardiovascular disease risk, consistent with the relationship between sodium intake and blood pressure. Despite communication and educational efforts focused on lowering sodium intake over the last three decades data suggest average US sodium intake has remained remarkably elevated, leading some to argue that current sodium guidelines are unattainable. The IOM in 2010 recommended gradual reductions in the sodium content of packaged and restaurant foods as a primary strategy to reduce US sodium intake, and research since that time suggests gradual, downward shifts in mean population sodium intake are achievable and can move the population toward current sodium intake guidelines. The current paper reviews recent evidence indicating: (1) significant reductions in mean population sodium intake can be achieved with gradual sodium reduction in the food supply, (2) gradual sodium reduction in certain cases can be achieved without a noticeable change in taste or consumption of specific products, and (3) lowering mean population sodium intake can move us toward meeting the current individual guidelines for sodium intake. PMID:25325254

  20. Blood feeding behavior of the stable fly

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Stable fly is a fly that looks similar to a house fly but both sexes are blood feeders. Blood is required for successful fertilization and development of eggs. Bites are painful but there is usually no pain after the fly stops feeding. The stable fly is a persistent feeder and will continue trying t...

  1. Structure of acid-stable carmine.

    PubMed

    Sugimoto, Naoki; Kawasaki, Yoko; Sato, Kyoko; Aoki, Hiromitsu; Ichi, Takahito; Koda, Takatoshi; Yamazaki, Takeshi; Maitani, Tamio

    2002-02-01

    Acid-stable carmine has recently been distributed in the U.S. market because of its good acid stability, but it is not permitted in Japan. We analyzed and determined the structure of the major pigment in acid-stable carmine, in order to establish an analytical method for it. Carminic acid was transformed into a different type of pigment, named acid-stable carmine, through amination when heated in ammonia solution. The features of the structure were clarified using a model compound, purpurin, in which the orientation of hydroxyl groups on the A ring of the anthraquinone skeleton is the same as that of carminic acid. By spectroscopic means and the synthesis of acid-stable carmine and purpurin derivatives, the structure of the major pigment in acid-stable carmine was established as 4-aminocarminic acid, a novel compound. PMID:11998314

  2. Quantum anomalous Hall effect in stable dumbbell stanene

    NASA Astrophysics Data System (ADS)

    Zhang, Huisheng; Zhang, Jiayong; Zhao, Bao; Zhou, Tong; Yang, Zhongqin

    2016-02-01

    Topological property of the dumbbell (DB) stanene, more stable than the stanene with a honeycomb lattice, is investigated by using ab initio methods. The magnetic DB stanene demonstrates an exotic quantum anomalous Hall (QAH) effect due to inversion of the Sn spin-up px,y and spin-down pz states. The QAH gap is found to be opened at Γ point rather than the usual K and K' points, beneficial to observe the effect in experiments. When a 3% tensile strain is applied, a large nontrivial gap (˜50 meV) is achieved. Our results provide another lighthouse for realizing QAH effects in two-dimensional systems.

  3. Approach to inherently stable interfaces for ceramic matrix composites

    SciTech Connect

    Besmann, T.M.; Kupp, E.R.; Stinton, D.P.; Shanmugham, S.

    1996-09-01

    Virtually all ceramic matrix composites require and interface coating between the fibers and matrix to achieve the desired mechanical performance. To date, the most effective interface materials for non- oxide matrix composites have been carbon and boron nitride. They are, however, susceptible to oxidation at elevated temperatures, and thus under many envisioned operating environments they will fail, possibly allowing oxidation of the fibers as well, adversely affecting mechanical behavior. Current efforts are directed toward developing stable interface coating, which include oxides and silicon carbide with appropriate thermomechanical properties.

  4. Florida's Fit to Achieve Program.

    ERIC Educational Resources Information Center

    Sander, Allan N.; And Others

    1993-01-01

    Describes Florida's "Fit to Achieve," a cardiovascular fitness education program for elementary students. Children are taught responsibility for their own cardiovascular fitness through proper exercise, personal exercise habits, and regular aerobic exercise. The program stresses collaborative effort between physical educators and classroom…

  5. Adequacy, Litigation, and Student Achievement

    ERIC Educational Resources Information Center

    Glenn, William

    2008-01-01

    The court system has been an increasingly important forum in the attempts to remedy the persistent achievement gaps in American education. In the past twenty years, school finance adequacy litigation has replaced desegregation as the most widely used legal strategy in these efforts. Despite the widespread use of adequacy litigation, few…

  6. Scheduling and Achievement. Research Brief

    ERIC Educational Resources Information Center

    Walker, Karen

    2006-01-01

    To use a block schedule or a traditional schedule? Which structure will produce the best and highest achievement rates for students? The research is mixed on this due to numerous variables such as: (1) socioeconomic levels; (2) academic levels; (3) length of time a given schedule has been in operation; (4) strategies being used in the classrooms;…

  7. School Desegregation and Black Achievement.

    ERIC Educational Resources Information Center

    Cook, Thomas; And Others

    Seven papers commissioned by the National Institute of Education in order to clarify the state of recent knowledge about the effects of school desegregation on the academic achievement of black students are contained in this report. The papers, which analyze 19 "core" empirical studies on this topic, include: (1) "What Have Black Children Gained…

  8. Mobility and the Achievement Gap.

    ERIC Educational Resources Information Center

    Skandera, Hanna; Sousa, Richard

    2002-01-01

    Research indicates that low achievement scores relate significantly to high school mobility rates. One explanation for this relationship is curricular inconsistency. Some suggest that school choice could contribute to a solution by breaking the link between a child's home address and school address, thus allowing students to remain at one school…

  9. The Racial Academic Achievement Gap

    ERIC Educational Resources Information Center

    Green, Toneka M.

    2008-01-01

    Closing the racial academic achievement gap is a problem that must be solved in order for future society to properly function. Minorities including African-American and Latino students' standardized test scores are much lower than white students. By the end of fourth grade, African American, Latino, and poor students of all races are two years…

  10. Can Judges Improve Academic Achievement?

    ERIC Educational Resources Information Center

    Greene, Jay P.; Trivitt, Julie R.

    2008-01-01

    Over the last 3 decades student achievement has remained essentially unchanged in the United States, but not for a lack of spending. Over the same period a myriad of education reforms have been suggested and per-pupil spending has more than doubled. Since the 1990s the education reform attempts have frequently included judicial decisions to revise…

  11. Game Addiction and Academic Achievement

    ERIC Educational Resources Information Center

    Sahin, Mehmet; Gumus, Yusuf Yasin; Dincel, Sezen

    2016-01-01

    The primary aim of this study was to investigate the correlation between game addiction and academic achievement. The secondary aim was to adapt a self-report instrument to measure game addiction. Three hundred and seventy high school students participated in this study. Data were collected via an online questionnaire that included a brief…

  12. Meeting a Math Achievement Crisis

    ERIC Educational Resources Information Center

    Jennings, Lenora; Likis, Lori

    2005-01-01

    An urban community spotlighted declining mathematics achievement and took some measures, in which the students' performance increased substantially. The Benjamin Banneker Charter Public School in Cambridge, Massachusetts, engaged the entire community and launched the campaign called "Math Everywhere", which changed Benjamin Banneker's culture as…

  13. Achieving Results in MBA Communication.

    ERIC Educational Resources Information Center

    Barrett, Deborah J.

    2002-01-01

    Describes how Rice University's Jones Graduate School of Management achieves their mission for the communication program. Discusses three keys to the success of the program: individual coaching, integrated team instruction, and constant assessment of the students and the program. Presents an overview of the program. (SG)

  14. Attribution Theory in Science Achievement

    ERIC Educational Resources Information Center

    Craig, Martin

    2013-01-01

    Recent research reveals consistent lags in American students' science achievement scores. Not only are the scores lower in the United States compared to other developed nations, but even within the United States, too many students are well below science proficiency scores for their grade levels. The current research addresses this problem by…

  15. Graders' Mathematics Achievement

    ERIC Educational Resources Information Center

    Bond, John B.; Ellis, Arthur K.

    2013-01-01

    The purpose of this experimental study was to investigate the effects of metacognitive reflective assessment instruction on student achievement in mathematics. The study compared the performance of 141 students who practiced reflective assessment strategies with students who did not. A posttest-only control group design was employed, and results…

  16. Epistemological Beliefs and Academic Achievement

    ERIC Educational Resources Information Center

    Arslantas, Halis Adnan

    2016-01-01

    This study aimed to identify the relationship between teacher candidates' epistemological beliefs and academic achievement. The participants of the study were 353 teacher candidates studying their fourth year at the Education Faculty. The Epistemological Belief Scale was used which adapted to Turkish through reliability and validity work by…

  17. Achieving a sustainable service advantage.

    PubMed

    Coyne, K P

    1993-01-01

    Many managers believe that superior service should play little or no role in competitive strategy; they maintain that service innovations are inherently copiable. However, the author states that this view is too narrow. For a company to achieve a lasting service advantage, it must base a new service on a capability gap that competitors cannot or will not copy.

  18. Achievement in Two School Cultures.

    ERIC Educational Resources Information Center

    Borth, Audrey M.

    The purpose of the study was to assess non-intellective correlates of achievement in a lower-class, all black, urban elementary school. These students were compared with a University school population which was different in many dimensions. There were residual similarities relative to the general role of the elementary school student. In neither…

  19. Literacy Achievement in Nongraded Classrooms

    ERIC Educational Resources Information Center

    Kreide, Anita Therese

    2011-01-01

    This longitudinal quantitative study compared literacy achievement of students from second through sixth grade based on two organizational systems: graded (traditional) and nongraded (multiage) classrooms. The California Standards Test (CST) scaled and proficiency scores for English-Language Arts (ELA) were used as the study's independent variable…

  20. PREDICTING ACHIEVEMENT FOR DEAF CHILDREN.

    ERIC Educational Resources Information Center

    BONHAM, S.J., JR.

    THIS STUDY WAS DONE TO DETERMINE THE PREDICTIVE VALUE OF INDIVIDUAL AND GROUP ACHIEVEMENT TESTS WHEN USED TO EVALUATE DEAF CHILDREN. THE 36 CHILDREN SELECTED FOR THIS STUDY WERE IN GRADES 2, 4, AND 6 IN THE KENNEDY SCHOOL IN DAYTON, OHIO. ALL HAD SEVERE AUDITORY HANDICAPS AND WERE 10 TO 16 YEARS OLD. FOUR PSYCHOLOGISTS ADMINISTERED THE FOLLOWING…

  1. Washington State's Student Achievement Initiative

    ERIC Educational Resources Information Center

    Pettitt, Maureen; Prince, David

    2010-01-01

    This article describes Washington State's Student Achievement Initiative, an accountability system implemented in 2005-06 that measures students' gains in college readiness, college credits earned, and degree or certificate completion. The goal of the initiative is to increase educational attainment by focusing on the critical momentum points…

  2. Perlman receives Sustained Achievement Award

    NASA Astrophysics Data System (ADS)

    Petit, Charles; Perlman, David

    David Perlman was awarded the Sustained Achievement Award at the AGU Fall Meeting Honors Ceremony, which was held on December 10, 1997, in San Francisco, California. The award recognizes a journalist who has made significant, lasting, and consistent contributions to accurate reporting or writing on the geophysical sciences for the general public.

  3. Great achievements by dedicated nurses.

    PubMed

    Whyte, Alison

    2016-04-27

    Like many nurses, those featured here are motivated by a desire to do everything they can to give high quality care to their patients. Nurses are often reluctant to seek recognition for their achievements, but by talking publicly about the difference they have made, Gillian Elwood, Anja Templin and Sandra Wood are helping to share good practice. PMID:27191295

  4. The Widening Income Achievement Gap

    ERIC Educational Resources Information Center

    Reardon, Sean F.

    2013-01-01

    Has the academic achievement gap between high-income and low-income students changed over the last few decades? If so, why? And what can schools do about it? Researcher Sean F. Reardon conducted a comprehensive analysis of research to answer these questions and came up with some striking findings. In this article, he shows that income-related…

  5. Goal Setting to Achieve Results

    ERIC Educational Resources Information Center

    Newman, Rich

    2012-01-01

    Both districts and individual schools have a very clear set of goals and skills for their students to achieve and master. In fact, except in rare cases, districts and schools develop very detailed goals they wish to pursue. In most cases, unfortunately, only the teachers and staff at a particular school or district-level office are aware of the…

  6. Helping Rural Schools Achieve Success.

    ERIC Educational Resources Information Center

    Collins, Susan

    2003-01-01

    Senator Collins of Maine plans to fight for proper federal funding of the Rural Education Achievement Program (REAP) that allows rural schools to combine federal funding sources. Collins, and Senator Dianne Feinstein, will soon introduce legislation that will eliminate inequities in the current Social Security law that penalize teachers and other…

  7. School Districts and Student Achievement

    ERIC Educational Resources Information Center

    Chingos, Matthew M.; Whitehurst, Grover J.; Gallaher, Michael R.

    2015-01-01

    School districts are a focus of education reform efforts in the United States, but there is very little existing research about how important they are to student achievement. We fill this gap in the literature using 10 years of student-level, statewide data on fourth- and fifth-grade students in Florida and North Carolina. A variance decomposition…

  8. Potential-Based Achievement Goals

    ERIC Educational Resources Information Center

    Elliot, Andrew; Murayama, Kou; Kobeisy, Ahmed; Lichtenfeld, Stephanie

    2015-01-01

    Background: Self-based achievement goals use one's own intrapersonal trajectory as a standard of evaluation, and this intrapersonal trajectory may be grounded in one's past (past-based goals) or one's future potential (potential-based goals). Potential-based goals have been overlooked in the literature to date. Aims: The primary aim of the present…

  9. Socioeconomic Determinants of Academic Achievement

    ERIC Educational Resources Information Center

    Tomul, Ekber; Savasci, Havva Sebile

    2012-01-01

    This study aims to investigate the relationship between academic achievement and the socioeconomic characteristics of elementary school 7th grade students in Burdur. The population of the study are 7th grade students who had education at elementary schools in Burdur in the 2007-2008 academic year. Two staged sampling was chosen as suitable for the…

  10. Multimodal treatment of unresectable hepatocellular carcinoma to achieve complete response results in improved survival

    PubMed Central

    Newell, Pippa H; Wu, YingXing; Hoen, Helena; Uppal, Richa; Thiesing, John Tyler; Sasadeusz, Kevin; Cassera, Maria A; Wolf, Ronald F; Hansen, Paul; Hammill, Chet W

    2015-01-01

    Introduction With technological advances, questions arise regarding how to best fit newer treatment modalities, such as transarterial therapies, into the treatment algorithm for patients with hepatocellular carcinoma (HCC). Methods Between 2005 and 2011, 128 patients initially treated with transarterial radioembolization or chemoembolization using drug-eluting beads were identified. The response was graded retrospectively. Toxicity was measured 1, 3, and 6 months after the first and last treatments. Results Sixty-five patients (53%) were advanced stage. Twenty patients (16%) had an initial complete response, but with additional treatments, this was increased to 46 (36%). Patients with a complete response as their best response to treatment had a median survival [95% confidence interval (CI)] of 5.77 (2.58, upper limit not yet reached) years, significantly longer than those whose best response was a partial response, 1.22 (0.84, 2.06) years and those with stable disease as their best response, 0.34 (0.29, 0.67) years. Repeated treatments did not increase toxicity. Discussion This retrospective review of patients treated for intermediate and advanced stage HCC revealed a significant survival advantage in patients who achieved a complete response. These data support use of a multi-modality approach to intermediate and advanced stage HCC, combining liver-directed treatments as necessary to achieve a complete response. PMID:25580988

  11. Is preschool executive function causally related to academic achievement?

    PubMed

    Willoughby, Michael T; Kupersmidt, Janis B; Voegler-Lee, Mary E

    2012-01-01

    The primary objective of this study was to reevaluate the well-established result that preschoolers' performance on executive function tasks are positively associated with their performance on academic achievement tests. The current study replicated the previously established concurrent associations between children's performance on EF tasks and academic achievement tests. Specifically, children's performance on measures of inhibitory and motor control were positively associated with their performance on tests of reading, writing, and mathematics achievement (rs = .2-.5); moreover, although diminished in magnitude, most of these associations held up even after including an earlier measure of academic achievement as a covariate (rs = .1-.3). However, the application of an alternative analytic method, fixed effects analysis, a method that capitalizes on repeated measures data to control for all time stable measured and unmeasured covariates, rendered the apparent positive associations between executive function and academic achievement nonsignificant (rs = .0-.1). Taken together, these results suggest that the well-replicated association between executive function abilities and academic achievement may be spurious. Results are discussed with respect to the importance of utilizing analytic methods and research designs that facilitate strong causal inferences between executive function and academic achievement in early childhood, as well as the limitations of making curriculum development recommendations and/or public policy decisions based on studies that have failed to do so. PMID:21707258

  12. Preview-Based Stable-Inversion for Output Tracking

    NASA Technical Reports Server (NTRS)

    Zou, Qing-Ze; Devasia, Santosh

    1999-01-01

    Stable Inversion techniques can be used to achieve high-accuracy output tracking. However, for nonminimum phase systems, the inverse is non-causal - hence the inverse has to be pre-computed using a pre-specified desired-output trajectory. This requirement for pre-specification of the desired output restricts the use of inversion-based approaches to trajectory planning problems (for nonminimum phase systems). In the present article, it is shown that preview information of the desired output can be used to achieve online inversion-based output tracking of linear systems. The amount of preview-time needed is quantified in terms of the tracking error and the internal dynamics of the system (zeros of the system). The methodology is applied to the online output tracking of a flexible structure and experimental results are presented.

  13. Note: A new regulation method of stable operation of high power cathode ion source

    SciTech Connect

    Jiang, C. C.; Xie, Y. H. Hu, C. D.; Xie, Y. L.; Liu, S.; Liang, L. Z.; Liu, Z. M.

    2015-05-15

    The hot cathode ion source will tend to be unstable when operated with high power and long pulse. In order to achieve stable operation, a new regulation method based on the arc power (discharge power) feedback control was designed and tested on the hot cathode ion source test bed with arc discharge and beam extraction. The results show that the new regulation method can achieve stable arc discharge and beam extraction. It verifies the success of feedback control of arc source with arc power.

  14. HIV and chronic kidney disease.

    PubMed

    Naicker, Saraladevi; Rahmanian, Sadaf; Kopp, Jeffrey B

    2015-01-01

    Chronic kidney disease (CKD) is a frequent complication of HIV infection, occurring in 3.5 - 48.5%, and occurs as a complication of HIV infection, other co-morbid disease and infections and as a consequence of therapy of HIV infection and its complications. The classic involvement of the kidney by HIV infection is HIV-associated nephropathy (HIVAN), occurring typically in young adults of African ancestry with advanced HIV disease in association with APOL1 high-risk variants. HIV-immune complex disease is the second most common diagnosis obtained from biopsies of patients with HIV-CKD. CKD is mediated by factors related to the virus, host genetic predisposition and environmental factors. The host response to HIV infection may influence disease phenotype through activation of cytokine pathways. With the introduction of antiretroviral therapy (ART), there has been a decline in the incidence of HIVAN, with an increasing prevalence of focal segmental glomerulosclerosis. Several studies have demonstrated the overall improvement in kidney function when initiating ART for HIV CKD. Progression to end stage kidney disease has been reported to be more likely when high grade proteinuria, severely reduced eGFR, hepatitis B and/C co-infection, diabetes mellitus, extensive glomerulosclerosis, and chronic interstitial fibrosis are present. Improved renal survival is associated with use of renin angiotensin system blockers and viral suppression. Many antiretroviral medications are partially or completely eliminated by the kidney and require dose adjustment in CKD. Certain drug classes, such as the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors, are metabolized by the liver and do not require dose adjustment. HIV-infected patients requiring either hemo- or peritoneal dialysis, who are stable on ART, are achieving survival rates comparable to those of dialysis patients without HIV infection. Kidney transplantation has been performed successfully in HIV

  15. 25 by 25: Achieving Global Reduction in Cardiovascular Mortality.

    PubMed

    Dugani, Sagar; Gaziano, Thomas A

    2016-01-01

    Four non-communicable diseases-cardiovascular disease, chronic respiratory disease, diabetes mellitus, and cancer-account for over 60 % of all deaths globally. In recognition of this significant epidemic, the United Nations set forth a target of reducing the four major NCDs by 25 % by 2025. Cardiovascular disease alone represents half of these deaths and is the leading cause of death globally, representing as much as 60 % of all deaths in regions such as Eastern Europe. In response, the WHO set specific targets on conditions and risk factors and changes in the health systems structure in order to achieve the goals. The focus was set on lifestyle risk factors-physical activity, salt-intake, and tobacco-and established conditions-obesity, hypertension, and diabetes mellitus. Health system efforts to improve medical treatment of high risk are encouraged. Efforts to achieve the goal are being promoted by leading international CVD organizations.

  16. Metacognition, Achievement Goals, Study Strategies and Academic Achievement: Pathways to Achievement

    ERIC Educational Resources Information Center

    Vrugt, Anneke; Oort, Frans J.

    2008-01-01

    The purpose of this research was to develop and test a model of effective self-regulated learning. Based on effort expenditure we discerned effective self-regulators and less effective self-regulators. The model comprised achievement goals (mastery, performance-approach and -avoidance goals), metacognition (metacognitive knowledge, regulation and…

  17. Changes in multifractal properties for stable angina pectoris

    NASA Astrophysics Data System (ADS)

    Knežević, Andrea; Martinis, Mladen; Krstačić, Goran; Vargović, Emil

    2005-12-01

    The multifractal approach has been applied to temporal fluctuations of heartbeat (RR) intervals, measured in various regimes of physical activity (ergometric data), taken from healthy subjects and those having stable angina pectoris (SAP). The problem we address here is whether SAP changes multifractality observed in healthy subjects. The G-moment method is used to analyse the multifractal spectrum. It is observed that both sets of data characterize multifractality, but a different trend in multifractal behaviour is found for SAP disease, under pronounced physical activity.

  18. Foraging and farming as niche construction: stable and unstable adaptations.

    PubMed

    Rowley-Conwy, Peter; Layton, Robert

    2011-03-27

    All forager (or hunter-gatherer) societies construct niches, many of them actively by the concentration of wild plants into useful stands, small-scale cultivation, burning of natural vegetation to encourage useful species, and various forms of hunting, collectively termed 'low-level food production'. Many such niches are stable and can continue indefinitely, because forager populations are usually stable. Some are unstable, but these usually transform into other foraging niches, not geographically expansive farming niches. The Epipalaeolithic (final hunter-gatherer) niche in the Near East was complex but stable, with a relatively high population density, until destabilized by an abrupt climatic change. The niche was unintentionally transformed into an agricultural one, due to chance genetic and behavioural attributes of some wild plant and animal species. The agricultural niche could be exported with modifications over much of the Old World. This was driven by massive population increase and had huge impacts on local people, animals and plants wherever the farming niche was carried. Farming niches in some areas may temporarily come close to stability, but the history of the last 11,000 years does not suggest that agriculture is an effective strategy for achieving demographic and political stability in the world's farming populations.

  19. Foraging and farming as niche construction: stable and unstable adaptations

    PubMed Central

    Rowley-Conwy, Peter; Layton, Robert

    2011-01-01

    All forager (or hunter–gatherer) societies construct niches, many of them actively by the concentration of wild plants into useful stands, small-scale cultivation, burning of natural vegetation to encourage useful species, and various forms of hunting, collectively termed ‘low-level food production’. Many such niches are stable and can continue indefinitely, because forager populations are usually stable. Some are unstable, but these usually transform into other foraging niches, not geographically expansive farming niches. The Epipalaeolithic (final hunter–gatherer) niche in the Near East was complex but stable, with a relatively high population density, until destabilized by an abrupt climatic change. The niche was unintentionally transformed into an agricultural one, due to chance genetic and behavioural attributes of some wild plant and animal species. The agricultural niche could be exported with modifications over much of the Old World. This was driven by massive population increase and had huge impacts on local people, animals and plants wherever the farming niche was carried. Farming niches in some areas may temporarily come close to stability, but the history of the last 11 000 years does not suggest that agriculture is an effective strategy for achieving demographic and political stability in the world's farming populations. PMID:21320899

  20. Highly Reflective Multi-stable Electrofluidic Display Pixels

    NASA Astrophysics Data System (ADS)

    Yang, Shu

    Electronic papers (E-papers) refer to the displays that mimic the appearance of printed papers, but still owning the features of conventional electronic displays, such as the abilities of browsing websites and playing videos. The motivation of creating paper-like displays is inspired by the truths that reading on a paper caused least eye fatigue due to the paper's reflective and light diffusive nature, and, unlike the existing commercial displays, there is no cost of any form of energy for sustaining the displayed image. To achieve the equivalent visual effect of a paper print, an ideal E-paper has to be a highly reflective with good contrast ratio and full-color capability. To sustain the image with zero power consumption, the display pixels need to be bistable, which means the "on" and "off" states are both lowest energy states. Pixel can change its state only when sufficient external energy is given. There are many emerging technologies competing to demonstrate the first ideal E-paper device. However, none is able to achieve satisfactory visual effect, bistability and video speed at the same time. Challenges come from either the inherent physical/chemical properties or the fabrication process. Electrofluidic display is one of the most promising E-paper technologies. It has successfully demonstrated high reflectivity, brilliant color and video speed operation by moving colored pigment dispersion between visible and invisible places with electrowetting force. However, the pixel design did not allow the image bistability. Presented in this dissertation are the multi-stable electrofluidic display pixels that are able to sustain grayscale levels without any power consumption, while keeping the favorable features of the previous generation electrofluidic display. The pixel design, fabrication method using multiple layer dry film photoresist lamination, and physical/optical characterizations are discussed in details. Based on the pixel structure, the preliminary

  1. Computing Stable Outcomes in Hedonic Games

    NASA Astrophysics Data System (ADS)

    Gairing, Martin; Savani, Rahul

    We study the computational complexity of finding stable outcomes in symmetric additively-separable hedonic games. These coalition formation games are specified by an undirected edge-weighted graph: nodes are players, an outcome of the game is a partition of the nodes into coalitions, and the utility of a node is the sum of incident edge weights in the same coalition. We consider several natural stability requirements defined in the economics literature. For all of them the existence of a stable outcome is guaranteed by a potential function argument, so local improvements will converge to a stable outcome and all these problems are in PLS. The different stability requirements correspond to different local search neighbourhoods. For different neighbourhood structures, our findings comprise positive results in the form of polynomial-time algorithms for finding stable outcomes, and negative (PLS-completeness) results.

  2. Polymeric foams stable at high temperatures

    NASA Technical Reports Server (NTRS)

    Riccitiello, S. R.; Harrison, E. S.; Delano, C. B.

    1976-01-01

    Crosslinked poly(N-arylenebenzimidazoles) are stable up to 370 C. Polymers are made by mixing appropriate stoichiometric amounts of tetramine and aromatic dicarboxylic acid anhydride with phenol or alkyl-substituted phenol.

  3. Thermally Stable Piezoelectric and Pyroelectric Polymers

    NASA Technical Reports Server (NTRS)

    Simpson, Joycelyn O.; St. Clair, Terry L.

    2006-01-01

    A class of thermally stable piezoelectric and pyroelectric polymers, and an improved method of making them, have been invented. These polymers can be used as substrates for a wide variety of electromechanical transducers, sensors, and actuators.

  4. DNA modifications: Another stable base in DNA

    NASA Astrophysics Data System (ADS)

    Brazauskas, Pijus; Kriaucionis, Skirmantas

    2014-12-01

    Oxidation of 5-methylcytosine has been proposed to mediate active and passive DNA demethylation. Tracking the history of DNA modifications has now provided the first solid evidence that 5-hydroxymethylcytosine is a stable epigenetic modification.

  5. Stable Isotope Signatures for Microbial Forensics

    SciTech Connect

    Kreuzer, Helen W.

    2012-01-03

    The isotopic distribution of the atoms composing the molecules of microorganisms is a function of the substrates used by the organisms. The stable isotope content of an organism is fixed so long as no further substrate consumption and biosynthesis occurs, while the radioactive isotopic content decays over time. The distribution of stable isotopes of C, N, O and H in heterotrophic microorganisms is a direct function of the culture medium, and therefore the stable isotope composition can be used to associate samples with potential culture media and also with one another. The 14C content depends upon the 14C content, and therefore the age, of the organic components of the culture medium, as well as on the age of the culture itself. Stable isotope signatures can thus be used for sample matching, to associate cultures with specific growth media, and to predict characteristics of growth media.

  6. Mechanically and thermally stable maser cavity resonator

    NASA Technical Reports Server (NTRS)

    Vessot, R. F. C.; Hoffman, T. E.; Levine, M. W.

    1972-01-01

    New type cavity resonator is designed for hydrogen maser. Resonator consists of three pieces of glass-ceramic material having extremely low thermal coefficient of expansion and provides very stable mechanical tuning.

  7. Evolutionary origin of asymptotically stable consensus.

    PubMed

    Tang, Chang-Bing; Wu, Bin; Wang, Jian-Bo; Li, Xiang

    2014-01-01

    Consensus is widely observed in nature as well as in society. Up to now, many works have focused on what kind of (and how) isolated single structures lead to consensus, while the dynamics of consensus in interdependent populations remains unclear, although interactive structures are everywhere. For such consensus in interdependent populations, we refer that the fraction of population adopting a specified strategy is the same across different interactive structures. A two-strategy game as a conflict is adopted to explore how natural selection affects the consensus in such interdependent populations. It is shown that when selection is absent, all the consensus states are stable, but none are evolutionarily stable. In other words, the final consensus state can go back and forth from one to another. When selection is present, there is only a small number of stable consensus state which are evolutionarily stable. Our study highlights the importance of evolution on stabilizing consensus in interdependent populations. PMID:24699444

  8. Ultra Stable Microwave Radiometers for Future Sea Surface Salinity Missions

    NASA Technical Reports Server (NTRS)

    Wilson, William J.; Tanner, Alan B.; Pellerano, Fernando A.; Horgan, Kevin A.

    2005-01-01

    The NASA Earth Science System Pathfinder (ESSP) mission Aquarius will measure global sea surface salinity with 100-km spatial resolution every 8 days with an average monthly salinity accuracy of 0.2 psu (parts per thousand). This requires an L-band low-noise radiometer with the long-term calibration stability of less than 0.1 K over 8 days. This three-year research program on ultra stable radiometers has addressed the radiometer requirements and configuration necessary to achieve this objective for Aquarius and future ocean salinity missions. The system configuration and component performance have been evaluated with radiometer testbeds at both JPL and GSFC. The research has addressed several areas including component characterization as a function of temperature, a procedure for the measurement and correction for radiometer system non-linearity, noise diode calibration versus temperature, low noise amplifier performance over voltage, and temperature control requirements to achieve the required stability. A breadboard radiometer, utilizing microstrip-based technologies, has been built to demonstrate this long-term stability. This report also presents the results of the radiometer test program, a detailed radiometer noise model, and details of the operational switching sequence optimization that can be used to achieve the low noise and stability requirements. Many of the results of this research have been incorporated into the Aquarius radiometer design and will allow this instrument to achieve its goals.

  9. Exemplar pediatric collaborative improvement networks: achieving results.

    PubMed

    Billett, Amy L; Colletti, Richard B; Mandel, Keith E; Miller, Marlene; Muething, Stephen E; Sharek, Paul J; Lannon, Carole M

    2013-06-01

    A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "perfect care," and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs. It has achieved reductions in central line-associated blood stream infections (CLABSI), increased breast-milk feeding rates at hospital discharge, and is now working to improve delivery room management. Solutions for Patient Safety (SPS) has achieved significant improvements in adverse drug events and surgical site infections across all 8 Ohio children's hospitals, with 7700 fewer children harmed and >$11.8 million in avoided costs. SPS is now expanding nationally, aiming to eliminate all events of serious harm at children's hospitals. National collaborative networks include ImproveCareNow, which aims to improve care and outcomes for children with inflammatory bowel disease. Reliable adherence to Model Care Guidelines has produced improved remission rates without using new medications and a significant increase in the proportion of Crohn disease patients not taking prednisone. Data-driven collaboratives of the Children's Hospital Association Quality Transformation Network initially focused on CLABSI in PICUs. By September 2011, they had prevented an estimated 2964 CLABSI, saving 355 lives and $103,722,423. Subsequent improvement efforts include CLABSI reductions in additional settings and populations.

  10. Coronary artery disease (image)

    MedlinePlus

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the ... blood to the heart can slow or stop, causing chest pain (stable ...

  11. Achieving urinary continence in children.

    PubMed

    Wu, Hsi-Yang

    2010-07-01

    Achievement of urinary continence is an important developmental step that most children attain with the assistance of their parents and caregivers. Debate continues as to the best time to toilet train; in some Asian and African cultures children are trained as infants, while training at age 2-3 years is more typical in Western cultures. Infant voiding is not merely a spinal reflex, as the sensation of bladder filling is relayed to the brain. However, the ability of the brain to inhibit bladder contractions, and to achieve coordinated bladder contraction with sphincter relaxation, matures over time. While there is a concern that later toilet training may be responsible for an increase in urinary incontinence in children, no controlled studies on early versus late toilet training exist to evaluate this hypothesis. A number of medical conditions such as spina bifida, posterior urethral valves, cerebral palsy and autism can cause incontinence and difficulties in toilet training. The decision to start toilet training a child should take into account both the parents' expectation of how independent the child will be in terms of toileting, and the child's developmental readiness, so that a realistic time course for toilet training can be implemented.

  12. Achieving permanency for LGBTQ youth.

    PubMed

    Jacobs, Jill; Freundlich, Madelyn

    2006-01-01

    This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family connection before leaving the child welfare system; however, LGBTQ youth are not routinely included in the permanency discussions. At the same time, efforts in addressing the needs of LGBTQ youth have increased, but permanency is rarely mentioned as a need. This article offers models of permanence and practices to facilitate permanence with LGBTQ youth and their families. It also offers a youth-driven, individualized process, using youth development principles to achieve relational, physical, and legal permanence. Reunification efforts are discussed, including services, supports, and education required for youth to return to their family of origin. For those who cannot return home, other family resources are explored. The article also discusses cultural issues as they affect permanence for LGBTQ youth, and, finally, addresses the need for ongoing support services to sustain and support permanency.

  13. Updates and achievements in virology.

    PubMed

    Buonaguro, Franco M; Campadelli-Fiume, Gabriella; De Giuli Morghen, Carlo; Palù, Giorgio

    2010-07-01

    The 4th European Congress of Virology, hosted by the Italian Society for Virology, attracted approximately 1300 scientists from 46 countries worldwide. It also represented the first conference of the European Society for Virology, which was established in Campidoglio, Rome, Italy in 2009. The main goal of the meeting was to share research activities and results achieved in European virology units/institutes and to strengthen collaboration with colleagues from both western and developing countries. The worldwide representation of participants is a testament to the strength and attraction of European virology. The 5-day conference brought together the best of current virology; topics covered all three living domains (bacteria, archaea and eucarya), with special sessions on plant and veterinary virology as well as human virology, including two oral presentations on mimiviruses. The conference included five plenary sessions, 31 workshops, one hepatitis C virus roundtable, ten special workshops and three poster sessions, as well as 45 keynote lectures, 191 oral presentations and 845 abstracts. Furthermore, the Gesellschaft fur Virologie Loeffler-Frosch medal award was given to Peter Vogt for his long-standing career and achievements; the Gardner Lecture of the European Society for Clinical Virology was presented by Yoshihiro Kawaoka, and the Pioneer in Virology Lecture of the Italian Society for Virology was presented by Ulrich Koszinowski.

  14. A high-capacity, capsid-modified hybrid adenovirus/adeno-associated virus vector for stable transduction of human hematopoietic cells.

    PubMed

    Shayakhmetov, Dmitry M; Carlson, Cheryl A; Stecher, Hartmut; Li, Qiliang; Stamatoyannopoulos, George; Lieber, André

    2002-02-01

    To achieve stable gene transfer into human hematopoietic cells, we constructed a new vector, DeltaAd5/35.AAV. This vector has a chimeric capsid containing adenovirus type 35 fibers, which conferred efficient infection of human hematopoietic cells. The DeltaAd5/35.AAV vector genome is deleted for all viral genes, allowing for infection without virus-associated toxicity. To generate high-capacity DeltaAd5/35.AAV vectors, we employed a new technique based on recombination between two first-generation adenovirus vectors. The resultant vector genome contained an 11.6-kb expression cassette including the human gamma-globin gene and the HS2 and HS3 elements of the beta-globin locus control region. The expression cassette was flanked by adeno-associated virus (AAV) inverted terminal repeats (ITRs). Infection with DeltaAd5/35.AAV allowed for stable transgene expression in a hematopoietic cell line after integration into the host genome through the AAV ITR(s). This new vector exhibits advantages over existing integrating vectors, including an increased insert capacity and tropism for hematopoietic cells. It has the potential for stable ex vivo transduction of hematopoietic stem cells in order to treat sickle cell disease.

  15. Basic Skills Achievement, 1981-82.

    ERIC Educational Resources Information Center

    Austin Independent School District, TX. Office of Research and Evaluation.

    The Austin Independent School District (AISD) office of Research and Evaluation presents Basic Skills Achievement, 1981-82 (BSA). The BSA answers the following questions: (1) How does AISD student achievement compare to student achievement nationwide? (2) How does AISD's 1981-82 student achievement compare to the achievement of students in past…

  16. Antiviral Protection via RdRP-Mediated Stable Activation of Innate Immunity.

    PubMed

    Painter, Meghan M; Morrison, James H; Zoecklein, Laurie J; Rinkoski, Tommy A; Watzlawik, Jens O; Papke, Louisa M; Warrington, Arthur E; Bieber, Allan J; Matchett, William E; Turkowski, Kari L; Poeschla, Eric M; Rodriguez, Moses

    2015-12-01

    For many emerging and re-emerging infectious diseases, definitive solutions via sterilizing adaptive immunity may require years or decades to develop, if they are even possible. The innate immune system offers alternative mechanisms that do not require antigen-specific recognition or a priori knowledge of the causative agent. However, it is unclear whether effective stable innate immune system activation can be achieved without triggering harmful autoimmunity or other chronic inflammatory sequelae. Here, we show that transgenic expression of a picornavirus RNA-dependent RNA polymerase (RdRP), in the absence of other viral proteins, can profoundly reconfigure mammalian innate antiviral immunity by exposing the normally membrane-sequestered RdRP activity to sustained innate immune detection. RdRP-transgenic mice have life-long, quantitatively dramatic upregulation of 80 interferon-stimulated genes (ISGs) and show profound resistance to normally lethal viral challenge. Multiple crosses with defined knockout mice (Rag1, Mda5, Mavs, Ifnar1, Ifngr1, and Tlr3) established that the mechanism operates via MDA5 and MAVS and is fully independent of the adaptive immune system. Human cell models recapitulated the key features with striking fidelity, with the RdRP inducing an analogous ISG network and a strict block to HIV-1 infection. This RdRP-mediated antiviral mechanism does not depend on secondary structure within the RdRP mRNA but operates at the protein level and requires RdRP catalysis. Importantly, despite lifelong massive ISG elevations, RdRP mice are entirely healthy, with normal longevity. Our data reveal that a powerfully augmented MDA5-mediated activation state can be a well-tolerated mammalian innate immune system configuration. These results provide a foundation for augmenting innate immunity to achieve broad-spectrum antiviral protection. PMID:26633895

  17. Antiviral Protection via RdRP-Mediated Stable Activation of Innate Immunity.

    PubMed

    Painter, Meghan M; Morrison, James H; Zoecklein, Laurie J; Rinkoski, Tommy A; Watzlawik, Jens O; Papke, Louisa M; Warrington, Arthur E; Bieber, Allan J; Matchett, William E; Turkowski, Kari L; Poeschla, Eric M; Rodriguez, Moses

    2015-12-01

    For many emerging and re-emerging infectious diseases, definitive solutions via sterilizing adaptive immunity may require years or decades to develop, if they are even possible. The innate immune system offers alternative mechanisms that do not require antigen-specific recognition or a priori knowledge of the causative agent. However, it is unclear whether effective stable innate immune system activation can be achieved without triggering harmful autoimmunity or other chronic inflammatory sequelae. Here, we show that transgenic expression of a picornavirus RNA-dependent RNA polymerase (RdRP), in the absence of other viral proteins, can profoundly reconfigure mammalian innate antiviral immunity by exposing the normally membrane-sequestered RdRP activity to sustained innate immune detection. RdRP-transgenic mice have life-long, quantitatively dramatic upregulation of 80 interferon-stimulated genes (ISGs) and show profound resistance to normally lethal viral challenge. Multiple crosses with defined knockout mice (Rag1, Mda5, Mavs, Ifnar1, Ifngr1, and Tlr3) established that the mechanism operates via MDA5 and MAVS and is fully independent of the adaptive immune system. Human cell models recapitulated the key features with striking fidelity, with the RdRP inducing an analogous ISG network and a strict block to HIV-1 infection. This RdRP-mediated antiviral mechanism does not depend on secondary structure within the RdRP mRNA but operates at the protein level and requires RdRP catalysis. Importantly, despite lifelong massive ISG elevations, RdRP mice are entirely healthy, with normal longevity. Our data reveal that a powerfully augmented MDA5-mediated activation state can be a well-tolerated mammalian innate immune system configuration. These results provide a foundation for augmenting innate immunity to achieve broad-spectrum antiviral protection.

  18. Antiviral Protection via RdRP-Mediated Stable Activation of Innate Immunity

    PubMed Central

    Painter, Meghan M.; Morrison, James H.; Zoecklein, Laurie J.; Rinkoski, Tommy A.; Watzlawik, Jens O.; Papke, Louisa M.; Warrington, Arthur E.; Bieber, Allan J.; Matchett, William E.; Turkowski, Kari L.; Poeschla, Eric M.; Rodriguez, Moses

    2015-01-01

    For many emerging and re-emerging infectious diseases, definitive solutions via sterilizing adaptive immunity may require years or decades to develop, if they are even possible. The innate immune system offers alternative mechanisms that do not require antigen-specific recognition or a priori knowledge of the causative agent. However, it is unclear whether effective stable innate immune system activation can be achieved without triggering harmful autoimmunity or other chronic inflammatory sequelae. Here, we show that transgenic expression of a picornavirus RNA-dependent RNA polymerase (RdRP), in the absence of other viral proteins, can profoundly reconfigure mammalian innate antiviral immunity by exposing the normally membrane-sequestered RdRP activity to sustained innate immune detection. RdRP-transgenic mice have life-long, quantitatively dramatic upregulation of 80 interferon-stimulated genes (ISGs) and show profound resistance to normally lethal viral challenge. Multiple crosses with defined knockout mice (Rag1, Mda5, Mavs, Ifnar1, Ifngr1, and Tlr3) established that the mechanism operates via MDA5 and MAVS and is fully independent of the adaptive immune system. Human cell models recapitulated the key features with striking fidelity, with the RdRP inducing an analogous ISG network and a strict block to HIV-1 infection. This RdRP-mediated antiviral mechanism does not depend on secondary structure within the RdRP mRNA but operates at the protein level and requires RdRP catalysis. Importantly, despite lifelong massive ISG elevations, RdRP mice are entirely healthy, with normal longevity. Our data reveal that a powerfully augmented MDA5-mediated activation state can be a well-tolerated mammalian innate immune system configuration. These results provide a foundation for augmenting innate immunity to achieve broad-spectrum antiviral protection. PMID:26633895

  19. Smoking control: challenges and achievements

    PubMed Central

    da Silva, Luiz Carlos Corrêa; de Araújo, Alberto José; de Queiroz, Ângela Maria Dias; Sales, Maria da Penha Uchoa; Castellano, Maria Vera Cruz de Oliveira

    2016-01-01

    ABSTRACT Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

  20. Music training and mathematics achievement.

    PubMed

    Cheek, J M; Smith, L R

    1999-01-01

    Iowa Tests of Basic Skills (ITBS) mathematics scores of eighth graders who had received music instruction were compared according to whether the students were given private lessons. Comparisons also were made between students whose lessons were on the keyboard versus other music lessons. Analyses indicated that students who had private lessons for two or more years performed significantly better on the composite mathematics portion of the ITBS than did students who did not have private lessons. In addition, students who received lessons on the keyboard had significantly higher ITBS mathematics scores than did students whose lessons did not involve the keyboard. These results are discussed in relation to previous research on music training and mathematics achievement.

  1. Achieving Quality in Occupational Health

    NASA Technical Reports Server (NTRS)

    O'Donnell, Michele (Editor); Hoffler, G. Wyckliffe (Editor)

    1997-01-01

    The conference convened approximately 100 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Centered on the theme, "Achieving Quality in Occupational Health," conferees heard presentations from award winning occupational health program professionals within the Agency and from private industry; updates on ISO 9000 status, quality assurance, and information technologies; workshops on ergonomics and respiratory protection; an overview from the newly commissioned NASA Occupational Health Assessment Team; and a keynote speech on improving women's health. In addition, NASA occupational health specialists presented 24 poster sessions and oral deliveries on various aspects of current practice at their field centers.

  2. Dietary vitamin K guidance: an effective strategy for stable control of oral anticoagulation?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Numerous factors have been identified as risk factors for instability of oral anticoagulation, including variability in vitamin K intake. However few studies have directly tested the feasibility of manipulating dietary vitamin K to achieve stable oral anticoagulation. Recent findings from a rando...

  3. Thermal design and test results for SUNLITE ultra-stable reference cavity

    NASA Technical Reports Server (NTRS)

    Amundsen, Ruth M.

    1991-01-01

    SUNLITE (Stanford University-NASA Laser In-Space Technology Experiment) is a space-based experiment which uses a reference cavity to provide a stable frequency reference for a terahertz laser oscillator. Thermal stability of the cavity is a key factor in attaining a stable narrow-linewidth laser beam. The mount which is used to support and align the cavity will provide thermal isolation from the environment. The baseline requirement for thermal stability of the cavity is 0.025 C/min, but the design is directed toward achieving stability well beyond this requirement to improve the science data gained. A prototype of the cavity mount was fabricated and tested to characterize the thermal performance. The thermal vacuum test involved stable high-resolution temperature measurements and stable baseplate temperature control over long durations. Based on test data, the cavity mount design satisfies the severe requirement for the cavity thermal stability.

  4. The Effects of Chronic Achievement Motivation and Achievement Primes on the Activation of Achievement and Fun Goals

    PubMed Central

    Hart, William; Albarracín, Dolores

    2013-01-01

    This research examined the hypothesis that situational achievement cues can elicit achievement or fun goals depending on chronic differences in achievement motivation. In 4 studies, chronic differences in achievement motivation were measured, and achievement-denoting words were used to influence behavior. The effects of these variables were assessed on self-report inventories, task performance, task resumption following an interruption, and the pursuit of means relevant to achieving or having fun. Findings indicated that achievement priming (vs. control priming) activated a goal to achieve and inhibited a goal to have fun in individuals with chronically high-achievement motivation but activated a goal to have fun and inhibited a goal to achieve in individuals with chronically low-achievement motivation. PMID:19968423

  5. On the cross-well dynamics of a bi-stable composite plate

    NASA Astrophysics Data System (ADS)

    Arrieta, Andres F.; Neild, Simon A.; Wagg, David J.

    2011-07-01

    Multi-stable composites are a novel type of composites capable of adopting multiple statically stable configurations. Due to the multi-stability property this type of composite material has been considered for several applications, particularly for morphing structures. The change of shape between stable states is achieved by a nonlinear mechanism known as snap-through. Most of the research done on these composites has focused on predicting the configuration after manufacture, its static characteristics and static actuation strategies to induce snap-through. However, these structures will operate subject to dynamic loads. Yet, very little work has been carried out to examine the dynamic behaviour of bi-stable composites. This paper focuses on the study of the cross-well dynamics of a bi-stable composite plate. A simple model previously derived for the dynamics confined to a single stable state is extended to include cross-well dynamics. The rich dynamics are experimentally investigated, focusing on cross-well oscillations and the key dynamic features of snap-through. Numerical simulations are obtained and compared to the experimental results showing good agreement. In particular, experimentally observed characteristics suggesting chaotic oscillations for cross-well dynamics are captured well by the proposed model. The results herein could be used for implementing control strategies for both configuration morphing and undesired snap-through suppression of bi-stable composites.

  6. Stable Isotope Enrichment Capabilities at ORNL

    SciTech Connect

    Egle, Brian; Aaron, W Scott; Hart, Kevin J

    2013-01-01

    The Oak Ridge National Laboratory (ORNL) and the US Department of Energy Nuclear Physics Program have built a high-resolution Electromagnetic Isotope Separator (EMIS) as a prototype for reestablishing a US based enrichment capability for stable isotopes. ORNL has over 60 years of experience providing enriched stable isotopes and related technical services to the international accelerator target community, as well as medical, research, industrial, national security, and other communities. ORNL is investigating the combined use of electromagnetic and gas centrifuge isotope separation technologies to provide research quantities (milligram to several kilograms) of enriched stable isotopes. In preparation for implementing a larger scale production facility, a 10 mA high-resolution EMIS prototype has been built and tested. Initial testing of the device has simultaneously collected greater than 98% enriched samples of all the molybdenum isotopes from natural abundance feedstock.

  7. High-Order Energy Stable WENO Schemes

    NASA Technical Reports Server (NTRS)

    Yamaleev, Nail K.; Carpenter, Mark H.

    2008-01-01

    A new third-order Energy Stable Weighted Essentially NonOscillatory (ESWENO) finite difference scheme for scalar and vector linear hyperbolic equations with piecewise continuous initial conditions is developed. The new scheme is proven to be stable in the energy norm for both continuous and discontinuous solutions. In contrast to the existing high-resolution shock-capturing schemes, no assumption that the reconstruction should be total variation bounded (TVB) is explicitly required to prove stability of the new scheme. A rigorous truncation error analysis is presented showing that the accuracy of the 3rd-order ESWENO scheme is drastically improved if the tuning parameters of the weight functions satisfy certain criteria. Numerical results show that the new ESWENO scheme is stable and significantly outperforms the conventional third-order WENO finite difference scheme of Jiang and Shu in terms of accuracy, while providing essentially nonoscillatory solutions near strong discontinuities.

  8. Concentration of stable elements in food products

    SciTech Connect

    Montford, M.A.; Shank, K.E.; Hendricks, C.; Oakes, T.W.

    1980-01-01

    Food samples were taken from commercial markets and analyzed for stable element content. The concentrations of most stable elements (Ag, Al, As, Au, Ba, Br, Ca, Ce, Cl, Co, Cr, Cs, Cu, Fe, Hf, I, K, La, Mg, Mn, Mo, Na, Rb, Sb, Sc, Se, Sr, Ta, Th, Ti, V, Zn, Zr) were determined using multiple-element neutron activation analysis, while the concentrations of other elements (Cd, Hg, Ni, Pb) were determined using atomic absorption. The relevance of the concentrations found are noted in relation to other literature values. An earlier study was extended to include the determination of the concentration of stable elements in home-grown products in the vicinity of the Oak Ridge National Laboratory. Comparisons between the commercial and local food-stuff values are discussed.

  9. Low work function, stable thin films

    DOEpatents

    Dinh, Long N.; McLean, II, William; Balooch, Mehdi; Fehring, Jr., Edward J.; Schildbach, Marcus A.

    2000-01-01

    Generation of low work function, stable compound thin films by laser ablation. Compound thin films with low work function can be synthesized by simultaneously laser ablating silicon, for example, and thermal evaporating an alkali metal into an oxygen environment. For example, the compound thin film may be composed of Si/Cs/O. The work functions of the thin films can be varied by changing the silicon/alkali metal/oxygen ratio. Low work functions of the compound thin films deposited on silicon substrates were confirmed by ultraviolet photoelectron spectroscopy (UPS). The compound thin films are stable up to 500.degree. C. as measured by x-ray photoelectron spectroscopy (XPS). Tests have established that for certain chemical compositions and annealing temperatures of the compound thin films, negative electron affinity (NEA) was detected. The low work function, stable compound thin films can be utilized in solar cells, field emission flat panel displays, electron guns, and cold cathode electron guns.

  10. High-Order Energy Stable WENO Schemes

    NASA Technical Reports Server (NTRS)

    Yamaleev, Nail K.; Carpenter, Mark H.

    2009-01-01

    A third-order Energy Stable Weighted Essentially Non-Oscillatory (ESWENO) finite difference scheme developed by Yamaleev and Carpenter was proven to be stable in the energy norm for both continuous and discontinuous solutions of systems of linear hyperbolic equations. Herein, a systematic approach is presented that enables 'energy stable' modifications for existing WENO schemes of any order. The technique is demonstrated by developing a one-parameter family of fifth-order upwind-biased ESWENO schemes; ESWENO schemes up to eighth order are presented in the appendix. New weight functions are also developed that provide (1) formal consistency, (2) much faster convergence for smooth solutions with an arbitrary number of vanishing derivatives, and (3) improved resolution near strong discontinuities.

  11. Stable isotope and elemental analysis in ants.

    PubMed

    Smith, Chris R; Tillberg, Chadwick V

    2009-07-01

    Over the past 20 yr, the use of stable isotopes to infer feeding ecology and the examination of how energetic and elemental exchanges are affected by and affect life (ecological stoichiometry) have gained momentum. The ecological diversity of ants makes them interesting models to explore dietary ecology and their role in food webs. Moreover, their ecological dominance in most habitats facilitates sampling. The protocol described here will produce samples adequate for submission to most labs that specialize in high-throughput analysis of stable isotopes; one should check with any particular lab for specific submission instructions. Note, however, that this protocol is designed specifically for the quantification of the natural abundance of stable isotopes; it does not cover the preparation of trace samples. PMID:20147207

  12. Effects of oral supplementation with stable strontium

    PubMed Central

    Skoryna, Stanley C.

    1981-01-01

    The biologic effects of stable strontium, a naturally occurring trace element in the diet and the body, have been little investigated. This paper discusses the effects of oral supplementation with stable strontium in laboratory studies and clinical investigations. The extent of intestinal absorption of various doses of orally administered strontium was estimated by determining serum and tissue levels with atomic absorption spectrophotometry. The central observation is that increased oral intake produces a direct increase in serum levels and intracellular uptake of strontium. The results of these studies, as well as those of other investigators, demonstrate that a moderate dosage of stable strontium does not adversely affect the level of calcium either in the serum or in soft tissues. In studies of patients receiving 1 to 1.5 g/d of strontium gluconate, a sustained increase in the serum level of strontium produced a 100-fold increase in the strontium:calcium ratio. In rats, studies indicate that an increase in intracellular strontium content following supplementation may exert a protective effect on mitochondrial structure, probably by means of a stabilizing effect of strontium on membranes. The strontium:calcium ratio in animals receiving a standard diet is higher in the cell than in the extracellular fluid; this may be of physiologic significance. An increase in density that corresponded to the deposition of stable strontium was observed in areas of bone lesions due to metastatic cancer in patients receiving stable strontium supplementation. This suggests the possibility of using strontium to mineralize osteophenic areas and to relieve bone pain. Also, because of reports of an inverse relation between the incidence of dental caries and a high strontium content in drinking water, the use of natural water containing relatively high levels of stable strontium should be considered. In each of these instances it is important to maintain a normal dietary intake of

  13. Effects of oral supplementation with stable strontium.

    PubMed

    Skoryna, S C

    1981-10-01

    The biologic effects of stable strontium, a naturally occurring trace element in the diet and the body, have been little investigated. This paper discusses the effects of oral supplementation with stable strontium in laboratory studies and clinical investigations. The extent of intestinal absorption of various doses of orally administered strontium was estimated by determining serum and tissue levels with atomic absorption spectrophotometry. The central observation is that increased oral intake produces a direct increase in serum levels and intracellular uptake of strontium. The results of these studies, as well as those of other investigators, demonstrate that a moderate dosage of stable strontium does not adversely affect the level of calcium either in the serum or in soft tissues. In studies of patients receiving 1 to 1.5 g/d of strontium gluconate, a sustained increase in the serum level of strontium produced a 100-fold increase in the strontium:calcium ratio. In rats, studies indicate that an increase in intracellular strontium content following supplementation may exert a protective effect on mitochondrial structure, probably by means of a stabilizing effect of strontium on membranes. The strontium:calcium ratio in animals receiving a standard diet is higher in the cell than in the extracellular fluid; this may be of physiologic significance.An increase in density that corresponded to the deposition of stable strontium was observed in areas of bone lesions due to metastatic cancer in patients receiving stable strontium supplementation. This suggests the possibility of using strontium to mineralize osteophenic areas and to relieve bone pain. Also, because of reports of an inverse relation between the incidence of dental caries and a high strontium content in drinking water, the use of natural water containing relatively high levels of stable strontium should be considered. In each of these instances it is important to maintain a normal dietary intake of

  14. Stable isotope labeling methods for DNA.

    PubMed

    Nelissen, Frank H T; Tessari, Marco; Wijmenga, Sybren S; Heus, Hans A

    2016-08-01

    NMR is a powerful method for studying proteins and nucleic acids in solution. The study of nucleic acids by NMR is far more challenging than for proteins, which is mainly due to the limited number of building blocks and unfavorable spectral properties. For NMR studies of DNA molecules, (site specific) isotope enrichment is required to facilitate specific NMR experiments and applications. Here, we provide a comprehensive review of isotope-labeling strategies for obtaining stable isotope labeled DNA as well as specifically stable isotope labeled building blocks required for enzymatic DNA synthesis. PMID:27573183

  15. Stable isotopes in Lithuanian bioarcheological material

    NASA Astrophysics Data System (ADS)

    Skipityte, Raminta; Jankauskas, Rimantas; Remeikis, Vidmantas

    2015-04-01

    Investigation of bioarcheological material of ancient human populations allows us to understand the subsistence behavior associated with various adaptations to the environment. Feeding habits are essential to the survival and growth of ancient populations. Stable isotope analysis is accepted tool in paleodiet (Schutkowski et al, 1999) and paleoenvironmental (Zernitskaya et al, 2014) studies. However, stable isotopes can be useful not only in investigating human feeding habits but also in describing social and cultural structure of the past populations (Le Huray and Schutkowski, 2005). Only few stable isotope investigations have been performed before in Lithuanian region suggesting a quite uniform diet between males and females and protein intake from freshwater fish and animal protein. Previously, stable isotope analysis has only been used to study a Stone Age population however, more recently studies have been conducted on Iron Age and Late medieval samples (Jacobs et al, 2009). Anyway, there was a need for more precise examination. Stable isotope analysis were performed on human bone collagen and apatite samples in this study. Data represented various ages (from 5-7th cent. to 18th cent.). Stable carbon and nitrogen isotope analysis on medieval populations indicated that individuals in studied sites in Lithuania were almost exclusively consuming C3 plants, C3 fed terrestrial animals, and some freshwater resources. Current investigation demonstrated social differences between elites and country people and is promising in paleodietary and daily life reconstruction. Acknowledgement I thank prof. dr. G. Grupe, Director of the Anthropological and Palaeoanatomical State Collection in Munich for providing the opportunity to work in her laboratory. The part of this work was funded by DAAD. Antanaitis-Jacobs, Indre, et al. "Diet in early Lithuanian prehistory and the new stable isotope evidence." Archaeologia Baltica 12 (2009): 12-30. Le Huray, Jonathan D., and Holger

  16. MHD stable regime of the tokamak

    SciTech Connect

    Cheng, C.Z.; Furth, H.P.; Boozer, A.H.

    1986-10-01

    A broad family of tokamak current profiles is found to be stable against ideal and resistive MHD kink modes for 1 less than or equal to q(0), with q(a) as low 2. For 0.5 less than or equal to q(0) < and q(a) > 1, current profiles can be found that are unstable only to the m = 1, n = 1 mode. A specific ''optimal'' tokamak profile can be selected from the range of stable solutions, by imposing a common upper limit on dj/dr - corresponding in ohmic equilibrium to a limitation of dT/sub e//dr by anomalous transport.

  17. Stable isotope ratios in hair and teeth reflect biologic rhythms.

    PubMed

    Appenzeller, Otto; Qualls, Clifford; Barbic, Franca; Furlan, Raffaello; Porta, Alberto

    2007-07-25

    Biologic rhythms give insight into normal physiology and disease. They can be used as biomarkers for neuronal degenerations. We present a diverse data set to show that hair and teeth contain an extended record of biologic rhythms, and that analysis of these tissues could yield signals of neurodegenerations. We examined hair from mummified humans from South America, extinct mammals and modern animals and people, both healthy and diseased, and teeth of hominins. We also monitored heart-rate variability, a measure of a biologic rhythm, in some living subjects and analyzed it using power spectra. The samples were examined to determine variations in stable isotope ratios along the length of the hair and across growth-lines of the enamel in teeth. We found recurring circa-annual periods of slow and fast rhythms in hydrogen isotope ratios in hair and carbon and oxygen isotope ratios in teeth. The power spectra contained slow and fast frequency power, matching, in terms of normalized frequency, the spectra of heart rate variability found in our living subjects. Analysis of the power spectra of hydrogen isotope ratios in hair from a patient with neurodegeneration revealed the same spectral features seen in the patient's heart-rate variability. Our study shows that spectral analysis of stable isotope ratios in readily available tissues such as hair could become a powerful diagnostic tool when effective treatments and neuroprotective drugs for neurodegenerative diseases become available. It also suggests that similar analyses of archaeological specimens could give insight into the physiology of ancient people and animals.

  18. Stable isotope ratios in hair and teeth reflect biologic rhythms.

    PubMed

    Appenzeller, Otto; Qualls, Clifford; Barbic, Franca; Furlan, Raffaello; Porta, Alberto

    2007-01-01

    Biologic rhythms give insight into normal physiology and disease. They can be used as biomarkers for neuronal degenerations. We present a diverse data set to show that hair and teeth contain an extended record of biologic rhythms, and that analysis of these tissues could yield signals of neurodegenerations. We examined hair from mummified humans from South America, extinct mammals and modern animals and people, both healthy and diseased, and teeth of hominins. We also monitored heart-rate variability, a measure of a biologic rhythm, in some living subjects and analyzed it using power spectra. The samples were examined to determine variations in stable isotope ratios along the length of the hair and across growth-lines of the enamel in teeth. We found recurring circa-annual periods of slow and fast rhythms in hydrogen isotope ratios in hair and carbon and oxygen isotope ratios in teeth. The power spectra contained slow and fast frequency power, matching, in terms of normalized frequency, the spectra of heart rate variability found in our living subjects. Analysis of the power spectra of hydrogen isotope ratios in hair from a patient with neurodegeneration revealed the same spectral features seen in the patient's heart-rate variability. Our study shows that spectral analysis of stable isotope ratios in readily available tissues such as hair could become a powerful diagnostic tool when effective treatments and neuroprotective drugs for neurodegenerative diseases become available. It also suggests that similar analyses of archaeological specimens could give insight into the physiology of ancient people and animals. PMID:17653263

  19. Competency-Based Achievement System

    PubMed Central

    Ross, Shelley; Poth, Cheryl N.; Donoff, Michel; Humphries, Paul; Steiner, Ivan; Schipper, Shirley; Janke, Fred; Nichols, Darren

    2011-01-01

    Abstract Problem addressed Family medicine residency programs require innovative means to assess residents’ competence in “soft” skills (eg, patient-centred care, communication, and professionalism) and to identify residents who are having difficulty early enough in their residency to provide remedial training. Objective of program To develop a method to assess residents’ competence in various skills and to identify residents who are having difficulty. Program description The Competency-Based Achievement System (CBAS) was designed to measure competence using 3 main principles: formative feedback, guided self-assessment, and regular face-to-face meetings. The CBAS is resident driven and provides a framework for meaningful interactions between residents and advisors. Residents use the CBAS to organize and review their feedback, to guide their own assessment of their progress, and to discern their future learning needs. Advisors use the CBAS to monitor, guide, and verify residents’ knowledge of and competence in important skills. Conclusion By focusing on specific skills and behaviour, the CBAS enables residents and advisors to make formative assessments and to communicate their findings. Feedback indicates that the CBAS is a user-friendly and helpful system to assess competence. PMID:21918129

  20. Achieving yield gains in wheat.

    PubMed

    Reynolds, Matthew; Foulkes, John; Furbank, Robert; Griffiths, Simon; King, Julie; Murchie, Erik; Parry, Martin; Slafer, Gustavo

    2012-10-01

    Wheat provides 20% of calories and protein consumed by humans. Recent genetic gains are <1% per annum (p.a.), insufficient to meet future demand. The Wheat Yield Consortium brings expertise in photosynthesis, crop adaptation and genetics to a common breeding platform. Theory suggest radiation use efficiency (RUE) of wheat could be increased ~50%; strategies include modifying specificity, catalytic rate and regulation of Rubisco, up-regulating Calvin cycle enzymes, introducing chloroplast CO(2) concentrating mechanisms, optimizing light and N distribution of canopies while minimizing photoinhibition, and increasing spike photosynthesis. Maximum yield expression will also require dynamic optimization of source: sink so that dry matter partitioning to reproductive structures is not at the cost of the roots, stems and leaves needed to maintain physiological and structural integrity. Crop development should favour spike fertility to maximize harvest index so phenology must be tailored to different photoperiods, and sensitivity to unpredictable weather must be modulated to reduce conservative responses that reduce harvest index. Strategic crossing of complementary physiological traits will be augmented with wide crossing, while genome-wide selection and high throughput phenotyping and genotyping will increase efficiency of progeny screening. To ensure investment in breeding achieves agronomic impact, sustainable crop management must also be promoted through crop improvement networks.

  1. Enhancing depression mechanisms in midbrain dopamine neurons achieves homeostatic resilience.

    PubMed

    Friedman, Allyson K; Walsh, Jessica J; Juarez, Barbara; Ku, Stacy M; Chaudhury, Dipesh; Wang, Jing; Li, Xianting; Dietz, David M; Pan, Nina; Vialou, Vincent F; Neve, Rachael L; Yue, Zhenyu; Han, Ming-Hu

    2014-04-18

    Typical therapies try to reverse pathogenic mechanisms. Here, we describe treatment effects achieved by enhancing depression-causing mechanisms in ventral tegmental area (VTA) dopamine (DA) neurons. In a social defeat stress model of depression, depressed (susceptible) mice display hyperactivity of VTA DA neurons, caused by an up-regulated hyperpolarization-activated current (I(h)). Mice resilient to social defeat stress, however, exhibit stable normal firing of these neurons. Unexpectedly, resilient mice had an even larger I(h), which was observed in parallel with increased potassium (K(+)) channel currents. Experimentally further enhancing Ih or optogenetically increasing the hyperactivity of VTA DA neurons in susceptible mice completely reversed depression-related behaviors, an antidepressant effect achieved through resilience-like, projection-specific homeostatic plasticity. These results indicate a potential therapeutic path of promoting natural resilience for depression treatment.

  2. UNCERTAINTY IN SOURCE PARTITIONING USING STABLE ISOTOPES

    EPA Science Inventory

    Stable isotope analyses are often used to quantify the contribution of multiple sources to a mixture, such as proportions of food sources in an animal's diet, C3 vs. C4 plant inputs to soil organic carbon, etc. Linear mixing models can be used to partition two sources with a sin...

  3. Conditional flux analysis and stable isotopes

    NASA Astrophysics Data System (ADS)

    Zeeman, M. J.; Knohl, A.; Sturm, P.; Buchmann, N. C.; Thomas, C. K.

    2009-12-01

    We propose to investigate to what extend conditional flux analysis can benefit from the addition of stable isotope information. Stable isotopes have been recognized for their potential as process tracer, and could add an extra dimension to the conditional flux concept, which aims at directly quantifying component fluxes and identifying their sources. Differences in 13C abundance in carbon dioxide can be used to distinguish assimilation or respiration sources, whereas the 18O abundance expresses differences in water exchange, for instance between canopy and soil. Lending to recent advances in measurement technology, stable isotopes can now be measured at high temporal resolutions (10Hz) required for commonly applied micrometeorological methods such as the eddy-covariance technique, or related conditional flux methods. We will present current ideas on how the conditional flux method, as recently proposed and evaluated by Thomas et al. (2008), Scanlon & Sahu (2008), to perform daytime flux partitioning at the ecosystem level, can be refined by stable isotope analysis (13C and 18O) of carbon dioxide as additional dimension for identification of fluxes.

  4. Substitution of stable isotopes in Chlorella

    NASA Technical Reports Server (NTRS)

    Flaumenhaft, E.; Katz, J. J.; Uphaus, R. A.

    1969-01-01

    Replacement of biologically important isotopes in the alga Chlorella by corresponding heavier stable isotopes produces increasingly greater deviations from the normal cell size and changes the quality and distribution of certain cellular components. The usefulness of isotopically altered organisms increases interest in the study of such permuted organisms.

  5. Evolutionarily stable anti-cancer therapies by autologous cell defection

    PubMed Central

    Archetti, Marco

    2013-01-01

    Game theory suggests an anti-cancer treatment based on the use of modified cancer cells that disrupt cooperation within the tumor. Cancer cells are harvested from the patient, the genes for the production of essential growth factors are knocked out in vitro and the cells are then reinserted in the tumor, where they lead to its collapse. Background and objectives: Current anti-cancer drugs and treatments based on gene therapy are prone to the evolution of resistance, because cancer is a process of clonal selection: resistant cell lines have a selective advantage and therefore increase in frequency, eventually conferring resistance to the whole tumor and leading to relapse. An effective treatment must be evolutionarily stable, that is, immune to the invasion of resistant mutant cells. This study shows how such a treatment can be achieved by autologous cell therapy using modified cancer cells, knocked out for genes coding for diffusible factors like growth factors. Methodology: The evolutionary dynamics of a population of cells producing diffusible factors are analyzed using a nonlinear public goods game in a structured population in which the interaction neighborhood and the update neighborhood are decoupled. The analysis of the dynamics of the system reveals what interventions can drive the population to a stable equilibrium in which no diffusible factors are produced. Results: A treatment based on autologous knockout cell therapy can be designed to lead to the spontaneous collapse of a tumor, without targeting directly the cancer cells, their growth factors or their receptors. Critical parameters that can make the therapy effective are identified. Concepts from evolutionary game theory and mechanism design, some of which are counterintuitive, can be adopted to optimize the treatment. Conclusions and implications: Although it shares similarities with other approaches based on gene therapy and RNA interference, the method suggested here is evolutionarily stable under

  6. Spontaneous and stable uniform lying helix liquid-crystal alignment

    NASA Astrophysics Data System (ADS)

    Outram, B. I.; Elston, S. J.

    2013-01-01

    The flexoelectro-optic effect in the uniform lying helix (ULH) geometry could provide many advantages over existing liquid-crystal technologies, however reliably forming the ULH has been problematic. Here, we achieve spontaneous, stable, and repeatable ULH alignment for materials with both positive and negative dielectric anisotropy in devices ranging from 1 to 7 μm in thickness without the need for any field application or flow-induced alignment, using a combination of weak homeotropic alignment conditions and unidirectional grooved surface profiles. The technique requires slow cooling from the isotropic phase and through the blue phase. Devices made using the technique display sub-millisecond and linear electro-optical responses.

  7. Stable and water-tolerant ionic liquid ferrofluids.

    PubMed

    Jain, Nirmesh; Zhang, Xiaoli; Hawkett, Brian S; Warr, Gregory G

    2011-03-01

    Ionic liquid ferrofluids have been prepared containing both bare and sterically stabilized 8-12 nm diameter superparamagnetic iron oxide nanoparticles, which remain stable for several months in both protic ethylammonium and aprotic imidazolium room-temperature ionic liquids. These ferrofluids exhibit spiking in static magnetic fields similar to conventional aqueous and nonaqueous ferrofluids. Ferrofluid stability was verified by following the flocculation and settling behavior of dilute nanoparticle dispersions. Although bare nanoparticles showed excellent stability in some ILs, they were unstable in others, and exhibited limited water tolerance. Stability was achieved by incorporating a thin polymeric steric stabilization layer designed to be compatible with the IL. This confers the added benefit of imbuing the ILF with a high tolerance to water. PMID:21338083

  8. Stable Cyclic Carbenes and Related Species beyond Diaminocarbenes

    PubMed Central

    Melaimi, Mohand; Soleilhavoup, Michèle

    2011-01-01

    The success of homogeneous catalysis can be attributed largely to the development of a diverse range of ligand frameworks that have been used to tune the behavior of various systems. Spectacular results in this area have been achieved using cyclic diaminocarbenes (NHCs) as a result of their strong σ-donor properties. Although it is possible to cursorily tune the structure of NHCs, any diversity is still far from matching their phosphorus-based counterparts, which is one of the great strengths of the latter. A variety of stable acyclic carbenes are known, but they are either reluctant to bind metals or they give rise to fragile metal complexes. During the last five years, new types of stable cyclic carbenes, as well as related carbon-based ligands (which are not NHCs), and which feature even stronger σ-donor properties have been developed. Their synthesis and characterization as well as the stability, electronic properties, coordination behavior, and catalytic activity of the ensuing complexes are discussed, and comparisons with their NHC cousins are made. PMID:20836099

  9. Stable, high efficiency gyrotron backward-wave oscillator

    SciTech Connect

    Fan, C. T.; Chang, T. H.; Pao, K. F.; Chu, K. R.; Chen, S. H.

    2007-09-15

    Stability issues have been a major concern for the realization of broadband tunability of the gyrotron backward-wave oscillator (gyro-BWO). Multimode, time-dependent simulations are employed to examine the stability properties of the gyro-BWO. It is shown that the gyro-BWO is susceptible to both nonstationary oscillations and axial mode competition in the course of frequency tuning. Regions of nonstationary oscillations and axial mode competition are displayed in the form of stability maps over wide-ranging parameter spaces. These maps serve as a guide for the identification and optimization of stable windows for broadband tuning. Results indicate that a shorter interaction length provides greater stability without efficiency degradation. These theoretical predictions have been verified in a Ka-band gyro-BWO experiment using both short and long interaction lengths. In the case of a short interaction length, continuous and smooth tunability, in magnetic field and in beam voltage, was demonstrated with the high interaction efficiency reported so far. A maximum 3-dB tuning range of 1.3 GHz with a peak power of 149 kW at 29.8% efficiency was achieved. In a comparative experiment with a longer interaction length, the experimental data are characterized by piecewise-stable tuning curves separated by region(s) of nonstationary oscillations, as predicted by theory.

  10. Li2OHCl crystalline electrolyte for stable metallic lithium anodes

    DOE PAGES

    Hood, Zachary D.; Wang, Hui; Samuthira Pandian, Amaresh; Keum, Jong Kahk; Liang, Chengdu

    2016-01-22

    In a classic example of stability from instability, we show that Li2OHCl solid electrolyte forms a stable solid electrolyte interface (SEI) with metallic lithium anode. The Li2OHCl solid electrolyte can be readily achieved through simple mixing of air-stable LiOH and LiCl precursors with a mild processing temperature under 400 °C. Additionally, we show that continuous, dense Li2OHCl membranes can be fabricated at temperatures less than 400 °C, standing in great contrast to current processing temperatures of over 1600 °C for most oxide-based solid electrolytes. The ionic conductivity and Arrhenius activation energy were explored for the LiOH-LiCl system of crystalline solidmore » electrolytes where Li2OHCl with increased crystal defects was found to have the highest ionic conductivity and reasonable Arrhenius activation energy. The Li2OHCl solid electrolyte displays stability against metallic lithium, even in extreme conditions past the melting point of lithium metal. Furthermore, to understand this excellent stability, we show that SEI formation is critical in stabilizing the interface between metallic lithium and the Li2OHCl solid electrolyte.« less

  11. Unconditionally stable time marching scheme for Reynolds stress models

    NASA Astrophysics Data System (ADS)

    Mor-Yossef, Y.

    2014-11-01

    Progress toward a stable and efficient numerical treatment for the compressible Favre-Reynolds-averaged Navier-Stokes equations with a Reynolds-stress model (RSM) is presented. The mean-flow and the Reynolds stress model equations are discretized using finite differences on a curvilinear coordinates mesh. The convective flux is approximated by a third-order upwind biased MUSCL scheme. The diffusive flux is approximated using second-order central differencing, based on a full-viscous stencil. The novel time-marching approach relies on decoupled, implicit time integration, that is, the five mean-flow equations are solved separately from the seven Reynolds-stress closure equations. The key idea is the use of the unconditionally positive-convergent implicit scheme (UPC), originally developed for two-equation turbulence models. The extension of the UPC scheme for RSM guarantees the positivity of the normal Reynolds-stress components and the turbulence (specific) dissipation rate for any time step. Thanks to the UPC matrix-free structure and the decoupled approach, the resulting computational scheme is very efficient. Special care is dedicated to maintain the implicit operator compact, involving only nearest neighbor grid points, while fully supporting the larger discretized residual stencil. Results obtained from two- and three-dimensional numerical simulations demonstrate the significant progress achieved in this work toward optimally convergent solution of Reynolds stress models. Furthermore, the scheme is shown to be unconditionally stable and positive.

  12. Mechanisms of stable lipid loss in a social insect.

    PubMed

    Ament, Seth A; Chan, Queenie W; Wheeler, Marsha M; Nixon, Scott E; Johnson, S Peir; Rodriguez-Zas, Sandra L; Foster, Leonard J; Robinson, Gene E

    2011-11-15

    Worker honey bees undergo a socially regulated, highly stable lipid loss as part of their behavioral maturation. We used large-scale transcriptomic and proteomic experiments, physiological experiments and RNA interference to explore the mechanistic basis for this lipid loss. Lipid loss was associated with thousands of gene expression changes in abdominal fat bodies. Many of these genes were also regulated in young bees by nutrition during an initial period of lipid gain. Surprisingly, in older bees, which is when maximum lipid loss occurs, diet played less of a role in regulating fat body gene expression for components of evolutionarily conserved nutrition-related endocrine systems involving insulin and juvenile hormone signaling. By contrast, fat body gene expression in older bees was regulated more strongly by evolutionarily novel regulatory factors, queen mandibular pheromone (a honey bee-specific social signal) and vitellogenin (a conserved yolk protein that has evolved novel, maturation-related functions in the bee), independent of nutrition. These results demonstrate that conserved molecular pathways can be manipulated to achieve stable lipid loss through evolutionarily novel regulatory processes.

  13. Stable, high efficiency gyrotron backward-wave oscillator

    NASA Astrophysics Data System (ADS)

    Fan, C. T.; Chang, T. H.; Pao, K. F.; Chu, K. R.; Chen, S. H.

    2007-09-01

    Stability issues have been a major concern for the realization of broadband tunability of the gyrotron backward-wave oscillator (gyro-BWO). Multimode, time-dependent simulations are employed to examine the stability properties of the gyro-BWO. It is shown that the gyro-BWO is susceptible to both nonstationary oscillations and axial mode competition in the course of frequency tuning. Regions of nonstationary oscillations and axial mode competition are displayed in the form of stability maps over wide-ranging parameter spaces. These maps serve as a guide for the identification and optimization of stable windows for broadband tuning. Results indicate that a shorter interaction length provides greater stability without efficiency degradation. These theoretical predictions have been verified in a Ka-band gyro-BWO experiment using both short and long interaction lengths. In the case of a short interaction length, continuous and smooth tunability, in magnetic field and in beam voltage, was demonstrated with the high interaction efficiency reported so far. A maximum 3-dB tuning range of 1.3GHz with a peak power of 149kW at 29.8% efficiency was achieved. In a comparative experiment with a longer interaction length, the experimental data are characterized by piecewise-stable tuning curves separated by region(s) of nonstationary oscillations, as predicted by theory.

  14. Air-Stable Black Phosphorus Devices for Ion Sensing.

    PubMed

    Li, Peng; Zhang, Dongzhi; Liu, Jingjing; Chang, Hongyan; Sun, Yan'e; Yin, Nailiang

    2015-11-11

    Black phosphorus (BP) is one of the most attractive graphene analogues, and its properties make it a promising nanomaterial for chemical sensing. However, mono- and few-layer BP flakes are reported to chemically degrade rapidly upon exposure to ambient conditions. Therefore, little is known about the performance and sensing mechanism of intrinsic BP, and chemical sensing of intrinsic BP with acceptable air stability remains only theoretically explored. Here, we experimentally demonstrated the first air-stable high-performance BP sensor using ionophore coating. Ionophore-encapsulated BP demonstrated significantly improved air stability. Its performance and sensing mechanism for trace ion detection were systematically investigated. The BP sensors were able to realize multiplex ion detection with superb selectivity, and sensitive to Pb(2+) down to 1 ppb. Additionally, the time constant for ion adsorption extracted was only 5 s. The detection limit and response rate of BP were both superior to those of graphene based sensors. Moreover, heavy metal ions can be effectively detected over a wide range of concentration with BP conductance change following the Langmuir isotherm for molecules adsorption on surface. The simplicity of this ionophore-encapsulate approach provides a route for achieving air-stable intrinsic black phosphorus sensors that may stimulate further fundamental research and potential applications.

  15. Heavy element stable isotope ratios: analytical approaches and applications.

    PubMed

    Tanimizu, Masaharu; Sohrin, Yoshiki; Hirata, Takafumi

    2013-03-01

    Continuous developments in inorganic mass spectrometry techniques, including a combination of an inductively coupled plasma ion source and a magnetic sector-based mass spectrometer equipped with a multiple-collector array, have revolutionized the precision of isotope ratio measurements, and applications of inorganic mass spectrometry for biochemistry, geochemistry, and marine chemistry are beginning to appear on the horizon. Series of pioneering studies have revealed that natural stable isotope fractionations of many elements heavier than S (e.g., Fe, Cu, Zn, Sr, Ce, Nd, Mo, Cd, W, Tl, and U) are common on Earth, and it had been widely recognized that most physicochemical reactions or biochemical processes induce mass-dependent isotope fractionation. The variations in isotope ratios of the heavy elements can provide new insights into past and present biochemical and geochemical processes. To achieve this, the analytical community is actively solving problems such as spectral interference, mass discrimination drift, chemical separation and purification, and reduction of the contamination of analytes. This article describes data calibration and standardization protocols to allow interlaboratory comparisons or to maintain traceability of data, and basic principles of isotope fractionation in nature, together with high-selectivity and high-yield chemical separation and purification techniques for stable isotope studies.

  16. Heavy element stable isotope ratios: analytical approaches and applications.

    PubMed

    Tanimizu, Masaharu; Sohrin, Yoshiki; Hirata, Takafumi

    2013-03-01

    Continuous developments in inorganic mass spectrometry techniques, including a combination of an inductively coupled plasma ion source and a magnetic sector-based mass spectrometer equipped with a multiple-collector array, have revolutionized the precision of isotope ratio measurements, and applications of inorganic mass spectrometry for biochemistry, geochemistry, and marine chemistry are beginning to appear on the horizon. Series of pioneering studies have revealed that natural stable isotope fractionations of many elements heavier than S (e.g., Fe, Cu, Zn, Sr, Ce, Nd, Mo, Cd, W, Tl, and U) are common on Earth, and it had been widely recognized that most physicochemical reactions or biochemical processes induce mass-dependent isotope fractionation. The variations in isotope ratios of the heavy elements can provide new insights into past and present biochemical and geochemical processes. To achieve this, the analytical community is actively solving problems such as spectral interference, mass discrimination drift, chemical separation and purification, and reduction of the contamination of analytes. This article describes data calibration and standardization protocols to allow interlaboratory comparisons or to maintain traceability of data, and basic principles of isotope fractionation in nature, together with high-selectivity and high-yield chemical separation and purification techniques for stable isotope studies. PMID:23397089

  17. Aspirin dosing in cardiovascular disease prevention and management: an update.

    PubMed

    Ganjehei, Leila; Becker, Richard C

    2015-11-01

    Aspirin has been in use for prevention and management of cardiovascular diseases for several decades. Clinical and epidemiological literature suggests that while net benefits of aspirin in primary prevention of CVDs are less clear, the benefits of aspirin in acute scenarios and secondary prevention settings are well established. However, its optimum dosing requirements have been up for debate especially in various settings of acute coronary syndrome and stable ischemic heart disease. The role of clinician in stratifying individual risk score to achieve net clinical benefit is an important determinant of initiating aspirin therapy. The purpose of this article is to review association of aspirin and CVD in general, and to review its dosing regimens in acute settings as well as primary and secondary prevention as suggested by various established guidelines. We also aim to provide the readers an update on recent changes and current evidence based practice trends.

  18. Development of a Safety Management Web Tool for Horse Stables.

    PubMed

    Leppälä, Jarkko; Kolstrup, Christina Lunner; Pinzke, Stefan; Rautiainen, Risto; Saastamoinen, Markku; Särkijärvi, Susanna

    2015-01-01

    Managing a horse stable involves risks, which can have serious consequences for the stable, employees, clients, visitors and horses. Existing industrial or farm production risk management tools are not directly applicable to horse stables and they need to be adapted for use by managers of different types of stables. As a part of the InnoEquine project, an innovative web tool, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. A literature review, empirical horse stable case studies, expert panel workshops and stakeholder interviews were carried out to support the design. The InnoHorse web tool includes a safety section containing a horse stable safety map, stable safety checklists, and examples of good practices in stable safety, horse handling and rescue planning. This new horse stable safety management tool can also help in organizing work processes in horse stables in general. PMID:26569319

  19. Development of a Safety Management Web Tool for Horse Stables.

    PubMed

    Leppälä, Jarkko; Kolstrup, Christina Lunner; Pinzke, Stefan; Rautiainen, Risto; Saastamoinen, Markku; Särkijärvi, Susanna

    2015-11-12

    Managing a horse stable involves risks, which can have serious consequences for the stable, employees, clients, visitors and horses. Existing industrial or farm production risk management tools are not directly applicable to horse stables and they need to be adapted for use by managers of different types of stables. As a part of the InnoEquine project, an innovative web tool, InnoHorse, was developed to support horse stable managers in business, safety, pasture and manure management. A literature review, empirical horse stable case studies, expert panel workshops and stakeholder interviews were carried out to support the design. The InnoHorse web tool includes a safety section containing a horse stable safety map, stable safety checklists, and examples of good practices in stable safety, horse handling and rescue planning. This new horse stable safety management tool can also help in organizing work processes in horse stables in general.

  20. Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial

    PubMed Central

    2010-01-01

    Background Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group. Methods/Design A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months. Discussion Evidence-based approaches to the high burden of obesity and