A randomized trial of aggressive lipid reduction for improvement of myocardial ischemia, symptom status, and vascular function in patients with coronary artery disease not amenable to intervention

PURPOSE: To determine the effects of aggressive lipid lowering on markers of ischemia, resistance vessel function, atherosclerotic burden, and Symptom status in patients with symptomatic coronary artery disease. METHODS: Sixty consecutive patients with coronary artery disease that was unsuitable for revascularization were assigned randomly to either usual therapy of lipids for patients with a low-density lipoprotein (LDL) cholesterol target level <116 mg/dL, or to a, more aggressive lipid-lowering strategy involving up to 80 mg/d of atorvastatin, with a target LDL cholesterol level <77 mg/dL. The extent and severity of inducible ischemia (by dobutamine echocardiography), vascular function.(brachial artery reactivity), atheroma burden (carotid intima-media thickness), and symptom status were evaluated blindly at baseline and after 12 weeks of treatment. RESULTS: After 12 weeks of treatment, patients in the aggressive therapy group had a significantly greater decrease in mean (+/- SD) LDL cholesterol level than those in the usual care group (29 +/- 38 mg/dL vs. 7 +/- 24 mg/dL, P = 0.03). Patients in the aggressive therapy group had a reduction in the number of ischemic wall segments (mean between-group difference of 1.3; 95% confidence interval: 0.1 to 2.0; P = 0.04), flow-mediated dilatation (mean between-group difference of 5.9%; 95% confidence interval: 2.5% to 9.4%; P = 0.001), and angina score after 12 weeks. There were no significant changes in atherosclerotic burden in either group. CONCLUSION: Patients with symptomatic coronary artery disease who are treated with aggressive lipid lowering have improvement of symptom status and ischemia that appears to reflect improved vascular function but not atheroma burden. Am J Med. 2003;114:445-453. (C) 2003 by Excerpta Medica Inc.

A wavelet-based adaptive technique for adsorption problems involving steep gradients

A general, fast wavelet-based adaptive collocation method is formulated for heat and mass transfer problems involving a steep moving profile of the dependent variable. The technique of grid adaptation is based on sparse point representation (SPR). The method is applied and tested for the case of a gas–solid non-catalytic reaction in a porous solid at high Thiele modulus. Accurate and convergent steep profiles are obtained for Thiele modulus as large as 100 for the case of slab and found to match the analytical solution.

Computationally efficient solution techniques for adsorption problems involving steep gradients in bidisperse particles

A piecewise uniform fitted mesh method turns out to be sufficient for the solution of a surprisingly wide variety of singularly perturbed problems involving steep gradients. The technique is applied to a model of adsorption in bidisperse solids for which two fitted mesh techniques, a fitted-mesh finite difference method (FMFDM) and fitted mesh collocation method (FMCM) are presented. A combination (FMCMD) of FMCM and the DASSL integration package is found to be most effective in solving the problems. Numerical solutions (FMFDM and FMCMD) were found to match the analytical solution when the adsorption isotherm is linear, even under conditions involving steep gradients for which global collocation fails. In particular, FMCMD is highly efficient for macropore diffusion control or micropore diffusion control. These techniques are simple and there is no limit on the range of the parameters. The techniques can be applied to a variety of adsorption and desorption problems in bidisperse solids with non-linear isotherm and for arbitrary particle geometry.

Multicomponent reversible reactions inside a porous catalyst pellet

This work deals with a solution method to handle multicomponents reversible reactions occurring inside a porous catalyst pellet. The complexity of this problem arises from the fact that the effective diffusivities and Biot number, which characterizes the external mass transfer, are different for each chemical species. In mathematical terms, this means that each chemical species has its own subspace and, therefore, when the technique of finite integral transform is applied to solve this multicomponent problem, each chemical species is associated with its own integral transform kernel. The analytical solutions obtained for this problem are compact and simple for any further manipulation. Application of this result to the catalytic reforming of C7 hydrocarbon system is shown in this paper.

Dynamic processes in contingent valuation: A case study involving the mahogany glider

This paper reports the results of an experiment involving a sample of 204 members of the public who were assessed on three occasions about their willingness to pay for the conservation of the mahogany glider. They were asked this question prior to information being provided to them about the glider and other focal wildlife species; after such information was provided, and finally after participants had had an opportunity to see live specimens of this glider. The mean willingness to pay of the relevant samples are compared and found to show significant variations. Theories are considered that help explain the dynamics of these variations. Serious concerns are raised about the capacity of information provision to reveal ‘true’ contingent valuations of public goods.

Instantaneous outbursts in underground coal mines: An overview and association with coal type

Instantaneous outbursts in underground coal mines have occurred in at least 16 countries, involving both methane (CH4) and carbon dioxide (CO2). The precise mechanisms of an instantaneous outburst are still unresolved but must consider the effects of stress, gas content and physico-mechanical properties of the coal. Other factors such as mining methods (e.g., development heading into the coal seam) and geological features (e.g., coal seam disruptions from faulting) can combine to exacerbate the problem. Prediction techniques continue to be unreliable and unexpected outburst incidents resulting in fatalities are a major concern for underground coal operations. Gas content thresholds of 9 m(3)/t for CH4 and 6 m(3)/t for CO2 are used in the Sydney Basin, to indicate outburst-prone conditions, but are reviewed on an individual mine basis and in mixed as situations. Data on the sorption behaviour of Bowen Basin coals from Australia have provided an explanation for the conflicting results obtained by coal face desorption indices used for outburst-proneness assessment. A key factor appears to be different desorption rates displayed by banded coals, which is supported by both laboratory and mine-site investigations. Dull coal bands with high fusinite and semifusinite contents tend to display rapid desorption from solid coal, for a given pressure drop. The opposite is true for bright coal bands with high vitrinite contents and dull coal bands with high inertodetrinite contents. Consequently, when face samples of dull, fusinite-or semifusinite-rich coal of small particle size are taken for desorption testing, much gas has already escaped and low readings result. The converse applies for samples taken from coal bands with high vitrinite and/or inertodetrinite contents. In terms of outburst potential, it is the bright, vitrinite-rich and the dull, inertodetrinite-rich sections of a coal seam that appear to be more outburst-prone. This is due to the ability of the solid coal to retain gas, even after pressure reduction, creating a gas content gradient across the coal face sufficient to initiate an outburst. Once the particle size of the coal is reduced, rapid gas desorption can then take place. (C) 1998 Elsevier Science.

Solution of adsorption problems involving steep moving profiles

The moving finite element collocation method proposed by Kill et al. (1995) Chem. Engng Sci. 51 (4), 2793-2799 for solution of problems with steep gradients is further developed to solve transient problems arising in the field of adsorption. The technique is applied to a model of adsorption in solids with bidisperse pore structures. Numerical solutions were found to match the analytical solution when it exists (i.e. when the adsorption isotherm is linear). The method is simple yet sufficiently accurate for use in adsorption problems, where global collocation methods fail. (C) 1998 Elsevier Science Ltd. All rights reserved.

The case for involving the family in the treatment of childhood anxiety

Anxiety disorders are among the most common forms of psychopathology reported by children and adolescents. Anxiety disorders in children have debilitating consequences, both for the child and his/her family. In addition, research indicates that, in many cases, these disorders follow a chronic and persistent course. The efficacy of child-focused cognitive-behavioural interventions in the treatment of childhood anxiety disorders has been well demonstrated by recent, well-controlled research. This treatment outcome literature is briefly reviewed. Most recently, however, interventions used in the treatment of childhood anxiety disorders have taken the form of combined interventions aimed both at the anxious child and his or her family. This paper reviews two related bodies of research in presenting a case for the involvement of families in the treatment of childhood anxiety. First, the etiological evidence implicating the families of anxious children in the development and/or maintenance of childhood anxiety is presented. Second, the treatment outcome studies that have empirically evaluated this type of combined intervention are reviewed.

Dysmorphogenesis in psychosis: Quantitative and qualitative measures involving the head and face

In this study, we examined qualitative and quantitative measures involving the head and face in a sample of patients and well controls drawn from the Brisbane Psychosis Study. Patients with psychosis (n=310) and age and sex-matched controls (n=303) were drawn from a defined catchment area. Features assessed involved hair whorls (position, number, and direction), eyes (epicanthus), supraorbital ridge, ears (low set, protrusion, hypoplasia, ear lobe attachment, asymmetry, helix width), and mouth (palate height and shape, palate ridges, furrowed and bifid tongue). Quantitative measures related to skull size (circumference, width and length) selected facial heights and depths. The impact of selected risk factors (place and season of birth, fathers' occupation at time of birth, selfreported pregnancy and birth complications, family history) were examined in the entire group, while the association between age of onset and dysmorphology was assessed within the patient group. Significant group (cases versus controls) differences included: patients had smaller skull bases, smaller facial heights, larger facial depths, lower set and protruding ears, different palate shape and fewer palate ridges. In the entire sample significant associations included: (a) those with positive family history of mental illness bad smaller head circumference, cranial length and facial heights; (b) pregnancy and birth complications was associated with smaller facial beights: (c) larger head circumference was associated with higher ranked fathers' occupations at birth. Within the patient group, age of onset was significantly lower in those with more qualitative anomalies or with larger facial heights. The group differences were not due to outliers or distinct subgroups, suggesting that the factors responsible for the differences may be subtle and widely dispersed in the patient group. The Stanley Foundation supported this project.

Model for gas-liquid flow through wet porous medium

A method involving bubbling of air through a fibrous filter immersed in water has recently been investigated (Agranovski et al. [1]). Experimental results showed that the removal efficiency for ultra-fine aerosols by such filters was greatly increased compared to dry filters. Nuclear Magnetic Resonance (NMR) imaging was used to examine the wet filter and to determine the nature of the gas flow inside the filter (Agranovski et al. [2]). It was found that tortuous preferential pathways (or flow tubes) develop within the filter through which the air flows and the distribution of air and water inside the porous medium has been investigated. The aim of this paper is to investigate the geometry of the pathways and to make estimates of the flow velocities and particle removal efficiency in such pathways. A mathematical model of the flow of air along the preferred pathways has been developed and verified experimentally. Even for the highest realistic gas velocity the flow field was essentially laminar (Re approximate to 250). We solved Laplace's equation for stream function to map trajectories of particles and gas molecules to investigate the possibility of their removal from the carrier.

Finite-difference time-domain-based studies of MRI pulsed field gradient-induced eddy currents inside the human body

In modern magnetic resonance imaging (MRI), patients are exposed to strong, rapidly switching magnetic gradient fields that, in extreme cases, may be able to elicit nerve stimulation. This paper presents theoretical investigations into the spatial distribution of induced current inside human tissues caused by pulsed z-gradient fields. A variety of gradient waveforms have been studied. The simulations are based on a new, high-definition, finite-difference time-domain method and a realistic inhomogeneous 10-mm resolution human body model with appropriate tissue parameters. it was found that the eddy current densities are affected not only by the pulse sequences but by many parameters such as the position of the body inside the gradient set, the local biological material properties and the geometry of the body. The discussion contains a comparison of these results with previous results found in the literature. This study and the new methods presented herein will help to further investigate the biological effects caused by the switched gradient fields in a MRI scan. (C) 2002 Wiley Periodicals, Inc.

Spin-orbit mixing and nephelauxetic effects in the electronic spectra of nickel(II)-encapsulating complexes involving nitrogen and sulfur donors

A study of spin-orbit mixing and nephelauxetic effects in the electronic spectra of nickel(II)-encapsulating complexes involving mixed nitrogen and sulfur donors is reported. As the number of sulfur donors is systematically varied through the series [Ni(N6-xSx)](2+) (x = 0-6), the spin-forbidden (3)A(2)g --> E-1(g) and (3)A(2g) --> (1)A(1g) transitions undergo a considerable reduction in energy whereas the spin-allowed transitions are relatively unchanged. The [Ni(diAMN(6)sar)](2+) and [Ni(AMN(5)Ssar)](2+) complexes exhibit an unusual band shape for the (3)A(2g) --> T-3(2g) transition which is shown to arise from spin-orbit mixing of the E spin-orbit levels associated with the E-1(g) and T-3(2g) states. A significant differential nephelauxetic effect also arises from the covalency differences between the t(2g) and e(g) orbitals with the result that no single set of Racah B and C interelectron repulsion parameters adequately fit the observed spectra. Using a differential covalency ligand-field model, the spectral transitions are successfully reproduced with three independent variables corresponding to 10Dq and the covalency parameters f(t) and f(e), associated with the t(2g) and e(g) orbitals, respectively. The small decrease in f(t) from unity is largely attributed to central-field covalency effects whereas the dramatic reduction in f(e) with increasing number of sulfur donors is a direct consequence of the increased metal-ligand covalency associated with the sulfur donors. Covalency differences between the t(2g) and e(g) orbitals also result in larger 10Dq values than those obtained simply from the energy of the (3)A(2g) --> T-3(2g) spin-allowed transition.