Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention

INTRODUCTION Anemia and renal impairment are important co-morbidities among patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI). Disease progression to eventual death can be understood as the combined effect of baseline characteristics and intermediate outcomes. METHODS Using data from a prospective cohort study, we investigated clinical pathways reflecting the transitions from PCI through intermediate ischemic or hemorrhagic events to all-cause mortality in a multi-state analysis as a function of anemia (hemoglobin concentration <120 g/l and <130 g/l, for women and men, respectively) and renal impairment (creatinine clearance <60 ml/min) at baseline. RESULTS Among 6029 patients undergoing PCI, anemia and renal impairment were observed isolated or in combination in 990 (16.4%), 384 (6.4%), and 309 (5.1%) patients, respectively. The most frequent transition was from PCI to death (6.7%, 95% CI 6.1-7.3), followed by ischemic events (4.8%, 95 CI 4.3-5.4) and bleeding (3.4%, 95% CI 3.0-3.9). Among patients with both anemia and renal impairment, the risk of death was increased 4-fold as compared to the reference group (HR 3.9, 95% CI 2.9-5.4) and roughly doubled as compared to patients with either anemia (HR 1.7, 95% CI 1.3-2.2) or renal impairment (HR 2.1, 95% CI 1.5-2.9) alone. Hazard ratios indicated an increased risk of bleeding in all three groups compared to patients with neither anemia nor renal impairment. CONCLUSIONS Applying a multi-state model we found evidence for a gradient of risk for the composite of bleeding, ischemic events, or death as a function of hemoglobin value and estimated glomerular filtration rate at baseline.

Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna

Background: Current literature suggests a positive influence of additive classical homeopathyon global health and well-being in cancer patients. Besides encouraging case reports, thereis little if any research on long-term survival of patients who obtain homeopathic care duringcancer treatment. Design: Data from cancer patients who had undergone homeopathic treatment complementaryto conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in MalignantDiseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected,described and a retrospective subgroup-analysis with regard to survival time was performed.Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis ofdisease, quantitative and qualitative description of patient characteristics, and survival time. Results: In four years, a total of 538 patients were recorded to have visited the OutpatientUnit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7%(n = 287) who had undergone at least three homeopathic consultations within four years, 18.7%(n = 54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblas-toma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cellcarcinoma. Median overall survival was compared to expert expectations of survival outcomesby specific cancer type and was prolonged across observed cancer entities (p < 0.001). Conclusion: Extended survival time in this sample of cancer patients with fatal prognosis butadditive homeopathic treatment is interesting. However, findings are based on a small sample,and with only limited data available about patient and treatment characteristics. The relationshipbetween homeopathic treatment and survival time requires prospective investigation in largersamples possibly using matched-pair control analysis or randomized trials.

High depth-resolution laser ablation chemical analysis of additive-assisted Cu electroplating for microchip architectures

Laser ablation/ionisation mass spectrometry with a vertical resolution at a nanometre scale was applied for the quantitative characterisation of the chemical composition of additive-assisted Cu electroplated deposits used in the microchip industry. The detailed chemical analysis complements information gathered by optical techniques and allows new insights into the metal deposition process.

Detection and Isolation of Simultaneous Additive and Parametric Faults in Nonlinear Stochastic Dynamical Systems

This paper presents a new fault detection and isolation scheme for dealing with simultaneous additive and parametric faults. The new design integrates a system for additive fault detection based on Castillo and Zufiria, 2009 and a new parametric fault detection and isolation scheme inspired in Munz and Zufiria, 2008 . It is shown that the so far existing schemes do not behave correctly when both additive and parametric faults occur simultaneously; to solve the problem a new integrated scheme is proposed. Computer simulation results are presented to confirm the theoretical studies.

Preference intensity in MCDM when an additive utility function represents DM preferences

We propose a new method for ranking alternatives in multicriteria decision-making problems when there is imprecision concerning the alternative performances, component utility functions and weights. We assume decision maker?s preferences are represented by an additive multiattribute utility function, in which weights can be modeled by independent normal variables, fuzzy numbers, value intervals or by an ordinal relation. The approaches are based on dominance measures or exploring the weight space in order to describe which ratings would make each alternative the preferred one. On the one hand, the approaches based on dominance measures compute the minimum utility difference among pairs of alternatives. Then, they compute a measure by which to rank the alternatives. On the other hand, the approaches based on exploring the weight space compute confidence factors describing the reliability of the analysis. These methods are compared using Monte Carlo simulation.

Rapid prototyping of multi-scale biomedical microdevices by combining additive manufacturing technologies

The possibility of designing and manufacturing biomedical microdevices with multiple length-scale geometries can help to promote special interactions both with their environment and with surrounding biological systems. These interactions aim to enhance biocompatibility and overall performance by using biomimetic approaches. In this paper, we present a design and manufacturing procedure for obtaining multi-scale biomedical microsystems based on the combination of two additive manufacturing processes: a conventional laser writer to manufacture the overall device structure, and a direct-laser writer based on two-photon polymerization to yield finer details. The process excels for its versatility, accuracy and manufacturing speed and allows for the manufacture of microsystems and implants with overall sizes up to several millimeters and with details down to sub-micrometric structures. As an application example we have focused on manufacturing a biomedical microsystem to analyze the impact of microtextured surfaces on cell motility. This process yielded a relevant increase in precision and manufacturing speed when compared with more conventional rapid prototyping procedures.

Ku band waveguide diplexer design for satellite communication. Implementation by additive manufacturing and experimental characterization

Gran cantidad de servicios de telecomunicación tales como la distribución de televisión o los sistemas de navegación están basados en comunicaciones por satélite. Del mismo modo que ocurre en otras aplicaciones espaciales, existe una serie de recursos clave severamente limitados, tales como la masa o el volumen. En este sentido, uno de los dispositivos pasivos más importantes es el diplexor del sistema de alimentación de la antena. Este dispositivo permite el uso de una única antena tanto para transmitir como para recibir, con la consiguiente optimización de recursos que eso supone. El objetivo principal de este trabajo es diseñar un diplexor que cumpla especificaciones reales de comunicaciones por satélite. El dispositivo consiste en dos estructuras filtrantes unidas por una bifurcación de tres puertas. Además, es imprescindible utilizar tecnología de guía de onda para su implementación debido a los altos niveles de potencia manejados. El diseño del diplexor se lleva a cabo dividiendo la estructura en diversas partes, con el objetivo de que todo el proceso sea factible y eficiente. En primer lugar, se han desarrollado filtros con diferentes respuestas – paso alto, paso bajo y paso banda – aunque únicamente dos de ellos formarán el diplexor. Al afrontar su diseño inicial, se lleva a cabo un proceso de síntesis teórica utilizando modelos circuitales. A continuación, los filtros se optimizan con técnicas de diseño asistido por ordenador (CAD) full-wave, en concreto mode matching. En este punto es esencial analizar las estructuras y su simetría para determinar qué modos electromagnéticos se están propagando realmente por los dispositivos, para así reducir el esfuerzo computacional asociado. Por último, se utiliza el Método de los Elementos Finitos (FEM) para verificar los resultados previamente obtenidos. Una vez que el diseño de los filtros está terminado, se calculan las dimensiones correspondientes a la bifurcación. Finalmente, el diplexor al completo se somete a un proceso de optimización para cumplir las especificaciones eléctricas requeridas. Además, este trabajo presenta un novedoso valor añadido: la implementación física y la caracterización experimental tanto del diplexor como de los filtros por separado. Esta posibilidad, impracticable hasta ahora debido a su elevado coste, se deriva del desarrollo de las técnicas de manufacturación aditiva. Los prototipos se imprimen en plástico (PLA) utilizando una impresora 3D de bajo coste y posteriormente se metalizan. El uso de esta tecnología conlleva dos limitaciones: la precisión de las dimensiones geométricas (±0.2 mm) y la conductividad de la pintura metálica que recubre las paredes internas de las guías de onda. En este trabajo se incluye una comparación entre los valores medidos y simulados, así como un análisis de los resultados experimentales. En resumen, este trabajo presenta un proceso real de ingeniería: el problema de diseñar un dispositivo que satisfaga especificaciones reales, las limitaciones causadas por el proceso de fabricación, la posterior caracterización experimental y la obtención de conclusiones.

A general additive distance with time-reversibility and rate variation among nucleotide sites.

As additivity is a very useful property for a distance measure, a general additive distance is proposed under the stationary time-reversible (SR) model of nucleotide substitution or, more generally, under the stationary, time-reversible, and rate variable (SRV) model, which allows rate variation among nucleotide sites. A method for estimating the mean distance and the sampling variance is developed. In addition, a method is developed for estimating the variance-covariance matrix of distances, which is useful for the statistical test of phylogenies and molecular clocks. Computer simulation shows (i) if the sequences are longer than, say, 1000 bp, the SR method is preferable to simpler methods; (ii) the SR method is robust against deviations from time-reversibility; (iii) when the rate varies among sites, the SRV method is much better than the SR method because the distance is seriously underestimated by the SR method; and (iv) our method for estimating the sampling variance is accurate for sequences longer than 500 bp. Finally, a test is constructed for testing whether DNA evolution follows a general Markovian model.

Response of Catch-Per-Unit-Effort to Spatial and Environmental Factors: an Exploratory Data Analysis Using Generalized Additive Models

Understanding spatial distributions and how environmental conditions influence catch-per-unit-effort (CPUE) is important for increased fishing efficiency and sustainable fisheries management. This study investigated the relationship between CPUE, spatial factors, temperature, and depth using generalized additive models. Combinations of factors, and not one single factor, were frequently included in the best model. Parameters which best described CPUE varied by geographic region. The amount of variance, or deviance, explained by the best models ranged from a low of 29% (halibut, Charlotte region) to a high of 94% (sablefish, Charlotte region). Depth, latitude, and longitude influenced most species in several regions. On the broad geographic scale, depth was associated with CPUE for every species, except dogfish. Latitude and longitude influenced most species, except halibut (Areas 4 A/D), sablefish, and cod. Temperature was important for describing distributions of halibut in Alaska, arrowtooth flounder in British Columbia, dogfish, Alaska skate, and Aleutian skate. The species-habitat relationships revealed in this study can be used to create improved fishing and management strategies.

Transferability of Regional Permafrost Disturbance Susceptibility Modelling Using Generalized Linear and Generalized Additive Models

To effectively assess and mitigate risk of permafrost disturbance, disturbance-p rone areas can be predicted through the application of susceptibility models. In this study we developed regional susceptibility models for permafrost disturbances using a field disturbance inventory to test the transferability of the model to a broader region in the Canadian High Arctic. Resulting maps of susceptibility were then used to explore the effect of terrain variables on the occurrence of disturbances within this region. To account for a large range of landscape charac- teristics, the model was calibrated using two locations: Sabine Peninsula, Melville Island, NU, and Fosheim Pen- insula, Ellesmere Island, NU. Spatial patterns of disturbance were predicted with a generalized linear model (GLM) and generalized additive model (GAM), each calibrated using disturbed and randomized undisturbed lo- cations from both locations and GIS-derived terrain predictor variables including slope, potential incoming solar radiation, wetness index, topographic position index, elevation, and distance to water. Each model was validated for the Sabine and Fosheim Peninsulas using independent data sets while the transferability of the model to an independent site was assessed at Cape Bounty, Melville Island, NU. The regional GLM and GAM validated well for both calibration sites (Sabine and Fosheim) with the area under the receiver operating curves (AUROC) N 0.79. Both models were applied directly to Cape Bounty without calibration and validated equally with AUROC's of 0.76; however, each model predicted disturbed and undisturbed samples differently. Addition- ally, the sensitivity of the transferred model was assessed using data sets with different sample sizes. Results in- dicated that models based on larger sample sizes transferred more consistently and captured the variability within the terrain attributes in the respective study areas. Terrain attributes associated with the initiation of dis- turbances were similar regardless of the location. Disturbances commonly occurred on slopes between 4 and 15°, below Holocene marine limit, and in areas with low potential incoming solar radiation

Is socioeconomic position early in life associated with physical activity during adulthood following the accumulation of risk model with additive effects?

L'activité physique améliore la santé, mais seulement 4.8% des Canadiens atteignent le niveau recommandé. La position socio-économique est un des déterminants de l'activité physique les plus importants. Elle est associée à l’activité physique de manière transversale à l’adolescence et à l’âge adulte. Cette thèse a tenté de déterminer s'il y a une association à long terme entre la position socio-économique au début du parcours de vie et l’activité physique à l’âge adulte. S'il y en avait une, un deuxième objectif était de déterminer quel modèle théorique en épidémiologie des parcours de vie décrivait le mieux sa forme. Cette thèse comprend trois articles: une recension systématique et deux recherches originales. Dans la recension systématique, des recherches ont été faites dans Medline et EMBASE pour trouver les études ayant mesuré la position socio-économique avant l'âge de 18 ans et l'activité physique à ≥18 ans. Dans les deux recherches originales, la modélisation par équations structurelles a été utilisée pour comparer trois modèles alternatifs en épidémiologie des parcours de vie: le modèle d’accumulation de risque avec effets additifs, le modèle d’accumulation de risque avec effet déclenché et le modèle de période critique. Ces modèles ont été comparés dans deux cohortes prospectives représentatives à l'échelle nationale: la 1970 British birth cohort (n=16,571; première recherche) et l’Enquête longitudinale nationale sur les enfants et les jeunes (n=16,903; deuxième recherche). Dans la recension systématique, 10 619 articles ont été passés en revue par deux chercheurs indépendants et 42 ont été retenus. Pour le résultat «activité physique» (tous types et mesures confondus), une association significative avec la position socio-économique durant l’enfance fut trouvée dans 26/42 études (61,9%). Quand seulement l’activité physique durant les loisirs a été considérée, une association significative fut trouvée dans 21/31 études (67,7%). Dans un sous-échantillon de 21 études ayant une méthodologie plus forte, les proportions d’études ayant trouvé une association furent plus hautes : 15/21 (71,4%) pour tous les types et toutes les mesures d’activité physique et 12/15 (80%) pour l’activité physique de loisir seulement. Dans notre première recherche originale sur les données de la British birth cohort, pour la classe sociale, nous avons trouvé que le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux chez les hommes et les femmes pour l’activité physique de loisir, au travail et durant les transports. Dans notre deuxième recherche originale sur les données canadiennes sur l'activité physique de loisir, nous avons trouvé que chez les hommes, le modèle de période critique s’est ajusté le mieux aux données pour le niveau d’éducation et le revenu, alors que chez les femmes, le modèle d’accumulation de risque avec effets additifs s’est ajusté le mieux pour le revenu, tandis que le niveau d’éducation ne s’est ajusté à aucun des modèles testés. En conclusion, notre recension systématique indique que la position socio-économique au début du parcours de vie est associée à la pratique d'activité physique à l'âge adulte. Les résultats de nos deux recherches originales suggèrent un patron d’associations le mieux représenté par le modèle d’accumulation de risque avec effets additifs.

Mapping Whidbey Island and Possession Sound landslide susceptibility using an additive linear model

Senior thesis written for Oceanography 445

Contrast discrimination and pattern masking: contrast gain control with fixed additive noise

We studied the visual mechanisms that serve to encode spatial contrast at threshold and supra-threshold levels. In a 2AFC contrast-discrimination task, observers had to detect the presence of a vertical 1 cycle deg-1 test grating (of contrast dc) that was superimposed on a similar vertical 1 cycle deg-1 pedestal grating, whereas in pattern masking the test grating was accompanied by a very different masking grating (horizontal 1 cycle deg-1, or oblique 3 cycles deg-1). When expressed as threshold contrast (dc at 75% correct) versus mask contrast (c) our results confirm previous ones in showing a characteristic 'dipper function' for contrast discrimination but a smoothly increasing threshold for pattern masking. However, fresh insight is gained by analysing and modelling performance (p; percent correct) as a joint function of (c, dc) - the performance surface. In contrast discrimination, psychometric functions (p versus logdc) are markedly less steep when c is above threshold, but in pattern masking this reduction of slope did not occur. We explored a standard gain-control model with six free parameters. Three parameters control the contrast response of the detection mechanism and one parameter weights the mask contrast in the cross-channel suppression effect. We assume that signal-detection performance (d') is limited by additive noise of constant variance. Noise level and lapse rate are also fitted parameters of the model. We show that this model accounts very accurately for the whole performance surface in both types of masking, and thus explains the threshold functions and the pattern of variation in psychometric slopes. The cross-channel weight is about 0.20. The model shows that the mechanism response to contrast increment (dc) is linearised by the presence of pedestal contrasts but remains nonlinear in pattern masking.