Safety of Prasugrel Loading Doses in Patients Pre-Loaded With Clopidogrel in the Setting of Primary Percutaneous Coronary Intervention: Results of a Nonrandomized Observational Study.

OBJECTIVES: The aim of this study was to assess the safety of the concurrent administration of a clopidogrel and prasugrel loading dose in patients undergoing primary percutaneous coronary intervention. BACKGROUND: Prasugrel is one of the preferred P2Y12 platelet receptor antagonists for ST-segment elevation myocardial infarction patients. The use of prasugrel was evaluated clinically in clopidogrel-naive patients. METHODS: Between September 2009 and October 2012, a total of 2,023 STEMI patients were enrolled in the COMFORTABLE (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction [STEMI]) and the SPUM-ACS (Inflammation and Acute Coronary Syndromes) studies. Patients receiving a prasugrel loading dose were divided into 2 groups: 1) clopidogrel and a subsequent prasugrel loading dose; and 2) a prasugrel loading dose. The primary safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding in hospital at 30 days. RESULTS: Of 2,023 patients undergoing primary percutaneous coronary intervention, 427 (21.1%) received clopidogrel and a subsequent prasugrel loading dose, 447 (22.1%) received a prasugrel loading dose alone, and the remaining received clopidogrel only. At 30 days, the primary safety endpoint was observed in 1.9% of those receiving clopidogrel and a subsequent prasugrel loading dose and 3.4% of those receiving a prasugrel loading dose alone (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.25 to 1.30, p = 0.18). The HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) bleeding score tended to be higher in prasugrel-treated patients (p = 0.076). The primary safety endpoint results, however, remained unchanged after adjustment for these differences (clopidogrel and a subsequent prasugrel loading dose vs. prasugrel only; HR: 0.54 [95% CI: 0.23 to 1.27], p = 0.16). No differences in the composite of cardiac death, myocardial infarction, or stroke were observed at 30 days (adjusted HR: 0.66, 95% CI: 0.27 to 1.62, p = 0.36). CONCLUSIONS: This observational, nonrandomized study of ST-segment elevation myocardial infarction patients suggests that the administration of a loading dose of prasugrel in patients pre-treated with a loading dose of clopidogrel is not associated with an excess of major bleeding events. (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction [STEMI] [COMFORTABLE]; NCT00962416; and Inflammation and Acute Coronary Syndromes [SPUM-ACS]; NCT01000701).

Variable-stiffness composite panels: Defect tolerance under in-plane tensile loading

Automated Fiber Placement is being extensively used in the production of major composite components for the aircraft industry. This technology enables the production of tow-steered panels, which have been proven to greatly improve the structural efficiency of composites by means of in-plane stiffness variation and load redistribution. However, traditional straight-fiber architectures are still preferred. One of the reasons behind this is related to the uncertainties, as a result of process-induced defects, in the mechanical performance of the laminates. This experimental work investigates the effect of the fiber angle discontinuities between different tow courses in a ply on the un-notched and open-hole tensile strength of the laminate. The influence of several manufacturing parameters are studied in detail. The results reveal that 'ply staggering' and '0% gap coverage' is an effective combination in reducing the influence of defects in these laminates

Drug loading of mesoporous silicon particles

Porous silicon (PSi) is a promising material to be utilized in drug delivery formulations. The release rate of the drug compound can be controlled by changing the pore properties and surface chemistry of PSi. The loading of a poorly soluble drug into mesoporous silicon particles enhances its dissolution in the body. The drug loading is based on adsorption. The attainable maximum loaded amount depends on the properties of the drug compound and the PSi material, and on the process conditions. The loading solvent also essentially affects the adsorption process. The loading of indomethacin into PSi particles with varying surface modification was studied. Solvent mixtures were applied in the loading, and the loaded samples were analyzed with thermal analysis methods. The best degree of loading was obtained using a mixture of dichloromethane and methanol. The drug loads varied from 7.7 w-% to 26.8 w-%. A disturbing factor in the loading experiments was the tendency of indomethacin to form solvates with the solvents applied. In addition, the physical form and stability of indomethacin loaded in PSi and silica particles were studied using Raman spectroscopy. In the case of silica, the presence of crystalline drug as well as the polymorph form can be detected, but the method proved to be not applicable for PSi particles.

Reliability of intraoperative ultrasound in margin status assessment in women undergoing breast conserving surgery

Background: Effective treatment for breast cancer requires accurate preoperative planning, developing and implementing a consistent definition of margin clearance, and using tools that provide detailed real-time intraoperative information on margin status. Intraoperative ultrasound (IOUS) may fulfil these requirements and may offer few advantages that other preoperative localization and intraoperative margin assessment techniques may notPurpose: The goal of the present work is to determine how accurate the intraoperative ultrasound should be to acquire complete surgical excision with negative histological margins in patients undergoing Breast Conservative SurgeryDesign: A diagnostic test study with a cross-sectional design carried out in a tertiary referral hospital in Girona within a Breast Pathology UnitParticipants: Women diagnosed with breast cancer undergoing a Breast Conservative Surgery in the Breast Pathology Unit at Hospital Universitari de Girona Dr. Josep Trueta

Low metal loading catalysts used for the selective hydrogenation of styrene

A series of Group VIII metal catalysts was obtained for the semi-hydrogenation of styrene. Catalysts were characterized by Hydrogen Chemisorption, TPR and XPS. Palladium, rhodium and platinum low metal loading prepared catalysts presented high activity and selectivity (ca. 98%) during the semi-hydrogenation of styrene, being palladium the most active catalyst. The ruthenium catalyst also presented high selectivity (ca. 98%), but the lowest activity. For the palladium catalyst, the influence of the precursor salt and of the reduction temperature on the activity and selectivity were studied. The following activity series was obtained: PdN-423 > PdCl-673 > PdCl-373> PtCl-673 > RhCl-673 >> RuCl-673. As determined by XPS, differences in activity could be attributed, at least in part, to electronic effects.

Enzyme loading dependence of cellulose hydrolysis of sugarcane bagasse

The enzymatic hydrolysis of steam-pretreated sugarcane bagasse, either delignified or non-delignified, was studied as a function of enzyme loading. Hydrolysis experiments were carried out using five enzyme loadings (2.5 to 20 FPU/g cellulose) and the concentration of solids was 2% for both materials. Alkaline delignification improved cellulose hydrolysis by increasing surface area. For both materials, glucose concentrations increased with enzyme loading. On the other hand, enzyme loadings higher than 15 FPU/g did not result in any increase in the initial rate, since the excess of enzyme adsorbed onto the substrate restricted the diffusion process through the structure.

METHANE DRY REFORMING OVER Ni SUPPORTED ON PINE SAWDUST ACTIVATED CARBON: EFFECTS OF SUPPORT SURFACE PROPERTIES AND METAL LOADING

The influence of metal loading and support surface functional groups (SFG) on methane dry reforming (MDR) over Ni catalysts supported on pine-sawdust derived activated carbon were studied. Using pine sawdust as the catalyst support precursor, the smallest variety and lowest concentration of SFG led to best Ni dispersion and highest catalytic activity, which increased with Ni loading up to 3 Ni atoms nm-2. At higher Ni loading, the formation of large metal aggregates was observed, consistent with a lower "apparen" surface area and a decrease in catalytic activity. The H2/CO ratio rose with increasing reaction temperature, indicating that increasingly important side reactions were taking place in addition to MDR.

BUDDHISM AND MODERNITY: IN THE MARGIN OF DONALD S. LOPEZ JR.'S "BUDDHISM AND SCIENCE

ABSTRACT The present article aims at setting the issue of the relationship between Buddhism and science in a historical and philosophical frame wider than that one taken into account by the international scholarship so far. The historical point of view allows us to conclude that the narrative that connects Buddhism with science is not based on features intrinsic to Buddhist thought. In fact, such narrative prospered thanks to the development of a dialectic, typical of the 18th and 19th centuries, between science and religion. The philosophical point of view allows us to conclude that such narrative is backed by a metaphysical-like thought that denies the specificity of both science and Buddhism.

Swine effluent treatment using anaerobic digestion at different loading rates

The industrial swine production is characterized by generation of significant effluent amounts that require treatment. The most adopted practices by Brazilian swine farmers have been wastewater storage in lagoons and its subsequent use as a biofertilizer. Nutrient accumulation in soil and water creates the need for an effective management of these residues. The anaerobic digestion process is an important alternative and low-cost treatment for organic matter reduction. However, its efficiency is limited by the digester capacity of solid degradation, especially at low hydraulic retention times. Thus, the present study aimed to verify the behavior of an upflow anaerobic digester by increasing the organic loading rate. This was accomplished in three stages using, as a parameter, volatile solids at 0.5; 1.0 and 1.5 kgVS m-3 d-1, respectively. This digester model proved to be quite robust and effective in swine manure treatment, achieving high efficiency of volatile solid removal at all stages of the study (stage 1: 61.38%; stage 2: 55.18%; and stage 3: 43.18%). Biogas production was directly related to the increasing organic load, reaching 0.14, 0.85, and 0.86 Nm³ kgVS-1add., respectively, with no significant difference (p<0.05) of biogas methane concentration among the studied stages (73.7, 75.0, and 77.9%).

Mechanical damage during harvest and loading affect orange postharvest quality

Brazil is the world’s largest orange producer; however, part of this production is lost during postharvest. This loss can be minimized by controlling incidence of physical damage throughout the harvest and loading operations. Impacts can negatively modify quantitative and qualitative fruits aspects. The main goal of this study was to measure the impact magnitude in two types of harvest (manual and detachment) and during all steps from picking into bags until loading for transport to the processing industry and additionally evaluating, in laboratory, the physico-chemical quality of the fruit subjected to various impacts, similar to those found in the field. In order to evaluate the impact magnitude, an instrumented sphere was used (760 mm, Techmark, Inc, USA). The following physico-chemical parameters were evaluated during 6-days of storage: weight loss, soluble solids contents, titratable acidity, ascorbic acid content, pH, firmness and peel color. The greatest impacts were observed during harvest, during the detachment practice, and when loading and unloading from bulk storage, with average acceleration values between 249.5 and 531.52G. The impact incidence in oranges were responsible for reducing the soluble solids, titratable acidity, ascorbic acid and weight by to 5.5%; 8.7%; 4.6% and 0.5%, respectively, compared to the control. Impacts during harvest and the various pre-industry manipulation steps must be controlled as they interfere in postharvest quality and physiology of ‘Valência’ oranges.

Modelling of mechanical properties of CRFC composites under flexure loading

Carbon Fibre Reinforced Carbon (CFRC) Composites are increasing their applications due to their high strength and Young’s Modulus at high temperatures in inert atmosphere. Although much work has been done on processing and structure and properties relationship, few studies have addressed the modelling of mechanical properties. This work is divided in two parts. In the first part, a modelling of mechanical properties was carried out for two bi-directional composites using a model based on the Bernoulli-Euler theory for symmetric laminated beams. In the second part, acoustic emission (AE) was used as an auxiliary technique for monitoring the failure process of the composites. Differences in fracture behaviour are reflected in patterns of AE.

Instability of a square sheet under symmetric biaxial loading

An early experiment found that a square rubber sheet under symmetric biaxial loading may not remain square. This curious result has been one of the most instructive examples in finite elasticity. Here thermodynamic considerations are used to analyze this instability.

Study on Customer Perceived Value of Container Loading Equipment

The goal of the thesis was to gain understanding of organizational buying behavior and its effect from the selling perspective and to generate base for verifying customer value propositions for Actiw Oy. The first objective was to discover the current buying decision criteria of current customers to understand the buying motives which had led to the investment initially. Second objective was to understand how the buying decision criteria and customer experiences can be turned into customer value propositions. Research was done with 16 customer interviews, which were focused on obtaining the information on the buying center and the value of the solution. Thesis goes through the main theories of OBB and the theory behind customer value management. Based on customer interviews, the currently used customer value propositions were tested and categorized into points-of-parities and points-ofdifferences. The interviews confirmed customer behavior in new task and modified rebuy situations and also gave confirmation to the internally done customer value propositions. Main finding of the study was, that as the value propositions are possible to present more specifically to each new case instead of using all benefits at the same time.

Effect of loading type on the fatigue strength of symmetric and asymmetric welded joints made of ultra high strength steel

In this study, finite element analyses and experimental tests are carried out in order to investigate the effect of loading type and symmetry on the fatigue strength of three different non-load carrying welded joints. The current codes and recommendations do not give explicit instructions how to consider degree of bending in loading and the effect of symmetry in the fatigue assessment of welded joints. The fatigue assessment is done by using effective notch stress method and linear elastic fracture mechanics. Transverse attachment and cover plate joints are analyzed by using 2D plane strain element models in FEMAP/NxNastran and Franc2D software and longitudinal gusset case is analyzed by using solid element models in Abaqus and Abaqus/XFEM software. By means of the evaluated effective notch stress range and stress intensity factor range, the nominal fatigue strength is assessed. Experimental tests consist of the fatigue tests of transverse attachment joints with total amount of 12 specimens. In the tests, the effect of both loading type and symmetry on the fatigue strength is studied. Finite element analyses showed that the fatigue strength of asymmetric joint is higher in tensile loading and the fatigue strength of symmetric joint is higher in bending loading in terms of nominal and hot spot stress methods. Linear elastic fracture mechanics indicated that bending reduces stress intensity factors when the crack size is relatively large since the normal stress decreases at the crack tip due to the stress gradient. Under tensile loading, experimental tests corresponded with finite element analyzes. Still, the fatigue tested joints subjected to bending showed the bending increased the fatigue strength of non-load carrying welded joints and the fatigue test results did not fully agree with the fatigue assessment. According to the results, it can be concluded that in tensile loading, the symmetry of joint distinctly affects on the fatigue strength. The fatigue life assessment of bending loaded joints is challenging since it depends on whether the crack initiation or propagation is predominant.

Continental margin architecture : the palynological signature of glacioeustasy /

Palynomorphs from two siliciclastic margins were examined to gain insights into continental margin architecture. Sea level change is thought to be one of the primary controls on continental margin architecture. Because Late Neogene glacioeustasy has been well studied marine sediments deposited during the Late Neogene were examined to test this concept. Cores from the outer shelf and upper slope were taken from the New Jersey margin in the western North Atlantic Ocean and from the Sunda Shelf margin in the South China Sea. Continental margin architecture is often described in a sequence stratigraphic context. One of the main goals of both coring projects was to test the theoretical sequence stratigraphic models developed by a research group at Exxon (e.g. Wilgus et al., 1988). Palynomorphs provide one of the few methods of inferring continental margin architecture in monotonous, siliciclastic marine sediments where calcareous sediments are rare (e.g. New Jersey margin). In this study theoretical models of the palynological signature expected in sediment packages deposited during the various increments of a glacioeustatic cycle were designed. These models were based on the modem palynomorph trends and taphonomic factors thought to control palynomorph distribution. Both terrestrial (pollen and spores) and marine (dinocysts) palynomorphs were examined. The palynological model was then compared with New Jersey margin and Sunda Shelf margin sediments. The predicted palynological trends provided a means of identifying a complete cycle of glacioeustatic change (Oxygen Isotope Stage 5e to present) in the uppermost 80 meters of sediment on the slope at the New Jersey margin. Sediment availability, not sea meters of sediment on the slope at the New Jersey margin. Sediment availability, not sea level change, is thought to be the major factor controlling margin architecture during the late Pleistocene here at the upper slope. This is likely a function of the glacial scouring of the continents which significantly increases sediment availability during glacial stages. The subaerially exposed continental shelf during the lowstand periods would have been subject to significant amounts of erosion fi:om the proglacial rivers flowing fi-om the southern regions of the ice-sheet. The slope site is non-depositional today and was also non-depositional during the last full interglacial period. The palynomorph data obtained fi-om the South China Sea indicate that the major difference between the New Jersey Margin sites and the Sunda Shelf margin sites is the variation in sediment supply and the rate of sediment accumulation. There was significantly less variation in sediment supply between glacial and interglacial periods and less overall sediment accumulation at the Sunda Shelf margin. The data presented here indicate that under certain conditions the theoretical palynological models allow the identification of individual sequence stratigraphic units and therefore, allow inferences regarding continental margin architecture. The major condition required in this approach is that a complete and reliable database of the contemporaneous palynomorphs be available.