Prediction of 30-day mortality in older patients with a first acute myocardial infarction

This study sought predictors of mortality in patients aged >or=75 years with a first ST-segment elevation myocardial infarction (STEMI) and evaluated the validity of the GUSTO-I and TIMI risk models. Clinical variables, treatment and mortality data from 433 consecutive patients were collected. Univariable and multivariable logistic regression analyses were applied to identify baseline factors associated with 30-day mortality. Subsequently a model predicting 30-day mortality was created and compared with the performance of the GUSTO-I and TIMI models. After adjustment, a higher Killip class was the most important predictor (OR 16.1; 95% CI 5.7-45.6). Elevated heart rate, longer time delay to admission, hyperglycemia and older age were also associated with increased risk. Patients with hypercholesterolemia had a significantly lower risk (OR 0.46; 95% CI 0.24-0.86). Discrimination (c-statistic 0.79, 95% CI 0.75-0.84) and calibration (Hosmer-Lemeshow 6, p = 0.5) of our model were good. The GUSTO-I and TIMI risk scores produced adequate discrimination within our dataset (c-statistic 0.76, 95% CI 0.71-0.81, and c-statistic 0.77, 95% CI 0.72-0.82, respectively), but calibration was not satisfactory (HL 21.8, p = 0.005 for GUSTO-I, and HL 20.6, p = 0.008 for TIMI). In conclusion, short-term mortality in elderly patients with a first STEMI depends most importantly on initial clinical and hemodynamic status. The GUSTO-I and TIMI models are insufficiently adequate for providing an exact estimate of 30-day mortality risk.

Symmetry-breaking and chaos in electron transport in semiconductor superlattices

We study the motion of electrons in a single miniband of a semiconductor superlattice driven by THz electric field polarized along the growth direction. We work in the semiclassical balance-equation model, including different elastic and inelastic scattering rates, and incorporating the self-consistent electric field generated by electron motion. We explore regions of complex dynamics, which can include chaotic behaviour and symmetry-breaking. We estimate the magnitudes of dc current and dc voltage that spontaneously appear in regions of broken-symmetry for parameters characteristic of modern semiconductor superlattices. This work complements PRL 80(1998)2669 [ cond-mat/9709026 ].

Fuentes azufradas en cultivos de grano de la Región Pampeana

La presente tesis tuvo como objetivos: i. Evaluar la incidencia de la solubilidad y forma química de fuentes azufradas (azufre elemental y una fuente sulfatada soluble) en las respuestas en el rendimiento de trigo y soja de primera. ii. Analizar la residualidad de la aplicación de las fuentes azufradas en el trigo en el rendimiento de la soja de segunda. Asimismo, como objetivo secundario se planteó evaluar la influencia de variables edáficas y climáticas en las respuestas observadas. Se plantearon dos hipótesis: i. La necesidad de oxidación del azufre elemental (AE) reduce la respuesta y eficiencia de uso del S (EUS) en el cultivo de trigo, comparado con el sulfato de amonio (SA). Por el contrario, ese efecto es de menor magnitud en soja de primera, debido a las condiciones termo - hídricas más favorables. ii. La residualidad de la fertilización del trigo sobre el rendimiento de la soja de segunda, es mayor con el AE micronizado que con el SA. Se realizaron ocho ensayos de campo en trigo/soja 2da y nueve en soja de 1ra, durante dos años consecutivos en sitios ubicados en la Región Pampeana. Los tratamientos fueron: i. testigo (sin agregado de S), ii. fertilización con azufre elemental (AE) micronizado (0-0- 0+95 por ciento de S) en dos niveles de dosis, iii. fertilización con sulfato de amonio granulado (SA, 21-0-0+ 24 por ciento S), también en dos niveles de dosis. Las dosis evaluadas fueron 10 y 30 kg ha-1 de S (año 1) y 15 y 30 kg ha-1 (año 2). La fertilización azufrada afectó significativamente (p menor 0,05) los rendimientos del trigo en cuatro de cinco sitios en el primer año y en todos los sitios durante el segundo año. Las respuestas se ubicaron en el rango de 231 a 857 kg ha-1 en el primer año y entre 702 y 2119 kg ha-1 en el segundo año. No se observaron diferencias en respuesta entre fuentes azufradas (i.e. similar efectividad) o en la eficiencia agronómica del S aplicado (kg de grano kg de S aplicado- 1) en la mayoría de los sitios. Para el conjunto de experimentos, ambos fertilizantes fueron adecuados para proveer SO4 2-al cultivo. Estos resultados permitieron rechazar la hipótesis planteada. Tampoco se detectó efecto significativo de dosis o interacción fuente x dosis en la mayoría de los sitios (p mayor 0,05). La dosis más baja fue suficiente para cubrir la demanda de S del cultivo. Se observó una asociación positiva entre las respuestas y el contenido de MO del suelo y las precipitaciones (macollaje y total del ciclo) e inversa con la disponibilidad de S-SO4 2- a la siembra, aunque con bajo ajuste (R2 medio=0,18). No se detectó asociación entre las respuestas y la temperatura en macollaje o en el ciclo. En los experimentos con soja de 1ra, se observó una baja frecuencia de sitios con respuesta a la fertilización azufrada. En estos sitios, las respuestas fueron de 377-982 kg ha-1 (año 1) y de 151-361 kg ha-1 (año 2) y no se evidenció correlación significativa entre las respuestas y variables climáticas o edáficas en el primer año de evaluación. En el segundo año, las respuestas se correlacionaron en forma inversa con el contenido de S-SO42- inicial (R2=0,63). La eficiencia agronómica del S aplicado fue similar entre las fuentes azufradas durante el primer año y se observó efecto significativo de dosis. La dosis más alta fue más eficiente en proveer S al cultivo. En el segundo año, dependiendo de la localidad, se observaron algunas diferencias de efectividad entre las fuentes azufradas relacionadas con la influencia de variables de sitio. Los efectos residuales en la soja de 2da se observaron en pocos sitios experimentales. Las respuestas fueron de 58-689 (año 1) y de 186-512 kg ha-1 (año 2) y se pudieron asociar en forma inversa con el contenido de S-SO4 2- estimados al inicio del cultivo (R2=0,33). En los sitios con residualidad significativa (p manor 0,05) y con la menor dosis de S aplicada en el trigo antecesor, no se observaron diferencias significativas (p mayor 0,05) en eficiencia agronómica entre fuentes. Por el contrario, con la dosis mas elevada, la eficiencia del S aplicado como AE fue mayor que con SA. Por ello, la hipótesis planteada en el tema de residualidad se acepta, pero parcialmente. Los resultados obtenidos no permitieron determinar un patrón claro de residualidad de las fuentes azufradas en los sitios experimentales.

Analysis and modeling of heaping behavior of granular mixtures within a computational mechanics framework

This paper presents a continuum model of the flow of granular material during filling of a silo, using a viscoplastic constitutive relation based on the Drucker-Prager plasticity yield function. The performed simulations demonstrate the ability of the model to realistically represent complex features of granular flows during filling processes, such as heap formation and non-zero inclination angle of the bulk material-air interface. In addition, micro-mechanical parametrizations which account for particle size segregation are incorporated into the model. It is found that numerical predictions of segregation phenomena during filling of a binary granular mixture agree well with experimental results. Further numerical tests indicate the capability of the model to cope successfully with complex operations involving granular mixtures.

Hypercapnic acidosis attenuates pulmonary epithelial wound repair by an NF-kappa B dependent mechanism

Background: Hypercapnic acidosis exerts protective effects in acute lung injury but may also slow cellular repair. These effects may be mediated via inhibition of nuclear factor-kappa B (NF-kappa B), a pivotal transcriptional regulator in inflammation and repair.

Peptide DV-28 amide: An inhibitor of bradykinin-induced arterial smooth muscle relaxation encoded by Bombina orientalis skin kininogen-2

Skin kininogens from bombinid toads encode an array of bradykinin-related peptides and one such kininogen from Bombina maxima also encodes the potent bradykinin B2-receptor antagonist, kinestatin. In order to determine if the skin secretion of the closely-related toad, Bombina orientalis, contained a bradykinin inhibitory peptide related to kinestatin, we screened reverse phase HPLC fractions of defensive skin secretion using a rat tail artery smooth muscle preparation. A fraction was located that inhibited bradykinin-induced relaxation of the preparation and this contained a peptide of 3198.5 Da as determined by MALDI-TOF MS. Automated Edman degradation of this peptide established the identity of a 28-mer as: DMYEIKGFKSAHGRPRVCPPGEQCPIWV, with a disulfide-bridge between Cys18 and Cys24 and an amidated C-terminal Val residue. Peptide DV-28 was found to correspond to residues 133–160 of skin pre-kininogen-2 of B. orientalis that also encodes two copies of (Thr6)-bradykinin. The C-terminal residue, Gly-161, of the precursor open-reading frame, acts as the C-terminal amide donor of mature DV-28. DV-28 amide thus represents a new class of bradykinin inhibitor peptide from amphibian skin secretion.

Retrodirective Array Performance in the Presence of Near Field Obstructions

We investigate the situation where there are obstructing elements present in the near field of a retrodirective array. We describe three scattering cases, (1) by an array of straight wires, (2) by low loss medium density fibre board partially obscuring the array, and (3) by concrete blocks, totally and then partially obscuring the array. For all scenarios retrodirective action was shown to be able to provide various degrees of automatic compensation for loss in gain relative to that which would have occurred for a conventional (non-retrodirective) array in the presence of the same scattering screens. Gain improvements of up to 10 dB were observed when the retrodirective array was used. In addition we show how the induced variation of received and re-transmited amplitudes across the array, caused by the scattering screens, is the principle mechanism causing deterioration of the retrodirective arrays monostatic response.

Effect of temporal separation on synchronization in rhythmic performance

A variety of short time delays inserted between pairs of subjects were found to affect their ability to synchronize a musical task. The subjects performed a clapping rhythm together from separate sound-isolated rooms via headphones and without visual contact. One-way time delays between pairs were manipulated electronically in the range of 3 to 78 ms. We are interested in quantifying the envelope of time delay within which two individuals produce synchronous per- formances. The results indicate that there are distinct regimes of mutually coupled behavior, and that `natural time delay'o¨delay within the narrow range associated with travel times across spatial arrangements of groups and ensembleso¨supports the most stable performance. Conditions outside of this envelope, with time delays both below and above it, create characteristic interaction dynamics in the mutually coupled actions of the duo. Trials at extremely short delays (corresponding to unnaturally close proximity) had a tendency to accelerate from anticipation. Synchronization lagged at longer delays (larger than usual physical distances) and produced an increasingly severe deceleration and then deterioration of performed rhythms. The study has implications for music collaboration over the Internet and suggests that stable rhythmic performance can be achieved by `wired ensembles' across distances of thousands of kilometers.

Using simulation to assess cardiac first-responder schemes exhibiting stochastic and spatial complexities

A Monte-Carlo simulation-based model has been constructed to assess a public health scheme involving mobile-volunteer cardiac First-Responders. The scheme being assessed aims to improve survival of Sudden-Cardiac-Arrest (SCA) patients, through reducing the time until administration of life-saving defibrillation treatment, with volunteers being paged to respond to possible SCA incidents alongside the Emergency Medical Services. The need for a model, for example, to assess the impact of the scheme in different geographical regions, was apparent upon collection of observational trial data (given it exhibited stochastic and spatial complexities). The simulation-based model developed has been validated and then used to assess the scheme's benefits in an alternative rural region (not a part of the original trial). These illustrative results conclude that the scheme may not be the most efficient use of National Health Service resources in this geographical region, thus demonstrating the importance and usefulness of simulation modelling in aiding decision making.