The current and future state of interventional cardiology: a critical appraisal

After 75 years of invasive and over 50 years of interventional cardiology, cardiac catheter-based procedures have become the most frequently used interventions of modern medicine. Patients undergoing a percutaneous coronary intervention (PCI) outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a (drug-eluting) stent, in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases. The dominance of stenting over conservative therapy or balloon angioplasty on one hand and bypass surgery on the other hand is a flagrant example of how medical research is digested an applied in real life. Apart from electrophysiological interventions, closure ot the patent foramen ovale and percutaneous replacement of the aortic valve in the elderly have the potential of becoming daily routine procedures in catheterization laboratories around the world. Stem cell regeneration of vessels or heart muscle, on the other hand, may remain a dream never to come true.

Effect of automatic tube current modulation on radiation dose and image quality for low tube voltage multidetector row CT angiography: phantom study

RATIONALE AND OBJECTIVES: To evaluate the effect of automatic tube current modulation on radiation dose and image quality for low tube voltage computed tomography (CT) angiography. MATERIALS AND METHODS: An anthropomorphic phantom was scanned with a 64-section CT scanner using following tube voltages: 140 kVp (Protocol A), 120 kVp (Protocol B), 100 kVp (Protocol C), and 80 kVp (Protocol D). To achieve similar noise, combined z-axis and xy-axes automatic tube current modulation was applied. Effective dose (ED) for the four tube voltages was assessed. Three plastic vials filled with different concentrations of iodinated solution were placed on the phantom's abdomen to obtain attenuation measurements. The signal-to-noise ratio (SNR) was calculated and a figure of merit (FOM) for each iodinated solution was computed as SNR(2)/ED. RESULTS: The ED was kept similar for the four different tube voltages: (A) 5.4 mSv +/- 0.3, (B) 4.1 mSv +/- 0.6, (C) 3.9 mSv +/- 0.5, and (D) 4.2 mSv +/- 0.3 (P > .05). As the tube voltage decreased from 140 to 80 kVp, image noise was maintained (range, 13.8-14.9 HU) (P > .05). SNR increased as the tube voltage decreased, with an overall gain of 119% for the 80-kVp compared to the 140-kVp protocol (P < .05). The FOM results indicated that with a reduction of the tube voltage from 140 to 120, 100, and 80 kVp, at constant SNR, ED was reduced by a factor of 2.1, 3.3, and 5.1, respectively, (P < .001). CONCLUSIONS: As tube voltage decreases, automatic tube current modulation for CT angiography yields either a significant increase in image quality at constant radiation dose or a significant decrease in radiation dose at a constant image quality.

Erosion Damage Mapping: Assessing Current Soil Erosion Damage in Switzerland

Within the scope of a comprehensive assessment of the degree of soil erosion in Switzerland, common methods have been used in the past including test plot measurements, artificial rainfall simulation, and erosion modelling. In addition, mapping guidelines for all visible erosion features have been developed since the 1970s and are being successfully applied in many research and soil conservation projects. Erosion damage has been continuously mapped over a period of 9 years in a test region in the central Bernese plateau. In 2005, two additional study areas were added. The present paper assesses the data gathered and provides a comparison of the three study areas within a period of one year (from October 2005 to October 2006), focusing on the on-site impacts of soil erosion. During this period, about 11 erosive rainfall events occurred. Average soil loss rates mapped at each study site amounted to 0.7 t ha-1, 1.2 t ha-1 and 2.3 t ha-1, respectively. About one fourth of the total arable land showed visible erosion damage. Maximum soil losses of about 70 t ha-1 occurred on individual farm plots. Average soil erosion patterns are widely used to underline the severity of an erosion problem (e.g. impacts on water bodies). But since severe rainfall events, wheel tracks, headlands, and other “singularities” often cause high erosion rates, analysis of extreme erosion patterns such as maximum values led to a more differentiated understanding and appropriate conclusions for planning and design of soil protection measures. The study contains an assessment of soil erosion in Switzerland, emphasizing questions about extent, frequency and severity. At the same time, the effects of different types of land management are investigated in the field, aiming at the development of meaningful impact indicators of (un-)sustainable agriculture/soil erosion risk as well as the validation of erosion models. The results illustrate that conservation agriculture including no-till, strip tillage and in-mulch seeding plays an essential role in reducing soil loss as compared to conventional tillage.

Determination of the minimum alveolar concentration of isoflurane in Shetland ponies using constant current or constant voltage electrical stimulation

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane in Shetland ponies using a sequence of three different supramaximal noxious stimulations at each tested concentration of isoflurane rather than a single stimulation. STUDY DESIGN: Prospective, experimental trial. ANIMALS: Seven 4-year-old, gelding Shetland ponies. METHODS: The MAC of isoflurane was determined for each pony. Three different modes of electrical stimulation were applied consecutively (2 minute intervals): two using constant voltage (90 V) on the gingiva via needle- (CVneedle) or surface-electrodes (CVsurface) and one using constant current (CC; 40 mA) via surface electrodes applied to the skin over the digital nerve. The ability to clearly interpret the responses as positive, the latency of the evoked responses and the inter-electrode resistance were recorded for each stimulus. RESULTS: Individual isoflurane MAC (%) values ranged from 0.60 to 1.17 with a mean (+/-SD) of 0.97 (+/-0.17). The responses were more clearly interpreted with CC, but did not reach statistical significance. The CVsurface mode produced responses with a longer delay. The CVneedle mode was accompanied by variable inter-electrode resistances resulting in uncontrolled stimulus intensity. At 0.9 MAC, the third stimulation induced more positive responses than the first stimulation, independent of the mode of stimulation used. CONCLUSIONS: The MAC of isoflurane in the Shetland ponies was lower than expected with considerable variability among individuals. Constant current surface electrode stimulations were the most repeatable. A summation over the sequence of three supramaximal stimulations was observed around 0.9 MAC. CLINICAL RELEVANCE: The possibility that Shetland ponies require less isoflurane than horses needs further investigation. Constant current surface-electrode stimulations were the most repeatable. Repetitive supramaximal stimuli may have evoked movements at isoflurane concentrations that provide immobility when single supramaximal stimulation was applied.

Equine parasite control under prescription-only conditions in Denmark - Awareness, knowledge, perception, and strategies applied.

Due to widespread development of anthelmintic resistance in equine parasites, recommendations for their control are currently undergoing marked changes with a shift of emphasis toward more coprological surveillance and reduced treatment intensity. Denmark was the first nation to introduce prescription-only restrictions of anthelmintic drugs in 1999, but other European countries have implemented similar legislations over recent years. A questionnaire survey was performed in 2008 among Danish horse owners to provide a current status of practices and perceptions with relation to parasite control. Questions aimed at describing the current use of coprological surveillance and resulting anthelmintic treatment intensities, evaluating knowledge and perceptions about the importance of various attributes of parasite control, and assessing respondents' willingness to pay for advice and parasite surveillance services from their veterinarians. A total of 1060 respondents completed the questionnaire. A large majority of respondents (71.9%) were familiar with the concept of selective therapy. Results illustrated that the respondents' self-evaluation of their knowledge about parasites and their control associated significantly with their level of interest in the topic and their type of education (P<0.0001). The large majority of respondents either dewormed their horses twice a year and/or performed two fecal egg counts per horse per year. This approach was almost equally pronounced in foals, horses aged 1-3 years old, and adult horses. The respondents rated prevention of parasitic disease and prevention of drug resistance as the most important attributes, while cost and frequent fecal testing were rated least important. Respondents' actual spending on parasite control per horse in the previous year correlated significantly with the amount they declared themselves willing to spend (P<0.0001). However, 44.4% declared themselves willing to pay more than what they were spending. Altogether, results indicate that respondents were generally familiar with equine parasites and the concept of selective therapy, although there was some confusion over the terms small and large strongyles. They used a large degree of fecal surveillance in all age groups, with a majority of respondents sampling and/or treating around twice a year. Finally, respondents appeared willing to spend money on parasite control for their horses. It is of concern that the survey suggested that foals and young horses are treated in a manner very similar to adult horses, which is against current recommendations. Thus, the survey illustrates the importance of clear communication of guidelines for equine parasite control.

Poverty, Educational Attainment and Health Among America’s Children: Current and Future Effects of Population Diversification and Associated Socioeconomic Change

A complex of interrelated factors including minority status, poverty, education, health status, and other factors determine the general welfare of children in America, particularly in heavily diverse states such as Texas. Although racial/ethnic status is clearly only a concomitant factor in that determination it is a factor for which future projections are available and for which the relationships with the other factors in the complex can be assessed. After examining the nature of the interrelationships between these factors we utilize direct standardization techniques to examine how the future diversification of the United States and Texas will affect the number of children in poverty, the educational status of the householders in households in which children in poverty live and the health status of children in 2040 assuming that the current relationships between minority status and these socioeconomic factors continue into the future. In the results of the analyses, data are compared with the total population of the United States and Texas in 2040 assumed in the first simulation scenario, to have the race/ethnicity characteristics of 2008 and in the second those projected for 2040 by the U.S. Census Bureau for the nation and by the Texas State Data Center for Texas in 2040. The results show that the diversification of the population could increase the number of children in poverty in the United States by nearly 1.8 million more than would occur with the lower levels of diversification evident in 2008. In addition, poverty would become increasingly concentrated among minority children with minority children accounting for 76.2 percent of all children in poverty by 2040 and with Hispanic children accounting for nearly half of the children in poverty by 2040. Results for educational attainment show an increasing concentration of minority children in households with householders with very low levels of education such that by 2040, 85.2 percent of the increase in the number of children in poverty would be in households with a householder with less than a high school level of education. Finally, the results related to several health status factors show that children in poverty will have a higher prevalence of nearly all health conditions. For example, the number of children with untreated dental conditions could increase to more than 4 million in the United States and to nearly 500,000 in Texas. The results clearly show that improving the welfare of children in America will require concerted efforts to change the poverty, educational, and health status characteristics associated with minority status and particularly Hispanic status. Failing to do so will lead to a future in which America’s children are increasingly impoverished, more poorly educated, and less healthy and which, as a result, is an America with a more tentative future.

Phytoplankton Scales of Variability in the California Current System: 1. Interannual and Cross-Shelf Variability

In the California Current System, strong mesoscale variability associated with eddies and meanders of the coastal jet play an important role in the biological productivity of the area. To assess the dominant timescales of variability, a wavelet analysis is applied to almost nine years (October 1997 to July 2006) of 1-km-resolution, 5-day-averaged, Sea-viewing Wide Field-of-view Sensor (SeaWiFS) chlorophyll a (chl a) concentration data. The dominant periods of chlorophyll variance, and how these change in time, are quantified as a function of distance offshore. The maximum variance in chlorophyll occurs with a period of similar to 100-200 days. A seasonal cycle in the timing of peak variance is revealed, with maxima in spring/summer close to shore (20 km) and in autumn/winter 200 km offshore. Interannual variability in the magnitude of chlorophyll variance shows maxima in 1999, 2001, 2002, and 2005. There is a very strong out-of-phase correspondence between the time series of chlorophyll variance and the Pacific Decadal Oscillation (PDO) index. We hypothesize that positive PDO conditions, which reflect weak winds and poor upwelling conditions, result in reduced mesoscale variability in the coastal region, and a subsequent decrease in chlorophyll variance. Although the chlorophyll variance responds to basin-scale forcing, chlorophyll biomass does not necessarily correspond to the phase of the PDO, suggesting that it is influenced more by local-scale processes. The mesoscale variability in the system may be as important as the chl a biomass in determining the potential productivity of higher trophic levels.

Prediction and prevention of psychosis: current progress and future tasks

Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required

Conservation of threatened habitat types under future climate change – Lessons from plant-distribution models and current extinction trends in southern Germany

A higher risk of future range losses as a result of climate change is expected to be one of the main drivers of extinction trends in vascular plants occurring in habitat types of high conservation value. Nevertheless, the impact of the climate changes of the last 60 years on the current distribution and extinction patterns of plants is still largely unclear. We applied species distribution models to study the impact of environmental variables (climate, soil conditions, land cover, topography), on the current distribution of 18 vascular plant species characteristic of three threatened habitat types in southern Germany: (i) xero-thermophilous vegetation, (ii) mesophilous mountain grasslands (mountain hay meadows and matgrass communities), and (iii) wetland habitats (bogs, fens, and wet meadows). Climate and soil variables were the most important variables affecting plant distributions at a spatial level of 10 × 10 km. Extinction trends in our study area revealed that plant species which occur in wetland habitats faced higher extinction risks than those in xero-thermophilous vegetation, with the risk for species in mesophilous mountain grasslands being intermediary. For three plant species characteristic either of mesophilous mountain grasslands or wetland habitats we showed exemplarily that extinctions from 1950 to the present day have occurred at the edge of the species’ current climatic niche, indicating that climate change has likely been the main driver of extinction. This is largely consistent with current extinction trends reported in other studies. Our study indicates that the analysis of past extinctions is an appropriate means to assess the impact of climate change on species and that vulnerability to climate change is both species- and habitat-specific.

Phytoplankton Scales of Variability in the California Current System: 2. Latitudinal Variability

The California Current System encompasses a southward flowing current which is perturbed by ubiquitous mesoscale variability. The extent to which latitudinal patterns of physical variability are reflected in the distribution of biological parameters is poorly known. To investigate the latitudinal distribution of chlorophyll variance, a wavelet analysis is applied to nearly 9 years (October 1997 to July 2006) of 1-km-resolution Sea-viewing Wide Field-of-view Sensor (SeaWiFS) chlorophyll concentration data at 5-day resolution. Peaks in the latitudinal distribution of chlorophyll variance coincide with features of the coastal topography. Maxima in variance are located offshore of Vancouver Island and downstream of Heceta Bank, Cape Blanco, Point Arena, and possibly Point Conception. An analysis of dominant wavelengths in the chlorophyll data reveals a transfer of energy into smaller scales is generated in the vicinity of the coastal capes. The latitudinal distribution of variance in sea level anomaly corresponds closely to the chlorophyll variance in the nearshore region (<100 km offshore), suggesting that the same processes determine the distribution of both. Farther offshore, there is no correspondence between latitudinal patterns of sea level anomaly and chlorophyll variance. This likely represents a transition from physical to biological control of the phytoplankton distribution.

Respiration and ingestion rates of calanoid copepod in the northern Benguela Current System measured ex situ during the RSS Discovery D356 cruise in 2010

Respiration rates of 16 calanoid copepod species from the northern Benguela upwelling system were measured on board RRS Discovery in September/October 2010 to determine their energy requirements and assess their significance in the carbon cycle. Copepod species were sampled by different net types. Immediately after the hauls, samples were sorted to species and stages (16 species; females, males and C5 copepodids) according to Bradford-Grieve et al. (1999). Specimens were kept in temperature-controlled refrigerators for at least 12 h before they were used in experiments. Respiration rates of different copepod species were measured onboard by optode respirometry (for details see Köster et al., 2008) with a 10-channel optode respirometer (PreSens Precision Sensing Oxy-10 Mini, Regensburg, Germany) under simulated in situ conditions in temperature-controlled refrigerators. Experiments were run in gas-tight glass bottles (12-13 ml). For each set of experiments, two controls without animals were measured under exactly the same conditions to compensate for potential bias. The number of animals per bottle depended on the copepods size, stage and metabolic activity. Animals were not fed during the experiments but they showed natural species-specific movements. Immediately after the experiments, all specimens were deep-frozen at - 80 °C for later dry mass determination (after lyophilisation for 48 h) in the home lab. The carbon content (% of dry mass) of each species was measured by mass-spectrometry in association with stable isotope analysis and body dry mass was converted to units of carbon. For species without available carbon data, the mean value of all copepod species (44% dry mass) was applied. For the estimation of carbon requirements of copepod species, individual oxygen consumption rates were converted to carbon units, assuming that the expiration of 1 ml oxygen mobilises 0.44 mg of organic carbon by using a respiratory quotient (RQ) of 0.82 for a mixed diet consisting of proteins (RQ = 0.8-1.0), lipids (RQ = 0.7) and carbohydrates (RQ = 1.0) (Auel and Werner, 2003). The carbon ingestion rates were calculated using the energy budget and the potential maximum ingestion rate approach. To allow for physiological comparisons of respiration rates of deep- and shallow-living copepod species without the effects of ambient temperature and different individual body mass, individual respiration rates were temperature- (15°C, Q10=2) and size-adjusted. The scaling coefficient of 0.76 (R2=0.556) is used for the standardisation of body dry mass to 0.3 mg (mean dry mass of all analysed copepods), applying the allometric equation R= (R15°C/M0.76)×0.30.76, where R is respiration and M is individual dry mass in mg.

Table 1: Technetium-99 in seawater in the West Spitsbergen Current and adjacent areas, sorted from east to west

99Tc levels were measured in seawater samples collected between 2000 and 2002 in the West Spitsbergen Current (WSC) and along the western coast of Svalbard or Spitzbergen and compared with available oceanographic 3-D modelling results for the late 1990s. Additional data from related regions are also presented in order to support the data interpretation. The seawater in the Arctic fjord Kongsfjorden on the western coast of Svalbard is influenced by the WSC, as shown by the 99Tc levels in surface water. By means of the WSC, 99Tc reaches the Eastern Fram Strait, where one branch of the WSC turns west into the East Greenland Current (EGC), and another branch continues northwards into the Arctic Ocean. Surface seawater collected in the central part of the WSC during a cruise on board the R/V "Polarstern" in the summer of 2000, showed higher levels of 99Tc than samples measured in Kongsfjorden in the spring of 2000. However, all levels measured in surface water are of the same order of magnitude. Data from sampling of deeper water in the WSC and EGC provide information pertaining to the lateral distribution of 99Tc. In all vertical profiling surveys (conducted in spring and summer), the highest levels of 99Tc were found in surface water. Comparison with oceanographic 3-D modelling indicates both significant seasonal variations in the lateral stratification of the WSC and variations with depth over shorter vertical distances. This information can be applied in sampling strategies, environmental monitoring, long-range transport of pollutants and physical oceanography.

Electric current of an electrified jet issuing from a long metallic tube.

This paper presents an analysis of the transport of electric current in a jet of an electrically conducting liquid discharging from a metallic tube into a gas or a vacuum, and subject to an electric field due to a high voltage applied between the tube and a far electrode. The flow, the surface charge and the electric field are computed in the current transfer region of the jet, where conduction current in the liquid becomes surface current due to the convection of electric charge accumulated at its surface. The electric current computed as a function of the flow rate of the liquid injected through the tube increases first as the square root of this flow rate, levels to a nearly constant value when the flow rate is increased and finally sets to a linear increase when the flow rate is further increased. The current increases linearly with the applied voltage at small and moderate values of this variable, and faster than linearly at high voltages. The characteristic length and structure of the current transfer region are determined. Order-of-magnitude estimates for jets which are only weakly stretched by the electric stresses are worked out that qualitatively account for some of the numerical results.

Gaussian Multiscale Aggregation Applied to Segmentation in Hand Biometrics

This paper presents an image segmentation algorithm based on Gaussian multiscale aggregation oriented to hand biometric applications. The method is able to isolate the hand from a wide variety of background textures such as carpets, fabric, glass, grass, soil or stones. The evaluation was carried out by using a publicly available synthetic database with 408,000 hand images in different backgrounds, comparing the performance in terms of accuracy and computational cost to two competitive segmentation methods existing in literature, namely Lossy Data Compression (LDC) and Normalized Cuts (NCuts). The results highlight that the proposed method outperforms current competitive segmentation methods with regard to computational cost, time performance, accuracy and memory usage.