Comparative Effectiveness and Safety of New-Generation Versus Early-Generation Drug-Eluting Stents According to Complexity of Coronary Artery Disease: A Patient-Level Pooled Analysis of 6,081 Patients.

OBJECTIVES The purpose of this study was to compare the 2-year safety and effectiveness of new- versus early-generation drug-eluting stents (DES) according to the severity of coronary artery disease (CAD) as assessed by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score. BACKGROUND New-generation DES are considered the standard-of-care in patients with CAD undergoing percutaneous coronary intervention. However, there are few data investigating the effects of new- over early-generation DES according to the anatomic complexity of CAD. METHODS Patient-level data from 4 contemporary, all-comers trials were pooled. The primary device-oriented clinical endpoint was the composite of cardiac death, myocardial infarction, or ischemia-driven target-lesion revascularization (TLR). The principal effectiveness and safety endpoints were TLR and definite stent thrombosis (ST), respectively. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 2 years for overall comparisons, as well as stratified for patients with lower (SYNTAX score ≤11) and higher complexity (SYNTAX score >11). RESULTS A total of 6,081 patients were included in the study. New-generation DES (n = 4,554) compared with early-generation DES (n = 1,527) reduced the primary endpoint (HR: 0.75 [95% CI: 0.63 to 0.89]; p = 0.001) without interaction (p = 0.219) between patients with lower (HR: 0.86 [95% CI: 0.64 to 1.16]; p = 0.322) versus higher CAD complexity (HR: 0.68 [95% CI: 0.54 to 0.85]; p = 0.001). In patients with SYNTAX score >11, new-generation DES significantly reduced TLR (HR: 0.36 [95% CI: 0.26 to 0.51]; p < 0.001) and definite ST (HR: 0.28 [95% CI: 0.15 to 0.55]; p < 0.001) to a greater extent than in the low-complexity group (TLR pint = 0.059; ST pint = 0.013). New-generation DES decreased the risk of cardiac mortality in patients with SYNTAX score >11 (HR: 0.45 [95% CI: 0.27 to 0.76]; p = 0.003) but not in patients with SYNTAX score ≤11 (pint = 0.042). CONCLUSIONS New-generation DES improve clinical outcomes compared with early-generation DES, with a greater safety and effectiveness in patients with SYNTAX score >11.

A stakeholder analysis of the Texas Youth Commission issue for the Texas 80th Legislative Session

The following is a policy analysis based on the Advocacy Coalition Framework by Paul Sabatier. The study question was who were the stakeholders in the legislative process for the issue of the Texas Youth Commission (TYC) overhaul during the Texas 80th Legislative Session. This analysis included the stakeholders identifying characteristics including beliefs and interests, goals and resources, and finally, the winning legislative solutions as embodied in three bills that were passed. The study linked the stakeholders with three bills and expanded on the literature for the stakeholder group of Policy Brokers. The conclusions were that all stakeholders including Youth Advocates, the Policy People and Policy Brokers were effective in advancing legislative solutions to address the need for an agency overhaul of TYC and that the three new policies will be evaluated in the future as either short term change or long-term reforms based on their implementation. ^

Auxiliary material and basic geochemical and benthic foraminiferal stable isotope data for the interval bracketing Eocene Thermal Maximum 2 (ETM2) at DSDP Sites 401 and 550 in the northeastern Atlantic Ocean

Ever since its discovery, Eocene Thermal Maximum 2 (ETM2; ~53.7 Ma) has been considered as one of the "little brothers" of the Paleocene-Eocene Thermal Maximum (PETM; ~56 Ma) as it displays similar characteristics including abrupt warming, ocean acidification, and biotic shifts. One of the remaining key questions is what effect these lesser climate perturbations had on ocean circulation and ventilation and, ultimately, biotic disruptions. Here we characterize ETM2 sections of the NE Atlantic (Deep Sea Drilling Project Sites 401 and 550) using multispecies benthic foraminiferal stable isotopes, grain size analysis, XRF core scanning, and carbonate content. The magnitude of the carbon isotope excursion (0.85-1.10 per mil) and bottom water warming (2-2.5°C) during ETM2 seems slightly smaller than in South Atlantic records. The comparison of the lateral d13C gradient between the North and South Atlantic reveals that a transient circulation switch took place during ETM2, a similar pattern as observed for the PETM. New grain size and published faunal data support this hypothesis by indicating a reduction in deepwater current velocity. Following ETM2, we record a distinct intensification of bottom water currents influencing Atlantic carbonate accumulation and biotic communities, while a dramatic and persistent clay reduction hints at a weakening of the regional hydrological cycle. Our findings highlight the similarities and differences between the PETM and ETM2. Moreover, the heterogeneity of hyperthermal expression emphasizes the need to specifically characterize each hyperthermal event and its background conditions to minimalize artifacts in global climate and carbonate burial models for the early Paleogene.

Conflicto en el Territorio Nacional del Chaco : Las Cooperativas agrícolas frente al Estatuto del Peón Rural

La llegada a la presidencia de Juan Perón en 1946, significó para el agro argentino la continuidad de algunas políticas desarrolladas antes de la Revolución de 1943 y profundizadas por ésta. A esas decisiones de carácter productivo y de comercialización se sumaron aquellas orientadas a la mejora de la clase trabajadora rural, sector descuidado hasta el momento. La aplicación del Estatuto del Peón Rural (1947) en un territorio de frontera productiva y ocupacional como el Chaco, en un contexto local desfavorable, despertó uno de los más agitados enfrentamientos entre las entidades Cooperativas agrícolas-en representación de sus asociados- y la Administración local encargada de su aplicación. Es objetivo de este trabajo estudiar, desde la documentación que produjeron las cooperativas y los medios gráficos locales, el conflicto que se despertó en el Chaco al momento de implementarse el Estatuto del Peón

Conflicto en el Territorio Nacional del Chaco : Las Cooperativas agrícolas frente al Estatuto del Peón Rural

La llegada a la presidencia de Juan Perón en 1946, significó para el agro argentino la continuidad de algunas políticas desarrolladas antes de la Revolución de 1943 y profundizadas por ésta. A esas decisiones de carácter productivo y de comercialización se sumaron aquellas orientadas a la mejora de la clase trabajadora rural, sector descuidado hasta el momento. La aplicación del Estatuto del Peón Rural (1947) en un territorio de frontera productiva y ocupacional como el Chaco, en un contexto local desfavorable, despertó uno de los más agitados enfrentamientos entre las entidades Cooperativas agrícolas-en representación de sus asociados- y la Administración local encargada de su aplicación. Es objetivo de este trabajo estudiar, desde la documentación que produjeron las cooperativas y los medios gráficos locales, el conflicto que se despertó en el Chaco al momento de implementarse el Estatuto del Peón

Planktic foraminifera across the Cretaceous-Tertiary transition in the Antarctic Ocean

Three Antarctic Ocean K/T boundary sequences from ODP Site 738C on the Kerguelen Plateau, ODP Site, 752B on Broken Ridge and ODP Site 690C on Maud Rise, Weddell Sea, have been analyzed for stratigraphic completeness and faunal turnover based on quantitative planktic foraminiferal studies. Results show that Site 738C, which has a laminated clay layer spanning the K/T boundary, is biostratigraphically complete with the earliest Tertiary Zones P0 and P1a present, but with short intrazonal hiatuses. Site 752B may be biostratigraphically complete and Site 690C has a hiatus at the K/T boundary with Zones P0 and P1a missing. Latest Cretaceous to earliest Tertiary planktic foraminiferal faunas from the Antarctic Ocean are cosmopolitan and similar to coeval faunas dominating in low, middle and northern high latitudes, although a few endemic species are present. This allows application of the current low and middle latitude zonation to Antarctic K/T boundary sequences. The most abundant endemic species is Chiloguembelina waiparaensis, which was believed to have evolved in the early Tertiary, but which apparently evolved as early as Chron 30N at Site 738C. Since this species is only rare in sediments of Site 690C in the Weddell Sea, this suggests that a watermass oceanographic barner may have existed between the Indian and Atlantic Antarctic Oceans. The cosmopolitan nature of the dominant fauna began during the last 200,000 to 300,000 years of the Cretaceous and continued at least 300,000 years into the Tertiary. This indicates a long-term environmental crisis that led to gradual elimination of specialized forms and takeover by generalists tolerant of wide ranging temperature, oxygen, salinity and nutrient conditions. A few thousand years before the K/T boundary these generalists gradually declined in abundance and species became generally dwarfed due to increased environmental stress. There is no evidence of a sudden mass killing of the Cretaceous fauna associated with a bolide impact at the K/T boundary. Instead, the already declining Cretaceous taxa gradually disappear in the early Danian and the opportunistic survivor taxa (Ch. waiparaensis and Guembelitria cretacea) increase in relative abundance coincident with the evolution of the first new Tertiary species.

Marine osmium isotope record across the Cretaceous-Tertiary boundary

A composite late Maastrichtian (65.5 to 68.5 Ma) marine osmium (Os) isotope record, based on samples from the Southern Ocean (ODP Site 690), the Tropical Pacific Ocean (DSDP Site 577), the South Atlantic (DSDP Site 525) and the paleo-Tethys Ocean demonstrates that subaerially exposed pelagic carbonates can record seawater Os isotope variations with a fidelity comparable to sediments recovered from the seafloor. New results provide robust evidence of a 20% decline in seawater 187Os/188Os over a period of about 200 kyr early in magnetochron C29r well below the Cretaceous-Paleogene Boundary (KPB), confirming previously reported low-resolution data from the South Atlantic Ocean. New results also confirm a second more rapid decline in 187Os/188Os associated with the KPB that is accompanied by a significant increase in Os concentrations. Complementary platinum (Pt) and iridium (Ir) concentration data indicate that the length scale of diagenetic remobilization of platinum group elements from the KPB is less than 1 m and does not obscure the pre-KPB decline in 187Os/188Os. Increases in bulk sediment Ir concentrations and decreases in bulk carbonate content that coincide with the Os isotope shift suggest that carbonate burial flux may have been lower during the initial decline in 187Os/188Os. We speculate that diminished carbonate burial rate may have been the result of ocean acidification caused by Deccan volcanism.

Conflicto en el Territorio Nacional del Chaco : Las Cooperativas agrícolas frente al Estatuto del Peón Rural

La llegada a la presidencia de Juan Perón en 1946, significó para el agro argentino la continuidad de algunas políticas desarrolladas antes de la Revolución de 1943 y profundizadas por ésta. A esas decisiones de carácter productivo y de comercialización se sumaron aquellas orientadas a la mejora de la clase trabajadora rural, sector descuidado hasta el momento. La aplicación del Estatuto del Peón Rural (1947) en un territorio de frontera productiva y ocupacional como el Chaco, en un contexto local desfavorable, despertó uno de los más agitados enfrentamientos entre las entidades Cooperativas agrícolas-en representación de sus asociados- y la Administración local encargada de su aplicación. Es objetivo de este trabajo estudiar, desde la documentación que produjeron las cooperativas y los medios gráficos locales, el conflicto que se despertó en el Chaco al momento de implementarse el Estatuto del Peón

Geochemistry of bulk sediment from the Cape Basin

A technique for onsite application of X-ray fluorescence (XRF) spectrometry to samples from sediment cores aboard a research vessel was developed and tested. The method is sufficiently simple, precise, and fast to be used routinely for high-resolution analyses of depth profiles as well as surface samples. Analyses were performed with the compact high-performance energy-dispersive polarisation X-ray fluorescence (EDPXRF) analyser Spectro Xepos. Contents of the elements Si, Ti, Al, Fe, Mn, Mg, Ca, K, Sr, Ba, Rb, Cu, Ni, Zn, P, S, Cl and Br were simultaneously determined on 200-225 samples of each core within 24 h of recovery. This study presents a description of the employed shipboard preparation and analysis technique, along with some example data. We show land-based datasets that support our decisions to use powder samples and to reduce the original measuring time for onboard analyses. We demonstrate how well the results from shipboard measurements for the various elements compare with the land-based findings. The onboard geochemical data enabled us to establish an element stratigraphy already during the cruise. Correlation of iron, calcium and silicon enrichment trends with an older reference core provided an age model for the newly retrieved cores. The Spectro Xepos instrument performed without any analytical and technical difficulties which could have been caused by rougher weather conditions or continuous movement and vibration of the research vessel. By now, this XRF technique has been applied during three RV Meteor cruises to approximately 5,000 Late Quaternary sediment samples from altogether 23 gravity cores, 25 multicorer cores and two box cores from the eastern South Atlantic off South Africa/Namibia and the eastern Atlantic off NW Africa.

Late Oligocene rapid transformations in the South China Sea

Lithobiostratigraphic data indicate that the double reflectors on the seismic profile through Ocean Drilling Program (ODP) Site 1148 represent two unconformities that coincide, respectively, with the lower/upper Oligocene boundary at ~488 mcd, and Oligocene-Miocene boundary at 460 mcd. Two other unconformities, at ~478 and 472 mcd, respectively, were also identified within the upper Oligocene section. Together they erased a sediment record of about 3 Ma from this locality in a period of very active seafloor spreading. The existence of 32.8 Ma marine sediment at the terminated depth (850 mcd) indicates that the initial breakup of the South China Sea (SCS) was probably during 34-33 Ma, close to the Eocene-Oligocene boundary. High sedimentation rates of 60-115 m/my from the much expanded, N350 m lower Oligocene section resulted from rifting and rapid subsidence between 33 and 29 Ma. The mid-Oligocene unconformity at ~28.5 Ma, which also occurred in many parts of the Indo-West Pacific region, was probably related to a significant uplift of the Himalayan-Tibetan Plateau to the west and the initial collision between Indonesia and Australia in the south. A narrowed Indonesian seaway may have accounted for the late Oligocene warming and chalk deposition in the northern South China Sea including the Site 1148 locality. The unconformities and slumps near the Oligocene-Miocene boundary indicate a very unstable tectonic regime, probably corresponding to changes in the rotation of different land blocks and the seafloor spreading ridge from nearly E-W to NE-SW, as recognized earlier at magnetic Anomaly 7. This 25 Ma event also saw the first New Guinea terrane docking at the northern Australian craton. The low sedimentation rate of ~15 m/my in the early to middle Miocene may correspond to another period of rapid seafloor spreading and rapid widespread subsidence that effectively caused sediment source areas to retreat with a rapidly rising sea level. The isostatic nature of these late Oligocene unconformities and slumps with several major collision-uplift events indicate that the rapid changes in the early evolutionary history of the South China Sea were mainly responding to regional tectonic reconfiguration including the uplift-driven southeast extrusion of the Indochina subcontinent.

Chemistry of secondary minerals from the deep sheeted dike complex of ODP Holes 137-504B and 140-504B

Dolerites sampled from the lower sheeted dikes from Hole 504B during Ocean Drilling Program Legs 137 and 140, between 1562.4 and 2000.4 mbsf, were examined to document the mineralogy, petrography, and mineral parageneses associated with secondary alteration, to constrain the thermal history and composition of hydrothermal fluids. The main methods used were mineral chemical analyses by electron microprobe, X-ray diffraction, and cathodoluminescence microscopy. Temperatures of alteration were estimated on the basis of single and/or coexisting mineral chemistry. Permeability is important in controlling the type and extent of alteration in the studied dike section. At the meter-scale, intervals of weakly altered dolerites containing fresh olivine are interpreted as having experienced restricted exposure to hydrothermal fluids. At the centimeter- or millimeter-scale, alteration patches and extensively altered halos adjacent to veins reflect the permeability related to intergranular primary porosity and cracks. Most of the sheeted dike alteration in this case resulted from non-focused, pervasive fluid-rock interaction. This study confirms and extends the previous model for hydrothermal alteration at Hole 504B: hydrothermal alteration at the ridge axis followed by seawater recharge and off-axis alteration. The major new discoveries, all related to higher temperatures of alteration, are: (1) the presence of hydrothermal plagioclase (An80-95), (2) the presence of deuteric and/or hydrothermal diopside, and (3) the general increasing proportion of amphiboles, and particularly magnesio-hornblende with depth. We propose that the dolerites at Hole 504B were altered in five stages. Stage 1 occurred at high temperatures (less than 500° to 700°C) and involved late-magmatic formation of Na- and Ti-rich diopside, the hydrothermal formation of Na, Ti-poor diopside and the hydrothermal formation of an assemblage of An-rich plagioclase + hornblende. Stage 2 occurred at lower temperatures (250°-320°C) and is characterized by the appearance of actinolite, chlorite, chlorite-smectite, and/or talc (in low permeability zones) and albite. During Stage 3, quartz and epidote precipitated from evolved hydrothermal fluids at temperatures between 310° and 320°C. Anhydrite appeared during Stage 4 and likely precipitated directly from heated seawater. Stage 5 occurred off-axis at low temperatures (250°C) with laumontite and prehnite from evolved fluids.

Analysis of the prospects for updating the trade pillar of the European Union-Chile Association Agreement

The perception of the present state of trade relations with Chile is obscured by a lack of adequate understanding of its legal framework as well as of the policy behind it. This study attempts to clarify the present state of and future prospects for trade between the EU and Chile through an examination of previous agreements and the EU’s new approach to trade liberalisation. The authors agree with the large consensus existing on both the EU and Chilean sides regarding the efficacy of the Association Agreement, but note that any extension of an agreement with Chile should capture the spirit of older EU agreements rather than simply following the ‘NAFTA route’. The study also includes a comparative analysis between the EU-Chile agreement and current trade agreements being negotiated by the EU and Chile with third countries.