955 resultados para surrogate end points


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Hole 887B of the Ocean Drilling Program (ODP) comprises a 44 m (750 kyr) long continuous section recovered from the Patton-Murray Rise, an elevated plateau that is largely isolated from turbidite deposition. The Patton-Murray area is centered under the Alaska Gyre, a region characterized by the domal upwelling of nutrient-rich waters. Marked increases in productivity and rapid settling of biogenic matter are suggested throughout the section by the episodic accumulation of diatomaceous oozes up to ~1 m thick that are accompanied by barium enrichments. Significant delta13Corg maxima in the major diatomaceous bands suggest that mixedlayer [CO2(aq)] may have been drawn down significantly during some of the productivity events. The episodes of enhanced productivity at Site 887 occur synchronously with short-lived minima in planktonic foram delta18O, suggesting a direct link to low salinity, or less likely, warming, events in the Gulf of Alaska. There is no obvious explanation for the events, but they may be related to seasonal incursions of meltwater from Alaska. We speculate that episodic input of meltwater- or dust-borne iron from Asian or Alaskan sources may have promoted the extraordinary diatom production events recorded in the sedimentary record.

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The marine isotopic stage 3 (MIS3) at Ocean Drilling Program (ODP) Site 1060 (Gulf Stream) shows both sharp onset and end of interstadials, the existence of very short lived warm events during stadials, and points to differences in detail between the sea surface temperature (SST) record from the western North Atlantic and the atmospheric temperature record inferred from d18O in Greenland ice. Investigating MIS3 and obtaining comparable data from other locations appears crucial. The eastern Atlantic provides well-documented records of climate changes. We have selected a core from off Portugal and use it to examine Dansgaard/Oeschger events (D/O) at centennial-scale resolution (139 years on average between two data points). We have obtained a faunal data set for core MD01-2444, 37°N, 10°W, 2600 m water depth and use a group of species (Globigerina bulloides + Globigerinita glutinata) as a proxy of upwelling intensity driven by trade winds intensity changes. We tentatively relate the variation of this group to a North Atlantic Oscillation-like phenomenon (NAO) off Portugal. We observe that it resembles the rainfall index in the Caribbean as recorded at ODP Site 1002 (Cariaco Basin) which traces the Intertropical Convergence Zone (ITCZ) location through changes of terrigenous inputs. The driest intervals (ITZC to the south) at Site 1002 correspond to intervals of increased upwelling in MD01-2444 as well as the driest periods identified during stadials on similar cores in the area. Because the ITZC to the south is consistent with an El Niño-Southern Oscillation (ENSO+) situation, our study suggests a positive correlation between ENSO-like conditions and NAO-like conditions at a millennial timescale. During interstadial intervals when increased wetness over Cariaco is recorded (ITCZ to the north) and the upwelling in MD01-2444 is decreased, we see from both SSTs and faunal tropical indicators that MD01-2444 site is warm. In addition, interstadials are equally warm through each so-called Bond cycle. This contrasts with the Greenland Ice Core Project (GRIP) record where interstadial peaks are successively cooler through each Bond cycle. This record confirms a link between tropical climate linked to ITCZ position and the climate of southern Europe at millennial timescales, in spite of showing a very good correlation with polar latitudes (GRIP) through d18O on Globigerina bulloides. In addition, because the warmest SSTs and the d18O on G. bulloides are so remarkably different, our work points to changes in seasonality as a strong control over the climatic pattern of the North Atlantic area and the marked influence of winter conditions.

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The present study addresses the hypothesis that the Western Alborán Gyre in the Alborán Sea (the westernmost Mediterranean basin adjacent to the Strait of Gibraltar) influences the composition of the outflow through the Strait of Gibraltar. The process invoked is that strong and well-developed gyres help to evacuate the Western Mediterranean Deep Water from the Alboran basin, thus increasing its presence in the outflow, whereas weak gyres facilitates the outflow of Levantine and other Intermediate waters. To this aim, in situ observations collected at Camarinal (the main) and Espartel (the westernmost) sills of the Strait have been analyzed along with altimetry data, which were employed to obtain a representative proxy of the strength of the gyre. An encouraging correlation of the expected sign was observed between the time series of potential temperature at Espartel sill, which is show to keep information on the outflow composition, and the proxy of the Western Alborán Gyre, which strongly suggests the correctness of the hypothesis, although the weakness of the involved signals does not allow for drawing definitive conclusions.

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This paper presents a numerical study of a linear compressor cascade to investigate the effective end wall profiling rules for highly-loaded axial compressors. The first step in the research applies a correlation analysis for the different flow field parameters by a data mining over 600 profiling samples to quantify how variations of loss, secondary flow and passage vortex interact with each other under the influence of a profiled end wall. The result identifies the dominant role of corner separation for control of total pressure loss, providing a principle that only in the flow field with serious corner separation does the does the profiled end wall change total pressure loss, secondary flow and passage vortex in the same direction. Then in the second step, a multi-objective optimization of a profiled end wall is performed to reduce loss at design point and near stall point. The development of effective end wall profiling rules is based on the manner of secondary flow control rather than the geometry features of the end wall. Using the optimum end wall cases from the Pareto front, a quantitative tool for analyzing secondary flow control is employed. The driving force induced by a profiled end wall on different regions of end wall flow are subjected to a detailed analysis and identified for their positive/negative influences in relieving corner separation, from which the effective profiling rules are further confirmed. It is found that the profiling rules on a cascade show distinct differences at design point and near stall point, thus loss control of different operating points is generally independent.

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Congenital heart disease (CHD) is the most common birth defect, causing an important rate of morbidity and mortality. Treatment of CHD requires surgical correction in a significant percentage of cases which exposes patients to cardiac and end organ injury. Cardiac surgical procedures often require the utilisation of cardiopulmonary bypass (CPB), a system that replaces heart and lungs function by diverting circulation into an external circuit. The use of CPB can initiate potent inflammatory responses, in addition a proportion of procedures require a period of aortic cross clamp during which the heart is rendered ischaemic and is exposed to injury. High O2 concentrations are used during cardiac procedures and when circulation is re-established to the heart which had adjusted metabolically to ischaemia, further injury is caused in a process known as ischaemic reperfusion injury (IRI). Several strategies are in place in order to protect the heart during surgery, however injury is still caused, having detrimental effects in patients at short and long term. Remote ischaemic preconditioning (RIPC) is a technique proposed as a potential cardioprotective measure. It consists of exposing a remote tissue bed to brief episodes of ischaemia prior to surgery in order to activate protective pathways that would act during CPB, ischaemia and reperfusion. This study aimed to assess RIPC in paediatric patients requiring CHD surgical correction with a translational approach, integrating clinical outcome, marker analysis, cardiac function parameters and molecular mechanisms within the cardiac tissue. A prospective, single blinded, randomized, controlled trial was conducted applying a RIPC protocol to randomised patients through episodes of limb ischaemia on the day before surgery which was repeated right before the surgery started, after anaesthesia induction. Blood samples were obtained before surgery and at three post-operative time points from venous lines, additional pre and post-bypass blood samples were obtained from the right atrium. Myocardial tissue was resected during the ischaemic period of surgery. Echocardiographic images were obtained before the surgery started after anaesthetic induction and the day after surgery, images were stored for later off line analysis. PICU surveillance data was collected including ventilation parameters, inotrope use, standard laboratory analysis and six hourly blood gas analysis. Pre and post-operative quantitation of markers in blood specimens included cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), inflammatory mediators including interleukins IL-6, IL-8, IL-10, tumour necrosis factor (TNF-α), and the adhesion molecules ICAM-1 and VCAM-1; the renal marker Cystatin C and the cardiovascular markers asymmetric dymethylarginine (ADMA) and symmetric dymethylarginine (SDMA). Nitric oxide (NO) metabolites and cyclic guanosine monophosphate (cGMP) were measured before and after bypass. Myocardial tissue was processed at baseline and after incubation at hyperoxic concentration during four hours in order to mimic surgical conditions. Expression of genes involved in IRI and RIPC pathways was analysed including heat shock proteins (HSPs), toll like receptors (TLRs), transcription factors nuclear factor κ-B (NF- κ-B) and hypoxia inducible factor 1 (HIF-1). The participation of hydrogen sulfide enzymatic genes, apelin and its receptor were explored. There was no significant difference according to group allocation in any of the echocardiographic parameters. There was a tendency for higher cTnI values and inotropic score in control patients post-operatively, however this was not statistically significant. BNP presented no significant difference according to group allocation. Inflammatory parameters tended to be higher in the control group, however only TNF- α was significantly higher. There was no difference in levels of Cystatin C, NO metabolites, cGMP, ADMA or SDMA. RIPC patients required shorter PICU stay, all other clinical and laboratory analysis presented no difference related to the intervention. Gene expression analysis revealed interesting patterns before and after incubation. HSP-60 presented a lower expression at baseline in tissue corresponding to RIPC patients, no other differences were found. This study provided with valuable descriptive information on previously known and newly explored parameters in the study population. Demographic characteristics and the presence of cyanosis before surgery influenced patterns of activity in several parameters, numerous indicators were linked to the degree of injury suffered by the myocardium. RIPC did not reduce markers of cardiac injury or improved echocardiographic parameters and it did not have an effect on end organ function; some effects were seen in inflammatory responses and gene expression analysis. Nevertheless, an important clinical outcome indicator, PICU length of stay was reduced suggesting benefit from the intervention. Larger studies with more statistical power could determine if the tendency of lower injury and inflammatory markers linked to RIPC is real. The present results mostly support findings of larger multicentre trials which have reported no cardiac benefit from RIPC in paediatric cardiac surgery.

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In many major cities, fixed route transit systems such as bus and rail serve millions of trips per day. These systems have people collect at common locations (the station or stop), and board at common times (for example according to a predetermined schedule or headway). By using common service locations and times, these modes can consolidate many trips that have similar origins and destinations or overlapping routes. However, the routes are not sensitive to changing travel patterns, and have no way of identifying which trips are going unserved, or are poorly served, by the existing routes. On the opposite end of the spectrum, personal modes of transportation, such as a private vehicle or taxi, offer service to and from the exact origin and destination of a rider, at close to exactly the time they desire to travel. Despite the apparent increased convenience to users, the presence of a large number of small vehicles results in a disorganized, and potentially congested road network during high demand periods. The focus of the research presented in this paper is to develop a system that possesses both the on-demand nature of a personal mode, with the efficiency of shared modes. In this system, users submit their request for travel, but are asked to make small compromises in their origin and destination location by walking to a nearby meeting point, as well as slightly modifying their time of travel, in order to accommodate other passengers. Because the origin and destination location of the request can be adjusted, this is a more general case of the Dial-a-Ride problem with time windows. The solution methodology uses a graph clustering algorithm coupled with a greedy insertion technique. A case study is presented using actual requests for taxi trips in Washington DC, and shows a significant decrease in the number of vehicles required to serve the demand.

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Our survey findings confirm that 11 factors influence information and communication technology (ICT) diffusion for experienced ICT users. We offer a model that consists of 4 groups of categories: management (M); individual (I); technology (T); and environment (E). Our conclusions reinforce the importance of a coherent ICT diffusion strategy and supportive environment. This requires substantial investment in training and collegial learning support mechanisms. This paper provides an overview of the work undertaken and an analysis of its implications for the construction industry and we provide useful insights that a wide range of construction industry professionals and contractors may find useful.

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This chapter deals with the increasing issues surrounding end-of-life decision making. As the life trajectory for older people changes, the need for open discussion about their health problems and treatment becomes more critical. Acceptance of the ageing process itself is often not easy so the matter of a good death is even more distressing for some people to consider. The vignette provides an excellent discussion on the need for open dialogue with the older person and their families, whether they are acutely ill or have chronic health problems. How a person wishes to be treated when quality of life is not going to improve, no matter what interventions are put in place, seems essential for person-centred care. The issue of competency is one that must be determined before any decision is made by any person involved in care.

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The Google Online Marketing Challenge is an ongoing collaboration between Google and academics, to give students experiential learning. The Challenge gives student teams US$200 in AdWords, Google’s flagship advertising product, to develop online marketing campaigns for actual businesses. The end result is an engaging in-class exercise that provides students and professors with an exciting and pedagogically rigorous competition. Results from surveys at the end of the Challenge reveal positive appraisals from the three—students, businesses, and professors—main constituents; general agreement between students and instructors regarding learning outcomes; and a few points of difference between students and instructors. In addition to describing the Challenge and its outcomes, this article reviews the postparticipation questionnaires and subsequent datasets. The questionnaires and results are publicly available, and this article invites educators to mine the datasets, share their results, and offer suggestions for future iterations of the Challenge.

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We aim to assess the effects of end-of-life care pathways, compared with usual care or with care guided by another end-of-life care pathway across all healthcare settings (hospitals, residential aged care facilities, community). In particular, we aim to assess the effects on symptom severity and quality of life of people who are dying and/or those related to the care such as families, caregivers and health professionals.

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This paper presents effects of end-winding on shaft voltage in AC generators. A variety of design parameters have been considered to calculate the parasitic capacitive couplings in the machine structure with Finite Elements simulations and mathematical calculations. End-winding capacitances have also been calculated to have a precise estimation of shaft voltage and its relationship with design parameters in AC generators.

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Background In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review. Objectives To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community). Search strategy The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register,MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009. Selection criteria All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Data collection and analysis Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. Main results The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Authors’ conclusions Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.