Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement

Aims: We sought to analyse local distribution of aortic annulus and left ventricular outflow tract (LVOT) calcification in patients undergoing transcatheter aortic valve replacement (TAVR) and its impact on aortic regurgitation (AR) immediately after device placement. Methods and results: A group of 177 patients with severe aortic stenosis undergoing multislice computed tomography of the aortic root followed by TAVR were enrolled in this single-centre study. Annular and LVOT calcifications were assessed per cusp using a semi-quantitative grading system (0: none; 1 [mild]: small, non-protruding calcifications; 2 [moderate]: protruding [>1 mm] or extensive [>50% of cusp sector] calcifications; 3 [severe]: protruding and extensive calcifications). Any calcification of the annulus or LVOT was present in 107 (61%) and 63 (36%) patients, respectively. Prevalence of annulus/LVOT calcifications in the left coronary cusp was 42% and 25%, respectively, in the non-coronary cusp 28% and 13%, in the right coronary cusp 13% and 5%. AR grade 2 to 4 assessed by the method of Sellers immediately after TAVR device implantation was observed in 55 patients (31%). Multivariate regression analysis revealed that the overall annulus calcification (OR [95% CI] 1.48 [1.10-2.00]; p=0.0106), the overall LVOT calcification (1.93 [1.26-2.96]; p=0.0026), any moderate or severe LVOT calcification (5.37 [1.52-18.99]; p=0.0092), and asymmetric LVOT calcification were independent predictors of AR. Conclusions: Calcifications of the aortic annulus and LVOT are frequent in patients undergoing TAVR, and both the distribution and the severity of calcifications appear to be independent predictors of aortic regurgitation after device implantation. - See more at: http://www.pcronline.com/eurointervention/77th_issue/126/#sthash.Hzodgju5.dpuf

The role of the right frontal eye field in overt visual attention deployment as assessed by free visual exploration

The frontal eye field (FEF) is known to be involved in saccade generation and visual attention control. Studies applying covert attentional orienting paradigms have shown that the right FEF is involved in attentional shifts to both the left and the right hemifield. In the current study, we aimed at examining the effects of inhibitory continuous theta burst (cTBS) transcranial magnetic stimulation over the right FEF on overt attentional orienting, as measured by a free visual exploration paradigm. In forty-two healthy subjects, free visual exploration of naturalistic pictures was tested in three conditions: (1) after cTBS over the right FEF; (2) after cTBS over a control site (vertex); and, (3) without any stimulation. The results showed that cTBS over the right FEF-but not cTBS over the vertex-triggered significant changes in the spatial distribution of the cumulative fixation duration. Compared to the group without stimulation and the group with cTBS over the vertex, cTBS over the right FEF decreased cumulative fixation duration in the left and in the right peripheral regions, and increased cumulative fixation duration in the central region. The present study supports the view that the right FEF is involved in the bilateral control of not only covert, but also of overt, peripheral visual attention.

The influence of naturalistic, directionally non-specific motion on the spatial deployment of visual attention in right-hemispheric stroke

An impairment of the spatial deployment of visual attention during exploration of static (i.e., motionless) stimuli is a common finding after an acute, right-hemispheric stroke. However, less is known about how these deficits: a) are modulated through naturalistic motion (i.e., without directional, specific spatial features); and, b) evolve in the subacute/chronic post-stroke phase. In the present study, we investigated free visual exploration in three patient groups with subacute/chronic right-hemispheric stroke and in healthy subjects. The first group included patients with left visual neglect and a left visual field defect (VFD), the second patients with a left VFD but no neglect, and the third patients without neglect or VFD. Eye movements were measured in all participants while they freely explored a traffic scene without (static condition) and with (dynamic condition) naturalistic motion, i.e., cars moving from the right or left. In the static condition, all patient groups showed similar deployment of visual exploration (i.e., as measured by the cumulative fixation duration) as compared to healthy subjects, suggesting that recovery processes took place, with normal spatial allocation of attention. However, the more demanding dynamic condition with moving cars elicited different re-distribution patterns of visual attention, quite similar to those typically observed in acute stroke. Neglect patients with VFD showed a significant decrease of visual exploration in the contralesional space, whereas patients with VFD but no neglect showed a significant increase of visual exploration in the contralesional space. No differences, as compared to healthy subjects, were found in patients without neglect or VFD. These results suggest that naturalistic motion, without directional, specific spatial features, may critically influence the spatial distribution of visual attention in subacute/chronic stroke patients.

An evaluation of the Texas "A Woman's Right to Know" booklet: A state mandated patient education document for induced abortion

Many patient educational documents are written at a grade level higher than the level at which most individuals can read. This discrepancy can lead to treatment noncompliance and negative health outcomes. Therefore, it is important that patients receive readable health information. The Texas "A Woman's Right to Know" booklet is a state mandated informational document provided to women seeking abortion services. Given the significance of the abortion procedure, it is imperative that women considering having an abortion receive accurate and readable health materials. However, no published studies were found that evaluated the readability of the "A Woman's Right to Know" booklet. Therefore, the purpose of this study was to assess the readability of the "A Woman's Right to Know" booklet. To assess the readability, the Flesch-Kincaid readability test was used to evaluate the reading grade level of the entire "A Woman's Right to Know" booklet and each of the 7 sections of the booklet. The results showed that the readability of the entire booklet as well as each section of the booklet was written below the 8th grade reading level. Although the booklet was written below the estimated United States reading level (8th grade), the reading level of this booklet may still be too high for people in Texas who read below the 8th grade level. Based on these results, it is recommended that health care professionals involved in the distribution and explanation of the "A Woman's Right to Know" booklet provide their patients with both written and verbal medical information. The patients should be allowed to ask questions about the abortion procedure so that they can make the most informed choice.^

Analyzing left-truncated right-censored data with uncertain onset time with parametric models

Prevalent sampling is an efficient and focused approach to the study of the natural history of disease. Right-censored time-to-event data observed from prospective prevalent cohort studies are often subject to left-truncated sampling. Left-truncated samples are not randomly selected from the population of interest and have a selection bias. Extensive studies have focused on estimating the unbiased distribution given left-truncated samples. However, in many applications, the exact date of disease onset was not observed. For example, in an HIV infection study, the exact HIV infection time is not observable. However, it is known that the HIV infection date occurred between two observable dates. Meeting these challenges motivated our study. We propose parametric models to estimate the unbiased distribution of left-truncated, right-censored time-to-event data with uncertain onset times. We first consider data from a length-biased sampling, a specific case in left-truncated samplings. Then we extend the proposed method to general left-truncated sampling. With a parametric model, we construct the full likelihood, given a biased sample with unobservable onset of disease. The parameters are estimated through the maximization of the constructed likelihood by adjusting the selection bias and unobservable exact onset. Simulations are conducted to evaluate the finite sample performance of the proposed methods. We apply the proposed method to an HIV infection study, estimating the unbiased survival function and covariance coefficients. ^

Left, right and interval bivariate censored data: Evaluating screening mammography in the presence of lead -time bias, length bias and over-detection

Of the large clinical trials evaluating screening mammography efficacy, none included women ages 75 and older. Recommendations on an upper age limit at which to discontinue screening are based on indirect evidence and are not consistent. Screening mammography is evaluated using observational data from the SEER-Medicare linked database. Measuring the benefit of screening mammography is difficult due to the impact of lead-time bias, length bias and over-detection. The underlying conceptual model divides the disease into two stages: pre-clinical (T0) and symptomatic (T1) breast cancer. Treating the time in these phases as a pair of dependent bivariate observations, (t0,t1), estimates are derived to describe the distribution of this random vector. To quantify the effect of screening mammography, statistical inference is made about the mammography parameters that correspond to the marginal distribution of the symptomatic phase duration (T1). This shows the hazard ratio of death from breast cancer comparing women with screen-detected tumors to those detected at their symptom onset is 0.36 (0.30, 0.42), indicating a benefit among the screen-detected cases. ^

Sedimentology, planktonic foraminifera distribution and stable isotope composition during marine isotope stage 3 of ODP Site 172-1060 in the West Atlantic

We have studied Ocean Drilling Program Site 1060 on the Blake Outer Ridge, which lies beneath the Gulf Stream. We focus on marine isotope stage 3, 60-25 thousand years before present (ka). Sea surface temperatures (SSTs) inferred both from foraminiferal fauna and alkenone ratios, as well as counts of iceberg melt-out debris and benthic stable isotope analyses, enable our record to be interpreted in terms of regional hydrographic changes as well as changing thermohaline circulation (THC). The observed SST record is consistent with the air temperature record from the Greenland ice cores. However, Site 1060 exhibits important differences in detail compared with the ice core record, and when compared to other sites within the North Atlantic, significant longitudinal differences emerge. At Site 1060 in the western Atlantic, all Greenland stadials (GS) whether associated with Heinrich events (HEs) or not, show a similar small amplitude of cooling; mean faunal-based SSTaug during GS is only 1.5°C colder than during Greenland interstadials (GIS). In addition, during GS the coldest SSTs are limited to apparently brief events. This is in contrast to several eastern Atlantic sites where HE stadials exhibit coolings that are enhanced by 2°C compared to other GS and where cold conditions are not restricted to cold pulses but cover 2 ka-long intervals. Furthermore, Site 1060 SSTs remained warm right through each interstadial, in contrast to the sustained and uniform cooling trend through interstadials that is consistently observed in Greenland, indicated by measurements of delta18O in ice.

Design and Optimization of Power Delivery and Distribution Systems Using Evolutionary Computation Techniques

Nowadays computing platforms consist of a very large number of components that require to be supplied with diferent voltage levels and power requirements. Even a very small platform, like a handheld computer, may contain more than twenty diferent loads and voltage regulators. The power delivery designers of these systems are required to provide, in a very short time, the right power architecture that optimizes the performance, meets electrical specifications plus cost and size targets. The appropriate selection of the architecture and converters directly defines the performance of a given solution. Therefore, the designer needs to be able to evaluate a significant number of options in order to know with good certainty whether the selected solutions meet the size, energy eficiency and cost targets. The design dificulties of selecting the right solution arise due to the wide range of power conversion products provided by diferent manufacturers. These products range from discrete components (to build converters) to complete power conversion modules that employ diferent manufacturing technologies. Consequently, in most cases it is not possible to analyze all the alternatives (combinations of power architectures and converters) that can be built. The designer has to select a limited number of converters in order to simplify the analysis. In this thesis, in order to overcome the mentioned dificulties, a new design methodology for power supply systems is proposed. This methodology integrates evolutionary computation techniques in order to make possible analyzing a large number of possibilities. This exhaustive analysis helps the designer to quickly define a set of feasible solutions and select the best trade-off in performance according to each application. The proposed approach consists of two key steps, one for the automatic generation of architectures and other for the optimized selection of components. In this thesis are detailed the implementation of these two steps. The usefulness of the methodology is corroborated by contrasting the results using real problems and experiments designed to test the limits of the algorithms.

Application of active heat pulse method with fiber optic temperature sensing for estimation of wetting bulbs and water distribution in drip emitters.

Through the use of the Distributed Fiber Optic Temperature Measurement (DFOT) method, it is possible to measure the temperature in small intervals (on the order of centimeters) for long distances (on the order of kilometers) with a high temporal frequency and great accuracy. The heat pulse method consists of applying a known amount of heat to the soil and monitoring the temperature evolution, which is primarily dependent on the soil moisture content. The use of both methods, which is called the active heat pulse method with fiber optic temperature sensing (AHFO), allows accurate soil moisture content measurements. In order to experimentally study the wetting patterns, i.e. shape, size, and the water distribution, from a drip irrigation emitter, a soil column of 0.5 m of diameter and 0.6 m high was built. Inside the column, a fiber optic cable with a stainless steel sheath was placed forming three concentric helixes of diameters 0.2 m, 0.4 m and 0.6 m, leading to a 148 measurement point network. Before, during, and after the irrigation event, heat pulses were performed supplying electrical power of 20 W/m to the steel. The soil moisture content was measured with a capacitive sensor in one location at depths of 0.1 m, 0.2 m, 0.3 m and 0.4 m during the irrigation. It was also determined by the gravimetric method in several locations and depths before and right after the irrigation. The emitter bulb dimensions and shape evolution was satisfactorily measured during infiltration. Furthermore, some bulb's characteristics difficult to predict (e.g. preferential flow) were detected. The results point out that the AHFO is a useful tool to estimate the wetting pattern of drip irrigation emitters in soil columns and show a high potential for its use in the field.

The topographic distribution of the magnetic P100M to full- and half-field stimulation

Visual evoked magnetic responses were recorded to full-field and left and right half-field stimulation with three check sizes (70′, 34′ and 22′) in five normal subjects. Recordings were made sequentially on a 20-position grid (4 × 5) based on the inion, by means of a single-channel direct current-Superconducting Quantum Interference Device second-order gradiometer. The topographic maps were consistent on the same subjects recorded 2 months apart. The half-field responses produced the strongest signals in the contralateral hemisphere and were consistent with the cruciform model of the calcarine fissure. Right half fields produced upper-left-quadrant outgoing fields and lower-left-quadrant ingoing fields, while the left half field produced the opposite response. The topographic maps also varied with check size, with the larger checks producing positive or negative maximum position more anteriorly than small checks. In addition, with large checks the full-field responses could be explained as the summation of the two half fields, whereas full-field responses to smaller checks were more unpredictable and may be due to sources located at the occipital pole or lateral surface. In addition, dipole sources were located as appropriate with the use of inverse problem solutions. Topographic data will be vital to the clinical use of the visual evoked field but, in addition, provides complementary information to visual evoked potentials, allowing detailed studies of the visual cortex. © 1992 Kluwer Academic Publishers.

Distribution, density and abundance of Antarctic ice seals off Queen Maud Land and the eastern Weddell Sea

The Antarctic Pack Ice Seal (APIS) Program was initiated in 1994 to estimate the abundance of four species of Antarctic phocids: the crabeater seal Lobodon carcinophaga, Weddell seal Leptonychotes weddellii, Ross seal Ommatophoca rossii and leopard seal Hydrurga leptonyx and to identify ecological relationships and habitat use patterns. The Atlantic sector of the Southern Ocean (the eastern sector of the Weddell Sea) was surveyed by research teams from Germany, Norway and South Africa using a range of aerial methods over five austral summers between 1996-1997 and 2000-2001. We used these observations to model densities of seals in the area, taking into account haul-out probabilities, survey-specific sighting probabilities and covariates derived from satellite-based ice concentrations and bathymetry. These models predicted the total abundance over the area bounded by the surveys (30°W and 10°E). In this sector of the coast, we estimated seal abundances of: 514 (95 % CI 337-886) x 10**3 crabeater seals, 60.0 (43.2-94.4) x 10**3 Weddell seals and 13.2 (5.50-39.7) x 10**3 leopard seals. The crabeater seal densities, approximately 14,000 seals per degree longitude, are similar to estimates obtained by surveys in the Pacific and Indian sectors by other APIS researchers. Very few Ross seals were observed (24 total), leading to a conservative estimate of 830 (119-2894) individuals over the study area. These results provide an important baseline against which to compare future changes in seal distribution and abundance.

The Right to Bodily Integrity and the Rehabilitation of Offenders Through Medical Interventions : A Reply to Thomas Douglas

Peer reviewed

The Electoral Rise of Populist Radical Right Parties in Europe: Ideological Parameters and Social Motivations

Populist radical right parties have become major political actors in Europe. This paper analyses the path and the different phases that have led them from the fringes of public debate to their present signifi cance, which is based on their capacity to attract electoral support and infl uence the political agendas in their respective countries. Besides, an analysis of the core ideological beliefs of these parties, and of the topics on which their mobilization capacity rests, is provided, as well as of the type of voters that are attracted by them. Finally, the authors discuss the meaning and impact of the growing popularity of the ideas and proposals put forward by the populist radical right parties.

No right to sext? A critical examination of media and legal debates about teenage girls' sexual agency in the digital age

Advances in digital photography and distribution technologies enable many people to produce and distribute images of their sex acts. When teenagers do this, the photos and videos they create can be legally classified as child pornography since the law makes no exception for youth who create sexually explicit images of themselves. The dominant discussions about teenage girls producing sexually explicit media (including sexting) are profoundly unproductive: (1) they blame teenage girls for creating private images that another person later maliciously distributed and (2) they fail to respect—or even discuss—teenagers’ rights to freedom of expression. Cell phones and the internet make producing and distributing images extremely easy, which provide widely accessible venues for both consensual sexual expression between partners and for sexual harassment. Dominant understandings view sexting as a troubling teenage trend created through the combination of camera phones and adolescent hormones and impulsivity, but this view often conflates consensual sexting between partners with the malicious distribution of a person’s private image as essentially equivalent behaviors. In this project, I ask: What is the role of assumptions about teen girls’ sexual agency in these problematic understandings of sexting that blame victims and deny teenagers’ rights? In contrast to the popular media panic about online predators and the familiar accusation that youth are wasting their leisure time by using digital media, some people champion the internet as a democratic space that offers young people the opportunity to explore identities and develop social and communication skills. Yet, when teen girls’ sexuality enters this conversation, all this debate and discussion narrows to a problematic consensus. The optimists about adolescents and technology fall silent, and the argument that media production is inherently empowering for girls does not seem to apply to a girl who produces a sexually explicit image of herself. Instead, feminist, popular, and legal commentaries assert that she is necessarily a victim: of a “sexualized” mass media, pressure from her male peers, digital technology, her brain structures or hormones, or her own low self-esteem and misplaced desire for attention. Why and how are teenage girls’ sexual choices produced as evidence of their failure or success in achieving Western liberal ideals of self-esteem, resistance, and agency? Since mass media and policy reactions to sexting have so far been overwhelmingly sexist and counter-productive, it is crucial to interrogate the concepts and assumptions that characterize mainstream understandings of sexting. I argue that the common sense that is co-produced by law and mass media underlies the problematic legal and policy responses to sexting. Analyzing a range of nonfiction texts including newspaper articles, talk shows, press releases, public service announcements, websites, legislative debates, and legal documents, I investigate gendered, racialized, age-based, and technologically determinist common sense assumptions about teenage girls’ sexual agency. I examine the consensus and continuities that exist between news, nonfiction mass media, policy, institutions, and law, and describe the limits of their debates. I find that this early 21st century post-feminist girl-power moment not only demands that girls live up to gendered sexual ideals but also insists that actively choosing to follow these norms is the only way to exercise sexual agency. This is the first study to date examining the relationship of conventional wisdom about digital media and teenage girls’ sexuality to both policy and mass media.