Antiplatelet therapy and clinical outcomes in cardiovascular diseases

Cardiovascular diseases (CVD) is a leading cause of death in the world. Despite effective treatment regimens for ischaemic heart disease (IHD) and ischaemic stroke, mortality and recurrence rates remain high. Antiplatelet therapy is on effective treatment and reduces the risk of recurrent heart attack and stroke. Nevertheless, there are patients who stopped or interrupted their antiplatelet therapy for certain reasons or some patients may be resistant or poor responders to antiplatelet therapy. Furthermore, there is evidence of rebound effect in platelet activity after antiplatelet cessation and this may associate with increased risk of cardiovascular event. This thesis is divided into five main chapters (chapters 3 to 7) which attempt to provide data to help resolve the uncertainty. Chapter 1 highlights the background of cardiovascular diseases and the global burden of cardiovascular and cerebrovascular diseases. The metabolism of platelets, antiplatelet therapy and current antiplatelet therapy guidelines are described, followed by discussion of the risk of cardiovascular event and changes in antiplatelet therapy. Chapter 2 describes the data source from Virtual International Stroke Trial Archive (VISTA) and National Health Service Greater Glasgow and Clyde (NHSGGC) Safe Haven, followed by definition of outcome measures. In chapter 3, Virtual International Stroke Trial Archive (VISTA) data was examined to test whether continue with the same antiplatelet therapy or changing to a new antiplatelet regimen reduces the risk of subsequent events in patients who experience a stroke whilst taking antiplatelet therapy. The findings indicate that subjects who switch to a new antiplatelet regimen after stroke did not have a lower early recurrence rate than subjects who continued with the same antiplatelet therapy. Observations on bleeding complications were similar in both groups. However, changing antiplatelet regimen after stroke was associated with more favourable functional outcome across a full scale modified Rankin Scale (mRS) at 90 days. In chapter 4, association between early or later initiation of antiplatelet with a recurrent ischaemic stroke and bleeding complications was assessed using VISTA data. The findings indicate that there was no association between a recurrent ischaemic stroke and timing of initiation of antiplatelet drug after stroke. However, early initiation was associated with increased risk of bleeding. In terms of functional outcomes, this study demonstrated that the mid-time and late initiation of antiplatelet therapy after acute stroke are associated with better functional outcomes compared with early initiation. In chapter 5, a nested case-control study was performed to explore the rate of antiplatelet cessation and interruption in a sample of patients with recent ischaemic stroke and to assess the risk of cardiovascular events associated with cessation and interruption of antiplatelet. It was found that there was no increased risk of cardiovascular event among patients who had early cessation or interrupted/stopped antiplatelet therapy within 90 days following acute ischaemic stroke. In chapter 6, the incidence and predictors of cardiovascular events after DAPT cessation were evaluated. The incidence of cardiovascular event while taking DAPT and following discontinuation of DAPT was 15.7% and 16.7% respectively. This study found that increasing age was associated with an increased risk of cardiovascular event, whereas, revascularization-treated patients and longer duration of DAPT, were each associated with a decreased risk. The duration of DAPT six months and less was associated a significantly higher risk for cardiovascular event. In chapter 7, an untargeted metabolomics analysis was performed while on DAPT (aspirin plus ticagrelor) and once they stopped ticagrelor to identify metabolite changes associated with cardiovascular events after stopping DAPT. Ten ACS patients were recruited in this study and data were analysed for seven patients. Three hundred eleven putative metabolites were identified. This study found 16 putative metabolites significantly altered following ticagrelor cessation. Of these, seven metabolites were from lipid pathway and down-regulated some up to 3-fold. On the other hand, adenosine, from nucleotide metabolism was upregulated up to 2.6-fold. It concluded that there are changes in numerous pathways following DAPT discontinuation and whether these changes differ in patients who have cardiovascular event after stopping DAPT warrant further investigation. In chapter 8, a summary of the findings of this thesis are presented as well as the future directions of research in this area.

Rationale of Length Scale-Down Model Span Testing of Transmission Lines

Length scale-down (LS) model tests have been traditionally employed for laboratory studies on aeolian vibration of transmission line conductors. The span adopted is normally 30 m and is recommended by the relevant Indian, as well as other, standards. The traditionally adopted length of the LS model is reexamined herein to establish the rationale behind the choice. Based on the theoretical studies discussed, certain guidelines for the choice of model span of conductor are emphasized. In addition, the adequacy of the LS span as a tool for predicting the performance of the full span is reestablished.

Report : wireless data throughput testing on a mobile device using WiFi and GPRS

This project report presents the results of a study on wireless communication data transfer rates for a mobile device running a custombuilt construction defect reporting application. The study measured the time taken to transmit data about a construction defect, which included digital imagery and text, in order to assess the feasibility of transferring various types and sizes of data and the ICT-supported construction management applications that could be developed as a consequence. Data transfer rates over GPRS through the Telstra network and WiFi over a private network were compared. Based on the data size and data transfer time, the rate of transfer was calculated to determine the actual data transmission speeds at which the information was being sent using the wireless mobile communication protocols. The report finds that the transmission speeds vary considerably when using GPRS and can be significantly slower than what is advertised by mobile network providers. While WiFi is much faster than GPRS, the limited range of WiFi limits the protocol to residential-scale construction sites.

The "caring experience": testing the psychometric properties of the Caring Efficacy Scale

The purpose of the study was to undertake rigorous psychometric testing of the Caring Efficacy Scale in a sample of Registered Nurses. A cross-sectional survey of 2000 registered nurses was undertaken. The Caring Efficacy Scale was utilised to inform the psychometric properties of the selected items of the Caring Efficacy Scale. Cronbach’s Alpha identified reliability of the data. Exploratory Factor Analysis and Confirmatory Factor Analysis were undertaken to validate the factors. Confirmatory factor analysis confirmed the development of two factors; Confidence to Care and Doubts and Concerns. The Caring Efficacy Scale has undergone rigorous psychometric testing, affording evidence of internal consistency and goodness-of-fit indices within satisfactory ranges. The Caring Efficacy Scale is valid for use in an Australian population of registered nurses. The scale can be used as a subscale or total score reflective of self-efficacy in nursing. This scale may assist nursing educators to predict levels of caring efficacy.

Bayesian Accelerated Life Testing under Competing Weibull Causes of Failure

Consider a J-component series system which is put on Accelerated Life Test (ALT) involving K stress variables. First, a general formulation of ALT is provided for log-location-scale family of distributions. A general stress translation function of location parameter of the component log-lifetime distribution is proposed which can accommodate standard ones like Arrhenius, power-rule, log-linear model, etc., as special cases. Later, the component lives are assumed to be independent Weibull random variables with a common shape parameter. A full Bayesian methodology is then developed by letting only the scale parameters of the Weibull component lives depend on the stress variables through the general stress translation function. Priors on all the parameters, namely the stress coefficients and the Weibull shape parameter, are assumed to be log-concave and independent of each other. This assumption is to facilitate Gibbs sampling from the joint posterior. The samples thus generated from the joint posterior is then used to obtain the Bayesian point and interval estimates of the system reliability at usage condition.

Bayesian Accelerated Life Testing under Competing Weibull Causes of Failure

Consider a J-component series system which is put on Accelerated Life Test (ALT) involving K stress variables. First, a general formulation of ALT is provided for log-location-scale family of distributions. A general stress translation function of location parameter of the component log-lifetime distribution is proposed which can accommodate standard ones like Arrhenius, power-rule, log-linear model, etc., as special cases. Later, the component lives are assumed to be independent Weibull random variables with a common shape parameter. A full Bayesian methodology is then developed by letting only the scale parameters of the Weibull component lives depend on the stress variables through the general stress translation function. Priors on all the parameters, namely the stress coefficients and the Weibull shape parameter, are assumed to be log-concave and independent of each other. This assumption is to facilitate Gibbs sampling from the joint posterior. The samples thus generated from the joint posterior is then used to obtain the Bayesian point and interval estimates of the system reliability at usage condition.

Optimization of clamped beam geometry for fracture toughness testing of micron-scale samples

Fracture toughness measurements at the small scale have gained prominence over the years due to the continuing miniaturization of structural systems. Measurements carried out on bulk materials cannot be extrapolated to smaller length scales either due to the complexity of the microstructure or due to the size and geometric effect. Many new geometries have been proposed for fracture property measurements at small-length scales depending on the material behaviour and the type of device used in service. In situ testing provides the necessary environment to observe fracture at these length scales so as to determine the actual failure mechanism in these systems. In this paper, several improvements are incorporated to a previously proposed geometry of bending a doubly clamped beam for fracture toughness measurements. Both monotonic and cyclic loading conditions have been imposed on the beam to study R-curve and fatigue effects. In addition to the advantages that in situ SEM-based testing offers in such tests, FEM has been used as a simulation tool to replace cumbersome and expensive experiments to optimize the geometry. A description of all the improvements made to this specific geometry of clamped beam bending to make a variety of fracture property measurements is given in this paper.

Testing inflationary cosmology with the BICEP1 and BICEP2 experiments

Recent observations of the temperature anisotropies of the cosmic microwave background (CMB) favor an inflationary paradigm in which the scale factor of the universe inflated by many orders of magnitude at some very early time. Such a scenario would produce the observed large-scale isotropy and homogeneity of the universe, as well as the scale-invariant perturbations responsible for the observed (10 parts per million) anisotropies in the CMB. An inflationary epoch is also theorized to produce a background of gravitational waves (or tensor perturbations), the effects of which can be observed in the polarization of the CMB. The E-mode (or parity even) polarization of the CMB, which is produced by scalar perturbations, has now been measured with high significance. Con- trastingly, today the B-mode (or parity odd) polarization, which is sourced by tensor perturbations, has yet to be observed. A detection of the B-mode polarization of the CMB would provide strong evidence for an inflationary epoch early in the universe’s history.

In this work, we explore experimental techniques and analysis methods used to probe the B- mode polarization of the CMB. These experimental techniques have been used to build the Bicep2 telescope, which was deployed to the South Pole in 2009. After three years of observations, Bicep2 has acquired one of the deepest observations of the degree-scale polarization of the CMB to date. Similarly, this work describes analysis methods developed for the Bicep1 three-year data analysis, which includes the full data set acquired by Bicep1. This analysis has produced the tightest constraint on the B-mode polarization of the CMB to date, corresponding to a tensor-to-scalar ratio estimate of r = 0.04±0.32, or a Bayesian 95% credible interval of r < 0.70. These analysis methods, in addition to producing this new constraint, are directly applicable to future analyses of Bicep2 data. Taken together, the experimental techniques and analysis methods described herein promise to open a new observational window into the inflationary epoch and the initial conditions of our universe.

Comments on "micro-scale abrasive wear testing of PVD coatings on curved substrates"

Previously published expressions for the wear volume in the micro-scale abrasion test for curved specimen surfaces (K.L. Rutherford and I.M. Hutchings, Tribology Letters 2 (1996) 1-11) were based upon erroneous assumptions about the wear-scar geometry. Accurate volumes have now been computed, and the errors in the use of the original analytical equations are shown to be negligibly small (<0.5% error) for all practical cases. © J.C. Baltzer AG, Science Publishers.

Preliminary laboratory-scale model auger installation and testing of carbonated soil-MgO columns

This paper presents details of the installation and performance of carbonated soil-MgO columns using a laboratory-scale model auger setup. MgO grout was mixed with the soil using the auger and the columns were then carbonated with gaseous CO2 introduced in two different ways: one using auger mixing and the other through a perforated plastic tube system inserted into the treated column. The performance of the columns in terms of unconfined compressive strength (UCS), stiffness, strain at failure and microstructure (using X-ray diffraction and scanning electron microscopy) showed that the soil-MgO columns were carbonated very quickly (in under 1 h) and yielded relatively high strength values, of 2.4-9.4 MPa, which on average were five times that of corresponding 28-day ambient cured uncarbonated columns. This confirmed, together with observations of dense microstructure and hydrated magnesium carbonates, that a good degree of carbonation had taken place. The results also showed that the carbonation method and period have a significant effect on the resulting performance, with the carbonation through the perforated pipe producing the best results. Copyright © 2013 by ASTM International.

Are Fast Responses More Random? Testing the Effect of Response Time on Scale in an Online Choice Experiment

Scepticism over stated preference surveys conducted online revolves around the concerns over “professional respondents” who might rush through the questionnaire without sufficiently considering the information provided. To gain insight on the validity of this phenomenon and test the effect of response time on choice randomness, this study makes use of a recently conducted choice experiment survey on ecological and amenity effects of an offshore windfarm in the UK. The positive relationship between self-rated and inferred attribute attendance and response time is taken as evidence for a link between response time and cognitive effort. Subsequently, the generalised multinomial logit model is employed to test the effect of response time on scale, which indicates the weight of the deterministic relative to the error component in the random utility model. Results show that longer response time increases scale, i.e. decreases choice randomness. This positive scale effect of response time is further found to be non-linear and wear off at some point beyond which extreme response time decreases scale. While response time does not systematically affect welfare estimates, higher response time increases the precision of such estimates. These effects persist when self-reported choice certainty is controlled for. Implications of the results for online stated preference surveys and further research are discussed.

Electron-phonon interaction in atomic-scale conductors: Einstein oscillators versus full phonon modes

Two extreme pictures of electron-phonon interactions in nanoscale conductors are compared: one in which the vibrations are treated as independent Einstein atomic oscillators, and one in which electrons are allowed to couple to the full, extended phonon modes of the conductor. It is shown that, under a broad range of conditions, the full-mode picture and the Einstein picture produce essentially the same net power at any given atom in the nanojunction. The two pictures begin to differ significantly in the limit of low lattice temperature and low applied voltages, where electron-phonon scattering is controlled by the detailed phonon energy spectrum. As an illustration of the behaviour in this limit, we study the competition between trapped vibrational modes and extended modes in shaping the inelastic current-voltage characteristics of one-dimensional atomic wires.