Critical leg ischaemia with tissue loss : a challenge for the vascular surgeon

There is a widespread reporting habit of combining the outcomes for patients with rest pain (Fontaine III) and tissue loss (Fontaine IV) under the single category of critical leg ischaemia (CLI). This study focused on patients with ischaemic tissue loss treated with infrainguinal bypass surgery (IBS). All patients included in the study were treated at Helsinki University Central Hospital in 2000-2007. First, ulcer healing time after IBS and factors influencing healing time were prospectively assessed in 2 studies including 148 and 110 patients, respectively. Second,the results of redo IBS were retrospectively evaluated in 593 patients undergoing primary IBS for CLI with tissue loss . Third,long-term outcome were retrospectively analysed in 636 patients who underwent IBS for CLI with tissue loss . Fourth, the outcome of IBS was retrospectively compared with endovascular treatment (PTA) of the infrapopliteal arteries in 1023 CLI patients. Fifth, the influence multidrug resistant Pseudomans aeruginosa (MDR Pa) bacteria contamination in CLI patients treated with IBS was retropectively assessed. Sixty-four patients with positive MDR Pa -culture were matched with 64 MDR Pa - negative controls. Complete ulcer healing rate, including the ischemic ulcers and incisional wounds, was 40% at 6 months after IBS and 75% at one year. Diabetes was a risk factor for prolonged complete ulcer healing time. Ischaemic tissue lesions located in mid-and hindfoot healed poorly. At one year after IBS 50% of the patients were alive with salvaged leg and completely healed ulcers. The absence of gap between tertiary graft patency and leg salvage rates indicates the importance of a patent infrainguinal graft to save a leg with ischaemic tissue loss. Long-term survival for patients with ischaemic tissue loss was poor, 38% at 5 years. Only 30% of the patients were alive without amputation at 5 years. Several of the patient comorbidities increased independently the mortality risk; coronary artery disease, renal insufficiency, chronic obstructive lung disease and high age. When both PTA and bypass is feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to bypass surgery in CLI when redo surgery is actively utilized. MDR Pa in a patient with CLI should be considered as a serious event with increased risk of early major amputation or death. Conclusion: Despite a successful infrainguinal bypass healing of the ischaemic ulcers and incisional wounds ulcer healing is a slow process especially in diabetics. Bypass surgery and PTA improve the outcome of the ischaemic leg but the mortality rate of the patients is high due to their severe comorbidities.

The Home of Hearing : George Lindbeck's understanding of community

The aim of this thesis was to examine the understanding of community in George Lindbeck s The Nature of Doctrine. Intrinsic to this question was also examining how Lindbeck understands the relation between the text and the world which both meet in a Christian community. Thirdly this study also aimed at understanding what the persuasiveness of this understanding depends on. The method applied for this task was systematic analysis. The study was conducted by first providing an orientation into the nontheological substance of the ND which was assumed useful with respect to the aim of this study. The study then went on to explore Lindbeck in his own context of postliberal theology in order to see how the ND was received. It also attempted to provide a picture of how the ND relates to Lindbeck as a theologian. The third chapter was a descriptive analysis into the cultural-linguistic perspective, which is understood as being directly proportional to his understanding of community. The fourth chapter was an analysis into how the cultural-linguistic perspective sees the relation between the text and the world. When religion is understood from a cultural-linguistic perspective, it presents itself as a cultural-linguistic entity, which Lindbeck understands as a comprehensive interpretive scheme which structures human experience and understanding of oneself and the world in which one lives. When one exists in this entity, it is the entity which shapes the subjectivities of all those who are at home in this entity which makes participation in the life of a cultural linguistic entity a condition for understanding it. Religion is above all an external word that moulds and shapes our religious existence and experience. Understanding faith then as coming from hearing, is something that correlates with the cultural-linguistic depiction of reality. Religion informs us of a religious reality, it does not originate in any way from ourselves. This externality linked to the axiomatic nature of religion is also something that distinguishes Lindbeck sharply from liberalist tendencies, which understand religion as ultimately expressing the prereflective depths of the inner self. Language is the central analogy to understanding the medium in which one moves when inhabiting a cultural-linguistic system because language is the transmitting medium in which the cultural-linguistic system is embodied. The realism entailed in Lindbeck s understanding of a community is that we are fundamentally on the receiving end when it comes to our identities whether cultural or religious. We always witness to something. Its persuasiveness rests on the fact that we never exist in an unpersuaded reality. The language of Christ is a self-sustaining and irreducible cultural-linguistic entity, which is ontologically founded upon Christ. It transmits the reality of a new being. The basic relation to the world for a Christian is that of witnessing salvation in Christ: witnessing Christ as the home of hearing the message of salvation, which is the God-willed way. Following this logic, the relation of the world and the text is one of relating to the world from the text, i.e. In Christ through the word (text) for the world, because it assumes it s logic from the way Christ ontologically relates to us.

Performance prediction and loss analysis of low specific speed submersible pumps

A performance prediction procedure is presented for low specific speed submersible pumps with a review of loss models given in the literature. Most of the loss theories discussed in this paper are one dimensional and improvements are made with good empiricism for the prediction to cover the entire range of operation of the low specific speed pumps. Loss correlations, particularly in the low flow range, are discussed. Prediction of the shape of efficiency-capacity and total head-capacity curves agrees well with the experimental results in almost the full range of operating conditions. The approach adopted in the present analysis, of estimating the losses in the individual components of a pump, provides means for improving the performance and identifying the problem areas in existing designs of the pumps. The investigation also provides a basis for selection of parameters for the optimal design of the pumps in which the maximum efficiency is an important design parameter. The scope for improvement in the prediction procedure with the nature of flow phenomena in the low flow region has been discussed in detail.

Electron energy loss spectroscopic study of Cr(CO)6, Mo(CO)6 and W(CO)6 in the vapour phase

Electron energy loss spectra (EELS) of Cr, Mo and W hexacarbonyls in the vapour phase are reported. Most of the bands observed are similar to those in optical spectra, but the two high energy transitions in the 9·8–11·2 eV region are reported here for the first time. Based on the orbital energies from the ultraviolet photoelectron spectra and the electronic transition energies from EELS and earlier optical studies, the molecular energy level schemes of these molecules are constructed.

Anomalous viscous loss in emulsions

We propose a model for concentrated emulsions based on the speculation that a macroscopic shear strain does not produce an affine deformation in the randomly close-packed droplet structure. The model yields an anomalous contribution to the complex dynamic shear modulus that varies as the square root of frequency. We test this prediction using a novel light scattering technique to measure the dynamic shear modulus, and directly observe the predicted behavior over six decades of frequency and a wide range of volume fractions.

Dielectric function and optical conductivity of TiOx (0.8loss spectroscopy

Reflection electron energy-loss spectra are reported for the family of compounds TiOx over the entire homogeneity range (0.8 < a: < 1.3). The spectra exhibit a plasmon feature on the low-energy side, while several interband transitions are prominent at higher energies. The real and imaginary parts of dielectric functions and optical conductivity for these compounds are determined using the Kramers-Kronig analysis. The results exhibit systematic behavior with varying oxygen stoichiometry.

Constraint loss under dynamic loading in rate independent plastic solids

The objectives of this paper are to examine the loss of crack tip constraint in dynamically loaded fracture specimens and to assess whether it can lead to enhancement in the fracture toughness at high loading rates which has been observed in several experimental studies. To this end, 2-D plane strain finite element analyses of single edge notched (tension) specimen and three point bend specimen subjected to time varying loads are performed. The material is assumed to obey the small strain J(2) flow theory of plasticity with rate independent behaviour. The results demonstrate that a valid J-Q field exists under dynamic loading irrespective of the crack length and specimen geometry. Further, the constraint parameter Q becomes strongly negative at high loading rates, particularly in deeply cracked specimens. The variation of dynamic fracture toughness K-dc with stress intensity rate K for cleavage cracking is predicted using a simple critical stress criterion. It is found that inertia-driven constraint loss can substantially enhance K-dc for (K) over dot > 10(5) MPa rootm/s.

Efficient algorithms for learning kernels from multiple similarity matrices with general convex loss functions

In this paper we consider the problem of learning an n × n kernel matrix from m(1) similarity matrices under general convex loss. Past research have extensively studied the m = 1 case and have derived several algorithms which require sophisticated techniques like ACCP, SOCP, etc. The existing algorithms do not apply if one uses arbitrary losses and often can not handle m > 1 case. We present several provably convergent iterative algorithms, where each iteration requires either an SVM or a Multiple Kernel Learning (MKL) solver for m > 1 case. One of the major contributions of the paper is to extend the well knownMirror Descent(MD) framework to handle Cartesian product of psd matrices. This novel extension leads to an algorithm, called EMKL, which solves the problem in O(m2 log n 2) iterations; in each iteration one solves an MKL involving m kernels and m eigen-decomposition of n × n matrices. By suitably defining a restriction on the objective function, a faster version of EMKL is proposed, called REKL,which avoids the eigen-decomposition. An alternative to both EMKL and REKL is also suggested which requires only an SVMsolver. Experimental results on real world protein data set involving several similarity matrices illustrate the efficacy of the proposed algorithms.