Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.

OBJECTIVES: in a retrospective study, attempts have been made to identify individual organ-dysfunction risk profiles influencing the outcome after surgery for ruptured abdominal aortic aneurysms. METHODS: out of 235 patients undergoing graft replacement for abdominal aortic aneurysms, 57 (53 men, four women, mean age 72 years [s.d. 8.8]) were treated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistically. A simple multi-organ dysfunction (MOD) score was adopted. RESULTS: the perioperative mortality was 32%. Three patients died intraoperatively, four within 48 h and 11 died later. A significant influence for pre-existing risk factors was identified only for cardiovascular diseases. Multiple linear-regression analysis indicated that a haemoglobin <90 g/l, systolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD score >/=4 died (n=7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors. CONCLUSION: patients with ruptured aortic aneurysms from treatment should not be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU support.

The protracted Permo-Triassic crisis and multi-episode extinction around the Permian-Triassic boundary

The Permo-Triassic crisis was a major turning point in geological history. Following the end-Guadalupian extinction phase, the Palaeozoic biota underwent a steady decline through the Lopingian (Late Permian), resulting in their decimation at the level that is adopted as the Permian-Triassic boundary (PTB). This trend coincided with the greatest Phanerozoic regression. The extinction at the end of the Guadalupian and that marking the end of the Permian are therefore related. The subsequent recovery of the biota occupied the whole of the Early Triassic. Several phases of perturbations in [delta]13Ccarb occurred through a similar period, from the late Wuchiapingian to the end of the Early Triassic. Therefore, the Permian-Triassic crisis was protracted, and spanned Late Permian and Early Triassic time. The extinction associated with the PTB occurred in two episodes, the main act with a prelude and the epilogue. The prelude commenced prior to beds 25 and 26 at Meishan and coincided with the end-Permian regression. The main act itself happened in beds 25 and 26 at Meishan. The epilogue occurred in the late Griesbachian and coincided with the second volcanogenic layer (bed 28) at Meishan. The temporal distribution of these episodes constrains the interpretation of mechanisms responsible for the greatest Phanerozoic mass extinction, particularly the significance of a postulated bolide impact that to our view may have occurred about 50,000[no-break space]Myr after the prelude. The prolonged and multi-phase nature of the Permo-Triassic crisis favours the mechanisms of the Earth's intrinsic evolution rather than extraterrestrial catastrophe. The most significant regression in the Phanerozoic, the palaeomagnetic disturbance of the Permo-Triassic Mixed Superchron, widespread extensive volcanism, and other events, may all be related, through deep-seated processes that occurred during the integration of Pangea. These combined processes could be responsible for the profound changes in marine, terrestrial and atmospheric environments that resulted in the end-Permian mass extinction. Bolide impact is possible but is neither an adequate nor a necessary explanation for these changes.

Laboratory Evaluation of Polymer and Multi-Grade Asphalt Binders, MLR-90-5, 1992

A number of claims have been made that polymer modified asphalt cements, multi-grade asphalt cements, and other modifications of the liquid asphalt will prevent rutting and other deterioration of asphalt mixes, thereby, extending the service life of asphalt pavements. This laboratory study evaluates regular AC-20 asphalt cement, PAC-30 polymer modified asphalt cement and AC-10-30 multi-grade asphalt cement. PAC-30 was also evaluated with 15% Gilsonite and 15% Witcurb in a 75% crushed stone - 25% sand mix. These mixtures were evaluated for all Marshall properties along with indirect tensile, resilient modulus, and creep resistance.

Vertailun vuoksi? : Boolen algebra alueellisen vertailun välineenä

English abstract

Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies

The aim of this study was to provide an insight into normative values of the ascending aorta in regards to novel endovascular procedures using ECG-gated multi-detector CT angiography. Seventy-seven adult patients without ascending aortic abnormalities were evaluated. Measurements at relevant levels of the aortic root and ascending aorta were obtained. Diameter variations of the ascending aorta during cardiac cycle were also considered. Mean diameters (mm) were as follows: LV outflow tract 20.3 +/- 3.4, coronary sinus 34.2 +/- 4.1, sino-tubular junction 29.7 +/- 3.4 and mid ascending aorta 32.7 +/- 3.8 with coefficients of variation (CV) ranging from 12 to 17%. Mean distances (mm) were: from the plane passing through the proximal insertions of the aortic valve cusps to the right brachio-cephalic artery (BCA) 92.6 +/- 11.8, from the plane passing through the proximal insertions of the aortic valve cusps to the proximal coronary ostium 12.1 +/- 3.7, and between both coronary ostia 7.2 +/- 3.1, minimal arc of the ascending aorta from left coronary ostium to right BCA 52.9 +/- 9.5, and the fibrous continuity between the aortic valve and the anterior leaflet of the mitral valve 14.6 +/- 3.3, CV 13-43%. Mean aortic valve area was 582.0 +/- 131.9 mm(2). The variation of the antero-posterior and transverse diameters of the ascending aorta during the cardiac cycle were 8.4% and 7.3%, respectively. Results showed large inter-individual variations in diameters and distances but with limited intra-individual variations during the cardiac cycle. A personalized approach for planning endovascular devices must be considered.

Statistical assessment of dataset shift and model portability in multi-angle in-track image acquisitions

In this study we propose an evaluation of the angular effects altering the spectral response of the land-cover over multi-angle remote sensing image acquisitions. The shift in the statistical distribution of the pixels observed in an in-track sequence of WorldView-2 images is analyzed by means of a kernel-based measure of distance between probability distributions. Afterwards, the portability of supervised classifiers across the sequence is investigated by looking at the evolution of the classification accuracy with respect to the changing observation angle. In this context, the efficiency of various physically and statistically based preprocessing methods in obtaining angle-invariant data spaces is compared and possible synergies are discussed.

Comparative study of the LC-MS/MS and UPLC-MS/MS for the multi-residue analysis of quinolones, penicillins and cephalosporins in cow milk, and validation according to the regulation 2002/657/EC

The aim of this study was to develop and validate an analytical method to simultaneously determine European Union-regulated beta-lactams (penicillins and cephalosporins) and quinolones in cow milk. The procedure involves a new solid phase extraction (SPE) to clean-up and pre-concentrate the three series of antibiotics before analysis by liquid chromatography¿tandem mass spectrometry (LC-MS/MS) and ultra-high-performance liquid chromatography¿tandem mass spectrometry (UPLC-MS/MS). LC-MS/MS and UPLC-MS/MS techniques were also compared. The method was validated according to the Directive 2002/657/EC and subsequently applied to 56 samples of raw cow milk supplied by the Laboratori Interprofessional Lleter de Catalunya (ALLIC) (Laboratori Interprofessional Lleter de Catalunya, Control Laboratory Interprofessional of Milk of Catalunya).

European Cardiovascular Magnetic Resonance (EuroCMR) registry--multi national results from 57 centers in 15 countries.

BACKGROUND: The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. METHODS: Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. RESULTS: The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year). CONCLUSION: The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

A Multi-Project Scheduling Procedure for Transportation Projects, Part II, HR-339, 1994

The Iowa Department of Transportation (IDOT) has been requiring Critical Path Method (CPM) schedules on some larger or more schedule sensitive projects. The Office of Construction's expectations for enhanced project control and improved communication of project objectives have not been fully met by the use of CPM. Recognizing that the current procedures might not be adequate for all projects, IDOT sponsored a research project to explore the state-of-the-art in transportation scheduling and identify opportunities for improvement. The first phase of this project identified a technique known as the Linear Scheduling Method (LSM) as an alternative to CPM on certain highway construction projects. LSM graphically displays the construction process with respect to the location and the time in which each activity occurs. The current phase of this project was implemented to allow the research team the opportunity to evaluate LSM on all small groups of diverse projects. Unlike the first phase of the project, the research team was closely involved in the project from early in the planning phase throughout the completion of the projects. The research strongly suggests that the linear scheduling technique has great potential as a project management tool for both contractors and IDOT personnel. However, before this technique can become a viable weapon in the project management arsenal, a software application needs to be developed. This application should bring to linear scheduling a degree of functionality as rich and as comprehensive as that found in microcomputer based CPM software on the market today. The research team recommends that the IDOT extend this research effort to include the development of a linear scheduling application.

ConnectomeViewer - Multi-Modal Multi-Level Network Visualization and Analysis.

Introduction: The field of Connectomic research is growing rapidly, resulting from methodological advances in structural neuroimaging on many spatial scales. Especially progress in Diffusion MRI data acquisition and processing made available macroscopic structural connectivity maps in vivo through Connectome Mapping Pipelines (Hagmann et al, 2008) into so-called Connectomes (Hagmann 2005, Sporns et al, 2005). They exhibit both spatial and topological information that constrain functional imaging studies and are relevant in their interpretation. The need for a special-purpose software tool for both clinical researchers and neuroscientists to support investigations of such connectome data has grown. Methods: We developed the ConnectomeViewer, a powerful, extensible software tool for visualization and analysis in connectomic research. It uses the novel defined container-like Connectome File Format, specifying networks (GraphML), surfaces (Gifti), volumes (Nifti), track data (TrackVis) and metadata. Usage of Python as programming language allows it to by cross-platform and have access to a multitude of scientific libraries. Results: Using a flexible plugin architecture, it is possible to enhance functionality for specific purposes easily. Following features are already implemented: * Ready usage of libraries, e.g. for complex network analysis (NetworkX) and data plotting (Matplotlib). More brain connectivity measures will be implemented in a future release (Rubinov et al, 2009). * 3D View of networks with node positioning based on corresponding ROI surface patch. Other layouts possible. * Picking functionality to select nodes, select edges, get more node information (ConnectomeWiki), toggle surface representations * Interactive thresholding and modality selection of edge properties using filters * Arbitrary metadata can be stored for networks, thereby allowing e.g. group-based analysis or meta-analysis. * Python Shell for scripting. Application data is exposed and can be modified or used for further post-processing. * Visualization pipelines using filters and modules can be composed with Mayavi (Ramachandran et al, 2008). * Interface to TrackVis to visualize track data. Selected nodes are converted to ROIs for fiber filtering The Connectome Mapping Pipeline (Hagmann et al, 2008) processed 20 healthy subjects into an average Connectome dataset. The Figures show the ConnectomeViewer user interface using this dataset. Connections are shown that occur in all 20 subjects. The dataset is freely available from the homepage (connectomeviewer.org). Conclusions: The ConnectomeViewer is a cross-platform, open-source software tool that provides extensive visualization and analysis capabilities for connectomic research. It has a modular architecture, integrates relevant datatypes and is completely scriptable. Visit www.connectomics.org to get involved as user or developer.

Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration.

BACKGROUND: Whether nucleoside reverse transcriptase inhibitors increase the risk of myocardial infarction in HIV-infected individuals is unclear. Our aim was to explore whether exposure to such drugs was associated with an excess risk of myocardial infarction in a large, prospective observational cohort of HIV-infected patients. METHODS: We used Poisson regression models to quantify the relation between cumulative, recent (currently or within the preceding 6 months), and past use of zidovudine, didanosine, stavudine, lamivudine, and abacavir and development of myocardial infarction in 33 347 patients enrolled in the D:A:D study. We adjusted for cardiovascular risk factors that are unlikely to be affected by antiretroviral therapy, cohort, calendar year, and use of other antiretrovirals. FINDINGS: Over 157,912 person-years, 517 patients had a myocardial infarction. We found no associations between the rate of myocardial infarction and cumulative or recent use of zidovudine, stavudine, or lamivudine. By contrast, recent-but not cumulative-use of abacavir or didanosine was associated with an increased rate of myocardial infarction (compared with those with no recent use of the drugs, relative rate 1.90, 95% CI 1.47-2.45 [p=0.0001] with abacavir and 1.49, 1.14-1.95 [p=0.003] with didanosine); rates were not significantly increased in those who stopped these drugs more than 6 months previously compared with those who had never received these drugs. After adjustment for predicted 10-year risk of coronary heart disease, recent use of both didanosine and abacavir remained associated with increased rates of myocardial infarction (1.49, 1.14-1.95 [p=0.004] with didanosine; 1.89, 1.47-2.45 [p=0.0001] with abacavir). INTERPRETATION: There exists an increased risk of myocardial infarction in patients exposed to abacavir and didanosine within the preceding 6 months. The excess risk does not seem to be explained by underlying established cardiovascular risk factors and was not present beyond 6 months after drug cessation.

Aplicação dos conceitos de modelagem e de redes de Petri na análise do processo produtivo da indústria sucroalcooleira

A modelagem, como meio de análise de processos do agronegócio, bem como de cadeias produtivas, atende à demanda por métodos apropriados. O presente trabalho objetivou avaliar a aderência dos conceitos de modelagem e de rede de Petri aplicados ao complexo agroindustrial da cana-de-açúcar. Utilizou-se uma empresa real para a aquisição das informações. Os modelos das cadeias de atividades foram validados com o uso da rede de Petri, por meio de um método de análise em que são simulados todos os caminhos possíveis e os estados que o sistema modelado pode atingir. O estudo resultou em 14 conjuntos de etapas de produção, englobando todas as operações unitárias das cadeias produtivas do açúcar e do álcool, desde o plantio da cana até o armazenamento do açúcar e do álcool.