DESyne novolimus-eluting coronary stent is superior to Endeavor zotarolimus-eluting coronary stent at five-year follow-up: final results of the multicentre EXCELLA II randomised controlled trial

AIMS Newer-generation drug-eluting stents (DES) have been shown to be superior to first-generation DES. Current-generation DES have zotarolimus, everolimus or biolimus as antiproliferative drugs. Novolimus, a metabolite of sirolimus, has been specifically developed to provide efficacy similar to currently available agents at a lower dose and thus requires a lower polymer load. We report the final five-year outcomes of the EXCELLA II trial comparing a zotarolimus-eluting stent (ZES) with a novolimus-eluting stent (NES). METHODS AND RESULTS EXCELLA II is a prospective, multicentre, single-blind, non-inferiority clinical trial. Patients (n=210) with a maximum of two de novo lesions in two different epicardial vessels were randomised (2:1) to treatment with either NES (n=139) or ZES (n=71). At five-year follow-up, patients in the NES group had a significantly lower incidence of the patient-oriented (HR 0.53, 95% CI: 0.32-0.87, p=0.013) and device-oriented (HR 0.38, 95% CI: 0.17-0.83, p=0.011) composite endpoints. There was no difference in cardiac death and definite/probable stent thrombosis between the two groups; however, there was a trend towards reduction in myocardial infarction and repeat revascularisation in the NES group at five-year follow-up. CONCLUSIONS At five-year follow-up, the incidence of device- and patient-oriented events was significantly lower in the NES group. Further studies, adequately powered for clinical outcomes, are warranted. TRIAL REGISTRATION ClinicalTrials.gov number NCT00792753.

A 2-year multicentre, open-label, randomized, controlled study of growth hormone (Genotropin(®) ) treatment in very young children born small for gestational age: Early Growth and Neurodevelopment (EGN) Study

OBJECTIVE In Europe, growth hormone (GH) treatment for children born small for gestational age (SGA) can only be initiated after 4 years of age. However, younger age at treatment initiation is a predictor of favourable response. To assess the effect of GH treatment on early growth and cognitive functioning in very young (<30 months), short-stature children born SGA. DESIGN A 2-year, randomized controlled, multicentre study (NCT00627523; EGN study), in which patients received either GH treatment or no treatment for 24 months. PATIENTS Children aged 19-29 months diagnosed as SGA at birth, and for whom sufficient early growth data were available, were eligible. Patients were randomized (1:1) to GH treatment (Genotropin(®) , Pfizer Inc.) at a dose of 0·035 mg/kg/day by subcutaneous injection, or no treatment. MEASUREMENTS The primary objective was to assess the change from baseline in height standard deviation score (SDS) after 24 months of GH treatment. RESULTS Change from baseline in height SDS was significantly greater in the GH treatment vs control group at both month 12 (1·03 vs 0·14) and month 24 (1·63 vs 0·43; both P < 0·001). Growth velocity SDS was significantly higher in the GH treatment vs control group at 12 months (P < 0·001), but not at 24 months. There was no significant difference in mental or psychomotor development indices between the two groups. CONCLUSIONS GH treatment for 24 months in very young short-stature children born SGA resulted in a significant increase in height SDS compared with no treatment.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial.

BACKGROUND The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. METHODS The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. RESULTS Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. CONCLUSIONS After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. TRIAL REGISTRATION Registered on www.clinicaltrials.gov: NCT01878331.

Small-diameter titanium Grade IV and titanium-zirconium implants in edentulous mandibles: three-year results from a double-blind, randomized controlled trial

OBJECTIVE The aim of this study was to compare crestal bone-level changes, soft tissue parameters and implant success and survival between small-diameter implants made of titanium/zirconium (TiZr) alloy or of Grade IV titanium (Ti) in edentulous mandibles restored with removable overdentures. MATERIALS AND METHODS This was a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann bone-level implants (diameter 3.3 mm), one of Ti Grade IV (control) and one of TiZr (test), in the interforaminal region. Implants were loaded after 6-8 weeks and removable Locator-retained overdentures were placed within 2 weeks of loading. Modified plaque and sulcus bleeding indices, radiographic bone level, and implant survival and success were evaluated up to 36 months. RESULTS Of 91 treated patients, 75 completed the three-year follow-up. Three implants were lost (two control and one test implant). The survival rates were 98.7% and 97.3%, and the mean marginal bone level change was -0.78 ± 0.75 and -0.60 ± 0.71 mm for TiZr and Ti Grade IV implants. Most patients had a plaque score of 0 or 1 (54% for test and 51.7% for control), and a sulcus bleeding score of 0 (46.1% for test and 44.9% for control). No significant differences were found between the two implant types for bone-level change, soft tissue parameters, survival and success. CONCLUSIONS After 36 months, similar outcomes were found between Ti Grade IV and TiZr implants. The results confirm that the results seen at 12 months continue over time.

This Was Not on the Syllabus!: An Examination of First-Year Urban Teachers' Self-Efficacy

Many first-year teachers find it difficult to reach the needs of all their students in part, because they feel their college coursework left them ill-prepared for the complexity they face in the classroom. This is particularly true among urban teachers who often face crowded classrooms of diverse students with a wide range of instructional needs. This study is a comparative case study of two University of Connecticut graduates during their first year teaching in urban schools. Using mixed-methods, the study draws on interviews, questionnaires, and videotape data shared as a part of a monthly teacher study group of similar graduates. I also draw on group conversations in which teachers discussed their ability to reach the needs of all of their students as this was related to their preservice coursework. My findings suggest that many first-year teachers feel university coursework failed to help them. One teacher felt it did not help her at all, while the other felt it helped her but she still could not meet all of her students' needs. Many first-year, urban teachers do not feel confident in the classroom as a result of their preparation from coursework. With this lack in confidence, the teachers may be more likely to leave their urban position, and this may contribute to the high turnover of teachers in urban placements.

Two Perspectives on GIS/LIS Education in the United States

Education in Geographic information science (GIS/LIS) happens in the United States both within surveying-related academic programs and in other academic programs that use spatially oriented data and information. This article presents an overview of two such programs. The first is a four-year Bachelor of Science degree program in Geographic Information Science at Texas A&M University-Corpus Christi. The second is a concentration with a four-year Bachelor of Science degree program in Natural Resources at the University of Connecticut (UConn). Geographic information science is the primary focus of the Texas A&M program, whereas GIS/LIS is an emphasis of the UConn program. Both approaches are presented for comparison.

The population health performance of medical students at two medical schools

Public Health and medicine are complimentary disciplines dedicated to the health and well-being of humankind. Worldwide, medical school accreditation bodies require the inclusion of population health in medical education. In 2003, the Institutes of Medicine (IOM) recommended that all medical students receive basic public health training in population-based prevention. The purpose of this study was to (1) examine the public health clinical performance of third-year medical students at two independent medical schools, (2) compare the public health clinical practice performance of the schools, and (3) identify underlying predictors of high and low public health clinical performance at one of the medical schools. ^ This study is unique in its analysis and report of observed medical student public health clinical practices. The cohort consisted of 751 third-year medical students who completed a required clinical performance exam using trained standardized patients. Medical student performance scores on 24 consensus public health items derived from nine patient cases were analyzed.^ The analysis showed nearly identical results for both medical schools at the 60%, 65%, and 70% pass rate. Students performed poorly on items associated with prevention, behavioral science, and surveillance. Factors associated with high student performance included being from an underrepresented minority, matching to a primary care residency, and high class ranking. A review of medical school curriculum at both schools revealed a lack of training in four public health domains. Nationally, 32% of medical students reported inadequate training in public health in the year 2006.^ These findings suggest more dedicated teaching time for public health domains is needed at the medical schools represented in this study. Finally, more research is needed to assess attainment of public health knowledge and skills for medical students nationwide if we are to meet the recommendations of the IOM. ^

Perinatal mortality and quality of care at the National Institute of Perinatology: A 3-year analysis

Quality of medical care has been indirectly assessed through the collection of negative outcomes. A preventable death is one that could have been avoided if optimum care had been offered. The general objective of the present project was to analyze the perinatal mortality at the National Institute of Perinatology (located in Mexico City) by social, biological and some available components of quality of care such as avoidability, provider responsibility, and structure and process deficiencies in the delivery of medical care. A Perinatal Mortality Committee data base was utilized. The study population consisted of all singleton perinatal deaths occurring between January 1, 1988 and June 30, 1991 (n = 522). A proportionate study was designed.^ The population studied mostly corresponded to married young adult mothers, who were residents of urban areas, with an educational level of junior high school or more, two to three pregnancies, and intermediate prenatal care. The mean gestational age at birth was 33.4 $\pm$ 3.9 completed weeks and the mean birthweight at birth was 1,791.9 $\pm$ 853.1 grams.^ Thirty-five percent of perinatal deaths were categorized as avoidable. Postnatal infection and premature rupture of membranes were the most frequent primary causes of avoidable perinatal death. The avoidable perinatal mortality rate was 8.7 per 1000 and significantly declined during the study period (p $<$.05). Preventable perinatal mortality aggregated data suggested that at least part of the mortality decline for amenable conditions was due to better medical care.^ Structure deficiencies were present in 35% of avoidable deaths and process deficiencies were present in 79%. Structure deficiencies remained constant over time. Process deficiencies consisted of diagnosis failures (45.8%) and treatment failures (87.3%), they also remained constant through the years. Party responsibility was as follows: Obstetric (35.4%), pediatric (41.4%), institutional (26.5%), and patient (6.6%). Obstetric responsibility significantly increased during the study period (p $<$.05). Pediatric responsibility declined only for newborns less than 1500 g (p $<$.05). Institutional responsibility remained constant.^ Process deficiencies increased the risk for an avoidable death eightfold (confidence interval 1.7-41.4, p $<$.01) and provider responsibility ninety-fivefold (confidence interval 14.8-612.1, p $<$.001), after adjustment for several confounding variables. Perinatal mortality due to prematurity, barotrauma and nosocomial infection, was highly preventable, but not that due to transpartum asphyxia. Once specific deficiencies in the quality of care have been identified, quality assurance actions should begin. ^

Second Year Performance of Honeycrisp on 31 Dwarfing Rootstocks in the Iowa Planting of the NC-140 2010 Regional Apple Rootstock Trial

To evaluate the adaptability and performance of new and promising apple rootstocks in the dwarfing size-control category, a NC-140 regional rootstock trial was established in 2010 at 12 sites in the United States (CO, IA, IL, IN, MA, MI, MN, NJ, NY, OH, UT, WI), two sites in Canada (BC, NS), and one site in Mexico (CHIH) with Honeycrisp serving as the test cultivar. The Iowa planting, located at the ISU Horticulture Research Station, includes 31 rootstocks with new selections from the Cornell-Geneva breeding program (G, CG.), Russia (Bud), Germany (PiAu), and Japan (Supp), with M.26, M.9 Pajam 2, and M.9 T337 serving as industry standards. Tissue cultured propagated (TC) rootstocks of G.41, G.202, and G.935 were included for comparison with normal (N) stool bed propagated rootstocks. This report summarizes the tree-growth characteristics of the Iowa planting during the 2011 growing season.

Seaweed - epiphyte - mesograzer communities were tested for their responses to elevated seawater temperature and [CO2] in benthic mesocosms experiments across four consecutive seasons of one year in Kiel, Germany

Rising seawater temperature and CO2 concentrations (ocean acidification) represent two of the most influential factors impacting marine ecosystems in the face of global climate change. In ecological climate change research full-factorial experiments across seasons in multi-species, cross-trophic level set-ups are essential as they allow making realistic estimations about direct and indirect effects and the relative importance of both major environmental stressors on ecosystems. In benthic mesocosm experiments we tested the responses of coastal Baltic Sea Fucus vesiculosus communities to elevated seawater temperature and CO2 concentrations across four seasons of one year. While increasing [CO2] levels only had minor effects, warming had strong and persistent effects on grazers which affected the Fucus community differently depending on season. In late summer a temperature-driven collapse of grazers caused a cascading effect from the consumers to the foundation species resulting in overgrowth of Fucus thalli by epiphytes. In fall/ winter, outside the growing season of epiphytes, intensified grazing under warming resulted in a significant reduction of Fucus biomass. Thus, we confirm the prediction that future increasing water temperatures influence marine food-web processes by altering top-down control, but we also show that specific consequences for food-web structure depend on season. Since Fucus vesiculosus is the dominant habitat-forming brown algal system in the Baltic Sea, its potential decline under global warming implicates the loss of key functions and services such as provision of nutrient storage, substrate, food, shelter and nursery grounds for a diverse community of marine invertebrates and fish in Baltic Sea coastal waters.

Influence of fertilization on the growth of radicchio "Rosso di Chioggia" cultivated in two different environments

Este trabajo evalúa la influencia de la fertilización en radicchio tipo "Rosso de Chioggia" (precocidad media) sobre algunos índices de crecimiento. Se realizaron ensayos durante dos campañas en Rovigo (Italia) y una en Mendoza (Argentina), aplicándose dosis crecientes de NPK, identificadas como N0P0K0, N1P1K1, N2P2K2, en Mendoza y en Rovigo, además, N3P2K2. Durante el cultivo se calcularon índices de crecimiento como: relative growth rate (RGR), net assimilation rate (NAR), leaf area ratio (LAR), specific leaf area (SLA), leaf weigh ratio (LWR), crop growth ratio (CGR), leaf area index (LAI) and leaf area duration (LAD). En Mendoza, el CGR estuvo fuertemente influenciado por NAR desde el trasplante hasta alcanzar 776 grados días (GDD); desde 1052 a 1653 GDD el CGR fue afectado por el LAI el cual aumentó marcadamente debido a las condiciones ambientales favorables. Entre los 1052 y 1653 GDD el incremento del LAI determinó una reducción en la eficiencia fotosintética. En Rovigo, la tendencia de los índices fue disímil en los dos años, encontrándose respuestas diferentes en LAR y en SLA. En el segundo año, el CGR siempre arrojó valores más altos, mientras que NAR no difirió en ninguno de los años. En la segunda mitad del ciclo, CGR estuvo fuertemente asociado a una menor eficiencia fotosintética, debido a la formación de la cabeza. Valores elevados de LAI indicaron una extensión del ciclo, retrasando la formación de la cabeza. Las plantas alcanzaron la madurez comercial con LWR entre 0,35 - 0,40 g g-1. En ambos ambientes, no se observó claramente el efecto de la fertilización sobre los índices; si bien las dosis más altas mostraron mayor actividad de crecimiento en las etapas tempranas.

Minimum water input event for seedling emergence of three native perennial grasses of the Central Monte desert (Argentina) influenced by the effect of shade and the season of the year

In deserts, seedling emergence occurs only after precipitation threshold has been exceeded, however, the presence of trees modifies microenvironmental conditions that might affect the effectiveness of a water pulse. In the Monte desert, Prosopis flexuosa trees generate different micro-environmental conditions that might influence grass seedlings establishment. The objective of this work was: a) to know the effective minimum water input event that triggers the emergence of native perennial grass seedlings; b) to relate this fact with the effect of the shade of P. flexuosa canopy and the seasonal temperatures. Three important forage species of the Monte were studied: Pappophorum caespitosum and Trichloris crinita, with C4, and Jarava ichu, with C3 metabolism. Each season, seeds of these species were sown in pots placed at two light conditions: shade (similar to P. flexuosa cover) and open area, and with seven irrigation treatments (0, 10, 20, 30, 40, 2*10 and 3*10 mm). J. ichu did not emerge in any of the treatments. Significant seedling emergence was registered for P. caespitosum and T. crinita in shade conditions with 40 mm irrigation treatment in summer. Since 40 mm precipitation events are infrequent in the Monte, seedling emergence for these species would be restricted to exceptional rainy years. The facilitating effect of P. flexuosa shade would be important during the hot season.

Two historical maps from nineteenth-century Palestine, with links to digitized maps in shapefile format

Reconstructing past landscapes from historical maps requires quantifying the accuracy and completeness of these sources. The accuracy and completeness of two historical maps of the same period covering the same area in Israel were examined: the 1:63,360 British Palestine Exploration Fund map (1871-1877) and the 1:100,000 French Levés en Galilée (LG) map (1870). These maps cover the mountainous area of the Galilee (northern Israel), a region with significant natural and topographical diversity, and a long history of human presence. Land-cover features from both maps, as well as the contours drawn on the LG map, were digitized. The overall correspondence between land-cover features shown on both maps was 59% and we found that the geo-referencing method employed (transformation type and source of control points) did not significantly affect these correspondence measures. Both maps show that in the 1870s, 35% of the Galilee was covered by Mediterranean maquis, with less than 8% of the area used for permanent agricultural cropland (e.g., plantations). This article presents how the reliability of the maps was assessed by using two spatial historical sources, and how land-cover classes that were mapped with lower certainty and completeness are identified. Some of the causes that led to observed differences between the maps, including mapping scale, time of year, and the interests of the surveyors, are also identified.

Multi-year high-frequency current and water quality in-situ observations at the Guadiana Estuary

High-frequency data collected continuously over a multiyear time frame are required for investigating the various agents that drive ecological and hydrodynamic processes in estuaries. Here, we present water quality and current in-situ observations from a fixed monitoring station operating from 2008 to 2014 in the lower Guadiana Estuary, southern Portugal (37°11.30' N, 7°24.67' W). The data were recorded by a multi-parametric probe providing hourly records (temperature, salinity, chlorophyll, dissolved oxygen, turbidity, and pH) at a water depth of ~1 m, and by a bottom-mounted acoustic Doppler current profiler measuring the pressure, near-bottom temperature, and flow velocity through the water column every 15 min. The time-series data, in particular the probe ones, present substantial gaps arising from equipment failure and maintenance, which are ineluctable with this type of observations in harsh environments. However, prolonged (months-long) periods of multi-parametric observations during contrasted external forcing conditions are available. The raw data are reported together with flags indicating the quality status of each record. River discharge data from two hydrographic stations located near the estuary head are also provided to support data analysis and interpretation.

Profiles of diatoms, pollen, XRD, XRF and organic composition of two sediment cores (PG2022 and PG2023) from Lake Kyutyunda in Yakutia, NE Siberia, Russia

Although the climate development over the Holocene in the Northern Hemisphere is well known, palaeolimnological climate reconstructions reveal spatiotemporal variability in northern Eurasia. Here we present a multi-proxy study from north-eastern Siberia combining sediment geochemistry, and diatom and pollen data from lake-sediment cores covering the last 38,000 cal. years. Our results show major changes in pyrite content and fragilarioid diatom species distributions, indicating prolonged seasonal lake-ice cover between ~13,500 and ~8,900 cal. years BP and possibly during the 8,200 cal. years BP cold event. A pollen-based climate reconstruction generated a mean July temperature of 17.8°C during the Holocene Thermal Maximum (HTM) between ~8,900 and ~4,500 cal. years BP. Naviculoid diatoms appear in the late Holocene indicating a shortening of the seasonal ice cover that continues today. Our results reveal a strong correlation between the applied terrestrial and aquatic indicators and natural seasonal climate dynamics in the Holocene. Planktonic diatoms show a strong response to changes in the lake ecosystem due to recent climate warming in the Anthropocene. We assess other palaeolimnological studies to infer the spatiotemporal pattern of the HTM and affirm that the timing of its onset, a difference of up to 3,000 years from north to south, can be well explained by climatic teleconnections. The westerlies brought cold air to this part of Siberia until the Laurentide ice-sheet vanished 7,000 years ago. The apparent delayed ending of the HTM in the central Siberian record can be ascribed to the exceedance of ecological thresholds trailing behind increases in winter temperatures and decreases in contrast in insolation between seasons during the mid to late Holocene as well as lacking differentiation between summer and winter trends in paleolimnological reconstructions.