Edoxaban versus enoxaparin–warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial

Background Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. Methods We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin–warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15–50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)—stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region—was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. Findings Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin–warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin–warfarin group (odds ratio [OR] 0·46, 95% CI 0·12–1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin–warfarin (OR 1·48, 95% CI 0·64–3·55). The results were independent of the TEE-guided strategy and anticoagulation status. Interpretation ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. Funding Daiichi Sankyo provided financial support for the study. © 2016 Elsevier Ltd

Efecto de los dispositivos de emisión de microondas, radiofrecuencia no ablativa y ultrasonido microfocalizado en el tratamiento de la hiperhidrosis primaria revisión sistemática de la literatura

Antecedentes y objetivos: La hiperhidrosis primaria afecta el 2,8% de la población de Estados Unidos. Condición que impacta el desarrollo social de los individuos afectados, ocasionando fobia social. Existen opciones disponibles para el tratamiento de la hiperhidrosis incluyendo medicamentos tópico, sistémico, inyectable y quirúrgico. El objetivo de ésta revisión sistemática de la literatura es determinar la efectividad y seguridad de los dispositivos de emisión de microondas, radiofrecuencia no ablativa y sistema de ultrasonido microfocalizado para el tratamiento de la hiperhidrosis primaria. Materiales y métodos: Se realizó una revisión sistemática de la literatura de artículos obtenidos de bases de datos: Medline, Cochrane, Embase, Ovid y Scielo. Se incluyeron ensayos clínicos aleatorizados controlados, ensayos cuasiexperimentales desde el 2011; donde evaluaran el uso de estos dispositivos en el manejo de hiperhidrosis primaria. Resultados: Se seleccionaron 21 artículos en total. Se encontró que con los tres dispositivos se logra una reducción significativa a puntajes entre 1 y 2 de la escala de Severidad de la Hiperhidrosis; en 3 estudios se encontró mejoría en la calidad de vida; los eventos adversos fueron transitorios, siendo más frecuentes con el dispositivo de emisión de microondas. Conclusión: Primera revisión sistemática de la literatura sobre el efecto de estos tres dispositivos en el manejo de hiperhidrosis. Se espera aportar a la literatura existente una recomendación acerca de la efectividad y seguridad de estos dispositivos para que sea aplicado en los pacientes con diagnóstico de hiperhidrosis primaria.

Plan de mejoramiento a la Supply Chain de BCD TRAVEL Colombia

Mediante el acercamiento que se hizo al área corporativa de BCD TRAVEL COLOMBIA y considerando el importante crecimiento actual del Sector Turismo y más precisamente de los viajes con motivo corporativo en el país, surge la necesidad del presente trabajo. Al hacer un análisis interno en la organización y de su entorno, se evidenció que la compañía tiene carencia en procesos y establecimiento de nuevas estrategias que le permitan identificar y potencializar oportunidades en su mercado objetivo y en torno a sus clientes y proveedores, lo cual, puede amenazar y comprometer la estabilidad y prestigio de empresa y así mismo su perdurabilidad. Se elaborará un propuesta de mejora en torno a el área de mercadeo y de logística con el fin de estructurar herramientas que le permitan a la compañía tener un horizonte definido, conocer su posición estratégica en el mercado actual, a donde quiere llegar y que debe hacer para lograr los objetivos establecidos en su unidad de negocio corporativa, la cual representa el mayor porcentaje de ingresos para la compañía. . Se espera que los planes de mejora y estrategias establecidas generen servicios de valor agregado e impacten positivamente a lo largo de la cadena de suministro logrando mayor rentabilidad, competitividad y seguimiento de todos los procesos de esta unidad de negocio.

Rapid hologram generation utilizing layer-based approach and graphic rendering for realistic three-dimensional image reconstruction by angular tiling

An approach of rapid hologram generation for the realistic three-dimensional (3-D) image reconstruction based on the angular tiling concept is proposed, using a new graphic rendering approach integrated with a previously developed layer-based method for hologram calculation. A 3-D object is simplified as layered cross-sectional images perpendicular to a chosen viewing direction, and our graphics rendering approach allows the incorporation of clear depth cues, occlusion, and shading in the generated holograms for angular tiling. The combination of these techniques together with parallel computing reduces the computation time of a single-view hologram for a 3-D image of extended graphics array resolution to 176 ms using a single consumer graphics processing unit card. © 2014 SPIE and IS and T.

A transfer matrix approach for evaluation of the response of a multi-layer infinite plate to a two-dimensional pressure excitation

A 6 X 6 transfer matrix is presented to evaluate the response of a multi-layer infinite plate to a given two-dimensional pressure excitation on one of its faces or, alternatively, to evaluate the acoustic pressure distribution excited by the normal velocity components of the radiating surfaces. It is shown that the present transfer matrix is a general case embodying the transfer matrices of normal excitation and one-dimensional pressure excitation due to an oblique incident wave. It is also shown that the present transfer matrix obeys the necessary checks to categorize the physically symmetric multi-layer plate as dynamically symmetric. Expressions are derived to obtain the wave propagation parameters, such as the transmission, absorption and reflection coefficients, in terms of the elements of the transfer matrix presented. Numerical results for transmission loss and reflection coefficients of a two-layer configuration are presented to illustrate the effect of angles of incidence, layer characteristics and ambient media.

Patterned self-adaptive polymer brushes by "grafting to" approach and microcontact printing

Patterned self-adaptive PS/P2VP mixed polymer brushes were prepared by "grafting to" approach combining with microcontact printing (muCP). The properties of the patterned surface were investigated by lateral force microscopy (LFM), XPS and water condensation figures. In the domains with grafted P2VP, the PS/P2VP mixed brushes demonstrated reversible switching behavior upon exposure to selective solvents for different components. The chemical composition of the top layer as well as the surface wettability can be well tuned due to the perpendicular phase segregation in the mixed brushes. While in the domains without grafted P2VP, the grafted PS did not have the capability of switching. The development and erasing of the pattern is reversible under different solvent treatment.

Design of a turn-linker-turn foldamer by incorporating meta-amino benzoic acid in the middle of a helix forming hexapeptide sequence: A helix breaking approach

Single crystal X-ray diffraction studies reveal that the incorporation of meta-amino benzoic acid in the middle of a helix forming hexapeptide sequence such as in peptide I Boc-Ile(1)-Aib(2)-Val(3)-m-ABA(4)-Ile(5)-Aib(6)-Leu(7)-OMe (Aib: alpha-amino isobutyric acid: m-ABA: meta-amino benzoic acid) breaks the helix propagation to produce a turn-linker-turn (T-L-T) foldamer in the solid state. In the crystalline state two conformational isomers of peptide I self-assemble in antiparallel fashion through intermolecular hydrogen bonds and aromatic pi-pi interactions to form a molecular duplex. The duplexes are further interconnected through intermolecular hydrogen bonds to form a layer of peptides. The layers are stacked one on top of the other through van der Waals interactions to form hydrophilic channels filled with solvent methanol. (C) 2009 Elsevier B.V. All rights reserved.

Coupling aerosol surface and bulk chemistry with a kinetic double layer model (K2-SUB): oxidation of oleic acid by ozone

We present a kinetic double layer model coupling aerosol surface and bulk chemistry (K2-SUB) based on the PRA framework of gas-particle interactions (Poschl-Rudich-Ammann, 2007). K2-SUB is applied to a popular model system of atmospheric heterogeneous chemistry: the interaction of ozone with oleic acid. We show that our modelling approach allows de-convoluting surface and bulk processes, which has been a controversial topic and remains an important challenge for the understanding and description of atmospheric aerosol transformation. In particular, we demonstrate how a detailed treatment of adsorption and reaction at the surface can be coupled to a description of bulk reaction and transport that is consistent with traditional resistor model formulations. From literature data we have derived a consistent set of kinetic parameters that characterise mass transport and chemical reaction of ozone at the surface and in the bulk of oleic acid droplets. Due to the wide range of rate coefficients reported from different experimental studies, the exact proportions between surface and bulk reaction rates remain uncertain. Nevertheless, the model results suggest an important role of chemical reaction in the bulk and an approximate upper limit of similar to 10(-11) cm(2) s(-1) for the surface reaction rate coefficient. Sensitivity studies show that the surface accommodation coefficient of the gas-phase reactant has a strong non-linear influence on both surface and bulk chemical reactions. We suggest that K2-SUB may be used to design, interpret and analyse future experiments for better discrimination between surface and bulk processes in the oleic acid-ozone system as well as in other heterogeneous reaction systems of atmospheric relevance.

Variational approach in weighted Sobolev spaces to scattering by unbounded rough surfaces

We consider the problem of scattering of time harmonic acoustic waves by an unbounded sound soft surface which is assumed to lie within a finite distance of some plane. The paper is concerned with the study of an equivalent variational formulation of this problem set in a scale of weighted Sobolev spaces. We prove well-posedness of this variational formulation in an energy space with weights which extends previous results in the unweighted setting [S. Chandler-Wilde and P. Monk, SIAM J. Math. Anal., 37 (2005), pp. 598–618] to more general inhomogeneous terms in the Helmholtz equation. In particular, in the two-dimensional case, our approach covers the problem of plane wave incidence, whereas in the three-dimensional case, incident spherical and cylindrical waves can be treated. As a further application of our results, we analyze a finite section type approximation, whereby the variational problem posed on an infinite layer is approximated by a variational problem on a bounded region.

Determining the contribution of volcanic ash and boundary layer aerosol in backscatter lidar returns: a three‐component atmosphere approach

A solution of the lidar equation is discussed, that permits combining backscatter and depolarization measurements to quantitatively distinguish two different aerosol types with different depolarization properties. The method has been successfully applied to simultaneous observations of volcanic ash and boundary layer aerosol obtained in Exeter, United Kingdom, on 16 and 18 April 2010, permitting the contribution of the two aerosols to be quantified separately. First a subset of the atmospheric profiles is used where the two aerosol types belong to clearly distinguished layers, for the purpose of characterizing the ash in terms of lidar ratio and depolarization. These quantities are then used in a three‐component atmosphere solution scheme of the lidar equation applied to the full data set, in order to compute the optical properties of both aerosol types separately. On 16 April a thin ash layer, 100–400 m deep, is observed (average and maximum estimated ash optical depth: 0.11 and 0.2); it descends from ∼2800 to ∼1400 m altitude over a 6‐hour period. On 18 April a double ash layer, ∼400 m deep, is observed just above the morning boundary layer (average and maximum estimated ash optical depth: 0.19 and 0.27). In the afternoon the ash is entrained into the boundary layer, and the latter reaches a depth of ∼1800 m (average and maximum estimated ash optical depth: 0.1 and 0.15). An additional ash layer, with a very small optical depth, was observed on 18 April at an altitude of 3500–4000 m. By converting the lidar optical measurements using estimates of volcanic ash specific extinction, derived from other works, the observations seem to suggest approximate peak ash concentrations of ∼1500 and ∼1000 mg/m3,respectively, on the two observations dates.

Numerical simulation of viscous three-dimensional flow over aerospace vehicles using Euler/boundary-layer zonal approach

This paper presents a viscous three-dimensional simulations coupling Euler and boundary layer codes for calculating flows over arbitrary surfaces. The governing equations are written in a general non orthogonal coordinate system. The Levy-Lees transformation generalized to three-dimensional flows is utilized. The inviscid properties are obtained from the Euler equations using the Beam and Warming implicit approximate factorization scheme. The resulting equations are discretized and approximated by a two-point fmitedifference numerical scheme. The code developed is validated and applied to the simulation of the flowfield over aerospace vehicle configurations. The results present good correlation with the available data.

Flow of a micropolar fluid bounded by a stretching sheet

We consider boundary layer flow of a micropolar fluid driven by a porous stretching sheet. A similarity solution is defined, and numerical solutions using Runge-Kutta and quasilinearisation schemes are obtained. A perturbation analysis is also used to derive analytic solutions to first order in the perturbing parameter. The resulting closed form solutions involve relatively complex expressions, and the analysis is made more tractable by a combination of offline and online work using a computational algebra system (CAS). For this combined numerical and analytic approach, the perturbation analysis yields a number of benefits with regard to the numerical work. The existence of a closed form solution helps to discriminate between acceptable and spurious numerical solutions. Also, the expressions obtained from the perturbation work can provide an accurate description of the solution for ranges of parameters where the numerical approaches considered here prove computationally more difficult.

High-performance ceramic membranes with a separation layer of metal oxide nanofibers

In conventional fabrication of ceramic separation membranes, the particulate sols are applied onto porous supports. Major structural deficiencies under this approach are pin-holes and cracks, and the dramatic losses of flux when pore sizes are reduced to enhance selectivity. We have overcome these structural deficiencies by constructing hierarchically structured separation layer on a porous substrate using lager titanate nanofibers and smaller boehmite nanofibers. This yields a radical change in membrane texture. The resulting membranes effectively filter out species larger than 60 nm at flow rates orders of magnitude greater than conventional membranes. This reveals a new direction in membrane fabrication.

Metal oxide nanofibres membranes assembled by spin-coating method

Ceramic membranes are of particular interest in many industrial processes due to their ability to function under extreme conditions while maintaining their chemical and thermal stability. Major structural deficiencies under conventional fabrication approach are pin-holes and cracks, and the dramatic losses of flux when pore sizes are reduced to enhance selectivity. We overcome these structural deficiencies by constructing hierarchically structured separation layer on a porous substrate using larger titanate nanofibres and smaller boehmite nanofibres. This yields a radical change in membrane texture. The differences in the porous supports have no substantial influences on the texture of resulting membranes. The membranes with top layer of nanofibres coated on different porous supports by spin-coating method have similar size of the filtration pores, which is in a range of 10–100 nm. These membranes are able to effectively filter out species larger than 60 nm at flow rates orders of magnitude greater than conventional membranes. The retention can attain more than 95%, while maintaining a high flux rate about 900 L m-2 h. The calcination after spin-coating creates solid linkages between the fibres and between fibres and substrate, in addition to convert boehmite into -alumina nanofibres. This reveals a new direction in membrane fabrication.