Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. CONCLUSIONS: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Cognitive-behavioural therapy for inflammatory bowel disease: 24-month data from a randomised controlled trial

PURPOSE: There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT.

METHODS: The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models.

RESULTS: CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05).

CONCLUSIONS: Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.

SER analysis of multi-way relay networks with M-QAM modulation in the presence of imperfect channel estimation

Multi-way relay networks (MWRNs) allow multiple users to exchange information with each other through a single relay terminal. MWRNs are often incorporated with capacity achieving lattice codes to enable the benefits of high-rate signal constellations to be extracted. In this paper, we analytically characterize the symbol error rate (SER) performance of a functional decode and forward (FDF) MWRN in the presence of channel estimation errors. Considering Μ-ary quadrature amplitude modulation(QAM) with square constellations as an important special case of lattice codes, we obtain asymptotic expressions for the average SER for a user in FDF MWRN. The accuracy of the analysis at high signal-to-noise ratio is validated by comparison with the simulation results. The analysis shows that when a user decodes other users with better channel conditions than itself, the decoding user experiences better error performance. The analytical results allow system designers to accurately assess the non-trivial impact of channel estimation errors and the users’ channel conditions on the SER performance of a FDF MWRN with M-QAM modulation.

Atrazine movement in a dark red latosol of the tropics.

Atrazine dissplacement was studied in a soll profile as function of water movement and time after herbicide application, taldng into account possible influences of preferential flow on keaching. The experiment consisted of two 7 x 7 m plots of a dark red latosol (Kanduidalfic Eutrudox), located at Pirecicaba, SP, Brazil (22o43'S and 47o25'W), 250 km inside continent, at an altitude of 580 m. One plot was previously treated with 1,000 kg/ha of lime, in order to increase saturation to 88%, and 500 kg/ha of gypsum. Each plot was instrumented with tensiometers, neutron probe acess tubes and soil solution extractors, in order to monitor water and atrazine flows. Atrazine was applied at the high rate of 6 kg/ha of active principllle. Results showed intensiive leaching of atrazine in the whole soil profile, up to the instrumented depth of 150 cm, alredy at the first sampling, seven days after herbicide application. The limed plot showed much higher atrazine leachinng losses than the other plot. The atrazine adsorption capacity of the soll is very low, its maximum value being of the order of 10%, for the 0-15 cm surface layer.

UN PLAN PARA RECUPERAR LOS RÍOS Y ACUÍFEROS DEL VALLE CENTRAL

El mayor consumo de agua en Costa Rica ocurre en el Valle Central, pues ahíestá asentada cerca del 60% de la población del país. Sin embargo, la disponibilidad de agua está disminuyendo debido al crecimiento demográfico y al decreciente volumen de los ríos y aguas subterráneas.El Valle Central posee cerca de 57 ríos que podrían utilizarse como fuente de agua potable. pero sólo 10 de ellos tienen sus nacientes ubicadas en bosques primarios y son adecuadas para este fin. Las nacientes de la mayoría de los otros ríos se encuentran en tierras económicamente improductivas, tales como pastizales y áreas de bosques muy alterados, que pierden su volumen de agua durante la estación seca.Las proyecciones de crecimiento demográfico hasta el año 2100 permiten visualizar un marcado incremento en la demanda de agua, el cual se mantendrá durante los próximos 50 años. Consecuentemente, para proporcionar un adecuado suministro de agua para esta creciente población. es fundamental detener la contaminación de las aguas subterráneas y recobrar el volumen de agua de los ríos.En este trabajo se propone un plan sencillo para aumentar el volumen de agua de los ríos del Valle Central y para proteger nuestros acuíferos. Se mencionan también otros beneficios económicos y sociales que tendría la aplicación de esta propuesta.Abstract: About 60% of the popuiation of Costa Rica lives in the Central Valley where consequcntly occurs the highest water consumption. As a contrast water shortness is increasing in this country due to population growth and diminishing volume of river and subterranean water.There are about 57 rivers in the Central Valley that could be used as a source of water but only 10 of them have their headwaters inside primary forest and are appropriate for this purpose. The headwaters of mosi of the nvers lay in underproductive lands such as grass fields and very disturbed forest and bose their water volume during dry season.Population growth estimates until year 2100 allow foreseeing a high rate of increase in water demand for the next 50 years. In order to have an adequate supply of water for ihis expanding population it is mandatory to stop subterranean water pollution and to recovcr nver water volume.In this paper 1 propose a simple plan to augment the water volume of the headwaters of the rivers of the Central Valley and to protect our subterranean water sources. Other social and economic benefits that stem from this plan are also analyzed.

Use of organic compost containing waste from small ruminants in corn production.

Composting is a useful way of transforming livestock waste into organic fertilizer, which is proven to increase soil nutrient levels, and thus crop yield. Remains from production and slaughter of small ruminants can become a source of important elements for plant growth, such as N, after microorganism-driven decomposition.The aim of this investigation was to evaluate the effects of this compost on soil fertility and on the nutritional status and yield of the corn crop. The experiment was conducted in a Haplic Luvisol in a randomized block design with six treatments and five application rates of the organic compound in Mg ha-1: 3 (half the standard rate), 6 (standard rate), 9 (one and a half times the standard rate), 12 (twice the standard rate), and 24 (four times the standard rate) and an additional treatment with mineral fertilizers (110, 50 e 30 kg ha-1 of N, P2O5 and K2O, respectively), with four blocks. Evaluations were performed for two harvests of rainfed crops, measuring soil fertility, nutritional status, and grain yield. The compost increased P, K, Na and Zn values in the 0.00-0.20 m layer in relation of mineral fertilization in 616, 21, 114 and 90 % with rate 24 Mg ha-1 in second crop. Leaf N, Mg, and S contents, relative chlorophyll content, and the productivity of corn kernels increased in 27, 32, 36, 20 e 85 %, respectively, of low rate (3 Mg ha-1) to high rate (24 Mg ha-1) with of application of the compost. Corn yield was higher with application of organic compost in rate of 24 Mg ha-1 than mineral fertilizer combination in second crop.

Using accelerometer, high sample rate GPS and magnetometer data to develop a cattle movement and behaviour model

The study described in this paper developed a model of animal movement, which explicitly recognised each individual as the central unit of measure. The model was developed by learning from a real dataset that measured and calculated, for individual cows in a herd, their linear and angular positions and directional and angular speeds. Two learning algorithms were implemented: a Hidden Markov model (HMM) and a long-term prediction algorithm. It is shown that a HMM can be used to describe the animal's movement and state transition behaviour within several “stay” areas where cows remained for long periods. Model parameters were estimated for hidden behaviour states such as relocating, foraging and bedding. For cows’ movement between the “stay” areas a long-term prediction algorithm was implemented. By combining these two algorithms it was possible to develop a successful model, which achieved similar results to the animal behaviour data collected. This modelling methodology could easily be applied to interactions of other animal species.

Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

Background: High-flow nasal cannulae (HFNC) create positive oropharyngeal airway pressure but it is unclear how their use affects lung volume. Electrical impedance tomography (EIT) allows assessment of changes in lung volume by measuring changes in lung impedance. Primary objectives were to investigate the effects of HFNC on airway pressure (Paw) and end-expiratory lung volume (EELV), and to identify any correlation between the two. Secondary objectives were to investigate the effects of HFNC on respiratory rate (RR), dyspnoea, tidal volume and oxygenation; and the interaction between body mass index (BMI) and EELV. Methods: Twenty patients prescribed HFNC post-cardiac surgery were investigated. Impedance measures, Paw, PaO2/FiO2 ratio, RR and modified Borg scores were recorded first on low flow oxygen (nasal cannula or Hudson face mask) and then on HFNC. Results: A strong and significant correlation existed between Paw and end-expiratory lung impedance (EELI) (r=0.7, p<0.001). Compared with low flow oxygen, HFNC significantly increased EELI by 25.6% (95% CI 24.3, 26.9) and Paw by 3.0 cmH2O (95% CI 2.4, 3.7). RR reduced by 3.4 breaths per minute (95% CI 1.7, 5.2) with HFNC use, tidal impedance variation increased by 10.5% (95% CI 6.1, 18.3) and PaO2/FiO2 ratio improved by 30.6 mmHg (95% CI 17.9, 43.3). HFNC improved subjective dyspnoea scoring (p=0.023). Increases in EELI were significantly influenced by BMI, with larger increases associated with higher BMIs (p<0.001). Conclusions: This study suggests that HFNC improve dyspnoea and oxygenation by increasing both EELV and tidal volume, and are most beneficial in patients with higher BMIs.

Risedronate in adults with osteogenesis imperfecta type I: Increased bone mineral density and decreased bone turnover, but high fracture rate persists

Summary Bisphosphonates can increase bone mineral density (BMD) in children with osteogenesis imperfecta (OI). In this study of adults with OI type I, risedronate increased BMD at lumbar spine (but not total hip) and decreased bone turnover. However, the fracture rate in these patients remained high. Introduction Intravenous bisphosphonates given to children with OI can increase BMD and reduce fracture incidence. Oral and/or intravenous bisphosphonates may have similar effects in adults with OI. We completed an observational study of the effect of risedronate in adults with OI type I. Methods Thirty-two adults (mean age, 39 years) with OI type I were treated with risedronate (total dose, 35 mg weekly) for 24 months. Primary outcome measures were BMD changes at lumbar spine (LS) and total hip (TH). Secondary outcome measures were fracture incidence, bone pain, and change in bone turnover markers (serum procollagen type I aminopropeptide (P1NP) and bone ALP). A meta-analysis of published studies of oral bisphosphonates in adults and children with OI was performed. Results Twenty-seven participants (ten males and seventeen females) completed the study. BMD increased at LS by 3.9% (0.815 vs. 0.846 g/cm 2, p=0.007; mean Z-score, -1.93 vs. -1.58, p=0.002), with no significant change at TH. P1NP fell by 37% (p=0.00041), with no significant change in bone ALP (p=0.15). Bone pain did not change significantly (p=0.6). Fracture incidence remained high, with 25 clinical fractures and 10 major fractures in fourteen participants (0.18 major fractures per person per year), with historical data of 0.12 fractures per person per year. The meta-analysis did not demonstrate a significant difference in fracture incidence in patients with OI treated with oral bisphosphonates. Conclusions Risedronate in adults with OI type I results in modest but significant increases in BMD at LS, and decreased bone turnover. However, this may be insufficient to make a clinically significant difference to fracture incidence.

Impression creep of zinc and the rate-controlling dislocation mechanism of plastic flow at high temperatures

The impression creep behaviour of zinc is studied in the range 300 to 500 K and the results are compared with the data from conventional creep tests. The steady-state impression velocity is found to exhibit the same stress and temperature dependence as in conventional tensile creep with the same power law stress exponent. Also studied is the effect of indenter size on the impression velocity. The thermal activation parameters for plastic flow at high temperatures derived from a number of testing techniques agree reasonably well. Grain boundary sliding is shown to be unimportant in controlling the rate of plastic flow at high temperatures. It is observed that the Cottrell-Stokes law is obeyed during high-temperature deformation of zinc. It is concluded that a mechanism such as forest intersection involving attractive trees controls the high-temperature flow rather than a diffusion mechanism.

Extraordinary high strain rate superplasticity in electrodeposited nano-nickel and alloys

Superplastic materials exhibit very large elongations to failure,typically >500%, and this enables commercial forming of complex shaped components at slow strain rates of similar to 10(-4) s(-1). We report extraordinary record superplastic elongations to failure of up to 5300% at both high strain rates and low temperature in electrodeposited nanocrystalline Ni and some Ni alloys. Superplasticity is not related to the presence of sulfur or a low melting phase at grain boundaries. (C) 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

A Low ML-Decoding Complexity, High Coding Gain, Full-Rate, Full-Diversity STBC for 4 x 2 MIMO System

This paper proposes a full-rate, full-diversity space-time block code(STBC) with low maximum likelihood (ML) decoding complexity and high coding gain for the 4 transmit antenna, 2 receive antenna (4 x 2) multiple-input multiple-output (MIMO) system that employs 4/16-QAM. For such a system, the best code known is the DjABBA code and recently, Biglieri, Hong and Viterbo have proposed another STBC (BHV code) for 4-QAM which has lower ML-decoding complexity than the DjABBA code but does not have full-diversity like the DjABBA code. The code proposed in this paper has the same ML-decoding complexity as the BHV code for any square M-QAM but has full-diversity for 4- and 16-QAM. Compared with the DjABBA code, the proposed code has lower ML-decoding complexity for square M-QAM constellation, higher coding gain for 4- and 16-QAM, and hence a better codeword error rate (CER) performance. Simulation results confirming this are presented.

High-Temperature (1023 K to 1273 K 750 degrees C to 1000 degrees C]) Plastic Deformation Behavior of B-Modified Ti-6Al-4V Alloys: Temperature and Strain Rate Effects

A minor addition of B to the Ti-6Al-4V alloy, by similar to 0.1 wt pct, reduces its as-cast prior beta grain size by an order of magnitude, whereas higher B content leads to the presence of in situ formed TiB needles in significant amounts. An experimental investigation into the role played by these microstructural modifications on the high-temperature deformation behavior of Ti-6Al-4V-xB alloys, with x varying between 0 wt pct and 0.55 wt pct, was conducted. Uniaxial compression tests were performed in the temperature range of 1023 K to 1273 K (750 degrees C to 1000 degrees C) and in the strain rate range of 10(-3) to 10(+1) s(-1). True stress-true strain responses of all alloys exhibit flow softening at lower strain rates and oscillations at higher strain rates. The flow softening is aided by the occurrence of dynamic recrystallization through lath globularization in high temperature (1173 K to 1273 K 900 degrees C to 1000 degrees C]) and a lower strain rate (10(-2) to 10(-3) s(-1)) regime. The grain size refinement with the B addition to Ti64, despite being marked, had no significant effect on this. Oscillations in the flow curve at a higher strain rate (10(0) to 10(+1) s(-1)), however, are associated with microstructural instabilities such as bending of laths, breaking of lath boundaries, generation of cavities, and breakage of TiB needles. The presence of TiB needles affected the instability regime. Microstructural evidence suggests that the matrix cavitation is aided by the easy fracture of TiB needles.

Microstructural features of flow instability in α-titanium cylinders under high strain rate compression at 25°C to 400°C

Cylindrical specimens of commercial pure titanium have been compressed at strain rates in the range of 0.1 to 100 s-1 and temperatures in the range of 25-degrees-C to 400-degrees-C. At strain rates of 10 and 100 s-1, the specimens exhibited adiabatic shear bands. At lower strain rates, the material deformed in an inhomogeneous fashion. These material-related instabilities are examined in the light of the ''phenomenological model'' and the ''dynamic materials mode.'' It is found that the regime of adiabatic shear band formation is predicted by the phenomenological model, while the dynamic materials model is able to predict the inhomogeneous deformation zone. The criterion based on power partitioning is competent to predict the variations within the inhomogeneous deformation zone.

Constitutive modeling of ice in the high strain rate regime

The objective of the present work is to propose a constitutive model for ice by considering the influence of important parameters such as strain rate dependence and pressure sensitivity on the response of the material. In this regard, the constitutive model proposed by Carney et al. (2006) is considered as a starting basis and subsequently modified to incorporate the effect of brittle cracking within a continuum damage mechanics framework. The damage is taken to occur in the form of distributed cracking within the material during impact which is consistent with experimental observations. At the point of failure, the material is assumed to be fluid-like with deviatoric stress almost dropping down to zero. The constitutive model is implemented in a general purpose finite element code using an explicit formulation. Several single element tests under uniaxial tension and compression, as well as biaxial loading are conducted in order to understand the performance of the model. Few large size simulations are also performed to understand the capability of the model to predict brittle damage evolution in un-notched and notched three point bend specimens. The proposed model predicts lower strength under tensile loading as compared to compressive loading which is in tune with experimental observations. Further the model also asserts the strain rate dependency of the strength behavior under both compressive as well as tensile loading, which also corroborates well with experimental results. (C) 2010 Elsevier Ltd. All rights reserved.