The new Hollywood, 1981–1999: special/visual effects

The emergence and development of digital imaging technologies and their impact on mainstream filmmaking is perhaps the most familiar special effects narrative associated with the years 1981-1999. This is in part because some of the questions raised by the rise of the digital still concern us now, but also because key milestone films showcasing advancements in digital imaging technologies appear in this period, including Tron (1982) and its computer generated image elements, the digital morphing in The Abyss (1989) and Terminator 2: Judgment Day (1991), computer animation in Jurassic Park (1993) and Toy Story (1995), digital extras in Titanic (1997), and ‘bullet time’ in The Matrix (1999). As a result it is tempting to characterize 1981-1999 as a ‘transitional period’ in which digital imaging processes grow in prominence and technical sophistication, and what we might call ‘analogue’ special effects processes correspondingly become less common. But such a narrative risks eliding the other practices that also shape effects sequences in this period. Indeed, the 1980s and 1990s are striking for the diverse range of effects practices in evidence in both big budget films and lower budget productions, and for the extent to which analogue practices persist independently of or alongside digital effects work in a range of production and genre contexts. The chapter seeks to document and celebrate this diversity and plurality, this sustaining of earlier traditions of effects practice alongside newer processes, this experimentation with materials and technologies old and new in the service of aesthetic aspirations alongside budgetary and technical constraints. The common characterization of the period as a series of rapid transformations in production workflows, practices and technologies will be interrogated in relation to the persistence of certain key figures as Douglas Trumbull, John Dykstra, and James Cameron, but also through a consideration of the contexts for and influences on creative decision-making. Comparative analyses of the processes used to articulate bodies, space and scale in effects sequences drawn from different generic sites of special effects work, including science fiction, fantasy, and horror, will provide a further frame for the chapter’s mapping of the commonalities and specificities, continuities and variations in effects practices across the period. In the process, the chapter seeks to reclaim analogue processes’ contribution both to moments of explicit spectacle, and to diegetic verisimilitude, in the decades most often associated with the digital’s ‘arrival’.

Flexibility and inhibitor binding in Cdc25 phosphatases

Cdc25 phosphatases involved in cell cycle checkpoints are now active targets for the development of anti-cancer therapies. Rational drug design would certainly benefit from detailed structural information for Cdc25s. However, only apo- or sulfate-bound crystal structures of the Cdc25 catalytic domain have been described so far. Together with previously available crystalographic data, results from molecular dynamics simulations, bioinformatic analysis, and computer-generated conformational ensembles shown here indicate that the last 30-40 residues in the C-terminus of Cdc25B are partially unfolded or disordered in solution. The effect of C-terminal flexibility upon binding of two potent small molecule inhibitors to Cdc25B is then analyzed by using three structural models with variable levels of flexibility, including an equilibrium distributed ensemble of Cdc25B backbone conformations. The three Cdc25B structural models are used in combination with flexible docking, clustering, and calculation of binding free energies by the linear interaction energy approximation to construct and validate Cdc25B-inhibitor complexes. Two binding sites are identified on top and beside the Cdc25B active site. The diversity of interaction modes found increases with receptor flexibility. Backbone flexibility allows the formation of transient cavities or compact hydrophobic units on the surface of the stable, folded protein core that are unexposed or unavailable for ligand binding in rigid and densely packed crystal structures. The present results may help to speculate on the mechanisms of small molecule complexation to partially unfolded or locally disordered proteins.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Comparação de dois sistemas de imagem para avaliação do perfil de tecido mole em cirurgia ortognática

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aplicação de filtro harmônico em sistemas elétricos de baixa tensão utilizando Lógica Fuzzy

Em um sistema elétrico existem vários circuitos e equipamentos industriais que se comportam como dispositivos não-lineares. Esse comportamento geram sinais que causam distorções dentro desse sistema. Essas distorções são chamadas de Harmônicas, que calculada de forma ampla nos fornece o valor do THD (do inglês Total Harmonic Distortion ou Distorção Harmônica Total). Este trabalho apresenta uma das várias soluções para minimizar esse indicador através da detecção por um algoritmo computacional instalado no medidor de THD apropriado e pela utilização de filtros harmônicos passivos. Este algoritmo computacional detecta e calcula em quais frequências o valor do THD está elevado em comparação a um índice normativo definido utilizando para isso a Lógica Fuzzy. Uma vez definido a necessidade da aplicação do filtro harmônico esse será projetado pelo algoritmo computacional. O filtro harmônico entregado neste trabalho será o filtro passivo devido a sua fácil instalação e ao seu baixo custo. Dessa forma, o algoritmo computacional proposto funciona no início da medição do THD, no equipamento medidor, indicando uma faixa classificatória de THD medido, utilizando para isso a Lógica Fuzzy, identifica a necessidade ou não da instalação do filtro harmônico passivo e seu projeto, e finaliza efetuando um novo cálculo de THD.

Investigação do efeito terapêutico do Psyllium sobre a dislipidemia infanto-juvenil

Psyllium é uma fonte rica de fibra solúvel mucilaginosa e é considerado um suplemento dietético útil no tratamento de pacientes com hipercolesterolemia. O objetivo deste estudo foi avaliar a eficácia e a segurança da suplementação do psyllium na redução do perfil lipídico em crianças e adolescentes brasileiros dislipidêmicos. Cinqüenta e cinco sujeitos (6-19 anos) com hipercolesterolemia moderada foram avaliados em um estudo clínico, paralelo, duplo cego, controlado e randomizado, conduzido em 2 períodos. Inicialmente, todos participantes recrutados passaram por um estágio de adaptação à dieta restrita em gordura saturada (<7%) e colesterol (<200 mg/dia) que durou 6 semanas antes do tratamento. Após este período, os participantes elegíveis foram alocados aleatoriamente para 2 grupos (controle n=25 e psyllium n=30) usando uma seqüência numerada randomizada gerada por computador. Durante o período de 8 semanas do ensaio clínico, o grupo psyllium manteve a dieta restrita em gordura saturada e colesterol, suplementada diariamente com 7,0 g de psyllium , enquanto o grupo controle recebeu a mesma dieta adicionada com uma quantidade equivalente de celulose (placebo). No final do tratamento, quatro sujeitos foram excluídos após randomização (perdas no seguimento) totalizando 51 sujeitos (grupo controle=24; grupo psyllium n=27), que completaram o estudo. O grupo que recebeu psyllium apresentou um decréscimo significativo nas concentrações de colesterol total (CT) (4,1% [-0,20mmol/L]; p=0,01) e de LDL-colesterol (LDL-c) (7,2% [-0,24 mmol/L]; p<0,001) em comparação à linha de base. Reduções adicionais foram observadas quando comparadas com o grupo controle (CT:4,1% [0,20mmol/L]; p=0,002) e (LDL-c:7,8% [0,26mmol/L]; p=0,007). Nenhum dos participantes relatou aversão ao cheiro, sabor e textura do psyllium, nem a presença de efeitos adversos significativos. A terapia com psyllium se mostrou eficaz na redução das concentrações do LDL-c e demonstrou ser seguro e aceitável pela população do estudo.

SAGE analysis highlights the putative role of underexpression of ribosomal proteins in GH-secreting pituitary adenomas

Background: Although the molecular pathogenesis of pituitary adenomas has been assessed by several different techniques, it still remains partially unclear. Ribosomal proteins (RPs) have been recently related to human tumorigenesis, but they have not yet been evaluated in pituitary tumorigenesis. Objective: The aim of this study was to introduce serial analysis of gene expression (SAGE), a high-throughput method, in pituitary research in order to compare differential gene expression. Methods: Two SAGE cDNA libraries were constructed, one using a pool of mRNA obtained from five GH-secreting pituitary tumors and another from three normal pituitaries. Genes differentially expressed between the libraries were further validated by real-time PCR in 22 GH-secreting pituitary tumors and in 15 normal pituitaries. Results: Computer-generated genomic analysis tools identified 13 722 and 14 993 exclusive genes in normal and adenoma libraries respectively. Both shared 6497 genes, 2188 were underexpressed and 4309 overexpressed in tumoral library. In adenoma library, 33 genes encoding RPs were underexpressed. Among these, RPSA, RPS3, RPS14, and RPS29 were validated by real-time PCR. Conclusion: We report the first SAGE library from normal pituitary tissue and GH-secreting pituitary tumor, which provide quantitative assessment of cellular transcriptome. We also validated some downregulated genes encoding RPs. Altogether, the present data suggest that the underexpression of the studied RP genes possibly collaborates directly or indirectly with other genes to modify cell cycle arrest, DNA repair, and apoptosis, leading to an environment that might have a putative role in the tumorigenesis, introducing new perspectives for further studies on molecular genesis of somatotrophinomas.

Untersuchung der DNA-bindenden Eigenschaften neuer Nukleobasen-gekoppelter Pyrrolcarboxamide, Combilexine und Hetaren[a]carbazol-Derivate: Validierung und Etablierung von in-vitro- und in-silico-Methoden

Da maligne Neoplasien durch Mutationen in Proto-Onko- und/oder Tumorsuppressorgenen ausgelöst werden, stellt die DNA eines der wichtigsten Targets für die Entwicklung neuer Zytostatika dar. Auch bei den im Arbeitskreis Pindur designten und synthetisier-ten Verbindungen der Nukleobasen-gekoppelten Pyrrolcarboxamid-, der Hetaren[a]carbazol- und der Combilexin-Reihe handelt es sich um DNA-Liganden mit potentiell antitumoraktiven Eigenschaf-ten. Die einen dualen Bindemodus aufweisenden Combilexine bestehen aus einem Interkalator (u. a. Naphthalimid, Acridon), der über einen Linker variabler Kettenlänge mit einer rinnenbin-denden, von Netropsin abgeleiteten Bispyrrol-, oder einer bioisosteren Imidazol-, Thiazol- oder Thiophen-pyrrolcarboxamid-struktur verknüpft ist. Das N-terminale Ende der Combilexine wird von einer N,N-Dimethylaminopropyl- oder -ethyl-Seitenkette gebildet. Die DNA-Affinitäten der Liganden wurden mittels Tm-Wert-Messung-en bestimmt. Diese Denaturierungsexperimente wurden sowohl mit poly(dAdT)2- als auch mit Thymus-DNA (~42% GC-Anteil) durchge-führt, um Aussagen zur Stärke und zur Sequenzselektivität der DNA-Bindung machen zu können. Des Weiteren wurden die Bindekon-stanten einiger ausgewählter Vertreter mit Hilfe des Ethidium-bromid-Verdrängungsassays ermittelt; einige Testverbindungen wurden zudem auf potentiell vorhandene, TOPO I-inhibierende Eigenschaften untersucht. Diese biochemischen und biophysika-lischen Tests wurden durch Molecular Modelling-Studien ergänzt, die die Berechnung von molekularen Eigenschaften, die Durch-führung von Konformerenanalysen und die Simulation von DNA-Ligand-Komplexen (Docking) umfassten. Durch Korrelation der in vitro-Befunde mit den in silico-Daten gelang es, vor allem für die Substanzklasse der Combilexine einige richtungweisende Struktur-Wirkungsbeziehungen aufzustellen. So konnte gezeigt werden, dass die Einführung eines Imidazol-Rings in die rinnen-bindende Hetaren-pyrrolcarboxamid-Struktur der Combilexine aufgrund der H-Brücken-Akzeptor-Funktion des sp2-hybridisierten N-Atoms eine Verschiebung der Sequenzselektivität der DNA-Bindung von AT- zu GC-reichen Arealen der DNA bedingt. Zudem erwies sich ein C3-Linker für die Verknüpfung des Naphthalimids mit dem rinnenbindenden Strukturelement als am besten geeignet, während bei den Acridon-Derivaten die Verbindungen mit einem N-terminalen Buttersäure-Linker die höchste DNA-Affinität aufwiesen. Dies ist sehr wahrscheinlich auf die im Vergleich zum Naphthalimid-Molekül geringere y-Achsen-Ausdehnung (bzgl. eines x/y-Koordinatensystems) des Acridons zurückzuführen. Die ermittelten Struktur-Wirkungsbeziehungen können dazu herangezogen werden, das rationale Design neuer DNA-Liganden mit potentiell stärkerer DNA-Bindung zu optimieren.

Integrative Musterbildung kranialer Strukturen

Form und Gestalt kraniofazialer Strukturen sind primär beeinflusst durch die inhärente Integration der unterschiedlichsten Funktionssysteme und externer selektiver Einflüsse. Die Variabilität der Schädel-Morphe ist ein Indikator für solche Einflussfaktoren und damit ein idealer Gegenstand für vergleichende Analysen morphogenetischer Formbildung. Zur Ermittlung morphologisch-adaptiver Trends und Muster wurden sowohl Hypothesen zur morphologischen Differenziertheit als auch zu Korrelationen zwischen modularen Schädelkompartimenten (fazial, neurokranial, basikranial) untersucht. Zusätzlich wurden aus Schichtröntgenaufnahmen (CT) virtuelle Modelle rekonstruiert, welche die Interpretation der statistischen Befunde unterstützen sollten. Zur Berechnung der Gestaltunterschiede wurden mittels eines mechanischen Gelenkarm-Messgerätes (MicroScribe-G2) max. 85 ektokraniale Messpunkte (Landmarks) bzw. dreidimensionale Koordinaten an ca. 520 Schädeln von fünf rezenten Gattungen der Überfamilie Hominoidea (Hylobates, Pongo, Gorilla, Pan und Homo) akquiriert. Aus dem Datensatz wurden geometrische Störfaktoren (Größe, Translation, Rotation) mathematisch eliminiert und die verbleibenden Residuale bzw. ‚Gestalt-Variablen‘ diversen multivariat-statistischen Verfahren unterzogen (Faktoren, Cluster-, Regressions- und Korrelationsanalysen sowie statistische Tests). Die angewandten Methoden erhalten die geometrische Information der Untersuchungsobjekte über alle Analyseschritte hinweg und werden unter der Bezeichnung „Geometric Morphometrics (GMM)“ als aktueller Ansatz der Morphometrie zusammengefasst. Für die unterschiedlichen Fragestellungen wurden spezifische Datensätze generiert. Es konnten diverse morphologische Trends und adaptive Muster mit Hilfe der Synthese statistischer Methoden und computer-basierter Rekonstruktionen aus den generierten Datensätzen ermittelt werden. Außerdem war es möglich, präzise zu rekonstruieren, welche kranialen Strukturen innerhalb der Stichprobe miteinander wechselwirken, einzigartige Variabilitäten repräsentieren oder eher homogen gestaltet sind. Die vorliegenden Befunde lassen erkennen, dass Fazial- und Neurokranium am stärksten miteinander korrelieren, während das Basikranium geringe Abhängigkeiten in Bezug auf Gesichts- oder Hirnschädelveränderungen zeigte. Das Basikranium erweist sich zudem bei den nicht-menschlichen Hominoidea und über alle Analysen hinweg als konservative und evolutiv-persistente Struktur mit dem geringsten Veränderungs-Potential. Juvenile Individuen zeigen eine hohe Affinität zueinander und zu Formen mit einem kleinem Gesichts- und großem Hirnschädel. Während das Kranium des rezenten Menschen primär von Enkephalisation und fazialer Retraktion (Orthognathisierung) dominiert ist und somit eine einzigartige Gestalt aufweist, zeigt sich der Kauapparat als maßgeblich formbildendes Kompartiment bei den nicht-menschlichen Formen. Die Verbindung von GMM mit den interaktiven Möglichkeiten computergenerierter Modelle erwies sich als valides Werkzeug zur Erfassung der aufgeworfenen Fragestellungen. Die Interpretation der Befunde ist durch massive Interkorrelationen der untersuchten Strukturen und der statistisch-mathematischen Prozeduren als hoch komplex zu kennzeichnen. Die Studie präsentiert einen innovativen Ansatz der modernen Morphometrie, welcher für zukünftige Untersuchungen im Bereich der kraniofazialen Gestaltanalyse ausgebaut werden könnte. Dabei verspricht die Verknüpfung mit ‚klassischen’ und modernen Zugängen (z. B. Molekularbiologie) gesteigerte Erkenntnismöglichkeiten für künftige morphometrische Fragestellungen.

Die Verbindung von Kleinwinkelstreuung und in silico-Methodik zur Aufklärung von Konformationswechseln großer Proteinkomplexe

In dieser Dissertation wurden die Methoden Homologiemodellierung und Molekulardynamik genutzt, um die Struktur und das Verhalten von Proteinen in Lösung zu beschreiben. Mit Hilfe der Röntgenkleinwinkelstreuung wurden die mit den Computermethoden erzeugten Vorhersagen verifiziert. Für das alpha-Hämolysin, ein Toxin von Staphylococcus aureus, das eine heptamere Pore formen kann, wurde erstmalig die monomere Struktur des Protein in Lösung beschrieben. Homologiemodellierung auf Basis verwandter Proteine, deren monomere Struktur bekannt war, wurde verwendet, um die monomere Struktur des Toxins vorherzusagen. Flexibilität von Strukturelementen in einer Molekulardynamiksimulation konnte mit der Funktionalität des Proteines korreliert werden: Intrinsische Flexibilität versetzt das Protein in die Lage den Konformationswechsel zur Pore nach Assemblierung zu vollziehen. Röntgenkleinwinkelstreuung bewies die Unterschiede der monomeren Struktur zu den Strukturen der verwandten Proteine und belegt den eigenen Vorschlag zur Struktur. Überdies konnten Arbeiten an einer Mutante, die in einer sogenannten Präporenkonformation arretiert und nicht in der Lage ist eine Pore zu formen, zeigen, dass dieser Übergangszustand mit der Rotationsachse senkrecht zur Membran gelagert ist. Eine geometrische Analyse beweist, dass es sterisch möglich ist ausgehend von dieser Konformation die Konformation der Pore zu erreichen. Eine energetische und kinetische Analyse dieses Konformationswechsels steht noch aus. Ein weiterer Teil der Arbeit befasst sich mit den Konformationswechseln von Hämocyaninen. Diese wurden experimentell mittels Röntgenkleinwinkelstreuung verfolgt. Konformationswechsel im Zusammenhang mit der Oxygenierung konnten für die 24meren Hämocyanine von Eurypelma californicum und Pandinus imperator beschrieben werden. Für eine Reihe von Hämocyaninen ist nachgewiesen, dass sie unter Einfluss des Agenz SDS Tyrosinaseaktivität entfalten können. Der Konformationswechsel der Hämocyanine von E. californicum und P. imperator bei der Aktivierung zur Tyrosinase mittels SDS wurde experimentell bestätigt und die Stellung der Dodekamere der Hämocyanine als wesentlich bei der Aktivierung festgestellt. Im Zusammenhang mit anderen Arbeiten gilt damit die Relaxierung der Struktur unter SDS-Einfluss und der sterische Einfluss auf die verbindenden Untereinheiten b & c als wahrscheinliche Ursache für die Aktivierung zur Tyrosinase. Eigene Software zum sogenannten rigid body-Modellierung auf der Basis von Röntgenkleinwinkelstreudaten wurde erstellt, um die Streudaten des hexameren Hämocyanins von Palinurus elephas und Palinurus argus unter Einfluss der Effektoren Urat und Koffein strukturell zu interpretieren. Die Software ist die erste Implementierung eines Monte Carlo-Algorithmus zum rigid body-Modelling. Sie beherrscht zwei Varianten des Algorithmus: In Verbindung mit simulated annealing können wahrscheinliche Konformationen ausgefiltert werden und in einer anschließenden systematischen Analyse kann eine Konformation geometrisch beschrieben werden. Andererseits ist ein weiterer, reiner Monte Carlo-Algorithmus in der Lage die Konformation als Dichteverteilung zu beschreiben.

PS-GANS: A Patient-Specific, Gravity Assisted Navigation System for Acetabular Cup Placement

In this paper we propose a new system that allows reliable acetabular cup placement when the THA is operated in lateral approach. Conceptually it combines the accuracy of computer-generated patient-specific morphology information with an easy-to-use mechanical guide, which effectively uses natural gravity as the angular reference. The former is achieved by using a statistical shape model-based 2D-3D reconstruction technique that can generate a scaled, patient-specific 3D shape model of the pelvis from a single conventional anteroposterior (AP) pelvic X-ray radiograph. The reconstructed 3D shape model facilitates a reliable and accurate co-registration of the mechanical guide with the patient’s anatomy in the operating theater. We validated the accuracy of our system by conducting experiments on placing seven cups to four pelvises with different morphologies. Taking the measurements from an image-free navigation system as the ground truth, our system showed an average accuracy of 2.1 ±0.7 o for inclination and an average accuracy of 1.2 ±1.4 o for anteversion.

Long-term clinical outcomes of biodegradable polymer biolimus-eluting stents versus durable polymer sirolimus-eluting stents in patients with coronary artery disease (LEADERS): 4 year follow-up of a randomised non-inferiority trial

Background The effectiveness of durable polymer drug-eluting stents comes at the expense of delayed arterial healing and subsequent late adverse events such as stent thrombosis (ST). We report the 4 year follow-up of an assessment of biodegradable polymer-based drug-eluting stents, which aim to improve safety by avoiding the persistent inflammatory stimulus of durable polymers. Methods We did a multicentre, assessor-masked, non-inferiority trial. Between Nov 27, 2006, and May 18, 2007, patients aged 18 years or older with coronary artery disease were randomly allocated with a computer-generated sequence to receive either biodegradable polymer biolimus-eluting stents (BES) or durable polymer sirolimus-eluting stents (SES; 1:1 ratio). The primary endpoint was a composite of cardiac death, myocardial infarction, or clinically-indicated target vessel revascularisation (TVR); patients were followed-up for 4 years. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00389220. Findings 1707 patients with 2472 lesions were randomly allocated to receive either biodegradable polymer BES (857 patients, 1257 lesions) or durable polymer SES (850 patients, 1215 lesions). At 4 years, biodegradable polymer BES were non-inferior to durable polymer SES for the primary endpoint: 160 (18·7%) patients versus 192 (22·6%) patients (rate ratios [RR] 0·81, 95% CI 0·66–1·00, p for non-inferiority <0·0001, p for superiority=0·050). The RR of definite ST was 0·62 (0·35–1·08, p=0·09), which was largely attributable to a lower risk of very late definite ST between years 1 and 4 in the BES group than in the SES group (RR 0·20, 95% CI 0·06–0·67, p=0·004). Conversely, the RR of definite ST during the first year was 0·99 (0·51–1·95; p=0·98) and the test for interaction between RR of definite ST and time was positive (pinteraction=0·017). We recorded an interaction with time for events associated with ST but not for other events. For primary endpoint events associated with ST, the RR was 0·86 (0·41–1·80) during the first year and 0·17 (0·04–0·78) during subsequent years (pinteraction=0·049). Interpretation Biodegradable polymer BES are non-inferior to durable polymer SES and, by reducing the risk of cardiac events associated with very late ST, might improve long-term clinical outcomes for up to 4 years compared with durable polymer SES. Funding Biosensors Europe SA, Switzerland.

Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials

Background Idiopathic pulmonary fibrosis is a progressive and fatal lung disease with inevitable loss of lung function. The CAPACITY programme (studies 004 and 006) was designed to confirm the results of a phase 2 study that suggested that pirfenidone, a novel antifibrotic and anti-inflammatory drug, reduces deterioration in lung function in patients with idiopathic pulmonary fibrosis. Methods In two concurrent trials (004 and 006), patients (aged 40–80 years) with idiopathic pulmonary fibrosis were randomly assigned to oral pirfenidone or placebo for a minimum of 72 weeks in 110 centres in Australia, Europe, and North America. In study 004, patients were assigned in a 2:1:2 ratio to pirfenidone 2403 mg/day, pirfenidone 1197 mg/day, or placebo; in study 006, patients were assigned in a 1:1 ratio to pirfenidone 2403 mg/day or placebo. The randomisation code (permuted block design) was computer generated and stratified by region. All study personnel were masked to treatment group assignment until after final database lock. Treatments were administered orally, 801 mg or 399 mg three times a day. The primary endpoint was change in percentage predicted forced vital capacity (FVC) at week 72. Analysis was by intention to treat. The studies are registered with ClinicalTrials.gov, numbers NCT00287729 and NCT00287716. Findings In study 004, 174 of 435 patients were assigned to pirfenidone 2403 mg/day, 87 to pirfenidone 1197 mg/day, and 174 to placebo. In study 006, 171 of 344 patients were assigned to pirfenidone 2403 mg/day, and 173 to placebo. All patients in both studies were analysed. In study 004, pirfenidone reduced decline in FVC (p=0·001). Mean FVC change at week 72 was −8·0% (SD 16·5) in the pirfenidone 2403 mg/day group and −12·4% (18·5) in the placebo group (difference 4·4%, 95% CI 0·7 to 9·1); 35 (20%) of 174 versus 60 (35%) of 174 patients, respectively, had a decline of at least 10%. A significant treatment effect was noted at all timepoints from week 24 and in an analysis over all study timepoints (p=0·0007). Mean change in percentage FVC in the pirfenidone 1197 mg/day group was intermediate to that in the pirfenidone 2403 mg/day and placebo groups. In study 006, the difference between groups in FVC change at week 72 was not significant (p=0·501). Mean change in FVC at week 72 was −9·0% (SD 19·6) in the pirfenidone group and −9·6% (19·1) in the placebo group, and the difference between groups in predicted FVC change at week 72 was not significant (0·6%, −3·5 to 4·7); however, a consistent pirfenidone effect was apparent until week 48 (p=0·005) and in an analysis of all study timepoints (p=0·007). Patients in the pirfenidone 2403 mg/day group had higher incidences of nausea (125 [36%] of 345 vs 60 [17%] of 347), dyspepsia (66 [19%] vs 26 [7%]), vomiting (47 [14%] vs 15 [4%]), anorexia (37 [11%] vs 13 [4%]), photosensitivity (42 [12%] vs 6 [2%]), rash (111 [32%] vs 40 [12%]), and dizziness (63 [18%] vs 35 [10%]) than did those in the placebo group. Fewer overall deaths (19 [6%] vs 29 [8%]) and fewer deaths related to idiopathic pulmonary fibrosis (12 [3%] vs 25 [7%]) occurred in the pirfenidone 2403 mg/day groups than in the placebo groups. Interpretation The data show pirfenidone has a favourable benefit risk profile and represents an appropriate treatment option for patients with idiopathic pulmonary fibrosis.

Contemporary Hollywood And The Attention Economy

This thesis had two goals: to explore the transformation of Hollywood from the 1930s to present, and to investigate how Contemporary Hollywood functions in a growing attention economy. Evident in the types of films that it produces as well as its evolving industrial structure, Contemporary Hollywood significantly differs from the Classical Hollywood of the 1930s. New digital technologies like surround sound and computer-generated imagery (CGI) have allowed studios to create a different type of film like the blockbuster and to have more extensive control over their films. Additionally, growing exhibition and distribution platforms have also fundamentally altered the industrial landscape of Hollywood. In order to combat this more egalitarian distribution system, Contemporary Hollywood has turned to conglomeratization. But, what has caused such a radical shift in the form and function of Contemporary Hollywood and its films? This thesis argues that Hollywood is failing to thrive in this new media landscape¿not because of changing technologies¿but because of a changing consumer. Richard Lanham theorizes that we are living in a growing attention economy, where human attention is the most valuable commodity in such an information-saturated society. For the current consumer, there is near-constant media over-stimulation: he or she is exposed to any number of screens (mobile phones, laptops, tablets, televisions, etc.) at any given time. Because we can access anything from anywhere at anytime, we¿ve become somewhat schizophrenic and impatient in terms of the media that we consume in our lives.

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.