Towards a consistent definition of a significant delta troponin with z-scores: A way out of chaos?

Aims: We assessed the diagnostic performance of z-scores to define a significant delta cardiac troponin (cTn) in a cohort of patients with well-defined clinical outcomes. Methods: We calculated z-scores, which are dependent on the analytical precision and biological variation, to report changes in cTn. We compared the diagnostic performances of a relative delta (%Δ), actual delta (Δ), and z-scores in 762 emergency department patients with symptoms of suspected acute coronary syndrome. cTn was measured with sensitive cTnI (Beckman Coulter), highly sensitive cTnI (Abbott), and highly sensitive cTnT (Roche) assays. Results: Receiver operating characteristic analysis showed no statistically significant differences in the areas under the curve (AUC) of z-scores and Δ with both superior compared to %Δ for all three assays (p<0.001). The AUCs of z-scores measured with the Abbott hs-cTnI (0.955) and Roche hs-cTnT (0.922) assays were comparable to Beckman Coulter cTnI (0.933) (p=0.272 and 0.640, respectively). The individualized Δ cut-off values that were required to emulate a z-score of 1.96 were: Beckman Coulter cTnI 30 ng/l, Abbott hs-cTnI 20 ng/l, and Roche hs-cTnT 7 ng/l. Conclusions: z-scores allow the use of a single cut-off value at all cTn levels, for both cTnI and cTnT and for sensitive and highly sensitive assays, with comparable diagnostic performances. This strategy of reporting significant changes as z-scores may obviate the need for the empirical development of assay-specific cut-off rules to define significant troponin changes.

Experimentally reduced hip-abductor muscle strength and frontal-plane biomechanics during walking

Researchers have postulated that reduced hip-abductor muscle strength may have a role in the progression of knee osteoarthritis by increasing the external knee-adduction moment. However, the relationship between hip-abductor strength and frontal-plane biomechanics remains unclear. To experimentally reduce hip-abduction strength and observe the subsequent changes in frontal-plane biomechanics. Descriptive laboratory study. Research laboratory. Eight healthy, recreationally active men (age = 27 ± 6 years, height = 1.75 ± 0.11 m, mass = 76.1 ± 10.0 kg). All participants underwent a superior gluteal nerve block injection to reduce the force output of the hip-abductor muscle group. Maximal isometric hip-abduction strength and gait biomechanical data were collected before and after the injections. Gait biomechanical variables collected during walking consisted of knee- and hip-adduction moments and impulses and the peak angles of contralateral pelvic drop, hip adduction, and ipsilateral trunk lean. Hip-abduction strength was reduced after the injection (P = .001) and remained lower than baseline values at the completion of the postinjection gait data collection (P = .02). No alterations in hip- or knee-adduction moments (hip: P = .11; knee: P = .52) or impulses (hip: P = .16; knee: P = .41) were found after the nerve block. Similarly, no changes in angular kinematics were observed for contralateral pelvic drop (P = .53), ipsilateral trunk lean (P = .78), or hip adduction (P = .48). A short-term reduction in hip-abductor strength was not associated with alterations in the frontal-plane gait biomechanics of young, healthy men. Further research is needed to determine whether a similar relationship is true in older adults with knee osteoarthritis.

Integrated decoupling and matching network incorporated in the ground plane of a compact monopole array

Compact arrays enable various applications such as antenna beam-forming and multi-input, multi-output (MIMO) schemes on limited-size platforms. The reduced element spacing in compact arrays introduces high levels of mutual coupling which can affect the performance of the adaptive array. This coupling causes a mismatch at the input ports, which disturbs the performance of the individual elements in the array and affects the implementation of beam steering. In this article, a reactive decoupling network for a 3-element monopole array is used to establish port isolation while simultaneously matching input impedance at each port to the system impendence. The integrated decoupling and matching network is incorporated in the ground plane of the monopole array, providing further development scope for beamforming using phase shifters and power splitters in double-layered circuits.

Investigating the impact of project definition clarity on project performance: Structural equation modeling study

Having a clear project definition is crucial for successful construction projects. It affects design quality, project communication between stakeholders and final project performance in terms of cost, schedule and quality. This study examines the relationship between project definition and final project performance through a structural equation model comprising 4 latent constructs and 6 path hypotheses using data from a questionnaire survey of 120 general contractors in the Malaysian construction industry. The results show that in the study population, all three items impact the project performance, but the link between design quality and project performance is indirect. Instead, the clarity of project definition affects project performance indirectly through design quality and project communication and design quality affects project performance indirectly through project communication. The primary contribution is to provide quantitative confirmation of the more general statements made in the literature from around the world and therefore adds to and consolidates existing knowledge. Practical implications derived from the finding are also proposed for various project stakeholders. Furthermore, as lack of the clarity of project definition is a very common occurrence in construction projects globally, these findings have important ramifications for all construction projects in expanding and clarifying existing knowledge on what is needed for the successful delivery of construction projects.

Development of a new design expression for the in-plane shear capacity of the partially grouted concrete masonry walls

Partially grouted masonry walls subjected to in-plane shear exhibit a complex behaviour because of the influence of the aspect ratio, the pre-compression, the grouting pattern, the ratios of the horizontal and the vertical reinforcements, the boundary conditions and the characteristics of the constituent materials. The existing in-plane shear expressions for the partially grouted masonry are formulated as sum of strength of three parameters, namely, the masonry, the reinforcement and the axial force. The parameter ‘masonry’ includes the wall aspect ratio and the masonry compressive strength; the aspect ratio of the unreinforced panel inscribed into the grouted cores and bond beams are not considered, although failure is often dominated by these unreinforced masonry panels. This paper describes the dominance of these panels, particularly those that are squat, to the shear capacity of whole of shear walls. Further, the current design formulae are shown highly un-conservative by many researchers; this paper provides a potential reason for this un-conservativeness. It is shown that by including an additional term of the unreinforced panel aspect ratio a rational design formula could be established. This new expression is validated with independent test results reported in the literature – both Australian and overseas; the predictions are shown to be conservative.

Resilience: A new definition of health for people and communities

What enables people to bounce back from stressful experiences? How do certain individuals maintain a sense of purpose and direction over the long term, even in the face of adversity? This is the first book to move beyond childhood and adolescence to explore resilience across the lifespan. Coverage ranges from genetic and physiological factors through personal, family, organizational, and community processes. Contributors examine how resilience contributes to health and well-being across the adult life cycle; why—and what happens when—resilience processes fail; ethnic and cultural dimensions of resilience; and ways to enhance adult resilience, including reviews of exemplary programs.

Electronic Control of Facial Selection in Additions to Sterically Unbiased Ketones and Olefins

By definition, the two faces of a pi bond are equivalent.1 However, they are rendered nonequivalent in most molecules because of the absence of a plane of symmetry encompassing the double bond and the adjacent substituents. As a result, additions to trigonal centers from the two faces need not be equally facile. Exploiting this stereodifferentiation in a controlled manner represents one of the core problems in organic synthesis. Evidently, the factors which determine such diastereoselection need to be delineated in as much detail as possible.

Design expressions for the in-plane shear capacity of confined masonry shear walls containing squat panels

In-plane shear capacity formulation of reinforced masonry is commonly conceived as the sum of the capacities of three parameters, viz, the masonry, the reinforcement, and the precompression. The term “masonry” incorporates the aspect ratio of the wall without any regard to the aspect ratio of the panels inscribed (and hence confined) by the vertical and the horizontal reinforced grout cores. This paper proposes design expressions in which the aspect ratio of such panels is explicitly included. For this purpose, the grouted confining cores are regarded as a grid of confining elements within which the panels are positioned. These confined masonry panels are then considered as building blocks for multi-bay, multi-storied confined masonry shear walls and analyzed using an experimentally validated macroscopic finite-element model. Results of the analyzes of 161 confined masonry walls containing panels of height to length ratio less than 1.0 have been regressed to formulate design expressions. These expressions have been first validated using independent test data sets and then compared with the existing equations in some selected international design standards. The concept of including the unreinforced masonry panel aspect ratio as an additional term in the design expression for partially grouted/confined masonry shear walls is recommended based on the conclusions from this paper.

Imaging in turbid media using quasi-ballistic photons

We study by means of experiments and Monte Carlo simulations, the scattering of light in random media, to determine the distance up to which photons travel along almost undeviated paths within a scattering medium, and are therefore capable of casting a shadow of an opaque inclusion embedded within the medium. Such photons are isolated by polarisation discrimination wherein the plane of linear polarisation of the input light is continuously rotated and the polarisation preserving component of the emerging light is extracted by means of a Fourier transform. This technique is a software implementation of lock-in detection. We find that images may be recovered to a depth far in excess of that predicted by the diffusion theory of photon propagation. To understand our experimental results, we perform Monte Carlo simulations to model the random walk behaviour of the multiply scattered photons. We present a. new definition of a diffusing photon in terms of the memory of its initial direction of propagation, which we then quantify in terms of an angular correlation function. This redefinition yields the penetration depth of the polarisation preserving photons. Based on these results, we have formulated a model to understand shadow formation in a turbid medium, the predictions of which are in good agreement with our experimental results.

Analytical solution of unsteady three-dimensional MHD boundary layer flow and heat transfer due to impulsively stretched plane surface

The unsteady magnetohydrodynamic viscous flow and heat transfer of Newtonian fluids induced by an impulsively stretched plane surface in two lateral directions are studied by using an analytic technique, namely, the homotopy method. The analytic series solution presented here is highly accurate and uniformly valid for all time in the entire region. The effects of the stretching ratio and the magnetic field on the surface shear stresses and heat transfer are studied. The surface shear stresses in x- and y-directions and the surface heat transfer are enchanced by increasing stretching ratio for a fixed value of the magnetic parameter. For a fixed stretching ratio, the surface shear stresses increase with the magnetic parameter, but the heat transfer decreases. The Nusselt number takes longer time to reach the steady state than the skin friction coefficients. There is a smooth transition from the initial unsteady state to the steady state.

Concept of "Crossover Point" and its Application on Threshold Voltage Definition for Undoped-Body Transistors

As the conventional MOSFET's scaling is approaching the limit imposed by short channel effects, Double Gate (DG) MOS transistors are appearing as the most feasible candidate in terms of technology in sub-45nm technology nodes. As the short channel effect in DG transistor is controlled by the device geometry, undoped or lightly doped body is used to sustain the channel. There exits a disparity in threshold voltage calculation criteria of undoped-body symmetric double gate transistors which uses two definitions, one is potential based and the another is charge based definition. In this paper, a novel concept of "crossover point'' is introduced, which proves that the charge-based definition is more accurate than the potential based definition.The change in threshold voltage with body thickness variation for a fixed channel length is anomalous as predicted by potential based definition while it is monotonous for charge based definition.The threshold voltage is then extracted from drain currant versus gate voltage characteristics using linear extrapolation and "Third Derivative of Drain-Source Current'' method or simply "TD'' method. The trend of threshold voltage variation is found same in both the cases which support charge-based definition.

Concept of Crossover point and its application on Threshold Voltage definition for Undoped-Body Transistors

As the conventional MOSFETs scaling is approaching the limit imposed by short channel effects, Double Gate (DG) MOS transistors are appearing as the most feasible andidate in terms of technology in sub-45nm technology nodes. As the short channel effect in DG transistor is controlled by the device geometry, undoped or lightly doped body, is used to sustain the channel. There exits a disparity in threshold voltage calculation criteria of undoped-body symmetric double gate transistors which uses two definitions, one is potential based and the another is charge based definition. In this paper, a novel concept of "crossover point" is introduced, which proves that the charge-based definition is more accurate than the potential based definition. The change in threshold voltage with body thickness variation for a fixed channel length is anomalous as predicted by, potential based definition while it is monotonous for change based definition. The threshold voltage is then extracted from drain currant versus gate voltage characteristics using linear extrapolation and "Third Derivative of Drain-Source Current" method or simply "TD" method. The trend of threshold voltage variation is found some in both the cases which support charge-based definition.

Flow of metal into the flash gap in the last stages of a plane-strain closed-die forging operation

In closed-die forging the flash geometry should be such as to ensure that the cavity is completely filled just as the two dies come into contact at the parting plane. If metal is caused to extrude through the flash gap as the dies approach the point of contact — a practice generally resorted to as a means of ensuring complete filling — dies are unnecessarily stressed in a high-stress regime (as the flash is quite thin and possibly cooled by then), which reduces the die life and unnecessarily increases the energy requirement of the operation. It is therefore necessary to carefully determine the dimensions of the flash land and flash thickness — the two parameters, apart from friction at the land, which control the lateral flow. The dimensions should be such that the flow into the longitudinal cavity is controlled throughout the operation, ensuring complete filling just as the dies touch at the parting plane. The design of the flash must be related to the shape and size of the forging cavity as the control of flow has to be exercised throughout the operation: it is possible to do this if the mechanics of how the lateral extrusion into the flash takes place is understood for specific cavity shapes and sizes. The work reported here is part of an ongoing programme investigating flow in closed-die forging. A simple closed shape (no longitudinal flow) which may correspond to the last stages of a real forging operation is analysed using the stress equilibrium approach. Metal from the cavity (flange) flows into the flash by shearing in the cavity in one of the three modes considered here: for a given cavity the mode with the least energy requirement is assumed to be the most realistic. On this basis a map has been developed which, given the depth and width of the cavity as well as the flash thickness, will tell the designer of the most likely mode (of the three modes considered) in which metal in the cavity will shear and then flow into the flash gap. The results of limited set of experiments, reported herein, validate this method of selecting the optimum model of flow into the flash gap.

Justifying threshold voltage definition for undoped body transistors through ``crossover point'' concept

Two different definitions, one is potential based and the other is charge based, are used in the literatures to define the threshold voltage of undoped body symmetric double gate transistors. This paper, by introducing a novel concept of crossover point, proves that the charge based definition is more accurate than the potential based definition. It is shown that for a given channel length the potential based definition predicts anomalous change in threshold voltage with body thickness variation while the charge based definition results in monotonous change. The threshold voltage is then extracted from drain current versus gate voltage characteristics using linear extrapolation, transconductance and match-point methods. In all the three cases it is found that trend of threshold voltage variation support the charge based definition.