Validation of Two US Risk Scores for Percutaneous Coronary Intervention in a Single-Center Portuguese Population of Patients with Acute Coronary Syndrome

INTRODUCTION: New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score. METHODS: In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores. RESULTS: A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91-0.96) compared with NCDR (0.87, 95% CI 0.83-0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81-0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6-97.7; IDI 0.136, 95% CI 0.073-0.199) or NCDR (NRI 79.2, 95% CI 60.2-98.2; IDI 0.148, 95% CI 0.087-0.209). CONCLUSION: The NCDR and Mayo Clinic risk scores are useful for risk stratification of in-hospital mortality in a European population of patients with ACS undergoing coronary angioplasty. However, the GRACE score is still to be preferred.

I have faith in my thing, you know what I mean? Mixed method elements on individual investments on religious markets.

In contemporary society, religious signification and secular systems mix and influence each other. Holistic conceptions of a world in which man is integrated harmoniously with nature meet representations of a world run by an immanent God. On the market of the various systems, the individual goes from one system to another, following his immediate needs and expectations without necessarily leaving any marks in a meaningful long term system. This article presents the first results of an ongoing research in Switzerland on contemporary religion focusing on (new) paths of socialization of modern that individuals and the various (non-) belief systems that they simultaneously develop

Comparison of clinical and angiographic prognostic risk scores in elderly patients presenting with acute coronary syndrome and referred for percutaneous coronary intervention.

BACKGROUND: Multiple risk prediction models have been validated in all-age patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI); however, they have not been validated specifically in the elderly. METHODS: We calculated the GRACE (Global Registry of Acute Coronary Events) score, the logistic EuroSCORE, the AMIS (Acute Myocardial Infarction Swiss registry) score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in a consecutive series of 114 patients ≥75 years presenting with ACS and treated with PCI within 24 hours of hospital admission. Patients were stratified according to score tertiles and analysed retrospectively by comparing the lower/mid tertiles as an aggregate group with the higher tertile group. The primary endpoint was 30-day mortality. Secondary endpoints were the composite of death and major adverse cardiovascular events (MACE) at 30 days, and 1-year MACE-free survival. Model discrimination ability was assessed using the area under receiver operating characteristic curve (AUC). RESULTS: Thirty-day mortality was higher in the upper tertile compared with the aggregate lower/mid tertiles according to the logistic EuroSCORE (42% vs 5%; odds ratio [OR] = 14, 95% confidence interval [CI] = 4-48; p <0.001; AUC = 0.79), the GRACE score (40% vs 4%; OR = 17, 95% CI = 4-64; p <0.001; AUC = 0.80), the AMIS score (40% vs 4%; OR = 16, 95% CI = 4-63; p <0.001; AUC = 0.80), and the SYNTAX score (37% vs 5%; OR = 11, 95% CI = 3-37; p <0.001; AUC = 0.77). CONCLUSIONS: In elderly patients presenting with ACS and referred to PCI within 24 hours of admission, the GRACE score, the EuroSCORE, the AMIS score, and the SYNTAX score predicted 30 day mortality. The predictive value of clinical scores was improved by using them in combination.

Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism.

Background: The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI), and its simplified version (sPESI) are well known clinical prognostic scores for pulmonary embolism (PE).Objectives: To compare the prognostic performance of these scores in elderly patients with PE. Patients/Methods: In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥65 years with symptomatic PE. The outcome was 30-day overall mortality. We dichotomized patients as low- vs. higher-risk in all three scores using the following thresholds: GPS scores ≤2 vs. >2, PESI risk classes I-II vs. III-V, and sPESI scores 0 vs. ≥1. We compared 30-day mortality in low- vs. higher-risk patients and the areas under the receiver operating characteristic curve (ROC). Results: Overall, 3.8% of patients (17/449) died within 30 days. The GPS classified a greater proportion of patients as low risk (92% [413/449]) than the PESI (36.3% [163/449]) and the sPESI (39.6% [178/449]) (P<0.001 for each comparison). Low-risk patients based on the sPESI had a mortality of 0% (95% confidence interval [CI] 0-2.1%) compared to 0.6% (95% CI 0-3.4%) for low-risk patients based on the PESI and 3.4% (95% CI 1.9-5.6%) for low-risk patients based on the GPS. The areas under the ROC curves were 0.77 (95%CI 0.72-0.81), 0.76 (95% CI 0.72-0.80), and 0.71 (95% CI 0.66-0.75), respectively (P=0.47). Conclusions: In this cohort of elderly patients with PE, the GPS identified a higher proportion of patients as low-risk but the PESI and sPESI were more accurate in predicting mortality.

Memory mixed with desire : a preliminary study of philosophy and literature in the works of Friedrich Nietzsche and Milan Kundera

Memory Mixed with Desire: A preliminary study of Philosophy and Literature in the works of Friedrich Nietzsche and Milan Kundera Robert Spinelli Brock University, Department of Philosophy This thesis studies intertextuality in the works of Friedrich Nietzsche and Milan Kundera through the primary themes of memory and forgetting. The thesis starts with two introductory chapters that delineate memory according to Nietzsche and Kundera respectively. From here, I move into a discussion of Nietzsche's Ubermensch as an example of the type of forgetting that Nietzsche sees as a cure for the overabundance of memory that has led to Christian morality. Next, I explore the Kunderan concept of kitsch as the polar opposite of what Nietzsche has sought in his philosophy, finishing the chapter by tying the two thinkers together in a Kunderan critique of Nietzsche. The thesis ends with a chapter devoted to the Eternal Return beginning with an exegesis of Nietzsche's idea and ending with a similar exegesis of Kundera's treatment of this thought. What I suggest in this chapter is that the Eternal Return might itself be a form of kitsch even in its attempt to revalue existence.

Exploring multiracial/cultural identities through mothers' voices /

This study explored the experiences of mothers of multiracial/cultural children within the context of family, school, and community. Three categories of mothers of multiracial/cultural children were interviewed privately and then invited to meet as a group to explore some of their reflections and experiences. The categories consisted of 4 mothers with multiracial/cultural children presently attending elementary school, 2 mothers of multiracial/cultural children who are now adults and 3 mothers from my own multiracial/cultural family. The study explored the researcher's personal quest for a multiracial/cultural identity and combined interviews with her daughter, her sister, and her mother to reveal the multiracial/cultural experience from a personal perspective. Content analysis of the narratives revealed that multiracial/cultural children produce their own culture and establish new and personally relevant priorities as they develop their self-identities. Findings further indicated that present-day, mainstream mothers from the dominant majority group of Canadians, tell a different story than similar mothers of previous cohorts, and that although sociopolitical and economic changes have influenced the experiences ofthese women, their stories remain remarkably similar across racial and cultural lines. The findings from this study may promote the development of multicultural programs in Canada as they offer both prospects and challenges to multiracial/cultural children and multicultural educators. It is hoped that this study will provide a better understanding of multiculturalism and encourage educators to heighten their racial and cultural awareness as they strive to critically examine their own cultural stories and realign their praxis within the evolving Canadian mosaic.

Studies of some cocondensations of nickel atoms with unsaturated organic ligands and with mixed ligand systems

The cocondensation of nickel with a number of unsaturated ligands was studied, as was the cocondensation with a number of mixed ligand systems. Enamines were found not to react with nickel while acrylonitrile was polymerized. In the mixed ligand syst.ems different products were obtained than when the ligands were cocondensed individually. Cocondensations of benzyl halide/allyl halide mixtures gave unstable products that were not observed when the halides were cocondensed individually. The effect of Kao-Wool insulation on nickel/benzyl halide cocondensations was found to be significant. Kao-Wool caused the bulk of the benzyl halide to be polymeri zed to a number of poly-benzylic species. An alkali metal reactor was designed for the evaporation of sodium and potassium atoms into cold solutions of metal halide and an or ganic substrate. This apparatus was used to synthesize Ni(P¢3 )3' but proved unsuccessful for synthesizing a nickel-enamine compound.

Traitement vocal et vieillissement normal : apports comportementaux et neurofonctionnels

La voix est tout sauf un stimulus auditif ordinaire. Pour cause, elle prend son importance de manière très précoce chez l’Homme lorsque, dans l’environnement amniotique, le fœtus entend pour la toute première fois la voix de sa mère. C’est en quelque sorte par l’intermédiaire de cette voix que les premiers contacts avec le monde extérieur, mais également avec l’Autre, s’effectuent. Le statut particulier de la voix humaine perdure au fil du développement, devenant plus tard le principal médium véhiculant le langage oral, si significatif pour l’Homme. En parallèle, et de manière tout aussi adaptative, elle permet la transmission d’informations non langagières renseignant sur l’identité, l’état émotionnel mais également le statut social de chaque individu. C’est ainsi que simplement en entendant la voix d’une personne inconnue, il est généralement possible d’en extrapoler son âge, son genre, mais également d’avoir une idée assez précise de l’état émotionnel dans lequel elle se trouve. Les capacités permettant d’extraire de la voix les divers éléments informationnels qu’elle contient ne seraient toutefois pas stables au fil du temps. Ainsi, le vieillissement normal semble associé à des difficultés de traitement des informations vocales de nature langagière, mais également non langagière. De nombreuses études se sont intéressées au déclin des capacités de traitement du discours avec l’âge. Beaucoup moins de travaux ont cependant considéré les conséquences du vieillissement sur le domaine paralinguistique et, lorsque des travaux s’y sont attardés, c’est essentiellement la sphère affective qui a été investiguée. En raison de ce peu d’études, mais également de leur focus portant spécifiquement sur la sphère émotionnelle, il est extrêmement ardu de généraliser les résultats obtenus au traitement vocal général. La présente thèse s’est donc intéressée aux capacités de traitement de la voix dans le vieillissement normal. La première étude de cette thèse (Article 1) avait pour objectif d’évaluer l’impact du vieillissement normal sur les capacités comportementales de traitement paralinguistique vocal non émotionnel. Pour ce faire, une batterie informatisée composée de quatre tâches a été élaborée : la batterie d’évaluation de la perception vocale (Batterie EPV; tâches de catégorisation de genre, de discrimination de sources sonores, adaptative de discrimination et de mémorisation). Cette batterie permettait de comparer les performances d’adultes jeunes et âgés lors du traitement de stimuli vocaux et non vocaux, mais également lors du traitement de divers stimuli vocaux. Cette première étude met en évidence, pour trois des quatre tâches comportementales, des performances inférieures chez les adultes âgés et ce, malgré le contrôle statistique des contributions du déclin auditif et cognitif. Pour les aînés, le traitement de stimuli vocaux, en comparaison au traitement de stimuli non vocaux, n’était toutefois pas systématiquement inférieur à celui des jeunes adultes. Sans que les performances ne puissent être prédites par la mesure cognitive utilisée comme covariable (performances au MoCA), il appert que les demandes cognitives inhérentes aux tâches participent à ces différences intergroupes. Le second article de ce travail visait quant à lui à explorer à l’aide de l’imagerie par résonnance magnétique fonctionnelle (IRMf), l’influence du vieillissement normal sur les réseaux neuronaux sous-tendant le traitement de l’information vocale, une telle investigation n’ayant jamais été effectuée auparavant. Pour ce faire, une tâche d’écoute passive (permettant le contraste de blocs de sons vocaux et non vocaux) ainsi qu’une tâche adaptative de discrimination ont été utilisées. La tâche adaptative, basée sur une type de protocole psycoacoustique « up-down », assurait l’obtention de niveau de performance équivalent entre les deux groupes, une condition nécessaire pour la comparaison de groupe au niveau neurofonctionnel. La comparaison des adultes jeunes et âgés n’a mis en évidence aucune disparité quant au recrutement des aires répondant préférentiellement à la voix : les aires vocales temporales (AVT). Ce résultat suggère que l’âge n’affecte pas la mobilisation des aires spécialisées dans le traitement de la voix. Néanmoins, à l’extérieur des AVT et chez les aînés, le sous recrutement d’une portion du cortex auditif a été observé, en parallèle au recrutement additionnel de régions pariétale, temporale et frontale (Article 2 – Étude 1). Lors de la réalisation d’une tâche adaptative de discrimination, contrairement à ce qui était attendu, les seuils de discrimination des deux groupes d’âges étaient comparables. Pour effectuer la tâche, les participants âgés ont cependant recruté un réseau neuronal plus étendu que celui des jeunes adultes, et pour les aînés, l’activation additionnelle de régions frontale et temporale sous-tendaient la réalisation de la tâche (Article 2 - Étude 2). Les données comportementales présentées dans cette thèse suggèrent que l’effet délétère que semble avoir le vieillissement normal sur les capacités de traitement paralinguistique vocal affectif est également retrouvé lors du traitement d’informations vocales émotionnellement neutres. En parallèle, la mise en place de phénomènes de plasticité cérébrale est objectivée. Ces derniers ne toucheraient cependant pas les réseaux spécialisés dans le traitement de la voix, qui seraient recrutés de manière comparable par les adultes jeunes et âgés. Néanmoins, la tâche d’écoute passive a mis en évidence la présence, chez les aînés, du recrutement sous-optimal d’une portion du cortex auditif (gyrus temporal transverse). En parallèle, et ce pour les deux tâches, des réseaux neuronaux surnuméraires étaient sollicitées par les adultes âgés, permettant potentiellement d’assurer, chez les ainés, le maintien de performances adéquates.

Alkylation of phenol with methanol over mixed oxides of tin with some rare earth elements

Alkylation of phenol with methanol has been carried out over Sn-La and Sn-Sm mixed oxides of varying compositions at 623 K in a vapour phase flow reactor. It is found that the product selectivity is greatly influenced by the acid-base properties of the catalysts. Ortho-cresol formation is favoured over catalysts with weak acid sites whereas formation of 2,6-xylenol occurs in the presence of stronger acid sites. The cyclohexanol decomposition reaction and titrimetric method using Hammett indicators have been employed to elucidate the acid-base properties of the catalysts.

Studies on the catalysis by sulfated mixed oxides of tin with some rare earth elements

A comparative study of acid-base properties and catalytic activity of Sn-La and Sn-Sm mixed oxides and their corresponding sulfate modified analogues are reported in this thesis. The catalytic activity and product selectivity in the decomposition of alcohols are correlated with the acid-base and redox properties of the catalyst systems under study The effect of catalyst preparation, pretreatment and various reaction parameters on the catalytic activity of sulfate modified oxides is investigated in the oxidative dehydrogenation reactions The experimental conditions are optimised to synthesise industrially important organic chemicals viz. 2,6 xylenol, o-cresol, N-methylanilne and N,N-dimethylaniline employing the mixed oxide systems. The effect of sulfate treatment on the catalytic activity of these systems in the alkylation reactions of phenol, anisole and aniline is also investigated and the merits and demerits of sulfate treatment are highlighted.

Studies On Strength Characteristics Of Soil Mixed With Bio-Waste

Researches are always in quest for finding innovative methods for ground improvement using sustainable and environmental friendly solutions. Theproduction of large quantity of biowastes all over the world faces serious problems of handling and disposal. Coir pith is a biowaste from coir industry and sugarcane baggase is another biowaste obtained after extractingjuice from sugar cane. So the present study is an investigation into the effect of coir pith and sugarcane baggase on some geotechnical properties of red earth. The investigation includes study on variation of properties such as O.M.C, maximum dry density, C.B.R. values,unconfined compressive strength and permeability when these materials are included in soil. Several conclusions are arrived at, on the basis of the experiments conducted and it may be helpful for predicting the behavior of such soil matrix

Dealing with primary mixed ability groups : o qué hacer en clase. 'Tratando con grupos de habilidad mixtos de primaria'.

Un grupo de profesoras implicadas en experiencias de implantación del Inglés en el ciclo medio de Educación Primaria recoge en este documeto sus experiencias, reflexiones y materiales elaborados durante el proceso. La introducción aporta una serie de observaciones sobre las características del alumnado, la contextualización del Inglés como tercera lengua, los objetivos generales del área en esta etapa, el papel del profesorado y del alumnado y la organización del aula de inglés. Se incluyen una serie de actividades y materiales para cada uno de los cursos de 2õ y 3õ ciclo, asi como pautas para su utilización. Los contenidos de cada uno de los cursos se organizan en torno a una serie de temas (topics) seleccionados de acuerdo con la edad e intereses del alumnado.

The mixed-up chameleon : with all new illustrations.

En una visita al zoológico local el camaleón, que odia cambiar de color para que coincida con su entorno, está encantado y envidioso de la belleza y el talento de los demás animales que ve y desea las diferentes partes o rasgos de los maravillosos animales. Desea ser guapo como un flamenco, poder nadar como un pez, alto como una jirafa. A medida que la historia avanza y todos sus deseos se conceden camaleón parece muy extraño, con la cola de zorro, tronco de elefante. Pero es sólo cuando no puede coger una pequeña mosca que vuela cuando desea e que podría ser él mismo. Indicado para discriminación visual y diferencias de palabras. También pueden sacar la conclusión de se feliz con lo que tienes.

New delay-dependent stability criteria for uncertain neutral systems with mixed time-varying delays and nonlinear perturbations

The problem of stability analysis for a class of neutral systems with mixed time-varying neutral, discrete and distributed delays and nonlinear parameter perturbations is addressed. By introducing a novel Lyapunov-Krasovskii functional and combining the descriptor model transformation, the Leibniz-Newton formula, some free-weighting matrices, and a suitable change of variables, new sufficient conditions are established for the stability of the considered system, which are neutral-delay-dependent, discrete-delay-range dependent, and distributeddelay-dependent. The conditions are presented in terms of linear matrix inequalities (LMIs) and can be efficiently solved using convex programming techniques. Two numerical examples are given to illustrate the efficiency of the proposed method