Response of the lower St. Lawrence Estuary to external forcing in winter

Mostly because of a lack of observations, fundamental aspects of the St. Lawrence Estuary's wintertime response to forcing remain poorly understood. The results of a field campaign over the winter of 2002/03 in the estuary are presented. The response of the system to tidal forcing is assessed through the use of harmonic analyses of temperature, salinity, sea level, and current observations. The analyses confirm previous evidence for the presence of semidiurnal internal tides, albeit at greater depths than previously observed for ice-free months. The low-frequency tidal streams were found to be mostly baroclinic in character and to produce an important neap tide intensification of the estuarine circulation. Despite stronger atmospheric momentum forcing in winter, the response is found to be less coherent with the winds than seen in previous studies of ice-free months. The tidal residuals show the cold intermediate layer in the estuary is renewed rapidly ( 14 days) in late March by the advection of a wedge of near-freezing waters from the Gulf of St. Lawrence. In situ processes appeared to play a lesser role in the renewal of this layer. In particular, significant wintertime deepening of the estuarine surface mixed layer was prevented by surface stability, which remained high throughout the winter. The observations also suggest that the bottom circulation was intensified during winter, with the intrusion in the deep layer of relatively warm Atlantic waters, such that the 3 C isotherm rose from below 150 m to near 60 m.

Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study

OBJECTIVES: We sought to determine the risk of late stent thrombosis (ST) during long-term follow-up beyond 3 years, searched for predictors, and assessed the impact of ST on overall mortality. BACKGROUND: Late ST was reported to occur at an annual rate of 0.6% up to 3 years after drug-eluting stent (DES) implantation. METHODS: A total of 8,146 patients underwent percutaneous coronary intervention with a sirolimus-eluting stent (SES) (n=3,823) or paclitaxel-eluting stent (PES) (n=4,323) and were followed up to 4 years after stent implantation. Dual antiplatelet treatment was prescribed for 6 to 12 months. RESULTS: Definite ST occurred in 192 of 8,146 patients with an incidence density of 1.0/100 patient-years and a cumulative incidence of 3.3% at 4 years. The hazard of ST continued at a steady rate of 0.53% (95% confidence interval [CI]: 0.44 to 0.64) between 30 days and 4 years. Diabetes was an independent predictor of early ST (hazard ratio [HR]: 1.96; 95% CI: 1.18 to 3.28), and acute coronary syndrome (HR: 2.21; 95% CI: 1.39 to 3.51), younger age (HR: 0.97; 95% CI: 0.95 to 0.99), and use of PES (HR: 1.67; 95% CI: 1.08 to 2.56) were independent predictors of late ST. Rates of death and myocardial infarction at 4 years were 10.6% and 4.6%, respectively. CONCLUSIONS: Late ST occurs steadily at an annual rate of 0.4% to 0.6% for up to 4 years. Diabetes is an independent predictor of early ST, whereas acute coronary syndrome, younger age, and PES implantation are associated with late ST.

Stent thrombosis in early-generation drug-eluting stents versus newer-generation everolimus-eluting stent assorted by LVEF.

OBJECTIVE Everolimus drug-eluting stents (EES) are superior to early-generation drug-eluting stents (DES), releasing sirolimus (SES) or paclitaxel (PES) in preventing stent thrombosis (ST). Since an impaired LVEF seems to increase the risk of ST, we aimed to investigate the difference in outcome of patients with varying LVEF using EES versus early-generation DES. METHODS In a prospective cohort study, we compared the risk of ST in patients in three LVEF subgroups: normal (LVEF >50%), mildly impaired (LVEF >40% and ≤50%) and moderate-severely impaired (LVEF ≤40%). Within these various LVEF groups, we compared EES with SES and PES after adjustment for baseline differences. RESULTS We assessed a cohort of 5363 patients, with follow-up of up to 4 years and available LVEF. Overall definite ST occurred in 123 (2.3%) patients. ST rates were higher in the LVEF moderate-severely impaired group compared with the normal LVEF group (2.8% vs 2.1%; HR 1.82; CI 1.10 to 3.00). Especially early ST (EST) was more frequent in the moderate-severely impaired LVEF group (HR 2.20; CI 1.06 to 4.53). Overall rates of definite ST were lower in patients using EES compared with patients using SES or PES in all LVEF groups. Interaction terms were not statistically significant. ST rates were higher in the moderate-severely impaired LVEF group compared with the normal LVEF group when using SES or PES, but not significantly different when using EES. CONCLUSIONS EES was associated with a lower risk of definite ST compared with early-generation DES. This lower risk was independent of LVEF, even though ST rates were higher in patients with a moderate-severely impaired LVEF. TRIAL REGISTRATION NO MEC-2013-262.

Clima, lage und boden in ihrer wechselwirkung auf die wald-vegetation. Eröffnungschrift der vorlesungen an der Königl. Baier forst-lehranstalt zu Aschaffenburg in 1823.

Mode of access: Internet.

Botanisches handbuch; oder, Diagnostik der einheimischen und der vorzüglichsten in Teutschland im freien fortkommenden fremden forstgewächse, mit besonderer hinweisung auf den schönbusch bei Aschaffenburg.

Mode of access: Internet.