Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Scanning Electron Microscopy Studies on Tear and Wear Failure of Short Kevlar Fiber-Thermoplastic- Polyurethane Composite

Tear and wear properties of short kevlar fiber, thermoplastic polcurethane (TPU) composite with respect to fiber loading-and fiber onentation has been studied and the fracture surfaces were examined under scanning electron microscope (SEM). Tear strength first decreased up to 20 phr fiber loading and then gradually increased with increasing fiber loading. Anisotropy in tear strength was evident beyond a fiber loading of 20 phr. Tear fracture surface of unfilled TPU showed sinusoidal folding characteristics of high strength matrix. At low fiber loading the tear failure was mainly due to fibermatrix failure whereas at higher fiber loading the failure occurred by fiber breakage. Abrasion loss shows a continuous rise with increasing fiber loading, the loss in the transverse orientation of fibers being higher than that in the longitudinal orientation. The abraded surface showed lone cracks and ridges parallel to the direction of abrasion indicating an abrasive wear mechanism. In the presence of fber the abrasion loss was mainly due to fiber low.

Biochemical Studies on the Protective Effect of Taurine on Experimentally Induced Fulminat Hepatic Failure in Rats

Fulminant hepatic failure (FHF) is a dramatic and challenging syndrome in clinical medicine. Although an uncommon disorder, it is usually fatal and occurs in previously healthy person. While the causes of FHF remain unclear, viral hepatitis and drug-induced liver injury account for the majority of cases. Hepatitis E causes large-scale epidemics of hepatitis in the Indian subcontinent, involving hundreds of thousands of cases with high mortality. FHF is associated with several clinical features like jaundice, shrunken liver, easy bruising, low levels of serum proteins, fatigue, multi-organ failure etc and metabolic derangements like hypoglycemia, hyperlipidemia, hyponatremia, defective protein synthesis, reduced energy production, decreased rate of urea production etc. These disturbances are predominantly attributed to oxidative stress, membrane destabilization and osmolytic imbalances. The options available for these patients are quite minimal with liver transplantation being one of them. But the procedure is ridden with issues causing it to find less favor among the patients and the caregivers. Use of hepatoprotective and cytoprotective drugs, is being considered to be a more acceptable alternative as a strategy to enhance liver regeneration. In this regard use of taurine a naturally occurring amino acid that plays a crucial role in many physiological processes would prove to be effective. In the present study, hepatoprotective effect of taurine on a rat model of induced FHF was studied. Taurine supplementation has effectively counteracted the metabolic and structural aberrations in the liver caused by D-galactosamine intoxication.

Studies in molecular mechanics using spectroscopic data exact force field and bond in homogeneity

This thesis deals with some studies in molecular mechanic using spectroscopic data. It includes an improvement in the parameter technique for the evaluation of exact force fields, the introduction of a new and simple algebraic method for the force field calculation and a study of asymmetric variation of bonding forces along a bond.

Palladium Catalyzed Carbon-Carbon/Carbonheteroatom Bond Formation Reactions Utilizing Pentafulvene Derived Bicyclic Hydrazines

The reactions involving fulvenes and its derivatives have received a great deal of attention over the years in synthetic organic chemistry. Functionalizations of fulvenes provide versatile and powerful approaches to various polycyclic systems and natural products. They serve as versatile intermediates in the construction of various ring systems through inter- as well as intramolecular cycloadditions. Compared to the rich literature on the cycloaddition reactions of pentafulvenes, much less attention has been paid to the synthetic utilization of their cycloadducts. Tactical manipulations on the chosen adduct offer the prospects for designing a variety of useful molecular skeletons. Addition of heterodienophiles to fulvenes offers an efficient strategy towards the synthesis of azabicyclic olefins. However, there have been no serious attempts to study the synthetic utility of these substrates. In this context and with the intention of utilizing pentafulvenes towards synthetically important molecules, author decided to explore the reactivity of pentafulvene derived azabicyclic olefins. Our attention was focused on the synthetic potential associated with the ring opening of fulvene derived bicyclic hydrazines under palladium catalysis. It was envisioned that the desymmetrization of these adducts using various soft nucleophiles will provide a novel access to synthetically and biologically important alkylidene cyclopentenes. The investigations along this line form the focal theme of this thesis entitled “PALLADIUM CATALYZED CARBONCARBON/ CARBON-HETEROATOM BOND FORMATION REACTIONS UTILIZING PENTAFULVENE DERIVED BICYCLIC HYDRAZINES

Identification of models using failure rate and mean residual life of doubly truncated random variables

In this paper, we study the relationship between the failure rate and the mean residual life of doubly truncated random variables. Accordingly, we develop characterizations for exponential, Pareto 11 and beta distributions. Further, we generalize the identities for fire Pearson and the exponential family of distributions given respectively in Nair and Sankaran (1991) and Consul (1995). Applications of these measures in file context of lengthbiased models are also explored

Nonlinear Analysis of Shear Dominant Prestressed Concrete Beams using ANSYS

This study reports the details of the finite element analysis of eleven shear critical partially prestressed concrete T-beams having steel fibers over partial or full depth. Prestressed T-beams having a shear span to depth ratio of 2.65 and 1.59 that failed in shear have been analyzed using the ‘ANSYS’ program. The ‘ANSYS’ model accounts for the nonlinearity, such as, bond-slip of longitudinal reinforcement, postcracking tensile stiffness of the concrete, stress transfer across the cracked blocks of the concrete and load sustenance through the bridging action of steel fibers at crack interface. The concrete is modeled using ‘SOLID65’- eight-node brick element, which is capable of simulating the cracking and crushing behavior of brittle materials. The reinforcement such as deformed bars, prestressing wires and steel fibers have been modeled discretely using ‘LINK8’ – 3D spar element. The slip between the reinforcement (rebars, fibers) and the concrete has been modeled using a ‘COMBIN39’- nonlinear spring element connecting the nodes of the ‘LINK8’ element representing the reinforcement and nodes of the ‘SOLID65’ elements representing the concrete. The ‘ANSYS’ model correctly predicted the diagonal tension failure and shear compression failure of prestressed concrete beams observed in the experiment. The capability of the model to capture the critical crack regions, loads and deflections for various types of shear failures in prestressed concrete beam has been illustrated.

A study on mitigating the effect of sulphates in lime stabilised Cochin marine clays

Soft clays known for their high compressibility, low stiffness and low shear strength are always associated with large settlement. In place soil treatment using calcium-based stabilizers like lime and cement is a feasible solution to readdress strength deficiencies and problematic shrink/swell behaviour of unstable subgrade soils. Out of these, lime has been proved unambiguously as the most effective and economical stabilising agent for marine clays. Lime stabilisation creates long-term chemical changes in unstable clay soils to create strong, but flexible, permanent structural layers in foundations and other pavement systems. Even though calcium-based stabilizers can improve engineering properties of soft clays, problems can arise when they are used in soils rich in sulphates. It is possible for marine clays to be enriched with sulphates, either by nature or due to the discharge of nearby industrial wastes containing sulphates. The presence of sulphates is reported to adversely affect the cation exchange and pozzolanic reactions of cement and lime treated soil systems. The anions of sulphates may combine with the available calcium and alumina, and form insoluble ettringite in the soil system. Literature on sulphate attack in lime treated marine clays reports that formation of ettringite in lime-sodium sulphate-clay system is capable of adversely affecting the engineering behavior of marine clays. Only very few studies have been conducted on soft marine clays found along the coastal belt of Kerala and that too, is limited to Cochin marine clays. The studies conducted also have the limitation that the strength behaviour of lime stabilised clay was investigated only for one year. Practically no data pertaining to long term adverse effects likely to be brought about by sulphates on the strength and compressibility characteristics of Cochin marine clays is available. The overriding goal of this investigation was thus to examine the effectiveness of lime stabilisation in Cochin marine clays under varying sulphate contents. The study aims to reveal the changes brought about by varying sulphate contents on both physical and engineering properties of these clays stabilised by lime and the results for various curing periods up to two years is presented in this thesis. Quite often the load causing an unacceptable settlement may be less than the load required to cause shear failure and therefore attempt has been made in this research to highlight sulphate induced changes in both the compressibility and strength characteristics of lime treated Cochin marine clays. The study also aimed at comparing the available IS methods for sulphate quantification and has attempted to determine the threshold level of sulphate likely make these clays vulnerable by lime stabilisation. Clays used in this study were obtained from two different sites in Kochi and contained sulphate in two different concentrations viz., 0.5% and 0.1%. Two different lime percentages were tried out, 3% and 6%. Sulphate content was varied from 1% to 4% by addition of reagent grade sodium sulphate. The long term influence of naturally present sulphate is also investigated. X-ray diffraction studies and SEM studies have been undertaken to understand how the soil-lime reactions are affected in the presence of sodium sulphate. Natural sulphate content of 0.1% did not seem to have influenced normal soil lime reactions but 0.5% sulphate could induce significant changes adversely in both compressibility and strength behaviour of lime treated clays after long duration. Compressibility is seen to increase drastically with increasing sulphate content suggesting formation of ettringite on curing for longer periods. Increase in compression index and decrease in bond strength with curing period underlined the adverse effects induced in lime treated marine clays by the presence of sulphates. Presence of sulphate in concentrations ranging from 0.5 % to 4% is capable of adversely affecting the strength of lime treated marine clays. Considerable decrease is observed with increasing concentrations of sulphate. Ettringite formation due to domination of sodium ions in the system was confirmed in mineralogical studies made. Barium chloride and barium hydroxide is capable of bringing about beneficial changes both in compressibility and strength characteristics of lime treated Cochin marine clays in the presence of varying concentrations of sulphate and is strongly influenced by curing time. Clay containing sodium sulphate has increased strength values when either of barium compounds was used with lime ascompared with specimens treated with lime only. Barium hydroxide is observed to remarkably increase the strength as compared to barium chloride,when used in conjunction with lime to counteract the effect of sulphate.

Theory for the change of bond character in divalent-metal clusters

To determine the size dependence of the bonding in divalent-metal clusters we use a many-electron Hamiltonian describing the interplay between van der Waals (vdW) and covalent interactions. Using a saddle-point slave-boson method and taking into account the size-dependent screening of charge fluctuations, we obtain for Hg_n a sharp transition from vdW to covalent bonding for increasing n. We show also, by solving the model Hamiltonian exactly, that for divalent metals vdW and covalent bonding coexist already in the dimers.

Rissbildung und Zugtragverhalten von mit Stabstahl und Fasern bewehrtem Ultrahochfesten Beton (UHPC)

Ultrahochfester Beton (UHPC) ist ein sehr gefügedichter zementgebundener Werkstoff, der sich nicht nur durch eine hohe Druckfestigkeit, sondern auch durch einen hohen Widerstand gegen jede Form physikalischen oder chemischen Angriffs auszeichnet. Duktiles Nachbruchverhalten bei Druckversagen wird meist durch die Zugabe dünner kurzer Fasern erreicht. In Kombination mit konventioneller Betonstahl- oder Spannbewehrung ermöglicht UHPC die Ausführung sehr schlanker, weitgespannter Konstruktionen und eröffnet zugleich neue Anwendungsgebiete, wie zum Beispiel die flächenhafte Beschichtung von Brückendecks. Durch das Zusammenwirken kontinuierlicher Bewehrungselemente und diskontinuierlich verteilter kurzer Fasern ergeben sich unter Zugbeanspruchung Unterschiede gegenüber dem bekannten Stahl- und Spannbeton. In der vorliegenden Arbeit wird hierzu ein Modell entwickelt und durch eine umfangreiche Versuchsreihe abgesichert. Ausgangspunkt sind experimentelle und theoretische Untersuchungen zum Verbundverhalten von Stabstählen in einer UHPC-Matrix und zum Einfluss einer Faserzugabe auf das Reiß- und Zugtragverhalten von UHPC. Die Modellbildung für UHPC-Zugelemente mit gemischter Bewehrung aus Stabstahl und Fasern erfolgt auf der Grundlage der Vorgänge am diskreten Riss, die daher sehr ausführlich behandelt werden. Für den elastischen Verformungsbereich der Stabbewehrung (Gebrauchslastbereich) kann damit das Last-Verformungs-Verhalten für kombiniert bewehrte Bauteile mechanisch konsistent unter Berücksichtigung des bei UHPC bedeutsamen hohen Schwindmaßes abgebildet werden. Für die praktische Anwendung wird durch Vereinfachungen ein Näherungsverfahren abgeleitet. Sowohl die theoretischen als auch die experimentellen Untersuchungen bestätigen, dass der faserbewehrte UHPC bei Kombination mit kontinuierlichen Bewehrungselementen selbst kein verfestigendes Verhalten aufweisen muss, um insgesamt verfestigendes Verhalten und damit eine verteilte Rissbildung mit sehr keinen Rissbreiten und Rissabständen zu erzielen. Diese Beobachtungen können mit Hilfe der bisher zur Verfügung stehenden Modelle, die im Wesentlichen eine Superposition isoliert ermittelter Spannungs-Dehnungs-Beziehungen des Faserbetons und des reinen Stahls vorsehen, nicht nachvollzogen werden. Wie die eigenen Untersuchungen zeigen, kann durch ausreichend dimensionierte Stabstahlbewehrung zielgerichtet und ohne unwirtschaftlich hohe Fasergehalte ein gutmütiges Verhalten von UHPC auf Zug erreicht werden. Die sichere Begrenzung der Rissbreiten auf deutlich unter 0,1 mm gewährleistet zugleich die Dauerhaftigkeit auch bei ungünstigen Umgebungsbedingungen. Durch die Minimierung des Material- und Energieeinsatzes und die zu erwartende lange Nutzungsdauer lassen sich so im Sinne der Nachhaltigkeit optimierte Bauteile realisieren.

Crisis or failure of hegemonic masculinities in David Lodge’s Campus Trilogy

This bachelor’s thesis examines the crisis of hegemonic masculinities in David Lodge’s Campus Trilogy. In the course of the thesis, I demonstrate that the male characters in the novels aspire to hegemonic ideals of masculinity, but that ultimately most of them fail in their aspirations. However, I also show that this does not lead to the abandonment of this pursuit, but merely to its reformulation and a continued attempt of male characters to aspire to this reformulated ideal. In order to achieve this, I conduct a close reading of the novels and based on this, first determine the predominant types of hegemonic masculinities in each novel, and then whether certain characters aspire to these hegemonic ideals. Next I analyze whether or not they are successful. This analysis is chiefly based on the sociological concept of hegemonic masculinities developed by Connell. With the help of this concept, this thesis shows that several types of masculinities can be identified in the novels and that these exist in hierarchical relation to each other. Furthermore, it shows that these aspirations and the ideals themselves are always prone to crises that are brought on by societal changes in their environment. However, it is also demonstrated that in most cases these crises do not lead to the collapse of the ideal or the failure of its pursuit, but rather to the reformulation and continuation of both.

Electronic origin of bond softening and hardening in femtosecond-laser-excited magnesium

Many ultrafast structural phenomena in solids at high fluences are related to the hardening or softening of particular lattice vibrations at lower fluences. In this paper we relate femtosecond-laser-induced phonon frequency changes to changes in the electronic density of states, which need to be evaluated only in the electronic ground state, following phonon displacement patterns. We illustrate this relationship for a particular lattice vibration of magnesium, for which we—surprisingly—find that there is both softening and hardening as a function of the femtosecond-laser fluence. Using our theory, we explain these behaviours as arising from Van Hove singularities: We show that at low excitation densities Van Hove singularities near the Fermi level dominate the change of the phonon frequency while at higher excitations Van Hove singularities that are further away in energy also become important. We expect that our theory can as well shed light on the effects of laser excitation of other materials.