Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry.

BACKGROUND: The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown. METHODS: Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke. RESULTS: Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE. CONCLUSION: In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.

Metric Short Course for the Office of Bridges and Structures, HR-378, 1995

This metric short course was developed in response to a request from the Office of Bridges and Structures to assist in the training of engineers in the use of metric units of measure which will be required in all highway designs and construction after September 30, 1996 (CFR Presidential Executive Order No. 12770). The course notes which are contained in this report, were developed for a half-day course. The course contains a brief review of metrication in the U.S., metric units, prefixes, symbols, basic conversions, etc. The unique part of the course is that it presents several typical bridge calculations (such as capacity of reinforced concrete compression members, strength of pile caps, etc.) worked two ways: inch-pound units throughout with end conversion to metric and initial hard conversion to metric with metric units throughout. Comparisons of partial results and final results (obtained by working the problems the two ways) are made for each of the example problems.

HIV-1 elite controllers: beware of super-infections.

Super- and co-infection with HIV-1 are generally associated with accelerated disease progression. We report on the outcome of super-infection in two HIV-1 infected individuals previously known as elite controllers. Both presented an acute retroviral syndrome following super-infection and showed an immuno-virological progression thereafter. Host genotyping failed to reveal any of the currently recognized protective factors associated with slow disease progression. This report indicates that elite controllers should be informed of the risk of super-infection, and illustrates the complexity of mounting broad anti-HIV immunity.

HIV-1 Transmission During Recent Infection and During Treatment Interruptions as Major Drivers of New Infections in the Swiss HIV Cohort Study.

BACKGROUND: Reducing the fraction of transmissions during recent human immunodeficiency virus (HIV) infection is essential for the population-level success of "treatment as prevention". METHODS: A phylogenetic tree was constructed with 19 604 Swiss sequences and 90 994 non-Swiss background sequences. Swiss transmission pairs were identified using 104 combinations of genetic distance (1%-2.5%) and bootstrap (50%-100%) thresholds, to examine the effect of those criteria. Monophyletic pairs were classified as recent or chronic transmission based on the time interval between estimated seroconversion dates. Logistic regression with adjustment for clinical and demographic characteristics was used to identify risk factors associated with transmission during recent or chronic infection. FINDINGS: Seroconversion dates were estimated for 4079 patients on the phylogeny, and comprised between 71 (distance, 1%; bootstrap, 100%) to 378 transmission pairs (distance, 2.5%; bootstrap, 50%). We found that 43.7% (range, 41%-56%) of the transmissions occurred during the first year of infection. Stricter phylogenetic definition of transmission pairs was associated with higher recent-phase transmission fraction. Chronic-phase viral load area under the curve (adjusted odds ratio, 3; 95% confidence interval, 1.64-5.48) and time to antiretroviral therapy (ART) start (adjusted odds ratio 1.4/y; 1.11-1.77) were associated with chronic-phase transmission as opposed to recent transmission. Importantly, at least 14% of the chronic-phase transmission events occurred after the transmitter had interrupted ART. CONCLUSIONS: We demonstrate a high fraction of transmission during recent HIV infection but also chronic transmissions after interruption of ART in Switzerland. Both represent key issues for treatment as prevention and underline the importance of early diagnosis and of early and continuous treatment.

Mélanges de littérature. 1 / Stendhal ; établissement du texte et préfaces par Henri Martineau

Collection : Le Livre du divan ; 1-3

Antropología de la Educación 1 : la constitución de las ciencias sociales.

Manual dirigido a los estudiantes de Educación y sus especialidades. Parte de conferir a la Educación el alcance de fenómeno que invade todos los ámbitos de la vida humana y por ello, genuinamente antropológico. Es por esta razón que la Educación, Pedagogía o Ciencias de la Educación, se sitúa en el cruce de otros saberes antropológicos que, positivizados -hechos objeto de conocimiento científico-, dan contenido a la aparición de la gran confederación de ciencias antropológicas, agrupadas bajo las denominaciones de ciencias humanas o sociales, cuyo territorio está delimitado por la filosofía y por las historias y, entre medias: la psicología, sociología, política, economía, demografía, etc. Este primer volumen se centra, metodológicamente, en poner de relieve el soporte de las ciencias sociales en la comprensión de la antropología integral y, desde aquí, la contribución de todas ellas a la construcción de un pensameinto global sobre el fenómeno de la Educación, con visión antropológica. El manual se divide en cinco capítulos.

La investigaci??n educativa sobre la universidad : actas de las jornadas : Madrid, 31 mayo - 1 junio 1990

Se recogen las ponencias y comunicaciones presentadas a las Jornadas sobre la investigaci??n educativa en la Universidad, organizadas por el CIDE y por la Divisi??n de Investigaci??n del ICE de la Universidad Polit??cnica de Madrid, celebradas durante los d??as 31 de mayo y 1 de junio de 1990. El material reunido se divide en tres grandes bloques tem??ticos: el acceso a la Universidad, el rendimiento acad??mico y las actitudes y condiciones de la vida del estudiante.

Modelagem e estimação de parâmetros genéticos e fenotípicos para pesos do nascimento à seleção (378 dias) de machos Nelore

Genetic parameters for weights (17, 942 records), obtained in intervals of 60 days, from the birth to selection (378 days of age), of 2,582 males of the Nellore breed was estimated in univariate analyses by the Maximum Restricted Likelihood method. The models of analysis models included the fixed effects of contemporary groups, month of birth, mother age and age when the weights were collected as covariate. Three models differing in random effects were tested: the model 1 (M1) was adjusted for the direct and maternal addictive genetic effects and maternal permanent environment; in model 2 (M2) the maternal genetic effect was excluded; and the model 3 (M3) was only adjusted for the direct addictive genetic effect. The test of likelihood (LRT) detected significant differences, for all the ages, of M2 and M1 in relation to the simple model (M3), evidencing the importance of the maternal effects. Except for the birth weight (0.40), low values (0.05 to 0.12) of h(2) were found for M1 and M2 until 8 months of age and, after this period, reasonable increase could be observed, reaching 0.28 until 13 months of age. The estimates of the total variance fraction, due to the effect of maternal permanent environment, were high and practically became unaffected between the models 1 and 2. Maternal effects, not necessarily decomposed (in genetic addictive and permanent environment), affected the Nellore males growth. Models that contemplate maternal effects, besides the genetic addictive direct effects, are more realistic to describe the trajectory of the variances in the initial phases of growth of Nelore male calves.

Seleção para peso pós-desmama em um rebanho Gir. 1. Resposta direta e correlacionada em 21 anos de seleção

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estimativas de tendências e parâmetros genéticos do peso padronizado aos 378 dias de idade, medidas corporais e perímetro escrotal de machos Nelore de Sertãozinho, SP

Os objetivos deste estudo foram estimar as tendências e os parâmetros genéticos e fenotípicos do peso padronizado aos 378 dias de idade (P378), medidas corporais e perímetro escrotal de machos Nelore, pertencentes às populações selecionadas e controle da Estação Experimental de Zootecnia de Sertãozinho. As herdabilidades, estimadas considerando-se modelo de touro e modelo animal, foram, respectivamente, 0,53±0,12 e 0,36 para P378; 0,38±0,11 e 0,58 para altura na garupa; 0,31±0,10 e 0,10 para perímetro torácico; 0,40± 0,11 e 0,13 para comprimento do corpo; 0,39±0,11 e 0,30 para comprimento do dorso; 0,33±0,10 e 0,12 para comprimento da garupa; 0,08± 0,07 e 0,14 para distância de ísquios; 0,23±0,09 e 0,08 para distância de íleos e 0,57±0,13 e 0,44 para perímetro escrotal. A correlação genética mais alta entre P378 e medidas corporais foi encontrada para perímetro torácico (0,86 ± 0,08); as demais variaram de 0,46 a 0,72. Os resultados deste estudo mostraram que, em função dos valores médios a altos das herdabilidades estimadas para P378 e da maioria das características de medidas do corpo dos animais, houve considerável variação genética aditiva nesses atributos. Além disso, devido às altas correlações genéticas de P378 com a maioria das características, pode-se concluir ser bastante provável que grande parte dos genes que controlam o peso pós-desmame também seja responsável pelo desenvolvimento das diferentes regiões do corpo de machos Nelore. A magnitude desses parâmetros justifica a tendência genética positiva nas características de seleção direta e nas secundárias.