In a randomized trial, 1905 patients with left main coronary artery disease were assigned to either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG). At 5 years, the ...rates of the composite of death, stroke, or myocardial infarction were not significantly different between the two groups.
In a randomized trial, over 1900 patients with left main coronary artery disease were assigned to percutaneous coronary intervention or coronary-artery bypass grafting. At 3 years, PCI was ...noninferior to CABG with respect to the rate of death, stroke, or myocardial infarction.
Left main coronary artery disease is associated with high morbidity and mortality owing to the large amount of myocardium at risk. European and U.S. guidelines recommend that most patients with left main coronary artery disease undergo coronary-artery bypass grafting (CABG).
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Randomized trials have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents might be an acceptable alternative for selected patients with left main coronary disease.
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Specifically, in the subgroup of patients with left main coronary disease in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial, the rate of a composite of death, stroke, myocardial infarction, . . .
This hugely informative and wide-ranging analysis on the management of projects, past, present and future, is written both for practitioners and scholars. Beginning with a history of the discipline's ...development, Reconstructing Project Management provides an extensive commentary on its practices and theoretical underpinnings, and concludes with proposals to improve its relevancy and value. Written not without a hint of attitude, this is by no means simply another project management textbook. The thesis of the book is that 'it all depends on how you define the subject'; that much of our present thinking about project management as traditionally defined is sometimes boring, conceptually weak, and of limited application, whereas in reality it can be exciting, challenging and enormously important. The book draws on leading scholarship and case studies to explore this thesis. The book is divided into three major parts. Following an Introduction setting the scene, Part 1 covers the origins of modern project management – how the discipline has come to be what it is typically said to be; how it has been constructed – and the limitations of this traditional model. Part 2 presents an enlarged view of the discipline and then deconstructs this into its principal elements. Part 3 then reconstructs these elements to address the challenges facing society, and the implications for the discipline, in the years ahead. A final section reprises the sweep of the discipline's development and summarises the principal insights from the book. This thoughtful commentary on project (and program, and portfolio) management as it has developed and has been practiced over the last 60-plus years, and as it may be over the next 20 to 40, draws on examples from many industry sectors around the world. It is a seminal work, required reading for everyone interested in projects and their management.
The ε4 allele of the apolipoprotein E gene (
APOE4
) is associated with cognitive decline during aging, is the greatest genetic risk factor for Alzheimer’s disease and has links to other ...neurodegenerative conditions that affect cognition. Increasing evidence indicates that
APOE
genotypes differentially modulate the function of the cerebrovasculature (CV), with apoE and its receptors expressed by different cell types at the CV interface (astrocytes, pericytes, smooth muscle cells, brain endothelial cells). However, research on the role of apoE in CV dysfunction has not advanced as quickly as other apoE-modulated pathways. This review will assess what aspects of the CV are modulated by
APOE
genotypes during aging and under disease states, discuss potential mechanisms, and summarize the therapeutic significance of the topic. We propose that
APOE4
induces CV dysfunction through direct signaling at the CV, and indirectly via modulation of peripheral and central pathways. Further, that
APOE4
predisposes the CV to damage by, and exacerbates the effects of, additional risk factors (such as sex, hypertension, and diabetes). ApoE4-induced detrimental CV changes include reduced cerebral blood flow (CBF), modified neuron-CBF coupling, increased blood–brain barrier leakiness, cerebral amyloid angiopathy, hemorrhages and disrupted transport of nutrients and toxins. The apoE4-induced detrimental changes may be linked to pericyte migration/activation, astrocyte activation, smooth muscle cell damage, basement membrane degradation and alterations in brain endothelial cells.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Hirsch, Devaney, and Smale's classic Differential Equations, Dynamical Systems, and an Introduction to Chaos has been used by professors as the primary text for undergraduate and graduate level ...courses covering differential equations. It provides a theoretical approach to dynamical systems and chaos written for a diverse student population among the fields of mathematics, science, and engineering. Prominent experts provide everything students need to know about dynamical systems as students seek to develop sufficient mathematical skills to analyze the types of differential equations that arise in their area of study. The authors provide rigorous exercises and examples clearly and easily by slowly introducing linear systems of differential equations. Calculus is required as specialized advanced topics not usually found in elementary differential equations courses are included, such as exploring the world of discrete dynamical systems and describing chaotic systems.
Classic text by three of the world's most prominent mathematicians Continues the tradition of expository excellenceContains updated material and expanded applications for use in applied studies
In the absence of conventional lymphatics, drainage of interstitial fluid and solutes from the brain parenchyma to cervical lymph nodes is along basement membranes in the walls of cerebral ...capillaries and tunica media of arteries. Perivascular pathways are also involved in the entry of CSF into the brain by the convective influx/glymphatic system. The objective of this study is to differentiate the cerebral vascular basement membrane pathways by which fluid passes out of the brain from the pathway by which CSF enters the brain. Experiment 1: 0.5 µl of soluble biotinylated or fluorescent Aβ, or 1 µl 15 nm gold nanoparticles was injected into the mouse hippocampus and their distributions determined at 5 min by transmission electron microscopy. Aβ was distributed within the extracellular spaces of the hippocampus and within basement membranes of capillaries and tunica media of arteries. Nanoparticles did not enter capillary basement membranes from the extracellular spaces. Experiment 2: 2 µl of 15 nm nanoparticles were injected into mouse CSF. Within 5min, groups of nanoparticles were present in the pial-glial basement membrane on the outer aspect of cortical arteries between the investing layer of pia mater and the glia limitans. The results of this study and previous research suggest that cerebral vascular basement membranes form the pathways by which fluid passes into and out of the brain but that different basement membrane layers are involved. The significance of these findings for neuroimmunology, Alzheimer’s disease, drug delivery to the brain and the concept of the Virchow–Robin space are discussed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
It has been known for decades that the application of pulsed direct current can significantly enhance the formability of metals. However, the detailed mechanisms of this effect have been difficult to ...separate from simple Joule heating. Here, we study the electroplastic deformation of Ti-Al (7 at.% Al), an alloy that is uniquely suited for uncoupling this behaviour because, contrary to most metals, it has inherently lower ductility at higher temperature. We find that during mechanical deformation, electropulsing enhances cross-slip, producing a wavy dislocation morphology, and enhances twinning, which is similar to what occurs during cryogenic deformation. As a consequence, dislocations are prevented from localizing into planar slip bands that would lead to the early failure of the alloy under tension. Our results demonstrate that this macroscopic electroplastic behaviour originates from defect-level microstructural reconfiguration that cannot be rationalized by simple Joule heating.
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International business (IB) research has predominantly relied on value constructs to account for the influence of societal culture, notably Hofstede's cultural dimensions. While parsimonious, the ...value approach's assumptions about the consensus of values within nations, and the generality and stability of cultural patterns of behavior are increasingly challenged. We review two promising alternatives - the constructive approach centering on schemas and the intersubjectivist approach centering on norms - and the evidence that demonstrates their usefulness in accounting for international differences in the behavior of managers, employees, and consumers. We propose a situated dynamics framework, specifying the role of values, schemas, and norms in accounting for cultural differences, and delineating conditions under which each causal mechanism is operative. Values play a more important role in accounting for cultural differences in weak situations where fewer constraints are perceived; schemas play a more important role when situational cues increase their accessibility and relevance; and norms play a more important role when social evaluation is salient. Directions for future research based on this integrative framework and its implications for the measurement of culture and application in IB are discussed.
Varying definitions of procedural myocardial infarction (PMI) are in widespread use.
This study sought to determine the rates and clinical relevance of PMI using different definitions in patients ...with left main coronary artery disease randomized to percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) surgery in the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial.
The pre-specified protocol definition of PMI (PMIProt) required a large elevation of creatine kinase-MB (CK-MB), with identical threshold for both procedures. The Third Universal Definition of MI (types 4a and 5) (PMIUD) required lesser biomarker elevations but with supporting evidence of myocardial ischemia, different after PCI and CABG. For the PMIUD, troponins were used preferentially (available in 49.5% of patients), CK-MB otherwise. The multivariable relationship between each PMI type and 5-year mortality was determined.
PMIProt occurred in 34 of 935 (3.6%) patients after PCI and 56 of 923 (6.1%) patients after CABG (difference −2.4%; 95% confidence interval CI: −4.4% to −0.5%; p = 0.015). The corresponding rates of PMIUD were 37 (4.0%) and 20 (2.2%), respectively (difference 1.8%; 95% CI: 0.2% to 3.4%; p = 0.025). Both PMIProt and PMIUD were associated with 5-year cardiovascular mortality (adjusted hazard ratio HR: 2.18 95% CI: 1.13 to 4.23 and 2.87 95% CI: 1.44 to 5.73, respectively). PMIProt was associated with a consistent hazard of cardiovascular mortality after both PCI and CABG (pinteraction = 0.86). Conversely, PMIUD was strongly associated with cardiovascular mortality after CABG (adjusted HR: 11.94; 95% CI: 4.84 to 29.47) but not after PCI (adjusted HR: 1.14; 95% CI: 0.35 to 3.67) (pinteraction = 0.004). Results were similar for all-cause mortality and with varying PMIUD biomarker definitions. Only large biomarker elevations (CK-MB ≥10× upper reference limit and troponin ≥70× upper reference limit) were associated with mortality.
The rates of PMI after PCI and CABG vary greatly with different definitions. In the EXCEL trial, the pre-specified PMIProt was associated with similar hazard after PCI and CABG, whereas PMIUD was strongly associated with mortality after CABG but not after PCI. (EXCEL Clinical Trial EXCEL; NCT01205776)
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