Left ventricular dysfunction is in most cases the consequence of myocardial ischemia. It may occur transiently during an attack of angina and usually it is reversible. It may persist over hours or ...even days in patients after an episode of ischemia followed by reperfusion, leading to the so-called condition of stunning. In patients with persistent limitation of coronary flow, left ventricular dysfunction may be present over months and years, or indefinitely in subjects with fibrosis, scar formation, and remodeling after myocardial infarction. However, chronic left ventricular dysfunction does not mean permanent or irreversible cell damage. Hypoperfused myocytes can remain viable but akinetic. This type of dysfunction has been called hibernating myocardium. The dysfunction due to hibernation can be partially or completely restored to normal by reperfusion. It is, therefore, important to clinically recognize a hibernating myocardium. In the present article we evaluate stunning and hibernation with respect to clinical decision making and, when possible, we refer to our ongoing clinical experience.
The aim of the present study was to evaluate insulin secretion by the pancreatic B cell in a group of patients with severe chronic pancreatitis and without overt diabetes. For this purpose we have ...measured plasma insulin and C-peptide peripheral levels in the fasting state and after a 100-g oral glucose load in 10 patients with severe chronic pancreatitis and fasting normoglycemia, and in 10 sex-, age-, and weight-matched healthy controls. As compared to normal subjects, patients with chronic pancreatitis showed: (1) significantly higher plasma glucose levels after oral glucose load (area under the plasma glucose curve 1708 +/- 142 vs 1208 +/- 47 mmol/liter X 240 min, P less than 0.005); (2) plasma insulin levels significantly higher at fasting (0.11 +/- 0.008 vs 0.08 +/- 0.005 nmol/liter, P less than 0.01) but not after oral glucose administration (area under the plasma insulin curve 79 +/- 12 vs 88 +/- 16 nmol/liter X 240 min); (3) significantly lower plasma C-peptide concentrations both in the fasting state (0.15 +/- 0.01 vs 0.54 +/- 0.05 nmol/liter, P less than 0.001) and after oral glucose load (area under the plasma C-peptide curve 211 +/- 30 vs 325 +/- 37 nmol/liter X 240 min, P less than 0.05). The finding of diminished plasma C-peptide levels suggests that chronic pancreatitis is associated with an impaired B-cell function even in the absence of overt diabetes. The increased or unchanged plasma insulin levels in spite of decreased plasma C-peptide concentrations indicate that in chronic pancreatitis insulin metabolism is reduced, most likely within the liver.
Index structures for structured documents Lee, Yong Kyu; Yoo, Seong-Joon; Yoon, Kyoungro ...
International Conference on Digital Libraries: Proceedings of the first ACM international conference on Digital libraries; 20-23 Mar. 1996,
04/1996
Conference Proceeding
...Dr. Hill recommended innovative approaches to effective solutions with an emphasis on creating partnerships to align stakeholder resources, increasing nursing's capacity and diversity, and ...redesigning nursing education and practice to optimize prevention. Education, Engagement, Environment, Evidence, Evaluation) Blood pressure, BMI, and weight reduction Diabetes and hypertension Blood pressure and diabetes improved Smoking cessation (education, counseling, and follow-up) Significant "quit" rate CVD risk with medication counseling and management Less CAD progression; all CVD risk factors lowered; decreased Framingham score CVD risk management cost evaluation Cost effective Table 1 Nurse Case Management Trials--Summary of Findings BMI = body mass index; CAD = coronary artery disease; CVD = cardiovascular disease.
Secondary indexes are often used in database management systems for secondary key retrieval. Although their use can improve retrieval time significantly, the cost of index maintenance and storage ...increases the overhead of the file processing application. The optimal set of indexed secondary keys for a particular application depends on a number of application dependent factors. In this paper a cost function is developed for the evaluation of candidate indexing choices and applied to the optimization of index selection. Factors accounted for include file size, the relative rates of retrieval and maintenance and the distribution of retrieval and maintenance over the candidate keys, index structure, and system charging rates. Among the results demonstrated are the increased effectiveness of secondary indexes for large files, the effect of the relative rates of retrieval and maintenance, the greater cost of allowing for arbitrarily formulated queries, and the impact on cost of the use of different index structures.
Six National Aeronautics and Space Administration (NASA) satellite projects containing twenty-one contracts with approximately 1,000 changes were investigated for the purpose of developing predictive ...models of contract change incidence which could be used for budgetary and control purposes. Of particular interest were the number, timing, and dollar amounts of changes that can be expected to occur on future contracts.
The research indicated that (1) change costs on satellite contracts have negative exponential frequency distributions, (2) contracts within the same project have the same average change costs, (3) the expected number of changes on a satellite contract is a function of the dollar size of the contract and the average project cost/change, and (4) change timing is influenced by many factors which tend to have a confounding effect on changes.
A procedure for collecting and analyzing change data and for developing suitable models is outlined. The primary limitations of the models relate to the fact that only NASA satellite contracts were involved and to the availability of a small data base for modeling.
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