Brill's Companion to Greek Land Warfare Beyond the Phalanx brings together emerging and established scholars to build on the new consensus of multiform Greek warfare, on and off the battlefield, ...beyond the usual chronological, geographical, and operational boundaries.
Summary Background Diabetes is regarded as a coronary heart disease risk equivalent—ie, people with the disorder have a risk of coronary events similar to those with previous myocardial infarction. ...We assessed whether chronic kidney disease should be regarded as a coronary heart disease risk equivalent. Methods We studied a population-based cohort with measures of estimated glomerular filtration rate (eGFR) and proteinuria from Alberta, Canada. We used validated algorithms based on hospital admission and medical-claim data to classify participants with baseline history of myocardial infarction or diabetes and to ascertain which patients were admitted to hospital for myocardial infarction during follow-up (the primary outcome). For our primary analysis, we defined baseline chronic kidney disease as eGFR 15–59·9 mL/min per 1·73 m2 (stage 3 or 4 disease). We used Poisson regression to calculate unadjusted rates and relative rates of myocardial infarction during follow-up for five risk groups: people with previous myocardial infarction (with or without diabetes or chronic kidney disease), and (of those without previous myocardial infarction), four mutually exclusive groups defined by the presence or absence of diabetes and chronic kidney disease. Findings During a median follow-up of 48 months (IQR 25–65), 11 340 of 1 268 029 participants (1%) were admitted to hospital with myocardial infarction. The unadjusted rate of myocardial infarction was highest in people with previous myocardial infarction (18·5 per 1000 person-years, 95% CI 17·4–19·8). In people without previous myocardial infarction, the rate of myocardial infarction was lower in those with diabetes (without chronic kidney disease) than in those with chronic kidney disease (without diabetes; 5·4 per 1000 person-years, 5·2–5·7, vs 6·9 per 1000 person-years, 6·6–7·2; p<0·0001). The rate of incident myocardial infarction in people with diabetes was substantially lower than for those with chronic kidney disease when defined by eGFR of less than 45 mL/min per 1·73 m2 and severely increased proteinuria (6·6 per 1000 person-years, 6·4–6·9 vs 12·4 per 1000 person-years, 9·7–15·9). Interpretation Our findings suggest that chronic kidney disease could be added to the list of criteria defining people at highest risk of future coronary events. Funding Alberta Heritage Foundation for Medical Research.
Given the attendant risks of mortality and morbidity, acute MI remains a principal focus of cardiovascular therapeutics. ...30-day mortality and rehospitalization rates for acute MI are publicly ...reported in an effort to promote optimal acute MI care, and aspects of MI care delivery are the focus of local, regional, and national quality initiatives (1-3). Updates or revisions to the American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines for PCI, ST-segment elevation myocardial infarction (STEMI), and unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) have been published within the last 3 years, building upon prior versions published earlier in the decade (5-7).
Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center ...studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3% of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic shock were clinical variables independently associated with the development of no-reflow (p <0.001). The angiographic factors independently associated with no-reflow included longer lesion length, higher risk class C lesions, bifurcation lesions, and impaired preprocedure Thrombolysis In Myocardial Infarction flow (p <0.001). No-reflow was associated with greater in-hospital mortality (12.6% vs 3.8%, adjusted odds ratio 2.20, 95% confidence interval 1.97 to 2.47, p <0.001) and unsuccessful lesion outcome (29.7% vs 6.6%, adjusted odds ratio 4.70, 95% confidence interval 4.28 to 5.17, p <0.001) compared to patients without no-reflow. In conclusion, the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes.
The extinction of the dinosaurs Brusatte, Stephen L.; Butler, Richard J.; Barrett, Paul M. ...
Biological reviews of the Cambridge Philosophical Society,
20/May , Volume:
90, Issue:
2
Journal Article
Peer reviewed
Open access
ABSTRACT
Non‐avian dinosaurs went extinct 66 million years ago, geologically coincident with the impact of a large bolide (comet or asteroid) during an interval of massive volcanic eruptions and ...changes in temperature and sea level. There has long been fervent debate about how these events affected dinosaurs. We review a wealth of new data accumulated over the past two decades, provide updated and novel analyses of long‐term dinosaur diversity trends during the latest Cretaceous, and discuss an emerging consensus on the extinction's tempo and causes. Little support exists for a global, long‐term decline across non‐avian dinosaur diversity prior to their extinction at the end of the Cretaceous. However, restructuring of latest Cretaceous dinosaur faunas in North America led to reduced diversity of large‐bodied herbivores, perhaps making communities more susceptible to cascading extinctions. The abruptness of the dinosaur extinction suggests a key role for the bolide impact, although the coarseness of the fossil record makes testing the effects of Deccan volcanism difficult.
We show enhanced efficiency and stability of a high performance organic solar cell (OPV) when the work‐function of the hole collecting indium‐tin oxide (ITO) contact, modified with a ...solution‐processed nickel oxide (NiOx) hole‐transport layer (HTL), is matched to the ionization potential of the donor material in a bulk‐heterojunction solar cell. Addition of the NiOx HTL to the hole collecting contact results in a power conversion efficiency (PCE) of 6.7%, which is a 17.3% net increase in performance over the 5.7% PCE achieved with a poly(3,4‐ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) HTL on ITO. The impact of these NiOx films is evaluated through optical and electronic measurements as well as device modeling. The valence and conduction band energies for the NiOx HTL are characterized in detail through photoelectron spectroscopy studies while spectroscopic ellipsometry is used to characterize the optical properties. Oxygen plasma treatment of the NiOx HTL is shown to provide superior contact properties by increasing the ITO/NiOx contact work‐function by 500 meV. Enhancement of device performance is attributed to reduction of the band edge energy offset at the ITO/NiOx interface with the poly(N‐9′‐heptadecanyl‐2,7‐carbazole‐alt‐5,5‐(4′,7′‐di‐2‐thienyl‐2′,1′,3′‐benzothidiazole) (PCDTBT):6,6‐phenyl‐C61 butyric acid methyl ester PCBM and 6,6‐phenyl‐C71 butyric acid methyl ester (PC70BM) active layer. A high work‐function hole collecting contact is therefore the appropriate choice for high ionization potential donor materials in order to maximize OPV performance.
Enhanced efficiency and stability of a high performance organic solar cell is demonstrated when the hole collecting indium‐tin oxide contact is modified with solution‐processed nickel oxide and the high work‐function contact is matched with the donor ionization potential. We use photoemission spectroscopy to characterize the band edge positions in the contact layer, a multilayer matrix optical model and a diode model to explain the improvements in contact quality in comparison to the hole‐transport layer, polyethylene dioxythiophene:polystyrene sulfonate.
The current staging system for chronic kidney disease is based primarily on estimated glomerular filtration rate (eGFR) with lower eGFR associated with higher risk of adverse outcomes. Although ...proteinuria is also associated with adverse outcomes, it is not used to refine risk estimates of adverse events in this current system.
To determine the association between reduced GFR, proteinuria, and adverse clinical outcomes.
Community-based cohort study with participants identified from a province-wide laboratory registry that includes eGFR and proteinuria measurements from Alberta, Canada, between 2002 and 2007. There were 920 985 adults who had at least 1 outpatient serum creatinine measurement and who did not require renal replacement treatment at baseline. Proteinuria was assessed by urine dipstick or albumin-creatinine ratio (ACR).
All-cause mortality, myocardial infarction, and progression to kidney failure.
The majority of individuals (89.1%) had an eGFR of 60 mL/min/1.73 m(2) or greater. Over median follow-up of 35 months (range, 0-59 months), 27 959 participants (3.0%) died. The fully adjusted rate of all-cause mortality was higher in study participants with lower eGFRs or heavier proteinuria. Adjusted mortality rates were more than 2-fold higher among individuals with heavy proteinuria measured by urine dipstick and eGFR of 60 mL/min/1.73 m(2) or greater, as compared with those with eGFR of 45 to 59.9 mL/min/1.73 m(2) and normal protein excretion (rate, 7.2 95% CI, 6.6-7.8 vs 2.9 95% CI, 2.7-3.0 per 1000 person-years, respectively; rate ratio, 2.5 95% CI, 2.3-2.7). Similar results were observed when proteinuria was measured by ACR (15.9 95% CI, 14.0-18.1 and 7.0 95% CI, 6.4-7.6 per 1000 person-years for heavy and absent proteinuria, respectively; rate ratio, 2.3 95% CI, 2.0-2.6) and for the outcomes of hospitalization with acute myocardial infarction, end-stage renal disease, and doubling of serum creatinine level.
The risks of mortality, myocardial infarction, and progression to kidney failure associated with a given level of eGFR are independently increased in patients with higher levels of proteinuria.
How did evolution generate the extraordinary diversity of vertebrates on land? Zero species are known prior to ~380 million years ago, and more than 30,000 are present today. An expansionist model ...suggests this was achieved by large and unbounded increases, leading to substantially greater diversity in the present than at any time in the geological past. This model contrasts starkly with empirical support for constrained diversification in marine animals, suggesting different macroevolutionary processes on land and in the sea. We quantify patterns of vertebrate standing diversity on land during the Mesozoic-early Paleogene interval, applying sample-standardization to a global fossil dataset containing 27,260 occurrences of 4,898 non-marine tetrapod species. Our results show a highly stable pattern of Mesozoic tetrapod diversity at regional and local levels, underpinned by a weakly positive, but near-zero, long-term net diversification rate over 190 million years. Species diversity of non-flying terrestrial tetrapods less than doubled over this interval, despite the origins of exceptionally diverse extant groups within mammals, squamates, amphibians, and dinosaurs. Therefore, although speciose groups of modern tetrapods have Mesozoic origins, rates of Mesozoic diversification inferred from the fossil record are slow compared to those inferred from molecular phylogenies. If high speciation rates did occur in the Mesozoic, then they seem to have been balanced by extinctions among older clades. An apparent 4-fold expansion of species richness after the Cretaceous/Paleogene (K/Pg) boundary deserves further examination in light of potential taxonomic biases, but is consistent with the hypothesis that global environmental disturbances such as mass extinction events can rapidly adjust limits to diversity by restructuring ecosystems, and suggests that the gradualistic evolutionary diversification of tetrapods was punctuated by brief but dramatic episodes of radiation.
Procedures for testing organic solar cell devices and modules with respect to stability and operational lifetime are described. The descriptions represent a consensus of the discussion and ...conclusions reached during the first 3 years of the international summit on OPV stability (ISOS). The procedures include directions for shelf life testing, outdoor testing, laboratory weathering testing and thermal cycling testing, as well as guidelines for reporting data. These procedures are not meant to be qualification tests, but rather generally agreed test conditions and practices to allow ready comparison between laboratories and to help improving the reliability of reported values. Failure mechanisms and detailed degradation mechanisms are not covered in this report.
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► The consensus of ISOS-3 with respect to stability of organic solar cells is presented. ► Recommended procedures for measuring and reporting the stability of polymer solar cells is presented. ► Protocols were developed at 3 different levels: basic, intermediate, and advanced. ► Protocol categories include: dark, outdoor, and simulated laboratory weathering.
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