The Research Patient Data Repository (RPDR) is a clinical data registry that gathers medical records from various hospital systems and stores them centrally in one data warehouse. Research ...investigators can obtain aggregate total of patients that meet specific query criteria and can obtain patient identifiers and complete electronic medical records through the RPDR with IRB approval. The existence of the RPDR is a critical resource to the Partners HealthCare System research community and supports many millions of dollars in clinical research. We have calculated the benefits of such a research system to help justify its establishment in other healthcare entities.
The demands on a pulmonary arterial hypertension (PAH) treatment algorithm are multiple and in some ways conflicting. The treatment algorithm usually includes different types of recommendations with ...varying degrees of scientific evidence. In addition, the algorithm is required to be comprehensive but not too complex, informative yet simple and straightforward. The type of information in the treatment algorithm are heterogeneous including clinical, hemodynamic, medical, interventional, pharmacological and regulatory recommendations. Stakeholders (or users) including physicians from various specialties and with variable expertise in PAH, nurses, patients and patients’ associations, healthcare providers, regulatory agencies and industry are often interested in the PAH treatment algorithm for different reasons. These are the considerable challenges faced when proposing appropriate updates to the current evidence-based treatment algorithm.The current treatment algorithm may be divided into 3 main areas: 1) general measures, supportive therapy, referral strategy, acute vasoreactivity testing and chronic treatment with calcium channel blockers; 2) initial therapy with approved PAH drugs; and 3) clinical response to the initial therapy, combination therapy, balloon atrial septostomy, and lung transplantation. All three sections will be revisited highlighting information newly available in the past 5 years and proposing updates where appropriate. The European Society of Cardiology grades of recommendation and levels of evidence will be adopted to rank the proposed treatments.
The addition of aqueous pH 7 solutions of 7.2×10
-3
M pertechnetate to dilute aqueous 2.5% MeOH solutions containing a water-solubilized sapphyrin, ...3,12,13,22-tetraethyl-8,17-bisbis(hydroxyethyl)-amino)carbonylethyl-2,7,18,23-tetramethylsapphyrin (1), gives rise to spectroscopic changes in the UV-Vis spectrum of 1 that are consistent with anion-binding and sapphyrin deaggregation. The spectroscopic changes induced by pertechnetate were found to differ dramatically from those induced by the addition of either pure water or dilute nitric acid; however, they were found to parallel those seen when sodium phosphate was added to solutions of 1 under analogous experimental conditions. Fits of the spectroscopic titration data to a 1:1 binding profile revealed that the effective K describing the interaction of pertechnetate anion with 1 was ca. 3900±300 M
-1
; this value compares to the effective K of 23000±3000 M
-1
that describes the corresponding interaction of sodium phosphate with 1.
The first comparative kinetic study of the addition of the isolobal and isosteric CO and N2 ligands to a spin triplet organometallic compound, i.e. Cp*MoCl(PMe3)2, is reported. A fast and ...quantitative addition process occurred when interacting Cp*MoCl(PMe3)2 with CO, which is followed by a subsequent slower process involving PMe3 replacement and formation of Cp*MoCl(CO)2(PMe3). The N2 addition, on the other hand, is much slower and proceeds incompletely to an equilibrium position. The temperature dependence of this equilibrium gives the parameters for the reaction ΔH = −22.8 ± 2.1 kcal/mol and ΔS = −67 ± 7 cal·mol-1·K-1. The activation parameters for the CO addition are ΔH⧧ = 5.0 ± 0.3 kcal/mol and ΔS⧧ = −35 ± 4 cal·mol-1·K-1, while the activation parameters for the N2 addition are ΔH⧧ = 14.0 ± 1.0 kcal/mol and ΔS⧧ = −20 ± 3 kcal/mol. Extrapolation of the rates to 25 °C indicates a difference of more than three orders of magnitude: kCO = 29 ± 3 M-1 s-1 and kN2 = 0.014 ± 0.001 M-1 s-1. Theoretical calculations with full geometry optimization at the MP2 level have been carried out on the model systems CpMoCl(PH3)2 + L (L = CO or N2), the calculated energetics of the system being in agreement with experiment. The 16-electron CpMoCl(PH3)2 molecule is found to be more stable in the spin triplet state, the excited 1A‘ state being 10.9 kcal/mol higher in energy. The Mo−L bond formation is calculated to be exothermic by 27.9 kcal/mol for L = N2 and by 60.0 kcal/mol for L = CO. Calculations along the L addition coordinate show an initial ligand rearrangement related barrier for both the spin singlet and the spin triplet surfaces. After overcoming this barrier, the spin singlet curve descends in energy earlier for the CO vs the N2 addition as expected from greater diffuseness of the CO donor and acceptor orbitals. As the N2 ligand continues to approach the metal, the 3A‘‘ surface becomes increasingly repulsive whereas the addition of CO leads to an attractive interaction and a bound triplet state.
Current ambient air quality standards are mass-based and restricted to PM
2.5 and PM
10 fractions. The major contribution to both PM
2.5 and PM
10 fractions is from particles belonging to the coarse ...mode and generated by mechanical processes. These standards are thus unable to effectively control particle concentrations from combustion sources, such as motor vehicles and power plants, which tend to emit very small particles that are almost entirely respirable and in the submicron range, and dominate the nucleation and accumulation modes, which contribute much less to particle mass concentration.
The aim of this work was to examine whether PM
1 and PM
10 would be a more effective combination of mass standards than PM
2.5 (dominant in the nucleation and accumulation modes) and PM
10 (dominant in the coarse mode) in controlling combustion-related ambient particles, as well as those originating from mechanical processes. First, a large body of data on particle size distributions in a range of environments in South East Queensland, Australia, was analysed, with an aim of identifying the relation between modality in the distributions and sources of particles belonging to different modes. The analyses included a matrix of the following elements: particle volume and number distributions, type of environment and locations of the modes in the range of PM
1, PM
2.5 and PM
10 fractions. Second, with the same aim, 600 published modal location values relating to number, surface area, volume and mass size distributions for a range of environments worldwide were analysed. The analysis identified a clear and distinct separation between the location of the modes for a substantial number of environments worldwide and particle metrics, which suggests that modality in particle size distributions may be a parameter that has potential to be used in the development of PM
1 air quality guidelines and standards. Based on these analyses, implications for choosing different mass standards for airborne particulate matter are discussed in the paper.
This paper presents the formulation of a simple method for the prediction of the additional stresses induced in frame type integral bridges due to thermal expansion of the deck. These stresses are ...controlled to a large extent by the restraint provided to the deck by the backfill soil adjacent to the abutments. The first part of the paper develops a realistic means of assessing appropriate equivalent elastic stiffness values for the backfill using results from recent high quality laboratory soil testing. A boundary element type approach is then used to derive approximate general expressions, written in terms of the soil stiffness and the flexural rigidity of the abutment, for the lateral and rotational restraint provided by both the abutment and soil. These expressions are subsequently manipulated into a form that enables designers to make use of standard frame analysis computer programs for the prediction of thermal expansion effects. The proposed method is shown to compare well with predictions obtained using a finite element model of the soil and structure.
The identity of the limiting HoIII species in aqueous solutions with high carbonate concentrations has been determined to be Ho(CO3)45−. Single crystals of Co(NH3)6Na(μ−H2O)(H2O)42Ho(CO3)4·4H2O were ...obtained by the addition of Co(NH3)63+ to an aqueous 0.04 M solution of HoIII in 2.1 M Na2CO3. The asymmetric unit contains the anion, Ho(CO3)45−, a Co(NH3)63+ cation and two Na+ cations, which are bound to H2O molecules in an edge‐sharing bioctahedral geometry. The Ho(CO3)45− anion is eight coordinate with four bidentate carbonate ligands bound to the Ho atom. The molecule has essentially C2v symmetry with two coplanar carbonates making a vane, which is perpendicular to a similar vane produced by the other two carbonate ligands. An alternative way to this view molecule is through the geometry of the C atoms, which are found in a distorted tetrahedron. The average Ho−O distance was determined to be 2.361(5) Å, while the average Ho−C distance was 2.784(6) Å. The IR and Raman spectra were determined in both the solid state and solution in order to confirm the solution speciation. The Raman data show a single CO32− stretch for the solid at 1062 cm−1. The solution data show multiple peaks with the most prominent being at 1048 cm−1, which is consistent with the literature reports of an equilibrium mixture. The IR data for the solids confirm the X‐ray results showing bidentate carbonate ligands by the splitting of the ν3 band of the CO32−. The crystal data for Co(NH3)6Na(μ‐H2O)(H2O)42Ho(CO3)4·4H2O are as follows: monoclinic space group P2/n, a = 8.7091(5) Å, b = 10.8744(6) Å, c = 15.7971(9) Å, β = 93.117(1)°, Z = 2, R1 = 0.0307, wR2 = 0.0756.
Ecdysone 20-monooxygenase is the insect cytochrome P-450 dependent steroid hydroxylase system responsible for the conversion of ecdysone to 20-hydroxyecdysone. Using an in vitro radioassay, the ...levels of ecdysone 20-monooxygenase activity were quantified during embryogenesis in the egg, and in the fat body and midgut tissues during the fourth larval, fifth larval, and pupal-pharate adult stadia of the tobacco hornworm Manduca sexta. Although basal, ecdysone 20-monooxygenase activity was detected during the latter stages of larval embryo-genesis. Postembryologically, a single major peak or increase was detected in both fat body and midgut tissues during each stadium. In the fourth larval instar, both fat body and midgut ecdysone 20-monooxygenase activities were found to peak in the latter half of the stadium at the time of spiracle apolysis; both activities dropped to basal levels by the time of ecdysis. During the fifth larval stadium, fat body steroid hydroxylase activity was found to rise during the feeding stage (days 1-4), then dropped back to basal levels by the onset of pharate pupal development on day 7 of the stadium. Midgut monoooxygenase activity during the fifth larval stadium, however, remained basal during the feeding stage, then rose dramatically to peak on day 5 with the onset of wandering, then dropped back to basal levels by the onset of pharate pupal development. Both fat body and midgut hydroxylase activities were basal during the pupal stage and only rose late in pharate-adult development, just prior to adult eclosion.
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