BackgroundThe activation criteria for primary percutaneous coronary intervention (PPCI) includes chest pain in association with either ST-segment elevation (STEMI) or new-onset left bundle branch ...block (LBBB) on the ECG. However, defining LBBB as new is challenging acutely and the poor specificity of indeterminate chronicity LBBB may result in unnecessary PPCI activations. Published data are conflicting with regard to the utility of LBBB as a triage criterion for PPCI and subsequent outcomes are undefined.MethodsConsecutive patients attending a single UK tertiary centre for presumed PPCI between September 2008 and December 2010 were included (n=1328). The activation ECG was obtained from the hospital PPCI database, as were demographic data. Outcome data were obtained from notes and national databases. MACE was defined as a composite of mortality and unplanned revascularisation. Two interventionists blinded to patient outcome reviewed the angiographic images and adjudicated if the activation was appropriate.ResultsChest pain with LBBB (LBBB-activation) occurred in 88 patients (6.6%) of the PPCI cohort. Comparing LBBB-activations to those with STEMI demonstrated that LBBB-activations were older (mean age 70.3±12.4 vs 64.6±13.4 years; p<0.001) and less likely to be male (67.0% vs 76.8%; p=0.004). Otherwise, baseline demographics were similar. Eighteen (20.5%) patients with LBBB had an acute thrombotic coronary occlusion confirmed at angiography and received PPCI. The final adjudicated diagnoses for LBBB-activations were acute coronary syndrome (ACS) (39.8%), non-ACS cardiac (28.4%) and non-cardiac (31.8%). A history of previous MI (p=0.002) and presence of cardiogenic shock on arrival (p=0.04) were more prevalent in the appropriate LBBB-activations. One-year mortality and MACE were higher for appropriate LBBB-activations than the STEMI activations (27.8% vs 7.9%; p=0.002 (Abstract 026 figure 1) and 33.3% vs 9.1%; p<0.001 respectively).Abstract 026 Figure 1ConclusionsLess than half of LBBB-activations had an ACS and, of these, only half had a thrombotic coronary occlusion requiring PPCI. However, LBBB-activations have a significantly worse prognosis and merit urgent referral. Enhanced triage methods are required to correctly identify acute MI requiring PPCI in those with LBBB.Abstract 026 Figure 2
Current psychosocial and health behavioural covariates of past cosmetic surgery were assessed in a population-based sample (n = 14,100) aged 45-50 years, from the baseline survey of the Women’s ...Health Australia study. Seven percent (n = 982) reported having ever had cosmetic surgery. Multivariate analysis found that self-reported dieting frequency in the past year and body mass index were highly significant covariates of cosmetic surgery; perception about body weight was moderately significant, and satisfaction with body weight was unrelated. A higher likelihood of cosmetic surgery was also found for women who had ever been in a violent relationship, who had been verbally abused recently, smokers, those taking medication for sleep or nerves and those with private hospital insurance. There were moderate associations between cosmetic surgery and state of residence, higher occupational status, alcohol use, higher stress and poorer mental health. Life satisfaction, social support, recent life events, physical health, area of residence, country of birth and marital status, though all significant at the univariate level, were unrelated in multivariate analyses. The psychological and health implications of the findings are discussed.
This paper takes a critical look at the progress of the commercialisation of service robots. For over 20 years researchers and developers have been trying to develop robots for service or household ...applications. So far the forecast market potential has not been achieved. Service robots through the nature of their target applications are highly price sensitive and up to now the cost of sensors and controllers has proved prohibitively expensive. The commitment of Siemens to the development of a general purpose controller for mobile robots may provide industry with a much needed standard platform on which to develop commercial systems, but these need to become more user than developer orientated.
We present results on the mass, spin, and redshift distributions with phenomenological population models using the ten binary black hole mergers detected in the first and second observing runs ...completed by Advanced LIGO and Advanced Virgo. We constrain properties of the binary black hole (BBH) mass spectrum using models with a range of parameterizations of the BBH mass and spin distributions. We find that the mass distribution of the more massive black hole in such binaries is well approximated by models with no more than 1% of black holes more massive than \(45\,M_\odot\), and a power law index of \(\alpha = {1.3}^{+1.4}_{-1.7}\) (90% credibility). We also show that BBHs are unlikely to be composed of black holes with large spins aligned to the orbital angular momentum. Modelling the evolution of the BBH merger rate with redshift, we show that it is at or increasing with redshift with 93% probability. Marginalizing over uncertainties in the BBH population, we find robust estimates of the BBH merger rate density of \(R = {53.2}^{+55.8}_{-28.2}\) Gpc\(^{-3}\) yr\(^{-1}\) (90% credibility). As the BBH catalog grows in future observing runs, we expect that uncertainties in the population model parameters will shrink, potentially providing insights into the formation of black holes via supernovae, binary interactions of massive stars, stellar cluster dynamics, and the formation history of black holes across cosmic time.
A postal questionnaire was used to assess the symptoms, use of medical facilities, and employment status of patients with angina pectoris and normal coronary angiograms following cardiac ...catheterization. In a retrospective study of 187 patients, 66 had left ventricular dysfunction demonstrated by abnormal regional wall motion and 121 had normal left ventricular function. At follow-up twelve to forty-six months following catheterization, 89% with left ventricular dysfunction and 82% with normal ventricular function had continued to experience chest pain. There was no significant change in the admission rate to hospital because of chest pain or the proportion of patients who were working, after catheterization as compared with before, in either group. Some patients with left ventricular regional wall motion abnormalities appeared to have progressive left ventricular dysfunction. In a prospective study of 63 patients, detailed investigation of esophageal function was performed. Twenty-two patients had left ventricular wall motion abnormalities. The majority of the 41 patients with normal left ventricular wall motion had esophageal abnormalities that were treated appropriately. At follow-up six to twenty-four months following catheterization significantly fewer patients with normal left ventricular function continued to experience chest pain compared with those with left ventricular dysfunction. Following catheterization the hospital admission rate fell significantly and the proportion of patients working increased significantly in the group with normal left ventricular function. The hospital admission rate and employment status of patients with left ventricular dysfunction did not change significantly following angiography. These findings suggest, therefore, that investigation for and treatment of esophageal dysfunction should be performed in patients with angina pectoris, normal coronary angiograms, and normal left ventricular function.
Background Rotational atherectomy (RA) is an established treatment of heavily-calcified coronary stenoses. Previous data suggest higher procedural complication rates when Burr-to-Artery (BTA) ratios ...exceed 0.7; the manufacturer-recommended BTA being 0.6. Little contemporary data exists regarding safe and optimal burr sizing, which may be important when considering RA via the radial approach with lower-caliber guiding catheters. Methods Single-centre retrospective review of patients undergoing elective RA between 2004 and 2011. Procedural success was defined as successful stent deployment with residual stenosis <30%, and complications defined as death, pericardial effusion/tamponade, coronary dissection/perforation and emergent CABG. Demographic and outcome data were obtained from local/national databases and casenote review. Quantitative coronary angiographic analysis was performed on archived films. Results Elective RA was successful in 197/220 cases (89.5%) with 72% of cases male and 22% diabetic (mean age 71.1±8.9 years). Target vessel was LAD (50.9%), RCA (35.0%), LCx (10.9%) and LMS (3.2%). Mean reference diameter was 3.45±0.6 mm and mean diameter stenosis (DS) 71.9±12.9%. Maximum burr size/case ranged from 1.25–2 mm (mode 1.5 mm) with mean BTA 0.43±0.08. 10 procedural complications occurred (4.5%); one wire fracture, two dissections, three perforations, two emergency CABG, one unretractable burr and one death. No difference in mean BTA was observed between procedures with/without complications (0.38±0.03 vs 0.43±0.08; p=0.33), but residual DS was higher in those with complications (12.3±21.2 vs 58.8±31.2; p<0.01). No correlation was observed between maximum burr size and age, sex, DS or minimum luminal diameter. At 36-month follow-up mortality was 11.7% and target vessel revascularisation (TVR) 22.8%. Conclusions Elective RA with low BTA is associated with high procedural success and low complication rates. These data imply that elective RA with a lower BTA than recommended is both safe and effective and need not preclude a transradial approach.
Explosives detection via fast neutron transmission spectroscopy Overley, J.C.; Chmelik, M.S.; Rasmussen, R.J. ...
Nuclear instruments & methods in physics research. Section B, Beam interactions with materials and atoms,
10/2006, Letnik:
251, Številka:
2
Journal Article
Recenzirano
A review of a five-year project on detection of explosives in luggage is presented. Experimental methods are described. Explosive detection algorithms based on elemental distributions in a ...5-dimensional space are also described. Single-blind tests of the method suggest that a false-alarm rate of 4% and a detection rate of 93% are possible. Improvements in the method are suggested. Measurements of neutron total cross sections for chlorine are presented.
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