Collateral donor artery physiology and the influence of a chronic total occlusion on fractional flow reserve

Background— The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO. Methods and Results— In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product: 177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow: 306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P<0.001). Conclusions— Recanalization of a CTO results in a modest increase in the FFR of the predominant collateral donor vessel associated with a reduction in coronary flow. A larger increase in FFR is associated with greater coronary stenosis severity

Primary subfertility with partial septate uterus and longitudinal vaginal septum

A 22 year old married woman presented with the complaints of severe dyspareunia, difficulty in conceiving for 18 months, menorrhagia and dysmenorrhoea since menarche. Clinical examination revealed longitudinal vaginal septum. Ultrasound scan revealed two endometrial cavities with a single cervix. Hysterosalpingogram revealed septum which had separated the endometrial cavity with no free spillage of contrast media on both fallopian tubes. Ultrasound KUB and intravenous urethrography did not reveal any abnormality in the urinary system. Resection of vaginal septum, hysteroscopic septoplasty and diagnostic laparoscopy were performed. Three months after the surgery, she was relieved from the symptoms. However, no comments on fertility issue can be made at the moment as the couple is practicing contraceptive methods

New evidence for the intentional use of calomel as a white pigment

In this work we report the results of the in-situ application of micro-Raman spectroscopy to the analysis of two historic painted objects: a 15th-century illuminated manuscript and a late-16th-century portrait miniature. Both objects were unexpectedly found to contain calomel (Hg2Cl2), intentionally used as a white pigment. Calomel was a widespread and popular medicine until it fell out of use at the end of the 19th century due to its toxicity, and a material called ‘mercury white’ is referred to in 16th-century technical literature on painting. However, although calomel has been recognised in the past as a degradation product of cinnabar in both wall and easel paintings, its deliberate use as a pigment on cultural heritage objects has only been documented recently, in white areas painted on 17th-century South American objects. The present study describes the first-ever verified use of calomel as a white pigment on European works of art, both of which pre-date its documented use in South America

Evaluation of potential risk of transmission of avian influenza A viruses at live bird markets in response to unusual crow die-offs in Bangladesh

In response to unusual crow die‐offs from avian influenza A(H5N1) virus infection during January‐February 2017 in Dhaka, Bangladesh, a One Health team assessed potential infection risks in live bird markets (LBMs). Evidence of aerosolized avian influenza A viruses was detected in LBMs and in the respiratory tracts of market workers, indicating exposure and potential for infection. This study highlighted the importance of surveillance platforms with a coordinated One Health strategy to investigate and mitigate zoonotic risk

Self-organized stable pacemakers near the onset of birhythmicity

General amplitude equations for reaction-diffusion systems near to the soft onset of birhythmicity described by a supercritical pitchfork-Hopf bifurcation are derived. Using these equations and applying singular perturbation theory, we show that stable autonomous pacemakers represent a generic kind of spatiotemporal patterns in such systems. This is verified by numerical simulations, which also show the existence of breathing and swinging pacemaker solutions. The drift of self-organized pacemakers in media with spatial parameter gradients is analytically and numerically investigated.Comment: 4 pages, 4 figure

A comparative force assessment of 4 methods to move a patient up a bed

This study compared four different postures and positions regularly suggested for moving a patient up towards the head of the bed, using both novice and expert users. The trial was carried out in a laboratory using 21 participants (10 novices and 11 experts). All participants completed all conditions (n = 4) three times each (n = 3 repetitions). The physical force at each hand was recorded using electronic four compression/tension meters, recorded on DasyLab software. After each condition a subjective review questionnaire was completed. The data was processed with excel and SPSS to evaluate the differences between the conditions. A significant statistical reduction was found when comparing combined force for all carers (F(3,27) = 24.63, p <.05) and the load per individual (F(2.21,44.21) = 27.26, p <.05). However there was found to be no statistical difference between left and right hand or upper or lower hand. Transfers carried out with the carer pulling the patient towards them corresponded with a lower force to complete the transfer. This study suggests that a position with an oblique offset base and an action of pull and push in line with the carer could be the preferred position for a wide range of patient transfers

Alternative Routes for a Proposed Nigerian Superhighway to Limit Damage to Rare Ecosystems and Wildlife

The Cross River State Government in Nigeria is proposing to construct a ‘‘Cross River Superhighway’’ that would bisect critical remaining areas of tropical rainforest in south eastern Nigeria. We offer and evaluate two alternative routes to the superhighway that would be less damaging to forests, protected areas, and biological diversity. The first alternative we identified avoids intact forests entirely while seeking to benefit agriculture and existing settlements. The second alternative also avoids intact forests while incorporating existing paved and unpaved roads to limit construction costs. As currently proposed, the superhighway would be 260 km long, would intersect 115 km of intact forests or protected areas, and would cost an estimated ～US$2.5 billion to construct. Alternative Routes 1 and 2 are only slightly longer (～290 and ～353 km, respectively) and have markedly lower estimated construction costs (～US$0.92 billion). Furthermore, the alternative routes would have negligible impacts on forests and protected areas and would be better aligned to benefit local communities and agriculture. We argue that alternative routings such as those we examined here could markedly reduce the economic and environmental costs, and potentially increase the socioeconomic benefits, for the proposed Cross River Superhighway

Contested Compliance Regimes in Global Production Networks: Insights from the Bangladesh Garment Industry

This article reports the findings of a field study on the emergence of collective agreements led by global brands enacting compliance measures to improve safety and working conditions in the Bangladesh garment industry. We explore how key actors in the Bangladesh garment sector who constitute the local production system of the global supply chain experienced the implementation of global agreements on factory safety. We argue that global safety compliance measures through multi-stakeholder initiatives provide legitimacy to multinational corporations and their global brands but do little to address the structural problems arising from exploitative pricing and procurement practices, which are the key reasons for deplorable working conditions in garment factories. Our findings indicate that neoliberal development policies of the state, where local economies are incorporated into global production networks, resulted in differential treatment and regulation of specific populations that comprise garment factory workers. The reconfiguration of state power to meet the demands of global supply chains also involved use of state violence to suppress dissent while undermining labour rights and working conditions. Our article contributes to the politicization of multinational corporations in global production chains by showing how contestations between workers, factory owners, the state, trade unions and multinational corporations create new private forms of governance and new regimes of compliance in the industr