Hemoglobin level is an independent predictor for adverse cardiovascular outcomes in women undergoing evaluation for chest pain Results from the National Heart, Lung, and Blood Institute women's ischemia syndrome evaluation study

AbstractObjectivesThis study was designed to investigate the relationship between hemoglobin level (Hgb) and adverse cardiovascular outcomes in women with suspected ischemia.BackgroundLow Hgb levels correlate with increased cardiovascular morbidity and mortality in patients presenting with acute myocardial infarction (MI) or congestive heart failure (CHF). However, the prognostic significance of Hgb in women with suspected ischemia is unclear.MethodsAs part of the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE), we prospectively studied 936 women referred for coronary angiography to evaluate suspected ischemia. We compared Hgb levels with cardiovascular risk factors, core lab interpreted angiograms, inflammatory markers, and adverse cardiovascular outcomes.ResultsOf women enrolled, 864 (mean age 58.4 ±11.6 years) had complete Hgb, angiogram, and follow-up (mean 3.3 ± 1.7 years) data. The mean Hgb was 12.9 g/dl (range 7.7 to 16.4 g/dl) and 184 women (21%) were anemic (Hgb <12 g/dl). Anemic women had higher creatinine and were more likely to be nonwhite and have a history of diabetes, hypertension, and CHF (p < 0.05). However, we found no difference in EF or severity of coronary artery disease. Anemic women had a higher risk of death from any cause (10.3% vs. 5.4%; p = 0.02) and total adverse outcomes (26% vs. 16%, p < 0.01). In a multivariable model, decreasing Hgb was associated with significantly higher risk of adverse outcomes (hazard ratio = 1.20, p = 0.002). Also, anemic women had shorter survival time free of adverse outcome (p < 0.001).ConclusionsOur findings extend previous reports, linking lower hemoglobin levels with higher risk for adverse cardiovascular outcomes, to women evaluated for suspected ischemia in the absence of acute MI or CHF

Transportation Energy Futures Series: Freight Transportation Demand: Energy-Efficient Scenarios for a Low-Carbon Future

Freight transportation demand is projected to grow to 27.5 billion tons in 2040, and to nearly 30.2 billion tons in 2050. This report describes the current and future demand for freight transportation in terms of tons and ton-miles of commodities moved by truck, rail, water, pipeline, and air freight carriers. It outlines the economic, logistics, transportation, and policy and regulatory factors that shape freight demand, the trends and 2050 outlook for these factors, and their anticipated effect on freight demand. After describing federal policy actions that could influence future freight demand, the report then summarizes the capabilities of available analytical models for forecasting freight demand. This is one in a series of reports produced as a result of the Transportation Energy Futures project, a Department of Energy-sponsored multi-agency effort to pinpoint underexplored strategies for reducing GHGs and petroleum dependence related to transportation

Threshold Haemoglobin Levels and the Prognosis of Stable Coronary Disease: Two New Cohorts and a Systematic Review and Meta-Analysis

Background: Low haemoglobin concentration has been associated with adverse prognosis in patients with angina and myocardial infarction (MI), but the strength and shape of the association and the presence of any threshold has not been precisely evaluated.Methods and findings: A retrospective cohort study was carried out using the UK General Practice Research Database. 20,131 people with a new diagnosis of stable angina and no previous acute coronary syndrome, and 14,171 people with first MI who survived for at least 7 days were followed up for a mean of 3.2 years. Using semi-parametric Cox regression and multiple adjustment, there was evidence of threshold haemoglobin values below which mortality increased in a graded continuous fashion. For men with MI, the threshold value was 13.5 g/dl (95% confidence interval [CI] 13.2-13.9); the 29.5% of patients with haemoglobin below this threshold had an associated hazard ratio for mortality of 2.00 (95% CI 1.76-2.29) compared to those with haemoglobin values in the lowest risk range. Women tended to have lower threshold haemoglobin values (e. g, for MI 12.8 g/dl; 95% CI 12.1-13.5) but the shape and strength of association did not differ between the genders, nor between patients with angina and MI. We did a systematic review and meta-analysis that identified ten previously published studies, reporting a total of only 1,127 endpoints, but none evaluated thresholds of risk.Conclusions: There is an association between low haemoglobin concentration and increased mortality. A large proportion of patients with coronary disease have haemoglobin concentrations below the thresholds of risk defined here. Intervention trials would clarify whether increasing the haemoglobin concentration reduces mortality

Integrated stand for the fiber optics technique operations

W artykule przedstawiono zintegrowane stanowisko pozwalające wykonywać operacje spotykane w laboratoryjnej praktyce techniki światłowodowej i badać poprawność ich realizacji. W szczególności możliwe jest przygotowanie końcówki światłowodowej za pomocą cięcia, klejenia żywicą, szlifowania z polerowaniem czoła światłowodu. Dodatkowe wyposażenie pozwala również na montaż elementów optoelektronicznych ze światłowodami. W artykule zamieszczono wyniki badań wykonanych końcówek światłowodowych.In the paper a integrated stand for the optical fiber technique operations met in the laboratory practice is presented. The stand allows preparing the fiber ends using such operations as cutting, gluing with epoxy resin, end surface grinding and polishing as well as the quality study of prepared ends. An additional equipment makes possible to assemble optoelectronics elements with optical fibers. Some results of the prepared optical fiber ends are given