Complete arterial grafting for coronary artery disease?

AbstractJ Thorac Cardiovasc Surg 2003;125:782-

Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery – a systematic literature review

Many adult patients require temporary inotropic support after cardiac surgery. We reviewed the literature systematically to establish, present and classify the evidence regarding choice of inotropic drugs. The available evidence, while limited in quality and scope, supports the following observations; although all β-agonists can increase cardiac output, the best studied β-agonist and the one with the most favourable side-effect profile appears to be dobutamine. Dobutamine and phosphodiesterase inhibitors (PDIs) are efficacious inotropic drugs for management of the low cardiac output syndrome. Dobutamine is associated with a greater incidence of tachycardia and tachyarrhythmias, whereas PDIs often require the administration of vasoconstrictors. Other catecholamines have no clear advantages over dobutamine. PDIs increase the likelihood of successful weaning from cardiopulmonary bypass as compared with placebo. There is insufficient evidence that inotropic drugs should be selected for their effects on regional perfusion. PDIs also increase flow through arterial grafts, reduce mean pulmonary artery pressure and improve right heart performance in pulmonary hypertension. Insufficient data exist to allow selection of a specific inotropic agent in preference over another in adult cardiac surgery patients. Multicentre randomized controlled trials focusing on clinical rather than physiological outcomes are needed

Estudio y diseño de un mecanismo alternativo de comprimir muelles

En aquest treball s'han analitzat els compressors de molles de vehícle lleuger existents al mercat i s'ha proposat una solució de millora diferent dels ja existents.En este trabajo se han analizado los compresores de muelles de vehículo ligero existentes en el mercado y se ha propuesto una solución de mejora diferente a los ya existentes.In this work, the existing light vehicle spring compressors on the market have been analyzed and a different improvement solution to the existing ones has been proposed

Power in the Land

In 1542 William Ramsden bought his wife’s family home at Longley and so began a long association between the Ramsdens and Huddersfield which lasted until Sir John Frecheville Ramsden sold his greatly increased Huddersfield estate to the Corporation in 1920. This collection of essays is published to commemorate the centenary of that event. Seven local historians examine different aspects of the Ramsden family’s relationship with the town and its inhabitants, especially in the nineteenth century.  The book incorporates new research and gives fresh insights into the events which led to Huddersfield becoming ‘the town that bought itself’ a century ago

Pop stars and idolatry: an investigation of the worship of popular music icons, and the music and cult of Prince.

Prince is an artist who integrates elements from the sacred into his work. He uses popular iconography to present himself as an icon of consumer culture, as a deified ‘rock god’ worshipped by his fans, and as a preacher leading his audience like a congregation. His personality cult mixes spirituality and sexuality, and deals with issues of ecstasy and liberation, a transgressional approach that draws both controversy and public interest. This paper investigates Prince’s work and the role of the pop star as an icon within contemporary culture, an icon that contains a physicality and sexuality not present in contemporary western religious traditions. It discusses to what extent popular musical culture operates as a form of religious practice within contemporary western culture, and the implications that this has. The paper investigates the construction of Prince’s public character, his manipulation of the star system, and how he uses popular iconography to blur the distinctions between spirituality and sexuality, the idealised performer and the real world, the sacred and the profane, and the human and the divine. It explores how he possesses and is possessed by the audience, who enter into the hollow vessel he offers up to his fans

Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years: Results from the Radial Artery Patency and Clinical Outcomes trial

ObjectiveTo investigate the optimum conduit for coronary targets other than the left anterior descending artery, we evaluated long-term patencies and clinical outcomes of the radial artery, right internal thoracic artery, and saphenous vein through the Radial Artery Patency and Clinical Outcomes trial.MethodsAs part of a 10-year prospective, randomized, single-center trial, patients undergoing primary coronary surgery were allocated to the radial artery (n = 198) or free right internal thoracic artery (n = 196) if aged less than 70 years (group 1), or radial artery (n = 113) or saphenous vein (n = 112) if aged at least 70 years (group 2). All patients received a left internal thoracic artery to the left anterior descending, and the randomized conduit was used to graft the second largest target. Protocol-directed angiography has been performed at randomly assigned intervals, weighted toward the end of the study period. Grafts are defined as failed if there was occlusion, string sign, or greater than 80% stenosis, independently reported by 3 assessors. Analysis is by intention to treat.ResultsAt mean follow up of 5.5 years, protocol angiography has been performed in groups 1 and 2 in 237 and 113 patients, respectively. There are no significant differences within each group in preoperative comorbidity, age, or urgency. Patencies were similar for either of the 2 conduits in each group (log rank analysis, P = .06 and P = .54, respectively). The differences in estimated 5-year patencies were 6.6% (radial minus right internal thoracic artery) in group 1 and 2.9% (radial minus saphenous vein graft) in group 2.ConclusionAt mean 5-year angiography in largely asymptomatic patients, the selection of arterial or venous conduit for the second graft has not significantly affected patency. This finding offers surgeons, for now, enhanced flexibility in planning revascularization

The RadFxSat-2 Mission to Measure SEU Rates in FinFET Microelectronics

The RadFxSat-2 mission was launched January 17, 2021 with Virgin Orbit\u27s LauncherOne under the NASA ELaNa-20 initiative. RadFxSat-2 carries a radiation effects payload designed to investigate single event upsets (SEUs) in sub-65 nm commercial memories, including a FinFET-based memory. Sub-65 nm technologies have demonstrated enhanced sensitivity to low-energy protons, but current models have not considered low-energy protons as a source of SEUs. Missions utilizing the latest commercial technologies could experience a higher error rate than predicted. RadFxSat-2 was designed to assess SEU rates for FinFET SRAMs operated in low-Earth orbit (LEO), a proton-heavy environment. Details of the mission and data collected over the previous two years are presented. Results from RadFxSat-2 suggest that FinFET-based microelectronic technologies are suitable for high-performance, high-density storage in LEO

An adaptive agent model for analysing co-evolution of management and policies in a complex rangeland system

This paper describes an adaptive agent model of rangelands based on concepts of complex adaptive systems. The behavioural and biological processes of pastoralists, regulators, livestock, grass and shrubs are modelled as well as the interactions between these components. The evolution of the rangeland system is studied under different policy and institutional regimes that affect the behaviour and learning of pastoralists, and hence the state of the ecological system. Adaptive agent models show that effective learning and effective ecosystem management do not necessarily coincide and can suggest potentially useful alternatives to the design of policies and institutions. (C) 2000 Elsevier Science B.V

Pathways to Coastal Resiliency: The Adaptive Gradients Framework

Current and future climate-related coastal impacts such as catastrophic and repetitive flooding, hurricane intensity, and sea level rise necessitate a new approach to developing and managing coastal infrastructure. Traditional “hard” or “grey” engineering solutions are proving both expensive and inflexible in the face of a rapidly changing coastal environment. Hybrid solutions that incorporate natural, nature-based, structural, and non-structural features may better achieve a broad set of goals such as ecological enhancement, long-term adaptation, and social benefits, but broad consideration and uptake of these approaches has been slow. One barrier to the widespread implementation of hybrid solutions is the lack of a relatively quick but holistic evaluation framework that places these broader environmental and societal goals on equal footing with the more traditional goal of exposure reduction. To respond to this need, the Adaptive Gradients Framework was developed and pilot-tested as a qualitative, flexible, and collaborative process guide for organizations to understand, evaluate, and potentially select more diverse kinds of infrastructural responses. These responses would ideally include natural, nature-based, and regulatory/cultural approaches, as well as hybrid designs combining multiple approaches. It enables rapid expert review of project designs based on eight metrics called “gradients”, which include exposure reduction, cost efficiency, institutional capacity, ecological enhancement, adaptation over time, greenhouse gas reduction, participatory process, and social benefits. The framework was conceptualized and developed in three phases: relevant factors and barriers were collected from practitioners and experts by survey; these factors were ranked by importance and used to develop the initial framework; several case studies were iteratively evaluated using this technique; and the framework was finalized for implementation. The article presents the framework and a pilot test of its application, along with resources that would enable wider application of the framework by practitioners and theorists