Assessment of the relationships between myocardial contractility and infarct tissue revealed by serial magnetic resonance imaging in patients with acute myocardial infarction

Imaging changes in left ventricular (LV) volumes during the cardiac cycle and LV ejection fraction do not provide information on regional contractility. Displacement ENcoding with Stimulated Echoes (DENSE) is a strain-encoded cardiac magnetic resonance (CMR) technique that measures strain directly. We investigated the relationships between strain revealed by DENSE and the presence and extent of infarction in patients with recent myocardial infarction (MI). 50 male subjects were invited to undergo serial CMR within 7 days of MI (baseline) and after 6 months (follow-up; n = 47). DENSE and late gadolinium enhancement (LGE) images were acquired to enable localised regional quantification of peak circumferential strain (Ecc) and the extent of infarction, respectively. We assessed: (1) receiver operating characteristic (ROC) analysis for the classification of LGE, (2) strain differences according to LGE status (remote, adjacent, infarcted) and (3) changes in strain revealed between baseline and follow-up. 300 and 258 myocardial segments were available for analysis at baseline and follow-up respectively. LGE was present in 130/300 (43 %) and 97/258 (38 %) segments, respectively. ROC analysis revealed moderately high values for peak Ecc at baseline [threshold 12.8 %; area-under-curve (AUC) 0.88, sensitivity 84 %, specificity 78 %] and at follow-up (threshold 15.8 %; AUC 0.76, sensitivity 85 %, specificity 64 %). Differences were observed between remote, adjacent and infarcted segments. Between baseline and follow-up, increases in peak Ecc were observed in infarcted segments (median difference of 5.6 %) and in adjacent segments (1.5 %). Peak Ecc at baseline was indicative of the change in LGE status between baseline and follow-up. Strain-encoded CMR with DENSE has the potential to provide clinically useful information on contractility and its recovery over time in patients with MI

How factors of collaboration affect delivery of construction projects with a high degree of reliance on building services; an action research and cross-case study analysis of Edinburgh primary schools

The construction industry has often been criticised for lack of collaboration and the effect this has on delivering value to Clients.This research was undertaken from the viewpoint of a practicing Quantity Surveyor (Professional Doctorate) to investigate how factors of collaborative procurement of building services (for clarity, the Mechanical, Electrical and Plumbing work servicing the building) affect the delivery of “Client defined value”. Focusing on the building services aspect was due to the high proportion of build value (£) this represents and the significance that collaboration has on this area.It was recognised that whilst authors and commentators noted the benefits of undertaking projects collaboratively with the supply chain, there appeared to be a gap in empirical evidence of practical outcomes from this approach. Whilst practitioners espoused that collaboration with the supply chain should provide Client value benefits, this was largely not evidenced by the Academy. It is this “gap” this research sought to explore through investigation.This exploratory / descriptive enquiry in to, what is considered a social phenomenon, combines constructivism and subjectivism, is interpretivist, and deploys a mixed-method approach; favouring a qualitative model in its narrative aspect. Due to the Professional Doctorate route, methods evolved over the research period; they include the use of Literature Review, Focus-groups, a degree of Action Research, Social Network Analysis and Cross-case Study Analysis.Key Findings support the existing literature in that the act of collaboration within construction project teams should have positive outcomes when enacted correctly and effectively. The research suggests however that the nature of individual actors within construction project teams, their personalities, their ability to trust and be trustworthy, and the way they interact with the project’s social network, has a significant impact on the effectiveness of Collaborative procurement approaches. This is potentially more acute in the area of Building Services especially when considering that “Client Value” parameters do not always consider this aspect discretely. The importance on Client leadership and them dictating their precise value requirements at an early stage is also commented on.Key words :Trust, Collaboration, Procurement, Knowledge Transfer, Client leadershi

Lake Michigan lower food web: Long-term observations and \u3ci\u3eDreissena\u3c/i\u3e impact

Lake Michigan has a long history of non-indigenous introductions that have caused significant ecological change. Here we present a summary of eight papers that document recent changes and the current state of the lower food web of southern Lake Michigan after the establishment of large dreissenid populations. Results are based on long-term data sets collected by federal and academic research and monitoring programs that place recent changes into a historic context. Dramatic and significant changes in the lower food web, such as the loss of the spring diatom bloom, large declines in phytoplankton productivity, and a decline of Mysis populations, were directly or indirectly attributed to the expansion of Dreissena rostriformis bugensis. Total phosphorus concentrations and loadings also have decreased in the last 20 years. Changes in the Lake Michigan ecosystem induced by D. r. bugensis have produced conditions in the offshore pelagic region that are similar to oligotrophic Lake Superior. The future state of the lower food web in southern Lake Michigan is difficult to predict, mainly because population trends of D.r. bugensis in cold, offshore regions are unknown. Hence, monitoring programs designed to collect long-term, consistent data on the lower food web of Lake Michigan are essential

AP’s Corner

Crossword and bridge problem

Eye movements during information processing tasks: Individual differences and cultural effects

AbstractThe eye movements of native English speakers, native Chinese speakers, and bilingual Chinese/English speakers who were either born in China (and moved to the US at an early age) or in the US were recorded during six tasks: (1) reading, (2) face processing, (3) scene perception, (4) visual search, (5) counting Chinese characters in a passage of text, and (6) visual search for Chinese characters. Across the different groups, there was a strong tendency for consistency in eye movement behavior; if fixation durations of a given viewer were long on one task, they tended to be long on other tasks (and the same tended to be true for saccade size). Some tasks, notably reading, did not conform to this pattern. Furthermore, experience with a given writing system had a large impact on fixation durations and saccade lengths. With respect to cultural differences, there was little evidence that Chinese participants spent more time looking at the background information (and, conversely less time looking at the foreground information) than the American participants. Also, Chinese participants’ fixations were more numerous and of shorter duration than those of their American counterparts while viewing faces and scenes, and counting Chinese characters in text

Amino Acid Substitutions at Position 43 of Nae I Endonuclease: EVIDENCE FOR CHANGES INNaeI STRUCTURE

NaeI endonuclease contains a 10-amino acid region with sequence similarity to the active site KXDG motif of DNA ligase except for leucine (Leu-43) in NaeI ((43)LXDG(46)). Changing Leu-43 to lysine abolishes the NaeI endonuclease activity and replaces it with topoisomerase and recombinase activities. Here we report the results of substituting Leu-43 with alanine, arginine, asparagine, glutamate, and histidine. Quantitating specific activities and DNA binding values for the mutant proteins determined the range of amino acids at position 43 that alter NaeI mechanism. Substituting alanine, asparagine, glutamate, and histidine for Leu-43 maintained endonuclease activity, but at a lower level. On the other hand, substituting positively charged arginine, like lysine at position 43, converted NaeI to a topoisomerase with no observable double-strand cleavage activity. The specific activities of NaeI-43K and NaeI-43R and their relative sensitivities to salt, the topoisomerase-inhibiting drug N-[4-(9-acridinylamino)-3-methoxyphenyl]methane-sulfonamide (amsacrine) and single-stranded DNA showed that the two activities are similar. The effect of placing a positive charge at position 43 on NaeI structure was determined by measuring (for NaeI and NaeI-43K) relative susceptibilities to proteolysis, UV, circular dichroism spectra, and temperature melting transitions. The results provide evidence that a positive charge at position 43 induces dramatic changes in NaeI structure that affect both the Endo and Topo domains of NaeI. The identification of four putative DNA ligase motifs in NaeI leads us to speculate that structural changes that superimpose these motifs on the ligase structure may account for the changes in activity

Diagnostic accuracy of 3.0-T magnetic resonance T1 and T2 mapping and T2-weighted dark-blood imaging for the infarct-related coronary artery in Non-ST-segment elevation myocardial infarction

Background: Patients with recent non–ST‐segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically. Methods and Results: We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2‐weighted short tau inversion recovery [T2W‐STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non–ST‐segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0‐T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct‐related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W‐STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct‐related artery were similar (P=0.125), and both were superior to T2W‐STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W‐STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001). Conclusions: In patients with non–ST‐segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W‐STIR for identifying the infarct‐related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non–ST‐segment elevation myocardial infarction. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422

International perspectives of nurses, midwives and allied health professionals clinical academic roles: Are we at tipping point?

© 2019 Debbie Carrick-Sen, Ann Moore, Patricia Davidson, Han Gendong, & Debra Jackson. Healthcare research activity improves patient outcomes. Nurses, Midwives and Allied Health Professions (NMAHPs) make an important contribution to clinical research. Within the United Kingdom (UK), there is a 25-year history of increasing healthcare research capacity and capability through clinical academic roles. Medical colleagues were the first to introduce the role in 2005. In 2007, a national policy identified inequalities in access to and success of research training fellowships between medical and nursing healthcare professionals. This was followed by a number of national initiatives, which continue to evolve to the present day. There is evidence that the UK has reached the 'tipping point' to increase NMAHP research capacity and capability through clinical academic roles. Despite these initiatives substantial gaps remain. Outside, the UK, the term 'clinical academic' is not well understood. There is evidence of the presence of senior clinical academic roles, a clinical professor within Australia and the United States, for example, but there is a lack of opportunities and of a formulised research training pathway at a junior level. There is interest and appreciation of the NMAHP research-active clinical academic within the clinical setting in the Nordic countries and China, but the pace of change is slow due to co-existing priorities involving change and innovation. There is a need to develop and agree both national and international definitions that describes the NMAHP research-focused clinical academic role activity