Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease

AbstractThe consecutive 2 year experience with patients undergoing first-time surgery for mitral regurgitation with and without coronary artery disease was reviewed. From January 1988 to January 1990, 127 patients with pure mitral regurgitation undergoing first-time operation were surgically treated. No other valve lesion, no reoperation and no congenital defects were included. The mean patient age was 62 years with 26% of the patients > 70 years. Twenty-six percent of the entire group was in functional class IV. Seventy-five patients received mitral valve repair and 52 underwent mitral valve replacement with a St. Jude or Hancock valve. In patients undergoing mitral valve repair, there was a higher incidence of those > 70 years old and of coronary artery disease and in patients undergoing mitral valve replacement there was a higher incidence of functional class IV.The operative mortality rate was 2.3% (3 of 127 patients). No patient failed to be discontinued from cardiopulmonary bypass and all three deaths occurred after mitral valve replacement, with one from complications of chronic renal failure and dialysis. There was no significant difference in patients who either did or did not have a concomitant coronary artery bypass graft and there was no difference related to age or functional class. Postoperative complications occurred in five patients in the valve repair group, including recurrent mitral regurgitation in two necessitating reoperation, and in three patients in the valve replacement group.With newer operative and postoperative management techniques, especially preservation of the papillary muscle annular continuity, the risk of mitral valve surgery, particularly of valve repair, is considerably lower than in previous years

The VISTA Science Archive

We describe the VISTA Science Archive (VSA) and its first public release of data from five of the six VISTA Public Surveys. The VSA exists to support the VISTA Surveys through their lifecycle: the VISTA Public Survey consortia can use it during their quality control assessment of survey data products before submission to the ESO Science Archive Facility (ESO SAF); it supports their exploitation of survey data prior to its publication through the ESO SAF; and, subsequently, it provides the wider community with survey science exploitation tools that complement the data product repository functionality of the ESO SAF. This paper has been written in conjunction with the first public release of public survey data through the VSA and is designed to help its users understand the data products available and how the functionality of the VSA supports their varied science goals. We describe the design of the database and outline the database-driven curation processes that take data from nightly pipeline-processed and calibrated FITS files to create science-ready survey datasets. Much of this design, and the codebase implementing it, derives from our earlier WFCAM Science Archive (WSA), so this paper concentrates on the VISTA-specific aspects and on improvements made to the system in the light of experience gained in operating the WSA.Comment: 22 pages, 16 figures. Minor edits to fonts and typos after sub-editting. Published in A&

Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults

Multi-model simulations of the impact of international shipping on Atmospheric Chemistry and Climate in 2000 and 2030

The global impact of shipping on atmospheric chemistry and radiative forcing, as well as the associated uncertainties, have been quantified using an ensemble of ten state-of-the-art atmospheric chemistry models and a predefined set of emission data. The analysis is performed for present-day conditions ( year 2000) and for two future ship emission scenarios. In one scenario ship emissions stabilize at 2000 levels; in the other ship emissions increase with a constant annual growth rate of 2.2% up to 2030 ( termed the "Constant Growth Scenario" (CGS)). Most other anthropogenic emissions follow the IPCC ( Intergovernmental Panel on Climate Change) SRES ( Special Report on Emission Scenarios) A2 scenario, while biomass burning and natural emissions remain at year 2000 levels. An intercomparison of the model results with observations over the Northern Hemisphere (25 degrees - 60 degrees N) oceanic regions in the lower troposphere showed that the models are capable to reproduce ozone (O-3) and nitrogen oxides (NOx= NO+ NO2) reasonably well, whereas sulphur dioxide (SO2) in the marine boundary layer is significantly underestimated. The most pronounced changes in annual mean tropospheric NO2 and sulphate columns are simulated over the Baltic and North Seas. Other significant changes occur over the North Atlantic, the Gulf of Mexico and along the main shipping lane from Europe to Asia, across the Red and Arabian Seas. Maximum contributions from shipping to annual mean near-surface O-3 are found over the North Atlantic ( 5 - 6 ppbv in 2000; up to 8 ppbv in 2030). Ship contributions to tropospheric O3 columns over the North Atlantic and Indian Oceans reach 1 DU in 2000 and up to 1.8 DU in 2030. Tropospheric O-3 forcings due to shipping are 9.8 +/- 2.0 mW/m(2) in 2000 and 13.6 +/- 2.3 mW/m(2) in 2030. Whilst increasing O-3, ship NOx simultaneously enhances hydroxyl radicals over the remote ocean, reducing the global methane lifetime by 0.13 yr in 2000, and by up to 0.17 yr in 2030, introducing a negative radiative forcing. The models show future increases in NOx and O-3 burden which scale almost linearly with increases in NOx emission totals. Increasing emissions from shipping would significantly counteract the benefits derived from reducing SO2 emissions from all other anthropogenic sources under the A2 scenario over the continents, for example in Europe. Globally, shipping contributes 3% to increases in O-3 burden between 2000 and 2030, and 4.5% to increases in sulphate under A2/CGS. However, if future ground based emissions follow a more stringent scenario, the relative importance of ship emissions will increase. Inter-model differences in the simulated O-3 contributions from ships are significantly smaller than estimated uncertainties stemming from the ship emission inventory, mainly the ship emission totals, the distribution of the emissions over the globe, and the neglect of ship plume dispersion

Paramaterizations of inclusive cross sections for pion production in proton-proton collisions. II. Comparison to new data

A set of new, precise data have recently been made available by the NA49 collaboration for charged pion production in proton-proton and proton-Carbon reactions at 158 GeV. The current paper compares this new data to five currently available arithmetic parameterizations. Although a precise fit is not expected, two of the parameterizations do not work very well but the other three are able to provide a moderately good, but not precise fit to the proton-proton data. The best two of these three parameterizations are scaled to the proton-Carbon data and again provide a moderately good, but not precise fit.Comment: 11 pages, 13 figures, Accepted for publication in Physical Review

Peritoneal and hemodialysis: I. Differences in patient characteristics at initiation

Peritoneal and hemodialysis: I. Differences in patient characteristics at initiation.BackgroundComparisons of mortality outcomes between peritoneal dialysis (PD) and hemodialysis (HD) patients have shown varying results, which may be caused by the unequally distributed clinical conditions of patients at initiation. To address this issue, we evaluated the clinical characteristics of 105,954 patients at the initiation of PD and HD, using the U.S. national incidence data on treated end-stage renal disease from the Medical Evidence Form, 1995 to 1997.MethodsA general linear model was used to analyze differences of age, albumin, creatinine, blood urea nitrogen (BUN), and hematocrit; categorical data analysis to evaluate body mass index (BMI), grouped into four categories: !19, 19–25 (!25), 25–30 (!30), and 30+; and logistic regression to assess the likelihood of initiating PD versus HD. Diabetics (DM) were analyzed separately from non-diabetics (NDM). Explanatory variables in the logistic regression included incidence year, race, gender, age, BMI, albumin, creatinine, BUN, and hematocrit. Race included white and black. Age was categorized into four groups: 20–44, 45–64, 65–74, and 75+.ResultsAt the initiation of dialysis PD patients were approximately 6 years younger (P ! 0.0001) than HD patients. PD patients also had higher (P ! 0.0001) albumin (+0.35 g/dL for DM and +0.23 g/dL for NDM) and hematocrit (+1.64% for DM and +1.71% for NDM) levels, and lower (P ! 0.04) BUN (-8.75 mg/dL for DM and -5.24 mg/dL for NDM) and creatinine (-0.51 mg/dL for DM and -0.23 mg/dL for NDM) levels than HD patients. Whites had a higher (P ! 0.0001) likelihood of starting PD than blacks, and patients with BMI !19 had a lower (P ! 0.0001) chance of beginning on PD.ConclusionPD patients had favorable clinical conditions at the initiation of dialysis, which should be taken into consideration when comparing dialysis outcomes between the two modalities

The UKIDSS Galactic Plane Survey

'The definitive version is available at www.blackwell-synergy.com .' Copyright Blackwell Publishing DOI: 10.1111/j.1365-2966.2008.13924.xThe UKIDSS Galactic Plane Survey (GPS) is one of the five near-infrared Public Legacy Surveys that are being undertaken by the UKIDSS consortium, using the Wide Field Camera on the United Kingdom Infrared TelescopePeer reviewe

A One Health investigation of Salmonella enterica serovar Wangata in north-eastern New South Wales, Australia, 2016-2017

Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.Whole genome sequencing for this project was supported by the NSW Public Health Pathogen Genomics Consortium, CIDM-PH, NSW Health