Aortic valve replacement in octogenarians

<p>Abstract</p> <p>Background and Aims</p> <p>As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR) in octogenarians.</p> <p>Methods</p> <p>68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37) underwent isolated AVR whilst 46% (31) underwent combined AVR and CABG.</p> <p>Results</p> <p>Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm². The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p < 0.05). Survival was not adversely affected by the addition of coronary artery bypass grafts to aortic valve replacement, the presence of peripheral vascular disease, hypertension or diabetes. In this study duration of cross clamp or bypass time were not found to reach significance as independent predictors of mortality.</p> <p>Conclusion</p> <p>Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.</p

The Detonation Mechanism of the Pulsationally-Assisted Gravitationally-Confined Detonation Model of Type Ia Supernovae

We describe the detonation mechanism comprising the "Pulsationally Assisted" Gravitationally Confined Detonation (GCD) model of Type Ia supernovae SNe Ia. This model is analogous to the previous GCD model reported in Jordan et al.(2008); however, the chosen initial conditions produce a substantively different detonation mechanism, resulting from a larger energy release during the deflagration phase. The resulting final kinetic energy and nickel-56 yields conform better to observational values than is the case for the "classical" GCD models. In the present class of models, the ignition of a deflagration phase leads to a rising, burning plume of ash. The ash breaks out of the surface of the white dwarf, flows laterally around the star, and converges on the collision region at the antipodal point from where it broke out. The amount of energy released during the deflagration phase is enough to cause the star to rapidly expand, so that when the ash reaches the antipodal point, the surface density is too low to initiate a detonation. Instead, as the ash flows into the collision region (while mixing with surface fuel), the star reaches its maximally expanded state and then contracts. The stellar contraction acts to increase the density of the star, including the density in the collision region. This both raises the temperature and density of the fuel-ash mixture in the collision region and ultimately leads to thermodynamic conditions that are necessary for the Zel'dovich gradient mechanism to produce a detonation. We demonstrate feasibility of this scenario with three 3-dimensional (3D), full star simulations of this model using the FLASH code. We characterized the simulations by the energy released during the deflagration phase, which ranged from 38% to 78% of the white dwarf's binding energy. We show that the necessary conditions for detonation are achieved in all three of the models.Comment: 22 pages, 8 figures; Ap

Direct dark matter detection around the corner? Prospects in the constrained MSSM

We outline the WIMP dark matter parameter space in the Constrained MSSM by performing a comprehensive statistical analysis that compares with experimental data predicted superpartner masses and other collider observables as well as a cold dark matter abundance. We find that 10.10 pbSI p10-8 pb for direct WIMP detection (with details slightly dependent on the assumptions made). We conclude that most of the 95% probability region for the cross section will be explored by future one-tonne detectors, that will therefore cover most of the currently favoured region of parameter space. \ua9 2007 IOP Publishing Ltd

Sensitivity and Insensitivity of Galaxy Cluster Surveys to New Physics

We study the implications and limitations of galaxy cluster surveys for constraining models of particle physics and gravity beyond the Standard Model. Flux limited cluster counts probe the history of large scale structure formation in the universe, and as such provide useful constraints on cosmological parameters. As a result of uncertainties in some aspects of cluster dynamics, cluster surveys are currently more useful for analyzing physics that would affect the formation of structure than physics that would modify the appearance of clusters. As an example we consider the Lambda-CDM cosmology and dimming mechanisms, such as photon-axion mixing.Comment: 24 pages, 8 eps figures. References added, discussion of scatter in relations between cluster observables lengthene

Sex-Related Differences in Violence Exposure, Neural Reactivity to Threat, and Mental Health

The prefrontal cortex (PFC), hippocampus, and amygdala play an important role in emotional health. However, adverse life events (e.g., violence exposure) affect the function of these brain regions, which may lead to disorders such as depression and anxiety. Depression and anxiety disproportionately affect women compared to men, and this disparity may reflect sex differences in the neural processes that underlie emotion expression and regulation. The present study investigated sex differences in the relationship between violence exposure and the neural processes that underlie emotion regulation. In the present study, 200 participants completed a Pavlovian fear conditioning procedure in which cued and non-cued threats (i.e., unconditioned stimuli) were presented during functional magnetic resonance imaging. Violence exposure was previously assessed at four separate time points when participants were 11-19 years of age. Significant threat type (cued versus non-cued) × sex and sex × violence exposure interactions were observed. Specifically, women and men differed in amygdala and parahippocampal gyrus reactivity to cued versus non-cued threat. Further, dorsolateral PFC (dlPFC) and inferior parietal lobule (IPL) reactivity to threat varied positively with violence exposure among women, but not men. Similarly, threat-elicited skin conductance responses varied positively with violence exposure among women. Finally, women reported greater depression and anxiety symptoms than men. These findings suggest that sex differences in threat-related brain and psychophysiological activity may have implications for mental health

Supersymmetry Without Prejudice

We begin an exploration of the physics associated with the general CP-conserving MSSM with Minimal Flavor Violation, the pMSSM. The 19 soft SUSY breaking parameters in this scenario are chosen so as to satisfy all existing experimental and theoretical constraints assuming that the WIMP is a conventional thermal relic, ie, the lightest neutralino. We scan this parameter space twice using both flat and log priors for the soft SUSY breaking mass parameters and compare the results which yield similar conclusions. Detailed constraints from both LEP and the Tevatron searches play a particularly important role in obtaining our final model samples. We find that the pMSSM leads to a much broader set of predictions for the properties of the SUSY partners as well as for a number of experimental observables than those found in any of the conventional SUSY breaking scenarios such as mSUGRA. This set of models can easily lead to atypical expectations for SUSY signals at the LHC.Comment: 61 pages, 24 figs. Refs., figs, and text added, typos fixed; This version has reduced/bitmapped figs. For a version with better figs please go to http://www.slac.stanford.edu/~rizz

Managing by design

This editorial written by myself and Marc Gruber of EPFL. It explores the role of design thinking in the management of large organisations, and focuses on how design principles can be applied to the design of the workplace and the nature of work itself. As Head of Service Design at the RCA, my contribution is on how to apply design thinking methods for managers and the 6 key elements described in this approach In the last decade the importance of design and the value of design thinking as a tool for innovation has been recognized by both business and government. Design has become a strategic tool for business helping to translate technological innovation into user value, connecting with consumer needs and creating compelling product and service experiences that create new business value. In this paper we consider a further application of design thinking by considering how managers can apply it to the design of the workplace experience. Many enterprises, especially those in the knowledge economy, are defined by their human resources and their capacity to attract and retain talent. In this competitive environment the design of the employee experience and the services that support them and enable them to deliver value to the clients and colleagues, is a key differentiator. Applying design thinking to the design of work itself, the systems that support it, and the physical and virtual environments in which it takes place can help business and organizational leaders to attract and retain top talent, as well as to enhance productivity and operational effectiveness. In this paper we explore the key factors and principles by which leaders and managers can apply design thinking to transform the workplace experience and we propose 6 key elements for managers to enable that transformation and enhance social capital and business and organisational performance

An international, phase III randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with long-term follow-up: and experience of conducting a clinical trial in a rare gynecological tumor

Objectives We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. Methods We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II–IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-capecitabine, paclitaxel-carboplatin-bevacizumab, or oxaliplatin-capecitabine-bevacizumab. Chemotherapy was given 3-weekly for 6 cycles, and bevacizumab (3-weekly) was continued as maintenance (for 12 cycles). Endpoints included overall-survival (OS), progression-free survival (PFS), toxicity and quality of life (QoL). Results The trial stopped after 50 patients were recruited due to slow accrual. Median follow-up was 59 months. OS hazard ratios (HR) for the two main comparisons were: 0.78 (p = 0.48) for Oxal-Cape vs. Pac-Carbo (each with/without bevacizumab), and 1.04 (p = 0.92) for bevacizumab vs. no bevacizumab. Corresponding PFS HRs were: 0.84 and 0.80. Retrospective central pathology review revealed only 45% (18/40) cases with available material had confirmed primary mEOC. Among these, OS HR for Oxal-Cape vs. Pac-Carbo was 0.36 (p = 0.14); PFS HR = 0.62 (p = 0.40). Grade 3–4 toxicity was seen in 61% Pac-Carbo, 61% Oxal-Cape, 54% Pac-Carbo-Bev, and 85% Oxal-Cape-Bev. QoL was similar between the four arms. Conclusion mEOC/GOG0241 represents an example of a randomized rare tumor trial. Logistical challenges led to early termination, including difficulties in local histopathological diagnosis and accessing drugs outside their labelled indication. There was misalignment between central funders who support clinical trials in rare cancers and the deprioritisation of such work by those managing and funding research at a local level. Rare cancer trials should include centralised pathology review before treatment. Clinical trial registry number: ISRCTN83438782