7,288 research outputs found

    An integral test of inelastic scattering cross sections using measured neutron spectra from thick shells of Ta, W, Mo, and Be

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    Integral test of inelastic scattering cross sections using measured neutron spectra from thick shells of Ta, W, Mo, and B

    Microvascular resistance predicts myocardial salvage and infarct characteristics in ST-elevation myocardial infarction

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    <b>Background:</b> The pathophysiology of myocardial injury and repair in patients with ST‐elevation myocardial infarction is incompletely understood. We investigated the relationships among culprit artery microvascular resistance, myocardial salvage, and ventricular function.<p></p> <b>Methods and Results:</b> The index of microvascular resistance (IMR) was measured by means of a pressure‐ and temperature‐sensitive coronary guidewire in 108 patients with ST‐elevation myocardial infarction (83% male) at the end of primary percutaneous coronary intervention. Paired cardiac MRI (cardiac magnetic resonance) scans were performed early (2 days; n=108) and late (3 months; n=96) after myocardial infarction. T2‐weighted‐ and late gadolinium–enhanced cardiac magnetic resonance delineated the ischemic area at risk and infarct size, respectively. Myocardial salvage was calculated by subtracting infarct size from area at risk. Univariable and multivariable models were constructed to determine the impact of IMR on cardiac magnetic resonance–derived surrogate outcomes. The median (interquartile range) IMR was 28 (17–42) mm Hg/s. The median (interquartile range) area at risk was 32% (24%–41%) of left ventricular mass, and the myocardial salvage index was 21% (11%–43%). IMR was a significant multivariable predictor of early myocardial salvage, with a multiplicative effect of 0.87 (95% confidence interval 0.82 to 0.92) per 20% increase in IMR; P<0.001. In patients with anterior myocardial infarction, IMR was a multivariable predictor of early and late myocardial salvage, with multiplicative effects of 0.82 (95% confidence interval 0.75 to 0.90; P<0.001) and 0.92 (95% confidence interval 0.88 to 0.96; P<0.001), respectively. IMR also predicted the presence and extent of microvascular obstruction and myocardial hemorrhage.<p></p> <b>Conclusion:</b> Microvascular resistance measured during primary percutaneous coronary intervention significantly predicts myocardial salvage, infarct characteristics, and left ventricular ejection fraction in patients with ST‐elevation myocardial infarction.<p></p&gt

    Calcite Kinetics for Spiral Growth and Two-Dimensional Nucleation

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    Calcite crystals grow by means of molecular steps that develop on {10.4} faces. These steps can arise stochastically via two-dimensional (2D) nucleation or emerge steadily from dislocations to form spiral hillocks. Here, we determine the kinetics of these two growth mechanisms as a function of supersaturation. We show that calcite crystals larger than ∼1 μm favor spiral growth over 2D nucleation, irrespective of the supersaturation. Spirals prevail beyond this length scale because slow boundary layer diffusion creates a low surface supersaturation that favors the spiral mechanism. Sub-micron crystals favor 2D nucleation at high supersaturations, although diffusion can still limit the growth of nanoscopic crystals. Additives can change the dominant mechanism by impeding spiral growth or by directly promoting 2D nucleation

    Glory Oscillations in the Index of Refraction for Matter-Waves

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    We have measured the index of refraction for sodium de Broglie waves in gases of Ar, Kr, Xe, and nitrogen over a wide range of sodium velocities. We observe glory oscillations -- a velocity-dependent oscillation in the forward scattering amplitude. An atom interferometer was used to observe glory oscillations in the phase shift caused by the collision, which are larger than glory oscillations observed in the cross section. The glory oscillations depend sensitively on the shape of the interatomic potential, allowing us to discriminate among various predictions for these potentials, none of which completely agrees with our measurements

    Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care

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    BACKGROUND & AIMS: There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care. METHODS: We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria. RESULTS: In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59). CONCLUSIONS: Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required

    Irritable Bowel Syndrome

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    Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder whose symptoms include abdominal pain associated with a change in stool form or frequency. The condition affects between 5% and 10% of otherwise healthy individuals in the community at any one point in time and, in most people, runs a relapsing and remitting course. The best described risk factor is acute enteric infection, but IBS is also more common in people with psychological co-morbidity, and in young adult females. The pathophysiology of IBS remains incompletely understood, but it is well established that there is disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered central nervous system processing. Other less reproducible mechanisms may include genetic associations, alterations in gastrointestinal microbiota, and disturbances in mucosal and immune function. In most people the diagnosis can be made based on the clinical history, with limited, judicious, use of investigations, unless alarm symptoms such as weight loss or rectal bleeding are present, or there is a family history of inflammatory bowel disease or coeliac disease. Once the diagnosis is made, an empathetic approach is key, and can improve quality of life and symptoms, and reduce health care expenditure. The mainstays of treatment include patient education about the condition, dietary changes, soluble fibre, and antispasmodic drugs. Other treatments tend to be reserved for those with more severe symptoms; these include central neuromodulators, intestinal secretagogues, drugs acting on 5-hydroxytryptamine or opioid receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), and psychological therapies. The increased understanding of the pathophysiology of IBS in the last 10 years has led to a healthy pipeline of novel drugs in development

    Gauge Orbit Types for Theories with Classical Compact Gauge Group

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    We determine the orbit types of the action of the group of local gauge transformations on the space of connections in a principal bundle with structure group O(n), SO(n) or Sp(n)Sp(n) over a closed, simply connected manifold of dimension 4. Complemented with earlier results on U(n) and SU(n) this completes the classification of the orbit types for all classical compact gauge groups over such space-time manifolds. On the way we derive the classification of principal bundles with structure group SO(n) over these manifolds and the Howe subgroups of SO(n).Comment: 57 page

    The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions

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    BACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. METHODS: We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. RESULTS: Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. CONCLUSIONS: In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions
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