Impact of On-Clopidogrel Platelet Reactivity on Incidence of Peri-Interventional Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation.

Dual anti-platelet therapy (DAPT) with clopidogrel and acetylsalicylic acid (ASA) has previously been recommended after transcatheter aortic valve implantation (TAVI) and is still the standard of care in patients who underwent coronary stent placement within 3 months prior to TAVI. This study sought to evaluate whether on-treatment platelet reactivity is a predictor for the occurrence of bleeding events after TAVI. This study enrolled 484 patients undergoing TAVI from November 2013 until April 2018. Patients were either on long-term DAPT with clopidogrel and ASA or received loading doses of both drugs before TAVI, reflecting the standard of care at the time of the patient's enrollment. Platelet reactivity was determined by multi-electrode impedance aggregometry before TAVI, at days 1 and 5 thereafter. Peri-interventional bleeding was assessed up to 5 days following TAVI and coded according to BARC-classification. Bleeding events were seen in 199 (41.1%) patients. The most frequent were BARC 2 bleeding cases (24.2%), followed by BARC 1 (6.0%), BARC 3b (5.2%), and BARC 3a (4.5%) cases. Low on-clopidogrel platelet reactivity before TAVI was present in 243 patients, of which 44.4% had a bleeding event. In contrast, the incidence of bleeding was 30.5% in the 95 patients with high on-clopidogrel platelet reactivity. Multivariate logistic regression analysis identified low/normal/high on-clopidogrel platelet reactivity (OR: 0.533; CI: 0.309-0.917; p = 0.023) and use of oral anticoagulation (OR: 1.766; CI: 1.209-2.581; p = 0.003) as strongest predictors for peri-interventional bleeding events. These findings support current recommendations advocating against the routine use of dual antiplatelet therapy following TAVI

TESLA Technical Design Report Part III: Physics at an e+e- Linear Collider

The TESLA Technical Design Report Part III: Physics at an e+e- Linear ColliderComment: 192 pages, 131 figures. Some figures have reduced quality. Full quality figures can be obtained from http://tesla.desy.de/tdr. Editors - R.-D. Heuer, D.J. Miller, F. Richard, P.M. Zerwa

Physics searches at the LHC

With the LHC up and running, the focus of experimental and theoretical high energy physics will soon turn to an interpretation of LHC data in terms of the physics of electroweak symmetry breaking and the TeV scale. We present here a broad review of models for new TeV-scale physics and their LHC signatures. In addition, we discuss possible new physics signatures and describe how they can be linked to specific models of physics beyond the Standard Model. Finally, we illustrate how the LHC era could culminate in a detailed understanding of the underlying principles of TeV-scale physics.Comment: 184 pages, 55 figures, 14 tables, hundreds of references; scientific feedback is welcome and encouraged. v2: text, references and Overview Table added; feedback still welcom

Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

<p>Abstract</p> <p>Background</p> <p>Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.</p> <p>Methods</p> <p>This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.</p> <p>The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.</p> <p>Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.</p> <p>Discussion</p> <p>If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.</p> <p>Trial Registration</p> <p>ISRCTN59603527</p

Accelerometer-based physical activity in a large observational cohort - study protocol and design of the activity and function of the elderly in Ulm (ActiFE Ulm) study

<p>Abstract</p> <p>Background</p> <p>A large number of studies have demonstrated a positive effect of increased physical activity (PA) on various health outcomes. In all large geriatric studies, however, PA has only been assessed by interview-based instruments which are all subject to substantial bias. This may represent one reason why associations of PA with geriatric syndromes such as falls show controversial results. The general aim of the Active-Ulm study was to determine the association of accelerometer-based physical activity with different health-related parameters, and to study the influence of this standardized objective measure of physical activity on health- and disability-related parameters in a longitudinal setting.</p> <p>Methods</p> <p>We have set up an observational cohort study in 1500 community dwelling older persons (65 to 90 years) stratified by age and sex. Addresses have been obtained from the local residents registration offices. The study is carried out jointly with the IMCA - Respiratory Health Survey in the Elderly implemented in the context of the European project IMCA II. The study has a cross-sectional part (1) which focuses on PA and disability and two longitudinal parts (2) and (3). The primary information for part (2) is a prospective 1 year falls calendar including assessment of medication change. Part (3) will be performed about 36 months following baseline. Primary variables of interest include disability, PA, falls and cognitive function. Baseline recruitment has started in March 2009 and will be finished in April 2010.</p> <p>All participants are visited three times within one week, either at home or in the study center. Assessments included interviews on quality of life, diagnosed diseases, common risk factors as well as novel cognitive tests and established tests of physical functioning. PA is measured using an accelerometer-based sensor device, carried continuously over a one week period and accompanied by a prospective activity diary.</p> <p>Discussion</p> <p>The assessment of PA using a high standard accelerometer-based device is feasible in a large population-based study. The results obtained from cross-sectional and longitudinal analyses will shed light on important associations between PA and various outcomes and may provide information for specific interventions in older people.</p

CP Studies and Non-Standard Higgs Physics

There are many possibilities for new physics beyond the Standard Model that feature non-standard Higgs sectors. These may introduce new sources of CP violation, and there may be mixing between multiple Higgs bosons or other new scalar bosons. Alternatively, the Higgs may be a composite state, or there may even be no Higgs at all. These non-standard Higgs scenarios have important implications for collider physics as well as for cosmology, and understanding their phenomenology is essential for a full comprehension of electroweak symmetry breaking. This report discusses the most relevant theories which go beyond the Standard Model and its minimal, CP-conserving supersymmetric extension: two-Higgs-doublet models and minimal supersymmetric models with CP violation, supersymmetric models with an extra singlet, models with extra gauge groups or Higgs triplets, Little Higgs models, models in extra dimensions, and models with technicolour or other new strong dynamics. For each of these scenarios, this report presents an introduction to the phenomenology, followed by contributions on more detailed theoretical aspects and studies of possible experimental signatures at the LHC and other colliders.Comment: Report of the CPNSH workshop, May 2004 - Dec 2005, 542 pages. The complete report as well as its individual chapters are also available from http://kraml.home.cern.ch/kraml/cpnsh/report.htm

Effiziente Impulskompression im industriellen Kontext mittels Multipasszellen

Wir stellen einen kommerziellen Prototyp eines auf Multipasszellen basierenden Spektralverbreiterungs- und -komprimierungssystems vor. Er ist in der Lage 40 fs-Impulse von einem 250 fs-Treiberlaser mit hervorragender Effizienz von 92 % zu erzeugen, was zu einer Verfünffachung der Spitzenleistung führt. Bei der maximalen Eingangsleistung (10 W) ist die Stabilität so hoch wie die Stabilität des Treiberlasers.We present a commercial prototype of a multipass cell based spectral broadening and compression system capable of generating 40 fs pulses from a 250 fs driving laser with excellent throughput efficiency of 92 % resulting in a fivefold increase in peak power. At the maximum input power (10 W) the stability is as good as the stability of the driving laser

Tissue-Autonomous Phenylpropanoid Production Is Essential for Establishment of Root Barriers.

Plants deposit hydrophobic polymers, such as lignin or suberin, in their root cell walls to protect inner tissues and facilitate selective uptake of solutes. Insights into how individual root tissues contribute to polymer formation are important for elucidation of ultrastructure, function, and development of these protective barriers. Although the pathways responsible for production of the barrier constituents are established, our models lack spatiotemporal resolution-especially in roots-thus, the source of monomeric barrier components is not clear. This is mainly due to our restricted ability to manipulate synthesis of the broadly important phenylpropanoid pathway, as mutants in this pathway display lethal or pleiotropic phenotypes. Here, we overcome this challenge by exploiting highly controlled in vivo repression systems. We provide strong evidence that autonomous production of phenylpropanoids is essential for establishment of the endodermal Casparian strip as well as adherence of the suberin matrix to the cell wall of endodermis and cork. Our work highlights that, in roots, the phenylpropanoid pathway is under tight spatiotemporal control and serves distinct roles in barrier formation across tissues and developmental zones. This becomes evident in the late endodermis, where repression of phenylpropanoid production leads to active removal of suberin in pre-suberized cells, indicating that endodermal suberin depositions might embody a steady state between continuous synthesis and degradation

Spektrale Verbreiterung in Multipasszellen bis 2 mJ Impulsenergie

Wir präsentieren erste Ergebnisse mit einem Prototyp der nächsten Ausbaustufe unseres kommerziellen Spektralverbreiterungs- und -komprimierungssystems basierend auf der Multipasszellentechnologie. Er ist für 2,0 mJ Eingangsenergie bei 0,9 ps Impulsdauer ausgelegt und soll komprimierte Ausgangsimpulse von unter 100 fs liefern. Bei der vollen Eingangsenergie wurde eine spektrale Verbreiterung auf 30 nm Bandbreite bei -10 dB mit einem Fourier-Transformlimit von 0.11 ps erzielt wurde. Die Transmission der Durchschnittsleistung betrug dabei 90,5 %We present first results with a prototype of the next development stage of our commercial spectral broadening and compression system based on the multi-pass cell technology. It is designed for 2.0 mJ input energy at 0.9 ps pulse duration and is expected to deliver compressed output pulses of below 100 fs. At the full input energy of 2.0 mJ a spectral broadening to 30 nm bandwidth at -10 dB with a Fourier transform limit of 0.11 ps as achieved. The transmission of the average power was 90.5 %