The effect of right ventricular apical and non-apical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials

BACKGROUND The right ventricular apex (RVA) is the traditional lead site for chronic pacing but in some patients may cause impaired left ventricular (LV) systolic function over time. Comparisons with non-apical (RVNA) pacing sites have generated inconsistent results and recent meta-analyses have demonstrated unclear benefit due to heterogeneity across studies. METHODS AND RESULTS A systematic search for randomized controlled trials that compared LVEF outcomes between RVNA and RVA pacing was performed up to October 2014. Twenty four studies (n = 1628 patients) met the inclusion criteria. To avoid between study heterogeneity two homogenous groups were created; group one where studies reported a difference (in favor of RVNA pacing) and group two where studies reported no difference between pacing sites. For group one weighted mean difference (WMD) between RVNA and RVA pacing in terms of LVEF at follow-up was 5.40% (95% CI: 3.94 to 6.87), related in part to group one's RVA arm demonstrating a significant reduction (mean loss -3.31%; 95% CI: -6.19 to -0.43) in LVEF between study baseline and end of follow-up. Neither of these finding were seen in group two. Weighted regression modeling demonstrated that inclusion of poor baseline LVEF (<40%) in combination with greater than 12 months follow-up was three times more common in group one compared to group two (weighted RR 2.82; 95% CI 1.03 - 7.72; P = 0.043). CONCLUSIONS In patients requiring chronic right ventricular pacing where there is inclusion of impaired baseline LVEF (<40%), RVA pacing is associated with deterioration in LV function relative to RVNA pacing. This article is protected by copyright. All rights reserved

The Global Health System: Lessons for a Stronger Institutional Framework

Governmen

SeaWiFS Technical Report Series

The Sea-viewing Wide Field-of-view Sensor (SeaWiFS) mission will provide operational ocean color that will be superior to the previous Coastal Zone Color Sensor (CZCS) proof-of-concept mission. An algorithm is needed that exploits the full functionality of SeaWiFS whilst remaining compatible in concept with algorithms used for the CZCS. This document describes the theoretical rationale of radiance band-ratio methods for determining chlorophyll-a and other important biogeochemical parameters, and their implementation for the SeaWIFS mission. Pigment interrelationships are examined to explain the success of the CZCS algorithms. In the context where chlorophyll-a absorbs only weakly at 520 nm, the success of the 520 nm to 550 nm CZCS band ratio needs to be explained. This is explained by showing that in pigment data from a range of oceanic provinces chlorophyll-a (absorbing at less than 490 nm), carotenoids (absorbing at greater than 460 nm), and total pigment are highly correlated. Correlations within pigment groups particularly photoprotectant and photosynthetic carotenoids are less robust. The sources of variability in optical data are examined using the NIMBUS Experiment Team (NET) bio-optical data set and bio-optical model. In both the model and NET data, the majority of the variance in the optical data is attributed to variability in pigment (chlorophyll-a), and total particulates, with less than 5% of the variability resulting from pigment assemblage. The relationships between band ratios and chlorophyll is examined analytically, and a new formulation based on a dual hyperbolic model is suggested which gives a better calibration curve than the conventional log-log linear regression fit. The new calibration curve shows the 490:555 ratio is the best single-band ratio and is the recommended CZCS-type pigment algorithm. Using both the model and NET data, a number of multiband algorithms are developed; the best of which is an algorithm based on the 443:555 and 490:555 ratios. From model data, the form of potential algorithms for other products, such as total particulates and dissolved organic matter (DOM), are suggested

SeaWiFS Technical Report Series. Volume 29: SeaWiFS CZCS-type pigment algorithm

The Sea-viewing Wide Field-of-view Sensor (SeaWiFS) mission will provide operational ocean color that will be superior to the previous Coastal Zone Color Sensor (CZCS) proof-of-concept mission. an algorithm is needed that exploits the full functionality of SeaWiFS whilst remaining compatible in concept with algorithms used for the CZCS. This document describes the theoretical rationale of radiance band-radio methods for determining chlorophyll alpha and other important biogeochemical parameters, and their implementation for the SeaWiFS mission. Pigment interrelationships are examined to explain the success of the CZCS algorithms. In the context where chlorophyll alpha absorbs only weakly at 520 nm, the success of the 520 nm to 550 nm CZCS band ratio needs to be explained. This is explained by showing that in pigment data from a range of oceanic provinces chlorophyll alpha (absorbing at less than 490 nm), carotenoids (absorbing at greater than 460 nm), and total pigment are highly correlated. Correlations within pigment groups particularly photoprotectant and photosynthetic carotenoids are less robust. The sources of variability in optical data re examined using the NIMBUS Experiment Team (NET) bio-optical data set and bio-optical model. In both the model and NET data, the majority of the variance in the optical data is attributed to variability in pigment (chlorophyll alpha, and total particulates, with less than 5% of the variability resulting from pigment assemblage. The relationships between band ratios and chlorophyll is examined analytically, and a new formulation based on a dual hyperbolic model is suggested which gives a better calibration curve than the conventional log-log linear regression fit. The new calibration curve shows that 490:555 ratio is the best single-band ratio and is the recommended CZCS-type pigment algorithm. Using both the model and NET data, a number of multiband algorithms are developed; the best of which is an algorithm based on the 443:555 and 490:555 ratios. From model data, the form of potential algorithms for other products, such as total particulates and dissolved organic matter (DOM), are suggested

Integrating Communication Skills and Planning Techniques

Practitioners have long stressed the need to teach professional commumcations skills to planning students. This paper describes ten years of experience in teaching a course in which communications skills and techniques of gathering and analyzing information are taught concurrently while investigating a problem of importance in the community. The course involves an ongoing collaboration, a "marriage of convenience," between an academic and a planner, casting city/county planning staff as clients for students This has proven useful for pedagogy and has had some positive impact on the community.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69149/2/10.1177_0739456X9201100206.pd

Pulmonary Biomarkers Based on Alterations in Protein Expression after Exposure to Arsenic

OBJECTIVE: Environmental exposure to arsenic results in multiple adverse effects in the lung. Our objective was to identify potential pulmonary protein biomarkers in the lung-lining fluid of mice chronically exposed to low-dose As and to validate these protein changes in human populations exposed to As. METHODS: Mice were administered 10 or 50 ppb As (sodium arsenite) in their drinking water for 4 weeks. Proteins in the lung-lining fluid were identified using two-dimensional gel electrophoresis (n = 3) or multidimensional protein identification technology (MUDPIT) (n = 2) coupled with mass spectrometry. Lung-induced sputum samples were collected from 57 individuals (tap water As ranged from ~ 5 to 20 ppb). Protein levels in sputum were determined by ELISA, and As species were analyzed in first morning void urine. RESULTS: Proteins in mouse lung-lining fluid whose expression was consistently altered by As included glutathione-S-transferase (GST)-omega-1, contraspin, apolipoprotein A-I and A-IV, enolase-1, peroxiredoxin-6, and receptor for advanced glycation end products (RAGE). Validation of the putative biomarkers was carried out by evaluating As-induced alterations in RAGE in humans. Regression analysis demonstrated a significant negative correlation (p = 0.016) between sputum levels of RAGE and total urinary inorganic As, similar to results seen in our animal model. CONCLUSION: Combinations of proteomic analyses of animal models followed by specific analysis of human samples provide an unbiased determination of important, previously unidentified putative biomarkers that may be related to human disease

Focal Plane Alignment Utilizing Optical CMM

In many applications, an optical detector has to be located relative to mechanical reference points. One solution is to specify stringent requirements on (1) mounting the optical detector relative to the chip carrier, (2) soldering the chip carrier onto the printed circuit board (PCB), and (3) installing the PCB to the mechanical structure of the subsystem. Figure 1 shows a sketch of an optical detector mounted relative to mechanical reference with high positional accuracy. The optical detector is typically a fragile wafer that cannot be physically touched by any measurement tool. An optical coordinate measuring machine (CMM) can be used to position optical detectors relative to mechanical reference points. This approach will eliminate all requirements on positional tolerances. The only requirement is that the PCB is manufactured with oversized holes. An exaggerated sketch of this situation is shown in Figure 2. The sketch shows very loose tolerances on mounting the optical detector in the chip carrier, loose tolerance on soldering the chip carrier to the PCB, and finally large tolerance on where the mounting screws are located. The PCB is held with large screws and oversized holes. The PCB is mounted loosely so it can move freely around. The optical CMM measures the mechanical reference points. Based on these measurements, the required positions of the optical detector corners can be calculated. The optical CMM is commanded to go to the position where one detector corner is supposed to be. This is indicated with the cross-hairs in Figure 2(a). This figure is representative of the image of the optical CMM monitor. Using a suitable tapping tool, the PCB is manually tapped around until the corner of the optical detector is at the crosshairs of the optical CMM. The CMM is commanded to another corner, and the process is repeated a number of times until all corners of the optical detector are within a distance of 10 to 30 microns of the required position. The situation is sketched in Figure 2(b) (the figure also shows the tapping tool and where to tap). At this point the fasteners for the PCB are torqued slightly so the PCB can still move. The PCB location is adjusted again with the tapping tool. This process is repeated 3 to 4 times until the final torque is achieved. The oversized mounting holes are then filled with a liquid bonding agent to secure the board in position (not shown in the sketch). A 10- to 30-micron mounting accuracy has been achieved utilizing this method.

Global Antifungal Profile Optimization of Chlorophenyl Derivatives against Botrytis cinerea and Colletotrichum gloeosporioides

Twenty-two aromatic derivatives bearing a chlorine atom and a different chain in the para or meta position were prepared and evaluated for their in vitro antifungal activity against the phytopathogenic fungi Botrytis cinerea and Colletotrichum gloeosporioides. The results showed that maximum inhibition of the growth of these fungi was exhibited for enantiomers S and R of 1-(40-chlorophenyl)- 2-phenylethanol (3 and 4). Furthermore, their antifungal activity showed a clear structure-activity relationship (SAR) trend confirming the importance of the benzyl hydroxyl group in the inhibitory mechanism of the compounds studied. Additionally, a multiobjective optimization study of the global antifungal profile of chlorophenyl derivatives was conducted in order to establish a rational strategy for the filtering of new fungicide candidates from combinatorial libraries. The MOOPDESIRE methodology was used for this purpose providing reliable ranking models that can be used later

Results from the NASA Capability Roadmap Team for In-Situ Resource Utilization (ISRU)

On January 14, 2004, the President of the United States unveiled a new vision for robotic and human exploration of space entitled, "A Renewed Spirit of Discovery". As stated by the President in the Vision for Space Exploration (VSE), NASA must "... implement a sustained and affordable human and robotic program to explore the solar system and beyond " and ".. .develop new technologies and harness the moon's abundant resources to allow manned exploration of more challenging environments." A key to fulfilling the goal of sustained and affordable human and robotic exploration will be the ability to use resources that are available at the site of exploration to "live off the land" instead of bringing everything from Earth, known as In-Situ Resource Utilization (ISRU). ISRU can significantly reduce the mass, cost, and risk of exploration through capabilities such as: mission consumable production (propellants, fuel cell reagents, life support consumables, and feedstock for manufacturing & construction); surface construction (radiation shields, landing pads, walls, habitats, etc.); manufacturing and repair with in-situ resources (spare parts, wires, trusses, integrated systems etc.); and space utilities and power from space resources. On January 27th, 2004 the President's Commission on Implementation of U.S. Space Exploration Policy (Aldridge Committee) was created and its final report was released in June 2004. One of the report's recommendations was to establish special project teams to evaluate enabling technologies, of which "Planetary in situ resource utilization" was one of them. Based on the VSE and the commission's final report, NASA established fifteen Capability Roadmap teams, of which ISRU was one of the teams established. From Oct. 2004 to May 2005 the ISRU Capability Roadmap team examined the capabilities, benefits, architecture and mission implementation strategy, critical decisions, current state-of-the-art (SOA), challenges, technology gaps, and risks of ISRU for future human Moon and Mars exploration. This presentation will provide an overview of the ISRU capability, architecture, and implementation strategy examined by the ISRU Capability Roadmap team, along with a top-level review of ISRU benefits, resources and products of interest, and the current SOA in ISRU processes and systems. The presentation will also highlight the challenges of incorporating ISRU into future missions and the gaps in technologies and capabilities that need to be filled to enable ISRU