Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting

AbstractNeuropsychologic impairment in patients undergoing cardiopulmonary bypass may be associated with cerebral blood flow changes arising from different management protocols for carbon dioxide tension during bypass. Seventy patients having coronary artery bypass grafting were randomized to either pH-stat or alpha-stat acid-base management during cardiopulmonary bypass with a membrane oxygenator. In each patient, cerebral blood flow (xenon 133 clearance), middle cerebral artery blood flow velocity (transcranial Doppler sonography), and cerebral oxygen metabolism (cerebral metabolic rate and cerebral extraction ratio) were measured during four phases of the operation: before bypass, during bypass (at hypothermia and at normothermia), and after bypass. A battery of neuropsychologic tests were also conducted before and 6 weeks after the operation. During hypothermic (28º C) bypass, cerebral blood flow was significantly (p < 0.001) greater in the pH-stat group (41 ml•100 gm -1 •min -1 ; 95% confidence interval 39 to 43 ml•100 gm -1 •min -1 ) than in the alpha-stat group (24 ml•100 gm -1 •min -1 ; confidence interval 22 to 26 ml•100 gm -1 •min -1 ) at constant pressure and flow. Arterial carbon dioxide tensions were 41 mm Hg (40 to 41 mm Hg) and 26 mm Hg (25 to 27 mm Hg), respectively; pH was 7.36 (7.34 to 7.38) and 7.53 (7.51 to 7.55), respectively. Middle cerebral artery flow velocity was significantly (p < 0.05) reduced in the alpha-stat group to 87% (77% to 96%) of the prebypass value, whereas it was significantly (p < 0.05) increased (152%; 141% to 162%) in the pH-stat group. Cerebral extraction ratio for oxygen demonstrated relative cerebral hyperemia during hypothermic (28º C) bypass in both the pH-stat and alpha-stat groups (0.12 [0.11 to 0.14] and 0.25 [0.22 to 0.28], respectively); however, hyperemia was significantly more pronounced in the pH-stat group, indicating greater disruption in cerebral autoregulation. Neuropsychologic impairment criteria of deterioration in results of three or more tests revealed that a significantly (Fisher's exact test, p = 0.02) higher proportion of patients in the pH-stat group fared poorly than in the alpha-stat group at 6 weeks (17/35, 48.6% [32% to 65.1%], and 7/35, 20% [6.7% to 33.2.2%], respectively). In conclusion, patients receiving alpha-stat management had less disruption of cerebral autoregulation during cardiopulmonary bypass, accompanied by a reduced incidence of postoperative cerebral dysfunction. (J THORAC CARDIOVASC SURG 1996;111:1267-79

Glacial Aerodynamic Roughness Estimates:Uncertainty, Sensitivity, and Precision in Field Measurements

Calculation of the sensible and latent heat (turbulent) fluxes is required in order to close the surface energy budget of glaciers and model glacial melt. The aerodynamic roughness length, z0, is a key parameter in the bulk approach to calculating sensible heat flux; yet, z0 is commonly considered simply as a tuning parameter or generalized between surfaces and over time. Spatially and temporally distributed observations of z0 over ice are rare. Both direct (from wind towers and sonic anemometers) and indirect (from microtopographic surveys) measurements of z0 are subject to sensitivities and uncertainties that are often unstated or overlooked. In this study, we present a quantitative evaluation of aerodynamic profile-based and microtopographic methods and their effect on z0 using data collected from Storglaciären and Sydöstra Kaskasatjäkkaglaciären, Tarfala Valley, Arctic Sweden. Aggressive data filters discard most of the wind tower data but still produce realistic z0 values of 1.9 mm and 2 mm. Despite uncertainty introduced by scale and resolution dependence, microtopographic methods produced estimates of z0 comparable to wind tower values and those found on similar surfaces. We conclude that (1) in the absence of direct turbulent flux measurements from sonic anemometers, the profile and microtopographic methods provide realistic z0 values, (2) both 2D and 3D microtopographic methods are dependent on scale, resolution, and the chosen detrending method, and (3) careful calibration of these parameters could enable glacier-wide investigations of z0 from remotely sensed data, including those increasingly available from satellite platforms

Associations between diabetes and both cardiovascular disease and all-cause mortality are modified by grip strength: evidence from UK Biobank, a prospective population-based cohort study

OBJECTIVE Grip strength and diabetes are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to predispose to adverse health outcomes is unknown. This study determined the interactions between diabetes and grip strength and their association with health outcomes. RESEARCH DESIGN AND METHODS We undertook a prospective, general population cohort study by using UK Biobank. Cox proportional hazards models were used to explore the associations between both grip strength and diabetes and the outcomes of all-cause mortality and CVD incidence/mortality as well as to test for interactions between diabetes and grip strength. RESULTS 347,130 UK Biobank participants with full data available (mean age 55.9 years, BMI 27.2 kg/m2, 54.2% women) were included in the analysis, of which 13,373 (4.0%) had diabetes. Over a median follow-up of 4.9 years (range 3.3–7.8 years), 6,209 died (594 as a result of CVD), and 4,301 developed CVD. Participants with diabetes were at higher risk of all-cause and CVD mortality and CVD incidence. Significant interactions (P &lt; 0.05) existed whereby the risk of CVD mortality was higher in participants with diabetes with low (hazard ratio [HR] 4.05 [95% CI 2.72, 5.80]) versus high (HR 1.46 [0.87, 2.46]) grip strength. Similar results were observed for all-cause mortality and CVD incidence. CONCLUSIONS Risk of adverse health outcomes among people with diabetes is lower in those with high grip strength. Low grip strength may be useful to identify a higher-risk subgroup of patients with diabetes. Intervention studies are required to determine whether resistance exercise can reduce risk

Stability Walls in Heterotic Theories

We study the sub-structure of the heterotic Kahler moduli space due to the presence of non-Abelian internal gauge fields from the perspective of the four-dimensional effective theory. Internal gauge fields can be supersymmetric in some regions of the Kahler moduli space but break supersymmetry in others. In the context of the four-dimensional theory, we investigate what happens when the Kahler moduli are changed from the supersymmetric to the non-supersymmetric region. Our results provide a low-energy description of supersymmetry breaking by internal gauge fields as well as a physical picture for the mathematical notion of bundle stability. Specifically, we find that at the transition between the two regions an additional anomalous U(1) symmetry appears under which some of the states in the low-energy theory acquire charges. We compute the associated D-term contribution to the four-dimensional potential which contains a Kahler-moduli dependent Fayet-Iliopoulos term and contributions from the charged states. We show that this D-term correctly reproduces the expected physics. Several mathematical conclusions concerning vector bundle stability are drawn from our arguments. We also discuss possible physical applications of our results to heterotic model building and moduli stabilization.Comment: 37 pages, 4 figure

Type 0A 2D Black Hole Thermodynamics and the Deformed Matrix Model

Recently, it has been proposed that the deformed matrix model describes a two-dimensional type 0A extremal black hole. In this paper, the thermodynamics of 0A charged non-extremal black holes is investigated. We observe that the free energy of the deformed matrix model to leading order in 1/q can be seen to agree to that of the extremal black hole. We also speculate on how the deformed matrix model is able to describe the thermodynamics of non-extremal black holes.Comment: 12 page

Performance Evaluation of Spatial Modulation and QOSTBC for MIMO Systems

YesMultiple-input multiple-output (MIMO) systems require simplified architectures that can maximize design parameters without sacrificing system performance. Such architectures may be used in a transmitter or a receiver. The most recent example with possible low cost architecture in the transmitter is spatial modulation (SM). In this study, we evaluate the SM and quasi-orthogonal space time block codes (QOSTBC) schemes for MIMO systems over a Rayleigh fading channel. QOSTBC enables STBC to be used in a four antenna design, for example. Standard QO-STBC techniques are limited in performance due to self-interference terms; here a QOSTBC scheme that eliminates these terms in its decoding matrix is explored. In addition, while most QOSTBC studies mainly explore performance improvements with different code structures, here we have implemented receiver diversity using maximal ratio combining (MRC). Results show that QOSTBC delivers better performance, at spectral efficiency comparable with SM

Insights Into Pāhoehoe Lava Emplacement Using Visible and Thermal Structure-From-Motion Photogrammetry

We present the evolution over 3 months of a 2016–2017 pāhoehoe flow at Kīlauea as it changed from a narrow sheet flow into a compound lava field fed by a stable system of tubes. The portion of the flow located on Kīlauea's coastal plain was characterized using helicopter-based visible and thermal structure-from-motion photogrammetry to construct a series of georeferenced digital surface models and thermal maps on eight different days. Results reveal key influences on the emplacement and evolution of such long-lived pāhoehoe flows. This region of the flow grew by ~12 × 10 6 m 3 with a near-constant time-average discharge rate of 1.2–2.7 m 3/s. The development of two tube systems is captured and shows an initial nascent tube enhanced by a narrow topographic confinement, which later inflated and created a topographic inversion that modulated the emplacement of a second flow lobe with its own tube system. The analysis of breakouts at various stages of the field's life suggests that the evolution of the thermal and morphological properties of the flow surface reflect its maturity. Thermal properties of breakouts were used to expand the empirical relationship of breakout cooling to longer timescales. This study contributes to the long-term development and validation of more accurate predictive models for pāhoehoe, required during the management of long-lasting lava flow crises in Hawai'i and elsewhere

Multi-Antenna OFDM System Using Coded Wavelet with Weighted Beamforming

yesA major drawback in deploying beamforming scheme in orthogonal frequency division multiplexing (OFDM) is to obtain the optimal weights that are associated with information beams. Two beam weighting methods, namely co-phasing and singular vector decomposition (SVD), are considered to maximize the signal beams for such beamforming scheme. Initially the system performance with and without interleaving is investigated using coded fast Fourier transform (FFT)-OFDM and wavelet-based OFDM. The two beamforming schemes are applied to the wavelet-based OFDM as confirmed to perform better than the FFT-OFDM. It is found that the beam-weight by SVD improves the performance of the system by about 2dB at the expense of the co-phasing method. The capacity performances of the weighting methods are also compared and discussed

Surveying Standard Model Flux Vacua on T6/Z2×Z2T^6/Z_2\times Z_2

We consider the SU(2)LxSU(2)R Standard Model brane embedding in an orientifold of T6/Z2xZ2. Within defined limits, we construct all such Standard Model brane embeddings and determine the relative number of flux vacua for each construction. Supersymmetry preserving brane recombination in the hidden sector enables us to identify many solutions with high flux. We discuss in detail the phenomenology of one model which is likely to dominate the counting of vacua. While Kahler moduli stabilization remains to be fully understood, we define the criteria necessary for generic constructions to have fixed moduli.Comment: 30 pages, LaTeX, v2: added reference