Patient reactions to cancelled or postponed heart operations.

Objectives The aim was to survey the rate and cause of cancellations of planned cardiac operations at a Swedish clinic during 1999, and to study how the patients were affected. Design Questionnaires were distributed to 74 patients who had their operations cancelled. Their mood after discharge was measured with The Hospital Anxiety and Depression scale. Ninety-three patients, who were operated on without postponement, served as controls. Results Sixty-one percent of the patients in the cancellation group reacted negatively, especially if the reason for cancellation was organizational (P = 0.03). The women in the cancellation group had a significantly higher degree of depression than men (P = 0.01) and both women (P = 0.02) and men (P = 0.003) in the control group. Most of the patients, however, were satisfied with the nursing staff's reception and information. Conclusions The patients reacted negatively to the cancellation, especially if it had organizational reasons. Women subjected to cancellation had a significantly higher degree of depression than other patients. To be avoided, organizational and medical problems must be identified in time. One way to do this is to introduce a preadmission nurse clinic

Increased expression of vascular endothelin type B and angiotensin type 1 receptors in patients with ischemic heart disease

<p>Abstract</p> <p>Background</p> <p>Endothelin-1 and angiotensin II are strong vasoconstrictors. Patients with ischemic heart disease have elevated plasma levels of endothelin-1 and angiotensin II and show increased vascular tone. The aim of the present study was to examine the endothelin and angiotensin II receptor expression in subcutaneous arteries from patients with different degrees of ischemic heart disease.</p> <p>Methods</p> <p>Subcutaneous arteries were obtained, by biopsy from the abdomen, from patients undergoing coronary artery bypass graft (CABG) surgery because of ischemic heart disease (n = 15), patients with angina pectoris without established myocardial infarction (n = 15) and matched cardiovascular healthy controls (n = 15). Endothelin type A (ET_A) and type B (ET_B), and angiotensin type 1 (AT₁) and type 2 (AT₂) receptors expression and function were examined using immunohistochemistry, Western blot and <it>in vitro </it>pharmacology.</p> <p>Results</p> <p>ET_Aand, to a lesser extent, ET_Breceptor staining was observed in the healthy vascular smooth muscle cells. The level of ET_Breceptor expression was higher in patients undergoing CABG surgery (250% ± 23%; P < 0.05) and in the patients with angina pectoris (199% ± 6%; P < 0.05), than in the healthy controls (100% ± 28%). The data was confirmed by Western blotting. Arteries from CABG patients showed increased vasoconstriction upon administration of the selective ET_Breceptor agonist sarafotoxin S6c, compared to healthy controls (P < 0.05). No such difference was found for the ET_Areceptors. AT₁and, to a lesser extent, AT₂receptor immunostaining was seen in the vascular smooth muscle cells. The level of AT₁receptor expression was higher in both the angina pectoris (128% ± 25%; P < 0.05) and in the CABG patients (203% ± 41%; P < 0.05), as compared to the healthy controls (100% ± 25%). The increased AT₁receptor expression was confirmed by Western blotting. Myograph experiment did however not show any change in vasoconstriction to angiotensin II in CABG patients compared to healthy controls (P = n.s).</p> <p>Conclusion</p> <p>The results demonstrate, for the first time, upregulation of ET_Band AT₁receptors in vascular smooth muscle cells in ischemic heart disease. These receptors may play a role in the pathophysiology of ischemic heart disease and could provide important targets for pharmaceutical interventions.</p

Slakthus-Fem: En Analys av Billy Pilgrims Psykiska Trauma

Kurt Vonnegut’s Slaughterhouse-Five focuses on Billy Pilgrim’s travels through time and his experiences during World War II. More than that, it is a story about the journey of a clearly troubled protagonist whose mental state, best described as broken, is never fully explored in the novel. The aim of this essay is to bring light to the intricacies of Billy’s curious mental state, and to explore the theory that the alien encounters as well as the time travelling that he experiences are the result of Post-Traumatic Stress Disorder that Billy suffers from. This is done by analyzing Billy’s experiences with time travel, emotional numbing, and Tralfamadorians and connecting it to known symptoms and causes of PTSD. The results show that Billy does indeed showcase strong signs of PTSD, which were most likely caused by a combination of childhood experiences and trauma during the war. This PTSD manifests itself through Billy’s time travelling and alien encounters, which are used as a coping mechanism.Kurt Vonneguts Slakthus 5 fokuserar på Billy Pilgrims resor genom tiden och hans upplevelser under andra världskriget. Ännu mer än det så är det en berättelse om resan av en helt klart besvärad huvudperson vars mentala tillstånd, som bäst kan beskrivas som brutet, aldrig riktigt förklaras i romanen. Syftet med denna uppsats är att skapa en klarhet till förvecklingarna av Billys besynnerliga mentala tillstånd, och att undersöka teorin att utomjordingarna såväl som resorna genom tiden som han upplever är resultat av posttraumatisk stressyndrom som Billy lider av. Detta utförs genom att analysera Billys upplevelser av tidsresor, emotionellt bedövande och Tralfamadorer och ansluta dem till symtomer och orsaker till PTSD. Resultaten visar att Billy visar tydliga tecken på PTSD, som troligen orsakades av en kombination av barndomsupplevelser och trauma under sin tid som soldat. Denna PTSD manifisterar sig genom Billys tidsresor och möten med utomjordingar, som används som en coping mekanism.

Vidareutveckling av tidsanalys utav processer utan avbrott på flerkärniga system under AER modellen

Real-time multi-core systems with shared memory are harder to analyze due to varying execution times caused by congestion in accessing the shared memory. A promising way to make these systems more deterministic is the Acquisition-Execution-Restitution (AER)-model which takes a memory-centric approach to scheduling which enables the multicore problem to be seen as a single core scheduling problem. Memorycentric scheduling means that instead of scheduling tasks onto cores the memory accesses are scheduled onto the memory, where in this case the memory phases are allowed to access the shared memory nonpreemptively during their allocated slots. In this thesis an extended version of the AER-model and a new Idle-time Insertion Policy (IIP), which can make decisions on whether to leave resources idle when there is work to be done as an attempt to improve schedulability, is presented. These can be used in conjunction with a state-of-the-art scheduling analysis tool to perform timing analysis on job sets under the AER-model. The extended AER-model introduces scheduling windows for the Acquisition (A)-phase and Restitution (R)-phase of tasks in a way that no further precedence constraints need to be considered by the scheduler as not to schedule any of the A-phase or R-phase in the wrong order. The developed IIP is then used by the analysis tool to make sure that there is at least one free core in the system before a new task is scheduled as this needs to be put into consideration in a memory-centric scheduler. The extended AER-model and the developed IIP are then benchmarked with task sets coherent to the AUTOSAR-framework. The benchmarks explore the schedulability ratio when varying task amount, core amount, scheduling algorithms and the window ratio for the phases. The results show that Earliest Deadline First (EDF) outperforms other algorithms that are special versions of Rate-Monotonic Scheduling (RMS) where priorities are assigned based on a combination of a tasks period and its utilization. The results also show that tasks with a window ratio of 60% as well as task sets of sizes between 100 to 150 yields the highest schedulability ratio.Flerkärniga realtissystem med delade minnen är svårare att analysera på grund av varierande exekveringstider orsakade av stockning vid åtkomst av det delade minnet. Ett lovande sätt att göra dessa system mer deterministiska är Acquisition-Execution-Restitution (AER)modellen som tar ett minnes-centriskt tillvägagångssätt till schemaläggning som möjliggör för flerkärniga system att betraktas som enkärniga system, vilket reducerar komplexiteten. Minnes-centrisk schemaläggning innebär att istället för schemaläggning utav processer till kärnor så schemaläggs enbart individuella processers åtkomster till minnet där i detta fall minnes-faserna får fri tillgång till det delade minnet utan avbrott. Denna avhandling presenterar en vidareutvecklad AERmodel och en ny Idle-time Insertion Policy (IIP) som fattar beslut om en resurs ska lämnas inaktiv trots att det finns arbete att utföra i ett försöka att förbättra prestandan av schemaläggaren. Dessa kan användas i samband med ett toppmodernt analysverktyg för schemaläggning för att utföra tidsanalys på processer under AER-modellen. Den vidareutvecklade AER-modellen introducerar schemaläggningsfönster för Acquisition (A)-fasen och Restitution (R)-fasen utav processer på ett sätt som gör det överflödigt för en schemaläggare att behöva oroa sig om någon företrädesrätt mellan de bägge faserna. Den utvecklade IIP’n används sedan av analysverktyget för att se till att det finns minst en ledig kärna i processorn när en ny process ska schemaläggas, eftersom det inte är något som annars garanteras vid användning av ett minnes-centriskt tillvägagångssätt. Den vidareutvecklade AERmodellen och IIP’n sätts sedan på prov genom tester där de schemalägger processer som följer AUTOSAR standarden. Testerna utforskar hur väl processerna schemaläggs när antalet procceser, antalet kärnor och fönster-faktorn för faserna varieras. Resultaten visar att Earliest Deadline First (EDF) presterar bättre än andra schemaläggnignsalgoritmer som prioriterar processer utifrån deras period och körtid, processer med en fönster-faktor på 60% presterar bäst och att schemaläggning när antalet processer är mellan 100 och 150 är optimalt

Vidareutveckling av tidsanalys utav processer utan avbrott på flerkärniga system under AER modellen

Real-time multi-core systems with shared memory are harder to analyze due to varying execution times caused by congestion in accessing the shared memory. A promising way to make these systems more deterministic is the Acquisition-Execution-Restitution (AER)-model which takes a memory-centric approach to scheduling which enables the multicore problem to be seen as a single core scheduling problem. Memorycentric scheduling means that instead of scheduling tasks onto cores the memory accesses are scheduled onto the memory, where in this case the memory phases are allowed to access the shared memory nonpreemptively during their allocated slots. In this thesis an extended version of the AER-model and a new Idle-time Insertion Policy (IIP), which can make decisions on whether to leave resources idle when there is work to be done as an attempt to improve schedulability, is presented. These can be used in conjunction with a state-of-the-art scheduling analysis tool to perform timing analysis on job sets under the AER-model. The extended AER-model introduces scheduling windows for the Acquisition (A)-phase and Restitution (R)-phase of tasks in a way that no further precedence constraints need to be considered by the scheduler as not to schedule any of the A-phase or R-phase in the wrong order. The developed IIP is then used by the analysis tool to make sure that there is at least one free core in the system before a new task is scheduled as this needs to be put into consideration in a memory-centric scheduler. The extended AER-model and the developed IIP are then benchmarked with task sets coherent to the AUTOSAR-framework. The benchmarks explore the schedulability ratio when varying task amount, core amount, scheduling algorithms and the window ratio for the phases. The results show that Earliest Deadline First (EDF) outperforms other algorithms that are special versions of Rate-Monotonic Scheduling (RMS) where priorities are assigned based on a combination of a tasks period and its utilization. The results also show that tasks with a window ratio of 60% as well as task sets of sizes between 100 to 150 yields the highest schedulability ratio.Flerkärniga realtissystem med delade minnen är svårare att analysera på grund av varierande exekveringstider orsakade av stockning vid åtkomst av det delade minnet. Ett lovande sätt att göra dessa system mer deterministiska är Acquisition-Execution-Restitution (AER)modellen som tar ett minnes-centriskt tillvägagångssätt till schemaläggning som möjliggör för flerkärniga system att betraktas som enkärniga system, vilket reducerar komplexiteten. Minnes-centrisk schemaläggning innebär att istället för schemaläggning utav processer till kärnor så schemaläggs enbart individuella processers åtkomster till minnet där i detta fall minnes-faserna får fri tillgång till det delade minnet utan avbrott. Denna avhandling presenterar en vidareutvecklad AERmodel och en ny Idle-time Insertion Policy (IIP) som fattar beslut om en resurs ska lämnas inaktiv trots att det finns arbete att utföra i ett försöka att förbättra prestandan av schemaläggaren. Dessa kan användas i samband med ett toppmodernt analysverktyg för schemaläggning för att utföra tidsanalys på processer under AER-modellen. Den vidareutvecklade AER-modellen introducerar schemaläggningsfönster för Acquisition (A)-fasen och Restitution (R)-fasen utav processer på ett sätt som gör det överflödigt för en schemaläggare att behöva oroa sig om någon företrädesrätt mellan de bägge faserna. Den utvecklade IIP’n används sedan av analysverktyget för att se till att det finns minst en ledig kärna i processorn när en ny process ska schemaläggas, eftersom det inte är något som annars garanteras vid användning av ett minnes-centriskt tillvägagångssätt. Den vidareutvecklade AERmodellen och IIP’n sätts sedan på prov genom tester där de schemalägger processer som följer AUTOSAR standarden. Testerna utforskar hur väl processerna schemaläggs när antalet procceser, antalet kärnor och fönster-faktorn för faserna varieras. Resultaten visar att Earliest Deadline First (EDF) presterar bättre än andra schemaläggnignsalgoritmer som prioriterar processer utifrån deras period och körtid, processer med en fönster-faktor på 60% presterar bäst och att schemaläggning när antalet processer är mellan 100 och 150 är optimalt

Att arbeta med konflikthantering : implementering och undersökning av en form av fokusgruppsamtal i skolan

I have chosen an action research approach for this essay. I want to incorporate a method of conflict management in the work of the personnel at a school and also discuss their thoughts and experience in conflict management. I wanted to incorporate modern knowledge about constructive conflict management for everyday use and I stress that if we can evolve these skills among the personnel in schools then we have a better chance of helping children with deviant behavior which often end up in conflict because of it. This will also help all the other children and personnel to manage conflict situations in a better way. I want to introduce a new way of thinking about conflict management which in many ways is different from how it is today. Briefly the method which I advocate revolves around paying attention to every ones basic needs and says that everyone can win and no one has to loose. he main purpose of this essay has been to find out if focus group conversations is a viable method for improving conflict management in the school system. Several of the participants has in their evaluations written that it was a rewarding and interesting way to work. Some participants also had a reservation that this work took time from our scheduled conferences so we might miss some important information

Implementation and Evaluation of Espresso Stream Cipher in 65nm CMOS

With the upcoming 5G networks and expected growth of the Internet of Things (IoT), the demand for fast and reliable encryption algorithms will increase. As many systems might be time critical and run on internal power sources, the algorithms must be small, fast, energy efficient and have low latency. A new stream cipher called Espresso has been proposed to answer these demands, optimizing for several parameters unlike other stream ciphers such as Trivium and Grain. Espresso has previously been compared to the industry standard, Advanced Encryption Standard (AES), in a FPGA implementation and has shown promising results in terms of power usage but further testing needs to be done to gain knowledge about the ciphers characteristics. The purpose of this thesis is to implement and evaluate Espresso in 65nm CMOS technology and compare it to AES. Espresso is implemented in VHDL in several configurations, optimizing for size and latency. The implementations are then compared to AES is in terms of area, throughput, energy efficiency and latency through simulation. This is done using the UMC 65nm CMOS library and Synopsys Design Vision. It is found that Espresso, implemented with 1 bit sequential loading of the key and IV, is 18.2x smaller, 3.2x faster, uses 9.4x less power and has 1.5x less latency than AES. When implemented with full parallel loading, Espresso still is 13.6x smaller, 3.2x faster, draws 7.1x less power while also having 3.2x lower latency than AES. Espressos energy efficiency can further be improved by applying low- power techniques although some techniques, like clock gating and power gating, have limited applicability due to of the nature of stream ciphers.Med de kommande 5G nätverken och den förväntade tillväxten av Internet of Things (IoT) kommer efterfrågan på snabba och pålitliga krypteringsalgoritmer att öka. Eftersom många system kan vara tidskritiska och drivas av interna kraftkällor måste algoritmerna vara små, snabba, energieffektiva och ha låg latens. Ett nytt strömchiffer vid namn Espresso har föreslagits som ett svar på dessa krav och har optimiserats för flera parametrar till skillnad från andra strömchiffer såsom Trivium och Grain. Espresso har tidigare jämförts med branschstandarden, Advanced Encryption Standard (AES), i en FPGA implementation och visat lovande resultat för strömförbrukning men ytterligare tester måste utföras för att få kunskap om algoritmens egenskaper. Syftet med detta examensarbete är att implementera och utvärdera Espresso i 65nm CMOS teknologi och jämföra den med AES. Espresso implementeras i flera konfigurationer i VHDL som optimiserar för storlek och latens. Implementationerna jämförs sedan med AES i area, genomströmning, energieffektivitet och latens genom simulering. Detta görs med hjälp av UMC 65nm CMOS biblioteket och Synopsys Design Vision. Resultaten visar att Espresso implementerad med sekventiell laddning av nyckel och IV är 18.2x mindre, 3.2x snabbare, använder 9.4x mindre ström och har 1.5x mindre latens än AES. När Espresso implementeras med full parallel laddning är den fortfarande 13.6x mindre, 3.2x snabbare, drar 7.1x mindre ström men har samtidigt 3.2x lägre latens än AES. Espresso’s energieffektivitet kan förbättras ytterligare genom att applicera strömsparande tekniker, även om vissa tekniker såsom clock gating och power gating har begränsad användbarhet på grund av strömchiffers natur

Pulmonary vascular resistance related to endothelial function after lung transplantation

In 8 donor pigs, flush perfusion was performed with a low-potassium-dextran solution. Ring segments were taken from a small intralobar pulmonary artery in the right lung immediately after perfusion and after 24 hours of cold storage for studies in organ baths. Stable vasoconstriction was induced with the thromboxane mimic U-46619, and acetylcholine was used to induce endothelium-dependent relaxation. The maximum relaxation was significantly reduced after flush perfusion compared with fresh nonperfused controls, and a significant additional reduction was seen after the 24-hour storage period. The left donor lung was transplanted into a recipient after 24 hours of cold storage. Contralateral pneumonectomy was then performed, making the recipient entirely dependent on the transplanted lung for survival. All 8 pigs were in good condition throughout the 24-hour observation period, with arterial oxygen tension of around 165 mm Hg (range, 80 to 275 mm Hg; inspired oxygen fraction, 0.5) and pulmonary vascular resistance of around 450 dyne.s.cm-5 (range, 260 to 730 dyne.s.cm-5). The maximum endothelium-dependent relaxation for each donor was checked for correlation to pulmonary vascular resistance and to systolic, mean, and diastolic pulmonary artery pressures as recorded at 4-hour intervals. Regression analyses showed arterial oxygen tension to be unrelated to pulmonary vascular resistance and endothelial dysfunction to be unrelated to pulmonary artery pressure but to correlate to pulmonary vascular resistance, this correlation being significant after reperfusion for 16 hours (p < 0.05) and highly significant after 24 hours (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS

Eliminating the strong pulmonary vasoconstriction caused by Euro-Collins solution

Single-flush perfusion with Euro-Collins solution (ECS), after pretreatment with prostaglandin E1 or prostacyclin, is at most centers the standard procedure for preservation of lungs for transplantation. In a previous study, we showed that the high potassium content of ECS causes strong pulmonary vasoconstriction at temperatures higher than 20 degrees C. In the present study, five drugs used as pretreatment and added to the perfusate were compared for their ability to counteract ECS-induced constriction of porcine pulmonary arteries: papaverine reduced the vasoconstrictive effect by 92% +/- 4%; nifedipine, by 62% +/- 6%; the thromboxane A2 receptor antagonist daltroban, by 15% +/- 4%; and prostaglandin E1, by 12% +/- 4%. On the other hand, prostacyclin not only failed to reduce ECS-induced vasoconstriction but at the highest concentration tested, enhanced it by 37% +/- 7%. The combination of papaverine (10(-4) mol/L) and nifedipine (10(-6.5) mol/L) was the only pretreatment to abolish ECS-induced vasoconstriction; moreover, it has no adverse effect on endothelial function. Neither prostaglandin E1 nor prostacyclin effectively counteracts ECS-induced vasoconstriction, though they may have other beneficial effects

Transapical versus transfemoral aortic valve implantation: a comparison of survival and safety.

Transcatheter aortic valve implantation (TAVI) is a therapeutic option for high-risk patients with aortic stenosis. Procedural mortality remains high in comparison with conventional aortic valve replacement (AVR) because patients determined for TAVI are commonly denied conventional surgery. We aimed to evaluate access-related complications between the transfemoral (TF) and the transapical (TA) approach and to compare survival between TAVI and conventional AVR in propensity-score-matched patients