Palliation of Abdominal Aortic Aneurysms in the Endovascular Era

AbstractObjectivesTo establish outcome of patients with abdominal aortic aneurysm (AAA) deemed unfit for repair.DesignRetrospective non-randomised study.Materials and methodsIdentification of males with >5.5 cm or females with >5.0 cm AAA turned down for elective repair between 01/01/2006–24/07/2009 from a prospective database. Comorbidities, reasons for non-intervention, aneurysm size, survival, use of CPEX (cardio-pulmonary exercise) testing and cause of death were analysed. Although well-established at the time, patients unfit for open operation were not considered for endovascular repair.ResultsSeventy two patients were unsuitable for AAA repair. Aneurysm size ranged from 5.3 cm to 12 cm. Functional status, comorbidity and patient preference determined decision to palliate. Sixty percent of patients were alive at study close. Aneurysm rupture was cause of death in 46%. CPEX testing was performed in 54%, whose mortality was 28%, vs. 54% in the non-CPEX group (P < 0.05).Median survival of patients with 5.1–6.0 cm AAA was 44 months and 11% died of rupture. Between 6.1 and 7.0 cm median survival was 26 months and 20% died of rupture. However, with >7 cm aneurysms, survival was 6 months and 43% ruptured.ConclusionUnder half the deaths in our comorbid cohort were due to rupture. However, decision to palliate may be revisited as risk-benefit ratio changes with aneurysm expansion

The Value of Transcranial Doppler in Predicting Cerebral Ischaemia During Carotid Endarterectomy

AbstractObjectives: transcranial Doppler (TCD) measurement of middle cerebral artery velocity (MCAV) is an indirect method of assessing cerebral blood flow and therefore predicting patients at risk of stroke during carotid endarterectomy (CEA), and may be used to determine the need for shunting. This study evaluates the accuracy of three accepted TCD criteria in predicting the need for a shunt. Design: prospective study. Methods: one hundred and twenty consecutive CEA were performed under loco/regional anaesthesia. Patients monitored by TCD and Awake neurological examination were included. Shunts were inserted if there was neurological deterioration. Awake patient monitoring was compared with the three TCD criteria. Results: inadequate TCD recordings were obtained in 16 operations (13%). In the remainder (104 cases), 12 developed symptoms of cerebral ischaemia and required a shunt (12%). Comparisons with the three accepted criteria were as follows: (1) m MCAV <30 cm/s had a sensitivity, specificity, PPV and NPV of 92%, 49%, 19%, and 98%, respectively; (2) clamp/pre-clamp ratio <0.6 had a sensitivity, specificity, PPV and NPV of 92%, 75%, 33% and 99%, respectively; (3) greater than 50% reduction in m MCAV had a sensitivity, specificity, PPV and NPV valves of 83%, 77%, 32% and 97%, respectively. Conclusions: TCD flow velocities are not a reliable method for detecting cerebral ischaemia and therefore determining the need for a shunt in CEA

Minimizing Effective Many-Body Interactions

A simple two-level model is developed and used to test the properties of effective interactions for performing nuclear structure calculations in truncated model spaces. It is shown that the effective many-body interactions sensitively depend on the choice of the single-particle basis and they appear to be minimized when a self- consistent Hartree-Fock basis is used.Comment: (15 pages of text and 1 postscript figure (Figure available upon request), Preprint Number not assigned ye

The Increasing Role of Percutaneous Transluminal Angioplasty in the Primary Management of Critical Limb Ischaemia

AbstractObjective: to review the current role and results of angioplasty in the management of critical limb ischaemia (CLI) in a single institution.Methods: data on 526 patients with 608 ischaemic limbs, treated between January 1994 and December 1999 was collected prospectively and analysed retrospectively. Patients were divided into 3 groups according to the date of presentation: group 1 (1994–95), group 2 (1996–97) and group 3 (1998–99). The groups were comparable in terms of demographics, mode of presentation and level of disease.Results: Revascularisation was attempted in 87%, 81% and 91% for groups 1, 2 and 3 respectively (NS). Primary percutaneous transluminal angioplasty (PTA) rates increased from 44% (1994–95) to 69% (1998–99) (p < 0.001), and surgical revascularisation rates decreased correspondingly (p<0.01). Overall cumulative patient survival and limb salvage rates were 82% and 89% for 1 year and 45% and 87% for 5 years, respectively. No statistically significant difference existed between the three groups regarding patient survival, limb salvage rates and mean hospital stay (19, 12 and 12 days, respectively).Conclusion: PTA is increasingly replacing bypass surgery in the treatment of CLI, without compromising patient survival or limb salvage rates

Analyzing Power Measurements for (p,n) Reactions

This work was supported by the National Science Foundation Grant NSF PHY 78-22774 A02 & A03 and by Indiana Universit

Analyzing-Power Measurements for (p,n) Reactions

This work was supported by the National Science Foundation Grant NSF PHY 81-14339 and by Indiana Universit

Dissolving microarray patches for transdermal delivery of risperidone for schizophrenia management

Schizophrenia is a psychiatric disorder that results from abnormal levels of neurotransmitters in the brain. Risperidone (RIS) is a common drug prescribed for the treatment of schizophrenia. RIS is a hydrophobic drug that is typically administered orally or intramuscularly. Transdermal drug delivery (TDD) could potentially improve the delivery of RIS. This study focused on the development of RIS nanocrystals (NCs), for the first time, which were incorporated into dissolving microneedle array patches (DMAPs) to facilitate the drug delivery of RIS. RIS NCs were formulated via wet-media milling technique using poly(vinylalcohol) (PVA) as a stabiliser. NCs with particle size of 300 nm were produced and showed an enhanced release profile up to 80 % over 28 days. Ex vivo results showed that 1.16 ± 0.04 mg of RIS was delivered to both the receiver compartment and full-thickness skin from NCs loaded DMAPs compared to 0.75 ± 0.07 mg from bulk RIS DMAPs. In an in vivo study conducted using female Sprague Dawley rats, both RIS and its active metabolite 9-hydroxyrisperidone (9-OH-RIS) were detected in plasma samples for 5 days. In comparison with the oral group, DMAPs improved the overall pharmacokinetic profile in plasma with a ∼ 15 folds higher area under the curve (AUC) value. This work has represented the novel delivery of the antipsychotic drug, RIS, through microneedles. It also offers substantial evidence to support the broader application of MAPs for the transdermal delivery of poorly water-soluble drugs

A VALUE PLATFORM ANALYSIS PERSPECTIVE ON CUSTOMER ACCESS INFORMATION TECHNOLOGY

Customer access information technologies (CAITs) provide a link between a firm and its customers. Firms invest in CAITs to reduce costs, increase revenues and market share, lock in existing customers and capture new ones. These benefits, however, are notoriously difficult to measure. This paper proposes an evaluative method for CAlT deployment called value platform analysis, that is based on a conceptual model drawn from the theory of retail outlet deployment in marketing science. The model focuses on the impact of CAIT features and environmental features on transactions generated by the CAIT. Specific econometric models are developed for deployment. Hypotheses regarding the likely impact of automated teller machine (ATM) location design choices and environmental features on ATM transactions are evaluated. The results indicate that there are a number of key features influencing ATM performance. Two distinct ATM deployment scenarios emerge: one for servicing a bank's own customers, and another for providing transaction services for customers for a fee.Information Systems Working Papers Serie