Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy

BackgroundTo test the hypothesis that point-of-care assays of platelet reactivity would demonstrate reduced response to antiplatelet therapy in patients who experienced Drug Eluting Stent (DES) ST whilst on dual antiplatelet therapy compared to matched DES controls. Whilst the aetiology of stent thrombosis (ST) is multifactorial there is increasing evidence from laboratory-based assays that hyporesponsiveness to antiplatelet therapy is a factor in some cases.MethodsFrom 3004 PCI patients, seven survivors of DES ST whilst on dual antiplatelet therapy were identified and each matched with two patients without ST. Analysis was performed using (a) short Thrombelastogram PlateletMapping™ (TEG) and (b) VerifyNow Aspirin and P2Y12 assays. TEG analysis was performed using the Area Under the Curve at 15 minutes (AUC15) as previously described.ResultsThere were no differences in responses to aspirin. There was significantly greater platelet reactivity on clopidogrel in the ST group using the Accumetrics P2Y12 assay (183 ± 51 vs. 108 ± 31, p = 0.02) and a trend towards greater reactivity using TEG AUC15 (910 ± 328 vs. 618 ± 129, p = 0.07). 57% of the ST group by TEG and 43% of the ST cases by Accumetrics PRU had results > two standard deviations above the expected mean in the control group.ConclusionThis study demonstrates reduced platelet response to clopidogrel in some patients with DES ST compared to matched controls. The availability of point-of-care assays that can detect these responses raises the possibility of prospectively identifying DES patients at risk of ST and manipulating their subsequent risk

Impact Testing of Stainless Steel Material at Cold Temperatures

Stainless steels are used for the construction of numerous spent nuclear fuel or radioactive material containers that may be subjected to high strains and moderate strain rates during accidental drop events. Mechanical characteristics of these base materials and their welds under dynamic loads in the strain rate range of concern are not well documented. However, a previous paper [1] reported on impact testing and analysis results performed at the Idaho National Laboratory using 304/304L and 316/316L stainless steel base material specimens at room and elevated temperatures. The goal of the work presented herein is to add recently completed impact tensile testing results at -20 degrees F conditions for dual-marked 304/304L and 316/316L stainless steel material specimens (hereafter referred to as 304L and 316L, respectively). Recently completed welded material impact testing at -20 degrees F, room, 300 degrees F, and 600 degrees F is also reported. Utilizing a drop-weight impact test machine and 1/4-inch to 1/2-inch thick dog-bone shaped test specimens, the impact tests achieved strain rates in the 4 to 40 per second range, depending upon the material temperature. Elevated true stress-strain curves for these materials reflecting varying strain rates and temperatures are presented herein

Current Activities of the ASME Subgroup NUPACK

Current activities of the American Society of Mechanical Engineers (ASME), Section III Subgroup on Containment Systems for Spent Fuel High-Level Waste Transport Packagings (also known as Subgroup NUPACK) are reviewed with emphasis on the recent revision of Subsection WB. Also, brief insightson new proposals for the development of rules for internal support structures and for a strain-based acceptance criteria are provided

Microseismic joint location and anisotropic velocity inversion for hydraulic fracturing in a tight Bakken reservoir

To improve the accuracy of microseismic event locations, we developed a new inversion method with double-difference constraints for determining the hypocenters and the anisotropic velocity model for unconventional reservoirs. We applied this method to a microseismic data set monitoring a Middle Bakken completion in the Beaver Lodge area of North Dakota. Geophone arrays in four observation wells improved the ray coverage for the velocity inversion. Using an accurate anisotropic velocity model is important to correctly assess the height growth of the hydraulically induced fractures in the Middle Bakken. Our results showed that (1) moderate-to-strong anisotropy exists in all studied sedimentary layers, especially in the Upper and Lower Bakken shale formations, where the Thomsen parameters (ϵ and γ) can be greater than 0.4, (2) all the events selected for high signal-to-noise ratio and used for the joint velocity inversion are located in the Bakken and overlying Lodgepole formations, i.e., no events are detected in the Three Forks formation below the Bakken, and (3) more than half of the strong events are in two clusters at approximately 100 and 150 m above the Middle Bakken. Reoccurrence of strong, closely clustered events suggested activation of natural fractures or faults in the Lodgepole formation. The sensitivity analysis for the inversion results showed that the relative uncertainty in parameter δ is larger than other anisotropy parameters. The microseismic event locations and the anisotropic velocity model are validated by comparing synthetic and observed seismic waveforms and by S-wave splitting.Shell Oil Compan

A Program for Risk Assessment Associated with IGSCC of BWR Vessel Internals

A program is being carried out for the US Nuclear Regulatory Commission (NRC) by the Idaho National Engineering and Environmental Laboratory (INEEL), to conduct an independent risk assessment of the consequences of failures initiated by intergranular stress corrosion cracking (IGSCC) of the reactor vessel internals of boiling water reactor (BWR) plants. The overall project objective is to assess the potential consequences and risks associated with the failure of IGSCC-susceptible BWR vessel internals, both singly and in combination with the failures of others, with specific consideration given to potential cascading and common mode effects on system performance. This paper presents a description of the overall program that is underway to modify an existing probabilistic risk assessment (PRA) of the BWR/4 plant to include IGSCC-initiated failures, subsequently to complete a quantitative PRA

Evaluating the effects of increasing physical activity to optimize rehabilitation outcomes in hospitalized older adults (MOVE Trial): Study protocol for a randomized controlled trial

Background: Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge. Physical activity levels in rehabilitation are also low. It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation will lead to better mobility outcomes at discharge. Methods/Design: A single blind, parallel-group, multisite randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. The cost effectiveness of the intervention will also be examined. Older people (age >60 years) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals. A computer-generated blocked stratified randomization sequence will be used to assign 198 participants in a 1:1 ratio to either an 'enhanced physical activity' (intervention) group or a 'usual care plus' (control) group for the duration of their inpatient stay. Participants will receive usual care and either spend time each week performing additional physical activities such as standing or walking (intervention group) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games (control group). Self-selected gait speed will be measured using a 6-meter walk test at discharge (primary outcome) and 6 months follow-up (secondary outcome). The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge. Additional measures of mobility (Timed Up and Go, De Morton Mobility Index), function (Functional Independence Measure) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up. The trial commenced recruitment on 28 January 2014. Discussion: This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000884707(Date of registration 08 August 2013); ClinicalTrials.gov Identifier NCT01910740(Date of registration 22 July 2013)

Managing climate change risks in Africa - A global perspective

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Precarious lives and resistant possibilities: the labour of people with learning disabilities in times of austerity

This paper draws on feminist and queer philosophers? discussions of precarity and employment, too often absent from disability studies, to explore the working lives of people with learning disabilities in England in a time of austerity. Recent policy shifts from welfare to work welcome more disabled people into the job market. The reality is that disabled people remain under-represented in labour statistics and are conspicuously absent in cultures of work. We live in neoliberal-able times where we all find ourselves precarious. But, people with learning disabilities experience high levels of uncertainty in every aspect of their lives, including work, relationships and community living. Our research reveals an important analytical finding: that when people with learning disabilities are supported in imaginative and novel ways they are able to work effectively and cohesively participate in their local communities (even in a time of cuts to welfare). We conclude by acknowledging that we are witnessing a global politics of precarity and austerity. Our urgent task is to redress the unequal spread of precaritization across our society that risks leaving people with learning disabilities experiencing disproportionately perilous lives. One of our key recommendations is that it makes no economic sense (never mind moral sense) to pull funding from organisations that support people with intellectual disabilities to work

The Rule of Law is Dead! Long Live the Rule of Law!

Polls show that a significant proportion of the public considers judges to be political. This result holds whether Americans are asked about Supreme Court justices, federal judges, state judges, or judges in general. At the same time, a large majority of the public also believes that judges are fair and impartial arbiters, and this belief also applies across the board. In this paper, I consider what this half-law-half-politics understanding of the courts means for judicial legitimacy and the public confidence on which that legitimacy rests. Drawing on the Legal Realists, and particularly on the work of Thurman Arnold, I argue against the notion that the contradictory views must be resolved in order for judicial legitimacy to remain intact. A rule of law built on contending legal and political beliefs is not necessarily fair or just. But it can be stable. At least in the context of law and courts, a house divided may stand