Comparative prediction of cardiac events by wall motion, wall motion plus coronary flow reserve, or myocardial perfusion analysis: a multicenter study of contrast stress echocardiography

ObjectivesThis study sought to determine whether the increasing difficulty of assessing wall motion (WM), Doppler coronary flow reserve on the left anterior descending coronary artery (CFR-LAD), and myocardial perfusion (MP) during stress echocardiography (SE) was justified by increasing prognostic information in patients with known or suspected coronary artery disease.BackgroundThe use of echocardiographic contrast agents during SE permits the assessment of both CFR-LAD and MP, but their relative incremental prognostic value is undefined.MethodsThis study followed a multicenter cohort of 718 patients for 16 months after high-dose dipyridamole contrast SE for evaluation of known or suspected coronary artery disease. The ability of WM, CFR-LAD, and MP to predict cardiac events was studied by multivariable models and risk reclassification.ResultsAbnormal SE was detected as a reversible WM abnormality in 18%, reversible MP defect in 27%, and CFR-LAD <2 in 38% of subjects. Fifty cardiac events occurred (annualized event rate 6.0%). A normal MP stress test had a 1-year hard event rate of 1.2%. The C-index of outcomes prediction based on clinical data was improved with MP (p < 0.001) and WM/CFR-LAD (p = 0.037), and MP (p = 0.003) added to clinical and WM data. Net risk reclassification was improved by adding MP (p < 0.001) or CFR-LAD (net reclassification improvement p = 0.001) in addition to clinical and WM data. The model including clinical data, WM/CFR-LAD, and MP performed better than that without MP did (p = 0.012).ConclusionsThe multiparametric assessment of WM, CFR-LAD and MP during stress testing in patients with known or suspected coronary artery disease is feasible. Contrast SE allowed better prognostication, irrespective of the use of CFR-LAD or MP. The addition of either CFR-LAD or MP assessment to standard WM analysis and clinical parameters yielded progressively higher values for the prediction of cardiac events and may be required in today's intensively treated patients undergoing SE, because their average low risk of future cardiac events requires methods with higher predictive sensitivity than that available with standalone WM assessment

Synonymy and stratigraphic ranges of Belemnopsis in the Heterian and Ohauan Stages (Callovian-Tithonian), southwest Auckland, New Zealand.

Belemnopsis stevensi, Belemnopsis maccrawi, and Belemnopsis sp. A (Challinor 1979a) are synonymous; B. stevensi has priority. New belemnite material from Kawhia Harbour and Port Waikato, together with graphical study methods, indicates that many small fragmentary specimens associated with B. stevensi in the lower part of its stratigraphic range are probably the same taxon. B. stevensi has been found only in the Middle and Upper Heterian Stage (Lower Kimmeridgian) at Kawhia and only in the Lower Ohauan Stage (Upper Kimmeridgian) at Port Waikato. This apparently disjunct distribution is attributed to poor exposure in the relevant sections. Belemnopsis kiwiensis n.sp., Belemnopsis cf. sp. B, Belemnopsis sp. B, Belemnopsis sp. D, and Belemnopsis spp. are associated with B. stevensi near the lowest known point in its stratigraphic range. The distribution of stratigraphically useful belemnites within the Heterian and Ohauan Stages is: Conodicoelites spp. (Lower Heterian; correlated with Lower Callovian); Belemnopsis annae (Lower and Middle Heterian; Lower Callovian/Lower Kimmeridgian); Belemnopsis stevensi (Middle Heterian/Lower Ohauan; Kimmeridgian); Belemnopsis keari (Upper Heterian; Kimmeridgian); Belemnopsis trechmanni (Upper Ohauan; Upper Kimmeridgian/Middle Tithonian). The apparently extreme range of Belemnopsis annae remains unexplained. Klondyke Sandstone (new) is recognised as the basal member of Moewaka Formation (Port Waikato area)

Mortuary Caves and the Dammar Trade in the Towuti–Routa Region, Sulawesi, in an Island Southeast Asian Context

Archaeological evidence from survey and cave excavation in the Towuti–Routa region of Sulawesi suggests the following sequence of late Holocene cultural change. Settled communities whose subsistence included an agricultural component had established themselves by the early centuries a.d. and began the use of caves for mortuary purposes. Extended inhumations are the oldest attested mortuary practice, overlapping in time with secondary burials in large earthenware jars dated to around a.d. 1000. The third, ethnohistorically described practice involved the surface disposal of the deceased, including the use of imported martavans for the elite, between approximately a.d. 1500 and 1900. This sequence of mortuary practices has not been documented elsewhere in Island Southeast Asia, although each practice has multiple parallels. The Towuti–Routa dammar trade, which was at its peak at the time of European contact, can perhaps account for the quantity of exotic items imported to the region but not the specifics of the mortuary practices

Design of a speed meter interferometer proof-of-principle experiment

The second generation of large scale interferometric gravitational wave detectors will be limited by quantum noise over a wide frequency range in their detection band. Further sensitivity improvements for future upgrades or new detectors beyond the second generation motivate the development of measurement schemes to mitigate the impact of quantum noise in these instruments. Two strands of development are being pursued to reach this goal, focusing both on modifications of the well-established Michelson detector configuration and development of different detector topologies. In this paper, we present the design of the world's first Sagnac speed meter interferometer which is currently being constructed at the University of Glasgow. With this proof-of-principle experiment we aim to demonstrate the theoretically predicted lower quantum noise in a Sagnac interferometer compared to an equivalent Michelson interferometer, to qualify Sagnac speed meters for further research towards an implementation in a future generation large scale gravitational wave detector, such as the planned Einstein Telescope observatory.Comment: Revised version: 16 pages, 6 figure

Expectations and emotions concerning infant transitions to ECEC : international dialogues with parents and teachers

Although a large body of literature recognises the impact of parent-teacher relationships on infant everyday experiences, less is known about the emotional experience and associated expectations of the adults themselves during earliest transitions. In the context of a multi-site international investigation across five countries–Brazil, Finland, Scotland, New Zealand, and the United States–the present paper examines teacher and parent interviews to reveal expectations prior to and after the transition to ECEC, highlighting the associated emotions that arise during this process. Irrespective of whether expectations are met, parents universally express insecurities and fears in relation to the transition. Parents are aware of the impact that the various aspects of the ECEC setting have on their child, and acknowledge difficulty in relinquishing control of the care of their child. Despite these concerns, parents consistently articulate their strong trust in the institution and the professional expertise of the staff. Correspondingly, teachers are keenly aware of the importance of their role in supporting families, and hold certain expectations for how the transition experience will play out accordingly. Regardless of country of context, the study shows that clear communication surrounding both centre and parental expectations establishes high levels of trust and ameliorates anxiety. Teacher-parent dialogues concerning routines, preferences, and anticipations are seen as pivotal in supporting a positive transition for all

Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case–control study

&lt;br&gt;Background: To investigate whether later diagnosis of psychiatric disorder can be predicted from analysis of mother-infant joint attention (JA) behaviours in social-communicative interaction at 12 months.&lt;/br&gt; &lt;br&gt;Method: Using data from a large contemporary birth cohort, we examined 159 videos of a mother-infant interaction for joint attention behaviour when children were aged one year, sampled from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Fifty-three of the videos involved infants who were later considered to have a psychiatric disorder at seven years and 106 were same aged controls. Psychopathologies included in the case group were disruptive behaviour disorders, oppositional-conduct disorder, attention-deficit/hyperactivity disorder, pervasive development disorder, anxiety and depressive disorders. Psychiatric diagnoses were obtained using the Development and Wellbeing Assessment when the children were seven years old.&lt;/br&gt; &lt;br&gt;Results: None of the three JA behaviours (shared look rate, shared attention rate and shared attention intensity) showed a significant association with the primary outcome of case–control status. Only shared look rate predicted any of the exploratory sub-diagnosis outcomes and was found to be positively associated with later oppositional-conduct disorders (OR [95% CI]: 1.5 [1.0, 2.3]; p = 0.041).&lt;/br&gt;&lt;br&gt;Conclusions: JA behaviours did not, in general, predict later psychopathology. However, shared look was positively associated with later oppositional-conduct disorders. This suggests that some features of JA may be early markers of later psychopathology. Further investigation will be required to determine whether any JA behaviours can be used to screen for families in need of intervention.&lt;/br&gt

Downregulation of Mcl-1 has anti-inflammatory pro-resolution effects and enhances bacterial clearance from the lung

Phagocytes not only coordinate acute inflammation and host defense at mucosal sites, but also contribute to tissue damage. Respiratory infection causes a globally significant disease burden and frequently progresses to acute respiratory distress syndrome, a devastating inflammatory condition characterized by neutrophil recruitment and accumulation of protein-rich edema fluid causing impaired lung function. We hypothesized that targeting the intracellular protein myeloid cell leukemia 1 (Mcl-1) by a cyclin-dependent kinase inhibitor (AT7519) or a flavone (wogonin) would accelerate neutrophil apoptosis and resolution of established inflammation, but without detriment to bacterial clearance. Mcl-1 loss induced human neutrophil apoptosis, but did not induce macrophage apoptosis nor impair phagocytosis of apoptotic neutrophils. Neutrophil-dominant inflammation was modelled in mice by either endotoxin or bacteria (Escherichia coli). Downregulating inflammatory cell Mcl-1 had anti-inflammatory, pro-resolution effects, shortening the resolution interval (R(i)) from 19 to 7 h and improved organ dysfunction with enhanced alveolar–capillary barrier integrity. Conversely, attenuating drug-induced Mcl-1 downregulation inhibited neutrophil apoptosis and delayed resolution of endotoxin-mediated lung inflammation. Importantly, manipulating lung inflammatory cell Mcl-1 also accelerated resolution of bacterial infection (R(i); 50 to 16 h) concurrent with enhanced bacterial clearance. Therefore, manipulating inflammatory cell Mcl-1 accelerates inflammation resolution without detriment to host defense against bacteria, and represents a target for treating infection-associated inflammation

Data cultures of mobile dating and hook-up apps : emerging issues for critical social science research

The ethical and social implications of data mining, algorithmic curation and automation in the context of social media have been of heightened concern for a range of researchers with interests in digital media in recent years, with particular concerns about privacy arising in the context of mobile and locative media. Despite their wide adoption and economic importance, mobile dating apps have received little scholarly attention from this perspective – but they are intense sites of data generation, algorithmic processing, and cross-platform data-sharing; bound up with competing cultures of pro- duction, exploitation and use. In this paper, we describe the ways various forms of data are incorporated into, and emerge from, hook-up apps’ business logics, socio-technical arrangements, and cultures of use to produce multiple and intersecting data cultures. We propose a multi-layered research agenda for critical and empirical inquiry into this field, and suggest appropriate conceptual and methodological frameworks for exploring the social and political challenges of data cultures

Anti-ischemic therapy and stress testing: pathophysiologic, diagnostic and prognostic implications

Anti-ischemic therapy, in particular beta-blockers, is the most commonly employed drug for the control of myocardial ischemia in patients with stable coronary artery disease. Its widespread use also in patients with suspected coronary artery disease has important practical, clinical diagnostic and prognostic implications because diagnostic tests are heavily influenced by its effects. In the present review, the pathophysiological mechanisms of ischemia protection by antianginal therapy are described. Not all stressors are created equal in front of the different classes of antianginal drugs and on their turn the different classes of drugs exert different levels of protection on inducible ischemia. Several clinical implications can be drawn: From the diagnostic viewpoint antianginal therapy decreases test sensitivity, offsetting the real ischemic burden for a too high percentage of false negative tests. From the prognostic viewpoint test positivity in medical therapy identifies a group of subjects at higher risk of experiencing cardiac death and positivity on medical therapy can be considered a parameter of ischemia severity. Nonetheless in patients with known coronary artery disease the ability of antianginal therapy to modify the ischemic threshold at stress testing represent a powerful means to assess therapy efficacy. From a practical viewpoint, the use of antianginal therapy at time of testing has advantages and disadvantages which are largely dependent on the purpose a test is performed: if the purpose of testing is to diagnose ischemia, it should be performed in the absence of antianginal medications. If the purpose of testing is to assess the protective effects of antianginal therapy, the test should be performed on medications