Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31758 patients treated between 2000 and 2007

<p>Background: The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age ≥75 years) patients and whether it has changed over time.</p> <p>Methods and Results: The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, χ2 test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ2 test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (χ2 test for trend, P=0.142) or overall (χ2 test for trend, P=0.083).</p> <p>Conclusions: Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.</p&gt

Quantifying error in OSCE standard setting for varying cohort sizes: A resampling approach to measuring assessment quality

Background: The use of the borderline regression method (BRM) is a widely accepted standard setting method for OSCEs. However, it is unclear whether this method is appropriate for use with small cohorts (e.g. specialist post-graduate examinations). Aims and methods: This work uses an innovative application of resampling methods applied to four pre-existing OSCE data sets (number of stations between 17 and 21) from two institutions to investigate how the robustness of the BRM changes as the cohort size varies. Using a variety of metrics, the ‘quality’ of an OSCE is evaluated for cohorts of approximately n=300 down to n=15. Estimates of the standard error in station-level and overall pass marks, R2 coefficient, and Cronbach’s alpha are all calculated as cohort size varies. Results and conclusion: For larger cohorts (n>200), the standard error in the overall pass mark is small (less than 0.5%), and for individual stations is of the order of 1-2%. These errors grow as the sample size reduces, with cohorts of less than 50 candidates showing unacceptably large standard error. Alpha and R2 also become unstable for small cohorts. The resampling methodology is shown to be robust and has the potential to be more widely applied in standard setting and medical assessment quality assurance and research

Temporally explicit life cycle assessment as an environmental performance decision making tool in rare earth project development

This is the final version. Available from Elsevier via the DOI in this record.The study shows that a detailed LCA can be carried out for a proposed mining project as soon as Prefeasibility (PFS) data are available. The prefeasibility study is one of the key early steps in bringing a deposit towards production and results are often publically available. This study applies the technique to a rare earth deposit because rare earth element (REE) consumption is increasing owing to their use in low-carbon technologies such as electric vehicles and wind turbines. It is therefore particularly important to understand the environmental impacts of the raw materials. A number of REE deposits are under development to give additional supply and many possess novel mineral compositions and will require different processing methods than previously used. Assessing the environmental performance of the production of REE during the development of projects offers significant insights into how to improve the sustainability of a project. In this study we used life cycle assessment (LCA) to quantify the environmental impacts for producing rare earth oxide (REO) from the Bear Lodge Project, United States. The Life Cycle Impact Assessment results were produced for each year over the life of the project, generating insight about the relationships between ore composition, grade, processing method and environmental impacts. The environmental impacts vary significantly during the life of a project and a temporally explicit LCA can highlight these.Natural Environment Research Council (NERC

Mineral processing simulation based-environmental life cycle assessment for rare earth project development: a case study on the Songwe Hill project

This is the final version. Available on open access from Elsevier via the DOI in this recordRare earth elements (REE), including neodymium, praseodymium, and dysprosium are used in a range of low-carbon technologies, such as electric vehicles and wind turbines, and demand for these REE is forecast to grow. This study demonstrates that a process simulation-based life cycle assessment (LCA) carried out at the early stages of a REE project, such as at the pre-feasibility stage, can inform subsequent decision making during the development of the project and help reduce its environmental impacts. As new REE supply chains are established and new mines are opened. It is important that the environmental consequences of different production options are examined in a life cycle context in order that the environment footprint of these raw materials is kept as low as possible. Here, we present a cradle-to-gate and process simulation-based life cycle assessment (LCA) for a potential new supply of REE at Songwe Hill in Malawi. We examine different project options including energy selection and a comparison of on-site acid regeneration versus virgin acid consumption which were being considered for the project. The LCA results show that the global warming potential of producing 1 kg of rare earth oxide (REO) from Songwe Hill is between 17 and 87 kg CO2-eq.A scenario that combines on-site acid regeneration with off-peak hydroelectric and photovoltaic energy gives the lowest global warming potential and performs well in other impact categories.This approach can equally well be applied to all other types of ore deposits and should be considered as a routine addition to all pre-feasibility studies.Natural Environment Research Council (NERC

Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: a systematic review

Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery.  The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched.  Last search was 5 th August 2016.  Studies were included if they reported gestational age, IQ measure and the ages assessed.  The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472).  Two independent reviewers assessed the studies.  Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included.  For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing.  Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion:  Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks).  This should be considered when discussing timing of delivery.  For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores

Using cascading Bloom filters to improve the memory usage for de Brujin graphs

De Brujin graphs are widely used in bioinformatics for processing next-generation sequencing data. Due to a very large size of NGS datasets, it is essential to represent de Bruijn graphs compactly, and several approaches to this problem have been proposed recently. In this work, we show how to reduce the memory required by the algorithm of [3] that represents de Brujin graphs using Bloom filters. Our method requires 30% to 40% less memory with respect to the method of [3], with insignificant impact to construction time. At the same time, our experiments showed a better query time compared to [3]. This is, to our knowledge, the best practical representation for de Bruijn graphs.Comment: 12 pages, submitte

Multiple Pulsejet Boring Device

A method and device for boring a hole [5] through a material along a desired path includes an umbilical subsystem [2000] connected to a boring subsystem [3000] having a plurality of pulsejets [3100]. These pulsejets [3100] repeatedly receive and ignite a combustible fluid [7] in a combustion chamber [3230] causing a portion of the fluid [7] to be forced out of a nozzle [3260] at high speeds as a fluid slug [10] that impacts materials ahead of the pulsejet [3100]. A controller [3310] controls the amount of fluid provided to each pulsejet [3100], and the firing timing, thereby controlling the intensity in which each slug [10] impacts the material. By modulating the intensity and firing sequence of each of the pulsejets [3100], material ahead of the boring subsystem [3000] is differentially bored thereby allowing steering of the boring subsystem [3000]

Fluorescence from a few electrons

Systems containing few Fermions (e.g., electrons) are of great current interest. Fluorescence occurs when electrons drop from one level to another without changing spin. Only electron gases in a state of equilibrium are considered. When the system may exchange electrons with a large reservoir, the electron-gas fluorescence is easily obtained from the well-known Fermi-Dirac distribution. But this is not so when the number of electrons in the system is prevented from varying, as is the case for isolated systems and for systems that are in thermal contact with electrical insulators such as diamond. Our accurate expressions rest on the assumption that single-electron energy levels are evenly spaced, and that energy coupling and spin coupling between electrons are small. These assumptions are shown to be realistic for many systems. Fluorescence from short, nearly isolated, quantum wires is predicted to drop abruptly in the visible, a result not predicted by the Fermi-Dirac distribution. Our exact formulas are based on restricted and unrestricted partitions of integers. The method is considerably simpler than the ones proposed earlier, which are based on second quantization and contour integration.Comment: 10 pages, 3 figures, RevTe

Introduced birds in urban remnant vegetation : does remnant size really matter?

Introduced birds are a pervasive and dominant element of urban ecosystems. We examined the richness and relative abundance of introduced bird species in small (1&ndash;5 ha) medium (6&ndash;15 ha) and large (&gt;15 ha) remnants of native vegetation within an urban matrix. Transects were surveyed during breeding and non-breeding seasons. There was a significant relationship between introduced species richness and remnant size with larger remnants supporting more introduced species. There was no significant difference in relative abundance of introduced species in remnants of different sizes. Introduced species, as a proportion of the relative abundance of the total avifauna (native and introduced species), did not vary significantly between remnants of differing sizes. There were significant differences in the composition of introduced bird species between the different remnant sizes, with large remnants supporting significantly different assemblages than medium and small remnants. Other variables also have substantial effects on the abundance of introduced bird species. The lack of significant differences in abundance between remnant sizes suggests they were all equally susceptible to invasion. No patches in the urban matrix are likely to be unaffected by introduced species. The effective long-term control of introduced bird species is difficult and resources may be better spent managing habitat in a way which renders it less suitable for introduced species (e.g. reducing areas of disturbed ground and weed dominated areas).<br /