Tibial Artery Calcification as a Marker of Amputation Risk in Patients With Peripheral Arterial Disease

ObjectivesThe purpose of this study was to evaluate the relationship between calcification in tibial arteries, the degree of limb ischemia, and the near-term risk of amputation.BackgroundDetermining the amputation risk in patients with peripheral arterial disease (PAD) remains difficult. Developing new measures to identify patients who are at high risk for amputation would allow for targeted interventions and focused trials aimed at limb preservation.MethodsTwo hundred twenty-nine patients underwent evaluation by history, arterial Doppler, and multislice computed tomography of the lower extremities. We then explored the relationship between a tibial artery calcification (TAC), traditional risk factors for PAD, limb status at presentation, and near-term amputation risk.ResultsIncreased age and traditional atherosclerosis risk factors were associated with higher TAC scores. Patients with critical limb ischemia had the highest TAC scores, and increasing TAC scores were associated with worsening levels of limb ischemia in ordinal regression analysis. Receiver-operator characteristic analysis suggested that the TAC score predicted amputation better than the ankle-brachial index (ABI). Symptomatic patients with a TAC score greater than 400 had a significantly increased risk of amputation. In Cox regression analysis, there was a strong association between the TAC score and the risk of major amputation that remained after adjustment for traditional risk factors and the ABI.ConclusionsIn patients presenting with PAD, the TAC score is associated with the stage of disease and it identifies those who are at high risk for amputation better than traditional risk factors and an abnormal ABI

A comprehensive hydrodynamic analysis of a full-scale oxidation ditch using Population Balance Modelling in CFD simulation

This work exhibits the importance of the experimental validation when full-scale computational fluid dynamics (CFD) models are developed to provide a detailed analysis of the spatial variations in 3D of the fluid flow inside aerated tanks. Single-phase and two-phase CFD models were performed to study the fluid behaviour carefully by means of the velocity profiles and the aeration pattern in a full-scale oxidation ditch. Air hold-up, bubble size distribution and interfacial area density were calculated by polydisperse models where Population Balance Model (PBM) was governed by break-up and coalescence; the free-surface approach allowed the CFD model to describe the three-dimensional effect of bubbly plumes in large scales in detail. Tracer tests were carried out to obtain the flow pattern and the hydraulic distribution of the flow into two wastewater treatment lanes in order to define the boundary conditions for the model correctly. Despite the difficulty of performing velocity measurements of the fluid in 3D, with and without air bubbles, these provided essential information to validate the CFD model. From this analysis, several simulations were performed to improve the hydrodynamics and the operation of the process by relocating the propellers

The Void Abundance with Non-Gaussian Primordial Perturbations

We use a Press-Schechter-like calculation to study how the abundance of voids changes in models with non-Gaussian initial conditions. While a positive skewness increases the cluster abundance, a negative skewness does the same for the void abundance. We determine the dependence of the void abundance on the non-Gaussianity parameter fnl for the local-model bispectrum-which approximates the bispectrum in some multi-field inflation models-and for the equilateral bispectrum, which approximates the bispectrum in e.g. string-inspired DBI models of inflation. We show that the void abundance in large-scale-structure surveys currently being considered should probe values as small as fnl < 10 and fnl^eq < 30, over distance scales ~10 Mpc.Comment: Submitted to JCA

Cosmic Chronometers: Constraining the Equation of State of Dark Energy. I: H(z) Measurements

We present new determinations of the cosmic expansion history from red-envelope galaxies. We have obtained for this purpose high-quality spectra with the Keck-LRIS spectrograph of red-envelope galaxies in 24 galaxy clusters in the redshift range 0.2 < z < 1.0. We complement these Keck spectra with high-quality, publicly available archival spectra from the SPICES and VVDS surveys. We improve over our previous expansion history measurements in Simon et al. (2005) by providing two new determinations of the expansion history: H(z) = 97 +- 62 km/sec/Mpc at z = 0.5 and H(z) = 90 +- 40 km/sec/Mpc at z = 0.8. We discuss the uncertainty in the expansion history determination that arises from uncertainties in the synthetic stellar-population models. We then use these new measurements in concert with cosmic-microwave-background (CMB) measurements to constrain cosmological parameters, with a special emphasis on dark-energy parameters and constraints to the curvature. In particular, we demonstrate the usefulness of direct H(z) measurements by constraining the dark- energy equation of state parameterized by w0 and wa and allowing for arbitrary curvature. Further, we also constrain, using only CMB and H(z) data, the number of relativistic degrees of freedom to be 4 +- 0.5 and their total mass to be < 0.2 eV, both at 1-sigma.Comment: Submitted to JCA

A critical analysis of high-redshift, massive galaxy clusters: I

We critically investigate current statistical tests applied to high redshift clusters of galaxies in order to test the standard cosmological model and describe their range of validity. We carefully compare a sample of high-redshift, massive, galaxy clusters with realistic Poisson sample simulations of the theoretical mass function, which include the effect of Eddington bias. We compare the observations and simulations using the following statistical tests: the distributions of ensemble and individual existence probabilities (in the >M,>z sense), the redshift distributions, and the 2d Kolmogorov-Smirnov test. Using seemingly rare clusters from Hoyle et al. (2011), and Jee et al. (2011) and assuming the same survey geometry as in Jee et al. (2011, which is less conservative than Hoyle et al. 2011), we find that the (>M,>z) existence probabilities of all clusters are fully consistent with LCDM. However assuming the same survey geometry, we use the 2d K-S test probability to show that the observed clusters are not consistent with being the least probable clusters from simulations at >95% confidence, and are also not consistent with being a random selection of clusters, which may be caused by the non-trivial selection function and survey geometry. Tension can be removed if we examine only a X-ray selected sub sample, with simulations performed assuming a modified survey geometry.Comment: 20 pages, 6 figures, 2 tables, modified to match accepted version (JCAP); title changed, main analysis unchanged, additional analysi

Balanço do nitrogênio e fósforo em solo com cultivo orgânico de hortaliças após a incorporação de biomassa de guandu.

Os objetivos deste trabalho foram avaliar os efeitos de faixas de guandu (Cajanus cajan) e da incorporação da biomassa proveniente de sua poda na fertilidade do solo e na produtividade de três hortaliças sob cultivo orgânico. O delineamento usado foi de blocos casualizados completos em esquema de parcelas subsubdivididas com três repetições. As produtividades de beterraba, cenoura e feijão-de-vagem não foram afetadas pelos tratamentos. Nas parcelas onde não houve incorporação da biomassa de guandu, o balanço de nitrogênio no sistema foi negativo, ao passo que com a incorporação, esse balanço foi positivo. Embora tenha ocorrido balanço positivo para o fósforo nas parcelas sem a incorporação de biomassa de guandu, houve um aumento significativo na absorção desse elemento pelas hortaliças quando o material foi incorporado. O sistema de cultivo em aléias de guandu pode representar uma prática vantajosa para os produtores orgânicos, por contribuir na manutenção da fertilidade do solo

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Sugar-and-acid profile of Penjar tomatoes and its evolution during storage

The alcobaca mutation in the Penjar tomato (Solanum lycopersicum L.) variety alters the ripening process and confers a long shelf life (more than four months). Storage of Penjar tomatoes leads to a distinctive sensory profile valued by local consumers, who prefer aged tomatoes to fresh ones. To study chemical changes occurring during storage, we characterized the complete sugar-and-acid profile of 25 accessions at harvest and at 2 and 4 months after harvest. We found considerable variability in the sugar-and-acid profile within the Penjar variety, especially for fructose and glucose. Some accessions presented exceptionally high values for sugars, making them especially interesting for breeding programs. During postharvest, the concentration of glucose, fructose, and citric acid decreased, whereas the concentration of malic and glutamic acids increased. Data from this study offer novel insights into postharvest changes in tomato quality parameters and help elucidate the reasons for the appreciation of this variety by consumers.Postprint (published version