791–6 Prospective Application of RAND Expert Panel Ratings, ACC/AHA Guidelines, and the University of Maryland Revascularizatlon Appropriateness Score (RAS): Only RAS Predicts Clinical Outcome

Several scoring systems exist for evaluating the appropriateness of PTCA and CABG. However, they have not been prospectively correlated with outcome. We prospectively studied 61 pts referred to the catheterization laboratory who were treated with PTCA (33). CABG (15) or medical therapy (13). Forty-five were male; the mean age was 60.2±12.8 years (range 32–87). During a mean followup of 9.3±3.8 months (range 3–16.1),66 events occurred in 35 patients including angina (25), MI (3), death (6), cardiac readmission (17). PTCA (4), CABG (7), CHF (4).For all patients, revascularization appropriateness was ranked by the RAS, ACC/AHA. and RAND Scoring systems. Application of RAS yielded revascularization appropriateness ratings of Necessary (N), Appropriate (A), or Inappropriate (1). Of 11 patients ranked N who did not receive revascularization, 10 had adverse events, compared with 17 of 35 who received revascularization (p=0.02). Of 5 pts ranked I for revascularization who received either PTCA or CABG, 3 had adverse events. In total, 13 of 16 pts who received treatment that was discordant with a N or I RAS rating had adverse events, compared with 20 of 45 who received concordant treatment. (p=0.02)s. These discordant treatments included unnecessary PTCA (5). failure to perform CABG (1), PTCA (3), or either (7). Statistical significance persisted when only “hard” events (excluding angina) were considered (p=0.03). Concordance of treatment with RAND and ACC/AHA revascularization appropriateness scores for PTCA and CABG were not predictive of adverse events in this population.ConclusionRevascularization appropriateness scoring systems differ in their ability to predict outcomes. Of the 3 approaches studied, only treatment concordant with RAS treatment recommendations reduced subsequent adverse events

A METHOD TO ANALYZE SOCCER OFFENSIVE SEQUENCES

There is a range of possibilities to analyze the soccer game in relation to physical-technical-tactical aspects. The importance of going toward the goal rapidly since the recovery of possession was defended by Grehaigne et al (1996). The main technique to analyze soccer attack speed in literature was presented by Yue et al (2008). The aim of this study was to propose a method to analyze offensive sequences in soccer based on goal progression velocity (GPV) and goal progression indicator (GPI)

Lawful access to cannabis: gains, losses and design criteria

“Legalisation” does not specify a policy. Cannabis could be made available for use by adults under a wide variety of conditions: cheap or expensive, offered by for-profit enterprises, by not-for-profits (including consumer co-operatives), as a state monopoly (for production or sales or both), or even on a “grow-your-own” basis. It could be cheap (as it would be in a free market) or expensive (due to taxes or minimum pricing). Marketing efforts could be free or restrained. Users could be “nudged” toward temperate use – for example, through a system of user-set but enforceable periodic purchase limits – or left to their own devices. Policy-makers should keep in mind Pareto’s Law, which applies to cannabis consumption: about four-fifths of consumption is accounted for by about one-fifth of consumers. That fact will drive the commercial strategies of for-profit producers and sellers, and should focus the attention of public agencies on the risks and harms to the heavy-using minority. Uncertainties abound, and consequently policies should be designed to allow the system to learn from experience. But it is possible to try to predict and evaluate – albeit imperfectly – the likely consequences of proposed policy changes and to use those predictions to choose systems of legal availability that would result in better, rather than worse, combinations of gain and loss from the change

Atomic Parity Violation : Principles, Recent Results, Present Motivations

We review the progress made in the determination of the weak charge, Q\_w, of the cesium nucleus which raises the status of Atomic Parity Violation measurements to that of a precision electroweak test. Not only is it necessary to have a precision measurement of the electroweak asymmetry in the highly forbidden 6S-7S transition, but one also needs a precise calibration procedure. The 1999 precision measurement by the Boulder group implied a 2.5 sigma deviation of Q\_w from the theoretical prediction. This triggered many particle physicist suggestions as well as examination by atomic theoretical physicists of several sources of corrections. After about three years the disagreement was removed without appealing to "New Physics". Concurrently, an original experimental approach was developed in our group for more than a decade. It is based on detection by stimulated emission with amplification of the left- right asymmetry. We present our decisive, recent progress together with our latest results. We emphasize the important impact for electroweak theory, of future measurements in cesium possibly pushed to the 0.1% level. Other possible approaches are currently explored in several atoms

A Hybrid Global Minimization Scheme for Accurate Source Localization in Sensor Networks

We consider the localization problem of multiple wideband sources in a multi-path environment by coherently taking into account the attenuation characteristics and the time delays in the reception of the signal. Our proposed method leaves the space for unavailability of an accurate signal attenuation model in the environment by considering the model as an unknown function with reasonable prior assumptions about its functional space. Such approach is capable of enhancing the localization performance compared to only utilizing the signal attenuation information or the time delays. In this paper, the localization problem is modeled as a cost function in terms of the source locations, attenuation model parameters and the multi-path parameters. To globally perform the minimization, we propose a hybrid algorithm combining the differential evolution algorithm with the Levenberg-Marquardt algorithm. Besides the proposed combination of optimization schemes, supporting the technical details such as closed forms of cost function sensitivity matrices are provided. Finally, the validity of the proposed method is examined in several localization scenarios, taking into account the noise in the environment, the multi-path phenomenon and considering the sensors not being synchronized

An examination of factors influencing the choice of therapy for patients with coronary artery disease

BACKGROUND: A diverse range of factors influence clinicians' decisions regarding the allocation of patients to different treatments for coronary artery disease in routine cardiology clinics. These include demographic measures, risk factors, co-morbidities, measures of objective cardiac disease, symptom reports and functional limitations. This study examined which of these factors differentiated patients receiving angioplasty from medication; bypass surgery from medication; and bypass surgery from angioplasty. METHODS: Univariate and multivariate logistic regression analyses were conducted on patient data from 214 coronary artery disease patients who at the time of recruitment had been received a clinical assessment and were reviewed by their cardiologist in order to determine the form of treatment they were to undergo: 70 would receive/continue medication, 71 were to undergo angioplasty and 73 were to undergo bypass surgery. RESULTS: Analyses differentiating patients receiving angioplasty from medication produced 9 significant univariate predictors, of which 5 were also multivariately significant (left anterior descending artery disease, previous coronary interventions, age, hypertension and frequency of angina). The analyses differentiating patients receiving surgery from angioplasty produced 12 significant univariate predictors, of which 4 were multivariately significant (limitations in mobility range, circumflex artery disease, previous coronary interventions and educational level). The analyses differentiating patients receiving surgery from medication produced 14 significant univariate predictors, of which 4 were multivariately significant (left anterior descending artery disease, previous cerebral events, limitations in mobility range and circumflex artery disease). CONCLUSION: Variables emphasised in clinical guidelines are clearly involved in coronary artery disease treatment decisions. However, variables beyond these may also be important factors when therapy decisions are undertaken thus their roles require further investigation

A randomised trial of intrapericardial bleomycin for malignant pericardial effusion with lung cancer (JCOG9811)

Safety and efficacy of intrapericardial (ipc) instillation of bleomycin (BLM) following pericardial drainage in patients with malignant pericardial effusion (MPE) remain unclear. Patients with pathologically documented lung cancer, who had undergone pericardial drainage for MPE within 72 h of enrolment, were randomised to either arm A (observation alone after drainage) or arm B (ipc BLM at 15 mg, followed by additional ipc BLM 10 mg every 48 h). The drainage tube was removed when daily drainage was 20 ml or less. The primary end point was survival with MPE control (effusion failure-free survival, EFFS) at 2 months. Eighty patients were enrolled, and 79 were eligible. Effusion failure-free survival at 2 months was 29% in arm A and 46% in arm B (one-sided P=0.086 by Fisher's exact test). Arm B tended to favour EFFS, with a hazard ratio of 0.64 (95% confidence interval: 0.40–1.03, one-sided P=0.030 by log-rank test). No significant differences in the acute toxicities or complications were observed. The median survival was 79 days and 119 days in arm A and arm B, respectively. This medium-sized trial failed to show statistical significance in the primary end point. Although ipc BLM appeared safe and effective in the management of MPE, the therapeutic advantage seems modest

Ventrolateral Origin of Each Cycle of Rhythmic Activity Generated by the Spinal Cord of the Chick Embryo

BACKGROUND: The mechanisms responsible for generating rhythmic motor activity in the developing spinal cord of the chick embryo are poorly understood. Here we investigate whether the activity of motoneurons occurs before other neuronal populations at the beginning of each cycle of rhythmic discharge. METHODOLOGY/PRINCIPAL FINDINGS: The spatiotemporal organization of neural activity in transverse slices of the lumbosacral cord of the chick embryo (E8-E11) was investigated using intrinsic and voltage-sensitive dye (VSD) imaging. VSD signals accompanying episodes of activity comprised a rhythmic decrease in light transmission that corresponded to each cycle of electrical activity recorded from the ipsilateral ventral root. The rhythmic signals were widely synchronized across the cord face, and the largest signal amplitude was in the ventrolateral region where motoneurons are located. In unstained slices we recorded two classes of intrinsic signal. In the first, an episode of rhythmic activity was accompanied by a slow decrease in light transmission that peaked in the dorsal horn and decayed dorsoventrally. Superimposed on this signal was a much smaller rhythmic increase in transmission that was coincident with each cycle of discharge and whose amplitude and spatial distribution was similar to that of the VSD signals. At the onset of a spontaneously occurring episode and each subsequent cycle, both the intrinsic and VSD signals originated within the lateral motor column and spread medially and then dorsally. By contrast, following a dorsal root stimulus, the optical signals originated within the dorsal horn and traveled ventrally to reach the lateral motor column. CONCLUSIONS/SIGNIFICANCE: These findings suggest that motoneuron activity contributes to the initiation of each cycle of rhythmic activity, and that motoneuron and/or R-interneuron synapses are a plausible site for the activity-dependent synaptic depression that modeling studies have identified as a critical mechanism for cycling within an episode