Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance

BACKGROUND: Optimal criteria for valve replacement are unclear in asymptomatic/minimally symptomatic patients with aortic regurgitation (AR) and normal left ventricular (LV) performance at rest. Moreover, previous studies have not assessed the prognostic capacity of load-adjusted LV performance ("contractility") variables, which may be fundamentally related to clinical state. Therefore, 18 years ago, we set out to test prospectively the hypothesis that objective noninvasive measures of LV size and performance and, specifically, of load-adjusted variables, assessed at rest and during exercise (ex), could predict the development of currently accepted indications for operation for AR. METHODS AND RESULTS: Clinical variables and measures of LV size, performance, and end-systolic wall stress (ESS) were assessed annually in 104 patients by radionuclide cineangiography at rest and maximal ex and by echocardiography at rest; ESS was derived during ex. During an average 7.3-year follow-up among patients who had not been operated on, 39 of 104 patients either died suddenly (n = 4) or developed operable symptoms only (n = 22) or subnormal LV performance with or without symptoms (n = 13) (progression rate=6.2%/y). By multivariate Cox model analysis, change (delta) in LV ejection fraction (EF) from rest to ex, normalized for deltaESS from rest to ex (deltaLVEF-deltaESS index), was the strongest predictor of progression to any end point or to sudden cardiac death alone. Unadjusted deltaLVEF was almost as efficient. Symptom status modified prediction on the basis of the deltaLVEF-deltaESS index. The population tercile at highest risk by deltaLVEF-deltaESS progressed to end points at a rate of 13.3%/y, and the lowest-risk tercile progressed at 1.8%/y. CONCLUSIONS: Currently accepted symptom and LV performance indications for valve replacement, as well as sudden cardiac death, can be predicted in asymptomatic/minimally symptomatic patients with AR by load-adjusted deltaLVEF-deltaESS index, which includes data obtained during exercise.     

Functional knockout of the transient outward current, long-QT syndrome, and cardiac remodeling in mice expressing a dominant-negative Kv4 alpha subunit

Amino acid changes S180A (S-->A at site 180), H197Y, Y277F, T285A, and A308S are known to shift the maximum wavelength of absorption (lambda max) of red and green visual pigments toward blue, essentially in an additive fashion. To test the generality of this "five-sites" rule, we have determined the partial amino acid sequences of red and green pigments from five mammalian orders (Artiodactyla, Carnivora, Lagomorpha, Perissodactyla, and Rodentia). The result suggests that cat (Felis catus), dog (Canis familiaris), and goat (Capra hircus) pigments all with AHYTA at the five critical sites have lambda max values of approximately 530 nm, whereas rat (Rattus norvegicus) pigment with AYYTS has a lambda max value of approximately 510 nm, which is accurately predicted by the five-sites rule. However, the observed lambda max values of the orthologous pigments of European rabbit (Oryctolagus cuniculus), white-tailed deer (Odocoileus virginianus), gray squirrel (Sciurus carolinensis), and guinea pig (Cavia procellus) are consistently more than 10 nm higher than the predicted values, suggesting the existence of additional molecular mechanisms for red and green color vision. The inferred amino acid sequences of ancestral organisms suggest that the extant mammalian red and green pigments appear to have evolved from a single ancestral green-red hybrid pigment by directed amino acid substitutions.     

Organizational Commitment: Clarifying the Concept and Simplifying the Existing Construct Typology

This paper examines popular concepts and "types" of organizational commitment in light of the definition of commitment and common factors that pertain to all commitments. It argues that a commitment is best conceptualized as a single, fundamental construct that may vary according to differences in focus, terms, and time-specific evaluation. Analysis of affective commitment measures indicates that certain measures contain more than one set of terms and make assumptions about evaluation that add constraints to the basic meaning of commitment. Recommendations include the argument that commitment measures address one set of terms and avoid evaluative phraseology.     

Age differences in identifying words in synthetic speech

OBJECTIVES: We investigated whether context or different speech rates could improve older adult performance on identification of synthetically generated words. BACKGROUND: Synthetic speech systems can potentially improve the daily functioning of older adults. However, research must determine whether older adults can effectively implement current text-to-speech technologies, which few studies have examined. Older adults' sensory and cognitive declines may cause difficulties in identifying words in synthetic speech. METHODS: Ninety-six participants (young, middle-aged, and older adults) identified auditory monosyllabic words (half natural, half synthetic) presented in isolation or at the ends of sentences. Participants heard speech at either normal or slower rates. RESULTS: We found an interaction of age, context, and voice type and that slower speech rates worsened performance for all groups. Contrasts revealed that context reduced age differences, though only for natural speech. Hearing acuity was highly correlated with age and fully accounts for the interaction. CONCLUSIONS: Context improves performance for everyone in natural speech. However, whereas context improves performance for synthetic speech, it does not differentially reduce the age impairment for older adults. Slower speed generally impairs everyone's performance compared with the normal rate. APPLICATIONS: Systems using synthetic speech should avoid presenting words in isolation, and rich contextual support should be consistently adopted. Synthetic speech fidelity must be improved significantly before becoming truly useful for older adult populations.     

The fine structure of the interrenal cells of the duck (Anas platyrhynchos) with evidence for possible exocytotic release of steroids

The duck interrenal cell possesses ultrastructural characteristics common to other steroid-secreting cells. Lipid droplets and mitochondria are abundant and lie principally at the apical end of the cell. Lipid droplets are not membrane-limited. Cisternae of smooth endoplasmic reticulum that are occasionally continuous with the less abundant rough endoplasmic reticulum are a prominent feature of the interrenal cell. Tubular profiles of rough endoplasmic reticulum often lie tangentially to mitochondria and ribosomes are either free, grouped in polyribosomal clusters, or bound to the endoplasmic reticulum. Mitochondria possess tubular cristae in the inner regions of the gland and frequently contain a paracrystalline array of small 10nm (o.d.) tubules and less frequently a hexagonal array of 40 nm trilaminar rings. Other cytoplasmic components include dense bodies, residual bodies, microtubules, microfilaments and specialized single membrane-bound vesicles. Gap junctions, intermediate junctions and interdigitating processes constitute the main intercellular associations. No tight junctions were identified. The single membrane-bound vesicles which are occasionally filled with a low electron-dense, lipid-like material form septate-like "junctions" with the plasma membrane. The septa bridge an intracellular gap of 15-17 nm. The vesicles are usually located near the subendothelial space at the basal and basilateral regions of the cell. Occasionally, vesicles fuse with the plasma membrane. It is suggested that these vesicles represent morphological evidence for the exocytotic release of steroid hormones.     

The relationship of education to blood pressure: findings on 40,000 employed Chicagoans

The relationship of education to both actual blood pressure and the prevalence of high blood pressure, based on a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 95 mm Hg or greater, was analyzed among 27,033 men and women, white and black, age 25-44 and 45-64, from the Chicago Heart Association Detection Project in Industry. The educational status of each individual was categorized as not a high school graduate, high school graduate, some college, or college graduate. A statistically significant inverse association between education and high blood pressure was present in all groups of whites. This association could not be "accounted for" by differences in age, relative weight, and heart rate among the educational strata. Controlling for these variables did, however, lessen the association. Among black males a significant inverse association between education level and blood pressure was found for the younger group. For the older black males there was a clear inverse association although with the small numbers it did not achieve statistical significance. For black females there was no clear association.     

Symbolic connectionism in natural language disambiguation

Natural language understanding involves the simultaneous consideration of a large number of different sources of information. Traditional methods employed in language analysis have focused on developing powerful formalisms to represent syntactic or semantic structures along with rules for transforming language into these formalisms. However, they make use of only small subsets of knowledge. This article describes how to use the whole range of information through a neurosymbolic architecture which is a hybridization of a symbolic network and subsymbol vectors generated from a connectionist network. Besides initializing the symbolic network with prior knowledge, the subsymbol vectors are used to enhance the system's capability in disambiguation and provide flexibility in sentence understanding. The model captures a diversity of information including word associations, syntactic restrictions, case-role expectations, semantic rules and context. It attains highly interactive processing by representing knowledge in an associative network on which actual semantic inferences are performed. An integrated use of previously analyzed sentences in understanding is another important feature of our model. The model dynamically selects one hypothesis among multiple hypotheses. This notion is supported by three simulations which show the degree of disambiguation relies both on the amount of linguistic rules and the semantic-associative information available to support the inference processes in natural language understanding. Unlike many similar systems, our hybrid system is more sophisticated in tackling language disambiguation problems by using linguistic clues from disparate sources as well as modeling context effects into the sentence analysis. It is potentially more powerful than any systems relying on one processing paradigm     

A general compiler framework for speculative multithreaded processors

Speculative multithreading (SpMT) promises to be an effective mechanism for parallelizing nonnumeric programs, which tend to have irregular and pointer-intensive data structures and complex flows of control. Proper thread formation is crucial for obtaining good speedup in an SpMT system. This paper presents a compiler framework for partitioning a sequential program into multiple threads for parallel execution in an SpMT system. This framework is very general and supports speculative threads, nonspeculative threads, loop-centric threads, and out-of-order thread spawning. It is therefore useful for compiling for a wide variety of SpMT architectures. For effective partitioning of programs, the compiler uses profiling, interprocedural pointer analysis, data dependence information, and control dependence information. The compiler is implemented on the SUIF-MachSUIF platform. A simulation-based evaluation of the generated threads shows that the use of nonspeculative threads and nonloop speculative threads provides a significant increase in speedup for nonnumeric programs.     

Small bowel perforation secondary to metastatic lung carcinoma

Since 1961, there have been a total of seven patients with small bowel perforation caused by metastatic lung carcinoma reported in the literature. Perforation of the small bowel to metastatic lung carcinoma must be considered when evaluating older patients who have histories of heavy cigarette smoking and signs and symptoms suggestive of pulmonary neoplasia. Primary resection and end-to-end anastomosis of the perforated bowel is the treatment of choice. No patient with small bowel perforation secondary to lung carcinoma has survived more than four months.