Responses of systemic and pulmonary veins to the presence of an intravascular stent in a swine model

The outcome of stent implantation for children with pulmonary venous obstruction has been characterized by late reocclusion associated with a marked vessel neointimal proliferation. The purpose of this study was to compare the responses of the systemic vein and pulmonary vein to the presence of an intravascular stent, using a Yorkshire swine (N = 10) model. Under cardiopulmonary bypass, a single Palmaz stent was placed in the inferior vena cava (IVC) and right lower pulmonary vein (PV) with sacrifice at 4.9-6.1 months. Angiography and hemodynamic data were determined at 1 and 3 months post-stent implant and prior to euthanasia. All stents were found to be patent, with no difference in degree of thrombosis or neointimal formation. No statistical difference was found in the initial and final stent diameter for both inferior vena cava and pulmonary vein stents (PV initial 6.8 +/- 0.9; final 7.1 +/- 0.6) (IVC initial 10.4 +/- 1.2; final 10.4 +/- 1.2). Electron microscopy demonstrated smooth endothelialization of both pulmonary and systemic venous stent devices. No thrombosis was found on gross morphology. The data indicate that there is no intrinsic difference in the response of the pulmonary vein to the presence of a stent device. The clinical experience of restenosis following stent implantation for pulmonary vein stenosis appears to be more related to variables of final stent diameter combined with the marked intrinsic abnormal vessel architecture, as seen with this condition.     

Natural history of cows' milk allergy in children: immunological outcome over 2 years

In this investigation 98 children (median age 24 months) with cows' milk allergy (CMA) were studied over a median period of 2 years to see whether acquisition of clinical tolerance to cows' milk was associated with the changes in levels of IgG and IgE anti-cows' milk antibodies, and skin test reactivity to a cows' milk extract. Two groups of CMA patients were examined. The first were IgE sensitized and responded rapidly to small volumes of cows' milk with urticaria, and/or exacerbations of eczema, and/or wheeze, and/or vomiting (n = 69). The second, a late reacting group (n = 29) demonstrated coughing, diarrhoea, eczematoid rashes, and/or a combination of these which developed more than 20 hr after commencing normal volumes of cows' milk. Significant immunological changes were confined to the 69 IgE sensitized immediate-reacting-group of patients. Of these, there were 15 children who achieved clinical tolerance to cows' milk and they showed a significant fall in the levels of skin test reactivity to cows' milk over the study period (P < 0.01). In addition, these 15 children had lower serum IgE antibodies to cows' milk proteins both at the outset and the final follow-up compared with the 54 patients whose CMA persisted. No consistent change in the IgG antibody responses to cows' milk proteins was seen in either group of patients over the study period. The findings suggest patients with immediate type hypersensitivity to cows' milk proteins whose disease persists for more than 2 years have a more severe dysregulation of IgE synthesis to cows' milk proteins from the outset.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experiences developing architectures for realizing thin‐client diagram editing tools

Diagram‐centric applications such as software design tools, project planning tools and business process modelling tools are usually ‘thick‐client’ applications running as stand‐alone desktop applications. There are several advantages to providing such design tools as Web‐based or even PDA‐ and mobile‐phone‐based applications. These include ease of access and upgrade, provision of collaborative work support and Web‐based integration with other applications. However, building such thin‐client diagram editing tools is very challenging. We have developed several thin‐client diagram editing applications realized as a set of plug‐in extensions to a meta‐tool for visual design environment development. In this paper, we discuss key user interaction and software architecture issues, illustrate examples of interacting with our thin‐client diagram editing tools, describe our design and implementation approaches, and present the results of several different evaluations of the resultant applications. Our experiences will be useful for those interested in developing their own thin‐client diagram editing architectures and applications. Copyright © 2007 John Wiley & Sons, Ltd.     

Partitioning Nominal Attributes in Decision Trees

To find the optimal branching of a nominal attribute at a node in an L-ary decision tree, one is often forced to search over all possible L-ary partitions for the one that yields the minimum impurity measure. For binary trees (L = 2) when there are just two classes a short-cut search is possible that is linear in n, the number of distinct values of the attribute. For the general case in which the number of classes, k, may be greater than two, Burshtein et al. have shown that the optimal partition satisfies a condition that involves the existence of ₂ ^L hyperplanes in the class probability space. We derive a property of the optimal partition for concave impurity measures (including in particular the Gini and entropy impurity measures) in terms of the existence ofL vectors in the dual of the class probability space, which implies the earlier condition.Unfortunately, these insights still do not offer a practical search method when n and k are large, even for binary trees. We therefore present a new heuristic search algorithm to find a good partition. It is based on ordering the attribute's values according to their principal component scores in the class probability space, and is linear in n. We demonstrate the effectiveness of the new method through Monte Carlo simulation experiments and compare its performance against other heuristic methods.     

Evidence that increased calcium intake does not prevent early postmenopausal bone loss

Calcium's ability to prevent bone loss in early postmenopausal women is controversial. We used data on 394 women from the placebo group of the Early Postmenopausal Interventional Cohort study, a clinical trial of alendronate, to investigate the relation of calcium intake to bone loss. Calcium intake was recorded, and bone mineral density (BMD) (in the lumbar spine, total body, forearm, and hip) and biochemical markers of bone turnover (serum total alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide crosslink levels) were measured at baseline and annually thereafter. Women whose baseline calcium intake was <500 mg/d were advised to increase their calcium intake. Mean (+/- SE) BMD decreased by 1.9% +/- 0.16% at the lumbar spine and 1.6% +/- 0.14% at the hip over the 24-month period. Despite wide variations in baseline calcium intake and changes in calcium intake, these measures were not significantly associated with changes in BMD or bone turnover. Even women whose total calcium intake was >1333 mg/d (the highest tertile of total calcium intake) showed a decline in BMD of almost 2%, similar to declines in the lower two tertiles of total calcium intake (<869 and 869-1333 mg/d, respectively). Increased calcium intake resulted in modest mean increases of approximately 200 mg/d. We were unable to demonstrate that increases of this magnitude or much greater (1 g/d) were protective against declines in BMD at any site, even in women who had the lowest calcium intake at baseline. In addition to adequate calcium intake, more effective therapy appears to be required when the therapeutic goal is to increase or maintain BMD.     

Systolic function of the univentricular heart: comparison of the Simpson's rule with acoustic quantification

BACKGROUND: Acoustic quantification (AQ) is a new method of obtaining real-time information about systolic ventricular function. This method establishes a ;blood-tissue interface' and computes an intraventricular blood volume in real time to derive a beat to beat instantaneous ejection fraction. AQ assessment of systolic function has been reported previously in patients with normal cardiotypes and varying degrees of myocardial dysfunction. OBJECTIVE: To determine the potential utility of AQ in patients with abnormal ventricular morphology, in whom systolic function may be difficult to measure by traditional methods. PATIENTS AND DESIGN: Seventeen children (nine females) ranging in age from five days to 18 years (mean 6.9 years) with univentricular left ventricle heart morphology underwent a prospective and comparative echocardiographic study of ventricular function with the use of AQ and manual planimetry (single plane Simpson's rule). Imaging was done during steady state without sedation. Routine scan planes were performed, followed by repeat scanning of the univentricle from the apical four-chamber view in the AQ mode. Subsequently, manual planimetry using Simpson's rule was performed from an online graphical analysis package to measure systolic and diastolic frames from the conventional replay images. These data were used to calculate ejection fraction using standards previously established. The results were then compared with real-time AQ results. SETTING: Tertiary care referral center. RESULTS: Scan time for the combined standard and AQ imaging averaged 45 mins (range 35 to 65 mins). Measured ejection fraction by AQ and manual planimetry were 44 +/- 11% and 46 +/- 10%, respectively. Statistical analysis by repeated measures ANOVA with Bonferroni/Dunn correction (F = 0.6, df = 1,32, P = 0.44) demonstrated significant agreement between AQ and manual planimetry with an intraclass correlation coefficient of 0.93. Bland-Altman analysis was used to provide a graphic display of the clinical significance of differences in the comparison of the two methods of measurement. CONCLUSIONS: These findings support the use of AQ for continuous online determination of indexes of systolic function for patients with univentricular left ventricle morphology. The variability in the morphology inherently present within this group of patients results in a wider variability of determined ejection fraction. Particular attention must be directed to the technical aspects of image acquisition and AQ application to ensure accuracy.     

Effects of advertising billboards during simulated driving

There is currently a great deal of interest in the problem of driver distraction. Most research focuses on distractions from inside the vehicle, but drivers can also be distracted by objects outside the vehicle. Major roads are increasingly becoming sites for advertising billboards, and there is little research on the potential effects of this advertising on driving performance. The driving simulator experiment presented here examines the effects of billboards on drivers, including older and inexperienced drivers who may be more vulnerable to distractions. The presence of billboards changed drivers’ patterns of visual attention, increased the amount of time needed for drivers to respond to road signs, and increased the number of errors in this driving task.     

SUMLOW: early design‐stage sketching of UML diagrams on an E‐whiteboard

Most visual diagramming tools provide point‐and‐click construction of computer‐drawn diagram elements using a conventional desktop computer and mouse. SUMLOW is a unified modelling language (UML) diagramming tool that uses an electronic whiteboard (E‐whiteboard) and sketching‐based user interface to support collaborative software design. SUMLOW allows designers to sketch UML constructs, mixing different UML diagram elements, diagram annotations, and hand‐drawn text. A key novelty of the tool is the preservation of hand‐drawn diagrams and support for manipulation of these sketches using pen‐based actions. Sketched diagrams can be automatically ‘formalized’ into computer‐recognized and ‐drawn UML diagrams and then exported to a third party CASE tool for further extension and use. We describe the motivation for SUMLOW, illustrate the use of the tool to sketch various UML diagram types, describe its key architecture abstractions and implementation approaches, and report on two evaluations of the toolset. We hope that our experiences will be useful for others developing sketching‐based design tools or those looking to leverage pen‐based interfaces in software applications. Copyright © 2007 John Wiley & Sons, Ltd.     

Corrosion resistance of zinc-magnesium coated steel

A significant body of work exists in the literature concerning the corrosion behaviour of zinc-magnesium coated steel (ZMG), describing its enhanced corrosion resistance when compared to conventional zinc-coated steel. This paper begins with a review of the literature and identifies key themes in the reported mechanisms for the attractive properties of this material. This is followed by an experimental programme where ZMG was subjected to an automotive laboratory corrosion test using acidified NaCl solution. A 3-fold increase in time to red rust compared to conventional zinc coatings was measured. X-ray diffraction, X-ray photoelectron spectroscopy and scanning electron microscopy were used to characterize the corrosion products formed. The corrosion products detected on ZMG included simonkolleite (Zn₅Cl₂(OH)₈ · H₂O), possibly modified by magnesium uptake, magnesium hydroxide (Mg(OH)₂) and a hydroxy carbonate species. It is proposed that the oxygen reduction activity at the (zinc) cathodes is reduced by precipitation of alkali-resistant Mg(OH)₂, which is gradually converted to more soluble hydroxy carbonates by uptake of atmospheric carbon dioxide. This lowers the surface pH sufficiently to allow thermodynamically for general precipitation of insoluble simonkolleite over the corroding surface thereby retarding the overall corrosion reactions, leaving only small traces of magnesium corrosion products behind. Such a mechanism is consistent with the experimental findings reported in the literature.