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.     

Plasma-derived proteins in airway defence, disease and repair of epithelial injury

One significant characteristic of the airway mucosa in vivo, that cannot easily be mimicked in vitro, is its microcirculation, which generates a highly dynamic, biologically active milieu of plasma-derived molecules that may pass to the airway lumen in vivo. New data on the mechanisms of airway mucosal exudation indicate that the protein systems of circulating plasma may contribute significantly to the biology and immunology of the lamina propria, its surface epithelium and the luminal surface, not only in injured airways, but also in airways that are activated but display no sign of oedema, epithelial disruption, or increased absorption capacity. We suggest that present knowledge of the mechanisms of plasma exudation, together with rapidly emerging information (not detailed herein) on receptors, target cells and cellular responses to the plasma-derived molecules, must be considered in any realistic model that investigates "immuno-inflammatory" mechanisms of the airway mucosa.     

Holographic correction of large telescope primaries by proximal, off-axis beacons

Compact telescope configurations incorporating a holographic correction of large, low-quality primary collectors are demonstrated. Aberration correction is demonstrated with an off-axis laser beacon located close to the primary. This arrangement results in a compact telescope with minimum obscuration. The reduction of additional off-axis aberrations introduced by the method is also demonstrated.     

Isotype-specific antibody responses to foot-and-mouth disease virus in sera and secretions of "carrier' and "non-carrier' cattle

Isotype-specific antibody responses to foot-and-mouth disease virus (FMDV) were measured in the sera and upper respiratory tract secretions of vaccinated and susceptible cattle challenged with FMDV by direct contact or by intranasal inoculation. A comparison was made between cattle that eliminated FMDV and those that developed and maintained a persistent infection. Serological and mucosal antibody responses were detected in all animals after challenge. IgA and IgM were detected before the development of IgG1 and IgG2 responses. IgM was not detected in vaccinated cattle. Challenge with FMDV elicited a prolonged biphasic secretory antibody response in FMDV "carrier' animals only. The response was detected as FMDV-specific IgA in both mucosal secretions and serum samples, which gained statistical significance (P < 0.05) by 5 weeks after challenge. This observation could represent the basis of a test to differentiate vaccinated and/or recovered convalescent cattle from FMDV "carriers'.     

Real-time path planning in dynamic virtual environments using multiagent navigation graphs

We present a novel approach for efficient path planning and navigation of multiple virtual agents in complex dynamic scenes. We introduce a new data structure, Multi-agent Navigation Graph (MaNG), which is constructed using first- and second-order Voronoi diagrams. The MaNG is used to perform route planning and proximity computations for each agent in real time. Moreover, we use the path information and proximity relationships for local dynamics computation of each agent by extending a social force model [Helbing05]. We compute the MaNG using graphics hardware and present culling techniques to accelerate the computation. We also address undersampling issues and present techniques to improve the accuracy of our algorithm. Our algorithm is used for real-time multi-agent planning in pursuit-evasion, terrain exploration and crowd simulation scenarios consisting of hundreds of moving agents, each with a distinct goal.     

Optical information for car following: the driving by visual angle (DVA) model

OBJECTIVE: The present study developed and tested a model of car following by human drivers. BACKGROUND: Previous models of car following are based on 3-D parameters such as lead vehicle speed and distance information, which are not directly available to a driver. In the present paper we present the driving by visual angle (DVA) model, which is based on the visual information (visual angle and rate of change of visual angle) available to the driver. METHOD: Two experiments in a driving simulator examined car-following performance in response to speed variations of a lead vehicle defined by a sum of sine wave oscillations and ramp acceleration functions. In addition, the model was applied to six driving events using real world-driving data. RESULTS: The model provided a good fit to car-following performance in the driving simulation studies as well as in real-world driving performance. A comparison with the advanced interactive microscopic simulator for urban and nonurban networks (AIMSUN) model, which is based on 3-D parameters, suggests that the DVA was more predictive of driver behavior in matching lead vehicle speed and distance headway. CONCLUSION: Car-following behavior can be modeled using only visual information to the driver and can produce performance more predictive of driver performance than models based on 3-D (speed or distance) information. APPLICATION: The DVA model has applications to several traffic safety issues, including automated driving systems and traffic flow models.     

Patient views of adverse events: comparisons of self-reported healthcare staff attitudes with disclosure of accident information

In the present paper, we report results of surveys in 2003 in Japan and Denmark about patients' views about adverse events, focusing on the actions of healthcare staff involved in a medical accident. Results show that patients were more likely to indicate negative expectations to a doctor's reactions after a medical accident when asked in general terms than when asked in relation to concrete case stories. When asked in general terms, 66% (47%) of Japanese (Danish) respondents expected that doctors sometimes hold back on providing information to patients about a medical accident, while 37% (7%) did so when asked about a concrete, mild-outcome case. We examine some possible reasons for the relatively high level of distrust of Japanese patients, and we discuss whether the seemingly lower level of disclosure in Japan than in Denmark and the negative stories in the Japanese press may have an impact. We also suggest some implications for introducing a patient-centred or customer-centred approach to risk management in healthcare and other domains.     

Transient temperature responses of hydronic radiant floor heating system by different pipe embedding depth and water supply condition

"Ondol" is a Korean unique heating system. It is a specific radiant floor heating system using combustion heat of briquette or timber in Korea. Such traditional "Ondol" is changed to radiant heating system with pipe-coil embedded in the floor or slab. This study has contributed to the understandings of the transient behaviours of Ondol-heated floor panels and enclosure exposed to this type of heating system. The result is that the water supply temperature had a large effect on the rate of increase in floor surface and room air temperature. But, in spite of a higher water supply temperature, the heat flow rate was not increased considerably. The shallow pipe embedding depths, of course, result in a low heat flow rate.