The Hybrid Approach to Intervention of Chronic Total Occlusions

The "hybrid" approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to provide guidance on optimal crossing strategy selection. Dual angiography remains the cornerstone of clinical decision making in CTO PCI. Four angiographic parameters are assessed: (a) morphology of the proximal cap (clear-cut or ambiguous); (b) occlusion length; (c) distal vessel size and presence of bifurcations beyond the distal cap; and (d) location and suitability of location and suitability of a retrograde conduit (collateral channels or bypass grafts) for retrograde access. Antegrade wire escalation is favored for short (<20 mm) occlusions, usually escalating rapidly from a soft tapered-tip polymer-jacketed guidewire to a stiff polymer-jacketed or tapered-tip guidewire. Antegrade dissection/re-entry is favored in long (≥20 mm long) occlusions, trying to minimize the dissection length by re-entering into the distal true lumen immediately after the occlusion. Primary retrograde approach is preferred for lesions with an ambiguous proximal cap, poor distal target, good interventional collaterals, and heavy calcification,as well as chronic kidney disease. The "hybrid" approach advocates early change between strategies to enable CTO crossing in the most efficacious, efficient, and safe way. Several early studies are demonstrating high success and low complication rates with use of the "hybrid" approach, supporting its expanding use in CTO PCI

Gauge symmetry and W-algebra in higher derivative systems

The problem of gauge symmetry in higher derivative Lagrangian systems is discussed from a Hamiltonian point of view. The number of independent gauge parameters is shown to be in general {\it{less}} than the number of independent primary first class constraints, thereby distinguishing it from conventional first order systems. Different models have been considered as illustrative examples. In particular we show a direct connection between the gauge symmetry and the W-algebra for the rigid relativistic particle.Comment: 1+22 pages, 1 figure, LaTeX, v2; title changed, considerably expanded version with new results, to appear in JHE

Energy End-Use : Industry

The industrial sector accounts for about 30% of the global final energy use and accounts for about 115 EJ of final energy use in 2005. 1Cement, iron and steel, chemicals, pulp and paper and aluminum are key energy intensive materials that account for more than half the global industrial use. There is a shift in the primary materials production with developing countries accounting for the majority of the production capacity. China and India have high growth rates in the production of energy intensive materials like cement, fertilizers and steel (12–20%/yr). In different economies materials demand is seen to grow initially with income and then stabilize. For instance in industrialized countries consumption of steel seems to saturate at about 500 kg/capita and 400–500 kg/capita for cement. The aggregate energy intensities in the industrial sectors in different countries have shown steady declines – due to an improvement in energy efficiency and a change in the structure of the industrial output. As an example for the EU-27 the final energy use by industry has remained almost constant (13.4 EJ) at 1990 levels. Structural changes in the economies explain 30% of the reduction in energy intensity with the remaining due to energy efficiency improvements. In different industrial sectors adopting the best achievable technology can result in a saving of 10–30% below the current average. An analysis of cost cutting measures for motors and steam systems in 2005 indicates energy savings potentials of 2.2 EJ for motors and 3.3 EJ for steam. The payback period for these measures range from less than 9 months to 4 years. A systematic analysis of materials and energy flows indicates significant potential for process integration, heat pumps and cogeneration for example savings of 30% are seen in kraft, sulfite, dairy, chocolate, ammonia, and vinyl chloride. An exergy analysis (second law of thermodynamics) reveals that the overall global industry efficiency is only 30%. It is clear that there are major energy efficiency improvements possible through research and development (R&D) in next generation processes. A comparison of energy management policies in different countries and a summary of country experiences, program impacts for Brazil, China, India, South Africa shows the features of successful policies. Energy management International Organization for Standardization (ISO) standards are likely to be effective in facilitating industrial end use efficiency. The effective use of demand side management can be facilitated by combination of mandated measures and market strategies. A frozen efficiency scenario is constructed for industry in 2030. This implies a demand of final energy of 225 EJ in 2030. This involves an increase of the industrial energy output (in terms of Manufacturing Value Added (MVA)) by 95% over its 2005 value. Due to normal efficiency improvements the Business as Usual scenario results in a final energy demand of 175 EJ. The savings possibilities in motors and steam systems, process improvements, pinch, heat pumping and cogeneration have been computed for the existing industrial stock and for the new industries. An energy efficient scenario for 2030 has been constructed with a 95% increase in the industrial output with only a 17% increase in the final energy demand (total final energy demand for industry (135 EJ)). The total direct and indirect carbon dioxide emissions from the industry sector in 2005 is about 9.9 GtCO 2 . Assuming a constant carbon intensity of energy use, the business as usual scenario results in carbon dioxide (CO 2 ) emissions increasing to 17.8 GtCO 2 annually in 2030. In the energy efficient scenario this reduces to 11.6 GtCO 2 . Renewables account for 9% of the final energy of industry (10 EJ in 2005). If an aggressive renewables strategy resulting in an increase in renewable energy supply to 23% in 2030 is targeted (23 EJ), it is possible to have a scenario of constant greenhouse gas (GHG) emissions by the industrial sector (at 2005 levels) with a 95% increase in the industrial output. Several interventions will be required to achieve the energy efficient or constant GHG emission scenario. For the existing industry measures include developing capacity for systems assessment for motors, steam systems and pinch analysis, sharing and documentation of best practices, benchmarks and roadmaps for different industry segments, access to low interest finance etc. A new energy management standard has been developed by ISO for energy management in companies. Its adoption will enable industries to systematically monitor and track energy efficiency improvements. In order to level the playing field for energy efficiency a paradigm shift is required with the focus on energy services not on energy supply per se. This requires a re-orientation of energy supply, distribution companies and energy equipment manufacturing companies. Planning for next generation processes and systems needs the development of long term research agenda and strategic collaborations between industry, academic and research institutions and governments

The Heat Kernel on AdS_3 and its Applications

We derive the heat kernel for arbitrary tensor fields on S^3 and (Euclidean) AdS_3 using a group theoretic approach. We use these results to also obtain the heat kernel on certain quotients of these spaces. In particular, we give a simple, explicit expression for the one loop determinant for a field of arbitrary spin s in thermal AdS_3. We apply this to the calculation of the one loop partition function of N=1 supergravity on AdS_3. We find that the answer factorizes into left- and right-moving super Virasoro characters built on the SL(2, C) invariant vacuum, as argued by Maloney and Witten on general grounds.Comment: 46 pages, LaTeX, v2: Reference adde

A new Rhodococcus aetherivorans strain isolated from lubricant-contaminated soil as a prospective phenol biodegrading agent

Microbe-based decontamination of phenol-polluted environments has significant advantages over physical and chemical approaches by being relatively cheaper and ensuring complete phenol degradation. There is a need to search for commercially prospective bacterial strains that are resistant to phenol and other co-pollutants, e.g. oil hydrocarbons, in contaminated environments, and able to carry out efficient phenol biodegradation at a variable range of concentrations. This research characterizes the phenol-biodegrading ability of a new actinobacteria strain isolated from a lubricant-contaminated soil environment. Phenotypic and phylogenetic analyses showed that the novel strain UCM Ac-603 belonged to the species Rhodococcus aetherivorans, and phenol degrading ability was quantitatively characterized for the first time. R. aetherivorans UCM Ac-603 tolerated and assimilated phenol (100% of supplied concentration) and various hydrocarbons (56.2–94.4%) as sole carbon sources. Additional nutrient supplementation was not required for degradation and this organism could grow at a phenol concentration of 500 mg L −1 without inhibition. Complete phenol assimilation occurred after 4 days at an initial concentration of 1750 mg L −1 for freely-suspended cells and at 2000 mg L −1 for vermiculite-immobilized cells: 99.9% assimilation of phenol was possible from a total concentration of 3000 mg L −1 supplied at daily fractional phenol additions of 750 mg L −1 over 4 days. In terms of phenol degradation rates, R. aetherivorans UCM Ac-602 showed efficient phenol degradation over a wide range of initial concentrations with the rates (e.g. 35.7 mg L −1 h −1 at 500 mg L −1 phenol, and 18.2 mg L −1 h −1 at 1750 mg L −1 phenol) significantly exceeding (1.2–5 times) reported data for almost all other phenol-assimilating bacteria. Such efficient phenol degradation ability compared to currently known strains and other beneficial characteristics of R. aetherivorans UCM Ac-602 suggest it is a promising candidate for bioremediation of phenol-contaminated environments. </p

Breaks and the Statistical Process of Inflation:The Case of Estimating the ‘Modern’ Long-Run Phillips Curve*

‘Modern’ theories of the Phillips curve inadvertently imply that inflation is an integrated or near integrated process but this implication is strongly rejected using United States data. Alternatively, if we assume that inflation is a stationary process around a shifting mean (due to changes in monetary policy) then any estimate of long-run relationships in the data will suffer from a ‘small-sample’ problem as there are too few stationary inflation ‘regimes’. Using the extensive literature on identification of structural breaks we identify inflation regimes which are used in turn to estimate with panel data techniques the United States long-run Phillips curve

The urgent need to develop emergency EYE care in the UK:the way forward?

For two decades prior to 2004, a steady state existed of ~14 million general Accident and Emergency (A&amp;E) annual attendances in England. This total has risen each year since, with 22.9 million attendances recorded in 2015/16 (https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2016/06/Monthly-AE-Report-December-16.pdf). Resultant pressure on A&amp;E has received a great deal of public attention and extra resourcing with medical staff numbers rising 71% from 2002 to 2012

Modulation of enhancer looping and differential gene targeting by Epstein-Barr virus transcription factors directs cellular reprogramming

Epstein-Barr virus (EBV) epigenetically reprogrammes B-lymphocytes to drive immortalization and facilitate viral persistence. Host-cell transcription is perturbed principally through the actions of EBV EBNA 2, 3A, 3B and 3C, with cellular genes deregulated by specific combinations of these EBNAs through unknown mechanisms. Comparing human genome binding by these viral transcription factors, we discovered that 25% of binding sites were shared by EBNA 2 and the EBNA 3s and were located predominantly in enhancers. Moreover, 80% of potential EBNA 3A, 3B or 3C target genes were also targeted by EBNA 2, implicating extensive interplay between EBNA 2 and 3 proteins in cellular reprogramming. Investigating shared enhancer sites neighbouring two new targets (WEE1 and CTBP2) we discovered that EBNA 3 proteins repress transcription by modulating enhancer-promoter loop formation to establish repressive chromatin hubs or prevent assembly of active hubs. Re-ChIP analysis revealed that EBNA 2 and 3 proteins do not bind simultaneously at shared sites but compete for binding thereby modulating enhancer-promoter interactions. At an EBNA 3-only intergenic enhancer site between ADAM28 and ADAMDEC1 EBNA 3C was also able to independently direct epigenetic repression of both genes through enhancer-promoter looping. Significantly, studying shared or unique EBNA 3 binding sites at WEE1, CTBP2, ITGAL (LFA-1 alpha chain), BCL2L11 (Bim) and the ADAMs, we also discovered that different sets of EBNA 3 proteins bind regulatory elements in a gene and cell-type specific manner. Binding profiles correlated with the effects of individual EBNA 3 proteins on the expression of these genes, providing a molecular basis for the targeting of different sets of cellular genes by the EBNA 3s. Our results therefore highlight the influence of the genomic and cellular context in determining the specificity of gene deregulation by EBV and provide a paradigm for host-cell reprogramming through modulation of enhancer-promoter interactions by viral transcription factors

Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants

Background Blood volume and haemoglobin (Hb) levels are increased by delayed umbilical cord clamping, which has been reported to improve clinical outcomes of preterm infants. The objective was to determine whether Hb level at birth was associated with short term outcomes in preterm infants born at ≤32 weeks gestation. Methods Data were collected retrospectively from electronic records: Standardised Electronic Neonatal Database, Electronic Patient Record, Pathology (WinPath), and Blood Bank Electronic Database. The study was conducted in a tertiary perinatal centre with around 5,500 deliveries and a neonatal unit admission of 750 infants per year. All inborn preterm infants of 23 to 32 weeks gestational age (GA) admitted to the neonatal unit from January 2006 to September 2012 were included. The primary outcomes were intra-ventricular haemorrhage, necrotising entero-colitis, broncho-pulmonary dysplasia, retinopathy of prematurity, and death before discharge. The secondary outcomes were receiving blood transfusion and length of intensive care and neonatal unit days. The association between Hb level (g/dL) at birth and outcomes was analysed by multiple logistic regression adjusting for GA and birth weight (BWt). Results Overall, 920 infants were eligible; 28 were excluded because of missing data and 2 for lethal congenital malformation. The mean (SD) GA was 28.3 (2.7) weeks, BWt was 1,140 (414) g, and Hb level at birth was 15.8 (2.6) g/dL. Hb level at birth was significantly associated with all primary outcomes studied (P <0.001) in univariate analyses. Once GA and BWt were adjusted for, only death before discharge remained statistically significant; the OR of death for infants with Hb level at birth <12 g/dL compared with those with Hb level at birth of ≥18 g/dL was 4.1 (95% CI, 1.4–11.6). Hb level at birth was also significantly associated with blood transfusion received (P <0.01) but not with duration of intensive care or neonatal unit days. Conclusions Low Hb level at birth was significantly associated with mortality and receiving blood transfusion in preterm infants born at ≤32 weeks gestation. Further studies are needed to determine the association between Hb level at birth and long-term neurodevelopmental outcomes

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal