![]() ![]() In previous reports from FRISC II, troponin T ⩾ 0.03 µg/l 9 or troponin I ⩾ 0.03 µg/l 20 identified patients with increased risk, which therefore were used as cut offs. Troponin T concentration, which was available for 95% of the population, or troponin I, for patients without available troponin T, was used to define the occurrence of increased concentration of biochemical marker of myocardial damage. For body mass index, cholesterol, and fibrinogen no clear cut off level could be identified and the median level was chosen as the cut off. Therefore, for age, 70 years was chosen as the cut off level. In this study patients older than 70 years had a higher incidence of death/MI, whereas in the group between 65–70 years end point rates were similar to those below 65 years (data not shown). On the basis of previous experiences with risk stratification in stable and unstable CAD, variables at baseline that can predict a worse prognosis were selected (table 1 1). As long term dalteparin treatment had no significant effect on 12 months’ outcome, the dalteparin and placebo groups have been combined in the present report. Thereafter, the patients continued long term treatment with dalteparin or placebo. In the non-invasive group coronary angiography or revascularisation was recommended in case of recurrent angina and severe ischaemia during a pre-discharge exercise test or with (new) MI.Īll patients received open label dalteparin for at least five days and always until a scheduled revascularisation procedure. Revascularisation was recommended for all patients with a ⩾ 70% diameter obstruction in any artery supplying a significant proportion of the myocardium. In the early invasive group coronary angiography and if appropriate revascularisation was to be performed within seven days. The patients gave informed, written consent and were randomly assigned to an early invasive or early non-invasive strategy and to short or long term treatment with dalteparin. 17, 18 The objective of this study was to develop a scoring system (the FRISC score) consisting of clinically relevant and accessible factors that may be used to select patients for an early invasive strategy. 13– 16 However, a score focusing on treatment effect would be even more helpful in a clinical setting. Several univariable risk indicators 5, 6, 7, 8, 9, 10, 11, 12 and multivariable risk scores have been used for risk stratification. Thus, a means for selecting patients is needed. ![]() However, not all patients with an episode of unstable CAD will benefit from this treatment, which is both expensive and associated with an inherent procedural risk. 1– 4 Subsequently, treatment recommendations have been changed and revascularisation procedures have increased substantially. In the FRISC (fast revascularisation in instability in coronary disease) II, TACTICS (treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy), and RITA (randomised intervention trial of unstable angina) III trials primary end point rates were reduced by the early invasive strategy. Unstable coronary artery disease (CAD)-unstable angina or non-ST elevation myocardial infarction (MI)-can be treated with an early invasive or a primarily non-invasive regimen. Neither death nor death/MI was reduced in patients with 0–2 risk factors.Ĭonclusion: In unstable CAD, this scoring system based on factors independently associated with an adverse outcome can be used shortly after admission to the hospital for risk stratification and for selection of patients to an early invasive treatment strategy. ![]() In patients with ⩾ 5 of these factors the invasive strategy reduced mortality from 15.4% (20 of 130) to 5.2% (7 of 134) (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.15 to 0.78, p = 0.006). Results: Seven factors, age > 70 years, male sex, diabetes, previous MI, ST depression, and increased concentrations of troponins and markers of inflammation (interleukin 6 or C reactive protein), were associated with an independent increased risk for death or death/MI. From the non-invasive cohort independent variables of death or death/MI were identified. Methods: Patients were randomly assigned to an early invasive or a non-invasive strategy. Main outcome measures: One year rates of mortality and death/myocardial infarction (MI). Patients: 2457 patients with unstable CAD from the FRISC II study. Objective: To develop a scoring system for risk stratification and evaluation of the effect of an early invasive strategy for treatment of unstable coronary artery disease (CAD).ĭesign: Retrospective analysis of a randomised study (FRISC II fast revascularisation in instability in coronary disease). ![]()
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It also impressed on her the titanic scale of geology. “I feel much more confident as a field geologist, which is exactly what I wanted,” she says. “Ultimately, that’s what MISTI is all about: an experience that tells students they want to get into science.”įor Guenther, the trip was an essential part of her education as a geologist. “They get influenced by it, and a lot of people chose their career paths after it,” says Jagoutz. “They financed the workshop where we came up with the whole concept of this work.” And, says Jagoutz, the students really love the experience. “MISTI-India has been good to us,” he says. MISTI and Jagoutz go back a long time, with MISTI funding class excursions, department field trips, and a number of Jagoutz’s students. Both Guenther and Martin were supported by MIT International Science and Technology Initiatives (MISTI) and the MISTI Global Seed Fund. This past summer, Guenther and Martin spent six weeks in Ladakh collecting rock samples from the Eurasian plate to prove that this was not also further south, mapping the region and doing structural analyses. “You can’t really do field work on the moon,” she jokes. Shrock Professor of Earth and Planetary Sciences, where the research takes place entirely in the lab. She works on the compositions of lunar glasses with Tim Grove, the Robert R. Guenther had been looking for a chance to gain more field experience. “At the end, he told us he was probably going again and to let him know if we were interested,” Guenther explains. Megan Guenther, a junior in EAPS, first heard about the opportunity to do field work in Ladakh when Martin gave a presentation about his research in her structural geology class last fall. ![]() Back at MIT, Martin measured the paleomagnetic signature of these rocks, and his results placed the Kohistan-Ladakh arc right at the equator, in agreement with Jagoutz’s theory. In summer 2018, Martin and Jade Fischer, a junior double-majoring in EAPS and physics, spent six weeks in Ladakh collecting samples from the volcanic rocks. “That’s why Ladakh is a really cool place to go to, because you can walk though this whole collision,” says Martin. If you were to take a slice of the Kohistan-Ladakh region of the Himalayas in northern India, you would see a succession of rock layers representing the India plate and the Eurasia plate, with the volcanic island arc sandwiched in between. “We can measure, essentially, the latitude that a rock was formed at,” explains Martin. At the Equator, magnetite in newly formed rocks will be magnetized parallel to the ground but the further north or south it is, the more inclined the magnetization will be. Some rock minerals, such as magnetite, contain iron and act as tiny bar magnets, orienting their magnetization along Earth’s magnetic field. To test this hypothesis, Jagoutz and Martin turned to paleomagnetism. “That’s how simple it is.” But it can mean a world of difference in terms of explaining the paleoclimate - not just in the Himalayas, but globally as well. If the others are right, the fragments should be 20 degrees north,” he explains. “If I’m right, the arc sits near the equator. However, there is debate on whether these islands first collided with the Eurasian plate to the north or the Indian plate to the south. Many geologists agree on the existence of an arc of volcanic islands that formed on the boundary of a smaller tectonic plate, similar to the Mariana Islands in the Pacific Ocean. “We think it was much more complicated than that, because it’s always more complicated.”Įighty million years ago, India and Eurasia were 4,000 miles apart, separated by an ancient body of water that geologists call the Neotethys Ocean, but Jagoutz believes there was more than just seawater between the two. “The mainstream idea is: There was Eurasia there was India and they collided 50 million years ago,” says Oliver Jagoutz, an associate professor in EAPS and Martin’s advisor. The crash site Martin is investigating is the Himalayas, a 1,400-mile mountain range that rose when the Indian and Eurasian tectonic plates scrunched together. “You’re just a tiny ant wandering over this massive chaos,” he adds. “You’ve got to work out how the car crash happened, how fast the cars were going, at what angle they impacted,” explains Martin, a graduate student at MIT’s Department of Earth, Atmospheric and Planetary Sciences (EAPS). According to Craig Martin, deciphering Earth’s geologic past is like an ant climbing over a car crash. ![]() ![]() ![]() They have a broken link on their site too for the updates history: Meaning on systems which alert when a secure site tries to launch a non secure URL and then again when the non-secure connection redirects to a secure connection. I cannot at this time find a logical respelling of that URL to get it to work. (2)Added the photo browser, and removed the PhotoBrowser.exe. (3)fixed the flickering of layout window. 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This means if you want to change something you have to cancel and start from new again.Hopefully they will arrive on the next incarnation of this product?Īllows alteration of colours very nicely, in fact about the best I have seen in something in this price range.Īlso sadly appears to be lacking two important functions which are 'UNDO' and 'CLEAR'. Could not verify handyprint trial license code#.Could not verify handyprint trial license windows 10#.Could not verify handyprint trial license drivers#. ![]() |
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