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Background: Coronary heart disease (CHD) is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention (CR/SP) remains low. We assessed the effectiveness of SMARTphone and WeChat-based CR/SP (SMART-CR/SP) in the first randomised controlled trial (RCT) of a dedicated social media-based CR/SP program for patients with CHD. Methods: In this parallel-group, single-blind, RCT, CHD patients from a large tertiary hospital in Shanghai, China were randomised (1:1) to an eight-week 'intensive', followed by a 16-week 'step down' program of SMART-CR/SP, or usual care. Assessments were conducted at baseline, eight and 24 weeks. The primary outcome was functional capacity measured by six-minute walk test distance (6MWTD). Secondary outcomes included CHD knowledge, and risk factor control. Analysis was by intention-to-treat. Findings: Between November 17, 2016 and March 18, 2017, 312 patients (mean age, 60.5 [SD 9.2] years, 81.4% male) were randomised to SMART-CR/SP (n=156) or usual care (n=156). The mean increase in 6MWTD was greater at both eight (46.5 vs. 20.9 m; 95% CI 9.6 to 41.5; p=0.002) and 24 weeks (54.2 vs. 26.2 m; 95% CI 10.9 to 44.9; p=0.001) in the SMART-CR/SP group versus controls. The SMART-CR/SP group had a better knowledge of CHD score at eight (17.9 vs. 13.8; 95% CI 2.84 to 5.44; p

A circulation-based discrete vortex method is used on a three-element airfoil system. Kutta conditions and Kelvin's circulation theorem are additional conditions required for this method to determine the circulation distributions on each element and to determine vortex shedding. Discrete shed vortices are introduced near the four sharp edges to represent the sharp-edge vortex shedding caused by unsteady flow separation. The computational procedure warrants neutrally stable solutions of the self-sustained fluctuating flowfield that can provide broad-band spectral information for far-field noise predictions. The near-field vortex method directly calculates the parameters used in an asymptotic formula for far-field sound computation that attributes the noise sources to vortex interactions among the shed vortices and the surface circulations of the three-element airfoil system. The far-field noise characters are then analyzed and compared to the experimental data in the literature.

Following the publication on the principle and theory of a newly proposed non-imaging focusing heliostat, this paper presents a report on the design, optical alignment and application of the first prototype heliostat. In the architecture of the first prototype, 25 mirrors, each with a dimension of 40×40 cm, are arranged into five rows and five columns to form a total reflective area of 4 m2. The design of the essential part of the first prototype heliostat will be discussed in this paper, which consists of two primary elements; a rotation–elevation system for tracking a mirror support frame which carries 25 mirror facets, and a separate two-axis tracking system for compensating (each second) off-axis aberrations of 24 slave facets relative to the central mirror, which is fixed in the mirror frame. The rotation–elevation system consists of a pedestal supporting a rotational tracking mechanism carrying a U-shaped arm and a second tracking system for tracking a moving frame in elevation. The moving frame carries a central stationary (relative to the frame) mirror, called a master mirror. Slave mirrors are arrayed in five rows and five columns, and eight stepper motors drive the outer four rows and columns relative to the master mirror via a computer programme implementing newly proposed formulas to eliminate the first-order aberration. With a second stage concentrator comprising a small aperture size parabolic mirror (diameter of 60 cm), a cost-effective high temperature solar furnace was constructed. In our experiment, the highest furnace temperature of 3400°C has been recorded through the melting of pure tungsten wires.

In this study, column tests were used to determine the retention capability of three types of estuarine alluvia collected adjacent to landfill sites in South Wales. Selective sequential extraction (SSE) was used to study the retention mechanisms of heavy metals in the soil columns obtained from leaching experiments. Acid digestion was later used to check the validity of the SSE results. Breakthrough curves show good retention of heavy metal ions (Pb, Cu, and Zn) by all soils, where almost 99% of heavy metals were retained with the Ce/Co values in the order of 10−3. The retention strength of these soils was observed to be constant up to five pore volumes (PV). This corresponds with the pH of the effluents and pore water of soil slices, which also show good buffering capacity against very acidic leachate up to 5PV. The heavy metal extraction profiles from SSE show very similar trends with the retention profiles from the leaching experiments, where heavy metals were retained mainly at the top part where the leachate entered the column. SSE indicates qualitatively that heavy metals precipitated with carbonates and amorphous materials (oxides/hydroxides) are higher than heavy metal retention via exchangeable mechanisms. The mass balance calculation gives range of deviation of 1–16% of the total soil extraction. The distribution of the heavy metals with various soil constituents are ranked in the following order: Carbonates>Amorphous oxides hydroxides>Organic matter>Exchangeable phases.

The ‘internet-driven information age’ is a term in common usage, implying that everyone can access all the information they need, when they need it. The purpose of this brief paper is to outline some web sources that highlight the possibilities and potential for accessing web-based knowledge. From this the clinician will be encouraged to follow leads along the labyrinth of links to a greater appreciation of how this resource can be used to shape their practice. Examples of web links are provided for: search engines; library-based sources, including medical databases and electronic journals; evidence-based practice databases, mail-groups; electronic conferences; research centres; and general health sources. Importantly, this review does not aspire to be all-inclusive, for the web changes, chameleon-like, to the seasons. The web is here to stay. It will provide the framework for much education and will guide clients to a greater appreciation of their disease or disability than ever before. It may ultimately be the tool through which health fund agents will promote best practice, including self-help to clients, and therefore direct discriminating individuals to select health practitioners who have been endorsed by professional and fund agencies as providing a contemporary service which conforms to evidence-based practice.

Introduction – objectifs Le risque et le spectre des evenements cardiovasculaires (ECV) restent mal connus au cours de la co-infection VIH-VHC. Materiels et methodes Au sein de la cohorte prospective multicentrique HEPAVIH-ANRS CO13, nous avons releve les ECV majeurs (syndrome coronarien aigu (SCA), revascularisation coronaire (RC), mort subite (MS), accident vasculaire cerebral ischemique (AVC)) et mineurs (maladie thromboembolique (MTE), maladie vasculaire peripherique (MVP), insuffisance cardiaque congestive), mesure leur incidence et recherche des facteurs predictifs d’ECV. Les tests de Chi 2 et de Wilcoxon ont ete utilises pour depister des facteurs predictifs d’ECV. Le modele de Cox a ete utilise apres ajustement des parametres selectionnes en analyse univariee. Resultats Parmi les 1 175 patients co-infectes VIH-VHC inclus de 2006 a 2008 (70,4 % d’hommes, âge moyen de 45,0 ans) et suivis jusqu’en septembre 2013 (mediane de suivi de 57,6 mois), nous avons observes un total de 42 ECV pour 28 patients. L’incidence des ECV est de 8,3 pour 1 000 personne-annees (IC95 = 5,0-11,6). Les ECV majeurs comprenaient 4 MS, 10 SCA, 1 RC, 2 AVC. Les ECV mineurs comprenaient 10 MVP et 3 MTE. Les patients avec ECV etaient plus souvent de sexe masculin (p = 0,0092), avait plus souvent une lipoatrophie (p = 0,0399), un niveau plus eleve de cholesterol total (p = 0,0165), de LDL-cholesterol (p = 0,0132) et de triglycerides (p = 0,0002) que les patients sans evenement. Ni l’eradication du VHC par antiretroviraux ni le tabac (p = 0,6414) n’influencait la survenue d’ECV (p = 0,1730). En analyse multivariee, le niveau de LDL-cholesterol (RR = 6,202 IC95 = 1,580-24,352 ; p = 0,0089) et de triglycerides (RR = 2,010, IC95 = 1,207-3,347 ; p = 0,0076) etaient des facteurs predictifs independants d’ECV. Conclusion Chez les patients co-infectes VIH-VHC, les ECV sont domines par les SCA et les MVP. Les niveaux de LDL-cholesterol et de triglycerides etaient des facteurs predictifs independants d’ECV.

S A T U R D A Y 163 Mast Cells with a Unique Phenotype Are Highly Elevated in Chronic Rhinosinusitis with Nasal Polyps T. Takabayashi, A. Kato, A. T. Peter, L. A. Suh, R. Carter, J. Norton, L. C. Grammer, B. K. Tan, R. K. Chandra, D. B. Conley, R. C. Kern, S. Fujieda, R. P. Schleimer; The Division of Allergy and Immunology Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, The Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, University of Fukui, Fukui, JAPAN, Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the role of mast cells is poorly understood. The objective of this study was to investigate the presence, localization and phenotype of mast cells in affected tissues from patients with chronic rhinosinusitis (CRS). METHODS: We collected nasal tissue and nasal lavage fluid from patients with CRS and control subjects. We analyzed mRNA for the mast cell proteases tryptase, chymase and carboxypeptidase A3 (CPA3), using real-time PCR, and assessed the presence of mast cell proteases using ELISA and immunohistochemistry. We also performed immunofluorescence to observe the pattern of colocalization of the mast cell proteases. RESULTS: Tryptase mRNA and protein were significantly increased in nasal polyps frompatientswithCRSwNPcomparedwith uncinate tissue from patients with CRS or healthy subjects. We made the striking observation that therewere abundantmast cells localizedwithinglands of nasalpolyps and that these mast cells expressed all three proteases. We also observed increased numbers of mast cells in epithelium but not elsewhere within the lamina propria in nasal polyps. The mast cells detected in epithelium in nasal polyps were characterized by expression of tryptase and CPA3 but not chymase. CONCLUSIONS: Herein we demonstrate increased mast cells in epithelium and glands of nasal polyp tissue, and show that nasal polyp mast cells have unique phenotypes that vary by tissue location. These diverse subsets of mast cells may contribute to the pathogenesis of CRSwNP.