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Introduction: The prognostic significance of prior heart failure in acute coronary syndromes has not been well studied. Accordingly, we evaluated the baseline characteristics, management patterns and clinical outcomes in patients with acute coronary syndromes who had prior heart failure.Methods and results: The study population consisted of acute coronary syndrome patients in the Global Registry of Acute Coronary Events, expanded Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events between 1999 and 2008. Of the 13,937 eligible patients (mean age 66±13 years, 33% female and 28.3% with ST-elevation myocardial infarction), 1498 (10.7%) patients had a history of heart failure. Those with prior heart failure tended to be older, female and had lower systolic blood pressure, higher Killip class and creatinine on presentation. Prior heart failure was also associated with significantly worse left ventricular systolic function and lower rates of cardiac catheterization and coronary revascularization. The group with previous heart failure had significantly higher rates of acute decompensated heart failure, cardiogenic shock, myocardial (re)infarction and mortality in hospital. In multivariable analysis, prior heart failure remained an independent predictor of in-hospital mortality (odds ratio 1.48, 95% confidence interval 1.08–2.03, p=0.015).Conclusions: Prior heart failure was associated with high risk features on presentation and adverse outcomes including higher adjusted in-hospital mortality in acute coronary syndrome patients. However, acute coronary syndrome patients with prior heart failure were less likely to receive evidence-based therapies, suggesting potential opportunities to target more intensive treatment to improve their outcome.

Although an early invasive approach has become standard strategy for the management of non–ST-segment elevation myocardial infarction (NSTEMI), the frequency and timing in Canada is uncertain.

We examine the clinical characteristics and outcomes of ST-elevation myocardial infarction (STEMI) patients receiving various reperfusion therapies in 2 contemporary Canadian registries.

The role of acetylsalicylic acid (ASA [aspirin]) and warfarin in secondary prevention after acute coronary syndromes (ACS) is well established. However, there are sparse data comparing the presentation and outcomes of patients who present with ACS while on ASA and/or warfarin therapy and those on neither.

Randomized trials have established the efficacy of clopidogrel in acute coronary syndromes (ACS). The benefit of clopidogrel has also been observed in the subgroup of ACS patients who subsequently undergo coronary artery bypass surgery (CABG); however, this therapy is discontinued preoperatively and the frequency with which clopidogrel is restarted post-CABG is unknown.

Current guidelines support an early invasive strategy in the management of high-risk non-ST elevation acute coronary syndromes (NSTE-ACS). Although studies in the 1990s suggested that highrisk patients received less aggressive treatment, there are limited data on the contemporary management patterns of NSTE-ACS in Canada.

We previously reported linkage of bipolar disorder to 5q33q34 in families from two closely related population isolates, the Central Valley of Costa Rica CVCR and Antioquia, Colombia CO. Here we present follow up results from finescale mapping in large CVCR and CO families segregating severe bipolar disorder, BPI, and in 343 population triosduos from CVCR and CO. Employing densely spaced SNPs to fine map the prior linkage peak region increases linkage evidence and clarifies the position of the putative BPI locus. We performed twopoint linkage analysis with 1134 SNPs in an approximately 9 Mb region between markers D5S410 and D5S422. Combining pedigrees from CVCR and CO yields a LOD score of 4.9 at SNP rs10035961. Two other SNPs rs7721142 and rs1422795 within the same 94 kb region also displayed LOD scores greater than 4. This linkage peak coincides with our prior microsatellite results and suggests a narrowed BPI susceptibility regions in these families. To investigate if the locus implicated in the familial form of BPI also contributes to disease risk in the population, we followed up the family results with association analysis in duo and trio samples, obtaining signals within 2 Mb of the peak linkage signal in the pedigrees; rs12523547 and rs267015 P  0.00004 and 0.00016, respectively in the CO sample and rs244960 in the CVCR sample and the combined sample, with P  0.00032 and 0.00016, respectively. It remains unclear whether these association results reflect the same locus contributing to BP susceptibility within the extended pedigrees. © 2009 WileyLiss, Inc.

Batten disease (juvenile neuronal ceroid lipofuscinosis JNCL) is an autosomal recessive neurodegenerative disorder characterized by blindness, seizures, and relentless decline in cognitive, motor, and behavioral function. Onset is in the early school years, with progression to death typically by late adolescence. Development of a clinical instrument to quantify severity of illness is a prerequisite to eventual assessment of experimental therapeutic interventions

Before computers, astronomical data were transmitted orally, then in manuscripts and finally in printed almanacs. The structure of the data was determined by the needs of users and by the nature of the medium of transmission. As computers have evolved in the past two decades we have learned to utilize them in the transmission process. A new series of electronic almanacs produced by the Nautical Almanac Office provides data to high precision and exploits computers as the medium of transmission.

Single blood pressure readings represent the conventional approach for determining the presence and severity of hypertension. However, the relationship between single (casual) readings and the whole-day blood pressure average is weak, especially in patients with borderline hypertension and in the elderly. In this study we have compared casual blood pressures with the averages of blood pressures obtained during short-term (two-hour) and long-term (24-hour) ambulatory monitoring in patients with mild (n=19), moderate (n=11), or predominant systolic (n=11) essential hypertension. The blood pressure averages obtained during long-term monitoring were significantly lower than the casual blood pressure in all three subgroups. The averages of short-term monitoring in the morning were in between the other two blood pressure levels. The correlation coefficients between two-hour morning averages of pressure and whole-day averages were highly significant (p<0.01 or better), and stronger than those between casual and whole-day average pressures, in the group of patients as a whole and in all three subgroups. The slopes of the regression equations were close to unity. Therefore, ambulatory short-term monitoring of blood pressure in the morning is superior to casual blood pressure and probably is an adequate substitute for whole-day observations in quantifying whole-day blood pressure levels in hypertensive patients, especially in patients with mild hypertension and in those with predominant systolic hypertension.

The reproducibility of the whole-day blood pressure, measured by an automated non-invasive device at 7.5 minute intervals, was examined in 6 hypertensive patients in a quiet in-hospital environment. During a repeat study performed two weeks after the baseline monitoring period, the average 24-hour systolic blood pressure had changed significantly in 3 patients and the diastolic blood pressure in 2. If the day was divided into 12 consecutive 2-hour periods, systolic blood pressure averages during corresponding periods of the two studies correlated significantly in 3 of the 6 patients, and diastolic blood pressure averages in 5. After a third 24-hour monitoring period, carried out in 4 of the 6 patients, it was found that the baseline study correlated more strongly with the second repeat study than with the first, and that the correlations between the two latter studies were the strongest of all. Thus, even during relatively non-stimulatory conditions the 24-hour blood pressure is not constant in all patients; there is a tendency, however, towards greater reproducibility of the whole-day blood pressure patterns as patients become more familiar with the monitoring procedure.

Physical measures of mineral deposit characteristics, such as grade and tonnage, long have been used in both subjective and analytic models to predict favorability of areas for the occurrence of mineral deposits of particular types. After a deposit has been identified, however, the explorationist must decide whether to continue data collection, begin an economic feasibility study, or abandon the prospect. The decision maker can estimate the probability that a deposit will be commercial by examining physical measures. The amount of sampling data required before such a probability estimate can be considered reliable can be determined. A logit probability model estimated from onshore titanium-bearing heavy-mineral deposit data identifies and quantifies the relative influence of a deposit's physical measures on the chances of the deposit becoming commercial. A principal conclusion that can be drawn from the analysis is that, along with a measure of deposit size, the characteristics most important in predicting commercial potential are grades of the constituent minerals. Total heavy-mineral-bearing sand grade or even total titanium grade (without data on constituent mineral grades) are poor predictors of the deposit's commercial potential.

A new principle for appraising and correcting the focus of a high-power microscope is described. Besides affording greater precision than is achieved visually, the principle lends itself readily to fully automatic operation, including “tracking” a moving slide. A servo system employing this principle has been built and been operated routinely for over a year. It maintains correct focus within about 0.1 μ and does so over a period of several days if necessary. The equipment operates irrespective of changes in thickness and index of cover slip, index of immersion fluid, thickness and flatness of specimen slide, temperature effects in the various optical and mechanical components. It operates even when the specimen slide area in question is blank (i.e., unoccupied).The principle is well suited to microscope systems that employ photoelectric or photographic detection and that call for the greatest possible accuracy of focus. It may be used with UV, visible, or IR radiation, and hence it is applicable to UV and IR microscopy as well as visual range microscopy.Besides assisting focusing, the new principle can be used to explore the surface topography of microscopically “stepped” surfaces; unlike various other methods it should be applicable even if the steps have an area as small as one square micron. It has been found effective also in evaluating longitudinal chromatic aberration in high quality objectives.

A new principle for appraising and correcting the focus of a high-power microscope is described. Besides affording greater precision than is achieved visually, the principle lends itself readily to fully automatic operation, including “tracking” a moving slide. A servo system employing this principle has been built and been operated routinely for over a year. It maintains correct focus within about 0.1 µ and does so overaperiod of several days if necessary. The equipment operates irrespective of changes in thickness and index of cover slip, index of immersion fluid, thickness and flatness of specimen slide, temperature effects in the various optical and mechanical components. It operates even when the specimen slide area in question is blank (i.e., unoccupied).The principle is well suited to microscope systems that employ photoelectric or photographic detection and that call for the greatest possible accuracy of focus. It may be used with UV, visible, or IR radiation, and hence it is applicable to UV and IR microscopy as well as visual range microscopy.Besides assisting focusing, the new principle can be used to explore the surface topography of microscopically “stepped” surfaces; unlike various other methods it should be applicable even if the steps have an area as small as one square micron. It has been found effective also in evaluating longitudinal chromatic aberration in high quality objectives.