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BACKGROUND - The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.
METHODS - We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
RESULTS - At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.
CONCLUSIONS - Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
In classic category learning studies, subjects typically learn to assign items to 1 of 2 categories, with no further distinction between how items on each side of the category boundary should be treated. In real life, however, we often learn categories that dictate further processing goals, for instance, with objects in only 1 category requiring further individuation. Using methods from category learning and perceptual expertise, we studied the perceptual consequences of experience with objects in tasks that rely on attention to different dimensions in different parts of the space. In 2 experiments, subjects first learned to categorize complex objects from a single morphspace into 2 categories based on 1 morph dimension, and then learned to perform a different task, either naming or a local feature judgment, for each of the 2 categories. A same-different discrimination test before and after each training measured sensitivity to feature dimensions of the space. After initial categorization, sensitivity increased along the category-diagnostic dimension. After task association, sensitivity increased more for the category that was named, especially along the nondiagnostic dimension. The results demonstrate that local attentional weights, associated with individual exemplars as a function of task requirements, can have lasting effects on perceptual representations.
Attention is the process that selects which sensory information is preferentially processed and ultimately reaches our awareness. Attention, however, is not a unitary process; it can be captured by unexpected or salient events (stimulus driven) or it can be deployed under voluntary control (goal directed), and these two forms of attention are implemented by largely distinct ventral and dorsal parieto-frontal networks. For coherent behavior and awareness to emerge, stimulus-driven and goal-directed behavior must ultimately interact. We found that the ventral, but not dorsal, network can account for stimulus-driven attentional limits to conscious perception, and that stimulus-driven and goal-directed attention converge in the lateral prefrontal component of that network. Although these results do not rule out dorsal network involvement in awareness when goal-directed task demands are present, they point to a general role for the lateral prefrontal cortex in the control of attention and awareness.
This document is a revision of a previously published cardiothoracic curriculum for diagnostic radiology residency, and reflects interval changes in the clinical practice of cardiothoracic radiology and changes in the Accreditation Council for Graduate Medical Education (ACGME) requirements for diagnostic radiology training programs. The revised ACGME Program Requirements for Residency Education in Diagnostic Radiology went into effect December 2003.
The acute respiratory distress syndrome (ARDS), a process of non-hydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies carries a high morbidity, mortality (10-90%) and financial cost. The reported annual incidence in the United States is 150,000 cases, but this figure has been challenged and may be different in Europe. Part of the reason for these uncertainties is the heterogeneity of diseases underlying ARDS and the lack of uniform definitions for ARDS. Thus, those whose wish to know the true incidence and outcome on this clinical syndrome are stymied. The European American Consensus Committee on ARDS was formed to focus on these issues and on the pathophysiologic mechanisms of the process. It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important in order to address the recent plethora of potential therapeutic agents for the prevention and treatment of ARDS.