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Mortality in patients with STEMI-associated cardiogenic shock (CS) is increasing. Whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol (CSP) can improve their care delivery and mortality is unknown. We evaluated the impact of a CSP on incidence and outcomes in patients with STEMI-associated CS. We implemented a 4-step CSP including: (1) Emergency Department catheterization lab activation; (2) STEMI Safe Handoff Checklist; (3) immediate catheterization lab transfer; (4) and radial-first percutaneous coronary intervention (PCI). We studied 1,272 consecutive STEMI patients who underwent PCI and assessed for CS incidence per National Cardiovascular Data Registry definitions within 24-hours of PCI, care delivery, and mortality before (January 1, 2011, to July 14, 2014; n = 723) and after (July 15, 2014, to December 31, 2016; n = 549) CSP implementation. Following CSP implementation, CS incidence was reduced (13.0% vs 7.8%, p = 0.003). Of 137 CS patients, 43 (31.4%) were in the CSP group. CSP patients had greater IABP-Shock II risk scores (1.9 ± 1.8 vs 2.8 ± 2.2, p = 0.014) with otherwise similar hemodynamic and baseline characteristics, cardiac arrest incidence, and mechanical circulatory support use. Administration of guideline-directed medical therapy was similar (89.4% vs 97.7%, p = 0.172) with significant improvements in trans-radial PCI (9.6% vs 44.2%, p < 0.001) and door-to-balloon time (129.0 [89:160] vs 95.0 [81:116] minutes, p = 0.001) in the CSP group, translating to improvements in infarct size (CK-MB 220.9 ± 156.0 vs 151.5 ± 98.5 ng/ml, p = 0.005), ejection fraction (40.8 ± 14.5% vs 46.7 ± 14.6%, p = 0.037), and in-hospital mortality (30.9% vs 14.0%, p = 0.037). In conclusion, CSP implementation was associated with improvements in CS incidence, infarct size, ejection fraction, and in-hospital mortality in patients with STEMI-associated CS. This strategy offers a potential solution to bridging the historically elusive gap in their care.

Pea proteins are promising plant proteins in the food industry but their flavor limits consumer acceptance. In this study, the impacts of extraction pH (8.5, 9.5 and 10) and cultivars (Agassiz and Trapeze) on the aromatic flavor profile of spray-dried pea proteins at each one of the three alkaline extraction-isoelectric precipitation steps were investigated by a headspace-solid phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) metabolomic approach. In total, 53, 54, and 48 representative compounds were obtained for each extraction step, respectively, and were used by Venn diagram, principal component analysis, hierarchical cluster analysis, and heatmap analysis to demonstrate the flavor variations among pea proteins with different extraction pH and cultivars. In addition, the changes of 7 beany-flavor markers during the extraction process were tracked and results showed that, in general, their content peaked in the second extraction step while 28% of the comparisons between the initial and final step showed a significant difference. The results of this study could provide a better understanding of flavor development of pea proteins during their production.

Background: Chilli-pepper (CP) is well known for its anti-inflammatory, antioxidant, anticancer, and blood glucose regulation effects. However, the impact of CP on all-cause and cardiovascular mortality is not clear. Methods: A comprehensive search was performed using Ovid, Cochrane, Medline, Embase, and Scopus. We screened the studies from inception till January 16, 2020, and reported the outcomes of our interest after consumption of CP (Figure1a). The inclusion criteria were: all observational and randomized controlled trials reporting the outcomes of interest, and pediatric, animal studies, letters/case reports, reviews, abstracts, and book chapters were excluded. All-cause mortality was studied as the primary endpoint. Cardiovascular, cerebrovascular, and cancer-related deaths were studied as secondary outcomes. Results: From 4729 studies screened, four studies including 570,762 subjects met the inclusion criteria. Random-effects pooled analysis showed that there was a 25% reduction in the relative risk of all-cause mortality for regular CP consumers, compared to non-consumers (relative risk (RR): 0.75; 95% confidence intervals (CI): 0.64-0.88, p = 0.0004, Figure1b). Furthermore, there were a 26% and 23% reduction in the RR of death due to cardiovascular causes (RR: 0.74; 95% CI: 0.62-0.88, p=0.0006, Figure1c) and cancer (RR: 0.77; 95% CI: 0.71-0.84, p=0.0001, Figure 1d), respectively. However, there were no statistically significant differences in cerebrovascular accidents (RR: 0.76; 95% CI: 0.36-1.60, p=0.47). Conclusion: In a contemporary meta-analysis of 570,762 subjects, regular CP consumption was associated with a significant reduction in all-cause, cardiovascular, and cancer-related mortalities. Future studies are needed to better understand the potential mechanisms of the mortality benefits of CP consumption.

Several studies designed to augment high density lipoprotein (HDL) levels have so far been unsuccessful in reducing rates of major adverse cardiovascular and cerebrovascular events (MACCE). In this study, we report the effect of HDL-C levels on overall survival outcomes and rates of MACCE following percutaneous coronary intervention (PCI). We reviewed patients who underwent PCI at the Cleveland Clinic from 2005 to 2017 and followed them through the end of 2018. Restricted cubic splines incorporated into Cox proportional hazard regression models were used to assess the outcomes. The HDL-C level associated with the lowest mortality was used as a reference value.15,633 patients underwent PCI during the study period, of which 70% were male, 81% were white, and 73% were on statins. The mean age at the time of procedure was 65.8 ± 11.8 years. After adjusting for demographics, co-morbidities, lipid profile, statin use, and date of procedure, our model demonstrated a U-shaped association between HDL-C and overall mortality, with HDL-C levels of 30-50 mg/dl associated with the most favorable outcomes, and HDL-C levels30 mg/dl or50 mg/dl associated with worse outcomes. A sensitivity analysis in men yielded a similar U-shaped association. In conclusion, our study shows that both low and high levels of HDL-C are associated with worse overall survival, with no effect on rates of MACCE in PCI patients. Further studies are required to understand the mechanism of this association between elevated HDL-C levels with increased overall mortality in patients with atherosclerotic cardiovascular disease (ASCVD).

The journey to Mars will be an ambitious, yet arduous task as it will entail culmination of all the information we have gathered over many decades. While the mission is of utmost importance, preservation of astronaut's well-being is paramount also. To that end, mitigation of radiation risk especially afflicting cardiovascular disease (CVD) is of great interest and challenge. Current data from astronauts on low earth orbit and Apollo missions provides insight on the risk of CVD from radiation exposure. However, data is limited given the small cohort size of astronauts who embarked on just nine prolonged missions. Therefore, a cerebral approach to understanding and mitigating risks are essential. This paper discusses the need for a predictive preclinical model to help understand and mitigate the effects of radiation on astronauts. We will discuss strengths and limitations of preclinical models and the methods of validating and constructing a model to predict human clinical outcomes. Our bedside-bench-bedside approach focuses on adapting the preclinical model through common investigative tools used between humans and animals. The result will be an optimization of preclinical model to a point of being a surrogate clinical model capable of predicting CVD outcomes in astronauts exposed to radiation.

The beany flavor of pea protein limits its application in the food industry. This study aimed at addressing this problem by combining the advantages of solid-based spray drying technique and the ability of cyclodextrins (CD) to entrap volatiles. Pea protein isolates (PPI) was extracted by alkaline extraction-isoelectric precipitation, followed by co-spray drying with CD. The resulted PPI-CD showed no major structure changes. HS-SPME-GC-MS coupled to untargeted metabolomics successfully identified 23 aroma compounds that represent the different odorants among PPI-control, physically mixed PPI-CD, and co-spray dried PPI-CD samples. Heat map analysis also showed a remarkable beany odor mitigation effect upon the addition of CD, which was further proved to be due to CD entrapping aroma compounds during spray drying. In the meantime, the functional attributes of PPI-CD were not adversely impacted by the addition of CD.

Background: Cardiac arrest (CA) complicating ST-elevation myocardial infarction (STEMI) is associated with a disproportionately higher risk of mortality. We described the contemporary presentation, management, and outcomes of CA patients in the era of primary percutaneous coronary intervention (PCI). Methods: We reviewed 1,272 consecutive STEMI patients who underwent PCI between 1/1/2011-12/31/2016 and compared characteristics and outcomes between non-CA (N = 1,124) and CA patients (N = 148), defined per NCDR definitions as pulseless arrest requiring cardiopulmonary resuscitation and/or defibrillation within 24-hr of PCI. Results: Male gender, cerebrovascular disease, chronic kidney disease, in-hospital STEMI, left main or left anterior descending culprit vessel, and initial TIMI 0 or 1 flow were independent predictors for CA. CA patients had longer door-to-balloon-time (106 [83,139] vs. 97 [74,121] minutes, p = 0.003) and greater incidence of cardiogenic shock (48.0% vs. 5.9%, p < 0.001), major bleeding (25.0% vs. 9.4%, p < 0.001), and 30-day mortality (16.2% vs. 4.1%, p < 0.001). Risk score for 30-day mortality based on presenting characteristics provided excellent prognostic accuracy (area under the curve = 0.902). However, over long-term follow-up of 4.5 ± 2.4 years among hospital survivors, CA did not portend any additional mortality risk (HR: 1.01, 95% CI: 0.56–1.82, p = 0.97). Conclusions: In a contemporary cohort of STEMI patients undergoing primary PCI, CA occurs in >10% of patients and is an important mechanism of mortality in patients with in-hospital STEMI. While CA is associated with adverse outcomes, it carries no additional risk of long-term mortality among survivors highlighting the need for strategies to improve the in-hospital care of STEMI patients with CA.

Stroke is one of the potential complications of mitral clip (MC) procedure with a reported incidence of 0.2% to 2.8%. We studied the incidence of stroke at 30 days after a mitral clip (MC) by performing meta-analysis from previously published literature. Ovid, Medline, Embase, Scopus and Cochrane

The color of active pharmaceutical ingredients (APIs) can be a critical quality attribute for pharmaceutical products. Color variation can be indicative of contaminants, chemical impurities, solid-state form impurities, or degradation products. The color of the pharmaceutical materials is typically specified and determined using visual appearance testing. To avoid the inherent subjectivity of visual appearance testing, to understand the link between the color and the process parameters, and to facilitate quality agreements between customers and vendors of chemical starting materials, quantitative color measurements utilizing visible spectroscopic methods are increasingly needed. In this work, a systematic method development strategy (MDS) is described to assist with the development of robust and rugged quantitative color measurement methods based on a science- and risk-based approach aligned with quality-by-design principles. The MDS is illustrated using typical scenarios encountered in method development through several examples including a method developed for 2,3-dimethyl-2H-indazol-6-amine, a starting material in the commercial synthesis of pazopanib hydrochloride API. Flowcharts and examples are presented to illuminate key decision points in the MDS process including selection of (1) solution-state versus solid-state spectroscopic method, (2) optimal color space for reporting color measurement results, and (3) appropriate method risk assessment and control to ensure successful method implementation. General guidance is also provided to facilitate the discussion for setting quantitative color specifications.

d-Psicose is a hexoketose monosaccharide sweetener, which is a C-3 epimer of d-fructose and is rarely found in nature. It has 70 % relative sweetness but 0.3 % energy of sucrose, and is suggested as an ideal sucrose substitute for food products. It shows important physiological functions, such as blood glucose suppressive effect, reactive oxygen species scavenging activity, and neuroprotective effect. It also improves the gelling behavior and produces good flavor during food process. This article presents a review of recent studies on the properties, physiological functions, and food application of d-psicose. In addition, the biochemical properties of d-tagatose 3-epimerase family enzymes and the d-psicose-producing enzyme are compared, and the biotechnological production of d-psicose from d-fructose is reviewed.

With increased dependence on elevators in high-rise buildings, a reliable and effective backup power system is in urgent need. In this work, a hybrid backup power system that consists of hydrogen fuel cells, batteries and ultracapacitors is introduced. The electric power system was modeled using the multi-physics/system-dynamics modeling tool, Modelica/Dymola. Power performance of the backup power system was examined using an elevator model built on the same platform. A hybrid energy storage system with ultracapacitors and batteries was designed to deal with the large transient current flow and cost constraint. The size of more cost sensitive fuel cell power system was significantly reduced. This simulation-based design and analysis support the testing and production of the proposed new system.

With limited available space in the city and increasing land cost, multi-storey and high-rise buildings now dominate most urban areas of the world. The irresistible trend to build taller and taller buildings to leverage increasing land cost turns elevator from a tool of convenience to a necessity of life. This dependence of elevator further requires its continuous function in spite of power failure caused by a variety of reasons. Reliable and effective elevator power backup system becomes an urgent need today. In this work, advanced electric power backup technologies, including battery, ultracapacitor and hydrogen fuel cells, are examined. To design a functional elevator backup power system, and to assess the feasibility of a battery–ultracapacitor–fuel cell hybrid elevator backup power system with superior performance, the modeling and simulation of an elevator and its backup power system are carried out. Based on its resemblance to an electric vehicle traveling vertically, the elevator, its power need and performance are modeled using the MatLab/Simulink based hybrid vehicle design and analysis tool, ADvanced VehIcle SimulatOR (ADVISOR). The modeling and simulation provide guidelines for selecting and sizing energy storage and conversion devices. More importantly, the quantitative analysis allows complex battery–ultracapacitor–fuel cell hybrid backup power system to be optimized to reach the best potential of each components for a given elevator usage cycle. To explore the feasibility of wide commercial applications of this technology, the initial cost, maintain costs and reliability of the battery–ultracapacitor–fuel cell hybrid elevator backup power system are also discussed.Copyright © 2007 by ASME

Hybrid vehicle technology is beginning to make a significant mark in the automotive industry, most notably by the Toyota Prius THS-II and its one-mode technology, but also by two-mode architectures recently introduced. GM-Allison, Renault, and the Timken Company have attempted to capitalize on the advantages over simpler series and parallel architectures that the series-parallel configuration confers on the Prius while also improving the design by allowing the powertrain configuration to physically shift and operate in two different modes depending on the driving load. This work provides an overview of the state-of-the-art in two-mode hybrid vehicle architectures, and demonstrates the performance of this technology in comparison to the market-leading Toyota Prius one-mode hybrid vehicle technology and conventional ICE technology. Simulations in the NREL ADVISOR® software compare the performances of the one- and two-mode architectures against a parallel-full design and the ICE baseline for four different drive cycles and a vehicle with varying weight that simulates a commercial vehicle application. A configuration that is a variation of those designed by GM-Allison was chosen as the representative of the two-mode architectures. The performance metric was fuel economy. The fuel economy was measured over the course of the drive cycles: (1) Urban Dynamometer Driving Schedule for Heavy Duty Vehicles (UDDSHDV); (2) New York City Truck (NYCT); (3) City-Suburban Heavy Vehicle Route (CSHVR); and (4) Highway Fuel Economy Test (HWFET). The vehicle model uses a module developed in-house for a Kenworth T400 truck with a payload that varies from empty to completely full. The results demonstrate that the two-mode architecture provides significantly improved performance to that of the conventional non-hybrid design and comparable performance to that of the parallel-full hybrid design. Furthermore, the one-mode design is shown to be sub-optimal for this vehicle type. Development and optimization of the control strategy, which is the direction of the current research, should allow for additional improvement in fuel economy; optimization of vehicular components could result in improvements in acceleration ability, gradeability, and top speed performance, which lags behind the performance capabilities of the conventional powertrain vehicle in these metrics. The study confirms that two-mode architecture presents unique advantages for constantly changing driving cycles and vehicle payloads and represents the future of hybrid vehicle technology.Copyright © 2007 by ASME

An electronically controlled continuous variable transmission (e–CVT) which consists of planetary gears and electric machines plays a key role in advanced hybrid powertrains of HEV/PHEV/EREVs. Design of these e–CVTs for best performance is a challenging task due to the complexity of these e–CVTs and hybrid powertrain system derived from them. In this work, a performance modelling and optimisation–based design method is introduced to automatically identify the best performance of an e–CVT or other complex hybrid vehicle powertrain system. The complex design optimisation problem for peak powertrain performance is solved using a unique two–stage search method to significantly reduce needed computation and assure the accuracy of the optimisation. Four representative e–CVT powertrain designs of representative HEV/PHEV/EREVs were used as case studies. Test results are calibrated using verified data to reveal the performance characteristics and potential of each powertrain designs. Application of this method to produce new e–CVT and gear–train designs with enhanced performance is demonstrated.

Electric vehicles (EV/HEV/PHEV/EREV) draw mechanical power or regenerate electric power using multiple electric motors and generators (M/Gs). To achieve optimal vehicles electrical/mechanical energy conversion efficiency and to prolong the pure electric range of these vehicles, the energy conversion efficiency is to be maximised against powertrain component operation parameters using high fidelity model and simulation. However, the energy conversion efficiency model using vehicle powertrain component model and simulation is complex and computationally intensive. An efficient global optimisation tool is needed to produce the optimal efficiency look-up surface for real-time control system implementation, or to search for the optimal operation parameters in real time. In this work, a new two-mode-plus EREV design is used. The optimal vehicle energy conversion efficiency under various powertrain component operation parameters are obtained using three alternative global optimisation tools, GA, PSO, and SEUMRE....

The purposes of this paper are to improve on the nomenclature of Hybrid Vehicles (HVs), and to present an enhanced methodology to report the Fuel Economy (FE) of emerging Plug-in Hybrid Vehicles (PHVs). New definitions for HVs and PHVs are presented that include some powertrain configurations that were excluded by the previous definitions, such as the parallel micro-hybrid configuration. The methodology presented to calculate the FE for PHVs involves independently reporting fuel and electrical consumption and eliminates the usage of US driving and owner-charging statistics used in previous methods.

In this paper, we present a review of the recent advances in hybrid vehicle powertrain architectural design. The paper begins with a discussion and categorisation of the various types of hybrid vehicles. The current leading technology is the one-mode design of the Toyota Hybrid System, and the intent of the state-of-the-art architectures is to improve upon the perceived weaknesses of the one-mode design. The proposed designs employ multi-regime architectures that allow for the transmission to operate in any one of series, parallel, or power-split configurations, depending upon the road load, driver demand, and control strategy. These new designs found in the literature are discussed and compared. The work allows further study and detailed modelling of the promising multi-regime architectures to be carried out.

In this work, the dynamic model of a multi-regime hybrid vehicle powertrain architecture is presented. The study focuses on the formulae governing the operation of the planetary gear systems in the powertrain and on the performance of a more complex heavy-duty vehicle with varying loading conditions. The model is compared with models of the Toyota Hybrid System, a generic full-parallel design, and a conventional powertrain, all implemented for a commercial delivery vehicle in the ADVISOR simulation software. Computer simulations in ADVISOR compare the performance of the various designs, using fuel consumption as the performance metric, for four different drive cycles common for this vehicular application. The results demonstrate that the multi regime architecture provides significantly improved performance to that of the conventional and THS design and comparable performance to that of the full parallel hybrid design. The study confirms that the multi-regime architecture presents unique advantages for wide-ranging road loads and vehicle payloads and that multi-regime designs likely represent the future of hybrid vehicle technology.