Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation
Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear.
METHODS
In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days.
RESULTS
A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P=0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups.
Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension
The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear.
METHODS
In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.
RESULTS
Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P=0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group.
Moving the Goalposts for Blood Pressure — Time to Act
We often lament the lack of confirmatory studies that can either reassure us all that the previous evidence for a trialed intervention is robust or indicate that the evidence is questionable. Zhang and colleagues have conducted such a study — the STEP trial1 — which in essence investigates the veracity of the findings of the previous trial SPRINT,2 but in an older cohort and in China, a country with a considerable burden of high blood pressure and stroke. The investigators have demonstrated impressive organizational skills in completing recruitment for such a large multicenter trial within a calendar year. As in . . .
Effect of Salt Substitution on Cardiovascular Events and Death
Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain.
METHODS
We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia.
RESULTS
A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P=0.76).
Paton Marketing: Quality Solutions for Effective Internet Marketing
Paton Marketing is an Internet Marketing Company Miami that has helped many clients generate great revenues through various online marketing techniques and procedures. Paton Marketing offers services like Search Engine Optimization, Website Development, Pay per Click Management, Reputation Management, and Social Media Marketing. We provide all the services you need at affordable rates.
Our online marketing strategy constantly thrives to get desired results for the clients. Our SEO campaigns cover all critical and diverse factors ranging from on-page, back link, content to website design. All SEO aspects are covered with the simplified three phase approach of Plan, Optimize and Track to strategize, execute and report SEO campaigns.
Miami Marketing Agency uses expert knowledge in a range of marketing services to help bring our clients’ websites to unprecedented levels of success. Through effective online marketing strategies and our expert SEO services, we can help turn your website in to your business’ most powerful lead generator. Google, like many other search engine ranks pages based on certain criteria. To start with, the quality of your site matters a lot.
We also specialize in Web Development and Web Design. Paton Marketing provides our clients with a strategically-developed premium custom website. A great website will go a long way in getting your business noticed online. It also delivers a high-quality user experience. We keep your website up to date regularly.
Internet marketing is much more than site creation. It requires precise marketing techniques and tools across the board. Without our professional assistance, your website will simply fail to generate essential web traffic. Web marketing also entails weekly progress reports. This includes web traffic, along with the number of hits your site secures on a weekly basis.
Miami Marketing Agency also specializes in Reputation Management. Reputation Management is one of most important factor in web marketing. Negative content can terribly affect your business. Paton Marketing Reputation Management strategies can protect your online reputation by suppressing negative content on the search results. We create positive and multiple micro-sites ensuring that the negative links are pushed further out of search results.
If you are struggling with web traffic issues, our dedicated marketing team can help you within time and budget. Simply contact us today.
Best computer science papers online
Computer science papers are part of the diverse types of assignments that students will encounter in their academic endeavor. Student undertaking engineering and computer science course will write computer science papers before they complete their course. It is important that student familiarize themselves with the right skills needed to complete such papers. The first vital skill in writing any academic paper is practice. Student should practice how to write different computer science papers. Some of the academic papers that students may encounter include computer essays, term papers, research papers, thesis and dissertation. It is vital for the student to practice the writing process depending on his academic level. Unfortunately, not all students have the ideal skills to complete an academic paper. Some students may have the right ideas regarding the completion of the paper, but they lack the skills to out the ideas into a sensible computer science paper. Such students risk failure if they persist to present poorly written papers.
Computer science papers services gives students a chance to complete their assignment in a way that guarantees excellent scores. The affordability of the computer science writings that we write makes us an ideal choice for students. We have affordable rates that suit students of varied financial statuses. The low pricing of the service is attributed to the desire of the company to serve all students. We have retained a standard fee throughout the years. We rarely hike the prices of computer science papers. The quality of the computer science papers also makes the company the ideal choice for many students. We have excellent writers who are dedicated to serving all students. The writers are well trained and certified. This means that we engage the service of professionals in the completion of the writing. We also operate 24/7 ensuring that the company does not experience any backlog in terms of completion of computer science papers.
The 24/7 operations also ensure that we are capable of handling urgent papers. Sometimes a client may place computer science papers that are very urgent. In such scenarios, we ensure that the client finds a reliable service provider who will ensure that the urgent computer science papers are completed. The company remains open throughout the year regardless of the holiday in question. The timely delivery of completed computer science papers makes the company an ideal choice for many students. We are known to deliver completed papers on time. This is attributed to many factors. We, for instance, have a dedicated team of writers who work tirelessly to ensure there is no backlog of computer science papers. We also have a first-come-first served strategy in which writers work on computer science papers that student sent first. The earlier the client sends a writing request, the sooner he shall receive a completed paper.
Originality is also emphasized with all computer science papers written from scratch. We also ensure that we scan all completed paper through a plagiarism checker to determine authenticity.
Clients who require a plagiarism report can request for one from the customer service. The
customer care service is also available 24/7 to assist all students with their enquiries. Scanning of completed papers is guaranteeing that students receive papers with 0% level of plagiarism.
We also offer editing service at a reasonably low price. Try the computer science papers services today.
Cheap Computer Science Papers
Today the inevitable wind of change in technology has taken over since computers and progress are attached to each other. With the dawn of information and technology, which has produced computerization, computer science has taken adequate significance. As a subject of truth, a preponderance of people around the globe is receiving computer science education.
Scholars who are offering computer science courses are required to prepare or write computer science papers as the assignments assigned to them by their professors of instructors. In every University offering computer science courses, students are required to undertake coursework assignments after every one or two weeks. These assignments are mostly in the form of short computer projects that require detail writings. Furthermore, the assignments are of diversified categories such as computer science term papers, computer science essay, computer science dissertation essay, and computer science research paper among others. Developing computer science papers is not an easy task since it requires abundant time to complete writing the papers.
Preponderance part of students agonize with computer science papers since they always have limited time to complete their assignments, yet their supervisors demand completed assignments in the shortest time possible. Many students combine their courses with other small courses making their academic workload bulky and difficult in handling. As a result of multitasking, under limited time and external support many students end up performing poorly in their computer science papers assignments. Since computer science is an expansive field, which handles topics such as programming, and artificial intelligence a lot of effort is needed in terms of knowledge gathering. Nevertheless, due to the bulky syllabus students take in computer science papers it becomes practically impossible for them to handle their papers well.
The only savior for those kinds of students is to ask for assistance from computer science papers writing companies such as Computer science papers writing agency. Computer papers writing agency is a full-grown entrepreneurship entity aimed at helping students in writing computer science papers and all other academic papers. This agency has a long lasting legacy in preparing fully complete computer science papers credentials for students in all academic levels.
This legacy has been sustained by its persistence in writing quality and original computer science papers for more than three decades now. In addition, this company has endeavored to secure is clients who have witnessed its professionalism in preparing computer science papers.
On the different note, computer science papers agency has a team of writers who ensure thorough preparations of all academic document prepared by this company. As if not enough, these writers are also professional team of graduates from recognized Universities such as Harvard, Cambridge and Stanford. Additionally, these writers have postgraduate and undergraduate certified degrees for various courses offered in the universities. There should not be any reason for any student to dread requesting for their support since they are also alumni from different Universities. These writers have intensive knowledge on working out all academic papers since their many years of experience guarantees their efficiency in preparing all papers.
This agency has zero% tolerance policy on plagiarism cases since it has current software used in scanning all academic papers to ensure originality. On professionalism, the company ensures that all documents have grammar and spelling corrections of 95% and above scores. The company also provides a variety of styles of writing such as Harvard, Oxford MLA, APA and Chicago among others. Come one come all and witness a great deal of cheap computer science documents.
Professional computer science paper writers
Students pursuing computer science courses write computer science papers during and at the end of the semester. Students experience problems when writing computer science papers and this affects their grades. Some students do not have the skills and knowledge needed to write such assignments. Others have no time to complete the homework. This has compelled students to submit low quality computer science papers. As a result, students buy computer science papers from writing organizations. Many organizations around the globe offer help to students.
Most organizations helping students in their academic do not offer legitimate help, and this has affected student achievement. Students do not have the capability to differentiate genuine companies from those not genuine. Thus, they buy computer science papers from any company.
Students should consider various things when purchasing computer science paper including quality, deadline and plagiarism. Students should get assistance from companies that have the following attributes.
First, students should buy computer science papers from companies that have specialist writers.
Different companies hire different writers, and this determines the quality of services they offer to students. Some companies hire poor writers and others experienced and expert writers.
Therefore, students should be familiar with the writers before deciding to buy computer science papers. Students should get aid from specialist writers. The writers should have specialized in the computer science field. They can have knowledge in different areas of computer science.
This will ensure students get professional and satisfactory assignments. Many companies do not have the capability to employee specialist writers with adequate knowledge in computer science.
Instead, the companies employ writers with general degree and knowledge. The writers offer low quality services to students as they lack the skills and knowledge. The writers should have masters, doctorate and undergraduate qualifications. This will enable students to get pleasant work. The writers will also serve students from diverse academic levels. Some companies employ college writers with no knowledge and experience in writing masters, doctorate and undergraduate computer science papers.
Second, students should buy computer science papers from writers capable of providing original assignments. The writers should not obtain content from the internet and paste it as this influences student score. The writers should be able to use different sources and paraphrase the content of every source. The content not paraphrased should be put in quotes. Quotations preserve the originality of ideas and also prevent plagiarism. Hence, the writers should have experience in synthesizing content gotten from different sources into complete and original computer science papers. The writers should detect plagiarism before handing the home work to respective clients. This will eliminate any traces of plagiarism and boost student grades. The custom writing company should give originality and student score priority.
Third, students should buy computer science papers from writers capable of providing quality work. Quality comprises of correct grammar, coherency, no spelling errors and plagiarism. The writers should be conversant with the quality components to ensure each component is included.
The writers should ensure the assignments have no grammar and spelling mistakes. They should proofread the content to eliminate such mistakes. Editors should also check the assignments for errors before sending them to clients. Additionally, the writers should read computer science papers to ensure they have coherency. The flow of computer science papers affects student grades. The reader should be able to connect the ideas and read them clearly.
Online Chicago style writing services
Sometimes students normally find it hard to format their papers using the formatting style that the teacher has requested. One of this formatting style includes Chicago style. Teachers usually expect to receive papers that have been formatted properly according to what they have asked. Writing of Chicago style papers usually takes two forms. The first form includes writing of the papers using the bibliography and note system and the second include writing using the author date system. When writing Chicago style papers the nature of the style of the sources being used normally serve extremely well in determining the style that the student will prefer over the other style.
Writing Chicago style papers is usually easy; however, some students mostly find it hard when it comes to putting footnotes and end-notes. No matter the many years the student might have in writing Chicago style papers, they usually have doubt if they are doing what is right. In order to avoid the doubt, most students decide to seek form assistance from professionals who have experience in writing Chicago style papers. Chicago style writing company has experience writers who are professionals in writing Chicago style papers. These are writers who have qualities like no other in writing academic papers using Chicago style. In order to have remarkable class performance, students should buy Chicago style papers from this company.
Expert writers
Chicago style papers are usually written by writers who have received training and they are experienced in writing papers from any level of education. The writers ensure that the papers are written based on the standards of customer. Before they can start writing the papers, they have to make sure that it is assigned to that the writer who is an expert in that field. Chicago style papers writers possess the right skills in formatting Chicago style papers. The writers are specialized in numerous academic fields, which make it possible for them to serve the requirements and needs of all the students in different countries in the globe. The writers have gained unmatched experience because this is a company that has been operational for a while. Chicago style papers writers are aware of the different academic requirements by different learning institutions. Therefore, they have to ensure that the papers that they sell to the students have to be accepted by the lecturers.
High quality papers
All Chicago style papers have to be written according to the instructions that the writers have requested. This ensures that they meet the standard of the customer and that of the instructor. All Chicago style papers are normally written using proper grammar and have no language errors. The writers also check for plagiarism using the plagiarism software to check for any traces of plagiarized materials. This ensures that the papers are original. There is also a panel of editors who ensure that the proof read the papers so that to make sure that the writers clearly followed the customer’s instructions and the paper does not have language or grammar error.
Students who have the problem with writing Chicago style papers can contact with the writers in this company and buy Chicago style paper written following their instructions. The prices of this papers are affordable, and any student can manage the budget the also be able to, meet their daily needs.
Author is associated with Superior Papers which is a global Custom Essay Writing and Term Paper Writing Company. If you would like help in Research Papers and Term Paper Help you can visit Chicago Style Papers