Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Background-A recent landmark report has demonstrated that plasma B-type natriuretic peptide (BNP) measured in acute coronary syndromes independently predicts mortality, heart failure, and new myocardial infarction. After acute cardiac injury, left ventricular ejection fraction (LVEF) is also of prognostic significance and plays a major role in determining the therapeutic response. Methods and Results-The present report is the first from a substantial (nϭ666) cohort of patients with acute myocardial infarction to test the prognostic utility of concurrent measurements of BNP, amino-terminal BNP (N-BNP), norepinephrine, and radionuclide LVEF. The B-type peptides and LVEF were predictors of death, heart failure, and new myocardial infarction (all PϽ0.001) independent of patient age, gender, previous myocardial infarction, antecedent hypertension or diabetes, previous heart failure, plasma norepinephrine, creatinine, cholesterol, drug therapy, and coronary revascularization procedures. The combination of N-BNP (or BNP) with LVEF substantially improved risk stratification beyond that provided by either alone. Elevated N-BNP (or BNP) predicted new myocardial infarction only in patients with LVEF Ͻ40%. LVEF Ͻ40% coupled to N-BNP over the group median conferred substantial 3-year risks of death, heart failure, and new myocardial infarction of 37%, 18%, and 26%, respectively. N-BNP and BNP were equivalent prognostic markers for these clinical outcomes.

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The nature of manual manipulation of objects is discussed. It is argued that a functional distinction should be made between palmar grips which immobilise an object in the hand, and digital patterns which permit manipulation. Such a distinction is separate from any anatomically defined power and precision configurations. Manipulative hand movements may be grouped into three classes, based on differences between sequenced patterns of movement and synergies, the latter being further subdivided into simple and reciprocal patterns. Within each of the three classes, a number of individual movement patterns are described. These differ mainly in the number of digits involved and the way in which the thumb is employed. The classification is concerned with movements of the digits directed at manipulating an object within the hand. It is not concerned with movements of the hand as a whole, using the wrist or more proximal joints, while holding an immobilised object.

In several experiments, observers were given glimpses of 4-word arrays. Accuracy of word localization was tested after each array. Some words, called familiar, appeared many times across the series of arrays; others, called novel, appeared only once. The ratio of novel to familiar words in an array ranged from 0:4 to 4:0. When familiar and novel words were not intermixed (in 0:4 and 4:0 arrays), localization accuracy was higher for familiar words. However, when they were intermixed, especially in 1:3 arrays, accuracy tended to be higher for the novel words. This novel popout effect was the outcome of the suppressed localizability of the familiar words (relative to the 0:4 baseline) and the enhanced localizability of the novel words (relative to the 4:0 baseline). Novel popout may reflect an automatic orientation of attention away from more fluently unfolding regions of the perceptual field (familiar objects) and toward less fluently unfolding regions (novel objects).