Efficacy and safety of thrombin-receptor antagonist (atopaxar and vorapaxar) in patients with acute coronary syndrome or coronary artery disease-a meta-analysis of randomized controlled trials

Background: Meta-analysis for the efficacy and safety data of thrombin-receptor antagonist (TRA) based on patients with acute coronary syndrome (ACS) or coronary artery disease (CAD) and indirect comparisons between TRAs were not available. Objectives: We intended to synthesize the primary end points based on different patient populations (ACS or CAD) as well as perform indirect comparison between two newly invented antiplatelet agents atopaxar and vorapaxar. Methods: A literature search was performed in MEDLINE, Embase, and Cochrane Library. Incidences of major adverse cardiovascular events (MACEs) and bleeding events according to thrombolysis in myocardial infarction were selected as primary outcomes, whereas adverse effects were considered as secondary outcomes. Corresponding results were synthesized using Revman 5.1 according to ACS or CAD cohorts. Results: Among the seven included randomized controlled trials, the efficacy end points in the TRA treatment group were favorable compared with placebo. Specifically, the odds ratio (OR) of MACEs was 0.80 (95% confidence interval [CI] 0.52-1.22) for patients with ACS and 0.74 (95% CI 0.53-1.05) for the cohort with CAD. The events of bleeding were unanimously superior in the placebo arm for both cohorts. The indirect comparison showed a superior trend in favor of atopaxar over vorapaxar in occurrences of MACEs (OR 0.93; 95% CI 0.38-1.32), myocardial infarction (OR 0.52; 95% CI 0.13-0.95), and cardiovascular death (OR 0.82; 95% CI 0.12-4.24) and caused less incidence of bleeding. Conclusions: Besides being more effective than placebo in improving the incidence of MACEs but with a higher risk of bleeding, TRAs may exert different effects in patients with ACS and CAD. Indirect comparisons also suggested that atopaxar might be better than vorapaxar in lowering the incidence of MACEs, myocardial infarction, and cardiovascular death and at the same time with lower risks of bleeding.

Metaphor as a methodological tool : identifying teachers’ social justice dispositions across diverse secondary school settings

This article investigates the social justice dispositions of teachers and principals in secondary schools as inferred from their metaphoric expressions. Drawing on a Bourdieuian account of disposition, our focus is the use of metaphor as a methodological tool to identify and reveal these otherwise latent forces within our data. Our analysis shows evidence of redistributive, recognitive and activist conceptions of social justice. We argue that these three social justice dispositions may be insufficient to meaningfully address persisting inequalities in the school system and that a capability-based social justice disposition – absent in our data – is needed. We conclude by highlighting that: social justice dispositions can change; a valid interpretation of metaphors requires ‘contextual stabilization’; and metaphors for social justice are differently constructed in different contexts, influenced by the different social, cultural and material conditions of schools.

Molecular and immunological analysis of hen's egg yolk allergens with a focus on YGP42 (Gal d 6)

Allergy to hen's (Gallus domesticus) egg white is one of the most common forms of food allergy. Allergy to hen's yolk also exists however, to a lesser extent when compared to egg white allergy. Two minor allergens from the hen's egg yolk known as α-livetin (Gal d 5) and YGP42 (Gal d 6) were discovered recently. In this study, we investigated whether sensitization to egg white is associated with reactivity to egg yolk as well. Sera obtained from 25 patients with allergy to egg white were tested for specific IgE binding for egg yolk proteins through western immunoblotting. 36% of patients were found with true IgE-sensitization against egg yolk proteins. It was found that most of the IgE reactive yolk proteins were fragments of major precursor proteins of hen; vitellogenin-1 (VTG-1), vitellogenin-2 (VTG-2) and apolipoprotein B (Apo B). The egg yolk allergen Gal d 6 is the C-terminal part of VTG-1 and was found to be allergenic in significant percentage of egg white allergy patients. These results highlight the significance of Gal d 6 as an important allergen of egg yolk. Therefore, the secondary aim of this study involved developing a recombinant version of YGP42 in an Escherichia coli expression system. Recombinant Gal d 6 (rGal d6) was expressed as a fusion peptide with a 6 × His tag and purified using metal chelating resin. The inhibition ELISA results showed that rYGP42 was IgE reactive and was able to inhibit IgE binding to crude egg yolk (CEY) by up to 30%. Traditionally, it was thought that allergy to egg yolk occurred independently from sensitization to egg white. This study underlies the importance of concomitant sensitization to egg yolk proteins in patients allergic to egg white. Evidence reported in this study strongly suggests that egg yolk has potentially undiscovered allergens and therefore warrants further investigation. Furthermore, IgE reactive Gal d 6 presented in this study has the potential to be used in diagnosis and immunotherapy to treat egg allergy.

Towards providing quality secondary education : training and retaining quality teachers in Malaysia

With the gradual attainment of universal primary education, governments are shifting their attention to secondary education. Responding to the increasing demand for secondary education presents serious challenges and major opportunities in the quest for Education For All (EFA), and countries are striving to find policy responses to address these emergingissues. It is clear that teachers play a fundamental role in addressing challenges faced by secondary education. Ensuring the presence of competent secondary teachers in urban and rural areas is a major concern in both quantitative and qualitative terms. Existing studies on teacherrelated issues and analyses of teacher policy in developing countries tend to focus on primary education, probably due to the special emphasis given to primary education in the EFA process. In order to fill the gaps and respond to the increasing demand for quality secondaryeducation, the Education Policy and Reform (EPR) unit of the UNESCO Asia and Pacific Regional Bureau for Education (UNESCO Bangkok) coordinated a regional research study on secondary teacher policy and management in 2007 and 2008. This series includes a regional synthesis paper on comparative assessment of issues and policies affecting secondary teachers in East and South-East Asia, and five case studies: Lao People’s Democratic Republic, Malaysia, People’s Republic of China, Republic of Korea, and Thailand. Three major areas related to secondary teachers are discussed in the case studies: quantitative analysis of demand and supply of secondary teachers, quality of secondaryteachers, and compensation. Each study is presented as a summary of the original study, and gives an overview of the status and issues of the country’s secondary education system. Researchers and officials from several universities and education ministries collaborated in thepreparation of the study. UNESCO Bangkok would like to sincerely thank all those individuals and institutions who provided their expertise and professional experience to this research. The findings presented in the series are intended to help governments gain insight into policyfor secondary teachers across a diverse range of countries, and draw lessons for possible policy responses to challenges and problems in the expansion of secondary education.

Evaluation of deterministic and complex analytical hierarchy process methods for agricultural land suitability analysis in a changing climate

Land suitability analysis is employed to evaluate the appropriateness of land for a particular purpose whilst integrating both qualitative and quantitative inputs, which can be continuous in nature. However, in agricultural modelling there is often a disregard of this contiguous aspect. Therefore, some parametric procedures for suitability analysis compartmentalise units into defined membership classes. This imposition of crisp boundaries neglects the continuous formations found throughout nature and overlooks differences and inherent uncertainties found in the modelling. This research will compare two approaches to suitability analysis over three differing methods. The primary approach will use an Analytical Hierarchy Process (AHP), while the other approach will use a Fuzzy AHP over two methods; Fitted Fuzzy AHP and Nested Fuzzy AHP. Secondary to this, each method will be assessed into how it behaves in a climate change scenario to understand and highlight the role of uncertainties in model conceptualisation and structure. Outputs and comparisons between each method, in relation to area, proportion of membership classes and spatial representation, showed that fuzzy modelling techniques detailed a more robust and continuous output. In particular the Nested Fuzzy AHP was concluded to be more pertinent, as it incorporated complex modelling techniques, as well as the initial AHP framework. Through this comparison and assessment of model behaviour, an evaluation of each methods predictive capacity and relevance for decision-making purposes in agricultural applications is gained.

Experimental and finite element analysis of machinability of AL-6XN super austenitic stainless steel

This paper presents a finite element cutting modelbased on physical microstructure to investigate the thermomechanicalbehaviour of AL-6XN Super AusteniticStainless Steel in the primary shear zone. Frozen chip rootsamples were created under dry turning operation to observethe plasticity behaviour occurring in the shear zones to comparewith the model for analysis. Chip samples were generatedunder cutting velocities at 65 and 94 m/min, feed rate at0.2 mm/rev and depth of cut at 1 mm. Temperature on thecutting zone was recorded by infrared thermal camera.Secondary and backscatter electron detectors were used toinvestigate the deformed microstructure and to calculate theplastic strain. Experimental results showed the formation ofmicrocracks (build-up edge triggers) at the chip root stagnationzone of both samples. The austenite phase patterns wereevident against the cutting tool tip in the stagnation zone of thechip root fabricated at 65 m/min. The movement of thesepatterns caused the formation of the slip lines within thegrains. The backscatter diffraction maps showed the formationof special grain boundaries within the slip lines, workhardeninglayer and in the chip region. Strain measurementsin the microstructures of the chip roots fabricated at 94 and65 m/min showed high values of 6.5 and 5.7 (mm/mm) respectively.The finite element model was used to measure thestress, strain, temperature and chip morphology. Numericalresults were compared to the outcomes of the experimentalwork to validate the finite element model. The model validatingprocess showed good agreement between theexperimental and numerical results, and the error values werecalculated. For a 94- and 65-m/min cutting speeds, 7.5 and5.2% were the errors in the strain, 3 and 2.5% were the error inthe temperature and 4.7 and 6.8% were the error in the shearplane angles.