Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Multimodal image fusion of anatomical structures for diagnosis, therapy planning and assistance

This paper provides an overview of work done in recent years by our research group to fuse multimodal images of the trunk of patients with Adolescent Idiopathic Scoliosis (AIS) treated at Sainte-Justine University Hospital Center (CHU). We first describe our surface acquisition system and introduce a set of clinical measurements (indices) based on the trunk's external shape, to quantify its degree of asymmetry. We then describe our 3D reconstruction system of the spine and rib cage from biplanar radiographs and present our methodology for multimodal fusion of MRI, X-ray and external surface images of the trunk We finally present a physical model of the human trunk including bone and soft tissue for the simulation of the surgical outcome on the external trunk shape in AIS.

Re-engineering and Re-defining University Libraries in the context of modern Information and Communication Technologies: a study with special reference to the University Libraries in Kerala

Information and communication technologies are the tools that underpin the emerging “Knowledge Society”. Exchange of information or knowledge between people and through networks of people has always taken place. But the ICT has radically changed the magnitude of this exchange, and thus factors such as timeliness of information and information dissemination patterns have become more important than ever.Since information and knowledge are so vital for the all round human development, libraries and institutions that manage these resources are indeed invaluable. So, the Library and Information Centres have a key role in the acquisition, processing, preservation and dissemination of information and knowledge. ln the modern context, library is providing service based on different types of documents such as manuscripts, printed, digital, etc. At the same time, acquisition, access, process, service etc. of these resources have become complicated now than ever before. The lCT made instrumental to extend libraries beyond the physical walls of a building and providing assistance in navigating and analyzing tremendous amounts of knowledge with a variety of digital tools. Thus, modern libraries are increasingly being re-defined as places to get unrestricted access to information in many formats and from many sources.The research was conducted in the university libraries in Kerala State, India. lt was identified that even though the information resources are flooding world over and several technologies have emerged to manage the situation for providing effective services to its clientele, most of the university libraries in Kerala were unable to exploit these technologies at maximum level. Though the libraries have automated many of their functions, wide gap prevails between the possible services and provided services. There are many good examples world over in the application of lCTs in libraries for the maximization of services and many such libraries have adopted the principles of reengineering and re-defining as a management strategy. Hence this study was targeted to look into how effectively adopted the modern lCTs in our libraries for maximizing the efficiency of operations and services and whether the principles of re-engineering and- redefining can be applied towards this.Data‘ was collected from library users, viz; student as well as faculty users; library ,professionals and university librarians, using structured questionnaires. This has been .supplemented by-observation of working of the libraries, discussions and interviews with the different types of users and staff, review of literature, etc. Personal observation of the organization set up, management practices, functions, facilities, resources, utilization of information resources and facilities by the users, etc. of the university libraries in Kerala have been made. Statistical techniques like percentage, mean, weighted mean, standard deviation, correlation, trend analysis, etc. have been used to analyse data.All the libraries could exploit only a very few possibilities of modern lCTs and hence they could not achieve effective Universal Bibliographic Control and desired efficiency and effectiveness in services. Because of this, the users as well as professionals are dissatisfied. Functional effectiveness in acquisition, access and process of information resources in various formats, development and maintenance of OPAC and WebOPAC, digital document delivery to remote users, Web based clearing of library counter services and resources, development of full-text databases, digital libraries and institutional repositories, consortia based operations for e-journals and databases, user education and information literacy, professional development with stress on lCTs, network administration and website maintenance, marketing of information, etc. are major areas need special attention to improve the situation. Finance, knowledge level on ICTs among library staff, professional dynamism and leadership, vision and support of the administrators and policy makers, prevailing educational set up and social environment in the state, etc. are some of the major hurdles in reaping the maximum possibilities of lCTs by the university libraries in Kerala. The principles of Business Process Re-engineering are found suitable to effectively apply to re-structure and redefine the operations and service system of the libraries. Most of the conventional departments or divisions prevailing in the university libraries were functioning as watertight compartments and their existing management system was more rigid to adopt the principles of change management. Hence, a thorough re-structuring of the divisions was indicated. Consortia based activities and pooling and sharing of information resources was advocated to meet the varied needs of the users in the main campuses and off campuses of the universities, affiliated colleges and remote stations. A uniform staff policy similar to that prevailing in CSIR, DRDO, ISRO, etc. has been proposed by the study not only in the university libraries in kerala but for the entire country.Restructuring of Lis education,integrated and Planned development of school,college,research and public library systems,etc.were also justified for reaping maximum benefits of the modern ICTs.

Estudio de caso. “el papel de los refugiados en la implementación de la política de libre circulación de la cedeao: visto desde el flujo de Liberia a Ghana”

Este estudio de caso tiene como objetivo determinar las implicaciones del flujo de población refugiada en la implementación de la política de libre circulación de la CEDEAO; tomando como referente el flujo desde Liberia hacia Ghana generado por la Guerra Civil. Esta investigación defiende que las implicaciones pueden estar relacionadas a las dinámicas que se asocian al movimiento de personas, las cuales pueden ser negativas o positivas, razón por la cual los Estados pueden reaccionar endureciendo las políticas migratorias, la obtención de permisos laborales y de residencia, y el cierre de fronteras o la expulsión de refugiados; con el fin de evitar consecuencias a nivel político, económico o en materia de seguridad. Para comprobar lo anterior se va a realizará un análisis de texto, sobre posiciones nacionales y políticas comunitarias, así como una revisión de estudios y estadísticas relacionados con el tema.

A Longitudinal Three-Center Study of Dental Arch Relationship in Patients With Bilateral Cleft Lip and Palate

Objective: To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP). Design: Retrospective longitudinal intercenter outcome study. Patients: Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers. Setting: Three cleft palate centers with different treatment protocols. Main Outcome Measures: Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models. Results: There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p = .027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p = .041) and 12.9% (p = .009), respectively. Conclusions: Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.

Differences in muscle activity during hand dexterity tasks between women with arthritis and a healthy reference group

Background. Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group. Methods. Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC. Results. The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and—for the EDC—also when writing with a pen and using a key (p < 0.02). The exercise “rolling dough with flat hands” required the lowest %MVIC and may be less effective in improving muscle strength. Conclusions. Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.

Uma investigação empírico-exploratória acerca da causalidade dos indicadores operacionais de call center com a satisfação dos clientes

Year after year the call center industry comes presenting high growth, either in Brazil or the world, using increasing contingent of people and receiving large amount of financial resources. Supporting all this industry, exists a theoretical reference that privileges the search of the improvement of diverse operational performance indicators. This study, empirically examines the relationship between caller satisfaction and diverse operational performance indicators currently used for call center management in Brazil. For in such a way, a group of telecommunications segment call centers will be used searching to determine which indicators are really more significantly correlated with the customer satisfaction. Of this form, it is aimed at to add new evidences and explanations to existing literature, in way that companies of call center industry can give a more adequate service to their customer, opposite to solely focus its efforts in the improvement of a great set of performance pointers that, effectively, can not become related with the customer satisfaction.

Avaliação de efetividade do centro de reabilitação de adultos - CRA/NATAL/RN

Public services with an emphasis on rehabilitation treatment of disabled people, as established law, have aimed to ensure quality and equity assistance in a rehabilitation way to the segment highlighted. As for people with physical disabilities, the Unified Health System (hereby SUS) through the directive GM/ MS No. 818 of 2001, requires the creation of hierarchical and regionalized services networks at different levels of complexity to ensure appropriate assistance. This study whose title is Evaluation of effectiveness of the Adult Rehabilitation Center in Rn: elements for a discussion aimed to evaluate the effectiveness of rehabilitation services that institution, reference in the State of Rio Grande do Norte, has directed its patients, more specifically those who have had a stroke and therefore are disabled ones. From the standpoint of methodological conduction, it was prioritized a qualitative and empirical theoretical research which was carried out from the following courses: literature references with authors who are the themes pertaining to rehabilitation, inclusion, public policy evaluation, health policy and disability; documentary research through Regulation of Technical Procedures, files, records, informative booklets that were of great importance to the knowledge of the institution, as well as its functioning and dynamics of field research that was materialized with the managers, rehabilitation staff and Center s users, through the application of semi-structured interviews as a tool for data collection. The information obtained was analyzed from the critical analysis of discourse. As a result, it was identified some technical, administrative and financial difficulties which have obliterated the effectiveness of services provided, such as: lack of many professionals to meet existing demand, poor quality of equipment and the physical structure, limits on autonomy management as a result of dependence along with the SESAP/RN; besides the excessive bureaucratization in the administrative processes compromising Center s problem-solving needs. However, in the narratives of managers, rehabilitation staff of patients, despite the difficulties, treatment made by Centre has effectiveness to the extent that has been contributing even in a limited way to improve their quality of life

Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

O psicólogo na proteção social especial: atuação junto às vítimas de violação de direitos no CREAS

The objective of this research was to investigate psychologist‟s practices at the Reference Specialized Center of Social Assistance (CREAS), special social care unit of medium complexity of the Unique System of Social Assistance (SUAS). With the creation of CREAS occurred the reorganization of specialized services and programs which were scattered within the socialassitantial network and began to be part of this center, creating a mosaic of actions directed to people with their rights violated. At the same time, there was a significant arrival of psychologists to the field of Social Assistance and their questioning facing specialized social demands and the (un)definitions of SUAS‟ policy concerning to special social protection. Was aimed in this research to investigate how psychologist‟s practices are developed at CREAS using semi-structured interviews and following the practices developed by three psychologists at a CREAS in the state of Rio Grande do Norte (RN), indicated by the Ministry of Social Development and Fight against Hunger (MDS) as one of the national references in 2008. It was highlighted a complex work field, which is delineated between the user´s rights perspective and the maintenance of historical difficulties concerning to the Social Assistance. In which the professional is requested to act toward the fight against rights violation, but does not find a field where is possible inter-sector and articulated work, in addition of being exposed to the precariousness of work and the weakness of employment ties, associated to the lack of formation to work in the area. Accordingly, there is still a range of challenges to psychologists in the building of a profession which confront risk situations and break off rights violation.

Application of the concepts of agro-tourism, agricultural diversification and food and nutrition for the development of Caribbean communities with reference to standards and priority setting

Introduction There is a renewed call for a new approach to development with emphasis on community empowerment or participation, with the belief that more sustainable activities will be undertaken in those communities. Much of that call, however, is coming not from within the communities, but primarily from advocates of change who may have little to do with those communities. What then will the new approach bring apart from a change in who are the decision-makers? And how do we ensure that the change that is called for will, in fact, bring added benefits to the communities themselves? To be sure, there are some successful stories of a community approach to problem solving. However, there are also many more stories of project failures. Serious analytical work, therefore, needs to be done to determine the factors that promote a successful community-based approach; when this approach should be used; and the methodology that should be employed. In an attempt to determine these factors, a brief analysis will be made of some of the governing structures in the subregion and their possible impact on the proposed new approach. Some of the earlier efforts at stakeholder and community approach to projects will also be examined as well as the new development strategy that is prompting the call for this new paradigm. The new paradigm focuses to a large extent on decision-making and community empowerment. With few exceptions, it is short on the promotion of tangible activities that are based on the resource inventory of the communities. This is not surprising, since, as noted before, the advocates of community empowerment may have very little connection with the communities and, in most cases, are unfamiliar with the resource base. Hence, a theoretical case is made, suggesting more style than substance. Another obvious shortcoming of this new paradigm is its continued over- dependence on assistance from the outside to build communities. Externally funded projects, seminars and meetings outside of the communities and foreign technical assistance continue to dominate these projects. While, of course, all communities have basic common needs such as water, health, education and electricity, there is sufficient diversity within communities to allow for tailoring of activities and programmes such that their differences become assets. It is in that context, that agro-tourism activities, standards, agricultural diversification, food and nutrition and priority setting have been chosen as aspects and activities for promoting community development, drawing on the various strengths of communities, rural or urban.

Os desafios dos/as profissionais da Psicologia diante do imperativo da quebra de sigilo nos casos de violência sexual intrafamiliar vivenciada por crianças

Pós-graduação em Psicologia - FCLAS

Serological Diagnosis of Paracoccidioidomycosis: High Rate of Inter-laboratorial Variability among Medical Mycology Reference Centers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pimavanserin, a selective serotonin (5-HT)2A-inverse agonist, enhances the efficacy and safety of risperidone, 2 mg/day, but does not enhance efficacy of haloperidol, 2 mg/day: Comparison with reference dose risperidone, 6 mg/day

Most atypical antipsychotic drugs (APDs), e. g. risperidone (RIS), produce more extensive blockade of brain serotonin (5-HT)(2A) than dopamine (DA) D-2 receptors. This distinguishes them from typical APDs, e.g. haloperidol (HAL). Our objective was to test the hypothesis that augmentation of low doses of RIS or HAL (2 mg/day) with pimavanserin (PIM), a selective 5-HT2A inverse agonist, to enhance 5-HT2A receptor blockade, can achieve efficacy comparable to RIS, 6 mg/day, but with lesser side effects. In a multi-center, randomized, double-blind, 6 week trial, 423 patients with chronic schizophrenia experiencing a recent exacerbation of psychotic symptoms were randomized to RIS2mg + placebo (RIS2PBO), RIS2mg + PIM20mg (RIS2PIM), RIS6mg + PBO (RIS6PBO), HAL2mg + PBO (HAL2PBO), or HAL2mg + PIM20mg (HAL2PIM). Improvement in psychopathology was measured by the PANSS and CGI-S. The reduction in PANSS Total Score with RIS2PIM at endpoint was significantly greater than RIS2PBO: -23.0 vs. -16.3 (p = 0.007), and not significantly different from the RIS6PBO group: -23.2 points. The percentage of patients with >= 20% improvement at day 15 in the RIS2PIM group was 62.3%, significantly greater than the RIS6PBO (42.1%; p = 0.01) and the RIS2PBO groups (37.7%; p = 0.002). Weight gain and hyperprolactinemia were greater in the RIS6PBO group than the RIS2PIM group but there was no difference in extrapyramidal side effects (EPS). HAL2PBO and HAL2PIM were not significantly different from each other in efficacy but HAL2PIM had less EPS at end point. Both HAL groups and RIS6PBO showed equal improvement in psychopathology at endpoint, indicating HAL 2 mg/day is effective to treat an acute exacerbation in chronic schizophrenia patients. In conclusion, a sub-effective RIS dose combined with PIM to enhance 5-HT2A receptor blockade provided faster onset of action, and at endpoint, equal efficacy and better safety, compared to standard dose RIS. These results support the conclusion that 5-HT2A receptor blockade is a key component of the action of some atypical APDs and can reduce EPS due to a typical APD. (C) 2012 Elsevier B.V. All rights reserved.

Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract Background Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population. The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil. Methods A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview. Results After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%). Conclusion We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil. While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.