When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?

Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.3:L-O (1910)

Towards effective research-paper recommender systems and user modeling based on mind maps

Magdeburg, Univ., Fak. für Informatik, Diss., 2015

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.8:suppl.P-Z (1940)

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.7:suppl.J-O (1933)

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.2:E-K (1904)

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.5:SO-Z (1915)

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.6:suppl.A - I (1922)

Catalogue of the books, manuscripts, maps and drawings in the British museum (Natural history) ....

v.4:P-SN (1913)

The Field Museum-Oxford University expedition to Kish, Mesopotamia, by Henry Field, Assistant Curator of Physical Anthropology. 14 plates in photogravure and 2 maps.

no.28(1929)

Bifurcations of homoclinic tangency in two-dimensional area-preserving and reversible maps

Report for the scientific sojourn at the Research Institute for Applied Mathematics and Cybernetics, Nizhny Novgorod, Russia, from July to September 2006. Within the project, bifurcations of orbit behavior in area-preserving and reversible maps with a homoclinic tangency were studied. Finitely smooth normal forms for such maps near saddle fixed points were constructed and it was shown that they coincide in the main order with the analytical Birkhoff-Moser normal form. Bifurcations of single-round periodic orbits for two-dimensional symplectic maps close to a map with a quadratic homoclinic tangency were studied. The existence of one- and two-parameter cascades of elliptic periodic orbits was proved.

Renormalization and α-limit set for expanding Lorenz maps

We establish a one-to-one correspondence between the renormalizations and proper totally invariant closed sets (i.e., α-limit sets) of expanding Lorenz map, which enable us to distinguish periodic and non-periodic renormalizations. We describe the minimal renormalization by constructing the minimal totally invariant closed set, so that we can define the renormalization operator. Using consecutive renormalizations, we obtain complete topological characteriza- tion of α-limit sets and nonwandering set decomposition. For piecewise linear Lorenz map with slopes ≥ 1, we show that each renormalization is periodic and every proper α-limit set is countable.

Structural analysis of Turtle mountain (Alberta) using digital elevation model: Toward a progressive failure

In 1903, the eastern slope of Turtle Mountain (Alberta) was affected by a 30 M m3-rockslide named Frank Slide that resulted in more than 70 casualties. Assuming that the main discontinuity sets, including bedding, control part of the slope morphology, the structural features of Turtle Mountain were investigated using a digital elevation model (DEM). Using new landscape analysis techniques, we have identified three main joint and fault sets. These results are in agreement with those sets identified through field observations. Landscape analysis techniques, using a DEM, confirm and refine the most recent geology model of the Frank Slide. The rockslide was initiated along bedding and a fault at the base of the slope and propagated up slope by a regressive process following a surface composed of pre-existing discontinuities. The DEM analysis also permits the identification of important geological structures along the 1903 slide scar. Based on the so called Sloping Local Base Level (SLBL) an estimation was made of the present unstable volumes in the main scar delimited by the cracks, and around the south area of the scar (South Peak). The SLBL is a method permitting a geometric interpretation of the failure surface based on a DEM. Finally we propose a failure mechanism permitting the progressive failure of the rock mass that considers gentle dipping wedges (30°). The prisms or wedges defined by two discontinuity sets permit the creation of a failure surface by progressive failure. Such structures are more commonly observed in recent rockslides. This method is efficient and is recommended as a preliminary analysis prior to field investigation.

Shifts in species richness, herbivore specialization, and plant resistance along elevation gradients.

Environmental gradients have been postulated to generate patterns of diversity and diet specialization, in which more stable environments, such as tropical regions, should promote higher diversity and specialization. Using field sampling and phylogenetic analyses of butterfly fauna over an entire alpine region, we show that butterfly specialization (measured as the mean phylogenetic distance between utilized host plants) decreases at higher elevations, alongside a decreasing gradient of plant diversity. Consistent with current hypotheses on the relationship between biodiversity and the strength of species interactions, we experimentally show that a higher level of generalization at high elevations is associated with lower levels of plant resistance: across 16 pairs of plant species, low-elevation plants were more resistant vis-à-vis their congeneric alpine relatives. Thus, the links between diversity, herbivore diet specialization, and plant resistance along an elevation gradient suggest a causal relationship analogous to that hypothesized along latitudinal gradients.