Perioperative antiplatelet therapy.

Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.

Acute flare induced by the calcific tendonitis of the rotator cuff: inhibition of IL-1 a potential therapeutic target?

Introduction: Calcific tendonitis of rotator cuff is observed on plainradiographs in 10% of adults, but remains asymptomatic in half thesecases. Sometimes, these calcifications induce acute flares withmassive inflammation similar to gout or CPPD crisis. Analgesics/anti-inflammatory medications are usually not sufficient to controlssymptoms in these situations. Local steroid infiltration with or withoutremoval of the calcific deposition with a needle aspiration may beuseful. A new approach could be IL-1 inhibitors. Indeed, basic calciumphosphate crystals are capable of stimulating the release of activeIL-1β in vitro. These crystals trigger IL-1β release, in an analogousmanner to MSU crystals in acute gout, suggesting that IL-1β blockademay be clinically useful.Case presentation: This report describes a 70-year old woman withacute rest pain of the right shoulder since 48 hours. On examination,we found massive limitations of active and passive movements. Thepatient evaluated, on the visual scale, her symptoms at 10/10 the nightand 5/10 the day. The radiography and showed a rounded, 8 mmcalcification in the subscapularis tendon. The ultrasound aspectrevealed a heterogeneous calcification partially non solid, surroundedby massive inflammation on Doppler. C-reactive protein anderythrocyte sedimentation rate were high (74 mg/ml, 54 mm/hour).The patient received subcutaneous injections of anakinra: 100 mgdaily for 3 days (D1-D3). We evaluated the patient in our consult at dayD1, D2, D3, D7, D16 and by phone at D70.This treatment rapidly relieved the inflammatory symptoms (within afew hours with no relapse). The mobility of the shoulder, the biologicsparameters improved and the size of the calcification as well thedegree of inflammation regressed on ultrasound after 3 days.Conclusion: This is the first report of a woman with an acute flareinduced by calcific tendonitis who received anakinra. IL-1 inhibitionmay be a therapeutic target in calcific tendonitis. To analyse thisresponse more precisely and elaborate definitive conclusions, aprospective pilot study is on-going in our ambulatory institute.

Outpatient treatment of pulmonary embolism.

Pulmonary embolism (PE) is traditionally treated in hospital. Growing evidence from non randomized prospective studies suggests that a substantial proportion of patients with non-massive PE might be safely treated in the outpatient setting using low molecular weight heparins. Based on this evidence, professional societies started to recommend outpatient care for selected patients with non-massive PE. Despite these recommendations, outpatient treatment of non-massive PE appears to be uncommon in clinical practice. The major barriers to PE outpatient care are, firstly, the uncertainty as how to identify low risk patients with PE who are candidates for outpatient care and secondly the lack of high quality evidence from randomized trials demonstrating the safety of PE outpatient care compared to traditional inpatient management. Also, although clinical prognostic models, echocardiography and cardiac biomarkers accurately identify low risk patients with PE in prospective studies, the benefit of risk stratification strategies based on these instruments should be demonstrated in prospective management studies and clinical trials before they can be implemented as decision aids to guide PE outpatient treatment. Before high quality evidence documenting the safety of an outpatient treatment approach is published, outpatient management of non-massive PE cannot be generally recommended.

Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement.

During transapical transcatheter aortic valve replacement (TA-TAVR), the apical closure remains a challenge for the surgeon, having the risk for ventricular tear and massive bleeding. Apical closure devices are already under clinical evaluation, but only a few can lead to a full percutaneous TA-TAVR. We describe the successful use of a 9-mm myocardial occluder (ventricular septal defect occluder) that was used to seal the apex after a standard TA-TAVR (using the Sapien XT 23-mm transcatheter valve and the Ascendra + delivery system). The placement of the nonmodified myocardial occluder was performed through the Ascendra + delivery system, with a very small amount of blood loss and an acceptable sealing of the apical tear. This approach is feasible and represents a further step toward true-percutaneous transapical heart valve procedures. Modified apical occluders are under evaluation in animal models.

Microfacies analysis of the lower paleocene beda formation in Western Concession 59 and Block 59F, Sirte Basin, Libya /

The rock sequence of the Tertiary Beda Formation of S. W. concession 59 and 59F block in Sirte Basin of Libya has been subdivided into twelve platformal carbonate microfacies. These microfacies are dominated by muddy carbonates, such as skeletal mudstones, wackestones, and packstones with dolomites and anhydrite. Rock textures, faunal assemblages and sedimentary structures suggest shallow, clear, warm waters and low to moderate energy conditions within the depositional shelf environment. The Beda Formation represents a shallowing-upward sequence typical of lagoonal and tidal flat environments marked at the top by sabkha and brackish-water sediments. Microfossils include benthonic foraminifera, such as miliolids, Nummulites, - oerculina and other smaller benthonics, in addition to dasycladacean algae, ostracods, molluscs, echinoderms, bryozoans and charophytes. Fecal pellets and pelloids, along with the biotic allochems, contributed greatly to the composition of the various microfacies. Dolomite, where present, is finely crystalline and an early replacement product. Anhydrite occurs as nodular, chickenwire and massive textures indicating supratidal sabkha deposition. Compaction, micr it i zat ion , dolomit izat ion , recrystallization, cementation, and dissolution resulted in alteration and obliteration of primary sedimentary structures of the Beda Formation microfacies. The study area is located in the Gerad Trough which developed as a NE-SW trending extensional graben. The Gerad trough was characterized by deep-shallow water conditions throughout the deposition of the Beda Formation sediments. The study area is marked by several horsts and grabens; as a result of extent ional tectonism. The area was tectonically active throughout the Tertiary period. Primary porosity is intergranular and intragranular, and secondary processes are characterized by dissolution, intercrystalline, fracture and fenestral features. Diagenesis, through solution leaching and dolomitization, contributed greatly to porosity development. Reservoir traps of the Beda Formation are characterized by normal fault blocks and the general reservoir characteristics/properties appear to be facies controlled.

Geology of the Rankin Inlet area, Northwest Territories /

The Rankin Inlet area, on the west shore of Hudson Bay in the Northwest Territories, is in the Churchill Structural Province. Metamorphosed volcanic and sedimentary rocks, previously mapped as Archean and part of the Kaminak Group, underlie most of the area. The Rankin Inlet Group consists of greywacke, with minor conglomeratic greywacke, quartzite and dolomite, overlain by massive and pillowed basaltic flows. Gabbro sills intrude the sediments near the base of the volcanic sequence and three serpentinite sills outcrop at the base of the volcanic sequence. The sediments are in fault-contact with quartz monzonite to the south and were intruded by granitic rocks to the northwest. Two periods of folding were defined by the mapping. The first generation folds are recumbent isoclinal folds, with northwest-trending and northeast-dipping axial planes, formed through gravitational sliding. The second generation folds are symmetrically disposed about the axis of the granitic intrusion and have east-southeast trending and nearly vertical axial planes. Whole-rock analysis of 64 rock samples indicates that metasomatic alteration accompanied the intrusion of both the granitic rocks and the serpentinite. The volcanic rocks, gabbro and serpentinite were derived from a magma of oceanic tholeiitic affinities. The stratigraphic sequence and chemistry of the volcanic rocks of the Rankin Inlet Group indicate that this assemblage is correlative with the Hurwitz Group rather than the Kaminak Group and is therefore Aphebian in age.

A reconnaissance study of the metamorphic petrology and volcanic geochemistry of a portion of the Island Lake greenstone belt, Manitoba /

The Island Lake greenstone belt is one of the major Archean supracrustal exposures in the northwestern part of the Superior Province of the Canadian Shield. This belt is subdivided into two units: 1) a lower sequence characterised by pillowed to massive, locally pyroclastic, basalt to andesite with a thin central zone of felsic derivatives, all of which are interbedded with and overlain by thick sequences of turbidite facies rock; 2) the upper unit which consists of thick stratified conglomerate overlain by thickly bedded arkose and feldspathic greywacke. Reconnaissance sampling traverses were completed across both the strike of the belt and along its margins with adjacent granitoids. Most of the belt is within the greenschist metamorphic f acies with amphibolite facies occurring in certain areas near t he margins. A post-tectonic, low pressure thermal event may be responsible for the development of a unit of cordierite schi s t which stretches southeastwards from the east end of Cochrane Bay. Volcanism is cyclical in nature changing from tholeiitic to calc-alkaline. There is a general progression in the character of the lavas from mafic t o felsic with stratigraphic height. Chemica l d a ta sugges t that h i gh level fractionation of a mantle- derived ' dry' magma i s t he s ource of the thole i iti c lavas. Contamination of this magma with 'we t' sia l and subsequent fractionation may be r esponsi b l e for the calcalkaline phases .Observations of stratigraphic relationships (in particular the contact between the supracrustals and the granitoids) coupled with the metamorphic and chemical studies, allow the construction of a preliminary model for the evolution of the Island Lake greenstone belt. The following sequential development is suggested: 1) a platform stage characterised by the subaqueous effusion of mafic to intermediate lavas of alternating tholeiitic and calc-alkaline affinities; 2) an edifice stage marked by the eruption of felsic calc-alkaline rocks; 3) an erosional stage characterised by the deposit~on of thick sequences of turbidite facies rocks; 4) the impingement of granitic masses into the margins of the greenstone belt, which was probably related to a downward warping of the supracrustal pilei 5) the erosion of sialic massifs surrounding and within the greenstone belt and of early supracrustal piles, to give the clastic upper unit.

A geochemical and petrological study of volcanic rocks in the Beardmore-Geraldton Archaean Greenstone Belt, Northwestern Ontario

Three repetitive sequences of northward youngIng, east striking, linear, volcano-sedimentary units are found in the late Archaean BeardmoreGeraldton greenstone belt, situated within the Wabigoon subprovince of the Superior Province of northwestern Ontario. The volcanic components are characterised by basaltic flows that are pillowed at the top and underlain by variably deformed massive flows which may In part be intrusive. Petrographic examination of the volcanic units indicates regional metamorphism up to greenschist facies (T=3250 C - 4500 C, P=2kbars) overprinted by a lower amphibolite facies thermal event (T=5750 C, P=2kbars) confined to the south-eastern portion of the belt. Chemical element results suggest olivine, plagioclase and pyroxene are the main fractionating mineral phases. Mobility studies on the varIOUS chemical elements indicate that K, Ca, Na and Sr are relatively mobile, while P, Zr, Ti, Fet (total iron = Fe203) and Mg are relatively immobile. Discriminant diagrams employing immobile element suggests that the majority of the samples are of oceanic affinity with a minor proportion displaying an island arc affinity. Such a transitional tectonic setting IS also refle.cted in REE data where two groups of volcanic samples are recognised. Oceanic tholeiites are LREE depleted with [La/Sm] N = 0.65 and a relatively flat HREE profile with [Sm/Yb] N = 1.2. Island arc type basalts (calc-alkaline) are LREE enriched, with a [La/Sm] N = 1.6, and a relatively higher fractionated HREE profile with [Sm/Yb] N = 1.9. Petrogenetic modelling performed on oceanIC tholeiites suggests derivation from a depleted spinel lherzolite source which undergoes 20% partial melting. Island arc type basalts can be derived by 10% partial melting of a hypothetical amphibolitised oceanic tholeiite source. The majority of the volcanic rocks in the Beardmore-Geraldton Belt are interpreted to represent fragments of oceanic crust trapped at a consuming plate margin. Subsequent post accretionary intrusion of gabbroic rocks (sensu lato) with calc-alkaline affinity is considered to result in the apparent hybrid tectonic setting recognized for the BGB.

Sedimentology and micromorphology of drumlin sediments at Chimney Bluffs State Park, New York, United States of America

The drumlin sediments at Chimney Bluffs, New York appear to represent a block-inmatrix style glacial melange. This melange comprises sand stringers, lenses and intraclasts juxtaposed in an apparently massive diamicton. Thin section examination of these glacigenic deposits has revealed microstructures indicative of autokinetic subglacial defonnation which are consistent with a deformable bed origin for the diamicton. These features include banding and. necking of matrix grains, oriented plasma fabrics and the formation of pressure shadows at the long axis ends of elongate clasts. Preservation of primary stratification within the sand intraclasts appears to suggest that these features were pre-existing up-ice deposits that were frozen, entrained, then deposited as part of a defonning till layer beneath an advancing ice sheet. Multi-directional micro-shearing within the sand blocks is thought to reflect the frozen nature of the sand units in such a high strain environment. It is also contended that dewatering of the sediment pile leading to the eventual immobilisation of the defonning till layer was responsible for opening sub-horizontal fissures within the diamicton. These features were subsequently infilled with mass flow poorly sorted sands and silts which were subjected to ductile defonnation during the waning stages of an actively deforming till layer. Microstructures indicative of the dewatering processes in the sand units include patches of fine-grained particles within a coarser-grained matrix and the presence of concentrated zones of translocated clays. However, these units were probably confined within an impermeable diamicton casing that prevented massive pore water influxes from the deforming till layer~ Hence, these microstructures probably reflect localised dewatering of the sand intraclasts. A layered subglacial shear zone model is proposed for the various features exhibited by the drumlin sediments. The complexity of these structures is explained in terms of ii superposing deformation styles in response to changing pore water pressures. Constructional glaciotectonics, as implied by the occurrence of sub-horizontal fissuring, is suggested as the mechanism for the stacking of the sand intraclast units within the diamicton. The usefulness of micromorphology in complimenting the traditional sedimentology of glacigenic deposits is emphasised by the current study. An otherwise massive diamicton was shown to contain microstructures indicative of the very high strain rates expected in a complexly deforming till layer. . It is quite obvious from this investigation that the classification of diamictons needs to be re-examined for evidence of microstructures that could lead to the re-interpretation of diamicton forming processes. RESUME Le pacquet de sediments drumlinaire de Chimney Bluffs, New York, represent un "bloc-en-matrice" genre de melange glaciale. Des structures microscopique comprennent l'evidence pour la defonnation intrinseque attribuee a l'origine lit non resistant du drumlin. PreselVation des structures primaires au coeur des blocs arenaces suggere que ceux sont des depots preexistant qui furent geles, entraines et par la suite sedimentes au milieu d'une couche de debris sous-glaciaires en voie de deformation. Des failles microscopiques a l'interieur des blocs arenaces appuient aussi l'idee d'un bloc cohesif (c'est-a-dire gele) au centre d'un till non resistant. Des implications significatives s'emergent de cette etude pour les conditions sous-glaciaire et les processus de la formation des drumlin.

Temporal variation in the coral reefs of the east coast of the inner gulf of Thailand

A series of permanent line transects established on fourteen reefs on the eastern seaboard of the Gulf of Thailand were monitored through a three-year period (1995- 1998) using a video transect method. Hierarchical cluster analysis shows three distinctive reef community types dominated by 1) Porites, 2) Acropora and 3) zoantharians. The reefs are developed under naturally turbid conditions and relatively low salinity due to the proximity of four major river outlets located in the uppermost area of the gulf. The number of Acroporid species on the reefs is positively correlated with distance from the major flver outlets. Eighty-seven species of scleractinian coral were found on the transects. Over the three-year period, the comparison of 1995-97-98 matched stations using Repeated Measures ANOV A reveals no significant time-dependent change in percent area cover of reef components except for an overall significant reduction in the faviid coral component. In the 1997-98 matched station comparison, statistical tests reveal significant increases in both Acropora and Porites components that translated into an overall increase in total living coral cover. These findings indicate that the overall environmental conditions have been favorable for coral growth. Outcompetition of massive corals by faster growing corals on several reefs also indicates conditions favorable for reef expansion. Growth of newlyformed Porites colonies over primary rock substrate and dead coral skeleton was presumably responsible for its rapid increase. Although these reefs are in an area of rapid industrialization and population growth, resultant anthropogenic effects have not yet stopped active coral accretion.

Geochemistry and petrogenesis of the McElroy and Larder Lake assemblages, Abitibi Greenstone Belt, Northeastern Ontario

The McElroy and Larder Lake assemblages, located in the southern Abitibi Greenstone Belt are two late Archean metavolcanic sequences having markedly contrasting physical characteristics arid are separated from one another by a regional fault. An assemblage is an informal term which describes stratified volcanic and/or sedimentary rock units built during a specific time period in a similar depositional or volcanic setting and are commonly bounded by faults, unconformities or intrusions. The petrology and petrogenesis of these assemblages have been investigated to determine if a genetic link exists between the two adjacent assemblages. The McElroy assemblage is homoclinal sequence of evolved massive and pillowed fl.ows, which except for the basal unit represents a progressively fractionated volcanic pile. From the base to the top of the assemblage the lithologies include Fe-tholeiitic, dendritic flows; komatiite basaltic, ultramafic flows; Mg-tholeiitic, leucogabbro; Mg-tholeiitic, massive flows and Fe-tholeiitic, pillowed flows. Massive flows range from coarse grained to aphanitic and are commonly plagioclase glomerophyric. The Larder Lake assemblage consists of komatiitic, Mg-rich and Fe-rich tholeiitic basalts, structurally disrupted by folds and faults. Tholeiitic rocks in the Larder Lake assemblage range from aphanitic to coarse grained massive and pillowed flows. Komatiitic flows contain both spinifex and massive textures. Geochemical variability within both assemblages is attributed to different petrogenetic histories. The lithologies of the McElroy assemblage were derived by partial melting of a primitive mantle source followed by various degrees of crystal fractionation. Partial melting of a primitive mantle source generated the ultramafic flows and possibly other flows in the assemblage. Fractionation of ultramafic flows may have also produced the more evolved McElroy lithologies. The highly evolved, basal, dendritic flow may represent the upper unit 3 of a missing volcanic pile in which continued magmatism generated the remaining McElroy lithologies. Alternatively, the dendritic flows may represent a primary lava derived from a low degree (10-15%) partial melt of a primitive mantle source which was followed by continued partial melting to generate the ultramafic flows. The Larder Lake lithologies were derived by partial melting of a komatiitic source followed by gabbroic fractionation. The tectonic environment for both assemblages is interpreted to be an oceanic arc setting. The McElroy assemblage lavas were generated in a mature back arc setting whereas the Larder Lake lithologies were produced during the early stages of komatiitc crust subduction. This setting is consistent with previous models involving plate tectonic processes for the generation of other metavolcanic assemblages in the Abitibi Greenstone Belt.

'What ever happened to breakdancing?' : transnational b-boy/b-girl networks, underground video magazines and imagined affinities

In 1997, Paul Gilroy was able to write: "I have been asking myself, whatever happened to breakdancing" (21), a form of vernacular dance associated with urban youth that emerged in the 1970s. However, in the last decade, breakdancing has experienced a massive renaissance in movies (You Got Served), commercials ("Gotta Have My Pops!") and documentaries (the acclaimed Freshest Kids). In this thesis, 1 explore the historical development of global b-boy/bgirl culture through a qualitative study involving dancers and their modes of communication. Widespread circulation of breakdancing images peaked in the mid-1980s, and subsequently b-boy/b-girl culture largely disappeared from the mediated landscape. The dance did not reemerge into the mainstream of North American popular culture until the late 1990s. 1 argue that the development of major transnational networks between b-boys and b-girls during the 1990s was a key factor in the return of 'b-boying/b-girling' (known formerly as breakdancing). Street dancers toured, traveled and competed internationally throughout this decade. They also began to create 'underground' video documentaries and travel video 'magazines.' These video artefacts circulated extensively around the globe through alternative distribution channels (including the backpacks of traveling dancers). 1 argue that underground video artefacts helped to produce 'imagined affinities' between dancers in various nations. Imagined affinities are identifications expressed by a cultural producer who shares an embodied activity with other practitioners through either mediated texts or travels through new places. These 'imagined affinities' helped to sustain b-boy/b-girl culture by generating visual/audio representations of popularity for the dance movement across geographical regions.

Warren Hartman fonds, 1970, 1972-1996, 1998, n.d.

Warren Hartman was born in 1942 in Toronto, Ontario. He received a B.A. in Fine Arts and Drama from Brock University in 1981 and a Masters of Arts in Humanities at the State University of New York at Buffalo in 1987. In the 1950s he did considerable work as a child-actor both in theatre and television. From 1953 to 1961 he was in the New Play Society under the direction of Dora Mavor Moore. His last two years there were spent as a scholarship student. From 1963 to 1966 he did an apprenticeship with Suzanne Mess, Head of Costume Design at The Canadian Opera Company in Toronto. In 1976 Warren attended a Master Class in Scenography at the Banff School of Fine Arts with Josef Svoboda. In the spring of 1970 Warren was a guest designer at Brock University and from 1970 to 1972 he remained at Brock as resident designer and special lecturer. During this time he was also an instructor and costume designer at Sheridan College in Oakville. It was in 1972 that he became the designer-in-residence at Brock University. From 1984 he held the position of Associate Professor at The Department of Fine Arts at Brock University until the fall of 1996. Some of the highlights of Warren’s career also include: stage managager with the Street Hat Players in Port Carling, Ontario, 1960-1961; a freelance designer for over 100 shows; costume coordinator(production manager) for the Canadian Opera Company, 1964 -1970; resident costume designer for The Canadian Opera Company, 1965- 1970; founder and artistic director of Dei Gelosi Campagnia, St.Catharines, Ontario, 1970-1973; freelance director of some thirty-five shows; co-producer for Quebec City Summer Stock Company, Quebec City, Quebec, 1975; a consultant with Alberta Culture for the Provincial Government of Alberta, 1986-1987 and associate artistic director at Theatre Network, Edmonton, Alberta, 1986-1987. Warren Hartman was the recipient of the Jean Chalmers Award for contributions to Canadian Theatre for persons 25 years of age or under, in 1965. He was a founding member of Associated Designers of Canada and was affiliated with Canadian Actors Equity. Warren Hartman died on Feb. 11, 1998 several days after suffering a massive stroke. A memorial service was held at Brock University in May of 1998 and a bursary fund was established in his name.

Micromorphology of Last Glacial Maximum Grounding line sediments around the Antarctic Peninsula

Sediments recovered from seven Last Glacial Maximum grounding lines sites, around the Antarctic Peninsula, were analyzed using micromorphology. This is the first evidence that grounding line sediments from around the Antarctic Peninsula have complex deformational histories and subglacial origins. It was determined that grounding zone wedge contain multiple units, or diamicton layers, with homogenized boundaries. The multiple diamicton units / layers are due to the accretionary formation of a grounding line wedge. All the sediments were deposited via deformation, and continual reincorporation, homogenization of lower diamicton layers by upper diamicton layers produced what macroscopically appeared to be a single massive diamicton unit. The morainal ridge that was sampled, alternatively, is composed of a single unit, or diamicton layer, that was subglacial in origin and believed to have been pushed out to form a ridge that was subsequently deformed via glacial push.

Improving Short DNA Sequence Alignment with Parallel Computing

Variations in different types of genomes have been found to be responsible for a large degree of physical diversity such as appearance and susceptibility to disease. Identification of genomic variations is difficult and can be facilitated through computational analysis of DNA sequences. Newly available technologies are able to sequence billions of DNA base pairs relatively quickly. These sequences can be used to identify variations within their specific genome but must be mapped to a reference sequence first. In order to align these sequences to a reference sequence, we require mapping algorithms that make use of approximate string matching and string indexing methods. To date, few mapping algorithms have been tailored to handle the massive amounts of output generated by newly available sequencing technologies. In otrder to handle this large amount of data, we modified the popular mapping software BWA to run in parallel using OpenMPI. Parallel BWA matches the efficiency of multithreaded BWA functions while providing efficient parallelism for BWA functions that do not currently support multithreading. Parallel BWA shows significant wall time speedup in comparison to multithreaded BWA on high-performance computing clusters, and will thus facilitate the analysis of genome sequencing data.