Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

Impact of the Interdecadal Pacific Oscillation on Tropical Cyclone Activity in the North Atlantic and Eastern North Pacific.

Tropical cyclones (TCs) are among the most devastating weather systems affecting the United States and Central America (USCA). Here we show that the Interdecadal Pacific Oscillation (IPO) strongly modulates TC activity over the North Atlantic (NA) and eastern North Pacific (eNP). During positive IPO phases, less (more) TCs were observed over NA (eNP), likely due to the presence of stronger (weaker) vertical wind shear and the resulting changes in genesis potential. Furthermore, TCs over NA tend to keep their tracks more eastward and recurve at lower latitudes during positive IPO phases. Such variations are largely determined by changes in steering flow instead of changes in genesis locations. Over the eNP, smaller track variations are observed at different IPO phases with stable, westward movements of TCs prevailing. These findings have substantial implications for understanding decadal to inter-decadal fluctuations in the risk of TC landfalls along USCA coasts.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

© Cambridge University Press 2014.Background Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized. Method We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs. Results NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system. Conclusions Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

Witnessing Crisis in Contemporary and Golden Age Spain

In this volume, experts on the Spanish Golden Age from the United Kingdom, Ireland, and the United States offer analyses of contemporary works that have been influenced by the classics from the sixteenth and seventeenth centuries.

The Great War on the small screen: Representing the First World War in contemporary Britain

In Britain since the 1960s television has been the most influential medium of popular culture. Television is also the site where the Western Front of popular culture clashes with the Western Front of history. This book examines the ways in which those involved in the production of historical documentaries for this most influential media have struggled to communicate the stories of the First World War to British audiences. Documents in the BBC Written Archives Centre at Caversham, Berkshire, the Imperial War Museum, and the Liddell Hart Centre for Military Archives all inform the analysis. Interviews and correspondence with television producers, scriptwriters and production crew, as well as two First World War veterans who appeared in several recent documentaries provide new insights for the reader. Emma Hanna takes the reader behind the scenes of the making of the most influential documentaries from the landmark epic series The Great War (BBC, 1964) up to more recent controversial productions such as The Trench (BBC, 2002) and Not Forgotten: The Men Who Wouldn't Fight (BBC, 2008). By examining the production, broadcast and reception of a number of British television documentaries this book examines the difficult relationship between the war's history and its popular memory.

Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

To tremble the zero: art in the age of algorithmic reproduction

'To Tremble the Zero: Art in the Age of Algorithmic Reproduction' is a philosophic, political and sensuous journey playing with (and against) Benjamin's 'Art in the Age of Mechanical Reproduction'. In an age inundated by the 'post-': postmodernity, posthuman, post art, postsexual, post-feminist, post-society, post-nation, etc, 'To Tremble the Zero' sets out to re/present the nature of what it means to do or make 'art', as well as what it means to be or have 'human/ity' when the ground is nothing other than the fractal, and algorithmically infinite, combinations of zero and one. The work will address also the unfortunate way in which modern forms of metaphysics continue to creep 'unsuspectingly' into our understanding of contemporary media/electronic arts, despite (or perhaps even because of) the attempts by Latour, Badiou, or Agamben especially when addressing the zero/one as if a contradictory 'binary' rather than as a kind of 'slice' or (to use Deleuze and Guattari) an immanent plane of immanence. This work argues that by retrieving Benjamin, Einstein, Gödel, and Haraway, a rather different story of art can be told.

Hide and seek with rebels: tracing contemporary queer art in cracks and rips

This Article does not have an abstract.

A review of some common Indo-Malayan and western Pacific species of Chthamalus barnacles (Crustacea: Cirripedia)

The type specimens of the common tropical intertidal barnacles Chthamalus malayensis and C. moro, were re-investigated and compared with other specimens of Chthamalus from the Indian Ocean, Indo-Malaya, northern Australia, Vietnam, China and the western Pacific, using ‘arthropodal’ as well as shell characters. Chthamalus malayensis occurs widely in Indo-Malayan and tropical Australian waters. It ranges westwards in the Indian Ocean to East Africa and northwards in the Pacific to Vietnam, China and the Ryukyu Islands. Chthamalus malayensis has the arthropodal characters attributed to it by Pope (1965); conical spines on cirrus 1 and serrate setae with basal guards on cirrus 2. Chthamalus moro is currently fully validated only for the Philippines, Indonesia, Taiwan, the Xisha (Paracel) Islands, the Ryukyu Islands, the Mariana Islands, the Caroline Islands, Fiji and Samoa. It is a small species of the ‘challengeri’ subgroup, lacking conical spines on cirrus 1 and bearing pectinate setae without basal guards on cirrus 2. It may be a ‘relict’ insular species. Chthamalus challengeri also lacks conical spines on cirrus 1 and has pectinate setae without basal guards on cirrus 2. Records of C. challengeri south of Japan are probably erroneous. However, there is an undescribed species of the ‘challengeri’ subgroup in the Indian Ocean, Indo-Malaya, Vietnam and southern China and yet more may occur in the western Pacific. The subgroups ‘malayensis’ and ‘challengeri’ require genetic investigation. Some comments are included on the arthropodal characters and geographical distributions of Chthamalus antennatus, C. dalli and C. stellatus