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

Macro- and Microevolution of Languages: Exploring Linguistic Divergence with Approaches from Evolutionary Biology

There are more than 7000 languages in the world, and many of these have emerged through linguistic divergence. While questions related to the drivers of linguistic diversity have been studied before, including studies with quantitative methods, there is no consensus as to which factors drive linguistic divergence, and how. In the thesis, I have studied linguistic divergence with a multidisciplinary approach, applying the framework and quantitative methods of evolutionary biology to language data. With quantitative methods, large datasets may be analyzed objectively, while approaches from evolutionary biology make it possible to revisit old questions (related to, for example, the shape of the phylogeny) with new methods, and adopt novel perspectives to pose novel questions. My chief focus was on the effects exerted on the speakers of a language by environmental and cultural factors. My approach was thus an ecological one, in the sense that I was interested in how the local environment affects humans and whether this human-environment connection plays a possible role in the divergence process. I studied this question in relation to the Uralic language family and to the dialects of Finnish, thus covering two different levels of divergence. However, as the Uralic languages have not previously been studied using quantitative phylogenetic methods, nor have population genetic methods been previously applied to any dialect data, I first evaluated the applicability of these biological methods to language data. I found the biological methodology to be applicable to language data, as my results were rather similar to traditional views as to both the shape of the Uralic phylogeny and the division of Finnish dialects. I also found environmental conditions, or changes in them, to be plausible inducers of linguistic divergence: whether in the first steps in the divergence process, i.e. dialect divergence, or on a large scale with the entire language family. My findings concerning Finnish dialects led me to conclude that the functional connection between linguistic divergence and environmental conditions may arise through human cultural adaptation to varying environmental conditions. This is also one possible explanation on the scale of the Uralic language family as a whole. The results of the thesis bring insights on several different issues in both a local and a global context. First, they shed light on the emergence of the Finnish dialects. If the approach used in the thesis is applied to the dialects of other languages, broader generalizations may be drawn as to the inducers of linguistic divergence. This again brings us closer to understanding the global patterns of linguistic diversity. Secondly, the quantitative phylogeny of the Uralic languages, with estimated times of language divergences, yields another hypothesis as to the shape and age of the language family tree. In addition, the Uralic languages can now be added to the growing list of language families studied with quantitative methods. This will allow broader inferences as to global patterns of language evolution, and more language families can be included in constructing the tree of the world’s languages. Studying history through language, however, is only one way to illuminate the human past. Therefore, thirdly, the findings of the thesis, when combined with studies of other language families, and those for example in genetics and archaeology, bring us again closer to an understanding of human history.

Rights jurisprudence and the charter : evaluating the changing structure of Canadian federalism /

Abstract . Rights jiirisprudence in Canada dates back as far as Confederation in 1867. Between this date and 1982, the organizing principle of Confederation - federalism - has kept this jurisprudence solely within the supremacy of Parliament, subject to its confines and division of powers. After 1982, however, a new constitutional organizing principle was introduced, when Prime Minister Pierre Trudeau introduced the patriation initiative, touted as the "people's package". Individual rights and freedoms were now guaranteed by the Constitution. Citizens of Canada now had a direct link to the Constitution via the Charter and there were now two significantly different organizing principles within the constitutional order widch created an unstable coexistence. This instability has led to a clash between judicially enforced Charter rights and federalism. The Charter has since had both a nationalizing and centralizing effect on Canadian federalism. This thesis explores the relationship between rights and federalism in Canada fix)m Confederation to present day by comparing the jurisprudence of pre and post Charter Canada. An analysis of Supreme Court's (and its predecessor's, the JCPC) decisions shows the profound effect the Charter has had on Canadian federalism. The result has been an undermining of federalism in Canada, with Parliamentary Supremacy replaced by Constitutional supremacy, and ultimately. Judicial Supremacy. Moreover, rights discourse has largely replaced federalism discourse. Canadians have become very attached to their Charter, and are unwilling to allow any changes to the constitution that may affect their rights as political elites discovered the hard way after the collapse of the Meech and Charlottetown Accords. If federalism is to remain a relevant and viable organizing principle in the Constitution, then governments, especially at the provincial level, must find new and iimovative ways to assert their importance within the federation.

Test of Hockman and Oldham's job characteristics model in a post-secondary educational setting

One hundred and seventy-two subj ects participated in this quantitative, correlational survey which tested Hackman and Oldham's Job Characteristics Model in an educational setting. Subjects were Teaching Masters, Chairmen and Deans from an Ontario community college. The data were collected via mailed questionnaire, on all variables of the model. Several reliable, valid instruments were used to test the variables. Data analysis through Pearson correlation and stepwise multiple regression analyses revealed that core job characteristics predicted certain critical psychological states and that these critical psychological states, in turn were able to predict various personal and work outcomes but not absenteeism. The context variable, Satisfaction with Co-workers, was the only consistent moderating variable between core characteristics and critical psychological states; however, individual employee differences did moderate the relationship between critical psychological states and all of the personal and work outcomes except Internal Work Motivation. Two other moderator variables, Satisfaction with Context and Growth Need Strength, demonstrated an ability to predict the outcome General Job Satisfaction. The research suggests that this model may be used for job design and redesign purposes within the community college setting.

"Welcome to my life" : the experiences of single mothers who are the recipients of multiple state provided benefits

Abstract This research takes the lens of social reproduction as a starting point for an examination of the effects of recent social welfare reforms on the lives o.fsingle mothers. As the cumulative effects o.f diminishing state provided benefits take hold, tensions are heightened as single mothers internalize the insecurity of earning an income in 11 capitalist labour market, while trying to carry out all that is involved in social reproduction with inadequate means of survival. Through interviewing single mothers who are the recipients of mUltiple state provided benefits (social assistance, student loans, subsidized housing and subsidized childcare), this thesis illuminates the cOl1linued regulation of women in an effort to assure that social reproduction is occurring at the lowest cost possible. State provided benefits are set lip in such a way that it is near impossible for single mothers to make ends meet without entering the labour force or entering into co-residential relationships. This push towards the labour force and/or marriage via punitive welfare policies illuminates the devaluation of the labour that is done at home. Through interviewing 5 single mothers, I will demonstrate the extensive labour that goes into maintaining their households. In addition .J case managers are interviewed. The employees of social assistance, subsidized hOllsing, subsidized childcare and student loans, have much agency in deeming who is worthy of receiving benefits. The employees of these agencies have the ability to make these women's lives easier or more complicated by how the workers interpret the policy regulations. Social policies are of paramount importance in the quest for women's equality and thus have consequences for how women's daily lives are organized. The rules and regulations that govern the individual policies are complex and bureaucratic and have implications for the ways in which women must organize their lives in order to survive. The shifts in social policy have been guided by neo-liberal assumptions with a focus on individual responsibility and a market-modeled welfare state. The caring work that is involved in raising children to be productive in a capitalist society is ignored or devalued in current policies. The emphasis in each polic.:v is on getting women who receive benefits into the paid work force, with little facilitation or investment into the caring work these women do on a daily basis that in turn supports capitalism. Policies, such as social assistance, subsidized housing, subsidized childcare and student loans, are set up in such a way that ignores the reality of women's day-to-day lives and devalues the necessary work done at home. It takes an abundance of labour and strategizing for women to seek out necessary means of survival, labour that is amplified when a woman is dealing with mUltiple slate provided benefits.

The role of intrapartum intravenous therapy and method of delivery on newborn weight loss : challenging the 7% rule

It is common practice to initiate supplemental feeding in newborns if body weight decreases by 7-10% in the first few days after birth (7-10% rule). Standard hospital procedure is to initiate intravenous therapy once a woman is admitted to give birth. However, little is known about the relationship between intrapartum intravenous therapy and the amount of weight loss in the newborn. The present research was undertaken in order to determine what factors contribute to weight loss in a newborn, and to examine the relationship between the practice of intravenous intrapartum therapy and the extent of weight loss post-birth. Using a cross-sectional design with a systematic random sample of 100 mother-baby dyads, we examined properties of delivery that have the potential to impact weight loss in the newborn, including method of delivery, parity, duration of labour, volume of intravenous therapy, feeding method, and birth attendant. This study indicated that the volume of intravenous therapy and method of delivery are significant predictors of weight loss in the newborn (R2=15.5, p<0.01). ROC curve analysis identified an intravenous volume cut-point of 1225 ml that would elicit a high measure of sensitivity (91.3%), and demonstrated significant Kappa agreement (p<0.01) with excess newborn weight loss. It was concluded that infusion of intravenous therapy and natural birth delivery are discriminant factors that influence excess weight loss in newborn infants. Acknowledgement of these factors should be considered in clinical practice.

Interior of Founders' Hall, Chapman College, Orange, California

Founders' Hall [now Roosevelt Hall], Chapman College, Orange, California. Life trustee James Roosevelt’s name graces this historical building, which was originally named Founders’ Hall, until its rededication in 1994. This building completed in 1928 (2 floors, 12,280 sq.ft.) is listed in the National Registry for Historical Buildings and houses the Center for Academic Success, Department of Languages, Division of Social Sciences and the Writing Center. Originally constructed to serve as the Art & Cafeteria Building for Orange Union High School, it was acquired by Chapman in 1954.

Interior of Founders' Hall, Chapman College, Orange, California

Desk and waiting area in Founders' Hall [now Roosevelt Hall], Chapman College, Orange, California. Life trustee James Roosevelt’s name graces this historical building, which was originally named Founders’ Hall, until its rededication in 1994. This building completed in 1928 (2 floors, 12,280 sq.ft.) is listed in the National Registry for Historical Buildings and houses the Center for Academic Success, Department of Languages, Division of Social Sciences and the Writing Center. Originally constructed to serve as the Art & Cafeteria Building for Orange Union High School, it was acquired by Chapman in 1954.

Interior of Founders' Hall, Chapman College, Orange, California

Inside Founders' Hall [now Roosevelt Hall], Chapman College, Orange, California. Life trustee James Roosevelt’s name graces this historical building, which was originally named Founders’ Hall, until its rededication in 1994. This building completed in 1928 (2 floors, 12,280 sq.ft.) is listed in the National Registry for Historical Buildings and houses the Center for Academic Success, Department of Languages, Division of Social Sciences and the Writing Center. Originally constructed to serve as the Art & Cafeteria Building for Orange Union High School, it was acquired by Chapman in 1954.

Interior of Founders' Hall, Chapman College, Orange, California

Inside Founders' Hall [now Roosevelt Hall], Chapman College, Orange, California. Life trustee James Roosevelt’s name graces this historical building, which was originally named Founders’ Hall, until its rededication in 1994. This building completed in 1928 (2 floors, 12,280 sq.ft.) is listed in the National Registry for Historical Buildings and houses the Center for Academic Success, Department of Languages, Division of Social Sciences and the Writing Center. Originally constructed to serve as the Art & Cafeteria Building for Orange Union High School, it was acquired by Chapman in 1954.

Interior of Founders' Hall, Chapman College, Orange, California

Lounge area inside Founders' Hall [now Roosevelt Hall], Chapman College, Orange, California. Life trustee James Roosevelt’s name graces this historical building, which was originally named Founders’ Hall, until its rededication in 1994. This building completed in 1928 (2 floors, 12,280 sq.ft.) is listed in the National Registry for Historical Buildings and houses the Center for Academic Success, Department of Languages, Division of Social Sciences and the Writing Center. Originally constructed to serve as the Art & Cafeteria Building for Orange Union High School, it was acquired by Chapman in 1954.

Welland Canal Survey of Lands Nathan Pawling 1826; includes map and text.

Survey map and description of Nathan Pawling's land created by The Welland Canal Company. Included is a written description of the land along with a drawing of the land. Noteable features include; the dock, pier and tow path. The original bed of 12 mile creek is also noted on the map. Surveyor notes are seen in pencil on the map. The map notes the division of land between Pawling and Robert Brown's land. Click on 'detail' to see Map.

Welland Canal Survey of Lands Jacob Bowman 1826

Survey map and description of Jacob Bowman's land created by The Welland Canal Company. Included is a written description of the land along with a drawing of the land. Noteable features include; spring, Queenston Road, division of lots, Reservoir. Surveyor notes are seen in pencil on the map.

St. Catharines and District Labour Council fonds, 1957-1986

The St. Catharines and District Labour Council was founded in May 1957 by unionized workers from St. Catharines, Thorold, Merritton, Port Dalhousie and Grimsby. They sought to improve the social and economic welfare of workers; promote the organization of workers into unions for their mutual benefit, regardless of race, creed, colour, or national origin; encourage the sale of union-made goods and services; promote worker education; provide workers with a voice in politics; and safeguard the democratic nature of the labour movement. The Council, affiliated with both the Canadian Labour Congress and the Ontario Federation of Labour, was instrumental in assisting local workers with their labour disputes, including Canadian Pulp and Paper workers at Abitibi Provincial Paper in Thorold [1975-76], and Gallaher Paper [1999], workers at the St. Catharines Eaton’s store [1985], as well as smaller disputes such as that between the part-time secretarial staff and the Welland County Roman Catholic Separate School Board [1972] and workers of the Skyway Lumber Company [1972]. The Council also assisted the community at large by offering a Community Counseling Service [1971-1976] to help citizens with issues concerning various government agencies, social services and Acts, such as the Vacation Pay Act, Landlord and Tenant Act, Employment Standards Act, unemployment insurance claims and workman’s compensation claims. Other projects that the Council organized included an annual Education Institute [1958-1965] and the annual publication of Labour Review, a summary of the Council’s past year. The Labour Council continued to operate until 2010, when several local Labour Councils merged to form the Niagara Regional Labour Council.

Souvenir of Niagara Camp

Camp Niagara, in Niagara-on-the-Lake, Ontario, was used as summer training grounds for the Second Division of the Canadian Expeditionary Force at the start of World War I in 1914. In 1917, the Camp was used to train a group of expatriate Poles and Polish Americans who were recruited to serve in the war. Over 22, 000 volunteers of the Polish diaspora from across Canada and the United States trained at Camp Niagara, known to them as Camp Kosciuszko.