Drug-drug interaction studies of cardiovascular drugs involving P-glycoprotein, an efflux transporter, on the pharmacokinetics of edoxaban, an oral factor Xa inhibitor.

BACKGROUND: Edoxaban, an oral direct factor Xa inhibitor, is in development for thromboprophylaxis, including prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). P-glycoprotein (P-gp), an efflux transporter, modulates absorption and excretion of xenobiotics. Edoxaban is a P-gp substrate, and several cardiovascular (CV) drugs have the potential to inhibit P-gp and increase drug exposure. OBJECTIVE: To assess the potential pharmacokinetic interactions of edoxaban and 6 cardiovascular drugs used in the management of AF and known P-gp substrates/inhibitors. METHODS: Drug-drug interaction studies with edoxaban and CV drugs with known P-gp substrate/inhibitor potential were conducted in healthy subjects. In 4 crossover, 2-period, 2-treatment studies, subjects received edoxaban 60 mg alone and coadministered with quinidine 300 mg (n = 42), verapamil 240 mg (n = 34), atorvastatin 80 mg (n = 32), or dronedarone 400 mg (n = 34). Additionally, edoxaban 60 mg alone and coadministered with amiodarone 400 mg (n = 30) or digoxin 0.25 mg (n = 48) was evaluated in a single-sequence study and 2-cohort study, respectively. RESULTS: Edoxaban exposure measured as area under the curve increased for concomitant administration of edoxaban with quinidine (76.7 %), verapamil (52.7 %), amiodarone (39.8 %), and dronedarone (84.5 %), and exposure measured as 24-h concentrations for quinidine (11.8 %), verapamil (29.1 %), and dronedarone (157.6 %) also increased. Administration of edoxaban with amiodarone decreased the 24-h concentration for edoxaban by 25.7 %. Concomitant administration with digoxin or atorvastatin had minimal effects on edoxaban exposure. CONCLUSION: Coadministration of the P-gp inhibitors quinidine, verapamil, and dronedarone increased edoxaban exposure. Modest/minimal effects were observed for amiodarone, atorvastatin, and digoxin.

Long-distance quantum communication just around the corner?

info:eu-repo/semantics/published

Doxifluridine and leucovorin: an oral treatment combination in advanced colorectal cancer

Purpose: This study was designed to test the activity and feasibility of an all-oral regimen of levo-leucovorin and doxifluridine (dFUR) in the treatment of advanced colorectal cancer and to establish whether the pharmacokinetics of dFUR and fluorouracil (FU) are affected by demographic and/or biologic parameters. Materials and Methods: One hundred eight patients with histologically proven colorectal cancer received orally administered levo-leucovorin 25 mg followed 2 hours later by dFUR 1,200 mg/m2 on days 1 to 5, with the cycle being repeated every 10 days. Results: Among 62 previously untreated patients, two complete responses (CRs) and 18 partial responses (PRs) were observed (overall response rate, 32%; 95% confidence interval, 21% to 45%). The median response duration was 4 months (range, 2 to 13) and the median survival time, 14 months. Among 46 pretreated patients, there were three CRs and three PRs (response rate, 13%; 95% confidence interval, 5% to 26%). In this group of patients, the median response duration was 4 months (range, 1 to 12) and the median survival time, 12 months. No toxic deaths were observed. The only World Health Organization (WHO) grade 3 to 4 side effect was diarrhea (32 patients). Conclusion: This regimen is active in previously untreated colorectal cancer patients and combines good compliance with safety. Limited but definite efficacy was also detected in the patients previously treated with FU, which suggests incomplete cross- resistance between the two drugs. The pharmacokinetic results suggest that the conversion rate of dFUR to FU increases between days 1 and 5, but that FU levels remain low in comparison to those measured after classical FU therapy. Under the experimental conditions used in this study, the interpatient variability of pharmacokinetic parameters remains largely unexplained by the tested variables.

Symmetrical freedom quilts: the ethnomathematics of ways of communication, liberation, and art

Symmetrical Freedom Quilts may be considered as links between mathematics, history, ethnomathematics, and the art of quilting. A quilt theme is a pedagogical way to integrate mathematics, art, and history in an interdisciplinary approach. This article combines an ethnomathematical-historical perspective by elaborating a history project related to the Underground Railroad. This work will allow teachers to develop classroom projects that help students to better understand geometry, especially concepts of symmetry and transformations. One of the objectives of this project is to stimulate student’s creativity and interest, because quilts may be considered as cultural and mathematical expressions of student’s daily life.

Multilevel mesh partitioning for heterogeneous communication networks

Multilevel algorithms are a successful class of optimisation techniques which address the mesh partitioning problem for distributing unstructured meshes onto parallel computers. They usually combine a graph contraction algorithm together with a local optimisation method which refines the partition at each graph level. To date these algorithms have been used almost exclusively to minimise the cut edge weight in the graph with the aim of minimising the parallel communication overhead, but recently there has been a perceived need to take into account the communications network of the parallel machine. For example the increasing use of SMP clusters (systems of multiprocessor compute nodes with very fast intra-node communications but relatively slow inter-node networks) suggest the use of hierarchical network models. Indeed this requirement is exacerbated in the early experiments with meta-computers (multiple supercomputers combined together, in extreme cases over inter-continental networks). In this paper therefore, we modify a multilevel algorithm in order to minimise a cost function based on a model of the communications network. Several network models and variants of the algorithm are tested and we establish that it is possible to successfully guide the optimisation to reflect the chosen architecture.

Does the medium dictate the message? Cultivating communication in an asynchronous environment

Virtual learning environments (VLEs) are often perceived by education establishments as an opportunity to widen access without traditional overheads. An integral part of most VLEs is asynchronous computer conferencing and on-line moderators must help students migrate quickly to the new virtual environment to minimize learning disruption. This paper focuses on 21 new on-line moderators and reports their changing perceptions re their role and concerns, from their first appointment through to the end of the delivery of their first on-line course. The findings suggest that it is only after socialization occurs that information can be exchanged and lead to knowledge construction. These are supported by, and extend, prior research by Z Berge, R Mason, M Paulsen and G Salmon and are reinforced by empirical work with a further 19 new on-line moderators.

Requirements and design of an integrated European environmental information communication system, (IEEICS)

The needs for various forms of information systems relating to the European environment and ecosystem are reviewed, and limitations indicated. Existing information systems are reviewed and compared in terms of aims and functionalities. We consider TWO technical challenges involved in attempting to develop an IEEICS. First, there is the challenge of developing an Internet-based communication system which allows fluent access to information stored in a range of distributed databases. Some of the currently available solutions are considered, i.e. Web service federations. The second main challenge arises from the fact that there is general intra-national heterogeneity in the definitions adopted, and the measurement systems used throughout the nations of Europe. Integrated strategies are needed.

Oral agreements: estoppel, constructive trusts and restitution

Analyses the House of Lords judgment in Cobbe v Yeoman's Row Management Ltd in relation to claims by the prospective purchaser under an oral agreement for sale of a block of flats based on proprietary estoppel, a constructive trust and common law restitution brought against the owner of the property who sought to resile from the agreement after the purchaser had, at considerable expense, obtained planning permission to redevelop the property in reliance on assurances given by the owner that if permission was granted the sale would be honoured.

Communication system model for information rate evaluation of differential detection over time-varying channels

A communication system model for mutual information performance analysis of multiple-symbol differential M-phase shift keying over time-correlated, time-varying flat-fading communication channels is developed. This model is a finite-state Markov (FSM) equivalent channel representing the cascade of the differential encoder, FSM channel model and differential decoder. A state-space approach is used to model channel phase time correlations. The equivalent model falls in a class that facilitates the use of the forward backward algorithm, enabling the important information theoretic results to be evaluated. Using such a model, one is able to calculate mutual information for differential detection over time-varying fading channels with an essentially finite time set of correlations, including the Clarke fading channel. Using the equivalent channel, it is proved and corroborated by simulations that multiple-symbol differential detection preserves the channel information capacity when the observation interval approaches infinity.

More public rescues for more private finance failures - a critique of the EC Communication on PPPs

A critique of the EC Communication on PPPs, challenging the scale of state aid offered to PPPs, the role of PPPs in the economic recovery strategy for the EU, and drawing attention to the damage done to public authorities by 'innovative' financing mechanisms.

Experiences during three generations of web based learning. Six years of web based communication

This paper tells the story of how a set of university lectures developed during the last six years. The idea is to show how (1) content, (2) communication and (3) assessment have evolved in steps which are named “generations of web learning”. The reader is offered a stepwise description of both didactic foundations of university lectures and practical implementation on a widely available web platform. The relative weight of directive elements has gradually decreased through the “three generations”, whereas characteristics of self-responsibility and self-guided learning have gained in importance. -Content was in early times presented and expected to be learned but in later phases expected to be constructed for examples of case studies. -Communication meant in early phases to deliver assignments to the lecturer but later on to form teams, exchange standpoints and review mutually. -Assessment initially consisted in marks invented and added up by the lecturer but was later enriched by peer review, mutual grading and voting procedures. How much “added value” can the web provide for teaching, training and learning? Six years of experience suggest: mainly insofar as new (collaborative and selfdirected) didactic scenarios are implemented! (DIPF/Orig.)