Dramatic effect of early clopidogrel administration in reducing mortality and MACE rates in ACS patients. Data from the Swiss registry AMIS-Plus.

BACKGROUND: Patients who have acute coronary syndromes with or without ST-segment elevation have high rates of major vascular events. We evaluated the efficacy of early clopidogrel administration (300 mg) (<24 hours) when given with aspirin in such patients. METHODS: We included 30,243 patients who had an acute coronary syndrome with or without ST segment elevation. Data on early clopidogrel administration were available for 24,463 (81%). Some 15,525 (51%) of the total cohort were administrated clopidogrel within 24h of admission. RESULTS: In-hospital death occurred in 2.9% of the patients in the early clopidogrel group treated with primary PCI and in 11.4% of the patients in the other group without primary percutaneous coronary intervention (PCI) and no early clopidogrel. The unadjusted clopidogrel odds ratio (OR) for mortality was 0.31 (95% confidence interval 0.27-0.34; p <0.001). Incidence of major adverse cardiac death (MACE) was 4.1% in the early clopidogrel group treated with 1°PCI and 13.5% in the other group without primary PCI and no early clopidogrel (OR 0.35, confidence interval 0.32-0.39, p <0.001). Early clopidogrel administration and PCI were the only treatment lowering mortality as shown by mutlivariate analysis. CONCLUSIONS: The early administration of the anti-platelet agent clopidogrel in patients with acute coronary syndromes with or without ST-segment elevation has a beneficial effect on mortality and major adverse cardiac events. The lower mortality rate and incidence of MACE emerged with a combination of primary PCI and early clopidogrel administration.

Intranasal administration of the synthetic polypeptide from the C-terminus of the circumsporozoite protein of Plasmodium berghei with the modified heat-labile toxin of Escherichia coli (LTK63) induces a complete protection against malaria challenge.

Needle-free procedures are very attractive ways to deliver vaccines because they diminish the risk of contamination and may reduce local reactions, pain or pain fear especially in young children with a consequence of increasing the vaccination coverage for the whole population. For this purpose, the possible development of a mucosal malaria vaccine was investigated. Intranasal immunization was performed in BALB/c mice using a well-studied Plasmodium berghei model antigen derived from the circumsporozoite protein with the modified heat-labile toxin of Escherichia coli (LTK63), which is devoid of any enzymatic activity compared to the wild type form. Here, we show that intranasal administration of the two compounds activates the T and B cell immune response locally and systemically. In addition, a total protection of mice is obtained upon a challenge with live sporozoites.

On the Upper Ordovician unconformity in the Pyrenees: New evidence from the La Cerdanya area

In recent years, contradictory reports about whether or not an unconformity exists at the base of the Upper Ordovician succession of the Pyrenees have been made. In the Cerdanya area (Central Pyrenees), good outcrop evidence for this unconformity is displayed at the base of the Rabassa conglomerates. In this area, the Upper Ordovician rocks overlie a tilted Cambro-Ordovician sequence, displaying an angular unconformity and indicating a break in the stratigraphic series. Moreover, the existence of such an unconformity is supported by the distribution of Variscan minor structures, suggesting that the Cambro-Ordovician and the Upper Ordovician strata initially had different orientations before the main Variscan folding.

Empirical errors of small area estimates from the multisource National Forest Inventory in Eastern Finland

Abstract

Promotion of learning skills in the study of economics. pilot project in the subject area of

This communication is part of a larger teaching innovation project financed by the University ofBarcelona, whose objective is to develop and evaluate transversal competences of the UB, learningability and responsibility. The competence is divided into several sub-competencies being the ability toanalyze and synthesis the most intensely worked in the first year. The work presented here part fromthe results obtained in phase 1 and 2 previously implemented in other subjects (Mathematics andHistory) in the first year of the degree of Business Administration Degree. In these subjects’ previousexperiences there were deficiencies in the acquisition of learning skills by the students. The work inthe subject of Mathematics facilitated that students become aware of the deficit. The work on thesubject of History insisted on developing readings schemes and with the practical exercises wassought to go deeply in the development of this competence.The third phase presented here is developed in the framework of the second year degree, in the WorldEconomy subject. The objective of this phase is the development and evaluation of the same crosscompetence of the previous phases, from a practice that includes both, quantitative analysis andcritical reflection. Specifically the practice focuses on the study of the dynamic relationship betweeneconomic growth and the dynamics in the distribution of wealth. The activity design as well as theselection of materials to make it, has been directed to address gaps in the ability to analyze andsynthesize detected in the subjects of the first year in the previous phases of the project.The realization of the practical case is considered adequate methodology to improve the acquisition ofcompetence of the students, then it is also proposed how to evaluate the acquisition of suchcompetence. The practice is evaluated based on a rubric developed in the framework of the projectobjectives. Thus at the end of phase 3 we can analyze the process that have followed the students,detect where they have had major difficulties and identify those aspects of teaching that can help toimprove the acquisition of skills by the students. The interest of this phase resides in the possibility tovalue whether tracing of learning through competences, organized in a collaborative way, is a goodtool to develop the acquisition of these skills and facilitate their evaluation.

Present day distribution and historical biogeography of the tribu Ophidiini (Ophidiformes, Ophidiidae, Ophidiinae) from the East Tropical Atlantic (CLOFETA area) and North-East Atlantic and Mediterranean (CLOFNAM area)

The present day geographic distribution of the Ophidiini tribe (Ophidiidae, Ophidiinae) in the Clofnam (North- Eastern Atlantic and Mediterranean) and Clofeta (Eastern Tropical Atlantic) areas is revised in this paper. Results show that Parohidion vassali is not a Mediterranean endemic species, and the presence of Ophidion barbatum in the Atlantic is confirmed. Moreover, the paper tries to analyse the historical events which could have caused the present situation of two genera, Ophidion and Parophidion, both in the Atlantic and in the Mediterranean. Although first fossil records of Ophidion and Parophidion date from the Pliocene, when considering all the historical events occurred from the existence of the Tethys Sea to the opening of the Atlantic and the Mediterranean formation, a much earlier origin of these genera seems to be more likely. The situation of Ophidion barbatum and O. rochei in the Mediterranean and Black Sea is also discussed

Morphometric analysis of feedforward pathways from the primary somatosensory area (S1) of rats

We used biotinylated dextran amine (BDA) to anterogradely label individual axons projecting from primary somatosensory cortex (S1) to four different cortical areas in rats. A major goal was to determine whether axon terminals in these target areas shared morphometric similarities based on the shape of individual terminal arbors and the density of two bouton types: en passant (Bp) and terminaux (Bt). Evidence from tridimensional reconstructions of isolated axon terminal fragments (n=111) did support a degree of morphological heterogeneity establishing two broad groups of axon terminals. Morphological parameters associated with the complexity of terminal arbors and the proportion of beaded Bp vs stalked Bt were found to differ significantly in these two groups following a discriminant function statistical analysis across axon fragments. Interestingly, both groups occurred in all four target areas, possibly consistent with a commonality of presynaptic processing of tactile information. These findings lay the ground for additional work aiming to investigate synaptic function at the single bouton level and see how this might be associated with emerging properties in postsynaptic targets.

Mapping the spatial distribution of geomorphological processes in the Okstindan area of northern Norway, using Geomorphic Process Units as derived from remote sensing and ground survey

The delineation of Geomorphic Process Units (GPUs) aims to quantify past, current and future geomorphological processes and the sediment flux associated with them. Five GPUs have been identified for the Okstindan area of northern Norway and these were derived from the combination of Landsat satellite imagery (TM and ETM+) with stereo aerial photographs (used to construct a Digital Elevation Model) and ground survey. The Okstindan study area is sub-arctic and mountainous and is dominated by glacial and periglacial processes. The GPUs exclude the glacial system (some 37% of the study area) and hence they are focussed upon periglacial and colluvial processes. The identified GPUs are: 1. solifluction and rill erosion; 2. talus creep, slope wash and rill erosion; 3. accumulation of debris by rock and boulder fall; 4. rockwalls; and 5. stable ground with dissolved transport. The GPUs have been applied to a ‘test site’ within the study area in order to illustrate their potential for mapping the spatial distribution of geomorphological processes. The test site within the study area is a catchment which is representative of the range of geomorphological processes identified.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

Glacier shrinkage and climatic change in the Russian Altai from the mid-20th century: An assessment using remote sensing and PRECIS regional climate model

This paper examines changes in the surface area of glaciers in the North and South Chuya Ridges, Altai Mountains in 1952-2004 and their links with regional climatic variations. The glacier surface areas for 2004 were derived from the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) imagery. Data from the World Glacier Inventory (WGI)dating to 1952 and aerial photographs from 1952 were used to estimate the changes. 256 glaciers with a combined area of 253±5.1 km2 have been identified in the region in 2004. Estimation of changes in extent of 126 glaciers with the individual areas not less than 0.5 km2 in 1952 revealed a 19.7±5.8% reduction. The observed glacier retreat is primarily driven by an increase in summer temperatures since the 1980s when air temperatures were increasing at a rate of 0.10 - 0.13oC a-1 at the glacier tongue elevation. The regional climate projections for A2 and B2 CO2 emission scenarios developed using PRECIS regional climate model indicate that summer temperatures will increase in the Altai in 2071-2100 by 6-7oC and 3-5oC respectively in comparison with 1961-1990 while annual precipitation will increase by 15% and 5%. The length of the ablation season will extend from June-August to the late April – early October. The projected increases in precipitation will not compensate for the projected warming and glaciers will continue to retreat in the 21st century under both B2 and A2 scenarios.

Rescuing a telecom giant from the jaws of bankruptcy: a case study and an interview with Sir Richard Lapthorne, chairman of Cable & Wireless

Purpose – The purpose of this paper is to demonstrate key strategic decisions involved in turning around a large multinational operating in a dynamic market. Design/methodology/approach – The paper is based on analysis of archival documents and a semi-structured interview with the chairman of the company credited with its rescue. Findings – Turnaround is complex and involves both planned and emergent strategies. The progress is non-linear requiring adjustment and change in direction of travel. Top management credibility and vision is critical to success. Rescue is only possible if the company has a strong cash generative business among its businesses. The speed of decision making, decisiveness and the ability to implement strategy are among the key ingredients of success. Originality/value – Turnaround is an under-researched area in strategy. This paper contributes to a better understanding in this important area and bridges the gap between theory and practice. It provides a practical view and demonstrates how a leading executive with significant expertise and successful turnaround track record deals with inherent dilemmas of turnaround

Synoptic preconditions for extreme flooding during the summer Asian Monsoon in the Mumbai area

The summer monsoon season is an important hydrometeorological feature of the Indian subcontinent and it has significant socioeconomic impacts. This study is aimed at understanding the processes associated with the occurrence of catastrophic flood events. The study has two novel features that add to the existing body of knowledge about the South Asian Monsoon: 1) combine traditional hydrometeorological observations (rain gauge measurements) with unconventional data (media and state historical records of reported flooding) to produce value-added century-long time-series of potential flood events, and 2) identify the larger regional synoptic conditions leading to days with flood potential in the time-series. The promise of mining unconventional data to extend hydrometeorological records is demonstrated in this study. The synoptic evolution of flooding events in the western-central coast of India and the densely populated Mumbai area are shown to correspond to active monsoon periods with embedded low-pressure centers and have far upstream influence from the western edge of the Indian Ocean basin. The coastal processes along the Arabian Peninsula where the currents interact with the continental shelf are found to be key features of extremes during the South Asian Monsoon

Project portfolio management: an analysis from the insurance industry IT area

This paper aims to bring more information related to the critical question "how IT areas of insurance companies are defining and delivering their strategic initiatives Portfolios?" and make conclusions based on the collected data. To reach these interpretations, it is composed of a theoretical investigation on the theme, a strategy delineation for the research methodology and a conclusion presentation based on the findings. In this last part, this study concluded that explored organization does not applied a sufficient number of best practices answering the critical question as "the company is not mature on this subject".